Category: Advocacy

The Rundown – June 2023

State Recap

EOHHS Holds Hearing on Chapter 257 Rates for Certain Elder Care Services

On May 19th, HCA testified at the EOHHS Chapter 257 rate review hearing. As a reminder, EOHHS has proposed increasing rates for Enhanced Community Options Program (ECOP) Direct Services from $749.47 to $976.08 per client per month and rates for Home Care Program Direct Services from $326.35 to $424.34 per client per month, which amounts to a 30% increase to the base rate for both ECOP and Home Care Program Services.

During our testimony, HCA highlighted our concerns with the lack of transparency when it comes to the rate review process and that EOHHS should use real-time inflation data rather than projected, expected inflation data when determining cost adjustment factors (CAF). HCA wants to thank all members that submitted written testimony for the hearing, your input is very important. EOHHS still plans to meet the July 1st, 2023, deadline to promulgate the new proposed rates.

Senate Starts Debate over Senate FY24 Budget Amendment

In the end of May, the Senate started debates over amendments to their proposed FY24 budget. After 2 days of debate, the Senate has added $65.4 million in line-item spending to its $55.8 billion plan. One amendment of note that is set to pass is Sen. Patricia Jehlen amendment # 400, which would amend the Chapter 257 Rate Reserve line item 1599-6903 as follows: “By inserting after the words “any human service provider receiving revenue under said Chapter 257” the following: “, and any home care agency subcontracting with such human service providers to provide home care services,”. This amendment would specifically single out that home care providers would need to comply with the 75% pass-through requirement that is stipulated in the line item. We would like to note that this pass-through requirement is much broader than a pass-through amendment that was floated during the House budget debate, that HCA along with the Home Care Aide Council successfully blocked. HCA along with the Home Care Aide Council drafted a letter to Senate Ways and Means staff and Senator Jehlen that stipulated our concerns with the amendment.

We emphasized that the amendment is redundant since home care is already mentioned in the line item and that it has the potential to create regulatory confusion. We also noted the by including the amendment language it would single out one provider group under Chapter 257 and would raise an issue of equity. We argued that the pass-through requirement should apply to chapter 257 requirements broadly and equitably to all providers. In the end the amendment was added to the Senate budget proposal that should be passed in the coming days. Once passed by the Senate the legislature will create a conference committee to debate the differences between the house and senate bills before sending a final bill for the governors signature. HCA will continue to advocate for the amendment to not be included in the final budget proposal.

Look Ahead

State Budget

In the beginning of June, the Senate should pass their state budget proposal for FY24. Once passed, the lengthy budget process will move to the next stop, conference committee debate. In June, after the senate passes their proposal a conference committee will be formed with legislators from both the House and Senate. The committee’s purpose is to iron out the differences between both budget proposals and create one final budget proposal for the legislator to pass.

While it seems like we are getting close to the finish line, that’s far from true. It could take a couple of weeks for the conference committee to debate the differences. Even then, once it’s created and passed by the legislature, it will still need to be reviewed and approved by Governor Healey, who is allowed to send back the proposal with suggested changes. Which is a common occurrence, last year former Governor Charlie Baker sent back the legislature proposal with amended language for an outside section.

Technically, the state has until June 30, 2023, when last year’s budget runs out, to pass a new budget and continue funding the government. The state never meets this deadline and passes a supplemental budget to extend FY23 funding until they are able to pass a new budget. Last year it took till July 28th, for Massachusetts to pass their FY23 budget, making Massachusetts one of the last states to pass a budget.

I will provide another budget update next month when inevitably the FY24 budget has not been passed.

Federal Recap

Debt Ceiling Debate Rages On

The main focus of everyone on Capitol Hill has been the on-going debate surrounding increasing the debt ceiling. For a brief backstory, the debt ceiling is the maximum amount of money that the United States can borrow cumulatively by issuing bonds. The debt ceiling was created under the Second Liberty Bond Act of 1917 and is also known as the debt limit or statutory debt limit. If U.S. government national debt levels bump up against the ceiling, then the Treasury Department must resort to other extraordinary measures to pay government obligations and expenditures until the ceiling is raised again or risk a drop in the U.S. credit rating or defaulting on loans (which both would be disastrous). The debt ceiling has been raised or suspended over 78 times since 1917 with the most recent raise being in 2021. Treasury Secretary Janet Yellen has been sounding the alarms for the last couple of months that the U.S. is at risk of hitting the debt ceiling as soon as June 5, NEXT MONDAY, setting a deadline for Congress to vote to either raise or suspend the debt limit.

Since the end of April, there has surprisingly been progress in the negotiations. President Biden and Speaker of the House Kevin McCarthy struck a true compromise over Memorial Day weekend on a package to avert a disaster. The package would suspend the debt ceiling through Jan. 1, 2025, effectively moving any future debate till after the 2024 presidential election but would also reign in future government spending. Under the deal, non-defense spending, such as Medicare and Medicaid, would remain relatively flat in fiscal 2024 and increase by only 1% in fiscal 2025, 2% below a planned 3% increase in defense spending. After fiscal 2025, there would be no budget caps. One of the most contentious points of the deal is an increase to work requirements for adults that receive food stamps through SNAP. Lastly the deal stipulates that the student loan payment moratorium would be lifted this August.

