Officials continue push to move seniors into Medicaid managed care, even plans plagued by delays, denials
INDIANA — The state has recommended several companies to provide Medicaid managed care to seniors but by early October had yet to issue $15 billion in contracts.
Most Indiana beneficiaries are already on such plans, but nursing home associations have pushed back against the transition for the elderly and those with disabilities.
In March, the Family and Social Services Department approved four insurers to run the plans, and the state has continued to work this fall on infrastructure for the changeover. Providers will be paid a single per-person, or capitated, fee per patient under the new system, Indiana media reported.
“From the outset, (our) primary concern with the transition to a managed care model has been the introduction of additional layers between our healthcare providers and the care they provide to their residents,” Indiana Health Care Association officials said. “While work still remains prior to the program’s launch in 2024, we appreciate FSSA’s partnership and will continue to work with them over the next year to ensure our providers have the tools that are necessary to maintain high-quality care for their residents in the new managed care environment.”
AG presses for monitor in case of troubled SNF; operator threatens closure
NEW YORK — Attorneys for a massive nursing home told a state Supreme Court judge in October that the facility would likely close if a request by the attorney general to appoint monitors is approved.
Lawyers for Cold Spring Hill Center for Nursing and Rehabilitation told Justice Lisa Cairo that the requests for independent health and financial monitors are a “draconian remedy” that would give the monitors “unrestricted power,” according to court filings.
“The [Attorney General’s] proposal would put her candidates in nearly total control of every aspect of Cold Spring Hill’s operation,” the facility’s attorneys wrote in a Sept. 29 filing. “Instead of monitors, the AG effectively asks the court to appoint receivers for the facility. There is scant to nonexistent precedent for such a draconian remedy against a nursing home.”
The state health department has asked the court to appoint a caretaker to oversee the 606-bed facility while officials try to revoke its license, according to court documents. Meanwhile, Attorney General Letitia James also requested the court put sufficient funds into escrow so 440 employees continue receiving health benefits, which were expected to cease Oct. 15.
38 nursing homes agree to accept patients needing opioid use disorder treatment
PENNSYLVANIA — Three nursing homes and four provider groups operating multiple facilities agreed to admit individuals managing opioid use disorder.
Attorney General Michelle Henry announced an order issued by her office covers 38 facilities. By law, nursing homes cannot deny admissions to patients based on opioid use disorder unless they are actively engaged in illegal drug use.
“Opioid dependency impacts every Pennsylvania community, and those receiving medication that enables recovery should not be discriminated against,” Henry said in a Sept. 21 press release.
The order followed an investigation into the case of a 76-year-old man who became addicted to morphine that had been prescribed to manage lupus. After a surgery, he was denied admission by 11 nursing homes and filed a complaint with the AG’s office.
Analysis predicts 4,000-bed loss
MICHIGAN — An estimated 4,000 skilled nursing beds would go out of service following implementation of proposed federal staffing minimums, according to an analysis by the state’s largest nursing home advocacy group.
The Health Care Association of Michigan surveyed members and accessed facility statistics through the American Health Care Association’s LTC Tracker to find that 71% of facilities in the state would not meet requirements of the proposed staffing rule for certified nurse aides.
In addition, 41% of facilities would not be able to meet the requirement to provide 0.55 hours of direct care by a registered nurse and “almost no” facilities are capable of having an RN on duty 24/7.
“It’s a numbers game in that we truly do not have the workers to get back to pre-pandemic levels, let alone meet this proposed staffing mandate,” said HCAM President Melissa Samuel.
Feds target nursing homes for violating ADA
COLORADO — The Justice Department has sued the state of Colorado for unnecessarily segregating adults with physical disabilities, including older adults, in nursing homes in violation of the Americans with Disabilities Act and the US Supreme Court’s Olmstead decision.
The department previously notified Colorado of its findings of civil rights violations in a March 2022 letter to Gov. Jared Polis (D). It identified steps the state should take to remedy violations, but the department said this fall that most nursing facility residents remain unaware of state services available to help them move back to the community, such as help with bathing, dressing and meds.
“Far too often, people with physical disabilities — including older adults — are institutionalized in nursing facilities when they could live in their own homes,” said Assistant Attorney General Kristen Clarke of the Justice Department’s Civil Rights Division.
From the November 2023 Issue of McKnight's Long-Term Care News
