Category: Advocacy

Budget Passes With Telehealth, Pediatric Palliative Care Funding

After years of advocacy and passing budget items with weak language that did not compel MassHealth to act, the Governor signed off on the $33.6 billion FY2014 state budget with a provision that recognizes home telehealth as a reimbursable service.

There is still plenty of work to be done with MassHealth, but passing the telehealth language in the budget is the furthest the Home Care Alliance has gone towards achieving reimbursement for an established service known to create efficiencies, improve care, and reduce costs.

The Alliance will be including a push for telehealth in comments on the state’s proposed home health regulation changes. Any agencies or advocates interested in commenting with HCA in an attempt to have the state include telehealth reimbursement in regulation to ensure its permanence should have a letter in to MassHealth by the July 26th deadline. Agencies can contact James Fuccione at the Alliance for details.

Also included in the the final budget is $1.5 million for the Pediatric Palliative Care Network, which serves the unmet physical, emotional, social and spiritual needs of children in Massachusetts with life-limiting illnesses. This is more than $670,000 of additional funding over previous budgets.

The Alliance would like to thank all the agencies and advocates who sent emails, made phone calls, met with legislators and otherwise supported telehealth and the pediatric palliative care funding. These items passing in the final budget represent a huge victory for home care and prove that persistent advocacy pays off.

Return to www.thinkhomecare.org.

CMS Reveals Proposed Rule with Further Cuts to Home Health Care

After Medicare payment cuts to home health agencies amounting to an estimated $72.5 billion over a 10-year period, the Centers for Medicare and Medicaid Services (CMS) released the proposed rule on the Home Health Prospective Payment System with further cuts reducing payments by $290 million.

CMS announced the rule in a press release, which estimates that approximately 3.5 million beneficiaries received home health services from nearly 12,000 home health agencies, costing Medicare approximately $18.2 billion in 2012.

The release continues that the proposed decreases reflect the effects of the 2.4 percent home health payment update percentage ($460 million increase), the rebasing adjustments to the national, standardized 60-day episode payment rate, the national per-visit payment rates, and the non-routine medical supplies (NRS) conversion factor ($650 million decrease), and the effects of ICD-9-CM coding adjustments ($100 million decrease). In addition, the rule proposes routine updates to the HH PPS payment rates such as updating the payment rates by the HH PPS payment update percentage and updating the home health wage index for 2014.

The CMS proposal is based on a projected 2013 differential between cost and revenue (margins) of 13.63 percent, which is at “severe odds” with calculations by the National Association for Home Care & Hospice (NAHC) and MedPAC.

Using a larger database than employed by CMS, NAHC estimates the 2013 margin at 8 percent to 9 percent. NAHC is seeking clarifications and a full disclosure of its calculation data and methodology. At this point, NAHC believes that the proposal is based on an unsupportable calculation.

“The proposal places the 3.5 million Medicare beneficiaries receiving home care services at risk of losing access to care as nearly half of the providers of this vital service would be paid less than the cost of care. It is neither fair nor right and needs to be changed,” stated Val J. Halamandaris, president of NAHC.

The Home Care Alliance is working with NAHC and other organizations to analyze the full extent of the proposed rule and advocate against these additional cuts.

Return to www.thinkhomecare.org.

Advocacy Alert: Send a Message to Support Telehealth and Pediatric Palliative Care

The Massachusetts House and Senate have named members of a select “conference committee” that will work to negotiate differences between the House and Senate budgets for a final version to be sent to Governor Patrick.

Please visit the Home Care Alliance’s Legislative Action Center and send a message to the conference committee members to support two important budget amendments. The message will automatically be sent to conference committee members.

The first (Senate Amendment #718) would create MassHealth reimbursement for telehealth services provided by a certified home health agency.  Language was included in previous budgets with weaker language that did not compel MassHealth to act. This year we again seek the inclusion of this cost-saving service with the words “the commonwealth shall recognize telehealth remote patient monitoring provided by home health agencies as a service to clients otherwise reimbursable through Medicaid” as stated in Senate amendment #718.

The second amendment (Senate amendment # 629) would add $674,789 to the state’s pediatric palliative care program, which serves the unmet physical, emotional, social and spiritual needs of children in Massachusetts with life-limiting illnesses.

Since both of these amendments were approved in the Senate budget, but not the House, advocates have to urge that conference committee members support the inclusion of the amendments in their negotiated version. If you live in the area of one of the conference committee members and would like to advocate for these amendments directly, the committee members are listed below with link to their profile pages (including contact info) on the state legislature’s website.

