3. The number of patients diverted from higher cost care settings and the estimated average savings per resident diverted.
The claims data indicate that LLHCSA recipients accounted for higher nursing home costs than the comparison group of recipients, but that the LLHCSA recipients had lower inpatient expenditures than the comparison group. Average nursing home expenditures for both the LLHCSA and non-LLHCSA groups were much higher than the average expenditures for inpatient care for both groups. There is little evidence to suggest that LLHCSA recipients were diverted from the nursing home setting but some evidence to suggest that inpatient service use was relatively modest for LLHCSA recipients.
4. Whether the provision of services provided through a limited license home care services agency generated a cost savings.
Overall average per member per month (PMPM) expenditures for LLHCSA recipients in 2003 were $2,475 while 2003 PMPM expenditures for the non-LLHCSA recipients were $2,514, a difference of $39 PMPM less for LLHCSA recipients. Given that no recipient level clinical information was available to match LLHCSA and non-LLHCSA recipients, these very similar PMPM expenditures provide little evidence that the provision of services through a limited license home care services agency generated any overall cost savings.
5. Whether the expenditures, the number of hours and the number of recipients receiving personal care services in adult homes and enriched housing programs changed compared to the prior two years before implementing this section.
Although the use of personal care services and expenditures for these services in adult homes rose initially after the implementation of this section (1999 and 2001), 2003 data suggest that total and average expenditures for personal care services in adult homes dropped dramatically between 2001 and 2003. The most current data indicate that the use of personal care services in adult homes has not increased compared to the period prior to the implementation of this section.
The level of savings projected in the statutory approval of the program are not supported by the initial evaluation data;
There is no evidence to suggest that LLHCSA recipients were diverted from the nursing home setting, but some evidence to suggest that LLHCSA recipients were diverted from the hospital setting.