Cindy Bauer, BSN, RN’s Post

Yes the fine system needs to be stricter

The federal government has implemented a new rule that requires home healthcare companies to spend at least 80% of their Medicaid payments on workers' wages, rather than administrative overhead or other costs. This "Ensuring Access to Medicaid Services" rule was finalized by the U.S. Department of Health and Human Services. The rule aims to address workforce shortages in the home healthcare industry by increasing worker pay. According to the White House, over 7 million seniors and people with disabilities rely on home and community-based services funded by Medicaid, and the higher wages are expected to reduce turnover and improve the quality of care. The rule also requires states to be more transparent about their Medicaid home care payment rates and create advisory groups with home healthcare beneficiaries and workers to consult on rates and compensation. https://lnkd.in/dN2CiJpi #healthcare #medicaid #homehealth

Medicaid can help cover the significant costs of nursing home care, which often surpasses $100,000 annually. While Medicare covers only short-term rehab services, Medicaid offers broader support for long-term care, including nursing, room and board, and rehabilitative services. However, qualifying for Medicaid involves meeting strict income and asset requirements, which vary by state. For single individuals, assets typically must not exceed one house, one car, and $2,000. Married couples face slightly higher thresholds. Applicants may need to undergo a "spend-down" process to reduce assets to qualifying levels, which must align with a five-year "look back" rule to prevent disqualifications for improper asset transfers. Consulting an elder law attorney or Medicaid expert is highly recommended to navigate this complex process. Once approved, Medicaid can reduce financial stress for seniors and families, though it limits personal choice in nursing home selection. The program remains a critical safety net for many in need of long-term care. Our team supports clients by navigating Medicaid’s complex eligibility requirements for nursing home care. We assist with compliance in asset management, spend-down strategies, and the "look-back" period to ensure qualification. By providing expert guidance, we help clients secure Medicaid coverage, reducing financial burdens while maintaining quality care for their loved ones. Cliniqon is committed to delivering Guaranteed Quality, Ensured Compliance, and Unparalleled Outcomes in Home Health and Hospice agencies. #HomeHealthServices #HospiceCare #FrontEndServices #BackOfficeSolutions #HealthcareManagement #RevenueCycleManagement #HealthcareCompliance #PatientSupport #CareCoordination #MedicalBilling #ClaimsManagement #PatientEngagement #HealthcareOutsourcing #MedicalCoding #ProviderSupport #CliniqonCare #HealthcareSolutions #PatientCareExcellence #HomeHealthRCM #HospiceBilling U.S. News & World Report

The federal government will require home healthcare companies to pay workers more. The “Ensuring Access to Medicaid Services” rule, finalized by the U.S. Department of Health and Human Services this week, requires at least 80% of Medicaid payments for home care services go to workers’ wages, as opposed to administrative overhead or other costs. According to the White House announcement on Monday, more than seven million seniors and people with disabilities rely on home and community-based services (HCBS), often funded by Medicaid, to provide this type of long-term care in their own homes and communities. The White House cited a study showing higher wages will likely reduce turnover and lead to a higher quality of care for people receiving these services. #homehealth #medicaid

In a recent House hearing, a Medicaid official faced Republican criticism over new regulations enforcing minimum nursing home staffing and increased pay for home care workers. Rep. Brett Guthrie expressed concerns about the impact on nursing homes already facing closures and workforce shortages. Rep. Cathy McMorris Rodgers highlighted fears of closures due to unattainable staffing requirements. Republicans introduced bills to counter these rules. However, Daniel Tsai from the Centers for Medicare & Medicaid Services defended the regulations, citing safety and dignity concerns. Democrats supported the rules, emphasizing the need for quality care standards. Committee members discussed additional Medicaid bills, including bipartisan efforts to address waitlists for home- and community-based services and Rep. Debbie Dingell's proposal to make "The Money Follows the Person" program permanent. Congresswoman Jan Schakowsky criticized the Medicaid Estate Recovery Program for its financial burden on low-income families, prompting Tsai to express willingness to collaborate on reform. Our team of professionals can streamline processes by conducting thorough analyses, identifying inefficiencies, implementing optimized workflows, and providing tailored solutions. With our expertise, we aim to enhance productivity, reduce costs, and improve overall organizational effectiveness. We are the One! #revenuecycle #revenuecyclemanagement #priorauthorization #medicalbilling #medicalcoding #healthcare #healthcaretechnology #accountsreceivables #denialmanagement #consulting #management #implementationpartner MedPage Today

