Category: Advocacy

HCA Urges Congress to Comment on Proposed Medicare Rule

The Home Care Alliance has distributed a letter to the Massachusetts Congressional Delegation, including Senators Kerry and Brown, in hopes that they will sign on and forward the comments to the Centers for Medicare and Medicaid Services (CMS) on behalf of the home health industry. The letter is in response to a CMS proposed rule that would severely threaten access to care services.

The letter urges CMS to scale back broad Medicare cuts to home health based on “case mix creep” and “upcoding,” among other factors, and alter the physician face-to-face visit requirement so that it is not a barrier between patients and the care they need.

Please contact your Congressperson TODAY, and urge them to support the comment letter.

Return to www.thinkhomecare.org.

Help Promote HOME CARE VOTES

The Home Care Alliance has prepared an awareness campaign centered on “getting out the vote” for home health and home care patients.

Patients served by home care agencies may not be able to physically get to their polling place to vote, but absentee ballots are available so that people can retain one more piece of their independence by exercising their right to vote from home.

This program involves informing patients that absentee ballots are available at their local town and city halls. All they have to do is apply by mail or have a family member apply to receive one. Your staff can help patients fill out the information to apply for the absentee ballot and even assist the patient in filling out the ballot itself, so long as the patient verifies the ballot and the fact that they were assisted with their signature.

For agencies who are interested, a press release is available upon request for local media (Note: for Medicare-certified agencies, the press release can be used as an opportunity to also raise awareness around the CMS proposed rule changes).

This program is one more way to have the voice of home care heard at a critical time. Please contact the Alliance for more information.

Return to www.thinkhomecare.org.

 

Chronology of Health Care Reform Provisions Affecting Home Care

Below is a timeline for when provisions of national health care reform impacting home care are set to be implemented.

The Table comes courtesy of the National Association for Home Care & Hospice.

January 1, 2010 

(proposed extension to January 1, 2011 by regulation)

 Sec. 6407. Face to face encounter with patient required before physicians may certify eligibility for home health services or durable medical equipment under Medicare; Sec. 10605 of Manager’s Amendment. Certain other providers permitted to conduct face to face encounter for home health services.
Face-to-face physician encounter requirement (including telehealth encounter) with patients within a reasonable timeframe as determined by the Secretary; nurse practitioners, advanced practice nurses, and physician assistants may substitute for physicians to meet the face-to-face encounter requirement.
January 1, 2010 Sec. 6406. Requirement for Physicians to Provide Documentation on Referrals to Programs at High Risk of Waste and Abuse.
Physician must maintain and provide access to documentation on Medicare home health referrals if requested. Home health agencies must maintain and provide access to documentation of certification of Medicare home health services if requested.
April 1, 2010 Sec. 3131. Payment Adjustment for Home Health Care
Sec. 3131(c). Application of the Medicare Rural Home Health Add-on Policy.
3% rural add-on for episodes and visits ending on or after April 1, 2010 and before January 1, 2016.
July 1, 2010 (regulation out July 6) Sec. 6405 Physicians who order items or services required to be Medicare enrolled physicians or eligible professionals; Sec. 10604 of Manager’s Amendment. Technical Correction to Section 6405.
Medicare enrolled physician requirement regarding care plan certification
September 30, 2010 Sec. 5101. National Health Care Workforce Commission. 

Establishes commission to review health care workforce and projected workforce needs.
October 1, 2010 Sec. 2401. Community First Choice Option. Expanded Medicaid home care through agencies and self-directed care.
October 1, 2010 Sec. 2402. Removal of barriers to Home and Community based Services.
Expanded rebalancing requirements and waiver authority and removal of restrictions on waivers.
October 1, 2010 Sec. 2403. Money Follows the Person Rebalancing Demonstration.
Extension through September 2016.
2010 Sec. 6401. Provider Screening and other enrollment requirements under Medicare, Medicaid, and CHIP.
Require background screening and credentialing of provider and supplier owners and managers, require compliance plans, gives CMS the authority to impose a temporary moratorium on new providers
2010 Sec. 3502. Establish Community Health Teams to Support Patient-Centered Medical Home. 

Grants to community-based interdisciplinary, interprofessional teams to support primary care practices; includes chronic care management.
2010 Sec. 6201. Nationwide program for National and State background checks on direct patient access employees of long-term care facilities and providers.
Extends existing pilot program for background checks on direct patient access employees of long-term care facilities and providers to a nationwide program (based on individual state choice of participation).  Definition of long-term care facility or provider includes providers of home care.
2010 – 2014 Sec. 4201. Community Transformation Grants 

Competitive grants to State and local governmental agencies and community based organizations for the implementation, evaluation and dissemination of evidence-based community preventive health activities in order to reduce chronic disease rates, prevent the development of secondary conditions, address health disparities and develop a stronger evidence-base of effective prevention programming.  Authorized appropriations for 2010 – 2014.

