The Rundown – May 2023

State Recap

EOHHS Releases Proposed Chapter 257 Rates for Certain Elder Care Services

On Friday, Executive Office for Health and Human Services (EOHHS) released their proposed Chapter 257 Rates for Certain Elder Care Services. We are happy to report that EOHHS proposed increasing Enhanced Community Options Program (ECOP) Direct Services from $749.47 to $976.08 per client per month and Home Care Program Services Direct Services from $326.35 to $424.34 per client per month, which amounts to about a 30% increase to the base rate for both ECOP and Home Care Program Services.

While a 30% increase on the surface seems high, that percentage does not consider the temporary rate add-ons (EPTS, ARPA, and DALA appeal settlement) that agencies have become accustomed to. After accounting for all, the percent increase is closer to 7%. EOHHS still plans to meet their deadline of July 1st, 2023, to implement the new proposed rates.

EOHHS also announced that they will be holding a public hearing on the proposed rates on Friday, May 19, 2023, at 9:00am EST. HCA will be providing testimony at the hearing and encourage everyone to provide testimony as well. We will be sure to send around our draft testimony before and we are happy to help anyone with their testimony as well.

House Passes Budget Proposal

The House voted unanimously (156-0) to approve their $56.2 billion state budget for FY24, sending their spending plan to the Senate. The over $56 billion budget plan included significant increases in spending for education, childcare, environmental agencies, transportation, and hundreds of millions in tax relief. Not included in the Houses budget is the Enough Pay to Stay (EPTS) rate add-on. This didn’t come as a surprise since it was not included in their initial proposal and with new rates set to be released soon, we did not expect the house to include fully funding a rate add-on at this time.

Knowing that the House would not be inclined to fully fund the EPTS rate add-on at this time due to the rate review, HCA along with the EPTS coalition did submit an amendment to the house budget proposal that would fund a rate add on for 3 months or one quarter of FY24. We filed this language because we were concerned if EOHHS would meet the July 1^st, 2023, deadline to promulgate new Chapter 257 rates, and if they didn’t, we wanted to make sure there wouldn’t be a massive rate cliff since the EPTS and ARPA rate add-ons expire on the same date. The amendment was not included in the final house budget but did garner some co-sponsors during the amendment process. The budget process will now shift to the Senate.

Tax Relief Package

The House also passed their $1.1 billion tax relief package a month after Governor Healey released her $742 million tax relief package. The Houses tax package includes many of the same provisions that were included in the Governors tax relief package, such as;

• Decreasing the short-term capital gains tax from 12% to 5%.
• Combine the Child Care Expenses Credit with the Dependent Member of Household Credit to create one refundable $600 credit per dependent, while eliminating the current cap.
• Increase Estate Tax threshold from $1 million to $2 million (Healey proposed $3 million).
• Increase the rental deduction cap from $3,000 to $4,000.
• Double the Senior Circuit Breaker Tax Credit from $1,200 to $2,400.

Two proposals included that were not in the Governor’s proposal were 1.) increasing the Earned Income Tax Credit (EITC) from 30% to 40% of the federal credit. 2.) establishing a single factor apportionment in Mass based solely on receipts matching what 39 other states currently do. The tax proposal would also alter Chapter 62f of general law which triggers a tax refund if the state has excess revenue to adjust the credit to an equal amount per taxpayer rather than based on percentage of what taxpayer paid the commonwealth. The House tax proposal will tag along with the House budget proposal to the Senate side to be debated and most likely changed before going to vote.

HCA Provided Verbal Testimony on Licensure Bill for Non-Medical Services

The Home Care Alliance provided verbal testimony during a hearing held by the Joint Committee on Elder Affairs on H.649/S.380, An Act to Improve Massachusetts Home Care, which would create a licensure system for non-medical home care services.

For many years, the Home Care Alliance and our members have advocated for home care licensure, as we believe that agencies should be held to a baseline set of standards that would protect consumers and workers. We believe that this bill has the framework to do just that, without overburdening providers, and driving consumers to seek services in the unregulated, underground market.

