Category: Regulation

Community-Based Care Transitions Program Announces New Participating Sites

A second round of participating sites were announced by CMS for the Community Based Care Transitions Program (CCTP) and two teams of providers are in Massachusetts.

Covering the central and western part of the state, the accepted projects are from Elder Services of Berkshire County, which includes Berkshire VNA as a partner, and Elder Services of Worcester, which includes a partnership with Metrowest Home Care & Hospice. A summary of the Berkshire County project has not been posted, but the Worcester/Metro West project summary was posted and notes the prior care transitions experience of Metrowest Home Care & Hospice. That project draws on the home care agency’s experience by including a transition RN, telephonic support above what the Coleman care transition model calls for, and also a palliative care component is implemented when necessary.

CMS continues to accept applications for the CCTP with dates for review listed below. The Home Care Alliance has resources available for any  home care agencies interested in applying or for entities looking to include agencies as partners. Those interested can contact James Fuccione at HCA.

  • March 27, 2012– Applications must be received by March 6th to be considered for this review
  • April 10 – Applications must be received by March 20th to be considered for this review
  • April 26 – Applications must be received by April 5th to be considered for this review
  • May 10 – Applications must be received by April 19th to be considered for this review
  • May 30 – Applications must be received by May 9th to be considered for this review
  • June 11 – Applications must be received by May 21st to be considered for this review
  • June 28 – Applications must be received by June 7th to be considered for this review

Return to www.thinkhomecare.org.

US House/Senate Approaching Deal on Delaying Physician Cuts, Payroll Tax

House and Senate leaders have agreed on legislation to be voted on by their respective colleagues that delays a cut to Medicare fees to physicians.

By passing that legislation, physicians will avoid a 27 percent cut for another 10 months, the payroll tax holiday will be extended for one year, and unemployment insurance will be extended. According to the National Association for Home Care & Hospice, the physician fix has to be offset, but the proposal does not include any cuts to home care or hospice and does not include any home care copay.

What it does include is cutting Medicare bad debt payments for hospitals and nursing homes by about $6.9 billion over ten years; cutting clinical lab payments by $2.7 billion; rebasing Medicaid Disproportionate Share Hospital payments to save more than $4 billion; cutting the Affordable Care Act (ACA) prevention fund by $5 billion; and eliminating extra federal money provided by the ACA to Louisiana Medicaid, saving $2.5 billion.

As reported in a previous newsfeed post, the President’s proposed budget does include home care cuts and copays, which, if approved, would come on top of scheduled cuts from the affordable care act and a 2% cut from the federal budget sequestration process.

Both the House and Senate are expected to pass the deal today (Friday, February 17) and the President will sign the bill into law as soon as it reaches his desk.

For more information on the “physician fix” and payroll tax legislation, see stories from the Associated Press,  CNN, and USA Today.

Return to www.thinkhomecare.org.

President Obama Releases Budget with Copays and Payment Impact for Home Care

President Barack Obama released his proposal for the Fiscal Year 2013 Federal Budget with a scaled back version of copayments for home health care as well as payment adjustments for all post-acute providers.

According to the President’s proposal, a home health copayment of $100 per home health episode would be established and would be applicable for episodes with five or more visits not preceded by a hospital or other inpatient post-acute care stay. This, the budget narrative continues, would ap­ply to new beneficiaries beginning in 2017. The President’s budget notes that this is consistent with a MedPAC recom­mendation to establish a per episode copayment, although MedPAC had recommended a more severe copayment of $150 per episode.

MedPAC’s recommnedation cited by the President’s budget team noted that “beneficiaries without a prior hospitalization account for a rising share of epi­sodes” and that “adding beneficiary cost sharing for home health care could be an additional mea­sure to encourage appropriate use of home health services.” This proposal is estimated to save approximately $350 million over 10 years.

According to the National Association for Home Care & Hospice (NAHC), the President’s Budget also includes a reduced Market Basket Index (inflation) update from 2014 to 2021. The proposed update reductions of 1.1 percentage points each year affect all post-acute providers. These reductions, NAHC states, would be in addition to the 2014 home health rate rebasing and the productivity adjustments starting in 2015. The President estimates this measure will save $63 billion over ten years taking into account the other adjustments for all post acute providers.

Additionally, the Independent Payment Advisory Board (IPAB), which was initially established in the Affordable Care Act, will be strengthened under the President’s budget proposal. The group is charged with keeping Medicare solvent by enacting cost-saving measures if Medicare spending exceeds certain levels. The President’s proposal essentially lowers those spending triggers.

The budget blueprint touts some of the fraud and abuse crackdown and prevention achievements the administration has made and advances suggestions for furthering that effort:

  • Cre­ate new initiatives to reduce improper payments in Medicare;
  • Dedicate penalties for failure to use electronic health records toward deficit reduction;
  • Update Medicare payments to more appropriately account for utilization of advanced imaging;
  • Re­quire prior authorization for advanced imaging;
  • Direct States to track high prescribers and utiliz­ers of prescription drugs in Medicaid to identify aberrant billing and prescribing patterns; and af­firm Medicaid’s position as a payer of last resort by removing exceptions to the requirement that State Medicaid agencies reject medical claims when another entity is legally liable to pay the claim.
  • Alleviate State program integrity reporting requirements by consolidating redundant error rate measure­ment programs to create a streamlined audit program with meaningful outcomes, while main­taining the Federal and State’s government abil­ity to identify and address improper Medicaid payments.

