STATE INITIATIVES IN ASSISTED LIVING.
Peck: How have states addressed the issue of assisted living affordability?
Mollica: Only about 10 states have not yet approved Medicaid coverage for assisted living. A recent trend, though, has been for states to develop demonstration projects before implementing a state wide system. They are also reviewing reimbursement methods. Some states are looking at tiered reimbursement for varied levels of assistance, as opposed to a flat rate that tends to discourage providers from keeping people in their facilities as their needs increase.
Peck: Would you say that the states are coming close to solving the problem of affordability?
Mollica: No, although they're going in the right direction. Even though only 60,000 assisted living residents are receiving Medicaid nationwide--a very small number--that's a 50% growth from 1998.
Although overcapacity and competition might be encouraging providers to take an interest, I don't think the private sector will be able solve the affordability problem with the current financial structure. Medicaid does not pay for room and board, so initiatives are needed that combine Medicaid with programs like HUD 202 conversions and section 8 for assisted living. It's important for an assisted living provider considering accepting a Medicaid rate now to be completely sure about what is covered and not covered, and what resources, if any, might be available to make up the difference.
Peck: How are states determining the level of care that can be provided by assisted living?
Mollica: Most states do not draw a hard-and-fast line between assisted living and skilled nursing. In general, the same person can be in both settings, although there are some differences among the states. But clearly the issues here are becoming more difficult, and states might really want to make sure that resident agreements include the "move out" criteria.
As for the differences I mentioned, the states are quite a mixed bag. Some states allow assisted living facilities to care for whomever they have the staff and the training to serve. Some states specify that assisted living can manage only certain conditions under defined parameters. Others require residents seeking additional medical services to get them from sources outside the facility. And still others forbid that medical care be provided by these facilities under any circumstances.
Peck: What about quality of care?
Mollica: There is nothing like the OBRA regulations or the Minimum Data Set (MDS) out there yet. Most states require an assessment, a care plan and an annual or biannual survey, and of course states also respond to consumer com plaints. As to whether there has been a "tightening" of these regulations, I'd have to say that it depends on one's perspective. What some would call "tightening," others would call "clarification." As a general rule, though, as resident acuity increases, the regulations get more specific.
Peck: Have states seen any financial savings yet in moving away from nursing homes and toward home- and community-based care? Or, conversely, has there been a "woodwork" effect of more people claiming more benefits?
Mollica: There has been no evidence of a woodwork effect with assisted living. Basically, people don't want to leave their homes if they don't have to, and all states provide Medicaid coverage for home care. What has happened, as far as state expenditures are concerned, is that as the assisted living supply has grown, nursing home occupancy has dropped dramatically, which has reduced the growth of state expenditures.
Peck: What do you speculate that state legislatures will be working on this year with respect to assisted living?
Mollica: Many will be focusing on the U.S. Supreme Court's Olmstead v. LC decision, which mandated that people be served in the "least restrictive" environment. Clearly, assisted living would bean important option here.
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|Article Type:||Brief Article|
|Date:||Mar 1, 2001|
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