Category: Advocacy

Caring Magazine Highlights Massachusetts Care Transitions Programs

The great work being done by home care agencies in Massachusetts around care transitions was highlighted in an article in the current issue of Caring Magazine, the monthly publication of the National Association for Home Care & Hospice (NAHC).

In the article written by the Home Care Alliance, the focus is on four agencies involved in the STAAR project (State Action on Avoidable Readmissions) and how their collaborative programs have changed how care transitions are handled.

Additionally, the Home Care Alliance’s “Opt-In” document, a guide to Optimum Performance Standards for Transitions to and From Home Health, is highlighted and shown as a beacon for the work performed by these four agencies and any other agencies or  providers working with home health to improve care transitions.

Return to www.thinkhomecare.org.

 

 

 

DHCFP Proposes New ASAP Rates, Hearing Scheduled

Implementing another provision of the Purchase of Service reform, the MA Division of Health Care Finance & Policy is assuming rate setting authority over ASAP rates effective January 1, 2012.  This week, DHCFP published the proposed rates for calendar year 2012, along with a notice of a public hearing to be held on Wednesday, December 14, 2011 at 10:00 AM at the DHCFP, Two Boylston Street, 5th floor, Boston.

DHCFP is proposing a new section of its regulations at 114.4 CMR 17.00: Rates for Certain Elder Care Services.  The proposed regulation establishes payment rates for Home Care and Enhanced Community Options Program (ECOP) services purchased by the Executive Office of Elder Affairs. The regulation establishes a bundled monthly payment to ASAPs for each client.  The proposed rate for the Home Care/Respite Care program is $266.52 per client per month.  This rate does not include any increase from the current rate. The proposed rate for ECOP is $662.12 per client per month, an increase of just $2.92 from the current contract rate.

Note that the DHCFP regulation does not set contractor agency rates.  Those will continue to be set through the Homemaker NOI process managed by EOEA.

The Alliance will be testifying at the public hearing.  Any agencies interested in providing testimony – either in person or in writing – are encouraged to contact James Fuccione at the Alliance office.

Return to www.thinkhomecare.org.

Celebrate and Raise Awareness: November is National Home Care and Hospice Month

Every year, the home care and hospice community celebrates and raises awareness of the services that help keep people independent and at home for National Home Care & Hospice Month and National Family Caregivers Month in November.

With the Joint Select Committee on Deficit Reduction debating proposals to reduce the nation’s debt by trillions of dollars, the advocacy focus for this year must focus on opposing suggestions to impose copayments on Medicare home health services. A message also has to be sent that home care paid it’s fair share, $39.7 billion over ten years to be exact, for implementing the Affordable Care Act as well as how the industry has been thrown years of regulatory reductions.

Home care and hospice are cost-effective methods that care for people in the setting where they are most comfortable and familiar. Please help the Home Care Alliance raise awareness of these important issues and services, but also celebrate the great work performed by aides, clinicians, managers and all staff that make those services possible.

Here are some ways to celebrate and raise awareness for National Home Care & Hospice Month:

For Providers –

Press Release: Tailor this press release on National Home Care and Hospice Month to include information about your agency and the services you provide. Then, distribute to your local newspaper and/or local senior newsletter (Please contact the Alliance if you would like assistance or have any questions). There is also a separate press release template for hospices.

Op-Ed/Letter to the Editor: Select from the Opinion-Editorial drafts below depending on your interest (HCA would be happy to work with agencies on more specific or localized op-eds or letters to the editor).

For Everyone –

Facebook: Go to the Home Care Alliance’s Facebook page and click “like” on the most recent status regarding Home Care Month.

Twitter: add the hash-tag #homecaremonth to your tweets this month and especially if you’re helping celebrate and raise awareness.

Posters: Download and print the posters below. Post in your home or office, or send to friends and colleagues.

Advocacy: Send an email advocacy message to legislators from HCA’s Legislative Action Center.

Resources for Caregivers:

-Order the Home Care Alliance’s new 2012 Guide to Private Home Care Services and see HCA’s other helpful publications.

–Alzheimer’s Disease caregiver tip sheet from the National Family Caregivers Association.

–Guide to Advance Care Planning from the National Hospice & Palliative Care Organization.

-Information on the Home Care Alliance’s Home Care Accreditation Program.

-Read President Obama’s Proclamation to honor National Family Caregiver’s Month.

Return to www.thinkhomecare.org.

A Challenge to Home Care

Interesting and at least a bit encouraging, the CMS Director Don Berwick references home health as an essential part of a coordinated, seamless, patient centered care team in his October 20th, editorial in the New England Journal of Medicine (“Making  Good on ACO’s Promise). But, Dr Berwick leaves home health out of the definition of what will be required of applying entities to become Medicare’s first ACOs.  Dr Berwick presents  a vision in which Medicare beneficiaries “should find their care experience enhanced by a program that supports providers in engaging with their patients to deliver on the three-part aim: better care for individuals, better health for populations, and lower cost growth through improvements in care.”

