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.”

Return to www.thinkhomecare.org.

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.

 

 

Conference Committee Budget Includes Telehealth, Homemaker Wage Increase

With the new state fiscal year technically arriving, the legislature’s budget conference committee released their compromise version between the House and Senate funding proposals that comes in at $36.5 billion.

With the delay in negotiations, the legislature recently approved a $4.6 billion budget to fund the government and related services through the end of July. The Governor, meanwhile, will have 10 days to review the conference committee’s budget and send recommended vetoes, which can be overturned with a two-thirds vote in both the House and Senate.ma budget pie chart pic

Among the priority items of the Home Care Alliance and others of benefit and interest is language allowing MassHealth to continue their work on implementing home telehealth service rates and rules. This is the second year in a row that the Alliance has achieved getting language that continues the association’s work with the state on an important service that is currently not reimbursed.

Another major win for home care came with the approval of the Homemaker Wage Increase that will amount to $6.1 million, if the funding makes it through the remainder of the budget process. According to the Home Care Aide Council, this appropriation would provide an annualized wage increase of approximately 75 cents an hour to more than 17,000 homemakers and personal care homemakers.

Among other notable items, the conference committee’s budget accomplishes the following:

  • Funding the “Home and Community-Based Services Policy Lab,” ($250,000) which seeks to study the cost-effectiveness and value of home and community-based care. It is expected that services provided by members of the Home Care Alliance that contract with Aging Service Access Points will be included in an initial phase and other Medicaid and Medicare home health services will be included in subsequent phases.
  • The state’s elder services network’s “purchased services” line item received the higher funding amount in the compromise budget of $104,411,964.
  • The Elder Nutrition Program covering “Meals on Wheels” received even more funding ($7.37 million) than the higher amount awarded by the House ($7.12 million).
  • The MassHealth Senior Care line item received slightly increased funding, which came from the House, at $3.197 billion while the MassHealth Managed Care account was level funded throughout the budget process at $4.792 billion.
  • The Human Services Salary Reserve was given $8 million to fund better wages for human service workers.
  • Pediatric Palliative Care gained a slight increase with $1.55 million.
  • The Board of Registration in Pharmacy will establish four new specialty licenses for retail sterile compounding pharmacy, retail complex non-sterile compounding, and institutional pharmacy license to apply to hospitals and an out-of-state pharmacy license for those doing business in Massachusetts.

For more information, the conference committee’s budget can be viewed here.

Return to www.thinkhomecare.org.

Study Results Released on Health IT Adoption in MA

According to a study on the adoption of Health IT and electronic health record systems (EHR) by healthcare providers across the state, home health agencies come in fourth by “practice type.”

The study conducted by the Massachusetts eHealth Institute (MeHI) shows that 74% of home health agencies have adopted a Health IT system, which places them behind primary care physicians, specialists and Rehab/Therapy, but ahead of skilled nursing facilities and behavioral health providers. The chart below displays MeHI’s results.

MeHI EHR Adoption ChartNearly 80 percent of healthcare institutions and practices in Massachusetts report they are using EHRs – and 50 percent of consumers indicated they have used health IT to directly communicate with their health care provider, review test results, renew prescriptions or schedule appointments.

However, according to MeHI, this study confirms that there are medical practice areas in which the benefits of eHealth are penetrating at a rate slower than the statewide total.

MeHI also found that ,of those with an EHR system, most practices and providers are using their EHR for medication reconciliation (81%), quality reporting (81%), electronic prescribing or eRx (76%). A smaller percentage of practices are using their EHRs for clinical decision support rules (64%) and public health reporting (55%).

MeHI recommends state assistance for certain provider groups, including home health agencies, could benefit with accelerating the adoption process.

For more on MeHI and their efforts to guide Health IT adoption, visit mehi.masstech.org.

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.

 

State Budget Process Moves to Conference Committee

As expected, the House and Senate Chairs of their respective Committees on Ways and Means will co-chair a six-member conference committee that will work out the differences between the House and Senate budget plans.

The House-approved plan calls for $36.32 billion while the Senate plan was set at $36.4 billion. Although they are similar in terms of total amounts, there are some important differences in both funding support and policy changes.

The Home Care Alliance sent a letter outlining those differences as they pertain to home care services in a letter to each conference committee member.

