Conference Committee Announces Final Budget With Little Support for Home Care

The legislature’s state budget conference committee, made up of six members of the House and Senate’s respective Ways & Means Committees, decided on a final version of the fiscal year 2016 Massachusetts budget pie chart pic

The $38.1 billion plan that is being sent to the Governor for his approval does not include the Home Care Alliance’s priority language that created a special commission to study and recommend licensure options for private care agencies. The commission language was included in the Senate’s version, but not the House, which left the conference committee to decide its fate.

The conference committee also did not include an expansion of income eligibility for services ordered through Aging Service Access Points (ASAPs) that the Alliance also supported.

One bright spot was that an advisory council on “mobile integrated healthcare” (MIH) was passed and includes a representative of the Home Care Alliance. The language defines MIH as:

a health care program approved by the department [of public health] that utilizes mobile resources to deliver care and services to patients in an out-of-hospital environment in coordination with health care facilities or other health care providers. Such medical care and services include, but are not limited to, community paramedic provider services, chronic disease management, behavioral health, preventative care, post-discharge follow-up visits, or transport or referral to facilities other than hospital emergency departments.

Other notes from a preliminary analysis of the Conference Committee’s budget include the following:

  • The MassHealth Managed Care line item continued to grow by another $770 million while MassHelath Senior Care, which governs the Senior Care Options program, dipped by more than $10 million.
  • In the Elder Affairs line items, State Home Care Program “Purchased Services” was set by the conference committee at about $2 million below FY15 spending, although the Enhanced Community Options Program (ECOP) grew by nearly $5.6 million.
  • Thanks to the efforts of home care supporter Senator Sal DiDomenico, the funding for the Pediatric Palliative Care Network was raised to $1.8 million from $1.5 million in FY15, but that’s still inadequate to serve the number of children currently on a waiting list for such care.
  • The Department of Higher Education’s “Nursing and Allied Health Workforce” line item ended up being level funded at $200,000 after being zeroed out by the Governor earlier this year.

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Advocacy Alert: Urge FY16 Budget Conference Committee to Support Home Care

The House and Senate have formed a six-member “conference committee” that will merge the two budget proposals into a final fiscal plan for the state. Agencies and advocates can help get home care included in the reconciled budget by sending a message to the committee.
Work is ongoing, but must be completed by the beginning of the new state fiscal year on July 1st so time is limited to send an email. The House Conference Committee members are Representatives Brian Dempsey (D-Haverhill), Stephen Kulik (D-Worthington), and Todd Smola (R-Warren) while the Senate  members include Senators Karen Spilka (D-Ashland), Sal DiDomenico (D-Everett), and Vinny deMacedo (R-Plymouth).
Specifically, the Home Care Alliance is pushing the inclusion of a special commission to study state oversight options and minimum standards for private pay home care agencies. The Alliance is also supporting other amendments to expand access to home care services for seniors and also to create a comprehensive and collaborative state plan for Mobile Integrated Health.
The message itself can be viewed before sending and outlines the items that the Alliance is supporting. They include the following:
  • Senate Outside Section 90 as amended: Private Home Care Agency Study
    • Private-pay home care agencies across the state that provide mostly non-medical support services in the home have no state oversight and a study commission is needed to determine the best solution.
    • This commission will make recommendations on licensure standards and potential quality measures that will protect consumers and create a level playing field in the industry.
  • House Amendment #336: Mobile Integrated Healthcare
    • Recognizing the success and utility of existing “community paramedicine” programs on a smaller scale, this language ensures that the Department of Public Health and stakeholders in the public safety and healthcare communities convene to determine the best possible model of “mobile integrated health” for Massachusetts.
  • Senate Amendment #747: Expanding Eligibility for Home Care Services
    • This language raises the Elder Affairs home care program income eligibility limit to 300% of the federal poverty level ($35,010 in CY 2014), and requires all home care enrollees who are not on MassHealth to make a copayment towards the cost of their services on a sliding fee basis.
    • The program currently has a top income limit set at 224% of the FY 15 federal poverty level ($26,561). Raising home care to 300% of FPL allows the program to serve the “near poor” who are currently excluded.

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Advocacy Alert: Email your Senator to Support Home Care in the Senate Budget

The Alliance has worked with home care champions in the Senate to file amendments to the Ways & Means budget to improve home health care services. The HCA now needs home care agencies and advocates to send a message to gain support these proposals TODAY by clicking here!

