Omnibus Provides Diverse Funding Options For Health Care Workforce

Inside Health Policy / By Bridget Early

As a worsening health care workforce crisis continues to plague providers across the country, federal legislators envision a financial fix including $1.3 billion for the health care workforce in the fiscal 2022 omnibus spending package, which passed the House and Senate this week and would address staffing shortages and bolster retention efforts across a multitude of struggling sectors.

Legislators and stakeholders have discussed a number of ways to slow the skyrocketing rates of resignations and retirements that have been exacerbated by the COVID-19 pandemic. Student and educator loan forgiveness, increased graduate medical education slots, fast-tracked visa processes for foreign national providers, and broad additional funding for facilities have all been considered.

The omnibus funding encompasses all of these options, according to an explanatory statement that accompanies the legislation, with a special focus on groups experiencing the most acute worker shortages, including nurses, maternal care specialists, behavioral health specialists and rural providers.

Loan forgiveness and scholarships. The omnibus package includes $3.5 million in scholarships for disadvantaged students to educate midwives. The explanatory statement says this is meant to address the national shortage of maternity care providers and the lack of diversity in the maternity care workforce.

For nurses, the package includes $280.5 million for staff education and retention efforts, loan forgiveness and scholarships, which experts have recently lauded as a prime method of expanding the nursing pipeline. A complementary fund for loan forgiveness for nurse faculty would receive $28.5 million, the explanatory statement says.

The omnibus package also includes several separate funding pots for the education of health care providers, the explanatory statement says, such as $55 million for medical student education; $20 million for graduate psychology education; $24 million for substance use disorder treatment and recovery loan repayment programs; and $5 million for pediatric subspecialty loan repayments...

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From Alabama to Utah, Efforts to Vaccinate Medicaid Enrollees Against Covid Run Into Obstacles

KHN / By Phil Galewitz

Medicaid enrollees continue to get vaccinated against covid at far lower rates than the general population despite vigorous outreach efforts by government officials and private organizations to get low-income people inoculated, according to data from several states.

That leaves many Medicaid enrollees — who tend to be sicker than those with private insurance — at higher risk for severe illness, hospitalization, or death from the virus.

Nationally, more than 215 million Americans — including 75% of adults and 57% of children ages 12 to 17 — are fully vaccinated, according to the Centers for Disease Control and Prevention. Among children 5 to 11 years old, who have only been eligible for a shot since early November, about 25% have been fully vaccinated. A vaccine has not yet been authorized for children younger than 5.

Read more @ KHN

Value-Based Care Through Postacute Home Health Under CMS PACT Regulations

The American Journal of Managed Care, February 2022, Volume 28, Issue 2 (Racsa et al.)

ABSTRACT

Objectives: To assess in a Medicare Advantage population (1) whether discharge to home health, compared with discharge to home, following an inpatient stay subject to CMS postacute care transfer (PACT) regulations, is associated with better outcomes or lower expenditures and (2) whether the impact differs among subpopulations.

Study Design: Claims-based retrospective cohort study.

Methods: Instrumental variable (IV) analysis, with prior hospital-level probability of discharge to home health as the IV, to control for unobservable as well as observable confounders.

Results: Compared with 15,071 patients discharged to home, 4160 patients discharged to and receiving timely home health services were 60% less likely to be readmitted within 30 days and 37% less likely at 90 days. Total expenditures from time of admission to 90 days post discharge were 11% lower in the home health group. The association of discharge to home health with reduced readmission and reduced costs varied by subpopulations defined by surgical vs medical diagnosis-related group and receipt of intensive care management following discharge.

Conclusions: The PACT policy may be promoting greater value by reducing readmissions while lowering total expenditures for patients who do not require intensive postacute care. Findings were in contrast to those of previous studies, in which discharge to home health has been associated with higher rates of readmission. Earlier studies did not control for unmeasurable confounders, involved narrowly defined populations, and used older data.

Read Study at https://doi.org/10.37765/ajmc.2022.88827

Colorado Found to Violate ADA

HomeCare News

DENVER (March 4, 2022)—The Justice Department has concluded that the state of Colorado unnecessarily segregates people with physical disabilities in nursing facilities, in violation of the Americans with Disabilities Act (ADA) and the Supreme Court’s decision in Olmstead v. L.C. The department’s findings, detailed in a letter to Colorado Governor Jared Polis, follow a thorough and multi-year investigation into the state’s system of care for people with physical disabilities.

The ADA and the Olmstead ruling require state and local governments to make services available to people with disabilities in the most integrated setting appropriate to their needs, regardless of age or type of disability. However, many Coloradans with physical disabilities are denied a meaningful choice to receive the services they need in their own homes and communities. Community-based services that can help people live at home successfully include help bathing, dressing, managing medications and preparing meals.

“People with disabilities have too often been unlawfully segregated in institutions like nursing facilities,” said Assistant Attorney General Kristen Clarke of the Justice Department’s Civil Rights Division. “The Civil Rights Division will vigorously enforce the rights of people with physical disabilities, including older adults, to access the community-based services they need to age in place and thrive at home.”

“Older Coloradans and Coloradans with physical disabilities increasingly expect to remain at home as their support needs increase,” said U.S. Attorney Cole Finegan for the District of Colorado. “I’m hopeful this situation can be remedied so that individuals with physical disabilities are no longer isolated.” 

The department’s investigation found that a significant number of Colorado’s Medicaid-funded nursing facility residents are interested in transitioning to community-based settings and could successfully do so with appropriate supports. However, few Coloradans with physical disabilities who want to move out of their nursing facilities are able to do so. The investigation found that most residents are unaware of the services available to help them move and live successfully in the community. 

The right to receive needed services in the community instead of an institution has become particularly acute during the COVID-19 pandemic. Reports show that a significant number of all deaths from COVID-19 in the United States are linked to nursing facilities and other long-term care facilities. Enabling people to move out of nursing facilities and into the community can reduce that risk and satisfy the ADA by avoiding unnecessary institutionalization.

This investigation was conducted by the Civil Rights Division’s Disability Rights Section with the assistance of the U.S. Attorney’s Office of the District of Colorado. The full findings letter can be found here. Additional information about the Civil Rights Division’s Olmstead enforcement is available on its website at ada.gov/olmstead.