Megan Fournier

2016 NEHCC Call for Speakers Now Open!

The Call for Speakers for the New England Home Care and Hospice Conference and Trade Show is now open with new opportunities to speak! The grid below provides detailed information about the different options available to potential presenters.

The NEHHC welcomes Speaker Presentation applications from a diverse audience of home health and healthcare experts.

All proposals can be submitted by clicking below and must be entered by December 18th, 2015 for consideration.

For more information click HERE.

HCA is Coming to Western MA!

The Home Care Alliance will hold two member events in the western part of the state in November. Check out details below:

Wednesday, November 4th 2:00 – 5:00PM : Western MA Membership Forum
- Meeting being held at Cooley-Dickinson VNA & Hospice in Northampton, MA
- Join the staff of HCA for a networking meeting to discuss products, programs, policy positions and more for the home care industry!
- To register for this FREE meeting click HERE.
Thursday, November 5th 9:00AM – 1:00PM : Home Health 101
- Meeting being held at the Lord Jefferey’s Inn in Amherst, MA
- Home Health 101 is a 4 hour session presented by Colleen Bayard, HCA’s Director of Clinical and Regulatory Affairs, that will review the Conditions of Participation, Medicare and Medicaid requirements for home health care, as well as, an update on Face to Face, components needed for physician orders, Medicare’s undated definition of homebound, differentiating Medicare as an health insurance vs. quality oversight, therapy re-assessment update and more.
- To register for this meeting click HERE.

For more information on all of our upcoming events be sure to go to our calendar on our website at http://www.thinkhomecare.org.

Hope to see you there!

For any questions contact Megan Fournier at mfournier@thinkhomecare.org or by phone at 617-482-8830.

Follow-Up on the 2016 PPS Rule & Value-Based Purchasing Webinar

Huge thanks to Todd Montigney and Diane Link of BlackTree Healthcare Consulting for their webinar today. They discussed the implications of the 2016 Medicare rate changes and the proposed Value-Based Purchasing Model. Massachusetts is one of nine states randomly selected by CMS to test a Medicare payment model that would increase payments to agencies that score high on quality measures, and penalize agencies that score low. Diane did a particularly good job of explaining how CMS will compare agency performance on 29 quality measures with statewide benchmarks to calculate an overall score to determine how much an agency’s payments will be adjusted up or down.

If you missed the webinar, you can download the Powerpoint presentation here and click here to listen to a recording of the session for the next 14 days.

The Alliance will be preparing comments to CMS on the proposed update to Medicare rates as well as on the Value-Based Purchasing proposal, and would like to hear suggestions from members.

Are you looking forward to VBP, or are you dreading it? What do you think of the 29 measures CMS plans to track – too many? And how about their proposal to adjust rates in 2018 by as much as 5% up or down based on agencies’ quality scores in 2016?

Give us your thoughts by emailing to Alliance Executive Director Pat Kelleher by September 1st. Or better yet, submit your own comments to CMS here.

We Need Your Opinion!

To compete and succeed in tomorrow’s home health marketplace, agencies need highly-skilled clinicians and thoughtful, visionary leaders. To help our members prepare for that future, HCA of MA is considering two in-depth, extended training programs for the coming year. We need to assess member interest before we proceed. The two programs we are considering are Building a Home Health Behavioral Health Program and Emerging Leaders in Home Care.

The Behavioral Health Program would be a 12-month program that would provide participating agencies the clinical training and administrative guidance necessary to launch a behavioral health program that is compliant with current Medicare home health regulations. The program would provide a comprehensive operational manual, in-person and webinar-based clinical trainings for as many as five staff per agency, diagnosis-specific care guides and monthly teleconferences to guide participants on a path towards success in terms of enhanced agency capabilities and revenues and better care for a now underserviced population. Cost per agency inclusive of all on site meetings, manuals and 12 training webinars (for multiple staff) would be approximately $6,700.

HCA is also considering whether to repeat the popular Emerging Leaders in Home Care certificate program with Suffolk University. This program, which commits a person to a full day per week, over the course of nine months (with short breaks in between classes) provides next generation leaders in-depth graduate-level education in marketing, finance, policy and human resources, all specifically designed for home care agency managers. Graduates of the program will be able to apply four course credits toward several Master’s Degree Programs at Suffolk University, including the new Master’s Program in Community Health. Cost per person for the Emerging Leaders Program will be approximately $2,400, depending on the number of students.

