Category: Advocacy

Alliance Testifies on Home Care Legislation to Committee on Elder Affairs

The Massachusetts Legislature’s Joint Committee on Elder Affairs held a public hearing on July 31, 2017. Several of the bills heard are of interest to home care.

The committee heard testimony on bills relating to:

  • Home Care Licensure/Worker Registries:
    • S.364/H. 341 An Act Strengthening the Massachusetts Home Care Program
    • H. 344 An Act Relative to Consumer Protection and Home Care Services
    • H. 1187 An Act relative to home health and hospice aides
    • H. 2068 An Act Establishing a Home Care Aide Training Registry
    • H. 2889 An Act Strengthening Home Care Services
    • S.343 An Act Establishing a Home Care Aide Training Registry
  • Home Care Workforce Bill (Enough Pay to Stay Initiative)

The Home Care Alliance of Massachusetts and some of its members testified on all of the bills, and you can read that testimony at the links below:

If you have any questions, or would like any further information about these legislative proposals, do not hesitate to reach out to Jake Krilovich at jkrilovich@thinkhomecare.org.

Skilled Nursing Campaign Garners Media Attention

This week, the Alliance’s parent-provider skilled nursing campaign received national media coverage. The campaign seeks higher reimbursement rates from MassHealth for continuous skilled nursing services. Currently, agencies are unable to compete for nurses with area hospitals, and has led to a 37% nurse turnover rate, and nearly 24% of MassHealth-Authorized service hours going unfilled.

On Sunday, The Boston Globe featured a front-page story into the life of one of the parents caring for a child in the Massachusetts Continuous Skilled Nursing Program. Noelia Ferreira has gone over 100 days without a skilled nurse coming to her home to care for her daughter Abi. The article beautifully explains Noelia’s struggles to find adequate care and her commitment to keeping Abi safe at home.

As a result of this front page feature, WGBH invited Noelia and MA Pediatric Home Nursing Care Campaign founder, Angela Ortiz, to be interviewed by host, Jim Braude. Footage of the interview can be viewed here.

The campaign is leveraging this exposure to raise awareness and momentum in our fight for adequate reimbursement rates. Please visit www.mychildcantwait.com to write or call Governor Baker urging action.

Alliance Statement on NAHC President Val Halamandaris’ Passing

The Home Care Alliance of Massachusetts is deeply saddened by the passing of Val J. Halamandaris, president of the National Association for Home Care & Hospice (NAHC).

Val dedicated most of his professional life to public service, and transformed the home care industry over the last five decades by fighting for elderly, disabled, and dying Americans. For 20 years, he served as counsel to the Senate and House Committees on Aging before founding NAHC and serving as its president for the last 30 years.

When Val started at NAHC, home care wasn’t what it is today. Institutionalization of the elderly was the standard, and Val sought to change the United States’ policy on this fundamental issue.

“The home care industry suffered an enormous loss this week. Val Halamandaris’ dedication to fighting for Americans’ rights to age in their homes and receive the care that they deserve was unprecedented.We all mourn this loss, but celebrate his 50 years of commitment to our most vulnerable,” said Alliance Board Chair, Holly Chaffee.

Val is survived by his wife, Kathleen, three sons, their wives, six grandchildren, and his brother. A funeral mass will be held for him at 10:00 am on Saturday at St. Peter’s Roman Catholic Church on Capitol Hill in Washington, D.C. In lieu of flowers, memorial contributions may be made to the Caring Institute.

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Advocacy Success: Governor Baker Proposes Amendment to Home Care Worker Registry

Do you ever wonder if your phone calls into legislator’s offices’ ever do anything? I certainly do. The feeling that you care so deeply about an issue and fight so hard for it, but that the effort isn’t reciprocated by our elected officials.

Or how about when you hear legislators say, “I’m waiting to hear from constituents on this issue.”… Are they really? Do they actually want to hear from us?

When advocates ask me this, I’m always one to say ‘yes, they do want to hear from you.’ But I also understand how people feel when they see common sense solutions seemingly receive no consideration.

Before I go on, I need to disclose that we have to keep fighting for this particular issue. The legislature could reject the Governor’s proposal. But the advocacy behind the recently proposed Home Care Worker Registry should answer all of these questions above and serve as a model.

As you’ve heard numerous times from the Alliance, the Massachusetts Legislature has proposed and included in its final version of the FY18 budget a Home Care Worker Registry. This registry would require agencies to submit its worker’s private information like gender and home address to the Department of Elder Affairs. We have raised numerous legal and privacy implications for this legislation and have fought throughout the budget process to defeat and modify the language.

Last week, we sent out two advocacy action alerts asking you all to send emails into Governor Baker’s office requesting him to amend this registry language and insert an opt-in option for home care workers to chose whether they want this private information disclosed to agencies, ASAP contractors or employer organizations.

In total, Alliance members sent nearly 150 emails to the governor’s office, and yesterday afternoon we found out that the Governor sent back this section to the legislature offering an opt-in amendment. It was one of 9 sections in the over $40 billion budget that he chose to amend. Think about that for a second…

This is a clear accomplishment that proves these emails and phone calls do matter. That working with coalition partners in sync can make a difference.

