Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Policy & Regulation News

New Growth in Home and Community-Based Services Spending

By Jacqueline DiChiara

- The Centers for Medicare & Medicaid Services (CMS) has released its “milestone” 2013 Medicaid Expenditures for Long-Term Services and Supports Report. According to the Center for Medicaid and CHIP Services (CMCS), 2013 was the first year where home and community-based services (HCBS) represented a large portion of long-term services. HCBS additionally supports (LTSS) expenditures.

home and community based services

Some inpatient, comprehensive services are covered via Medicaid as institutional benefits, the report explains. Institutional benefits are defined as residential facilities that offer complete care, including room and board, for those admitted. Such institutions are licensed and certified according to federal standards.

Comprehensive services are billed and reimbursed via a singular bundled payment, although there is variation among states regarding what institutional rates encompass. For instance, physical therapy may or may not be reimbursed via a singular bundled payment.

Regarding Medicaid eligibility, variation exists among institutional residents. Resultantly, there is variation among residents for whether or not Medicaid services are connected to the level of care needed.

Brief summary of report’s key data

The report notes LTSS expansion where LTSS was provided through managed care organizations – from 4 percent in 2008 to 10 percent in 2013.

HCBS accounted for 72 percent of the total spending associated with programs directed at a population with developmental disabilities. Forty percent of spending was aimed at older individuals or those with developmental disabilities. Thirty-six percent of spending was aimed at individuals with severe mental illness or high levels of emotional disturbance.  

Although there was no noted change in the historical difference in HCBS spending across the collective spectrum, HCBS spending in 2013 for the three aforementioned populations went up in direct conjunction with institutional services.

There was a 2 percent increase in the percentage of total LTSS spent on HCBS from 2012 to 2013. Says CMCS, “The shifting balance was attributable to both an increase in HCBS spending of 7.6 percent and a 0.7 decrease in spending for institutional services.” 2013 was the third year in a row where HCBS spending rose and institutional spending fell.

Considering CMS's future goals and quality objectives

Improving the quality of healthcare administered is of key importance. According to the report, “CMS is working in partnership with states, consumers and advocates, providers and other stakeholders to create a sustainable, person-driven long-term support system in which people with disabilities and chronic conditions have choice, control and access to a full array of quality services that assure optimal outcomes, such as independence, health and quality of life.”

A series of grants, including the Money Follows the Person (MFP) Grant – expanded via the Affordable Care Act (ACA) – aids states in rebalancing their Medicaid long-term care systems. According to the report, over 40,000 individuals with chronic conditions and disabilities transitioned into a community setting from institutions through MFP programs as of 2013.

Top areas of needed improvement and energies include advancing cultural needs and healthcare transparency and offering locational choice. Other goals include promoting the awareness of private funding sources and economic efficiency.

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