HCAC e-news
August 12, 2002  /   Published by Home Care Association of Colorado

MEDICAID HOME HEALTH
RATES RESTORED TO 6/30/02 LEVELS

1. MEDICAL SERVICES BOARD RESTORES MOST HOME HEALTH RATES TO JUNE 30th LEVELS. 

The Colorado Board of Medical Services on Friday, August 9th, agreed by a vote of 8 to 2 to restore rates paid to Medicaid home health providers for skilled nursing, home health aide and therapy services to what they were on June 30, 2002. The rates will be restored to last year’s levels beginning September 1, 2002. The only home health service that was not restored to its previous level was Private Duty Nursing (PDN) which will continue to be paid at five percent less than was paid last year.

The unprecedented roll-back of provider rates to a higher level just two months after severe rate cuts by the Board at its June 14th meeting has been described by many as a great success. However, it came following much discussion and compromise, dozens of meetings, and major trade-offs by home health providers, consumers and Medicaid officials alike. The major trade-off by consumers was the elimination of physical, occupational and speech therapies from the home health benefit for long-term care clients (defined as those with 61 days or more of service) who are 18 years of age and over. Medically necessary therapies may still be obtained by consumers at out-patient clinics and private practices or may be provided by therapists who have recently been granted the authority to bill Medicaid directly for their services.

The new Medicaid home health rates beginning September 1st will be as follows:

- Skilled Nursing $ 71.42 per visit

- Acute & Long Term Home Health Aide basic unit (first hour) $ 31.66

- Acute & Long Term Home Health Aide extended unit (addtl 1/2 hour) $ 9.46

- Physical Therapy $ 61.43 per visit

- Occupational Therapy $ 65.24 per visit

- Speech Therapy $ 66.95 per visit

Private Duty Nursing rates remain at the reduced rate that was set on July 1, 2002:

- RN $ 29.20 per hour

- LPN $21.02 per hour

Watch future E-Bulletins and the management report for details on meetings, negotiations and association positions which led to the restoration of rates.

2. OTHER MEDICAID CHANGES ARE IMPLEMENTED.

While accepting the Dept. of Health Care Policy’s recommendation to roll back rates, the Board of Medical Services also confirmed its earlier decisions:

- In order to receive Long Term Home Health benefits, a client must pass the long term care screen;

- Acute Home Health means services for acute conditions that are provided for up to 60 calendar days;

- Long Term Home Health means services provided for 61 days and over;

- Beginning September 1, the maximum reimbursement for a 24-hour period for Acute Care or an Acute Care Episode is $291 and for Long Term Home Health is $227;

- Single Entry Point Agencies will authorize all Long Term Home Health for clients 18 and over;

- The Medicaid fiscal agent will authorize care for clients under 18;

- The threshold for placement in a nursing facility is now 25 points, up from 19;

- The PDN criteria for medical need related to oxygen administration and tube feedings for pediatric clients has changed;

- The HCBS-EBD program is now capped at 13,000 clients;

- Cost Containment means the cost for providing care in the community (including HCBS-EBD, long term home health services and Home Care Allowance) must be less than the cost of providing care in an institutional setting, and

- Admission to the Home Care Allowance Program was frozen on July 1, 2002.

3. READ THE RULES AS PROPOSED BY HCPF STAFF!

The rules that were accepted by the Board of Medical Services may be reviewed and downloaded at:

http://www.chcpf.state.co.us
Scroll to Medical Services Board; Then to "Agendas with Proposed Rules;"
Then to August 9, 2002; Document 1 and 4

Also of interest to home care agencies are Documents 2, 8 and 9

Another Membership Benefit Brought to You by
The Home Care Association of Colorado

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Home Care Association of Colorado
7853 East Arapahoe Court #2100, Centennial, Colorado 80112-1361 U.S.A.
Phone (303) 694-4728      Fax (303) 694-4869
hcac@assnoffice.com

Last edited by sgb on 08/17/05