The Texas Health and Human Services Commission announced in the February 16 Texas Register its intent to submit an amendment that would add customized power wheelchairs for Medicaid-eligible recipients living in nursing facilities to Medicaid coverage under the state plan. The estimated cost for the coverage is about $2.5 million for fiscal year 2007.
For more information, see the relevant section in the Texas Register.
The Department of Labor (DOL) announced that it will spend more than $43 million dealing with shortages in the health care industry, including long term care. (Source)
On several occasions, I’ve blogged about the shortage of nurses and geriatric physicians. As baby boomers retire and age, many will need long term care, which will put pressure on an industry already faced with worker shortages. Ironically, baby boomer retirement is linked to shortages among long term caregivers.
DOL and leaders in the health care industry will focus on such tasks as:
• expanding the pipeline of youth entering the health care profession;
• identifying alternative labor pools such as immigrants, veterans, and older workers that can be tapped and trained;
• developing alternative training strategies for educating and training health care professionals, such as apprenticeship, distance learning, and accelerated training;
• developing tools and curriculum for enhancing the skills of health care professionals for nationwide distribution…
For more information about the grants, see the Federal Register entry (PDF).
(Pictured: Secretary of Labor Elaine Chao)
Fiscal Year 2008 Medicare funding for skilled nursing facilities will be cut by more than $10 billion over five years, and long term care associations are seeing red.
Medicare and Medicaid cover close to 80 percent of nursing home patients. According to the American Health Care Association (AHCA), which represents long term care providers, Medicaid underpays patients by almost $13 per patient a day, but Medicare compensates for some of the shortfall.
AHCA president and CEO Bill Yarwood said, “Now is precisely the time we as a nation must be investing in and strengthening America’s long term care infrastructure - not weakening it by cutting critical Medicare and Medicaid funding, which are essential for the quality long term care and services relied upon by America’s frail, elderly and disabled.”
Alan Rosenbloom, president of the Alliance for Quality Nursing, is concerned about how the budget cuts will affect Medicare’s “post-acute” benefit.
In a letter dated February 13, the Texas Department of Aging and Disability Services (DADS) alerted Intermediate Care Facility for Persons with Mental Retardation (ICF-MR) Providers about its annual Long-Term Services and Supports Experience Survey 2007 Project.
A random sample of recipients who receive long-term services through ICF-MRs will be interviewed by the NACES Plus Foundation, Inc., for the purpose of assessing and improving quality of care. For more information, download the letter here.
In a letter dated February 6, DADS informed Nursing, Assisted Living, and Adult Day Care Facilities, Intermediate Care Facilities for Persons with Mental Retardation and/or Related Conditions, and Home and Community Support Services Agencies about updates to information related to criminal background checks.
Pursuant to Chapter 250 of the Health and Safety Code, certain providers are required to check the criminal background of employees, and all are authorized to obtain criminal history from the Texas Department of Public Safety. For more details, download the letter here.
Lawmakers in Congress are questioning reimbursements to certain physician-owned specialty hospitals, which they claim cut corners on basic care to save money. (Source)
Senator Charles Grassley, highest ranking Republican member of the Senate Finance Committee, told the Houston Chronicle, “The fundamental problem with physician-owned specialty hospitals is that decision-making is more likely driven by financial interests rather than what is best for patients.”
Their concern stems from an incident that took place at a specialty hospital in Abilene. A patient went into respiratory arrest after an operation, but instead of administering emergency procedures, staffers called 911. He later died at Abilene Regional Medical Center.
Although there was three-year moratorium on specialty hospital Medicare reimbursements, West Texas Hospital was given an exception, receiving $4.1 million. Grassley and Senator Max Baucus (both pictured), a Democrat, sent a letter to the Centers for Medicare and Medicaid Services (CMS), asking CMS to explain why. No answer yet.
On behalf of the Texas Department of Aging and Disability Services (DADS), the Texas Health and Human Services Commission adopted amendments that would allow an individual receiving services through the Home and Community-based Services Program to participate in the consumer directed services option (CDS), which is “a service delivery option in which an individual or legally authorized representative (LAR) employs and retains service providers and directs the delivery of program services.”
DADS received written comments about the amendments and included comments and responses in the February 9 Texas Register update. To read more, see the relevant section.
The Texas Department of Aging and Disability Services announced that effective March 15, 2007, it will no longer mail hard copies of general information letters regarding Home and Community-based Services (HCS) and Texas Home Living programs (TxHmL) to program providers and mental retardation authorities (MRA).
You may download HCS letters here and TxHmL letters here.
For more information how to subscribe to receive e-mail updates, download the letter here.
