Trach/Vent child needs nursing coverage

[mom2jimmyc]

Hi,

My son is 12 and has SMA Type 1. He is trach/vent dependent. I am a single mom who works part-time as a homecare LPN). He has primary insurance with Medicaid as secondary. Primary pays a couple of months per year then Medicaid takes over. He is approved for 16 hours/day nursing. I only use 8 hours per day. I have major issues getting coverage on weekends. There is no incentive for nurses to work weekends and barely an increased rate paid over a basic peds case. My question is does know what the hourly reimbursement rate Medicaid pays the agency is? Is there an increased rate for t/v versus basic? Is there an increase rate for weekends? Thanks for your help.

[KelRN215, BSN, RN]

Medicaid reimbursement is a flat rate. It is not increased for nights, weekends, holidays.

[meanmaryjean, DNP, RN]

Yup- my agency pays the same for days, evenings, nights, weekends etc. We also have NO weekend requirement. And we do not provide care on federal holidays except in very, very rare cases.

Differential for trach/vent vs. a straight g-tube case is a paltry 50 cents on the hour.

[mom2jimmyc]

Thanks! Do you know how if the flat rate is dependent on the acuity of the case? Do you know how much the flat rate is? I spoke to our case worker and she said she doesn't ever see that info.

[ceebeejay]

Medicaid reimbursement varies by state. Each state implements it as they see fit. In my state, there is a flat rate. There is a higher rate for medically fragile children, which trach/vent children usually are, but it has to be approved. No increase in rate for weekends.

Check your states website for Medicaid providers. In NY it's EMEDNY.org. Private Duty Nursing will show the rates they pay RNs and LPNs. The rate to agencies is different.

[mom2jimmyc]

Wow 50 cents is disgraceful. The difference between the extent and intensity of care is extreme. That makes me want to cry. Obviously, this is why the basic gtube cases are filled yet the kiddos on life support go without coverage. :0(

[KelRN215, BSN, RN]

It is not dependent on the acuity of the case. It is a flat rate. There is one rate for RNs and another for LPNs. I do not know what it is for the agency you get services from, it would vary by state since Medicaid is a state program.

[KelRN215, BSN, RN]

Wow 50 cents is disgraceful. The difference between the extent and intensity of care is extreme. That makes me want to cry. Obviously, this is why the basic gtube cases are filled yet the kiddos on life support go without coverage. :0(

Actually, I would say that is because A) G-tube cases get way fewer hours than trach/vent cases and B) there are more nurses out there with G-tube experience than there are with trach/vent.

[caliotter3]

Some agencies will indicate the reimbursement rate in their disclosures in the original contract. I have seen this many times when the client's copy of the contract is included in the field chart. Ask the agency business manager, they have no reason to withhold this information from you.

[caliotter3]

Wow 50 cents is disgraceful. The difference between the extent and intensity of care is extreme. That makes me want to cry. Obviously, this is why the basic gtube cases are filled yet the kiddos on life support go without coverage. :0(

A good deal of the problem also has to do with the fact that agencies will not make the time or effort to properly train their nursing staff to do trach and vent care. How much of an inconvenience can it be to set up a training session with an experienced nurse that teaches thoroughly?

[NRSKarenRN, BSN, RN]

Medicaid payments for skilled nursing RN/LPN vary by state and per contract with agency. It is a flat rate, no differental for acuity except for increased # hours approved for those on vents 24/7.

Issue you have is current agency providing staffing unable to meet you needs. Contact agency and his MA Case Manager regarding your staffing, can try to request 2nd agency as backup.

[systoly]

in my state, you could be hired by the agency and be assigned to your sons care

maybe you could ask the agency if this is permissable in your state