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State cuts home health benefit because of skyrocketing costs

State cuts home health benefit because of skyrocketing costs

Posted: Wednesday, August 27, 2008 6:36 am
By: AP

By ERIK SCHELZIG Associated Press Writer NASHVILLE (AP) — Ten-nessee is cutting an unlimited home care benefit for about 1,000 TennCare patients because of skyrocketing costs. Gov. Phil Bredesen says the state can’t afford the current levels of private duty nursing and home health programs. Tennessee is the only state that offers those benefits without restrictions. The program’s total price has ballooned by an average of about 50 percent each year, from $18 million in 2000 to more than $240 million in 2007. Bredesen, a Democrat, told reporters recently that the cost is all the more glaring in the context of the economic pressures the state is under. “That’s just a crazy way to spend $250 million compared with all the other needs you have in health care — let alone education or anything else,” he said. The escalating costs come at a time when the Bredesen administration has brought overall spending for TennCare under control by cutting 170,000 adults from the expanded Medicaid program and reducing benefits for thousands more. Those cuts — and changes in federal pharmacy benefit rules — helped save $1.65 billion in TennCare program costs in 2006. But officials overlooked the private duty nursing benefit, Bredesen said. The governor noted that it is an average of five times cheaper to place people needing 24-hour care into nursing homes than to take care of them at home. The new home care rules that take effect on Sept. 8 will limit services to a maximum of two visits a day for a total of 40 hours a week. The restrictions won’t apply to adults who need to use a ventilator for more than 12 hours a day or those who have a tracheotomy and are dependent on certain other nursing services. About 10,800 TennCare patients received some type of home nursing care, and about 1,000 of them now get more hours of care than will be allowed under the new rules. The state is projected to save about $88 million by putting limits on the home care benefit for existing and future enrollees, said TennCare spokeswoman Marilyn Wilson. Tony Garr, executive director of the Tennessee Health Care Campaign, a health care advocacy group, said one month was not enough warning for patients — some of whom had been receiving about 160 hours of care a week. “It’s not only unfair, it’s going to cause serious harm to families and individuals,” he said. “People simply don’t have the time and the resources to make adjustments and do that in 30 days.” Garr also argued that the cutback in care isn’t needed because managed care organizations contracting with TennCare will all soon be paid flat rates for patients regardless of how many services they receive. “Why is the state of Tennessee carrying the water for the managed care organizations when these are national companies, have lots of reserves, make lots of money and make a profit on health care?” he asked. In a recent speech to the Nashville Health Care Council, Bredesen predicted a backlash from TennCare advocates similar to the reaction to the 2005 cuts. “I’m sure you will see in the television and read in the newspapers a reprisal of some of the stuff about how people are going to die because we’re changing this particular benefit around,” Bredesen said. “But the reality is that it’s something that should have been on the front end — we didn’t get it right.” Published in The Messenger 8.26.08

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