Category: Advocacy

One Care Initiative Launches Ombudsman Program

The Massachusetts One Care Initiative, which aims to better coordinate care and services for dually eligible individuals ages 21-64, officially launched the One Care Ombudsman program (OCO). Home health agencies involved in One Care should be aware of this new resource.

According to a notice sent by the state, the OCO:

  • Is an independent program operated by the Disability Policy Consortium (contracted by EOHHS) and its partners, Health Care For All (HCFA) and Consumer Quality Initiatives (CQI);
  • Addresses concerns and helps resolve conflicts regarding members’ enrollment in One Care or access to covered benefits and services so they can receive the benefits and exercise the rights they are entitled to in One Care; and
  • Works with members and their representatives, as well as MassHealth and the three One Care plans, to find resolutions to members’ concerns or complaints.

The OCO does not duplicate or replace other resources that are already available to help people with One Care (such as the SHINE program, the One Care plans’ member services, and MassHealth Customer Service). The OCO is an additional resource to support members who need or request independent problem-resolution assistance beyond what is available now. The OCO provides three main types of services: Continue reading “One Care Initiative Launches Ombudsman Program”

CMS Reopens Bundled Payment Initative for Post-Acute Care

The Bundled Payments for Care Improvement initiative, developed by the Center for Medicare and Medicaid Innovation, has been reopened for additional models focusing on post-acute.

Through the initiative, organizations partner together and enter into payment arrangements that include financial and performance accountability for episodes of care. There four models of bundled payment being tested, but models 2 and 3 are areas where home health agencies can play a central role.

  • Model 2 is titled Retrospective Acute Care Hospital Stay plus Post-Acute Care, where the episode of care includes the inpatient stay in the acute care hospital and all related services during the episode.
  • Model 3 is Retrospective Post-Acute Care Only, where the episode of care is triggered by an acute care hospital stay and begins at initiation of post-acute care services with a participating home health agency, skilled nursing facility, inpatient rehabilitation facility, long-term care hospital.

More information on the program and the “open period” where new proposals can be submitted is available here. In order to be considered for participation in the Bundled Payments for Care Improvement initiative, all open period submissions must be submitted by April 18, 2014.

Return to www.thinkhomecare.org.

Governor’s Budget Gives Big Support to ASAP, Home Care Programs

Despite having his state of the Commonwealth address delayed by a snowstorm, Governor Deval Patrick was required to release his budget proposal this past Wednesday to officially kick off budget deliberations for fiscal year 2015.

A huge win for elder home care services came in line items that support the Aging Service Access Points and state Home Care Program, which received an additional $16.9 million, according to Executive Office of Elder Affairs Secretary Ann Hartstein. Among those funds are increases of $9.8 million for the Enhanced Community Options Program (ECOP) and $7.5 million for the “basic” category of services.

Combined, according to Secretary Hartstein, those two line item increases will eliminate waiting lists through the end of fiscal year 2015. The funding boost works out to an additional hour of homemaking services per consumer per month on average, but Secretary Hartstein stressed that, in reality, the money would pay for whatever services people may need when they need them.

The Governor also put a $1.3 million increase to the Senior Supportive Housing account, which will expand “assisted living facility-type services” for seniors in public housing. Specifically, the money will add another 10 public housing sites where senior residents will be supported by home care services.

Another $1.2 million was added in a new line item titled “Home Care Workforce Training Fund.” This new account will support workforce training for Aging Service Access Points, although the administration is not yet clear on which workers will receive training. Case management, protective services and direct care workers are all on the table as potential recipients.

MassHealth experienced major changes in the budget, mostly related to federal healthcare reform. Since the MassHealth Basic and Essential programs were eliminated, a combined $706.3 million is now in populations with expanded coverage and in the new MassHealth plans.   The MassHealth Senior Care account was granted another $271.4 million by the Governor and the MassHealth Managed Care account saw an additional $336.7 million. The MassHealth Fee-for-Service line item was raised by $205 million. It is unclear how these increases might result in better reimbursement rates for home health agencies. A formal rate reassessment hearing is still being eagerly awaited.

Other items of note from the Governor’s budget include the following:

  • Applying the state sales tax to candy and soda. The administration estimates that would raise roughly $57 million for health promotion and prevention programs.
  • The Governor’s budget cuts the MassHealth Nursing Home Supplimental Rates by $20.7 million
  • Pediatric Palliative Care is essentially level funded at just over $1.5 million
  • The Governor’s budget includes a special fund for federal assistance (FMAP) relative to health reform and healthcare access expansion called the Health Insurance Expansion Fund.
  • The DPH budget gets an overall increase of 1% with details in Commissioner Cheryl Bartlett’s “Mass Public Health” blog post.

