Advocacy Alert: Gain Support for Home Care in Workforce Development Bill

Today, the State Senate will be discussing more than 200 amendments to Senate Bill 2423, “An Act relative to job creation, workforce development and infrastructure investment.”

The Home Care Alliance is actively advocating on the following issues and urge HCA members and advocates to contact their state senator by sending a message through our ADVOCACY CENTER and calling offices by using the talking points below.

If you do NOT know who represents you in the State Senate, please visit this site for assistance.

  • OPPOSE Amendment #136 – “Strengthening the Home Care Program”
    • Background: This amendment would create a publicly-available registry listing the personal information of home care workers.
    • The Home Care Alliance is opposed to allowing the public access to the personal information of home care workers proposed in this amendment, including full legal name, date of birth, home address and gender of these workers.
    • This information provides no benefit to consumers of home care services and no benefits to home care workers.
  • SUPPORT Amendment #148 – “Labor Commission Membership”
    • Background: Section 109 of S.2423 creates a special commission to investigate and report on barriers to meeting labor market demands in the commonwealth, including home care – however, there is no home care membership on the commission.
    • The Home Care Alliance supports placing a home care agency representative with knowledge of home care workforce on the Labor Commission.

If you have any questions, please contact James Fuccione at the Alliance.

Return to www.thinkhomecare.org.

Governor Outlines Budget Vetoes, Slashes Pediatric Palliative Care

With $256 million in spending reductions, the Governor approved his final approved FY17 state budget and it’s now up to the House and Senate to now discuss overrides before formal sessions conclude at the end of July.

Among the items preserved was a $200,000 item for the Department of Higher Education that funds the Nursing and Allied Health Workforce Initiative. The Home Care Alliance is among a large group of stakeholders that advocates for funding that supports grants to teams of colleges, health care providers, and workforce investment boards to advance training and education for nurses and direct care workers.

The governor did, however, reduce the legislature’s funding recommendation for the pediatric palliative care network by $400,000. The remaining $1.8 million is essentially a level-funding from previous years. It was one of 303 line items that saw reduced funding.

The largest reduction the Governor recommended was a $17.8 million drop in Nursing Home Supplemental Rates. The House and conference committee had recommended a total of $337.9 million while the Senate had suggested $332.9 million, but the number being sent by the Governor back to the legislature currently sits at $330.1 million.

Details on the Governor’s FY17 budget can be found on the “Governor’s FY17 Vetoes” webpage.

Return to www.thinkhomecare.org

Home Care Commission Denied in Budget, Cuts Handed to Elder Services

The merits of protecting consumers, setting minimum standards for companies and agencies providing in-home care, and controlling state costs were not enough to advance a Home Care Oversight Commission through the state budget.

The state’s FY17 Conference Committee released their final budget proposal on behalf of the legislature after regrouping in light of declining revenue projections. The Home Care Commission, which was included in the Senate budget, but not in the House, had to survive a “conference committee” of House ma budget pie chart picand Senate budget leaders that negotiated a fiscal plan between the two sides.

With Massachusetts being one of only five states without state oversight of home health care, and also with a goal to place some standards on private-pay home care, the commission would have convened legislators, home health agencies, private-pay home care, state officials, consumer groups and trade associations to recommend solutions. The language stipulated that there be separate sets of recommendations for home health and private pay home care.

Elsewhere in the budget, the declining revenue projections filtered through to hit the elder services network. Based on FY16 spending levels, a $2 million cut was made to “Elder Home Care Purchased Services” and $2.6 million reduction in the “Elder Home Care Case Management and Administration” account.

Two pieces of good news came in that Elder Protective Service got a boost of $4.5 over FY16 spending and the Pediatric Palliative Care Network received a boost of $404,578, but the Nursing and Allied Health Workforce Initiative remained leveled out at $200,000.

More silver lining came with a $1 million pilot program to test expanding income eligibility standards for services ordered by Aging Service Access Points.

In terms of MassHealth line items, the expected trends continued with the conference committee reducing the “Fee-for-Service” account by $161.7 million while increasing the accounts tied to MassHealth Managed Care ($71.1 million) and MassHealth Senior Care ($160.4 million).

Nursing Home Supplemental Rates also saw a raise with $45 million over FY16 spending.

The $39.15 billion budget now moves to the Governor for final approval and any further updates will be shared as they become available.

