State health care authorities have approved a change in how health care providers are reimbursed for long-term Medicaid support and services. But some of those providers maintain the new system doesn’t pay enough for them to maintain quality care for all enrollees.
The Council on Human Services unanimously voted yes on Wednesday to approve a tiered-rate payment system for the home- and community-based services waiver, replacing a fee-for-service system.
That waiver to the Affordable Care Act affects approximately 5,000 Iowans with traumatic brain injuries or developmental or intellectual disabilities who go to providers for day habilitation or adult day care services.
Department of Human Service staffers who spoke during the meeting said the rule change was a move in the right direction, as it pays for the member care rather than based on the provider setting the individual is in.
However, the change left some local providers with less funding for the same level of services, including a small Johnson County organization, the Village Community, that is facing a funding cut of more than 50 percent.
“I guess I’m disappointed,” said Ann Brownsberger, executive director of the Village Community, who listen in on the teleconference meeting. “It just went over with very little fanfare and very little discussion, and I think the concerns that have been expressed by the community as a whole — members, families, providers — I feel were really unheard and dismissed.”
The Council, which acts as a policymaking and advisory body on matters within the Department of Human Service jurisdiction, voted after reviewing public comment on the proposed rule change.
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Under the previous payment model, the approximately 423 providers who serve that waiver population received funds based on a fee-for-service model.
The payment model approved by the Council on Human Services Wednesday places each member under the home- and community-based services waiver into tiers — one through six — based on the enrollee’s needs. Tier one is the lesser amount of reimbursement, and tier six the greatest.
Department of Human Service staffers touted the assessment that was done to place individuals in these tiers. But providers in public comment hearings and in remarks to The Gazette said the assessment was not comprehensive and did not accurately measure the level of care the members actually need.
“The concept for why they transitioned to tiered rates I don’t disagree with,” the Village Community’s Brownsberger said. “I have no issue with being reimbursed a lesser amount for individuals who have fewer needs and a higher amount for individuals who have more needs.
“My only beef with tiered rates is the actual rates. ... It would be nice if there were a system in place where your reimbursement was somehow reflective of the quality of care you are providing.”
Located near West Branch, the Village Community offers day habilitation and supported community living services five days a week to a total of 14 members, the majority of whom are on the autism spectrum and range in age between 18 and 32.
The Village Community received $150 a day per member under the fee-for-service system.
But under the new tiered rate system, the provider can receive $117.03 a day at most for individuals in tier six — a minority of its members. Most are on tier two or three, meaning it receives $71.15 or $81.03 a day respectively for those enrollees.
Brownsberger said the Village Community is working with the Department of Human Services on an exception to policy, which the agency was granted until June but hopes to extend. Brownsberger said the next steps for her and other officials aren’t clear if it isn’t granted that exception again.
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Department of Human Services spokesman Matt Highland said in an email to The Gazette that tiered rates were put in place as a result of a law — a section of House File 653, passed last year — that went into effect Dec. 1.
While the rule was adopted without public comment, two public-comment hearings were held in February — after the rule was in effect.
“The rules process typically takes around six months,” Highland said in the email to The Gazette. “When there is an effective date which may conflict with the lengthy rules process, emergency rule-making authority is provided.”
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