Dual Eligible Services Demo RFR Now Available

The state’s Executive Office of Health and Human Services (EOHHS) has released the Request for Responses relative to the demonstration project to integrate care for dually eligible individuals.

The RFR is a solicitation for potential Integrated Care Organizations, or ICO’s, that will manage the integration of services and payment for dual eligibles aged 21-64. The Home Care Alliance is holding a special event for all agencies interested in this initiative. Please see the event in our Calendar section titled “Building Partnerships with Managed Care Plans for Dual Eligible Care” where special guest speakers will educate attendees on the demonstration and how agencies can play a key role. Potential ICO’s have also been invited for discussion and networking.

For those interested in viewing the  solicitation and corresponding materials, the instructions are below:

1)  In your browser, enter the URL for the Commonwealth’s procurement web page: www.comm-pass.com.

2)  Near the bottom of the page, click on the hyperlink that reads: “Search for Solicitations.”

3)  When the Search page comes up, scroll down to the section that says “Search by Specific Criteria” and in the document number box, enter the following: 12CBEHSDUALSICORFR.

4)  The Search result will appear as a hyperlink at the top of the new page. It should read: “There is 1 solicitation(s) found that match your search criteria.”  Click on this sentence and it will take you to the Comm-PASS listing for this solicitation.

5)  Click on “view” (the eyeglasses on the right) and you will get the summary page for the Request for Responses for Integrated Care Organizations.

6)   Click on the blue folder-type tab called “Specifications” and you will see the RFR documents and appendices that have been posted for this topic. In addition, the required forms that Respondents to the RFR will need to provide are available under the “Forms and Terms” tab.  To view the documents, click on the eyeglasses to the right of the title of each document,  .

The documents will also be posted shortly on our duals demonstration website, www.mass.gov/masshealth/duals, under “Information for Organizations Interested in Serving as ICOs.”

Responses to the RFR will be due to MassHealth by 4:00 PM (EDT), July 30, 2012.

Return to www.thinkhomecare.org.

HCA Updates “Regulatory Center” on Website

Get confused by all the home health care regulations? Have trouble finding the exact regulation you are searching for? Want to find one handy location with all the regulatory links?

Visit the “Regulatory Center” page on thinkhomecare.org  for convenient links to home health care’s federal and state regulations.  You will also find home care related links to Medicare, MassHealth, Managed Care and the Executive Office of Elder Affairs.

Return to www.thinkhomecare.org.

State Budget Update: Senate Ways and Means Releases Proposal for Debate

The Senate Committee on Ways and Means released their recommendations for the state’s fiscal year 2013 budget. The full 40-member Senate will introduce amendments by the end of this week and will debate the proposal beginning next week. Here are some of the highlights concerning home care:

MassHealth Line Items:

  • The MassHealth Managed Care account (line item 4000-0500) dips $6 million below what the House approved in their version at $4.158 billion.
  • The MassHealth Senior Care account (line item 4000-0600) comes in at $7,230,000 below what the House proposed at $2.756 billion.
  • The MassHealth Fee-for-Service Payments account (4000-0700) saw a bigger slash from the House version of $26.8 million, coming in at $1.927 billion.

Elder Affairs/State Home Care Program Line Items:

  • Elder Enhanced Home Care Services (9110-1500) saw a decrease from the House version of $1,327,853 set at $46.4 million.
  • The Home Care Purchased Services account (9110-1630) was also set below the House’s budget version by $497,837 at a total of $97.2 million.
  • The Elder Nutrition account (9110-1900) does not match the House’s version, but still restores a cut to that program made by the Governor. The Senate Ways and Means version is set at $6.325 million.

In summary, the Senate Ways and Means budget proposal chips down all MassHealth and Elder Affairs line items. These amounts may be restored at least partially after the full Senate concludes their debate and also following when the Senate and House name members to a conference committee to work out differences between the two budgets.

The Home Care Alliance will continue to advocate for a MassHealth nursing rate increase, Certificate of Need, Telehealth, and strengthening pediatric home care services.

