Regs set to control costs of home care

Caregivers worry times allowed for some paid tasks are not realistic

Posted: Wednesday, November 30, 2005

The state adopted tighter regulations Tuesday to save money on a costly program to care for the disabled and elderly in their homes.

After costs ballooned from about $8 million to $80 since 2000 - an increase that officials blamed on billing abuse - the state proposed new rules to monitor assistants.

"I think we will see the costs leveling off," said Jon Sherwood, medical assistance administrator for the Alaska Department of Health and Social Services.

Without the regulations, the state would pay $97 million per year in the near future, Sherwood said.

While drafting the regulations, caregivers were dreading many of the new changes, fearing their clients' needs won't be met.

"I think there's going to be some positive to the changes and there's going to be some negative as well," said Tara Smith, a supervisor at Cornerstone Home Health.

Assistants help those who can't do daily tasks on their own such as eating, bathing and using the bathroom. Agencies specializing in home health care pay workers an average of $12 to $14.50 an hour and bill the state $21 an hour with the remainder covering the company's overhead. The money comes from Medicaid, with the federal government contributing 60 percent and the state paying the rest.

While conducting an audit of the program, the Alaska Department of Health and Social Services determined earlier this year that some caregivers were abusing the program.

Former Commissioner Joel Gilbertson said some assistants provided services not covered by the program and did not have proof that services were done.

Assistants can no longer bill the state for being on "standby," unless approved in the client's plan of care.

But personal care assistants say the state is responsible for the increase in costs because of inadequate management. Additional state overseers were not hired as the number of beneficiaries rose from 1,300 in 2001 to 3,800 this year, said Graham Smith, owner of Priority Home Healthcare.

The state did not keep detailed records on the patients or the assistants, said Barbara Knapp of the Division of Seniors and Disability Services said during a workshop session in August.

That will change as caregivers must file records of each chore performed per visit. Assistants say the times allowed for each task are questionable.

For example, a draft proposal this summer allowed 30 minutes for laundry and 30 minutes for shopping. Sherwood said after a public comment period some flexibility was added.

"I think the times are limited because they don't want the program to be abused," said Tara Smith. "But where they come up with these times, I don't know."

"I don't think all of them are realistic," she added.

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