Cong Markey Briefs Health Care On Debt Ceiling Discussions

Yesterday, Congressman Edward Markey conducted a briefing for members  of the health care and health research communities on the debt ceiling discussions and the possible impact on these sectors going forward.   Although the Super Committee has received a significant amount of the attention, the debt discussions will actually occur in three steps.

The first step will include a cut of $900 billion. These cuts must be effective on 10/1/2011. Medicare and Medicaid cannot be included in this first cut, but all other federal spending including defense and non defense can be considered.

Step 2 is the Super Committee, comprised of six Senators and Representatives. The budget target for this Committee is $1.2 trillion.  Their work must be done by Sept 23rd and if recommendations are made, must be voted on by Dec 23rd.  The bring a proposal forward will require 7 or the 12 votes.  In Senate, a simple majority vote will be needed to pass.

According to Markey, this group “will go from 0 to 60 miles per hour” to meet the September 23 deadline and for this group “everything is on the table.”    This group has broad latitude to propose changes in benefits or  program design in terms of federal entitlements, including Medicare and Medicaid benefits and program design;  eligibility and contributions to Social Security;  defense spending, tax rates, “loopholes”  and contributions, etc.  Markey indicated that all of the Republican appointees have pledged to support no new revenues, which will make this Committee’s work more difficult.

Should the Super Committee not reach consensus, the process will move to Step 3, which would be a an automatic cut on 10/1/13 of $1.2 trillion in spending, 50% of which would come from “security” and 50% from non security spending.  Under this scenario, the sole restriction is that Medicare cuts would be set at 2%.

Congressman Markey engaged the group in discussing:

What is you message to the Super Committee?

What would you recommend that Super Committee members do if there are no revenues and only cuts to achieve the goal?  Is moving to Step 3 preferable to this scenario?

Is a Step 3, i.e. 2% cut in Medicare in Oct 2013 sustainable?

Question to Home Care:   What is your message to Congress on this?

Join Us for Falls Prevention Awareness Day

This year’s Falls Prevention Awareness Day will be taking place from 10:00am to 12:00pm on September 22 in the Great Hall of the Massachusetts State House. The event will feature speeches by State Senator Richard Moore and Executive Office of Elder Affairs Secretary Ann Hartstein.

Once again, clinicians, community activists, state officials and honored guests will gather to raise awareness that falls are both common and costly. Efforts are in place in our state to introduce falls prevention activities across the health care continuum and into the daily lives of older adults. Join the Massachusetts Falls Prevention Coalition and our experts to help prevent falls across all settings. Presentations will be made by the VNA of Boston and other providers with falls prevention programs.

Attendance is free and there is no registration for the event. Simply RSVP to James Fuccione at HCA ( or Alissa Weintraub at Mass Senior Care (

The mission of the Massachusetts Falls Prevention Coalition is to promote healthy lifestyles, behaviors and strategies to reduce the incidence and severity of falls and fall related injuries across the lifespan in Massachusetts.

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State Bill Filed to Expand Hospice Coverage

According to a report by State House News Service, a bill was recently filed by a group of legislators that would expand hospice coverage to about 120,000 more residents on MassHealth.

Senate Bill 1999, An Act extending hospice care to the MassHealth basic and MassHealth essential programs was filed by Senator Patricia Jehlen and seeks what its title states. Hospice coverage, according to State House News, is available to about 1 million MassHealth recipients, but not to roughly 120,000 who are on more restrictive plans known as MassHealth Basic and MassHealth Essential.

The inspiration for this bill comes from a report assembled by the Massachusetts Commission on End-Of-Life Care, which was established by the legislature in 2009 to study issues surrounding end-of-life care and how such care is provided in the state.

The Home Care Alliance applauds the initiative to expand hospice coverage so that people can fulfill their preference to receive end-of-life care in their homes. While approximately 67 percent of Massachusetts residents say they would prefer to die at home, only 24 percent actually do, according to statistics compiled by the commission, the Massachusetts chapter of AARP, and the state Department of Public Health.

