The Rundown – January

Federal

Apologies for the delay with the January edition of “The Rundown”, but if the federal government could delay swearing in their members, then I can be late with my report. To put it mildly, things got a little crazy since November at the federal level.

Federal Budget

To put it mildly, things got a little crazy since November at the federal level. Let’s start off with the least complicated stuff that happened. In December, the government passed a massive $1.7 trillion omnibus spending bill that would fund the government through September 2023. The spending package includes language that would increase transparency of the payment rate-setting method employed by CMS. We were disappointed that the package does not include language that would suspend the entirety of the behavioral adjustment cut to the CY 2023 home health payment in CMS’s CY 2023 Final Rule. Additional provisions that were included that are noteworthy include:

  • Two-year extension of Medicare telehealth provisions
  • Two-year delay in implementing the Medicare tele-mental health in-person requirement.
  • Paygo waived 2 years (was a 4% Medicare cuts across the board for 2023 and 2024)
  • Rural add on extended at 1% for 1 year for frontier counties
  • Medicaid Money Follows the Person program and spousal improvement protections extended to 2027
  • Modification of the 2023 Medicare Physician Fee Schedule that will increase payments by 2.5% in 2023 and 1.25% in 2024.

Speaker Race

Now to when things got crazy. Like a high school student trying to pass their driving test, it took House Republicans more than just a couple tries to elect a Speaker of the House. For about 4 days the public witness what House Republicans called “debating”, but what I would call the manifestation of a twitter comment section. A Speaker being named was mainly being held up by members of the House Freedom Caucus, who are generally considered the most conservative and farthest-right bloc of the Republican party. The Freedom had an extensive list of demands, such as, restore any member’s ability to make a “Motion to Vacate the Chair” and force a vote on removing the Speaker, and Decline to raise debt ceiling without a plan to cap spending and balance the federal budget in 10 years. Finally, late on Thursday night a final agreement was struck between the outliers and Republican leadership to garner their support and to elect a Rep. McCarthy as Speaker of the House and officially swear in the 117th Congress.

Now that everyone has been sworn in, the 117th Congress will see the Republicans in control of the House and the Democrats with a slim hold on the Senate. This will result in a lot of fanfare, twitter feuds, but very little actual legislative bills passed. As part of the agreement with the Freedom Caucus, McCarthy agreed that the House would not pass any budget that would increase spending and that they would look to reduce spending on any spending that is not defense related. This leaves the prospect of Congress passing any federal legislation requiring CMS to delay or suspend their rate cuts unlikely.  

State Update

New Year, new government! This January, Maura Healey was sworn in as the 73rd Governor of the Commonwealth of Massachusetts. Healey is the first women to serve as Governor of Massachusetts and the nation’s first openly lesbian governor. Healey, previously the states Attorneys General since 2014, is a moderate Democrat with strong union ties. Healey received and endorsement from multiple union groups, including SEIU1199, who represents over 115,000 health care, higher education, public sector, and building service workers in Massachusetts. During her transition period HCA wrote a memo to Healey’s transition team detailing our legislative priorities for her time as governor.

January also marks the beginning of the 193rd Session of the Massachusetts State Legislature. HCA has been in close contact with state legislative champions to have our key bills refiled by the filing deadline (January 20th). We will be refiling both the Licensure, and Rate Setting bills. HCA will also be holding a Home Care 101 seminar on January 7th with members of the Enough Pay to Stay Coalition. During the seminar, HCA and the EPTS will educate state staffers on the ins and outs of the home care industry and the vital role that home care workers play in Massachusetts’ health care system!

We would also like to set up state legislature visits with agencies. If an agency is willing to have their state representative/senator visit their office/operation, please email me at hcollins@thinkhomecare.org, and I will help to set up the visits.  

