Sustain and Expand Home Care in Rhode Island
On September 1, 2023, the Rhode Island Office of the Health Insurance Commissioner (OHIC) released its recommendations for selected social and human service programs paid by state funds, including Medicaid-contracted home care services. The final reports to the General Assembly (state legislature) can be viewed at https://ohic.ri.gov/regulatory-review/social-and-human-service-programs-review.
The final report only focused on attendant care service units (S5125), homemaker service units (S5130), nursing assessment and evaluation visits (T1001) and private duty and independent nursing services units (T1000 and T1000-TE). Milliman, the primary consulting firm utilized by OHIC to generate their reports, relied on an “independent rate model” (IRM) that they created to “reconstruct rates based on the reasonable and necessary costs of an efficient provider.” In short, Milliman and OHIC identified a “New England average” to establish its rate recommendations. While these recommended rate increases at 49.1% to 74.5% may bring Rhode Island closer to competitiveness with the northern three New England states (Vermont, New Hampshire and Maine), it does not allow for Rhode Island home care providers to offer competitive wages to its neighbors in Connecticut and Massachusetts.
Adding insult to injury, Governor Dan McKee (D-RI) proposed to only increase home care and all other social and human service programs’ rates to one-third of the OHIC recommendations to begin on October 1, 2024. His reasons are due to uncertainty of state revenue and Medicaid caseload projections that will be determined with greater confidence in May 2024. This is a political maneuver to negotiate with the General Assembly later in the legislative session as they move closer to finalizing a budget proposal for State Fiscal Year 2025 (SFY25) set to begin on July 1, 2024. Political tactics only add more Medicaid beneficiaries seeking home care services on the wait lists and add to the growing number of home care CNAs, nurses and other allied health professionals to leave the field for higher wages and benefits.
Take Action Now! Tell your State Representative and State Senator to support House Bill 7298 and Senate Bill 2309. This bill proposes fully-funding the OHIC rate recommendations to Medicaid-contracted home care providers on July 1, 2024. Additionally, it establishes a price floor that prohibits managed care organizations (commercial health insurance companies that participate in the Medicaid Program) to reimburse at rates less than fee-for-service (FFS; traditional Medicaid), includes a 18.9% proposed increase for skilled nursing services and allows home care administrators to train their paraprofessional staff directly in compliance with the state’s behavioral health training program.
Sustain and Expand Home Care in Rhode Island
On September 1, 2023, the Rhode Island Office of the Health Insurance Commissioner (OHIC) released its recommendations for selected social and human service programs paid by state funds, including Medicaid-contracted home care services. The final reports to the General Assembly (state legislature) can be viewed at https://ohic.ri.gov/regulatory-review/social-and-human-service-programs-review.
The final report only focused on attendant care service units (S5125), homemaker service units (S5130), nursing assessment and evaluation visits (T1001) and private duty and independent nursing services units (T1000 and T1000-TE). Milliman, the primary consulting firm utilized by OHIC to generate their reports, relied on an “independent rate model” (IRM) that they created to “reconstruct rates based on the reasonable and necessary costs of an efficient provider.” In short, Milliman and OHIC identified a “New England average” to establish its rate recommendations. While these recommended rate increases at 49.1% to 74.5% may bring Rhode Island closer to competitiveness with the northern three New England states (Vermont, New Hampshire and Maine), it does not allow for Rhode Island home care providers to offer competitive wages to its neighbors in Connecticut and Massachusetts.
Adding insult to injury, Governor Dan McKee (D-RI) proposed to only increase home care and all other social and human service programs’ rates to one-third of the OHIC recommendations to begin on October 1, 2024. His reasons are due to uncertainty of state revenue and Medicaid caseload projections that will be determined with greater confidence in May 2024. This is a political maneuver to negotiate with the General Assembly later in the legislative session as they move closer to finalizing a budget proposal for State Fiscal Year 2025 (SFY25) set to begin on July 1, 2024. Political tactics only add more Medicaid beneficiaries seeking home care services on the wait lists and add to the growing number of home care CNAs, nurses and other allied health professionals to leave the field for higher wages and benefits.
Take Action Now! Tell your State Representative and State Senator to support House Bill 7298 and Senate Bill 2309. This bill proposes fully-funding the OHIC rate recommendations to Medicaid-contracted home care providers on July 1, 2024. Additionally, it establishes a price floor that prohibits managed care organizations (commercial health insurance companies that participate in the Medicaid Program) to reimburse at rates less than fee-for-service (FFS; traditional Medicaid), includes a 18.9% proposed increase for skilled nursing services and allows home care administrators to train their paraprofessional staff directly in compliance with the state’s behavioral health training program.