Advocacy Alert: Urge your US Rep to Support HHPPS Proposed Rule Letter

With another $350 million cut to Medicare home health payment and Massachusetts selected as one of nine states for a “Value-Based Purchasing” Pilot, it is important that a strong message is sent to CMS and that means getting strong support from our state’s Congressional Delegation.

A new message is posted on the Home Care Alliance’s Advocacy Center that you can easily send to your federal elected representative to gain support for a Congressional sign-on letter to CMS. Just fill out the contact information, hit “send” at the bottom of the page, and the message will automatically go to your member of Congress.

The letter, which can be seen below, voices concern about the burdensome payment reductions and severe Value-Based Purchasing penalty in CMS’ proposed rule. Home health care champion Congressman Jim McGovern is co-leading the effort – known as a “dear colleague” letter in Congress – and the Alliance continues to appreciate his ongoing support of our issues.

Here is the text of the letter:

The Honorable Andy Slavitt
Acting Administrator
Centers for Medicare and Medicaid Services
7500 Security Boulevard
Baltimore, Maryland 21244-1850

Dear Acting Administrator Slavitt:

We are writing today to express our concern with Medicare home health funding cuts set forth in the Home Health Prospective Payment System (HHPPS) proposed rule for 2016. Home healthcare is a vital service that allows millions of the most vulnerable senior citizens and disabled individuals to receive the treatment they need in the cost-effective environment they most prefer – their home. As a result, we request a careful reconsideration of two of the draft policy changes in light of their anticipated impact on homebound Medicare beneficiaries and the home health delivery system upon which they depend.

First, we are concerned with the draft HHPPS rule’s proposal to cut home health payment rates by an additional 1.72 percent in 2016 and again in 2017. This proposed “case mix” reduction is of concern because it appears to be based on a 2000-2010 case mix weight change analysis rather than changes in the condition of beneficiaries during the 2012 to 2014 period that Medicare proposes to address.

Second, the draft rule proposes a Home Health Value-Based Purchasing (HHVBP) program that would impose an incentive/penalty range of as much as 5 to 8 percent over a 5-year period. We are very concerned with the aggressive nature in which the Secretary intends to ramp up HHVBP. Implementing a VBP program with a 5 percent withhold that increases to 8 percent just three years later is too much too fast. We are also concerned that the Secretary is proposing 25 measures for use in the HHVBP— far too many for providers to focus on.

In closing, we wish to express our concern that, in its current form, the draft rule may drive Medicare reimbursement to unsustainable levels for thousands of small, rural and other home health providers across the country, impacting the care upon which many of the most vulnerable Medicare beneficiaries, as well as their communities, depend. As a result, we request that the Agency reconsider its proposed case mix cut until it evaluates the specific causes of case mix weight changes from 2012 to 2014 and consider a more reasonable implementation schedule for the proposed withhold amount in the HHVBP program.

We thank you for your attention to this critical matter.

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We Need Your Opinion!

To compete and succeed in tomorrow’s home health marketplace, agencies need highly-skilled clinicians and thoughtful, visionary leaders.  To help our members prepare for that future, HCA of MA is considering two in-depth, extended training programs for the coming year.  We need to assess member interest before we proceed.  The two programs we are considering are Building a Home Health Behavioral Health Program and Emerging Leaders in Home  Care.

The Behavioral Health Program would be a 12-month program that would provide participating agencies the clinical training and administrative guidance necessary to launch a behavioral health program that is compliant with current Medicare home health regulations. The program would provide a comprehensive operational manual, in-person and webinar-based clinical trainings for as many as five staff per agency, diagnosis-specific care  guides and monthly teleconferences to guide participants on a path towards success in terms of enhanced agency capabilities and revenues and better care for a now underserviced population. Cost per agency inclusive of all on site meetings, manuals and 12 training webinars (for multiple staff) would be approximately $6,700.

HCA is also considering whether to repeat the popular Emerging Leaders in Home Care certificate program with Suffolk University.  This program, which commits a person to a full day per week, over the course of nine months (with short breaks in between classes) provides next generation leaders in-depth graduate-level education in marketing, finance, policy and human resources, all specifically designed for home care agency managers.  Graduates of the program will be able to apply four course credits toward several Master’s Degree Programs at Suffolk University, including the new Master’s Program in Community Health.  Cost per person for the Emerging Leaders Program will be approximately $2,400, depending on the number of students.