The Rundown – December

No Time to Waste! Urge Your Member of Congress to Delay CMS’s 2023 Home Health Rate Cuts

While I usually use the first section to cover federal news, this cannot wait. On October 31, 2022, the Centers for Medicare & Medicaid Services (CMS) released a final rule that will reduce Medicare payments for home health services by $635 million in 2023 and approximately $18 billion over the next decade. It was mandated by Congress in 2018 that CMS develop a payment model that would be “budget neutral”, not one that would reduce funding for home health care by over $18 billion.

Following the release of the final rule, HCA along with the National Association for Home Care and Hospice (NAHC) re-engaged with the sponsoring offices of The Preserving Access to Home Health Act (S. 4605/H.R. 8581) on refining the legislation to delay CMS from implementing their 2023 home health payment cut for one year, as well as strengthen transparency of the Centers for Medicare & Medicaid Services (CMS) in their rate-setting. Our champions on Capitol Hill are working to substitute this amended language in the negotiations for the year-end package. 

With time running out in the 117th Congress, lawmakers are inching closer to passing a final spending bill to keep the government funded. Home health advocates are pushing hard for a yearlong delay of the 2023 home health payment cut, which would otherwise take effect on January 1, 2023. However, NAHC has informed us that there is significant opposition to delaying these cuts.

We need your help once again and there is no time to spare! 

HCA members sent over 200 emails to members of the Massachusetts delegation urging their support ofS. 4605/H.R. 8581Your continuous outreach resulted in Massachusetts Rep. Jim McGovern and helped to persuade CMS from backing off their initially proposed 7% rate cut. We must continue our aggressive outreach in order to persuade Congress to include the revised language in the year-end budget!

Helping out is as easy as clicking on the this ACTION ALERT link, filing in your information which will send a pre-written email to your member of Congress urging them to support a year-long delay (2023) of CMS’s proposed home health rate cut and call for added transparency in CMS rate-setting practices.

It is so easy thatmy 6-month-old golden retriever Daisy was able to do it and she got her nose stuck in a peanut butter jar the other day. I will be sending out numerous reminders to reach out to your member of Congress over the next couple of weeks! You will not be able to escape me as I try to get as many people to help us in our mission to stop CMS. We need you and anyone that you know to reach out!

Federal Recap

Now back to the recap. This edition will be lighter than previous editions due to the holiday season. The time between mid-November and the new year is notoriously slow due to the holiday season, but there is still some stuff I would like to update you all on.

Campaign season has officially come to a close! Ralph Warnock won the Georgia run-off election this week, defeating Republican challenger and self-proclaim Texan (his words) Herschel Walker. Warnock’s win gives Democrats a 1 seat majority in the Senate, wrapping up 2 years of 50-50 split in the Senate. Though this may not seem like a large enough margin to matter, it will have a big impact over the next two years. With a 1 vote majority, Democrats can take much more operational control of the Senate, easing the confirmation of contentious nominees, clearing the way for investigations and availing themselves of breathing room on a variety of matters. Democrats will now hold a one-seat advantage on congressional committees that are now evenly split. This will prevent Republicans from being able to block confirmation nominees while in committee if Democrats are able to hold together on a nominee. The Biden Administration will likely use this opportunity to pack the lower courts with Democratic judges. Many judicial nominees only require a one vote majority to be passed through committee and the Senate. Democrats will still be blocked from passing sweeping legislation in the Senate due to the risk of a filibuster by the Republicans.

Nancy Pelosi and Steny Hoyer both announced that they will be stepping down from their position as Speaker of the House and House Majority Leader respectively. Pelosi and Hoyer’s announcement marks the end of the era for the number 1 and 2 in the Democratic party and will usher in a new era in Democratic politics. Democrats moved quickly to fill their leadership vacancies, electing Rep. Hakeem Jeffries (NY-8) to be party leader, Massachusetts own Katherine Clark (MA-5) to be minority whip (number 2) and Rep. Pete Aguilar (CA-31), to Jeffries current position of Democratic caucus chairman (number 3). Pelosi and Hoyer both stated that they will still serve in the House the remainder of their terms, which I will imagine will result in them still holding puppet power till they retire. The new leadership will have their hands full in the new year when Republicans take over control of the House. Current Republican Leader, Rep. Kevin McCarthy (CA-23) is expected to be elected Speaker of the House in the new session. McCarthy has already signaled that he plans to make the House into a TV spectacle for the next two years. McCarthy has been setting up a the potential for congressional investigation into the Hunter Biden laptop scandal, which will be sure to make great TV.

