Home Care Alliance Signs onto CMS Letter to House and Senate Leadership

The Alliance signed onto an advocacy letter written by the National Association for Home Care and Hospice (NAHC) to House and Senate leadership asking for their support in suspending the implementation of CMS’s final for the Home Health Prospective Payment System (HHPPS).

This week, the Alliance signed onto an advocacy letter written by the National Association for Home Care and Hospice (NAHC) to House and Senate leadership asking for their support in suspending the implementation of CMS’s final for the Home Health Prospective Payment System (HHPPS). As a reminder, CMS’s final rule if implemented would reduce Medicare payments for home health services by $635 million in 2023 and trigger an estimated $18 billion in payment reductions over the next decade.

The Alliance joined 49 other home care associations across the nation in signing this letter. The letter highlights the immense impact that the final rule would have on the agency across the country, noting that “the impact of those payment cuts would exacerbate the ongoing dismantling of this essential benefit that serves over 3 million of the most vulnerable Medicare beneficiaries, providing them with exceptional care quality in their own homes, preventing high-cost hospitalizations, and offering an alternative to life-changing institutional care while saving Medicare billions in spending every year.

NAHC is currently working with key sponsors and co-sponsors of the CMS bill (S.4605/H.R.8581)that was introduced in August, to re-write the bill in response to CMS’s final ruling. The exact details of the revision of the bill have not yet been determined, but once they are the Alliance will re-engage with the Massachusetts delegation to update them on the changes and to garner their support for the new version of the bill. We will also be asking our members to once again reach out to their member of Congress to support the new version of the bill.

The Rundown – November Midterm Election Edition

Federal Recap

Red wave!!!! More like a drizzle, just like meteorologist over-projecting rain fall during a summer storm, everyone over speculated how well Republicans would result in the midterm elections. While Massachusetts went the way everyone thought It would with Democrats holding onto every seat, nationally Republicans did not have the night that anyone could have expected. Republican pundit Ben Shapiro said it another way “from red wave to red wedding.”

Historically speaking a sitting president usually loses big during the midterm election, but that did not happen this election cycle. For the last 2 years pollsters, political pundits and politicians have called for Republicans to win big this midterm season, winning back control of the House and the Senate. Though Republicans are most likely going to win back control of the House, it was not by the margin that they expected nor as it as widespread as people thought. While all races have not been called it is looking like President Biden and the Democratic party lost the fewest number of House seats during a Democratic presidents first midterm election in over 40 years. Democrats went into the night with a large margin to overcome to hold control of the House and Senate. To keep control, Democrats needed to win at least 45 races in competitive districts, where Republicans had to win 19 to gain control. As of this morning, Republicans have only won 7 and Democrats have won 24 of those races.

In key swing states such as Pennsylvania, Georgia, New Hampshire, Ohio, and Arizona, there was massive Democratic voter turnout, largely made up of young voters, impeded the expected red wave. Democrats saw key wins in districts in these states where voters said that abortion rights were their top priority, knocking off some incumbents and far right competitors. Democrats were also able to flip the Senate seat in Pennsylvania where Democratic candidate John Fetterman won by a bigger margin than expected, keeping the Democrats chances of keeping control of the Senate alive. 3 states are yet to fully be decided, with one state (Georgia) going to a runoff election and Nevada and Arizona vote count not fully completed. Democrats are currently leading in the Senate race in Arizona and a closing the gap in the Nevada senate race. There is a chance where Democrats could go into the Georgia run-off election with a chance to take a 1 seat majority in the Senate.

It wasn’t all good bad news for Republicans though. Republicans went down to Florida and came back with a beautiful tan and great beach side condo. Republican Governor and suspected future Republican candidate for President, Ron DeSantis, dominated his competition by over 20 points. The fun in the sun didn’t stop their where republicans rode a red wave through Florida sweeping many house races and dominated in the one Senate race where incumbent Marco Rubio won by almost 18 points. Republicans were also able to defeat New York Rep. Sean Patrick Maloney, a high-ranking Democrat who is the chair of the Democratic Congressional Campaign Committee and is responsible for getting other Democrats reelected. This is a major blow for Democrats who lost their high-ranking comrade in a state where they also just re-drew the district lines in favor of Democrats. Republicans are also still expected to win majority of the House which is nothing to gloss over. Republican control of the House kills any chance of significant democrat agenda items passing without large support from Republicans over Biden’s last 2 years in office. Such as key democratic agenda policy related to climate change and union growth (PRO Act).

