For Immediate Release: Judge Overby rules in favor of Home Care patients!

Carter Wrenn posted on February 19, 2010 21:44

For Immediate Release:

Contact Tim Rogers 919-848-3450 (office) 919-961-3555 cell

February 19, 2010

Today, the Honorable Donald W. Overby, Administrative Law Judge with the North Carolina Office of Administrative Hearings, entered an Order enjoining the Department of Health and Human Services from recalculating hours of services for Medicaid recipients of Personal Care Services using a new mathematical formula specifically designed by the Department to drastically cut in-home service hours with no individual assessment. If the injunction sought by the Association for Home & Hospice Care of North Carolina (“AHHC”) had not been entered, the Department intended to send out nearly 37,000 letters to the elderly, disabled, and chronically ill that receive these in-home services cutting average hours by over 40%.

Judge Overby heard three days of testimony on the injunction motion, including the testimony of nurses, family members, and caregivers, who told the judge that these drastic cuts would cause tremendous harm to the individuals who depend on these services and that many would be forced into hospital emergency rooms and more expensive institutional care.

AHHC filed this lawsuit because the Department was ignoring the medical needs of recipients and not following the law. In his Order, Judge Overby expressed great concern about testimony by the Medicaid Director Dr. Craigan Gray that his agency is bound to follow the law only if it has the money! As the Order states: “The state surely cannot and would not tolerate such a position by its corporate and individual citizens.” It is AHHC’s position that Medicaid must follow the law in all cases and not continue perpetuating untruths about the numbers of people ineligible for the services.

“We could not be more delighted with the court’s decision in ruling on behalf of 37,000 PCS patients” said Tim Rogers, CEO of the Association for Home and Hospice Care. “The court stated emphatically medical necessity is the key to who should receive care – and that has been our point all along. In the decision, Judge Overby commented that the faces and plights of individual PCS recipients and their medical needs could not be ignored.

“There has been a lot of political rhetoric from DHHS Secretary Lanier Cansler and Medicaid officials claiming they were not cutting care to any patient who needed it. In fact, they are cutting care to needy, qualified patients not based on medical need but a math formula without a physical examination of a single patient by the State.

It’s just common sense a bureaucrat sitting at a computer in Raleigh can’t tell if an eighty year grandmother who is legally blind, diabetic, and an amputee say, in Manteo, is sick and needs home care services. “The injunction halts Secretary Cansler’s plan. On behalf of the patients cared for by North Carolina’s home care industry, we are grateful for this decision and look forward to the full hearing on April 26. Today, the voices of North Carolina’s elderly, disabled, and chronically ill citizens were heard.”

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N.C. plans crippling cutbacks in Personal Care

posted on December 10, 2009 21:41

The following Op-Ed by Tim Rogers, CEO of the Association for Home and Hospice Care, was published in the News and Observer in response to an earlier editorial by DHHS Secretary Lanier Cansler claiming critical medical care to elderly and disabled patients on Medicaid is not being cut.

N.C. plans crippling cutbacks in Personal Care

Published Thu, Dec 10, 2009 02:00 AM
Modified Thu, Dec 10, 2009 06:33 AM
RALEIGH Over 37,000 elderly and disabled citizens in North Carolina rely upon the assistance of trained home care aides to be able to remain in their own homes. They need assistance with such basic activities as bathing, dressing, eating, toileting and ambulation. This Medicaid program, called Personal Care Services, saves North Carolina many millions of dollars, because most of these elderly and disabled individuals would be in much more expensive nursing homes and rest homes without this basic assistance.

Unfortunately, this cost-effective, essential program is under siege with recent plans by the state Department of Health and Human Services (DHHS) to cut over 8,000 elderly and disabled people from the program and reduce the services for the remaining 29,000 to such an extent that most will no longer be able to remain at home.

