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In March, the Centers for Medicare & Medicaid Services (CMS) approved a state request to allow greater provision of personal care services in acute care facilities. While the change is not yet widespread, it could open doors in the future for providers and patients who need in-person care in alternative settings.
A change to a Medicaid program may seem negligible, but since Medicaid program directors talk to each other just as much—and take feedback and apply it to their own state programs—it’s a change worth paying attention to.
Essentially, this option was granted for additional in-person care for patients in acute care facilities during the COVID-19 pandemic, with Rhode Island later receiving approval through an 1115 demonstration to make the change permanent.
Home and Community Based Services (HCBS) providers can now step in and provide care that would not otherwise be part of a hospital’s care plan. For example, certain individuals may have needs that hospital staff cannot respond to, such as dementia or other behavioral challenges, Damon Terzaghi — the director of Medicaid advocacy at NAHC — told Home Health Care News.
This is one reason why IDD providers and advocacy groups in particular pushed for such changes during the height of the pandemic. Eventually the option was included in the CARES Act.
The better care patients can receive in the acute setting, the better. More specifically, the more care they can receive tailored to their specific needs, the better.
Home care providers can step in now and improve the level of care and comfort for patients in Rhode Island.
“The real drive of this policy is to make things easier for participants,” Terzaghi said.
He gave some examples. Take an older adult with dementia who broke his hip and was hospitalized. The cognitive problems can create challenges that hospital staff cannot handle, potentially leading to poorer health outcomes for the patient. At this time, behavioral health care or personal care could be provided by an outside home care agency.
Providers would not provide the care the hospital is already obligated to provide, but would instead expand care plans for these types of individuals.
“Having a caregiver who is perhaps a little more trusted — or who is familiar with their own routines, nuances or the specifics of their behavior — would be extremely valuable in mitigating potential adverse events,” Terzaghi said. “Helping the individual calm down, making sure their needs are being taken care of, things like that. And then the fact that that person is in the hospital helps make that transition back into the community quicker and smoother.”
Popularization of the concept
Rhode Island is a pioneer in adopting Medicaid-funded personal care services in the acute care setting, but it is likely that other states will adopt it as positive outcome data emerges as a result of the change.
“If one state makes an innovation and has a good experience with it – meaning there is good cost-effectiveness associated with it – other states adopt it,” says Darby Anderson, executive vice president and chief government relations officer at Addus HomeCare Corp. (Nasdaq: ADUS). ), said HHCN. “These days, it’s the state Medicaid directors who are talking, as well as the more programmatic people who are involved in the programs.”
If more states were to adopt this flexibility, it would be a huge benefit for patients. But it would also provide a tailwind for providers and payers, although to what extent remains unclear.
Anderson believes flexibility is already worth advocating for, but doesn’t yet see a direct path to increased business for HCBS providers.
But symbolically, further adoption would be a win for the HCBS provider community. There are also additional benefits to providers’ care plans, Terzaghi said.
“This increases predictability and increases the ability of providers to create a schedule and assume that even if that person ends up being hospitalized for some reason, we don’t have to look at reassignment hours,” he said. “It’s a lot more predictable for everyone across the board. I think it’s definitely beneficial for providers. I think it will increase predictability and potentially lead to some increase in sales as well.”
With the flexibility implemented, the next step is to wait and see how things pan out for Rhode Island.
If HCBS providers, patients, and hospitals all benefit—through better outcomes and perhaps some cost savings—it could spark some kind of change across the country.
“What results have we seen? “Has the provision of these services ultimately demonstrated benefits to individuals, providers and the state?” said Terzaghi. “And if so, will this become widespread across the country and remain permanent? I think these are really important questions to explore further.”