Senate Passes $32.4 Billion Budget with Telehealth Reimbursement

Building off the success of getting a telehealth amendment in the Senate’s Health Care Payment Reform bill, the Home Care Alliance earned a victory with the Senate also passing a telehealth amendment during their budget deliberations.

The amendment establishes MassHealth reimbursement for telehealth services provided by home health agencies through regulations that have yet to be determined. The next step for the initiative, though, is to get through a conference committee where the House and Senate meet to hammer out the differences in their separate budget proposals. That final product is then sent to the Governor for his approval.

The Alliance will have new advocacy messages available on the Legislative Action Center once the legislature’s budget conference committee is named.

The Alliance’s other priorities pertaining to Certificate of Need, home health nursing rates past 60 days of care, and relative to pediatric home care were not passed, although the certificate of need issue is seeing increased interest. This and the passage of telehealth owe credit to the hundreds of emails sent out by HCA members and advocates through the Legislative Action Center.

The other major item that the Senate approved was the Human Service Salary Reserve worth $20 million. This account to provide a slight increase in pay for 31,500 human service workers in the state was not approved by the House and will be a huge bargaining chip in conference committee negotiations. If passed, the increase in pay would amount to about $12 per week, per worker.

Other amendments of note that passed the Senate budget include a special commission to study causes, prevention and treatment strategies pertaining to Chronic Obstructive Pulmonary Disorder (COPD). This would present an opportunity for home care to promote their chronic disease management programs and telehealth services. Also passed was an amendment that would create an advisory committee on long-term services and supports. If passed in the state’s final budget, home care agencies would have a chance to be on the committee or at least to submit data and recommendations.

Finally, other rejected amendments from the Senate included items from the state’s Home Care Program from the Executive Office of Elder Affairs that funds the ASAP programs. Specifically, the amendments for Home Care Purchased Services, Enhanced Community Options, and Case Management were all denied.

Return to

Advocacy Alert: Contact Your State Senator to Support Home Care in the FY13 Budget

The Massachusetts senate is set to debate what will become their version of the state’s FY13 budget this week. Several senators have filed amendments to the budget proposal on behalf of the Home Care Alliance that reflect industry priorities and agency members and advocates are encouraged to contact their senator to urge their support.

Below are prepared emails that can be sent simply by clicking the issue of concern, filling out the contact information form, reviewing the message and clicking “send.” Fact sheets are available by clicking the “read about this issue” link below each heading.

Support Certificate of Need for Home Care in FY13 Budget
Support Telehealth in the FY13 Budget
Please Support Home Health Rates in the FY13 Budget
Support Pediatric Home Care in the FY13 Budget

Senate offices can also be contacted by phone and a listing of each senator is available here. For those who are unsure who represents them in the senate, go to and type in your address.

When calling, ask that they support the following amendments (mention the amendment number, name, and who sponsored the amendment).

# 559               Certificate of Need                                          Offered by Sen. Michael Moore

  • Massachusetts is one of five states without either licensure or a CON requirement for home care and the proper oversight will ensure a level of quality assurance for patients without adding cost to the Commonwealth.

# 692               Telehealth Reimbursement                              Offered by Sen. Richard Moore

  • Instructing MassHealth to reimburse home health care providers for telehealth remote patient monitoring would save costs by not having to pay for unnecessary nursing visits, is used in many other states, and the service is reimbursed by Medicare.

# 554               Home Health Rates                                        Offered by Sen. Michael Moore

  • The MassHealth home health payment rate was cut by 20 percent to patients receiving skilled nursing care past 60 days of care in December of 2008. This amendment would restore that rate and would strengthen agencies that keep at-risk MassHealth clients out of costlier settings.

# 682               Pediatric Home Care Services             Offered by Sen. Thomas Kennedy

  • This amendment does not increase any rate, but merely shifts existing payment recognizing a home health agency’s administrative requirements over independent nurses who have no such requirements.

Return to

Guest Post: Fraud and Abuse Tied to MD Face-to-Face Encounters

The following is a guest blog post on fraud and abuse issues by Robert W. Markette, Jr., CHC, Of Counsel for
Benesch Friedlander Coplan & Aronoff LLP. Mr. Markette’s primary areas of practice are health law and litigation and his wide range of health care clients includes home health, hospice and private duty providers.

