Governor’s Budget Gives Big Support to ASAP, Home Care Programs

Despite having his state of the Commonwealth address delayed by a snowstorm, Governor Deval Patrick was required to release his budget proposal this past Wednesday to officially kick off budget deliberations for fiscal year 2015.

A huge win for elder home care services came in line items that support the Aging Service Access Points and state Home Care Program, which received an additional $16.9 million, according to Executive Office of Elder Affairs Secretary Ann Hartstein. Among those funds are increases of $9.8 million for the Enhanced Community Options Program (ECOP) and $7.5 million for the “basic” category of services.

Combined, according to Secretary Hartstein, those two line item increases will eliminate waiting lists through the end of fiscal year 2015. The funding boost works out to an additional hour of homemaking services per consumer per month on average, but Secretary Hartstein stressed that, in reality, the money would pay for whatever services people may need when they need them.

The Governor also put a $1.3 million increase to the Senior Supportive Housing account, which will expand “assisted living facility-type services” for seniors in public housing. Specifically, the money will add another 10 public housing sites where senior residents will be supported by home care services.

Another $1.2 million was added in a new line item titled “Home Care Workforce Training Fund.” This new account will support workforce training for Aging Service Access Points, although the administration is not yet clear on which workers will receive training. Case management, protective services and direct care workers are all on the table as potential recipients.

MassHealth experienced major changes in the budget, mostly related to federal healthcare reform. Since the MassHealth Basic and Essential programs were eliminated, a combined $706.3 million is now in populations with expanded coverage and in the new MassHealth plans.   The MassHealth Senior Care account was granted another $271.4 million by the Governor and the MassHealth Managed Care account saw an additional $336.7 million. The MassHealth Fee-for-Service line item was raised by $205 million. It is unclear how these increases might result in better reimbursement rates for home health agencies. A formal rate reassessment hearing is still being eagerly awaited.

Other items of note from the Governor’s budget include the following:

  • Applying the state sales tax to candy and soda. The administration estimates that would raise roughly $57 million for health promotion and prevention programs.
  • The Governor’s budget cuts the MassHealth Nursing Home Supplimental Rates by $20.7 million
  • Pediatric Palliative Care is essentially level funded at just over $1.5 million
  • The Governor’s budget includes a special fund for federal assistance (FMAP) relative to health reform and healthcare access expansion called the Health Insurance Expansion Fund.
  • The DPH budget gets an overall increase of 1% with details in Commissioner Cheryl Bartlett’s “Mass Public Health” blog post.

Stay tuned for more  budget-related news and advocacy alerts.

Return to www.thinkhomecare.org.

Controversial Hospice Article Draws Response

photo credit: NY Times/Ruby Washington

Once again, the actions of the few bad actors in home health and hospice are getting media attention rather than the vast majority of agencies that are devoted to providing high quality care to keep people comfortable and at home.

In an investigative report, the Washington Post highlights findings that the number of patients discharged alive from hospice rose by 50 percent between 2002 and 2012. The article also highlights numbers from the Medicare Payment Advisory Commission (MedPAC) stating that in 2011, nearly 60 percent of Medicare’s hospice expenditure of $13.8 billion went toward patients who stay on hospice care longer than six months. The article singles out for-profit hospices in particular, but still puts all hospices in a negative context.

In fact, the article has prompted responses from the National Association for Home Care and Hospice (NAHC) as well as the National Hospice and Palliative Care Organization (NHPCO). In a letter to the editor, NAHC ends their rebuttal by writing:

We must all do our part to ensure that hospice remains a viable choice for terminally ill patients and their loved ones.  Articles of this type may unwittingly discourage use of hospice care, thereby denying terminally ill patients and their families access to vital services that support and comfort them during and in the aftermath of one of life’s most difficult journeys.  Under these circumstances, no one is well served.

The New York Times’ “New Old Age Blog” digs much deeper into the Washington Post’s findings and notes the many layers to the issue and why those numbers may have surfaced. For instance, the blogger writes:

What’s happening here? Hospices have lamented for years that dying patients wait too long to call, enrolling at the eleventh hour when they could have benefited months earlier. Now, we’re hearing more about patients doing as hospice believers (including me) have urged, calling earlier in the course of a terminal disease — and then, in a substantial minority of cases, getting bounced.

Return to www.thinkhomecare.org.