We understand that these programs are higher in cost than most of our programs. We would like to hear from you to determine if there is enough interest among our membership to present them (but please note that your response to this survey does NOT obligate you in any way at this time!)

Thank you for taking the time to provide feedback to us.

Click HERE to take our survey!

New Sick Leave Regulations Q&A’s

The Home Care Alliance recently held a webinar on the New Sick Leave Regulations with the law firm KurkerPaget. KurkerPaget has been hard at work trying to answer the numerous questions about the new policy. They have attempted to answer the questions that members have provided to them last week to the best of their ability. You will find these questions and their answers to them below. Some of the questions were unclear to them, and others were so policy-specific that they could not answer them outside of an attorney/client relationship. Please note that although their answers are based on the sick leave law regulations, their responses should not be construed as legal advice, and should not be relied upon for that purpose. At this point, members are free to contact KurkerPaget if they want help answering additional questions or to have us review their policies.

HCA Webinar Follow-Up Questions/Answers

Question: We have a policy in regards to agency closed holidays. If an employee calls in the day before or day after the holiday, they forfeit the holiday and cannot submit sick and/or vacation time in place. Can we still do that? My guess says that we must allow sick time use but do not have to pay holiday?

Answer: These types of policies are okay with regards to not paying for the holiday, but an employer must allow an employee to use earned sick leave.

Question: Do we have to pay orientation/training time worked?

Answer: This is not addressed in the regulations; the Attorney General’s Office has not issued any guidance on whether such meetings/trainings should be considered actual work for purposes of accruing employee sick leave.

Question: If an employee accrues 40 hours in 2015, carries it over to 2016, and then uses it all in January, does the employer have to start accruing more time for the employee in 2016 or can you wait until the following year, 2017?

Answer: The employee should begin accruing again (up to 40 hours), but the employer is not required to permit the employee to use the additional earned sick leave in 2016 because employee has already used 40 hours in 2016.

Question: For per diem/per visit employees, for whom you pay a flat travel rate for each visit, does the travel rate need to be included in the calculation?

Answer: We are not sure that we understand how this question relates to employee sick leave. If the employee is paid for travel time ordinarily, this time/pay should be included to reasonably estimate the time the employee is working for purposes of calculating the employee’s accrual of sick time.

Question: Earning hours for “actively working” … so if an employee comes in for an in-service (paid for time in training, but they are not working), we do NOT need to count these hours toward accrued time? Is this correct?

Answer: The regulations do not use the term “actively working,” although they use the term “actual work” for determining when an employee begins to accrue earned sick leave. Although the regulations do not address this issue specifically, we have no reason to believe that trainings that occur as a requirement of an employee’s employment would be exempted for purposes of accrual.

Question: Could we pay our per diem employees an hourly rate that a regular full time staff [employee] is getting hourly? Ex. Avg. RPT. Paid $38/hr. which also is the rate paid staff they are paid when working in the office. i.e., conference time.

Answer: You need to provide a reasonable estimate of the time that the employee is spending to complete her assignment. If the hypothetical you provide is a reasonable calculation, it is fine.

Question: “Actual first day of work.” Does this include a paid orientation day? Many employees who attend a paid orientation day do not start working the field for a while after an orientation.

Answer: See above. This is not addressed in the regulations; the Attorney General’s Office has not issued any guidance on whether such meetings/trainings should be considered actual work for purposes of accruing employee sick time.

Question: If an employee carries over 30 hours into the next year (January 1, 2016), are they only eligible to accrue another 10 hours that year (2016) or are they eligible to accrue another 40 hours?

Answer: Employers may cap accrual and use to 40 hours per year.

Question: We have a current paid time off policy in place which we plan to [use to] access the Safe Harbor. Can we modify our paid time off policy to a sick time policy and keep the accrual the same 30 hours and lump sum accrual until the end of this year?

Answer: We cannot answer questions that are policy-specific without reviewing that policy.

Question: Does the employee need to provide documentation of use for each and every instance? Even 1 hour?

Answer: Employers can require employees to personally verify that any use of earned sick time was for allowable purposes, but can only require medical documentation in limited circumstances.

Question: How do we determine worked for baylors

Answer: We are not sure that we understand what is being asked, and it would be difficult to answer without speculating.

