Category: Advocacy

State Bill Filed to Expand Hospice Coverage

According to a report by State House News Service, a bill was recently filed by a group of legislators that would expand hospice coverage to about 120,000 more residents on MassHealth.

Senate Bill 1999, An Act extending hospice care to the MassHealth basic and MassHealth essential programs was filed by Senator Patricia Jehlen and seeks what its title states. Hospice coverage, according to State House News, is available to about 1 million MassHealth recipients, but not to roughly 120,000 who are on more restrictive plans known as MassHealth Basic and MassHealth Essential.

The inspiration for this bill comes from a report assembled by the Massachusetts Commission on End-Of-Life Care, which was established by the legislature in 2009 to study issues surrounding end-of-life care and how such care is provided in the state.

The Home Care Alliance applauds the initiative to expand hospice coverage so that people can fulfill their preference to receive end-of-life care in their homes. While approximately 67 percent of Massachusetts residents say they would prefer to die at home, only 24 percent actually do, according to statistics compiled by the commission, the Massachusetts chapter of AARP, and the state Department of Public Health.

The legislation has been referred to the Joint Committee on Health Care Financing and the Alliance will continue to provide updates on this proposal as it becomes available.

Return to www.thinkhomecare.org.

Advocacy Needed During August Recess to Avoid Cuts and Co-Pays

A so-called Debt Reduction Super Committee evolved out of the federal debt ceiling debate and will be charged with reducing the federal deficit over the next ten years.

Although cuts to entitlement programs and home health co-payments are on the table as options, a potential bright spot was reported this week in that US Senator John Kerry (D-MA) is among the members appointed to the Super Committee. Kerry was instrumental in getting cuts to home health reduced as part of health care reform.

Even with the work of Senator Kerry, Medicare home health payments are still taking a $39.7 billion hit over the next ten years. Additionally, CMS is proposing a 5.06% reduction in payments for calendar year 2012. Both of those points need to be raised when this committee considers even deeper cuts that could drastically impact agencies and patients.

Home health co-pays are another option that must be broadly opposed. Seniors could be forced to pay as much as $150 per 60-day episode of home health care, which would only push those who cannot afford it or unwilling to pay into costlier care.

Below are issues and materials that advocates can use to contact the Massachusetts Congressional Delegation, not just during August recess, but as the discussion of the Super Committee progresses. There are also materials and advocacy messages that can be used to urge Congressional support of other home care initiatives.

Advocates should be contacting their Congressperson, as well as Senator Kerry, to ask that they in turn urge the Super Committee to oppose home care cuts and copays.

Home Care Co-Pays & Medicare Cuts:

Support Home Health Access Protection Act:

Support Home Health Planning Improvement Act:

See a list of other issues, talking points, and messages available on the HCA Legislative Action Center. You can also compose your own message here.

Return to www.thinkhomecare.org.

 

Public Hearing on Temporary Nursing Agency Regulation

The state’s Division of Health Care Finance & Policy (DHCFP) is holding a public hearing and accepting written comments on amendments to regulations regarding temporary nursing services.

According to an official hearing notice, DHCFP is required to review and establish maximum rates that temporary nursing agencies may charge facilities annually. The proposed regulation is estimated to result in an increase of 4.13%, or $2.56 million, in aggregate provider expenditures for temporary nursing services.

It should be noted that eighteen of the 108 nursing facility rates decrease, all in Health Service Area 3 – Merrimack Valley, due to a decrease in the median reimbursement paid to permanent staff at nursing facilities in that region, according to the notice.

The hearing will take place at 10:00am on Wednesday, September 7th at DHCFP Headquarters, located at 2 Boylston St in Boston. For more info on the regulation, visit the regulation page on DHCFP’s website (See or search 114.3 CMR 45.00)

Return to www.thinkhomecare.org.

CMS Responds to Congressional Letter on MD Face-to-Face

Congressman Jim McGovern, along with the rest of the state’s Congressional Delegation, received a response to a letter sent to the Centers for Medicare and Medicaid Services (CMS) that reflected the struggles of home health providers in Massachusetts relative to the physician face-to-face encounter requirement.

Unfortunately, the response from CMS is mostly a reiteration of the reasoning behind the rule and a commitment to monitor the implementation of the policy “to ensure that there are no unintended disruptions in access to medically necessary home health care for our beneficiaries.”

