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AARP: States Lag In Keeping Medicaid Enrollees Out Of Nursing Homes

AARP: States Lag In Keeping Medicaid Enrollees Out Of Nursing Homes

By Phil Galewitz, Kaiser Health News | June 14, 2017

States are making tepid progress helping millions of elderly and disabled people on Medicaid avoid costly nursing home care by arranging home or community services for them instead, according to an AARP report released Wednesday.

“Although most states have experienced modest improvements over time, the pace of change is not keeping up with demographic demands,” said the report, which compared states’ efforts to improve long-term care services over the past several years. AARP’s first two reports on the subject were in 2011 and 2014.

The organization ranked states’ performance on long-term care benchmarks such as a supply of home health aides, nursing home costs, long nursing home stays, the employment rate of people with disabilities and support for working caregivers.

With 10,000 people a day turning 65 and the eldest baby boomers beginning to turn 80 in 2026, the demand for long-term care services is expected to soar in coming years.

AARP officials said the House’s bill to repeal the Affordable Care Act would worsen the situation by capping annual federal revenue for states’ Medicaid programs. That bill is now before the Senate.

“The proposed cuts to Medicaid — the largest public payer of long-term assistance — would result in millions of older adults and people with disabilities losing lifesaving supports,” said Susan Reinhard, senior vice president and director of the AARP Public Policy Institute.

The report found strikingly wide variances in the share of state Medicaid spending for long-term care directed to home- and community-based services for elderly and disabled adults in 2014, the latest year for data covering all states. Minnesota, the top-ranked state, spent about 69 percent, but Alabama, ranked last, spent less than 14 percent.

Nationwide, the average edged up from 39 percent in 2011 to 41 percent in 2014.

Only nine states and the District of Columbia spent more on home- and community-based services than on nursing home care, according to the report. Such services include home health care, caregiver training and adult day care.

People turning 65 this year face about a 50-50 chance of needing long-term care services in their lifetime, AARP officials said.

Trish Riley, executive director of the National Academy for State Health Policy, said states face several obstacles to expand home- and community-based options. They include a strong nursing home lobby that does not want to give up its Medicaid dollars and a shortage of transportation and housing options, particularly in rural areas.

An Alabama Medicaid spokeswoman said the state is working on the issue highlighted by AARP but refused to comment on its report.

John Matson, a spokesman for the Alabama Nursing Home Association, rejected the notion that nursing homes are to blame. “We think it’s a shift that needs to happen in Alabama. We can’t build enough nursing homes to meet [the needs of] everyone that is coming,” he said.

The state’s effort to shift Medicaid patients from long-term care into managed care organizations starting next year will help, because those entities will have a financial incentive to keep people at home for care when possible, Matson said.

Reinhard said many states have struggled to expand home- and community-based options for Medicaid enrollees needing long-term care because that is an optional benefit. Nursing homes are mandatory under federal law. While states focus on Medicaid coverage for children and families — as well as non-disabled adults covered by the Medicaid expansion under the Affordable Care Act — adults with disabilities have received less attention.

“Long-term care is a stepchild of the program and not a top focus for states,” she said.

To view the full report, go to The report was funded by the AARP Foundation, The Commonwealth Fund and The SCAN Foundation.

KHN’s coverage of aging and long-term care issues is supported by The SCAN Foundation.

Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation. | @philgalewitz

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RCO Implementation On Schedule; New Regions Offered to Other Probationary RCOs

RCO Implementation On Schedule; New Regions Offered to Other Probationary RCOs

MONTGOMERY – The Alabama Medicaid Agency has been notified that Envolve, a wholly-owned subsidiary of Centene, is ending its agreement as a capital contributor with all five Alabama Healthcare Advantage (AHA) organizations that had planned to operate as Regional Care Organizations this fall.

Alabama Medicaid Commissioner Stephanie Azar said the AHA organizations have notified the Agency that they intend to end their pursuit of full certification, pending a final decision by the five regional boards in the upcoming days.

While the immediate result would be the loss of five probationary RCOs, the Agency is still in position to implement Regional Care Organizations by Oct. 1, 2017, under a 2013 state law that allows current probationary RCOs to provide services in additional regions, Commissioner Azar said.

The law requires the State to first offer existing probationary RCOs the opportunity to provide services in other regions if no RCOs are certified in a region. The withdrawal of AHA would leave Regions B, D and E without a certified RCO.  The Agency has implemented a process to offer the vacant regions to other probationary RCOS.

Two probationary RCOs have availed themselves of the process. Alabama Community Care – Region A and My Care Alabama have taken initial steps to qualify to offer services in these three regions. Both organizations are already probationary RCOs in the north Alabama region (Region A) and Alabama Community Care – Region C is also a probationary RCO in the western region of the state. Both have put in writing interest to provide services in Regions B, D, and E and are working closely with the Agency to accomplish this goal. As a result, the Agency has confidence the state can have at least one certified RCO in each of the regions by Oct. 1, 2017.

