Category: Regulation

HCAs Home Health & Hospice Emergency Prep Workbook Now Available

HCA’s new Home Health Care & Hospice Emergency Preparedness Workbook, co-published with RBC Limited, is now available!

The workbook incorporates all of the Emergency Preparedness requirements in the proposed new regulations recently developed by CMS, and includes a number of sample policies and tools to make compliance easier.

Barbara Citarella of RBC Limited will conduct a series of two webinars on August 27 and September 3 to discuss the proposed regulations and orient home health and hospice providers to the new manual.

You can purchase the Workbook and register for the webinars here.

Webinars will be held on the following dates:

Part I August 27, 2014
10:00 – 11:30 AM

Part II September 3, 2014
10:00 – 11:30 AM

Return to www.thinkhomecare.org.

Alliance Comments on Proposed LTC Insurance Regulations

Fresh off the heels of the Department of Labor Standards’ decision to drop private-pay home care licensing, the state’s Division of Insurance is accepting comments on regulations related to long-term care insurance.

The Home Care Alliance offered oral and written testimony on proposed amendments to 211 CMR 65.00 at a public hearing on August 1st. The regulations aim to set new standards for long-term care insurance policies, rate setting and cost controls and creates various consumer protections.

More importantly for home care agencies, they propose that home care agencies must meet standards set by the Executive Office of Elder Affairs in order to be covered under long-term care insurance plans. Given the impending gap in state oversight with DLS’ new regulations, the fact that those agencies with elder services contracts represent a fraction of private pay home care agencies, and that many agencies relying on long-term care insurance do not work with Aging Service Access Points, the Alliance suggested the following measures:

  • The Home Care Alliance’s Accreditation Program and unexpired DLS licenses should be placeholder requirements for long-term care insurance coverage until the state and advocates can pass meaningful licensure measures.
  • Home Care Alliance Accreditation allows workers who are not home health aides/certified nursing assistants to provide certain services in the home and DOI’s regulations should reflect that flexibility.
  • In the “sample definitions,” the Activities of Daily Living do not include “grooming and personal hygiene,” which is a traditional ADL and one that is vital to the well-being of people wishing to avoid facility-based care.

More details are available in the full copy of HCA’s comments, which can be obtained by contacting James Fuccione at the Alliance.

Those agencies or advocates wishing to comment have until 5:00pm on Friday, August 15th. Comments can be emailed to doidocket.mailbox@state.ma.us and the subject line should read “Docket No. G2014-0.”

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CMS Establishing Star Rating System for Home Health Care

In an effort to be consistent with quality reporting measures for various health care providers, the Centers for Medicare and Medicaid Services (CMS) are reportedly beginning to bring home health care, hospitals and dialysis facilities into the five-star rating system used for other sectors.

Already, nursing homes, Medicare health plans with Part B coverage, Medicare Advantage plans, physician group practices, and accountable care organizations use the star rating system. According to Visiting Nurse Associations of America (VNAA), CMS hopes to transition home health care to the five star rating by the end of 2014, or at latest, the beginning of 2015. However, the Home Health Quality Improvement Campaign (HHQI) reports that hospitals will be the next provider group to get the star rating system and home health will come online in 2016.

Nursing homes are rated on staffing, health inspections and a set of 9 quality measures on the Nursing Home Compare website. Home health agencies and other providers each have their own range of quality criteria. Currently, there are no details on how CMS plans to determine the star ratings for home health agencies.

More information on this topic will be reported as it becomes available.

Return to www.thinkhomecare.org.

Alliance Presents Comments on DLS Proposal to Drop Private Home Care Agencies

A gap in the state’s oversight of private pay home care agencies will result from regulatory changes proposed by the Massachusetts Division of Labor Standards (DLS), a division within the Executive Office of Labor and Workforce Development.

Currently, DLS registers private pay home care agencies and has been falsely classifying them with employment and staffing agencies. After years of advocacy, DLS recognizes the misrepresentation and makes the appropriate change in their proposed regulatory changes.

The Home Care Alliance offered written and verbal comments at a public hearing in Boston held by DLS, which is making changes sparked by a mandate to update regulations relative to the “Temporary Workers Right-to-Know” Law, which became effective more than a year ago.

In addition to incorporating provisions of the new law into the Staffing Agency regulations, DLS is updating all of their regulations and proposing to drop home care agencies from their definition of “Employment Agencies” and to redefine “Domestic Employee” as a worker paid directly by a household or a family, among other changes.

The Alliance’s Private Care Advisory Committee reviewed the implications of this change for member agencies an approved comments on behalf of the association. These comments include the following:

The proposed changes from the Department of Labor Standards (DLS) recognize that home care agencies do not belong in the same oversight structure as employment, staffing and placement agencies. As much as this shift is welcomed, we must also acknowledge that Massachusetts lacks any other licensure or state oversight for home care agencies. The certified sector is subject to oversight from the Department of Public Health in their role as a federal quality and compliance agent. With an aging population, private-pay home care is a rapidly-growing sector with a rapidly growing workforce. In fact, the federal Bureau of Labor Statistics places home care aides as one of the fastest growing occupations over the next decade.