Stay tuned for more  budget-related news and advocacy alerts.

Return to www.thinkhomecare.org.

Controversial Hospice Article Draws Response

photo credit: NY Times/Ruby Washington

Once again, the actions of the few bad actors in home health and hospice are getting media attention rather than the vast majority of agencies that are devoted to providing high quality care to keep people comfortable and at home.

In an investigative report, the Washington Post highlights findings that the number of patients discharged alive from hospice rose by 50 percent between 2002 and 2012. The article also highlights numbers from the Medicare Payment Advisory Commission (MedPAC) stating that in 2011, nearly 60 percent of Medicare’s hospice expenditure of $13.8 billion went toward patients who stay on hospice care longer than six months. The article singles out for-profit hospices in particular, but still puts all hospices in a negative context.

In fact, the article has prompted responses from the National Association for Home Care and Hospice (NAHC) as well as the National Hospice and Palliative Care Organization (NHPCO). In a letter to the editor, NAHC ends their rebuttal by writing:

We must all do our part to ensure that hospice remains a viable choice for terminally ill patients and their loved ones.  Articles of this type may unwittingly discourage use of hospice care, thereby denying terminally ill patients and their families access to vital services that support and comfort them during and in the aftermath of one of life’s most difficult journeys.  Under these circumstances, no one is well served.

The New York Times’ “New Old Age Blog” digs much deeper into the Washington Post’s findings and notes the many layers to the issue and why those numbers may have surfaced. For instance, the blogger writes:

What’s happening here? Hospices have lamented for years that dying patients wait too long to call, enrolling at the eleventh hour when they could have benefited months earlier. Now, we’re hearing more about patients doing as hospice believers (including me) have urged, calling earlier in the course of a terminal disease — and then, in a substantial minority of cases, getting bounced.

Return to www.thinkhomecare.org.

Guest Blog Post: Participate in MeHI’s Health IT Research Study

By Laurance Stuntz, Director at the Massachusetts e-Health Institute (MeHI)

Horizontal Banner - Home Care Alliance
Click the image to complete survey!

Care Providers: Make your voice heard!  Participate in MeHI’s Health IT Research Study

Here at the Massachusetts eHealth Institute (MeHI), we have been busy traveling across the state to meet with healthcare providers, listen to their concerns, and share many of the programs our organization is undertaking to help with health IT adoption in the Bay State.

Our series of regional meetings have continued this fall, and have been very well attended from many healthcare segments including home care. These events have provided a great forum for providers and their organization’s leaders to ask questions about what’s ahead for health IT and how it will affect their particular area of specialty in the patient care continuum. In addition, we have been speaking at important local home care events including the Home Care Alliance Financial Management Conference.

With all of this activity and interest, we recognize that providers have a wide range of attitudes, opinions and needs regarding health IT adoption. We know there is much more work to be done and we want to partner with you to develop new strategies and programs to support complete EHR and Health Information Exchange adoption across the state, including ongoing improvement of the overall effectiveness of use of EHRs. It’s vital that you and your colleagues have a seat at the table.

This is why MeHI is undertaking a Provider and Consumer Research Study. This effort is aimed at gathering comprehensive information on the use, needs and attitudes toward health IT among both providers and consumers.

The research firm Market Decisions will be contacting thousands of health care providers and hundreds of consumers across Massachusetts to speak with them about health IT. The research will help identify specific challenges with health IT adoption and provide us with valuable insights.

If you are contacted, we encourage you to take 5 to 10 minutes to speak with the Market Decisions representatives to provide your perspective about the use of health IT in Massachusetts, including what you see as the major challenges in adopting these technologies. If you would like to take the survey now, please follow the link below to participate. We want your input!

http://www.research.net/s/MA_Home_Care

We hope that you will take the time to participate in this important survey. We are confident the first-hand perspectives we collect will lead to the development of thoughtful, well-informed strategies for providing the best health IT support and services to providers, as well as an improved healthcare experience for patients.

Laurance Stuntz is a Director at MeHI, a division of the Massachusetts Technology Collaborative. MeHI was empowered by the Massachusetts legislature to expand the adoption of eHealth technologies and further innovation in health IT across the Commonwealth. Follow Laurance on Twitter at @lstuntz

Return to www.thinkhomecare.org

National Association Provides Update on Rebasing, SGR

The National Association for Home Care & Hospice (NAHC) held a conference call revealing a frantic final week of advocacy activity before Congress takes its holiday recess until the New Year.

The major part of that activity for home health agencies centered around the attempt to delay the impacts of Medicare “rebasing” cuts through an amendment to the Medicare Sustainable Growth Rate (SGR) fix – also known as the physician fix.