2010 Sec. 10501. National Diabetes Prevention Program 

Grants to entities determined by the Secretary for community-based diabetes prevention programs.
2010 – 2014 Sec. 4202. Healthy Aging, Living Well; Evaluation of Community-Based Prevention and Wellness Programs for Medicare Beneficiaries  

Grants to state or local health departments and Indian tribes to carry out 5-year pilot programs to provide public health community interventions, screenings, and clinical referrals for individuals between 55 and 64.
2010 Sec. 4204. Demonstration Program to Improve Immunization Coverage. 

Demonstration program awarding grants to states to improve the provision of recommended immunizations through the use of evidence-based, population-based interventions for high-risk populations.
2010 – 2015 Sec. 2951. Grants for Early Childhood Home Visitation. 

Grants to states to establish quantifiable and measurable 3 and 5 year benchmarks to demonstrate improvements in maternal and newborn health, prevention of child injuries and abuse, improvements in family economic self-sufficiency and school readiness/achievement, and improvements in coordination and referrals between other community resources.
2010 (authorized for five years, with option of additional five years) Sec. 2601. Medicaid Waiver Demonstration Projects for Dual Eligibles. 

Medicaid waivers for coordinating care for dual eligible beneficiaries.
January 1, 2011 Sec. 2703. Health Homes for Chronically Ill Patients 

Planning grants to states to develop a new state plan option to permit Medicaid enrollees with at least two chronic conditions, one condition and risk of developing another, or at least a serious and persistent mental health condition to select a designated provider (could include a home health agency), a team of healthcare professionals operating with such a provider, or a health team as the individual’s health home for purposes of providing the individual with health home services.  States taking up option provided with 90 percent of FMAP for two years for home health related services, including care management, care coordination, and health promotion.
January 1, 2011 Sec. 3021. Establish a Center for Medicare and Medicaid Innovation within CMS.
Opportunities for chronic care and other initiatives includes funding home health providers who offer chronic care management services to applicable individuals in cooperation with interdisciplinary teams (xiv).  Telehealth advancement opportunities through new CMS Innovations Center but no guarantee.
January 1, 2011 Sec. 3026. Community Based Transitions Program 

Funding for hospitals with high admission rates and community-based organizations that improve care transition services for high risk Medicare beneficiaries.  ($500 million total.)
January 1, 2011 Sec. 3131. Payment Adjustment for Home Health Care
Sec. 3131(b). Program Specific Outlier Cap.
Beginning in 2011, cap total outliers at 2.5%; impose individual agency outlier cap of 10%.
January 1, 2011 Sec. 3401 Revision of certain market basket updates and incorporation of productivity improvements into market basket updates that do not already incorporate such improvements.; Sec. 10319 of Manager’s Amendment. Revisions to market basket adjustments.
Reduce home health market basket update by 1 percentage point in 2011, 2012, and 2013.
October 1, 2011 Sec. 3006. Plans for a Value-Based Purchasing Program for Skilled Nursing Facilities and Home Health Agencies.
Secretary of HHS shall submit plan for value—based purchasing program for home health agencies to Congress by Oct. 1, 2011.
2011 (enroll) 

2016 (coverage begins)

 Sec. 8001. Community Living Assistance Services and Supports Act (CLASS Act).
Establish voluntary national home and community-based long term care insurance program. Beneficiaries vest after 5 years paying premiums.
January 1, 2012 Sec. 3024.  Independence at Home demonstration program.
Tests a payment incentive and service delivery model that utilizes physician and nurse practitioner directed home-based primary care teams.
January 1, 2012 – December 31, 2016 Sec. 2704. Bundled Payments Medicaid. 

Medicaid demonstration project in 8 states to pay bundled payments to hospitals for episodes of care that include hospitalizations.
January 1, 2012 Sec. 3022. Accountable Care Organizations. 

Establishes a shared savings program that rewards Accountable Care Organizations (ACO) that take responsibility for the costs and quality of care.  ACO’s may include groups of health care providers.
October 1, 2012 Sec. 3025. Hospital Readmissions and Reductions Program.
Reduce hospital payments for readmissions.
January 1, 2013 Sec. 3023. National Pilot Program on Payment Bundling.
Directs HHS Secretary to develop a national, voluntary pilot program encouraging bundled payment models for hospitals, doctors, and post-acute care providers. Entities including a hospital, a physician group, a SNF and a home health agency may apply to participate. Requires the Secretary to establish this program by January 1, 2013 for a period of five years. Before January 1, 2016, the Secretary is also required to submit a plan to Congress to expand the pilot program if doing so will result in improving the quality of patient care and reducing spending.
January 1, 2014 Sec. 3131. Payment Adjustment for Home Health Care; Sec. 10315 of Manager’s Amendment. Revisions to Home Health Provisions.
Rebase starting in 2014 phasing in through 2017; rebasing adjustment limited to no more than 3.5% reduction per year.
January 1, 2014 – December 31, 2018 Sec. 2404. Protection for Recipients of Home and Community Based Services Against Spousal Impoverishment.
Spousal impoverishment protection for home care eligibility.
January 1, 2014 Sec. 1513. Shared Responsibility for Employers.
Assess employers with more than 50 employees that do not offer coverage and have at least one full-time employee who receives a premium tax credit a fee of $2,000 per full-time employee, excluding the first 30 employees from the assessment. (Effective January 1, 2014) 