Clearly Dr Berwick’s  vision is one that we all of share.  “Coordinated care,” he writes, ” is meant to allow providers to break away from the tyranny of the 15-minute visit, instill a renewed sense of collegiality, and return to the type of medicine that patients and families want.”  In this brave new world of coordination and collegiality, it will still be up to home care  to “sell” these organizing entities that home care has long understood and practiced patient centeredness, and that we have experience to spare and to share.

The Alliance is committed to helping us rise to Dr Berwick’s challlenge.

Find a full copy of the rule, here.


CLASS Act – Over Before it’s Begun

Once again, the needs of an aging nation in terms of support for long term care have been pushed aside with HHS Secretary Kathleen Sibelius’ announcement that the Obama Administration will not proceed with plans to implement a federally coordinated, voluntary national long term care insurance plan – known as the CLASS act

According to today’s Wall Street Journal, HHS officials gave up after “actuaries spent 19 months attempting to design a voluntary long-term care insurance program that met the requirements of the law.”  That called for making sure the program would remain fiscally solvent and pay for itself for at least 75 years.

Although the Class Act provision is little linked to the Affordable Care Act provision around providing basic health insurance universally, its  demise has inched open further the door to those who seeking to dismantle all of ACA piece by piece.   Senate Minority Leader Mitch McConnell (R., Ky.) said. “It is worth remembering that the Class Act is only one of the unwise, unsustainable components of an unwise, unsustainable law.”

Just what is unwise and unsustainable in your opinion: providing basic coverage and seeking a collective and shared solution to an aging society?   Or doing nothing?

Reports: CLASS Act Program is Being Removed from Health Care Reform

News outlets across the country are reporting on the elimination of the CLASS Act (Community Living Assistance Services and Supports), which would have provided a modest long-term care insurance benefit to help elders access community care services and remain in their homes.

This provision would have been a boost to home health, but research and reports by Health and Human Services found that there was no way to ensure that the program would be sustainable and the official announcement to repeal the program came late Friday afternoon.

The move itself, aside from political posturing, does not change the fact that there is “an enormous need” for long term care insurance as HHS Secretary Kathleen Sebelius put it. The New York Times quoted Secretary Sebelius as adding “At $75,000 a year for a nursing home and $18,000 a year for home health care, most families cannot afford to pay out of pocket.”

Return to www.thinkhomecare.org.

“At $75,000 a year for a nursing home and $18,000 a year for home health care, most families cannot afford to pay out of pocket,” she said.

HCA Comments to Federal Deficit Reduction Committee

With a home health copayment and other potential hazards hanging in the balance, the Home Care Alliance sent off an official letter to the Joint Select Committee on Deficit Reduction to reiterate strong opposition to what would amount to a “sick tax” on certain Medicare patients.

Following up on the recent visit to Washington DC, the letter was sent to the co-called Super Committee, which includes Massachusetts Senator John Kerry, and was copied to the state’s Congressional Delegation. The letter was especially timely, as a group of Alliance members and staff met last week with Senator Kerry to discuss specific concerns.  

The Alliance particularly targeted a recent proposal from President Obama to institute a copayment for Medicare home health services. If passed, the copayment would amount to $100 per 60-day episode on certain Medicare beneficiaries beginning in 2017. The copayment would not be imposed for episodes following a stay in an acute care facility and would apply to patients receiving five or more visits.

The Alliance’s letter, aside from opposing the copayments, also points out that Massachusetts has not experienced the same growth in the number of home health agencies as other parts of the country.  The Alliance argues that such broad payment reductions or copayments are punishing the wrong people and not targeting offenders of fraud and abuse. The Alliance also offers alternatives like a moratorium on new certified agencies, better targeting fraud and abuse in areas of substantial growth, and further capping outlier payments.

Agencies and concerned advocates are encouraged to submit comments opposing the copay and offering alternative solutions as mentioned in the Alliance’s letter to the Joint Committee on Deficit Reduction by visiting the comment submission page of their website.

The Alliance also has the opening remarks of Committee Co-Chair Senator Patty Murray (D-Washington) on the HCA YouTube page and will continue to provide updates as they become available.

Return to www.thinkhomecare.org.

HCA Issues Statement on Home Care Copay Proposed by President

In response to President Barack Obama’s proposal to impose a co-payment on Medicare home health services, the Home Care Alliance has issued a release to the press. Any home care agencies or concerned advocates is encouraged to follow up with local media and make the public aware of this proposal.

Below is the Home Care Alliance’s statement:

President Proposes Home Health Copays to Help Reduce Federal Deficit

Industry Calls Copayments an Inappropriate Burden and a Tax on Most Vulnerable Elders

Boston, MA – With the debate over the federal budget debt ceiling heating up, the Home Care Alliance of Massachusetts has joined organizations from across the nation in vehement opposition to President Barack Obama’s proposal to impose co-payments for Medicare Home Health Services.

What began as a recommendation to Congress by the Medicare Payment Advisory Committee (MEDPAC) is now entrenched in discussions over how the country will raise revenues and reduce spending.

