NYAPRS 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.
Is Your Organization Ready For The “HCBS Era”?
Open Minds; Monica E. Oss, 4/28/2015
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Home and community-based services (HCBS) is a specific term for Medicaid waivers that allow states to provide non-institutional and non-clinic-based services, to serve consumers who traditionally have received care in institutional settings. These waivers typically apply to expanded 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 a bit esoteric, and very specific to a small population of individuals with very serious support needs. But, I think the changes in HCBS services that we’re seeing in Medicaid are the bellwether for a change across all health care payers – for two reasons.
First, the change within Medicaid itself is notable. And, with health care reform, Medicaid is now rivaling Medicare as the “largest payer” (in terms of numbers of consumers covered) in the U.S. 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. As Medicaid costs have risen – due to both expanded coverage and longer life spans, HCBS are increasingly becoming the “option” for Medicaid to reduce costs by providing service to consumers outside of institutional settings. Between 2005 and 2012, 26 states conducted a total of 38 studies – these studies “consistently provide evidence of cost containment and a slower rate of spending growth as states have expanded HCBS” (see State Studies Find Home and Community-Based Services to Be Cost-Effective).
And as a result, state Medicaid plans are expanding their HCBS waiver programs – In 2014, 41 states implemented HCBS waivers or SPA expansions, and 46 had adopted plans to do so in fiscal year 2015 (see 47 States To Expand Medicaid LTSS In 2015 and Medicaid Is The Largest Payer – Now What?). Also in 2014, the Feds released their rule defining settings eligible for Medicaid reimbursement for HCBS (see CMS Finalizes Community Setting Requirements For Medicaid HCBS Programs; Does Not Exclude Assisted Living Option). States are focused on closing state hospitals and moving consumers to the community (see The Emerging Community-Based Market Niche). 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 I/DD HCBS Waiver Spending Grows 10% – From $25 Billion In 2009 To $27 Billion In 2011). In addition, Medicaid paid $134.1 billion for institutional care or HCBS in 2012 (see Medicaid Funded $134 Billion, 61% Of U.S. Long-Term Services & Supports Spending In 2012).
The second reason goes beyond Medicaid and into the broader health care system. 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 (see Home & Community-Based Services Toolkit). And, there is the perennial goal of reducing readmissions by supporting consumers recently released back into the community (see The 4:1 ROI Of Hospital Discharge Transition Programs).
Is your organization thinking about delivering services under the expanding Medicaid HCBS waivers – or delivering some other type of non-clinical-based service? In this month’s issue, we take a deeper look at Medicaid waivers and why they are important (see What Are Medicaid Waivers & Why Do They Matter?); why states are relying on waivers (see Why Do States Need Home & Community Based Services Waivers?), as examples in California and Minnesota (see A Spotlight On California HCBS Waivers and A Spotlight On Minnesota HCBS Waivers); and the top waiver developments and expansions around the country (see The New HCBS Rule Reshaping Community-Based Services and For HCBS, 2014 Was A Year Of Developments).
If your executive team is looking at HCBS, there are critical questions to answer in evaluating that option. What does the market look like in your state? For what consumers are community-based services most appropriate? 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.
https://www.openminds.com/market-intelligence/editorials/organization-ready-hcbs.htm/