HPC Releases Proposed ACO Standards for Comment

The Commonwealth of Massachusetts is in the midst of a massive initiative to transform MassHealth payment and care delivery through the creation of Accountable Care Organizations (ACO). MassHealth has convened eight separate work groups to provide input and recommendations on various aspects of this transformation. The Home Care Alliance is represented on six of those eight work groups.

In support of that initiative, the state’s Health Policy Commission (HPC) this week released a set of draft ACO certification standards.

According to the HPC, the purpose of the certification program is to “complement existing local and national care transformation and payment reform efforts, validate value-based care, and promote investments by all payers in efficient, high-quality, and cost-effective care across the continuum.”

The HPC’s proposed standards include criteria, documentation requirements and questions for public comment. HCA intends to comment, so any members with thoughts, suggestions or answers on any of the proposed criteria or questions should contact James Fuccione at the Alliance.

For those looking to submit comments independent of the HCA, a public hearing will be hosted by the HPC on January 6 and the overall submission deadline for written feedback is January 29. That may seem like a far-off deadline, but with the holidays and the state’s budget process kicking up, any comments submitted to HCA well before that date would be appreciated.

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HCA Executive Director Named to Key Health Policy Advisory Group

Home Care Alliance Executive Director Patricia Kelleher has been named to the Health Policy Commission Advisory Council joining a list of other health care leaders  who will help guide the implementation of the state’s Health Care Cost Containment Law.

Better known as Chapter 224, (“An Act Improving the Quality of Health Care and Reducing Costs through Increased Transparency, Efficiency and Innovation”) the law requires the Health Policy Commission’s (HPC) Executive Director to establish the Advisory Council and designate members with diverse perspectives on the health care system to two-year terms. The Council will advance Chapter 224 implementation by advising on the HPC’s overall operations and policies, providing feedback on a grant program to support new system delivery and payment reform methods, and encouraging public and stakeholder engagement in the HPC’s work.

“This is an impressive group that promises to enrich the HPC’s work,” said Executive Director Seltz. “They are part of the coalition that made the first chapter of Massachusetts health care reform such a resounding success and the passage of our nation-leading cost containment law possible. Each member will bring a different and important perspective to our work to implement Chapter 224. I am grateful for their willingness to serve.”

The Advisory Council includes the following members from across the state:

  • Christine Alessandro, Executive Director, BayPath Elder Services, Inc.
  • Dianne Anderson, RN, President & CEO, Lawrence General Hospital
  • Michael Caljouw, Vice President, Government & Regulatory Affairs, Blue Cross Blue Shield of Massachusetts
  • JD Chesloff, Executive Director, Massachusetts Business Roundtable
  • Cheryl Clark, MD, Director of Health Equity Research & Intervention, Brigham & Women’s Hospital
  • John Cox, President, Cape Cod Community College
  • Karen Day, Executive Director, US Policy, AstraZeneca
  • Ralph de la Torre, President & CEO, Steward Health Care System
  • Vicker “Vic” Digravio, President & CEO, Association of Behavioral Health
  • Ronald Dunlap, MD, South Shore Hospital, President-Elect, Massachusetts Medical Society
  • John Erwin, Executive Director, Conference of Boston Teaching Hospitals
  • Julian Harris, MD, Director, Office of Medicaid
  • Jim Hunt, President & CEO, Massachusetts League of Community Health Centers
  • Jon Hurst, President, Retailers Association of Massachusetts
  • Dan Keenan, Senior Vice President, Government Relations, Sisters of Providence Health System
  • Patricia Kelleher, Executive Director, Home Care Alliance of Massachusetts
  • Gene Lindsey, MD, President & CEO, Atrius Health
  • Geoff MacKay, President & CEO, Organogenesis
  • David Martin, Senior Director, Health Policy, Covidien
  • David Matteodo, Executive Director, Massachusetts Association of Behavioral Health Systems, Inc.
  • Dolores Mitchell, Executive Director, Group Insurance Commission
  • Abraham “Ned” Morse, President, Massachusetts Senior Care Association
  • Joyce Murphy, Executive Vice Chancellor, Commonwealth Medicine, University of Massachusetts Medical School
  • Lynn Nicholas, President & CEO, Massachusetts Hospital Association
  • Cheryl Pascucci, APRN, FNP-C, Commonwealth Care Alliance
  • Lora Pellegrini, President & CEO, Massachusetts Association of Health Plans
  • Julie Pinkham, Executive Director, Massachusetts Nurses Association
  • Donald Thieme, Executive Director, Massachusetts Council of Community Hospitals
  • David Torchiana, MD, President & CEO, Massachusetts General Physicians Organization
  • Celia Wcislo, Vice President, 1199 SEIU of Massachusetts
  • Brian Wheelan, Executive Vice President for Corporate Strategy & Development, Beacon Health Strategies
  • Amy Whitcomb Slemmer, Executive Director, Health Care for All

