Bills distract from necessity of disability spending reform

Nursing home operators, long the taxpayers’ worst nightmare in Louisiana, continue to fight behind the scenes to protect their power and privilege by supporting bills this legislative session that could distract policy-makers from the necessary goal of spending a greater portion of long-term health care dollars on less-expensive, more effective community- and home-based care and less of it on inefficient institutionalization care.

HB 1273 by House Speaker Jim Tucker would have the Department of Health and Hospitals study waiver programs to Medicaid that allows for home- and community-based care instead of institutionalization, as well as implement decisions The waiver programs cost substantially less and for all but the most incapacitated people provide more opportunity for individualized, superior care than by being institutionalization in private sector nursing homes, and produce even greater savings for most than residence in a state-run developmental center.

The bill asks for formulation of cost-savings measures in operation of the waiver programs. No doubt a study would provide some good information in this regard in terms of ensuring only those who truly have substantial, qualifying disabilities receive waivers and that agencies providing for these needs do so efficiently. But Tucker and other lawmakers seem oblivious to the real problem of escalating costs in nursing home payments and they ignore the Louisiana Legislative Auditor’s report of a few years ago that showed back then just a few simple changes to reflect best practices in reimbursement would save the state nearly $100 million. (Instead, the Legislature responded by writing the wasteful standards into law.)

If Tucker and lawmakers are serious about controlling the costs of health care provision to our most vulnerable citizens, they would pass legislation instructing these kinds of guidelines be formulated and implemented by DHH for institutionalized care in the state. There’s still time to amend HB 1273 to do so but nursing home interests would fight this because in its present form it takes the heat off of them.

The same logic applies to HB 914 by Rep. Jim Fannin. It would alter last year’s successful legislation that automatically deploys a portion of a declared non-recurring budgetary surplus to working on funding the backlog of New Opportunities Waivers that allow for the more severely disabled to receive residential care outside of institutions and to be able to work as a result, contributing their talents to society, productivity to the economy, and tax dollars to the state Treasury. Last year’s law mandates surplus money goes to create new slots to work on the backlog approaching 12,000; this change would allow these funds to be used also to support previous slot commitments meaning the backlog not necessarily would be addressed.

There is a rationale to the bill, as current law does not provide a new revenue source to sustain the new slots after they come into being paid for the first year by the one-time surplus money. Thus, the Legislature would have discretion in choosing whether to add new slots or fund existing one. But it would only perpetuate the same problem of not encouraging the state to wean itself from more expensive institutional-based care – the goal of nursing homes – and allowing the fix to the underfinanced waiver system to continue to be based on one-time funds. (The state is legally compelled to make this transition by its settlement in the Barthelemy case.) For this reason, HB 914 really does nothing and should be dispensed with.

The real problem, of course, is that the state’s nursing homes want to keep the gravy train rolling for them by continuing to have people who could be better and more inexpensively served by waiver programs to be warehoused into nursing homes. Supporting this legislation in its current form attacks the competing, more efficient use of taxpayers’ dollars in order to prop up their overbuilt industry. If they really want to provide most effectively to the state’s neediest and most efficiently to taxpayers, legislators need to understand this and to alter HB 1273 accordingly while letting HB 914 quietly expire.