The Top Home Care Stories of 2013

As 2013 comes to a close, the Home Care Alliance looks back on the year in home care news. The Jimmo case, Boston Marathon Bombing, and the shutdown of the federal government all were stories that had an enormous impact on home care agencies and made some people realize the importance of home care services. Other stories more specific to the industry like Medicare “rebasing” cuts and HCA’s policy victory of getting state-based reimbursement for home telemonitoring reflect the ongoing work needed to push decision-makers on what home care can do for people.

See the top home care news of 2013 and let us know what you think in the comments section!

January

Judge Approves ‘Improvement Standard’ Settlement

On January 24, 2013, the Chief Judge of Vermont’s U.S. District Court gave her approval  during a scheduled fairness hearing for an ‘improvement standard’ settlement (Jimmo v. Sebelius).  This settlement could lead to more long-term care in the home health setting and open the benefit to patients who were previously denied coverage….

Guest Post: New MA Staffing Agency Regs

On January 31, 2013, Massachusetts will become the second state to require staffing agencies to provide basic job information to employees assigned to temporary or part-time jobs.  An Act Establishing a Temporary Worker’s Right to Know will amend Massachusetts General Law, chapter 149, section 159C.  The following article provides an overview of the substance of the law and how to comply….

Continue reading “The Top Home Care Stories of 2013”

Guest Blog Post: Participate in MeHI’s Health IT Research Study

By Laurance Stuntz, Director at the Massachusetts e-Health Institute (MeHI)

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Care Providers: Make your voice heard!  Participate in MeHI’s Health IT Research Study

Here at the Massachusetts eHealth Institute (MeHI), we have been busy traveling across the state to meet with healthcare providers, listen to their concerns, and share many of the programs our organization is undertaking to help with health IT adoption in the Bay State.

Our series of regional meetings have continued this fall, and have been very well attended from many healthcare segments including home care. These events have provided a great forum for providers and their organization’s leaders to ask questions about what’s ahead for health IT and how it will affect their particular area of specialty in the patient care continuum. In addition, we have been speaking at important local home care events including the Home Care Alliance Financial Management Conference.

With all of this activity and interest, we recognize that providers have a wide range of attitudes, opinions and needs regarding health IT adoption. We know there is much more work to be done and we want to partner with you to develop new strategies and programs to support complete EHR and Health Information Exchange adoption across the state, including ongoing improvement of the overall effectiveness of use of EHRs. It’s vital that you and your colleagues have a seat at the table.

This is why MeHI is undertaking a Provider and Consumer Research Study. This effort is aimed at gathering comprehensive information on the use, needs and attitudes toward health IT among both providers and consumers.

The research firm Market Decisions will be contacting thousands of health care providers and hundreds of consumers across Massachusetts to speak with them about health IT. The research will help identify specific challenges with health IT adoption and provide us with valuable insights.

If you are contacted, we encourage you to take 5 to 10 minutes to speak with the Market Decisions representatives to provide your perspective about the use of health IT in Massachusetts, including what you see as the major challenges in adopting these technologies. If you would like to take the survey now, please follow the link below to participate. We want your input!

http://www.research.net/s/MA_Home_Care

We hope that you will take the time to participate in this important survey. We are confident the first-hand perspectives we collect will lead to the development of thoughtful, well-informed strategies for providing the best health IT support and services to providers, as well as an improved healthcare experience for patients.

Laurance Stuntz is a Director at MeHI, a division of the Massachusetts Technology Collaborative. MeHI was empowered by the Massachusetts legislature to expand the adoption of eHealth technologies and further innovation in health IT across the Commonwealth. Follow Laurance on Twitter at @lstuntz

Return to www.thinkhomecare.org

ACO Strategies Reviewed At Financial Managers Conference

The Home Care Alliance’s annual Financial Managers Conference was held last week at the Conference Center at Waltham Woods.   The conference included presentations on benchmarking and operational efficiencies (from principals from BKD and McBee Associates), as well as a presentation from Emily Brower, the Director of ACO programs at Atrius Health.  Atrius Health is one of five Pioneer ACOs in Eastern MA.  Ms Brower’s presentation was summarized in Home Health Technology Report by Tim Rowan, who  was also at the conference to present on IT Trends.

Ms Brower talked frankly about their need to manage costs, their dependence on their home care agency VNA Care Network/VNA of Boston and their progress in creating truly integrated plans of care.  Read Tim Rowan’s summary here.

For more news like this follow the Alliance (@thinkhomecare) and Tim Rowan on Twitter (@TimRowan).

Return to www.thinkhomecare.org.

National Association Provides Update on Rebasing, SGR

The National Association for Home Care & Hospice (NAHC) held a conference call revealing a frantic final week of advocacy activity before Congress takes its holiday recess until the New Year.

