Notice of Observation Status Law Signed by President

Legislation requiring hospitals to notify Medicare beneficiaries when they are technically in an outpatient “observation” status was recently signed into law by President Obama.

The NOTICE ACT (Notice of Observation Treatment and Implication for Care Eligibility) requires hospitals to inform patients of their status when they are in observation, but not officially admitted, for more than 24 hours and classified as an outpatient. A written notice must, among other points, state that the beneficiary’s outpatient stay will not count toward the three-day inpatient stay required for the individual to be eligible for Medicare coverage of a stay a skilled-nursing facility. Hospitals will have until August 2016 to comply with the new law.

The NOTICE Act is good news for the home health agencies because tracking the status of the patient hospital stay proved to be a challenge. Patients were often unaware of whether their stay with the hospital was an inpatient admission or an observation stay leaving the HHA uncertain if Transfer/ROC OASIS were needed. Now with the implementation of this notice the HHA will be able to determine an observation stay and know that a Transfer/ROC OASIS is not needed. An Agency may choose to complete a “Significant Change in Condition” OASIS (Reason for Assessment, 5- Other follow-up) based on their agency policy.

Return to www.thinkhomecare.org.

Advocacy Alert: Urge your US Rep to Support HHPPS Proposed Rule Letter

With another $350 million cut to Medicare home health payment and Massachusetts selected as one of nine states for a “Value-Based Purchasing” Pilot, it is important that a strong message is sent to CMS and that means getting strong support from our state’s Congressional Delegation.

A new message is posted on the Home Care Alliance’s Advocacy Center that you can easily send to your federal elected representative to gain support for a Congressional sign-on letter to CMS. Just fill out the contact information, hit “send” at the bottom of the page, and the message will automatically go to your member of Congress.

The letter, which can be seen below, voices concern about the burdensome payment reductions and severe Value-Based Purchasing penalty in CMS’ proposed rule. Home health care champion Congressman Jim McGovern is co-leading the effort – known as a “dear colleague” letter in Congress – and the Alliance continues to appreciate his ongoing support of our issues.

Here is the text of the letter:

The Honorable Andy Slavitt
Acting Administrator
Centers for Medicare and Medicaid Services
7500 Security Boulevard
Baltimore, Maryland 21244-1850

Dear Acting Administrator Slavitt:

We are writing today to express our concern with Medicare home health funding cuts set forth in the Home Health Prospective Payment System (HHPPS) proposed rule for 2016. Home healthcare is a vital service that allows millions of the most vulnerable senior citizens and disabled individuals to receive the treatment they need in the cost-effective environment they most prefer – their home. As a result, we request a careful reconsideration of two of the draft policy changes in light of their anticipated impact on homebound Medicare beneficiaries and the home health delivery system upon which they depend.

First, we are concerned with the draft HHPPS rule’s proposal to cut home health payment rates by an additional 1.72 percent in 2016 and again in 2017. This proposed “case mix” reduction is of concern because it appears to be based on a 2000-2010 case mix weight change analysis rather than changes in the condition of beneficiaries during the 2012 to 2014 period that Medicare proposes to address.

Second, the draft rule proposes a Home Health Value-Based Purchasing (HHVBP) program that would impose an incentive/penalty range of as much as 5 to 8 percent over a 5-year period. We are very concerned with the aggressive nature in which the Secretary intends to ramp up HHVBP. Implementing a VBP program with a 5 percent withhold that increases to 8 percent just three years later is too much too fast. We are also concerned that the Secretary is proposing 25 measures for use in the HHVBP— far too many for providers to focus on.

In closing, we wish to express our concern that, in its current form, the draft rule may drive Medicare reimbursement to unsustainable levels for thousands of small, rural and other home health providers across the country, impacting the care upon which many of the most vulnerable Medicare beneficiaries, as well as their communities, depend. As a result, we request that the Agency reconsider its proposed case mix cut until it evaluates the specific causes of case mix weight changes from 2012 to 2014 and consider a more reasonable implementation schedule for the proposed withhold amount in the HHVBP program.

