New Advocacy Message to Support Nurse Delegation

The “Nurse Delegation” bill (S.1138, An Act Relative to Home Health Aides) has been stuck in the Joint Committee on Public Health since it was among a list of other matters that had a public hearing last July.

The Home Care Alliance’s Legislative Action Center now includes an email message that can be sent to the committee urging them to advance the bill forward in the legislative process! Just follow the instructions on this link to take action.

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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.

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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.

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Caring Magazine Highlights Massachusetts Care Transitions Programs

The great work being done by home care agencies in Massachusetts around care transitions was highlighted in an article in the current issue of Caring Magazine, the monthly publication of the National Association for Home Care & Hospice (NAHC).

In the article written by the Home Care Alliance, the focus is on four agencies involved in the STAAR project (State Action on Avoidable Readmissions) and how their collaborative programs have changed how care transitions are handled.

Additionally, the Home Care Alliance’s “Opt-In” document, a guide to Optimum Performance Standards for Transitions to and From Home Health, is highlighted and shown as a beacon for the work performed by these four agencies and any other agencies or  providers working with home health to improve care transitions.

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CMS Community-Based Care Transitions Program Update

The Centers for Medicare and Medicaid Services (CMS) has provided new guidance and updates on their Community-Based Care Transitions Program.

New panel review dates for submitting applications beyond August 18th have been posted and are as follows:

  • October 6 & 7, 2011 – Applications must be received by September 6th to be considered for this review.
  • November 15 & 16, 2011 – Applications must be received by October 14th to be considered for this review.
  • November 30 & December 1, 2011 – Applications must be received by October 28th to be considered for this review.

Secondly, more than a full page of new guidance has been added to the program’s Question & Answer section. Below are a few examples:

  • Q: How shall we anticipate to cover up front costs? I heard that CBOs would be paid a per eligible discharge rate that is determined by target population, interventions proposed, anticipated volume and expected reduction in readmissions (cost savings) Can you give a concrete example of how this payment methodology would work?

A: Because this program seeks to build off of earlier care transitions initiatives and requires applicants to have a track record in the delivery of care transition services we are not paying “start up” costs. CBOs will be paid on a monthly basis for services delivered in the previous month. This payment will be whatever the agreed upon per eligible discharge rate is multiplied by the number of eligible beneficiaries served in the previous month. Please refer to the budget worksheet available on our program webpage for additional guidance on developing the per eligible discharge rate.

A: These are the patient experience measures that CBOs will be required to collect and report during the program. We will provide the instruments to awardees at the time of award.

The Home Care Alliance has also made a webinar available on the experiences from a previous CMS care transitions demonstration program that worked through 14 QIO’s across the US. The webinar focuses on, among other things, drawing from the Home Health Quality Improvement campaign’s Best Practices Intervention Package.

More info from this newsfeed on care transitions is available here.

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Panel Review Dates Announced for Care Transitions Program

The Centers for Medicare and Medicaid Services announced panel review deadlines for applications to be submitted for the Affordable Care Act’s Section 3026 Community-Based Care Transitions Program.

  • July 19, 2011 – Applications must be received no later than June 20, 2011 to be considered for this review.
  • August 24, 2011 – Applications must be received no later than July 15, 2011 to be considered for this review.
  • September 19, 2011 – Applications must be received no later than August 18, 2011 to be considered for this review.

The Home Care Alliance has received questions regarding the assembly of a budget for the application and a helpful guide  is available upon request for those interested.

Guidance is also still available on the Q&A section of the CMS Care Transition Program’s web page.

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New Materials and Guidance for CMS Care Transitions Program

A pair of presentations with helpful information and resources regarding the CMS Community-Based Care Transitions Program have been made available.

For home health agencies interested in applying or just getting started with the process, this CMS PowerPoint provides a good summary of the information, helpful links and resources, and answers to some of the more frequently asked questions.

