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CMS Announces Guidance for State Medicaid Programs That Encourage Adequate Payment Rates for Home Care

Posted on Thursday, August 11, 2016 2:04 PM

The Center for Medicaid and CHIP Services (CMCS), at the Centers for Medicare & Medicaid Services (CMS), recently released guidance that encouraged state Medicaid programs to strengthen and stabilize the home care workforce.

“CMS and states are taking important steps to support increased access to high-quality home and community based care,” the guidance states. “These steps are helping to remedy a longstanding imbalance between institutional and home and community-based care: data for fiscal year 2014 showed that 53 percent of total Medicaid long-term services and supports (LTSS) expenditures were spent on home and community-based services (HCBS), a marked change from 2009 when only 45 percent of LTSS expenditures were on HCBS.”

The guidance also states: “A stable workforce, engaged in the delivery of services and supports that address the needs and preferences of beneficiaries, is a critical element to achieving continued progress.”

The following recommendations are included in the guidance:
Wage Analyses
• “Access to services is critical to ensuring that individuals get the care they need to live in the community, and wage thresholds help to attract dedicated and engaged workers.”
• “CMS encourages states and providers to be mindful of the relationship between wage sufficiency, workforce health, and access to care. Wages paid to individual workers are often slow to be adjusted in response to inflation and economic growth, and can lag behind wage increases in other health and service sectors. Analyses of how the home care industry relates to the larger marketplace within a state are encouraged when states establish rate-setting methodologies to providers, and when providers determine the wage structure for their employees. This includes taking into account geographic differences in wages within a state.”
• “When developing payment rates for home care services, states should also consider business costs incurred by a provider – whether a home care agency or an individually employed worker – associated with the recruitment, skills training, and retention of qualified workers.”

Provider Qualifications and Basic Training
• Recognizing the importance of balancing program integrity and self-direction
• For services provided primarily in the home, such as personal care services, qualifications can include possession of a valid driver’s license, a minimum age threshold, and the receipt of any training required by the state
• Minimum qualification requirements such as first aid and CPR certification should not restrict the ability of beneficiaries to require individualized training on the specific ways to provide care based on their own needs and preferences
• In many consumer directed personal care programs, much of the training can also be provided directly by the beneficiary

Workforce Identity
• “Home care workers may be employed by an agency, such as a home health agency or personal care agency, or may be employed directly by a beneficiary under self-directed service models. Because home care workers often deliver care on site in the homes of beneficiaries receiving services, and travel from home to home independently, home care workers may interact with their professional peers infrequently, which can promote isolation and disengagement, and make professional development challenging.”
• “Establishing an open registry of workers for public use can help strengthen the identity of the workforce and improve beneficiary awareness of available, qualified home care workers. To be most effective, the registry should include individuals who have attained any required educational or training standards (discussed more below), but states can use registries in different ways, including offering it as an option but not requiring beneficiaries to select home care workers from it.”

The full document is available here.

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