Nursing home reimbusement steady despite other state cuts

Dec. 16, 2003 — Despite cuts in in-home services such as those proposed in California, nursing home reimbursement rates have remained steady in most cases, according to a report by the General Accounting Office. Of the states studied for its report, “only Illinois, Massachusetts, Michigan, and Texas cut the per diem rates paid to all nursing homes” during fiscal years 1998 through 2004. “In over three-quarters of these states, nursing home per diem rates grew, on average, by an amount that exceeded the skilled nursing facility market basket index, the index used by the Centers for Medicare & Medicaid Services to measure changes in the price of nursing home goods and services for Medicare.”

The GAO report notes that “almost half of all Americans over the age of 65 will rely on nursing home care at some point in their lives, and two in three nursing home residents have their care covered at least in part by Medicaid. Under Medicaid, states set nursing home payment rates and the federal government reimburses a share of state spending,” says the GAO report.

“According to the most recently available data, Medicaid nursing home expenditures exceed $43 billion, and total Medicaid spending for fiscal year 2003 is expected to double by 2012,” says the report.

For the report, GAO interviewed state and nursing home industry officials in 19 states and obtained documentation about nursing home payment rates and methods, including state methods to determine nursing home per diem rates for fiscal years 1998 through 2004. “Although each of the 19 states experienced recent fiscal pressure, states’ nursing home payment rates have remained largely unaffected,” reported GAO.

Read report at http://www.gao.gov/atext/d04143.txt

RELATED RESOURCES:

Department of Health and Human Services, Centers for Medicare and Medicaid Services: Medicare Program; Revisions to Payment Polices Under the Physician Fee Schedule for Calendar Year 2004. GAO-04-266R, November 19, 2003 (4 pages).

National Council on Disability analysis of federal and state implementation of the Supreme Court’s Olmstead decision.

Texas gets Medicaid waiver for 4,000 people

Feb. 24, 2004 — Last week the U.S. Dept. of Health and Human Services’ Centers on Medicaid and Medicare Services approved a long-awaited Medicaid “home and community-based services waiver.” Medicaid waivers allow states to waive Medicaid regulations. Texas now gets to waive the requirment, written into Medicaid law, that money be used to institutionalize people. This waiver, one of hundreds nationwide, will allow state officials to use Medicaid dollars to pay for services in an indivividual’s home.

The waiver approved Feb. 17 will provide services to persons who are developmentally disabled or mentally retarded who otherwise would require care in a nursing home or other institution. “Those served under this waiver will receive respite care, minor home modifications, skilled nursing, adaptive aids, behavioral support, specialized therapies, dental treatment and other services,” says a press release from HHS.

“The waiver will help nearly 4,000 state residents, many of whom are currently on waiting lists for these services,” says the release.

More about Medicaid Waivers at our website

A story in the Jan. 26 Fort Worth Star-Telegram reported that some parents of disabled children who need Medicaid services are divorcing in order to qualify for the low-income program. Only low-income individuals receive Medicaid.

EXPERT SOURCES:

Bob Kafka
ADAPT
bkafka@juno.com
512-442-0252 (512-431-4085 cellphone.)

Rosalie A. Kane, Ph.D.
Division for Health Services Research & Policy
School of Public Health
University of Minnesota
Phone: 612-624-5171
Fax: 612-624-5434
kanex002@umn.edu
Website: http://www.bioethics.umn.edu/faculty/kane_r.shtml

Larry Polivka, Ph.D.
Director, Florida Policy Exchange Center on Aging
University of South Florida
lpolivka@admin.usf.edu
ÊWebsite: http://www.fpeca.usf.edu/

---

Effort grows to abolish Medicare ‘homebound’ rule

Effort grows to abolish Medicare ‘homebound’ rule

Feb. 20, 2001 — Atlanta resident David Jayne is the catalyst for a newly formed national grassroots effort to amend Medicare’s “homebound” policy. A website at http://www.amendhomeboundpolicy.homestead.com/background.html gives details.

Jayne, who has amyotropic lateral sclerosis (ALS; sometimes called “Lou Gehrig’s Disease”) came to the attention of disabiity activists nationwide following a series of newspaper stories last fall. When Atlanta Journal Constitution reporter Bill Torpy profiled Jayne and his outreach to others with ALS, reporting that Jayne left his home to give speeches, Healthfield Home Health, who had been sending an attendant to Jayne’s home to help him get out of bed and take a shower, notified Jayne that the company was cutting off his services immediately — because he went out and so was longer considered “homebound.”

Jayne soon began a petition drive to change the federal Medicare rules.

Current Medicare rules insist that those receiving Medicare “home care” benefits stay “virtually bound to their homes in order retain such benefits,” says the mission statement of the newly formed National Coalition to Amend the Medicare Homebound Restriction for Severely Disabled Americans, or NCAHB. They call the current policy “an anachronism,” and are pushing Congress to “implement an alternative to the current policy which recognizes that persons with significant chronic illnesses must not spend their lives homebound.”

Jayne’s petition can be found at http://www.amendhomeboundpolicy.homestead.com/petition.html

Bill Torpy’s story, “The Tin Man’s Heart”, from the 11/26/2000 Atlanta Journal-Constitution, is online at http://www.rideforlife.com/n_jayne112900.htm.

A good overview of the issue can be found in disability issues columnist Mike Volkman’s 12/24/2000 Albany Times Union column ‘Homebound Rule Must be Abolished,”, and from disability journalist Miriam Braunstein’s article in New Mobility magazine, “Homebound and Wishing They Weren’t.

The “Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000” (BIPA), signed into law on December 21, includes a clarification of the Medicare homebound definition. A good article explaining it can be found at the Center for Medicare Advocacy website.

Another good background piece is “There’s No Place Like ‘Homebound’: Understanding Medicare’s ‘Confined To Home’ Requirements,” by attorney Lewis Golinker, Director of the Assistive Technology Law Center in Ithaca, New York (607-277-7286).

More background can be found at http://www.amendhomeboundpolicy.homestead.com/background.html.

Links

About The Center for An Accessible Society