Alliance Submits Comments on PPS Rule

The Home Care Alliance of MA today submitted comments to CMS on the proposed rule setting Medicare home health rates for 2014. CMS has proposed cutting rates by 3.5% for each of the next four years.

Citing data concerns, inadequate allowances for increasing regulatory costs and operating margins, inequities in the proposed wage index, and an incomplete analysis of the impact on both agencies and Medicare patients of CMS’s proposal to cut rates for each of the next four years, the Alliance urges CMS to go back to the drawing board on 2014 rates.

The Alliance’s comments are available here.

Comments to CMS on the proposed rule are due TODAY at 5:00 p.m., and can be submitted online at  Enter “RIN 0938-AR52” in the search box to find the proposed rule.

Home Health Data on PatientCareLink Updated

Updated Home Health Compare data has been posted to the PatientCareLink website. Home Health Compare data allows consumers to compare the quality outcomes of Medicare-certified home health care agencies on a variety of standardized quality measures. See how the agencies in your area compare to other agencies and to national average scores.

Alliance Leadership Elected

The results of the 2013 election of officers and Board members for the Home Care Alliance of Massachusetts were announced at the Annual Meeting on June 21, 2013, at All Care VNA & Hospice, Lynn.

The following individuals were elected to officer positions:

  • President:  Beverly Pavasaris, President, Brockton VNA, Brockton
  • Vice President:  Jeanne Ryan, Executive Director, VNA & Hospice of Cooley-Dickinson, Northampton
  • Secretary:  Wayne A. Regan, Senior Vice President, MetroWest HomeCare & Hospice, Framingham
  • Elected to two-year terms on the Board of Directors:
  • Jann Ahern, Executive Director, South Shore VNA, Rockland
  • Maureen Bannan, Executive Director, Walpole Area VNA, Walpole
  • Holly Chaffee, CEO, Porchlight VNA, Lee
  • Theresa Larson, Regional Home Care Director, The Essex Group, South Dartmouth
  • Laurie Rubin, President, QualityWORKS, Holliston
  • Kathleen M. Trier, Executive Director and CEO, Community VNA, Attleboro

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Guest Post: New MA Staffing Agency Regs

By: Allyson Kurker, Kurker Paget, LLC

On January 31, 2013, Massachusetts will become the second state to require staffing agencies to provide basic job information to employees assigned to temporary or part-time jobs.  An Act Establishing a Temporary Worker’s Right to Know will amend Massachusetts General Law, chapter 149, section 159C.  The following article provides an overview of the substance of the law and how to comply.

Why was the law passed?

According to Governor Patrick, the law was passed because “thousands of Massachusetts workers are sent off to work by staffing agencies without any idea of where they are going, what work they will do, and what they will be paid.  This bill levels the playing field for all of our businesses while fulfilling our responsibility to make sure all of our workers are being treated fairly.”

Who does the law protect?

Any person employed directly by a staffing agency to provide temporary or part-time employment services to a work site employer.  Temporary employment lasts less than 10 weeks.

Does this law apply to all temporary workers?

No.  The notification requirements do not apply to secretaries, administrative assistants or professionals as that word is defined in 29 USC § 152.

What is a staffing agency?

An employment agency that places workers in jobs, assignments, engagements or employment for a fee. The official definition of an employment agency can be found in Massachusetts General Laws chapter 140, section 46A.  The Commonwealth’s FAQs about Employment Agencies is a helpful resource.

What does the law require?

The bullet list below summarizes the information a staffing agency is required to provide to part-time or temporary employees:

  • the staffing agency’s contact information;
  • the staffing agency’s workers’ compensation carrier;
  • the rate of pay for the job;
  • shift start and end time, and if known, the duration of the assignment;
  • the date of pay day;
  • details related to any meals or transportation, such as whether either is provided, and whether either the staffing agency or the work-site employer is going to charge for meals or transportation;
  • a description of the position and whether it requires special clothing, tools, licenses, or training; and
  • the name of the worksite employer

In addition, staffing agencies must post a notice of rights provided under the law, as well as the Massachusetts Department of Labor Standards’ contact information.

How can I comply with the notice requirements if I won’t see the employee prior to the commencement of the assignment?

Agencies may communicate the required information by telephone, provided that written details are provided to the employee before the end of the first pay period.

Is there a sample notice I can use?

The Department of Labor Standards will provide a sample notice to all staffing agencies that will satisfy the notification requirements prescribed by the law.  This sample notice has not been posted on the DLS’s website yet, but check back soon.

