During Black History Month, we’re honored to share stories from members of color. That is why it was my privilege to talk with Felicia Moore of Neighborhood Home Care.
Moving from Mississippi to Massachusetts would be a culture shock for anyone. However, Felicia Moore of Neighborhood Home Care has used that experience to educate and serve communities in which healthcare can be hard to find and is often misunderstood.
During Black History Month, the Home Care Alliance of Massachusetts is honored to share stories from members of color who own and operate home care agencies in Massachusetts. That is why it was my privilege to talk with Felicia. She is passionate about providing healthcare and education, especially to those in underserved communities. You can see it through the way she speaks and reminisces about her experiences.
Felicia shares what drew her to home care, how it has shaped her journey, and what differentiates her agency from others. In the clips below, she shares with us a client story that has stuck with her, as well as on the importance of trust in forming connections with clients in their homes.
Veteran litigator Angelo Spinola answers questions about how agencies are rising to meet the biggest employment law challenges they face, including those posed by the COVID-19 Pandemic.
Even in the best of times, human resource issues pose an enormous challenge to home care agencies. But when responding to a global pandemic, many agencies found themselves scrambling to address new questions. How do you help employees with childcare challenges? How do you handle on-boarding (and firing) when everyone is working off-site? Who pays for COVID tests, and how should time spent getting the test be compensated? Can employers require vaccinations?
For the 15th episode of Talking Home Care, Pat speaks with Angelo Spinola of Littler Mendelson, a leading employment law litigator about these and other issues. They also discuss the subscription-based, on-line Home Care Toolkit Littler developed and constantly updates. The Toolkit gives agencies access to a world-class HR resource, policy manual, and document library that’s like adding an expert to your staff.
The Home Care Alliance of Massachusetts has negotiated a special agreement with Littler to give our members access to the Toolkit at a great price, with a portion of all sales supporting the Alliance! To learn more or to order your subscription, contact Melissa Mann at MMann@littler.com or (404)760-3928.
You may listen to the podcast by clicking any of the platform images above, clicking “play,” or downloading it directly (Length: 40 minutes; Size: 29 MB).
Front-line heroes share their stories about overcoming the challenges posed by the COVID-19 Pandemic.
The COVID-19 Pandemic has created huge challenges to healthcare systems across the globe, including here in Massachusetts. As part of National Home Care and Hospice Month, we collected first-hand stories from our members about the front-line challenges they faced, and how they overcame them.
For the 14th episode of Talking Home Care, we’ve collected these stories into a single podcast. They are introduced by Alliance Executive Director Pat Kelleher and are read by drama students at Winthrop Middle School.
You may listen to the podcast by clicking any of the platform images above, clicking “play,” or downloading it directly (Length: 41 minutes; Size: 29 MB).
Dr. Ashish Jha of Brown University sees a difficult winter ahead in terms of battling COVID-19, but reasons to hope in the spring.
In mid-November, I had the pleasure of listening to a virtual presentation from Dr. Ashish Jha, Dean of the Brown University School of Public Health, as part of the Massachusetts Association of Health Plans Health Policy Speaker Series. At the time, people were finalizing their Thanksgiving plans while the Coronavirus Pandemic began its fall resurgence.
Dr. Jha expressed deep concern about our present situation. “The virus is in a very bad place,” he said at the beginning of his remarks. In his assessment, there is no doubt that there is more virus in the community today than during the springtime peak, and the current count of 200,000 new cases each day is unacceptable. However, he believes there is a path forward that will bring us to something like pre-pandemic normalcy in the near future, especially with the promise of effective vaccines. As such, he said, our priority must be to save lives during the winter months.
Jha put a great deal of focus on what he called “priorities,” noting that COVID-19 does not care about our priorities are. In other words, he said, that while he was personally emphatic to our individual needs, the virus does not care that I prioritize seeing some family, but not others. The virus will spread wherever and whenever it sees fit.
Jha also discussed priorities in the context of the public policy response to the pandemic. He believes maintaining fully operating schools and hospitals should be our sole societal priorities. Yet, he said, just days before his talk, New York City shut down in-person learning, while continuing to allow people still to dine together indoors. This is, he called “upside-down.“
Jha was, however, not naïve to the fact that shifting our priorities to focus on schools and hospitals is expensive. It means large-scale federal support for restaurants and their workers to survive the winter months. He recognized this decision is “politically challenging,” as broad economic shutdowns have been unpopular and politicized. But, in his opinion, it is the best way for us to save lives as we await distribution of vaccines.
The more hopeful part of Jha’s presentation centered around the rapid development of vaccines. At the beginning of the pandemic, he admits he hoped for a 50-60% effective vaccine. Now that early data shows two vaccine candidates with 90%+ efficacy, he is extremely hopeful. He also noted that scientific integrity was not compromised through this process, it was just expedited by conducting the typical steps all at once (e.g., simultaneous human and animal studies).