“It has been shown in many studies that copayments are an inefficient and regressive ‘sick tax’ that falls most heavily on the poorest and oldest Medicare beneficiaries,” said Patricia M. Kelleher, the Executive Director of the Home Care Alliance of Massachusetts. 

Congress eliminated home health copayments in 1972 as part of a Medicare modernization effort that concluded that such copayments fell disproportionately on the home health users with the highest Medicare expenses and the worst health status. Moreover, they discouraged using home health in lieu of more expensive nursing facility stays. As recently as 2003, Congress rejected a home care co-pay proposal for the same reasons.

President Obama’s proposal calls for a copayment of $100 per Medicare episode and excludes Medicare episodes immediately following a hospital stay. The measure would only apply to new beneficiaries beginning in 2017 and is estimated to save approximately $400 million over 10 years.

“Imposing of a copayment would continue an assault on the Medicare home health benefit that witnessed $39.7 billion in cuts passed by Congress last year,” said Kelleher. “Additionally, on January 1, 2011, Medicare added a new impediment to accessing services by requiring that homebound elderly and disabled patients, as well as hospice patients, will now need to have a ‘face-to-face encounter’ with a physician or nurse practitioner in order to receive home health services under Medicare.”

Most home health users are age 75 or older and in very poor health.  A Commonwealth Fund Report recently found that individuals of all incomes with fair or poor health status or age 85 and older spent almost 30 percent of their income already on uncovered medical care, primarily due to Medicare gaps, deductibles and copayments. Additional publications, including the New England Journal of Medicine, have released findings that an increase in such copayments lowers utilization and increases hospitalizations.

“Home health agencies in Massachusetts have supported aggressive efforts to slow growth of home health spending, including testifying in support of a moratorium on new agencies,” said Kelleher. “Asking patients to pay more is not the answer.”   

Return to www.thinkhomecare.org.

Cong Markey Briefs Health Care On Debt Ceiling Discussions

Yesterday, Congressman Edward Markey conducted a briefing for members  of the health care and health research communities on the debt ceiling discussions and the possible impact on these sectors going forward.   Although the Super Committee has received a significant amount of the attention, the debt discussions will actually occur in three steps.

The first step will include a cut of $900 billion. These cuts must be effective on 10/1/2011. Medicare and Medicaid cannot be included in this first cut, but all other federal spending including defense and non defense can be considered.

Step 2 is the Super Committee, comprised of six Senators and Representatives. The budget target for this Committee is $1.2 trillion.  Their work must be done by Sept 23rd and if recommendations are made, must be voted on by Dec 23rd.  The bring a proposal forward will require 7 or the 12 votes.  In Senate, a simple majority vote will be needed to pass.

According to Markey, this group “will go from 0 to 60 miles per hour” to meet the September 23 deadline and for this group “everything is on the table.”    This group has broad latitude to propose changes in benefits or  program design in terms of federal entitlements, including Medicare and Medicaid benefits and program design;  eligibility and contributions to Social Security;  defense spending, tax rates, “loopholes”  and contributions, etc.  Markey indicated that all of the Republican appointees have pledged to support no new revenues, which will make this Committee’s work more difficult.

Should the Super Committee not reach consensus, the process will move to Step 3, which would be a an automatic cut on 10/1/13 of $1.2 trillion in spending, 50% of which would come from “security” and 50% from non security spending.  Under this scenario, the sole restriction is that Medicare cuts would be set at 2%.

Congressman Markey engaged the group in discussing:

What is you message to the Super Committee?

What would you recommend that Super Committee members do if there are no revenues and only cuts to achieve the goal?  Is moving to Step 3 preferable to this scenario?

Is a Step 3, i.e. 2% cut in Medicare in Oct 2013 sustainable?

Question to Home Care:   What is your message to Congress on this?

Join Us for Falls Prevention Awareness Day

This year’s Falls Prevention Awareness Day will be taking place from 10:00am to 12:00pm on September 22 in the Great Hall of the Massachusetts State House. The event will feature speeches by State Senator Richard Moore and Executive Office of Elder Affairs Secretary Ann Hartstein.

Once again, clinicians, community activists, state officials and honored guests will gather to raise awareness that falls are both common and costly. Efforts are in place in our state to introduce falls prevention activities across the health care continuum and into the daily lives of older adults. Join the Massachusetts Falls Prevention Coalition and our experts to help prevent falls across all settings. Presentations will be made by the VNA of Boston and other providers with falls prevention programs.

Attendance is free and there is no registration for the event. Simply RSVP to James Fuccione at HCA (jfuccione@thinkhomecare.org) or Alissa Weintraub at Mass Senior Care (aweintraub@maseniorcare.org).

The mission of the Massachusetts Falls Prevention Coalition is to promote healthy lifestyles, behaviors and strategies to reduce the incidence and severity of falls and fall related injuries across the lifespan in Massachusetts.

Return to www.thinkhomecare.org.