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 care 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) provide opportunities for Medicaid beneficiaries to receive services in their own 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 3.5 million individuals receive HCBS through various Medicaid Waiver programs.

State Medicaid agencies have the following four HCBS options:

1915(c) - Home and Community-Based Waivers

1915(i) - State Plan Home and Community-Based Services

1915(j) - Self-Directed Personal Assistance Services Under State Plan

1915(j) State Options

COVID -19 impact on home and community based services

Growth:

Medicaid beneficiaries increasingly are receiving LTSS through HCBS. In fiscal year (FY) 2016, Medicaid programs spent approximately $94 billion on HCBS compared to about $72 billion on institutional services, which represented a 10 percent increase in HCBS spending over FY 2015.

The shift in spending from institutional to home and community-based settings reflects federal and state policies. Referred to as rebalancing, these efforts have been driven by concerns about the high cost of institutional care and to and meet beneficiary preferences to live in the community. They have included the Money Follows the Person (MFP) demonstration program, which provides participating states with grants to assist beneficiaries living in institutions to transition back to the community.

COVID-19 has accelerated the trend in providing more HCBS in lieu of Nursing Home and other institutional services. Proposed additional funding for HCBS will enable states to reduce their HCBS waiver waiting lists and add more people to HCBS.

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

Challenges for Home Care Agencies

Even though HCBS programs are growing, Home Care Agencies providing Home and Community-Based Services face many challenges to managing these programs.

There are four options for states to develop waiver programs. 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.

Many states have contracted with one or more Managed Care Organizations (MCOs) to provide services under Medicaid programs including HCBS Waiver programs. Each Managed Care Organization can have different requirements for the services.

The 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 one or more EVV aggregators. When a Home Care Agency operates across multiple states, the challenge of working with multiple EVV aggregators grows.

Varying requirements for each state and the MCOs within the state make authorization management very challenging for home care agencies providing services under HCBS programs. These programs usually limit the number of hours of services provided per day, per day, and/or per month. This adds another layer of difficulty to manage authorizations.

One of the waiver programs is Consumer Directed Services which is managed through traditional home health care agencies. Even though the patient is able to hire the caregiver and schedule the services, home care agencies will bill for the services provided and pay the caregivers. This unique situation creates scheduling, authorization management, and billing challenges for the agencies.

Some of the 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.

Patients may qualify for multiple services and/or programs at the same time creating an additional layer of difficulty.

An effective software platform should have the functions and features to help agencies to manage the challenges posed by various Home and Community-Based Services.

Key Features required in a software platform to manage Home and Community-based Services

The following are some of the features required in a home health care software platform to effectively manage the challenges posed by Home and Community Based Services.

Ability to manage multiple programs and services under one patient record
Aide Care Plan with tasks that can be personalized for each patient.
Ability to document tasks performed and collect EVV data using Mobile devices
Ability to handle different authorization limits and integrate these limits with scheduling and billing
Scheduling integrated with authorization and billing to minimize unauthorized and non-billable services
EVV framework to interface with one or more state EVV aggregators
EVV validations to reduce rejections when visits are sent to aggregators
Ability to allow the caregivers to clock in, clock out, and document the services provided using smartphones without a schedule for Consumer Directed Services
Option to submits claims directly to Medicaid or MCOs
Ability to create unique invoice formats for local waiver programs
Use schedules to create timesheets for payroll
Ability to handle scheduling and billing requirements for services provided in Group Home Settings

An effective software platform should be able to accommodate these requirements in addition to managing other services provided by home health care agencies

Conclusion

CareVoyant understands the demanding requirements to manage 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 that will help a home health care agency to 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.