We need your help to get this bill over the finish line. Please Click this LINK to submit pre-written testimony to the committee. Submitting written testimony shows legislators and committee staff how much support this bill has amongst the industry and Massachusetts at-large. This increases the chance that the bill is voted out of committee and potentially be voted on and passed by the entire legislature. Your voice matters and we want to help you use it!

Look Ahead

Senates to Propose State Budget Proposal Soon

The Senate is expected to release their budget proposal next Wednesday, May 10^th with a budget amendment deadline of Friday, May 12^th. Since EOHHS released new chapter 257 rates that incorporate the EPTS, ARPA, and DALA settlement rate add-ons we do not expect the Senate to include an EPTS rate add-on.

We will still be keeping a close eye on their budget proposal and any amendments that are filed to the budget. During the House budget process an amendment was added that would require a 75% of rate payments to home care agency providers for the elder home care program be spent by such home care agency providers on direct care workforce wages and benefits. The amendment was not added to the House’s final budget proposal after HCA along with the EPTS coalition worked hard to educate legislators and committee staff about the issues with amendment and how the language is not needed. We will keep a close eye to see if the same amendment is added to the Senate budget proposal.

Federal Recap

CMS Proposes That 80% of Medicaid Payments for Home Care Go to Direct Care Workers

Recently, the Centers for Medicare & Medicaid Services proposed two rules surrounding access to Medicaid. Among the provisions is a requirement that at least 80% of Medicaid payments for personal care, homemaker and home health aide services be spent on compensation for direct care workers.

The two proposed rules are Ensuring Access to Medicaid Services (Access NPRM); and Managed Care Access, Finance, and Quality (Managed Care NPRM). The former, Access NPRM, also would call for the following related to home care and home- and community-based services:

• Require states to publish the average hourly rate paid to direct care workers delivering personal care, home health aide and homemaker services;
• Require states to establish an advisory group for interested parties to advise and consult on provider payment rates and direct compensation for direct care workers;
• Require states to report on waiting lists in section 1915(c) waiver programs; service delivery timeliness for personal care, homemaker and home health aide services; and a standardized set of HCBS quality measures;
• Promote public transparency related to the administration of Medicaid‑covered HCBS through public reporting of quality, performance, and compliance measures;
• Establish a new strategy for oversight, monitoring, quality assurance, and quality improvement for HCBS programs;
• Strengthen person‑centered service planning and incident management systems in HCBS; and
• Require states to establish grievance systems in fee-for-service HCBS programs.

“The Biden-Harris Administration has made clear where we stand: We believe all Americans deserve the peace of mind that having health care coverage brings,” Department of Health and Human Services Secretary Xavier Becerra said in a statement. “We are proposing important actions to remove barriers to care, engage consumers, and improve access to services for all children and families enrolled in these critical programs.”

Providers expressed a lukewarm reaction to the rule. While they were pleased that the Biden administration is addressing access challenges and rate transparency with HCBS, they did not appreciate that the rule does not confront actual payment rates. NAHC said in response to the proposal that “however, we are concerned that CMS is not proactively addressing the chronically woeful state payment rates for home and community-based services and instead is creating a new bureaucratic analysis that may or may not ever impact the wages of workers. We are further concerned that CMS has decided to forego ensuring adequate state payments in favor of applying an arbitrary requirement to pass through a proportion of the rates to direct care workers. This policy cannot be effective without consideration of the actual payment rates or the substantial administrative requirements that federal and state regulations place on providers.”