Below is a list of the items the Alliance will be leading on and supporting in the FY16 Senate budget process.

Restoring Home Nursing Rates: Senator Jennifer Flanagan

•    Purpose: This budget language seeks to restore the MassHealth rate for home health nursing visits past 60 calendar days of care to the payment level prior to the rate cut of December 1, 2008. This amendment creates a consistent rate for as long as an individual on MassHealth requires home health care.

Improved MassHealth Rates for Home Health Aide Services: Senator Barbara L’Italien

•    Purpose: Since 2007, home health aide rates to agencies from MassHealth have remained at $24.40 per hour, which is meant to cover aide salary, benefits, travel, supervision and administrative costs for the employing home health agency. This amendment seeks to raise the rate MassHealth reimburses home health agencies for home health aide services by 12% at a cost to MassHealth of $1.75 million.

Study of MassHealth Third Party Liability: Senator Anne Gobi

•    Purpose: A study is necessary because correct reimbursement coverage determinations for Medicare/Medicaid dual eligibles are far more complex in home health care than in other medical services as the services and program coverage rules are very similar. The process of submitting all or most MassHealth home health claims for review and re-review to Medicare is highly costly to both agencies and the state. The rate of Medicare coverage has also been steadily declining.

Homemaker Salary Reserve: Senator Michael Barrett

•    Purpose: Appropriate $3 million from the Community First Trust Fund for a FY16 Homemaker Salary Reserve.  This request will continue a campaign to support essential workers by providing an annualized wage and benefit increase of approximately 32 cents an hour to over 26,000 homemakers and personal care homemakers.

Community-Based Safety Net Adjustment: Senator Kathleen O’Connor Ives

•    Purpose: Treat non-profit home health agencies that provide a significant number of home health visits to MassHealth patients as safety-net providers eligible for upward rate adjustments.

FMAP Trust Fund: Senator Michael Rodrigues

•    Purpose: On January 1, 2014, Massachusetts began receiving an enhanced Federal Medical Assistance Percentage (FMAP) for certain Medicaid expansion populations through the ACA.  This amendment creates a trust fund to house this funding and dedicate it to Medicaid and low-income health programs.

Expand Elder Service Home Care Income Eligibility: Senator Barbara L’Italien

•    Purpose: Raise the income eligibility standard for State Home Care Program services funded by Elder Affairs to those below 300% of the Federal Poverty Level.

For more information on what was included in the Senate Ways & Means budget, visit this previous blog post.

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House Approves Budget Plan with Little Support for Home Care

This week, the Massachusetts House of Representatives quickly buzzed through nearly 1,100 amendments to their FY2016 budget proposal and came out with roughly $38.1 billion spending plan.

The House included little from all corners of the advocacy spectrum and the same was true for home care. None of the Home Care Alliance’s priority items and many of those the organization supported were not advanced so HCA will be among many groups relying on the Senate to step up when their budget plan comes out early next month.

Among the items that were approved and supported by the HCA was an initiative to shape a comprehensive Mobile Integrated Health plan for the state, which named the Alliance to an advisory panel for that effort.

Also, $200,000 was approved for the Department of Higher Education’s “Nursing and Allied Health Workforce” account that has, in the past, spurred a home care nurse residency program. The Governor’s budget had zeroed out that line item.

Other notable items approved in the House budget include the following:

  • $8.8 million increase for MassHealth Nursing Home Supplemental Rates.
  • $500,000 for a pilot program in the “greater Quincy area” to implement a model of field triage of behavioral health patients under medical control by specially-trained emergency medical services providers and transport of appropriate, non-medically complex patients to a behavioral health site of care for most effective treatment rather than to an acute hospital emergency department.
  • $50,000 to establish Financial Abuse Specialist Teams (FAST) to improve the ability of elder protective services programs to investigate and respond to reports of financial exploitation.
  • $750,000 for the Meals on Wheels program, which brought that item to $7.1 million – still below the Governor’s proposed funding for that initiative.
  • A prospective, global payment pilot program established under MassHealth under which Medicaid contracts with risk-bearing provider organizations for the provision and coordination of health care services for their attributed members beginning not later than September 1, 2016. The pilot would require that such risk-bearing provider organizations shall be able to provide coordinated care through the provider’s network of primary care providers and that such providers shall have experience and demonstrated capabilities to provide behavioral health services including psychiatric and substance abuse beds. Under the proposed program, Medicaid shall reimburse such providers on a prospective monthly basis provided that these organizations obtained a risk certificate or a waiver from the Division of Insurance.