With these significant factors in mind, and the gap in state oversight, we urge a commitment from and partnership with DLS and the Executive Office of Labor and Workforce Development (EOLWD) to collaborate with the Home Care Alliance, its private pay agency membership, and other organizations to help transition away from DLS registration.

As part of the partnership and collaboration proposed by the Alliance with DLS is joint education and outreach to agencies regarding current state rules and regulations, information for agencies about the Alliance’s Home Care Accreditation Program, helpful information for consumers, and assistance in advocating other state offices and the legislature on the need for agency oversight.

The proposed regulations and a summary are available on the DLS website. Any home care agency interested in commenting can request the Alliance’s full comments and send a supporting letter to James Fuccione at the Alliance who will collect and submit any comments received. If agencies wish to submit comments directly, they can be mailed to Heather Rowe, Director, Department of Labor Standards, 19 Staniford Street, 2nd floor, Boston, MA 02114.

Return to www.thinkhomecare.org.

 

 

Urgent: Your Advocacy Needed on F2F Fix Now

We cant fix it without your help!!!

The Home Care Alliance of Massachusetts is working nationally on new strategy for a F2F fix in the House Appropriations Committee.

The Alliance, along with the Forum of State Home Care Associations (FSA) of the National Association for Home Care and Hospice (NAHC), is pushing on a unified front for a simple legislative fix that would provide relief from the onerous Medicare face-to-face (F2F) rule.

The  legislation would specifically allow for physician certification of the face-to-face requirement on the ‘485,’ or plan-of-care document, in place of a separate, redundant narrative requirement currently being enforced by the U.S. Centers for Medicare and Medicaid Services (CMS).

What we need from you!

Massachusetts has no Congressional representative on the House Appropriations Committee, which is where we are trying to get the language introduced.   

All HCA members should urge their Congressional representatives to reach out to House Appropriations Committee Ranking Member Nita Lowey (D-NY) seeking assurances that the face-to-face fix is included in the House Appropriations bill.

The best way to reach your Congressional Representative is to call the main switchboard at (202) 224-3121.

In addition to calling your House representative, every Alliance member should send an e-mail.  This process will only take a minute of your time. Click HERE to send a message to Congress with a push of the button.

Script for Phone Call or email

Please Help Home Care:  Insert F2F Fix in Appropriations Bill

The home care industry needs your help to fix the face-to-face encounter rule. This federal rule requires a physician to certify that he or she has seen a home care patient face-to-face for authorization of home care services. The problem is not so much the requirement itself, but CMS’  interpretation of the requirement, and its expectations for physicians to document it. A simple line of legislative language would clarify Congress’ intent for the regulation to be met with the least disruption in patient care services.

Please work with your Congressional Colleagues on the Appropriations Committee to advance this vital legislation. If you need, I would be happy to forward the draft legislation, along with further background information, to your office.

Links for More Information

Home Care Face-to-Face Mandate: A Major Problem, a Simple Fix. Use this resource to show Congressional offices how the existing 485/plan-of-care already certifies the patient’s need for home care and could include a simple edit for meeting the face-to-face mandate.

The HCA-FSA-NAHC draft legislation to fix F2F. This draft legislation simply states: “Physician documentation of the face to face encounter shall consist solely of a simple and concise confirmation that such encounter occurred and that is provided by notation on the same plan of care document the physician signs to order the home health services required by the patient.”

Thank you for your help.

Return to www.thinkhomecare.org.

 

Summary of Conference Call WIth Senior CMS Officials on the Face-to-Face Rule

On May 20th, the Home Care Alliance of MA, along with several member agencies, physicians and a representative from the MA Medical Society had the opportunity to speak to a number of officials at CMS regarding problems with the face to face rule.  Among those on the call from CMS were: Laurence Wilson, Director, Chronic Care Policy Group;  Carol Blackford, Deputy Director, Chronic Care Policy Group and Randy Throndset, Director, Division of Home Health and Hospice.

Below is the summary of the meeting and our suggested fixes as sent to the CMS officials in a follow-up email.  Thank you to members Judy Flynn and Dr Mark Yurkofsky, Partners Health Care at Home; Robin Seidman, Metrowest Home Care & Hospice; Dr Richard Lopez and Keren Diamond, Atrius Health/VNA Care Network/VNAB,  Jeanne Ryan, VNA & Hospice of Cooley Dickinson, and Alex Calcagno, Mass Medical Society for participating and making such a strong presentation. Continue reading “Summary of Conference Call WIth Senior CMS Officials on the Face-to-Face Rule”

New Program Instruction Approved for Home Care Agencies Working with ASAPs

After more than a year of the Home Care Alliance and other stakeholders working with the state’s Executive Office of Elder Affairs, an updated Program Instruction (PI) for the state’s Aging Service Access Points working with home health agencies has been approved and will go into effect on May 1st.

The PI addresses a range of concerns that were raised around assessment, care planning, supervision, payment and   communication between the nurse at the home health agency and the corresponding Aging Service Access Point (ASAP).  It replaces some very outdated PI’s and is the product of several meetings and edits sent through countless emails

A workgroup consisted of Home Care Alliance staff, the Mass Home Care Aide Council, and staff from the Executive Office of Elder Affairs along with several ASAP directors and ASAP nurses.

The Home Care Alliance is very pleased with the updated direction from the state, which will improve communication and collaboration between home health agencies and ASAP’s.

Return to www.thinkhomecare.org.

Advocacy Alert: Help Gather Support for Home Care Budget Amendments

The Home Care Alliance’s priority amendments in the House budget now have numbers, which means you can email or call your state representative and easily ask that they support these important policies to advance home care services!

  • Amendment #968: Rep. Sean Garballey’s amendment to restore the MassHealth rate for home health nursing visits past 60 days of care to the payment level prior to December 1, 2008 so that patients with the most severe conditions can have their care continued and remain independent at home. MassHealth cut the rate once a person was receiving home nursing for more than 60 days, which runs counter to the state’s goal of keeping people in the community and driving down the cost of care.
  • Amendment #89: Rep. Kate Hogan’s amendment to study home health service capacity in the Commonwealth and recommend policy strategies for better state oversight of home care agencies. Massachusetts is one of only five states without either licensure or a “determination of need” process for home health agencies. In recent years the Commonwealth has experienced rapid growth in the number of certified home health agencies. This proposal is in response to that growth and would help to identify the current number of home health agencies and their licensure and ensure high levels of quality home care.
  • Amendment #491: Rep. John Mahoney and Rep. Mark Cusack’s amendment that would establish MassHealth reimbursement for telehealth services provided by home health agencies. This amendment was successfully passed in last year’s budget and this year’s version will ensure MassHealth is statutorily able to finish their work in creating a regulatory and reimbursement structure.
  • Amendment #775: Rep. James O’Day’s amendment to reestablish the Homemaker Wage Increase account. This appropriation would provide an annualized wage increase of approximately 75 cents an hour to over 17,000 homemakers and personal care homemakers.

Our Legislative Action Center makes it easy to advocate. Just click on the FY15 budget message, fill in your contact info, and hit send! The system will automatically send the message to your state representative.

You can also call 617-722-2000 and press “2” to speak to an operator in the House of Representatives to urge your State Rep to support amendments #89, #491, #775 and #968. You can use the talking points above when speaking to an aide or leaving a message.

Contact James Fuccione at the Alliance with any questions.

Return to www.thinkhomecare.org.

House Ways & Means Releases Budget; Call Now To Support Amendments!

The state’s House Committee on Ways & Means this week released its proposed $36.2 billion fiscal year 2015 budget.

The House budget closely follows the Governor’s budget proposal in most line items related to home care providers, with slightly smaller allocations for MassHealth Senior Care Plans,boston-statehouse and EOEA Administration, and slightly more funding for local Councils on Aging. The House budget does not include the $1.2M Home Care Workforce Training Fund that was in the Governor’s budget.

Several legislative champions will be submitting amendments to the budget at the request of the Alliance. HCA members are encouraged to contact your local state representative TODAY and urge them to co-sponsor the budget priorities listed below.

A pre-written email is available on the Alliance’s Legislative Action webpage. For those choosing to call their local Representatives, please use the information below. Reps can offer formal support by contacting the office of the Representatives that are filing the amendments. Continue reading “House Ways & Means Releases Budget; Call Now To Support Amendments!”

HCA Responds to Proposed PCMH Standards

Following a public hearing and a request for feedback, the Home Care Alliance submitted comments on proposed standards for physician practices seeking designation as Patient-Centered Medical Homes (PCMH).

The state’s Health Policy Commission (HPC), created in the state’s Health Care Cost Containment Law, is charged with developing and implementing standards of certification for PCMH in the Commonwealth and will be working to finalize the proposed criteria in the coming months.

The Alliance’s comments promoted the potential of partnerships with home care agencies based on their ability to help physician practices meet some of the proposed standards. The Alliance specifically suggested that PCMH certification require that physician practices meaningfully partner with at least two agencies for the lowest tier of the designation with higher numbers of partnerships in higher tiers. The HPC currently has Basic, Advanced, and Optimal levels of PCMH certification, which may change in name.

The purpose of the certification process is to complement existing local and national care transformation and payment reform efforts, validate value-based care, and promote investments by payers in efficient, high-quality and cost effective primary care.

Return to www.thinkhomecare.org.