Key Home Health and Hospice Provisions Included in Health Reform

March 26, 2010

With all the changes through the process, it was difficult at times to keep up with the provisions of national health reform that applied to home health and hospice.

Luckily, the National Association for Home Care & Hospice (NAHC) has released the key provisions for both home health care and hospice, and included the general employer requirements.

For more information, see HCA’s other blog posts on what the house passed and the House “reconciliation” summary, or type “health reform” into the blog’s search feature.

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Elder Affairs Releases Nine Principles for Aging Well

March 24, 2010

At an event held at UMass Boston with Governor Deval Patrick, Executive Office of Elder Affairs Secretary Ann Hartstein released the “Nine Principles for Aging Well.”

The Home Care Alliance, as part of the Elder Stakeholders group that regularly meets with AARP and Secretary Hartstein, assisted in the formation of these principles, which includes:

  • To have access to affordable long-term services and supports that can sustain individuals in the setting of their choice, including a consumer’s full participation in managing services.
  • To lend meaningful support to caregivers to preserve the beneficial impact caregiving has upon the caregiver, the person depending upon them and society at large.

These principles will be used to guide Elder Affairs and the Governor as they move forward with an aging agenda for the future (Click on the above image for a larger view).

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Health Care Reform and Home Care: What We Know Today

March 23, 2010

On Sunday, March 21st the US House of Representatives passed historic Health Care Reform Legislation.   The bill that passed is that which emerged from the Senate Finance Committee and that passed the Senate at the end of 2009.   As has previously been reported,  the Senate version of reform has been – for home care – less damaging than bills that had previously passed the House. While indications are that there may be some changes to Medicare provisions in the “reconciliation” bill being debated this week in the Senate, there is no indication that there will be changes to the home care language.  What we should expect for home care will be:

• A delayed and phased approach to rebasing of home health payments (rebasing would begin in 2014 and be phased in over four years, as compared with the House’s proposal of complete rebasing in 2011);

• Rejection of the Medicare Payment Advisory Commission’s proposed acceleration to 2010 of the 2011 case-mix creep adjustment;

• Preservation of the full market basket update for 2010, with 1 percentage point reductions off the market basket in 2011, 2012, and 2013

• Reinstatement of the rural payment differential (add-on) at 3 percent from April 1, 2010 until Jan. 2, 2016.

The federal long term care program – the CLASS act – is in,  as are demonstration and pilot programs for providing chronic care management, transitions in care, and post-acute care management.  All of these should involve home care.

Additionally, effective in 2014, employers of more than 50 people will be required either to provide coverage or pay a penalty for not offering health insurance to employees. (It is unclear at this point how federal insurance mandates will be handled in relation to the Massachusetts mandates already in place.)

The National Association for Home Care has called the bill “a combination of new opportunities for home care — and threats to the viability of the home health services community.”

With many of the home care cuts  delayed, and demonstration projects to help shape, we will need every voice in Washington to make sure our issues continue to be heard above the continuing health care reform roar.

Health Reform Reconciliation Summary

March 19, 2010

With a historic vote set for this weekend where the US House of Representative will vote on the Senate’s health reform proposal, there will again be changes to what may eventually be the final package.

In addition, there will be a House supplement or reconciliation bill with provisions from the House proposal. For more information, see the House Committee on Rules Section-by-Section summary of The Health Care & Education Affordability Reconciliation Act of 2010.

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Revised Regulations and Billing Guide for MassHealth Hospice

March 19, 2010

MassHealth has revised their hospice regulations to reflect changes in CMS hospice rules. The new rules require hospice providers to coordinate their hospice services with the Medicaid personal care benefit, as appropriate. MassHealth members no longer have to waive their PCA services if they elect the hospice benefit.

Also, physicians signing the hospice certification statement will be required to personally compose a narrative explaining the clinical findings that support life expectancy of six months or less.

MassHealth has also revised the billing guide for the UB-04 which is posted on the MassHealth website.

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What’s Next for Health Care Reform in Massachusetts?

March 16, 2010

Three days of hearings by the Mass Division of Health Care Finance & Policy (DHCFP) on Health Care Cost Trends in Massachusetts started with a bang as the Attorney General of Massachusetts Martha Coakley released and testified on a report from her office detailing how clout and market share and not quality contribute to wide variation in reimbursement and drive prices up in Massachusetts.

Also being considered and discussed by state officials are data on payment variation submitted by insurers – such as these from Harvard Pilgrim Health Care, which also appeared in the Boston Globe.

At stake in the discussions are some very immediate proposals by the Governor to expand the authority of the state’s Division of Insurance to approve or deny health insurance premium increases.  Longer term, these hearings are about degree of regulatory oversight of premium and rate setting, urgency and viability of global payments and/or systemic payment reform and ultimately, perhaps, the success or failure of the Massachusetts  universal health insurance law.

For those who are interested in what may shape health care reform in Massachusetts for the near future, the event is available through Live Streaming:

Or view the powerpoint presentations as they are posted at DHCFP website.

Otherwise stay tuned.

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Alliance Board Approves ACO Position

March 12, 2010

The Home Care Alliance Board of Directors approved an official position for the organization on Accountable Care Organizations, including guiding principles that the home care industry would like to see included as payment reform moves closer to a reality.

To support a care model that is appropriately inclusive of a robust community health care network, the Home Care Alliance of Massachusetts believes that the Accountable Care Organization design must:

•    Recognize the value of true clinical integration between acute and post acute care

•    Consider carefully the current composition of the home health care industry, their unique patterns of care delivery  and their dual role as providers of both post acute services and (Medicaid) long term care, and

•    Include in the infrastructure design some explicit direction on the use of home health services that supports inclusion of existing quality providers and avoids unintentional development by ACOs of duplicative community care services.

Download the ACO position document for more information and contact the Alliance with any questions or comments.

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