黑料正能量 Note: In this succinct guide from Monica Oss of Open Minds, she contends that the new service delivery continuum made available through HCBS services will be matched by payers like Medicare and private insurance recognizing the market leverage possible by capitalizing on new investments in this area. Providers of HCBS services may be tasked in the coming years with moving beyond even HCBS as a niche approach, and aligning contracts and services with a broader array of payers. Not only could this give way to a true community-based safety net, but could enhance ongoing integration efforts across facility types.
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Open Minds; Monica E. Oss, 4/28/2015
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Home and community-based services (HCBS) is听a specific term for Medicaid waivers听that allow states to provide non-institutional听and non-clinic-based services,听to serve听consumers who traditionally have received care in institutional settings.听These waivers typically apply to expanded听personal care, home health, adult day care, respite care, and services for individuals suffering from a number of conditions, such as mobility problems, brain injury, intellectual disabilities, and developmental disabilities.
For many managers of health and human services, these HCBS waivers and the HCBS themselves seem听a bit esoteric, and very specific to a small population of individuals with very serious support needs.听But, I think the changes in HCBS services that we鈥檙e seeing in Medicaid are the bellwether for a change across all health care payers 鈥 for two reasons.
First, the change within Medicaid itself is notable. And, with health care reform, Medicaid is now rivaling Medicare as the 鈥渓argest payer鈥 (in terms of numbers of consumers covered) in the U.S.听 And, Medicaid (alone or in conjunction with Medicare) is now providing health care coverage to some of our citizens with the greatest treatment and support needs.听As Medicaid costs have risen 鈥 due to both expanded coverage and longer life spans,听HCBS are increasingly becoming the 鈥渙ption鈥 for Medicaid to reduce costs by providing service to consumers outside of institutional settings.听Between 2005 and 2012, 26 states conducted a total of 38 studies 鈥 these studies 鈥渃onsistently provide evidence of cost containment and a slower rate of spending growth as states have expanded HCBS鈥 (see听).
And as a result, state Medicaid听plans are听expanding their HCBS waiver programs 鈥 In 2014, 41 states implemented HCBS waivers or SPA expansions, and 46 had adopted plans to do so in fiscal year 2015 (see听听and听). Also in 2014, the Feds released their rule defining settings eligible for Medicaid reimbursement for HCBS (see ). States are focused on closing state hospitals and moving consumers to the community (see听).听This potential market is large and getting larger. Between 2009 and 2011, state and federal spending on Medicaid waiver HCBS for people with intellectual and developmental disabilities (I/DD) increased by 10.7%, from $25.1 billion in 2009 to $27.8 billion in 2011 (see听). In addition, Medicaid paid $134.1 billion for institutional care or HCBS in 2012 (see听).
The second reason goes beyond Medicaid and into the broader health care system.听As all payers and health plans look for greater value from investment of health care resources and an aging population, the experience of Medicaid with HCBS and the availability of new remote monitoring tools are creating a new service delivery continuum听(see听). And, there is the perennial goal of reducing readmissions by supporting consumers recently released back into the community (see听).
Is your organization thinking about delivering services under the expanding Medicaid听HCBS waivers 鈥 or delivering some other type of non-clinical-based service?听听In this month鈥檚 issue, we take a deeper look at Medicaid waivers and why they are important (see听); why states are relying on waivers (see听), as examples in California and Minnesota (see听听and听); and the top waiver developments and expansions around the country (see听听and听).
If your executive team is looking at HCBS, there are critical questions to answer in evaluating that option.听What does the market look like in your state? For what consumers are community-based services most appropriate?听What staffing, what tech tools, and what clinical protocols are all vital to supporting your community-based efforts? The answers to these questions will be the key to a sustainable service delivery model.
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