It only takes a minute to send a message and advocate for these important issues!

Return to www.thinkhomecare.org.

RFA Available for ‘Money Follows the Person’ Transition Coordination

The team managing the Money Follows the Person Demonstration released the following announcement regarding RFA’s to provide “transition coordination.” Any agencies interested are encouraged to either apply or at least become familiar with some of the community supports and services involved in the demonstration.

 

The Executive Office of Health and Human Services (EOHHS) has issued an RFA to contract with multiple qualified entities to provide MFP transition coordination to MassHealth Members enrolled in the Money Follows the Person (MFP) Demonstration. MFP transition coordination involves the performance of a broad a range of functions that will assist and enable individuals to transition from a nursing facility, long-stay hospital or intermediate care facility for people with intellectual disabilities to a community-setting with supports and services.

To view this document, please follow the directions below:

  • On the Comm-pass Home Page (http://www.Comm-pass.com), click on the “Solicitations” tab.
  • Click on the tab “Browse all Open Solicitations”.
  • Click on the second bullet “By Entity/Department”.
  • Find the Executive Office of Health and Human Services, and select by clicking on the check box.
  • On the Department page, Executive Office of Health and Human Services should be the only agency listed.  Click on the Select check box.
  • Scroll down to the procurement: 13MEEHSMFPTRANSITION (“Request for Applications for MFP Transitio …”)
  • Click the eyeglass icon on the right.
  • Click on the “Specifications” tab.

 

Return to www.thinkhomecare.org.

Advocacy Alert: Send a Message to Support Home Health Care in Senate Budget

A new advocacy message has been posted on the Home Care Alliance’s Legislative Action Center webpage and is ready to be sent off to state senators to support home health care in the senate’s FY14 budget.

HCA has three priority amendments in the Senate Budget that would create a home health care “certificate of need” process (amendment #517), establish MassHealth reimbursement for home telehealth services (amendment #718), and improve payment for pediatric home health agencies (amendment #593). The Alliance needs emails to senators to gain support for these important amendments so see the new advocacy message, fill out your contact info, and the message will automatically be sent to the senator representing you! It only takes a minute of your time and every email counts.

The Alliance is also supporting three other amendments. One would create an FMAP Trust Fund (#634) that will set up a special fund for payments from the federal government relative to health care reform, rather than having the money go into the state’s General Fund, which is less transparent. The other two amendments HCA supports would provide a rate add-on for personnel providing homemaker and personal care homemaker services to elderly clients (#544) and an amendment to boost funding for pediatric palliative care by $674,000 (#629).

Help advance home care in the state budget and send a message TODAY!

Return to www.thinkhomecare.org.

State Senate Releases FY14 Budget Proposal

The Senate Committee on Ways & Means continued the state budget-making process today by releasing their version of the FY14 budget, which will be debated before the full Senate next week.

The $33.92 billion proposal is a $1.4 billion increase over estimated FY13 spending, but $904.3 million less than what the Governor proposed. The Senate Ways & Means version is also $67.5 million less than what the full House of Representatives approved in their budget last month.

Here are some items of note:

  • $4.5 billion for the MassHealth Managed Care line item – $39.5 million over the final House budget.
  • $2.9 billion for the MassHealth Senior Care line item – $42.5 million over the final House budget.
  • $187.2 million to fully fund the elder home care programs, an additional investment of $6.2M over FY 2013, to eliminate the current waitlist of 1,500 seniors. This includes $98.7 million for Home Care Purchased Services.
  • $10.5 million for Grants to Councils on Aging, increasing support to $8 per elder, marking the highest ever level of state support for councils on aging.
  • $2.1 billion for the MassHealth Fee-for-Service line item – $7.2 million LESS than the final House budget.
  • Level-funding the Pediatric Palliative Care Program.

The Home Care Alliance will again be working with Senators to file three budget amendments to create a home health certificate of need program, establish MassHealth reimbursement of home telehealth, and strengthening pediatric home health.

As the Alliance works over the next few days to submit these amendments, association members and advocates should be on the lookout for “advocacy alerts” with message templates that can be sent to Senate offices. Of course, more information on budget development will be released as it becomes available.

Return to www.thinkhomecare.org.

Help Get Vital Support for Home Care Amendments in FY14 House Budget

boston-statehouseA new advocacy message that home care agencies and advocates can send to their state representatives has been posted on the Home Care Alliance’s “Legislative Action Center.”