Check back to the blog to find out how you can support HCA’s budget priorities.

Return to www.thinkhomecare.org.

State Budget Update: House Ways and Means Releases Budget Proposal

The House Committee on Ways & Means released its proposal for the state’s fiscal year 2013 budget and while there are few changes in dollar amounts, here are the initial highlights:

  • The MassHealth Managed Careaccount (line item 4000-0500) follows the Governor’s proposal by increasing $183,988,029 over FY12 spending to $4,164,475,376.
  • The MassHealth Senior Care account (line item 4000-0600) also followed Governor’s budget blueprint by increasing $196,976,192 over FY12 spending to $2,763,630,662 .
  • The MassHealth Fee-for-Service Payments account (4000-0700) maintained the Governor’s proposal of increasing $129,850,745 over FY12 spending to $1,939,680,126.
  • Elder Enhanced Home Care Services (9110-1500) was given a bigger increase by House Ways & Means of $827,853 – as opposed to the Governor’s $672,147 – to a total of $47,289,340.
  • The Home Care Purchased Services account (9110-1630) is level funded at $97.8 million.
  • The Elder Nutrition account (9110-1900) is level funded at $6.3 million, which would restore a cut of $1.5 million made by the Governor.

This all essentially means that House Ways & Means followed the Governor when it came to the MassHealth accounts, which were increased with funding, but only to account for anticipated increases in enrollment. This budget proposal also shows a commitment to the state’s Home Care Program and restores the Elder Nutrition Program that funds “meals on wheels.”

What is not seen is increases to MassHealth home health rates or any language related to telehealth services, pediatric home care and a certificate of need process. The Home Care Alliance is pushing for amendments on these matters and will let member agencies, supporters and advocates know when they are officially submitted.

Additional items of note include a special commission to study elder protective services, increase public awareness of elder abuse, and establish reporting mechanisms.

Stay tuned as more information will be reported as it becomes available.

Return to www.thinkhomecare.org.

CMS Announces New Accountable Care Organizations in Massachusetts

Two out of the first 27 accountable care organizations (ACO’s) in CMS’ new Shared Savings Program reside in Massachusetts and will be online with its counterparts from across the country this month.

According to a press release by CMS, “The selected organizations have agreed to be responsible for improving care for nearly 375,000 beneficiaries in eighteen states through better coordination among providers.”

The CMS statement continues that all ACOs that succeed in providing high quality care may share in the savings to Medicare, as long as their performance reduces the cost of care and is sufficiently rated on 33 quality measures. The quality measures relate to, among other things, care coordination and patient safety, use of appropriate preventive health services, improved care for at-risk populations, and the patient experience of care.

The Massachusetts ACO’s include Jordan Community ACO and Physicians of Cape Cod AC. CMS provides summaries of each ACO and the Massachusetts initiatives are described here:

  • The Jordan Community ACO is a not-for-profit organization based in Plymouth, Massachusetts and founded in 2012. The Jordan Community ACO consists of more than 100 physicians from Plymouth Bay Medical Associates, Jordan Physician Associates, and a number of specialty physicians from Jordan Hospital. Together, the Jordan Community ACO physicians coordinate the healthcare of more than 6,000 Medicare beneficiaries in Plymouth and Barnstable Counties. This approach ensures that patients receive the right care from the right provider at the right time, making it possible to identify and address problems early, before hospital care becomes necessary.
  • Physicians of Cape Cod ACO has been coordinating care for beneficiaries through a managed care program for 10 years, and intends to bring the expertise developed in that program to the ACO model for fee-for-service beneficiaries. It is expected to serve approximately 5,000 beneficiaries living in Cape Cod, Massachusetts.

Five of the 27 ACO’s are also participating in the Advance Payment ACO program, although none of them are in Massachusetts. One project is located in northern New Hampshire and called the North Country ACO. These 27 ACO’s join the 32 “Pioneer ACO’s” that have 5 projects in Massachusetts.

