| 41 | | - | WHEREAS, the State has a limited number of beds in nursing homes for patients requiring the level of care provided by nursing homes; and WHEREAS, the Community Care Foster Family Home (CCFFH) program and Expanded Adult Residential Care Home (E-ARCH) program provide additional options for patients requiring nursing home-level care throughout the State; and WHEREAS, caregivers in CCFFHs and E-ARCHs effectively provide the proper care needed for nursing home-level patients, including assistance with activities of daily living, specialized care such as the use of feeding tubes and catheters; and the provision of basic wound care, maintenance exercise programs, cognitive stimulation, dietary management, and other custodial care as needed; and WHEREAS, receiving care at CCFFHs and E-ARCHs can reduce the length of hospital stays; provide emotional, financial, and physical relief to families caring for an ill senior or other family member in their own home; and reduce the risk of homelessness, morbidity, and mortality in patients requiring nursing home-level care; and WHEREAS, the Adult Residential Care Home (ARCH) program was introduced in Hawaii in or around the 1950s to provide assisted living type care; it was expanded in 1994 to provide nursing home-level care as the E‑ARCH program under the Department of Health, serving approximately fourteen hundred patients with the potential for an even greater capacity; and WHEREAS, the pilot CCFFH program was started in 1979 by The Queen's Medical Center; it started receiving Medicaid funding under a federal Medicaid waiver in 1984, initially under the direction of the Department of Human Services, and currently under the Department of Health, which serves approximately three thousand patients with the potential for an even greater capacity; and WHEREAS, the 1984 CCFFH federal Medicaid waiver was approved based on its success as a high-quality alternative to nursing home placement for Medicaid patients that cost two-thirds or less than placement in a nursing home; and WHEREAS, the level of CCFFH reimbursement has not kept pace with that two-thirds target ratio; and in 2020, the reimbursement rate to CCFFH providers was approximately one-sixth of that for nursing home placements; and WHEREAS, caregivers who accept Medicaid patients into their CCFFH receive $47.06 per day plus the patient's Social Security Assistance (SSA) for a maximum of $2,500 per month for room, board, and patient care, while a nursing home receives $280.00 per day, plus SSA for the same patient for a maximum of $10,100 per month (with HMSA insurance, Kaiser health plan, and UHA insurance at slightly higher rates); and WHEREAS, studies by the American Association of Retired Persons show that Hawaii needs to improve efforts to provide lower cost long-term care services available in the community under Hawaii's MedQuest Medicaid program rather than the more expensive care in nursing homes; and WHEREAS, CCFFH and E-ARCH operators are often dually employed in nursing homes, hospitals, assisted living facilities, and other health care facilities around the State to supplement their income and maintain their own health benefits, which creates greater risk for the spread of infectious disease; and WHEREAS, many CCFFH caregivers decline to accept Medicaid patients and instead save empty beds for private-pay patients to optimize their income, thus reducing the number of beds available for Medicaid patients; now, therefore, BE IT RESOLVED by the Senate of the Thirty-first Legislature of the State of Hawaii, Regular Session of 2022, that the Department of Human Services is requested to: (1) Review the existing payment model for Medicaid reimbursement for patients who require nursing home-level of care in the community; (2) Study the feasibility of increasing the Medicaid reimbursement rates for CCFFH, E-ARCH, and other types of Home and Community Based Service (HCBS) care providers and services; and (3) Determine the overall effect of increasing the Medicaid reimbursement rates for CCFFH, E-ARCH, and other types of HCBS care providers and services; and BE IT FURTHER RESOLVED that the Department of Human Services is requested to submit a report of its findings and recommendations to the Legislature no later than thirty days prior to the convening of the Regular Session of 2023; and BE IT FURTHER RESOLVED that certified copies of this Resolution be transmitted to the Director of Human Services, President of Adult Foster Homecare Association of Hawaii, and President of Alliance of Residential Care Administrators. Report Title: Community Care Foster Family Home (CCFFH); Expanded Adult Residential Care Home (E-ARCH); Home and Community Based Service (HCBS); Medicaid Reimbursement; Increase; Feasibility Study |
