Author: James Fuccione

CMS adds Guidance on Independence at Home Demonstration

CMS has offered guidance in the form of additional FAQ’s on the Independence at Home Demonstration, which aims to test a service delivery model that utilizes physician and nurse practitioner-directed primary care teams to provide services to certain Medicare beneficiaries with multiple chronic illnesses in their homes.

Based on the opportunity for home care agencies to partner with physician practices on this project, the Home Care Alliance held a conference call on the program and made a presentation and other resources available on a previous newsfeed post.

Return to www.thinkhomecare.org.

Governor Releases FY13 Budget Blueprint

Governor Deval Patrick released his proposal for the state’s fiscal year 2013 budget, which sets the stage for the legislature to work out their own versions and come to an eventual agreement over the next six months.

The Governor’s budget does not include any projected increases or cuts for home health, as is the case with most programs (MassHealth Nursing Home Supplemental Rates are reduced from FY12 spending by more than $300 million in the Governor’s proposal).  The MassHealth line items are almost all increased to “meet projected need,” which just translates to level funding. Here is a list of the line-items of note, including the MassHealth accounts.

  • MassHealth Managed Care (line item 4000-0500) increased $183,988,029 over FY12 spending to $4,164,475,376
  • MassHealth Senior Care (line item 4000-0600) increased $196,976,192 over FY12 spending to $2,763,630,662 .
  • MassHealth Fee-for-Service Payments (4000-0700) increased $129,850,745 over FY12 spending to $1,939,680,126.
  • Home Care Purchased Services (9110-1630) had a short increase just over $2,000 to $97,783,061.
  • Elder Enhanced Home Care Services (9110-1500) increased $672,147 to $46,461,487 .

The Governor’s office provides more details on health care costs and reasoning for those decisions here. The Home Care Alliance will continue to provide more information as further analysis is completed. The Alliance will once again be advocating for line items of concern as the budget process moves forward, including on issues like payment rates and telehealth reimbursement from Medicaid.

For more general information, several articles from sources like Boston.com and MassLive.com are available that explain some of the Governor’s budget as well.

Return to www.thinkhomecare.org.

 

Check out the New Facebook Page on Nurse Delegation

The Home Care Alliance invites members, advocates, and anyone interested to “like” a new Facebook page focused on passing Senate Bill 1138, An Act Relative to Home Health Aides, which is also known as the Nurse Delegation bill.

The page will provide updates on the bill and the nurse delegation issue in general. Other important links can be followed to reports, news articles and pre-written advocacy messages that makes it easier to contact legislators for those concerned about the issue.

Return to www.thinkhomecare.org.

HCA Informs Members on Pioneer ACO and Independence at Home Programs

The Home Care Alliance held a well-attended conference call to inform members about two major programs recently announced by CMS:

First, the Department of Health and Human Services announced the first 32 organizations in 18 states that will participate in the new Pioneer Accountable Care Organization (ACO) initiative. This program is operated by the CMS Innovation Center under Section 3022 of the Affordable Care Act. Selected Pioneer ACOs include “physician-led organizations and health systems, urban and rural organizations, and organizations in various geographic regions of the country.” Five of those organizations are in Massachusetts:

  • Atrius Health Services
  • Beth Israel Deaconess Physician Organization
  • Mount Auburn Cambridge Independent Practice Association (MACIPA)
  • Partners Healthcare
  • Steward Health Care System

This Pioneer ACO Presentation was given by HCA Executive Director Pat Kelleher on the call and explains some of the points that home care agencies should be aware of as the initiative moves forward.

The CMS Center for Innovation also has a site full of resources on Pioneer ACO’s including FAQ’s and brief summaries of the selected ACO’s.

WBUR’s CommonHealth Blog had a feature on Pioneer ACO’s and asked each of the five accepted systems in Massachusetts what the program will mean for patients.

The second program announced was a solicitation for the new Independence at Home Demonstration Program (IAH), which aims to test a service delivery model that utilizes physician and nurse practitioner-directed primary care teams to provide services to certain Medicare beneficiaries with multiple chronic illnesses in their homes.

HCA also gave this presentation on the Independence at Home Demonstration on the conference call for members to explain that home care agencies can be a major partner to physician practices, despite the fact that the program is directed by a physician or nurse practitioner-led practice with experience in making home visits.

The IAH Demonstration’s webpage also has FAQ’s as well as the solicitation and application.

The Alliance will pass along any more information as it becomes available.

Return to www.thinkhomecare.org.

 

New Advocacy Message to Support Nurse Delegation

The “Nurse Delegation” bill (S.1138, An Act Relative to Home Health Aides) has been stuck in the Joint Committee on Public Health since it was among a list of other matters that had a public hearing last July.

The Home Care Alliance’s Legislative Action Center now includes an email message that can be sent to the committee urging them to advance the bill forward in the legislative process! Just follow the instructions on this link to take action.

Return to www.thinkhomecare.org.

Last Call for Presentations: New England Home Care Conference and Trade Show

The New England Home Care Conference & Trade Show is issuing a LAST CALL for presentations. Event organizers are looking for faculty with expertise and experience to present at this year’s conference, which will take place at MGM Grand Foxwoods in Mashantucket, Connecticut on May 31st and June 1st.

Last year’s event saw 400 attendees from the home care industry representing the New England Region.

The presentation application is available here or on www.nehcc.com.

Return to www.thinkhomecare.org.

