Applications for Home Care NOI to Open on Nov. 2

According to the Executive Office of Elder Affairs (EOEA), the Notice of Intent (NOI) Application will open on Monday, November 2nd and will remain opened until necessary in order to conduct system and/or document updates.

The Homemaker NOI is the process Home Care agencies must complete if they are interested in contracting with the State’s network of 26 Aging Services Access Points (ASAPs) to provide Homemaker and Personal Care services through the “State Home Care program.”

The posting for approved providers will be completed within 4-6 weeks of the submitted Application.

This link brings you to an update found on the NOI Announcements page:

http://hnoi-announce.800ageinfo.com/

Existing providers will need to confirm/update corporate data within their approved Application if any data has changed.  If a Provider’s information is staying the same, no action needs to be taken. The EOEA will keep rejected NOI Applications available for 90 days from the rejection date for purposes of re-submission. Otherwise, a new application will need to be created and submitted.

For any providers that were previously rejected in FY 15 and did not re-submit a rejected NOI Application within the 90-day period, they must create/submit a new FY 16 Application.

Please note the NOI Announcements page includes a link to the MassHealth FEW Provider Enrollment documents, including an overview document.

Return to www.thinkhomecare.org.

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.

Advocacy Alert: Help Advance Private Home Care Oversight

Last December, the Massachusetts Department of Labor Standards (DLS), which is a division of the Executive Office of Labor and Workforce Development (EOLWD), finalized regulation that removes private pay home care agencies from the Employment Agency Regulation.

This change, while a welcomed clarification, has left private home care agencies without any state oversight, which means that anyone can open up an agency and can start accepting out-of-pocket payment for providing non-medical supportive services to individuals in their home.

Governor Charlie Baker’s administration has provided a unique opportunity to advocate for reasonable state oversight of private home care agencies. Specifically, they are seeking feedback on how to clarify and streamline Massachusetts regulations across the board via a special webpage called “A Clearer Code.”

The Home Care Alliance of Massachusetts is asking agencies, home care workers and advocates to take the following steps to help home care consumers gain the protection and peace of mind they deserve:

Visit this website: http://www.mass.gov/anf/a-clearer-code-regulatory-reform.html

…And please fill out the online form as follows:

  • Name (optional):
  • Company/Organization (if applicable) (optional):
  • Address (optional):
  • Primary Phone (optional):
  • Email (optional):
  • CMR Number: 429 CMR 10.00
  • General Regulatory Themes: Select either Elders, Health Care, or Licensing & Permitting
  • Please list the Agency or Agencies affiliated with this regulation: Executive Office of Labor & Workforce, Executive Office of Elder Affairs, Office of Consumer Affairs & Business Regulation, Executive Office of Health and Human Services.
  • Describe the regulatory issue or observation: When this regulation was amended, it dropped state oversight of private-pay home agency services. There are now literally hundreds of private home care agencies operating unlicensed and unregulated. Massachusetts consumers, especially the elderly, deserve better.
  • Suggestions for easing regulatory compliance: We need the Governor to name a commission to study and make recommendations on private home care licensure standards as soon as possible. Home care agencies and the Home Care Alliance of Massachusetts needs to be at the table to determine the proper direction for quality services, ethical business practice and consumer protection for vulnerable seniors.

Return to www.thinkhomecare.org.

HCA Announces Sample Policies for Earned Sick Time Compliance

New regulations on paid earned sick time went into effect on July 1st and many companies, if not entire industries, are working to follow the rules.

The Home Care Alliance has kept member home care agencies up to date with analysis on regulation changes and informational webinars complete with Q & A’s, but some agencies have asked the HCA for sample earned sick time policies.

Fortunately, Alliance staff and a task force of HR directors from member agencies drafted such a sample policy, which was reviewed by attorneys Allyson Kurker and Margaret Paget of Kurker Paget LLC. In addition, the Attorney General’s Office (AGO) who was responsible for the regulation itself has posted a sample policy on their Earned Sick Time webpage and the Retailers Association of Massachusetts (RAM) also have publicly available policy templates that may be useful to home care agencies.

These resources are available below:

Return to www.thinkhomecare.org.

Earned Sick Time Final Regulation Summary and Analysis for Home Care Agencies

The final regulations on paid Earned Sick Time were released by the Attorney General’s Office (AGO) on Friday, June 19th with a number of substantial changes from the proposed regulations.   (The AG was charged with developing regulations to implement the new law – which was passed via a binding ballot question in 2014.)