Look Ahead

The only thing that we will be looking at in December is a potential year-end budget deal to fund the government for the next year. As I wrote before, it is imperative that you use this ACTION ALERT to urge your member of Congress, for some will be the now immensely powerful Katherine Clark, to urge them to support a year-long delay (2023) of CMS’s proposed home health rate cut and call for added transparency in CMS rate-setting practices. Congress could decide to punt negotiations on a 2023 budget by deciding to pass a continuing resolution (CR), that would fund the government at the current levels for a specific amount of additional time. That amount of time could range from additional month to a full year. CR’s have become common practice over the last decade and will likely be used at some point in this process. It is imperative that we ask that they include in any deal to stop CMS from implementing their rate cuts. Please use the ACTION ALERT to do your part. I am happy to help anyone if they would like to reach out to their member in a different way, whether by phone, fax, hell the pony express! Ill take anything. Your voices matter!

Urge Congress to Reject Cuts Hospice Cap

We are also asking that our Hospice members use this ACTION ALERT to urge their member of Congress to reject a major hospice payment cap cut from being included in any end-of-year legislative package that Congress is currently negotiating. As is often the case with large, year-end spending bills, there are many programs and policies Congress wants to “stuff in” to an omnibus funding package before the close of the year. In order to pay for all these priorities, lawmakers must identify “offsets” to fund them.

A significant reduction of the hospice aggregate cap, as has been recommended by MedPAC in the past, is being considered for one such “offset”. We need your help as hospice leaders to tell Congress that cutting the cap in a major and rushed way is bad policy.

It is imperative that we all do our part to make sure that there are no major hospice payment cap cut included in the end-of-year budget!! 

State Recap/Look Ahead

Just like at the federal level, this edition will be lighter than previous editions due to the holiday season. To quickly cover what has happened since the last rundown, Maura Healey has begun her transition process, naming members of her transition team. This marks what will be a long transition period for the Healey team. Healey is in a rare position as opposed to previous Governor-elects; Healey currently holds high office as the current Massachusetts Attorney General (AG). Healey will not only have to manage taking the reins from Governor Baker, but Healey will also have to manage transitioning her AG office over to AG-elect Andrea Campbell. Many legislators that I have spoken with have pointed out that this is no easy task and will likely result in a slower than usual transition period.

HCA is currently drafting several pieces that we will be sharing with the Healey transition team that clearly states our priorities for her time as Governor. We have also been in constant contact with our state legislative champions to advocate to the Governor-elects team on our behalf.

I will be sure to keep you up to date on any on-going developments as it pertains to the transition from Governor Baker to Governor-elect Healey.

No Time to Waste! Urge Your Member of Congress to Delay CMS’s 2023 Home Health Rate Cuts

On October 31, 2022, the Centers for Medicare & Medicaid Services (CMS) released a final rule that will reduce Medicare payments for home health services by $635 million in 2023 and approximately $18 billion over the next decade. It was mandated by Congress in 2018 that CMS develop a payment model that would be “budget neutral”, not one that would reduce funding for home health care by over $18 billion.

Following the release of the final rule, HCA along with the National Association for Home Care and Hospice (NAHC) re-engaged with the sponsoring offices of The Preserving Access to Home Health Act (S. 4605/H.R. 8581) on refining the legislation to delay CMS from implementing their 2023 home health payment cut for one year, as well as strengthen transparency of the Centers for Medicare & Medicaid Services (CMS) in their rate-setting. Our champions on Capitol Hill are working to substitute this amended language in the negotiations for the year-end package. 

