Twas the Night Before …

This past week, Helen Siegel, our Director of Regulatory and Clinical Affairs retired after 17 years of supporting our member agencies in all issues clinical, QI,  and regulatory.  Helen took more calls than anyone in our office and responded to any and all questions sent her way.  Her knowledge and presence will be missed.

As part of her send-off, her peers at the Alliance prepared this for her:

 

Twas the night before Christmas, At the Alliance, Park Square
Not a creature was stirring, was noone there?

No stockings were on the desks or the walls
Not even the blue tree with disco glitter balls.

No TPL calls, no help me to start
No meetings, no minutes, not a single faxed chart.

The staff were all quietly digesting  the news
Helen’s departing, who’ll fill her shoes?

No visions of sugar plums, no candy canes
Can sweeten the blow, can help ease the pain.

When all appeared lost, Tim said, I have a plan
We’ll write to Santa, yes, Santa’s our man.

We’ll ask him to find someone…not naughty but nice
Who can take all these calls, and give good advice.

And if he could, perhaps someone who knows,
face to face and QI, and maybe the SCOs.

The email was sent and then we waited and waited
I guess even we knew our wish too inflated.

For even for Santa the task proved too rough
A replacement for Helen, that’s just not his stuff.

Skills like these, well the fact that years to hone,
Good thing Helen still has her cell phone!

But tis the season of miracles and light
One by one, the eight candles bring hope, and burn bright

So with hope for the future, and a fate we can’t fight

Happy Retirement, Helen
And to all, a good night! 

Happy Holidays and Peace and Joy in 2012.

 

 

 

CMS Announces Independence At Home Demonstration Program

CMS continues to roll out initiatives from the Affordable Care Act in an attempt to test new ways to improve health care and lower cost.

The latest in this line of programs and funding opportunities is the Independence At Home Demonstration (Section 3024 of the ACA), which aims to test a service delivery model that utilizes physician and nurse practitioner-directed primary care teams to provide services to certain Medicare beneficiaries with multiple chronic illnesses in their homes.

According to the Independence At Home (IAH) Program Solicitation, in order to be involved in the Demonstration, “practices must be individual physicians or nurse practitioners or interdisciplinary teams composed of various members such as physicians, nurse practitioners, physician assistants, pharmacists, social workers, and other supporting staff.” The program itself is designed to provide comprehensive, coordinated, continuous and accessible care to high-need patients and to coordinate health care across all treatment settings.

Even though primary care is the lead in the IAH demo, the focus is on delivering care to patients in their homes and getting beneficiaries what they need to remain independent. In other words, the program could actually be of significant benefit to the home care industry as a whole because primary care practitioners will be making check-ups in the home and witnessing how patients function in their day-to-day environment. Based on those visits, the practices will be identifying services – like home care and other community based services – that help keep people out of costlier settings and the ER.

Practices are required to use electronic health systems and remote patient monitoring, both of which are used by many home health agencies. Also, practices must be available 24 hours per day, seven days per week to carry out plans of care. Applicable beneficiaries must have at least two chronic illnesses, must need human assistance with two or more Activities of Daily Living (ADL’s), have had a non-elective hospital admission within the last 12 months and have used acute or sub-acute rehabilitation services within the last 12 months.

HCA encourages agencies to see the other guidelines, which are laid out in the IAH Solicitation and a summary is provided in a PowerPoint provided on the IAH program webpage.

Return to www.thinkhomecare.org.

MassHealth Releases Dual Eligible Demo Proposal for Public Comment

After months of stakeholder meetings and public presentations, MassHealth has released their official proposal for the “State Demonstration to Integrate Care for Dual Eligible Individuals” to the Centers for Medicare and Medicaid Services (CMS).

The initiative seeks to combine Medicare and Medicaid funding to contract with an Integrated Care Organization (ICO) that will pay for coordinated and comprehensive care for dually eligible individuals ages 21 to 64. Massachusetts was one of 15 states to be awarded a planning grant for the project and has been in contact with CMS on crafting benefit design, enrollment processes, and payment processes.

The release of the draft proposal initiates a 30-day public comment period that will remain open until 5:00 pm, January 10, 2012. Two public hearings are also planned at the following dates and locations:

  • December 16, 2011, 1 pm – 4 pm, at the Worcester Public Library, Saxe Room, 3 Salem Square, Worcester, MA
  • January 4, 2012, 9 am – 12 noon, at the State Transportation Building, Conference Rooms 2 & 3, 10 Park Place, Boston, MA

For any agencies caring for dually eligible patients, we strongly encourage you to look at the proposal and send in comments. The Home Care Alliance would also like any case studies of these patients that agencies have been successful in keeping in the community.