The pre-written message urging the House to support the Alliance’s budget priorities will automatically be sent to your state representative based on the contact form that you fill out after clicking the link. You will be able to review the message before sending, if you choose, and it only takes a minute of your time!

Here are HCA’s priority budget amendments:

  • Telehealth Monitoring (Amendment #341), sponsored by Rep. John Mahoney:  – establishes MassHealth reimbursement for home telehealth services provided by a home health agency.
  • Home Health Agencies Certificate of Need (Amendment #552), sponsored by Rep. Kate Hogan – establishes a “certificate of need” process for new home health agencies.
  • Pediatric Home Health Care (Amendment #609), sponsored by Rep. Michael Brady – balances the payment formula for independent practitioners and agencies providing continuous nursing to account for an agency’s overhead, including scheduling and documentation requirements.

You may also call your state representative to urge their support of any of the amendments listed above. Those unsure about who represents them can lookup their legislator and contact info at www.wheredoivotema.com. The above links to each amend includes a fact sheet with talking points you can use on the phone call.

return to www.thinkhomecare.org.

 

House Begins Budget Process with Reductions from Governor, Improvements Over FY13

The House Committee on Ways & Means released their proposed version of the FY 2014 state budget today and although many items are reduced from what Governor Deval Patrick proposed, most items are still an improvement over fiscal year 2013.

House Ways & Means’ $33.8 billion budget reduces the MassHealth Senior Care, MassHealth Managed Care and MassHealth Fee-for-Service line items by a total of $205.8 million from what the Governor proposed, but those items still represent a collective increase of $625.1 million above the FY13 budget.

Meanwhile, most Elder Affairs line items that fund the State Home Care Program, administered by the Aging Service Access Point network, received slight reductions. One item, Home Care Case Management and Administration, saw a $478,097 increase over what the Governor proposed, but $593,317 less than the FY2013 number.

Below are the line items, the House Ways & Means funding level, and their difference (+ or -) from the Governor’s proposal and the FY2013 budget. Also included is a brief explanation of what the line item covers.

  • MassHealth Senior Care: $2,861,335,505 (-$50 million from Governor’s budget, +$105.2 million from FY2013)

The MassHealth Senior Care item funds services for seniors on MassHealth as well as the Senior Care Options, or SCO, Program.

  • MassHealth Managed Care: $4,499,411,804 (-$53.5 from Governor’s budget, +$331.9 million from FY2013)

MassHealth Managed Care is for services provided to medical assistance recipients under the Executive Office of Health and Human Services’ primary care clinician, mental health and substance abuse plan or through a health maintenance organization under contract with the executive office and for MassHealth benefits provided to children, adolescents and adults

  • MassHealth Fee-for-Service: $2,145,499,061 (-$102.3 million from Governor’s budget, +$188 million from FY2013)

MassHealth Fee-for-Service covers other MassHealth recipients not under Senior Care or Managed Care.

  • Home Care Purchased Services: $97,780,898 (-$8,891 from Governor’s budget, NO change from FY2013)
  • Home Care Case Management: $53,145,060 (+$478,097 from Governor’s budget, -$593,317 from FY2013)

Home Care Purchased Services and Home Care Case Management fund the operation of the state’s Home Care Program and its related contracts.

The Home Care Alliance will be working with state representatives to file amendments seeking MassHealth reimbursement of home telehealth services, a certificate of need process for home health agencies in the state, and an adjustment to pediatric home health care rates.

Budget amendments will be submitted by April 12th and the Home Care Alliance will send advocacy alerts looking for emails and phone calls asking state representatives for support on our amendments the week of April 15th. The full House of Representatives will debate the budget the following week.

Stay tuned for more information and for advocacy alerts on how you can help gain support.

Return to www.thinkhomecare.org.

Neighborhood Health Plan Drops Out of Dual Eligible Demonstration

Neighborhood Health Plan announced to partnering providers and organizations that they are withdrawing from the Dual Eligible Demonstration Project as an ICO, or Integrated Care Organization.

NHP was one of six groups that were working to become an ICO, but dropped out due to concern about payment rates conveyed from the state’s Executive Office of Health and Human Services (EOHHS) and the federal Centers for Medicare and Medicaid Services (CMS).

“EOHHS and CMS have acted in good faith to mitigate many of the factors involved in the rate discussions and unfortunately, for NHP, the final proposed rate structure, as projected, would result in substantial losses for NHP,” stated the emailed announcement.  “We feel that it is in our best interest at this time not to pursue the Duals demonstration further.”

