Author: James Fuccione

Breakdown of Governor Baker’s FY17 State Budget for Home Care

Confronting a $635 million budget gap and steep spending increases in several areas, including MassHealth, Governor Charlie Baker’s administration released a $39.5 billion budget plan that aims to reduce growth while investing in more efficient programs.

On a conference call with stakeholders, state Health and Human Services Secretary Marylou Sudders thanked the Home Care Alliance for collaboration on a package of proposed solutions that are slated to go into effect by March 1st. As noted in previous newsletters and emails to HCA members, MassHealth is seeking to establish a prior authorization process, a moratorium on new home health providers, and a conflict-free physician referral process. This includes a closer scrutiny on medication administration visits and clients with a high utilization rate of home health aides.

Secretary Sudders reported on the call that audits will be conducted effective immediately. She also explained that there are currently 195 certified home health agencies in the Commonwealth and 12 were referred to the MassHealth Fraud Unit under the state’s Attorney General’s Office. The HCA will continue to monitor audit activity and provide pertinent updates.

More generally in the Health and Human Services budget, MassHealth Managed Care and MassHealth Senior Care are receiving funding increases while the Fee-for-Service line item continues to decrease reflecting a move to programs like Senior Care Options (SCO), OneCare and other managed care services.

In the elder services line items, the Enhanced Home Care or ECOP program was consolidated into several line items by the Baker administration. The bulk of what was a $70 million line item went to Home Care Purchased Services and Case Management under the Aging Service Access Points (ASAPs).

Below are some other notable items related to home care in the Governor’s FY17 budget:

  • Nursing Home Supplemental Rates increased by $30 million. This is due to an increase to assessments on SNFs.
  • The line item for MassHealth Managed Care increases $149.1 million and the MassHealth Senior Care account rises by $160.4 million, while the MassHealth Fee-for-service item goes down by $113.7 million.
  • Elder Protective Services funding was increased by $4.9 million.
  • DPH’s Pediatric Palliative Care Network was essentially level-funded at $1.8 million.
  • Elder Nutrition (Meals on Wheels) was also nearly level funded at $7.2 million.
  • The Nursing and Allied Health Education Workforce Development item was eliminated. Last year it was funded at $200,000 by the legislature after being zeroed out by the Governor.

The budget process moves on to the House and Senate and further updates  – on both the budget as well as the HCA’s work with MassHealth on program changes to home health services – will be shared as information becomes available.

Return to www.thinkhomecare.org.

 

HPC Releases Proposed ACO Standards for Comment

The Commonwealth of Massachusetts is in the midst of a massive initiative to transform MassHealth payment and care delivery through the creation of Accountable Care Organizations (ACO). MassHealth has convened eight separate work groups to provide input and recommendations on various aspects of this transformation. The Home Care Alliance is represented on six of those eight work groups.

In support of that initiative, the state’s Health Policy Commission (HPC) this week released a set of draft ACO certification standards.

According to the HPC, the purpose of the certification program is to “complement existing local and national care transformation and payment reform efforts, validate value-based care, and promote investments by all payers in efficient, high-quality, and cost-effective care across the continuum.”

The HPC’s proposed standards include criteria, documentation requirements and questions for public comment. HCA intends to comment, so any members with thoughts, suggestions or answers on any of the proposed criteria or questions should contact James Fuccione at the Alliance.

For those looking to submit comments independent of the HCA, a public hearing will be hosted by the HPC on January 6 and the overall submission deadline for written feedback is January 29. That may seem like a far-off deadline, but with the holidays and the state’s budget process kicking up, any comments submitted to HCA well before that date would be appreciated.

Return to www.thinkhomecare.org.

Project Update: Webinar on Home Health IT Adoption and Utilization Analysis

On Thursday, December 3, 12:00 – 1:00 PM, the Home Care Alliance will offer a one-hour virtual overview of the current home health IT utilization trends across the Commonwealth.

Throughout the summer and fall, a team from the Massachusetts eHealth Collaborative  (MAeHC) developed and distributed a statewide home health HIT adoption survey aimed at identifying and remediating gaps. The survey process, along with an action plan to increase HIT adoption among home health providers, will be presented on this webinar.

Home health, along with other behavioral health and long term care providers did not receive incentives under the Health Information Technology or Economic and Clinical Health (HITECH) Act and American Recovery & Reinvestment Act (ARRA) which hospitals and eligible professionals have used to offset costs related to adoption health IT. The anticipation that new care and payment models, such as Accountable Care Organizations (ACOs), might support the cost of health IT adoption among “non-incentivized providers,” has been realized only in the most limited of fashions.

