Author: James Fuccione

MA Attorney General Announces Earned Sick Time ‘Transition Year’

At the first of a string of public hearings to provide input on proposed regulations on the forthcoming earned sick time law, Attorney General Maura Healey announced a “transition year” for employers already offering paid time-off.

The Attorney General explained that for the period of July 1 when the law goes into effect until December 31, 2015, “any employer with a paid time off policy in existence as of May 1, 2015, providing to employees the right to use at least 30 hours of paid time off during the calendar year 2015 shall be in compliance with the law with respect to those employees and to any other employees to whom the use of at least 30 hours of paid time off under the same conditions are extended.”

Further details are available on a bulletin released on the AG’s earned sick time webpage.

The AG also revealed the intent of her office to avoid a six-month delay in implementing the law, as has been requested by some business advocacy groups. With Healey holding firm on not delaying the law’s implementation, and with some major business groups endorsing the “transition year” move, it was very likely a compromise to grant some leniency to employers.

For more information on the earned sick time law as well as how you can submit comments and help the HCA comment, see this previous blog post.

Return to www.thinkhomecare.org.

Advocacy Alert: Email your Senator to Support Home Care in the Senate Budget

The Alliance has worked with home care champions in the Senate to file amendments to the Ways & Means budget to improve home health care services. The HCA now needs home care agencies and advocates to send a message to gain support these proposals TODAY by clicking here!

Below is a list of the items the Alliance will be leading on and supporting in the FY16 Senate budget process.

Restoring Home Nursing Rates: Senator Jennifer Flanagan

•    Purpose: This budget language seeks to restore the MassHealth rate for home health nursing visits past 60 calendar days of care to the payment level prior to the rate cut of December 1, 2008. This amendment creates a consistent rate for as long as an individual on MassHealth requires home health care.

Improved MassHealth Rates for Home Health Aide Services: Senator Barbara L’Italien

•    Purpose: Since 2007, home health aide rates to agencies from MassHealth have remained at $24.40 per hour, which is meant to cover aide salary, benefits, travel, supervision and administrative costs for the employing home health agency. This amendment seeks to raise the rate MassHealth reimburses home health agencies for home health aide services by 12% at a cost to MassHealth of $1.75 million.

Study of MassHealth Third Party Liability: Senator Anne Gobi

•    Purpose: A study is necessary because correct reimbursement coverage determinations for Medicare/Medicaid dual eligibles are far more complex in home health care than in other medical services as the services and program coverage rules are very similar. The process of submitting all or most MassHealth home health claims for review and re-review to Medicare is highly costly to both agencies and the state. The rate of Medicare coverage has also been steadily declining.

Homemaker Salary Reserve: Senator Michael Barrett

•    Purpose: Appropriate $3 million from the Community First Trust Fund for a FY16 Homemaker Salary Reserve.  This request will continue a campaign to support essential workers by providing an annualized wage and benefit increase of approximately 32 cents an hour to over 26,000 homemakers and personal care homemakers.

Community-Based Safety Net Adjustment: Senator Kathleen O’Connor Ives

•    Purpose: Treat non-profit home health agencies that provide a significant number of home health visits to MassHealth patients as safety-net providers eligible for upward rate adjustments.

FMAP Trust Fund: Senator Michael Rodrigues

•    Purpose: On January 1, 2014, Massachusetts began receiving an enhanced Federal Medical Assistance Percentage (FMAP) for certain Medicaid expansion populations through the ACA.  This amendment creates a trust fund to house this funding and dedicate it to Medicaid and low-income health programs.

Expand Elder Service Home Care Income Eligibility: Senator Barbara L’Italien

•    Purpose: Raise the income eligibility standard for State Home Care Program services funded by Elder Affairs to those below 300% of the Federal Poverty Level.

For more information on what was included in the Senate Ways & Means budget, visit this previous blog post.

Return to www.thinkhomecare.org.

Senate Ways & Means Budget Includes Wins for Home Care

The Home Care Alliance is proud to announce that the Senate Committee on Ways & Means included language for one of the organization’s priority issues that will help strengthen private-pay home care.

An “outside section” in the Senate Ways & Means Committee budget establishes a Commission to study and make recommendations for state oversight options for private-pay home care agencies. The language closely mirrors what the Alliance proposed. Also, it represents a huge step towards attaining not just minimum standards and consumer protection, but greater recognition that private pay home care is an option for families and individuals who need assistance.

