Overview

Millions of Americans, including children, adults, and seniors, need long-term care services because of disabling conditions and chronic illnesses. Medicaid is the primary payer across the nation for long-term support services. Medicaid allows for the coverage of these services through several vehicles and over a continuum of settings, ranging from institutional care to community-based long-term services and supports (LTSS). Two major components of LTSS are Institutional services and Home and Community Based Services (HCBS).

Home and Community-Based Services (HCBS) allow Medicaid beneficiaries to receive services in their home or community rather than institutions or other isolated settings. These programs serve a variety of targeted population groups, such as people with intellectual or developmental disabilities, physical disabilities, and/or mental illnesses. Over 3 million individuals receive HCBS through various Medicaid Waiver programs.

Medicaid beneficiaries are increasingly receiving LTSS through HCBS. In fiscal year (F.Y.) 2016, Medicaid programs spent approximately $94 billion on HCBS. The federal government and the states spent $116 billion on Medicaid home and community-based services (HCBS) in F.Y. 2020, serving millions of elderly adults and people with disabilities. That is a significant increase in HCBS spending.

Essential Features for Home and Community Based Services Software

Because states can limit enrollment in HCBS waivers, most states report having HCBS waiver waiting lists totaling over 692,000 people nationally. Proposed additional funding for HCBS will enable states to reduce their HCBS waiver waiting lists and add more people to HCBS. The need for HCBS services will continue to grow for the foreseeable future.

Home Health Care Agencies looking for growth and expansion should consider HCBS services as one of the options.

This blog will discuss 7 must-have software features required to manage HCBS Home Care Agencies efficiently.

Essential Features for HCBS Home Care Software

The following are the essential features for HCBS Home Care Software:

ONE Software, ONE Patient, All Home-Based Services

With the flexibility available to states, each state will have different requirements to provide services under HCBS. Sometimes, requirements may be different even within a state. The ability to meet all different requirements for HCBS programs under ONE Software and ONE Patient is critical to effectively managing all the programs. The Home Care Software platform should ensure that the agencies can add additional services, such as Private Duty Nursing, Non-Medical, Home Health, etc., under the same platform.

Authorization Management

States have wide latitude in designing the waiver programs for Home and Community Based Services. Authorizations for Home and Community-Based Services can vary from one program to another. Authorization limits may be by hours per day, week, month, or combination. Authorizations may also be by dollar amount, irrespective of the services provided. An effective home care software platform should offer an integrated authorization process to accommodate all the variations.

Advanced Scheduling

Home and Community-Based Services require robust scheduling functions to meet demanding and constantly changing scheduling requirements. Scheduling must be tightly integrated to prevent scheduling outside authorization and reduce non-billable services. The ability to schedule, bill, and pay one shift for services under different waiver programs will significantly improve scheduling efficiency. Staying within authorized limits will improve cash flow by eliminating non-billable services and paying employees for non-billable services.

Consumer Directed Services

One of the waiver programs is Consumer Directed Services which is managed through traditional home care agencies. Under this program, the patient will hire the caregiver and schedule the services, while home care agencies will bill for the services provided and pay the caregivers. The software platform should be able to handle Consumer Directed Services in addition to other services.

Integrated EVV Platform

21st Century Cures Act requires the states to implement an EVV (Electronic Visit Verification) system for services provided at home. Depending on the number of MCOs in a state, agencies may have to work with multiple EVV aggregators. When a Home Care Agency operates across various states, the challenge of working with multiple EVV aggregators grows. Home Care Software platform should have a robust EVV Framework to interface with multiple EVV Aggregators for the states or payers. EVV Framework should also validate visits to reduce rejections by aggregators.

EVV Platform should be able to personalize personal care tasks for each patient and document the tasks with an easy-to-use mobile EVV software.

Billing

With many waiver programs for Home and Community-Based Services, Home Care Agencies will need flexible and configurable software to meet the disparate requirements of these programs. A configurable claim scrubber will be essential to validate claims based on the requirements of individual programs before submitting the claims. The software should be able to configure the claims and invoice formats to meet billing requirements for different waiver programs.

Group Homes

Some Home and Community-Based Services will be provided in Group Home settings. Home Care Agencies providing these services will be paid a per-dem rate for the services provided. Home Care Software should be able to handle all the scheduling, billing, and documentation requirements for services provided in group homes.

Conclusion

CareVoyant understands the demanding requirements of managing Home and Community-Based Services while managing other services like Private Duty Nursing, Non-Medical Personal Care, and Home Health. CareVoyant software platform provides tools to help a home health care agency effectively manage Home and Community-Based Services (HCBS) along with other service lines.

ABOUT CAREVOYANT

CareVoyant is a leading provider of cloud-based integrated enterprise-scale home health care software that can support all home-based services under ONE Software, ONE Patient, and ONE Employee, making it a Single System of Record. We support all home based services, including Home Care, Private Duty Nursing, Private Duty Non-Medical, Home and Community Based Services (HCBS), Home Health, Pediatric Home Care, and Outpatient Therapy at Home.

CareVoyant functions – Intake, Authorization Management, Scheduling, Clinical with Mobile options, eMAR/eTAR, Electronic Visit Verification (EVV), Billing/AR, Secure Messaging, Notification, Reporting, and Dashboards – streamline workflow, meet regulatory requirements, improve quality of care, optimize reimbursement, improve operational efficiency and agency bottom line.

For more information, please visit CareVoyant.com or call us at 1-888-463-6797.