Advocacy Alert: Contact Congress Re: Amendment Delaying Rebasing Cuts

Congress is working in the final days before the holiday recess on a long-term Medicare Sustainable Growth Rate (SGR) process and an amendment to that process could delay the impending rebasing cut to home health care.

The Alliance is asking that agencies and advocates contact their Member of Congress TODAY to educate them about the amendment and what it means for Medicare home health agencies. U.S. Capitol Building

Senator Debbie Stabenow (D-MI) has offered an amendment that essentially delays the effects of rebasing so that CMS can hopefully adjust their methodology with updated and more accurate data. Educating the Massachusetts Congressional Delegation is crucial to getting support for the amendment as there is so much happening in the final two days of activity.

More information and a prepared email message is available on HCA’s Legislative Action Network and it only takes a minute to log on and add your voice to this critical push to delay a damaging 3.5% cut per year over the next four years.

We also urge members to call the offices of your Congressional representatives directly using the message below as a guide. Simply call the main switchboard at (202) 224-3121, request a transfer to the office of your Congressional representative, and ask to speak to the individual from that office that is responsible for health policy.Here is the text of the message to Congress if you choose to call:

The U.S. Centers for Medicare and Medicaid Services (CMS) has finalized a rule imposing unprecedented Medicare home health reductions under a process called “rebasing.” All told, the impact on providers will be a $200 million cut in each of the next four years.

We are asking for your support in backing an amendment from Senator Debbie Stabenow as well as any corresponding effort in the House to amend the Medicare Sustainable Growth Rate (SGR) process.

These are the largest cuts to home health in decades, and they will cause many agencies to close their doors, especially if these cuts are compounded by Medicare reductions via the continuing budget resolution. Such cuts are counter-productive at a time when health reform relies on cost-effective care at home to serve vulnerable citizens.

CMS’s rebasing cuts were finalized on November 22 and go into effect on January 1. This leaves little time to delay these disastrous cuts and compel CMS to conduct a more fair, accurate and thorough analysis of its fiscal assumptions.

The data is clear. Many Medicare-certified home care providers are already operating in the red across all sources of payment. These new cuts – scheduled to be compounded for each of the next four years – will cripple the industry and create barriers to care. Yet, despite similar trends across the country, CMS concludes that draconian rebasing reductions are needed to eliminate positive margins in home health. CMS’s math simply does not add up.

Many in Congress agree. A bipartisan letter sent to CMS raised strong concerns, stating that the rebasing methodology relies on “incomplete data and analysis that results in the under-counting of home health agencies’ costs per episode of care, and an inappropriately high rebasing adjustment.”

Home care providers nationwide thank you and your colleagues in Congress for your strong stance on rebasing and we ask for your continued active engagement supporting Senator Stabenow and others to delay rebasing and initiate a more rational approach from CMS.

Thank you.

Return to www.thinkhomecare.org

Stage 2 EMR Adoption Deadline Pushed Back One Year

Several healthcare industry news outlets, including Modern Healthcare, are reporting that CMS is extending the deadline that providers are required to show Stage 2 “Meaningful Use” criteria  of electronic health records (EMR).

The overall deadline is delayed for one full year and, according to Modern Healthcare, Stage 2 of the CMS incentive program to encourage EMR adoption will be extended through 2016. Stage 3 won’t begin until at least fiscal year 2017 for hospitals and calendar year 2017 for physicians and other eligible professionals that have by then completed at least two years at Stage 2.

CMS and the Office of the National Coordinator for Health Information Technology at HHS say that the delay is intended help both federal entities focus on helping providers meet Stage 2’s demands for patient engagement, interoperability and information exchange, as well as use data collected during that phase to inform policy decisions for Stage 3.

The proposed rules relative to the requirements providers must meet for Stage 3, as well as the 2017 Edition of standards that health IT developers must build and test their systems to match, are expected to be released in the fall of 2014 .

The Modern Healthcare article noted that the program, created under the America Recovery and Reinvestment Act of 2009, has paid out about $17 billion since January 2011, according to the latest CMS data.

Return to www.thinkhomecare.org.

Mass. EOHHS Holding FY15 Budget Hearings

A pair of public hearings will take place in Amherst and Boston this month to help guide the state’s Executive Office of Health and Human Services as they look to shape their fiscal year 2015 budget.

It is well documented that approximately half of the state government’s budget goes to health and human services so the department is constantly encouraged to find ways to do more with less.