With time running out in the 117th Congress, lawmakers are inching closer to passing a final spending bill to keep the government funded. Home health advocates are pushing hard for a yearlong delay of the 2023 home health payment cut, which would otherwise take effect on January 1, 2023. However, NAHC has informed us that there is significant opposition to delaying these cuts.

We need your help once again and there is no time to spare! 

HCA members sent over 200 emails to members of the Massachusetts delegation urging their support of The Preserving Access to Home Health Act. Your continuous outreach resulted in Massachusetts Rep. Jim McGovern and helped to persuade CMS from backing off their initially proposed 7% rate cut. We must continue our aggressive outreach in order to persuade Congress to include the revised language in the year-end budget!

Please use the action alert below to write to your member of Congress urging them to support a year-long delay (2023) of CMS’s proposed home health rate cut and call for added transparency in CMS rate-setting practices.

Home Care Alliance Signs onto CMS Letter to House and Senate Leadership

The Alliance signed onto an advocacy letter written by the National Association for Home Care and Hospice (NAHC) to House and Senate leadership asking for their support in suspending the implementation of CMS’s final for the Home Health Prospective Payment System (HHPPS).

This week, the Alliance signed onto an advocacy letter written by the National Association for Home Care and Hospice (NAHC) to House and Senate leadership asking for their support in suspending the implementation of CMS’s final for the Home Health Prospective Payment System (HHPPS). As a reminder, CMS’s final rule if implemented would reduce Medicare payments for home health services by $635 million in 2023 and trigger an estimated $18 billion in payment reductions over the next decade.

The Alliance joined 49 other home care associations across the nation in signing this letter. The letter highlights the immense impact that the final rule would have on the agency across the country, noting that “the impact of those payment cuts would exacerbate the ongoing dismantling of this essential benefit that serves over 3 million of the most vulnerable Medicare beneficiaries, providing them with exceptional care quality in their own homes, preventing high-cost hospitalizations, and offering an alternative to life-changing institutional care while saving Medicare billions in spending every year.

NAHC is currently working with key sponsors and co-sponsors of the CMS bill (S.4605/H.R.8581)that was introduced in August, to re-write the bill in response to CMS’s final ruling. The exact details of the revision of the bill have not yet been determined, but once they are the Alliance will re-engage with the Massachusetts delegation to update them on the changes and to garner their support for the new version of the bill. We will also be asking our members to once again reach out to their member of Congress to support the new version of the bill.

The Rundown – November Midterm Election Edition

Federal Recap

Red wave!!!! More like a drizzle, just like meteorologist over-projecting rain fall during a summer storm, everyone over speculated how well Republicans would result in the midterm elections. While Massachusetts went the way everyone thought It would with Democrats holding onto every seat, nationally Republicans did not have the night that anyone could have expected. Republican pundit Ben Shapiro said it another way “from red wave to red wedding.”

Historically speaking a sitting president usually loses big during the midterm election, but that did not happen this election cycle. For the last 2 years pollsters, political pundits and politicians have called for Republicans to win big this midterm season, winning back control of the House and the Senate. Though Republicans are most likely going to win back control of the House, it was not by the margin that they expected nor as it as widespread as people thought. While all races have not been called it is looking like President Biden and the Democratic party lost the fewest number of House seats during a Democratic presidents first midterm election in over 40 years. Democrats went into the night with a large margin to overcome to hold control of the House and Senate. To keep control, Democrats needed to win at least 45 races in competitive districts, where Republicans had to win 19 to gain control. As of this morning, Republicans have only won 7 and Democrats have won 24 of those races.

