HCA Goes to Washington

The Home Care Alliance and member agencies will join other associations and agencies from across the country for the annual NAHC March on Washington.


The annual conference provides a chance to lobby members of Congress on issues of concern and thank those who have supported our causes. For those who are not traveling to Washington DC, the Alliance has made materials available (see below) to use as a guide for a “virtual lobby day” on March 27th when HCA and members visit with the state’s congressional delegation.

Pre-written advocacy messages are available to send off on the virtual lobby day under “Federal/National Issues” on the Alliance’s Legislative Action Center and click any messages that are of concern or interest. The messages will automatically be sent to the correct member of Congress once the online form is filled out asking for contact information. There is also an option to “compose your own message” near the top of that webpage.

If HCA members and advocates choose to contact their

federal representatives by phone, the Alliance has assembled the following materials and fact sheets on some of home care’s priorities, but we invite you to share your own issues and concerns as well.

Finally, be sure to follow the Alliance’s activity in DC, including photos and updates, on Twitter.

Return to www.thinkhomecare.org.

President Obama Releases Budget with Copays and Payment Impact for Home Care

President Barack Obama released his proposal for the Fiscal Year 2013 Federal Budget with a scaled back version of copayments for home health care as well as payment adjustments for all post-acute providers.

According to the President’s proposal, a home health copayment of $100 per home health episode would be established and would be applicable for episodes with five or more visits not preceded by a hospital or other inpatient post-acute care stay. This, the budget narrative continues, would ap­ply to new beneficiaries beginning in 2017. The President’s budget notes that this is consistent with a MedPAC recom­mendation to establish a per episode copayment, although MedPAC had recommended a more severe copayment of $150 per episode.

MedPAC’s recommnedation cited by the President’s budget team noted that “beneficiaries without a prior hospitalization account for a rising share of epi­sodes” and that “adding beneficiary cost sharing for home health care could be an additional mea­sure to encourage appropriate use of home health services.” This proposal is estimated to save approximately $350 million over 10 years.

According to the National Association for Home Care & Hospice (NAHC), the President’s Budget also includes a reduced Market Basket Index (inflation) update from 2014 to 2021. The proposed update reductions of 1.1 percentage points each year affect all post-acute providers. These reductions, NAHC states, would be in addition to the 2014 home health rate rebasing and the productivity adjustments starting in 2015. The President estimates this measure will save $63 billion over ten years taking into account the other adjustments for all post acute providers.

Additionally, the Independent Payment Advisory Board (IPAB), which was initially established in the Affordable Care Act, will be strengthened under the President’s budget proposal. The group is charged with keeping Medicare solvent by enacting cost-saving measures if Medicare spending exceeds certain levels. The President’s proposal essentially lowers those spending triggers.

The budget blueprint touts some of the fraud and abuse crackdown and prevention achievements the administration has made and advances suggestions for furthering that effort:

  • Cre­ate new initiatives to reduce improper payments in Medicare;
  • Dedicate penalties for failure to use electronic health records toward deficit reduction;
  • Update Medicare payments to more appropriately account for utilization of advanced imaging;
  • Re­quire prior authorization for advanced imaging;
  • Direct States to track high prescribers and utiliz­ers of prescription drugs in Medicaid to identify aberrant billing and prescribing patterns; and af­firm Medicaid’s position as a payer of last resort by removing exceptions to the requirement that State Medicaid agencies reject medical claims when another entity is legally liable to pay the claim.
  • Alleviate State program integrity reporting requirements by consolidating redundant error rate measure­ment programs to create a streamlined audit program with meaningful outcomes, while main­taining the Federal and State’s government abil­ity to identify and address improper Medicaid payments.

Finally, the President’s budget makes a commitment to follow through on the Department of Labor’s proposed rule on removing the so-called “companionship exemption” for allowing overtime and minimum wage protections.

For more information, view the President’s budget proposal here.

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.

HCA Comments to Federal Deficit Reduction Committee

With a home health copayment and other potential hazards hanging in the balance, the Home Care Alliance sent off an official letter to the Joint Select Committee on Deficit Reduction to reiterate strong opposition to what would amount to a “sick tax” on certain Medicare patients.

Following up on the recent visit to Washington DC, the letter was sent to the co-called Super Committee, which includes Massachusetts Senator John Kerry, and was copied to the state’s Congressional Delegation. The letter was especially timely, as a group of Alliance members and staff met last week with Senator Kerry to discuss specific concerns.  

The Alliance particularly targeted a recent proposal from President Obama to institute a copayment for Medicare home health services. If passed, the copayment would amount to $100 per 60-day episode on certain Medicare beneficiaries beginning in 2017. The copayment would not be imposed for episodes following a stay in an acute care facility and would apply to patients receiving five or more visits.

The Alliance’s letter, aside from opposing the copayments, also points out that Massachusetts has not experienced the same growth in the number of home health agencies as other parts of the country.  The Alliance argues that such broad payment reductions or copayments are punishing the wrong people and not targeting offenders of fraud and abuse. The Alliance also offers alternatives like a moratorium on new certified agencies, better targeting fraud and abuse in areas of substantial growth, and further capping outlier payments.

Agencies and concerned advocates are encouraged to submit comments opposing the copay and offering alternative solutions as mentioned in the Alliance’s letter to the Joint Committee on Deficit Reduction by visiting the comment submission page of their website.

The Alliance also has the opening remarks of Committee Co-Chair Senator Patty Murray (D-Washington) on the HCA YouTube page and will continue to provide updates as they become available.

Return to www.thinkhomecare.org.

Advocacy Needed During August Recess to Avoid Cuts and Co-Pays

A so-called Debt Reduction Super Committee evolved out of the federal debt ceiling debate and will be charged with reducing the federal deficit over the next ten years.

Although cuts to entitlement programs and home health co-payments are on the table as options, a potential bright spot was reported this week in that US Senator John Kerry (D-MA) is among the members appointed to the Super Committee. Kerry was instrumental in getting cuts to home health reduced as part of health care reform.

Even with the work of Senator Kerry, Medicare home health payments are still taking a $39.7 billion hit over the next ten years. Additionally, CMS is proposing a 5.06% reduction in payments for calendar year 2012. Both of those points need to be raised when this committee considers even deeper cuts that could drastically impact agencies and patients.

Home health co-pays are another option that must be broadly opposed. Seniors could be forced to pay as much as $150 per 60-day episode of home health care, which would only push those who cannot afford it or unwilling to pay into costlier care.

Below are issues and materials that advocates can use to contact the Massachusetts Congressional Delegation, not just during August recess, but as the discussion of the Super Committee progresses. There are also materials and advocacy messages that can be used to urge Congressional support of other home care initiatives.

Advocates should be contacting their Congressperson, as well as Senator Kerry, to ask that they in turn urge the Super Committee to oppose home care cuts and copays.

Home Care Co-Pays & Medicare Cuts:

Support Home Health Access Protection Act:

Support Home Health Planning Improvement Act:

See a list of other issues, talking points, and messages available on the HCA Legislative Action Center. You can also compose your own message here.

Return to www.thinkhomecare.org.


Family Caregiver and Care Transitions Resources In One Place

The CHAMP (Collaboration for Homecare Advances in Management and Practice) team has become a good industry go-to site for comprehensive evidence based practices and tools.  CHAMP has just released free resources and downloadable tools under the topic: family caregivers.  Some of the tools on the CHAMP website were developed in New York as part of the Next Step in Care project.  This comprehensive Care Transitions website includes family and agency guides and checklists on everything from medication management  to HIPAA – many are in English, Russian, Spanish and Chinese.  All free of charge to interested users.