 

NewMMIS Announcement of Grace Period for Electronic Claims Submission Policy

All Provider Bulletins 212  from May 2011 (“Important Claims Submission Policy Changes”) and 217  from September 2011 (“Waiver Policy for Claim Submissions”) both announced an important change in the claims submission policy. Effective January 1, 2012, all MassHealth claims must be submitted electronically unless a provider has an approved electronic claim submission waiver.

Effective January 1, 2012, MassHealth will implement a 90-day grace period of the claims submission policy to allow providers additional time to convert to electronic claims submission and to apply for the electronic claim submission waiver. MassHealth will issue an all provider bulletin in January that further explains this grace period.

Questions can be directed to MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.

Return to www.thinkhomecare.org.

CMS Announces Independence At Home Demonstration Program

CMS continues to roll out initiatives from the Affordable Care Act in an attempt to test new ways to improve health care and lower cost.

The latest in this line of programs and funding opportunities is the Independence At Home Demonstration (Section 3024 of the ACA), which aims to test a service delivery model that utilizes physician and nurse practitioner-directed primary care teams to provide services to certain Medicare beneficiaries with multiple chronic illnesses in their homes.

According to the Independence At Home (IAH) Program Solicitation, in order to be involved in the Demonstration, “practices must be individual physicians or nurse practitioners or interdisciplinary teams composed of various members such as physicians, nurse practitioners, physician assistants, pharmacists, social workers, and other supporting staff.” The program itself is designed to provide comprehensive, coordinated, continuous and accessible care to high-need patients and to coordinate health care across all treatment settings.

Even though primary care is the lead in the IAH demo, the focus is on delivering care to patients in their homes and getting beneficiaries what they need to remain independent. In other words, the program could actually be of significant benefit to the home care industry as a whole because primary care practitioners will be making check-ups in the home and witnessing how patients function in their day-to-day environment. Based on those visits, the practices will be identifying services – like home care and other community based services – that help keep people out of costlier settings and the ER.

Practices are required to use electronic health systems and remote patient monitoring, both of which are used by many home health agencies. Also, practices must be available 24 hours per day, seven days per week to carry out plans of care. Applicable beneficiaries must have at least two chronic illnesses, must need human assistance with two or more Activities of Daily Living (ADL’s), have had a non-elective hospital admission within the last 12 months and have used acute or sub-acute rehabilitation services within the last 12 months.

HCA encourages agencies to see the other guidelines, which are laid out in the IAH Solicitation and a summary is provided in a PowerPoint provided on the IAH program webpage.

Return to www.thinkhomecare.org.

MassHealth Releases Dual Eligible Demo Proposal for Public Comment

After months of stakeholder meetings and public presentations, MassHealth has released their official proposal for the “State Demonstration to Integrate Care for Dual Eligible Individuals” to the Centers for Medicare and Medicaid Services (CMS).

The initiative seeks to combine Medicare and Medicaid funding to contract with an Integrated Care Organization (ICO) that will pay for coordinated and comprehensive care for dually eligible individuals ages 21 to 64. Massachusetts was one of 15 states to be awarded a planning grant for the project and has been in contact with CMS on crafting benefit design, enrollment processes, and payment processes.

The release of the draft proposal initiates a 30-day public comment period that will remain open until 5:00 pm, January 10, 2012. Two public hearings are also planned at the following dates and locations:

  • December 16, 2011, 1 pm – 4 pm, at the Worcester Public Library, Saxe Room, 3 Salem Square, Worcester, MA
  • January 4, 2012, 9 am – 12 noon, at the State Transportation Building, Conference Rooms 2 & 3, 10 Park Place, Boston, MA

For any agencies caring for dually eligible patients, we strongly encourage you to look at the proposal and send in comments. The Home Care Alliance would also like any case studies of these patients that agencies have been successful in keeping in the community.

Agencies can send comments to: duals@state.ma.us, or mailed to:

Executive Office of Health and Human Services
Attn:  Lisa Wong
One Ashburton Place, Rm. 1109
Boston, MA 02108

Return to www.thinkhomecare.org.

CMS Care Transition Program Update and Guidance

Masspro, the state’s quality improvement organization, held a conference call on the CMS Community Based Care Transitions Program and provided some useful guidance for those looking to apply or reapply for funding.

Based on a CMS call with QIO’s, there were three common elements that tripped up applications from community based organizations, hospitals and other partners:

  • Firstly, in many applications, CMS said that it was not clear that the community-based organization was eligible and did not fit the criteria laid out in the solicitation, fact sheets and Q&A’s.
  • Second, many applications included budget items that were outside of what CMS would fund. For instance, CMS will only fund activities directly related to the intervention and not indirect costs like data collection. CMS is also said to be aiming for an across-the-board 20 percent reduction in readmissions for the program collectively as an attainable and reasonable target. Budgets within an application should reflect that element.
  • Lastly, CMS found that there were a lack of community partnerships in the applications they reviewed. Looking at the seven successful applications, it is clear that there is a large group of partners serving a relatively broad geographic region.

In addition to the Masspro call, CMS has once again updated their CCTP webpage to include panel review dates for incoming applications through March 27th. Also, summaries of all seven of the successful applications are now posted.

The Home Care Alliance will continue to provide guidance and assistance to home care agencies interested in applying and will connect any hospital or community partners looking for home care agencies in their area.

Return to www.thinkhomecare.org.