IHCA Presents to Indiana House Ways & Means Committee Concerning Nursing Facility Policy

On September 29, 2015, the Indiana House Ways & Means Committee held a briefing for a select group of committee members with the aim to better understand the funding of and reimbursement for nursing facility services, as well as issues surrounding efforts to rebalance Indiana Medicaid’s Long Term Services and Supports spend. Representatives from the Indiana Family and Social Services Administration (FSSA), IHCA, LeadingAge Indiana, and HOPE were invited to make presentations to the committee.  The briefing resulted in an open conversation concerning current NF Medicaid reimbursement, the State’s policy objectives in rebalancing Long Term Services and Supports (LTSS) spending, and the NF trade associations’ perspectives on these issues.

The FSSA’s presentation began by discussing the agency’s desire to rebalance the LTSS spend towards more spending on Home and Community Based Services (HCBS) and less spending on institutional services.  The agency, through its contractor Myers & Stauffer, provided a detailed explanation of the Medicaid rate setting system, as well as an overview of the supplemental payment program that county hospitals have engaged in by being licensed to operate nursing facilities across Indiana. The presentation continued with financial projections of Indiana’s Medicaid program based on current spending levels for institutional and HCBS service spending, with reference of managed care as an often utilized method to achieve LTSS rebalancing. FSSA also discussed an idea related to reducing nursing facility capacity that implicates the supplemental payment program. The State’s discussion ended with the topic of HCBS waiver redesign to serve more Medicaid members in the community.

IHCA collaborated with LeadingAge Indiana and HOPE on the presentation made to the committee. Zach Cattell, IHCA President, began the presentation by discussing patient care and providing specific clinical examples of the types of patients that nursing facilities care for. Jim Leich, LeadingAge Indiana President, then provided an overview of the challenges that nursing facilities face with Medicare and discussed the importance of taking these challenges into consideration when discussing the rebalancing of LTSS spending. Terry Milller, HOPE President, provided insight on the changes of resident acuity and payment policy over the past 30 years. Zach Cattell from IHCA finished the presentation by explaining that a thorough plan is needed in order to correctly rebalance the system. The plan must focus on the needs of Hoosiers, and not simply on a budget target. IHCA focused on three key issues: 1) maintaining a direct relationship with the State for provision of NF services; 2) helping rebalance LTSS; and 3) stabilizing reimbursement and addressing nursing facility capacity.

The meeting was very productive for all that attended. It is clear that FSSA is serious about moving the needle on LTSS spending towards more Home and Community Based Services. It is also clear that the nursing facility profession must be proactive in providing the right solutions to this challenge.  Sometime in October FSSA will be finalizing its LTSS rebalancing plan, so be on the lookout for that as the month continues. To access the two presentations from the State and the PowerPoint from IHCA, LeadingAge Indiana and HOPE, click here. For more information or any questions, please contact Zach Cattell at zcattell@ihca.org or 317-616-9001.