The MA Department of Public Health recently released a set of draft regulations relative to a new requirement that – effective next year – will require hospitals and skilled nursing facilities to distribute information on palliative care and end of life care. Under the draft regulations, the facilities will be required:
Have a process to identify appropriate patients
Ensure that appropriate patients receive information
Distribute information about hospice and palliative care in a timely manner
Some HCA members have reviewed these draft regulations and believe that the draft definitions do not make a clear enough distinction between palliative care and hospice care almost using the terms interchangeably. There will be a public hearing on these rules in Boston on Nov 21st at 2 PM in the Public Health Council Room, Second Floor, Department of Public Health, 250 Washington Street, Boston.
The Alliance will be providing comments and encourages other members to do so, either in person or in writing. Electronic or written testimony can be submitted to: Reg.Testimony@state.ma.us as an attached Word document or as text within the body of an email and type “End-of-Life” in the subject line. All submissions must include the sender’s full name and address. The Department will post all electronic testimony that complies with these instructions on its website All testimony must be submitted by 5:00 p.m. on November 22, 2013.
Members are encouraged to also provide feedback to the Alliance for our testimony as well.
The Home Care Alliance is in the process of preparing comments on the June 27, 2013 Centers for Medicare and Medicaid Services (CMS) proposed rule that sets out the proposed rates for home health services in 2014. The proposed changes for 2014 include the first of a planned four year “rebasing” of home health rates.
By way of background: The requirement that rates be rebased in 2014 and phased-in proportionately over a four year period was included in Patient Protection and Affordable Care Act of 2010 (PPACA). The language reflects a MedPAC recommendation that rebasing is needed due to significant changes in services provided during the 60 episode of care, along with what MEDPAC believes to be “overpayments” for services, evidenced by profit margin calculations. The average episode of care in the base year used for rate setting involved 37 visits primarily made up of nursing and aide services. The current care utilization in an episode is less than 20 visits with few aide services and significantly more therapy visits. . From 2001 through 2011, MedPAC’s calculation of Medicare profit margin shows freestanding HHAs with an average ranging from 16-18%. For purposes of rebasing, the CMS profit margin calculation is 14%.
The proposed rated for 2014 reflect a 2.4% Market Basket Index adjustment to reflect estimate costs increases in 2014. CMS also proposes a total rebasing payment reduction of 14 percent, or the maximum cap of a 3.5% payment reduction for each year, over the next four years. CMS estimates that the overall impact of the proposed rate rebasing and other rate changes is a reduction in Medicare spending of $290 million in 2014.
The Alliance’s comments will reflect concerns that:
the methodology utilized by CMS to calculate home health margins is flawed in that it excluded hospital based cost report and does not include critical factors such as the impact of the recent sequestration cuts
the analysis in the rule is a one year impact assessment rather that the full four years of the rebasing action and is national in scope, ignoring regional and state impacts
is based on average national costs. Other methodologies produce very different results. For example, NAHC’s calculation is that using the median would produce a per episode cost $113.98 higher than the CMS proxy estimated
The Alliance welcomes member input on the local impact of these changes and also encourages members to submit their own comments with the local impact. (Send to Tim Burgers, tburgers@hcalliancema.org). Comments will be accepted by CMS through 5pm on Monday August 26th. Instructions on Electronic comments on this regulation can be found at: http://www.regulations.gov. The regulation in its entirety is here.
New York Congressmen Tom Reed and Paul Tonko, as well as New Jersey Congressmen Christopher Smith and Robert Andrews, are circulating a Congressional letter that seeks to streamline the burdensome Medicare home health face-to-face (F2F) requirement. We need your help in cultivating further Congressional support. Please act now!
The Congressional letter is addressed to U.S. Centers for Medicare and Medicaid Services (CMS) Administrator Marilyn Tavenner. Referring to the F2F mandate, the letter describes the “complicated, confusing and overlapping documentation requirements that exceed the intent of the law passed by Congress,” and it urges CMS to allow the F2F requirement to be met through the completion and collection of the separately signed 485 form. Such a change would significantly ease the burden of the F2F mandate.
Almost 40 state home care associations are already listed in support of the letter, but in order to have the strongest impact with CMS, we need resounding support from as many Members of Congress as as cosigners to this letter.
We need the full support and sign on from the MA House delegation. August 9 is the deadline for doing so.
House Ways and Means Committee Chairman Dave Camp (R-MI) released draft legislation that would seriously change the benefit structure of Medicare. Proposals included in the draft legislation range from increasing the Medicare Part B deductible for new enrollees to increasing income-related premiums under Parts B & D. Of greatest concern to home care and its members is the suggested implementation of a home health copay. The home health copay proposal in the draft legislation was also included in the President’s FY14 budget. It would impose a $100 copay on home health episodes not preceded by a hospital or nursing home stay, beginning in 2017 and applying to those who become newly eligible for Medicare in 2017 or later.
