HCA Applauds Tele-monitoring Support from MassHealth

After years of advocacy with the legislature and working collaboratively with MassHealth, the Home Care Alliance proudly testified at a public hearing on proposed remote patient monitoring (RPM) payment rates and regulations this week.

Alliance Legislative and Public Affairs Director James Fuccione commented that reimbursement for RPM will strengthen the ability of home health agencies to carry out their mission of keeping people healthy at home and commended MassHealth for including a broad definition that will allow agencies to be creative in their use of the service. Dana Sheer, NP of Partners Healthcare at Home, also submitted comments in support of RPM and offered recommendations on clarifying language.

The Alliance asked for clarification on a number of points, including whether an “installation/removal” fee of $50 would be paid by MassHealth for both or on each end of the set-up and removal of RPM equipment. HCA suggested that the fee be raised to $75 and paid on both ends. Additionally, the Alliance asked for guidance on how to proceed when multiple patients in the same setting could benefit from RPM services. Comments from the Alliance suggested that RPM could go a long way in assisting patients with behavioral health and substance abuse issues as well.

In his testimony, Mr. Fuccione raised the ongoing concern regarding MassHealth rates for nursing, therapy, and home health aide visits, and urged MassHealth to expedite a review and update of those rates.  He noted that the Alliance has had several recent meetings with MassHealth staff focusing on that very subject. However, the hearing was centered on the tele-monitoring proposal and the Home Care Alliance is thrilled to have spearheaded the push for reimbursement.

Massachusetts is one of only a few state Medicaid programs with financial support for RPM, which will be effective this November. MassHealth explained at the hearing that they expect a savings just within the home health program of $1.4 million.

The Alliance’s comments are available here and more updates on any changes MassHealth may make based on our comments will also be sent to member agencies.

Return to www.thinkhomecare.org.

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.

Join Us for Falls Prevention Awareness Day on Sept. 23rd

As part of the Massachusetts Falls Prevention Coalition, the Home Care Alliance of Massachusetts will be co-hosting the 8th annual Falls Prevention Awareness Day, which is taking place in the Great Hall of the State House in Boston on September 23rd from 10:00am to 1:00pm.

The event will follow the National Council on Aging’s theme of Strong Today, Falls Free® Tomorrow and includes a list of speakers and presenters. HCA’s Legislator of the Year Senator Patricia Jehlen will be giving welcoming remarks and Executive Office of Elder Affairs Secretary Ann Hartstein will be a featured speaker. Informational tables will line the Great Hall for legislative staff and members of the public to gather helpful resources on falls prevention strategies and local programs across the state.

There is no cost to attend this event. For more information, see the official flier for Falls Prevention Awareness Day.

Return to www.thinkhomecare.org.


CMS Reopens Bundled Payment Initative for Post-Acute Care

The Bundled Payments for Care Improvement initiative, developed by the Center for Medicare and Medicaid Innovation, has been reopened for additional models focusing on post-acute.

Through the initiative, organizations partner together and enter into payment arrangements that include financial and performance accountability for episodes of care. There four models of bundled payment being tested, but models 2 and 3 are areas where home health agencies can play a central role.

  • Model 2 is titled Retrospective Acute Care Hospital Stay plus Post-Acute Care, where the episode of care includes the inpatient stay in the acute care hospital and all related services during the episode.
  • Model 3 is Retrospective Post-Acute Care Only, where the episode of care is triggered by an acute care hospital stay and begins at initiation of post-acute care services with a participating home health agency, skilled nursing facility, inpatient rehabilitation facility, long-term care hospital.

More information on the program and the “open period” where new proposals can be submitted is available here. In order to be considered for participation in the Bundled Payments for Care Improvement initiative, all open period submissions must be submitted by April 18, 2014.

Return to www.thinkhomecare.org.

State Seeks Waiver from Three-Day Rule

With the input of several health care provider groups, including the Home Care Alliance, the state sent a letter on July 23rd to CMS Administrator Marilyn Tavenner officially requesting a waiver from the so-called “three-day rule.”

The rule refers to Medicare’s requirement that post-hospital extended care services in a skilled nursing facility are not allowed unless they are preceded by a hospital inpatient stay lasting three consecutive days. The Home Care Alliance joined other groups like Mass. Hospital Association, Mass. Senior Care Association, Mass. Medical Society and others in voicing support for such a waiver in multiple stakeholder meetings.

The idea is that patients can be properly directed to skilled nursing facility care and/or home health services, but eventually and ideally transitioning back into the community. All the while, patients would receive an appropriate level of care and avoid unnecessary hospitalizations.

The state’s Executive Office of Health and Human Services asks that the waiver include Medicare Fee-for-Service patients and last for three to five years.

The Home Care Alliance will continue to monitor the state’s request and provide updates.

Return to www.thinkhomecare.org.

New Info Coming Soon on Money Follows the Person Initiative

The Massachusetts version of the federal Money Follows the Person initiative, held a stakeholders meeting at the Worcester Public Library with a review of activity and a “heads-up” that an RFR will be coming out next month for the five coordinating entities that will manage money and services.

Dubbed Regional Coordinating Offices, or RCO’s, these newly formed entities will provide access to housing search for MFP transitional entities along with transition assistance itself as participant move from a facility to the community. RCO’s will also provide orientation and mobility training, assistive technology, and case management. The five RCO’s will chosen by January 2013 based on an RFR due out by this November.