The Home Care Alliance is pleased that most of the association’s comments were taken into consideration and the HCA thanks member home care agencies for their questions, concerns and suggestions. It is such involvement that allows the Alliance to better represent agencies and work for better results through our advocacy efforts.

Below is a basic summary of changes that home care agencies inquired about that were made between the proposed and final regulation.

Additionally, the Boston law firm Donahue, Barrett & Singal posted an analysis available to the public that is an excellent guide to the Earned Sick Time regulations. The Alliance has also partnered with Kurker Paget, LLC on a webinar for HCA members and further details and interpretation may become available.

Summary of Regulation Changes:

Section 33.01: Purpose, Scope and Other General Provisions

  • AGO added that “employees may choose to use, or employers may require employees to use, concurrent earned paid sick time…to receive pay when taking other statutorily-authorized leave that would otherwise be unpaid.”

Section 33.02: Definitions

  • AGO explained that “benefit year” is used interchangeably with “calendar year.”
  • The term “Calendar Year” was simplified to stand for any consecutive 12-month period as determined by the employer.
  • The term “Date of hire” was simplified to mean the employees “first date of actual work.”
  • Much more detail of employees and employers exempt from the law. Clarification that PCA’s are covered.
  • Regular hourly rate is newly defined as “the amount that an employee is regularly paid for each hour of work.”
  • “Same hourly rate” is clarified to mean employees regular hourly rate or, for employees earning varying rates from the same employer, either
    • The wages the employee would have been paid for the hours absent during the use of earned sick time if the employee had worked, or
    • A blended, weighted average of all regular rates over the previous pay period.
    • A clarification made in response to HCA’s comments for employees paid “fee-for-service,” the same hourly rate means a reasonable calculation of the wages or fees the employee would have received for the piece work, service or part thereof, if the employee had worked.
  • A clarification relative to “overtime, holiday pay, or other premium rates” that states “where an employee’s hourly regular hourly rate is a ‘differential rate,’ meaning  a different wage rate paid for the same work performed under differing conditions (e.g. a night shift), the ‘differential rate’ is not a premium.

 Section 33.03: Accrual and Use of Earned Sick Time

  • The AGO clarified that 40 hours per benefit year is the cap under the law. Employees  cannot accrue more unless the employer’s policy allows.
  • Employees accrue sick time only on hours worked, not while on PTO.
  • AGO added “Earned sick time may not be invoked as an excuse to be late for work without an authorized purpose under the regulations.”
  • AGO added “An employee may not accept a specific shift assignment with the intention of calling out sick for all or part of that shift.”
  • AGO added “Employers and their fee-for-service employees may arrange to make up hours during the same or next pay period.
  • AGO clarified “If an employee is exhibiting a clear pattern of taking leave on days just before or after a weekend, vacation, or holiday, an employer may discipline the employee for misuse of earned sick time, unless the employee provides verification of authorized use” under the regulation.

Break in Service

  • Regarding “Break in Service,” the AGO heard the Home Care Alliance’s concerns and shortened the timeline an employee has a right to use any unused sick time following “a break in service of up to four months.” However, following a break in service of between four months and one year, “an employee shall maintain the right to use earned sick time accrued before the break in service” if the unused time equals or exceeds 10 hours.

Transition Year/Safe Harbor

  • AGO clarified the “Transition Year/Safe Harbor” provision for employers with part time staff and per diem staff.
    • These employees must either accrue paid time off at the same rate as covered full time employees or receive prorated “lump sums” of paid time off.
    • If an employee is compensated other than on an hourly or salaried basis, the employee must accrue or receive lump sum allocations based on “a reasonable approximation of hours worked.”

 Section 33.06: Documentation of Use of Earned Sick Time

  • AGO clarified that an employer may require written documentation for an employee’s use of earned sick time that:
    • Exceeds 24 consecutive scheduled work hours;
    • Exceeds 3 consecutive days on which the employee was scheduled to work;
    • Occurs within 2 weeks prior to an employee’s final scheduled day of work before termination of employment, except in the case of temporary employees;
    • Occurs after 4 unforeseeable and undocumented absences within a three-month period.
  • AGO clarified that “health care providers may require employees making any use of earned sick time during local, state or federally declared emergencies to provide written documentation from a medical provider substantiating its use and to follow additional notification procedures set forth by the employer.” The employer may discipline the worker if they fail in this regard.