Other positive notes came from the Senate’s proposed budget as well. The line item funding the Pediatric Palliative Care Program was increased by $250,000 over what the House approved. The Mass. Department of Higher Education’s “Nursing and Allied Health Workforce” line item was allotted $200,000 after being zeroed out by the Governor and matches the House’s appropriation.

ma budget pie chart picThe Senate also included $150,000 in funding for the “Home and Community-Based Services Policy Lab,” which aims, in part, to study the effectiveness and value of state-funded community-based services.

In the elder services category, the Senate’s proposed budget ups the House in the Home Care Purchased Services account by $3 million along with an additional $866,677 in the Home Care Case Management and Administration account. The other notable increase from the Senate Ways & Means budget is in the elder nutrition program (meals on wheels), which came in $121,889 above the House.

In MassHealth, both the Managed Care and the Senior Care accounts were level-funded. The Senate increased the MassHealth Fee-for-Service line item, which has traditionally governed home health nursing rates, by $481.5 million over the House. However, without specific language for home health included, it would appear an amendment needs to be proposed to raise those MassHealth payment rates.

Outside sections that are mentionable include language to create a “MassHealth savings report” that aims to find savings and cash management strategies in the Executive Office of Health and Human Services budget by October 1, 2015. There is also a commission established to oversee the Center for Health Information and Analysis, whose mission it is to be the clearinghouse for quality, affordability, utilization, access, and outcomes information of the state’s health care system.

The Alliance will look to propose amendments to increase MassHealth rates for home health aides along with restoring skilled nursing rates from the 2008 payment cut. The Alliance also plans to play a supporting role in raising wages for homemakers and creating transparency on federal healthcare reform funding.

Stay tuned for advocacy alerts with details on sending emails urging your state senator to support home care in the state budget.

Return to www.thinkhomecare.org.

House Approves Budget Plan with Little Support for Home Care

This week, the Massachusetts House of Representatives quickly buzzed through nearly 1,100 amendments to their FY2016 budget proposal and came out with roughly $38.1 billion spending plan.

The House included little from all corners of the advocacy spectrum and the same was true for home care. None of the Home Care Alliance’s priority items and many of those the organization supported were not advanced so HCA will be among many groups relying on the Senate to step up when their budget plan comes out early next month.

Among the items that were approved and supported by the HCA was an initiative to shape a comprehensive Mobile Integrated Health plan for the state, which named the Alliance to an advisory panel for that effort.

Also, $200,000 was approved for the Department of Higher Education’s “Nursing and Allied Health Workforce” account that has, in the past, spurred a home care nurse residency program. The Governor’s budget had zeroed out that line item.

Other notable items approved in the House budget include the following:

  • $8.8 million increase for MassHealth Nursing Home Supplemental Rates.
  • $500,000 for a pilot program in the “greater Quincy area” to implement a model of field triage of behavioral health patients under medical control by specially-trained emergency medical services providers and transport of appropriate, non-medically complex patients to a behavioral health site of care for most effective treatment rather than to an acute hospital emergency department.
  • $50,000 to establish Financial Abuse Specialist Teams (FAST) to improve the ability of elder protective services programs to investigate and respond to reports of financial exploitation.
  • $750,000 for the Meals on Wheels program, which brought that item to $7.1 million – still below the Governor’s proposed funding for that initiative.
  • A prospective, global payment pilot program established under MassHealth under which Medicaid contracts with risk-bearing provider organizations for the provision and coordination of health care services for their attributed members beginning not later than September 1, 2016. The pilot would require that such risk-bearing provider organizations shall be able to provide coordinated care through the provider’s network of primary care providers and that such providers shall have experience and demonstrated capabilities to provide behavioral health services including psychiatric and substance abuse beds. Under the proposed program, Medicaid shall reimburse such providers on a prospective monthly basis provided that these organizations obtained a risk certificate or a waiver from the Division of Insurance.

Stay tuned to learn more about HCA’s advocacy around the Senate budget process and how you can weigh in to support better rates for visiting nurses, home health aides, and other workers along with establishing a commission to study private pay home care oversight options.

Return to www.thinkhomecare.org.

 

Paid Sick Time Proposed Regs Need Comments from Home Care Agencies

The Attorney General’s office released proposed regulations for the paid sick time law passed via ballot question and due to be effective on July 1, 2015.

The law essentially states that workers employed by companies with eleven or more employees can earn and use up to 40 hours of paid sick time per calendar year, while employees working for smaller employers can earn and use up to 40 hours of unpaid sick time per calendar year.

A full summary of the law, along with the proposed regulations and a list of public hearing dates are available on a special “Earned Sick Time” webpage on the Attorney General’s website. Associated Industries of Massachusetts (AIM) conducted a quick analysis of the draft regulations posted on their blog.

