May 10, 2006
Inside
1
“Our problems cannot be solved with
■ Homeless Veterans— p. 3 ■ New U.N. Treaty— p. 4 ■ Spring Time Fun— p. 8
the same consciousness that created them.” –Albert Einstein Page 2 Nonprofit Org. U.S. Postage PAID Mpls. MN Permit No. 4766
Volume 18, Number 5
Minnesota’s Disability
Community Newspaper
May 10, 2006
New Hurdles For PCA Approval: Some Weeded Out, But At What Cost? by Laura Tally
I
Rep. Sviggum leads session at Minnesota Capitol
n an effort to make the state and federally funded Personal Care Assistant (PCA) program more accountable, the Minnesota Department of Human Services (DHS) has implemented a new registration process to track PCAs and home health aides who perform PCA services in the community. As of April 30th, 2006, approximately 21,000 PCAs will have been assigned a new identification number. As a part of this process, DHS has found over 230 people unfit to be providing services. The reason individuals are denied a PCA identification number is either that they haven’t passed the criminal background check or they have outstanding debts to the
government, such as unpaid student loans or back taxes. The Department of Human Services believes that as such people have been removed from the work pool, the integrity of the PCA service program is enhanced. Billing requirements have also changed. In order for a Personal Care Provider Organization (PCPO) to bill for services performed by any PCA, they must now submit the new ID number for that PCA along with the consumer’s ID number and their own PCPO ID number. The new registration process makes it more difficult to register as a PCA. Until recently passing a DHS approved
criminal background check has been all that was needed to qualify as a personal care attendant. Now individuals must have a PCA ID number. To do so, they fill out an application, clear a DHS criminal background check and sign an agreement to abide by federal and state regulations for PCAs. This last step may be problematic. It is unclear how PCAs are expected to abide by the myriad of state and federal regulations when they are not involved in the direct billing process. For instance, a PCA simply bills the PCPO for an eight hour shift. The PCPO must then parse that eight hours into 15 minute task increments, each of which must meet stringent regula-
Congress Debates Cuts To Vital Health Care Benefits by John Tschida
A
s health care costs and insurance premiums continue to rise, proposals that would affect people with disabilities are advancing in Washington and at the State Capitol. Of greatest concern is a federal proposal that would strip the authority of states to require health plans to provide certain services or medical supplies. The Health and Insurance Marketplace Modernization Act (S.1955), sponsored by Sen. Michael Enzi (R-Wyoming), has already passed the U.S. House. A vote is expected this month in the Senate. Enzi has called the proposal the greatest effort in the last decade to make health insurance more affordable to small
businesses and working families. Opponents say the bill will hurt consumers and block access to critical health services. U.S. Senator Norm Coleman, a bill supporter, has said the measure will significantly lower the per-person coverage costs for small businesses. U.S. Sen. Mark Dayton opposes the bill and backs a separate health care savings proposal that would leave the state mandates intact. Current Minnesota law mandates the coverage of over two dozen benefits, including diabetes health strips and testing supplies, hearing aids for kids under 18, special dietary foods for kids born with phenylketonuria (PKU), and mental health services equal to
that of other health care. Additionally, Minnesota law requires that certain providers, such as speech, physical, and occupational therapists, be covered by insurance plans. Newly adopted children and children with disabilities— even after they reach adulthood—must also be covered. (A law passed by the state legislature in 2005 allowed health plans to design coverage that would not include all of the state mandated services, but it did not affect the provider or population-based mandates.) Opponents of such mandates, like the Council for Affordable Health Insurance, have long held that dictating specific services that must be covered only serves to drive up the cost of health care pre-
miums. Consumer advocates say without such requirements, health insurers would not include the services in their benefits packages. What is undeniable is that the number of people nationwide who are covered by employersponsored health insurance continues to decline, from 69 percent to 60 percent over the last 20 years, according to Harvard economist David Cutler. Not only are fewer businesses offering health insurance, but fewer workers are taking the insurance offered by employers, especially among younger adults. It’s also important to note that businesses that are self-insured, meaning those state businesses and organizations that pay their health care
claims out of their own funds instead of contracting with an insurance company, would not be affected by S.1955. Under an existing federal law, selfinsured businesses are already exempt from state-mandated service requirements.
Medicaid Next? Many people with disabilities do not rely on the private insurance market to receive their health coverage and instead rely on Medicaid (or Medical Assistance, in Minnesota). Medicaid pays for many services not covered by traditional private market health plans, including home care or personal care attendant services. These critical services, categorized as ‘maintenance’ Health Care - cont. on p. 11
tions. The PCA appears to have no control over, much less knowledge of, how this billing happens, and what regulations it is constrained by. Although this new process is meant to ensure better quality care for members of the community who rely on PCA services, the time delays and paperwork increases will place new burdens on the PCPO’s and consumers of personal care services. Consumers who need immediate care will face a three or more week time delay in getting a new PCA— the time it takes to assign an ID number to a new PCA. The more complicated billing procedures may also hinder access to PCAs when they are needed most. “Implementing this cumbersome, new system will likely cause disruptions in payment to agencies employing PCAs,” said Jeff Bangsberg, Government Relations Director for the Minnesota HomeCare Association. “My fear is that after the April 30th mandatory billing date to use the new PCA identification numbers, access to care will be compromised. Agencies might find it too expensive to serve clients with multiple PCAs because of this new bureaucracy.” PCPOs are being pulled in many directions as a result of this new process. Chief among them may be the risk of providing immediately needed PCA service to a client before knowing if the PCA will pass the background checks and thus be eligible for reimbursement. In order for an agency to be successful they must provide the disability community with PCA services in a timely manner. This is now very difficult because the ID number they must have from DHS to bill for services takes PCA Hurdles - cont. on p. 8