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Moore-Few and Barone told of delay in Medicaid rate increase
Monday afternoon, the board of directors for the Long-Term Care Unit (Moore-Few and Barone Alzheimer Care Centers) learned of a significant delay in receiving an increase in per patient payments by Missouri Medicaid as passed by the Missouri General Assembly.
Referring to a handout included in the board packet from the Missouri Health Care Association, this state’s largest long-term care trade association, LTC Administrator Steve Branstetter said, “As it says in the MHCA update, it looks like we’re not going to get that full $8.30 increase until the end of the 2019 fiscal year which is June 30 of next year.”
The previous timeline for the increase was to have been a lump sum payment back to July 1 in either December or January. Nursing care facilities such as Moore-Few and Barone will however, receive an increase of $7.76 once the Centers for Medicare and Medicaid approve the increase as part of a state plan amendment.
The other 54 cents will come on June 30, 2019 or shortly thereafter.
In his financial report, Branstetter told the five-members of the board that for August, the LTC reported a net loss of $6,210 with 161.2 days of cash on hand.
“Getting even part of the this Medicaid money is crucial for the LTC to stay in the black this fiscal year,” said Branstetter.
The four-page email from the MHCA, noted legislators added some special language around this increase as a way to protect the funds from being moved to other areas in the state Medicaid budget.
“Governor Greitens, without appropriation authority, moved money from other areas or line items of the Medicaid budge and appropriated $20 million to the foster children line item in the FY(fiscal year) 2018 budget.”
The MCHA email goes on to say “In order to prevent this situation from happening again, the House believed new language needed to be inserted into the Medicaid appropriations bills to prevent the Governor (then Greitens) from arbitrarily moving Medicaid appropriations from one-line item to another.”
MHCA warned legislators of unintentional consequences but were told “the language would not be a problem and, if necessary, a letter of intent could be drafted to alleviate any concerns.”
“As the email says, there is a problem and a ‘letter of intent’ won’t cut it with CMS and so the legislature will have to draft new language in a supplemental budget bill in January,” said Branstetter. “But we’ll be OK if we get that lump sum in December or January and then start getting the additional $7.76 per patient per day from then on.”
Moore-Few had an average of 76.35 patients per day during August while its budget called for 75 while Barone had 39.29 on a budget of 37.
So why the deficit for the month?
The executive summary of the financial report revealed four causes.
Salaries were above budget due to a number of vacancies in nursing positions, especially on the night shift.
“Our CNA (certified nurse assistant) classes have filled all our holes in that position but we’re having a hard time finding nurses and so we’ve been racking up some overtime to cover those shifts,” said Branstetter.
The LTC administrator immediately added that overtime is far cheaper than hiring nurses from a temporary service.
Branstetter added, “Besides, I’d much rather put that extra money in the pockets of our own than some outside service.”
The second cause of the August deficit is the self-funded insurance continues to report above budget for the month.
Third is that Moore-Few made a large purchase of supplies.
And finally, August had the double kick of being a three-payroll month and having five account payable Mondays.
Looking at September, Branstetter noted Moore-Few is running a census of 80 and Barone is almost always full and yet he expects it will be a very tight month financially.
Said Branstetter, “Despite all those headwinds, if we had had that Medicaid money we’d have made a profit in months like August and just about every month.”
He expressed hopes that come next January the LTC will have that lump sum going back to July 1 of this year and from then on start getting paid at a higher level every month.
Careful money management has also led to the LTC having sufficient financial reserves.
Branstetter mentioned that although the board had previously authorized the replacement of a whirlpool bath “I put that purchase on hold until we get that lump sum check into our account. Yeah, we have reserves but spending them is not how we built them up. We need more income before we go spending.”
One expenditure which was reviewed and authorized by the board was the renewal of the LTC’s contract for electronic health records.
“This is not just doctor notes but also every medication given and everything the nurses do,” said Angela Barrett, Barone Administrator and financial officer of the LTC. “It’s a great product and they give great service if we ever have a problem which is not that often.”
The three-year contract freezes the cost at around $110,000 per year reported Barrett.
Board President Dr. George Knox asked if this was in the budget and once assured it was and at about the budgeted amount, this contract was approved by the board.
In order to increase the knowledge of the board, Branstetter and Barrett try to schedule an education session each month. Lorina Byergo, the LTC marketing director and Karen McNair, the LTC and Nevada Regional Medical Center Registered Dietician provided an overview on the chronic disease self-management class “Feel Better Now” which they conduct at least twice per year.
“It’s a really well researched class developed by Stanford University,” said McNair. “The participants are surveyed and the results show those who take the class report doing a better job of managing with pain or emotions as well as with exercise, nutrition and their general outlook.”
McNair had the group close their eyes as she led them to focus on holding a slice of juicy lemon in their hand, focusing on what it looked like and then what it is like to eat it.
Those on hand then shared their thoughts and agreed that such a refocus from pain or being limited in certain ways to something positive was quite helpful.
“And best of all, it’s free; the entire cost of the class is underwritten by the Southwest Missouri Regional Arthritis Center,” said Byergo as she held up the thick textbook and other handouts provided as part of the program.
McNair said people are welcome to call the Moore-Few Care Center at (417) 448-3841 to sign-up for the next class which is conducted in the Moore-Few Community Room.