The Alliance will be testifying on these regulations at the Boston hearing on May 18th so the Alliance strongly encourages home care agencies to review the draft regulation and send comments to James Fuccione so the HCA can formulate testimony. We further encourage agencies to attend and comment at the other hearings and listening sessions to be held across the state and to notify HCA if you’re planning to do so in order for the comments to be consistent.

A full list of the hearing dates and locations are below:

Friday, May 8, 2015
Brockton Listening Session
Location: Brockton Public Library
(304 Main Street, Brockton, MA 02301)
Time: 10:00 am – 1:00 pm

Monday, May 11, 2015
Salem Listening Session
Location: City Hall Annex Building, 3rd Floor Conference room
(120 Washington Street, Salem, MA)
Time: 10:00 am – 1:00 pm

Friday, May 15, 2015
Lowell Listening Session
Location:  Lowell  Lowell Federal Building
(50 Kearney Square, Lowell, MA)
Time: 10:00 am – 1:00 pm

Monday, May 18, 2015
Boston Public Hearing
Location: Saltonstall Building, 2nd floor Conference Rooms C & D
(100 Cambridge Street,  Boston, MA)
Time- 10:30 am – 1:30 pm

Friday, May 22, 2015
Framingham Public Hearing
Location: Framingham Town Hall, Memorial Building, Ablondi Room
(150 Concord Street,  Framingham, MA 01702)
Time: 10:00 am – 1:00 pm

Friday, May 29, 2015
Springfield Public Hearing
Location: 1350 Main Street – 3rd Floor Community Room
Time: 10:30 am to 1:30 pm

Friday, May 29, 2015
Pittsfield Public Hearing
Location: Pittsfield City Hall – Council Chambers
(70 Allen Street, Pittsfield, MA)
Time: 10:00 am – 1:00 pm

Monday, June 1, 2015
Fall River Public Hearing
Location: City Hall: 1 Government Center – The Hearing Room
(1 Government Center, Fall River, MA 02722)
Time: 1:30 pm – 4:30 pm

Friday, June 5, 2015
Worcester Public Hearing
Location: Main Library- Saxe Room
(3 Salem Square, Worcester, MA 01608)
Time: 10:00 am – 1:00 pm

Return to www.thinkhomecare.org

Advocacy Alert: Email State Reps to Gain Support for Home Care in the House Budget!

The Home Care Alliance has been busy working with state representatives to file amendments to the recently released House version of the state’s FY16 budget. Now that those proposals are submitted, it is time to gain crucial support by asking other reps to cosponsor these amendments.

The amendments include the following proposals:

  • An increase in MassHealth rates for visiting nurses (filed by Rep. Sean Garballey)
  • Creating a commission to study state oversight options for private-pay home care agencies (filed by Rep. Mark Cusack)
  • An increase in MassHealth rates for home health aide services (filed by Rep. Chris Walsh)
  • A study of MassHealth’s Third Part Liability Billing process (filed by Rep. Paul Brodeur)

Agencies and advocates can send an email through HCA’s Advocacy Center just by clicking on the message, filling out the contact info form, and hitting “send.” The message will automatically shoot off to the correct Representative based on the address you enter.

Private pay home care agencies can send their own message for just the Study Commission language here, or a message can be sent for all the Alliance’s priorities here.

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

Return to www.thinkhomecare.org.

FY16 State Budget Plan Released by House

The House Committee on Ways & Means released their version of the state’s fiscal year 2016 budget with most accounts important to home care level funded. Out of the $38 billion in the proposed budget, $15.3 billion is spent on MassHealth, the state’s Medicaid program.

Since language proposed by the Home Care Alliance to establish a commission to study options for agency oversight was not included, the HCA will be working with state representatives to file amendments to the budget for a number of items, including establishing commissions to study and make recommendations on state oversight options for private pay agencies and certified agencies. The Alliance will also be seeking an increase of $3.1 million in payment rates for home health aides as well as a restoration of MassHealth home health nursing rates.

The Alliance will also be supporting a number of budget amendments spearheaded by other organizations to raise home care worker wages, seek relief from the impending paid sick time mandate and restore the line item funding the Nursing and Allied Health Education Workforce Development program.

Additionally, the Alliance will support efforts to increase funding for elder home care purchased services from Aging Service Access Points. The House Ways & Means budget reduced that line item from what the Governor proposed earlier this year by more than $3 million.

Stay tuned as the Alliance will be sending out advocacy alerts on how agencies and advocates can urge support of these important issues.

