Conference Committee Budget Includes Telehealth, Homemaker Wage Increase

With the new state fiscal year technically arriving, the legislature’s budget conference committee released their compromise version between the House and Senate funding proposals that comes in at $36.5 billion.

With the delay in negotiations, the legislature recently approved a $4.6 billion budget to fund the government and related services through the end of July. The Governor, meanwhile, will have 10 days to review the conference committee’s budget and send recommended vetoes, which can be overturned with a two-thirds vote in both the House and budget pie chart pic

Among the priority items of the Home Care Alliance and others of benefit and interest is language allowing MassHealth to continue their work on implementing home telehealth service rates and rules. This is the second year in a row that the Alliance has achieved getting language that continues the association’s work with the state on an important service that is currently not reimbursed.

Another major win for home care came with the approval of the Homemaker Wage Increase that will amount to $6.1 million, if the funding makes it through the remainder of the budget process. According to the Home Care Aide Council, this appropriation would provide an annualized wage increase of approximately 75 cents an hour to more than 17,000 homemakers and personal care homemakers.

Among other notable items, the conference committee’s budget accomplishes the following:

  • Funding the “Home and Community-Based Services Policy Lab,” ($250,000) which seeks to study the cost-effectiveness and value of home and community-based care. It is expected that services provided by members of the Home Care Alliance that contract with Aging Service Access Points will be included in an initial phase and other Medicaid and Medicare home health services will be included in subsequent phases.
  • The state’s elder services network’s “purchased services” line item received the higher funding amount in the compromise budget of $104,411,964.
  • The Elder Nutrition Program covering “Meals on Wheels” received even more funding ($7.37 million) than the higher amount awarded by the House ($7.12 million).
  • The MassHealth Senior Care line item received slightly increased funding, which came from the House, at $3.197 billion while the MassHealth Managed Care account was level funded throughout the budget process at $4.792 billion.
  • The Human Services Salary Reserve was given $8 million to fund better wages for human service workers.
  • Pediatric Palliative Care gained a slight increase with $1.55 million.
  • The Board of Registration in Pharmacy will establish four new specialty licenses for retail sterile compounding pharmacy, retail complex non-sterile compounding, and institutional pharmacy license to apply to hospitals and an out-of-state pharmacy license for those doing business in Massachusetts.

For more information, the conference committee’s budget can be viewed here.

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Study Results Released on Health IT Adoption in MA

According to a study on the adoption of Health IT and electronic health record systems (EHR) by healthcare providers across the state, home health agencies come in fourth by “practice type.”

The study conducted by the Massachusetts eHealth Institute (MeHI) shows that 74% of home health agencies have adopted a Health IT system, which places them behind primary care physicians, specialists and Rehab/Therapy, but ahead of skilled nursing facilities and behavioral health providers. The chart below displays MeHI’s results.

MeHI EHR Adoption ChartNearly 80 percent of healthcare institutions and practices in Massachusetts report they are using EHRs – and 50 percent of consumers indicated they have used health IT to directly communicate with their health care provider, review test results, renew prescriptions or schedule appointments.

However, according to MeHI, this study confirms that there are medical practice areas in which the benefits of eHealth are penetrating at a rate slower than the statewide total.

MeHI also found that ,of those with an EHR system, most practices and providers are using their EHR for medication reconciliation (81%), quality reporting (81%), electronic prescribing or eRx (76%). A smaller percentage of practices are using their EHRs for clinical decision support rules (64%) and public health reporting (55%).

MeHI recommends state assistance for certain provider groups, including home health agencies, could benefit with accelerating the adoption process.

For more on MeHI and their efforts to guide Health IT adoption, visit

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Urgent: Your Advocacy Needed on F2F Fix Now

We cant fix it without your help!!!

The Home Care Alliance of Massachusetts is working nationally on new strategy for a F2F fix in the House Appropriations Committee.

The Alliance, along with the Forum of State Home Care Associations (FSA) of the National Association for Home Care and Hospice (NAHC), is pushing on a unified front for a simple legislative fix that would provide relief from the onerous Medicare face-to-face (F2F) rule.

The  legislation would specifically allow for physician certification of the face-to-face requirement on the ‘485,’ or plan-of-care document, in place of a separate, redundant narrative requirement currently being enforced by the U.S. Centers for Medicare and Medicaid Services (CMS).

What we need from you!

Massachusetts has no Congressional representative on the House Appropriations Committee, which is where we are trying to get the language introduced.   

All HCA members should urge their Congressional representatives to reach out to House Appropriations Committee Ranking Member Nita Lowey (D-NY) seeking assurances that the face-to-face fix is included in the House Appropriations bill.

The best way to reach your Congressional Representative is to call the main switchboard at (202) 224-3121.

In addition to calling your House representative, every Alliance member should send an e-mail.  This process will only take a minute of your time. Click HERE to send a message to Congress with a push of the button.

Script for Phone Call or email

Please Help Home Care:  Insert F2F Fix in Appropriations Bill

The home care industry needs your help to fix the face-to-face encounter rule. This federal rule requires a physician to certify that he or she has seen a home care patient face-to-face for authorization of home care services. The problem is not so much the requirement itself, but CMS’  interpretation of the requirement, and its expectations for physicians to document it. A simple line of legislative language would clarify Congress’ intent for the regulation to be met with the least disruption in patient care services.

Please work with your Congressional Colleagues on the Appropriations Committee to advance this vital legislation. If you need, I would be happy to forward the draft legislation, along with further background information, to your office.

Links for More Information

Home Care Face-to-Face Mandate: A Major Problem, a Simple Fix. Use this resource to show Congressional offices how the existing 485/plan-of-care already certifies the patient’s need for home care and could include a simple edit for meeting the face-to-face mandate.

The HCA-FSA-NAHC draft legislation to fix F2F. This draft legislation simply states: “Physician documentation of the face to face encounter shall consist solely of a simple and concise confirmation that such encounter occurred and that is provided by notation on the same plan of care document the physician signs to order the home health services required by the patient.”

Thank you for your help.

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State Budget Process Moves to Conference Committee

As expected, the House and Senate Chairs of their respective Committees on Ways and Means will co-chair a six-member conference committee that will work out the differences between the House and Senate budget plans.

The House-approved plan calls for $36.32 billion while the Senate plan was set at $36.4 billion. Although they are similar in terms of total amounts, there are some important differences in both funding support and policy changes.

The Home Care Alliance sent a letter outlining those differences as they pertain to home care services in a letter to each conference committee member.

Here are the main bullet points from that letter where the HCA is asking for support:

  • Senate Amendment #929: Home Telehealth
    • This language was passed in the FY14 budget and allows MassHealth the policy support necessary to continue work on establishing rates and guidelines for home telehealth services.
    • Home Telehealth involves remote vital signs monitoring equipment. This service offers immediate cost savings by reducing the frequency of home health visits paid for by MassHealth, along with reduced hospitalizations through improved medication adherence, patient self-management and timely follow-up care.
  • Senate Amendment #683: Homemaker Wage Increase
    • Approved by a unanimous roll call vote in the Senate, this amendment increases pay by approximately $.75 cents per hour for homemakers and personal care homemakers serving clients enrolled in the Executive Office of Elder Affairs Home Care Program.
  • Senate Outside Section Relative to the Home and Community-Based Services Policy Lab
    • This language and corresponding funding would support the study of the cost-effectiveness of state-funded home and community-based services.
  • House Support for Elder Services Home Care Purchased Services (9110-1630)

The Alliance encourages home care agency members and advocates to contact the conference committee this week to ask for their support using the bullet points above. Here are the names and contact info for conference committee members:

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