If for some reason no probationary RCO becomes fully certified and contracts to offer services in these regions, then state law allows the state to offer “alternative care providers” the opportunity to operate in those regions.

Gov. Robert Bentley emphasized that Regional Care Organizations represent the best plan to transform the Medicaid health care delivery system in Alabama.

“We will continue to move forward with our Regional Care Organizations, because we must have a delivery system for Medicaid that provides high-quality care, while working to reduce the cost of healthcare. In Alabama, we have already started engaging in conversations with President Trump and incoming Health and Human Services Secretary Tom Price. We are closely monitoring Congress as they work to repeal and replace the Affordable Care Act,” he said. “As the federal government works with states to help develop a plan, in Alabama, we will continue to support RCOs because we feel it’s the best plan for the state.”

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Alabama Medicaid Pushes RCO Start Date to October 2017

Alabama Medicaid Pushes RCO Start Date to October 2017

The State of Alabama’s shift to managed care has been long in the works, and it looks as though the wait will be a little longer before the regional care organizations will be officially operational, according to the Alabama Medicaid Agency.

While Gov. Robert Bentley has said repeatedly that he remains committed to moving forward with the RCO system, earlier this week he admitted that there are too many questions and not enough answers to allow the system to become effective this summer as originally planned.

“The election changed things, but I think long-term funding is the real issue,” Gov. Bentley said. “I believe a managed care system based on outcomes rather than on fee-for-service is the best way to go for our Medicaid patients.”

Alabama has been working since 2013 toward a managed care system that would shift some of the state’s 1 million Medicaid patients to care through the RCO system, ensuring patients receive check-ups and preventive care while limiting expensive ER visits later on.

Also earlier this week, Alabama Medicaid issued clarification regarding reimbursement by RCOs for services provided to RCO Enrollees by out-of-network providers. This guidance only applies to the populations and the services included in the RCOs. For a listing of the populations and services included in the RCO please visit the Medicaid website.

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RCO Implementation Changes and Service Delivery Network Timelines

RCO Implementation Changes and Service Delivery Network Timelines

The Alabama Medicaid Agency is working with Centers for Medicare and Medicaid Services to amend the approved 1115 waiver to allow for an Oct. 1, 2017, start date for the Regional Care Organization program.

The deadline for probationary RCOs to demonstrate the existence of an adequate service delivery network by submitting to Medicaid signed contracts from their network providers is Jan. 10, 2017. As probationary RCOs work to meet this service delivery network adequacy deadline, providers may be contacted by probationary RCOs with whom they are not currently contracted.

Information about RCOs, implementation or other aspects of this managed care program may be found on the Agency’s RCO webpage

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Primary Care Cut Restored; Physicians Must Re-Attest to Qualify

Primary Care Cut Restored; Physicians Must Re-Attest to Qualify

In a press conference Thursday, Sept. 22, Gov. Robert Bentley and Alabama Medicaid Commissioner Stephanie Azar announced that the primary care cut, which became effective Aug. 1, will be restored on Oct. 1. However, Medicaid-enrolled primary care physicians who qualify for the Primary Care Enhanced Physicians Rates must self-attest in order to continue to receive the payments. No dates have been set by Medicaid for the attestation process. Medicaid will be sending a notice out to providers shortly on how to re-attest.

To qualify for the reinstated bump beginning Oct. 1, physicians will need to re-attest and meet one of the following requirements:

  1. A physician must have a specialty or subspecialty designation in family medicine, general internal medicine, or pediatrics that is recognized by the American Board of Medical Specialties (ABMS), the American Board of Physician Specialties (ABPS), or the American Osteopathic Association (AOA), and they actually practice in their specialty.
  2. A NON-board certified physician who practices in the field of family medicine, general internal medicine, or pediatrics or a subspecialty under one of these specialties, is eligible if he/she can attest that 60 percent of their paid Medicaid procedures billed are for certain specified procedure codes for evaluation and management (E&M) services and certain Vaccines for Children (VFC) vaccine administration codes.

Alabama Medicaid: Primary Care Enhanced Physician Rates “Bump” Certification and Attestation Form

*Note: Practitioners (physician assistants or certified registered nurse practitioners) providing services under the personal supervision of eligible physicians may qualify.

When the cuts originally took effect on Aug. 1, they amounted to 30 to 40 percent of medical practice revenue, according to Executive Director Mark Jackson.

“Regardless of what kind of business you’re in, if you’re seeing cuts of 30 and 40 percent, it’s going to make a major impact on your bottom line,” Jackson said.

The restoration of the bump will also allow the state to continue to implement RCOs. This renewed funding should put the rollout of the RCOs on track by next July, according to Azar.

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