In key swing states such as Pennsylvania, Georgia, New Hampshire, Ohio, and Arizona, there was massive Democratic voter turnout, largely made up of young voters, impeded the expected red wave. Democrats saw key wins in districts in these states where voters said that abortion rights were their top priority, knocking off some incumbents and far right competitors. Democrats were also able to flip the Senate seat in Pennsylvania where Democratic candidate John Fetterman won by a bigger margin than expected, keeping the Democrats chances of keeping control of the Senate alive. 3 states are yet to fully be decided, with one state (Georgia) going to a runoff election and Nevada and Arizona vote count not fully completed. Democrats are currently leading in the Senate race in Arizona and a closing the gap in the Nevada senate race. There is a chance where Democrats could go into the Georgia run-off election with a chance to take a 1 seat majority in the Senate.

It wasn’t all good bad news for Republicans though. Republicans went down to Florida and came back with a beautiful tan and great beach side condo. Republican Governor and suspected future Republican candidate for President, Ron DeSantis, dominated his competition by over 20 points. The fun in the sun didn’t stop their where republicans rode a red wave through Florida sweeping many house races and dominated in the one Senate race where incumbent Marco Rubio won by almost 18 points. Republicans were also able to defeat New York Rep. Sean Patrick Maloney, a high-ranking Democrat who is the chair of the Democratic Congressional Campaign Committee and is responsible for getting other Democrats reelected. This is a major blow for Democrats who lost their high-ranking comrade in a state where they also just re-drew the district lines in favor of Democrats. Republicans are also still expected to win majority of the House which is nothing to gloss over. Republican control of the House kills any chance of significant democrat agenda items passing without large support from Republicans over Biden’s last 2 years in office. Such as key democratic agenda policy related to climate change and union growth (PRO Act).

It is not fully clear at this moment what caused the lack of a red wave across the country. It is most likely not because of one thing, but likely a collection of reason. Many believe that abortion rights played a large hand, in addition to, bad Republicans candidate chooses, and possibly Bidens policy achievements. When it comes to perceived bad Republican candidates, election day saw a lot of candidates that were vocal 2020 election deniers lose. Alabama was the only state where a governor candidate that was a 2020 election denier win their race. In Georgia, Republicans were not fans of the Republican senate candidate Herschel Walker. While the Republican Governor, Brian Kemp, won his election with over 2.1 million votes, Herschel Walker only received a little over 1.9 million votes, showing that even though Republicans went to the polls to vote for Kemp, they decided to stay out of the Senate race and not vote for either candidate. 

While the elections have not been finalized in many states and there is still much anxiety over what the final results will be, there is one thing that is finally done……. Political ads! All those tv ads, texts and emails that have overrun our lives over the last couple months are finally done. We can now breathe a sigh of relief and drop our anxiety for when-ever our phone buzzes dreading a text or email from a campaign trying to ask for our money or get us to vote. I personally received over 45 emails in the last month asking for political donations. Even my Alma Mater, James Madison University, only sent me 10 emails this last month about my tuition payments. So I can now open my email and not want to throw my phone across the room.

State Recap

Governor/High Office Positions

History was made this election cycle as Massachusetts as state attorney general (AG) Maura Healey was elected governor, becoming Massachusetts first elected female governor and the first openly lesbian women elected governor in the nation. Healey dominated her Republican competitor, former state Rep. Geoff Diehl, beating him by almost 30 points. The result comes as no shock to residents as Healey never trailed in the polls and held huge advantages in fundraising and name recognition. Healey, whose stepfather was president of a local teachers’ union, has been vocal about her support for unions. Healey received and endorsement from multiple union groups including SEIU State Council, one of the largest union groups in Massachusetts. In 2016, as AG, Healey lead a multi-state brief in support of federal efforts to provide greater transparency, fairness in union elections. While campaigning, Healey said that she would invest in workforce development and support to help improve behavioral health access, promote the use of community health workers to meet the needs of underserved communities, and expand access to telehealth services.

