Federal Outlook
Potential Government Shutdown? Congress Continues to Prove that Doing Nothing is a Challenge
Once again, like every year, we are flirting with another government shutdown. The government is set to shutdown if a final deal or more likely a stopgap measure is not passed. Potential government shutdowns are nothing new now, we have been flirting with a government shutdown every year for what feels like an eternity and once again the potential shutdown is because of image politics.
The biggest holdup that could cause a government shutdown is that House Republican leadership for any stopgap package be tied to presidential candidate Donald Trump-pushed SAVE Act, which would require that people show proof of citizenship to register to vote.
House Speaker Mike Johnson announced this week that he will be holding a vote on his current package, which he previously pulled from the floor, that would fund the government for 6 months, to March 2025, and linking it with the SAVE Act. This package is already expected to fail, with a number of GOP lawmakers, a mix of fiscal conservatives and defense hawks, vowing to tank the package erasing Republicans razor thin majority in the House, 220-211. Some conservatives have stated publicly that they would never vote for a stopgap funding bills, while Armed Services Chairman Mike Rogers, has warned that a half year is too long for military spending to remain stagnant. On the other hand, the vast majority of House Republicans have signaled that they support the package and that they would like to see a vote held which would put lawmakers on the record.
Democrats, who are pushing for a ‘clean’ three-month funding extension without additional provisions, all plan to vote no, saying that the SAVE Act is a “poison pill”. Legislators argue that the SAVE Act is a redundant piece of legislation because it is already illegal for illegals to vote in elections and any instance of it happening is extremely rare.
Trump has publicly pushed at his rallies and over social media that Republicans should require the SAVE Act to be included in any funding package, or shutdown the government. Speaker Johnson did not signal if he would follow Trumps calls, but history has shown that he most likely would. “We’ll see what happens with the bill, all right? We’re on the field in the middle of the game. The quarterback’s calling the play. We’re going to run the play,” Johnson said. “I’m very confident, I know that all the Republicans believe in election security. We have some people who dislike CRs. You know what? I dislike continuing resolutions as well.”
Some Republicans have raised that it would be foolish to cause a government shutdown right now. Senate Republican Leader Mitch McConnell in a press conference warned his fellow Republicans that it would be “politically beyond stupid” for Congress to force a government shutdown a few weeks before Election Day, saying Republicans would “certainly” be blame. McConnell stopped short of calling on House Republicans to abandon their plans of advancing a bill that has no chance of passing the Senate, but made it clear that he wants to see some kind of bipartisan compromise over the next 13 days to avoid a shutdown.
So once again we are in the same position. Congress is yapping back and forth, vying for time on Fox and Face the Nation, flirting with a government shutdown that would have a real impact on Americans. It is really sad that our government system has fallen to this level, where it is impossible to even get a simple budget passed without going through all the hoopla. I know most of us have turned completely cynical towards Congress and have given up any hope, but in my opinion that only makes things worse. It is up to us to really think about who we are sending to Congress. We have no one to blame but ourselves for the current state of Congress, because we elected these partisan fatheads, who care more about making noise and being famous, then about being true legislators. When you go to vote in November, truly think about who you are voting for. Am I voting for them just because they are the same party as me? or am I voting for a person that I believe truly cares about serving their people.
Federal Recap
HCA Submits Comments for Home Health Payment Rule
At the end of August, HCA submitted its comments to the CMS Proposed CY2025 Home Health Rule. For a refresher, In June, the Centers for Medicare & Medicaid Services (CMS) released their annual proposed rates for Medicare home health services, proposing a permanent prospective adjustment to the CY 2025 home health payment rate of -4.067%. The proposed rule includes a CY 2025 home health payment update of 2.5%, which is offset by an estimated 3.6% decrease related to the PDGM rebalancing and an estimated 0.6% decrease that reflects a proposed fixed dollar loss. Overall, CMS estimates that Medicare payments to home health agencies in CY 2025 would decrease in the aggregate by 1.7%, or by about $280 million, compared to 2024 levels. This comes after CMS applied a 3.925% and a 2.890% reduction in CY23 and CY24 respectively. If implemented as proposed this would result in a 10% reduction over the last 3 years.
In our comments, HCA argued that additional cuts will further hinder home care agencies’ abilities to provide these vital services and that it could lead to more agencies going out of business, further shrinking coverage across the state. HCA met with the Massachusetts Congressional delegation over the last couple weeks to update them on the situation and to urge them to support The Preserving Access to Home Health Act of 2023 (S.2137/H.R. 5159), which would safeguard access to essential home-based, clinically advanced healthcare services for America’s older adults and people living with disabilities by preventing the Centers for Medicare & Medicaid Services (CMS) from implementing devastating cuts.
State Outlook
Still a Chance for Nurse Licensure Compact Amendment
As I’ve said numerous times over the last 2 months. Things are sssslllooooowwww at the state house. Glacier slow, Snorlax slow! Big Papi running to first slow! Rockstar roll-out of GTA 6 slow!!!!!
