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.

Get Out the Home Care Vote!!

As the 2020 Election approaches, the Alliance is launching a Get Out the Home Care Vote initiative. This voluntary, non-partisan initiative — which does not endorse any candidate or party – is aimed at ensuring access and electoral participation for the home care industry and its workforce.

Participating in our electoral process is one our most sacred rights as Americans.  As the 2020 Election approaches, the Home Care Alliance of Massachusetts is launching a Get Out the Home Care Vote initiative. This voluntary, non-partisan initiative — which does not endorse any candidate or party – is aimed at ensuring access and electoral participation for the home care industry and its workforce.

Get Out the Home Care Vote

Earlier this week, we mailed over 160 Get Out the Home Care Vote posters to Alliance members. These can be posted at agencies to remind employees of key election dates and deadlines and also provides QR codes with links to register to vote. In addition, knowing that our workforce is primarily in the field, we have compiled the Get Out the Home Care Vote resources below, which include pre-written email templates, voter registration resources, and key deadlines, all in one place!

All these resources are available to the public, regardless of membership-status with the Alliance. You are encouraged to print out the poster (11×17 paper), use the pre-written email templates and resource links as necessary.  There is power in numbers, and when we vote, we can shape the future of home care.

GOTV Resources

Downloads

Election Dates

  • October 17-30 – Early Voting
  • October 20 – Recommended deadline to request Mail in Voting
  • October 24 – Deadline to Register to Vote
  • November 3 – Election Day!

Links to Resources

Behavioral Adjustments Under Early PDGM

NAHC’s Bill Dombi replies to reports that patients across the country are being told they no longer qualify for certain Medicare services or that services have been cut or discontinued.

Kaiser Health News and other health care media outlets are reporting that patients across the country are being told they no longer qualify for certain Medicare home health services or that services have to be cut back or discontinued due to changes in Medicare scope of benefits.  On a call with state home care association executives this week, Bill Dombi, President of the National Association for Home Care and Hospice confirmed that they are hearing of such cases from patient advocacy groups, such as the Center for Medicare Advocacy.  If such behavior gives the industry “a reputation for putting bottom line ahead of patient care, it’s going to be bad long term for the home care industry,” said Dombi.

In terms of any shortcoming with the PDGM model, he said,  we want to be able to lay these at the feet of the model’s crafters at CMS, not having them come back at us for over adjusting behaviors even beyond what was built into the model. He further suggested that until proven otherwise it might be case of managers and field staff inaccurately translating direction from management as to what has changed. He suggested CMS might need to do some more education around what has changed (payment) and what has not (coverage).

NAHC will present a series of six new webinars – free to members and non-members – on PDGM in Real Time featuring an open forum in which attendees can share and gain insights with Home Care & Hospice Financial Managers Association (HHFMA) experts about what is working and not working in the early weeks of PDGM.

These webinars are designed to enable home health agencies to achieve “high performer” status through continuous operational improvements in financial, clinical, business analytics, and administrative operations as PDGM unfolds.

The schedule for the Wednesday webinars at 1 PM ET is as follows:

  1. February 12 at 1:00 PM ET Info Tech/EMR readiness
  2. February 19 at 1:00 PM ET PDGM coding
  3. February 26 at 1:00 PM ET PDGM cash flow & LUPAs
  4. March 4 at 1:00 PM ET Therapy in PDGM
  5. March 11 at 1:00 PM ET Clinical management of patient episode
  6. March 18 at 1:00 PM ET PDGM data analytics

Registration information can be found here.

Announcing our “Home, Not Alone” Speakers Bureau Campaign

The Alliance’s Home Care Speakers Bureau can bring presentations on careers and other subjects to nursing schools, job fairs, or student assemblies.

Health care is moving out of the institutional setting and into people’s homes. Nursing and other allied health professional positions are following a similar path as the percentage of nurses moving into work a in hospital setting continues to decrease annually. Yet, newly graduated nurses often leave school not having been exposed to the nursing opportunities and high degree of complexity and independence in home health care practice.

Our Home, Not Alone campaign seeks to drive interest in, and confidence about, making a nursing career in home care or hospice.