We thank you for your attention to this critical matter.

Return to www.thinkhomecare.org

We Need Your Opinion!

To compete and succeed in tomorrow’s home health marketplace, agencies need highly-skilled clinicians and thoughtful, visionary leaders.  To help our members prepare for that future, HCA of MA is considering two in-depth, extended training programs for the coming year.  We need to assess member interest before we proceed.  The two programs we are considering are Building a Home Health Behavioral Health Program and Emerging Leaders in Home  Care.

The Behavioral Health Program would be a 12-month program that would provide participating agencies the clinical training and administrative guidance necessary to launch a behavioral health program that is compliant with current Medicare home health regulations. The program would provide a comprehensive operational manual, in-person and webinar-based clinical trainings for as many as five staff per agency, diagnosis-specific care  guides and monthly teleconferences to guide participants on a path towards success in terms of enhanced agency capabilities and revenues and better care for a now underserviced population. Cost per agency inclusive of all on site meetings, manuals and 12 training webinars (for multiple staff) would be approximately $6,700.

HCA is also considering whether to repeat the popular Emerging Leaders in Home Care certificate program with Suffolk University.  This program, which commits a person to a full day per week, over the course of nine months (with short breaks in between classes) provides next generation leaders in-depth graduate-level education in marketing, finance, policy and human resources, all specifically designed for home care agency managers.  Graduates of the program will be able to apply four course credits toward several Master’s Degree Programs at Suffolk University, including the new Master’s Program in Community Health.  Cost per person for the Emerging Leaders Program will be approximately $2,400, depending on the number of students.

We understand that these programs are higher in cost than most of our programs.  We would like to hear from you to determine if there is enough interest among our membership to present them (but please note that your response to this survey does NOT obligate you in any way at this time!) 

Thank you for taking the time to provide feedback to us.

Click HERE to take our survey!

Advocacy Alert: Help Advance Private Home Care Oversight

Last December, the Massachusetts Department of Labor Standards (DLS), which is a division of the Executive Office of Labor and Workforce Development (EOLWD), finalized regulation that removes private pay home care agencies from the Employment Agency Regulation.

This change, while a welcomed clarification, has left private home care agencies without any state oversight, which means that anyone can open up an agency and can start accepting out-of-pocket payment for providing non-medical supportive services to individuals in their home.

Governor Charlie Baker’s administration has provided a unique opportunity to advocate for reasonable state oversight of private home care agencies. Specifically, they are seeking feedback on how to clarify and streamline Massachusetts regulations across the board via a special webpage called “A Clearer Code.”

The Home Care Alliance of Massachusetts is asking agencies, home care workers and advocates to take the following steps to help home care consumers gain the protection and peace of mind they deserve:

Visit this website: http://www.mass.gov/anf/a-clearer-code-regulatory-reform.html…

…And please fill out the online form as follows:

  • Name (optional):
  • Company/Organization (if applicable) (optional):
  • Address (optional):
  • Primary Phone (optional):
  • Email (optional):
  • CMR Number: 429 CMR 10.00
  • General Regulatory Themes: Select either Elders, Health Care, or Licensing & Permitting
  • Please list the Agency or Agencies affiliated with this regulation: Executive Office of Labor & Workforce, Executive Office of Elder Affairs, Office of Consumer Affairs & Business Regulation, Executive Office of Health and Human Services.
  • Describe the regulatory issue or observation: When this regulation was amended, it dropped state oversight of private-pay home agency services. There are now literally hundreds of private home care agencies operating unlicensed and unregulated. Massachusetts consumers, especially the elderly, deserve better.
  • Suggestions for easing regulatory compliance: We need the Governor to name a commission to study and make recommendations on private home care licensure standards as soon as possible. Home care agencies and the Home Care Alliance of Massachusetts needs to be at the table to determine the proper direction for quality services, ethical business practice and consumer protection for vulnerable seniors.

