11/23/2009   5:09 am

Department of Health (601)

Local Home Health and Personal Care Services (601 440 15)

This service area provides home health, personal care, and pre-admission screening for nursing home placement.

In 1965, Federal legislation established Medicare as the health insurance program for Social Security beneficiaries. The Medicare program includes a home health benefit that provides part-time or intermittent care for homebound Medicare recipients. Services require a written physician plan of care and include skilled nursing, physical, occupational and speech therapies, home health aide services and medical social work services. At the time Medicare was enacted, local health departments in Virginia established Medicare-certified Home Health Agencies under the direction of the Virginia Department of Health, Office of Home Health Services. Most local health departments provided home health services until the late-1980’s, when private home health agencies replaced most of the public agencies during the ensuing decade.

The Omnibus Budget Reconciliation Act of 1997 authorized the reimbursement system for Medicare Home Health benefits to change from fee-for-service to a Prospective Pay System. This change was implemented in October, 1997 and, along with the increasing prevalence of private agencies across the state, prompted the few remaining local health department home health agencies to close. The Western Tidewater Health District elected not to close its home health agency for two reasons. The district assessed the Prospective Pay System reimbursement method and determined that public agencies would not experience the reduction in revenue the Prospective Pay System was predicted to create in private sector agencies. In addition, the experience of the District indicated that there were no private agencies that would accept uninsured or low income self-pay patients or that would serve the total, very rural, geographic area of Western Tidewater. By electing to remain a home health provider, the District assured that services would be available to all eligible residents regardless of their ability to pay or where they lived in Western Tidewater.

The legislation that established Medicare also established the Medicaid insurance program under Title XIX of the Social Security Act as a jointly funded federal and state program to provide medical assistance to low-income individuals. Federal Medicaid law allows states to craft Medicaid waiver programs to meet specific state needs. In 1984, Virginia established the Personal Care program to offer in-home care in lieu of nursing home placement to Medicaid-eligible individuals if the in-home care was less expensive than the cost of a nursing home. A number of local health departments in Virginia elected to contract with the Department of Medical Assistance Services as personal care providers. Over the next 20 years, however, nearly all local health departments closed their Personal Care programs when private sector personal care agencies became robust enough to meet the needs of the community. The Pittsylvania-Danville and Western Tidewater Health Districts have maintained Personal Care programs. Both districts cover large rural areas where the private sector has been unable to meet the demand for services for numerous reasons and the public agencies continue to assure that all eligible residents are able to access the service.

Virginia has initiated other Medicaid waiver programs to improve health care access for specific low-income populations. Among others, they include an AIDS waiver, Respite services for Personal Care recipients, and Mental Retardation waiver services. The Western Tidewater Health District contracts with Deparment of Medical Assistance Services to provide Respite services as an adjunct to Personal Care. There are no other providers of Mental Retardation waiver services in the geographic area served by Western Tidewater, so the district also contracts with Deparment of Medical Assistance Services to provide those services to a population who would otherwise remain unserved.

The Medicaid program requires Nursing Home Pre-admission Screening to assure that extended care facility admission is appropriate. The Code of Virginia requires that local health department staff serve as members of the community-based screening teams. All local health departments in Virginia provide the physician and nurse members of the local screening team.

• Factors Impacting the Products and/or Services:
  Changes in Federal Medicare or Medicaid regulations may impact recipient eligibility, services authorized,
  or the reimbursement scale to home care agencies.
  
  Any change in the capacity of private sector providers (e.g., numbers of providers, financial constraints
  and organizational viability) will affect the need for local health departments to provide home care services.
  A decrease in private sector capacity will result in increasing the demand on public agencies to meet the
  need for services. Likewise, an increase in private sector capacity will cause public agencies to decrease or
  discontinue these services.
• Anticipated Changes to the Products and/or Services
  Medical technological advances will have an effect on the types of services that are appropriate to provide
  in the home environment.
  
  Increased availability of telemedicine.
• Listing of Products and/or Services
  • Medicare-certified home health care services which include: Skilled nursing Physical Therapy Speech Therapy Occupational Therapy Home Health Aide Medicaid-reimbursed Personal Care and Respite Care services. Respite services for eligible self-paying or privately-subsidized individuals Medicaid-reimbursed Mental Retardation waiver home care services Non-Medicaid funded Personal Care services
  • Community-based Nursing Home Pre-admission Screening services

• Provide community-based Nursing Home Pre-Admission Screening for Virginians who are at risk for nursing home placement.
  Objective Description
  This objective assures that frail or functionally dependent Virginians who request long term care are assessed by a professional team which makes sure that the appropriate level of service is authorized.
  Objective Strategies
  • The Local Health Department will work collaboratively with the local Department of Social Services to assure that Nursing Home screenings are scheduled in a timely manner and are consumer-responsive. Nursing Home Pre-admission Screening responsibilities will be defined in the Employee Work Profile. The local health department will identify a physician and a public health nurse to serve as members of the local community-based Nursing Home Pre-admission Screening team.
  Objective Measures
  • Community-based Nursing Home Pre-admission Screening conducted by local screening teams.
    Measure Class:

    Other

    Measure Type:

    Output

    Measure Frequency:

    Annual

    Preferred Trend:

    Up

    Measure Baseline Value:

    80

    Date:

    6/30/2004

    Measure Baseline Description: Percent

    Measure Target Value:

    100

    Date:

    6/30/2010

    Measure Target Description: Percent

    Data Source and Calculation: The Virginia Department of Health WebVISION system (state aggregate total from 7/1 – 6/30 of each year)

• The Western Tidewater Health Department Home Health Agency will accept individuals for care and will provide care based on medical need regardless of ability to pay.
  Objective Description
  Indigent and uninsured Virginians are often unable to access health services. By continuing to provide home health services in Western Tidewater Health District, medically indigent residents have access to services regardless of their ability to pay.
  Alignment to Agency Goals
  • Agency Goal:
  Objective Strategies
  • Based on the Home Health Agency annual report, if the percent of indigent care falls below 10 percent, measures will be taken to determine reasons for the decline and to ensure referring providers are aware that Western Tidewater Health District accepts medically indigent clients. Maintain a data collection system that provides for analysis of patient population, including demographics, income, insurance and employment information, health data, and services received.
  Objective Measures
  • Percentage of individuals receiving home health services who are medically indigent.
    Measure Class:

    Other

    Measure Type:

    Output

    Measure Frequency:

    Annual

    Preferred Trend:

    Maintain

    Measure Baseline Value:

    12

    Date:

    12/31/2004

    Measure Baseline Description: Percent

    Measure Target Value:

    10

    Date:

    6/30/2010

    Measure Target Description: Percent

    Data Source and Calculation: Centers for Medicare Services, Provider Statistical and Reimbursement Summary, the Virginia Department of Health WebVISION data, Calculation: Medically indigent home health clients as a percentage of the total home health clients.

Back to the Strategic Planning Page