Mr. Markette is also responsible for assisting the Home Care Alliance with its “Keeping it Legal in Home Care” resources on patient choice.

To view the entire article, click the link after the introduction:

As home health and hospice care continue to become more and more competitive and reimbursement continues to decline, referral sources are discovering new ways to leverage this for their own benefit. Two new examples include physicians requesting “administrative fees” to complete face to face paperwork and referral sources seeking “donations” from providers to defray the cost of capital equipment and other improvements. Providers need to understand the risks in these arrangements in order to avoid entering into arrangements that place them in violation of the Anti-Kickback Statute and/or the Stark Law.

The entire article from Mr. Markette is available here.


Return to

HCA Succeeds with Amendments to Senate Health Care Payment Reform Bill

The Massachusetts Senate spent the past week debating their landmark health care payment reform proposal, which included 265 amendments that were filed after Senate leadership released the bill to all Senators and the general public.

The Home Care Alliance worked to have several amendments filed and advocated for other amendments that were seen as beneficial.

The Alliance saw victories in the adoption of the following amendments:

  • Amendment #43, which instructs insurers to cover telemedicine.
  • Amendment #13, which allows employers to count a spouse or parent’s insurance coverage to qualify their employee under the state’s “fair share contribution” regulation.
  • Amendment # 223, which adds community-based behavioral providers to the e-Health Institute’s spectrum of care.
  • Amendment # 121, which requires hospitals, nursing homes, and assisted living facilities to provide appropriate patients with information regarding the availability of palliative care and end-of-life options.
  • An amendment installing a representative of a certified home care agency on an e-Health Commission.

The focus on health care payment reform will move to the House although the timing on that debate and process has not yet been formally announced. Stay tuned to our UPDATE newsletter and the HCA blog for the latest information. If members or advocates have any questions related to payment reform, please contact James Fuccione at the Alliance.

Return to

Health Care Market Reform Is Advancing – What Does it Mean?

All three branches of government, the Governor’s office, the State Senate and the House of Representatives have all now weighed in with versions of health care marketplace reform.  Even with little time left on the legislative calendar and a state budget to craft, there seems no doubt that something will pass, perhaps quickly and with limited public input beyond what was provided to legislatures in the bill crafting stages.

All of the bills are about market and delivery system reform, with a strong emphasis on health care economics, payment reform at a very global letter and physician practice issues (medical homes, tort reform).  There is very little in either bill about specific sectors beyond hospitals and physicians.  In each bill there are limited mentions of “downstream” providers such as home health, hospice or adult day health.  Workforce training has some prominence in both legislative branch proposals, as does Health IT (with home care a named recipient of possible funds).  WBUR’s Commonhealth blog has a concise summary of the legislative proposals.

Where does this leave the debate and what does it mean for home health? At a very macro level, the Home Care Alliance has been working with a Coalition or providers and insurers on some principles to achieve sustainable reform without enormous disruption.   The Coalition position is that any law must balance the need to reduce costs with a recognition that the health care sector is a key part of the state’s economy and that any measure must not lead to excessive reduction of jobs.

The Coalition is looking to support a bill that:  1) includes a voluntary (rather than mandatory) transition to integrated, globally paid systems; 2) preserves some fee-for-service payment where it makes sense in the market; and 3) includes a reasonable and attainable spending growth target, which the Coalition put at getting total health spending to 1% above the states Potential Gross State Product (PGSP) within three years and to even with  PSGP within five years.  By contrast the House and Senate bills call for a more aggressive glide path for health care spending, with the House looking at limiting growth to one half percent below PSGP.   At a breakfast meeting with the Boston Chamber of Commerce this week,  the governor indicated some support for the Coalition’s spending targets and voluntary transition process.

In terms of home care and hospice, it is clear that all bills envision a more integrated and accountable approach to care delivery.  From what we have seen and heard relative to integration efforts that are already moving  forward (Pioneer ACOs, medical homes),  hospital utilization is targeted to go down and more care will be delivered in the home, both traditional home care/hospice and new chronic,  palliative, and care transitions services.  The goal is to be sure that these services are provided by the entities in this state that have the skills and experience to do it correctly.