Stay tuned to learn more about HCA’s advocacy around the Senate budget process and how you can weigh in to support better rates for visiting nurses, home health aides, and other workers along with establishing a commission to study private pay home care oversight options.

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Advocacy Alert: Email State Reps to Gain Support for Home Care in the House Budget!

The Home Care Alliance has been busy working with state representatives to file amendments to the recently released House version of the state’s FY16 budget. Now that those proposals are submitted, it is time to gain crucial support by asking other reps to cosponsor these amendments.

The amendments include the following proposals:

  • An increase in MassHealth rates for visiting nurses (filed by Rep. Sean Garballey)
  • Creating a commission to study state oversight options for private-pay home care agencies (filed by Rep. Mark Cusack)
  • An increase in MassHealth rates for home health aide services (filed by Rep. Chris Walsh)
  • A study of MassHealth’s Third Part Liability Billing process (filed by Rep. Paul Brodeur)

Agencies and advocates can send an email through HCA’s Advocacy Center just by clicking on the message, filling out the contact info form, and hitting “send.” The message will automatically shoot off to the correct Representative based on the address you enter.

Private pay home care agencies can send their own message for just the Study Commission language here, or a message can be sent for all the Alliance’s priorities here.

Any questions can be directed to James Fuccione at the Alliance.

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FY16 State Budget Plan Released by House

The House Committee on Ways & Means released their version of the state’s fiscal year 2016 budget with most accounts important to home care level funded. Out of the $38 billion in the proposed budget, $15.3 billion is spent on MassHealth, the state’s Medicaid program.

Since language proposed by the Home Care Alliance to establish a commission to study options for agency oversight was not included, the HCA will be working with state representatives to file amendments to the budget for a number of items, including establishing commissions to study and make recommendations on state oversight options for private pay agencies and certified agencies. The Alliance will also be seeking an increase of $3.1 million in payment rates for home health aides as well as a restoration of MassHealth home health nursing rates.

The Alliance will also be supporting a number of budget amendments spearheaded by other organizations to raise home care worker wages, seek relief from the impending paid sick time mandate and restore the line item funding the Nursing and Allied Health Education Workforce Development program.

Additionally, the Alliance will support efforts to increase funding for elder home care purchased services from Aging Service Access Points. The House Ways & Means budget reduced that line item from what the Governor proposed earlier this year by more than $3 million.

Stay tuned as the Alliance will be sending out advocacy alerts on how agencies and advocates can urge support of these important issues.

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Governor Releases State Budget Proposal With MassHealth Savings

In his first budget as governor, Charlie Baker’s administration made sizable shifts within Health and Human Services, which accounts for 53 percent of the overall budget proposal. These shifts were done without negatively impacting most provider rates, including home health services.

In a conference call with provider and advocacy organizations, Executive Office of Health and Human Services Secretary Marylou Sudders announced that there was a 5.6 percent growth over FY15 in the total EOHHS budget and that line items in the Elder Affairs accounts governing the Aging Service Access Point network saw a 2.1 percent increase overall. This includes the following highlights:ma budget pie chart pic

  • A nearly $5.6 million increase over FY15 spending in the Elder Enhanced Home Care Services Program.
  • Level funding for the Home Care Purchased Services line item ($106.6 million), which governs contracts with home care providers.
  • A reduction of $13.7 million in the MassHealth Senior Care Account that includes, among other things, the Senior Care Options or SCO program. On the call with Secretary Sudders, it was explained that this was an adjustment on caseloads after re-determinations.
  • A continued reduction ($68,360,305) in MassHealth Fee-for-Service payments to “meet projected need.”
  • An increase of $768,713,676 in MassHealth Managed Care spending.
  • Level funding of grants to councils on aging and to the elder nutrition program.
  • A nominal increase in spending over FY15 on Pediatric Palliative Care.

For more information on the Governor’s proposed budget, visit the administration’s FY16 budget webpage.

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Conference Committee Budget Includes Telehealth, Homemaker Wage Increase

With the new state fiscal year technically arriving, the legislature’s budget conference committee released their compromise version between the House and Senate funding proposals that comes in at $36.5 billion.