President Biden Issues Executive Order to Make Home Care More Affordable

On Tuesday, President Biden signed an Executive Order (EO) that includes 50 directives to Cabinet-level agencies with the goal to improve transparency and access for home care services, including for veterans, while boosting industry standards and expanding areas of federal coverage. Some of the provisions included in the EO include:

• Directs HHS to consider issuing several regulations and guidance documents to improve the quality of home care jobs, including by leveraging Medicaid funding to ensure there are enough home care workers to provide care to seniors and people with disabilities enrolled in Medicaid, as well as build on the minimum staffing standards for nursing homes and condition a portion of Medicare payments on how well a nursing home retains workers.
• Identify which of their grant programs can support long-term care for individuals working on federal projects, and consider requiring applicants seeking federal job-creating funds to expand access to care for their workers.
• Directs the Department of Veterans Affairs (VA) to improve access to home-based care for veterans who require support with activities of daily living, like bathing and getting dressed, by giving them more decision-making power over who delivers that care and when.

In addition, the EO notes that the Department of Labor will publish a sample employment agreement so domestic child-care and long-term care workers and their employers can ensure both parties better understand their rights and responsibilities. The purpose of this is to grow awareness of employee’s options when it comes to unionizing. This is a report that we will be closely watching for when it is released. If you have any questions, please don’t hesitate to reach out.

Possible Bagel?

For those that didn’t religiously watch the West Wing, a bagel is another term for a recession. Forecasters at the Federal Reserve in April, warn of a possible recession later this year, further stowing doubt in the U.S. economy. Even though inflation eased this last month, only up 5% compared to last year, which is the lowest rate in the last 2 years, some recent data spooked forecasters to raise the probability of a bagel. Data that was released in April showed that retail spending is down, grocery sales were flat (even though prices went down), and service inflation (price of services like restaurant meals and haircuts) increased to over 7%, an absurdly high number. This is what led the federal reserve to increase interest rates once again in the beginning of May. This data along with reports that banks have started to cut back lending due to high interest rates and the recent collapses of SVB, Signature and just this last week One Republic bank, led some forecasters to raise the probability of a mild bagel later this year….. I hate when they do that, say something will happen “later this year”, it’s already May, almost halfway through the year? Does that mean it could happen in October or November? Then just say that!

Anyway, not everyone is predicting a mild bagel, some predict the economy to just “slow down” but not to fall into a bagel. But that still means that everyday people will continue to suffer. For the economy to “slow-down” that would mean that unemployment would rise, wage growth would drop, and the housing market would get worse than it is. In plain English, the Fed is trying to FUCK over average American’s and continue to make regular life harder and harder. I already accepted that I won’t be able to buy a house right now, but the Fed has made it clear that their actual goal is to making owning property impossible for millions of Americans. Bagel or no Bagel, it is getting really rough out here in America. And a bunch of fat-cat, ivy league people are trying to convince me that they are on my side during all this. History has shown that that is never the case. In the end, the more powerful and rich will continue to become richer and more powerful. All I can say is please put your money in some high yield savings accounts and hope for the best.

Pentagon Leak

We have finally hit the time that Si-Fi movies were predicting in the 80s when top-secret government documents were being leaked through video games. Like something out of The Americans, 21-year-old Jack Teixeira, American airman in the 102nd Intelligence Wing of the Massachusetts Air National Guard, leaked top secret Pentagon documents in a group chat on the platform Discord. The leaked highly classified documents included details about the war in Ukraine, intercepted communications about U.S. allies such as Israel, South Korea and Egypt, and details of American penetration of Russian military plans, among other topics. Teixeira charges include unauthorized retention and transmission of national defense information and unauthorized removal and retention of classified documents or material. The bulk of documents that were leaked are thought to have originate from the CIA’s Operations Center and the Pentagon’s Joint Chiefs of Staff. The documents appear to have been printed and folded twice. In some images there are items clearly visible in the background, including a hunting magazine, a knife and a tube of Gorilla-brand glue.

What I find most interesting about this story is that he used Discord. Now I have only been in this job for a little over a year but from everyone I have met, I can imagine that over 95% of you have no idea what discord is, and those that do is because they have kids that are at least teenagers. For those that don’t know discord is a rapidly growing communication platform where gamers can join parties to talk to other gamers. Think of it as like having one platform for all your group chats. That chat rooms vary, they could be filled with close friends, or just with people that share similar interests. While Discord is rapidly growing, its user rate is far behind bigger communication platforms like Twitter and Facebook. While 150 million active users may seem like a lot, that is only a quarter of Twitter’s active users (450 million) and a fraction of Facebooks 2.96 billion users.