But remember, we have work to do on this issue, so please keep an eye out for another advocacy alert that will urge the legislature to adopt the Governor’s suggestions and protect our workers!!

Brief Analysis: U.S. Senate’s Better Care Reconciliation Act

The United States Senate released its version of a new health care bill on June 22nd. Titled the Better Care Reconciliation Act (BCRA), the bill was met with energized advocacy groups immediately dispelling the measure. Earlier this week Congress’ nonpartisan budget referee, the Congressional Budget Office (CBO), estimated that 22 million people would be without insurance by 2026, 1 million less than the House bill which was passed in early May. Facing defeat in a floor vote, with nearly 8 Republican Senators coming out against the bill, Majority Leader Mitch McConnell (R-KY) delayed the vote until after the 4th of July Recess.

Here is a brief analysis of key provisions of the Senate Bill:

  • Medicaid Funding: The bill, like its House counterpart, vastly rolls back Medicaid expansion and phases out federal funding between 2021 and 2023 and further reductions would begin in 2025. The CBO estimates that Medicaid enrollment would fall by more than 15 million people by 2026. Like the House version, this bill would create a block grant mechanism calculated on a per capita basis. Governor Charlie Baker has expressed concern for this and noted that it could cost Massachusetts billions in federal Medicaid funding and leave nearly 264 thousand residents without insurance. The Governor also estimates that the state could face a $8.2 billion shortfall by 2025.
  • Pre-Existing Conditions: Unlike the House bill, insurance companies would be required to accept all applicants regardless of health status. That said, the bill allows states to ask permission to reduce required coverage of essential health benefits. This could result in massive increases for people who want to purchase a plan with essential health benefits. While the CBO estimates that some will see lower premiums, they will also see fewer benefits.
  • Adults Over 50: The Affordable Care Act (ACA) prevented insurers from charging older people more than 3 times what younger enrollees pay. Under the Senate Plan, insurers can charge five times more than younger people and ACA subsidies to help the lower income and elderly pay for insurance would be drastically lower.

What to watch? Since Congress is going through this process under a budget reconciliation rule, the Senate Bill must only have the same amount of savings on the deficit as the House version. Thus, since the Senate version saves over $320 billion over the next 10 years, and the House version saves approximately $100 billion over ten years, the Senate has roughly $200 billion to spend in order to build support with current ‘no’ vote Senators. Keep an eye on states that rely heavily on Medicaid funding, or states heavily impacted by the opioid epidemic. These are some of the Senators currently opposed to the bill, and Leadership may direct additional funding to their states to bring them to a ‘yes’ vote.

For more information or any questions, please contact Jake Krilovich at jkrilovich@thinkhomecare.org

Advocacy Alert: Budget Amendment to Ensure Access for Medically Complex Patients

Please send your legislators a message urging them to sign onto Representative Paul Donato’s budget amendment #769 which would provide funds to increase the pay of these nurses and ensure that our most medically complex citizens have access to the care they need.

Take Action Here

Issue Background: The Massachusetts Continuous Skilled Nursing program provides in-home skilled nursing care to support and keep people with medically complex needs safe at home. While MassHealth has recently proposed a very small increase to the rates for this service, the increase does nMA-State-Houseot make up for more than ten years with no increases.

Home care providers find that they are increasingly unable to compete with hospitals and other facilities for nurses; as a result,  hours of needed and authorized care are going undelivered,  leaving the patients vulnerable to expensive hospitalizations.

In 2016,  home health providers reported a 37% turnover rate of  their nurses, 53% of them left for higher pay at hospitals.

Return to www.thinkhomecare.org.

 

Advocacy Alert: Budget Amendment to Support Home Care Workforce

MA-State-HouseWhile demand for home based health and supportive care continues to grow in Massachusetts, the home care industry struggles to recruit and retain essential front line caregivers. New data collected last fall through a survey of home care agencies that contract with the state’s Aging Service Access Points (ASAPs) found that on average 25% of a home care agency’s direct care workforce changes every three months leading to intense instability within the organization.

Please click the link below to write or call your Representatives urging them to sign onto Representative Aaron Vega’s amendment #148 which begins to address the underlying causes for the growing home care worker shortage in Massachusetts and takes steps to assure that their will be workers to meet the demand.

Take Action Here

Massachusetts has been successful at rebalancing the long-term care system, and appropriately diverting consumers from nursing facilities to community care. Between FY12 and FY16, MassHealth has experienced a -5.8% reduction in annual bed days. The movement of care from nursing homes to the community has not been been met with the necessary reinvestments in workforce to ensure the workforce is available to support consumers in need of services. MassHealth has not raised the rate of reimbursement for a home health aide in almost a decade.

Return to www.thinkhomecare.org.

Alliance Quoted in Article on Worker Training, Background Checks

James Fuccione, former Director of Legislative and Public Affairs for the Home Care Alliance, was extensively quoted in an article in the Springfield Republican today.  The article, “Personal care attendants have less training, checks than other home care workers,” by Shira Schoenberg, Statehouse reporter for the Republican, compares background checks and training requirements for workers in the state Personal Care Attendant program with workers employed by home care agencies that provide services under the Executive Office of Elder Affairs home care program.