With the delay in negotiations, the legislature recently approved a $4.6 billion budget to fund the government and related services through the end of July. The Governor, meanwhile, will have 10 days to review the conference committee’s budget and send recommended vetoes, which can be overturned with a two-thirds vote in both the House and budget pie chart pic

Among the priority items of the Home Care Alliance and others of benefit and interest is language allowing MassHealth to continue their work on implementing home telehealth service rates and rules. This is the second year in a row that the Alliance has achieved getting language that continues the association’s work with the state on an important service that is currently not reimbursed.

Another major win for home care came with the approval of the Homemaker Wage Increase that will amount to $6.1 million, if the funding makes it through the remainder of the budget process. According to the Home Care Aide Council, this appropriation would provide an annualized wage increase of approximately 75 cents an hour to more than 17,000 homemakers and personal care homemakers.

Among other notable items, the conference committee’s budget accomplishes the following:

  • Funding the “Home and Community-Based Services Policy Lab,” ($250,000) which seeks to study the cost-effectiveness and value of home and community-based care. It is expected that services provided by members of the Home Care Alliance that contract with Aging Service Access Points will be included in an initial phase and other Medicaid and Medicare home health services will be included in subsequent phases.
  • The state’s elder services network’s “purchased services” line item received the higher funding amount in the compromise budget of $104,411,964.
  • The Elder Nutrition Program covering “Meals on Wheels” received even more funding ($7.37 million) than the higher amount awarded by the House ($7.12 million).
  • The MassHealth Senior Care line item received slightly increased funding, which came from the House, at $3.197 billion while the MassHealth Managed Care account was level funded throughout the budget process at $4.792 billion.
  • The Human Services Salary Reserve was given $8 million to fund better wages for human service workers.
  • Pediatric Palliative Care gained a slight increase with $1.55 million.
  • The Board of Registration in Pharmacy will establish four new specialty licenses for retail sterile compounding pharmacy, retail complex non-sterile compounding, and institutional pharmacy license to apply to hospitals and an out-of-state pharmacy license for those doing business in Massachusetts.

For more information, the conference committee’s budget can be viewed here.

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State Budget Process Moves to Conference Committee

As expected, the House and Senate Chairs of their respective Committees on Ways and Means will co-chair a six-member conference committee that will work out the differences between the House and Senate budget plans.

The House-approved plan calls for $36.32 billion while the Senate plan was set at $36.4 billion. Although they are similar in terms of total amounts, there are some important differences in both funding support and policy changes.

The Home Care Alliance sent a letter outlining those differences as they pertain to home care services in a letter to each conference committee member.

Here are the main bullet points from that letter where the HCA is asking for support:

  • Senate Amendment #929: Home Telehealth
    • This language was passed in the FY14 budget and allows MassHealth the policy support necessary to continue work on establishing rates and guidelines for home telehealth services.
    • Home Telehealth involves remote vital signs monitoring equipment. This service offers immediate cost savings by reducing the frequency of home health visits paid for by MassHealth, along with reduced hospitalizations through improved medication adherence, patient self-management and timely follow-up care.
  • Senate Amendment #683: Homemaker Wage Increase
    • Approved by a unanimous roll call vote in the Senate, this amendment increases pay by approximately $.75 cents per hour for homemakers and personal care homemakers serving clients enrolled in the Executive Office of Elder Affairs Home Care Program.
  • Senate Outside Section Relative to the Home and Community-Based Services Policy Lab
    • This language and corresponding funding would support the study of the cost-effectiveness of state-funded home and community-based services.
  • House Support for Elder Services Home Care Purchased Services (9110-1630)

The Alliance encourages home care agency members and advocates to contact the conference committee this week to ask for their support using the bullet points above. Here are the names and contact info for conference committee members:

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New Program Instruction Approved for Home Care Agencies Working with ASAPs

After more than a year of the Home Care Alliance and other stakeholders working with the state’s Executive Office of Elder Affairs, an updated Program Instruction (PI) for the state’s Aging Service Access Points working with home health agencies has been approved and will go into effect on May 1st.

The PI addresses a range of concerns that were raised around assessment, care planning, supervision, payment and   communication between the nurse at the home health agency and the corresponding Aging Service Access Point (ASAP).  It replaces some very outdated PI’s and is the product of several meetings and edits sent through countless emails

A workgroup consisted of Home Care Alliance staff, the Mass Home Care Aide Council, and staff from the Executive Office of Elder Affairs along with several ASAP directors and ASAP nurses.

The Home Care Alliance is very pleased with the updated direction from the state, which will improve communication and collaboration between home health agencies and ASAP’s.

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