While this is not exactly what both sides wanted, it is a true compromise between no cuts to spending that Dems wanted and massive cuts in spending that Republicans wanted. The biggest news is that this deal would prevent a potential economic meltdown that none of us have ever experienced. Just think about how hard life was when you had shitty credit. Now imagine if the U.S. credit rating was so bad that couldn’t even get pre-approved for a Kouls card. That is exactly what this deal would avert.

Look Ahead

Debt Ceiling

While there has been progress on the debt ceiling package, we are still not at the finish line. It wouldn’t be Congress without some superficial fanfare. Since Sunday, when text of the bill was released, Republicans and Democrats opponents of the bill in the House and Senate, mainly the house, have been SCREAMING for the last couple of days, calling this bill a shame. Republicans mad that they aren’t going farther with spending cuts, while Democrats hate the new work requirements and cuts to non-defense spending. There’s a lot of truly idiotic comments that I could write about, that just proved that there are a lot of members of Congress that only want the job for fanfare and notoriety and don’t even understand basic economics. But that would only give those members exactly what they want.

In the end all their shouting is as effective as a screen door in submarine. It’s a part of the game when both sides come to an actual agreement. The House passed the debt ceiling last night and Senate leadership on both sides has promised to move swiftly to pass the package before the June 5th deadline. Opponents on both sides in the Senate will still vocalize their opposition while the Senate debates the bill, but in the end, I believe that a deal will be met before June 5th. But when it comes to Congress you really never know what can happen, so, let’s all just hope for the best.

The main thing that we all need to keep a close eye on after the package is hopefully passed is now expected cuts to Medicare. With measly planned increases to all non-defense spending, there is a potential for deeper cuts to Medicare home care rates. CMS is already expected to propose further cuts and it could get a lot worse in the coming years. HCA is working closely with NAHC to stay up to date on any potential rate cuts that would directly impact our members. We will be sure to keep everyone updated if there are any potential cuts announced.

The Rundown – May 2023

State Recap

EOHHS Releases Proposed Chapter 257 Rates for Certain Elder Care Services

On Friday, Executive Office for Health and Human Services (EOHHS) released their proposed Chapter 257 Rates for Certain Elder Care Services. We are happy to report that EOHHS proposed increasing Enhanced Community Options Program (ECOP) Direct Services from $749.47 to $976.08 per client per month and Home Care Program Services Direct Services from $326.35 to $424.34 per client per month, which amounts to about a 30% increase to the base rate for both ECOP and Home Care Program Services.

While a 30% increase on the surface seems high, that percentage does not consider the temporary rate add-ons (EPTS, ARPA, and DALA appeal settlement) that agencies have become accustomed to. After accounting for all, the percent increase is closer to 7%. EOHHS still plans to meet their deadline of July 1st, 2023, to implement the new proposed rates.

EOHHS also announced that they will be holding a public hearing on the proposed rates on Friday, May 19, 2023, at 9:00am EST. HCA will be providing testimony at the hearing and encourage everyone to provide testimony as well. We will be sure to send around our draft testimony before and we are happy to help anyone with their testimony as well.

House Passes Budget Proposal

The House voted unanimously (156-0) to approve their $56.2 billion state budget for FY24, sending their spending plan to the Senate. The over $56 billion budget plan included significant increases in spending for education, childcare, environmental agencies, transportation, and hundreds of millions in tax relief. Not included in the Houses budget is the Enough Pay to Stay (EPTS) rate add-on. This didn’t come as a surprise since it was not included in their initial proposal and with new rates set to be released soon, we did not expect the house to include fully funding a rate add-on at this time.

Knowing that the House would not be inclined to fully fund the EPTS rate add-on at this time due to the rate review, HCA along with the EPTS coalition did submit an amendment to the house budget proposal that would fund a rate add on for 3 months or one quarter of FY24. We filed this language because we were concerned if EOHHS would meet the July 1st, 2023, deadline to promulgate new Chapter 257 rates, and if they didn’t, we wanted to make sure there wouldn’t be a massive rate cliff since the EPTS and ARPA rate add-ons expire on the same date. The amendment was not included in the final house budget but did garner some co-sponsors during the amendment process. The budget process will now shift to the Senate.

Tax Relief Package

The House also passed their $1.1 billion tax relief package a month after Governor Healey released her $742 million tax relief package. The Houses tax package includes many of the same provisions that were included in the Governors tax relief package, such as;

  • Decreasing the short-term capital gains tax from 12% to 5%.
  • Combine the Child Care Expenses Credit with the Dependent Member of Household Credit to create one refundable $600 credit per dependent, while eliminating the current cap.
  • Increase Estate Tax threshold from $1 million to $2 million (Healey proposed $3 million).
  • Increase the rental deduction cap from $3,000 to $4,000.
  • Double the Senior Circuit Breaker Tax Credit from $1,200 to $2,400.

