One Care Program Provides Update, Amends Financial Protections for Plans

March 31, 2015

The One Care initiative provided stakeholders with an update on enrollment population as well as the financial methodology governing the program and survey results illustrating enrollee opinions and satisfaction with services and the care team.

One Care, which coordinates Medicare and MassHealth services for dually eligible individuals between 21 and 64 years old, reported that the program has spent 14 percent – or $19.4million – on home and community-based services, including home health. This number reflects the life of the program thus far since it launched in October 2013. Pharmacy services represents the largest piece of the spending pie at 25 percent ($34.36 million).

The program has also conducted a round of enrollee surveys that found the following:

  • Over 80% of enrollees had met with their PCP; most are satisfied with the PCP
  • Over 70% had met with their Care Coordinator; 90% are satisfied
  • There was confusion about the role of the LTS Coordinator
  • When asked if they needed/wanted LTS Coordinator, many said no, or not sure;
  • Only 39% said they needed/wanted an LTS Coordinator;
  • Less than 45% had met with an LTS Coordinator

One Care administrators worked with CMS to update the financial methodology that was intended to protect the three plans (Commonwealth Care Alliance, Fallon Total Care, Network Health) and that info, along with the broader report to stakeholders, is available in a PowerPoint presentation.

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Deborah Wilson Shares Experience Treating Ebola Patients

March 20, 2015

debbiewilson055Deborah Wilson, a nurse with the Berkshire VNA, this week shared her story of treating Ebola patients in Liberia.  The HCA members attending the “Hot Topics” breakfast on “infection Control Best Practices” were mesmerized by her words and pictures.

In the best community health tradition, Wilson talked of challenges that were clinical and treatment related as well as educational.

“Death is a powerful motivator,” She said of village chiefs who were initially skeptical of community health workers who they feared were bringing Ebola in, not treating it.  Most eventually let educators in, she said, but not before six education workers were stoned to death in Guinea.

Wilson talked of work on the 120 bed ward, which consisted of patients lying on a concrete floor.  The devastation across families was so great, she said, because families often contracted disease by washing the dead bodies of loved ones. “Just after death is when a body can be most contagious,” she said.

Her stories and pictures capture the challenges associated with the life-saving Personal Protective Equipment they wore.  Clinicians were often only able to work in the ward for an hour at a time before clothing was soaked through and goggles were too fogged to see.

But Wilson noted that the community health initiative was effective:  the death rate while she was there went from over 80% to 60%.

Her amazing pictures are HERE!

Some of the great articles written from her experience are HERE!


Special Open Door Forum on F2F Template; Alliance Seeks F2F Data

March 13, 2015

CMS hosted a Special Open Door Forum call yesterday to provide an opportunity for physicians/practitioners, home health agencies and/or all other interested parties to provide feedback on both a paper clinical template and an electronic clinical template for face to face documentation.

Many questions were raised and often the presenters were unable to answer the audience’s questions; the presenters stated they would provide answers during at the April call. The PowerPoint presentation (see slide 5) raised many more questions on which physicians could actually certify homecare; the hospitalist or the community physician. Again the presenters were unable to clarify the regulation for the audience. The presenters were actually debating among themselves whether a discharge planner or physician’s staff could assist completing the documentation for the face to face. A caller confirmed that this was acceptable and CMS had already addressed this issue in the CMS Face to Face Questions, question number 8.

CMS is seeking public comment on this voluntary paper clinical template. Feedback and questions can be sent to:

Additional Special Open Door Forum calls on the templates will be held on April 8 and May 6, 2015, both at 1:00 PM Eastern Time.

In the Alliance’s continued advocacy on the Physician Face-to-Face Requirement, agencies that have ongoing appeals of claims denied for “invalid” F2F documentation are encouraged to send the number of denials, amount of money tied up in those claims, and the status of the appeals to James Fuccione at HCA.

We will share these data by congressional district with the Massachusetts federal delegation so that they can follow up with CMS. Months after a letter was sent from US Senators from the New England region on the same subject, CMS has failed to respond and the Alliance wants to make sure this issue gets the attention it deserves.

Please send this information, along with any questions, to James Fuccione at the Alliance.

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Governor Releases State Budget Proposal With MassHealth Savings

March 4, 2015

In his first budget as governor, Charlie Baker’s administration made sizable shifts within Health and Human Services, which accounts for 53 percent of the overall budget proposal. These shifts were done without negatively impacting most provider rates, including home health services.

In a conference call with provider and advocacy organizations, Executive Office of Health and Human Services Secretary Marylou Sudders announced that there was a 5.6 percent growth over FY15 in the total EOHHS budget and that line items in the Elder Affairs accounts governing the Aging Service Access Point network saw a 2.1 percent increase overall. This includes the following highlights:ma budget pie chart pic

  • A nearly $5.6 million increase over FY15 spending in the Elder Enhanced Home Care Services Program.
  • Level funding for the Home Care Purchased Services line item ($106.6 million), which governs contracts with home care providers.
  • A reduction of $13.7 million in the MassHealth Senior Care Account that includes, among other things, the Senior Care Options or SCO program. On the call with Secretary Sudders, it was explained that this was an adjustment on caseloads after re-determinations.
  • A continued reduction ($68,360,305) in MassHealth Fee-for-Service payments to “meet projected need.”
  • An increase of $768,713,676 in MassHealth Managed Care spending.
  • Level funding of grants to councils on aging and to the elder nutrition program.
  • A nominal increase in spending over FY15 on Pediatric Palliative Care.