DHHS recently signed a $24 million non-competitive, no-bid contract with a vendor that will take control over the determination of which elderly and disabled persons can receive in-home assistance and how many hours of care they will receive. The stated objective of this contract is to cut over 8,600 elderly and disabled people from the Personal Care Services program and cut hours of services by an average of 45 percent for the rest. These cuts are being planned even though doctors have ordered the services as being medically necessary for each individual in the program.

To illustrate the impact of the service cuts, an elderly person who needs assistance with bathing and eating will receive less than half the hours he or she was previously receiving - 20 hours or less a month. This is not even an hour a day.

Most of us believe it is necessary to be able to take a bath and eat every day. However, those individuals who rely on the help of aides to be able to perform these tasks will have to decide whether they want to eat on a Monday or a Wednesday, but certainly not every day.

A study conducted by the AARP Public Policy Institute shows that persons needing assistance with two activities of daily living (such as bathing and eating) require four times as much assistance as the department plans to provide with its changed policies.

The elderly and disabled who rely on this Medicaid program also will no longer have the assistance of an aide to do grocery shopping or pick up medicines. Perhaps DHHS has concluded that this is an inappropriate service that must be eliminated, but for the many thousands of elderly and disabled who have no other way of getting food and medicines, it is essential to have this assistance to remain at home.

Not only is DHHS' plan cruel and unfair to the elderly and disabled who need this program, it is shortsighted. Many of the 8,600 individuals who DHHS plans to eliminate from the program, and the many thousands more who will have their services drastically reduced, will have to be cared for in more expensive rest homes and nursing homes. This will be much more costly for the Medicaid program and taxpayers.

Many thousands of aides also will lose their jobs, at a time when North Carolina's unemployment rate is already above 10 percent. If these cuts are a matter of the Medicaid budget, then it makes no sense to take actions that will increase the budget by forcing people out of their homes and into more expensive institutions.

DHHS should stop its plans to cut this essential Medicaid home care program that allows so many elderly and disabled people to remain in their own homes and communities.

Timothy R. "Tim" Rogers is CEO of the Association for Home & Hospice Care of North Carolina.

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Send Three Emails to Save NC Home Health Medicaid PDN

Tim Rogers posted on November 09, 2009 10:41

Medicaid Director Craigan L. Gray is cutting home care to 350 Medicaid patients who suffer from MS, Cerebral Palsy and crippling diseases.

Medicaid PDN (Private Duty Nurses) is a little known program that serves 350 of the sickest and frailest people in North Carolina. These patients are paralyzed, have tracheotomies, use ventilators and are fed through tubes. And many are infants and young children.

Please take a moment to look at this video – which tells the story of eleven of these patients.

We will begin airing this video – on the Internet – across North Carolina Monday. And we are sending it to legislators and the press. I thank you for helping make this possible.

Cordially,

Tim Rogers

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Penny Wise and Pound Foolish

Tim Rogers posted on October 15, 2009 13:10

Duke Hospital, one of the most respected medical centers in the nation, has a new program that cuts health care costs with a novel use of ‘Home Care.’

Recently a University of California study has demonstrated how Home Care reduces health care costs: By keeping elderly people in their homes and out of more expensive Nursing Homes, by reducing the number of Emergency Room visits, hospital stays - and now with ‘Home Infusion Therapy.’

For years Medicaid has had a bias in favor of institutional care – for instance, by law states must provide Nursing Home Care but not Home Care. But today that’s changing – as part of a new Medicaid program twenty-nine states are embracing Home Care to improve the quality of care, reduce costs – and make patients happier.

Unfortunately, our state’s Medicaid policy remains tilted in favor of sending patients to Nursing Homes. In fact, the state just cut rates to Home Care providers, saying it would save money. But, in fact, the state is being ‘penny-wise and pound-foolish.’ Cutting Home Care rates means fewer providers, which means more patients have no choice but to go into Nursing Homes for care – which costs a lot more. It also means more ER visits. And more hospital stays. All of which lead to higher – not lower – health care costs.

It doesn't make sense: Other states are moving people out of Nursing Homes, back into their own homes - while our state can't move people into Nursing Homes fast enough.

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