Two proposals included that were not in the Governor’s proposal were 1.) increasing the Earned Income Tax Credit (EITC) from 30% to 40% of the federal credit. 2.) establishing a single factor apportionment in Mass based solely on receipts matching what 39 other states currently do. The tax proposal would also alter Chapter 62f of general law which triggers a tax refund if the state has excess revenue to adjust the credit to an equal amount per taxpayer rather than based on percentage of what taxpayer paid the commonwealth. The House tax proposal will tag along with the House budget proposal to the Senate side to be debated and most likely changed before going to vote.

HCA Provided Verbal Testimony on Licensure Bill for Non-Medical Services

The Home Care Alliance provided verbal testimony during a hearing held by the Joint Committee on Elder Affairs on H.649/S.380, An Act to Improve Massachusetts Home Care, which would create a licensure system for non-medical home care services.

For many years, the Home Care Alliance and our members have advocated for home care licensure, as we believe that agencies should be held to a baseline set of standards that would protect consumers and workers. We believe that this bill has the framework to do just that, without overburdening providers, and driving consumers to seek services in the unregulated, underground market.

We need your help to get this bill over the finish line. Please Click this LINK to submit pre-written testimony to the committee. Submitting written testimony shows legislators and committee staff how much support this bill has amongst the industry and Massachusetts at-large. This increases the chance that the bill is voted out of committee and potentially be voted on and passed by the entire legislature. Your voice matters and we want to help you use it!

Look Ahead

Senates to Propose State Budget Proposal Soon

The Senate is expected to release their budget proposal next Wednesday, May 10th with a budget amendment deadline of Friday, May 12th. Since EOHHS released new chapter 257 rates that incorporate the EPTS, ARPA, and DALA settlement rate add-ons we do not expect the Senate to include an EPTS rate add-on.

We will still be keeping a close eye on their budget proposal and any amendments that are filed to the budget. During the House budget process an amendment was added that would require a 75% of rate payments to home care agency providers for the elder home care program be spent by such home care agency providers on direct care workforce wages and benefits. The amendment was not added to the House’s final budget proposal after HCA along with the EPTS coalition worked hard to educate legislators and committee staff about the issues with amendment and how the language is not needed. We will keep a close eye to see if the same amendment is added to the Senate budget proposal.

Federal Recap

CMS Proposes That 80% of Medicaid Payments for Home Care Go to Direct Care Workers

Recently, the Centers for Medicare & Medicaid Services proposed two rules surrounding access to Medicaid. Among the provisions is a requirement that at least 80% of Medicaid payments for personal care, homemaker and home health aide services be spent on compensation for direct care workers.

The two proposed rules are Ensuring Access to Medicaid Services (Access NPRM); and Managed Care Access, Finance, and Quality (Managed Care NPRM). The former, Access NPRM, also would call for the following related to home care and home- and community-based services:

  • Require states to publish the average hourly rate paid to direct care workers delivering personal care, home health aide and homemaker services;
  • Require states to establish an advisory group for interested parties to advise and consult on provider payment rates and direct compensation for direct care workers;
  • Require states to report on waiting lists in section 1915(c) waiver programs; service delivery timeliness for personal care, homemaker and home health aide services; and a standardized set of HCBS quality measures;
  • Promote public transparency related to the administration of Medicaid‑covered HCBS through public reporting of quality, performance, and compliance measures;
  • Establish a new strategy for oversight, monitoring, quality assurance, and quality improvement for HCBS programs;
  • Strengthen person‑centered service planning and incident management systems in HCBS; and
  • Require states to establish grievance systems in fee-for-service HCBS programs.

“The Biden-Harris Administration has made clear where we stand: We believe all Americans deserve the peace of mind that having health care coverage brings,” Department of Health and Human Services Secretary Xavier Becerra said in a statement. “We are proposing important actions to remove barriers to care, engage consumers, and improve access to services for all children and families enrolled in these critical programs.”

Providers expressed a lukewarm reaction to the rule. While they were pleased that the Biden administration is addressing access challenges and rate transparency with HCBS, they did not appreciate that the rule does not confront actual payment rates. NAHC said in response to the proposal that “however, we are concerned that CMS is not proactively addressing the chronically woeful state payment rates for home and community-based services and instead is creating a new bureaucratic analysis that may or may not ever impact the wages of workers. We are further concerned that CMS has decided to forego ensuring adequate state payments in favor of applying an arbitrary requirement to pass through a proportion of the rates to direct care workers. This policy cannot be effective without consideration of the actual payment rates or the substantial administrative requirements that federal and state regulations place on providers.”