So, it begs the question why he would choose this platform to release the documents. If he wanted to blow the lid on the U.S.’s foreign activities he would have used a bigger platform to reach more people. Using Discord is equivalent to leaking a story to the Cape Cod times rather than the Boston Globe. Not a lot is known about his true reasoning for why he leaked the documents. What is known is that he was suspicious of law enforcement and the U.S. intelligence community and was prone to ranting about “government overreach,” one of the group members told the Post. It is reported that roughly half of the chat group members lived abroad and that those who appeared most interested in the classified material were primarily from the “Eastern Bloc and those post-Soviet countries.” I think he was just trying to show off to his friends in some sort of manner and didn’t care about the consequences. He forgot that real life isn’t like Call of Duty and that when you are caught, you can’t just start the level all over again.

Look Ahead

Debt Ceiling

Currently, all focus is on the debt ceiling negotiations. Congress is running out of time to increase the debt ceiling to avoid federal defaults. Treasury Secretary, Janet Yellen, recently announced that the U.S. could default on its debt as early as June 1 and must move quickly to avert disaster. A debt default could trigger an economic downturn, which would prompt a spike in unemployment.

House Republicans lead by Speaker Kevin McCarthy recently passed “The Breaking the Gridlock Act”, that would increase the debt ceiling but would also scale back a wide swath of annual government spending to last year’s levels, a cut of about 8%, and cap its growth by 1% each year after that. The package also includes provisions that would require certain adult Medicaid recipients to work, perform community service, or participate in an employment program for at least 80 hours per month or earn a certain minimum monthly income. It would apply to those ages 19 to 55, but not those who are pregnant, parents of dependent children, those who are physically or mentally unfit for employment or enrolled in education or in substance abuse programs, among other exceptions.

This is where a line has been drawn in the sand. Democrats strongly disagree with every aspect of the Republican bill, Democrats do not want to pass a debt ceiling bill that would require a cut in spending nor cap growth in any capacity, nor do they want to implement work requirements. With Democrats in control of the Senate by a super slim margin, they do not have any plan to pass the Republicans proposal as is. Publicly Democrats have railed against Republicans for their proposal, accusing Republicans of holding the country hostage to demand federal cuts that will hurt the poor. But behind close doors their are reports that senior Democrats and the White House are actively working with a group of Republicans on a last minute deal to either suspend or lift the debt ceiling. Little is known of what Democrats are willing to leave on the table from the Republican package. I do expect that a deal will be reached in some capacity by the end of the month that will increase the debt ceiling. Both political parties love the spectacle that these situations create, but at the end of the day the few actual adults on both sides will work out a deal to avoid a potential disaster.

2024 Presidential Election Race

There is a massive storm brewing that is expected to hit all of America, that storm is the 2024 presidential race. The race is getting closer and closer with each passing day, President Biden announced that he plans to run for office again, if elected he would 86 when his second term ends; making him the oldest president ever.

Reports are also speculating that Florida Governor DeSantis will soon announce a presidential exploratory committee and may even announce his candidacy in Mid-May. Cloudy skies are starting to form and before we know it, we will all once again experience the nausea that comes from the race for president.

Trump Arrest

Now many legal experts have said that the charges are not that strong, and that amongst the multiple cases he could be facing, this one is the weakest. This case will not go through the thick of the legal system, where expensive lawyers make their money filing motion after motion to delay and change the scope of the case. I do not imagine a final ruling on a case anytime soon. The arrests will not stop him from running from president. Political analysts are split on whether or not the arrest will hurt him politically. Trump has shown time after time that analyst know nothing and that anything can be true and false at the same time when it comes to Trump.