CMS revealed they are reviewing 150 additional applications for the Medicare Shared Savings Program, of which more than 50 are aiming to be in the Advance Payment Model.

More information is available in CMS’ announcement.

Return to www.thinkhomecare.org.

Governor Releases FY13 Budget Blueprint

Governor Deval Patrick released his proposal for the state’s fiscal year 2013 budget, which sets the stage for the legislature to work out their own versions and come to an eventual agreement over the next six months.

The Governor’s budget does not include any projected increases or cuts for home health, as is the case with most programs (MassHealth Nursing Home Supplemental Rates are reduced from FY12 spending by more than $300 million in the Governor’s proposal).  The MassHealth line items are almost all increased to “meet projected need,” which just translates to level funding. Here is a list of the line-items of note, including the MassHealth accounts.

  • MassHealth Managed Care (line item 4000-0500) increased $183,988,029 over FY12 spending to $4,164,475,376
  • MassHealth Senior Care (line item 4000-0600) increased $196,976,192 over FY12 spending to $2,763,630,662 .
  • MassHealth Fee-for-Service Payments (4000-0700) increased $129,850,745 over FY12 spending to $1,939,680,126.
  • Home Care Purchased Services (9110-1630) had a short increase just over $2,000 to $97,783,061.
  • Elder Enhanced Home Care Services (9110-1500) increased $672,147 to $46,461,487 .

The Governor’s office provides more details on health care costs and reasoning for those decisions here. The Home Care Alliance will continue to provide more information as further analysis is completed. The Alliance will once again be advocating for line items of concern as the budget process moves forward, including on issues like payment rates and telehealth reimbursement from Medicaid.

For more general information, several articles from sources like Boston.com and MassLive.com are available that explain some of the Governor’s budget as well.

Return to www.thinkhomecare.org.

 

Gov. Patrick Signs FY12 State Budget

Governor Deval Patrick signed the state’s fiscal year 2012 budget amounting to $30.6 billion with a victory for home health.

Language that would move MassHealth one step closer to reimbursing home health agencies for telehealth services was included in the “MassHealth Managed Care” line item:

…for purposes of long-term health care cost savings and enhanced patient care, the commonwealth may recognize telehealth remote patient monitoring provided by home health agencies as a service to clients otherwise reimbursable through Medicaid

The key word in this language is “may.” MassHealth is not directly instructed in the budget to reimburse for telehealth (as if the word “shall” was used), but it presents the state with the option to do so, which means that continued advocacy will be required to push the state towards that end. This is a solid victory for the Alliance’s budget advocacy thanks to the hundreds of emails that were sent from the HCA website’s Legislative Action Center and to the office of Senator Richard Moore.

Another item of interest is in regards to Adult Day Health where the Governor approved a budget that makes “no changes prior to December 31, 2011 in the clinical eligibility or level of reimbursement paid to providers of adult day health services for basic and complex levels of care.”  The budget also imposes a temporary moratorium on enrollment of new Adult Day Health providers until such time that a study is completed by the Executive Office of Health and Human Services. The study, due to the Legislature by December 31, 2011, will provide a basis for new licensure and rate structure and also will provide a needs assessment of ADH services going forward.

For more information, the full budget is available on Mass.gov.

Return to www.thinkhomecare.org.

Mass. House Ways & Means Budget Announced

The Massachusetts House Committee on Ways & Means released their version of the state budget earlier today and this will set the stage for the full House of Representatives to debate the bill in the next couple of weeks.

All MassHealth items remained level from the Governor’s proposed budget, which was released in January. That includes the following items:

  • MassHealth Senior Care at $2,495,602,264
  • MassHealth Fee-for-Service Payments: $2,026,206,633
  • MassHealth Managed Care: $3,872,835,669

The proposed $55 million cut to Adult Day Health Services was not repaired in this version, although there is general support in the legislature for overturning it and at least one Representative has committed to filing an amendment that would freeze rates and service levels while also imposing a moratorium on new programs and program expansions. A group of advocates led by the Massachusetts Adult Day Services Association, and including the Home Care Alliance, are working on the issue.