President Biden Issues Executive Order to Make Home Care More Affordable

On Tuesday, President Biden signed an Executive Order (EO) that includes 50 directives to Cabinet-level agencies with the goal to improve transparency and access for home care services, including for veterans, while boosting industry standards and expanding areas of federal coverage. Some of the provisions included in the EO include:

  • Directs HHS to consider issuing several regulations and guidance documents to improve the quality of home care jobs, including by leveraging Medicaid funding to ensure there are enough home care workers to provide care to seniors and people with disabilities enrolled in Medicaid, as well as build on the minimum staffing standards for nursing homes and condition a portion of Medicare payments on how well a nursing home retains workers.
  • Identify which of their grant programs can support long-term care for individuals working on federal projects, and consider requiring applicants seeking federal job-creating funds to expand access to care for their workers.
  • Directs the Department of Veterans Affairs (VA) to improve access to home-based care for veterans who require support with activities of daily living, like bathing and getting dressed, by giving them more decision-making power over who delivers that care and when.

In addition, the EO notes that the Department of Labor will publish a sample employment agreement so domestic child-care and long-term care workers and their employers can ensure both parties better understand their rights and responsibilities. The purpose of this is to grow awareness of employee’s options when it comes to unionizing. This is a report that we will be closely watching for when it is released. If you have any questions, please don’t hesitate to reach out.

Possible Bagel?

For those that didn’t religiously watch the West Wing, a bagel is another term for a recession. Forecasters at the Federal Reserve in April, warn of a possible recession later this year, further stowing doubt in the U.S. economy. Even though inflation eased this last month, only up 5% compared to last year, which is the lowest rate in the last 2 years, some recent data spooked forecasters to raise the probability of a bagel. Data that was released in April showed that retail spending is down, grocery sales were flat (even though prices went down), and service inflation (price of services like restaurant meals and haircuts) increased to over 7%, an absurdly high number. This is what led the federal reserve to increase interest rates once again in the beginning of May. This data along with reports that banks have started to cut back lending due to high interest rates and the recent collapses of SVB, Signature and just this last week One Republic bank, led some forecasters to raise the probability of a mild bagel later this year….. I hate when they do that, say something will happen “later this year”, it’s already May, almost halfway through the year? Does that mean it could happen in October or November? Then just say that!

Anyway, not everyone is predicting a mild bagel, some predict the economy to just “slow down” but not to fall into a bagel. But that still means that everyday people will continue to suffer. For the economy to “slow-down” that would mean that unemployment would rise, wage growth would drop, and the housing market would get worse than it is. In plain English, the Fed is trying to FUCK over average American’s and continue to make regular life harder and harder. I already accepted that I won’t be able to buy a house right now, but the Fed has made it clear that their actual goal is to making owning property impossible for millions of Americans. Bagel or no Bagel, it is getting really rough out here in America. And a bunch of fat-cat, ivy league people are trying to convince me that they are on my side during all this. History has shown that that is never the case. In the end, the more powerful and rich will continue to become richer and more powerful. All I can say is please put your money in some high yield savings accounts and hope for the best.

Pentagon Leak

We have finally hit the time that Si-Fi movies were predicting in the 80s when top-secret government documents were being leaked through video games. Like something out of The Americans, 21-year-old Jack Teixeira, American airman in the 102nd Intelligence Wing of the Massachusetts Air National Guard, leaked top secret Pentagon documents in a group chat on the platform Discord. The leaked highly classified documents included details about the war in Ukraine, intercepted communications about U.S. allies such as Israel, South Korea and Egypt, and details of American penetration of Russian military plans, among other topics. Teixeira charges include unauthorized retention and transmission of national defense information and unauthorized removal and retention of classified documents or material. The bulk of documents that were leaked are thought to have originate from the CIA’s Operations Center and the Pentagon’s Joint Chiefs of Staff. The documents appear to have been printed and folded twice. In some images there are items clearly visible in the background, including a hunting magazine, a knife and a tube of Gorilla-brand glue.

What I find most interesting about this story is that he used Discord. Now I have only been in this job for a little over a year but from everyone I have met, I can imagine that over 95% of you have no idea what discord is, and those that do is because they have kids that are at least teenagers. For those that don’t know discord is a rapidly growing communication platform where gamers can join parties to talk to other gamers. Think of it as like having one platform for all your group chats. That chat rooms vary, they could be filled with close friends, or just with people that share similar interests. While Discord is rapidly growing, its user rate is far behind bigger communication platforms like Twitter and Facebook. While 150 million active users may seem like a lot, that is only a quarter of Twitter’s active users (450 million) and a fraction of Facebooks 2.96 billion users.

So, it begs the question why he would choose this platform to release the documents. If he wanted to blow the lid on the U.S.’s foreign activities he would have used a bigger platform to reach more people. Using Discord is equivalent to leaking a story to the Cape Cod times rather than the Boston Globe. Not a lot is known about his true reasoning for why he leaked the documents. What is known is that he was suspicious of law enforcement and the U.S. intelligence community and was prone to ranting about “government overreach,” one of the group members told the Post. It is reported that roughly half of the chat group members lived abroad and that those who appeared most interested in the classified material were primarily from the “Eastern Bloc and those post-Soviet countries.” I think he was just trying to show off to his friends in some sort of manner and didn’t care about the consequences. He forgot that real life isn’t like Call of Duty and that when you are caught, you can’t just start the level all over again.

