Submitted by achenault on Mon, 05/04/2015 – 3:07pm
In March, the Ohio Consumer Voice for Integrated Care (OCVIC) published a news article detailing the outcry of consumers and Independent Providers (IPs) on the proposed elimination of IPs. After the outcry and testimony from consumers, IPs, and advocates, the language was removed, the timeline changed and a stakeholder advisory group will help the state make consumer self-direction (allowing consumers to hire IPs) available to all Ohioans. Our voices were heard.
But, now we are hearing a new, related outcry.
OCVIC has received several messages on the proposed new rates for Independent Providers and Agencies. Providers were told that Ohio Medicaid, in an effort to modernize the way it pays, engaged in a long term study to analyze factors such as labor market data, education, licensure status, and length of service visits to assist in developing a new rate structure for Home Health services. The results of that study resulted in a new proposed rate structure that will be effective July 1, 2015 if accepted. The new rate structure, providers are told, will ensure that all providers are present and providing services for a minimum of 35 minutes in order to get the higher base rate, increase reimbursement for RNs (since they have a higher skill level), and adjust the rates for all providers.
But, OCVIC manager John Arnold has heard comments from IPs on this proposed change, such as:
A public hearing on the proposed rule actions will be held on May 15, 2015, starting at 12:00 p.m. and continuing until all persons in attendance have had an opportunity to testify. The hearing will be held at 50 W. Town St., Room A501, Columbus, Ohio 43215. At this hearing, the Department will accept verbal and/or written testimony on the proposed rule actions under consideration.
Persons unable to attend the public hearing may submit written comments on the proposed rule actions. Any written comments received on or before the public hearing date will be treated as testimony and made available for public review.
If you would like to submit your testimony to be heard by this committee you may do so by following this link. There is a template provided, but in order for it to be effective you should provide as many details as possible about how this will affect you and your consumers.
OCVIC will evaluate the new proposed rates and will determine the next steps in our advocacy.
Submitted by achenault on Wed, 07/29/2015 – 12:00pm
This week, we celebrate the 50th anniversary of Medicare, the national insurance program providing coverage to over 50 million Americans over 65 and people with permanent disabilities. FOR IMMEDIATE RELEASE: CONTACT: John Arnold, 614-456-0060 ext. 237
December 15, 2014
Advocates Concerned About Confusion as MyCare Ohio Kicks In on January 1
Nearly 100,000 Ohioans who are dually eligible for Medicare and Medicaid are currently enrolled in managed care plans of MyCare Ohio, the demonstration to integrate and coordinate their care, for their Medicaid services.
On January 1, 2015, MyCare Ohio enrollees will begin also receiving their Medicare services through their MyCare plan, unless they choose to opt out. Enrollees who have not made a choice have already been assigned. Ohio Consumer Voice for Integrated Care (OCVIC) is extremely concerned about widespread confusion among many enrollees about their choices with respect to their Medicare services.
In the past 2 months, enrollees received notices from the state explaining their options. But these notices are way too complicated for the average person to understand – let alone older adults with cognitive impairments. OCVIC is fearful that enrollees will realize what’s happened only if they encounter interruptions of current Medicare services, including doctor visits and prescription drugs. MyCare Ohio Enrollees Need to Understand Their Choices and that Help is Available
MyCare Ohio enrollees can choose to continue receiving their Medicare services through the traditional program or a Medicare Advantage plan. But, to avoid having their Medicare automatically switched into their MyCare Ohio plan, enrollees have to take active steps to “opt out.” The problem is, many enrollees are confused.
In order to make a good decision about MyCare Ohio for themselves, people need to know:
Consumers must also understand that MyCare Ohio plans are managed care organizations. That means that in order to receive the most benefit,
These requirements may be very different for people who participate in the traditional Medicare fee-for-service program.
Certainly the coordination of all medical and home and community based services offered by MyCare Ohio is a benefit that may help a lot of people as well as having one insurance plan and member ID card that covers everything. But, making MyCare work is an individual decision. In this case, one size does not fit all.
For help in understanding your choices, enrollees can contact:
Your Local Area Agency on Aging
OSHIIP
Talk to Your Providers:
MyCare Ohio beneficiaries should talk with their doctors and other providers to make sure that they will still be able to serve them after January 2015. For more information about their plans and services they should call their MyCare insurance plan. The telephone numbers for each plan is listed below.
Providers who have additional questions about reimbursement, becoming a contracted provider, or how MyCare Ohio will work for their patients or clients should contact each plan’s provider service. These numbers are listed below.
Understanding MyCare Ohio is a challenge for most people and if this new demonstration is going to work in Ohio, we must make sure that it does no harm to our most vulnerable populations that are mandated to participate.
Consumers Need to Know:
1. MyCare Ohio members can add or remove coordination of their Medicare services every month. They must continue to have their Medicaid services coordinated by their MyCare plan.
2. There are benefits and potential drawbacks to having MyCare Ohio coordinate your Medicare services.
3. Free help is available in your community to help you to understand your choices. Contact your local Area Agency on Aging or OSHIIP.
Your doctors and other providers may be confused about whether they can treat you, if you are in MyCare Ohio. Talk to your providers and have them call your plan’s Provider Services to resolve whether they can continue as your provider.
Submitted by achenault on Wed, 01/14/2015 – 2:08pm
We are grateful for your generous gifts in the last weeks of 2014. Thanks to your support, UHCAN Ohio will continue, in 2015, to build the consumer voice to shape health care polices and develop solutions to meet Ohioans’ needs.
In 2015, we will:
From the bottom of our hearts, we thank you for taking your commitment to make health care work for all Ohioans to the next level by donating to UHCAN Ohio.