While he said that we must not lose sight of the short-term task at hand (containing the virus during the winter), Jha is hopeful that we could achieve 30% immunity by the end of January, at which point virus-spread tends to naturally slow. By April or May, he hopes anybody who wants to be vaccinated will be. This may sound ambitious, he noted, and distribution nuances as well as vaccine education, will surely slow any rollout; but he saw it as feasible.
In the meantime, he said we must continue to wear masks, get tested, and only see people from our own household.
Since the onset of the pandemic and the declarations of federal and state emergencies, the Home Care Alliance of Massachusetts shifted much of its attention and resources to COVID-19-related membership support. To that end, the Alliance:
Was the first state to create guidelines for members—both medical and non-medical—admitting COVID-positive patients. This guidance was adopted by many other states and shared by the National Association for Home Care & Hospice (NAHC)
Offered regular calls for CEOs of certified and private care agencies to share and learn from each other, as well as calls for clinical directors, HR mangers, and hospice directors
Published more than 50 COVID Updates, a new publication exclusively for our members
Advocated for, and secured, multiple Medicaid waivers, including full payment for remote visits, waiver of certain in-home assessment requirements, and allowance of a remote audio-visual face-to-face (F2F)
Worked with MassHealth on guidance to keep telehealth waivers permanent
Hosted more than a dozen webinars on topics such as: accessing the PPP program, documenting telehealth visits for payment, unemployment and COVID, the CARES ACT, and Medicare stimulus funding
Advocated with the state for COVID support funding, resulting in Massachusetts being among the most generous states in passing federal Medicaid money to agencies in the form of 10% rate increases for home health, 20% rate increases for continuous skilled nursing, and 10% provider payment relief for providers in the State Home Care Program
Answered hundreds of member regulatory questions related to the pandemic
Developed and hosted a COVID-19 Resource page that includes Allied member COVID resource services, generating more than 1,500 page views between March and August
Secured Board of Registration in Nursing clarification, assuring that the federal change related to NPs and home health services will remain operative in Massachusetts after the State of Emergency
Worked with MassHealth on the new agency-directed PCA model program
Coordinated strategy with the Home Care Aide Council on expanded services and increased funding in the EOEA home care program
Worked with the Massachusetts Medical Society to educate physicians about audio-visual F2F assessment requirements
Worked with assisted living facilities and other acute and post-acute providers to educate them on the federal temporary changes to the Medicare homebound requirement
Worked with the Betsy Lehman Center on an infection control training and toolbox for use in homemaker and aide training
Other 2019-2020 Work
Among the member supportive services over the past twelve months, the Alliance and Foundation have:
Moved the entire Spring Conference and Trade Show to a virtual platform available to members on demand
Offered members a one-time 15% dues discount
Worked with state legislators and other stakeholders to advance an effective non-medical home care licensure bill; Legislation is unlikely to be signed into
law prior to the end of the 2020 Legislative Session
Produced a series of videos for our website and for members’ use on working with Private Care home care agencies
By default, the page shows clearly-laid-out information about all of our Allied and Individual members. But by expanding either the Clinical & Caregiving or Business & Administration menus, you can filter the results by service type.
The page is intuitive, fast, and runs on all devices.
As the 2020 Election approaches, the Alliance is launching a Get Out the Home Care Vote initiative. This voluntary, non-partisan initiative — which does not endorse any candidate or party – is aimed at ensuring access and electoral participation for the home care industry and its workforce.
Participating in our electoral process is one our most sacred rights as Americans. As the 2020 Election approaches, the Home Care Alliance of Massachusetts is launching a Get Out the Home Care Vote initiative. This voluntary, non-partisan initiative — which does not endorse any candidate or party – is aimed at ensuring access and electoral participation for the home care industry and its workforce.
Earlier this week, we mailed over 160 Get Out the Home Care Vote posters to Alliance members. These can be posted at agencies to remind employees of key election dates and deadlines and also provides QR codes with links to register to vote. In addition, knowing that our workforce is primarily in the field, we have compiled the Get Out the Home Care Vote resources below, which include pre-written email templates, voter registration resources, and key deadlines, all in one place!
All these resources are available to the public, regardless of membership-status with the Alliance. You are encouraged to print out the poster (11×17 paper), use the pre-written email templates and resource links as necessary. There is power in numbers, and when we vote, we can shape the future of home care.
We want to hear from non-members about what they need and how we can help.
The home care industry has met the COVID-19 Pandemic with incredible skill, professionalism, and diligence.