Look Ahead

Debt Ceiling

Currently, all focus is on the debt ceiling negotiations. Congress is running out of time to increase the debt ceiling to avoid federal defaults. Treasury Secretary, Janet Yellen, recently announced that the U.S. could default on its debt as early as June 1 and must move quickly to avert disaster. A debt default could trigger an economic downturn, which would prompt a spike in unemployment.

House Republicans lead by Speaker Kevin McCarthy recently passed “The Breaking the Gridlock Act”, that would increase the debt ceiling but would also scale back a wide swath of annual government spending to last year’s levels, a cut of about 8%, and cap its growth by 1% each year after that. The package also includes provisions that would require certain adult Medicaid recipients to work, perform community service, or participate in an employment program for at least 80 hours per month or earn a certain minimum monthly income. It would apply to those ages 19 to 55, but not those who are pregnant, parents of dependent children, those who are physically or mentally unfit for employment or enrolled in education or in substance abuse programs, among other exceptions.

This is where a line has been drawn in the sand. Democrats strongly disagree with every aspect of the Republican bill, Democrats do not want to pass a debt ceiling bill that would require a cut in spending nor cap growth in any capacity, nor do they want to implement work requirements. With Democrats in control of the Senate by a super slim margin, they do not have any plan to pass the Republicans proposal as is. Publicly Democrats have railed against Republicans for their proposal, accusing Republicans of holding the country hostage to demand federal cuts that will hurt the poor. But behind close doors their are reports that senior Democrats and the White House are actively working with a group of Republicans on a last minute deal to either suspend or lift the debt ceiling. Little is known of what Democrats are willing to leave on the table from the Republican package. I do expect that a deal will be reached in some capacity by the end of the month that will increase the debt ceiling. Both political parties love the spectacle that these situations create, but at the end of the day the few actual adults on both sides will work out a deal to avoid a potential disaster.

2024 Presidential Election Race

There is a massive storm brewing that is expected to hit all of America, that storm is the 2024 presidential race. The race is getting closer and closer with each passing day, President Biden announced that he plans to run for office again, if elected he would 86 when his second term ends; making him the oldest president ever.

Reports are also speculating that Florida Governor DeSantis will soon announce a presidential exploratory committee and may even announce his candidacy in Mid-May. Cloudy skies are starting to form and before we know it, we will all once again experience the nausea that comes from the race for president.

Trump Arrest

Now many legal experts have said that the charges are not that strong, and that amongst the multiple cases he could be facing, this one is the weakest. This case will not go through the thick of the legal system, where expensive lawyers make their money filing motion after motion to delay and change the scope of the case. I do not imagine a final ruling on a case anytime soon. The arrests will not stop him from running from president. Political analysts are split on whether or not the arrest will hurt him politically. Trump has shown time after time that analyst know nothing and that anything can be true and false at the same time when it comes to Trump.

The Rundown – April 2023

Federal Recap

HCA Travels to DC to advocate for Home Care

To end the month, HCA along with member agencies, Care Central VNA & Hospice and Seraphic Springs Health Care Agency traveled to DC to meet with members of the Massachusetts congressional delegation. HCA updated congressional staff about the ongoing worker shortage that the industry is currently facing and the immense impact that further cuts by CMS for home health rate would have on the industry. We noted that if any further cuts are applied it could result in up to 50% of home health agencies across the country having a net margin below zero.

HCA would like to say a special thank you to Care Central VNA & Hospice and Seraphic Springs Home Care Agency, and Renee Walsh for taking the time to come down to DC to advocate for our industry.  HCA will continue to work with the Massachusetts congressional delegation to help prevent CMS from applying further cuts to home health rates. If you would like to join HCA on any future advocacy efforts in DC or at the state house, please reach out to Harrison Collins, hcollins@thinkhomecare.org. 

SVB Collapse

The month started slowly with the usual twitter beefs between members of Congress and the media continuing to speculate who will run for President in a year, and then…. Suddenly….. All HELL BROKE LOOSE!! Out of what seemed like nowhere, in a matter of 48hours, Silicon Valley Bank (SVB) collapsed, marking the biggest bank failure since 2008, and the second largest of all time. At the time the bank collapse, SVB’s total assets were over $220 billion, making them the 16th largest commercial bank in the US. Which was honestly more shocking to hear than the news that they collapsed. Learning the news that a bank that I barely knew about was that large was like finding out that the 16th biggest food chain in the US is Tatte Bakery & Cafe! And at-least they have delicious pastries.