In addition to the governor race, Democrats swept the elections for attorney general, auditor, secretary of state and treasurer, continuing Republicans’ drought of holding any of those offices. Former Boston City Council president Andrea Campbell, was elected to replace Muara Healey as attorney general, making her the first black women to be elected to the position. Campbell defeated second time nominee Jay McMahon, a Bourne attorney who has a background in law enforcement. Campbell, who previously served as deputy legal counsel under Governor Deval Patrick, received endorsements from the SEIU State Council and said that she is committed to advancing labor rights for residents of the Commonwealth.

Legislature

Democrats rode the coat-tails of Maura Healey’s massive win all the way down the ballot on Tuesday, resulting in Democrats flipping a couple of state House seats and holding on to win highly contested races in the state House and Senate. Democrats will now hold the most seats in House in over 10 years. In what many called “the most competitive race statewide,” incumbent Sen. Becca Rausch of Needham fended off a serious challenge from Republican Rep. Shawn Dooley. Rausch’s district that has historically flipped back and forth between the two parties.

Tuesday’s election will restore both chambers of the Legislature to full strength after seven different House districts sat vacant after representatives resigned partway through their two-year terms. House legislative leaders decided not to call special elections to fill those seats, citing the complexity of hosting contests for the existing district lines just a few months before the midterm elections. At least 21 winners of House races and five winners of Senate races in Tuesday’s general elections will be newcomers to the Legislature, most of whom emerged victorious in contests for open seats with no incumbent on the ballot.

Ballot Questions

This election included 4 ballot questions for voter to decide on, covering controversial topics including taxes to immigration policy. The 2 most contested ballot questions were Question 1 and Question 4. Question 1 asked voters to decide if the state should impose a “millionaire tax”, a 4% surtax on annual personal income above $1 million, while question 4 tried to repeal a new law that would allow undocumented immigrants to apply for Massachusetts driver’s licenses. Residents of the Commonwealth, in a somewhat shocking occurrence, voted in favor of imposing the millionaire tax and to keep in place the driver’s license bill. Question 1 passed with 52% of the vote, while Question 4 passed with a little over 53%. Campaigners on both sides for question spent ABSURDS amount of money to garner support from residents. The opposition spent nearly $13,518,519.82, which is chump change compared to the supportive campaign who spent OVER $27 MILLION DOLLARS. That over $43 million dollars on one ballot question. I wonder if any of that money would be taxed now.

The other two ballot questions, Question 2 and 3, covered dental insurance and liquor licenses. Question 2, which would require dental insurance companies to spend at least 83 percent of premiums on member dental expenses and quality improvements, instead of administrative expenses, received an overwhelming support with 73% of “yes” votes. And lastly, Question 3, which would increase the number of alcohol licenses a single company could hold while gradually reducing the number of licenses specifically allowing the sale of all alcoholic beverages including liquor, did not pass, as a 55% majority voted against the ballot initiative. What does Massachusetts have against alcohol? I think it has something to do with having successful sports teams, if your teams win a lot there is less of thought to drown your sorrows with happy hour alcohol sales.

Urge Congress to Support the Preserving Access to Home Health Act of 2022

CMS released their annual proposed rule for Medicare home health services, which includes a proposed reduction to payment rates, and an additional $2 billion in “clawback” cuts to home healthcare services for CY2023.

Please use the action alert below to write to your member of Congress urging them to support The Preserving Access to Home Health Act of 2022.

In June, the Centers for Medicare & Medicaid Services (CMS) released their annual proposed rule for Medicare home health services, which includes a proposed 7.69% reduction to payment rates, and an additional $2 billion in “clawback” cuts to home healthcare services for CY2023. With home care providers already facing an unprecedented workforce shortage, leading many to turn away patients due to lack of staff, inflation, and exceedingly high gasoline prices, now is not the time to cut payment rates.