Submitted by achenault on Thu, 02/19/2015 – 11:47am
Advocates for people with disabilities who are on Medicaid were shocked, on February 2nd, when the Kasich administration announced , as part of its proposed budget, the phase-out of Medicaid funding for Independent Providers (IPs) of home care services. Under the proposal, no new IPs could bill for Medicaid after July 2016 and would be phased out entirely by 2019. Instead, individuals would have to hire personal caregivers exclusively through agencies.
But, while advocates were shocked, many people with disabilities who use independent providers were FRIGHTENED – that they would lose the assistants they depend on for carrying out basic activities of daily living, including dressing, bathing, eating and other personal activities.
This latest twist comes right on the heels of enrollment of Medicare/Medicaid beneficiaries into “MyCare Ohio” managed care plans, which has caused major disruptions in vital services, such as transportation and approval of services, for many enrollees. The most widespread disruption from MyCare Ohio came when large numbers of Independent Providers found themselves without pay for months at a time, due to a glitch in planning by the managed care plans and the state.
What reason did the Ohio Office of Transformation, which oversees Medicaid, give for this surprising announcement about ending IPs? According to one budget summary http://1.usa.gov/1LdvIjO:
The Executive Budget requires Ohio Medicaid to eliminate the “independent service provider” option as a strategy to improve the administrative oversight of the program, decrease programmatic fraud and abuse, and improve health outcomes for individuals.
The rationale makes sense – unless you know people who have relied on IPs for decades. Many individuals with disabilities have switched to hiring their own IPs, based on extensive personal experiences with agencies. They say that, with an agency, you don’t always know who will show up (it’s up to the agency) or if they will show up. Not only do personally selected IPs tend to be more reliable than agency aides, but many individuals report having the same IP for a decade or more. Whether to use an agency or independent provider is a matter of personal choice – a hallmark of the promise of MyCare Ohio.
According to national experts on home care policy, the Kasich administration may have another reason for phasing out IPs – a change in federal rules governing home care services for people with disabilities and older adults that requires adjustments to Ohio policy regarding IPs. When the IPs billed the state for services, the state treated the IPs as “independent contractors,” who were responsible for paying their own taxes and were not eligible for overtime. The new rule clarifies that IPs are employees of the state, adding significant expenses to the state. In response to this situation, California allows IPs to bill for up to 20 hours of overtime pay over 40 hours of work. For Ohio to do the same would require increased funding in the budget.
There’s at least one other way that consumers can retain their IPs – by participating in the consumer-directed care program, where the consumer becomes the employer or shares responsibilities with a “fiscal intermediary” – a person or organization to help with the financial and other requirements (although this may be problematic with the new rules). Consumer-directed care is a wonderful option for some beneficiaries, but it’s not a good fit for every beneficiary because of the responsibilities. Now that we’ve uncovered a genuine roadblock to continuing the present access to Independent Providers, OCVIC and other advocates are exploring potential ways to expand access to IPs to more people who prefer them.
The Administration’s Surprise Smacked of Insensitivity
Whether or not, in the end, the administration’s proposal is justified by federal changes and other considerations, the manner in which the announcement was made – with no prior conversation with the disabilities community and advocates – inflicted unnecessary pain on consumers and advocates. These stakeholders have a long history of dialogue and collaboration with OHT, whose leaders know full well that many people with disabilities not only prefer independent providers (IPs), but rely on IPs for their daily survival. OHT has, in the past, previewed controversial proposals with stakeholders to seek input and improve the level of deliberations. The lack of advance discussion in this instance showed a surprising lack of sensitivity to the individuals involved, as well as the long relationship with the advocacy community.
We hope that OHT won’t repeat this “February Surprise” and, in the future, engages people early in decisions that may critically alter their well-being and subject them to undue harm.
Submitted by achenault on Tue, 12/15/2015 – 3:17pm
Ohio Consumer Voice for Integrated Care (a coalition led by UHCAN Ohio) recently sent a survey to our database of over 3,000 consumers on their experience with MyCare Ohio, Ohio’s integrated managed care program for Ohioans on both Medicare and Medicaid. We received over 400 responses – a very high number for a survey! The results – including the comments – really caught the attention of Ohio’s Medicaid Director and the MyCare Ohio plans.
The survey respondents’ made their voices heard. They brought significant new attention to two major problems enrollees are experiencing in MyCare Ohio. As a result of the survey, OCVIC is in conversations with decision makers to make major improvements in appropriate care coordination and the availability of all services, supplies, and equipment that members need. We want to thank our survey respondents for helping us to bring their voice to the leaders of MyCare Ohio. OCVIC will seek feedback on any proposed improvements and will keep everyone posted on the progress.
The survey was so effective in bringing consumers’ voices to decision makers that we’d like to use it again to get additional input. One of the things we learned from the responses is that doctors are largely not involved in the enrollees’ MyCare Ohio “integrated care team,” and that makes OCVIC worry about whether enrollees’ care is well-coordinated across both medical and long-term care settings. We also want to know more about members’ experiences with medical care to see what improvements are needed.
Therefore, in the near future, we will be creating a survey asking about members’ medical experience. If the second survey is anything like the first one, it will have a big impact in improving health care for MyCare Ohio enrollees.
Again, OCVIC wants to thank our network of MyCare Ohio consumers for participating in a very successful survey. If you have questions or comments, please don’t hesitate to contact John Arnold at jarnold@uhcanohio.org or (614) 456-0060 ext. 237. If you are interested in participating in our monthly consumer calls in which we talk about enrollees’ experiences and needed improvements, let John know.