In February 2011, CMS awarded a five-year Money Follows the Person Demonstration grant to Massachusetts. The funding will, according to the state’s office of Health and Human Services, will help transition more than 2,200 individuals out of nursing facilities, long-term care facilities, chronic care hospitals, and intermediate care facilities into community-based care.

HCA will continue to provide updates on this program, which are also available at on mass.gov here.

Return to www.thinkhomecare.org.

New Reports on Hospital Readmissions from STAAR and DHCFP

The Massachusetts State Action on Avoidable Readmission (STAAR) project has published a new report on the Patient Care Link website. The report – Reducing Readmissions: Highlights from the Massachusetts STAAR Cross Continuum Teams  – includes improvement stories from 22 of the 50 cross continuum teams working on reducing readmission.

Available on the Preventing Avoidable Readmissions page of the MA Coalition to Prevent Medical Errors website is a digest of customizable tools that eleven of the teams have made available free of charge. The STAAR work and these reports were funded by a grant from the Commonwealth Fund.

Also available from the state’s Division of Healthcare Finance & Policy (DHCFP) is a pair of new health care cost trend reports that conclude preventable hospitalizations have slowed, although preventable emergency department use has slightly risen.

The first report states that preventable hospitalizations are not driving cost growth, but remains a significant percentage of overall health care expenditures. Some of the more notable findings indicate that nearly half of preventable hospital admissions are for people aged 75 and older and 64 percent are for those over 65 years of age.

The report suggests something of no surprise to home care agencies, which is that managing chronic illnesses between non-acute health care settings is the best approach to combating the issue. However, the report further states the fee-for-service pay structure remains a barrier to that method working efficiently. Demographic influences aside from age were also noted as those lower income and some minority groups were more likely to receive costly and inefficient care that led to a higher rate of preventable hospitalizations among those groups.

As for the DHCFP report on hospital emergency department efficiency, the number of preventable ED visits rose 6.3 percent from 2006 to 2010 to a total of more than 1.17 million. Preventable or avoidable visits, the report continues, accounted for more than 45 percent of total ED visit costs.

To see both DHCFP reports, visit their  Cost Trends page.

Return to www.thinkhomecare.org.

Last Chance to Apply for CMS Community-Based Care Transitions Program

The final deadline for applications for the Community Based Care Transitions Program, administered by the Center for Medicare and Medicaid Innovation (CMMI), is quickly approaching.

Any interested applicants must have their proposals in by September 3rd to make the final panel review on September 20th. Any interested home health agencies can contact James Fuccione at the Home Care Alliance for assistance. Additionally, CMMI has made a slide deck available with everything health care providers and community-based organizations need to know for the application process.

Recently, there were 17 proposals that were accepted in the third round of site selections and, again, a Massachusetts project was among them. Here is the “site summary:”

Somerville-Cambridge Elder Services, a Massachusetts-designated Aging Services Access Point (ASAP) and an Area Agency on Aging (AAA), is partnering with Mystic Valley Elder Services,  two large integrated hospital networks (Cambridge Health Alliance and Hallmark Health System) and dozens of community-based health and social service providers to provide care transitions services to high-risk Medicare beneficiaries throughout Middlesex County, Massachusetts.

For more on HCA’s work on care transitions issues, see these blog posts.

Return to www.thinkhomecare.org.

IHI Releases “How-to-Guide” for Home Health/Community Settings

This week the Institute for HealthCare Improvement (IHI) posted on their website, The How-to Guide: Improving Transitions from the Hospital to Post-Acute Care Settings to Reduce Avoidable Re-hospitalizations. This How-to-Guide is designed to support hospital-based teams and their community partners to co-design and reliably implement improved care processes to ensure that patients who have been discharged from the hospital have an ideal transition to home or to the next community care setting. The Home Care Alliance is acknowledged as a contributor and editor of this document.

Return to www.thinkhomecare.org.

Community-Based Care Transitions Program Announces New Participating Sites

A second round of participating sites were announced by CMS for the Community Based Care Transitions Program (CCTP) and two teams of providers are in Massachusetts.

Covering the central and western part of the state, the accepted projects are from Elder Services of Berkshire County, which includes Berkshire VNA as a partner, and Elder Services of Worcester, which includes a partnership with Metrowest Home Care & Hospice. A summary of the Berkshire County project has not been posted, but the Worcester/Metro West project summary was posted and notes the prior care transitions experience of Metrowest Home Care & Hospice. That project draws on the home care agency’s experience by including a transition RN, telephonic support above what the Coleman care transition model calls for, and also a palliative care component is implemented when necessary.

CMS continues to accept applications for the CCTP with dates for review listed below. The Home Care Alliance has resources available for any  home care agencies interested in applying or for entities looking to include agencies as partners. Those interested can contact James Fuccione at HCA.

  • March 27, 2012– Applications must be received by March 6th to be considered for this review
  • April 10 – Applications must be received by March 20th to be considered for this review
  • April 26 – Applications must be received by April 5th to be considered for this review
  • May 10 – Applications must be received by April 19th to be considered for this review
  • May 30 – Applications must be received by May 9th to be considered for this review
  • June 11 – Applications must be received by May 21st to be considered for this review
  • June 28 – Applications must be received by June 7th to be considered for this review

Return to www.thinkhomecare.org.

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