While the industry continues to lobby for IT funding for long term care in future phases of “meaningful use,”   The Alliance, in partnership with MAeHC and the Massachusetts eHealth Institute (MeHI), has taken steps to better position home health agencies to demonstrate their value proposition as connected partners.

This event is FREE and open to any interested party.  (Note:  HCA will be offering a special webinar for members who participated in the survey.)

Please click here to register. https://attendee.gotowebinar.com/register/921473577991975937.

Return to www.thinkhomecare.org.

CMS Releases Final Home Health Rule, Adds Discharge Planning Proposal

CMS published the Final Rule for Medicare Home Health PPS and VBP for CY 2016 to its website yesterday.  The official notice will be published in the Federal Register on November 5.

CMS also announced a “Discharge Planning Proposed Rule,” that is estimated to cost home health agencies nationwide about $283 million. The proposal, which the Home Care Alliance will fully analyze, will revise discharge planning processes for hospitals, long-term care hospitals, inpatient rehabilitation facilities, and critical access hospitals in addition to home health.

In terms of changes made to the Home Health Final Rule, CMS pulled back slightly regarding both payment and in the Value Based Purchasing Program. Below is an analysis from HCA staff:

Value Based Purchasing:

The final rule makes minor changes to the VBP system from the proposed rule.  The same nine states (including MA) are selected, with all agencies in the state included in the VBP system.  VBP will begin January 1, 2016, with a 2015 baseline year on performance, with all agencies within each selected state competing against each other for payment adjustments tied to quality performance measures.

CMS made a small concession to industry concerns that the proposed risk corridor was too broad, and reduced the maximum payment reduction in the first year of the VBP from the proposed 5 percent to 3 percent. The payment adjustments will be increased incrementally over the course of the model with: 

  • a maximum payment adjustment of  3-percent (upward or downward) in 2018,
  • a maximum payment adjustment of 5-percent (upward or downward) in 2019,
  • a maximum payment adjustment of 6-percent (upward or downward) in 2020,
  • a maximum payment adjustment of 7-percent (upward or downward) in2021, and
  • a maximum payment adjustment of 8-percent (upward or downward) in 2022.

CMS dropped 4 process measures and 1 of the new reporting measures. The final set of 24 measures includes 10 outcome measures, 6 process measures, 5 HHCAHPS, and 3 New Measures.

Outcome Measures

  • Improvement in Pain Interfering with Activity-M1242
  • Improvement in Dyspnea- M1400
  • Improvement in Bathing-M1830
  • Improvement in Bed Transferring-M1850
  • Improvement in Ambulation-Locomotion M1860
  • Prior Functioning ADL/IADL-M1900
  • Improvement in Management of Oral Medications-M2020
  • Discharged to Community-M2420
  • Acute Care Hospitalization: Unplanned Hospitalization during first 60 days of Home Health- (Claims)
  • Emergency Department Use without Hospitalization- (Claims)

Process Measures

  • Influenza Vaccine Data Collection Period: Does this episode of care include any dates on or between October 1 and March 31?-M1041
  • Influenza Immunization Received for Current Flu Season-M1046
  • Pneumococcal Polysaccharide Vaccine Ever Received-M1051
  • Reason Pneumococcal vaccine not received-M1056
  • Drug Education on All Medications Provided to Patient/Caregiver during all Episodes of Care-M2015
  • Care Management: Types and Sources of Assistance-M2102

Home Health CAHPS: Satisfaction Survey Measures

  • Care of Patients
  • Communications between Providers and Patients
  • Specific Care Issues
  • Overall rating of home health care
  • Willingness to recommend the agency

New Measures

  • Influenza Vaccination Coverage for Home Health Care Personnel
  • Herpes zoster (Shingles) vaccination: Has the patient ever received the shingles vaccination?
  • Advance Care Plan

CMS has modified the reporting of the New Measures; HHAs will be required to begin reporting data (through a web portal) no later than October 7, 2016, for the period July, 2016, through September, 2016, and quarterly thereafter. As a result, the first quarterly performance report in July, 2016, will not account for any of the New Measures.

CY2016 PPS Rates

Case Mix Weights:  CMS made additional minor changes to the case mix weights based on additional analysis.

Case Mix Adjustment:  In a slight concession to industry comments, CMS is phasing in their proposed 2.88% case mix adjustment over three years instead of the two years they initially proposed.  So the final rule decreases the national, standardized 60-day episode payment amount by 0.97% each year in CY 2016, CY 2017, and CY 2018, instead of 1.44% for just 2016 and 2017. 

Market Basket Update:  The final CY 2016 home health market basket (2.3 percent) combined with the multifactor productivity adjustment (0.4 percentage points) results in a 1.9 percent home health payment update percentage.