Fitness for Duty

  • AGO clarified that “an employer may require an employee to provide a ‘fitness-for-duty’ certification, a work release, or other documentation from a medical provider before an employee returns to work after an absence during which earned sick time was used if such certification is customarily required and consistent with industry practice or state and federal safety requirements and reasonable safety concerns exist regarding the employee’s ability to perform duties.”
    • “Reasonable safety concerns” means a reasonable belief of significant risk of harm to the employee or others.

Section 33.07: Allowable Substitution of Employers’ Paid Time Off

  • AGO clarified that “an employer’s own paid time off, vacation, sick leave, or other policy may be substituted for earned sick time so long as 40 hours of time off is provided under the policy, or such lesser amount as each employee might earn if the employer were not using the substitute policy” and the employees can use PTO for the same purposes under the same conditions as outlined in the regulation.

Return to www.thinkhomecare.org.

MA Attorney General Announces Earned Sick Time ‘Transition Year’

At the first of a string of public hearings to provide input on proposed regulations on the forthcoming earned sick time law, Attorney General Maura Healey announced a “transition year” for employers already offering paid time-off.

The Attorney General explained that for the period of July 1 when the law goes into effect until December 31, 2015, “any employer with a paid time off policy in existence as of May 1, 2015, providing to employees the right to use at least 30 hours of paid time off during the calendar year 2015 shall be in compliance with the law with respect to those employees and to any other employees to whom the use of at least 30 hours of paid time off under the same conditions are extended.”

Further details are available on a bulletin released on the AG’s earned sick time webpage.

The AG also revealed the intent of her office to avoid a six-month delay in implementing the law, as has been requested by some business advocacy groups. With Healey holding firm on not delaying the law’s implementation, and with some major business groups endorsing the “transition year” move, it was very likely a compromise to grant some leniency to employers.

For more information on the earned sick time law as well as how you can submit comments and help the HCA comment, see this previous blog post.

Return to www.thinkhomecare.org.

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.

Return to www.thinkhomecare.org.

Senate Ways & Means Budget Includes Wins for Home Care

The Home Care Alliance is proud to announce that the Senate Committee on Ways & Means included language for one of the organization’s priority issues that will help strengthen private-pay home care.

An “outside section” in the Senate Ways & Means Committee budget establishes a Commission to study and make recommendations for state oversight options for private-pay home care agencies. The language closely mirrors what the Alliance proposed. Also, it represents a huge step towards attaining not just minimum standards and consumer protection, but greater recognition that private pay home care is an option for families and individuals who need assistance.

Other positive notes came from the Senate’s proposed budget as well. The line item funding the Pediatric Palliative Care Program was increased by $250,000 over what the House approved. The Mass. Department of Higher Education’s “Nursing and Allied Health Workforce” line item was allotted $200,000 after being zeroed out by the Governor and matches the House’s appropriation.

ma budget pie chart picThe Senate also included $150,000 in funding for the “Home and Community-Based Services Policy Lab,” which aims, in part, to study the effectiveness and value of state-funded community-based services.

In the elder services category, the Senate’s proposed budget ups the House in the Home Care Purchased Services account by $3 million along with an additional $866,677 in the Home Care Case Management and Administration account. The other notable increase from the Senate Ways & Means budget is in the elder nutrition program (meals on wheels), which came in $121,889 above the House.

In MassHealth, both the Managed Care and the Senior Care accounts were level-funded. The Senate increased the MassHealth Fee-for-Service line item, which has traditionally governed home health nursing rates, by $481.5 million over the House. However, without specific language for home health included, it would appear an amendment needs to be proposed to raise those MassHealth payment rates.

Outside sections that are mentionable include language to create a “MassHealth savings report” that aims to find savings and cash management strategies in the Executive Office of Health and Human Services budget by October 1, 2015. There is also a commission established to oversee the Center for Health Information and Analysis, whose mission it is to be the clearinghouse for quality, affordability, utilization, access, and outcomes information of the state’s health care system.

The Alliance will look to propose amendments to increase MassHealth rates for home health aides along with restoring skilled nursing rates from the 2008 payment cut. The Alliance also plans to play a supporting role in raising wages for homemakers and creating transparency on federal healthcare reform funding.

Stay tuned for advocacy alerts with details on sending emails urging your state senator to support home care in the state budget.

Return to www.thinkhomecare.org.

Paid Sick Time Proposed Regs Need Comments from Home Care Agencies

The Attorney General’s office released proposed regulations for the paid sick time law passed via ballot question and due to be effective on July 1, 2015.

