State News Round-Up: Fraud Busters Seek New Tech

Minnesota: Aggressive Push for Tech to Monitor Care

In an effort to utilize technology to combat home care fraud, authorities are investigating how monitoring systems could confirm that care is being properly delivered. 

The Department of Human Services recently issued a request for information about products and services that can be used in a home to verify the identity of a personal care assistant and confirm that care is being provided appropriately. The DHS also wants to be able to track how much time caregivers spend in homes.

The agency’s request for information asks vendors and other potential respondents to explain how the product works and is installed, how it transmits or stores data, and how it could help prevent patient-caregiver collusion in perpetrating fraud. Respondents also are to break down costs related to installation, repairs, moving the product to different settings, licensing and other considerations. 

The products and services should not rely on patients’ smartphones, tablets, computers, high-definition televisions or even Internet access, the DHS stated. 

Personal care assistance is reimbursed through Minnesota’s Medicaid program and accounts for the lion’s share of fraud. While personal in-home care represented 7% of 2014 Medicaid reimbursements, it was related to 43% of investigative work that year, according to the DHS. 

Submissions are due March 2.

New Jersey: Managed Care Transition Leaves Seniors High and Dry at Home

A shift in the payment system for in-home care has gotten off to a troubled start, leaving some Garden State seniors in limbo for months over whether services will be covered.  

Like several other states, New Jersey recently transitioned to a Medicaid managed care model in which a handful of private insurers are entirely responsible for administering long-term care benefits, including coverage for some in-home care. The idea is to create a more efficient system, but some consumers and providers alike say that goal seems distant, local newspaper The Record recently reported.

The insurers — Aetna, Amerigroup, Horizon, UnitedHealthcare and WellCare — began managing the Medicaid long-term care program in July. Some seniors that applied for home care benefits in July still are waiting to hear if they are covered, and in the meantime are without needed services or are paying large sums out-of-pocket, according to the Record. Even some long-term care and assisted living companies are complaining that they have not been paid since the shift occurred, with certain chains now owed millions of dollars, the newspaper reported.

For their part, the insurers say that problem stems from backlogs at county welfare offices, which have been “swamped” with new applicants taking advantage of the state’s Medicaid expansion under the Affordable Care Act. Horizon has said that despite the challenges, it already has helped transition 38 people out of nursing homes.

But seniors and their advocates counter that the insurers and other organizations have communicated poorly throughout this ordeal and that documentation is getting lost during the three-step approval process.

“Maria Aberasturi of Bergen County’s Adult Protective Services worries that the enrollment process has become so drawn out that the elderly and disabled or their harried caregivers will give up, forcing some into nursing homes early or leaving others in risky home situations,” Record Staff Writer Colleen Diskin reported.

Vermont: Lawmakers Float Home Health Payment Increase

Home care providers stand to see increased payments under a health care reform package on the verge of passing out of committee in the state’s House of Representatives.

The proposal includes $560,000 to boost payments to home health agencies, VTDigger recently reported. This is in line with what Gov. Peter Shumlin (D) proposed in his latest budget.

The plan drawn up by the House Health Care Committee differs from Shumlin’s budget in other ways, according to VTDigger. For instance, it increases cost-sharing subsidies for people signing up for insurance through exchange plans.

Funding for the $20 million health care package still is up in the air, VTDigger reported. The committee was set to deliberate the bill for 48 hours, beginning on Feb. 25. A health bill also is being considered by the state Senate, and likely will be reconciled with the House version into a single bill in the spring.

California: Workplace Violence Regulation Takes Shape

Home health and hospice providers, along with other health care employers, would have to implement workplace violence-prevention plans if a recently proposed draft regulation is enacted.

The draft regulation from the California Division of Occupational Health and Safety (Cal/OSHA) calls for written plans to help prevent workplace violence. The plans would have to address a number of issues, including how employees are to communicate about violence-related matters between shifts or units, and how incidents are to be reported. The regulation also calls for employee training that would include identification of workplace violence hazards and the measures in place to mitigate dangers. 

“For home health care and home-based hospice, procedures shall be implemented to identify and evaluate environmental risk factors such as the presence of weapons, evidence of substance abuse, the presence of uncooperative cohabitants, etc. during intake procedures, and at the time of the initial visit,” the draft document states.

Recently passed state legislation requires Cal/OSHA to promulgate a regulation of this type by July 1, 2016.

Wisconsin Lags on Home Care Jobs

Those looking for a career in home health care are positioned for success in many places nationwide, but they might want to avoid the Dairy State.

The latest quarterly jobs report from the Department of Workforce Development shows that the state has not been able to accelerate job creation during the economic recovery, John Schmid of the Milwaukee Journal Sentinel recently reported. In particular, the state has not kept pace with the country as a whole in growing certain types of occupations, including home health workers.

“While jobs for cashiers, baristas and home health nurses have proliferated nationally — and now represent the biggest and fastest-growing employment sectors in the United States — those types of low-paying jobs have grown at a much slower pace in Wisconsin,” Schmid noted.

The Journal Sentinel analyzed the state’s labor market in September, and focused on how its economy still is driven by manufacturing, while the United States generally has shifted to a more service-based economy dominated since the turn of the millennium by growth in health care and social services.

Written by Tim Mullaney

Tim Mullaney on Email
Tim Mullaney
If he’s not in the newsroom, Tim likes to be on the tennis court or traveling to a new destination. Recent highlights include Sri Lanka and Iceland.

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