Return to www.thinkhomecare.org.

HCA Breaks Down MassHealth 1115 Waiver Proposal

Months of stakeholder meetings and public engagement by MassHealth has resulted in a long-awaited draft proposal that aims to completely restructure the state’s Medicaid program.

Known as the Section 1115 Waiver, the 90-plus page document outlines a possible multi-year agreement  with the federal Centers for Medicare and Medicaid Services (CMS). The focus of the proposal is a move towards accountable care organizations (ACOs) and alternative payments while better addressing the needs of MassHealth members and putting in place a financially sustainable system of health care and support services.

Before the agreement can be made with CMS, however, there is a public comment period that runs until July 17th. The Home Care Alliance created a breakdown of the proposal so that members and advocates can better understand the key provisions.

MassHealth also provided a more basic fact sheet available on their 1115 Waiver Proposal webpage that also includes the full document and slide decks from previous public meetings.

The proposal attempts to seize an opportunity for new funding streams to support the creation of three types of ACOs that are required to partner with existing providers of behavioral health (BH) and long-term services and supports (LTSS). The state aims to rearrange provider and managed care relationships to set forth a better coordinated and integrated set of networks.

The first “pilot ACOs” are expected by MassHealth to come online later in 2016, while the full roll-out of the three ACO models, enhanced funding, and BH/LTSS integration will take place in October 2017.

The Alliance was appointed to several of the MassHealth stakeholder groups and plans to submit comments on the proposal on behalf of home care.

Return to www.thinkhomecare.org.

 

National Fraud “Hot Spots” Revealed in Largest-Ever Operation Announced by US DOJ

The US Department of Justice announced that 301 individuals have been charged with falsely billing Medicare a total of approximately $900 million in what is being called the largest coordinated Medicare fraud take down in history.

Home health services were among a list of services involved in the fraud schemes that also included physical and occupational therapy, durable medical equipment (DME) and prescription drugs. In the process, the HHS Inspector General released a data brief titled “Nationwide Analysis of Common Characteristics in OIG Home Health Fraud Cases.”

That data brief reveal some trends in outlier patterns among home health agencies and affiliated physicians, but also identifies 27 “hot spots” in 12 states where home health care fraud is prevalent. Massachusetts is not among the states shown in the map below where much of the home health fraud activity is occurring.

Recently, Massachusetts has been included in a planned “pre-claim review” demonstration starting “no earlier” than January 2017 that will, according to CMS, test whether such a process improves methods for the identification, investigation, and prosecution of Medicare fraud occurring among Home Health Agencies. Among the five states involved in the demonstration, Massachusetts is the only one not on any target list for the Medicare Fraud Task force known as HEAT (Health Care Fraud Prevention & Enforcement Action Team). For many years, the Home Care Alliance has repeatedly advocated for a temporary moratorium on new Medicare home health providers in response to recent growth in the number of new agencies, but such efforts have been denied by Medicare.

2016 HHA Fraud Hotspots

According the to HHS Inspector General, these are areas where characteristics commonly found in OIG-investigated cases of home health fraud were prevalent. The report states that “many of these hotspots are areas already recognized as having high rates of Medicare fraud, which suggests that home health fraud in these areas is an ongoing concern and that enforcement and program integrity efforts should continue.”

Advocacy Alert: Gain Support for the Home Care Oversight Commission

The roughly $40 billion that will make up the legislature’s FY17 proposal must first go through a six-member “conference committee” that will negotiate on differences between the House and Senate budget versions.

Included in the Senate version was a special commission that will study, discuss, and make recommendations on separate policies for state-based oversight of home health and private-pay home care agencies. It will take advocacy to ensure that this important provision is included in the conference committee’s negotiated budget, and action can be taken through the HCA’s Advocacy Center.

Simply fill out the contact forms and hit “send” to help gain support for the Home Care Commission!

The Commonwealth is one of five states without either licensure or a “certificate of need” process for home health care services. Massachusetts has also recently experienced rapid growth in the number of “certified” home health agencies. The related and significant spike in MassHealth spending has forced the state to establish program integrity measures on these agencies.

Likewise, private-pay home care agencies across the state that provide mostly non-medical support services in the home have no state oversight and a study commission is needed to determine the best solution.

The Alliance will continue to update it’s members on this proposal.

Return to www.thinkhomecare.org.