For more on the Physician Face-to-Face Encounter Requirement, see previous posts on the subject.

Return to www.thinkhomecare.org.

Alliance Meets with New Medicaid Director

photo of Julian HarrisThe Governor appointed a new Director of Medicaid in June and the Alliance has had the opportunity to meet with Dr. Julian Harris (pictured left) twice since he began acclimating to his new role.

HCA staff joined other advocates in a meeting that involved personal and organizational introductions to the new Director as well as a mention of a few top issues for each organization as it pertains to MassHealth activity. Prior to that, Alliance staff was among a small group of providers meeting with Health and Human Services Secretary JudyAnn Bigby and other officials on the Dual Eligibles Care Integration Project, which Dr. Harris sat in on.

According to a press release issued by the Governor’s office, Dr. Harris currently practices primary care at the Southern Jamaica Plain Community Health Center and hospitalist medicine at the Cambridge Health Alliance, both of which serve populations with high levels of participation in MassHealth and other state health programs. He is a clinical fellow on the faculty at Harvard Medical School and a senior resident in internal medicine and primary care at the Brigham and Women’s Hospital and its affiliated Southern Jamaica Plain Community Health Center. He formerly served at the World Bank, where he was charged with day-to-day management of the World Bank Institute’s AIDS program. He also worked on national health payment and delivery system reform for an international client at McKinsey & Company.

The Alliance looks forward to working with Dr. Harris on the challenges and opportunities for home care and MassHealth members.

Return to www.thinkhomecare.org.

Home Care Nurses Speak Up in Washington

As the “debate” continues in Washington over the debt ceiling and capping government spending, home care nurses added their voices to those speaking against propoals that would cut Medicare funding and impose co-payments. What is at stake are proposals by:  1) The National Commission on Fiscal Responsibility and Reform that would impose a uniform 20 percent co-pay and a uniform overall deductible of $550 for all Medicare services combined, including home health care;  or 2) the Medicare Payment Advisory Commission (MedPAC) which recommended a home health copay (as much as $150 per episode) for episodes not preceded by a hospital or nursing home stay as a means to encourage beneficiaries to control utilization of care.

Congressman James P McGovern (D-MA) a long time champion of home care spoke to the nurses saying:  “It is important that members of Congress understand that you are part of the solution,” McGovern said. McGovern said that keeping a person at home is cheaper and patients are ultimately happier.

Home Care Alliance Board member Elaine Stephens, of Overlook VNA,  represented Massachusetts at the nurses rally that also included remarks from National Association for Home Care President Val Halamandaris and Max Richtman, executive vice president and acting CEO, of the National Committee to Preserve Social Security and Medicare.

To send a message to Congress to keep home care cuts out of debt ceiling discussions, go to the Alliance’s advocacy page.

Mass State Website Looks To Add Home Health Compare Data

At its July meeting, the Massachusetts Quality and Cost Council (QCC) put on its agenda for the coming year a plan to place CMS  Home Health Compare data on its consumer education website.  The state’s My Health Care Options website was established by the Mass QCC as a resource for patients and families looking to make informed health care choices. The majority of the data on the site to date have been on hospital and medical practice quality and costs, with a new update of these data posted in January 2011.

Home health care was identified in the QCC’s Three Year Reporting Pla as “a vital service to the aging population and  an important area of information for consumers.”  The Council is exploring options to download the CMS data in a consumer friendly format, as opposed to simply placing a CMS website link.  The costs and feasibility of this are being reviewed prior to the Council’s next meeting.

Are consumers or other referral sources using CMS data now? Will  it get more visibility on the state’s website?  What are your thoughts?

CMS Community-Based Care Transitions Program Update

The Centers for Medicare and Medicaid Services (CMS) has provided new guidance and updates on their Community-Based Care Transitions Program.https://i0.wp.com/www.gmcf.org/transitions/images/transitions_image.jpg

New panel review dates for submitting applications beyond August 18th have been posted and are as follows:

  • October 6 & 7, 2011 – Applications must be received by September 6th to be considered for this review.
  • November 15 & 16, 2011 – Applications must be received by October 14th to be considered for this review.
  • November 30 & December 1, 2011 – Applications must be received by October 28th to be considered for this review.

