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In response to concerns about growth in home health utilization over the past two years, MassHealth has used their emergency regulation authority to introduce a home health prior authorization requirement as of March 1. According to MassHealth staff, the visit count for determining the need for prior authorization will start on March 1. Prior authorization is required for services in excess of the following thresholds:

• Intermittent skilled nursing visits after 30 visits in a 90-day period;
• Home health aide services after 240 units (60 hours) in a 90-day period;
• Physical therapy after 20 visits in a 12-month period (this is unchanged from previous requirement;
• Occupational therapy after 20 visits in a 12-month period;
• Speech-language therapy after 35 visits in a 12-month period;
• Home Health Aide services supportive of physical, occupational, or speech-language therapy after 20 physical, 20 occupational, or 35 speech-language therapy visits.

MassHealth has published numerous instructional documents, the links of which can be found below .  Links to the PA request forms and guidelines are also within the bulletin.

Bulletin:

http://www.mass.gov/eohhs/gov/laws-regs/masshealth/provider-library/provider-bulletins/home-health-agency-provider-bulletins.html

Transmittal Letter

http://www.mass.gov/eohhs/gov/laws-regs/masshealth/provider-library/transmittal-letters/home-health-agency-transmittal-letters.html

Home Health Medical Necessity Guideline:

http://www.mass.gov/eohhs/provider/insurance/masshealth/clinical-treatment/medical-necessity-determination/download-a-printer-friendly-version-of-the.html

HHA-2 and PA-HHA-SN forms (will be under Home Health Agency):

http://www.mass.gov/eohhs/gov/laws-regs/masshealth/provider-library/masshealth-provider-forms.html

It is expected that PAs will be processed through the MassHealth Provider Online Service Center (POSC).  All of the job aides and training links related to this can be found here:

http://www.mass.gov/eohhs/gov/newsroom/masshealth/providers/mmis-posc/trainingget-trained.html

HCA of MA continues to work with MassHealth to clarify agency questions and concerns around documentation and PA processing.  A list of Q & As should be available shortly.

 

 

 

 

 

 

 

Blue Cross Blue Shield of MA announced this week that in 2016 they will be expanding their end of life benefits to cover hospice for a longer period and to support end of life counseling both with physicians and other health care professionals. An expanded home care program is also in the planning stages.

The changes announced by BCBS come just as Medicare will begin covering end of life discussions.

The BCBS effort to expand benefits were in part driven by the experience of their Chief Executive Officer Andrew Dreyfus in assisting his own parents and brother at the ends of their lives.

The Home Care Alliance of MA applauds these actions as very much in keeping with the important Institute of Medicine Report “Dying in America,” which reinforced – with strong recommendations – that health care professionals must be empowered to ensure that end-of-life care is compassionate, affordable, sustainable, and of the best quality possible.

We look forward to working with BCBS of MA to support these efforts in the interest of all of our patients and families.

The October 28^th deadline to complete our Home Health HIT Adoption  survey is fast approaching.

The HCA Board of Directors and all of us involved in guiding this project do so with the belief that HIT represents the future of health care and home care.  So the question, you need to ask yourself is:  am I home care agency of the past – or am I positioning my agency for the future?

Completion of the survey itself can be part of an internal self assessment process to see where your agency is in terms of interconnectivity.  Completing the survey will assure that you will get a copy of a report with a roadmap to move your agency forward.

The survey can be completed here: https://www.surveymonkey.com/r/HIT_homecare.  If you would like we can also send you a printed copy as many of those who have already completed it are finding it easier to print out – share with members of their team and then have a single person collate and input the responses. Contact sdrakes@thinkhomecare.org to have this printable copy emailed to you.

To be sure you understand the questions and the survey’s value to you , we have scheduled an additional webinar for Wednesday October 21^st from 10-11AM. You can register here.

Additionally, we have arranged for LIVE!!!  support for questions you may have while completing the survey please. You can contact project managers Jessica Hatch (jhatch@maehc.org) or Jennifer Monahan (jmonahan@maehc.org) via email or can call them directly at the times below.

Be the future and get connected!