Under the Executive Office of Elder Affairs, the Home Care Purchased Services line item received a $1 million boost while all other items remained level.

The Home Care Alliance will be working with state representatives to file amendments on issues important to home health agencies and will provide updates including how agencies, patients, and families can help gain support for the Alliance’s budget proposals.

Return to www.thinkhomcare.org.

CMS Releases Proposed Rule on ACOs

A proposed rule has been released by the Centers for Medicare and Medicaid Services (CMS) for comment regarding the formation of Accountable Care Organizations or ACO’s, which create incentives for health care providers to work together to treat an individual patient across care settings.

Section 3022 of the Affordable Care Act created the Medicare Shared Savings Program that is intended to encourage providers of services and suppliers to create a new type of health care entity, which the statute calls an Accountable Care Organization. The proposed rule mentions home health, but it is important that comments on the rule are submitted to ensure that home health agencies are active participants in every ACO. Given the ACO initiative’s mission of caring for patients more efficiently and at a lower cost, this is an excellent opportunity for agencies to speak up.

The proposed rule was released on March 31 and comments will be accepted by CMS for 60 days.  You can comment:

  • By regular mail. You may mail written comments to the following address ONLY:

Centers for Medicare & Medicaid Services,
Department of Health and Human Services,
Attention: CMS-1345-P,
P.O. Box 8013,
Baltimore, MD 21244-8013.

Below is the full announcement from CMS on the Medicare Shared Savings Program that includes a summery of the Affordable Care Act provision on ACO’s and some information from the proposed rule.

SUMMARY OF PROPOSED RULE PROVISIONS FOR ACCOUNTABLE CARE ORGANIZATIONS UNDER THE MEDICARE SHARED SAVINGS PROGRAM

Overview

On March 31, 2011, the Centers for Medicare & Medicaid Services (CMS), an agency within the Department of Health and Human Services (HHS), proposed new rules under the Affordable Care Act to help doctors, hospitals, and other health care providers better coordinate care for Medicare patients through Accountable Care Organizations (ACOs).  ACOs create incentives for health care providers to work together to treat an individual patient across care settings – including doctor’s offices, hospitals, and long-term care facilities.  The Medicare Shared Savings Program will reward ACOs that lower growth in health care costs while meeting performance standards on quality of care and putting patients first.  Patient and provider participation in an ACO is purely voluntary.

In developing the proposed rule, CMS has worked closely with agencies across the Federal government to ensure a coordinated and aligned inter- and intra-agency effort to facilitate implementation of the Medicare Shared Savings Program (Shared Savings Program).

This fact sheet describes the proposals addressing the proposals for what ACOs are, how they can be created, and other general topics.  CMS has posted separate fact sheets on its web site to address in greater detail specific aspects of the proposed rule, such as the quality measures and performance scoring.

There will be a 60 day public comment period on this proposed rule. CMS encourages all interested members of the public, including providers, suppliers, and Medicare beneficiaries to submit comments so that CMS can consider them as it develops final regulations on the program.

Background:

Section 3022 of the Affordable Care Act, added a new section 1899 to the Social Security Act (the Act) that requires the Secretary to establish the Shared Savings Program by January 1, 2012.  This program is intended to encourage providers of services and suppliers (e.g., physicians, hospitals and others involved in patient care) to create a new type of health care entity, which the statute calls an “Accountable Care Organization (ACO)” that agrees to be held accountable for improving the health and experience of care for individuals and improving the health of populations while reducing the rate of growth in health care spending.  Studies have shown that better care often costs less, because coordinated care helps to ensure that the patient receives the right care at the right time, with the goal of avoiding unnecessary duplication of services and preventing medical errors.

