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In-Home Nursing Companies Facing Cuts Again

Companies that provide intensive in-home care to patients who might otherwise be in nursing homes could face big cuts under a cost-saving budget proposal the Health and Human Services Commission (HHSC) will consider today.

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Companies that provide intensive in-home care to patients who might otherwise be in nursing homes could face big cuts under a cost-saving budget proposal the Health and Human Services Commission (HHSC) will consider today.

A provision in the recently adopted 2012-13 budget directs the Department of Aging and Disability Services (DADS) to trim $15 million from the Community-based Alternatives, or CBA, program, but without cutting wages for direct care workers. Instead, the provision directs the program to dramatically lower administrative costs, which takes a direct hit at the businesses that care for the program’s clients. 

Specifically, the budget provision says the CBA administrative costs should be lowered to the level of a different — and opponents say less-intensive — home care program, the Primary Home Care and Community Attendant Services.

Advocates for keeping the CBA administrative rates intact say the two programs provide drastically different care: Primary Home Care focuses on basic daily functions, without nursing supervision, while CBA focuses on a patient’s health care needs — and requires more overhead.

CBA providers say the cuts mean an 18 percent reduction in administrative reimbursement rates, which are already underfunded by 9 percent. They say such a funding change will send the companies that provide such care into the red, and compromise care.

“I think it will put consumers at risk,” said Anita Bradberry, executive director of the Texas Association for Home Care, which represents such companies. “I think the whole program is at risk based on the severity of cuts."

Bradberry said if HHSC intends to make such budget cuts, the agency should look at stripping some of the bureaucratic and administrative requirements that cost providers. Already, CBA is a program that saves the state money, supporters say.

“The whole goal is to keep the cost to the state down,” Bradberry said. “If we screw this up it will cost the state more.”

Allison Lowery, a spokeswoman for the Department of Aging and Disability Services, said the agency is aware of the concerns about the rate reductions and has given them serious consideration.

“We’re doing everything we can to reduce the administrative requirements for providers and mitigate the impact of these reductions,” Lowery said. “The goal is to allow providers to operate the program more efficiently while maintaining the health and safety of the people the program serves.”

In a hearing on June 9, HHSC’s Medical Care Advisory Committee recommended that HHSC not change the CBA rules yet, and that the Department of Aging and Disability Services consider other methods to reduce costs. But HHSC is proceeding with the change, and holding a hearing today on the rates. Meanwhile, DADS will hold a hearing in mid-July to discuss ideas for reducing providers’ administrative requirements.

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