We understand that these programs are higher in cost than most of our programs.  We would like to hear from you to determine if there is enough interest among our membership to present them (but please note that your response to this survey does NOT obligate you in any way at this time!) 

Thank you for taking the time to provide feedback to us.

Click HERE to take our survey!

Advocacy Alert: Help Advance Private Home Care Oversight

Last December, the Massachusetts Department of Labor Standards (DLS), which is a division of the Executive Office of Labor and Workforce Development (EOLWD), finalized regulation that removes private pay home care agencies from the Employment Agency Regulation.

This change, while a welcomed clarification, has left private home care agencies without any state oversight, which means that anyone can open up an agency and can start accepting out-of-pocket payment for providing non-medical supportive services to individuals in their home.

Governor Charlie Baker’s administration has provided a unique opportunity to advocate for reasonable state oversight of private home care agencies. Specifically, they are seeking feedback on how to clarify and streamline Massachusetts regulations across the board via a special webpage called “A Clearer Code.”

The Home Care Alliance of Massachusetts is asking agencies, home care workers and advocates to take the following steps to help home care consumers gain the protection and peace of mind they deserve:

Visit this website:

…And please fill out the online form as follows:

  • Name (optional):
  • Company/Organization (if applicable) (optional):
  • Address (optional):
  • Primary Phone (optional):
  • Email (optional):
  • CMR Number: 429 CMR 10.00
  • General Regulatory Themes: Select either Elders, Health Care, or Licensing & Permitting
  • Please list the Agency or Agencies affiliated with this regulation: Executive Office of Labor & Workforce, Executive Office of Elder Affairs, Office of Consumer Affairs & Business Regulation, Executive Office of Health and Human Services.
  • Describe the regulatory issue or observation: When this regulation was amended, it dropped state oversight of private-pay home agency services. There are now literally hundreds of private home care agencies operating unlicensed and unregulated. Massachusetts consumers, especially the elderly, deserve better.
  • Suggestions for easing regulatory compliance: We need the Governor to name a commission to study and make recommendations on private home care licensure standards as soon as possible. Home care agencies and the Home Care Alliance of Massachusetts needs to be at the table to determine the proper direction for quality services, ethical business practice and consumer protection for vulnerable seniors.

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2015 Private Care Guides Now Available

Three editions, for your convenience.

Every day, home care agencies help tens of thousands of Bay Staters live safely – and better – at home. Though health insurance and public programs like Medicare often pay for home care following hospitalizations or during acute illnesses, they do not typically cover chronic or supportive home care services. Private duty home care agencies, however, specialize in these situations.

In order to help connect agencies who provide private home care with the families who need their services, the Alliance is pleased to announce the publication of the 2015 editions of the Guide to Private Home Care Services, which will begin shipping next week.

As like last year, the Guide is split into three regional editions:

The county-by-county cross-references help you easily find local care, and the short essays inside will give you all the information you need to make the best decision for those you love.

All members will receive copies in the mail over the next few weeks. Additional copies are available for order through the links above, and — as always — at no charge for orders of 50 or fewer. Anyone needing a more detailed directory of home care agencies might consider our 2015 Resource Directory, which includes a detailed town-by-town index of 187 agencies from every corner of the state.

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HCA Announces Sample Policies for Earned Sick Time Compliance

New regulations on paid earned sick time went into effect on July 1st and many companies, if not entire industries, are working to follow the rules.

The Home Care Alliance has kept member home care agencies up to date with analysis on regulation changes and informational webinars complete with Q & A’s, but some agencies have asked the HCA for sample earned sick time policies.

Fortunately, Alliance staff and a task force of HR directors from member agencies drafted such a sample policy, which was reviewed by attorneys Allyson Kurker and Margaret Paget of Kurker Paget LLC. In addition, the Attorney General’s Office (AGO) who was responsible for the regulation itself has posted a sample policy on their Earned Sick Time webpage and the Retailers Association of Massachusetts (RAM) also have publicly available policy templates that may be useful to home care agencies.

These resources are available below:

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CMS Announces Proposed Home Health PPS Update for 2016; Massachusetts Included in Value-Based Pilot

Massachusetts is one of nine states randomly assigned to pilot the Home Health Value-Based Purchasing (VBP) model, which is included in the calendar year 2016 Medicare Home Health PPS Rule released by CMS.

VBP will test whether incentives for better care can improve outcomes in the delivery of home health services.  The model will apply a payment reduction or increase to current Medicare-certified home health agency payments, depending on quality performance, for ALL agencies delivering services within the nine selected states.  Payment adjustments will be applied on an annual basis, beginning at five percent and increasing to eight percent in later years of the initiative.

