Comments Due on Dual Eligible Services Proposal

MassHealth’s final proposal for a State Demonstration to Integrate Care for Dual Eligible Individuals was submitted to CMS on February 16, 2012.  The final Demonstration Proposal and accompanying documents are listed on the demonstration’s webpage.

CMS is seeking public comment through a 30-day notice period.  During this time interested individuals or groups may submit comments to help inform CMS’ review of the proposal.   To be assured consideration, please submit comments by 5 p.m. EST, March 19. You may submit comments on this proposal to

The Home Care Alliance has offered formal suggestions prior to MassHealth’s submission of the proposal to CMS and will be submitting comments at this stage as well.  Any members interested in commenting can contact James Fuccione at the Alliance for guidance.

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US House/Senate Approaching Deal on Delaying Physician Cuts, Payroll Tax

House and Senate leaders have agreed on legislation to be voted on by their respective colleagues that delays a cut to Medicare fees to physicians.

By passing that legislation, physicians will avoid a 27 percent cut for another 10 months, the payroll tax holiday will be extended for one year, and unemployment insurance will be extended. According to the National Association for Home Care & Hospice, the physician fix has to be offset, but the proposal does not include any cuts to home care or hospice and does not include any home care copay.

What it does include is cutting Medicare bad debt payments for hospitals and nursing homes by about $6.9 billion over ten years; cutting clinical lab payments by $2.7 billion; rebasing Medicaid Disproportionate Share Hospital payments to save more than $4 billion; cutting the Affordable Care Act (ACA) prevention fund by $5 billion; and eliminating extra federal money provided by the ACA to Louisiana Medicaid, saving $2.5 billion.

As reported in a previous newsfeed post, the President’s proposed budget does include home care cuts and copays, which, if approved, would come on top of scheduled cuts from the affordable care act and a 2% cut from the federal budget sequestration process.

Both the House and Senate are expected to pass the deal today (Friday, February 17) and the President will sign the bill into law as soon as it reaches his desk.

For more information on the “physician fix” and payroll tax legislation, see stories from the Associated PressCNN, and USA Today.

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President Obama Releases Budget with Copays and Payment Impact for Home Care

President Barack Obama released his proposal for the Fiscal Year 2013 Federal Budget with a scaled back version of copayments for home health care as well as payment adjustments for all post-acute providers.

According to the President’s proposal, a home health copayment of $100 per home health episode would be established and would be applicable for episodes with five or more visits not preceded by a hospital or other inpatient post-acute care stay. This, the budget narrative continues, would ap­ply to new beneficiaries beginning in 2017. The President’s budget notes that this is consistent with a MedPAC recom­mendation to establish a per episode copayment, although MedPAC had recommended a more severe copayment of $150 per episode.

MedPAC’s recommnedation cited by the President’s budget team noted that “beneficiaries without a prior hospitalization account for a rising share of epi­sodes” and that “adding beneficiary cost sharing for home health care could be an additional mea­sure to encourage appropriate use of home health services.” This proposal is estimated to save approximately $350 million over 10 years.

According to the National Association for Home Care & Hospice (NAHC), the President’s Budget also includes a reduced Market Basket Index (inflation) update from 2014 to 2021. The proposed update reductions of 1.1 percentage points each year affect all post-acute providers. These reductions, NAHC states, would be in addition to the 2014 home health rate rebasing and the productivity adjustments starting in 2015. The President estimates this measure will save $63 billion over ten years taking into account the other adjustments for all post acute providers.

Additionally, the Independent Payment Advisory Board (IPAB), which was initially established in the Affordable Care Act, will be strengthened under the President’s budget proposal. The group is charged with keeping Medicare solvent by enacting cost-saving measures if Medicare spending exceeds certain levels. The President’s proposal essentially lowers those spending triggers.

The budget blueprint touts some of the fraud and abuse crackdown and prevention achievements the administration has made and advances suggestions for furthering that effort:

  • Cre­ate new initiatives to reduce improper payments in Medicare;
  • Dedicate penalties for failure to use electronic health records toward deficit reduction;
  • Update Medicare payments to more appropriately account for utilization of advanced imaging;
  • Re­quire prior authorization for advanced imaging;
  • Direct States to track high prescribers and utiliz­ers of prescription drugs in Medicaid to identify aberrant billing and prescribing patterns; and af­firm Medicaid’s position as a payer of last resort by removing exceptions to the requirement that State Medicaid agencies reject medical claims when another entity is legally liable to pay the claim.
  • Alleviate State program integrity reporting requirements by consolidating redundant error rate measure­ment programs to create a streamlined audit program with meaningful outcomes, while main­taining the Federal and State’s government abil­ity to identify and address improper Medicaid payments.