Finally, the President’s budget makes a commitment to follow through on the Department of Labor’s proposed rule on removing the so-called “companionship exemption” for allowing overtime and minimum wage protections.

For more information, view the President’s budget proposal here.

Return to www.thinkhomecare.org.

 

ABI Waiver Unit Shares Information for Home Care Agencies

As mentioned in a previous newsfeed post, MassHealth is soliciting services for a new waiver to care for individuals with Acquired Brain Injury in the community.

The ABI Waiver Unit at UMass Medical, which is the entity in charge of managing the waiver and disseminating related information, has released three documents (see below) to assist interested home care agencies in learning more and applying for waiver participation. The ABI Waiver Unit has indicated that they are specifically seeking speech, occupational and physical therapy services in the home.

  • ABI Description – One page summary of the state agencies and their roles in the implementation of the ABI Waivers
  • 2012 Technical Assistance Schedule – Statewide information sessions held to provide potential providers the opportunity to learn more about the Provider Enrollment Process
  • Credentialing Supplement – Outlines the submission requirements and the service specific submission requirements and defines the service expectations.

To RSVP for any of the technical assistance sessions, or to ask for more information, contact ABInetwMGr@umassmed.edu or call the UMass ABI Waiver Unit at 866-281-5602.

Return to www.thinkhomecare.org.

 

State Seeking Providers to Enroll in Community Based Service Waiver for Persons with Acquired Brain Injury

MassHealth, The Massachusetts Rehab Commission and UMass Medical School’s Acquired Brain Injury Unit are seeking service providers who work with individuals with Acquired Brain Injury (ABI) that reside in the community.

Two home and community-based services waivers, which MassHealth anticipates will serve 300 people over three years, are available for persons with ABI. These waivers, listed below, could help Medicaid-eligible persons with ABI move to the community from a nursing facility or chronic or rehabilitation hospital and get community-based services.

  • ABI Waiver with Residential Habilitation (ABI-RH) – This waiver is for individuals who need service in a provider-operated residence that has supervision and staffing 24 hours a day, seven days a week.
  • ABI Waiver with No Residential Habilitation (ABI-N)– This waiver is for individuals who can move to their own home or apartment or to the home of someone else.

All waiver participants will work with a case manager to develop a service plan that will reflect the waiver services and support they need in the community.

Services available in the ABI waivers include:

  • day services;
  • supported employment;
  • transportation;
  • community-based substance abuse treatment;
  • occupational, physical, or speech therapy;
  • specialized medical equipment;
  • homemaker;
  • personal care;
  • adult companion;
  • chore;
  • home-accessibility adaptations;
  • individual support and community habilitation; and
  • respite.

Additional ABI waiver services that will be contracted through MRC include:

  • Residential habilitation services; and
  • Transitional assistance services.

MassHealth regulations and provider enrollment forms are available here.

Also, UMass Medical School will be holding a series of technical assistance sessions to provide an overview of the waivers and services offered as well as an in-depth review of the application forms and submission requirements. The schedule for those sessions is below, and RSVP’s or questions can be sent to ABInetwMGr@umassmed.edu or by calling 866-281-5602.

 

 

 

 

 

 

Return to www.thinkhomecare.org.

Governor Releases FY13 Budget Blueprint

Governor Deval Patrick released his proposal for the state’s fiscal year 2013 budget, which sets the stage for the legislature to work out their own versions and come to an eventual agreement over the next six months.

The Governor’s budget does not include any projected increases or cuts for home health, as is the case with most programs (MassHealth Nursing Home Supplemental Rates are reduced from FY12 spending by more than $300 million in the Governor’s proposal).  The MassHealth line items are almost all increased to “meet projected need,” which just translates to level funding. Here is a list of the line-items of note, including the MassHealth accounts.

  • MassHealth Managed Care (line item 4000-0500) increased $183,988,029 over FY12 spending to $4,164,475,376
  • MassHealth Senior Care (line item 4000-0600) increased $196,976,192 over FY12 spending to $2,763,630,662 .
  • MassHealth Fee-for-Service Payments (4000-0700) increased $129,850,745 over FY12 spending to $1,939,680,126.
  • Home Care Purchased Services (9110-1630) had a short increase just over $2,000 to $97,783,061.
  • Elder Enhanced Home Care Services (9110-1500) increased $672,147 to $46,461,487 .

The Governor’s office provides more details on health care costs and reasoning for those decisions here. The Home Care Alliance will continue to provide more information as further analysis is completed. The Alliance will once again be advocating for line items of concern as the budget process moves forward, including on issues like payment rates and telehealth reimbursement from Medicaid.