Wage Index:  CMS made additional small adjustments to the Wage Index because they used an updated database of hospital wage data.  The final wage index is slightly lower than the proposed index for every geographic region in MA except Berkshire County.

Return to www.thinkhomecare.org

CMS Sends Brief Response on Congressional HHPPS Letter

A letter to CMS voicing deep concerns about the Home Health proposed rule with 133 signatures from members of Congress, including all nine US Representatives from Massachusetts, was sent in mid September.

CMS issued their response, which was more brief than usual and only served to thank the signers for sharing those concerns. CMS is obviously not sharing much as the finalized regulation is set to be released on November 1st.

The original congressional letter to CMS made a few major points. Concerns about the case mix cuts centered on the data CMS relied upon to make those adjustments, which were flagged as “outdated” and illogical. CMS essentially ignored the past five years of data and instead used a decade of data in the prior time period to make projections going forward.

The letter also raised concerns about the proposed Value-Based Purchasing Program (VBP) that will take place in nine states, including Massachusetts. Specifically, the five-to-eight percent penalty/reward window was put forth as much too severe and dramatic as was the immense list of quality measures that CMS proposed that agencies would track as part of the VBP.

Among those leading on the letter were Massachusetts Congressman and home health care champion Jim McGovern. The Alliance thanks Congressman McGovern and all in the state’s congressional delegation that signed on. More information will be announced following the release of the final rule.

Return to www.thinkhomecare.org

Applications for Home Care NOI to Open on Nov. 2

According to the Executive Office of Elder Affairs (EOEA), the Notice of Intent (NOI) Application will open on Monday, November 2nd and will remain opened until necessary in order to conduct system and/or document updates.

The Homemaker NOI is the process Home Care agencies must complete if they are interested in contracting with the State’s network of 26 Aging Services Access Points (ASAPs) to provide Homemaker and Personal Care services through the “State Home Care program.”

The posting for approved providers will be completed within 4-6 weeks of the submitted Application.

This link brings you to an update found on the NOI Announcements page:

http://hnoi-announce.800ageinfo.com/

Existing providers will need to confirm/update corporate data within their approved Application if any data has changed.  If a Provider’s information is staying the same, no action needs to be taken. The EOEA will keep rejected NOI Applications available for 90 days from the rejection date for purposes of re-submission. Otherwise, a new application will need to be created and submitted.

For any providers that were previously rejected in FY 15 and did not re-submit a rejected NOI Application within the 90-day period, they must create/submit a new FY 16 Application.

Please note the NOI Announcements page includes a link to the MassHealth FEW Provider Enrollment documents, including an overview document.

Return to www.thinkhomecare.org.

HCA Returns from Productive Washington, DC Trip

Home Care Alliance staff and member agencies attended the Visiting Nurse Associations of America’s (VNAA) Public Policy Leadership Conference in the nation’s capital this past week and met with most of the state’s Congressional delegation.

Before and during the trip, the Alliance was able to secure support from eight of the nine US Reps on a letter to CMS voicing concern on case mix cuts and the impending Value-Based Purchasing demonstration. The ninth congressperson may still sign on, but it was still a productive trip where home health agencies from across the country were lobbying on the Physician Face-to-Face Requirement, allowing NP’s and PA’s to sign and certify home health plans of care, expanding palliative care career opportunities and showing the impact of proposed payment cuts.

Much of the activity was documented on the HCA’s Twitter page along with photos of congressional visits. The Alliance will be following up on our meetings and advocacy in DC and will continue to represent our members regarding the CMS proposed rule, Face-to-Face, and other federal issues. The HCA thanks member agencies that attended as well as our supportive Congressional Delegation, particularly Congressman Jim McGovern who co-led the letter to CMS.

Return to www.thinkhomecare.org.

HCA Applauds Tele-monitoring Support from MassHealth

After years of advocacy with the legislature and working collaboratively with MassHealth, the Home Care Alliance proudly testified at a public hearing on proposed remote patient monitoring (RPM) payment rates and regulations this week.

Alliance Legislative and Public Affairs Director James Fuccione commented that reimbursement for RPM will strengthen the ability of home health agencies to carry out their mission of keeping people healthy at home and commended MassHealth for including a broad definition that will allow agencies to be creative in their use of the service. Dana Sheer, NP of Partners Healthcare at Home, also submitted comments in support of RPM and offered recommendations on clarifying language.

The Alliance asked for clarification on a number of points, including whether an “installation/removal” fee of $50 would be paid by MassHealth for both or on each end of the set-up and removal of RPM equipment. HCA suggested that the fee be raised to $75 and paid on both ends. Additionally, the Alliance asked for guidance on how to proceed when multiple patients in the same setting could benefit from RPM services. Comments from the Alliance suggested that RPM could go a long way in assisting patients with behavioral health and substance abuse issues as well.