The legislation has been referred to the Joint Committee on Health Care Financing and the Alliance will continue to provide updates on this proposal as it becomes available.

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Advocacy Needed During August Recess to Avoid Cuts and Co-Pays

A so-called Debt Reduction Super Committee evolved out of the federal debt ceiling debate and will be charged with reducing the federal deficit over the next ten years.

Although cuts to entitlement programs and home health co-payments are on the table as options, a potential bright spot was reported this week in that US Senator John Kerry (D-MA) is among the members appointed to the Super Committee. Kerry was instrumental in getting cuts to home health reduced as part of health care reform.

Even with the work of Senator Kerry, Medicare home health payments are still taking a $39.7 billion hit over the next ten years. Additionally, CMS is proposing a 5.06% reduction in payments for calendar year 2012. Both of those points need to be raised when this committee considers even deeper cuts that could drastically impact agencies and patients.

Home health co-pays are another option that must be broadly opposed. Seniors could be forced to pay as much as $150 per 60-day episode of home health care, which would only push those who cannot afford it or unwilling to pay into costlier care.

Below are issues and materials that advocates can use to contact the Massachusetts Congressional Delegation, not just during August recess, but as the discussion of the Super Committee progresses. There are also materials and advocacy messages that can be used to urge Congressional support of other home care initiatives.

Advocates should be contacting their Congressperson, as well as Senator Kerry, to ask that they in turn urge the Super Committee to oppose home care cuts and copays.

Home Care Co-Pays & Medicare Cuts:

Support Home Health Access Protection Act:

Support Home Health Planning Improvement Act:

See a list of other issues, talking points, and messages available on the HCA Legislative Action Center. You can also compose your own message here.

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Public Hearing on Temporary Nursing Agency Regulation

The state’s Division of Health Care Finance & Policy (DHCFP) is holding a public hearing and accepting written comments on amendments to regulations regarding temporary nursing services.

According to an official hearing notice, DHCFP is required to review and establish maximum rates that temporary nursing agencies may charge facilities annually. The proposed regulation is estimated to result in an increase of 4.13%, or $2.56 million, in aggregate provider expenditures for temporary nursing services.

It should be noted that eighteen of the 108 nursing facility rates decrease, all in Health Service Area 3 – Merrimack Valley, due to a decrease in the median reimbursement paid to permanent staff at nursing facilities in that region, according to the notice.

The hearing will take place at 10:00am on Wednesday, September 7th at DHCFP Headquarters, located at 2 Boylston St in Boston. For more info on the regulation, visit the regulation page on DHCFP’s website (See or search 114.3 CMR 45.00)

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CMS Responds to Congressional Letter on MD Face-to-Face

Congressman Jim McGovern, along with the rest of the state’s Congressional Delegation, received a response to a letter sent to the Centers for Medicare and Medicaid Services (CMS) that reflected the struggles of home health providers in Massachusetts relative to the physician face-to-face encounter requirement.

Unfortunately, the response from CMS is mostly a reiteration of the reasoning behind the rule and a commitment to monitor the implementation of the policy “to ensure that there are no unintended disruptions in access to medically necessary home health care for our beneficiaries.”

For more on the Physician Face-to-Face Encounter Requirement, see previous posts on the subject.

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ADRs Increasing

Home Care Alliance members are reporting an increase in” additional documentation requests” or ADRs from the fiscal intermediary, NHIC.  Although there does not seem to be a pattern to the diagnoses requested, the majority are LUPAs. Additionally, many are being denied after the initial review and the first appeal.  Members are encouraged to continue the appeal process if you feel your decision has merit.

The fiscal intermediaries are required to do a certain percentage of review and it is usually around 10%.  This is in addition to the TPL process which created a backlog until recently and is why they may be “catching up” to their regular workload.

Members are encouraged to contact Helen Siegel at with appeal results and/or if the number of ADRs seems unusually large.