 by Gov. Frank Murkowski September 05, 2004
The department did not take these issues lightly when evaluating needed changes in these regulations. The regulations pertaining to the chore and respite services had not been revised for more than ten years and were developed over a two year period while working with stakeholder groups, Medicaid providers, client representatives, and advocacy groups. Essentially, the regulations were changed to clarify confusing requirements, and to realign these regulations back to the original intent. DHSS believes that the service limits for chore and respite services are reasonable and are only two of several services available under the various Medicaid waiver programs (see enclose list of additional services). Virtually all waiver clients can receive a wide variety of services, as needed, that will allow clients to live in a home-like environment. To date, all clients who have had a new Plan of Care completed ad changed due to the revised regulations have been offered other types of services that more appropriately meet their individual needs. DHSS will continue to monitor this situation very closely to avoid the possibility of unnecessary institutionalization. The new regulations limit respite services to 520 hours a year and 14 days of daily respite per year (an additional 336 hours per year). Previous rules allowed an limited number of respite hours and 21 days of daily respite per year. The definition of respite care is "Services provided to individuals unable to care for themselves; furnished on a short-term basis because of the absence or need for relief of those persons normally providing the care." These services are not, and never have been, considered to be a substitute for Home Health Care covered under the Medicare program. We believe that 520 hours and 14 days per year is a sufficient amount of time for the relief of a family caregiver. The new regulations limit chore service to ten hours per week. Again, the federal authorization for this service is "Services needed to maintain the home in a clean, sanitary, and safe environment..These services will be provided only in cases where neither the individual, nor anyone else in the household, is capable of performing or financially providing for them, and where no other relative, caregiver,...or third party is capable of or responsible for their provision..." We believe that ten hours is a reasonable amount of time to keep a household in a clean, safe, and sanitary condition and to comply with federal rules. DHSS also financed the Adult Public Assistance (APA) Program through a recent regulatory change. This change only affected Medicaid clients in licensed assisted living homes. Prior to the regulation change, a client typically received monthly income in the amount of $564 in Federal Supplemental Security Income (SSI) and $362 in state general fund APA payment. The client was able to retain $100 as a personal needs allowance and the balance of $826 was used to pay for room and board to the assisted living provider. Under the refinance, the client will still retain the SSI payment and the $100 APA payment. The $262 reduction to APA clients is offset by an increase of $265 Medicare payment to the assisted living home. While some assisted living home providers have been concerned about the maximum amount that a client will be able to contribute to their room and board costs, we believe that this amount is reasonable. The client will contribute the $564 SSI payment and the Medicare Waiver payment was increased by $265. The sum of these two figures is $829 a month for room and board, or for a home with four Medicaid Waiver clients, $39,792 a year. This is before the Medicaid Waiver reimbursement to the assisted living home and should be more than sufficient to cover the cost for food/preparation, supplies, equipment, and building maintenance. It is important to note that the room and board payment is only for the cost of meals and bed space.. The Medicaid Waiver program reimburses the assisted living home for all other costs such as transportation, utilities, equipment, legal and accounting, taxes and insurance, rent/mortgage, and personnel. The Medicaid Waiver payments to the assisted living home providers range from $36,000 to $65,000 a year per client. These payments must be combined to understand the true state support to the Assisted Living Providers. Thank you Sen. Ellis for your correspondence and for the opportunity to provide accurate information. My administration remains committed to protecting access to community based care for seniors in Alaska. Sincerely yours,
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