New federal rules will disrupt care for disabled Kansans, state officials say

by Dave Ranney, KHI News Service

Topeka — A state official charged with overseeing Medicaid-funded services that help people with disabilities live in community-based settings rather than in nursing homes said Tuesday that coming changes in federal wage and hour rules are likely to increase costs, reduce access to care and give beneficiaries less say in deciding who will provide their care.

“We have great concerns about this,” said Kansas Department for Aging and Disability Services Secretary Kari Bruffett, testifying before a Statehouse meeting of the Robert G. Bethell Joint Committee on Home and Community Based Services and KanCare Oversight.

Kari Bruffett, former director of the Division of Health Care Finance, now serves as secretary of the Kansas Department of Aging and Disability Services.

The changes, which were first announced by the U.S. Department of Labor in September 2013, are set to take effect the first of the year. They require states to pay attendant care workers overtime if they work more than 40 hours a week.

Bruffett said the changes are expected to have little effect on home health companies that already pay their employees an hourly wage and have long been subject to laws governing overtime.

But in Kansas, she said, most of the state’s Medicaid-funded in-home services are based on an assessment of each individual’s needs and a formula for calculating how much the state will pay to have those needs met.

Medicaid beneficiaries then are given the choice of letting a home health agency provide the needed services or making those decisions for themselves.

Typically, a home health agency won’t agree to provide the services if the agreed-upon rate doesn’t cover its overtime costs. But there’s nothing to stop an individual from hiring a caregiver – an adult son or daughter, for example – who’s willing to provide the care for what the state is willing to pay.

Bruffett said KDADS is now being told that after Jan. 1, so-called self-directed caregivers will have to be paid minimum wage as well as overtime.

If the agreed-upon rate falls short of the required wages, she said, the state will have to cut services or pay more for them.

The rule change likely will double the cost of providing thousands of beneficiaries with sleep cycle support services, she said. That refers to the practice of paying someone to be present while a beneficiary sleeps so they’re available when the person in their care needs help toileting, taking medication, being repositioned to prevent bedsores or getting out of bed in the morning.

Currently, the state pays about $35 for six to eight hours of sleep cycle support. After the minimum-wage requirement takes effect, it’s likely to cost roughly $60 per person per night.

Bruffett warned that without sleep cycle support, thousands of vulnerable Kansas – frail elders and people with disabilities, primarily – likely would need to move to a nursing home setting.

“Those would not be good choices,” she said.

Bruffett said KDADS has not yet calculated how much it expects the change to cost the state. Instead, she said, the department is planning to “push back pretty hard,” noting that she recently wrote a letter to U.S. Department of Labor Secretary Tom Perez, asking him to exempt Kansas’ self-directed programs or delay implementation of the new rule.

“I’m not here to cause alarm,” she said, “but we do want people to know that changes are going to be made. And we’d like them to join us in pushing back. We’d like for there to be some kind of Kansas-specific exemption.”

Bruffett said she was aware that Perez has denied similar requests from other states.

The committee did not hear from anyone representing the U.S. Department of Labor.
In a news release last year, Perez called the rule changes “an important step toward guaranteeing that these professionals (direct care workers) receive the wage protections they deserve while protecting the right of individuals to live at home.”

Also, then-Department of Health and Human Services Secretary Kathleen Sebelius said the departments would “continue to engage with consumers, states, advocates and home care providers in the implementation of this rule to help people with disabilities, older adults and their families receive quality, person-centered services.”

But Mike Oxford, executive director at the Topeka Independent Living Resource Center, said that didn’t happen. Instead, states’ independent living centers, Medicaid directors, proponents of self-directed care and front-line advocacy groups were “purposely excluded” from the departments’ discussions, he said.
“I believe that these regulations are very shortsighted and will ultimately harm both workers and people with disabilities in Kansas and in many other places,” Oxford said.

“And what’s really sad is that this is going to highjack a lot of other issues that we have going on, like restoring cuts in services and addressing waiting list for services,” he said. “And now, we’re looking at having to spend all this money on overtime, which, when it’s all said and done, is going to lead to fewer services.”

Oxford encouraged Medicaid beneficiaries to contact their legislators about the changes.

The KHI News Service is an editorially independent initiative of the Kansas Health Institute. It is supported in part by a variety of underwriters. The News Service is committed to timely, objective and in-depth coverage of health issues and the policy-making environment. More about the News Service at khi.org/newsservice or contact 785-233-5443.