for a quick rundown, SVB was originally founded over a poker game, wild story, in 1983, Silicon Valley Bank became the go-to lender for tech startups that appeared too risky in the eyes of larger, more traditional banks. Eventually, Silicon Valley Bank would come to do business with nearly half of all U.S. tech startups backed by venture capitalists, including businesses such as Spotify, Pinterest, and Fitbit. SVB grew and grew and looked unstoppable. During the beginning of the pandemic with interest were low and egg cartons only cost $1.50, tech stocks exploded, which led to a surge in deposits at the bank, which then invested a large chunk of the cash into long-term U.S. government securities. But when interest rates started to sky rocket last year, not only did egg prices jumped up to $3.50, the huge amount of bonds they bought became worthless high, resulting in a 1.8 billion loss. The increase interest rates also resulted in a contraction in funding for startups, pushing startups to withdraw more and more money from their accounts to pay their debts. This meant that SVB had to cover the money for startups to withdraw, this pushed SVB to announce that they were selling $2.25 billion in new shares to plug the hole in its finances, and that they were holding a new funding round, which is not usual for big time banks. This made people LOSE THEIR MINDS. On a Wednesday March 8th, startups, and venture capital firms in droves started to withdraw all their money from SVB, fearing it was the 2008 bank collapse all over again, causing SVB stock to drop 60% on Thursday, March 9th. By Friday, March 10th, trading in SVB shares was halted and it had abandoned efforts to raise capital or find a buyer. California regulators intervened, shutting the bank down and placing it in receivership under the Federal Deposit Insurance Corporation, which typically means liquidating the bank’s assets to pay back depositors and creditors. In the matter of 3 days one of the biggest banks in the US failed, mainly because they failed to watch the Big Short. If only they watch past the scene with Margot Robbie in the bathtub, they would have learned NOT TO PUT ALL YOUR EGGS IN ONE BASKET.

Democrats were quick to point the blame at President Trumps for lifting of bank regulations during his administration, and the Feds failure to prevent the collapse. In a speech right after the collapse Massachusetts own, and vocal advocate for banking reform, Sen. Elizabeth Warren, called out former President Trump, for rolling back parts of Dodd-Frank act, which provides oversight over banks. One part of the act that was rolled back is the minimum amount banks had to keep on hand at any one time, which would give banks more money to invest and spend. Warren argues that this led to SVB to pump more money than they should have been able to into long-term U.S. government securities, which eventually collapsed. Sen. Warren and California Rep. Katie Porter, introduced a bill that would re-instate the parts of the Dobbs-Frank act that were rolled back.

Republicans, were also quick to blame federal regulators, but for the opposite reason, going to far. Some prominent Republicans including President Trump, slammed the Fed for stepping in to ensure that depositors – including the nearly 90% of whom had funds in SVB that exceeded the $250,000 limit of what is insured by the Federal Deposit Insurance Corporation (FDIC) – would have access to all of their money on Monday. The move represents the biggest federal intervention in the financial market since the 2008 economic collapse. GOP members believe that the government shouldn’t be in the act of bailing out banks for their bad practices, especially if those practices are “woke” polices. Likely presidential candidate Florida Governor Ron DeSantis used the news of SVB’s failure to further criticize corporations so called “woke” policies. DeSantis said “I mean, this bank, they’re so concerned with DEI and politics and all kinds of stuff. I think that really diverted from them focusing on their core mission,”. I don’t know about you, but I don’t know how having diversity in your business can lead to a bank spending too much money on government securities, but that’s just me.

President Trumps Arrest

Things continued to go off the walls when a week and a half later it was released that the Manhattan District Attorney Office invited President Trump to testify to the grand jury for his alleged role in the 2016 hush money payments to former porn star Stormy Daniels, which legal experts said was a sign that he would be indicted. This obviously send obviously sent the twitter world and Truth Social into a frenzy! President Trump jumped what I can only assume is an old blackberry to say on Truth Social, that he expects to be arrested on March 21 and calls on his supporters to protest (obviously in all caps), even though he hadn’t been notified that he would be. He later went on to warn of potential “death and destruction” if he is charged with a crime. All news coverage quickly changed to exclusively following the Trump potential arrest. And then finally on March 30 it was made aware that the President had indeed been indicted. This marked the first time that a former president was indicted for criminal charges. Which is honestly shocking if you look back at all our presidents including, Nixon, Clinton, Harding, and VP Spiro Agnew.

Maybe it’s just me but while I know its huge news that a former President was indicted is massive news, it just doesn’t feel like it really is. After how crazy the world has been for what feels like 20 years but has really only been 7, I just feel numb to all big news. I mean a former president is charged with a crime and it weirdly felt like less of a big deal than when a rival team loses their starting QB.

Look Ahead

Congress is out of session for the first two weeks of April for Easter Recess. In the meantime, and even when they get back all the focus will be President Trumps criminal probe and his arrest. Now since his actual arrest happened in April, I will cover his arrest in further detail in the next rundown. But other than that, there is not much else to look ahead for over the month of April at the federal level

State Recap

Traveling Nurses

The Health Policy Commission reported in late March that an increasing reliance on travel nurses is contributing to high turnover rates among nurses in Massachusetts.  The report even prompted the Health and Human Services Secretary Kate Walsh, to say that the hospital industry has to “get rid of these usurious travel agency contracts that hurt everybody,” and the attorney general has put temporary nursing agencies on warning of violating rate payment rules. Registered nurse vacancy rates in Massachusetts hospitals doubled from 6.4% in 2019 to 13.6% in 2022, with especially high vacancy rates in community hospitals, the HPC report says.