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State Holds Health Payment Reform Info Session

Health care advocates and stakeholders packed and overflowed a large conference room meant to host an information session on the implementation progress of the new health care payment reform law.

Governor Patrick walked in mid-session and summed up the intent of the meeting where every state agency and department mentioned in the law was present to speak on their respective piece. The Governor explained that it took a lot of work to pass what he termed ‘a good bill’, but added that ‘now the real work begins.’ He said that it will take work on the part of government, providers, and stakeholders to ensure that the law is implemented effectively and the way in which it was intended.

To that end, Health and Human Services Secretary JudyAnn Bigby reported that the 11-member board of the Health Policy Commission, the main group charged with developing the policy necessary to implement the law, will be convened by November 5. The work of putting together other task forces and commissions, including those where the Home Care Alliance has the authority to name a representative, has already begun.

One of HCA’s victories in the legislation was the ability to name members on the Behavioral Health Task Force and the Commission to Review Public Payer Reimbursement Rates.

Other state agencies and their responsibilities are being reconfigured, including the Division of Health Care Financing becoming the Center for Health Information and Analysis. That group will be an independent state agency and so-called “pricing activities” relative to rate setting will move under the Executive Office of Health and Human Services.

The Alliance will provide updates as they become available and the state has an implementation website with more information at http://www.mass.gov/governor/agenda/healthcare/cost-containment/.

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New Website Created on State Health Care Payment Law Implementation

The state has announced a new web page on Mass.gov that will serve as a clearinghouse for information as the state implements the new health care cost containment law signed by Governor Patrick in August.

The site will host important announcements about the new law as well as information on Grants & Demonstrations,Stakeholder Meetings andBoards, Commissions & Task Forces. 

Thanks to the advocacy efforts of the Home Care Alliance, the association has been given the authority to name members on the “Task Force Related to Behavioral, Substance Use Disorder, and Mental Health Treatment”  as Governor Deval Patrick, joined by Secretary Jay Gonzalez, Secretary JudyAnn Bigby, Rep. Steven Walsh, Rep. Ronald Mariano,  Attorney General Martha Coakley, Speaker of the House Robert DeLeo, signs the health care cost containment bill in Nurses' Hall. well as the “Commission to Review Public Payer Reimbursement Rates.”

The website also announces meetings to inform stakeholders of progress and potential opportunities related to the new law so those interested are encouraged to check the site regularly and stay tuned to our blog for other important updates.

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Healthcare Bill Summary

The MA legislature shifted into overdrive during the last few days of the 2011/2012 legislative session, which ended on July 31. Healthcare cost containment was among the major pieces of legislation that were approved during the last days of the session, and several provisions of the bill have significant impacts on home care providers.

Section 142 of the bill will significantly ease the burden of the Fair Share Contribution (FSC) requirement that employers offer health insurance to their workers. Under this section, any employees that have health insurance through a spouse’s coverage, military, disability, or Medicare will not be included in the calculation of an employer’s compliance with the FSC mandate. This change should be a relief to many home care agencies. Section 51 of the bill establishes appeal processes for employers faced with a FSC audit.