Don’t skip this meal

by Lori Wuellner

You would think the years of teaching healthy eating would have an osmosis effect on my boys, but I still struggle to get veggies and anything whole-wheat down them. Eating breakfast however is one important lesson they learned early on and continues to be a healthy habit they practice.

Eating breakfast has some big benefits such as fueling the body and brain for work or school. Children and adults who eat breakfast are able to concentrate and do better on their schoolwork and work. Eating breakfast helps with weight management too. People who skip breakfast more than make up for the calories later in the day.

Breakfast doesn’t have to be fancy. Set your alarm clock to allow 15 minutes to eat, and try these tips to streamline hectic mornings.

- Set out cereal, bowls, spoons and glasses before bedtime. In the morning, fill bowls and add calcium-rich, fat-free milk and sliced banana, berries or other fruits to your cereal.

- For a heartier breakfast, such as homemade pancakes, waffles or muffins, mix the dry ingredients the night before. Mix the wet ingredients (such as buttermilk and eggs) and store in the refrigerator. In the morning, mix together and cook.

Keep it quick. Try to include three different food groups as you choose your morning meal. Including some protein (egg, milk, Greek yogurt) helps to keep you full longer.

- Scrambled egg with cheese, whole-wheat tortilla, and orange juice- add a little diced green or red bell pepper to the eggs for a nutritional bonus

- Breakfast burrito made with a whole-wheat tortilla, scrambled egg, a few turkey sausage crumbles and salsa

- Yogurt parfait (layers of vanilla yogurt and fresh fruit topped with crunchy cereal) or breakfast smoothie with your favorite fruit. Smoothies are a great way to use up bananas that are going brown. Just toss peeled bananas in a baggie or container and put them in the freezer. Add them to your smoothie in place of ice.

- Breakfast Cereal Bar and milk

Check out the Kids A Cookin’ website for more recipes… http://www.kidsacookin.ksu.edu/Welcome.aspx

A favorite breakfast in our home is a recipe from the Kansas Wheat Commission, Whole Wheat Pancakes. I mix the dry ingredients the night before and add the remaining ingredients in the morning. We usually have a bowl of fresh fruit on the side and milk.

If you’ve gotten out of routine with breakfast over the summer, now is a good time to commit to eating the “most important meal of the day!”
(Source: NDSU Extension Service, Food Wise Newsletter, Issue #271, August 2013)

Lori Wuellner is a Wyandotte County Extension agent, Family and Consumer Sciences, K-State Research and Extension, 1216 N. 79th St., Kansas City, Kan. Telephone 913-299-9300, email lwuellne@ksu.edu.

Recipes
Breakfast Cereal Bars
3 cups whole-grain cereal (Chex, Cheerios, Kashi, etc.)
1 cup peanut butter
½ cup honey
1 cup raisins
¼ cup sliced almonds
1. In a bowl, mix together cereal, raisins, and almonds.
2. In another bowl, mix together peanut butter and honey.
3. Add dry ingredients to peanut butter/honey mixture. Mix well.
4. Press into a 9 x 9 pan.
5. For easier cutting, chill 20 minutes, then but into 16 squares. Wrap squares individually in plastic wrap for an on-the-go snack.
Makes 16 servings. Each serving has 200 calories, 26 g carbohydrates, 9 g fat and 7 g protein.
(Source: NDSU FoodWise)

Whole Wheat Pancakes
1 1/3 cups whole wheat flour
1 1/3 teaspoons baking powder
¼ teaspoon salt
¼ teaspoon baking soda
1 egg
1 1/3 cups buttermilk
1 tablespoon brown sugar
1 tablespoon oil
In medium bowl, stir or sift dry ingredients together. Beat egg, buttermilk, brown sugar and oil together. Stir into dry ingredients just until moistened. Batter should be slightly lumpy.
Pour ¼ cup batter for each cake onto a well-seasoned hot griddle. Turn when bubbles appear on surface. Turn only once. Makes twelve 4-inch pancakes.
Optional: add ½ cup fresh or frozen blueberries or serve hot, chunky, spiced applesauce or thick fruit sauce over pancakes instead of syrup for extra nutrition and fiber
Nutrition information per one pancake…77 calories, 3 g protein, 2 g fat, 12 g carbohydrates, 2 g fiber, 24 mg cholesterol, 140 mg sodium

Power restored at KU Hospital

Power was restored at the University of Kansas Hospital in Kansas City, Kan., after a power outage this morning.

The Board of Public Utilities’ outage map showed 3,649 customers without power at 10:55 a.m. Wednesday. That number was down to three customers at 11:40 a.m.

Also affected were schools in the Rosedale area of Kansas City, Kan.