Conference Committee Budget Includes Telehealth, Homemaker Wage Increase

With the new state fiscal year technically arriving, the legislature’s budget conference committee released their compromise version between the House and Senate funding proposals that comes in at $36.5 billion.

With the delay in negotiations, the legislature recently approved a $4.6 billion budget to fund the government and related services through the end of July. The Governor, meanwhile, will have 10 days to review the conference committee’s budget and send recommended vetoes, which can be overturned with a two-thirds vote in both the House and Senate.ma budget pie chart pic

Among the priority items of the Home Care Alliance and others of benefit and interest is language allowing MassHealth to continue their work on implementing home telehealth service rates and rules. This is the second year in a row that the Alliance has achieved getting language that continues the association’s work with the state on an important service that is currently not reimbursed.

Another major win for home care came with the approval of the Homemaker Wage Increase that will amount to $6.1 million, if the funding makes it through the remainder of the budget process. According to the Home Care Aide Council, this appropriation would provide an annualized wage increase of approximately 75 cents an hour to more than 17,000 homemakers and personal care homemakers.

Among other notable items, the conference committee’s budget accomplishes the following:

  • Funding the “Home and Community-Based Services Policy Lab,” ($250,000) which seeks to study the cost-effectiveness and value of home and community-based care. It is expected that services provided by members of the Home Care Alliance that contract with Aging Service Access Points will be included in an initial phase and other Medicaid and Medicare home health services will be included in subsequent phases.
  • The state’s elder services network’s “purchased services” line item received the higher funding amount in the compromise budget of $104,411,964.
  • The Elder Nutrition Program covering “Meals on Wheels” received even more funding ($7.37 million) than the higher amount awarded by the House ($7.12 million).
  • The MassHealth Senior Care line item received slightly increased funding, which came from the House, at $3.197 billion while the MassHealth Managed Care account was level funded throughout the budget process at $4.792 billion.
  • The Human Services Salary Reserve was given $8 million to fund better wages for human service workers.
  • Pediatric Palliative Care gained a slight increase with $1.55 million.
  • The Board of Registration in Pharmacy will establish four new specialty licenses for retail sterile compounding pharmacy, retail complex non-sterile compounding, and institutional pharmacy license to apply to hospitals and an out-of-state pharmacy license for those doing business in Massachusetts.

For more information, the conference committee’s budget can be viewed here.

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Study Results Released on Health IT Adoption in MA

According to a study on the adoption of Health IT and electronic health record systems (EHR) by healthcare providers across the state, home health agencies come in fourth by “practice type.”

The study conducted by the Massachusetts eHealth Institute (MeHI) shows that 74% of home health agencies have adopted a Health IT system, which places them behind primary care physicians, specialists and Rehab/Therapy, but ahead of skilled nursing facilities and behavioral health providers. The chart below displays MeHI’s results.

MeHI EHR Adoption ChartNearly 80 percent of healthcare institutions and practices in Massachusetts report they are using EHRs – and 50 percent of consumers indicated they have used health IT to directly communicate with their health care provider, review test results, renew prescriptions or schedule appointments.

However, according to MeHI, this study confirms that there are medical practice areas in which the benefits of eHealth are penetrating at a rate slower than the statewide total.

MeHI also found that ,of those with an EHR system, most practices and providers are using their EHR for medication reconciliation (81%), quality reporting (81%), electronic prescribing or eRx (76%). A smaller percentage of practices are using their EHRs for clinical decision support rules (64%) and public health reporting (55%).

MeHI recommends state assistance for certain provider groups, including home health agencies, could benefit with accelerating the adoption process.

For more on MeHI and their efforts to guide Health IT adoption, visit mehi.masstech.org.

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State Budget Process Moves to Conference Committee

As expected, the House and Senate Chairs of their respective Committees on Ways and Means will co-chair a six-member conference committee that will work out the differences between the House and Senate budget plans.

The House-approved plan calls for $36.32 billion while the Senate plan was set at $36.4 billion. Although they are similar in terms of total amounts, there are some important differences in both funding support and policy changes.

