Reimbursement of HCBS, Home Health Care and Private Duty ...
[Pages:9]Reimbursement of HCBS, Home Health Care and Private Duty Nursing:
The First Step in the Continuum of Care
In a continuing effort to keep people in their homes and out of higher cost facilities, we are requesting an increase in reimbursement for 200 plus small business, licensed home care agencies in Colorado.
This year the Medicaid Provider Rate Review Advisory Committee established by the Joint Budget Committee studied the state of homecare reimbursement. They made the recommendation that rates should be addressed. However, the Department did not make the request in the Governor's budget for FY 2017-2018.
The impact of the new Minimum Wage increase and the overall increase in costs to do business over many years is creating a very difficult business climate for providers of HCBS personal care & homemaker services, home health and private duty nursing.
There needs to be an adequate and financially healthy safety net of providers in order to provide the care needed in the home and reduce costs overall. Hospitals provide the most expensive delivery of care. They want to be able to discharge patients ASAP to make room for additional patients that need assistance.
We request a level of reimbursement that brings us to the Medicare and commercial/market rates that are currently being paid for these services. With more people being enrolled in Medicaid because of the expansion, it makes it even more crucial for these rates to be adequate.
We have included a chart on the back that identifies exactly where the targeted increases need to be placed and our recommendation for that specific increase. We do believe a request in supplemental for this year would be a creative way to address the direct pain the caregivers are having. The next tier could be completed in the Long Bill FY2017-2018. We would like the JBC to be specific to guide the department accordingly.
These issues will be considered in supplemental and budget figure setting for the Dept. of Health Care Policy & Financing. Thank you for your immediate attention and thank you in advance for any motions!
Betsy Murray
Eliza Schultz
Ellen Caruso, representing Homecare Association of Colorado
303-478-1207 720-732-0217 720-530-3034
Edie Busam, representing PSA/Professional Pediatric Homecare 303-523-6236
Andi Leopoldus, representing Discover Goodwill 719-641-4097
REVISED 1/15/2017
Proposed Rate Increases Home Health Care Services Skilled Nursing (per visit) Physical Therapist (per visit) Occupational Therapist (per visit) Speech Therapist (per visit)
Proposed Rate Increases Private Duty Nursing - LPN Services PDN - LPN (per hour)
Home Care Rate Request - FY 2017-18
Proposed
2017
90% of Colo
1/3 of 90% of
Colorado Avg
Medicare
Colo
Current Which is Medicare
LUPA* in Proposed Medicare
Medicaid Percent LUPA* per three years Increase LUPA* per
Rate per visit of:
visit
per visit per visit
visit
Number visits
Cost of Proposed Increase
TOTAL
GF
FF
$103.63 76% $113.34 76% $114.06 76% $123.16 76%
$135.98 $148.65 $149.66 $161.55
$122.38 $133.79 $134.69 $145.40
$18.75 $20.45 $20.63 $22.24
$6.24 $6.81 $6.87 $7.40
478,342 $ 2,986,966 $ 1,493,483 $ 1,493,483 111,502 $ 759,126 $ 379,563 $ 379,563 93,750 $ 644,168 $ 322,084 $ 322,084 97,682 $ 723,262 $ 361,631 $ 361,631
$ 5,113,522 $ 2,556,761 $ 2,556,761
Cost of Proposed Increase
Current
Proposed
1/3 of
Current Which is Colorado Medicaid Rate Proposed Proposed
Medicaid Percent Market Rate in three years Increase Increase per
Rate per hour of:
per hour
per hour per hour hour Number hours TOTAL
GF
FF
$30.81 82%
$37.50
$37.50 $6.69
$2.23
528,480 $ 1,178,510 $ 589,255 $ 589,255
Proposed Rate Increases Home & Community Based Svcs HCBS EBD Personal Care
Current rate $17/hour; Updated Market $25.00/hour Minimum wage increases $.99 /hour on 1/1/2017 HCBS EBD Homemaker
Current Which is Medicaid Percent Rate per hour of:
Current Colorado Market Rate per hour
Proposed Proposed Increase Medicaid Rate per 15 per hour minute
$17.00 68%
$25.00
$19.00 $0.50
$17.00 68%
$25.00
$19.00 $0.50
Cost of Proposed Increase
Number of 15
minute units TOTAL
GF
FF
29,906,148 $ 14,953,074 $ 7,476,537 $ 7,476,537
6,817,376 $ 3,408,688 $ 1,704,344 $ 1,704,344 $ 18,361,762 $ 9,180,881 $ 9,180,881
FMAP 50.00% per Eric Kurtz
Service Acronyms: Brain Injury waiver Children's Extensive Supports waiver Colorado Choice Transitions demonstration waiver Community Mental Health Supports waiver Consumer Directed Attendant Support Services
Betsy Murray, Eliza Schultz and Ellen Caruso, representing Homecare Association of Colorado 303-478-1207 720-732-0217 720-530-3034 Edie Busam, representing PSA/Professional Pediatric Homecare 303-523-6236 Andi Leopoldus, representing Discover Goodwill 719-641-4097
BI CES CCT CMHS CDASS
Elderly, Blind, and Disabled waiver Licensed Practical Nurse Persons Living with AIDS waiver Physical Therapy Private Duty Nurse
EBD LPH PLWA
PT PDN
*Medicare Low Utilization Payment Adjusted (LUPA) rate
Registered Nurse RN RN
Spinal Cord Injury waiverSCI
Supported Living
SLS
Services waiver
OVER...
Colorado Alliance for Pediatric Home Care
Protect our children
Bringing critical care to Colorado's most medically fragile children.
What is Private Duty Nursing?
Schuyler and her nurse, Gillian
Private Duty Nursing is: One nurse taking care of one patient in the patient's home.
What is Private Duty Nursing?
Schuyler and her mom, Jayme
Private Duty Nursing essentially creates a hospital room in the patient's home. The difference is that the cost of the brick and mortar, meals, housekeeping and other services is all taken care of by the family.
What is Private Duty Nursing?
The need of patients and families is constant. It's 24/7. There are no holidays. There are no breaks on weekends or nights. Families receive no days off when caring for a medically fragile child.
Current Medicaid reimbursement
CO Medicaid Reimbursement
LPN $30.81 per hour RN $45 per hour
LPN Current Pay Structure
$26.80 Salary, wages, weekend and night differentials, benefits, direct patient per hour care expenses, clinical supervision, quality assurance, training, (85%) education and unbillable services.
$2.13 Support services such as billing and collecting, payroll, accounting, per hour technology, recruiting, compliance, rent, utilities, telephone, (8% ) supplies, etc.
$1.85 (7%)
Interest expense, taxes, development expense
$30.78 Total
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