A bill filed by Rep. Judd Matheny (R-Tullahoma) and Sen. Janice Bowling (R-Tullahoma), “The HMO Transparency in Claims Processing Act of 2017,” makes Tennessee the first state to address problems home health care companies encounter in getting paid for their services.
HB51/SB133 will establish processes to facilitate prompt payment of claims and improved management in addressing the denial of claims for services delivered by home health care providers.
Home-based health services can provide an alternative to the nursing home model by offering care that enables seniors to “age in place,” often in their own residence and communities. According to AARP, seniors who have depleted their assets or never had resources sufficient to pay for needed care, typically resort to Medicaid as their safety net:
“Nearly a third of older people are projected to deplete their life savings and turn to Medicaid for assistance as their ability to care for themselves declines.”
However, data collated by AARP in 2013 showed nursing home use by seniors enrolled in Medicaid programs had decreased by about one-third since 1995, “despite the enormous growth among the oldest age groups most at risk of using nursing home services.”
AARP credits the use of private and less expensive Medicaid-paid home based services for this trend.
“Utilization of home based care, however, is not restricted to seniors” explains Matheny. “One of my constituents hasn’t been able to get some claims paid for over three years even though the services have been provided, some to children with disabilities living in more rural parts of Tennessee. Home care services can be especially important to individuals with disabilities living in rural areas.”
According to Home Health Care News’ reporting about this first-of-a-kind bill, “[m]ore than half of all Medicaid beneficiaries receive care from managed care organizations (MCOs) that contract with state Medicaid programs to provide services to beneficiaries.” Health Maintenance Organizations (HMOs) are one type of Managed MCO. TennCare is Tennessee’s state Medicaid program.
One of the nation’s largest home care companies, Almost Family, is working with Matheny and Bowling on the Tennessee bill; Tennessee’s HMOs and TennCare are listening. In fact, Matheny and Bowling convened a round table last week to jump start dialogue around the bill. Afterwards, Matheny said that:
“The first step was to get the parties of interest communicating. Our meeting was productive and I believe that the concerns raised by my bill were recognized to be legitimate obstacles for service delivery impacting both the consumers and the providers.”
Matheny has a very pragmatic view of what his bill can accomplish. “Managed care and home health services can compliment each other. The net result of this bill can be a win-win for consumers, the service providers and the funding entity.”