The Home Care Alliance sent a letter outlining those differences as they pertain to home care services in a letter to each conference committee member.

Here are the main bullet points from that letter where the HCA is asking for support:

  • Senate Amendment #929: Home Telehealth
    • This language was passed in the FY14 budget and allows MassHealth the policy support necessary to continue work on establishing rates and guidelines for home telehealth services.
    • Home Telehealth involves remote vital signs monitoring equipment. This service offers immediate cost savings by reducing the frequency of home health visits paid for by MassHealth, along with reduced hospitalizations through improved medication adherence, patient self-management and timely follow-up care.
  • Senate Amendment #683: Homemaker Wage Increase
    • Approved by a unanimous roll call vote in the Senate, this amendment increases pay by approximately $.75 cents per hour for homemakers and personal care homemakers serving clients enrolled in the Executive Office of Elder Affairs Home Care Program.
  • Senate Outside Section Relative to the Home and Community-Based Services Policy Lab
    • This language and corresponding funding would support the study of the cost-effectiveness of state-funded home and community-based services.
  • House Support for Elder Services Home Care Purchased Services (9110-1630)

The Alliance encourages home care agency members and advocates to contact the conference committee this week to ask for their support using the bullet points above. Here are the names and contact info for conference committee members:

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Upcoming One Care Shared Learning Conference

MassHealth and UMass Medical School are hosting a One Care Shared Learning Conference at three different locations across the state in early June.

June 3, 2014 June 10, 2014 June 18, 2014
7:30 A.M. – 1:00 P.M.
Springfield Marriott
2 Boland Way,
Springfield, MA 01103Register for the
Springfield Conference
Before May 23, 2014
7:30 A.M. – 1:00 P.M.
Best Western Royal
Plaza – Marlborough
181 Boston Post Rd. W,
Marlborough, MA 01752Register for the
Marlborough Conference
Before May 27, 2014
7:30 A.M. – 1:00 P.M.
Four Points by
Sheraton – Norwood
1125 Boston Providence Turnpike,
Norwood, MA 02062Register for the
Norwood Conference
Before June 4, 2014

This conference will focus on “Integration of Primary Care, Behavioral Health and Community Supports in Real Life Cases: Developing and Implementing Person-Centered Care for People with Complex Health Care Needs.”

Who should attend?

This conference is primarily for primary care providers (PCPs), behavioral health clinicians, long term services and supports (LTSS) providers – including home care agencies – and other community based organizations involved in One Care.

This conference will focus on the collaboration among the members of an integrated care team, focusing on each of their roles in developing and implementing person-centered care for people with complex health care needs. There are a limited number of spots available, and One Care plan staff and their contracted providers will be given priority.

To register for one of these conferences or for more information, visit www.mass.gov/masshealth/onecare/learning

Download the Conference Agenda(https://onecarelearning.ehs.state.ma.us/pdf/One-Care-Conference-Flyer-Agenda.pdf

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Advocacy Alert: Call and Email Your State Senator TODAY!

The budget amendments important to home care are up for debate today in the MA-State-HouseMassachusetts Senate.

The Home Care Alliance’s priority amendments include restoring the 20-percent rate cut for MassHealth home health visits past 60 days, creating a commission to study home health services and recommend oversight measures, and allowing MassHealth to continue their work to establish telehealth services provided by home care agencies.

We need calls and emails to be made NOW to senators to get support for the following amendments:

  • #684 – Senator Patricia D. Jehlen: Study Commission for Home Health Care Services and Oversight

Purpose: The Commonwealth is one of only five states without either licensure or a “determination of need” process for oversight of home health care. In recent years the Commonwealth has experienced rapid growth in the number of certified home health agencies. This proposal is in response to that growth and would help to identify the current number of home health agencies, services provided and available by region, and create recommendations for state oversight and quality standards.

