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Unified Long Term Care Services Advisory Workgroup – Update

“The best way to predict the future is to create it.”  Peter Drucker.

The ULTCS AWG is central to the changing State Medicaid landscape for all providers.  This month the PULSE will discuss this activity in more detail due to its prominence in the coming changes.  The workgroup met the last week of November to recap current activities and lay out next steps.  It was interesting to read a recent review of the meeting from a non-state associated home care agency this week regarding “what’s going on.”  Whether or not you’ve been involved during the last four years and not kept up with the work of this and/or many other associations, this reviewer’s first statement hits the mark head on… “As it stands now, these are not possible changes, these are real changes.”  However, going from that point on, while the review was mostly correct one major incorrect assumption was that there have not been any public hearings, discussions, or feedback provided.  Associations and volunteers have been working on these issues for close to six years now.  One can trace much of the initial ideas from a report completed by the joint committee, Ohio Commission to Reform Medicaid, which was published in 2005 during Governor Bob Taft term in office.  While it may appear things are happening now in a harsh and swift manner, the change that is coming regarding Medicaid has been laid by the hard work of many individuals from many walks of life.

Change is coming predicated on cost and the need to find an affordable ways to serve Ohioans without going broke. CMS is increasing the amount of money they are "matching" to support states in making these changes but much of that match goes away in the near future.  There is a movement which is being driven by the state administration and departments towards driving all of Medicaid into a case managed system.  The state is working on several fronts to develop waivers to functionally change the way Ohio currently does this work.  There are currently four subcommittees meeting under the ULTCS AWG:


Charge specified in Am. Sub. H.B. 153, Section 209.50., ULTCS ADVISORY WORKGROUP SUBCOMMITTEES:  The third subcommittee shall study the process of making Medicaid eligibility determinations for individuals seeking nursing facility services. The subcommittee shall complete a report of its study not later than December 31, 2011.


Charge specified in Am. Sub. H.B. 153, Section 209.50., ULTCS ADVISORY WORKGROUP SUBCOMMITTEES:  The fourth subcommittee shall study Medicaid reimbursement for nursing facility services, including issues related to the composition of peer groups, methodologies used to calculate reimbursement for capital costs, and the proportion of the total nursing facility reimbursement rate that should be based on the quality of care nursing facilities provide. The subcommittee shall complete a report of its study not later than December 31, 2012.


Single Waiver Work Team Description:  Facilitate the consolidation of Ohio’s five waivers for home- and community-based long-term care (Choices, Assisted Living, PASSPORT, Ohio Home Care and OHC Transitions Aging Carve-out) into a single state waiver to create even more flexibility for consumers.


Dual Eligibles Project Work Team Description:  Facilitate the creation and implementation of an integrated, comprehensive, and seamless approach to the delivery of healthcare services to beneficiaries dually eligible for both Medicare and Medicaid services. 

Attached is a recent PowerPoint program by Director Moody that gives a high-level overview of the direction.  The Office of Health Transformation ( houses current and past activities involved in these changes.  There are still a lot of questions and it is difficult to see how this puzzle will piece together in the end, but the drive by all involved parties is to be patient-centric, cut costs, improve quality and increase value in caring for Ohioans.

Home Care, Hospice and Palliative Care are all positioned to be impacted in different ways.  These events are ongoing, and in addition to national changes and concerns.  It can be very scary as a provider trying to determine what direction to take and decisions to make to keep your agency afloat.  Reimbursement and rates in the short run will continue to be pressure points that may drive some providers out of business. In the national press and articles like Eck (2010) (Home care, hospice care, and the affordable care act. American Health Lawyers Association.  Nov., 16-21) and other authors are very clear about expected changes within healthcare and these specific industries.  With profit margins being reported by MedPAC and a growth rate in Ohio of almost 50% more home care agencies in the last 4-5 years the prevailing economic thought is – “There’s room to cut costs.”  Of course, as above there are many other pressures affecting home care and hospice such as rules, policies and procedural shifts as well.  

Time is running out for the state on several CMS initiatives and we fully expect to see two major white papers or proposals before the end of the year that need to be reviewed and turned around quickly.  Details of two committee proposals, Single Waiver and Dual Eligible, will be the major focus of those proposals.