Exempt employers with 50 or fewer employees from any of the above penalties.
January 1, 2014 Sec. 10108. Free Choice Vouchers.
Require employers that offer coverage to their employees to provide a free choice voucher to employees with incomes less than 400% FPL who choose to enroll in a plan in the Exchange. The voucher amount is equal to what the employer would have paid to provide coverage to the employee under the employer’s plan and will be used to offset the premium costs for the plan in which the employee is enrolled. Employers providing free choice vouchers will not be subject to penalties for employees that receive premium credits in the Exchange. (Effective January 1, 2014) 

The term ‘full-time employee’ means an employee who is employed on average at least 30 hours of service per week.
January 15, 2014 Sec. 3403. Independent Medicare Advisory Board; Sec. 10320 of Manager’s Amendment. Expansion of the Scope of, and additional improvements to, the Independent Medicare Advisory Board.
Establish an Independent Payment Advisory Board comprised of 15 members to submit legislative proposals containing recommendations to reduce the per capita rate of growth in Medicare spending if spending exceeds a target growth rate. Beginning January 15, 2014, in years when Medicare costs are projected to be unsustainable, the Board’s proposals will take effect unless Congress passes an alternative measure that achieves the same level of savings. The Board would be prohibited from making proposals that ration care, raise taxes or Part B premiums, or change Medicare benefit, eligibility, or cost-sharing standards.
March 1, 2014 Sec. 3131(d). Study and Report on the Developments of the Home Health Payment Reforms In Order to Ensure Access to Care and Quality Services.
By March 1, 2014, HHS Secretary must report on home health rebasing and impact on access and quality.
March 1, 2014 Sec. 10315 (b).  Revisions to Home Health Care Provisions.

HHS Study and Report: By March 1, 2014, HHS must report results of a study with recommendations for legislative and administrative action, regarding home health agency costs for care provided to low-income beneficiaries or those in medically underserved areas, and those with varying levels of severity.
2014 Sec. 1302. Essential Health Benefits Requirements 

Secretary shall define essential health benefits with respect to any health plan; provides for notice and opportunity for public comment.
January 1, 2015 Sec. 3131(2)(B). MedPAC Study and Report.
MedPAC shall report by Jan. 1, 2015, on impact of rebasing.
January 1, 2015 Sec. 3401. Revision of Certain Market Basket Updates and Incorporation of Productivity Improvements into Market Basket Updates That Do Not Already Incorporate Such Improvements.
Annual productivity adjustment (estimated 1 percentage point reduction) beginning 2015.
January 1, 2015 Sec. 10315 (b) Revisions to Home Health Care Provisions.

Medicare Demonstration Project: HHS Secretary may provide for a four-year (beginning no later than January 1, 2015) $500M demonstration project to test whether making payment adjustments based on the study substantially improve access to care for patients with high severity levels of illness or for low-income or underserved Medicare beneficiaries.

Return to www.thinkhomecare.org.

Join Us for Annual Falls Awareness Day Event

What: 4th Annual Falls Prevention Awareness Day

When: September 22, 10:00am – 12:00pm

Where: Nurses Hall, Massachusetts State House, Boston

Come join the Home Care Alliance of Massachusetts, DPH Commissioner John Auerbach, the MA Executive Office of Elder Affairs, and others for this year’s Falls Prevention Awareness Day. The event will include speakers, a presentation of proclamations from the Massachusetts Senate and on behalf of Governor Deval Patrick and more.

For more information, check out the event flyer and contact the Alliance if you are interested in attending.

Return to www.thinkhomecare.org.

 

Call for Comments to CMS on Case Mix, Other Important Issues

Issue:

The Home Care Alliance is asking all Medicare-certified agencies to submit comments on the Proposed Rule issued by CMS on July 16, 2010, which addresses a variety of subjects that raise numerous concerns for home health services. These matters include:

  • 2010 HH PPS payments rates with a 3.89% case mix creep adjustment
  • New standards for therapy coverage, patient assessment, and documentation
  • Requirements for physician face-to-face encounters for care plan certification
  • Modifications of the 36-month rule on ownership changes
  • Modification of claims coding and data collections
  • Consumer Assessment of Healthcare Providers and Systems (CAHPS) implementation

Case Mix Background:

CMS has implemented three case mix weight change adjustments to date—2.75% rate reductions in each of 2008, 2009, and 2010. It planned on an additional reduction of 2.71% in 2011. In its recent Proposed Rule, CMS proposes to increase the 2011 adjustment to 3.79% and to add a further 3.79% adjustment in 2012.

