Bills attempt to slow Medicaid changes

The Health and Human Services Committee heard testimony Feb. 5 on two bills intended to slow proposed Medicaid changes in Nebraska.

LB854, introduced by Omaha Sen. Bob Krist, would prohibit the state Department of Health and Human Services (DHHS) from releasing a request for proposals relating to procurement of Managed Long Term Services and Supports (MLTSS) prior to Sept. 1, 2015.

Krist said DHHS actively has been pursuing MLTSS since last fall, but has had only two stakeholder meetings to help determine the best way to proceed. He said the state has a history of entering into privatization and contracts that have not gone well.

“We need to make them stop [and] take a breath,” Krist said. “The state needs to do this the right way.”

Heath Boddy, president and CEO of the Nebraska Health Care Association, testified in support of the bill. He said the process of converting Medicaid in Nebraska from a fee for service plan to managed care will be the most significant challenge that providers have faced in 20 years.

Boddy said other states have experienced setbacks with the process – including increased paperwork and decreased reimbursement rates – and Nebraska should take the time to research these experiences with MLTSS.

“There are plenty of things happening in other states that give us concern,” he said.

Mark Intermill of AARP also supported the bill. He said Nebraska is facing a significant increase in the number of people in the age group that will need long-term care. While managed care can be a good option, he said, the state should consider all of the implications of making the shift.

“We believe that there needs to be a better planning process,” Intermill said. “It needs to be a comprehensive and open planning process and not a predetermined conclusion.”

The committee also heard testimony on LB1076, introduced by Lincoln Sen. Kathy Campbell, which would postpone until 2015 changes in Medicaid authorization and payment for medically necessary home health services and reimbursement rates.

Campbell said the bill would require DHHS to review the outcomes obtained by 17 other states that have utilized the Balancing Incentive Program, which is intended to increase access to noninstitutional services for disabled adults and the elderly.

Those pilot programs conclude in 2015, she said, and LB1076 would give DHHS access to their experience before making proposed changes to Medicaid reimbursement rates for home health services in Nebraska.

“A number of states are already doing this and will publish the results of their efforts when those programs are completed,” Campbell said.

Stephanie Wise of Elite Professionals Home Care Company in Lincoln testified in support of the bill. Home health agencies likely no longer would be able to accept Medicaid patients if the reimbursement rate cuts proposed by DHHS take effect, she said, which would force many individuals into institutional settings.

“There is no way for any agency to sustain this kind of cut for any period of time,” Wise said.

Robert Rieck of Lincoln also supported the bill, saying his ability to use a home health agency is essential to his independence. Rieck said he’s been in a wheelchair for 18 years and does most things for himself, but needs assistance in the morning.

“I have no desire to go to a nursing home,” Rieck said, adding that some of the personal assistants he has hired on his own have been unreliable and have stolen from him.

“You’re stuck in a vulnerable position,” he said.

No opposition testimony was given on either bill and the committee took no immediate action on them.