Category: Regulation

MassHealth Releases Dual Eligible Demo Proposal for Public Comment

After months of stakeholder meetings and public presentations, MassHealth has released their official proposal for the “State Demonstration to Integrate Care for Dual Eligible Individuals” to the Centers for Medicare and Medicaid Services (CMS).

The initiative seeks to combine Medicare and Medicaid funding to contract with an Integrated Care Organization (ICO) that will pay for coordinated and comprehensive care for dually eligible individuals ages 21 to 64. Massachusetts was one of 15 states to be awarded a planning grant for the project and has been in contact with CMS on crafting benefit design, enrollment processes, and payment processes.

The release of the draft proposal initiates a 30-day public comment period that will remain open until 5:00 pm, January 10, 2012. Two public hearings are also planned at the following dates and locations:

  • December 16, 2011, 1 pm – 4 pm, at the Worcester Public Library, Saxe Room, 3 Salem Square, Worcester, MA
  • January 4, 2012, 9 am – 12 noon, at the State Transportation Building, Conference Rooms 2 & 3, 10 Park Place, Boston, MA

For any agencies caring for dually eligible patients, we strongly encourage you to look at the proposal and send in comments. The Home Care Alliance would also like any case studies of these patients that agencies have been successful in keeping in the community.

Agencies can send comments to: duals@state.ma.us, or mailed to:

Executive Office of Health and Human Services
Attn:  Lisa Wong
One Ashburton Place, Rm. 1109
Boston, MA 02108

Return to www.thinkhomecare.org.

CMS Care Transition Program Update and Guidance

Masspro, the state’s quality improvement organization, held a conference call on the CMS Community Based Care Transitions Program and provided some useful guidance for those looking to apply or reapply for funding.

Based on a CMS call with QIO’s, there were three common elements that tripped up applications from community based organizations, hospitals and other partners:

  • Firstly, in many applications, CMS said that it was not clear that the community-based organization was eligible and did not fit the criteria laid out in the solicitation, fact sheets and Q&A’s.
  • Second, many applications included budget items that were outside of what CMS would fund. For instance, CMS will only fund activities directly related to the intervention and not indirect costs like data collection. CMS is also said to be aiming for an across-the-board 20 percent reduction in readmissions for the program collectively as an attainable and reasonable target. Budgets within an application should reflect that element.
  • Lastly, CMS found that there were a lack of community partnerships in the applications they reviewed. Looking at the seven successful applications, it is clear that there is a large group of partners serving a relatively broad geographic region.

In addition to the Masspro call, CMS has once again updated their CCTP webpage to include panel review dates for incoming applications through March 27th. Also, summaries of all seven of the successful applications are now posted.

The Home Care Alliance will continue to provide guidance and assistance to home care agencies interested in applying and will connect any hospital or community partners looking for home care agencies in their area.

Return to www.thinkhomecare.org.

EOHHS Hosting FY2013 Budget Hearings

The Home Care Alliance is collecting written testimony and encouraging those interested to present oral testimony for upcoming hearings being hosted by the Executive Office of Health and Human Services (EOHHS) on the upcoming Fiscal Year 2013 budget.

Indications have been made that the upcoming budget will be just as difficult as those in previous years so it is important that home care agencies show up and submit written comments to convey the significance and value of the services they provide. EOHHS is seeking input about the best ways to preserve core services to the fullest extent possible without additional expenditures. As such, the Alliance suggests that agencies promote work in care transitions, disease management, and the general value of keeping people independent at home. The Alliance is also pushing for MassHealth coverage of telehealth technology as well as legislation on nurse delegation of medication administration, which we encourage people testifying to include in their comments.

Secretary JudyAnn Bigby, M.D., and the Assistant Secretaries at EOHHS will be on hand for both hearings so comments should begin by addressing them accordingly. The two hearings will be held this week and next week at the following dates and locations:

Friday, December 2, 2011 from 3:00-6:00 p.m.
Department of Mental Health Western Massachusetts Area Office
Northampton Haskell Building
1 Prince Street
Northampton, MA 01061

Friday, December 9, 2011 from 2:00–6:00 p.m.
Agganis Arena at Boston University
Francis D. Burke Club Room
925 Commonwealth Avenue
Boston, MA 02215-1204

Due to the number of individuals anticipated to attend the hearings, oral testimony will be limited to three minutes per individual. In the interest of time, representative panels are welcome and will be limited to a total of five minutes of oral testimony. If a number of home care agencies are interested, they will be added to a panel as HCA will be attending and testifying at the Boston hearing on December 9th. HCA asks that you also inform us if you sign up to attend or submit written comments on your own.

If you need accommodations please call 617-573-1600 and let the receptionist know.  Additionally, if you are planning to present oral testimony at the Boston hearing, please note that you must be in the building by no later than 5:50 p.m.

Written testimony can be sent to the Home Care Alliance to be submitted collectively, or may be mailed to:

Secretary JudyAnn Bigby, EOHHS
One Ashburton Place, Room 1109, Boston, MA 02108
Or emailed to:  eohhshearings@massmail.state.ma.us

Return to www.thinkhomecare.org.