For more general information, several articles from sources like Boston.com and MassLive.com are available that explain some of the Governor’s budget as well.

Return to www.thinkhomecare.org.

 

HCA Informs Members on Pioneer ACO and Independence at Home Programs

The Home Care Alliance held a well-attended conference call to inform members about two major programs recently announced by CMS:

First, the Department of Health and Human Services announced the first 32 organizations in 18 states that will participate in the new Pioneer Accountable Care Organization (ACO) initiative. This program is operated by the CMS Innovation Center under Section 3022 of the Affordable Care Act. Selected Pioneer ACOs include “physician-led organizations and health systems, urban and rural organizations, and organizations in various geographic regions of the country.” Five of those organizations are in Massachusetts:

  • Atrius Health Services
  • Beth Israel Deaconess Physician Organization
  • Mount Auburn Cambridge Independent Practice Association (MACIPA)
  • Partners Healthcare
  • Steward Health Care System

This Pioneer ACO Presentation was given by HCA Executive Director Pat Kelleher on the call and explains some of the points that home care agencies should be aware of as the initiative moves forward.

The CMS Center for Innovation also has a site full of resources on Pioneer ACO’s including FAQ’s and brief summaries of the selected ACO’s.

WBUR’s CommonHealth Blog had a feature on Pioneer ACO’s and asked each of the five accepted systems in Massachusetts what the program will mean for patients.

The second program announced was a solicitation for the new Independence at Home Demonstration Program (IAH), which aims to test a service delivery model that utilizes physician and nurse practitioner-directed primary care teams to provide services to certain Medicare beneficiaries with multiple chronic illnesses in their homes.

HCA also gave this presentation on the Independence at Home Demonstration on the conference call for members to explain that home care agencies can be a major partner to physician practices, despite the fact that the program is directed by a physician or nurse practitioner-led practice with experience in making home visits.

The IAH Demonstration’s webpage also has FAQ’s as well as the solicitation and application.

The Alliance will pass along any more information as it becomes available.

Return to www.thinkhomecare.org.

 

New Advocacy Message to Support Nurse Delegation

The “Nurse Delegation” bill (S.1138, An Act Relative to Home Health Aides) has been stuck in the Joint Committee on Public Health since it was among a list of other matters that had a public hearing last July.

The Home Care Alliance’s Legislative Action Center now includes an email message that can be sent to the committee urging them to advance the bill forward in the legislative process! Just follow the instructions on this link to take action.

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NewMMIS Announcement of Grace Period for Electronic Claims Submission Policy

All Provider Bulletins 212  from May 2011 (“Important Claims Submission Policy Changes”) and 217  from September 2011 (“Waiver Policy for Claim Submissions”) both announced an important change in the claims submission policy. Effective January 1, 2012, all MassHealth claims must be submitted electronically unless a provider has an approved electronic claim submission waiver.

Effective January 1, 2012, MassHealth will implement a 90-day grace period of the claims submission policy to allow providers additional time to convert to electronic claims submission and to apply for the electronic claim submission waiver. MassHealth will issue an all provider bulletin in January that further explains this grace period.

Questions can be directed to MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.

Return to www.thinkhomecare.org.

CMS Announces Independence At Home Demonstration Program

CMS continues to roll out initiatives from the Affordable Care Act in an attempt to test new ways to improve health care and lower cost.

The latest in this line of programs and funding opportunities is the Independence At Home Demonstration (Section 3024 of the ACA), which aims to test a service delivery model that utilizes physician and nurse practitioner-directed primary care teams to provide services to certain Medicare beneficiaries with multiple chronic illnesses in their homes.

According to the Independence At Home (IAH) Program Solicitation, in order to be involved in the Demonstration, “practices must be individual physicians or nurse practitioners or interdisciplinary teams composed of various members such as physicians, nurse practitioners, physician assistants, pharmacists, social workers, and other supporting staff.” The program itself is designed to provide comprehensive, coordinated, continuous and accessible care to high-need patients and to coordinate health care across all treatment settings.

Even though primary care is the lead in the IAH demo, the focus is on delivering care to patients in their homes and getting beneficiaries what they need to remain independent. In other words, the program could actually be of significant benefit to the home care industry as a whole because primary care practitioners will be making check-ups in the home and witnessing how patients function in their day-to-day environment. Based on those visits, the practices will be identifying services – like home care and other community based services – that help keep people out of costlier settings and the ER.

Practices are required to use electronic health systems and remote patient monitoring, both of which are used by many home health agencies. Also, practices must be available 24 hours per day, seven days per week to carry out plans of care. Applicable beneficiaries must have at least two chronic illnesses, must need human assistance with two or more Activities of Daily Living (ADL’s), have had a non-elective hospital admission within the last 12 months and have used acute or sub-acute rehabilitation services within the last 12 months.

HCA encourages agencies to see the other guidelines, which are laid out in the IAH Solicitation and a summary is provided in a PowerPoint provided on the IAH program webpage.

Return to www.thinkhomecare.org.