Here are the main bullet points from that letter where the HCA is asking for support:

  • Senate Amendment #929: Home Telehealth
    • This language was passed in the FY14 budget and allows MassHealth the policy support necessary to continue work on establishing rates and guidelines for home telehealth services.
    • Home Telehealth involves remote vital signs monitoring equipment. This service offers immediate cost savings by reducing the frequency of home health visits paid for by MassHealth, along with reduced hospitalizations through improved medication adherence, patient self-management and timely follow-up care.
  • Senate Amendment #683: Homemaker Wage Increase
    • Approved by a unanimous roll call vote in the Senate, this amendment increases pay by approximately $.75 cents per hour for homemakers and personal care homemakers serving clients enrolled in the Executive Office of Elder Affairs Home Care Program.
  • Senate Outside Section Relative to the Home and Community-Based Services Policy Lab
    • This language and corresponding funding would support the study of the cost-effectiveness of state-funded home and community-based services.
  • House Support for Elder Services Home Care Purchased Services (9110-1630)

The Alliance encourages home care agency members and advocates to contact the conference committee this week to ask for their support using the bullet points above. Here are the names and contact info for conference committee members:

Return to www.thinkhomecare.org.

Upcoming One Care Shared Learning Conference

MassHealth and UMass Medical School are hosting a One Care Shared Learning Conference at three different locations across the state in early June.

June 3, 2014 June 10, 2014 June 18, 2014
7:30 A.M. – 1:00 P.M.
Springfield Marriott
2 Boland Way,
Springfield, MA 01103Register for the
Springfield Conference
Before May 23, 2014		 7:30 A.M. – 1:00 P.M.
Best Western Royal
Plaza – Marlborough
181 Boston Post Rd. W,
Marlborough, MA 01752Register for the
Marlborough Conference
Before May 27, 2014		 7:30 A.M. – 1:00 P.M.
Four Points by
Sheraton – Norwood
1125 Boston Providence Turnpike,
Norwood, MA 02062Register for the
Norwood Conference
Before June 4, 2014

This conference will focus on “Integration of Primary Care, Behavioral Health and Community Supports in Real Life Cases: Developing and Implementing Person-Centered Care for People with Complex Health Care Needs.”

Who should attend?

This conference is primarily for primary care providers (PCPs), behavioral health clinicians, long term services and supports (LTSS) providers – including home care agencies – and other community based organizations involved in One Care.

This conference will focus on the collaboration among the members of an integrated care team, focusing on each of their roles in developing and implementing person-centered care for people with complex health care needs. There are a limited number of spots available, and One Care plan staff and their contracted providers will be given priority.

To register for one of these conferences or for more information, visit www.mass.gov/masshealth/onecare/learning

Download the Conference Agenda(https://onecarelearning.ehs.state.ma.us/pdf/One-Care-Conference-Flyer-Agenda.pdf

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”

Advocacy Alert: Call and Email Your State Senator TODAY!

The budget amendments important to home care are up for debate today in the MA-State-HouseMassachusetts Senate.

The Home Care Alliance’s priority amendments include restoring the 20-percent rate cut for MassHealth home health visits past 60 days, creating a commission to study home health services and recommend oversight measures, and allowing MassHealth to continue their work to establish telehealth services provided by home care agencies.

We need calls and emails to be made NOW to senators to get support for the following amendments:

  • #684 – Senator Patricia D. Jehlen: Study Commission for Home Health Care Services and Oversight

Purpose: The Commonwealth is one of only five states without either licensure or a “determination of need” process for oversight of home health care. 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, services provided and available by region, and create recommendations for state oversight and quality standards.

  • #839 – Senator Kathleen O’Connor-Ives: Restoring Home Nursing Rates

Purpose: This budget language seeks to restore the MassHealth rate for home health nursing visits past 60 days of care to the payment level prior to the rate cut of December 1, 2008 so that patients with the most severe conditions can have their care continued and remain independent at home. This amendment creates a consistent rate for as long as an individual on MassHealth requires home health care.

  • #929 – Senator Richard T. Moore: Establishing Reimbursement for Telehealth Services Provided by Home Health Agencies

Purpose: Maintain language from the FY2014 budget that established MassHealth reimbursement for home telehealth services provided by a home health agency, immediately providing cost savings and more efficient care. MassHealth is in the process of building corresponding rates and guidelines.

The Alliance is also supporting the Homemaker Wage Increase (#683) and increased funding for the state’s elder services programs (#687).

A full update will be available when the Senate completes debate, but HCA members and advocates can still send an email to their state senator here and follow the Alliance on Twitter (@thinkhomecare) for updates.

Return to www.thinkhomecare.org.