State Budget Cuts Impact Home Health Care

The Home Care Alliance participated in several calls with MassHealth and Health and Human Services on planned budget cuts from Governor Baker’s administration. In total, the Governor announced $98 million in cuts from the $39.25 billion state budget.

Although there are reductions in home health, there are positive rates increases to report.

After years of advocacy by the Alliance and more recent efforts from a coalition of continuous skilled nursing providers as well as a family-based network called the Mass. Pediatric Nursing Campaign, MassHealth informed the HCA that payment rates for Continuous Skilled Nursing will increase by 2.6%. According to MassHealth, this equates to a $2.2 million bump in rates, which will become effective January 1st, 2017.

For the RN and LPN day and night rates, the increase hovers around a $1 boost in what those agencies currently receive. The Alliance, along with the provider coalition and family-based campaign, will continue to advocate for further adjustments to continuous skilled nursing rates in the upcoming FY18 state budget cycle.

As for home health skilled nursing rates outside of CSN, payment will be reorganized by the length of service of the MassHealth member. As of July 1, 2017, MassHealth is planning to break up the current skilled nursing rate for home health agencies into three separate tiers. The first tier will be for patients on services from day 1 through 30, which will be increased from $86.99 to $89.21. The second rate tier will be 31-180 days and the third rate tier is any home health service beyond 180 days.

MassHealth has indicated that the rates in the second tier will remain relatively static and the third tier will be decreased, but post 30-day rates as of 7/1/17 will be budget neutral from the changes taking effect on January 1st. An announcement from EOHHS will specifically outline the new tiered rates, but according to MassHealth, anything regarding rates that is seen before the New Year is not finalized and therefore subject to change.

The other notable decrease will take effect on January 1st when MassHealth plans to approximate the budget impact of those proposed second and third rate tiers into the current post 60-rate. The cut in the post 60-day rate from 1/1/17 to 7/1/17 will be a 6.75% reduction. This means the current post 60-day rate of $69.59 will be roughly $64.89 for the first six months of 2017. (This rate remains higher than the medication administration rate originally considered by MassHealth.)

Laid out in another way, this will be how rates are currently planned to change:

January 1 – July 1:

Home health services post 60-day rate will be roughly $64.89 (6.75% reduction)

July 1:

Service days 1-30: $89.21

Service days 31-180: Rates will remain roughly the same, but are not yet finalized

Service days 180: Rates will be slightly reduced from the current post 60-day rate, but are not yet finalized.

MassHealth is also streamlining enrollment in the Independent Nursing program to cut their application process from 8 weeks down to one week.

The net state cut for home health is approximately $3.8 million out of $758 million in MassHealth spending on home health care services.

Most of the other cuts announced by the administration are restoring vetoes previously proposed by the Governor in the FY2017 budget, but that were overridden by the legislature. At that time, the Governor vetoed $255 million and the legislature overrode $231 million. Included in these cut overrides are certain hospital supplementary payments (particularly to pediatric and Western MA hospitals) as well as $1.1 million in cuts to public health hospitals.

Other impacted accounts include supplemental payments to nursing homes, which will be reduced by $2.8 million, as well as a $2.8 million cut to adult foster care (AFC).

The Pediatric Palliative Care account (4590-1503) is being reduced by $400,000.

The legislature has already announced their view that Governor Baker went too far with some of the announced cuts and they will be working on restoring some of the funding reductions.

HCA of MA has an upcoming meeting with MassHealth to review the Governor’s proposal.  Also on the agenda are issues with ICD-10 changes that are impacting agency billing and payment.

Return to www.thinkhomecare.org.

Advocacy Alert: Urge Congress to Delay Pre-Claim Review via the PUSH Act

With the election over, and Congress shifting slightly back to policy rather than politics, the Home Care Alliance is ramping up advocacy on an important piece of new legislation regarding CMS’ Pre-Claim Review Demonstration.

The Pre-Claim Undermines Seniors’ Health (PUSH) Act (H.R. 6226) offers relief from the demonstration, which has already created a chaotic and expensive mess in Illinois. Providers in that state initially experienced 60-80 percent denial rates and continue to struggle with “partial claim denials” that the Center for Medicare and Medicaid Services (CMS) does not count or recognizeU.S. Capitol Building. Pre-Claim Review also features a time-consuming new paperwork burden, an inefficient electronic system that cannot process documentation, and physician unfamiliarity with what is needed to be compliant due to poor education from CMS. These reasons have led to considerable cash flow problems at agencies, and at least one Illinois agency has closed its doors for good.

Massachusetts and three other states could soon be subject to the burdensome program if Congress does not act.

Please take a few minutes and send a message to your US representative urging repeal of the Pre-Claim Review Demonstration, sponsored by Rep. James P McGovern (D-MA) and Rep. Tom Price (R-GA). It only takes a minute to advocate and gaining support through congressional “co-sponsors” is critical.

Return to www.thinkhomecare.org.