HCA members and advocates are encouraged to email written comments to eohhshearings@massmail.state.ma.us by the time of the Boston hearing on December 11th. Subjects should include and focus on the following:

  • Raising MassHealth rates for skilled nursing
  • Encouraging a certificate/determination of need process for home health agencies
  • Urging formal support for S.1064, An Act Relative to Home Health and Hospice Aides, which allows nurses to delegate limited medication administration tasks to home health aides and CNA’s. With the hearings focusing on the EOHHS budget, commenters should focus on potential cost savings potential of “nurse delegation” issue.
  • Highlighting your agency’s efforts to reduce readmissions and other cost-effective programs.

For those interested in attending the hearings, the Amherst hearing will take place on December 6th from 10:00am to 2:00pm at Commonwealth Honors College while the Boston hearing will take place from 2:00pm to 6:00pm on December 11th at the UMass Boston Campus Center.

Any questions can be directed to James Fuccione at the Alliance.

Return to www.thinkhomecare.org.

Alliance Statement on CMS’ Final Rule Slashing Home Health Care Payments

The following is a statement from the Home Care Alliance regarding the CMS Final Rule on Home Health Rebasing. The Alliance invites its members and advocates to share this with their local media:

In a final rule released last Friday, the Centers for Medicare and Medicaid Services (CMS) have implemented a home health payment that will result in a 3.5 percent cut per year for the next four years.

It would be easy based on history to view the recent final rule from the Centers for Medicare and Medicaid Services (CMS) as “another year, another cut.” This year, however, is different.

The home health industry has absorbed $78 billion of cuts since 2009, which will be executed over the better part of the next decade. Those cuts come from the Affordable Care Act, other CMS final rules over recent years, and sequestration. The latest cuts amount to an additional and an untenable 14 percent – or $22 billion – reduction over the next four years.

These total reductions since 2009 and including the CMS final rule are comparable to the combined 2013 budgets of the federal departments of education and homeland security.

With an aging population and home health agencies caring for sicker patients that are released from the hospital at an earlier stage of recovery, the federal Medicare program is making it nearly impossible for quality providers to continue delivering effective services that end up saving taxpayers by preventing costlier facility-based health care under these circumstances.

The Home Care Alliance of Massachusetts joined providers and associations from across the country, as well as many members of Congress, in urging CMS to revisit what they had proposed back in July. Those calls and letters went disregarded and it is evident that CMS is trying to attain a numerical target in their budget ignoring logic at the expense of American seniors who benefit from care at home. CMS claims the cuts amount to a 1.05 percent reduction, which is a slight improvement over the proposed rule, but the cumulative impact of continued cuts scheduled for 2015, 2016, and 2017 drive the cut deeper.

The Home Care Alliance will be assembling with other advocates in Washington DC and online in a campaign to persist in opposing the cuts from CMS.

About the Home Care Alliance:

With a mission to unite people and organizations to advance community health through care and services in the home, the Home Care Alliance of Massachusetts is a non-profit trade association and advocacy group representing the voice of the state’s home-based health and care services. Founded in 1969, the Alliance represents 200 home care and home health agencies. For more information, visit www.thinkhomecare.org.

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Return to www.thinkhomecare.org.

Boston Children’s Hospital Releases Educational Videos for Families, Providers

A series of educational videos for patients, families and healthcare providers is being promoted by Boston Children’s Hospital regarding care of a central line in order to help decrease the number of CLABSI (Central Line-associated Blood Stream Infections).

Especially for agencies specializing in pediatric home health care, but applicable for all, these videos are a useful educational tool. The Alliance also posted the link on our Facebook page and encourage home care agencies to pass them along to patients and families that could be benefited.

More educational videos for home care agencies and family caregivers created by the Home Care Alliance are available on the Caregiver Video Resource Center that can also be found at our Home Care Month Webpage.

Return to www.thinkhomecare.org.

Visit Our New Home Care Month Webpage and Raise Awareness

November is National Home Care and Hospice Month and the Home Care Alliance has put up a special webpage full of resources and information to help agencies and advocates raise awareness.
The website promotes several informational pieces including:

  • “The Agency Advantage,” which lists reasons why people should choose a home care agency over an independent direct-hire individual.
  • “Your Care, Your Choice,” which highlights Medicare rules relative to patient choice.
  • “Keeping It Legal,” which is a resource for home care referral sources about ethical practices under federal regulations.
  • The Caregiver Video Resource Center, and more!

In addition, the website has a sample press release and letter-to-the-editor templates for agencies to send to their local media. Home Care Month is an excellent opportunity to recognize staff and be visible in the community.

Visit www.thinkhomecare.org/homecaremonth to help raise awareness and connect with the Alliance on Facebook and Twitter to let us know how you are celebrating!

Return to www.thinkhomecare.org.

Regional Trainings on MOLST Being Held

For those home health agencies looking to implement or simply learn more about MOLST (Medical Orders for Life Sustaining Treatment), the MOLST outreach and education team is hosting a series of regional meetings detailed below.

