Addus HomeCare CEO Dirk Allison on Wednesday cited the recent proposed home- and community-based services (HCBS) rule from the Centers for Medicare & Medicaid Services as one of the personal care, home health and hospice provider’s biggest challenges.
The proposed rule, which has spurred backlash from home care providers, including Addus, would require that at least 80% of Medicaid payments for personal care, homemaker and home health aide services be spent on compensation for direct care workers.
“20 percent doesn’t work everywhere,” Allison said at the Jefferies Healthcare Conference. “We don’t believe one-size-fits-all is the way to go.”
Every state has different HCBS qualifications and hourly rates. While Illinois pays $28 an hour, other states pay $15 an hour, he noted.
The proposed rule, if it takes effect, would put “a vast majority of the small mom-and-pops“ out of business, he said, noting that the states that pay caregivers less, such as in the Southwest, would suffer disproportionately.
Allison said that he agrees with the proposed rule’s two goals — expand personal care coverage and increase workers’ wages. He called these “two very valid goals.”
Last month, Addus said it was putting personal care acquisitions on hold until there is more clear direction around the proposed rule. The National Association for Home Care & Hospice and Partnership for Medicaid Home-Based Care recently requested a 60-day extension on the comment period for the proposed rule.
Besides requiring a portion of Medicaid HCBS payments go to workers, Ensuring Access to Medicaid Services (Access NPRM) also would do the following:
- Require states to publish the average hourly rate paid to direct care workers delivering personal care, home health aide and homemaker services;
- Require states to establish an advisory group for interested parties to advise and consult on provider payment rates and direct compensation for direct care workers;
- Require states to report on waiting lists in section 1915(c) waiver programs; service delivery timeliness for personal care, homemaker and home health aide services; and a standardized set of HCBS quality measures;
- Promote public transparency related to the administration of Medicaid‑covered HCBS through public reporting of quality, performance, and compliance measures;
- Establish a new strategy for oversight, monitoring, quality assurance, and quality improvement for HCBS programs;
- Strengthen person‑centered service planning and incident management systems in HCBS; and
- Require states to establish grievance systems in fee-for-service HCBS programs.