In response, lawmakers moved quickly to prevent this proposed rate cut that would have a devastating effect on the industry. In August, bipartisan lawmakers introduced The Preserving Access to Home Health Act of 2022 (S.4605/H.R.8581). would delay the 7.69% payment cut proposed for 2023, which would total $1.33 billion in 2023 alone. The bill would also block additional cuts of more than $2 billion as soon as 2024 due to an unjustified “clawback” of payments for critical home healthcare services delivered to seniors and people with disabilities during the pandemic. If the rule were to move forward, up to 45% of providers in Massachusetts will have an overall margin below zero. The Preserving Access to Home Health Act would reduce that impact to just 26% of HHAs, saving countless of agencies across the state.

Patients currently face extensive access challenges and the CMS proposed rule will only exasperate the problem. Home health leaders have consistently outlined concerns related to CMS’ methodology in proposing these payment adjustments while also highlighting significant increases in labor and supply costs across the home health community.

Please use the action alert below to write to your member of Congress urging them to support The Preserving Access to Home Health Act of 2022 (S.4605/H.R.8581).

Krilovich Named Executive Director of Home Care Alliance

The Alliance’s Board of Directors has appointed Jacob Krilovich as Executive Director of the Alliance.

Jake Krilovich, Executive Director of the Home Care Alliance of Massachusetts.

Boston, MA – The Board of Directors of the Home Care Alliance of Massachusetts has appointed Jacob Krilovich as Executive Director of the Alliance, effective January 3, 2022. Krilovich, a resident of Jamaica Plain, was previously Director of Legislative and Public Affairs for the Alliance. He succeeds Patricia Kelleher, who retired on December 31, 2021, after serving as Executive Director of the Alliance for 26 years.

Prior to joining the Alliance in 2017, Krilovich was Director of Advocacy for the National Multiple Sclerosis Society, Greater New England Chapter, Waltham, MA. Before that, he served as Government Relations Manager for ZERO – The End of Prostate Cancer in Washington, D.C. Earlier in his career, Krilovich was a Legislative Intern for State Senator Karen Spilka and former U.S. Representative Tim Walz. Krilovich holds a BA in Political Science from the University of Massachusetts, Amherst.

Alliance Board President Deborah Costello, who is also Chief Operating Officer at Beth Israel Lahey Health at Home, Beverly, noted, “A Search Committee of board members conducted a national search over the past months, and selected Jake based on his in-depth knowledge of the home care industry and his insights into the critical issues facing the Alliance and our provider agency members in the coming years.”

In accepting the position, Krilovich said, “Our health care delivery system is shifting rapidly, and home and community-based services will be at the center of that transition. I am grateful for the trust and confidence the Alliance’s Board of Directors is placing in me to lead the organization into this critical juncture for our industry and membership.”

About the Home Care Alliance:

With a mission to unite people and organizations to advance community health through care and services in the home, the Home Care Alliance of Massachusetts is a non-profit trade association and advocacy group providing representation, education, communication, advocacy and – ultimately – a voice for the state’s home health industry. Founded in 1969, the Alliance has grown to represent more than 170 home care and home health agencies across the state. For more information, visit www.thinkhomecare.org.

Alliance Comments to CMS on CY2022 Home Health Rule

To ensure that home health agencies in Massachusetts can provide high-quality care to older adults, the Home Care Alliance of Massachusetts has submitted comments to the federal government regarding the proposed rule for next year’s Medicare home health rates. Our comments to the Centers for Medicare and Medicaid Services (CMS) address several sections of the proposed rule, including:

  • CMS’s flawed reasoning behind the -4.36% “behavioral adjustment” to the rates;
  • Concerns about a budget neutrality adjustment based on 2020 data skewed by COVID;
  • A market basket adjustment that does not account for ongoing costs related to COVID;
  • Protections for counties with large wage index reductions;
  • Modifications to the Value Based Purchasing model before it is implemented nationwide;
  • Greater flexibility around the five-day deadline to submit the new Notice of Admission;
  • Greater flexibility to allow therapist to conduct initial assessments; and
  • Expanded allowances for virtual aide supervisions.