According to a new report from the Center on Budget and Policy Priorities (CBPP), the new Medicaid proof-of-citizenship law is having unintended consequences.
Last year, Congress passed a law requiring Medicaid beneficiaries and applicants to prove U.S. citizenship before receiving care. The law was intended to curb fraud in the Medicaid program and prevent illegal aliens, who are not legally authorized to be in the country, from receiving care through the program. But according to the report, U.S. citizens are the ones most negatively affected by the new law.
The measure requires Medicare beneficiaries and applicants to present birth certificates, passports, or other forms of identification, but in many cases, administrative red tape has caused delays in obtaining ID.
In “New Medicaid Citizenship Documentation Requirement Is Taking A Toll,” (PDF) the CBPP examined Medicaid programs in Iowa, Kansas, Louisiana, New Hampshire, Virginia, and Wisconsin, and found that between 18,000 and 20,000 Kansas residents eligible for Medicaid lost coverage after the law. Iowa had the largest coverage decline.
The new requirement also appears to be reversing part of the progress that states made over the past decade in streamlining access to Medicaid for individuals who qualify, and especially for children. For example, to improve access to Medicaid and reduce administrative costs, most states implemented mail-in application procedures, and many states reduced burdensome documentation requirements. The new Medicaid citizenship documentation requirement now appears to be pushing states in the opposite direction, by impeding access to Medicaid.
See related posts on the topic here.
Last year I blogged about a group of Texas pharmacists (independent operators) lobbying the White House for reimbursement for Medicare Part D prescription drugs. (See Texas Pharmacists Lobby White House)
The pharmacists were not receiving sufficient reimbursement to make up for the millions of dollars worth of drugs they gave to Part D patients for free, in part because Part D was new and confusing, and patients who needed medications couldn’t afford to wait for approval.
To make matters worse, the group said pharmacists had to wait up to 30 days to receive any reimbursement at all, as opposed to the usual week or 10 days for Medicaid or private insurers.
A year later, pharmacists are still feeling the fall-out. Some smaller pharmacists claim that Part D is forcing them to shut down because reimbursement rates are too low. From the Washington Times:
Community and independent pharmacists say the new Medicare prescription-drug benefit, known as Part D, has given pharmacy benefit managers leverage with insurance companies to set low reimbursement rates to pharmacies. As a result, beleaguered pharmacies are struggling to survive.
“You’re going to see considerably more pharmacies close in 2007. They cannot continue in this vein,” said Mike James, pharmacy owner and director of government affairs for the Association of Community Pharmacists.
The Association of Community Pharmacists estimates that the drug benefit’s payment structure was responsible for more than 1,000 closures of independent pharmacies nationwide last year.
One independent pharmacist still in business says he loses money with every Part D prescription. Things may get worse before they get better. A new Medicaid rule proposed late last year would save the government $8.4 million, but it also would further reduce reimbursements for pharmacists. (See Pharmacists Face Reduced Medicaid Reimbursements)
The following are some filed bills that may interest you:
SB 131 by West (D-Dallas) Requiring that for at least two unannounced inspections each licensing period, DADS would be required to invite someone from the facility’s family council to participate. A family council member would also be required to sit in at the exit conference and receive a copy of deficiencies. The measure also provides for the organization, rights and protection of the council.
SB 199 by Nelson (R-Flower Mound) Adds new Offenses to the list of convictions barring employment at certain facilities serving the elderly or persons with disabilities.
SB 318 by Deuell (R-Greenville) Identical to HB 912, the measure would keep the level of staff rate enhancement at no less than the levels paid during the fiscal year ending August 31, 2007.
SB 344 by Carona (R-Dallas) A TARC bill, identical to HB 404,that provides that in the event inspectors write additional deficiencies following the exit conference, DADS must provide an additional face to face exit conference on the new findings and they cannot satisfy the requirement with a telephone call, a fax or an email.
HB 361 by Pickett (D-El Paso) Relating to listing certain small facilities furnishing care to three or fewer residents.
HB 404 by Davis (R-Houston) A TARC bill, identical to SB 344,that provides that in the event inspectors write additional deficiencies following the exit conference, DADS must provide an additional face to face exit conference on the new findings and they cannot satisfy the requirement with a telephone call, a fax or an email.
HB 446 by Thompson (D-Houston) Relating to the increase of the personal needs allowance for certain Medicaid recipients who are residents of long-term care facilities from $45 to $75.
HB 650 by Rodriguez (D-Austin) Relating to the establishment of a task force to assist certain long-term care facilities in developing the capacity to provide services to individuals with disabilities through community-based arrangements.