Tag: Mass Regulations

Advocacy Alert: Urge Legislators to Co-sponsor HCA Priorities

Today (Monday, Feb. 2nd) is the deadline for legislators to officially co-sponsor legislation, so NOW is the time to contact your local state legislators and ask them to formally support bills of importance!

The Alliance has worked to file two bills with home health champions in the legislature. One bill is re-filed from past years and is known as the “Nurse Delegation” bill, which would improve the efficiency of home health care services and save state funding by allowing home health nurses to delegate certain medication administration tasks to a trained home health aide, hospice aide, or certified nurse assistant.
The other HCA legislative priority is called An Act Strengthening the Quality and Efficiency of Home Health Services. The bill would establish a commission to study oversight options for the Commonwealth that fit our unique and highly-regarded health care system. The commission will also study MassHealth payment rates and methods to determine if there is a more efficient way to reimburse for both traditional home health services like skilled nursing and therapy, but also palliative care, Alzheimer’s/dementia, behavioral health/substance abuse, and chronic disease management.

Please contact your local state representatives and senators to urge them to sign on as co-sponsors of these two measures. At this early point in the legislative session the proposals haven’t been assigned bill numbers. Right now they are identified as House Docket 3151 (Nurse Delegation) sponsored by Representative Kay Khan and House Docket 1864 (Home Health Commission) sponsored by Representative Kate Hogan. Ask your legislators to contact the main sponsor of each proposal to add their names as co-sponsors.

  • Suggested Phone Script: “Hello, My name is ___________ from [home care agency, city/town]. Please co-sponsor House Docket 3151 filed by Rep. Khan and House Docket 1864, filed by Rep. Hogan to advance the quality and efficiency of home care services. If you have any questions, please contact the Home Care Alliance at 617-482-8830.”

If you’re unsure who represents you, please visit www.wheredoivotema.com/ and enter your contact info or visit the state legislature’s website to search by name or location. You can also contact James Fuccione at the Alliance for for more information.

Return to www.thinkhomecare.org.

MA Minimum Wage Regs Clarified by DLS

Responding to comments from the Home Care Alliance, among a list of other interested organizations, the Massachusetts Department of Labor Standards (DLS) released changes and clarifications to the revised minimum wage regulation (454 CMR 27.00).

The full list of comments from advocacy and business groups as well as the official response from the state was made available through the DLS website and in a notice to those that commented.

Here is a summary of comments from the HCA and the repsonses from DLS:

HCA Comment:

Concerning the proposed promulgation of 454 CMR 27.00 and repeal of 455 CMR 2.00, our agencies seek clarification on Hours Worked under section 27.04. It is noted that the employer and the employee may agree in writing to exclude meal periods and a sleeping period of not more than eight hours. It is unclear, however, if those meal periods are in addition to the eight hours of sleeping time. If a home care worker is in the home for a 24-hour period, it should be clearly defined outside of any written agreements pertaining to what time for meals and sleeping is counted and compensable.

DLS Response:

Meal periods are separate from sleeping time. The“not more than eight hours” refers to sleeping time.

HCA Comment:

We would also appreciate clarification of a reasonable length of those meal periods and whether they are permissible even though the worker is required to remain at the work site during the meal break.

DLS Response:

A meal period is bona fide if the employee is completely relieved from duty and is able to leave the
premises. The DLS will respond to inquiries regarding particular circumstances where the employee is unable to leave the work site for reasons outside the employer’s control. If the employee is able to eat a meal but is not relieved from duty, the time must be paid.

HCA Comment:

We have concerns relative to section 27.07 relative to Notice and Recordkeeping. The
discussion about posting a notice in the primary language of a cohort of any 5% or more of the employers workforce raises a question: How do employers discover employees’ primary languages? This appears to violate the rules of the MA Commission Against Discrimination, and moreover, an employee may have the right to refuse to answer.

DLS Response:
 
In response to comments from employer’s, the section is modified to require the translated notice if the language is commonly spoken among employees at the worksite. The requirement is not overly burdensome for employers since notices in different languages are only required if the translation is available from the Commonwealth.

DLS Change to Regulation:
 
27.07 is amended: The workplace notice shall be posted in English, and in any other language that is commonly spoken by five percent (5%) or more of the employer’s workforce and for which a translated notice in that language is available from the Commonwealth.

Other comments, responses and changes can be viewed in the DLS summary of testimony.

DLS Posts Notice for Long-Term Care Insurers

As of December 19, the Massachusetts Department of Labor Standards (DLS) no longer requires private-pay home care agencies to register for licenses. