Category: Regulation

Health Care Cost Trends Hearings and Panels This Week

The state’s Division of Health Care Finance & Policy (DHCFP) is holding a series of presentations, speeches and panel discussions this week in regards to health care cost trends reports and cost containment efforts currently underway.

The full agenda for the week features a range of health care experts and stakeholders, including government officials, and there will also be limited room for public comment. This is another opportunity for those interested to hear the state’s work in highlighting cost disparities as well as an attempted move for the state towards global payments and health care cost control.

The hearings are being held from Monday, June 27, 2011 through Thursday, June 30, 2011 at Bunker Hill Community College, 250 New Rutherford Avenue, Boston, MA 02129.

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Monday, June 27, 2011 through Thursday, June 30, 2011

Bunker Hill Community College, 250 New Rutherford Avenue, Boston, MA 02129

MA Congressional Delegation Weighs in on Physician Face-to-Face Requirement

The Massachusetts Congressional Delegation has stepped up again, this time sending a letter to CMS Administrator Dr. Donald Berwick with concern over the physician face-to-face requirement.

Every member of the delegation – Senators Kerry and Brown, as well as US Reps Markey, Frank, Neal, Olver, McGovern, Tierney, Capuano, Lynch,  Tsongas and Keating – signed onto the letter noting that the Massachusetts health care community has made considerable efforts to comply with the rule, but the paperwork burden and duplicative nature of the requirement are proving problematic and that CMS should consider changes.

The letter itself is available here and the Home Care Alliance greatly appreciates the work and support from the Congressional Delegation.

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Secretary Bigby Addresses Alliance Annual Meeting

Massachusetts Secretary Judy Ann Bigby reviewed the Patrick Administration’s plans for reform of the health care delivery system in Massachusetts.  In her remarks, Secretary Bigby was clear that just as was the case with universal access, Massachusetts may well move before most other states or the federal government on issues such as global payment and integrated care organizations.  Secretary Bigby was clear that the building blocks for the ICOs – as she called then – would be primary care advanced medical home practices.  “I see a strong role for home based care in areas such as complex care management,” she said.  “Working out your role directly with doctors will be key.”

The state currently has out a Request for Information on the formation of ICOs/ACOs  – comments are due by July 13th.   At the meeting Secretary Bigby indicated an interest in ideas as to how the state policy makers  could support a role for high quality,  cost effective home care in redesigned systems. Among the ideas put forth at the meeting:  test episodic – rather than fee for service –  payment  for MassHealth home health care and do some modeling of what a home -based chronic care bundled payment would like.

Do you have ideas for Secretary Bigby – related to home care under health care reform?  Send them along for inclusion in either the Alliance’s ACO comments or in Annual Meeting follow-up with the Secretary.

State Seeks Comments on Accountable Care Organizations Through New RFI

The state’s Executive Office of Health and Human Services has released a Request for Information regarding the formation of Accountable Care Organizations (ACO’s) and are seeking comments from “all interested partComm-PASS logoies.”

The RFI includes an introductory letter from Health and Human Services Secretary Dr. JudyAnn Bigby and a thorough explanation of the state’s intentions for the transition to a new payment system. A response template is included in “Attachment A” of the document and comments should be submitted electronically through the Commonwealth Procurement Access and Solicitation System (Comm-PASS). Instructions are available in the RFI and the Home Care Alliance encourages home care agencies to submit comments as they see fit.

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Panel Review Dates Announced for Care Transitions Program

The Centers for Medicare and Medicaid Services announced panel review deadlines for applications to be submitted for the Affordable Care Act’s Section 3026 Community-Based Care Transitions Program.

  • July 19, 2011 – Applications must be received no later than June 20, 2011 to be considered for this review.
  • August 24, 2011 – Applications must be received no later than July 15, 2011 to be considered for this review.
  • September 19, 2011 – Applications must be received no later than August 18, 2011 to be considered for this review.

The Home Care Alliance has received questions regarding the assembly of a budget for the application and a helpful guide  is available upon request for those interested.

Guidance is also still available on the Q&A section of the CMS Care Transition Program’s web page.

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CMS Home Health Quality Campaign will Continue, NAHC Announces

The National Association for Home Care & Hospice (NAHC) has announced that the CMS Home Health Quality Improvement Campaign (HHQI) will continue after July 31, 2011.

The goal of the HHQI Campaign is to improve the quality of care home health patients receive as measured by a reduction of avoidable hospitalizations and improvement in the management of oral medications. Throughout the campaign, a variety of materials as well as online communication and sharing tools have been and will continue to be available to Campaign participants. These include Best Practice Intervention Packages (BPIPs), which will be released quarterly to share effective strategies with home health care providers.

Campaign participants will also be able to set improvement targets and view rates related to the publicly reported acute care hospitalization and oral medication measures through a free target-setting tool at the Home Health STAR (Setting Targets Achieving Results) Web site.

According to NAHC, the  second phase of the campaign was set to conclude at the end of July, but CMS has indicated that the HHQI movement will proceed into a third phase. As a result home health agencies will be able to continue to access free quality improvement resources at www.homehealthquality.org.

Before the next phase starts later this year (the details on what the third phase will entail has yet to be announced) home care agencies are asked to fill out a simple form and share input on how the campaign can improve. The HHQI National Campaign has created a brief three-question assessment that asks for insights, along with name, e-mail address and phone number. It can be filled out at: http://www.homehealthquality.org/hh/about/feedback/default.aspx.