116 US Reps Sign on to Prior Authorization Letter to CMS

Even though the public comment period for CMS’ proposed prior authorization demonstration ended on April 5th, the Home Care Alliance has been active in its continuing advocacy to oppose the measure.

Joining national associations and advocates from across the country, the HCA helped spearhead a congressional letter to CMS opposing prior authorization, which gained 116 signatures and was co-led by Massachusetts Congressman Jim McGovern. All but one member of the state’s congressional House delegation signed on. The Alliance thanks Congressmen Stephen Lynch, Joseph Kennedy, Bill Keating, Richard Neal, Seth Moulton and Congresswomen Niki Tsongas and Katherine Clark for their support.

The proposed five-state pilot includes Massachusetts, Florida, Texas, Illinois and Michigan and those five states have been lobbying members of Congress, but many others nationwide have joined in the fight realizing that a demonstration could, and likely would, lead to wider implementation.

In late February, the Home Care Alliance began its advocacy of the proposal by traveling to Washington DC to deliver a letter outlining the organization’s comments to members of Congress. The HCA and all others who gathered in opposition to the prior authorization demonstration await a response from CMS.

Return to www.thinkhomecare.org.

Senate Advances Home Care Commission in Budget

In a $39.5 billion budget, the Senate advanced Home Care Alliance priorities, namely a special commission that will study and make recommendations for state oversight of home care.

The commission would create a separate set of recommendations for certified home health and also private pay agencies. The group would include three representatives from each type of agency (certified and private-pay) as part of the membership along with policymakers, administration officials, and many others. During the Senate’s deliberations on more than 1,300 amendments, the Massachusetts Nurses Association and the MA Chapter of the National Academy of Elder Law Attorneys.

Unfortunately, efforts to gain payment increases for home health aides and homemakers were not approved despite collaboration with the Home Care Aide Council, Mass Home Care, and several dedicated Senate offices. Senator Joan Lovely (D-Salem) spoke well in debate on behalf of a home health payment review and Senator Barbara L’Italien (D-Andover) fought for inclusion of home health aide payment, in particular. Senator Patricia Jehlen (D-Somerville) and Senator Sal DiDomenico (D-Everett) also helped lead an effort to advance home care rates.

On a positive note,an amendment was defeated that would have created a publicly-available registry of home care workers that aimed to list private information.

In addition, the Senate approved a pilot program of just over $1 million that expands income eligibility standards for services coordinated through Aging Service Access Points.

Other notable items in the Senate’s budget include the following:

  • A feasibility study on allowing spouses to be paid caregivers under MassHealth.
  • Allowing a leave of absence for nursing home residents under MassHealth (20 medical leave days and 10 non-medical leave days).
  • A fund created from fines and penalties relative to patient abuse in nursing homes that funds the prevention of such action through staff training and education, enhanced inspections, and relocating residents to other facilities.
  • $20.5 million for the Nursing Home Quality Jobs Initiative as part of SNF Supplemental Rates.
  • $200,000 for Geriatric Mental Health Services.

The HCA thanks its members for the hundreds of emails and phone calls to Senators during the past two weeks. The state budget process moves on to a conference committee process where the House and Senate negotiate differences between their two FY17 proposals. The Alliance will continue to push for the commission to establish oversight measures as well as other items to strengthen home care.

Return to www.thinkhomecare.org.

 

Advocacy Alert: Help Gain Support for Home Care in the Senate Budget

ma budget pie chart picThe Massachusetts Senate is taking their turn in the fiscal year year 2017 state budget process with a $39.49 billion proposed starting point.

Senators have filed just over 1,100 amendments seeking to add a combination of funding and policy language that will be debated next week, but advocacy is needed to gain support for the issues critical to home care agencies.

The Home Care Alliance’s Advocacy Center features prepared emails focused on these issues that can automatically be sent to your state senator. Click here to send a message on all of HCA’s priorities – OR send a specific message to urge support for improved home health aide reimbursement or a study of MassHealth reimbursement for all home health services.

Here are explanations of the Alliance’s priority items:

MassHealth Reimbursement to Home Health Aides – Amendment #596 (Senator Barbara L’Italien)

  • Home Health Aide Rates have not been reviewed since 2007.
  • This amendment raises the rate MassHealth reimburses home health agencies for home health aide services by 12% at a cost to MassHealth of $3.66 million which after federal match becomes $7.32 million.
  • This increase would also effect the purchase of home health aide services ordered through the state network of Aging Service Access Points (ASAPs) at a cost of $5.25 million.

