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Access to Independent Providers: OHT Finally Clarifies Proposal to Redesign Home Care Programs

The outcry over the Kasich administration’s proposed “elimination of Independent Providers (IPs)” has led finally to clarification, by the Ohio Office of Health Transformation, that their proposal “does not eliminate independent providers.”  

In February 2015, OHT announced that the budget “requires Medicaid to eliminate the ‘independent service provider’ option” as a means to “decrease programmatic fraud and abuse.” This announcement sent shockwaves through the disabilities, developmental disabilities and aging communities, especially among individuals and families relying on IPs for home care. For two weeks in March, the House Finance Subcommittee on Health & Human Services heard testimony from individuals and family members opposing theproposal. Many recounted their bad experiences using an agency and expressed their desire to maintain their choice of who provides their most intimate care – such as dressing, feeding, bathing, and toileting. In his testimony, John Lepley, MyCare Ohio enrollee and OCVIC Central Region member co-chair, said, “The Independent Provider program allowed me to find excellent quality home health aides who were loyal to me and not to an agency.  No longer did I have to worry if my aide was going to show up on time — or show up at all, for that matter.  As a student at The Ohio State University, this was instrumental in allowing me to attend classes and eventually graduate with my Bachelor’s degree.” (Testimony can be found on the House Finance: Health & Human Services Subcommittee’s website under March 18.)

However, despite OHT’s announcement, their proposal did not eliminate IP services, but rather make changes to comply with federal labor rules and expand Ohio’s “self-direction” program.  Self direction allows the consumer to act as the employer – recruit, hire, schedule, supervise and discharge their chosen home care providers. A financial management company is available to handle payroll, time sheets, paying workers’ compensation, and other administrative functions.

UHCAN Ohio and Ohio Consumer Voice for Integrated Care leaders learned from national experts that Ohio faced possible liability in its current system of reimbursing IPs as if they were contractors of services, when under federal law, they should be classified as employees. For that reason, OCVIC manager John Arnold asked the subcommittee:

  • That the provision eliminating Independent Providers be removed from HB 64 and be replaced with language creating a workgroup (comprised of consumers, advocates, community organizations, providers, legislators, state administrators, and other stakeholders) that is required to develop a consumer-directed option for long-term services and supports in the timeframe necessary to address the state’s concerns regarding state liability as the potential employer of record for Independent Providers.

On March 24, OHT hosted a stakeholder meeting at which they shared their goals for expanding self direction in Ohio’s Medicaid HCBS programs: Increase access to home and community based services, make self-direction an option in every HCBS waiver program, comply with federal fair labor standards, and improve quality of in-home direct care.  The state agreed that the budget language, including transition timetable would change, and that a workgroup will be created to work out details of the transition.

Don’t ever doubt the power of a strong consumer voice!


OCVIC’s other Budget Testimony

In testimony, OCVIC’s Project Manager had three other budget recommendations to help MyCare Ohio Consumers:

  1. That funding be included in the SFY 2016/2017 state budget to improve the capacity of the Office of the State Long Term Care Ombudsman, which has been designated as the place where MyCare members and families can go for help if they have concerns about their care.
  2. Ohio has developed the Aging and Disability Resource Network, (ADRN), administered by the Area Agencies on Aging, which is designed to help those individuals who need long-term services and supports remain at home or in the community rather than be admitted to a nursing facility. OCVIC recommends that additional funds be included in the SFY 2016/2017 state budget to be directed to the AAAs and their ADRN partners to assure that the front door works as it was designed.
  3. That language be added to HB 64 that would require the Department of Medicaid to contract for an independent MyCare evaluation. OCVIC is requesting that Ohio contract with an Ohio university to examine the processes that have been used by the state and the managed care organizations and to determine how those processes have affected the MyCare participants.

OCVIC coalition members are hopeful that, with these important funding additions, MyCare consumers will experience a smoother transition to receiving their acute care and long-term services and supports from Managed Care Organizations; that enrollees will have better health outcomes; and that Medicaid budget growth will be constrained.

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