According to CMS, the model is designed so there is no selection bias, participant states are representative of home health agencies nationally, and there is sufficient participation to generate meaningful results among all Medicare-certified home health agencies nationally.

The proposed rule implements the third year of the four year phase-in of the rebasing adjustments to the HH PPS required by the Affordable Care Act.  The CY 2016 downward adjustment to the national standard episode rate is $80.95.  CMS also proposes to recalibrate the HH PPS case-mix weights for CY 2016, which would be the second year of recalibration and identical to CY 2015.

In addition, the proposed rule includes a decrease to the national, standardized 60-day episode payment amount by 1.72 percent in each of CY 2016 and CY 2017 to account for nominal case-mix coding intensity growth unrelated to changes in patient acuity between CY 2012 and CY 2014.  CMS will also be updating the HH PPS payment rates by the home health payment update percentage, 2.3 percent in CY 2016.

For the Home Health Quality Reporting Program, in keeping with the requirements of the Improving Medicare Post-Acute Care Transformation Act of 2014 (the IMPACT Act), CMS is proposing one standardized cross-setting measure for CY 2016 under the skin integrity and changes to skin integrity domain.  Measures for the IMPACT Act’s other domains will be addressed through future rule-making, although CMS is seeking feedback on four future, cross-setting measure constructs to potentially meet requirements of the IMPACT Act.

In order for home health agencies to avoid a two percent reduction in their annual HH payment update percentage, the rule further proposes to require all home health agencies to submit both admission and discharge OASIS assessments for a minimum of 70 percent of all patients with episodes of care occurring during the reporting period starting July 1, 2015.  CMS proposes to incrementally increase this compliance threshold by ten percent in each of the subsequent periods (July 1, 2016 and July 1, 2017) to reach 90 percent.

CMS has prepared a fact sheet about the proposed rule and a press release about the Home Health Value-Based Purchasing model.  The proposed rule will be officially published in the Federal Register on July 10, 2015. CMS will accept comments on the proposed rule, including comments about the Home Health Value-Based Purchasing model, until September 4, 2015.

The Alliance will closely examine the Value-Based Purchasing proposal — as well as all other aspects of the proposed rule — and will present a briefing for members within the next weeks.

We will work with the state associations in the other states chosen for the pilot to advocate for any needed changes to the program to protect agency cash flow and operational integrity.  We will also develop educational sessions for our members over the next months.  Stay tuned!

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Conference Committee Announces Final Budget With Little Support for Home Care

The legislature’s state budget conference committee, made up of six members of the House and Senate’s respective Ways & Means Committees, decided on a final version of the fiscal year 2016 Massachusetts budget pie chart pic

The $38.1 billion plan that is being sent to the Governor for his approval does not include the Home Care Alliance’s priority language that created a special commission to study and recommend licensure options for private care agencies. The commission language was included in the Senate’s version, but not the House, which left the conference committee to decide its fate.

The conference committee also did not include an expansion of income eligibility for services ordered through Aging Service Access Points (ASAPs) that the Alliance also supported.

One bright spot was that an advisory council on “mobile integrated healthcare” (MIH) was passed and includes a representative of the Home Care Alliance. The language defines MIH as:

a health care program approved by the department [of public health] that utilizes mobile resources to deliver care and services to patients in an out-of-hospital environment in coordination with health care facilities or other health care providers. Such medical care and services include, but are not limited to, community paramedic provider services, chronic disease management, behavioral health, preventative care, post-discharge follow-up visits, or transport or referral to facilities other than hospital emergency departments.

Other notes from a preliminary analysis of the Conference Committee’s budget include the following:

  • The MassHealth Managed Care line item continued to grow by another $770 million while MassHelath Senior Care, which governs the Senior Care Options program, dipped by more than $10 million.
  • In the Elder Affairs line items, State Home Care Program “Purchased Services” was set by the conference committee at about $2 million below FY15 spending, although the Enhanced Community Options Program (ECOP) grew by nearly $5.6 million.
  • Thanks to the efforts of home care supporter Senator Sal DiDomenico, the funding for the Pediatric Palliative Care Network was raised to $1.8 million from $1.5 million in FY15, but that’s still inadequate to serve the number of children currently on a waiting list for such care.
  • The Department of Higher Education’s “Nursing and Allied Health Workforce” line item ended up being level funded at $200,000 after being zeroed out by the Governor earlier this year.

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