The Department of Health and Human Services has paused proposed reporting changes for Nebraska providers who care for people with disabilities after numerous concerns and complaints.
The changes, which were set to go into effect Wednesday, would require providers, among other things, to log their GPS locations in order to be paid. The new date for the changes to go into effect is Jan. 8, to allow more time for implementation as well as working with stakeholders to ensure a smooth transition, according to an HHS news release.
In July, HHS sent out a provider bulletin regarding changes to the electronic visit verification system. The proposed regulations said provider claims would not be paid if:
* Providers don’t use GPS or an approved alternative method, such as a landline Interactive Voice Response, during a visit;
* A provider doesn't start or end an EVV visit at the scheduled location and within the allowed geofence radius;
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* The signatures of the recipient of services or their legal representative are not recorded in the EVV application during the visit.
Jeff Powell, director of communications for HHS, said the changes were required because of a state auditÌýof the program that showed HHS was not in full compliance with federal regulations for the program. The proposed regulations were an effort to curb fraud, which was pointed out in the audit.
Anna Keyzer of Lincoln said the proposed changes felt like a slap in the face and provided no grace for parents like her. The mother of three was in shock when she received the letter in July while caring for her 19-year-old son Simon Keyzer, who is nonverbal, deaf, blind, tube-fed and prone to harming himself.
Simon was adopted by Anna and her husband, Jon Keyzer, at 9 years old from an orphanage in Bulgaria. Anna said that at the time, Simon weighed 18 pounds and was poorly taken care of. Now Simon is wheelchair-bound, weighs 70 pounds and requires around-the-clock care.
He’s able to communicate with his parents through touch and noises. Anna said Simon loves to clap, swing and listen to music. While he can’t form words, he is able to buzz his lips and make a duck-like sound occasionally.
“He has a great belly laugh,†Anna said. “After all the abuse and all the trauma, the fact that he can still smile and have joy is a great gift.â€
Prior to the letter, Anna said she felt like the government was on her side and wanted to help families like hers.
“Now I feel like we’re not on the same team and they’re viewing me as a child that needs to be disciplined or a person who is taking advantage of them somehow,†Anna said. “I just don’t feel appreciated or seen or cared for at all.â€
Anna said she isn’t against stopping people who are committing fraud, but she wants there to be more exceptions for providers who live with the person they care for.
While Anna can only clock in for 16 hours a day, she said she works around the clock to provide care for her son. During the summer, she can clock in for a total of 112 hours a week. When Simon is attending Lincoln East High School during the school year, she can clock in for a total of 72 hours a week.
As a parent, Anna said she already has a case manager who checks in every few months to make sure her son is safe and taken care of and also verifies that Anna is providing a stable environment.
Anna attended a virtual town hall hosted by HHS on July 24 with hopes of having some of her concerns addressed but found herself frustrated. She said she was ready to ask questions but instead found cameras were turned off, microphones were muted and there were no options to submit questions.
“It was like, ‘We don’t care to hear from you, we don’t care to even allow you to ask us questions,’†Anna said.
The following week at a July 30 town hall, HHS directors said they had technical difficulties that prevented a chat option for questions. At the second town hall, more than 500 people joined online and were able to ask hundreds of questions regarding their concerns.
The technical difficulties that HHS encountered have caused parents to ask for more grace.
Prior to the announcement of the delay, Anna, Simon and another mother and her son went to the State Capitol to speak with senators and bring letters of their desires in hopes of being heard as a parent.Ìý
"I felt like someone seeing Simon would help them understand how hard my life is already and how making it harder is an injustice that is worth fighting," Anna said.
Anna said moms and caregivers came together to sign a letter with over 100 parents and caregivers that listed their concerns and ideas. A few hours later, notice came about the delay.
Tricia Gushard attended both town halls and said that it was interesting that HHS officials seemed to want patience for their technical errors but are unwilling to do the same for parents.
“The irony of it is for them to say when there’s technology issues, you might not get paid,†Tricia said. “That first town hall meeting, technology didn’t work … So (HHS) shouldn’t be paid for that day — how does that feel?â€
Tricia cares for her 24-year-old son Elijah Gushard, who requires 24/7 care. In addition to facing potential technical errors, Tricia said it can be exhausting caring for her son, remembering to clock in and noting her exact location.