Copays Avoided: Super Committee Fails to Reach Deal by Deadline

The Joint Select Committee on Deficit Reduction, also known as the Super Committee, charged with coming up with a plan to cut the national deficit by $1.8 trillion over the next decade failed to do so by their November 23rd deadline.

Although the group could not come to a compromise, the lack of a deal is a temporary win for home care because of what was on the table. Copayments on Medicare home health services were proposed and considered from several angles, including President Obama and the Medicare Payment Advisory Commission (MedPAC).

Now, because the six Democrats and six Republicans on the committee could not come to a compromise, a sequestration process begins where automatic and across-the-board spending cuts will be triggered and are planned to begin in January 2013. The debate on the subject, especially in Congress and for the upcoming election, will certainly not stop until that time and some course of action prior to the commencement of automatic cuts is likely to alter current plans.

See an official statement from the National Association for Home Care & Hospice on the Super Committee and avoiding a copay for Medicare home health services.

Senator John Kerry, a member of the 12-person committee, has proven once again to be a champion for home care issues. The Alliance has been in contact with his staff throughout the process who relayed HCA’s advocacy to the Senator. Such advocacy will need to continue until it is revealed how any cuts from the sequestration process will be doled out.

HCA will provide updates as the deficit reduction debate continues.

Return to www.thinkhomcare.org.

CMS Posts Final Rule for 2012 PPS Rates

CMS this week posted the final rule for Medicare home health PPS rates for calendar year 2012.  The finalized rates are slightly better than the proposed rates that CMS released in July, due to the fact that CMS has accepted industry recommendations to phase-in the case mix creep adjustment over two years, applying a 3.79% adjustment in 2012 and reserving 1.32% for 2013. Still, the 2012 national standard episodic rate of $2138.52 is a reduction from the 2011 rate of $2192.07.

The final 2012 rate is represents a 2.4% reduction from the 2011 rate, the result of a combined 2.4% market basket index inflation update, a 1% reduction in the inflation update required by the health care reform law, and a 3.79% case mix creep adjustment.
The final rule also adjusts the case mix weight for every HHRG to adjust for budget neutrality after removing eliminating hypertension as a factor in the calculation.  The rule also reduces the weights on high-therapy episodes and increasing weights on non-therapy episodes.

See this spreadsheet listing the updated rates for all HHRG’s in each MA geographic region.

In addition to setting forth updates to PPS, the final rule included some minor changes regarding face-to-face (F2F) encounters.  CMS is removing the modifier “attending” from the regulatory language to describe physicians who qualify as the physician who cared for the patient in an acute or post-acute facility. Most people considered the word ‘attending” to mean a community physician and not the in-patient physician.

Acknowledging that the Affordable Care Act did not preclude a patients’ acute or post-acute care physician from informing the certifying physician (physician who signs the 485) regarding their experience with the patient for the purpose of the F2F encounter requirement as an NPP can, CMS is also amending the F2F language to allow the acute or post-acute care physician to inform the certifying physician regarding the F2F.  The “community physician” could then complete the necessary documentation.

CMS believes these modifications allow additional flexibility in the process, making it easier for providers. Members with questions about the F2F changes can contact Helen Siegel at the Alliance office.

This finalized regulation will be the subject of an in-depth review by representatives of Blacktree Healthcare Consulting during the Alliance’s 2011 Financial Management Conference November 30 in Waltham.  Be sure to register today!

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.

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.


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.

Blue Cross AQC Contract Examined

An article in this week’s New England Journal of Medicine takes an interesting look at the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract in terms of its impact on cost and quality and lessons it may hold for broader attempts to move towards global payment, locally and nationally.

The report – Health Care Spending and Quality in Year 1 of the Alternative Quality Contract – was compiled by researchers at the Harvard Medical School, the Heller School and Boston University. According to the report the AQC contains three distinguishing features.  First, physician groups, in some cases together with a hospital, enter into 5-year global budget contracts (rather than standard 1-year contracts).   Second, AQC groups are eligible for pay-for-performance bonuses up to 10% of their budget, with performance measures of ambulatory care and hospital care each contributing to half of the calculation of the bonus. Third, AQC groups receive technical support from BCBS, including reports on spending, utilization, and quality, to assist them in managing their budget and improving quality.

At present, the authors report, there are 321 PCP practices and more than 4000 physicians in the AQC.   The very general findings:

  • AQC was associated with modestly lower medical spending and improved quality in the first year after implementation.
  •  AQC quality bonuses are much higher than those in most pay-for-performance programs in the United States, since they apply to the entire global budget rather than to physician services alone or PCP services alone.
  • Procedures, imaging, and testing accounted for more than 80% of the savings. Savings derived largely from less spending on facility services in the outpatient setting. There were no significant changes in spending for inpatient care or for physician services.

The question raised is: are savings at least for this non Medicare population more in “shifting outpatient care to providers who charged lower fees” than in behavior change?  If so, what lessens are here for broader global payment models, especially those that involve Medciare and Medicaid?