The Home Care Alliance joins the National Association for Home Care & Hospice (NAHC) in opposition to shifting additional costs onto Medicare home health beneficiaries in the form of more out of pocket expense. With respect to the proposed home health copayment, Congress eliminated such a “sick tax” on beneficiaries back in the 1970s when it was found that such copayments were ineffective at saving the Medicare program money, as people had to seek more costly care options. Home health copayments would be just as harmful – if not more so – today with a rise in the number of beneficiaries needing home health services as Baby Boomers start to retire. If reinstated, the Medicare home health copayment will likely lead to more people seeking care in much more costly care settings such as hospitals, nursing homes and emergency rooms.
Alliance members are encourage to submit comments to the Ways and Means Committee in opposition to a copayment via email to entitlementreform@mail.house.gov by August 16, 2013.
Welcome to the 2012/13 Annual Meeting. It’s both a pleasure and an honor to be serving in a second year as Alliance President . This year I am pleased to say we had tremendous interest from the membership in serving on the Board. I am delighted to welcome our new Board members, all of whom are already leaders in their own organizations and anyone of whom could be prepared to take the helm of the Alliance if asked. I also extend my thanks to those Board members who will be continuing on for another year, your advice and counsel have been welcome. And, I would like to recognize Joanne Kramer, VNA Care Network; Kathleen McDonough, Community Health Network and Bob Tonti, VNS of Marthas Vineyard, who are leaving the Board. Thank you for your service.
As we end one Alliance fiscal year and embark on another, let me just give you a few facts and figures on home care today in Mass. Firs, on the Home Care Alliance:
We have 208 Agency, 54 Allied and 12 individual members
The average size of non-certified member agency: $1.4m
The average size of certified member agency: $8.8m
The increase in Alliance total dues , FY09 – FY12: 25%
Total revenue of members: Has now passed one billion dollars!
* $895million (certified)
* $155 million (non certified)
Just a few facts on the non-certified home care business. These come from a survey that we co-marketed with the Home Care Association of America. The first slide shows our state’s average per hourly billing rates compared to national northeast and industry leaders. No surprise we are slightly higher .
The next shows our turnover rates, which to our credit are remarkably lower. I am not sure if these two are linked but certainly the fact that turnover rates that are almost 20% lower than the national are a credit to us as employers and a benefit to our patients.
Just a few facts on the Medicare certified business. This chart, which is Medicare data based, shows that almost 25% of Medicare beneficiaries leaving hospital are referred for home health services. This number, to our credit , is almost 8% higher than the national average of just under 17%. By the way, this also means in our state that we have far fewer people who are reported going home with no services. The national number according to Masspro Medicare data is 51%
This second to last slide just gives you a different look at some similar data that show that per capita use of home health in Mass is higher than the national average – and the highest by the way, in New England.. The closest to us is Connecticut where the use per 1000 beneficiaries is 109. The highest per capita usage –is 144, which no surprise is the number for Florida, TX and LA.
My final slide comes from a home care chart book that a subcommittee of our Board has been working on with some facts and examples about how home health delivers value in health care today. This slide set will soon be posted to our website for all members to download and adapt as they would like. I hope that you will find it useful.
Again thank you all for joining us here today and for standing up for home care by being active members in the Home Care Alliance. As always, I and the other Board members welcome your feedback.
CMS has added an MLN Matters article about the PECOS delay which was announced earlier this week. It is titled: SE1305 – Full Implementation of Edits on the Ordering/Referring Providers in Medicare Part B, DME, and Part A Home Health Agency (HHA) Claims (Change Requests 6417, 6421, 6696, and 6856).
NAHC has posed the following questions to CMS:
Must home health agencies issue a beneficiary notice to patients whose services will be terminated because of failure of their physician to be enrolled in PECOS and, if so, what notice?
May home health agencies hold beneficiaries liable for the cost of care?
Do apostrophes appear in PECOS files and in the edit files that will be used by the MACs (conflicting guidance from CMS to providers about use of apostrophes)
Will claims be edited against the original Phase 2 May 1, 2013 “from” date or will this date be amended?
Would CMS please add the effective date of physician enrollment to the Ordering/Referring File?
The Alliance appreciates NAHC pushing for these answers and will share information as we get it.