The major part of that activity for home health agencies centered around the attempt to delay the impacts of Medicare “rebasing” cuts through an amendment to the Medicare Sustainable Growth Rate (SGR) fix – also known as the physician fix.

Senator Debbie Stabenow (D-MI) offered an amendment on behalf of home care that would delay the cuts for one full year and give the industry the chance to lobby CMS to change their methodology with more updated and accurate data. Unfortunately, part of the compromise of the short -term physician fix was that it was a “clean” bill, which means no outside amendments. According to NAHC, even the hospital industry had amendments that were proposed and then withdrawn because of that agreement between Democrats and Republicans.

The short-term SGR fix will last for three months and must be offset by $7 billion. The good news there is that none of the offset is coming from the home health industry. Some of the hit is being hit is being absorbed by cuts to Long Term Care Hospitals and Disproportionate Share Hospital rates, but copays and additional reductions for home care  were avoided.

The light at the end of the tunnel comes from the fact that the Senate is working on a permanent SGR fix and the Stabenow amendment will still be in play for that effort. In addition, NAHC was successful in getting language from the FITT Act into the Senate’s proposal. The FITT Act essentially establishes a national pilot program for home-based telemonitoring provided by home health agencies. It will not be straight reimbursement, but is meant to be a shared savings approach where the providers and Medicare will share in any efficiencies gained. Moreover, if the program is successful, NAHC indicated that the program could be expanded by Medicare without going back to Congress for approval since it is a pilot and not a demonstration.

In terms of hospice care, NAHC also reported that another amendment would allow physician’s assistants to serve as the attending physician for hospice patients.

All of these wheels will be in motion in the New Year, but the main idea is that Democrats and Republicans compromised on a two-year deal that keeps the federal government running and it was done without implementing co-payments for home care. The 2% sequester cuts are extended for an additional two years, but those are not “new” cuts and are simply to make the budget scoring work. By the time the extended years are reached, the sequester could potentially be a thing of the past.

The Home Care Alliance thanks agencies for sending nearly 200 messages to the Massachusetts Congressional Delegation in two days. That education and advocacy will be critical as we move forward to fight rebasing in the New Year. Of course, further information will be provided as it becomes available.

 

Return to www.thinkhomecare.org.

 

Advocacy Alert: Contact Congress Re: Amendment Delaying Rebasing Cuts

Congress is working in the final days before the holiday recess on a long-term Medicare Sustainable Growth Rate (SGR) process and an amendment to that process could delay the impending rebasing cut to home health care.

The Alliance is asking that agencies and advocates contact their Member of Congress TODAY to educate them about the amendment and what it means for Medicare home health agencies. U.S. Capitol Building

Senator Debbie Stabenow (D-MI) has offered an amendment that essentially delays the effects of rebasing so that CMS can hopefully adjust their methodology with updated and more accurate data. Educating the Massachusetts Congressional Delegation is crucial to getting support for the amendment as there is so much happening in the final two days of activity.

More information and a prepared email message is available on HCA’s Legislative Action Network and it only takes a minute to log on and add your voice to this critical push to delay a damaging 3.5% cut per year over the next four years.

We also urge members to call the offices of your Congressional representatives directly using the message below as a guide. Simply call the main switchboard at (202) 224-3121, request a transfer to the office of your Congressional representative, and ask to speak to the individual from that office that is responsible for health policy.Here is the text of the message to Congress if you choose to call:

The U.S. Centers for Medicare and Medicaid Services (CMS) has finalized a rule imposing unprecedented Medicare home health reductions under a process called “rebasing.” All told, the impact on providers will be a $200 million cut in each of the next four years.

We are asking for your support in backing an amendment from Senator Debbie Stabenow as well as any corresponding effort in the House to amend the Medicare Sustainable Growth Rate (SGR) process.

These are the largest cuts to home health in decades, and they will cause many agencies to close their doors, especially if these cuts are compounded by Medicare reductions via the continuing budget resolution. Such cuts are counter-productive at a time when health reform relies on cost-effective care at home to serve vulnerable citizens.

CMS’s rebasing cuts were finalized on November 22 and go into effect on January 1. This leaves little time to delay these disastrous cuts and compel CMS to conduct a more fair, accurate and thorough analysis of its fiscal assumptions.

The data is clear. Many Medicare-certified home care providers are already operating in the red across all sources of payment. These new cuts – scheduled to be compounded for each of the next four years – will cripple the industry and create barriers to care. Yet, despite similar trends across the country, CMS concludes that draconian rebasing reductions are needed to eliminate positive margins in home health. CMS’s math simply does not add up.