Return to www.thinkhomecare.org.

2015 Private Care Guides Now Available

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Three editions, for your convenience.

Every day, home care agencies help tens of thousands of Bay Staters live safely – and better – at home. Though health insurance and public programs like Medicare often pay for home care following hospitalizations or during acute illnesses, they do not typically cover chronic or supportive home care services. Private duty home care agencies, however, specialize in these situations.

In order to help connect agencies who provide private home care with the families who need their services, the Alliance is pleased to announce the publication of the 2015 editions of the Guide to Private Home Care Services, which will begin shipping next week.

As like last year, the Guide is split into three regional editions:

The county-by-county cross-references help you easily find local care, and the short essays inside will give you all the information you need to make the best decision for those you love.

All members will receive copies in the mail over the next few weeks. Additional copies are available for order through the links above, and — as always — at no charge for orders of 50 or fewer. Anyone needing a more detailed directory of home care agencies might consider our 2015 Resource Directory, which includes a detailed town-by-town index of 187 agencies from every corner of the state.

Return to www.thinkhomecare.org.

HCA Announces Sample Policies for Earned Sick Time Compliance

New regulations on paid earned sick time went into effect on July 1st and many companies, if not entire industries, are working to follow the rules.

The Home Care Alliance has kept member home care agencies up to date with analysis on regulation changes and informational webinars complete with Q & A’s, but some agencies have asked the HCA for sample earned sick time policies.

Fortunately, Alliance staff and a task force of HR directors from member agencies drafted such a sample policy, which was reviewed by attorneys Allyson Kurker and Margaret Paget of Kurker Paget LLC. In addition, the Attorney General’s Office (AGO) who was responsible for the regulation itself has posted a sample policy on their Earned Sick Time webpage and the Retailers Association of Massachusetts (RAM) also have publicly available policy templates that may be useful to home care agencies.

These resources are available below:

Return to www.thinkhomecare.org.

CMS Announces Proposed Home Health PPS Update for 2016; Massachusetts Included in Value-Based Pilot

Massachusetts is one of nine states randomly assigned to pilot the Home Health Value-Based Purchasing (VBP) model, which is included in the calendar year 2016 Medicare Home Health PPS Rule released by CMS.

VBP will test whether incentives for better care can improve outcomes in the delivery of home health services.  The model will apply a payment reduction or increase to current Medicare-certified home health agency payments, depending on quality performance, for ALL agencies delivering services within the nine selected states.  Payment adjustments will be applied on an annual basis, beginning at five percent and increasing to eight percent in later years of the initiative.

According to CMS, the model is designed so there is no selection bias, participant states are representative of home health agencies nationally, and there is sufficient participation to generate meaningful results among all Medicare-certified home health agencies nationally.

The proposed rule implements the third year of the four year phase-in of the rebasing adjustments to the HH PPS required by the Affordable Care Act.  The CY 2016 downward adjustment to the national standard episode rate is $80.95.  CMS also proposes to recalibrate the HH PPS case-mix weights for CY 2016, which would be the second year of recalibration and identical to CY 2015.

In addition, the proposed rule includes a decrease to the national, standardized 60-day episode payment amount by 1.72 percent in each of CY 2016 and CY 2017 to account for nominal case-mix coding intensity growth unrelated to changes in patient acuity between CY 2012 and CY 2014.  CMS will also be updating the HH PPS payment rates by the home health payment update percentage, 2.3 percent in CY 2016.

For the Home Health Quality Reporting Program, in keeping with the requirements of the Improving Medicare Post-Acute Care Transformation Act of 2014 (the IMPACT Act), CMS is proposing one standardized cross-setting measure for CY 2016 under the skin integrity and changes to skin integrity domain.  Measures for the IMPACT Act’s other domains will be addressed through future rule-making, although CMS is seeking feedback on four future, cross-setting measure constructs to potentially meet requirements of the IMPACT Act.