ACOs and the Medicare Beneficiary:

An ACO provides an opportunity for Medicare beneficiaries to receive high quality evidence-based health care that eliminates waste and reduces excessive costs through improved care delivery.   However, there would be significant differences between ACOs, as described in the proposed rule and the private managed care plans offered under the Medicare Advantage program.  Beneficiaries would not enroll in a specific ACO.  Instead the proposed rule calls for Medicare to take a retrospective look at the beneficiary’s use of services to determine whether a particular ACO should be credited with improving care and reducing expenditures.  This means that an ACO would have an incentive to improve the quality of care for all patients seen by its member providers and suppliers.

The proposed rule would require providers participating in an ACO to notify the beneficiary that they are participating in an ACO, and that the provider will be eligible for additional Medicare payments for improving the quality of care the beneficiary receives while reducing overall costs or may be financially responsible to Medicare for failing to provide efficient, cost-effective care.  The beneficiary may then choose to receive services from the provider or seek care from another provider that is not part of the ACO.

The proposed rule would also require each provider in an ACO to notify the beneficiary that the beneficiary’s claims data may be shared with the ACO. This data sharing is intended to make it easier to coordinate the beneficiary’s care; however, the provider may not require a beneficiary to obtain services from another provider or supplier in the same ACO.  The provider must give the beneficiary the opportunity to opt-out of those data sharing arrangements.  For Medicare beneficiaries who choose not to opt-out of the data sharing arrangements, the proposed rule would limit data sharing to the purposes of the Shared Savings Program and would require compliance with applicable   privacy rules and regulations, including the provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Proposed eligibility requirements for an ACO:

Under the proposed rule, an ACO refers to a group of providers and suppliers of services (e.g., hospitals, physicians, and others involved in patient care) that will work together to coordinate care for the Medicare fee-for-service beneficiaries they serve. The goal of an ACO is to deliver seamless, high quality care for Medicare beneficiaries, instead of the fragmented care that has so often been part of fee-for-service health care.  The ACO would be a patient-centered organization where the patient and providers are true partners in care decisions.

The Affordable Care Act specifies that an ACO may include the following types of groups of providers and suppliers of Medicare-covered services:

  • ACO professionals (i.e., physicians and hospitals meeting the statutory definition) in group practice arrangements,
  • Networks of individual practices of ACO professionals,
  • Partnerships or joint ventures arrangements between hospitals and ACO professionals, or
  • Hospitals employing ACO professionals.
  • Other Medicare providers and suppliers as determined by the Secretary

In the proposed rule, the Secretary has used her discretion to add certain critical access hospitals as eligible to participate in the Shared Savings Program.

The statute also requires each ACO to establish a governing body representing ACO providers of services and suppliers and Medicare beneficiaries. The proposed rule would make each ACO responsible for routine self-assessment, monitoring and reporting of the care it delivers.

To participate in the Shared Savings Program, the proposed rule would require an ACO to complete an application providing the information requested by CMS, including how the ACO plans to deliver high quality care at lower costs for the beneficiaries it serves.  As proposed, the ACO must agree to accept responsibility for at least 5,000 beneficiaries.  If the application is approved, the ACO must sign an agreement with CMS to participate in the Shared Savings Program for a period of three years.   An ACO will not be automatically accepted into the Shared Savings Program.

The proposed rule outlines a monitoring plan that includes analyzing claims and specific financial and quality data as well as the quarterly and annual aggregated reports, performing site visits, and performing beneficiary surveys.

Under the proposed rule, there are a number of circumstances under which CMS may terminate the agreement with an ACO, including avoidance of at risk beneficiaries and failure to meet the quality performance standards.

Tying payment to improved care at lower cost:

Under the proposed rule, Medicare would continue to pay individual providers and suppliers for specific items and services as it currently does under the fee-for-service payment systems.  The proposed rule would require CMS to develop a benchmark for savings to be achieved by each ACO if the ACO is to receive shared savings, or be held liable for losses.  Additionally, an ACO would be accountable for meeting or exceeding the quality performance standards to be eligible to receive any shared savings.