Many in Congress agree. A bipartisan letter sent to CMS raised strong concerns, stating that the rebasing methodology relies on “incomplete data and analysis that results in the under-counting of home health agencies’ costs per episode of care, and an inappropriately high rebasing adjustment.”

Home care providers nationwide thank you and your colleagues in Congress for your strong stance on rebasing and we ask for your continued active engagement supporting Senator Stabenow and others to delay rebasing and initiate a more rational approach from CMS.

Thank you.

Return to www.thinkhomecare.org

Stage 2 EMR Adoption Deadline Pushed Back One Year

Several healthcare industry news outlets, including Modern Healthcare, are reporting that CMS is extending the deadline that providers are required to show Stage 2 “Meaningful Use” criteria  of electronic health records (EMR).

The overall deadline is delayed for one full year and, according to Modern Healthcare, Stage 2 of the CMS incentive program to encourage EMR adoption will be extended through 2016. Stage 3 won’t begin until at least fiscal year 2017 for hospitals and calendar year 2017 for physicians and other eligible professionals that have by then completed at least two years at Stage 2.

CMS and the Office of the National Coordinator for Health Information Technology at HHS say that the delay is intended help both federal entities focus on helping providers meet Stage 2’s demands for patient engagement, interoperability and information exchange, as well as use data collected during that phase to inform policy decisions for Stage 3.

The proposed rules relative to the requirements providers must meet for Stage 3, as well as the 2017 Edition of standards that health IT developers must build and test their systems to match, are expected to be released in the fall of 2014 .

The Modern Healthcare article noted that the program, created under the America Recovery and Reinvestment Act of 2009, has paid out about $17 billion since January 2011, according to the latest CMS data.

Return to www.thinkhomecare.org.

Your Care, Your Choice – Now In Spanish!

Earlier this year, the Alliance published two brochures regarding patient choice after a hospitalization or stay in other medical facilities.

We’re pleased to announce the publication of a Spanish translation of the patient-orientated version, “Your Care, Your Choice,” which reminds patients of their right to choose their own providers, and empowers them to report facilities that attempt to violate these rights.

Return to www.thinkhomecare.org.

CMS Presents Jimmo v. Sebelius Manual Update

CMS is conducting a call on program manual updates related to the Jimmo v.Sebelius law suit on the CMS MLN Connects,  Thursday, December 19th at  2-3pm ET.  The program title is Program Manual Updates to Clarify SNF, IRF, HH, and OPT Coverage Pursuant to Jimmo v. Sebelius

To Register: Visit MLN Connects™ Upcoming Calls. Space may be limited, register early.

Agenda

  • Clarification of Medicare’s longstanding policy on coverage for skilled services
  • No “Improvement Standard” is to be applied in determining Medicare coverage for maintenance claims that require skilled care
  • Enhanced guidance on appropriate documentation

On January 24, 2013, the U. S. District Court for the District of Vermont approved a settlement agreement in the case of Jimmo v. Sebelius, involving skilled care for the inpatient rehabilitation facility (IRF), skilled nursing facility (SNF), home health (HH), and outpatient therapy (OPT) benefits. “Nothing in this Settlement Agreement modifies, contracts, or expands the existing eligibility requirements for receiving Medicare coverage.”

The goal of this settlement agreement is to ensure that claims are correctly adjudicated in accordance with existing Medicare policy, so that Medicare beneficiaries receive the full coverage to which they are entitled. The settlement agreement sets forth a series of specific steps for CMS to undertake, including issuing clarifications to existing program guidance and new educational material on this subject.

As part of the educational campaign, this MLN Connects™ Call will provide an overview of the clarifications to the Medicare program manuals. These clarifications reflect Medicare’s longstanding policy that when skilled services are required in order to provide reasonable and necessary care to prevent or slow further deterioration, coverage cannot be denied based on the absence of potential for improvement or restoration. In this context, coverage of skilled nursing and skilled therapy services “…does not turn on the presence or absence of a beneficiary’s potential for improvement, but rather on the beneficiary’s need for skilled care.” Portions of the revised manual provisions also include additional material on the role of appropriate documentation in facilitating accurate coverage determinations for claims involving skilled care. Target Audience
Skilled Nursing Facilities; Inpatient Rehabilitation Facilities; Home Health Agencies; and providers and suppliers of therapy services under the Outpatient Therapy Benefit