Our dedicated speakers will bring presentations on careers and other subjects to nursing schools, job fairs, or student assemblies. Here is just a snippet of a presentation:

For more information about the program, visit the Home Care Speakers Bureau on our website.

The Alliance Revamps Its Advocacy Action Center

The Alliance’s redesigned Advocacy Action Center makes it easier for members to communicate with their elected officials on the pressing issues facing their agencies.

HCA CapitolFor the first time in many years, the Alliance has redesigned its Advocacy Action Center website, offering members an enhanced advocacy experience so they can easily communicate with their elected officials on the pressing issues facing their agencies. This  post will highlight some of the key changes so that you are prepared to take action and make a difference!

Main-Page Scrolling Advocacy Feature

The main Advocacy Action Center page now features a scrolling banner of key advocacy initiatives that the Alliance and its members are working on. The banner has a functioning link which you can click on to bring you directly to the action center to quickly send an email to your elected official.

Main-Page Buttons

Under the scrolling banner, you will see three buttons linking to sub-pages. This organizes the Advocacy Action Center into three easily accessible topics: Legislative Priorities, Testimony/Comments, and Facts & Figures. Note: The Facts & Figures sub-page is currently being updated.

Legislative Priorities Sub-Page

Among the biggest of changes, is our newly designed Legislative Priorities page. For the first time, members now have a centralized landing page which organizes all of the Alliance’s legislative priorities in one place. You’ll see the page is split in half, organized by State and Federal priorities.

You’ll also see that each legislative issue has a brief overview of the issue and the solution that HCA supports. Underneath each blurb are links to download the fact sheets for, or take action on, the issue!

We hope that you will find our new advocacy center easier to use so that you can engage with your elected officials, while focusing on running your agency!

Advocate and Engage on PDGM

There are many ways that home health agencies will need to prepare their agencies for the radical changes coming from PDGM in January 2020. The Alliance is here to help.

Last month, the Centers for Medicare & Medicaid Services (CMS) issued its proposed rule for 2019 home health payment rates and policy changes, which includes significant provisions that will impact your organization, staff, and the patients you serve.

Between now and when the Patient Driven Grouping Model (PDGM) goes into effect on January 1, 2020, there are multiple ways that home health agencies will need to prepare their agencies for the radical change. (See Coding and Billing webinars coming in September, at the bottom of this page) At the same time, home care must take action to mitigate the impact of what PDGM will look like and how it will impact organizational viability.

Home care’s collective advocacy efforts have undeniably made a difference in the past, including putting a stop (at least in Massachusetts) to the Pre-Claim Review Demonstration and scrapping the Home Health Groupings Model thanks to more than 1,200 comments submitted to CMS last year. The more that CMS and lawmakers hear from home health professionals, the better our chances are at reducing the severe cuts that accompany PDGM in its proposed form.

As currently proposed, the 2020 rule will:

  • Reduce the Medicare base rate by 8.01% next year, which amounts to a $1.298 billion reduction in home health payments in 2020 alone. CMS proposes the reduction to account for anticipated changes in provider behavior that are unrelated to changes in patients served or services delivered that increase payments. This newly proposed “behavioral adjustment” reduction is up from the 6.42% reduction that CMS initially proposed, and the reduction would start before any actual behavioral changes occur.
  • Phasing out RAPS over 2020 with total elimination of RAPs in 2021. Next year, CMS proposed reducing RAPs from 60/50% to 20% for existing home health agencies (HHAs), while new agencies would get no RAP. CMS claims that RAPs create fraud risks.
  • Starting in 2021, a Notice of Admission (NOA) must be submitted Notice of Admission must be submitted within five days of the start of care. For every day late, CMS plans to reduce base-rate reimbursements for the unit of care.

The Solution: Pass S.433/H.R.2573

This month, Congress is in recess and back in the states, which presents a pivotal opportunity for home health industry professionals to engage with lawmakers about a key legislative priority – the Home Health Payment Innovation Act (S.433/H.R.2573).

This legislation prohibits CMS’s ability to adjust payment based on “behavioral assumptions” as opposed to observed evidence of behavioral changes, thus rescinding the proposed 8.01% adjustment.
Additionally, this important legislation would:

  1. Achieve full budget neutrality over the period of 2020-2029.
  2. Require behavioral adjustments based on real, actual changes in provider behavior in response to the new payment model.
  3. Permit a phase-in of rate adjustments (up or down) when an annual adjustment would be greater than 2 percent. However, the phase-in would operate to ensure full budget neutrality by 2029.