The bill also includes a number of provisions related to home health’s role within Accountable Care Organizations and names the Alliance to a couple of new advisory panels.

The Alliance has prepared a more detailed summary of the bill’s provisions: http://www.thinkhomecare.org/associations/1892/files/HealthcareCostContainmentSummary.pdf.

Home Care Alliance, National Organizations Make Statements on Supreme Court Decision

In light of the Supreme Court’s decision to uphold the Affordable Care Act, the Home Care Alliance of Massachusetts and other organizations representing health care providers and consumers had this to say:

“Today’s decision of the US Supreme Court has established the Affordable Care Act as the law. With their ruling, the Supreme Court has removed enormous uncertainty – particularly in states other than Massachusetts and for those involved in ACA funded demonstrations – as to whether to move forward. They now can, and we think they must.  While some parts of the law will impact Massachusetts far less directly than other states, there is evidence that our state has already benefited by some provisions. Most notably, 62,000 seniors and people with disabilities in Massachusetts have seen significant savings on their prescription drugs because the law was upheld.

All providers, including home health care, were subject to Medicare rate reductions in the ACA in order to expand coverage and pay for reform demonstrations.  These cuts have not been easy to absorb. With this ruling, we must now get to work to deliver on the promise in our state not just of universal access to insurance, but to a better coordinated, and ultimately more cost effective delivery system.”

-Patricia Kelleher, HCA Executive Director

Statement from the National Association for Home Care & Hospice (NAHC):

“NAHC has long supported reforms that increase access to health care for all in the United States and supports health delivery reforms and the expansion of Medicaid eligibility. The ACA rightly shifts the focus of care from inpatient services and institutional care to the community setting, which home health agencies and hospices have effectively served for decades.

NAHC believes that the Affordable Care Act can and should be improved. Accordingly, NAHC will continue to work with both Democrats and Republicans to improve the legislation. NAHC will ask that its implementation date be delayed for two years so that states have the time to prepare for implementation, including the creation of exchanges. This delay will also save approximately $200 billion, which can be applied to deficit reduction, extending the SGR “doc fix” and avoiding the need for any further cuts to Medicare. NAHC will continue to argue that home health care has been cut disproportionately and will oppose the imposition of copayments or additional cuts. NAHC believes that a good case can be made for expanding the scope of Medicare home health services to reduce hospitalization costs and improve services for the 5 percent of Americans who are responsible for 50 percent of total U.S. health care costs.”

-Val Halamandaris, NAHC President

Here are other statements from the following organizations:

And statements from political leaders:

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HCA Achieves Gains for Home Care in House Health Care Bill

With the passage of a major health care payment reform bill by both the state’s senate and house of representatives, the Alliance will advocate for the successes gained in each version as the proposals advance.

In the recently passed House version, the Alliance was successful in advocating that home health and hospice services are included in the definition of “health care services” under an Accountable Care Organization able to accept global payments.

Other provisions achieved, include:

  • An amendment to strengthen the relationship between Patient-Centered Medical Homes and federally-certified home care agencies by ensuring that those agencies are available through the medical home to provide “after-hours” availability to home care patients.
  • An amendment that  improves the state’s “fair share contribution” calculation for determining an employer’s percentage of insured workers. With this amendment, any employee insured through a spouse, parent, Medicare/Medicaid, a veterans’ plan or disability plan would NOT be counted towards the employer’s test by the state and thus reduces the chance the employer would have to pay the “fair share contribution” penalty ($295 per employee).
  • An amendment adding “a community-based organization or group of community-based organizations” to those entities available to receive funding from the Prevention and Wellness Trust Fund.
  • An amendment ensuring that community-based behavioral health providers are included in the state’s health information technology planning process and that providers who serve high proportions of public payer clients will be given priority in receiving funding through a “health information technology revolving loan fund.”

The Alliance will continue to advocate for these provisions, in addition to those gained in the Senate, which can be seen in our blog post on the Senate’s passage of their payment reform bill.

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