Senator Debbie Stabenow (D-MI) offered an amendment on behalf of home care that would delay the cuts for one full year and give the industry the chance to lobby CMS to change their methodology with more updated and accurate data. Unfortunately, part of the compromise of the short -term physician fix was that it was a “clean” bill, which means no outside amendments. According to NAHC, even the hospital industry had amendments that were proposed and then withdrawn because of that agreement between Democrats and Republicans.

The short-term SGR fix will last for three months and must be offset by $7 billion. The good news there is that none of the offset is coming from the home health industry. Some of the hit is being hit is being absorbed by cuts to Long Term Care Hospitals and Disproportionate Share Hospital rates, but copays and additional reductions for home care  were avoided.

The light at the end of the tunnel comes from the fact that the Senate is working on a permanent SGR fix and the Stabenow amendment will still be in play for that effort. In addition, NAHC was successful in getting language from the FITT Act into the Senate’s proposal. The FITT Act essentially establishes a national pilot program for home-based telemonitoring provided by home health agencies. It will not be straight reimbursement, but is meant to be a shared savings approach where the providers and Medicare will share in any efficiencies gained. Moreover, if the program is successful, NAHC indicated that the program could be expanded by Medicare without going back to Congress for approval since it is a pilot and not a demonstration.

In terms of hospice care, NAHC also reported that another amendment would allow physician’s assistants to serve as the attending physician for hospice patients.

All of these wheels will be in motion in the New Year, but the main idea is that Democrats and Republicans compromised on a two-year deal that keeps the federal government running and it was done without implementing co-payments for home care. The 2% sequester cuts are extended for an additional two years, but those are not “new” cuts and are simply to make the budget scoring work. By the time the extended years are reached, the sequester could potentially be a thing of the past.

The Home Care Alliance thanks agencies for sending nearly 200 messages to the Massachusetts Congressional Delegation in two days. That education and advocacy will be critical as we move forward to fight rebasing in the New Year. Of course, further information will be provided as it becomes available.

 

Return to www.thinkhomecare.org.

 

Advocacy Alert: Contact Congress Re: Amendment Delaying Rebasing Cuts

Congress is working in the final days before the holiday recess on a long-term Medicare Sustainable Growth Rate (SGR) process and an amendment to that process could delay the impending rebasing cut to home health care.

The Alliance is asking that agencies and advocates contact their Member of Congress TODAY to educate them about the amendment and what it means for Medicare home health agencies. U.S. Capitol Building

Senator Debbie Stabenow (D-MI) has offered an amendment that essentially delays the effects of rebasing so that CMS can hopefully adjust their methodology with updated and more accurate data. Educating the Massachusetts Congressional Delegation is crucial to getting support for the amendment as there is so much happening in the final two days of activity.

More information and a prepared email message is available on HCA’s Legislative Action Network and it only takes a minute to log on and add your voice to this critical push to delay a damaging 3.5% cut per year over the next four years.

We also urge members to call the offices of your Congressional representatives directly using the message below as a guide. Simply call the main switchboard at (202) 224-3121, request a transfer to the office of your Congressional representative, and ask to speak to the individual from that office that is responsible for health policy.Here is the text of the message to Congress if you choose to call:

The U.S. Centers for Medicare and Medicaid Services (CMS) has finalized a rule imposing unprecedented Medicare home health reductions under a process called “rebasing.” All told, the impact on providers will be a $200 million cut in each of the next four years.

We are asking for your support in backing an amendment from Senator Debbie Stabenow as well as any corresponding effort in the House to amend the Medicare Sustainable Growth Rate (SGR) process.

These are the largest cuts to home health in decades, and they will cause many agencies to close their doors, especially if these cuts are compounded by Medicare reductions via the continuing budget resolution. Such cuts are counter-productive at a time when health reform relies on cost-effective care at home to serve vulnerable citizens.

CMS’s rebasing cuts were finalized on November 22 and go into effect on January 1. This leaves little time to delay these disastrous cuts and compel CMS to conduct a more fair, accurate and thorough analysis of its fiscal assumptions.

The data is clear. Many Medicare-certified home care providers are already operating in the red across all sources of payment. These new cuts – scheduled to be compounded for each of the next four years – will cripple the industry and create barriers to care. Yet, despite similar trends across the country, CMS concludes that draconian rebasing reductions are needed to eliminate positive margins in home health. CMS’s math simply does not add up.

Many in Congress agree. A bipartisan letter sent to CMS raised strong concerns, stating that the rebasing methodology relies on “incomplete data and analysis that results in the under-counting of home health agencies’ costs per episode of care, and an inappropriately high rebasing adjustment.”