The report also showed that the widespread industry shortage does not appear to be caused by fewer people wanting to become nurses, but rather nurses leaving the field after they had already begun working. The number of people completing nursing programs did not change during the pandemic and, in fact, there was an increase in the number of people earning advanced nursing degrees in 2020. As of 2021, contracted workers (travel nurses) represented about 5% of hospital patient care labor costs in the state, the report says. Across Massachusetts, health care facilities paid $1.5 billion to these workers in fiscal 2022 — a 154% increase over the previous year.

The increase of traveling nurses has had an impact not only on Hospitals but on home care agencies. With more and more nurses choosing to work for hospitals for short contracts for more pay, it has left the pool of potential nurses for home care agencies scarce. HCA has been working to increase nurse reimbursement rates to attract more people to the home care sector.

HCA Spends Week at State House Advocating for Legislative Priorities

Last week, HCA spent the week at the State House with HCA member agencies to meet with their state legislators to advocate for our legislative priorities. HCA talked to legislators about two bills that we strongly support, H.649/S.380, An Act to Improve Massachusetts Home Care and H.1195/S.755, An Act Clarifying Rate Setting Processes for Home Health and Home Care Services. Both bills will help aid in improving the home care industry and help to bring stability to our sector as a whole. HCA wants to say a special thank you to Maxim, Bayada, and Visiting Angels for taking the time to come to the state house to advocate for these vital pieces of legislation. If you too would like to participate in state legislative meetings, please reach out to Harrison Collins, hcollins@thinkhomecare.org.

Look Ahead

Elder Affairs Committee to Hold Hearing on Licensure

On Monday, April 10, at 9:30am EST, the Joint Committee on Elder Affairs will be holding a public hearing on several pieces of legislation, including H. 649/S.380, An Act to Improve Massachusetts Home Care. H.649/S.380 would create a licensure system that would establish baseline standards for agencies, to ensure a quality network of providers for consumers and keeping services affordable for those who rely on them. This hearing will give member agencies the change to persuade legislators as to why they should pass this bill and the benefit it would have for the industry.

If you would like to listen in on the hearing use the link HERE. HCA will be testifying in person, if you would like to testify for the hearing, either in-person or virtually, please use the link HERE to sign up to testify. HCA will also draft a template for agencies to use to submit written testimony for hearing. please let me know if you plan to testify for the hearing by emailing me at hcollins@thinkhomecare.org.

The Rundown – March 2023

I would apologize for not writing a February edition of “The Rundown”, but honestly there wasn’t enough to write about at the state and mainly the federal level to justify a rundown.

Federal Recap

At the federal level, over the last month and a half, Members of Congress have basically spent their time creating sounds bites for news stations and click bate twitter posts. For an example, On Presidents Day, Georgia Rep. Marjory Taylor Greene, wrote a tweet saying “We need a national divorce. We need to separate by red states and blue states and shrink the federal government. Everyone I talk to says this. From the sick and disgusting woke culture issues shoved down our throats to the Democrat’s traitorous America Last policies, we are done.” And she doubled down after on Fox news saying that a national divorce would be better than a civil war. Now as a child of divorced parents I can say from experience that while it’s great in the beginning for the child (U.S. citizens) beginning when both parents fight to show that they love their kids more by showering them with presents (tax cuts, tax relief etc.), that part ends quickly and the child is just left with a broken home (divided country) and a new bike. Have we not learned from history that, that never works. Yugoslavia in the 90s, Korea and Ireland in the early 1900s, and let us not forget……. The U.S. and the civil war. How would it even work? Where would purple states like Georgia, Arizona and Nevada, go?? What about interstate commerce. Anyway, I feel like that sums up what Members of Congress have been up to the last month and a half.

Look Ahead

Having to think about what lies ahead at the federal level honestly scares me The Republican will continue to use their majority in the House to hold hearing after hearing on topics that would make the Biden administration and Democrats look bad in the run up to the next presidential election. Democrats will continue to get nothing passed in the Senate where they hold a slim majority, and we will probably continue to hear rumors about more people entering the field for the Republican presidential race. Which all means more hearings and sounds bites from members such the human equivalent of a rat with hair gel, Rep. Matt Gaetz, and the growing example for why we need mandatory cognitive test for senior members, Sen. Dianne Feinstein.

I would recommend that people stay away from the news for a couple of months and just enjoy that both the Celtics and the Bruins are the best teams in their sports. As for me, as a born and raised New Yorker I can’t enjoy Mass sports teams so I will keep track of the non-sense and will keep you all updated if anything is noteworthy. I will be using the federal section over the next couple of months to vent my frustrating that we actually pay these people 100,000s of dollars to do nothing but be on fox news and MSNBC. So keep that in mind and maybe just skip to the State section of these rundowns

State Recap

Finally, to the state level where for the first time this year things are actually happening. For a brief recap before we get to the Governor’s budget and tax relief packages, the legislature finalized leadership and committee position in the Senate and the House. It took the legislature almost a full 2 months to finalize the positions, which means that the legislature could finally get down to business and start voting on bills that could have a real impact and not just legislation that names a bridge.