Just a couple of weeks ago, the Gushard family was at an Omaha Storm Chasers baseball game and was invited to stay for a free concert. If the proposed changes were in effect, Tricia said, they wouldn’t have been able to stay because they would need to be back home to clock out.
“You have to predict the future,†Tricia said. “I’m sorry, but nobody can plan their lives that way, especially when you have health issues like Elijah.â€
In Elijah’s 24 years, he’s had 48 surgeries, and only a couple have been planned ahead, Trisha said.
Justin “Gus†McFadden had a normal life until going into cardiac arrest as a 27-year-old, which resulted in his brain being deprived of oxygen. His mom, Linda Thayn, said the injury has affected his decision-making, short-term memory, focus and maturity level ever since.
Now as a 41-year-old, McFadden is cared for by Linda and his stepdad, Arlen Thayn, in Omaha. Each morning, Linda has to wake up her son because he has no concept of time or expectations. While McFadden enjoys watching TV and word search books, he can’t do many simple tasks for himself such as trimming his nails or showering.
When the proposed changes came out, Linda and Arlen were mostly concerned about the clocking-in and required GPS tracking. While Arlen said they could mitigate some of the impact, they couldn’t handle it all.
“We’re not trying to be difficult, we’re just trying to live a normal family life,†Arlen said. “The impact with these changes is the hardship they’re going to put on families.â€
Currently, Linda and Arlen clock in during the morning and clock out after they reach their maximum hours. However, with the proposed changes, they would be required to know where their final destination will be in order to clock out within the geofence radius.
During the town hall, HHS officials said the geofence radius is based on Nebraska zip codes, with a half-mile radius for rural zip codes and a quarter-mile radius for urban zip codes. Providers must clock out within their scheduled locations in order to receive their pay.
Linda said she and her husband want to follow the rules and they aren’t trying to take advantage of anyone, but they also know as parents that they can’t plan for everything. Arlen wants a system that has flexibility for when plans change.
“You can plan all you want to, but we all know that there are days that nothing goes according to plan,†Arlen said.
Arlen also has concerns about how HHS will be able to retain caregivers with the proposed changes.
“If you forget to clock in, you don’t get paid for that day,†Arlen said.
Joe Dondlinger, the chief financial officer at Apace, said the company provides services for about 800 people in Southeast Nebraska with intellectual and developmental disabilities. In addition to day programs and workforce opportunities, Apace has about 40 employees who provide in-home services.
With the proposed EVV changes, Dondlinger said his main concern is the discontinuance of manually populated claims. Each year, he said the company has about 40,000 in-home visits that, with the changes, would require about 80,000 geolocation data collections.
“From what I’ve seen, collecting geolocation data works, optimistically, about 95% of the time,†Dondlinger said. Assuming that it doesn’t work 5% of the time with no allowance for manually populated claims, that means some visits will not be paid, he said.
While Dondlinger does think the enforcement of geolocation is good, he recommends that the state have some way to still manually populate claims when GPS doesn't work properly.
On Aug. 6, the Nebraska Association of Service Providers filed a lawsuit asking a Lincoln judge to block the changes from going into effect. The NASP is the state association for home and community-based service organizations that contract with HHS to provide Medicaid waiver services for individuals.
NASP Executive Director Alana Schriver said in an email to the Journal Star that while NASP understands the importance of accountability and transparency in service delivery, the expedited timeline from HHS did not allow for adequate development and integration of software solutions or the necessary training and practice for staff members.
Schriver said that the proposed changes don’t allow for any room for technological or human error. When providers encounter issues, they are able to submit an appeal ticket, which Schriver said can take two to eight months to be handled.
“We are still obligated by wage and labor laws to pay our employees,†Schriver said in an email. “This will result in significant revenue losses, ultimately leading to a reduction in available services and job losses for our staff.â€
Like Dondlinger, Schriver would like to see manual corrections available and would like to work with HHS to provide a more compliant EVV system to ensure access for individuals supported by agency providers serving individuals.