In his testimony, Mr. Fuccione raised the ongoing concern regarding MassHealth rates for nursing, therapy, and home health aide visits, and urged MassHealth to expedite a review and update of those rates.  He noted that the Alliance has had several recent meetings with MassHealth staff focusing on that very subject. However, the hearing was centered on the tele-monitoring proposal and the Home Care Alliance is thrilled to have spearheaded the push for reimbursement.

Massachusetts is one of only a few state Medicaid programs with financial support for RPM, which will be effective this November. MassHealth explained at the hearing that they expect a savings just within the home health program of $1.4 million.

The Alliance’s comments are available here and more updates on any changes MassHealth may make based on our comments will also be sent to member agencies.

Return to www.thinkhomecare.org.

Guest Blog Post: The Caring Force Announces Video Contest to ‘Broadcast Your Love of Human Services’

Guest Blog Post

by Christine Batista, Public Policy & Communications Associate, ‘The Caring Force’

The Caring Force has officially launched the  2015 Broadcast Your Love of Human Services video contest. And this year, the contest will take place on Instagram!

A few of us here at The Caring Force took the initiative to broadcast OUR love of human services by posting a video on our Instagram page. Now it’s your turn!

Get ready to Broadcast Your Love for Human Services by grabbing your phone and having some fun. Simply create a 15-second video, post it on Instagram, tag @thecaringforce and use the hashtag #BroadcastYourLove. In addition to your Instagram post, be sure to fill out the form on our Broadcast Your Love of Human Services Video Contest Homepage.

There is so much you can do in 15 seconds – all you need is a little creativity and a phone!

Here are just a few ideas:

  • Tell us why you love what you do.
  • Talk about the difference that human services makes in the lives of the people you serve.
  • Describe your advocacy experience. Did you attend our rally? Did you get a response from your legislator?
  • Tell us why you think it is important that human service workers come together to rally for our shared goals.
  • And most importantly, have fun!

Submissions will then be shared by The Caring Force Instagram, Facebook and Twitter accounts after the video submission deadline. The number of likes and retweets for each submission will be tallied as votes.

As always, each of the three finalists — selected by your votes and our panel — will receive two complimentary passes to our 40th Annual Convention & Expo: 40 Years Forward, and be entered to win a VISA Gift Card for your organization.

So start brainstorming and posting your video! You can share your video on Instagram from now until September 14. But don’t wait too long!

 

Return to www.thinkhomecare.org.

What Federal Court’s Overtime Ruling Means for Home Care in Mass

A federal appeals court affirmed a regulation set by the Department of Labor that opens overtime wage protections for 2 million workers nationwide, but in Massachusetts applies only to independently-hired personal care attendants (PCAs).

The Boston Globe ran an article on the court’s decision and spoke to the Alliance to confirm that Massachusetts laws already cover overtime pay workers employed by home care agencies.

To clear up lingering confusion of how this decision applies to some, but not all home care workers in the state, the Alliance sent out the following press release:

What Federal Court’s Overtime Ruling Really Means for Home Care in Mass.

State Rules on Overtime, Minimum Wage Already Shielded Home Care Agency Workers

 BOSTON, MA – While a recent Federal Court of Appeals ruling opens the door for 2 million home care workers to receive overtime pay protections across the country, in Massachusetts the ruling is business as usual for approximately 20,000 home care agency workers already protected under state law.

“For many years, home care agencies here in Massachusetts have been governed by the state regulation on paid minimum wage and overtime so this is nothing new in our industry,” said Home Care Alliance Executive Director Patricia Kelleher. “We are encouraged and pleased that the federal law has been upheld, and hope that it will prompt greater compliance and understanding among any agencies in Massachusetts that were confused about whether to follow state or federal guidelines”

Private-pay home care agencies – paid out-of-pocket by individuals and families to provide in-home supportive services – have for years been obligated to follow the Massachusetts rules on providing overtime pay and minimum wage protections. However, independently-hired and consumer-directed personal care attendants paid through MassHealth have not had such protections. In addition to minimum wage and overtime requirements, private-pay home care agencies are required to conduct comprehensive background checks on workers, carry liability insurance.  Those agencies with accreditation through the Home Care Alliance also provide worker training and supervision to deliver the best possible services.

“Different states have different laws, and the fact that Massachusetts regulations go above and beyond a majority of states is a benefit to our workforce,” said Kelleher. “Home care agencies support adopting appropriate state oversight in the interest of protecting both consumers and workers.”

 

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