  • #839 – Senator Kathleen O’Connor-Ives: Restoring Home Nursing Rates

Purpose: This budget language seeks to restore the MassHealth rate for home health nursing visits past 60 days of care to the payment level prior to the rate cut of December 1, 2008 so that patients with the most severe conditions can have their care continued and remain independent at home. This amendment creates a consistent rate for as long as an individual on MassHealth requires home health care.

  • #929 – Senator Richard T. Moore: Establishing Reimbursement for Telehealth Services Provided by Home Health Agencies

Purpose: Maintain language from the FY2014 budget that established MassHealth reimbursement for home telehealth services provided by a home health agency, immediately providing cost savings and more efficient care. MassHealth is in the process of building corresponding rates and guidelines.

The Alliance is also supporting the Homemaker Wage Increase (#683) and increased funding for the state’s elder services programs (#687).

A full update will be available when the Senate completes debate, but HCA members and advocates can still send an email to their state senator here and follow the Alliance on Twitter (@thinkhomecare) for updates.

Return to www.thinkhomecare.org.

State Senate Proposes $36.2 billion Budget Plan with New Opportunities for Home Care

The Massachusetts Senate’s Ways & Means Committee took their turn in the state budget-crafting process with a $36.2 billion proposal that increases total state spending by almost $1.7 billion from this year.

Although some programs in the Elder Services line items took a hit, as did the MassHealth Senior Care Account, the Senate proposed other new items that pose potential opportunity.

In what is known as an “outside section,” which is a section of an appropriation bill that can create new policies, the Senate created a Home and Community-Based Services Policy Lab. According to the language, the policy lab would start with $500,000 of state funds to evaluate and analyze the outcomes and effectiveness of home and community-based services under the Secretary of Elder Affairs. This includes the state Home Care Program administered through Aging Service Access Points (ASAP’s) that contract with Home Care Alliance members.

This “policy lab,” which appears to be a program evaluation of state government-funded home and community-based services, could be the beginning of proving the effectiveness of services such as those provided by home care agencies. More information on this will be released as details are released.

Also, in another “outside section,” the Senate Ways & Means Committee created a new Community First Trust Fund, which is intended for enhanced federal financial participation (FFP) funding for the state that is tied to the Balanced Incentive Payment program (BIP), among other programs. In a previous blog post, the HCA reported on the state’s intentions around the BIP initiative that will bring more support to non-institutional long-term care services.

More budget analysis will come out in the coming days, including the Home Care Alliance’s budget amendment priorities where HCA members can help by contacting their state senators. The Alliance plans on repeating proposals to advance telehealth in home care, better MassHealth rates, and a study commission of home health care services and possible oversight recommendations.

Return to www.thinkhomecare.org.

New Program Instruction Approved for Home Care Agencies Working with ASAPs

After more than a year of the Home Care Alliance and other stakeholders working with the state’s Executive Office of Elder Affairs, an updated Program Instruction (PI) for the state’s Aging Service Access Points working with home health agencies has been approved and will go into effect on May 1st.

The PI addresses a range of concerns that were raised around assessment, care planning, supervision, payment and   communication between the nurse at the home health agency and the corresponding Aging Service Access Point (ASAP).  It replaces some very outdated PI’s and is the product of several meetings and edits sent through countless emails

A workgroup consisted of Home Care Alliance staff, the Mass Home Care Aide Council, and staff from the Executive Office of Elder Affairs along with several ASAP directors and ASAP nurses.

The Home Care Alliance is very pleased with the updated direction from the state, which will improve communication and collaboration between home health agencies and ASAP’s.

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Advocacy Alert: Help Gather Support for Home Care Budget Amendments

The Home Care Alliance’s priority amendments in the House budget now have numbers, which means you can email or call your state representative and easily ask that they support these important policies to advance home care services!

