Please describe the current methods of paying for Texas nursing homes.
Please describe the issues and problems you observe.
Please also describe the current status for prescription drug coverage.
Answer to Question: HCA 5722 Managing The Long-Term Care Setting
Methods currently used to pay for nursing home services in Texas, and the challenges involved
Medicaid has been the most popular way to pay for nursing home and long-term care.
Medicare coverage for long term care is limited.
Medicaid was the largest funding source for institutional care and provided health care to the majority of Texans.
You must meet these criteria to be eligible Texas’s Medicaid program for long-term care.
They must be in urgent need of certified skilled nursing services.
They must be admitted in the hospital for a minimum of 3 consecutive nights before being allowed to enter a nursing facility.
You can also have income and assets that limit your ability to make changes every year.
Texas is currently using the case-mix approach to assess patients. This is because the old method of reimbursement discriminated against certain patients.
Case mix method assigns patients to one or more of eleven classes.
First, the clinical status of patients will be assessed. After that, they will be assessed on the basis their functional ability.
DADS 2017, 2017).
This is because the Medicaid program has become increasingly complex, creating more problems and obstacles to achieving coverage.
Families could be facing serious financial difficulties if their Medicaid eligibility is not granted in time.
Current Status Of Prescription drug coverage
Prescription drug coverage (MedicarePart D) is responsible to cover the cost for prescription drugs.
The coverage is available to everyone who has Medicare, regardless of their income or health status.
The annual standard cost for prescription drugs benefits changes (Medicare Prescription Drug Insurance (Medicare Part D), 2017.
Refer toMedicare Prescription Drug Coverage (Medicare Part D). (2017). Tdi.texas.gov. Retrieved 18 June 2017, from https://www.tdi.texas.gov/consumer/hicap/medicarepartd.html