With these adjustments NAHC estimates that nearly 45% of home health agencies would receive Medicare payments that are below the cost of care. These rate cuts are in addition to the projected $39.7 billion in cuts coming from the 2010 federal health care reform legislation.

Action:

Please make sure you send your comments on these matters to three places:

1) CMS

  1. a. By Mail: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1510-P, P.O. Box 1850, Baltimore, MD 21244-1850
  2. b. Or electronically by clicking here, then clicking “submit comment.”

2)      The Home Care Alliance of Massachusetts

3)      Your Congressperson

Also, please contact your congressperson and urge their support of the Home Health Planning Improvement Act and the Home Health Access Protection Act.

Aside from the obvious destination of sending comments to CMS, it is important for the Home Care Alliance to compile testimony for federal advocacy. Information is vital in making the argument against case mix adjustments, face-to-face encounters for care plan approval, and etcetera.

In addition, your agency sending comments to your Congressperson and asking that they in turn assist in this process is another very important step. HCA will follow up with your elected official once we have received your comments, but it is important for them to hear from businesses in their district that deliver care to their constituents.

Comments to CMS are due by September 14, and agencies are encouraged to have staff, patients and their families submit comments on these matters as well. The Home Care Alliance will have testimony available for agencies to view at least two weeks prior to the deadline.

Please contact James Fuccione at the Home Care Alliance if you have any questions.

Return to www.thinkhomecare.org.

US House Approves Medicaid Funds

The US House of Representatives approved a $26.1 billion package that includes funds for education and Medicaid services. The proposal now goes to the President for his signature.

Estimates are that $655 million will come to Massachusetts with about two-thirds allocated for Medicaid.

The Boston Globe reports on today’s vote in this article and more information is available in a previous newsfeed post when the US Senate approved the funding proposal.

Return to www.thinkhomecare.org.

Medicaid Funding for States Clears US Senate

A federal program aimed at sending states funding for education and Medicaid providers cleared the US Senate by a vote of 61-38, according to reports by CNN and the Boston Globe.

Out of the $16 billion in Medicaid money and $10 billion for education, Massachusetts stands to receive $655 million in total with $405 million in one-time funds allocated for Medicaid services.

Massachusetts was one of 30 states that constructed their budget with the expectation that FMAP, or Federal Medical Assistance Percentages that supply federal funds to state Medicaid operations, would be extended. When that action was delayed, however, the state had to come up with a contingency budget that set up Medicaid-funded programs to be compensated mostly by the Massachusetts General Fund and a smaller percentage coming from FMAP.

Without these funds, Massachusetts and other states would be forced to make cuts. The program now moves to a vote in the US House of Representatives.

Return to www.thinkhomecare.org.

Conversation with Congressman John Tierney

North Shore Elder Services and the Danvers Council on Aging are hosting a conversation with Congressman John Tierney.

When: August 17, 1:30-3:30
Where: Danvers Council on Aging, 25 Stone Street, Danvers

Any person or Home Care Alliance member interested in attending is urged to ask for the Congressman’s support of the following:

If you have any questions or would like more information, please contact the Alliance.

Return to www.thinkhomecare.org.

Last Push for Nurse Delegation Bill in House

The Home Care Alliance and other organizations supporting S.860, An Act Relative to Home Health Aides, are making a final push to get the legislation before the full House of Representatives for a vote.

July 30 and 31 are the last days of the legislative session so we need your emails and phone calls today to your state reps to urge support for the Nurse Delegation bill.

Click here and fill out the form to send an email or, if you prefer to call, click here to find out who represents you in the Massachusetts House.

For more information on Nurse Delegation, go to our blog and search “nurse delegation” or “S.860.”

Return to www.thinkhomecare.org.

Support Needed for NPs, PAs Signing Home Health Plans of Care

Legislation has been introduced in both the US House and Senate to allow nurse practitioners, physician assistants, and certified nurse specialists to sign  home health plans of care:  S. 2814; H.R. 4993.

At present, only two members of the Massachusetts Congressional delegation have signed on to these bills:  Congressmen McGovern and Olver.  The goal is to get 100 cosigners before the August recess. Please contact your elected federal officials and ask them to sign on.  The Legislative Action Page of the Alliance website includes  background information (scroll down on the page until you see the subject “Allow NPs/PAs to Order Home Health Services).

Return to www.thinkhomecare.org.