One thing to continue to look out for over the next couple of months is the legislature’s ongoing negotiations on the economic development bill. As a refresher legislature failed to pass an economic development package before the end of formal session on July 31st. The economic development package would provide billions of dollars in bond authorizations and tax credits aimed at lifting the state’s life sciences and climate tech industries, as well as possibly legalize happy hour in the commonwealth for the first time in 40-years. One key provision that was proposed in the Senate version was language that would add Massachusetts to the Nurse Licensure Compact (NLC).
The NLC, which HCA has supported for years, would allow nurses from other states to practice in Massachusetts, increasing the pool of potential nurse candidates for unfilled home care nurse positions. Since the economic development packages included bond provisions, it must be passed during a formal session. House Speaker Ron Mariano and Senate President Karen Spilka have publicly expressed a willingness to return for a formal session once a deal is reached. Governor Healey has also pushed for the legislature to hold a formal session to pass the package sooner than later, but it is yet to be seen when that will be.
Negotiations on a final package have been ongoing over the last 2 months of informal sessions. The House and Senate differ greatly on how much the life science provisions should be funded, as well as the need to include the NLC provisions. HCA has been meeting with House and Senate members to raise the importance of including the NLC language in a final package.
A package could come out tomorrow, it could come out on thanksgiving, no one knows!! I hope that it is sooner rather than later, because I’m running out of things to write to fill this blog!
State Recap
Healey Signs Slimmed Downed Supplemental Budget
Months after Governor Healey originally proposed a supplemental budget, the legislature finally responded to her repeated emails saying, “any updates?” with a slimmer compromised package. Healey originally filed a $534.7 million supplemental budget on March 18, saying that it would “target resources at our most time-sensitive deficiencies, using available federal reimbursements and other resources to minimize the net cost to the state.”
Like an insurance provider to a patient, the legislature said, “we can do it cheaper”. The legislature sent back a significantly slimmed down compromise package, with a bottom line of $362 million. The largest spending item that didn’t make the cut: $175.5 million for supplemental payments to safety net hospitals through the Medical Assistance Trust Fund — which would be wholly offset by federal reimbursements. In addition to the supplemental payments through the Medical Assistance Trust Fund, lawmakers also scrapped funding for struggling hospitals and community health centers in their compromise deal. Which is interesting since we are seeing numerous hospitals on the brink of closing due to steward hospital greed.
The proposed supp budget deal does, however, provide more than $61.1 million for the health and human services workforce. The budget also includes $228 million for programs designed for those who prefer to get long-term care services in their home or community, rather than in an institutional setting, and $20 million to support survivors of violent crimes as dollars from Washington have dried up in recent years — both of which will be paid for fully by federal American Rescue Plan Act dollars.
We are concerned that additional funding for the home care line items were not included in the proposal, because from our analysis we believe that the home care POS line item is under funded by $40 million and the case management line item is underfunded by $8 million. We are hoping that they will look to do another supplemental budget in the winter when the new session is opened to fill the gap between the legislatures slimmed down package and Governor Healey’s package.
Governor Signs Long-Term Care Reforms into Law
Infection control plans, uniform patient transfer forms, heightened scrutiny of private equity and much more headline a compromise long-term care reform bill that Governor Healey signed .signed at the beginning of the moth. Nearly a month after legislative leaders ended their formal sessions for the term without an agreement on the bill — and more than 18 months after House Speaker Ron Mariano dubbed it one of his top priorities.
While the bill focuses mainly on nursing homes and long-term care facilities, it does include a couple of sections pertinent to home care. The bill would establish a task force, that The Alliance is named too, that would be tasked with studying and proposing recommendations to address acute care hospital throughput challenges and the impact of persistent delays in discharging patients from acute to post-acute care settings.
The bill also calls for EOHHS to administer a workforce training grant program to “advance skills of certified nurses’ aides, home health aides, homemakers and other entry-level workers in long-term care facilities to improve quality of care and improve worker access to and participation in a career pathway to become a licensed practical nurse.”
Rep. Thomas Stanley, who helped craft the original legislation and co-led the compromise talks on behalf of the House, called it “the first major overhaul in a quarter of a century.” The bill would increase state scrutiny of the role of private equity and real estate investment trusts in long-term care. In addition, Long-term care facilities would need to file disease outbreak response plans with the Department of Public Health to ensure they have measures in place ahead of time to prevent the spread of diseases.
The bill seeks to speed up discharges by requiring MassHealth and commercial insurers to craft a common transfer form to cut down on the administrative burden. Another section of the bill calls for a two-year pilot program requiring prior authorization requests related to hospital discharges to be completed by the next business day, even over the weekend, instead of the current two-day timeline.
The bill would require the division of insurance to develop a uniform prior authorization form for admission to a post-acute care facility or transition to a home health agency for any inpatient of an acute care hospital requiring covered post-acute care services. It also would require all acute care hospitals to use that uniform prior authorization form, and all payers or entities acting for a payer under contract to accept that form as sufficient to request prior authorization for the requested service, not later than 30 days after the form has been developed by the division of insurance.
Passage of this bill checks off one of the “top priority” pieces of legislation that in both chambers failed to complete before they wrapped up the last formal session of the term on August 1.
Gov. Maura Healey on Friday signed into law a package of reforms overhauling the long-term care industry in Massachusetts.
Think Home Care Blog 