Each year, the Missouri Council for In-Home Services (MCHS) advocates for positive changes within the industry including the rules, laws, and policies governing the in-home industry. Annually, the Council is successful in moving forward with these positive policy changes. Initiatives for 2009 include:
This year's budget process was complicated by multiple forces. Reflective of the nation Missouri's economy has weakened over the past year. State resources fall short of necessary totals to sustain state expenditures. The introduction of federal stimulus dollars came as a relief but also at a price. Interpreting intent and guidance which accompany many of the American Recovery & Reinvestment Act of 2009 (ARRA) dollars took significant time and effort on the part of the Administration and legislators charged with crafting a balanced budget.
Ultimately, the final budget presented to the Governor included a rate increase for home and community based services. The money set aside for a rate increase was withheld by the Governor due to reduced revenue in the state. Any potential rate increase resulting from the ultimate release of these dollars equate to $0.68 per hour. Legislators approved the expenditure for one time only, unless the FRA, outlined below is implemented and replaces the general revenue expended for this year's rate increase. Essentially the appropriated dollars being withheld might serve to jump start the implementation of a rate increase funded by revenue generated by a provider tax.
Federal Reimbursement Allowance: Provider Tax
For over 17 years Missouri has been a leader in the nation utilizing federal reimbursement allowances (FRA). FRA's are a mechanism by which a specific industry voluntarily subjects itself to an assessment/fee. The dollars collected are then pooled into a Medicaid fund and used to draw down federal matching funds thereby creating more total money to support a program/industry. Legislative leaders serving on the budget committees in both chambers urged the in-home industry to consider a similar mechanism to assist in funding the program and rate increases.
Legislation establishing an in-home FRA was passed this session and was signed into law. This legislation was crafted with the input from and endorsement by every in-home organization in the state as well as residential care and CDS providers. Once signed into law the FRA must be submitted to the Centers for Medicare & Medicaid Services (CMS) for review. CMS has to approve FRAs in order for the collected funds to be eligible for matching federal dollars. No provider assessment will be implemented until CMS has reviewed and issued an opinion. We are currently awaiting CMS to issue an opinion.
Community Partnership Referrals
Two years ago the Council and Missouri Alliance for Home Care (MAHC) colluded to insert language into the operating budget for the DHSS authorizing provider conducted assessments. This process has evolved to expedite the processing of referrals and assessments, reduced case load on DSDS workers, and helped seniors and the disabled avoid unnecessary entrance into nursing care. This year the language was removed from the budget and was included in legislation which passed and was signed into law. This means the process now known as CPRs will not have to be revisited by the legislature every year. Rules and regulations will need to be developed to assure consistent, comprehensive, state wide provider conducted assessments. This uniformity should improve the implementation of CPRs everywhere.