In order for home health agencies to avoid a two percent reduction in their annual HH payment update percentage, the rule further proposes to require all home health agencies to submit both admission and discharge OASIS assessments for a minimum of 70 percent of all patients with episodes of care occurring during the reporting period starting July 1, 2015.  CMS proposes to incrementally increase this compliance threshold by ten percent in each of the subsequent periods (July 1, 2016 and July 1, 2017) to reach 90 percent.

CMS has prepared a fact sheet about the proposed rule and a press release about the Home Health Value-Based Purchasing model.  The proposed rule will be officially published in the Federal Register on July 10, 2015. CMS will accept comments on the proposed rule, including comments about the Home Health Value-Based Purchasing model, until September 4, 2015.

The Alliance will closely examine the Value-Based Purchasing proposal — as well as all other aspects of the proposed rule — and will present a briefing for members within the next weeks.

We will work with the state associations in the other states chosen for the pilot to advocate for any needed changes to the program to protect agency cash flow and operational integrity.  We will also develop educational sessions for our members over the next months.  Stay tuned!

Return to www.thinkhomecare.org.

Conference Committee Announces Final Budget With Little Support for Home Care

The legislature’s state budget conference committee, made up of six members of the House and Senate’s respective Ways & Means Committees, decided on a final version of the fiscal year 2016 Massachusetts budget.ma budget pie chart pic

The $38.1 billion plan that is being sent to the Governor for his approval does not include the Home Care Alliance’s priority language that created a special commission to study and recommend licensure options for private care agencies. The commission language was included in the Senate’s version, but not the House, which left the conference committee to decide its fate.

The conference committee also did not include an expansion of income eligibility for services ordered through Aging Service Access Points (ASAPs) that the Alliance also supported.

One bright spot was that an advisory council on “mobile integrated healthcare” (MIH) was passed and includes a representative of the Home Care Alliance. The language defines MIH as:

a health care program approved by the department [of public health] that utilizes mobile resources to deliver care and services to patients in an out-of-hospital environment in coordination with health care facilities or other health care providers. Such medical care and services include, but are not limited to, community paramedic provider services, chronic disease management, behavioral health, preventative care, post-discharge follow-up visits, or transport or referral to facilities other than hospital emergency departments.

Other notes from a preliminary analysis of the Conference Committee’s budget include the following:

  • The MassHealth Managed Care line item continued to grow by another $770 million while MassHelath Senior Care, which governs the Senior Care Options program, dipped by more than $10 million.
  • In the Elder Affairs line items, State Home Care Program “Purchased Services” was set by the conference committee at about $2 million below FY15 spending, although the Enhanced Community Options Program (ECOP) grew by nearly $5.6 million.
  • Thanks to the efforts of home care supporter Senator Sal DiDomenico, the funding for the Pediatric Palliative Care Network was raised to $1.8 million from $1.5 million in FY15, but that’s still inadequate to serve the number of children currently on a waiting list for such care.
  • The Department of Higher Education’s “Nursing and Allied Health Workforce” line item ended up being level funded at $200,000 after being zeroed out by the Governor earlier this year.

Return to www.thinkhomecare.org.

New Sick Leave Regulations Q&A’s

 

The Home Care Alliance recently held a webinar on the New Sick Leave Regulations with the law firm KurkerPaget. KurkerPaget has been hard at work trying to answer the numerous questions about the new policy. They have attempted to answer the questions that members have provided to them last week to the best of their ability. You will find these questions and their answers to them below. Some of the questions were unclear to them, and others were so policy-specific that they could not answer them outside of an attorney/client relationship. Please note that although their answers are based on the sick leave law regulations, their responses should not be construed as legal advice, and should not be relied upon for that purpose. At this point, members are free to contact KurkerPaget if they want help answering additional questions or to have us review their policies.

HCA Webinar Follow-Up Questions/Answers

Question:            We have a policy in regards to agency closed holidays. If an employee calls in the day before or day after the holiday, they forfeit the holiday and cannot submit sick and/or vacation time in place. Can we still do that? My guess says that we must allow sick time use but do not have to pay holiday?