It is not fully clear at this moment what caused the lack of a red wave across the country. It is most likely not because of one thing, but likely a collection of reason. Many believe that abortion rights played a large hand, in addition to, bad Republicans candidate chooses, and possibly Bidens policy achievements. When it comes to perceived bad Republican candidates, election day saw a lot of candidates that were vocal 2020 election deniers lose. Alabama was the only state where a governor candidate that was a 2020 election denier win their race. In Georgia, Republicans were not fans of the Republican senate candidate Herschel Walker. While the Republican Governor, Brian Kemp, won his election with over 2.1 million votes, Herschel Walker only received a little over 1.9 million votes, showing that even though Republicans went to the polls to vote for Kemp, they decided to stay out of the Senate race and not vote for either candidate. 

While the elections have not been finalized in many states and there is still much anxiety over what the final results will be, there is one thing that is finally done……. Political ads! All those tv ads, texts and emails that have overrun our lives over the last couple months are finally done. We can now breathe a sigh of relief and drop our anxiety for when-ever our phone buzzes dreading a text or email from a campaign trying to ask for our money or get us to vote. I personally received over 45 emails in the last month asking for political donations. Even my Alma Mater, James Madison University, only sent me 10 emails this last month about my tuition payments. So I can now open my email and not want to throw my phone across the room.

State Recap

Governor/High Office Positions

History was made this election cycle as Massachusetts as state attorney general (AG) Maura Healey was elected governor, becoming Massachusetts first elected female governor and the first openly lesbian women elected governor in the nation. Healey dominated her Republican competitor, former state Rep. Geoff Diehl, beating him by almost 30 points. The result comes as no shock to residents as Healey never trailed in the polls and held huge advantages in fundraising and name recognition. Healey, whose stepfather was president of a local teachers’ union, has been vocal about her support for unions. Healey received and endorsement from multiple union groups including SEIU State Council, one of the largest union groups in Massachusetts. In 2016, as AG, Healey lead a multi-state brief in support of federal efforts to provide greater transparency, fairness in union elections. While campaigning, Healey said that she would invest in workforce development and support to help improve behavioral health access, promote the use of community health workers to meet the needs of underserved communities, and expand access to telehealth services.

In addition to the governor race, Democrats swept the elections for attorney general, auditor, secretary of state and treasurer, continuing Republicans’ drought of holding any of those offices. Former Boston City Council president Andrea Campbell, was elected to replace Muara Healey as attorney general, making her the first black women to be elected to the position. Campbell defeated second time nominee Jay McMahon, a Bourne attorney who has a background in law enforcement. Campbell, who previously served as deputy legal counsel under Governor Deval Patrick, received endorsements from the SEIU State Council and said that she is committed to advancing labor rights for residents of the Commonwealth.

Legislature

Democrats rode the coat-tails of Maura Healey’s massive win all the way down the ballot on Tuesday, resulting in Democrats flipping a couple of state House seats and holding on to win highly contested races in the state House and Senate. Democrats will now hold the most seats in House in over 10 years. In what many called “the most competitive race statewide,” incumbent Sen. Becca Rausch of Needham fended off a serious challenge from Republican Rep. Shawn Dooley. Rausch’s district that has historically flipped back and forth between the two parties.

Tuesday’s election will restore both chambers of the Legislature to full strength after seven different House districts sat vacant after representatives resigned partway through their two-year terms. House legislative leaders decided not to call special elections to fill those seats, citing the complexity of hosting contests for the existing district lines just a few months before the midterm elections. At least 21 winners of House races and five winners of Senate races in Tuesday’s general elections will be newcomers to the Legislature, most of whom emerged victorious in contests for open seats with no incumbent on the ballot.