The Region 3 meeting will be held on November 18 at Lahey Hospital & Medical Center in Burlington, MA.  Click here to register.  Registration will close on November 13.

The Region 4 meeting will be held on December 6 at Newton-Wellesley Hospital in Newton, MA.  Click here to register.  Registration will close on November 29.

The Region 5 meeting will be held on November 13 at New England Sinai Hospital in Stoughton, MA.  Click here to register.  There are just a few seats left.  Registration will close this Wednesday, November 6.

If you are (or will be) involved in implementing MOLST at your institution, or involved in training others about MOLST, come to these meetings to:

•    Learn more about MOLST
•    Become familiar with the MOLST process in order to communicate and honor your patients’ life-sustaining treatment decisions
•    Understand how to use available MOLST resources for implementation, including across the continuum of care

More information is available on the MOLST website.

Return to www.thinkhomecare.org.

MeHI Hosting Free Regional Health IT Meetings

The Massachusetts e-Health Institute (MeHI) is hosting free regional meetings to help attendees keep up-to-date on how they can gain the benefits of connected EHRs and the Massachusetts programs to support their adoption and use.

The sessions will include information about how MeHI, the Mass HIway and others are helping providers comply with Chapter 224 requirements for physician licensure and Stage 2 Meaningful Use.

The workshop will take place in Worcester on November 4th and will run from 8:00am to 11:30am. The event is free, but registration is required. More information on registration and the agenda for the event are available here.

Return to www.thinkhomecare.org.

Advocacy Alert: Out-of-State MD Orders Legislation

A state legislative priority of the Home Care Alliance will be considered by the state legislature’s Joint Committee on Public Health at their hearing on October 29th in hearing room B-1 of the State House.

The bill is S.1042, An Act to allow out-of-state physicians to order home care in the Commonwealth, and would allow an out-of-state physician in a bordering state to order home care services for a resident of Massachusetts.

Under the bill, the out-of-state physician will not be required to obtain a license form the Massachusetts Board of Registration in Medicine. However, the Massachusetts home health agency will obtain and keep documentation that the out-of-state physician’s license is in good standing. The home health referral must also be the result of an in-person examination. The legislation is intended to remove a significant barrier to home based services by increasing access to physicians and specialists for residents living on or near a border with a neighboring state, those with vacation homes in other states, and those traveling in other states.

Any agencies or advocates interested in submitting written comments or testifying in person can contact James Fuccione at HCA.

Return to www.thinkhomecare.org.

HCA Statement on Indictment of Waltham Home Health Agency Owner

Home Care Alliance of Massachusetts Decries Fraud Renews Call for Stricter Oversight or New Agencies, Moratorium

Boston, MA – The arrest on September 16th of the owner/proprietor of a Massachusetts home health agency on charges of defrauding the federal Medicare program should be seen as a wake-up call to federal and state officials that unlimited expansion of home health agencies is threat to the Medicare program and its beneficiaries.  The Home Care Alliance applauds the efforts of the federal Office of the Inspector General in identifying the aberrant behavior of this agency and reiterates its call for the federal government to do more to target abusive agencies.

“Home health agencies in Massachusetts work hard to comply with all federal and state rules and are an integral part of building a more patient centric, cost effective health care system,” said Patricia Kelleher, Executive Director of the Home Care Alliance of Massachusetts, a trade association for more than 190 Medicare certified and private pay home care agencies.  “We have been calling for more directive enforcement efforts aimed at outlier agencies, as opposed to blanket enforcement that burdens the high quality, highly ethical providers.

The Home Care Alliance has met with staff at CMS regularly over the past four years urging that there be: 1) More active enforcement of existing Medicare program rules, and 2) A more rigorous set of rules for entry into the industry in order reduce the growth of unqualified agencies.

The Alliance wrote to Health and Human Services Secretary Kathleen Sebellius in 2011 and 2012 urging her to immediately place a moratorium on the enrollment of new home health providers into the Medicare program. The Medicare Payment Advisory Commission (MedPAC) also made this recommendation in their March 2011 report to Congress, and the Secretary was granted the authority by the Patient Protection and Affordable Care Act to suspend payments to providers or establish a moratorium on new provider enrollment.

The Alliance has also filed state legislation to require any new agency to file and be granted a state “certificate of need” before applying for federal Medicare certification.

“The home health agencies in Massachusetts have worked hard to gain the trust of patients and families, as well as our physician and hospital partners,” said Beverly Pavasaris, President of the Home Care Alliance and Executive Director of the Brockton VNA. “Agencies such as mine, with more than 100 years of proving home based care, will not sit idly and let our good work and reputation be damaged by individuals intent on committing fraud.” Continue reading “HCA Statement on Indictment of Waltham Home Health Agency Owner”