However, the message from legislators is that much of what home care and hospice needs to do to ensure this may lie less in legislative language and more in market visibility:  in having confidence in what we do,  in being able to be more nimble pricing, and in demonstrating our effectiveness in reducing health care costs and delivering on quality.

The Alliance is supporting – beyond the Coalition principles above – reform language that would make more specific the language that exists in each bill about including home care services in integrated systems ACOs (Beacon ACOs, as the Senate bill calls them) and assuring our representation on certain governing task forces, such as that which will allocate state IT funds.

At the same time, we are also seeking to protect home cares services in the dual eligible demonstration and have invited Attorney General Martha Coakley’s office to our Annual Meeting to be sure that her efforts at looking the balance or imbalance in market power includes more than hospitals.  We have published and  made available to all provider groups and members a brochure on Home Care Role in a Global Payment Model.

Both our Board and our Legislative Committee are engaged in these efforts, but we need and welcome more member feedback about how we can continue to refine and advocate for a common industry position that assures home care a central role in the next chapter of healthcare reform.

State Budget Update: Senate Ways and Means Releases Proposal for Debate

The Senate Committee on Ways and Means released their recommendations for the state’s fiscal year 2013 budget. The full 40-member Senate will introduce amendments by the end of this week and will debate the proposal beginning next week. Here are some of the highlights concerning home care:

MassHealth Line Items:

  • The MassHealth Managed Care account (line item 4000-0500) dips $6 million below what the House approved in their version at $4.158 billion.
  • The MassHealth Senior Care account (line item 4000-0600) comes in at $7,230,000 below what the House proposed at $2.756 billion.
  • The MassHealth Fee-for-Service Payments account (4000-0700) saw a bigger slash from the House version of $26.8 million, coming in at $1.927 billion.

Elder Affairs/State Home Care Program Line Items:

  • Elder Enhanced Home Care Services (9110-1500) saw a decrease from the House version of $1,327,853 set at $46.4 million.
  • The Home Care Purchased Services account (9110-1630) was also set below the House’s budget version by $497,837 at a total of $97.2 million.
  • The Elder Nutrition account (9110-1900) does not match the House’s version, but still restores a cut to that program made by the Governor. The Senate Ways and Means version is set at $6.325 million.

In summary, the Senate Ways and Means budget proposal chips down all MassHealth and Elder Affairs line items. These amounts may be restored at least partially after the full Senate concludes their debate and also following when the Senate and House name members to a conference committee to work out differences between the two budgets.

The Home Care Alliance will continue to advocate for a MassHealth nursing rate increase, Certificate of Need, Telehealth, and strengthening pediatric home care services.

Check back to the blog to find out how you can support HCA’s budget priorities.

Return to

Wage & Hour Legal Memorandum; Briefings Scheduled for Alliance Members

Over the past months, the Alliance’s Private Care Advisory Committee has held a series of discussions with employment law attorney Allyson Kurker regarding Massachusetts wage & hour laws as they relate to home care agencies and workers.  A labor law attorney with significant experience advising home care agencies, Ms Kurker has researched the broad range of questions raised during those discussions and has prepared a Legal Memorandum on Wage and Hour Issues especially for Alliance members.

The memorandum covers several topics of interest to certified and private care agencies alike, including record keeping and payroll, overtime, exempt vs. non-exempt employees, working time, and issues specific to live-in caregivers.  The Memorandum is posted to the MA Regulatory page of the Alliance’s website (link is at the bottom right).

The Alliance will host two free member forums this month during which Ms Kurker will present the substance of the memorandum and address additional questions from the Alliance membership.   Agency CEOs and HR specialists are especially encouraged to attend one of the sessions:  Tuesday, May 22, at Great To Be Home Care, 2024 Westover Road, Chicopee, or Thursday, May 24, at CareWell Health Group, 141 Longwater Drive, Norwell.

Both sessions will include a continental networking breakfast at 8:30 followed by an Alliance Update presented by Alliance Executive Director Patricia Kelleher at 9:15, and the Wage & Hour presentation at 9:30.

The sessions are open to Alliance members only.  Pre-registration is required by calling Stephanie Drakes at 617/482-8830.