COMPARISON OF SELECTED ASPECTS OF STATE LICENSURE LAMS AND REGULATIONS GOVERNING HOME CARE Tena. Code Ann. §53-1301 et seq. 8. One or more: Skilled nursing care; (1) State/local gov't HHA's (may be excluded) (2) HHA's operated by federal gov't 5. Statewide advisory body 10. Sanctions available Den, Sus, Rov, Inj, Crim (w/o lic) Yes Yes Dept of Health Den, Sus, Rev, Inj, Civ F COMPARISON OF SELECTED ASPECTS OF STATE LICENSURE LAMS AND REGULATIONS COVERNING HOME CARE Utah Code Ann. §26-21-1 et seq. Dept of Health HHA Rules A. KHA B. Skilled nursing plus one: PT, ST, OT; Med SS; NH Aide B. One or more: Skilled nursing; PT, OT, or ST; Med SS; HN Aide svs; Med R&S; Specialized nutrition support; I-V therapy, and RT. COMPARISON OF SELECTED ASPECTS OF STATE LICENSURE LAWS AND REGULATIONS GOVERNING HOME CARE None Den, Sus, Rev, Prov, Probationary lic, Iaj, Crim (w/o lic) APPENDIX C HOME HEALTH BENEFITS UNDER MEDICARE A WORKING PAPER, JULY 21, 1986 (This working paper was prepared by Shelah Leader for AARP's Public Policy EXECUTIVE SUMMARY While expenditures for Medicare home health benefits represent only about 2.4% of total program outlays, it is one of the fastest growing components of the Medicare program. By most measures, home health use has grown greatly. But, the rate of increase in home health expenditures has moderated sharply in the past few years and has not matched previous and expected rates of growth. This fact is puzzling in light of reductions in the average length of hospital stay, the aging of our population, and previous growth rates. One possible explanation for declining growth rates in home health outlays is that the Health Care Financing Administration (HCFA) is reducing access to this benefit by means of claim denials and the application of vague eligibility criteria. There is some evidence that coverage decisions are arbitrary and capricious and the denial rate certainly varies greatly by geographic area. HCFA has failed to sponsor careful studies of the impact of prospective payment for hospital care on the need for and use of post-acute care services. Consequently, it is difficult to assess the extent to which the home health services now being provided satisfy demand. It is clear, however, that Medicare beneficiaries face serious problems in trying to take advantage of this benefit. First, home health care providers are not effectively regulated and quality control and consumer protections are weak or non-existent. The absence of outcome-oriented quality control measures is a significant weakness in the government's oversight of the program, as is the lack of graduated sanctions to apply against providers that fail to meet required minimum standards of performance. HCFA's policy and practice of restricting home health benefits to homebound persons in need of skilled nursing care on a part-time or intermittent basis following an episode of acute illness reflect the basic orientation of the Medicare program. This emphasis on acute illness leaves a significant gap in insurance coverage and service for the growing number of frail elderly and those with chronic conditions. |