The proposed rule would establish quality performance measures and a methodology for linking quality and financial performance that will set a high bar on delivering coordinated and patient-centered care by ACOs, and emphasize continuous improvement around the three-part aim of better care for individuals, better health for populations, and lower growth in expenditures.  The proposed rule would require the ACO to have in place procedures and processes to promote evidence-based medicine and beneficiary engagement in their care.  The proposed rule would require ACOs to report quality measures to CMS and give timely feedback to providers.  CMS expects that ACOs will invest continually in the workforce and in team-based care. To assure program transparency, the proposed rule would require ACOs to publicly report certain aspects of their performance and operations.

Under the proposed rule, an ACO that meets the program’s quality performance standards would be eligible to receive a share of the savings it generates below a specific expenditure benchmark that would be set by CMS for each ACO. The proposed rule would also hold ACOs accountable for downside risk by requiring ACOs to repay Medicare for a portion of losses (expenditures above its benchmark). To provide an entry point for organizations with varied levels of experience with and willingness to take on risk, the proposed rule would allow an ACO to choose one of two program tracks.  The first track would allow an ACO to operate on a shared savings only track for the first two years, but would then require the ACO to assume the risk for shared losses in the third year.  The second track would allow ACOs to share in savings and risk liability for losses beginning in their first performance year, in return for a higher share of any savings it generates.

The Shared Savings Program NPRM will appear in the April 7, 2011 issue of the Federal Register.  CMS will accept comments on the proposed rule until June 6, 2011, and will respond to them in a final rule to be issued later this year.  The Shared Savings Program will begin operating on January 1, 2012.

Please Note: Once the regulation is published on (April 7, 2011) the preceding link will be deactivated and the published version of the regulation will be available on the National Archives website at

http://www.archives.gov/federal-register/news.html.

*************************************************************

IMPROVING QUALITY OF CARE FOR MEDICARE PATIENTS: ACCOUNTABLE CARE ORGANIZATIONS

On March 31, 2011, the Centers for Medicare & Medicaid Services (CMS), an agency within the Department of Health and Human Services (HHS), proposed new rules under the Affordable Care Act to help doctors, hospitals, and other health care providers better coordinate care for Medicare patients through Accountable Care Organizations (ACOs).  ACOs create incentives for health care providers to work together to treat an individual patient across care settings – including doctor’s offices, hospitals, and long-term care facilities.  The Medicare Shared Savings Program will reward ACOs that lower growth in health care costs while meeting performance standards on quality of care and putting patients first.  Patient and provider participation in an ACO is purely voluntary.

This fact sheet describes the proposals to ensure that ACOs provide high quality care, including proposed quality measures, and a proposed method for scoring the performance of the ACO for purposes of the Shared Savings Program. There will be a 60 day public comment period on this proposed rule. CMS encourages all interested members of the public, including providers, suppliers, and Medicare beneficiaries to submit comments so that CMS can consider them as it develops final regulations on the program.

Background:

The Medicare Shared Savings Program, which is to be implemented on January 1, 2012, is intended to encourage providers of services and suppliers (e.g., physicians, hospitals and others involved in patient care) to coordinate patient care and improve communications with each other to get each beneficiary the right care at the right time, and see that the care is provided right the first time.  To accomplish this, the Act allows providers to create ACOs that will be held accountable for improving the health and experience of care for individuals, improving the health  of populations, and reducing the rate of growth in health care spending.  Studies show that better care often costs less, because coordinated care helps avoid unnecessary duplication of services and preventing medical errors.

Proposals For Assessing Quality Included in the ACO Proposed Rule:

Proposed Quality Measures:  For 2012, CMS proposes to use a number of quality measures to establish the quality performance standard ACOs must meet in order to share in savings, provided they also meet the program’s cost savings requirement. These 65 measures span five quality domains: Patient Experience of Care, Care Coordination, Patient Safety, Preventive Health, and At-Risk Population/Frail Elderly Health.   The list of proposed measures is included in the appendix to this fact sheet.

