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'Not disposable people’: Patients on ventilators caught in the middle as nursing homes bleed money
Instead of paying nursing homes directly, Pennsylvania hired three managed-care companies to administer Medicaid payments for nursing homes and other long-term services, including community-based supports, for the elderly and disabled.
Under the old system, rates were set based on costs. However, nursing homes typically would get paid 15 to 20 percent less than the rates, depending on the state’s annual budget allocation for health care.
To prevent care disruptions as the new system started, the managed-care companies were required to contract with all nursing homes that took Medicaid and pay them per-day rates that were no less than those they received in 2018 under the old system.
Those rates were a floor under initial three-year contracts, state officials said.
Ultimately under the new system, the managed-care companies are expected to negotiate rates with nursing homes and other service providers. The ventilator specialists believed they would be able to get higher rates that way.
That did not happen, nursing home operators say. They say the three managed-care companies, Independence Health Group’s AmeriHealth Caritas, Centene Corp.'s Pennsylvania Health & Wellness, and UPMC Community HealthChoices, have refused to negotiate rates closer to the cost of caring for ventilator patients.
Instead of paying nursing homes directly, Pennsylvania hired three managed-care companies to administer Medicaid payments for nursing homes and other long-term services, including community-based supports, for the elderly and disabled.
Under the old system, rates were set based on costs. However, nursing homes typically would get paid 15 to 20 percent less than the rates, depending on the state’s annual budget allocation for health care.
To prevent care disruptions as the new system started, the managed-care companies were required to contract with all nursing homes that took Medicaid and pay them per-day rates that were no less than those they received in 2018 under the old system.
Those rates were a floor under initial three-year contracts, state officials said.
Ultimately under the new system, the managed-care companies are expected to negotiate rates with nursing homes and other service providers. The ventilator specialists believed they would be able to get higher rates that way.
That did not happen, nursing home operators say. They say the three managed-care companies, Independence Health Group’s AmeriHealth Caritas, Centene Corp.'s Pennsylvania Health & Wellness, and UPMC Community HealthChoices, have refused to negotiate rates closer to the cost of caring for ventilator patients.
