Author: Pat Kelleher

Three of the largest trade associations representing 56,000 agency-based home care workers in Massachusetts have joined forces in an effort to assure that there will be a sufficient supply of home care workers in the Commonwealth to meet the needs of our aging population. Home Care Aides are #2 and Home Health Aides are #3 on the US Department of Labor’s list of the Fastest Growing Occupations in our nation between 2012 and 2022.

This new workforce initiative “Enough Pay To Stay,” sponsored by Mass Home Care, the Home Care Aide Council of Massachusetts, and the Home Care Alliance of MA , seeks an investment of $10.2 million to upgrade the rates paid for home care aides, home health aides, and care managers. These workers allow the elderly and disabled citizens to successfully  ‘age in place’ at home. The home care industry has suffered  from low wage/ high worker turnover for years.

According to the Bureau of Labor Statistics, the average hourly wage for a home care aide is $13.05, and the average home health aide makes $13.78  an hour. Turnover rates for these workers range from 20% to 60% annually. Rates paid by MassHealth to purchase home health aide services for some of the state’s have been frozen since 2007.These workers provide more than 2 million hours of care per year

The coalition is filing a budget request and new legislation for rate reform.

Here is the language for the budget request,  to be filed by Representative Aaron Vega (D-Holyoke):

“           9110-1635 For adjustments to rates and capitations for home and community based services provided through line items 9110-1500, 9110-1630,9110-1633, and 4000-0600; provided further that $2,766,000 shall be provided for an add on to established capitations  in the 9110-1633 and 9110-1500 accounts; provided further that $3,000,000 shall be provided for an adjustment to approved program rates issued under 1line item 9110-1630 to provide a rate add-on for wages, compensation and/or salary related costs for personnel providing homemaker and personal care homemaker services; and provided further that $4,500,000 shall be provided for adjusting rates for home health aide services funded through line item 4000-0600 for the purpose of providing Title XIX services.                                                                                   $10,266,000        

Join  us in  Nurses Hall at 11 or contact your local representative for support.

Following up on a successful rally and Lobby Day at the StateHouse in early January, the Pediatric Home Nursing Campaign was featured in a piece by John Keller on the Boston WBZ 4 evening news.   Angela Ortiz, the mother of a child with severe medical needs and one of the founders of the family coalition, was interviewed about the nursing shortage and state reimbursement rates that are far below what is needed to attract specialty nurses into home care.  See the full piece here

Families Fight For Nursing Care As House Approves Pay Raise For Legislative Leaders

To date, more than 30 representatives and senators have signed onto their family Bill of Rights – The Protection Act for the Continuous Skilled Care of Fragile Children in the Commonwealth.  Cosponsors can sign onto the bill through Feb 3.   A message about co-sponsorship can be sent through HCA’s website Advocacy Center.

Ms Ortiz, other members of the coalition, and HCA of MA,  all testified on the need for higher rates before MassHealth on January 20^th.

In response to concerns about growth in home health utilization over the past two years, MassHealth has used their emergency regulation authority to introduce a home health prior authorization requirement as of March 1. According to MassHealth staff, the visit count for determining the need for prior authorization will start on March 1. Prior authorization is required for services in excess of the following thresholds:

• Intermittent skilled nursing visits after 30 visits in a 90-day period;
• Home health aide services after 240 units (60 hours) in a 90-day period;
• Physical therapy after 20 visits in a 12-month period (this is unchanged from previous requirement;
• Occupational therapy after 20 visits in a 12-month period;
• Speech-language therapy after 35 visits in a 12-month period;
• Home Health Aide services supportive of physical, occupational, or speech-language therapy after 20 physical, 20 occupational, or 35 speech-language therapy visits.

MassHealth has published numerous instructional documents, the links of which can be found below .  Links to the PA request forms and guidelines are also within the bulletin.

