| 47 | | - | SECTION 1. The legislature finds that interest in strengthening long-term care services and supports is of broad interest nationally and in Hawaii. Recently, a Council of State Governments task force on effective and sustainable long-term care included a work group focused on sustainable funding. The department of human services med-QUEST division co-led the group, which authored a short briefing paper with national, state, and local recommendations. One of the recommendations included a rate study for home and community-based services. The legislature further finds that the department of human services med-QUEST division completed a study of home and community-based rates paid for community care foster family homes, expanded adult residential care homes, and other home and community-based services. The department of human services med‑QUEST division contracted Milliman, an actuarial firm, for a wide range of services and to conduct the study. The study commenced in July 2022, and the med-QUEST division issued the final report on December 30, 2022. The legislature also finds that a key part of the rate study included stakeholder outreach and engagement with home and community-based services providers and their associations, collecting provider cost and wage survey data, and getting provider feedback on draft rate calculations. Not surprisingly, the provider surveys showed significant wage pressure given the current labor market. The rate study methodology used wage and salary data for direct care staff and supervisors, employee‑related expenses, transportation and administration, program support, overhead, and United States Bureau of Labor and industry wage indices to pay for employee benefits such as health insurance. The legislature believes that the pandemic dramatically impacted healthcare and long-term care delivery systems. Many of these changes, particularly as they relate to patient preferences, facility staffing practices, and technology utilization, will persist long after the pandemic abates. Accordingly, now is an opportune time to revisit prior thinking about long-term care reimbursement and investigate ways that it can be reimagined to promote patient care quality, support livable wages for staff, and maximize efficiency. The legislature further finds that the med-QUEST division should undertake rate studies to better understand how the pandemic has shaped long-term care providers. These studies should consider how patient preferences have shifted away from institutional settings and to home and community-based ones; how patient needs evolve with the aging population; the growing complexity of patient care; and what can be done to align reimbursement with long-term trends in Hawaii. Specific attention is also necessary on programs that reward high-quality care; incentivize accepting and caring for medicaid beneficiaries, especially those with complex needs; pay wages necessary for the recruitment and retention of staff across the long-term care continuum; and consider the need to update the aging physical infrastructure of many of the State's facilities. The legislature also finds that it is important to focus on home and community-based services providers who serve groups with high utilization of services and who have gone the longest without a rate update such as case management agencies, community care foster family homes, and adult day health and day care centers. The Centers for Medicare and Medicaid Services is also changing payment methods for nursing facilities. State medicaid agencies will need to adopt new reimbursement methodologies that align with the new federal payment system. These all create opportunities to revise how providers of long‑term care are reimbursed to better meet current and future needs. Accordingly, the purpose of this Act is to appropriate funds for the achievement of full funding, including estimated payment increases, of medicaid home and community-based services. SECTION 2. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2023-2024 and the same sum or so much thereof as may be necessary for fiscal year 2024-2025 for the achievement of full funding, including estimated payment increases, of medicaid home and community-based services; provided that the department of human services shall obtain the maximum federal matching funds available for this expenditure; provided further that the department of human services shall pursue all funding sources known to the State, including private grants, prior to expending any general revenues appropriated pursuant to this Act. The sums appropriated shall be expended by the department of human services for the purposes of this Act. SECTION 3. This Act shall take effect on June 30, 3000. |
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| 47 | + | SECTION 1. The legislature finds that interest in strengthening long-term care services and supports is of broad interest nationally and in Hawaii. Recently, a Council of State Governments task force on effective and sustainable long-term care with Hawaii representation included a work group focused on sustainable funding. The department of human services med-QUEST division co-led the group, which authored a short briefing paper with national, local, and state recommendations. One of the recommendations included a rate study for home and community based services. The legislature further finds that the department of human services med-QUEST division completed a study of home and community based rates paid for community care foster family homes, expanded adult residential care homes, and other home and community based services. The department of human services med‑QUEST division contracted Milliman, an actuarial firm, for a wide range of services and to conduct the study. The study commenced in July 2022, and the department of human services med-QUEST division issued the final report on December 30, 2022. The legislature also finds that a key part of the rate study included stakeholder outreach and engagement with home and community based services providers and their associations, collecting provider cost and wage survey data, and getting provider feedback on draft rate calculations. Not surprisingly, the provider surveys showed significant wage pressure given the current labor market. The rate study methodology used wage and salary data for direct care staff and supervisors, employee‑related expenses, transportation and administration, program support, overhead, and Bureau of Labor and industry wage indices to pay for employee benefits such as health insurance. The legislature believes that the pandemic dramatically impacted healthcare and long-term care delivery systems. Many of these changes-particularly as they relate to patient preferences, facility staffing practices, and technology utilization--will persist long after the pandemic abates. Accordingly, now is an opportune time to revisit prior thinking about long-term care reimbursement and investigate ways that it can be reimagined to promote patient care quality, support livable wages for staff, and maximize efficiency. The legislature further finds that the med-QUEST division should undertake rate studies to better understand how the pandemic has shaped long-term care providers. These studies should consider how patient preferences have shifted away from institutional settings and to home- and community-based ones; how patient needs evolve with the aging population; the growing complexity of patient care; and what can be done to align reimbursement with long-term trends in Hawaii. Specific attention is also necessary on programs that reward high-quality care; incentivize accepting and caring for medicaid beneficiaries, especially those with complex needs; pay wages necessary for the recruitment and retention of staff across the long-term care continuum; and consider the need to update the aging physical infrastructure of many of the State's facilities. The legislature also finds that it is important to focus on home and community based services providers who serve groups with high utilization of services and who have gone the longest without a rate update such as case management agencies, community care foster family homes, and adult day health and day care centers. The Centers for Medicare and Medicaid Services is also changing payment methods for nursing facilities. State medicaid agencies will need to adopt new reimbursement methodologies that align with the new federal payment system. These all create opportunities to revise how providers of long‑term care are reimbursed to better meet current and future needs. Accordingly, the purpose of this Act is to appropriate moneys for the achievement of full funding, including estimated payment increases, of medicaid home- and community-based services. SECTION 2. There is appropriated out of the general revenues of the State of Hawaii the sum of $30,210,000 or so much thereof as may be necessary for fiscal year 2023-2024 and the same sum or so much thereof as may be necessary for fiscal year 2024-2025 for the achievement of full funding, including estimated payment increases, of medicaid home and community based services; provided that the department of human services shall obtain the maximum federal matching funds available for this expenditure; provided further that the department of human services shall pursue all funding sources known to the State, including private grants, prior to expending any general revenues appropriated pursuant to this Act. The sums appropriated shall be expended by the department of human services for the purposes of this Act. SECTION 3. This Act shall take effect on July 1, 2023. INTRODUCED BY: _____________________________ |
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