Email your Members of Congress

It’s not too late to get members of Congress informed and engaged on this important legislation. You can send an email directly from HCA’s member advocacy center.

At this point, Congressman Jim McGovern is the only member of the MA delegation signed on as a cosponsor. We must do better.

Fact Sheet: Senate 433 & HR 2573

Advocate in Person

Join home health industry advocates next month in Washington, D.C. for The Council of State Home Care Associations’ Third Annual Public Policy Summit and Advocacy Day!  On September 9, participate in a full-day summit featuring speakers including Hillary Loeffler, Director of the CMS’ Division of Home Health & Hospice.  On September 10, we be on Capitol Hill meeting with members of Congress to convey the critical need to pass S.433/H.R.2357.

Program details can be found here and registration information can be found at The Council’s website.

Submit Comments to CMS by September 9

Click here to submit comments to CMS in response to the 2020 proposed rule by 5:00 PM ET on Monday, September 9, 2019.

HCA and other industry organizations will provide more thorough comments on other problematic areas of the proposed rule. As previously stated, there is strength in numbers, so the more business-focused comments from providers – both large and small – are critical to giving CMS a full and clear picture of how devastating PDGM will be should it be implemented as proposed. Watch Update for draft comments.

Return to www.thinkhomecare.org.

Patient Legal Advocates

Information for clients/patients needing legal assistance around lost benefits or insurance.

The movement of many insured into “managed” environments has resulted in some questions to the HCA of MA regarding clients’ rights should home care services be terminated or suspended. Every Managed Care Organization (MCO) or Accountable Care Organization (ACO) – be they serving Medicare or Medicaid clients – has an obligation to have some form of patient (although not necessarily agency) internal appeal process. Agencies who are working with these organization should be versed in what these processes are.

For clients for whom the changes are threatening their well being, or seemingly discriminatory, or based on a pattern of inappropriate clinical decision making, there are legal services entities in this state who may be able to help. This list includes their names and contact information. Please note: these legal services entities will generally only take up a case if a client or, in some cases, a family member of a client calls. Keep this information on hand and share with any client who may need assistance.

Return to www.thinkhomecare.org.

HCA and Northeastern University Partner on Nurse Symposium in June

These days, it seems like every week a new report is published sounding the alarm of a rapidly aging population across the United States and a shortage of workers prepared to care for this barreling silver tsunami. So much of the media coverage and research is focused on the paraprofessional workforce.

See for example, these reports/publications:

However, the Home Care Alliance member surveys indicate that the problem is broader than just a shortage of home health aides. The availability of a trained nursing workforce to meet a growing home-based health care delivery system is also emerging as an issue. Compounding challenges are impacting our ability as an industry to attract nursing students into home and community-based settings after nursing school.  That is why, on June 7th the Home Care Alliance of Massachusetts and Northeastern’s School of Nursing are hosting a symposium on the very topic of building a home care nursing workforce at Northeastern University from 9AM – 3PM.

The event, titled: Nursing Call to Action: Building a Nursing Workforce to Deliver Complex Care at Home, will bring together more than 25 nursing schools and 25 home health providers for a day-long session. The program will kick-start a dialogue brainstorming new approaches for preparing and exposing Massachusetts nursing students for an increasingly intensive health delivery system in the home.

This event will look past the issue of reimbursement rates or ever-changing reforms at CMS, and instead will focus on four key areas:

  1. Identifying knowledge and skills gaps for LPN/RN new-grads and what changes can be made to address the gaps and develop competencies in executing highly complex services
  2. Elevating the visibility to nursing schools of the growing demand for home-based services and the need to expose students to possible careers in home care nursing
  3. Identifying strategies on recruitment as new-grads and experienced nurses prepare for possible careers in home care nursing
  4. Identifying barriers and strategies to get home health agencies more involved in clinical placements for nursing students

If you would like more information on this event, please reach out to Jake Krilovich. Please note: There is limited space for this event!