CMS considered a broad array of process and outcome measures would help in assessing an ACO’s success in delivering high-quality health care at both the individual and population levels.  Several of the proposed quality measures align with those used in other CMS quality programs, such as the Physician Quality Reporting System, the Electronic Health Record (EHR) Incentive Program, and the Hospital Inpatient Quality Reporting Program. CMS also sought to align the proposed ACO quality measures with the National Quality Strategy and other Department of Health and Human Services priorities.  CMS proposes that the measures would be reported to CMS through a combination of claims submission, data collection using a tool designed for clinical quality measure reporting, and surveys.

CMS is proposing to define the first quality performance period as beginning January 1, 2012 and ending December 31, 2012.

Proposed Quality Performance Scoring:

As required by the Affordable Care Act, before an ACO can share in any savings created, it must demonstrate that it is delivering high quality care.  Thus, a calculation of the quality performance standard will indicate whether an ACO has met the quality performance goals that would allow it to be considered eligible for shared savings.  The proposed method for scoring the measures and determining the performance level that must be achieved to share in savings under the Shared Savings Program is described in the proposed rule.

CMS proposes that the performance on each measure will be scored on a linear points scale and roll up into 5 scores for each of the 5 domains. The percentage of points earned for each domain will be aggregated using an equal weighting method to arrive at a single percentage that will be applied to the maximum sharing rate for which the ACO is eligible.
For the first year of the Shared Savings Program, CMS proposes to set the quality performance standard at the reporting level. This means that during the first performance period, ACOs will be required to report the quality measures completely and accurately in order to share in savings. However, CMS proposes to still score quality in the first year for informational purposes and to help define the benchmarks for future program years. CMS proposes to set the quality performance standard at a higher level in subsequent years.

Proposed Incorporation of the Physician Quality Reporting System into the Shared Savings Program:

The Affordable Care Act allows CMS to incorporate the Physician Quality Reporting System reporting requirements and incentive payments into the Shared Savings Program. ACO participant providers/suppliers who are also Physician Quality Reporting System eligible professionals may earn the Physician Quality Reporting System incentive as a group practice under the Shared Savings Program, by meeting its quality performance standard

The Shared Savings Program NPRM will appear in the April 7, 2011 issue of the Federal Register.  CMS will accept comments on the proposed rule until June 6, 2011 and will respond to them in a final rule to be issued later this year.  The Shared Savings Program will begin operating on January 1, 2012.

Return to www.thinkhomecare.org.

Governor Patrick Announces Proposed Budget

Governor Deval Patrick released his $30.5 billion budget blueprint for the state that decreases spending by $570 million, which the Governor said is the highest year-to-year cut in the state budget in 20 years.

Fortunately, among the many challenges presented, this budget maintains many home care-related items. The MassHealth Senior Care line item is increased in the Governor’s budget by more than $11.3 million to account for anticipated need. The same reasoning is behind increases in other line items, including, MassHealth Fee-for-Service Payments, MassHealth Essential, and MassHealth Managed Care. To be clear, these increases in funding account for growth of need for services paid for by these line items and does not translate to increased rates of payment.

The Elder Affairs home care line items were also mostly level funded with two exceptions. Home Care Purchased Services lost the funds it gained through FMAP allocation –originating with the federal government and funneled through the state – and through a supplemental budget passed in the waning days of the previous legislative session, which amount to $4.9 million. The other reduction, to “meet projected need due to reform,” was more than $10 million in the Prescription Advantage line item, although the explanation suggests that the federal government, through health care reform, will be picking up the state’s share of funding while maintaining the service.

The budget also accounts for previously announced reductions in Adult Day Health services, which will take effect March 15, 2011. More information on those changes are available here.

The Governor added in his address to the media that he will be filing payment reform legislation very soon.

The Home Care Alliance will continue to advocate for line items important to home care agencies and more information will follow as the budget season progresses.

Return to www.thinkhomecare.org.

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