{"id":17044,"date":"2018-10-30T04:31:56","date_gmt":"2018-10-30T04:31:56","guid":{"rendered":"http:\/\/arknews.org\/?p=17044"},"modified":"2018-10-30T05:20:16","modified_gmt":"2018-10-30T05:20:16","slug":"assisted-living-facilities-warn-21-7-percent-rate-cut-will-force-closures","status":"publish","type":"post","link":"https:\/\/arknews.org\/index.php\/2018\/10\/30\/assisted-living-facilities-warn-21-7-percent-rate-cut-will-force-closures\/","title":{"rendered":"Assisted living facilities warn 21.7 percent rate cut will force closures"},"content":{"rendered":"

 <\/p>\n

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ASSISTANCE NEEDED: Lenora Riedel said the rate cut threatens the survival of her assisted living facility in Huntsville.<\/figcaption><\/figure>\n

 <\/p>\n

At a public comment hearing Monday in Little Rock, several assisted living providers told officials from the Arkansas Department of Human Services that a planned 21.7 percent cut to their daily Medicaid reimbursement rates will lead to layoffs, reduced quality of care and the closure of facilities around the state. The rate cut will go into effect in January if approved by a legislative committee later this year.<\/span><\/p>\n

Assisted living facilities are residential facilities that are a step below nursing homes in terms of the level of care they provide. The DHS pays between $70.89 and $85.35 per day for a Medicaid beneficiary in assisted living. That would decrease to a flat $62.89 next year if the rule change was approved. Mark White, the DHS deputy director for Aging, Adult and Behavioral Health, said in an interview earlier in October that the current rates aren\u2019t backed up by any actuarial study, as required by federal Medicaid authorities.<\/span><\/p>\n

The current rates, White said, \u201cwere negotiated several years ago with the industry. [The federal Center for Medicare and Medicaid Services] has made it clear they want an actuarial study to support these rates, to show they\u2019re appropriate. \u2026 So we had our contracting actuary do a study. They looked at provider costs, and this is the recommendation they came back with.\u201d<\/span><\/p>\n

Assisted living providers dispute the findings of the actuary and say the study didn\u2019t properly consider overhead. The $62.89 per day figure \u201cis an arbitrary number,\u201d according to Michelle Joyner of Village Park, a facility in Conway. Joyner spoke at the Monday hearing. <\/span><\/p>\n

Assisted living providers are being asked to sell their services \u201cat cost,\u201d she said. \u201cThe only explanation is that Medicaid and [the DHS] are considering driving assisted living waiver businesses out of business.\"<\/span><\/p>\n

The assisted living rate is just one of several proposed rule changes coming to Arkansas's Medicaid programs that provide \u201clong-term services and supports\u201d to the elderly and people with physical disabilities. The DHS also plans to adopt a new method of allocating attendant care and personal care hours for ARChoices, a Medicaid waiver program that allows beneficiaries to receive services in their own home. (The current allocation method is the subject of a lawsuit brought against the state by ARChoices beneficiaries who said the DHS unjustly cut their care hours.<\/a>) It\u2019s switching to a new assessment tool to be used across all such programs.\u00a0<\/span><\/p>\n

The providers and family members who spoke at Monday\u2019s public comment hearing were affected by different components of the proposed changes, but all expressed anxiety about the direction these services were heading. Most said they were concerned the new rules and rate cuts would result in disabled and elderly people losing their options for independent living.<\/span><\/p>\n

\u201cDHS says they want to avoid people having to go in nursing homes. It seems in these programs they\u2019re doing everything they can to force people into [them],\u201d Bobbie Riffle of Sherwood said. Riffle\u2019s daughter is now in an assisted living facility, but she was previously on the ARChoices program until a decrease in her care hours made it too difficult for her to keep living at home. <\/span><\/p>\n

\u201cWe have struggled, really struggled over the past two years,\" Riffle said.<\/span><\/p>\n

Demand for assisted living appears to be high: White said there\u2019s a waiting list for the state\u2019s waiver program that allows Medicaid to pay for assisted living for qualified beneficiaries. There are only 1,300 slots available. In addition to Medicaid beneficiaries, many facilities also serve \u201cprivate pay\u201d residents \u2014 individuals who pay costs out of pocket.<\/p>\n

Lenora Riedel runs Countryside Assisted Living, a facility in Huntsville that serves 92 residents, 56 of them on Medicaid. She said at the Monday hearing that the reduced rate would force her to cut back her 48-person workforce by 25 percent. That means nursing staff would be required to pick up housekeeping, laundry and other duties, she said, while also handling a significantly larger patient load.<\/span><\/p>\n

Riedel said the actuarial study indicates a facility should have 19 staff for 50 residents. She said that's not enough to deliver \"the quality of service that we want to provide.\" But, she added, \"if we do not cut staffing by 10 to 14 people \u2014 which is what the standards say that we should do to survive the 21.7 percent cut \u2014 we would close down. That will force 92 people into a facility \u2014 or into a home where they cannot take care of themselves.\"<\/p>\n

When asked whether the DHS was concerned about assisted living facilities closing, White acknowledged that some providers are struggling, but he said the cause was less clear. <\/span><\/p>\n

\u201cThere have been a number of facilities that have been built in recent years \u2026 as private-pay facilities,\" White said. Some of those struggled to find enough private pay business to make ends meet, he said, and therefore have tried to access Medicaid, only to find there\u2019s a limited number of potential residents due to the cap on the waiver. \u201cWe don\u2019t know how much that\u2019s a Medicaid issue and how much that\u2019s an issue on their private pay side,\u201d he said.<\/span><\/p>\n

White said in an email that the proposed fiscal impact of the rule change package as a whole is a savings of $9.27 million to the state for the current 2019 fiscal year and $13.92 million for the next fiscal year.<\/span><\/p>\n

The Monday hearing was the fourth in a series of five hearings<\/a> on the proposed long-term services and supports rule changes. The final hearing is in Jonesboro on Nov. 7.<\/p>\n

This reporting is made possible in part by a yearlong fellowship sponsored by the Association of Health Care Journalists and supported by The Commonwealth Fund. It is published here courtesy of the Arkansas Nonprofit News Network, an independent, nonpartisan project dedicated to producing journalism that matters to Arkansans. Find out more at arknews.org.<\/i><\/p>\n","protected":false},"excerpt":{"rendered":"

\u201cI\u2019ve seen over the years just how many people have benefited from assisted living. It saved them from going to the nursing home when it wasn\u2019t safe for them to live at home,\u201d Riedel said. The rate cut will push \u201cmore and more people into nursing facilities that shouldn\u2019t be there.”<\/p>\n","protected":false},"author":5,"featured_media":17055,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[111],"tags":[139,140,115],"class_list":["post-17044","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-care","tag-archoices","tag-assisted-living","tag-medicaid"],"yoast_head":"\nAssisted living facilities warn 21.7 percent rate cut will force closures - Arkansas Nonprofit News Network<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/arknews.org\/index.php\/2018\/10\/30\/assisted-living-facilities-warn-21-7-percent-rate-cut-will-force-closures\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Assisted living facilities warn 21.7 percent rate cut will force closures - Arkansas Nonprofit News Network\" \/>\n<meta property=\"og:description\" content=\"\u201cI\u2019ve seen over the years just how many people have benefited from assisted living. 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