Moratorium could force some elderly out of assisted living

Posted: Tuesday, July 21, 2009

Some Kenai Peninsula senior citizens could find themselves out on the street in the not-too-distant future while state and federal assistance administrators work out their differences in the care older Alaskans are receiving.

The state believes quality care is being given to its seniors; the fed wants evidence proving that belief.

Until proof is received, the federal Centers for Medicare and Medicaid Services has ordered a moratorium on admissions into what it asserts is a lacking state waiver program.

Referred to as the "choice waiver program" by providers, the Home and Community Based Services Waivers program sets a negotiated rate for senior assisted living facilities to provide care for the senior, according to Bonita Quale, proprietor of Our House on the Lake in North Kenai and Our House 2 in Soldotna.

The type of care can range from helping the elderly person eat a meal to helping him or her take a bath.

Because of the federal moratorium Quale says she learned of a week ago, no more applications are being accepted for new admissions into the program.

"I have a married couple living here who spent their money down to qualify for choice waiver," Quale said. "They're waiting for their assessment," she said, explaining that once a person applies for the choice waiver, his or her needs must be assessed by a registered nurse before the application moves forward.

If the couple is not approved for the waiver, they will not be able to pay to stay at Quale's assisted living facility. Because they spent down their assets to qualify for the waiver program, they can no longer pay privately.

"As of Aug. 1, I won't be getting paid," Quale said.

"I can only do this for so long -- not that I don't want to," she said.

Rebecca Hilgendorf, director of Senior and Disability Services with the Alaska Department of Health and Social Services, said the state was notified of the moratorium June 26, and there is no indication of how long the moratorium will remain in place.

"We are working on a corrective action plan," said Hilgendorf.

The federal CMS agency reviewed Alaska's waiver program and Personal Care Services in May and issued its June 26 letter as a preliminary report.

"Based on a review of documents to date and CMS' focused review, we have significant concerns regarding the implementation and state oversight of Alaska's ... HCBS waivers, as well as the provision of state plan personal care services," said Barbara Richards, associate regional administrator for the CMS Division of Medicaid and Children's Health Operations.

Richards said the Alaska Medicaid Agency has not provided CMS sufficient assurance that necessary safeguards to protect the health and welfare of recipients of services are currently in place or being followed.

She also said personal care services are being provided in a way that is "not compliant with its currently approved state plan."

As a result of its findings, CMS imposed a moratorium on new admissions or enrollments into Alaska's four HCBS waiver programs.

CMS also is requiring the state to send all staff and managers responsible for operation of the HCBS and PCA programs to attend basic HCBS training, and either revise its PCA program or amend its Medicaid plan to assure compliance with federal rules in delivery of personal care services.

Until the state can demonstrate its compliance with federal rules regarding administration of existing waivers, it is not to submit any new HCBS waiver applications.

In a response letter, William Hogan, Alaska Department of Health and Social Services commissioner, said the state appreciates that the preliminary report is a "starting point for our conversations and work together," but said the state believes some of the facts, assumptions and findings "are not entirely complete or accurate."

Hogan asked if the moratorium also applies to those people whose applications were in process prior to June 26 -- waiting for assessment, waiting for a fair hearing -- or if they could still access services.

Hilgendorf said part of the reason for the moratorium is to catch up on a backlog of 1,857 reassessments waiting to be completed. The state normally extends services for those people already receiving services.

That is not the number of people affected by the moratorium, however.

"About 1,000 may be affected by the moratorium," Hilgendorf said. Those are people who have applied, but have not yet been approved.

The state sent a memo to all providers July 1 saying no new initial assessments would be conducted after July 2, said Hilgendorf.

When asked how long the application process takes typically, Hilgendorf said, especially in rural areas, the time to process an application can vary greatly, depending on travel and weather conditions. Another significant factor is the shortage of nurses to perform the initial assessments.

"To get to the initials (assessments), we try to get to them in 90 days," she said.

"If we have all the information we need to determine the level of care (needed)," it takes about a week to approve the application, she said.

"We do believe good quality care is happening in Alaska," Hilgendorf said. "The problem is we need evidence of that for CMS."

The state's corrective action plan is due to the feds by Sept. 1.

Phil Hermanek can be reached at

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