But even the best agencies need help navigating the maze of new regulations, HR changes, supply-chain issues, and other challenges we’ve faced since March. And that’s on top of all the other challenges — business and care-giving alike — that come from running a home care or home health care agency.
To get a better sense of your specific needs, we’re asking non-members to take a moment to complete a short, 1-page survey. Our team will then contact you within two business days to discuss how we can serve you and your agency.
The Home Care Alliance of Massachusetts has the tools, expertise, and resources you need so you can focus on what you do best: Serving your clients and protecting your employees.
NGS will resume medical record review after suspension from Public Health Emergency
National Government Services (NGS) recently contacted Alliance staff to review details for the resumption of medical record reviews. This follows the suspension of the Targeted Probe and Educate (TPE) audit because of the Public Health Emergency. We expect that this review will start this week. All the Medicare Administrative Contractors (MACs) will publish information indicating that medical reviews will resume.
NGS has shared some details with Alliance staff about this resumption, which are summarized below; however, the details are not yet posted on their website.
NGS will resume post-payment medical reviews. This is different than the TPE program. CMS has not provided any direction to the MACs thus far regarding the resumption of TPE.
The post-payment reviews are service-specific (as opposed to provider-specific) and will be a random sample. A service-specific review is one where the MAC is focused on the claim and not the provider.
CMS has given a resumption date of August 17, 2020. It is anticipated that providers will begin receiving Additional Documentation Requests (ADRs) once NGS posts more information on their website. NGS indicated it will post a brief description of the service-specific audits on its website and ADRs will be sent approximately 2-3 days after this posting.
The timeframe from which NGS will pull claims is January 2019 through February 29, 2020
The maximum number of claims to be pulled per provider is 20. There is no minimum. This is less than the total number under the TPE program, and a provider may or may not receive ADRs for a full 20 claims. It is anticipated that the majority of hospice and home health providers will not have this many claims pulled. Any providers having difficulty responding to the ADRs on time should contact NGS and they may be able to work with the provider if the provider makes them aware of the situation.
Providers should not wait to receive an ADR request in the mail, but should check the status of their claims processing and identify any with the S B6001 status. These are claims that have had an ADR generated.
NGS has 60 days to review the provider’s response to the post-payment ADR. Though providers have 45 days to respond to the ADR, a 30-day response is strongly recommended to ensure that the response is received and recorded by the 45th day.
A results letter will be sent after each claim is reviewed.
A provider may request education and the NGS may suggest education. Providers are not required to participate in education, although the Alliance strongly recommends it.
The error rate (payment error rate or claim error rate) is not as important with a service-specific post-payment review as it is with TPE, since there are no “rounds” in post-payment review as there are with TPE. The MACs are not setting error rate thresholds upon which further NGS action is predicated. As with all medical reviews, if NGS identifies a concern, i.e. a quality concern or indication of potential fraud or abuse, NGS will refer to the appropriate entity (i.e., the appropriate QIO or the division of CMS).
NGS will continue to make phone calls to providers for missing documentation or questions about documentation submitted.
It is still possible that providers will receive some other ADRs as part of other review programs such as CERT. CMS contractors, including Unified Program Integrity Contractors, may conduct targeted prepayment and post-payment reviews when there is evidence of potential fraud or gaming. CMS has not yet indicated if the results of the post-payment reviews that are resuming this month would be used for future TPE audits.
On July 6th, the Massachusetts Department of Public Health (DPH) updated the Comprehensive Personal Protective Equipment (PPE) Guidance based on CDC recommendations to clarify the PPE that health care personnel (HCP) use in a clinical care area, especially during this time when providers are trying to optimize PPE supplies. Although this guidance is specifically written for health facility use, there are some best practices that may be helpful for home health agencies when reviewing and updating their protocols.
In this updated guidance DPH has adopted a universal facemask use policy for health care personnel, to use at all times when in the clinical setting. Facemasks are defined as surgical or procedure masks worn to protect the mouth/nose against infectious materials. Homemade and cloth facemasks are not considered PPE. Their capability to protect HCP has not been demonstrated and they have not been shown to be effective in preventing transmission of illness.
DPH also updated the guidance regarding the use of KN95 respirators to be consistent with the Food and Drug Administration (FDA) update to the Non-NIOSH Approved Respirator Emergency Use Authorization (EUA) concerning non-NIOSH-approved respirators that have been approved in other countries. Consistent with the FDA’s updated EUA, KN95 respirators may be considered for use as a substitute for N95 respirators only if:
N95 respirators are not available, and
The KN95 respirators have been tested for filtration effectiveness, and
The use of KN95 respirators has been approved by your organization.
If a N95 respirator or equivalent is not available, a facemask should be used.
For more details on optimizing PPE refer to the updated guidance.