For more information on the Governor’s proposed budget, visit the administration’s FY16 budget webpage.

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Guest Blog Post: Discussing Care Choices on Advancing Illnesses

March 3, 2015

The following is a guest blog post from JoAnne Nowak MD who is Medical Director at Merrimack Valley Hospice. They are promoting a publication from the Massachusetts Department of Public Health, titled “Know Your Choices:  A Guide for Patients with Serious Advancing Illness.” The guide is meant to help healthcare providers adhere to a new state regulation that requires they inform patients with advancing illnesses about their care options and choices. This publication, which Merrimack Valley Hospice has adapted this publication for their use, lists the Home Care Alliance of Massachusetts as a resource and the Alliance encourages further promotion and distribution.

As a hospice and palliative care physician, I know that decisions about end of life care are deeply personal, and based on individual values and beliefs.  I’ve also seen first-hand how advance care planning can be an invaluable gift to those you love. Taking the time to talk with your family, close friends and your healthcare providers while you are in good health are all important steps in an advance care planning conversation.

In Massachusetts, a newly implemented regulation requires that all licensed hospitals, clinics, and long-term care facilities provide information about advance care planning, palliative care, hospice care, and other end of life care options to adults with serious illness.  The goal is to help patients start the conversation and make their end of life care wishes clearly known.

To help you begin, the Massachusetts Department of Public Health recently created “Know Your Choices:  A Guide for Patients with Serious Advancing Illness.” Merrimack Valley Hospice would like to make it easy for you to obtain this guide by making it available on our website because it contains important information about a variety of healthcare choices.  For your free copy, go to  You can also call 978-552-4186 to receive a copy by mail.

It’s time for all of us to start the conversation.

JoAnne Nowak MD
Medical Director, Merrimack Valley Hospice

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HCA’s 2014 Clinician of the Year Begins a New Tradition

March 3, 2015

2014 Clinician of the Year is our Resource Guide Cover Girl!

In what will be a new Home Care Association of MA tradition, our 2015 Home Health Resource Directory features on the cover our 2014 Clinician of the Year.  She is  Pauline Knight, RN, Hospice Nurse, Circle Home, Inc., Lowell.  Pauline was recognized last April at our Annual Innovations and Star Awards ceremony. Nominations are open for this year’s awards.   Maybe your nurse or therapist could be make our 2016 cover.  For nomination and event information, go here.

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Come to the ICD-10 Coding Conference Before October Transition

March 3, 2015

The anticipated transition to ICD-10 is to be implemented as scheduled on October 1, 2015. Now is the time to attend the ICD-10 Coding Conference being held on April 15-16 with Selman-Holman & Associates, LLC. Maybe you have started training, but where do you go from there? This intermediate ICD-10 course takes coders and other home health professionals one step closer to the finish line in the race to ICD-10 readiness. In this seminar, professionals will review the basics of the conventions and official guidelines relevant to ICD-10-CM, and begin to apply ICD-10 skills to advanced and complex coding scenarios in order to assure mastery of the ICD-10 code set. In addition, the course will review the current guidance for transitional claims testing and processing and provide attendees with an understanding of operational processes necessary to reduce productivity and financial losses. Recently released OASIS C-1 items and the impact of the proposed document on coding processes in home health will also be reviewed to provide a clear and comprehensive understanding of the coding process for ICD-10. In-depth scenarios will provide all attendees with the opportunity to apply learned principles to coding complex patient conditions using OASIS C-1 proposed coding data items using learned ICD-10-CM coding skills in order to assure competency.

To register for the ICD-10 Coding Conference, click here.

The Home Care Alliance of MA has been keeping a close eye on the status of the ICD-10 coding transformation, I have included some important information we have received below:

From: NAHC, Regulatory Affairs

An  ICD-10 Resource Page has been added to the NAHC web site.  click here

NAHC and the home health and hospice vendor community have a shared goal in assuring  that agencies are adequately preparing for the transition from ICD-9 to ICD-10 diagnosis coding. Included on the page are education and guidance materials along with tools to assist our members in attaining  that goal.

The materials have been provided by home health and hospice vendors who work with the NAHC membership. In addition to the materials, the vendors have provided their contact information along with a brief company profile.

The page will be updated as more contributions are received.

Providers should be aware that Congress will not likely delay the implementation date again. Therefore, we anticipate the transition to ICD-10 to be implemented as scheduled on October 1, 2015

CMS Bog:

Successful ICD-10 Testing Shows Industry Ready to Take Next Step to Modernize Health Care

I am delighted to announce that CMS has recently successfully completed the first week of end-to-end testing of new ICD-10 coding.

The International Classification of Diseases, or ICD, is used to standardize codes for medical conditions and procedures. While most countries already use the 10th revision of these codes (or ICD-10), the United States has yet to adopt this convention. Since ICD-10 codes are more specific than ICD-9, doctors can capture much more information, meaning they can better understand important details about the patient’s health than with ICD-9-CM.


Read more of the story here:


To register for the ICD-10 Coding Conference, click here. For any questions, contact Megan Fournier at or 617-482-8830

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