Ballot Questions

This election included 4 ballot questions for voter to decide on, covering controversial topics including taxes to immigration policy. The 2 most contested ballot questions were Question 1 and Question 4. Question 1 asked voters to decide if the state should impose a “millionaire tax”, a 4% surtax on annual personal income above $1 million, while question 4 tried to repeal a new law that would allow undocumented immigrants to apply for Massachusetts driver’s licenses. Residents of the Commonwealth, in a somewhat shocking occurrence, voted in favor of imposing the millionaire tax and to keep in place the driver’s license bill. Question 1 passed with 52% of the vote, while Question 4 passed with a little over 53%. Campaigners on both sides for question spent ABSURDS amount of money to garner support from residents. The opposition spent nearly $13,518,519.82, which is chump change compared to the supportive campaign who spent OVER $27 MILLION DOLLARS. That over $43 million dollars on one ballot question. I wonder if any of that money would be taxed now.

The other two ballot questions, Question 2 and 3, covered dental insurance and liquor licenses. Question 2, which would require dental insurance companies to spend at least 83 percent of premiums on member dental expenses and quality improvements, instead of administrative expenses, received an overwhelming support with 73% of “yes” votes. And lastly, Question 3, which would increase the number of alcohol licenses a single company could hold while gradually reducing the number of licenses specifically allowing the sale of all alcoholic beverages including liquor, did not pass, as a 55% majority voted against the ballot initiative. What does Massachusetts have against alcohol? I think it has something to do with having successful sports teams, if your teams win a lot there is less of thought to drown your sorrows with happy hour alcohol sales.

Home Care Providers Looking for Permanent Rate Boost

The Home Care Alliance was quoted in an article published by the CommonWealth that highlighted HCA’s and the Enough Pay to Stay (EPTS) Coalitions pursuit to make the EPTS rate add-ons permanent for home health aides. Below is an excerpt from the article.

Via CommonWealth, September 30, 2022

The Home Care Alliance was quoted in an article published by the CommonWealth that highlighted HCA’s and the Enough Pay to Stay (EPTS) Coalitions pursuit to make the EPTS rate add-ons permanent for home health aides. Below is an excerpt from the article.

Jake Krilovich, the executive director of the Home Care Alliance of Massachusetts, said one-year add-ons are not a great approach because they are temporary. “They go from state budget to state budget, and that leads to uncertainty for providers where they do not know if the add-on will continue past the next state budget,” said Krilovich. The rate add-ons went into effect as an emergency provision on September 2, and cover services from July 1 of this year through June 30, 2023. “We need the add-ons to try and pay workers more to attract more workers, but in the meantime, we’re working on bills that address structural reform and how rates are set,” said Krilovich.

Harrison Collins, the director of legislative and public affairs of the Home Care Alliance of Massachusetts, said the coalition is drafting a bill that would provide more secure rates for health and home care workers. “I couldn’t imagine my wage depending on a rate-add on every year, but that’s the world we live in, and that’s what goes on in this kind of sector,” said Collins. “It’s the people that need the service that end up getting hurt because the demand isn’t met.”

By Jusneel Mahal

Home Health Rate Bump Needs To Be Permanent

The Home Care Alliance was quoted in State House News Service’s coverage of an Executive Office of Health and Human Services public hearing on implementation of the Enough Pay to Stay rate add-ons. During the hearing HCA argued that the rate add-ons must be made permanent. Below is an excerpt from the State House News Service’s article.

Via State House News Services, September 29, 2022

The Home Care Alliance was quoted in State House News Service’s coverage of an Executive Office of Health and Human Services public hearing on implementation of the Enough Pay to Stay rate add-ons. During the hearing HCA argued that the rate add-ons must be made permanent. Below is an excerpt from the State House News Service’s article.

At an Executive Office of Health and Human Services public hearing on Wednesday to consider final regulations, Harrison Collins, director of legislative and public affairs at the Homecare Alliance of Massachusetts, said the rate add-ons would “minimize disruption on the providers and consumers” and said the increases need to be permanent, saying current rates are inadequate. “We hope the department will review these rates thoroughly this fall, as they are wholly inadequate to meet the current needs as evidenced by the number of [Executive Office of Elder Affairs] home care consumers who are awaiting all or partial services,” he said. The current base rates for home health aide services is $26.92 per hour, and the EOHHS hearing dealt with a $3.56 per hour addition on top of that base rate, Harrison told the News Service. The current average contracted rate for homemaker and personal care homemaker services through the Aging Service Access Points in the Executive Office of Elder Affairs Home Care Program is $29.14 per hour, he said. The hearing considered a $3.96 per hour rate add-on.

