Category: Advocacy

Advocacy Alert: Out-of-State MD Orders Legislation

A state legislative priority of the Home Care Alliance will be considered by the state legislature’s Joint Committee on Public Health at their hearing on October 29th in hearing room B-1 of the State House.

The bill is S.1042, An Act to allow out-of-state physicians to order home care in the Commonwealth, and would allow an out-of-state physician in a bordering state to order home care services for a resident of Massachusetts.

Under the bill, the out-of-state physician will not be required to obtain a license form the Massachusetts Board of Registration in Medicine. However, the Massachusetts home health agency will obtain and keep documentation that the out-of-state physician’s license is in good standing. The home health referral must also be the result of an in-person examination. The legislation is intended to remove a significant barrier to home based services by increasing access to physicians and specialists for residents living on or near a border with a neighboring state, those with vacation homes in other states, and those traveling in other states.

Any agencies or advocates interested in submitting written comments or testifying in person can contact James Fuccione at HCA.

Return to www.thinkhomecare.org.

Presentation: Cost Effective Home Care in Massachusetts

As more health care providers are held collaboratively accountable for patient outcomes and costs, it’s important for other parts of the system to understand the capabilities of home care and how these capabilities intersect with  success in containing health care costs while improving quality.

To tell home care’s  story, a subcommittee the Alliance’s Board of Directors developed a PowerPoint slide show of some home care facts and figures.  This slide show is now available to all to use and adapt as needed (3MB download), and may be previewed below:

Return to www.thinkhomecare.org.

Alliance Submits Comments on PPS Rule

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

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

The Alliance’s comments are available here.

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

NHIC- Ask the Contractor- August 15th

The Medicare Administrative Contractor, NHIC. Corp., will hold the Hospice & Home Health Ask the Contractor Teleconference (ACT) on August 15th at 10:00 a.m

Ask-the-Contractor Teleconference is an opportunity to speak directly with the contractor. NHIC staff representing a variety of functions will be available to answer questions. NHIC usually will provide some updates to the home health and hospice community but the majority of this call is dedicated to providers as a question and answer open forum.

Registration is required on NHIC’s website- Education Programs.

Return to www.thinkhomecare.org.

Deadline is TODAY for Congressional Signatures on Face-to-Face Letter

The deadline for a Congressional letter that seeks to streamline the burdensome Medicare home health face-to-face (F2F) requirement is today. New York Congressmen Tom Reed and Paul Tonko, as well as New Jersey Congressmen Christopher Smith and Robert Andrews, are circulating the letter and we need your help in cultivating Massachusetts Congressional support.   Please act now!

Use these talking points and call your legislator’s office and ask to speak to the healthcare staffer TODAY. Phone numbers for each office are listed below and if you’re unsure which member of Congress represents you, please contact James Fuccione at the Alliance.

Massachusetts federal delegation phone numbers:

Senator Elizabeth Warren:     (202) 224-4543
Senator Edward Markey:     (202) 224-2742
Congressman Jim McGovern:     (202) 225-6101
Congresswoman Niki Tsongas:     (202) 225-3411
Congressman Joe Kennedy:     (202) 225-5931
Congressman John Tierney:     (202) 225-8020
Congressman Stephen Lynch:     (202) 225-8273
Congressman Richard Neal:     (202) 225-5601
Congressman Michael Capuano:     (202) 225-5111
Congressman Bill Keating:     (202) 225-3111

The Congressional letter is addressed to U.S. Centers for Medicare and Medicaid Services (CMS) Administrator Marilyn Tavenner. Referring to the F2F mandate, the letter describes the “complicated, confusing and overlapping documentation requirements that exceed the intent of the law passed by Congress,” and it urges CMS to allow the F2F requirement to be met through the completion and collection of the separately signed 485 form.  Such a change would significantly ease the burden of the F2F mandate.

Almost 40 state home care associations (including the Alliance) are already listed in support of the letter, but in order to have the strongest impact with CMS, we need resounding support from as many Members of Congress as cosigners to this letter.

Agency members with any questions can contact James Fuccione at the Alliance.

Return to www.thinkhomecare.org.

Help Us to Convince CMS to Modify F2F!

New York Congressmen Tom Reed and Paul Tonko,  as well as New Jersey Congressmen Christopher Smith and Robert Andrews,  are circulating a Congressional  letter that seeks to streamline the burdensome Medicare home health face-to-face (F2F) requirement.  We need your help in cultivating further Congressional support.   Please act now!

The  Congressional letter is addressed to U.S. Centers for Medicare and Medicaid Services (CMS) Administrator Marilyn Tavenner.   Referring to the F2F mandate, the letter describes the “complicated, confusing and overlapping documentation requirements that exceed the intent of the law passed by Congress,” and it urges CMS to allow the F2F requirement to be met through the completion and collection of the separately signed 485 form.  Such a change would significantly ease the burden of the F2F mandate.

Almost 40 state home care associations are already listed in support of the letter, but in order to have the strongest impact with CMS, we need resounding support from as many Members of Congress as as cosigners to this letter.

We need the full support and sign on from the MA House delegation.    August 9 is the deadline for doing so.

Office emails and message here:   http://www.congressweb.com/nahcadvocacy/legislators?stateId=MA

 

House Ways and Means Chair Seeking Public Feedback on Medicare Reform Proposals

House Ways and Means Committee Chairman Dave Camp (R-MI) released draft legislation that would seriously change the benefit structure of Medicare. Proposals included in the draft legislation range from increasing the Medicare Part B deductible for new enrollees to increasing income-related premiums under Parts B & D. Of greatest concern to home care and its members is the suggested implementation of a home health copay. The home health copay proposal in the draft legislation was also included in the President’s FY14 budget. It would impose a $100 copay on home health episodes not preceded by a hospital or nursing home stay, beginning in 2017 and applying to those who become newly eligible for Medicare in 2017 or later.

