Rule change could save $28M a year, advocates say
HARTFORD — Under Connecticut law, a home health aide can spend all day caring for you, but if you need help taking your pills, you'll need a nurse to come give them to you.
Gov. Dannel P. Malloy next week will recommend changing that, a move his administration says could save the state more than $28 million a year and remove a barrier that keeps people from moving out of nursing homes.
The plan is likely win the backing of advocates of efforts to enable more seniors and people with disabilities to receive care at home, who say that the expenses associated with medication administration have made moving out of nursing homes cost-prohibitive for many people.
But it's also likely to draw opposition from nurses and some home health care agencies, which criticized a similar proposal last year, arguing that the expertise of nurses is needed to safely administer medications to vulnerable patients and identify problems that occur.
"You will find nobody in the state who deals with these patients who is in favor of this, not even if their job depends on the governor's goodwill," Rep. Peter Tercyak, D-New Britain, said Friday. Tercyak, who works as a home care nurse and co-chairs the Human Services Committee, said he would fight the proposal "tooth and nail."
Last fiscal year, the state spent $128.28 million to have nurses administer medication to about 8,500 Medicaid clients, averaging $54 per visit. One client, the heaviest user, received 2,650 nursing visits, costing the state $156,565.24 -- not including the cost of the drugs. Another 12 clients also required more than $100,000 apiece in medication administration fees.
Malloy's proposal will call for alternate methods for people to receive their medication, including allowing trained home health aides to dispense it according to the instructions of a nurse and letting clients use so-called assistive technology such as medication reminders and pill dispensers. The plan assumes that nurses would still administer medication for most clients and would not prevent doctors from requiring that nurses give patients the medication they prescribe.
Allowing for more flexibility in administering medications has been a recommendation of advocates for expanding the use of home-based long-term care. State officials have been working to help people who wish to move out of nursing homes transition to home or community settings through a federal demonstration program called Money Follows the Person. It requires that the cost of community care fall below certain levels that are based on what institutional care costs, and people monitoring the program say the cost of medication administration can stand in the way of people meeting the cost requirement.
"This is turning out to be one of the most significant barriers to success in Money Follows the Person," said Office of Policy and Management Secretary Benjamin Barnes, Malloy's budget director.
Connecticut is one of 44 states participating in Money Follows the Person. But during a recent six-month period, the state had 30 percent of the total cases nationally in which the projected cost prevented a person from moving into the community.
The Malloy administration's plan has four components. They would:
• Expand "nurse delegation" for medication administration, allowing home health aides who are trained and certified to administer oral and topical medications and eye drops. Home health care agencies would have to have specially trained home health aides to do so. Nurses would still be required to administer injections and medications identified by the client's doctor as having to be administered by licensed providers. Nurses would also be responsible for organizing the medications for home health aides and giving the aides individualized instructions. Some state funds would cover training and implementation costs.
• Allow agency-based personal care attendants to administer medications. Currently, independent personal care attendants hired through a Medicaid waiver program are allowed to administer medications if the clients hire and train them.
• Provide Medicaid coverage for the use of assistive technology such as medication reminders and automatic pill dispensers, which could be used in place of having a nurse administer the medications.
• Reduce the rates paid to nurses for administering medication by 10 percent, saving $10.3 million in the coming fiscal year and $11.2 million a year after that.
Altogether, the administration projected that the changes would save $20.5 million in the coming fiscal year, accounting for time to implement the changes, and $28.6 million annually after that.
— Arielle Levin Becker
This article originally appeared in CTMirror.com.
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