Modernizing the Medicare Home Health Benefit—at Last

Please help us advocate for The Choose Home Care Act, which would provide eligible recipients with SNF-like levels of care at home for 30 days post hospital discharge.

Last week, legislation was introduced in the US Senate that would provide the most significant update to the Medicare home health benefit since its inception. A strong bipartisan group of senators filed the Choose Home Care Act, which would provide eligible recipients with SNF-like levels of care at home for 30 days post hospital discharge. Services would include not only traditional nursing and therapy, but also meals, personal care, remote patient monitoring, and non-emergent transportation, if needed.

A study commissioned by NAHC and the Partnership for Quality Home Health care estimates that the Choose Home Care program could generate Medicare annual savings of $144-247 million with $1.6-2.8 billion in savings over 10 years. NAHC President Bill Dombi called this “must pass” legislation. So, we have a bipartisan bill that could save Medicare dollars, with support from AARP and others in the aging advocacy networks. Sounds like a slam dunk. But this is DC, so there are no such things.

While the advocacy focus is currently on the Senate bill, I hope that when the House acts, Massachusetts can lead the way and get our full delegation on board. Please help Choose Home and send a message to our two senators.

COVID-19: Where We Are and Where We Are Going

Dr. Ashish Jha of Brown University sees a difficult winter ahead in terms of battling COVID-19, but reasons to hope in the spring.

Dr. Ashish Jha

In mid-November, I had the pleasure of listening to a virtual presentation from Dr. Ashish Jha, Dean of the Brown University School of Public Health, as part of the Massachusetts Association of Health Plans Health Policy Speaker Series. At the time, people were finalizing their Thanksgiving plans while the Coronavirus Pandemic began its fall resurgence.

Dr. Jha expressed deep concern about our present situation. “The virus is in a very bad place,” he said at the beginning of his remarks. In his assessment, there is no doubt that there is more virus in the community today than during the springtime peak, and the current count of 200,000 new cases each day is unacceptable. However, he believes there is a path forward that will bring us to something like pre-pandemic normalcy in the near future, especially with the promise of effective vaccines. As such, he said, our priority must be to save lives during the winter months.

Jha put a great deal of focus on what he called “priorities,” noting that COVID-19 does not care about our priorities are.  In other words, he said, that while he was personally emphatic to our individual needs, the virus does not care that I prioritize seeing some family, but not others.  The virus will spread wherever and whenever it sees fit.

Jha also discussed priorities in the context of the public policy response to the pandemic. He believes maintaining fully operating schools and hospitals should be our sole societal priorities.  Yet, he said, just days before his talk, New York City shut down in-person learning, while continuing to allow people still to dine together indoors. This is, he called “upside-down.“

Jha was, however, not naïve to the fact that shifting our priorities to focus on schools and hospitals is expensive. It means large-scale federal support for restaurants and their workers to survive the winter months.  He recognized this decision is “politically challenging,” as broad economic shutdowns have been unpopular and politicized. But, in his opinion, it is the best way for us to save lives as we await distribution of vaccines.

The more hopeful part of Jha’s presentation centered around the rapid development of vaccines. At the beginning of the pandemic, he admits he hoped for a 50-60% effective vaccine. Now that early data shows two vaccine candidates with 90%+ efficacy, he is extremely hopeful. He also noted that scientific integrity was not compromised through this process, it was just expedited by conducting the typical steps all at once (e.g., simultaneous human and animal studies).

While he said that we must not lose sight of the short-term task at hand (containing the virus during the winter), Jha is hopeful that we could achieve 30% immunity by the end of January, at which point virus-spread tends to naturally slow. By April or May, he hopes anybody who wants to be vaccinated will be. This may sound ambitious, he noted, and distribution nuances as well as vaccine education, will surely slow any rollout; but he saw it as feasible.

In the meantime, he said we must continue to wear masks, get tested, and only see people from our own household.

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