Home care providers nationwide thank you and your colleagues in Congress for your strong stance on rebasing and we ask for your continued active engagement supporting Senator Stabenow and others to delay rebasing and initiate a more rational approach from CMS.

Thank you.

Return to www.thinkhomecare.org

Mass. EOHHS Holding FY15 Budget Hearings

A pair of public hearings will take place in Amherst and Boston this month to help guide the state’s Executive Office of Health and Human Services as they look to shape their fiscal year 2015 budget.

It is well documented that approximately half of the state government’s budget goes to health and human services so the department is constantly encouraged to find ways to do more with less.

HCA members and advocates are encouraged to email written comments to eohhshearings@massmail.state.ma.us by the time of the Boston hearing on December 11th. Subjects should include and focus on the following:

  • Raising MassHealth rates for skilled nursing
  • Encouraging a certificate/determination of need process for home health agencies
  • Urging formal support for S.1064, An Act Relative to Home Health and Hospice Aides, which allows nurses to delegate limited medication administration tasks to home health aides and CNA’s. With the hearings focusing on the EOHHS budget, commenters should focus on potential cost savings potential of “nurse delegation” issue.
  • Highlighting your agency’s efforts to reduce readmissions and other cost-effective programs.

For those interested in attending the hearings, the Amherst hearing will take place on December 6th from 10:00am to 2:00pm at Commonwealth Honors College while the Boston hearing will take place from 2:00pm to 6:00pm on December 11th at the UMass Boston Campus Center.

Any questions can be directed to James Fuccione at the Alliance.

Return to www.thinkhomecare.org.

Alliance Statement on CMS’ Final Rule Slashing Home Health Care Payments

The following is a statement from the Home Care Alliance regarding the CMS Final Rule on Home Health Rebasing. The Alliance invites its members and advocates to share this with their local media:

In a final rule released last Friday, the Centers for Medicare and Medicaid Services (CMS) have implemented a home health payment that will result in a 3.5 percent cut per year for the next four years.

It would be easy based on history to view the recent final rule from the Centers for Medicare and Medicaid Services (CMS) as “another year, another cut.” This year, however, is different.

The home health industry has absorbed $78 billion of cuts since 2009, which will be executed over the better part of the next decade. Those cuts come from the Affordable Care Act, other CMS final rules over recent years, and sequestration. The latest cuts amount to an additional and an untenable 14 percent – or $22 billion – reduction over the next four years.

These total reductions since 2009 and including the CMS final rule are comparable to the combined 2013 budgets of the federal departments of education and homeland security.

With an aging population and home health agencies caring for sicker patients that are released from the hospital at an earlier stage of recovery, the federal Medicare program is making it nearly impossible for quality providers to continue delivering effective services that end up saving taxpayers by preventing costlier facility-based health care under these circumstances.

The Home Care Alliance of Massachusetts joined providers and associations from across the country, as well as many members of Congress, in urging CMS to revisit what they had proposed back in July. Those calls and letters went disregarded and it is evident that CMS is trying to attain a numerical target in their budget ignoring logic at the expense of American seniors who benefit from care at home. CMS claims the cuts amount to a 1.05 percent reduction, which is a slight improvement over the proposed rule, but the cumulative impact of continued cuts scheduled for 2015, 2016, and 2017 drive the cut deeper.

The Home Care Alliance will be assembling with other advocates in Washington DC and online in a campaign to persist in opposing the cuts from CMS.

About the Home Care Alliance:

With a mission to unite people and organizations to advance community health through care and services in the home, the Home Care Alliance of Massachusetts is a non-profit trade association and advocacy group representing the voice of the state’s home-based health and care services. Founded in 1969, the Alliance represents 200 home care and home health agencies. For more information, visit www.thinkhomecare.org.

###

Return to www.thinkhomecare.org.

Visit Our New Home Care Month Webpage and Raise Awareness

November is National Home Care and Hospice Month and the Home Care Alliance has put up a special webpage full of resources and information to help agencies and advocates raise awareness.
The website promotes several informational pieces including:

  • “The Agency Advantage,” which lists reasons why people should choose a home care agency over an independent direct-hire individual.
  • “Your Care, Your Choice,” which highlights Medicare rules relative to patient choice.
  • “Keeping It Legal,” which is a resource for home care referral sources about ethical practices under federal regulations.
  • The Caregiver Video Resource Center, and more!

In addition, the website has a sample press release and letter-to-the-editor templates for agencies to send to their local media. Home Care Month is an excellent opportunity to recognize staff and be visible in the community.

Visit www.thinkhomecare.org/homecaremonth to help raise awareness and connect with the Alliance on Facebook and Twitter to let us know how you are celebrating!

Return to www.thinkhomecare.org.