Answer:               These types of policies are okay with regards to not paying for the holiday, but an employer must allow an employee to use earned sick leave.

Question:            Do we have to pay orientation/training time worked?

Answer:               This is not addressed in the regulations; the Attorney General’s Office has not issued any guidance on whether such meetings/trainings should be considered actual work for purposes of accruing employee sick leave.

Question:            If an employee accrues 40 hours in 2015, carries it over to 2016, and then uses it all in January, does the employer have to start accruing more time for the employee in 2016 or can you wait until the following year, 2017?

Answer:               The employee should begin accruing again (up to 40 hours), but the employer is not required to permit the employee to use the additional earned sick leave in 2016 because employee has already used 40 hours in 2016.

Question:            For per diem/per visit employees, for whom you pay a flat travel rate for each visit, does the travel rate need to be included in the calculation?

Answer:               We are not sure that we understand how this question relates to employee sick leave. If the employee is paid for travel time ordinarily, this time/pay should be included to reasonably estimate the time the employee is working for purposes of calculating the employee’s accrual of sick time.

Question:            Earning hours for “actively working” … so if an employee comes in for an in-service (paid for time in training, but they are not working), we do NOT need to count these hours toward accrued time? Is this correct?

Answer:               The regulations do not use the term “actively working,” although they use the term “actual work” for determining when an employee begins to accrue earned sick leave.  Although the regulations do not address this issue specifically, we have no reason to believe that trainings that occur as a requirement of an employee’s employment would be exempted for purposes of accrual.

Question:            Could we pay our per diem employees an hourly rate that a regular full time staff [employee] is getting hourly? Ex. Avg. RPT. Paid $38/hr. which also is the rate paid staff they are paid when working in the office. i.e., conference time.

Answer:               You need to provide a reasonable estimate of the time that the employee is spending to complete her assignment.  If the hypothetical you provide is a reasonable calculation, it is fine.

Question:            “Actual first day of work.” Does this include a paid orientation day? Many employees who attend a paid orientation day do not start working the field for a while after an orientation.

Answer:               See above. This is not addressed in the regulations; the Attorney General’s Office has not issued any guidance on whether such meetings/trainings should be considered actual work for purposes of accruing employee sick time.

Question:            If an employee carries over 30 hours into the next year (January 1, 2016), are they only eligible to accrue another 10 hours that year (2016) or are they eligible to accrue another 40 hours?

Answer:               Employers may cap accrual and use to 40 hours per year.

Question:            We have a current paid time off policy in place which we plan to [use to] access the Safe Harbor.  Can we modify our paid time off policy to a sick time policy and keep the accrual the same 30 hours and lump sum accrual until the end of this year?

Answer:               We cannot answer questions that are policy-specific without reviewing that policy.

Question:            Does the employee need to provide documentation of use for each and every instance? Even 1 hour?

Answer:               Employers can require employees to personally verify that any use of earned sick time was for allowable purposes, but can only require medical documentation in limited circumstances.

Question:            How do we determine worked for baylors

Answer:               We are not sure that we understand what is being asked, and it would be difficult to answer without speculating.

Question:            Can you clarify the statement under paid time off policies… employers that have unlimited sick leave policies are not required to track accrual or allow any rollover?

Answer:               If an employer does not limit the amount of sick time an employee can take in a year, they do not have to track accruals or provide rollover to the employees.  Of course, this assumes that the employee would be able to use at least 40 hours of earned sick leave at any point in the year.

Question:            Just to be clear – we have 24 hours per week employees who earn about 30 hours of sick time, but also earn additional personal and vacation time that equal over 40 hours in total.  We don’t have to give them another 10 hours of sick time to get them to the 40 hours, do we?

Answer:               We cannot answer questions that are policy-specific without reviewing that policy.  Generally, as long as you are providing at least 40 hours of for the same protected uses and under the same conditions as those provided for in the sick leave law, the policy is compliant. 