Question: Can you clarify the statement under paid time off policies… employers that have unlimited sick leave policies are not required to track accrual or allow any rollover?

Answer: If an employer does not limit the amount of sick time an employee can take in a year, they do not have to track accruals or provide rollover to the employees. Of course, this assumes that the employee would be able to use at least 40 hours of earned sick leave at any point in the year.

Question: Just to be clear – we have 24 hours per week employees who earn about 30 hours of sick time, but also earn additional personal and vacation time that equal over 40 hours in total. We don’t have to give them another 10 hours of sick time to get them to the 40 hours, do we?

Answer: We cannot answer questions that are policy-specific without reviewing that policy. Generally, as long as you are providing at least 40 hours of for the same protected uses and under the same conditions as those provided for in the sick leave law, the policy is compliant.

Question: Our current accruals are less than 1 hour for every 30 hours worked, but over a calendar year earn more than 40 hours. Do we need to change our accrual rates?

Answer: We cannot answer questions that are policy-specific without reviewing that policy. Generally, employees must be permitted to accrue earned sick leave in increments of no less than one hour for every 30 hours worked.

Question: If an employee works 10 hours a day but is paid for 14, what is the appropriate accrual and how should the employee be paid for sick time?

Answer: Earned sick leave accrues on no less than a one-hour for every thirty hours actually worked or reasonably estimated to have worked.

Question: If an employee has an earned time bank of 41 hours, and on January 1, 2016 they carry over that balance, can we put that balance towards their sick time?

Answer: We cannot answer questions that are policy-specific without reviewing that policy.

Question: Clarification on lump sum?

Answer: We are not sure that we understand what is being asked, and it would be difficult to answer without speculating.

Question: If an employee carries over 30 hours of sick time to the next calendar year, is the employee eligible to accrue 10 additional hours that year? If they use 40 hours of sick time, do they continue to accrue for that year?

Answer: Yes, employees are able to accrue and use 40 hours of sick time per calendar year.

Question: As of July 1^st, can we modify our Earned Time to a Sick Time bank?

Answer: We are not sure that we understand what is being asked, and it would be difficult to answer without speculating.

2015 Innovation Showcase & Star Awards Photos are Here!

HCA held its annual recognition event to honor the best and brightest individuals and programs in the home care industry. We acknowledged the work of certain individuals and agencies, but in doing so we celebrate all of home care, what it is and how we make a difference in so many lives.

Home care in Masachusetts has a long and proud history dating back over a century. The four programs and seven individuals that we recognized are both part of that great lineage and helping to shape a future for home centered care that is even more vibrant and impactful. They are working across the continuum to improve the post hospital transitions for patients and their families to promote rehabilitation and recovery. They are managing complex chronic illnesses
in ways that support independence, and they are expanding what it means to be a community-based provider. Most remarkably, as Pamela Mann, will reminded us at the ceremony, they do it all while holding on to the compassion, and high touch approach that has been the hallmark of the home health experience for more than a century.
Congratulations to all our Stars. You make us proud to be associated with you.

The pictures from this great event are available on our Facebook page. Click HERE to view them!

Photos courtesy of HCA Staff and Brendan Fournier

Deborah Wilson Shares Experience Treating Ebola Patients

Deborah Wilson, a nurse with the Berkshire VNA, this week shared her story of treating Ebola patients in Liberia. The HCA members attending the “Hot Topics” breakfast on “infection Control Best Practices” were mesmerized by her words and pictures.

In the best community health tradition, Wilson talked of challenges that were clinical and treatment related as well as educational.

“Death is a powerful motivator,” She said of village chiefs who were initially skeptical of community health workers who they feared were bringing Ebola in, not treating it. Most eventually let educators in, she said, but not before six education workers were stoned to death in Guinea.

Wilson talked of work on the 120 bed ward, which consisted of patients lying on a concrete floor. The devastation across families was so great, she said, because families often contracted disease by washing the dead bodies of loved ones. “Just after death is when a body can be most contagious,” she said.

Her stories and pictures capture the challenges associated with the life-saving Personal Protective Equipment they wore. Clinicians were often only able to work in the ward for an hour at a time before clothing was soaked through and goggles were too fogged to see.

But Wilson noted that the community health initiative was effective: the death rate while she was there went from over 80% to 60%.

Her amazing pictures are HERE!

