Home-health agency for Madison, Estill and Powell counties says it has to cut staff because of issues with Medicaid and Medicare

Declining reimbursements from Medicaid and Medicare are behind the Madison County Health Department's layoff of seven home-health employees last week. Director Nancy Crew said the cuts should not mean a reduction in care but that cuts were being made because "we've done all we can do without involuntary layoffs," Bill Robinson of the Richmond Register reports. The department's MEPCO subsidiary, which has offered home-health services in Madison, Estill and Powell counties since 1974, has been under financial pressure for two years despite cutting costs and not filling eight now-vacant positions. It had a deficit last year of $610,000.

Only about 15 percent of MEPCO's revenue comes from private insurance, said David Reed, the health department's financial director. That leaves MEPCO with a disproportionate number of Medicaid patients at a time when those re-reimbursements often are denied by managed-care companies, Reed said. Challenging those denials is a complicated process, sometimes requiring going to court to recover costs. The problem is not all with Medicaid. MEPCO’s Medicare reimbursements began a steep decline from nearly $3.24 million in 2008 to $2.55 million in 2012.  (Read more)

Home-health industry is the latest to complain about late payments since state switched to managed-care Medicaid

Kentucky's new Medicaid managed-care system is three months late in making payments to home-health agencies, officials told the House Health and Welfare Committee Thursday.

Nurses Registry and Home Health has outstanding claims of $300,000 to $400,000, Jeannie Lemaster, chief compliance officer, told lawmakers. "Kip Bowmar, executive director of the Kentucky Home Health Association, said only 8 percent of the claims from the approximately 150 home-health agencies have been paid since the switch to managed care Nov. 1," reports Beth Musgrave of the Lexington Herald-Leader.

"If these problems don't get corrected, there is a likelihood that some agencies could go out of business," Bowmar said.

Therapists who work with abused, neglected and at-risk children have likewise told lawmakers of back payments. Independent pharmacists have said "reimbursement rates are much lower than they were under traditional Medicaid, which means they are having to lay off employees," Musgrave reports.

In November, Kentucky made the switch to managed care for its 500,000 Medicaid recipients outside the Louisville region. The move is expected to save the state more than $1 billion in the next three years. Three companies, Coventry Cares, Wellcare of Kentucky and Kentucky Spirit, broker the care and are paid on a per-patient, per-month rate.

Lemaster said most of her agency's problems are with Coventry, which has denied 82 percent of their claims. "Lemaster said that because there are differences in the managed care companies and what is being approved for payments, there are inequities in the Medicaid system," Musgrave reports. "Some people are receiving services and others aren't."

Jill Midkiff, spokeswoman for the Cabinet for Health and Family Services, said problems related to the changeover are being ironed out. "The primary focus of the Medicaid program staff is and continues to be the prompt resolution of any issues that arise as we ease the transition of providers to managed care," she said. (Read more)

Kentucky looking at 'telecare' for Medicaid patients to cut costs

Kentucky is considering making tele-caregivers — off-site guardians who provide care by monitoring cameras and sensors in a patient's home — available to some disabled Medicaid patients. The move is expected to save money by requiring less onsite care, The Courier-Journal's Patrick Howington reports. Because they are being monitored remotely, such as by telecaregiver David Crowe (C-J photo by Jordan Kartholl), it also allows patients to stay in their own home, rather than go to a nursing home.

The service is offered by Rest Assured, a subsidiary of ResCare, which is based in Louisville. The Cabinet for Health and Family Services "has asked permission from federal officials to use Medicaid funds for 'telecare' services like Rest Assured, as is allowed in Indiana and at least one other state," Howington reports.

Electronic monitoring is about half as expensive as in-home care and far less than the $5,000 or more a month it costs for a Medicaid patient to live in a nursing home. Rest Assured charges about $10 an hour for its service, resulting in $2,400 a month for eight hours of daily care. Though not expected to solve the state's Medicaid budget shortfall, "anything we can save at this juncture is wonderful," said state Sen. Julie Denton, R-Louisville.

Rest Assured has about 375 clients nationwide "Depending on clients' needs, the system can provide limited services such as medication reminders and food-preparation guidance for an hour or two a day or comprehensive monitoring for up to 24 hours," Howington writes. Telecaregivers use video and sensors that monitor temperature change, carbon monoxide levels and how long a patient is in the bathroom. (Read more)