  • Amendment #968: Rep. Sean Garballey’s amendment to restore the MassHealth rate for home health nursing visits past 60 days of care to the payment level prior to December 1, 2008 so that patients with the most severe conditions can have their care continued and remain independent at home. MassHealth cut the rate once a person was receiving home nursing for more than 60 days, which runs counter to the state’s goal of keeping people in the community and driving down the cost of care.
  • Amendment #89: Rep. Kate Hogan’s amendment to study home health service capacity in the Commonwealth and recommend policy strategies for better state oversight of home care agencies. Massachusetts is one of only five states without either licensure or a “determination of need” process for home health agencies. In recent years the Commonwealth has experienced rapid growth in the number of certified home health agencies. This proposal is in response to that growth and would help to identify the current number of home health agencies and their licensure and ensure high levels of quality home care.
  • Amendment #491: Rep. John Mahoney and Rep. Mark Cusack’s amendment that would establish MassHealth reimbursement for telehealth services provided by home health agencies. This amendment was successfully passed in last year’s budget and this year’s version will ensure MassHealth is statutorily able to finish their work in creating a regulatory and reimbursement structure.
  • Amendment #775: Rep. James O’Day’s amendment to reestablish the Homemaker Wage Increase account. This appropriation would provide an annualized wage increase of approximately 75 cents an hour to over 17,000 homemakers and personal care homemakers.

Our Legislative Action Center makes it easy to advocate. Just click on the FY15 budget message, fill in your contact info, and hit send! The system will automatically send the message to your state representative.

You can also call 617-722-2000 and press “2” to speak to an operator in the House of Representatives to urge your State Rep to support amendments #89, #491, #775 and #968. You can use the talking points above when speaking to an aide or leaving a message.

Contact James Fuccione at the Alliance with any questions.

Return to www.thinkhomecare.org.

House Ways & Means Releases Budget; Call Now To Support Amendments!

The state’s House Committee on Ways & Means this week released its proposed $36.2 billion fiscal year 2015 budget.

The House budget closely follows the Governor’s budget proposal in most line items related to home care providers, with slightly smaller allocations for MassHealth Senior Care Plans,boston-statehouse and EOEA Administration, and slightly more funding for local Councils on Aging. The House budget does not include the $1.2M Home Care Workforce Training Fund that was in the Governor’s budget.

Several legislative champions will be submitting amendments to the budget at the request of the Alliance. HCA members are encouraged to contact your local state representative TODAY and urge them to co-sponsor the budget priorities listed below.

A pre-written email is available on the Alliance’s Legislative Action webpage. For those choosing to call their local Representatives, please use the information below. Reps can offer formal support by contacting the office of the Representatives that are filing the amendments. Continue reading “House Ways & Means Releases Budget; Call Now To Support Amendments!”

State Awarded Grant to Rebalance Spending on Community-Based Services

MassHealth announced that they have been awarded a 2% increase in federal funding that will aim to re-balance spending towards community-based long-term services and supports (LTSS). The state’s project summary is available here.

The initiative is known as the Balancing Incentive Program, or BIP, and the enhanced federal funding is provided through Section 4002 of the Affordable Care Act. To participate, states must commit to achieving 50% spending on non-institutional LTSS by September 2015 and implementing structural changes to improve their long-term care system.

The enhanced funds for Massachusetts will be used to directly or indirectly increase offerings of or access to Medicaid-funded LTSS. The specific uses of the funding will be determined over the next several months through a stakeholder engagement process and negotiations with CMS.

The enhanced federal funding will run until September 30, 2015, and is intended to support Medicaid-funded, non-institutional long-term care services for individuals of all ages with physical, mental health developmental/intellectual and cognitive disabilities.

In a presentation to stakeholders, including the Home Care Alliance, MassHealth said they intend to develop a “No Wrong Door” system. This system is designed to strengthen partnerships across state agencies and processes so that people receive the services they need from whomever they need regardless of the state agency an individual makes initial contact with or is referred to first. The program will also set up new clinical assessment tools and is required to set up a “conflict-free” case management system.

In total, MassHealth expects at least an additional $85 million and as much as $110.6 million in enhanced federal funding. The Home Care Alliance is part of a stakeholder group to advise the state on how the financial assistance will be spent. A July 31 deadline has been set for the state to submit a work plan.

Stay tuned to our blog for updates and more information.

Return to www.thinkhomecare.org.