 

 

Date	Time	Contact Person	Contact Number
October 20 – Tuesday	9:00 – 10:00 am	Jessica	339-222-6126
October 20 – Tuesday	2:00 – 3:00 pm	Jessica	339-222-6126
October22 – Thursday	9:00 – 10:00 am	Jennifer	603-717-5420
October 22 – Thursday	2:00 – 3:00 pm	Jennifer	603-717-5420
October 23 – Friday	12:00 – 1:00 pm	Jessica	339-222-6126
October 26 – Monday	12:00 – 1:00 pm	Jessica	339-222-6126
October 27 – Tuesday	9:00 – 10:00 am	Jennifer	603-717-5420
October 27 – Tuesday	12:00 – 1:00 pm	Jennifer	603-717-5420

Huge thanks to Todd Montigney and Diane Link of BlackTree Healthcare Consulting for their webinar today.  They discussed the implications of the 2016 Medicare rate changes and the proposed Value-Based Purchasing Model.  Massachusetts is one of nine states randomly selected by CMS to test a Medicare payment model that would increase payments to agencies that score high on quality measures, and penalize agencies that score low.  Diane did a particularly good job of explaining how CMS will compare agency performance on 29 quality measures with statewide benchmarks to calculate an overall score to determine how much an agency’s payments will be adjusted up or down.

If you missed the webinar, you can download the Powerpoint presentation here and click here to listen to a recording of the session for the next 14 days.

The Alliance will be preparing comments to CMS on the proposed update to Medicare rates as well as on the Value-Based Purchasing proposal, and would like to hear suggestions from members.

Are you looking forward to VBP, or are you dreading it?  What do you think of the 29 measures CMS plans to track – too many?  And how about their proposal to adjust rates in 2018 by as much as 5% up or down based on agencies’ quality scores in 2016?

Give us your thoughts by emailing to Alliance Executive Director Pat Kelleher by September 1st.  Or better yet, submit your own comments to CMS here.

One of the featured speakers at the HCA of MA Annual Meeting last week was Scott Taberner, newly named MassHealth’s Chief of Behavioral Health and Supportive Care.  LTSS is the new umbrella term under which all medical and personal care assistance that MassHealth clients may need – for several weeks, months, or years – when they experience difficulty completing self-care tasks as a result of aging, chronic illness, or disability.  This includes, but is not limited to, nursing facility care, adult daycare programs, home health services, personal care services, transportation, and assistance assistance provided by a family caregiver.

In his remarks,  Taberner indicated that the Baker administration is launching a major initiative to improve health outcomes for Masshealth clients and make the MassHealth program more sustainable over the long term.  As part of that initiative, considerable attention will be paid to what, how, to whom and by whom, LTSS services are provided.  On his agenda Are: rethinking  how to modify fee for service payment to pay for value and outcomes;  what provider contracting and management arrangements might look like in a Medicaid Accountable Care Organization;  and how, in general, MassHealth can improve the LTSS “experience” of clients and providers.

MassHealth is holding the last of its open public hearings on these topics in the coming weeks.  They are open to any entity to submit comments and suggestions to the team looking at this programmatic area.  Rate increases for all community based services are, of course, at the top of the Alliance’s request list.  We are looking for suggestions from our member agencies –  with a strong history of provding MassHealth LTSS  – for suggestions as to how both rates and programmatic reforms could enhance our capacity to serve MassHealth clients with both medical and behavioral health needs.

We believe this is a unique opportunity to bring forward creative approaches to restructuring the MassHealth home health and home care programs.  Alliance members are invited to submit any and all concerns and suggestions to Pat Kelleher by July 2 for inclusion in our comments.

The Alliance is pleased to publish its 2015 Annual Report, documenting its achievements, activities, and finances of the Home Care Alliance of Massachusetts and the Foundation for Home Health over the most recent year.

In addition to reading it below, you may download the PDF, or order a free copy via snailmail (supplies are limited).

Return to www.thinkhomecare.org.

 

HCA held its annual recognition event to honor the best and brightest individuals and programs in the home care industry. We acknowledged the work of certain individuals and agencies, but in doing so we celebrate all of home care, what it is and how we make a difference in so many lives.

Home care in Masachusetts has a long and proud history dating back over a century. The four programs and seven individuals that we recognized are both part of that great lineage and helping to shape a future for home centered care that is even more vibrant and impactful. They are working across the continuum to improve the post hospital transitions for patients and their families to promote rehabilitation and recovery. They are managing complex chronic illnesses
in ways that support independence, and they are expanding what it means to be a community-based provider. Most remarkably, as Pamela Mann, will reminded us at the ceremony, they do it all while holding on to the compassion, and high touch approach that has been the hallmark of the home health experience for more than a century.
Congratulations to all our Stars. You make us proud to be associated with you.

The pictures from this great event are available on our Facebook page. Click HERE to view them!

Photos courtesy of HCA Staff and Brendan Fournier