Question:            Our current accruals are less than 1 hour for every 30 hours worked, but over a calendar year earn more than 40 hours. Do we need to change our accrual rates?

Answer:               We cannot answer questions that are policy-specific without reviewing that policy.  Generally, employees must be permitted to accrue earned sick leave in increments of no less than one hour for every 30 hours worked.

Question:            If an employee works 10 hours a day but is paid for 14, what is the appropriate accrual and how should the employee be paid for sick time?

Answer:               Earned sick leave accrues on no less than a one-hour for every thirty hours actually worked or reasonably estimated to have worked. 

Question:            If an employee has an earned time bank of 41 hours, and on January 1, 2016 they carry over that balance, can we put that balance towards their sick time?

Answer:               We cannot answer questions that are policy-specific without reviewing that policy.

Question:            Clarification on lump sum?

Answer:               We are not sure that we understand what is being asked, and it would be difficult to answer without speculating.

Question:            If an employee carries over 30 hours of sick time to the next calendar year, is the employee eligible to accrue 10 additional hours that year? If they use 40 hours of sick time, do they continue to accrue for that year?

Answer:               Yes, employees are able to accrue and use 40 hours of sick time per calendar year.

Question:            As of July 1st, can we modify our Earned Time to a Sick Time bank?

Answer:               We are not sure that we understand what is being asked, and it would be difficult to answer without speculating.

PCA Contract Spurs Clarifying Statement from the Alliance

Prior to the June 30th deadline for the state to negotiate a new contract with independently-hired and consumer-directed Personal Care Attendants (PCA), a deal was struck with the Governor’s administration for an immediate 30-cent raise and a “pathway” towards a $15 per hour wage in three fiscal years. Those annual contracts for future fiscal years still have yet to be negotiated.

With this announcement, the Home Care Alliance released the statement below to legislators clarifying that this wage boost is only for PCAs and not for homemakers or home health aides paid via agencies by MassHealth.

We encourage home health agencies and advocates to forward this to their legislators to highlight the fact that MassHealth has not increased home health aide rates, nor has it increased skilled visiting nurse rates.

Contract is a Win for Personal Care Attendants, Not Home Health Care

HCA Seeks Better Pay for All Home Health Aides

BOSTON, MA – This week, workers in the state-funded Personal Care Attendant Program (PCA) negotiated a new contract with the Commonwealth that gives them an immediate 30-cent raise and puts PCAs on a path to $15 per hour. This contracted raise will not apply to home health aides or personal care homemakers that work in the MassHealth program or the State Home Care Program administered by the Executive Office of Elder Affairs (EOEA).

“The Home Care Alliance supports any direct care workers getting a higher wage, but people should know that home health aides are paid through home health agencies via rates set by MassHealth. MassHealth has not increased home health aide payment rates in eight years,” said Home Care Alliance Executive Director Patricia Kelleher. “Home health aides generally have a higher level of education and training than PCAs and care for medically complex patients. Yet, they are on a path to earn less because of the state’s inaction on payment rates.”

Even though they are paid by state funds, PCAs are hired directly by the individuals they serve and primarily provide assistance with activities of daily living for disabled adults. Home health aides work for home health care agencies that provide similar services, often as part of a care team that includes a nurse managing a plan of care overseen by a physician.

The Home Care Alliance has long advocated for higher payment rates from MassHealth to home health care agencies. Despite not getting an increase since 2007, most agencies have been increasing worker wages and already provide benefits to their home health aides.

 “The Alliance believes that raising wages for direct care workers in the community strengthens the ability of people to remain at home no matter what their needs. However, the Alliance also believes that there is a continuum of home care and that the entire continuum should be equally recognized and supported, “added Kelleher. “MassHealth needs to support agencies that employ home health aides so that reality of state support for these workers matches the headlines.”

Return to www.thinkhomecare.org.