Bulletin:

http://www.mass.gov/eohhs/gov/laws-regs/masshealth/provider-library/provider-bulletins/home-health-agency-provider-bulletins.html

Transmittal Letter

http://www.mass.gov/eohhs/gov/laws-regs/masshealth/provider-library/transmittal-letters/home-health-agency-transmittal-letters.html

Home Health Medical Necessity Guideline:

http://www.mass.gov/eohhs/provider/insurance/masshealth/clinical-treatment/medical-necessity-determination/download-a-printer-friendly-version-of-the.html

HHA-2 and PA-HHA-SN forms (will be under Home Health Agency):

http://www.mass.gov/eohhs/gov/laws-regs/masshealth/provider-library/masshealth-provider-forms.html

It is expected that PAs will be processed through the MassHealth Provider Online Service Center (POSC).  All of the job aides and training links related to this can be found here:

http://www.mass.gov/eohhs/gov/newsroom/masshealth/providers/mmis-posc/trainingget-trained.html

HCA of MA continues to work with MassHealth to clarify agency questions and concerns around documentation and PA processing.  A list of Q & As should be available shortly.

Blue Cross Blue Shield of MA announced this week that in 2016 they will be expanding their end of life benefits to cover hospice for a longer period and to support end of life counseling both with physicians and other health care professionals. An expanded home care program is also in the planning stages.

The changes announced by BCBS come just as Medicare will begin covering end of life discussions.

The BCBS effort to expand benefits were in part driven by the experience of their Chief Executive Officer Andrew Dreyfus in assisting his own parents and brother at the ends of their lives.

The Home Care Alliance of MA applauds these actions as very much in keeping with the important Institute of Medicine Report “Dying in America,” which reinforced – with strong recommendations – that health care professionals must be empowered to ensure that end-of-life care is compassionate, affordable, sustainable, and of the best quality possible.

We look forward to working with BCBS of MA to support these efforts in the interest of all of our patients and families.

The October 28^th deadline to complete our Home Health HIT Adoption  survey is fast approaching.

The HCA Board of Directors and all of us involved in guiding this project do so with the belief that HIT represents the future of health care and home care.  So the question, you need to ask yourself is:  am I home care agency of the past – or am I positioning my agency for the future?

Completion of the survey itself can be part of an internal self assessment process to see where your agency is in terms of interconnectivity.  Completing the survey will assure that you will get a copy of a report with a roadmap to move your agency forward.

The survey can be completed here: https://www.surveymonkey.com/r/HIT_homecare.  If you would like we can also send you a printed copy as many of those who have already completed it are finding it easier to print out – share with members of their team and then have a single person collate and input the responses. Contact sdrakes@thinkhomecare.org to have this printable copy emailed to you.

To be sure you understand the questions and the survey’s value to you , we have scheduled an additional webinar for Wednesday October 21^st from 10-11AM. You can register here.

Additionally, we have arranged for LIVE!!!  support for questions you may have while completing the survey please. You can contact project managers Jessica Hatch (jhatch@maehc.org) or Jennifer Monahan (jmonahan@maehc.org) via email or can call them directly at the times below.

Be the future and get connected!

One of the featured speakers at the HCA of MA Annual Meeting last week was Scott Taberner, newly named MassHealth’s Chief of Behavioral Health and Supportive Care.  LTSS is the new umbrella term under which all medical and personal care assistance that MassHealth clients may need – for several weeks, months, or years – when they experience difficulty completing self-care tasks as a result of aging, chronic illness, or disability.  This includes, but is not limited to, nursing facility care, adult daycare programs, home health services, personal care services, transportation, and assistance assistance provided by a family caregiver.

In his remarks,  Taberner indicated that the Baker administration is launching a major initiative to improve health outcomes for Masshealth clients and make the MassHealth program more sustainable over the long term.  As part of that initiative, considerable attention will be paid to what, how, to whom and by whom, LTSS services are provided.  On his agenda Are: rethinking  how to modify fee for service payment to pay for value and outcomes;  what provider contracting and management arrangements might look like in a Medicaid Accountable Care Organization;  and how, in general, MassHealth can improve the LTSS “experience” of clients and providers.

MassHealth is holding the last of its open public hearings on these topics in the coming weeks.  They are open to any entity to submit comments and suggestions to the team looking at this programmatic area.  Rate increases for all community based services are, of course, at the top of the Alliance’s request list.  We are looking for suggestions from our member agencies –  with a strong history of provding MassHealth LTSS  – for suggestions as to how both rates and programmatic reforms could enhance our capacity to serve MassHealth clients with both medical and behavioral health needs.

We believe this is a unique opportunity to bring forward creative approaches to restructuring the MassHealth home health and home care programs.  Alliance members are invited to submit any and all concerns and suggestions to Pat Kelleher by July 2 for inclusion in our comments.