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| 41 | + | WHEREAS, the State has a limited number of beds in nursing homes for patients requiring the level of care provided by nursing homes; and WHEREAS, the Community Care Foster Family Home (CCFFH) program and Expanded Adult Residential Care Home (E-ARCH) program provide additional options for patients requiring nursing home level care throughout the State; and WHEREAS, caregivers in CCFFHs and E-ARCHs effectively provide the proper care needed for nursing home level patients, including assistance with activities of daily living, specialized care such as the use of feeding tubes and catheters; and the provision of basic wound care, maintenance exercise programs, cognitive stimulation, dietary management, and other custodial care as needed; and WHEREAS, the availability of beds in CCFFHs and E-ARCHs can reduce the length of hospital stays; provide emotional, financial, and physical relief to families caring for an ill senior or other family member in their own home; and reduce the risk of homelessness, morbidity, and mortality in patients requiring nursing home level care; and WHEREAS, the ARCH program was introduced in Hawaii in or around the 1950s to provide assisted living type care; it was expanded in 1994 to provide nursing home level care as the E‑ARCH program under the Department of Health, serving approximately fourteen hundred patients with the potential for an even greater capacity; and WHEREAS, the pilot CCFFH program was started in 1979 by The Queen's Medical Center; it started receiving Medicaid funding under a federal Medicaid waiver in 1984, initially under the direction of the Department of Human Services, and currently under the Department of Health, which serves approximately three thousand patients with the potential for an even greater capacity; and WHEREAS, the 1984 CCFFH federal Medicaid waiver was approved based on its success as a high-quality alternative to nursing home placement for Medicaid patients that cost two-thirds or less than placement in a nursing home; and WHEREAS, the level of CCFFH reimbursement has not kept pace with that two-thirds target ratio; and in 2020, the reimbursement rate to CCFFH providers was approximately one-sixth of that for nursing home placements; and WHEREAS, caregivers who accept Medicaid patients into their CCFFH receive $47.06 per day plus the patient's Social Security Assistance (SSA) for a maximum of $2,500 per month for room, board, and patient care, while a nursing home receives $280.00 per day, plus SSA for the same patient for a maximum of $10,100 per month (with HMSA insurance, Kaiser health plan, and UHA insurance at slightly higher rates); and WHEREAS, studies by the American Association of Retired Persons show that Hawaii needs to improve efforts to provide lower cost long-term care services available in the community under Hawaii's MedQuest Medicaid program rather than the more expensive care in nursing homes; and WHEREAS, CCFFH and E-ARCH operators are often dually employed in nursing homes, hospitals, assisted living facilities, and other health care facilities around the State in order to supplement their income and maintain their own health benefits, which creates greater risk for the spread of infectious disease; and WHEREAS, many CCFFH caregivers decline to accept Medicaid patients and instead save empty beds for private-pay patients in order to optimize their income, thus reducing the number of beds available for Medicaid patients; now, therefore, BE IT RESOLVED by the Senate of the Thirty-first Legislature of the State of Hawaii, Regular Session of 2022, that the Department of Human Services is requested to review the existing payment model for Medicaid reimbursement for patients who require nursing home level of care in the community, study the feasibility of increasing the reimbursement rate to CCFFH and E-ARCH care providers, and determine the overall effect of increasing the rate for CCFFH and E-ARCH care providers; and BE IT FURTHER RESOLVED that the Department of Human Services is requested to submit a report of its findings and recommendations to the Legislature no later than thirty days prior to the convening of the Regular Session of 2023; and BE IT FURTHER RESOLVED that certified copies of this Resolution be transmitted to the Director of Human Services, Adult Foster Homecare Association of Hawaii, and Alliance of Residential Care Home Administrators. OFFERED BY: _____________________________ Report Title: Care Homes; Medicaid Reimbursement; Increase; Feasibility Study |
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