The Home Care Alliance is a Local Area Network of Excellence (LANE), which means that the association is responsible for agency recruitment in Massachusetts and the dissemination of information and materials from the national campaign. For more information on the campaign, please visit www.homehealthquality.org/.

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OIG Issues Advisory Opinion on E-Discharge Systems

The Office of the Inspector General issued an advisory opinion on May 13 (publicly posted on May 20th) stating that being charged a fee to electronically receive and respond to referral requests from hospitals for post discharge care violates the federal anti-kickback statute.

The full document relating to what are known as “e-discharge” systems includes background information, legal analysis, and potential sanctions from OIG is available here.

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Payment Rate Change Announced for Hospice

The state’s Division of Health Care Finance and Policy (DHCFP) announced an adjustment in the rate of payment for hospice services “in accordance with CMS requirements.”

The full announcement is available here.

The change is estimated by DHCFP to increase the MassHealth budget by $184,274 or 2.68%, which translates to a slight increase and not a cut as is sometimes meant when the state uses the word “adjustment.” According to the announcment, each rate is composed of a non-wage component and a wage component, in which the latter is adjusted by a county-specific, Massachusetts wage index, in accordance with CMS guidelines.

Depending on the service, the rates in these county-groupings change within the following ranges:

  • 3.5-3.7% for Norfolk, Suffolk, and Plymouth,
  • 3.0-3.2% for Middlesex,
  • 2.6-2.7% for Essex,
  • 2.4-2.5% for Bristol, 3.2-3.4% for Berkshire and Pittsfield,
  • 1.7-1.9% for Hampden, Hampshire, and Franklin,
  • 3.4-3.6% for Worcester,
  • 1.6-1.9% for Barnstable
  • 1.9-2.2% for Nantucket and Dukes.

Although the revisions were adopted by emergency regulation on May 27, they are still technically “proposed” and are subject to further change. DHCFP announced that there will be a hearing on July 7 in Boston for anyone interested in offering comments on the matter. See the full announcement for details.


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State Senate Budget Includes Telehealth

The state senate this week passed a $30.5 billion state budget for FY 2012 that included a major priority of the Home Care Alliance.

An amendment instructing MassHealth to reimburse for telehealth remote patient monitoring provided by a home health agency was adopted by the Senate.  That provision must now survive a conference committee made up of House and Senate members who will work out differences between the House and Senate budget proposals and send the finished version to the Governor for his approval.

The amendment passage is a victory for home health care and reflects a greater understanding from the state legislature on issues important to the industry. Moreover, the adoption of the telehealth amendment, while only a first step in the process, is also recognition of the cost savings that home health agencies and the use of technology can provide.

Most of the 599 budget amendments proposed in the Senate did not make it through, including restoration of MassHealth rates of payment for home health past 60 days, a pediatric home care amendment, and another that would have established a special care transitions rate for home care agencies.

Two amendments regarding adult day health were also adopted.  One would establish licensure standards for adult day health providers and the other would require MassHealth to notify the legislature of any changes to rates or clinical eligibility criteria for adult day health services.

Other amendments of note include:

  • An amendment was adopted that would require MassHealth to annually notify each beneficiary over 65 about their options regarding enrollment in voluntary programs, including Program of All Inclusive Care for the Elderly (PACE) plans, MassHealth Senior Care Options, Frail Elder Home and Community Based Waiver Program and “any other voluntary elected benefit to which such beneficiary is entitled to supplement or replace such beneficiary’s MassHealth benefits.”
  • An amendment was rejected that would allow nursing homes to place a hold on beds for residents who are transferred to the hospital for emergency care.
  • An amendment was adopted to provide an additional $1 million for elder protective services (total amount: $16,250,554).
  • An amendment was adopted to provide an undisclosed amount of funding to elder pre-admission options counseling.
  • An amendment was adopted providing an additional $4 million for Day Habilitation Services
  • The Salary Reserve for human service workers was not approved, but the Senate did approve a substitute amendment enable human service provider agencies to purchase health insurance through the Commonwealth Health Insurance Connector for their employees earning less than $40,000/year.

For any questions or further information on the state budget, contact James Fuccione at the Alliance.

Return to www.thinkhomecare.org.

New Materials and Guidance for CMS Care Transitions Program

A pair of presentations with helpful information and resources regarding the CMS Community-Based Care Transitions Program have been made available.

For home health agencies interested in applying or just getting started with the process, this CMS PowerPoint provides a good summary of the information, helpful links and resources, and answers to some of the more frequently asked questions.

Another helpful set of presentations sponsored by the Commonwealth Fund is available and includes a webinar with audio featuring:

  • Anne-Marie Audet, M.D., M.Sc., moderator, vice president, Quality Improvement and Efficiency, The Commonwealth Fund
  • Eric Coleman, M.D., M.P.H., director, Care Transitions Program, and professor of medicine at the University of Colorado Health Sciences Center
  • Garry MacKenzie, M.D., medical director of cardiology services at McKay-Dee Hospital Center in Ogden, Utah
  • Janice Fitzgerald, R.N., director of quality and medical management at Baystate Medical Center in Springfield, Mass.
Lastly, there have been a lot of questions regarding how to proceed with the “root cause analysis” in the application. A very helpful resource to assist in this matter is available courtesy of the Care Transitions Quality Improvement Organization Support Center (QIOSC).
More updates and resources will be provided by the Home Care Alliance as they become available.