Agencies can send comments to: duals@state.ma.us, or mailed to:

Executive Office of Health and Human Services
Attn:  Lisa Wong
One Ashburton Place, Rm. 1109
Boston, MA 02108

Return to www.thinkhomecare.org.

“That’s Democracy”

Anyone interested in a little insight into CMS under Dr. Don Berwick and what the legacy of  his short tenure might be can find a lot to consider in the online Health Affairs post:  “Now Departed From The Centers For Medicare And Medicaid Services…” written by Harris Meyer.    The article looks at Berwick’s efforts to both transform the health care delivery system, as well as the CMS agency and the 5,400 people it employs.    “We’re working on the agency culture and habits,” he said in an interview between meetings.  “We’re seeking boundarylessness, speed and agility, unconditional teamwork, innovation, and customer focus. ”  All indications are that the large bureaucracy was beginning to respond.

Interestingly, Berwick’s “that’s democracy” quote comes not in response to the partisanship in Washington DC that laid ruin to any chance he had at a permanent appointment.  Berwick used the phrase in reflecting on the outpouring of (mostly negative) comments received at CMS from health care stakeholders with the release of his preliminary proposal on Medicare Accountable Care Organizations.  “What happened is what should have happened,” he said. “We took our best shot, and smarter people than we are responded. That’s democracy.”

Democracy indeed. Read it for yourself and decide.

CMS Care Transition Program Update and Guidance

Masspro, the state’s quality improvement organization, held a conference call on the CMS Community Based Care Transitions Program and provided some useful guidance for those looking to apply or reapply for funding.

Based on a CMS call with QIO’s, there were three common elements that tripped up applications from community based organizations, hospitals and other partners:

  • Firstly, in many applications, CMS said that it was not clear that the community-based organization was eligible and did not fit the criteria laid out in the solicitation, fact sheets and Q&A’s.
  • Second, many applications included budget items that were outside of what CMS would fund. For instance, CMS will only fund activities directly related to the intervention and not indirect costs like data collection. CMS is also said to be aiming for an across-the-board 20 percent reduction in readmissions for the program collectively as an attainable and reasonable target. Budgets within an application should reflect that element.
  • Lastly, CMS found that there were a lack of community partnerships in the applications they reviewed. Looking at the seven successful applications, it is clear that there is a large group of partners serving a relatively broad geographic region.

In addition to the Masspro call, CMS has once again updated their CCTP webpage to include panel review dates for incoming applications through March 27th. Also, summaries of all seven of the successful applications are now posted.

The Home Care Alliance will continue to provide guidance and assistance to home care agencies interested in applying and will connect any hospital or community partners looking for home care agencies in their area.

Return to www.thinkhomecare.org.

More News on Care Transitions Funding

Despite tremendous national interest, the new CMS Center for Medicare and Medicaid Innovation (CMMI) has  funded only seven applicants to date under its new Care Transitions project.   While CMS will not say how many applications they received and rejected in the first round, or how many are pending review, information is slowly coming to light about the funded projects.  For entities still looking to apply – and CMMI is clear that they continue to want applicants!! – the information is potentially instructive.

One of the funded sites – in Greater Cincinnati – shared on the Medicaring blog (hosted by the non profit Altarum Institute) that they plan to serve about 5400 beneficiaries and save about $1 million using what they call a “modified Coleman Model.”   The same blog in a slightly earlier post ran an interesting piece on developing a “blended” per person rate as required by the Section 3026 budget worksheet.

Those who want more detail on what has been funded, can find a summary of projects on the CMS Care Transitions project website.  Two threads common to all projects and stressed on a call with awardees has been that  1) funded sites have some care transitions experience with a specific model and 2)  multiple hospital partners are involved.  In the case of the latter, CMS wants to see actual agreements in place, not just letters of support.

EOHHS Hosting FY2013 Budget Hearings

The Home Care Alliance is collecting written testimony and encouraging those interested to present oral testimony for upcoming hearings being hosted by the Executive Office of Health and Human Services (EOHHS) on the upcoming Fiscal Year 2013 budget.

Indications have been made that the upcoming budget will be just as difficult as those in previous years so it is important that home care agencies show up and submit written comments to convey the significance and value of the services they provide. EOHHS is seeking input about the best ways to preserve core services to the fullest extent possible without additional expenditures. As such, the Alliance suggests that agencies promote work in care transitions, disease management, and the general value of keeping people independent at home. The Alliance is also pushing for MassHealth coverage of telehealth technology as well as legislation on nurse delegation of medication administration, which we encourage people testifying to include in their comments.