Another helpful set of presentations sponsored by the Commonwealth Fund is available and includes a webinar with audio featuring:

  • Anne-Marie Audet, M.D., M.Sc., moderator, vice president, Quality Improvement and Efficiency, The Commonwealth Fund
  • Eric Coleman, M.D., M.P.H., director, Care Transitions Program, and professor of medicine at the University of Colorado Health Sciences Center
  • Garry MacKenzie, M.D., medical director of cardiology services at McKay-Dee Hospital Center in Ogden, Utah
  • Janice Fitzgerald, R.N., director of quality and medical management at Baystate Medical Center in Springfield, Mass.
Lastly, there have been a lot of questions regarding how to proceed with the “root cause analysis” in the application. A very helpful resource to assist in this matter is available courtesy of the Care Transitions Quality Improvement Organization Support Center (QIOSC).
More updates and resources will be provided by the Home Care Alliance as they become available.

New CMS Care Transitions Program Q&As, Open Door Forum

The Centers for Medicare and Medicaid Services (CMS) have released a new round of Questions & Answers in regards to the Community-Based Care Transitions Program.

See the full list of these helpful Q&A’s here, and below are a couple of the newest posts that may be of interest to home health agencies. One in particular about whether some of the responsibilities of the lead applicant can be subcontracted to other entities.

There is also an “open door forum” scheduled for May 5 and the Home Care Alliance strongly encourages all interested agencies to register and participate.

Yes that is acceptable; however, the applicant would need to demonstrate that each proposed subcontractor possessed expertise in the delivery of care transition services.

Experience with chronic care management/disease management is not synonymous with care transitions experience. The per eligible discharge rate is meant to cover a relatively short term intense intervention around admission to and discharge from an acute care hospital. This rate would not support an ongoing chronic care management program which usually requires a per member per month payment for an indefinite period.

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Helpful Q&As Posted on Care Transitions Program

The Centers for Medicare and Medicaid Services (CMS) has recently posted new Question & Answers regarding the Community-Based Care Transitions Program.

One such question that has emerged from multiple home health agencies concerns what constitutes a “community-based organization” or CBO.  See below for a pair of Q&A’s offering guidance:

  • Q: Does a home health provider qualify as a Community-Based Organization (CBO)? 
  • A: A home health agency would only qualify as a CBO if it was based in the community it proposed to serve and had a governing body with broad community representation of multiple health care stakeholders, including consumers. To ensure broad stakeholder involvement, 50% of the board representation should come from outside the home health agency.  Please also see our response to FAQ# 10418 for guidance on consumer representation.
  • Q (#10418 from above): Does a coalition representing a collaboration of community healthcare providers (medical centers, Federal Qualified Health Centers (FQHCs), health plans, educational leaders and local government) qualify as a Community-Based Organization (CBO)?
  • A: If the coalition is (1) a legal entity, such as a 501(c) (3) organization or other organization that has a taxpayer identification number and can accept payment, (2) has a governing body that includes broad community representation of multiple health care stakeholders, including consumers and (3) is physically located in the community it proposes to serve, then it could qualify as a CBO.  In addition, there must be adequate consumer representation on the governing board with voting rights. The consumers may not be providers or immediate family members of providers to satisfy this requirement.

See the full list of Q&A’s relative to this program here.

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Care Transitions Program Part of Partnership for Patients

Centers for Medicare and Medicaid Services Administrator Dr. Don Berwick and US Health and Human Services Secretary Kathleen Sebelius announced a massive initiative and federal funding opportunity dubbed the “Partnership for Patients.”

This billion dollar commitment from the federal government will be split between two goals:

  • Keep patients from getting injured or sicker. By the end of 2013, preventable hospital-acquired conditions would decrease by 40% compared to 2010.
  • Help patients heal without complication. By the end of 2013, preventable complications during a transition from one care setting to another would be decreased so that all hospital readmissions would be reduced by 20% compared to 2010.

Home health agencies will be most interested in the Community-Based Care Transitions Program, which will spread $500 million in funding to community-based organizations partnering with eligible hospitals for care transition services that include timely, culturally, and linguistically-competent post-discharge education, medication review and management, and patient-centered self-management support within 24 hours of discharge.

Recently, the solicitation and application have been released after months of waiting and the Home Care Alliance is continuing to encourage eligible agencies that qualify as Community-Based Organizations (CBO’s) to partner with hospitals, ASAP’s, and other providers to submit an application.

Here is the list of pertinent documents for this program:

Agencies that have any questions regarding this program can contact the Home Care Alliance.

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