The Home Care Alliance of Massachusetts collaborated with other advocates, collectively calling themselves the Enough Pay to Stay coalition, for these add-ons to supplement the current base rates for home health aide and homemaker services through the MassHealth Home Health and EOEA Home Care programs. “This supplement is needed because the current base rates are not adequate to meet the current environment on the ground and demand for services,” Harrison told the News Service.

Sam Drysdale/SHNS

The Rundown – October 2022

Federal Recap

Jake Krilovich flew down to D.C. to meet with members of the Massachusetts delegation to gain their support for The Preserving Access to Home Health Act of 2022, which would delay CMS’s from implementing their proposed 7.69% payment cut, and an additional $2 billion in “clawback” cuts to home healthcare services. We are happy to report that Congressman McGovern will be signing onto the bill, marking the first member of the Massachusetts delegation to co-sponsor the bill. We want to thank everyone who took the time to reach out to their Member of Congress asking for their support of this important bill.

In superficial news, House Speaker Nancy Pelosi said in early September that the House would work to introduce and pass a bill that would place new restrictions on lawmakers stock trading abilities. To absolutely no one’s shock the bill that was introduced received weak support from legislators on both sides of the aisle, killing any prospect of a stock trading bill in the near future. Who would have thought that lawmakers who currently subjected too little to zero oversight/penalties for the stocks they purchase, would be open to more regulations on their actions. Both Republicans and Democrats have been under constant scrutiny over the last couple years for their sometimes-blatant conflict of interest when it comes to buying stocks. As an example, 4 legislators  sold stocks in early 2020 after private briefings on the risks of a coronavirus outbreak in the United States. An analysis by The New York Times showed that from 2019 to 2021, 97 representatives and senators or their immediate family members reported trades of stocks, bonds or other financial assets that could have been influenced by committees they were serving on. Abigail Spanberger (D-VA-7), leading proponent of banning trading by members of Congress called out party leadership for not supporting a stock trading bill more aggressively. Rep. Spanberger called the delay an example of why her party needed new leaders in Congress, branding it “a failure of House leadership.”

I’m livin’ life, do or die, what can I say I’m 23 now, but will I live to [own a home]? The way things is going, I don’t know”– Coolio (RIP the legend). The Biden administration and legislators have been closing following the Federal Reserve’s (Fed) continuous interest rate hikes, which they say is to combat rising inflation. The Fed raised the federal funds rate again in September by .75 percentage points, bringing the benchmark rate to a range between 3% and 3.25% for the first time since 2008. The increase interest rates have caused the housing and stock market to plummet over the last month, with the S&P tumbling down 9.3% in September and average mortgage rate to sky-rocket over 6%, the highest since 2008. Increased interest and mortgage rates have made the prospect of younger people owning homes a pipe dream with no immediate hope around the corner.

Finally, just before the end of school bell was about to ring, legislators quietly (maybe too quiet) struck an agreement on short-term spending measure before a midnight deadline to avoid a government shutdown. Only 10 Republicans voted in favor of the bill along with all Democratic members of the House. The Senate had approved the measure a day earlier, on September 29. The agreement funds the government through December 16th, when Congress would be hoping to pass an omnibus bill to fund the government for fiscal year 2023. The stopgap measure includes $12.3 billion in emergency economic and military aid for Ukraine, $1 billion in heating assistance for low-income families through the Low-Income Home Energy Assistance Program, $20 million for the water crisis in Jackson, Mississippi, billions in disaster aid, and over $112 million for federal court security.

Look-Ahead

As I walk through the valley of the shadow of death, I take a look at my life and realize [just the campaigns are left]” – Coolio (couldn’t resist). October marks the final stretch of campaigning for the upcoming midterm elections in November. One more month of having to endure annoying campaign ads during commercials breaks of the Patriots games (is it just me? or is everyone else also getting ads for New Hampshire races). A year ago, experts widely predicting a red wave to crash the elections with Republicans winning both the House and Senate easily, but that is no longer the case. Recent polls have shown that Democrats have scraped their way back in both the House and Senate races. Polls show that Republicans are only slightly favored to take back the House while in a shocking turn of events Democrats are slightly favored to hold control of the Senate (Herschel Walker has some explaining to do to his party). But if 2016 taught us anything it’s that we need to take all polls with a grain of salt. These are only projections; at the end of the day no one really knows what will happen on election day.