MassHealth Home Health Reimbursement Review – Amendment #470 (Senator Joan Lovely)

  • Home health care is a cost-effective service that allows people of all ages – from maternal-child health services and pediatric patients to the elderly –to remain independent in their homes where they are most comfortable and at a lesser expense to their families and the Commonwealth.
  • Payment rates have not been reviewed since 2007. Current rates are based off of 2005 data and were cut in 2008.

Homemaker Wage Increase – Amendment #591 (Senator Michael Barrett)

  • On average, this request will provide an increase of $.50 per hour to homemakers and personal care homemakers providing care to clients enrolled in the Elder Home Care Program
  • This budget request will include language to raise the EOEA average compensation mandate in ASAP contracts from $12.69 per hour to $13.19 an hour for FY17

The Home Care Alliance appreciates that the Senate Committee on Ways & Means included language for the Home Care Oversight Commission, which seeks to convene legislators and stakeholders to recommend separate standards for licensure for private-pay home care and Medicare-certified home health.

The HCA is also supporting amendments, including #597 (Sen. L’Italien) to expand eligibility for in-home elder services and #622 (Sen. Humason) to bring Massachusetts into the Nurse Licensure Compact.

Other noteworthy items in the Senate budget include the following:

  • $2.6M for Pediatric Palliative Care, an increase of $800K over FY 2016 funds to meet the needs of terminally ill children and their families and eliminate the wait list for these critical services.
  • $200,000 for the Nursing and Allied Health Workforce initiative through the Mass. Department of Higher Education. Senator Michael Moore has proposed an amendment (#136) to raise the amount to $400,00, but this item from Senate Ways & Means goes a long way to ensuring that the item will be funded at previous levels.
  • Following the Governor’s lead, the Senate consolidated the Elder Enhanced Home Care (ECOP) line item and moved that funding to other accounts.
  • Nursing Homes secured $30 million (half of which will come from an added assessment on facilities) for added CNA reimbursement.
  • Nursing Home Supplemental Rates matched the Governor’s FY17 proposal at $332.9 million, which is $15 million below what the House approved.
  • The Home & Community Based Services Policy Lab also received funding not included in the House budget, which will help the state study the cost-effectiveness of certain long-term services and supports.

Return to www.thinkhomecare.org.

Special Guest Blog Post: Recognition and Advocacy During National Nurses Week

by Diane Jeffery, Executive Director of American Nurses Association – MassachusettsANA-MA

In celebrating National Nurses Week (May 6-12), we are, of course, taking the time to appreciate and recognize the daily contribution that nurses make to improving patients’ lives, but we are also focused on improving and advancing nursing as a profession – this week, and every week.

The theme of 2016 National Nurses Week is “A Culture of Safety – It Starts with YOU!” With that in mind, the American Nurses Association (ANA) is asking nurses to take personal responsibility in helping make their workplaces safer to enhance patient care and nurses’ health and well-being. We invite home health agencies to visit NursingWorld.org to view resources on how you can celebrate and recognize your nurses.

We are also pleased to carry out that vision in our advocacy. At the national level, ANA supports the Home Health Planning Improvement Act, which would allow Advanced Practice Nurses – including nurse practitioners, clinical nurse specialists and certified nurse midwives – to sign home health plans of care and certify Medicare patients for the home health benefit.

While APRNs satisfy Medicaid’s face-to-face requirement needed before home health can be authorized, APRNs are prohibited from signing home health plans of care and certifying Medicare patients for the home health benefit. This creates unnecessary delays and places impediments between an individual and the in-home care that they prefer and medically deserve.

At the state level, ANA-Massachusetts has long been a supporter of An Act Relative to Home Health and Hospice Aides, better known to some as the “Nurse Delegation” bill. It would allow, but not mandate, that a nurse may delegate certain medication administration tasks to a trained and certified home health or hospice aide.

Massachusetts is behind 36 other states that allow some type of delegation. If we are to care for an aging population, reduce costs by strengthening healthcare in the home and create efficiencies in our healthcare workforce, we need to elevate nurses to practice at the top of their license and elevate the aides that are critical team members.

Return to www.thinkhomecare.org.

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