The House passed its first significant bill of the session, voting 153-0 to pass a House Ways and Means redraft of Governor Healey’s FY2023 supplemental budget, includes elements of her $1 billion “immediate needs” bond bill. The $353 million billon, which also includes $585 million worth of bond authorizations, temporarily extends pandemic-era programs such as enhanced food assistance and free school meals. It also gives $44 million to the emergency shelter system to help offset medical costs for migrant families. The Bond authorizations include $400 million for the MassWorks grant program and $104 million for the Clean Water Trust, among other initiatives. 27 amendments were filed but quietly disregarded behind closed doors, which included $50 million in bond authorization for the Massachusetts Technology Park Corporation.

Governor Healey Tax Relief Package

Governor Healey jumped into the game as well in the end of February when she released an aggressive $859 million tax relief proposal, restarting a heated debate on Beacon Hill on tax relief. The plans main focus is to help keep people in the state by relieving the growing cost of living in Massachusetts and boost the state’s economic competitiveness. Healey included in her package a couple of proposals that were previously recommended by former Republican Governor Charlie Baker, including lowering the short-term capital gains tax from 12% to 5% and creating a new estate tax credit of up to $182,000, which would effectively eliminate the estate tax for all estates valued up to $3 million, higher than the current level of $1 million.

The largest share of the proposed relief, about $458 million, would come in the form of a new child and family tax credit, which would create a $600 refundable credit for each qualifying dependent, including children younger than 13 years old, adults who are disabled, and seniors. To help with rising rent and housing cost in Massachusetts, Healey is reviving a proposal to boost the maximum rental deduction from $3,000 to $4,000, which would affect 880,000 renters, and to double the maximum allowable credit for the senior circuit breaker credit, assisting 100,000 households. The package also includes a number of smaller proposals including increasing the apprenticeship tax credit to $5 million, including an exemption for employer assistance with student loan repayment, expanding the dairy tax credit from $6 to $8 million, expanded commuter transit benefits, and more.

Healey’s office said the tax package would carry a total cost in fiscal year 2024 of $859 million. It said the measure has a net cost of $742 million because the $117 million in affected short-term capital gains tax revenue by law would need to be placed into reserves and could not be spent as part of the annual budget. Healey also said that the relief package will be factored into her recently released budget proposal for FY24. It is now up to the legislature to decide if they want to increase or decrease the Governor’s tax proposal. The legislator previously shut down their own tax relief bill last year after they realized that Massachusetts owed nearly $3 billion in excess tax revenues back to taxpayers under a voter-approved law known as Chapter 62F. Since then, the legislature has shown little interest to re-address a tax relief package.

Governor Healey FY24 Budget Proposal

To kick off the month of March with some flare, Governor Healey released her first state budget proposal. Healey’s administration described the proposal as a “downpayment” on its goals of making Massachusetts a more affordable place to live, tackling climate change, and preparing students for careers in an evolving economy. The $55.5 billion budget proposal would increase spending by 4.1% over the current year (FY23) budget, which would account for the expected the growth rate in state revenues in FY2024 when accounting for $1 billion from the state’s new millionaire income surtax. Healey plans to use the $1 billion from the new surtax to increase funding for education ($510 million), including $100 million in childcare grants to providers, and transportation ($490 million), which includes $181 million in MBTA capital investments. The budget would also pump new money towards energy and environment initiatives, human service provider rates, housing programs and much more.

The proposal also includes a $3 billion increase for funding for EOHHS, compared to what former Governor Charlie Baker proposed in his budget proposal last year. Though MassHealth, would be funded in Healey’s budget at $19.8 billion, which would have a net cost to the state of $7.9 billion. That’s a decrease of $1.9 billion on a gross basis or $254 million after reimbursements compared to fiscal year 2023 spending projections. The decrease is driven, the administration said, by “caseload decline and intentional distribution of funds across fiscal years to mitigate a revenue cliff due to the end of the federal COVID Public Health Emergency.” As expected, Healey’s proposal did not include funding for the Enough Pay to Stay rate add-on. The Enough Pay to Stay rate add-on has never been included in a Governor’s proposal, if it were to be included, it would be added in later by the legislature.

Look Ahead

The release of Governor Healey’s budget recommendations marks the beginning of a long budget cycle that will see a lot of Healey’s proposed budget items be either changed or taken out. The House generally puts out, debates, and passes its own budget proposal in April, followed by the Senate in May. Those two budgets then typically spend much of June in a conference committee before lawmakers agree to a compromise version. Fiscal year 2024 begins July 1, but Massachusetts lawmakers seldom have the budget done in time for it to be in place for the start of the fiscal year, which could result in supplemental budgets being passed till they pass a full budget for FY24.

It is also now up to the legislature to decide if they want to increase or decrease the Governor’s tax proposal. The legislator previously shut down their own tax relief bill last year after they realized that Massachusetts owed nearly $3 billion in excess tax revenues back to taxpayers under a voter-approved law known as Chapter 62F. Since then, the legislature has shown little interest to re-address a tax relief package. We will have to wait and see what happens next.

The Rundown – January 2023

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. 8581. 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!

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.

Advocate On This Issue

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).

Advocate On This Issue

%d bloggers like this: