House Ways and Means Chair Seeking Public Feedback on Medicare Reform Proposals

House Ways and Means Committee Chairman Dave Camp (R-MI) released draft legislation that would seriously change the benefit structure of Medicare. Proposals included in the draft legislation range from increasing the Medicare Part B deductible for new enrollees to increasing income-related premiums under Parts B & D. Of greatest concern to home care and its members is the suggested implementation of a home health copay. The home health copay proposal in the draft legislation was also included in the President’s FY14 budget. It would impose a $100 copay on home health episodes not preceded by a hospital or nursing home stay, beginning in 2017 and applying to those who become newly eligible for Medicare in 2017 or later.

The Home Care Alliance joins the National Association for Home Care & Hospice (NAHC)  in opposition to shifting additional costs onto Medicare home health beneficiaries in the form of more out of pocket expense. With respect to the proposed home health copayment, Congress eliminated such a “sick tax” on beneficiaries back in the 1970s when it was found that such copayments were ineffective at saving the Medicare program money, as people had to seek more costly care options. Home health copayments would be just as harmful – if not more so – today with a rise in the number of beneficiaries needing home health services as Baby Boomers start to retire. If reinstated, the Medicare home health copayment will likely lead to more people seeking care in much more costly care settings such as hospitals, nursing homes and emergency rooms.

Alliance members are encourage to submit comments to the Ways and Means Committee in opposition to a copayment via email to by August 16, 2013.

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State Seeks Waiver from Three-Day Rule

With the input of several health care provider groups, including the Home Care Alliance, the state sent a letter on July 23rd to CMS Administrator Marilyn Tavenner officially requesting a waiver from the so-called “three-day rule.”

The rule refers to Medicare’s requirement that post-hospital extended care services in a skilled nursing facility are not allowed unless they are preceded by a hospital inpatient stay lasting three consecutive days. The Home Care Alliance joined other groups like Mass. Hospital Association, Mass. Senior Care Association, Mass. Medical Society and others in voicing support for such a waiver in multiple stakeholder meetings.

The idea is that patients can be properly directed to skilled nursing facility care and/or home health services, but eventually and ideally transitioning back into the community. All the while, patients would receive an appropriate level of care and avoid unnecessary hospitalizations.

The state’s Executive Office of Health and Human Services asks that the waiver include Medicare Fee-for-Service patients and last for three to five years.

The Home Care Alliance will continue to monitor the state’s request and provide updates.

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Proposed PPS Rule for Home Care and a Call to Action

In the July 3rd Federal Register, The Centers for Medicare and Medicaid Services (CMS) released the proposed Medicare Home Health Rule for 2014.  A key provision of this rule is the first year of a multi-year planned adjustment of home health prospective payment rates, otherwise known as “rebasing”.

The directive to rebase the home health PPS rates comes from language in the Affordable Care of 2010 that was a reaction to multiple years of MEDPAC Reports to Congress calling for dramatic steps to reform the home health payment system, which they claim have widely exceeded  program costs almost from the 2001 launch of the current PPS system.

Starting with 2014 rule and going forward through 2017, CMS plans to impose a 3.5% rebasing adjustment to the home health base rate.  This 3.5% reduction is based on CMS’ projection of an average home health profit margin of 13.63% in 2013 (calculated from 2011 data trended forward as the difference between the average national episode revenue in home health and the average national episode cost). The 2014 rule does include a 2.4% market basket update as well.

The phase-in of this rebasing cut and the inclusion of a market basket update is in conflict with what MEDPAC had recommended to Congress (no update and deeper and faster rebasing cuts) and is direct result of industry advocacy form these mitigating factors during the ACA debate.

Now, that type of industry advocacy is needed once again.  While eliminating any rebasing cut may well be impossible, it is possible that with strong Congressional support, we can challenge the CMS calculation and achieve some decrease in the 2014 cut.   Particularly subject to challenge is CMS’ calculation of industry profit margins from which the rebasing number are derived.

We also know the following about CMS’ calculations on profit margins:

  • Only freestanding and not hospital base agency cost reports are considered
  • They are at odds with what MEDPAC’s and NAHC’s numbers show
  • They may fail to adequately capture industry costs around mandates such as the Face to Face requirement, the ICD-10 implementation and investments in electronic health records .

The Alliance believes that we can make a strong case to Congress, but we need members to be engaged as advocates and as sources of information for us.

Please use the questions below as a guide to provide information on the anticipated impact of the CMS Proposed Rule by Friday, July 26th at 12pm. Alliance staff is traveling to Washington DC to meet with members of congress and the national associations, so please have information in ASAP:

  • What is the impact on your agency’s bottom line (in dollar amount and percent loss)?
  • What is the impact on staff, including reducing staff time, cutting jobs, or halting new hires?
  • Do you anticipate cutting or reducing service lines, particularly MassHealth/Medicaid?
  • What is the impact on innovative service lines, like hospital readmission, dementia, chronic disease management, falls prevention and etc?
  • How will the proposed rule affect other ways your agency does business?

Answers to the above can be emailed to James Fuccione at the Alliance

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New OASIS Q&As Released

The July Q&As are here!

CMS has just released the latest guidance for OASIS, July 2013 Quarterly Q&As.  This quarterly update contains 16 new question and answers including guidance related to:

  • Observation stays-When a patient is in observation status at a hospital past day 60 of the current episode, treat this event as a missed recertification and complete the recertification as soon as possible after the patient returns home
  • M1055- clarifying the response if an agency does not immunize patients
  • Clarification to multiple questions related to pressure ulcers and surgical wounds
  • Clarifying time frames in multiple M-items
    • M1240- time frame used to assess pain,
    • M1620 time frame when to assess bowel incontinence and
    • Clarification to M1242, Response 4 – “All the time”
  • Timely resumption of care (ROC)-when a ROC OASIS is done outside the required 48-hour time frame, clinicians must answer “no” to several best practice questions:
    • M1240 (Pain assessment),
    • M1300 (Pressure ulcer risk assessment),
    •  M1730 (Depression screening),
    •  M1910 (Falls risk assessment) and
    • M2250 (Plan of care synopsis).-if a best practice listed under M2250 is not applicable to the patient, answer “NA.”

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New Web Resource on Hospital Quality Adds Home Health Data

A collaborative effort of three leading healthcare trade associations has brought a new, first-in-the-nation website for consumers to find quality data on the state’s hospitals and, more recently, federally-certified home health agencies.

The Massachusetts Hospital Association, the Home Care Alliance of Massachusetts and the Organization on Nurse Leaders of Massachusetts and Rhode Island have teamed up to build the website called PatientCareLink. The site aims to deliver transparent quality and safety information from hospitals and home care agencies to patients and other healthcare stakeholders.

The data itself is drawn directly from the Medicare Home Health Compare website and is updated regularly. An alphabetical list of agencies is presented and each agency has their contact information and website included with selected quality measures that are compared to the national average for home health agencies.

The Alliance invites all to browse through the website, which will be continually promoted and improved, and see the website’s introductory video above with HCA’s Executive Director Patricia Kelleher.

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Budget Passes With Telehealth, Pediatric Palliative Care Funding

After years of advocacy and passing budget items with weak language that did not compel MassHealth to act, the Governor signed off on the $33.6 billion FY2014 state budget with a provision that recognizes home telehealth as a reimbursable service.

There is still plenty of work to be done with MassHealth, but passing the telehealth language in the budget is the furthest the Home Care Alliance has gone towards achieving reimbursement for an established service known to create efficiencies, improve care, and reduce costs.

The Alliance will be including a push for telehealth in comments on the state’s proposed home health regulation changes. Any agencies or advocates interested in commenting with HCA in an attempt to have the state include telehealth reimbursement in regulation to ensure its permanence should have a letter in to MassHealth by the July 26th deadline. Agencies can contact James Fuccione at the Alliance for details.

Also included in the the final budget is $1.5 million for the Pediatric Palliative Care Network, which serves the unmet physical, emotional, social and spiritual needs of children in Massachusetts with life-limiting illnesses. This is more than $670,000 of additional funding over previous budgets.

The Alliance would like to thank all the agencies and advocates who sent emails, made phone calls, met with legislators and otherwise supported telehealth and the pediatric palliative care funding. These items passing in the final budget represent a huge victory for home care and prove that persistent advocacy pays off.

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Alzheimer’s Association Holding Training for Direct Care Staff

The Massachusetts/New Hampshire Chapter of the Alzheimer’s Association is hosting a series of educational seminars for direct care staff and the Home Care Alliance encourages those interested to participate.

The format is a train the trainer model created to prepare attendees, already familiar with Alzheimer’s and dementia care, to train direct care staff in a wide array of care settings, including home care.

Here are the details:

Caring for People with Alzheimer’s Disease: A Habilitation Training Curriculum Date of next Training:

Tuesday, August 6, 2013

Alzheimer’s Association, 480 Pleasant Street, Watertown, MA 02472

The curriculum is a train the trainer model created to prepare attendees, already familiar with Alzheimer’s and dementia care, to train direct care staff in a wide array of care settings. The 7 hour training teaches attendees the 13 hour curriculum in best Habilitation Therapy practices. Modules include a PowerPoint presentation, discussion activities, lecture, and demonstration, role-play and group work. Continue reading “Alzheimer’s Association Holding Training for Direct Care Staff”