Finally, the President’s budget makes a commitment to follow through on the Department of Labor’s proposed rule on removing the so-called “companionship exemption” for allowing overtime and minimum wage protections.

For more information, view the President’s budget proposal here.

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Partnership for Patients Introduces Patient Safety Webinar Series

The Partnership for Patients and the National Priorities Partnership are promoting a free webinar series to help advance patient safety practices and improve both the partnerships between health care providers and the processes within organizations.

The first two webinars are titled “Creating and Sustaining Successful Partnerships between Hospitals and Community Organizations” and “Using Tools to Enable Rapid Cycle Improvement within Your Organization,” which are taking place on February 15th and 23rd, respectively. Visit the webinar series website to sign up.

Also, check out the Home Care Alliance’s calendar of events to find upcoming webinars and teleconferences.

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State Plan for Alzheimer’s Announced at Advocacy Event

The Home Care Alliance and member agencies supported the Alzheimer’s Association’s Advocacy Day on Tuesday at the Grand Staircase of the State House where Secretary of Elder Affairs Ann Hartstein announced the release of the “Massachusetts Alzheimer’s Disease and Related Disorders State Plan.”

HCA Executive Director Pat Kelleher was a steering committee member and chaired a work group that focused on “access to services,” which was instrumental in forming recommendations in the plan. The state will use the recommendations as a guide for taking steps to improve care and access to Alzheimer’s care.

Other speakers at Alzheimer’s Advocacy Day included State Senator Patricia Jehlen, State Representative Alice Wolf, and Dr. Allen Krieger from MIT who has early stage Alzheimer’s. A video of Dr. Krieger’s speech about dealing with the condition is posted on HCA’s YouTube page.

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ABI Waiver Unit Shares Information for Home Care Agencies

As mentioned in a previous newsfeed post, MassHealth is soliciting services for a new waiver to care for individuals with Acquired Brain Injury in the community.

The ABI Waiver Unit at UMass Medical, which is the entity in charge of managing the waiver and disseminating related information, has released three documents (see below) to assist interested home care agencies in learning more and applying for waiver participation. The ABI Waiver Unit has indicated that they are specifically seeking speech, occupational and physical therapy services in the home.

  • ABI Description – One page summary of the state agencies and their roles in the implementation of the ABI Waivers
  • 2012 Technical Assistance Schedule – Statewide information sessions held to provide potential providers the opportunity to learn more about the Provider Enrollment Process
  • Credentialing Supplement – Outlines the submission requirements and the service specific submission requirements and defines the service expectations.

To RSVP for any of the technical assistance sessions, or to ask for more information, contact or call the UMass ABI Waiver Unit at 866-281-5602.

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State Seeking Providers to Enroll in Community Based Service Waiver for Persons with Acquired Brain Injury

MassHealth, The Massachusetts Rehab Commission and UMass Medical School’s Acquired Brain Injury Unit are seeking service providers who work with individuals with Acquired Brain Injury (ABI) that reside in the community.

Two home and community-based services waivers, which MassHealth anticipates will serve 300 people over three years, are available for persons with ABI. These waivers, listed below, could help Medicaid-eligible persons with ABI move to the community from a nursing facility or chronic or rehabilitation hospital and get community-based services.

  • ABI Waiver with Residential Habilitation (ABI-RH) – This waiver is for individuals who need service in a provider-operated residence that has supervision and staffing 24 hours a day, seven days a week.
  • ABI Waiver with No Residential Habilitation (ABI-N) This waiver is for individuals who can move to their own home or apartment or to the home of someone else.

All waiver participants will work with a case manager to develop a service plan that will reflect the waiver services and support they need in the community.

Services available in the ABI waivers include:

  • day services;
  • supported employment;
  • transportation;
  • community-based substance abuse treatment;
  • occupational, physical, or speech therapy;
  • specialized medical equipment;
  • homemaker;
  • personal care;
  • adult companion;
  • chore;
  • home-accessibility adaptations;
  • individual support and community habilitation; and
  • respite.

Additional ABI waiver services that will be contracted through MRC include:

  • Residential habilitation services; and
  • Transitional assistance services.

MassHealth regulations and provider enrollment forms are available here.

Also, UMass Medical School will be holding a series of technical assistance sessions to provide an overview of the waivers and services offered as well as an in-depth review of the application forms and submission requirements. The schedule for those sessions is below, and RSVP’s or questions can be sent to or by calling 866-281-5602.







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