We are continuing to focus our attention on CMS’s annual proposed rule for Medicare home health services, that included a proposed 7.69% permanent cut, and an additional $2 billion in “clawback” cuts for CY2023. While we are excited that Congressman McGovern signed on, we need to keep the momentum going. HCA will continue to work with members of the delegation in hopes to get more members to sign on with Congressman McGovern. We need your help to get this bill over the finish line. Power comes in numbers. We are asking everyone to continue to reach out to their member of Congress to urge them to support this bill. Please use this action alert to write to your member of Congress urging them to support the Preserving Access to Home Health Act of 2022.

Lastly, Jerome Powell, Chair of the Fed, signaled the Feds plan to lift interest rates by another 1.25 percentage points before years end, which would bring the federal funds rate to 4.25-4.5% just in time for holiday shopping. Considering the Fed only has two meetings left, that could mean another 75-basis point hike in November followed by a half-point increase in December. Looking even farther into the future, the Fed is bracing to lift rates to 4.5-4.75 percent by next year. Six officials, however, see rates soaring to 4.75-5.0 percent in 2023, which would be the highest since 2007 if it comes to fruition. On Monday the United Nations warned that the Fed and other central banks risk pushing the global economy into recession followed by prolonged stagnation if they keep raising interest rates. The agency estimated that a percentage point rise in the Fed’s key interest rate lowers economic output in other rich countries by 0.5%, and economic output in poor countries by 0.8% over the subsequent three years.

State Recap

Extra! Extra! Read all about it! The Home Care Alliance was quoted in two recent articles that were published by State House News and the Commonwealth about the Enough Pay to Stay legislative add-on rates and the Home Care Alliances fight for better base rates through the upcoming rate review for home health aides. The Home Care Alliance is working tirelessly to grow awareness for the need for a proper rate review and for base rates to be increased to a level that can sustain the industry that allows for providers to meet growing demand for services.

Like the Red Sox, things in Massachusetts State House were mostly quiet in September. State legislators continue their never-ending negotiations on a final economic development bill. the $4 billion package includes amongst other provisions, $1 billion in tax rebates and reforms. Senate budget chief Michael Rodrigues told 1420 WBSM this week. “I do expect we will [be] able to pass an economic development bill in the neighborhood of maybe $2.5 billion,” Rodrigues said, forecasting a bottom line lower than the combined surplus and American Rescue Plan Act spending in the original bill.

Governor Baker has spent the last month on a press tour as he plans to leave office when his current term ends. This past week Baker made his final annual address to the Providers’ Council, highlighting all he has done over the last 8 years. Baker highlighted  the saga he went through as a candidate for governor and then as governor to increase Chapter 257 provider rates. “Chapter 257 was enacted in 2008 and it’s just a bunch of letters and numbers. But it was supposed to be a framework and that framework was supposed to ensure that human service organizations were adequately funded from that point forward. It didn’t get funded in 2009. It didn’t get funded in 2010 — by the way, those of you who have really long memories, when I ran for governor in 2010 I said we would fund Chapter 257,” Baker said. “It didn’t get funded in ’10, it didn’t get funded in ’11, it didn’t get funded in ’12, it didn’t get funded in ’13 and, in fact, by the time we were all running for office in 2014, the provider community was spending precious resources on a lawsuit to force the commonwealth to implement its own statute and live up to the requirements and the commitments that were made in Chapter 257.” By May of 2015, Baker said his administration had struck an agreement with providers that laid out the state’s commitments very specifically. “And that agreement has paid off,” Baker said, adding that his administration has overseen $813 million in incremental rate increase for human service providers through Chapter 257 since 2015.

Last month I reported that the MBTA shut down the orange and green line for a full month, and that I was highly skeptical that it would re-open in a month like they promised. Well I was wrong….. but not fully. Both the orange and green line re-opened a month after closure as promised, but with limited service. And by limited, I really mean limited. As someone who takes the orange line to work. Missing your train means the difference between being on time and being 20 minutes late to work. MBTA is still suffering from massive labor shortage which has caused them to reduce services. MBTA also has not thrown out the possibility of closing other lines for further repairs.  So technically things are better with the T, but I think that just goes to show how bad things have been recently.