The Home Care Alliance joins the National Association for Home Care & Hospice (NAHC)  in opposition to shifting additional costs onto Medicare home health beneficiaries in the form of more out of pocket expense. With respect to the proposed home health copayment, Congress eliminated such a “sick tax” on beneficiaries back in the 1970s when it was found that such copayments were ineffective at saving the Medicare program money, as people had to seek more costly care options. Home health copayments would be just as harmful – if not more so – today with a rise in the number of beneficiaries needing home health services as Baby Boomers start to retire. If reinstated, the Medicare home health copayment will likely lead to more people seeking care in much more costly care settings such as hospitals, nursing homes and emergency rooms.

Alliance members are encourage to submit comments to the Ways and Means Committee in opposition to a copayment via email to entitlementreform@mail.house.gov by August 16, 2013.

Return to www.thinkhomecare.org.

State Seeks Waiver from Three-Day Rule

With the input of several health care provider groups, including the Home Care Alliance, the state sent a letter on July 23rd to CMS Administrator Marilyn Tavenner officially requesting a waiver from the so-called “three-day rule.”

The rule refers to Medicare’s requirement that post-hospital extended care services in a skilled nursing facility are not allowed unless they are preceded by a hospital inpatient stay lasting three consecutive days. The Home Care Alliance joined other groups like Mass. Hospital Association, Mass. Senior Care Association, Mass. Medical Society and others in voicing support for such a waiver in multiple stakeholder meetings.

The idea is that patients can be properly directed to skilled nursing facility care and/or home health services, but eventually and ideally transitioning back into the community. All the while, patients would receive an appropriate level of care and avoid unnecessary hospitalizations.

The state’s Executive Office of Health and Human Services asks that the waiver include Medicare Fee-for-Service patients and last for three to five years.

The Home Care Alliance will continue to monitor the state’s request and provide updates.

Return to www.thinkhomecare.org.

Proposed PPS Rule for Home Care and a Call to Action

In the July 3rd Federal Register, The Centers for Medicare and Medicaid Services (CMS) released the proposed Medicare Home Health Rule for 2014.  A key provision of this rule is the first year of a multi-year planned adjustment of home health prospective payment rates, otherwise known as “rebasing”.

The directive to rebase the home health PPS rates comes from language in the Affordable Care of 2010 that was a reaction to multiple years of MEDPAC Reports to Congress calling for dramatic steps to reform the home health payment system, which they claim have widely exceeded  program costs almost from the 2001 launch of the current PPS system.

Starting with 2014 rule and going forward through 2017, CMS plans to impose a 3.5% rebasing adjustment to the home health base rate.  This 3.5% reduction is based on CMS’ projection of an average home health profit margin of 13.63% in 2013 (calculated from 2011 data trended forward as the difference between the average national episode revenue in home health and the average national episode cost). The 2014 rule does include a 2.4% market basket update as well.

The phase-in of this rebasing cut and the inclusion of a market basket update is in conflict with what MEDPAC had recommended to Congress (no update and deeper and faster rebasing cuts) and is direct result of industry advocacy form these mitigating factors during the ACA debate.

Now, that type of industry advocacy is needed once again.  While eliminating any rebasing cut may well be impossible, it is possible that with strong Congressional support, we can challenge the CMS calculation and achieve some decrease in the 2014 cut.   Particularly subject to challenge is CMS’ calculation of industry profit margins from which the rebasing number are derived.

We also know the following about CMS’ calculations on profit margins:

  • Only freestanding and not hospital base agency cost reports are considered
  • They are at odds with what MEDPAC’s and NAHC’s numbers show
  • They may fail to adequately capture industry costs around mandates such as the Face to Face requirement, the ICD-10 implementation and investments in electronic health records .

The Alliance believes that we can make a strong case to Congress, but we need members to be engaged as advocates and as sources of information for us.

Please use the questions below as a guide to provide information on the anticipated impact of the CMS Proposed Rule by Friday, July 26th at 12pm. Alliance staff is traveling to Washington DC to meet with members of congress and the national associations, so please have information in ASAP:

  • What is the impact on your agency’s bottom line (in dollar amount and percent loss)?
  • What is the impact on staff, including reducing staff time, cutting jobs, or halting new hires?
  • Do you anticipate cutting or reducing service lines, particularly MassHealth/Medicaid?
  • What is the impact on innovative service lines, like hospital readmission, dementia, chronic disease management, falls prevention and etc?
  • How will the proposed rule affect other ways your agency does business?

Answers to the above can be emailed to James Fuccione at the Alliance

Return to www.thinkhomecare.org.

New Web Resource on Hospital Quality Adds Home Health Data

A collaborative effort of three leading healthcare trade associations has brought a new, first-in-the-nation website for consumers to find quality data on the state’s hospitals and, more recently, federally-certified home health agencies.

The Massachusetts Hospital Association, the Home Care Alliance of Massachusetts and the Organization on Nurse Leaders of Massachusetts and Rhode Island have teamed up to build the website called PatientCareLink. The site aims to deliver transparent quality and safety information from hospitals and home care agencies to patients and other healthcare stakeholders.

The data itself is drawn directly from the Medicare Home Health Compare website and is updated regularly. An alphabetical list of agencies is presented and each agency has their contact information and website included with selected quality measures that are compared to the national average for home health agencies.

The Alliance invites all to browse through the website, which will be continually promoted and improved, and see the website’s introductory video above with HCA’s Executive Director Patricia Kelleher.

Return to www.thinkhomecare.org.