The law essentially states that workers employed by companies with eleven or more employees can earn and use up to 40 hours of paid sick time per calendar year, while employees working for smaller employers can earn and use up to 40 hours of unpaid sick time per calendar year.

A full summary of the law, along with the proposed regulations and a list of public hearing dates are available on a special “Earned Sick Time” webpage on the Attorney General’s website. Associated Industries of Massachusetts (AIM) conducted a quick analysis of the draft regulations posted on their blog.

The Alliance will be testifying on these regulations at the Boston hearing on May 18th so the Alliance strongly encourages home care agencies to review the draft regulation and send comments to James Fuccione so the HCA can formulate testimony. We further encourage agencies to attend and comment at the other hearings and listening sessions to be held across the state and to notify HCA if you’re planning to do so in order for the comments to be consistent.

A full list of the hearing dates and locations are below:

Friday, May 8, 2015
Brockton Listening Session
Location: Brockton Public Library
(304 Main Street, Brockton, MA 02301)
Time: 10:00 am – 1:00 pm

Monday, May 11, 2015
Salem Listening Session
Location: City Hall Annex Building, 3rd Floor Conference room
(120 Washington Street, Salem, MA)
Time: 10:00 am – 1:00 pm

Friday, May 15, 2015
Lowell Listening Session
Location:  Lowell  Lowell Federal Building
(50 Kearney Square, Lowell, MA)
Time: 10:00 am – 1:00 pm

Monday, May 18, 2015
Boston Public Hearing
Location: Saltonstall Building, 2nd floor Conference Rooms C & D
(100 Cambridge Street,  Boston, MA)
Time- 10:30 am – 1:30 pm

Friday, May 22, 2015
Framingham Public Hearing
Location: Framingham Town Hall, Memorial Building, Ablondi Room
(150 Concord Street,  Framingham, MA 01702)
Time: 10:00 am – 1:00 pm

Friday, May 29, 2015
Springfield Public Hearing
Location: 1350 Main Street – 3rd Floor Community Room
Time: 10:30 am to 1:30 pm

Friday, May 29, 2015
Pittsfield Public Hearing
Location: Pittsfield City Hall – Council Chambers
(70 Allen Street, Pittsfield, MA)
Time: 10:00 am – 1:00 pm

Monday, June 1, 2015
Fall River Public Hearing
Location: City Hall: 1 Government Center – The Hearing Room
(1 Government Center, Fall River, MA 02722)
Time: 1:30 pm – 4:30 pm

Friday, June 5, 2015
Worcester Public Hearing
Location: Main Library- Saxe Room
(3 Salem Square, Worcester, MA 01608)
Time: 10:00 am – 1:00 pm

Return to www.thinkhomecare.org

Guest Blog Post: Discussing Care Choices on Advancing Illnesses

The following is a guest blog post from JoAnne Nowak MD who is Medical Director at Merrimack Valley Hospice. They are promoting a publication from the Massachusetts Department of Public Health, titled “Know Your Choices:  A Guide for Patients with Serious Advancing Illness.” The guide is meant to help healthcare providers adhere to a new state regulation that requires they inform patients with advancing illnesses about their care options and choices. This publication, which Merrimack Valley Hospice has adapted this publication for their use, lists the Home Care Alliance of Massachusetts as a resource and the Alliance encourages further promotion and distribution.

As a hospice and palliative care physician, I know that decisions about end of life care are deeply personal, and based on individual values and beliefs.  I’ve also seen first-hand how advance care planning can be an invaluable gift to those you love. Taking the time to talk with your family, close friends and your healthcare providers while you are in good health are all important steps in an advance care planning conversation.

In Massachusetts, a newly implemented regulation requires that all licensed hospitals, clinics, and long-term care facilities provide information about advance care planning, palliative care, hospice care, and other end of life care options to adults with serious illness.  The goal is to help patients start the conversation and make their end of life care wishes clearly known.

To help you begin, the Massachusetts Department of Public Health recently created “Know Your Choices:  A Guide for Patients with Serious Advancing Illness.” Merrimack Valley Hospice would like to make it easy for you to obtain this guide by making it available on our website because it contains important information about a variety of healthcare choices.  For your free copy, go to http://www.homehealthfoundation.org/patients-resources.  You can also call 978-552-4186 to receive a copy by mail.

It’s time for all of us to start the conversation.

JoAnne Nowak MD
Medical Director, Merrimack Valley Hospice

Return to www.thinkhomecare.org.