The finalization of the Medicaid Access Rule, which mandates that 80% of Medicaid payments go directly to caregiver compensation, poses significant challenges for smaller home-based care agencies by limiting funds for operational costs and hindering the adoption of innovative care models. #homecare #homehealthcare #Medicaid #healthpolicy #seniorcare #homebasedcare https://lnkd.in/e_8mDYVy

Ensuring access to vital home health care for seniors is a pressing issue, especially in Ohio, where planned 2025 Medicare home health payment cuts and insufficient Medicare Advantage reimbursements threaten care accessibility. Studies reveal that seniors missing prescribed home health care are 42% more likely to die within 30 days of hospitalization compared to those receiving care, emphasizing the critical need for reforms. To safeguard seniors' health and dignity, advocates urge Congress to reverse home health payment cuts, adjust Medicare Advantage reimbursement rates to match traditional Medicare, and address healthcare labor cost surges. Workforce initiatives must integrate home-care-focused training to prepare professionals for rising demand, while simplified access and reduced administrative burdens are essential to ensure timely care. Transparency in Medicare Advantage’s impact data is crucial to push for reforms. Protecting Ohio’s seniors and the nation’s vulnerable population requires immediate bipartisan action in 2025 to support compassionate, accessible home health care. Our RCM team supports home health entities by optimizing reimbursement processes, ensuring accurate claims submissions, and minimizing denials related to Medicare and Medicare Advantage policies. We provide strategic guidance on navigating payment cuts, labor cost challenges, and administrative hurdles, enabling providers to focus on delivering essential care to seniors in need. Cliniqon is committed to delivering Guaranteed Quality, Ensured Compliance, and Unparalleled Outcomes in Home Health and Hospice agencies. #HomeHealthServices #HospiceCare #FrontEndServices #BackOfficeSolutions #HealthcareManagement #RevenueCycleManagement #HealthcareCompliance #PatientSupport #CareCoordination #MedicalBilling #ClaimsManagement #PatientEngagement #HealthcareOutsourcing #MedicalCoding #ProviderSupport #CliniqonCare #HealthcareSolutions #PatientCareExcellence #HomeHealthRCM #HospiceBilling NewsBreak

Long-term care providers are often reminded of the harsh reality that having the most money usually leads to success in policy battles, especially when it comes to government healthcare funding. The fight for more Medicare and Medicaid dollars is a constant struggle for nursing home operators who aim to provide quality care for the frail and vulnerable. While being correct on an issue is important, it may not always secure a win in the end. How are you preparing your organization for the changing landscape? https://buff.ly/4fx9UV1 #longtermcare #seniorcare

Major changes are coming to Medicare Advantage plans in 2025, impacting nursing homes and the care provided to seniors. The Centers for Medicare and Medicaid Services will be cutting base payments, affecting millions of enrollees. Learn more about how these adjustments will impact the healthcare industry and what seniors can expect moving forward in this insightful article. #Medicare #Healthcare #MedicareAdvantage #SeniorsCare #HealthInsurance #BidenAdministration

Imagine your future self (or your parents or spouse) with limited mobility. Maybe there was a fall or a degenerative condition like Parkinson’s. Especially if you are still clear in your mind, you naturally want to receive the care and support that you need in your home. Nobody *wants* to go to a nursing home. And nursing homes have waiting lists because of staffing challenges. Both the interests of you, the older adult, and of our health care system are served by keeping you at home.  So how do you receive that care in your home? Either your family members give up their jobs and time with their own family to be there for you, or professional home care agencies help you through your day. Medicare will not be paying for the home care agency. And if you cannot afford to write checks for many hours of care, Medicaid may be available through a so-called “waiver program” (what’s being waived is the usual requirement that you be in a nursing home if Medicaid is paying the bill).  Medicaid pays the home care agency. Here’s the problem. As with nursing homes, states tend to grossly underfund this program. Most home care providers I know will not participate in Medicaid because it would find them paying employees so little. If you can’t pay caregivers a decent wage, they predictably stop showing up for the people who need care. This article shows what happens in your state legislature when an increase in funding for home-based care comes up. In Wisconsin, the legislation ran into a buzzsaw when the fiscal note came out. Every piece of legislation gets a fiscal note — an analysis of what it will cost. And it wouldn’t be cheap to keep more people in their homes.  But it’s a heck of a lot cheaper than adequately funding nursing home care.  Your future self (or parent or spouse) is likely to need long-term care and support. Unless your personal financial planning is excellent, you will be banking on lawmakers to get past the sticker shock and figure this out. https://lnkd.in/e_n5hA7Q