What does the law prohibit?

Employment Fees:

Staffing agencies may not charge an applicant or employee:

  • To register to use its services.
  • For any cost associated with performing a criminal background check.
  • More than its actual costs for any of the following: bank cards, debit card, money orders or drug screens.
  • A fee for a good or service if such fee would cause the employee to earn less than minimum wage (currently, $8.00/hour).

Transportation Fees:

The following provisions apply to transportation:

  • If the agency provides transportation to the work site, it must notify the employee of any fee associated with the service.
  • Any transportation fee charged to the employee cannot exceed the actual cost to the agency, and cannot amount to more than 3% of the employee’s daily wages.
  • The agency cannot charge a transportation fee if it requires the employee to use its transportation.  Said another way, agencies only can charge for transportation if it is a service provided to the employee rather than a requirement of the position.

Other Prohibitions:

The law also specifically forbids certain activity, most of which should be common sense.  These prohibitions include: providing false or fraudulent information to applicants and employees; assigning employment by force or for illegal purposes; refusing to return an employee’s personal property, and; using any name that has not been registered with the DLS.

Allyson E. Kurker
Kurker Paget, LLC
(P) 978.254.5487

Alliance Submits Comments on PPS and Survey Rules

The Alliance today submitted comments to CMS on the proposed changes to the Medicare PPS rates for 2013 and the proposed new alternative sanctions in the survey enforcement process.  Specific issues that the Alliance addressed include the case mix creep adjustment, wage index concerns, proposed changes to the face-to-face and therapy reassessment requirements, and proposed Alternative sanctions—including civil money penalties – for agencies with condition-level deficiencies.  The Alliance’s comments are available on our website here

Alliance members are strongly encouraged to submit their own comments on the federal Regulations website.  Enter “CMS-1358-P” in the search box to find the PPS regulation, and follow the instructions to submit your comments.  Comments are due by September 4.

Healthcare Bill Summary

The MA legislature shifted into overdrive during the last few days of the 2011/2012 legislative session, which ended on July 31. Healthcare cost containment was among the major pieces of legislation that were approved during the last days of the session, and several provisions of the bill have significant impacts on home care providers.

Section 142 of the bill will significantly ease the burden of the Fair Share Contribution (FSC) requirement that employers offer health insurance to their workers. Under this section, any employees that have health insurance through a spouse’s coverage, military, disability, or Medicare will not be included in the calculation of an employer’s compliance with the FSC mandate. This change should be a relief to many home care agencies. Section 51 of the bill establishes appeal processes for employers faced with a FSC audit.

The bill also includes a number of provisions related to home health’s role within Accountable Care Organizations and names the Alliance to a couple of new advisory panels.

The Alliance has prepared a more detailed summary of the bill’s provisions:

CMS Releases Proposed PPS rates for 2013

CMS on Friday released an advance copy of the proposed regulation for changes to the home health PPS rates for calendar year 2013.

Brief highlights:

• The proposal increases the national base episodic rate by 0.16%, from $2,138.52 to $2,141.95.  (calculated using a 2.5 percent inflation update, a 1 point reduction mandated by the health care reform law, and a 1.32 percent case mix creep adjustment.)

• The portion of the rate adjusted by the wage index is increased from .77082 to .78535

• The county wage index is available here (click on the “download” at the bottom of the page).:

Here are changes for MA counties:

Current                2013

Barnstable                        1.2838                   1.2872
Boston                              1.2283                   1.2394
Middlesex                         1.1210                   1.1285
Essex                               1.0698                   1.0575
erkshire                            1.0616                   1.0745
Bristol                               1.0639                   1.0718
Springfield                        1.0247                   1.0390
Worcester                         1.1076                   1.1230
Dukes/Nantucket              1.3962                   1.3570

The proposed rule also:

  • allows certain non-physician practitioners in inpatient settings to conduct the required Face-to-face encounter;
  • increases flexibility in complying with the therapy reassessment requirements;
  • establishes hospice quality reporting requirements to begin in 2014, including various proposed measures to report;
  • creates an Informal Dispute Resolution process that agencies can use to dispute survey deficiencies;
  • establishes a range of “Intermediate Sanctions” for non-compliance with the Medicare Conditions of Participation, including civil money penalties, suspension of payment for new admissions, and temporary management.

The Alliance will conduct a thorough analysis of the proposed rule and prepare comments.  Watch for additional details in the next few weeks.

Comments are due by Sept. 4.