The following information was submitted by Elizabeth Hogue, Esq:
The U.S. Department of Health and Human Services (HHS) has issued final rules to:
Modify the Health Insurance Portability and Accountability Act (HIPAA) Privacy, Security and Enforcement Rules to implement statutory amendments under the Health Information Technology Economic and Clinical Health Act (HITECH Act) to strengthen the privacy and security protection for individuals’ health information;
Modify the rule for Breach Notification for Unsecured Protected Health Information (Breach Notification Rule) under the HITECH Act to address public comments received on the interim final rule;
Modify the HIPAA Privacy Rule to strengthen the privacy protections for genetic information by implementing section 105 of Title 1 of the Genetic Information Nondiscrimination Act of 2008 (GINA); and
Make other modifications to the HIPAA Privacy, Security, Breach Notification and Enforcement Rules to improve their workability and effectiveness, and to increase flexibility and decrease burden on regulated entities.
The final rules were published in the Federal Register on January 25,2013, and will be effective on March 26, 2013. Covered entities and business associates must comply with the final rules by September 23, 2013. This is the third in a series of articles that will address key provisions of the rules, their impact on post-acute providers, and practical solutions for compliance. Continue reading “New HIPAA Rules Issued: Disclosures and Revised Notices of Privacy Practices”
The Massachusetts eHealth Institute (“MeHI”), a component of the Massachusetts Technology Collaborative (“Mass Tech Collaborative”), has just released an RFP offering grants to eligible applicants to fund projects that ‘catalyze connections’ to the Statewide Health Information Exchange (the Mass HIway) by migrating existing processes away from paper based exchanges and exchanges using proprietary interfaces to use the Mass HIway. This program, budgeted at $2M, will issue awards up to $75,000 each. The state is holding on‐line information sessions for interested applicants on March 21 and March 27. Applications are due April 16th
By: Beverly Pavasaris, President, Brockton VNA President, Home Care Alliance of Massachusetts
Once again this legislative session, the Home Care Alliance of Massachusetts has filed a bill (An Act Relative to Home Health & Hospice Aides) to allow nurses working in home health agencies and hospices to delegate the administration of certain medications to home health aides. Before this would occur, the home health agencies would need to provide training, certify competency skills and establish documentation protocols according to the nurse delegation model developed by the National Council of State Boards of Nursing. Such regulations, according to the bill, will be drafted by the state’s Board of Registration in Nursing in collaboration with the Massachusetts Department of Public Health and with nursing input.
In past legislative sessions, I have testified in support of this bill as a creative and progressive solution to removing existing barriers that obstruct home health patients from getting needed care. Our legislation recognizes the changing scope of work that can be safely provided by paraprofessionals with appropriate nurse oversight and helps prepare our state for the aging of our population and growth in clients living at home with medical condition that are stable and predictable.
If this bill were to pass we would by no means be in the forefront of this issue. A number of states, including Oregon and Washington, and most recently Connecticut , have addressed at-home medication delegation, resolving that the need for assistance with managing and administering medications should not drive citizens into nursing homes. Aside from the improved efficiency of care, Connecticut anticipates a $28 million savings per year from their effort to allow certified home health aides to assist nurses with certain tasks.
An obstacle to getting this bill passed has been lack of support from the state’s professional nursing organization: MNA. The Alliance has met with them on numerous occasions and assured them that this bill is intended to keep nurses, who are uniquely qualified to promote the health of patients in their homes, closely involved in the administration of medication. They remain unconvinced.
At this time, the Board of Registration in Nursing is looking at revising their own delegation regulations to prepare for possible delegation of medication administration in the home. But we need the Legislature to act, and we would like to show them that we have nursing support.
Please get involved. If you belong to MNA, let them know you support this. If you would like to testify or set up a legislative meeting on this issue, contact James Fuccione, jfuccione@thinkhomecare.org.
Leading a home care agency in today’s changing healthcare environment is challenging to say the least! We must daily juggle the needs of patients, families, employees, referral sources, insurance companies, and regulatory agencies. With only so many hours on in a day, we jump to the operational solution that is the quickest or most obvious. Many times we are right, but some of the solutions we put in place are not always implemented effectively and are not sustained. Why?
In our rush to solve a problem so that we can move on to the next one, we often neglect some important fact finding. Experience shows us that there is no better way to get to the root of a problem than to go see for yourself what is actually happening. You need to ask – in person – of the people who do the work or who benefit from the work: what works and what does not. And then you need to go that next step: respectfully ask how they would do it better.
For a leader, this can be an eye-opening experience. What you may believe is working effectively and efficiently is often bogged down in work- arounds to an ineffective process. The best solutions can come from the people who are actually doing the work or from people who are the recipient of your product/care. Asking them why, rather than what forces people to think deep and to get to the root of an issue or problem
An added plus: buy in and adherence to a change can be more easily achieved if the people who do the work or who benefit from the work were the initiators of the solution. It is a win for your entire organization.
To all good leaders and managers, I say: get out of the office and go see what the issue is. And respectfully ask the powerful question: “why?”
Think Home Care Blog 