Secondly, more than a full page of new guidance has been added to the program’s Question & Answer section. Below are a few examples:

  • Q: How shall we anticipate to cover up front costs? I heard that CBOs would be paid a per eligible discharge rate that is determined by target population, interventions proposed, anticipated volume and expected reduction in readmissions (cost savings) Can you give a concrete example of how this payment methodology would work?

A: Because this program seeks to build off of earlier care transitions initiatives and requires applicants to have a track record in the delivery of care transition services we are not paying “start up” costs. CBOs will be paid on a monthly basis for services delivered in the previous month. This payment will be whatever the agreed upon per eligible discharge rate is multiplied by the number of eligible beneficiaries served in the previous month. Please refer to the budget worksheet available on our program webpage for additional guidance on developing the per eligible discharge rate.

A: These are the patient experience measures that CBOs will be required to collect and report during the program. We will provide the instruments to awardees at the time of award.

The Home Care Alliance has also made a webinar available on the experiences from a previous CMS care transitions demonstration program that worked through 14 QIO’s across the US. The webinar focuses on, among other things, drawing from the Home Health Quality Improvement campaign’s Best Practices Intervention Package.

More info from this newsfeed on care transitions is available here.

Return to www.thinkhomecare.org.

Gov. Patrick Signs FY12 State Budget

Governor Deval Patrick signed the state’s fiscal year 2012 budget amounting to $30.6 billion with a victory for home health.

Language that would move MassHealth one step closer to reimbursing home health agencies for telehealth services was included in the “MassHealth Managed Care” line item:

…for purposes of long-term health care cost savings and enhanced patient care, the commonwealth may recognize telehealth remote patient monitoring provided by home health agencies as a service to clients otherwise reimbursable through Medicaid

The key word in this language is “may.” MassHealth is not directly instructed in the budget to reimburse for telehealth (as if the word “shall” was used), but it presents the state with the option to do so, which means that continued advocacy will be required to push the state towards that end. This is a solid victory for the Alliance’s budget advocacy thanks to the hundreds of emails that were sent from the HCA website’s Legislative Action Center and to the office of Senator Richard Moore.

Another item of interest is in regards to Adult Day Health where the Governor approved a budget that makes “no changes prior to December 31, 2011 in the clinical eligibility or level of reimbursement paid to providers of adult day health services for basic and complex levels of care.”  The budget also imposes a temporary moratorium on enrollment of new Adult Day Health providers until such time that a study is completed by the Executive Office of Health and Human Services. The study, due to the Legislature by December 31, 2011, will provide a basis for new licensure and rate structure and also will provide a needs assessment of ADH services going forward.

For more information, the full budget is available on Mass.gov.

Return to www.thinkhomecare.org.

Advocacy Alert: Oppose Co-Pays for Home Health

The debt ceiling negotiations are accelerating in Washington and a deficit reduction deal could be imminent.  Clearly, from news reports, we know that  Medicare cuts are under serious consideration, including the imposition of a home health co-payment.

The Medicare Payment Advisory Commission (MedPAC), the National Commission on Fiscal Responsibility and Reform, and the Congressional Budget Office have all supported a copayment as a deficit reduction measures.   Also on the table, as reported in today’s Boston Globe, a substantial cut to medical education funding for Massachusetts teaching hospitals.   Given the clear evidence that imposing copayments can lead to delaying accesses to needed services (adding costs longer term), home health must send a message to their Senators and Representative urging them to oppose a home health co-pays in deficit reduction negotiations.

Given that these decisions may be made as early as next week, we are asking that you contact our federal officials, especially Senators Kerry and Brown today.

You may send a message using the NAHC Legislative Action Network (NAHC LAN). To oppose home health co-pays and payment cuts, click here. The sample messages found on the NAHC LAN should be personalized to provide members of Congress with your background and the potential impact payment cuts and co-pays would have on senior and disabled Medicare beneficiaries and their families in your state and district.

We suggest also weighing in by phone.  When calling, ask to speak to the staffer who handles Medicare issues.  You may obtain contact information for your Senators and Representative here:  Contact Your Elected Officials.  For a sample phone message, click here.

Return to www.thinkhomecare.org.