Return to www.thinkhomecare.org

 

One Care Program Provides Update, Amends Financial Protections for Plans

The One Care initiative provided stakeholders with an update on enrollment population as well as the financial methodology governing the program and survey results illustrating enrollee opinions and satisfaction with services and the care team.

One Care, which coordinates Medicare and MassHealth services for dually eligible individuals between 21 and 64 years old, reported that the program has spent 14 percent – or $19.4million – on home and community-based services, including home health. This number reflects the life of the program thus far since it launched in October 2013. Pharmacy services represents the largest piece of the spending pie at 25 percent ($34.36 million).

The program has also conducted a round of enrollee surveys that found the following:

  • Over 80% of enrollees had met with their PCP; most are satisfied with the PCP
  • Over 70% had met with their Care Coordinator; 90% are satisfied
  • There was confusion about the role of the LTS Coordinator
  • When asked if they needed/wanted LTS Coordinator, many said no, or not sure;
  • Only 39% said they needed/wanted an LTS Coordinator;
  • Less than 45% had met with an LTS Coordinator

One Care administrators worked with CMS to update the financial methodology that was intended to protect the three plans (Commonwealth Care Alliance, Fallon Total Care, Network Health) and that info, along with the broader report to stakeholders, is available in a PowerPoint presentation.

Return to www.thinkhomecare.org.

Special Open Door Forum on F2F Template; Alliance Seeks F2F Data

CMS hosted a Special Open Door Forum call yesterday to provide an opportunity for physicians/practitioners, home health agencies and/or all other interested parties to provide feedback on both a paper clinical template and an electronic clinical template for face to face documentation.

Many questions were raised and often the presenters were unable to answer the audience’s questions; the presenters stated they would provide answers during at the April call. The PowerPoint presentation (see slide 5) raised many more questions on which physicians could actually certify homecare; the hospitalist or the community physician. Again the presenters were unable to clarify the regulation for the audience. The presenters were actually debating among themselves whether a discharge planner or physician’s staff could assist completing the documentation for the face to face. A caller confirmed that this was acceptable and CMS had already addressed this issue in the CMS Face to Face Questions, question number 8.

CMS is seeking public comment on this voluntary paper clinical template. Feedback and questions can be sent to: HomeHealthTemplate@cms.hhs.gov.

Additional Special Open Door Forum calls on the templates will be held on April 8 and May 6, 2015, both at 1:00 PM Eastern Time.

In the Alliance’s continued advocacy on the Physician Face-to-Face Requirement, agencies that have ongoing appeals of claims denied for “invalid” F2F documentation are encouraged to send the number of denials, amount of money tied up in those claims, and the status of the appeals to James Fuccione at HCA.

We will share these data by congressional district with the Massachusetts federal delegation so that they can follow up with CMS. Months after a letter was sent from US Senators from the New England region on the same subject, CMS has failed to respond and the Alliance wants to make sure this issue gets the attention it deserves.

Please send this information, along with any questions, to James Fuccione at the Alliance.

Return to www.thinkhomecare.org.

Governor Releases State Budget Proposal With MassHealth Savings

In his first budget as governor, Charlie Baker’s administration made sizable shifts within Health and Human Services, which accounts for 53 percent of the overall budget proposal. These shifts were done without negatively impacting most provider rates, including home health services.

In a conference call with provider and advocacy organizations, Executive Office of Health and Human Services Secretary Marylou Sudders announced that there was a 5.6 percent growth over FY15 in the total EOHHS budget and that line items in the Elder Affairs accounts governing the Aging Service Access Point network saw a 2.1 percent increase overall. This includes the following highlights:ma budget pie chart pic

  • A nearly $5.6 million increase over FY15 spending in the Elder Enhanced Home Care Services Program.
  • Level funding for the Home Care Purchased Services line item ($106.6 million), which governs contracts with home care providers.
  • A reduction of $13.7 million in the MassHealth Senior Care Account that includes, among other things, the Senior Care Options or SCO program. On the call with Secretary Sudders, it was explained that this was an adjustment on caseloads after re-determinations.
  • A continued reduction ($68,360,305) in MassHealth Fee-for-Service payments to “meet projected need.”
  • An increase of $768,713,676 in MassHealth Managed Care spending.
  • Level funding of grants to councils on aging and to the elder nutrition program.
  • A nominal increase in spending over FY15 on Pediatric Palliative Care.

For more information on the Governor’s proposed budget, visit the administration’s FY16 budget webpage.

Return to www.thinkhomecare.org.