Some of the great articles written from her experience are HERE!

Come to the ICD-10 Coding Conference Before October Transition

The anticipated transition to ICD-10 is to be implemented as scheduled on October 1, 2015. Now is the time to attend the ICD-10 Coding Conference being held on April 15-16 with Selman-Holman & Associates, LLC. Maybe you have started training, but where do you go from there? This intermediate ICD-10 course takes coders and other home health professionals one step closer to the finish line in the race to ICD-10 readiness. In this seminar, professionals will review the basics of the conventions and official guidelines relevant to ICD-10-CM, and begin to apply ICD-10 skills to advanced and complex coding scenarios in order to assure mastery of the ICD-10 code set. In addition, the course will review the current guidance for transitional claims testing and processing and provide attendees with an understanding of operational processes necessary to reduce productivity and financial losses. Recently released OASIS C-1 items and the impact of the proposed document on coding processes in home health will also be reviewed to provide a clear and comprehensive understanding of the coding process for ICD-10. In-depth scenarios will provide all attendees with the opportunity to apply learned principles to coding complex patient conditions using OASIS C-1 proposed coding data items using learned ICD-10-CM coding skills in order to assure competency.

To register for the ICD-10 Coding Conference, click here.

The Home Care Alliance of MA has been keeping a close eye on the status of the ICD-10 coding transformation, I have included some important information we have received below:

From: NAHC, Regulatory Affairs

An ICD-10 Resource Page has been added to the NAHC web site. click here

NAHC and the home health and hospice vendor community have a shared goal in assuring that agencies are adequately preparing for the transition from ICD-9 to ICD-10 diagnosis coding. Included on the page are education and guidance materials along with tools to assist our members in attaining that goal.

The materials have been provided by home health and hospice vendors who work with the NAHC membership. In addition to the materials, the vendors have provided their contact information along with a brief company profile.

The page will be updated as more contributions are received.

Providers should be aware that Congress will not likely delay the implementation date again. Therefore, we anticipate the transition to ICD-10 to be implemented as scheduled on October 1, 2015

CMS Bog:

Successful ICD-10 Testing Shows Industry Ready to Take Next Step to Modernize Health Care

I am delighted to announce that CMS has recently successfully completed the first week of end-to-end testing of new ICD-10 coding.

The International Classification of Diseases, or ICD, is used to standardize codes for medical conditions and procedures. While most countries already use the 10th revision of these codes (or ICD-10), the United States has yet to adopt this convention. Since ICD-10 codes are more specific than ICD-9, doctors can capture much more information, meaning they can better understand important details about the patient’s health than with ICD-9-CM.

To register for the ICD-10 Coding Conference, click here. For any questions, contact Megan Fournier at mfournier@thinkhomecare.org or 617-482-8830

Not too Late to Register for : Understanding and Integrating Maintenance Therapy into Practice

Part 1 of 3 was a success and although it has come and gone, you can still register with access to all three webinars! Registration not only includes all three sessions but also includes access to the recordings for up to 90 days after the live session aired.

For many years many home health agencies have discharged patients who plateaued even when they needed continued skilled care to maintain their level of functioning or prevent deterioration and exacerbation of their condition. Yet the Medicare statute and regulations have never supported the imposition of an “Improvement Standard” in determining whether skilled care is required to prevent or slow deterioration in a patient’s condition. The CMS settlement in recent Jimmo vs Sibelius reaffirmed that when skilled services are required in order to provide care that is reasonable and necessary to prevent or slow further deterioration, coverage cannot be denied based on the absence of potential for improvement or restoration. Are your agency’s nurses and therapists appropriately trained for this? Or are you discharging patients who need and qualify for continued care?

Session 2: Wednesday, March 4

Session 3: Wednesday, March 18

12:00-1:30PM

Click HERE to register! Contact Megan Fournier mfournier@thinkhomecare.org for more information or questions.

Commit to Furthering Your Industry Knowledge- Register Today

The New England Home Care & Hospice Conference and Trade Show takes place at the Radisson Hotel in Manchester, NH on May 19-21. It’s this year’s premiere home care event and is the only one hosted by the six New England state home care associations. With a great line-up of national speakers, an array of sponsors and exhibitors and a proven track record as a fabulous event, this is the conference to attend! Registrations are affordable and discounts are available to state association members. Check it out at http://www.nehcc.com.

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