A report released on in September by the Massachusetts Health Policy Commission (HPC), an independent state agency charged with monitoring health care spending growth in Massachusetts, showed a surprising drop in health care spending in Massachusetts in 2020 for the first time since implementation of a landmark cost control law in 2012. HPC report shows that from 2019 to 2020, statewide total health care spending per capita fell 2.4 percent, bucking seven straight years of annual growth, while total health care spending per capita also decreased nationally in 2020, but at a smaller drop of 0.3 percent compared to the 2.4 percent drop in Massachusetts. HPC officials contend that this downward trend is only an anomaly and that they do not view the shift as meaningful progress toward containing prices. The spending growth that dominated recent years is “likely to continue” on an upward trajectory in 2021 and beyond, HPC analysts wrote in their report.

Look-Ahead

Just like I reported in my piece last month, everyone will be focusing on the upcoming elections in November. Everyone will be watching the race between Democrat Maura Healey and Republican Geoff Diehl for Governor.

Healey, 51, currently serves as attorney general, a position she’s held since 2014. If elected Healey would be the first woman elected governor in the state’s history. Diehl, 53, is a former state House Representative, who unsuccessfully challenged Senator Elizabeth Warren for her Senate seat in 2018. Originally from Texas, Diehl has the backing of the state Republican party along with Trump’s. Diehl is considered a more moderate alternative for Republican voters in the primary.

With everyone focusing on the upcoming election and the state legislator currently in informal session, I do not expect much action to happen at the state house in October. At most we would see movement on the economic development bill and possibly (I can only hope) the announcement of when sports betting will becoming legal in Massachusetts.  It’s been two months sense a Governor Baker signed a bill allowing for sports better and regulators are yet to come up with a timeline for when legal wagering might start in Massachusetts. In the meantime, everyone will just have to survive on fantasy sports and survival pools.

HCA will continue to closely track bill that are important to our industry, including the Licensure bill (H.4471) and a rate setting bill (S.774). While the chances are low, HCA has been meeting with legislators and their staff to urge them to take up and pass these bills during informal session. We will provide updates on the bills as needed.

Urge Congress to Support the Preserving Access to Home Health Act of 2022

CMS released their annual proposed rule for Medicare home health services, which includes a proposed reduction to payment rates, and an additional $2 billion in “clawback” cuts to home healthcare services for CY2023.

Please use the action alert below to write to your member of Congress urging them to support The Preserving Access to Home Health Act of 2022.

In June, the Centers for Medicare & Medicaid Services (CMS) released their annual proposed rule for Medicare home health services, which includes a proposed 7.69% reduction to payment rates, and an additional $2 billion in “clawback” cuts to home healthcare services for CY2023. With home care providers already facing an unprecedented workforce shortage, leading many to turn away patients due to lack of staff, inflation, and exceedingly high gasoline prices, now is not the time to cut payment rates.

In response, lawmakers moved quickly to prevent this proposed rate cut that would have a devastating effect on the industry. In August, bipartisan lawmakers introduced The Preserving Access to Home Health Act of 2022 (S.4605/H.R.8581). would delay the 7.69% payment cut proposed for 2023, which would total $1.33 billion in 2023 alone. The bill would also block additional cuts of more than $2 billion as soon as 2024 due to an unjustified “clawback” of payments for critical home healthcare services delivered to seniors and people with disabilities during the pandemic. If the rule were to move forward, up to 45% of providers in Massachusetts will have an overall margin below zero. The Preserving Access to Home Health Act would reduce that impact to just 26% of HHAs, saving countless of agencies across the state.

Patients currently face extensive access challenges and the CMS proposed rule will only exasperate the problem. Home health leaders have consistently outlined concerns related to CMS’ methodology in proposing these payment adjustments while also highlighting significant increases in labor and supply costs across the home health community.

Please use the action alert below to write to your member of Congress urging them to support The Preserving Access to Home Health Act of 2022 (S.4605/H.R.8581).

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