Secretary JudyAnn Bigby, M.D., and the Assistant Secretaries at EOHHS will be on hand for both hearings so comments should begin by addressing them accordingly. The two hearings will be held this week and next week at the following dates and locations:

Friday, December 2, 2011 from 3:00-6:00 p.m.
Department of Mental Health Western Massachusetts Area Office
Northampton Haskell Building
1 Prince Street
Northampton, MA 01061

Friday, December 9, 2011 from 2:00–6:00 p.m.
Agganis Arena at Boston University
Francis D. Burke Club Room
925 Commonwealth Avenue
Boston, MA 02215-1204

Due to the number of individuals anticipated to attend the hearings, oral testimony will be limited to three minutes per individual. In the interest of time, representative panels are welcome and will be limited to a total of five minutes of oral testimony. If a number of home care agencies are interested, they will be added to a panel as HCA will be attending and testifying at the Boston hearing on December 9th. HCA asks that you also inform us if you sign up to attend or submit written comments on your own.

If you need accommodations please call 617-573-1600 and let the receptionist know.  Additionally, if you are planning to present oral testimony at the Boston hearing, please note that you must be in the building by no later than 5:50 p.m.

Written testimony can be sent to the Home Care Alliance to be submitted collectively, or may be mailed to:

Secretary JudyAnn Bigby, EOHHS
One Ashburton Place, Room 1109, Boston, MA 02108
Or emailed to:  eohhshearings@massmail.state.ma.us

Return to www.thinkhomecare.org.

Copays Avoided: Super Committee Fails to Reach Deal by Deadline

The Joint Select Committee on Deficit Reduction, also known as the Super Committee, charged with coming up with a plan to cut the national deficit by $1.8 trillion over the next decade failed to do so by their November 23rd deadline.

Although the group could not come to a compromise, the lack of a deal is a temporary win for home care because of what was on the table. Copayments on Medicare home health services were proposed and considered from several angles, including President Obama and the Medicare Payment Advisory Commission (MedPAC).

Now, because the six Democrats and six Republicans on the committee could not come to a compromise, a sequestration process begins where automatic and across-the-board spending cuts will be triggered and are planned to begin in January 2013. The debate on the subject, especially in Congress and for the upcoming election, will certainly not stop until that time and some course of action prior to the commencement of automatic cuts is likely to alter current plans.

See an official statement from the National Association for Home Care & Hospice on the Super Committee and avoiding a copay for Medicare home health services.

Senator John Kerry, a member of the 12-person committee, has proven once again to be a champion for home care issues. The Alliance has been in contact with his staff throughout the process who relayed HCA’s advocacy to the Senator. Such advocacy will need to continue until it is revealed how any cuts from the sequestration process will be doled out.

HCA will provide updates as the deficit reduction debate continues.

Return to www.thinkhomcare.org.

Health Care Innovation Challenge Announced

A new funding opportunity has been announced by the CMS Center for Innovation (CMMI).

The Health Care Innovation Challenge, relative to Section 3021 of the Affordable Care Act, will award funding to innovative projects that test ways to deliver the three-part aim of better health, better health care and lower costs through improved quality for Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) enrollees.

Preference will be given to projects that focus on rapid workforce development. Eligible applicants include provider groups, health systems, payers and other private sector organizations, faith-based organizations, local governments, and public-private partnerships and for-profit organizations. States are not eligible to apply. Up to $1 billion is available for this opportunity. Individual awards expect to range from $1-$30 million over a three year period. Applications are due January 27, 2012.

If any home care agencies are interested in this opportunity, the Alliance will be providing assistance and guidance as with the Community-Based Care Transitions Program.

Return to www.thinkhomecare.org.

CMS Community Based Care Transitions Program Update

The Centers for Medicare and Medicaid Services (CMS) released more deadlines where they will be reviewing applications for the Community-Based Care Transitions Program (CCTP) and also announced seven accepted applications and further guidance on crafting a successful application.

The new panel review dates as well as those previously announced that are coming up are as follows:

  • January 12 & 13, 2012 – Applications must be received by December 22nd to be considered for this review.
  • January 31 & February 1 – Applications must be received by January 11th to be considered for this review.
  • February 17 & 20 – Applications must be received by January 30th to be considered for this review.

The CCTP Program fact sheet is helpful in that it contains a lot of the information in the Q&A’s, but in a more concise document. The document is mostly a reiteration of the program requirements and what CMS is looking for in an application.

The seven sites that are the first to be awarded include one program in the Merrimack Valley and North Shore of Massachusetts. CMS and all seven sites will be part of  a conference call on Tuesday, November 29th from 1:00pm-2:30pm to allow stakeholders to hear directly from some of the newly selected sites. CMS staff will be available to answer questions. Call in #: (800) 837-1936 Conference ID: 29693317.

If any home care agencies are interested in pursuing or continuing to pursue this opportunity, please contact the Home Care Alliance for assistance.

Return to www.thinkhomecare.org.