A bill aimed at eliminating barriers to assisted living for older adults in Indiana is being welcomed by state senior living leaders, who say it’s an acknowledgement by state lawmakers that the current system isn’t working.
HB 1592 would prohibit the state Family and Social Services Administration from implementing waitlists for assisted living services if slots are available under its federal Medicaid waiver. If no slots are available, then the agency must apply for additional waiver slots.
The bill also would require FSSA to apply for a new waiver that separates assisted living from other home- and community-based services. In addition, FSSA would have to reimburse for services from the application date rather than the approval date.
The FSSA implemented waitlists in response to a $1 billion Medicaid forecasting error last spring. One of the largest cost drivers was attendant care services covered by the Medicaid HCBS waiver, leaving the state to implement a waitlist for all HCBS waiver services. Those waitlists became the target of a lawsuit filed last fall by people who said they were deprived of access to assisted living communities covered under the state’s Medicaid benefit.
LeadingAge Indiana told McKnight’s Senior Living that it fully supports HB 1592 because it “represents a recognition by state legislators that Indiana’s current AL Waiver programs, with their associated waitlists, are just not working,” LeadingAge President and CEO Eric J. Essley, JD, MPA, said. “These programs are not saving the state money, are not providing consistent and appropriate care to seniors, and are pushing providers to the brink.”
The waitlists, he said, create uncertainty and stress for vulnerable Hoosiers, families and providers. The proposed legislation attempts to fix the “failed program” by “cutting it loose” and seeking approval for a new, free-standing program that can address residents’ needs.
Paul Peaper, president of the Indiana Center for Assisted Living, told McKnight’s Senior Living that HB 1592 attempts to require the state Medicaid agency to seek a standalone assisted living waiver, similar to what Ohio and Illinois implemented.
“We believe this will give our assisted living providers more certainty in the future and allow our state legislators and Medicaid agency to have a direct look at assisted living utilization as a whole.”
Multiple programs, multiple portals
The proposed legislation also aims to address concerns about the state’s new long-term care program for older adults, the Pathways for Aging program. Last year, Indiana split its Aged & Disabled waiver into two distinct programs: The Pathways for Aging program for adults aged 60 or more years, and the Health & Wellness Waiver for those aged 59 or fewer years. Both programs include access to Medicaid assisted living.
In the transition of Indiana’s Medicaid long-term services and supports programs to Medicaid managed care, providers complained that they were still waiting for reimbursement for services dating back to July, when the program launched, Paper said. Compounding the issue is the fact that Indiana’s Medicaid agency does not have a single portal to monitor claims status — providers must submit claims into individual insurance company systems that manage the programs.
Peaper said that HB 1592 would revert to a single billing portal to alleviate some of those challenges, as well as require additional reporting and auditing requirements on the insurance companies.
Source: McKnights Seniorliving