The Home Care Alliance  spoke with NHP and met with other potential ICO’s with most expressing concern about the rates of payment. For months, stakeholders have been told that providers will receive no less than Medicare payments for Medicare services and no less than Medicaid payments for Medicaid services, but it is unclear if that is the case.

The Home Care Alliance will be attending the next “open stakeholder” meeting on April 19th in Shrewsbury to obtain more information.

“We strongly believe in the potential of truly integrated care models to improve care for the dually eligible and all Medicaid populations,” the NHP statement continued. “We wish your organization and the remaining ICOs much success.”

Return to www.thinkhomecare.org.

HCA Executive Director Named to Key Health Policy Advisory Group

Home Care Alliance Executive Director Patricia Kelleher has been named to the Health Policy Commission Advisory Council joining a list of other health care leaders  who will help guide the implementation of the state’s Health Care Cost Containment Law.

Better known as Chapter 224, (“An Act Improving the Quality of Health Care and Reducing Costs through Increased Transparency, Efficiency and Innovation”) the law requires the Health Policy Commission’s (HPC) Executive Director to establish the Advisory Council and designate members with diverse perspectives on the health care system to two-year terms. The Council will advance Chapter 224 implementation by advising on the HPC’s overall operations and policies, providing feedback on a grant program to support new system delivery and payment reform methods, and encouraging public and stakeholder engagement in the HPC’s work.

“This is an impressive group that promises to enrich the HPC’s work,” said Executive Director Seltz. “They are part of the coalition that made the first chapter of Massachusetts health care reform such a resounding success and the passage of our nation-leading cost containment law possible. Each member will bring a different and important perspective to our work to implement Chapter 224. I am grateful for their willingness to serve.”

The Advisory Council includes the following members from across the state:

  • Christine Alessandro, Executive Director, BayPath Elder Services, Inc.
  • Dianne Anderson, RN, President & CEO, Lawrence General Hospital
  • Michael Caljouw, Vice President, Government & Regulatory Affairs, Blue Cross Blue Shield of Massachusetts
  • JD Chesloff, Executive Director, Massachusetts Business Roundtable
  • Cheryl Clark, MD, Director of Health Equity Research & Intervention, Brigham & Women’s Hospital
  • John Cox, President, Cape Cod Community College
  • Karen Day, Executive Director, US Policy, AstraZeneca
  • Ralph de la Torre, President & CEO, Steward Health Care System
  • Vicker “Vic” Digravio, President & CEO, Association of Behavioral Health
  • Ronald Dunlap, MD, South Shore Hospital, President-Elect, Massachusetts Medical Society
  • John Erwin, Executive Director, Conference of Boston Teaching Hospitals
  • Julian Harris, MD, Director, Office of Medicaid
  • Jim Hunt, President & CEO, Massachusetts League of Community Health Centers
  • Jon Hurst, President, Retailers Association of Massachusetts
  • Dan Keenan, Senior Vice President, Government Relations, Sisters of Providence Health System
  • Patricia Kelleher, Executive Director, Home Care Alliance of Massachusetts
  • Gene Lindsey, MD, President & CEO, Atrius Health
  • Geoff MacKay, President & CEO, Organogenesis
  • David Martin, Senior Director, Health Policy, Covidien
  • David Matteodo, Executive Director, Massachusetts Association of Behavioral Health Systems, Inc.
  • Dolores Mitchell, Executive Director, Group Insurance Commission
  • Abraham “Ned” Morse, President, Massachusetts Senior Care Association
  • Joyce Murphy, Executive Vice Chancellor, Commonwealth Medicine, University of Massachusetts Medical School
  • Lynn Nicholas, President & CEO, Massachusetts Hospital Association
  • Cheryl Pascucci, APRN, FNP-C, Commonwealth Care Alliance
  • Lora Pellegrini, President & CEO, Massachusetts Association of Health Plans
  • Julie Pinkham, Executive Director, Massachusetts Nurses Association
  • Donald Thieme, Executive Director, Massachusetts Council of Community Hospitals
  • David Torchiana, MD, President & CEO, Massachusetts General Physicians Organization
  • Celia Wcislo, Vice President, 1199 SEIU of Massachusetts
  • Brian Wheelan, Executive Vice President for Corporate Strategy & Development, Beacon Health Strategies
  • Amy Whitcomb Slemmer, Executive Director, Health Care for All

Return to www.thinkhomecare.org.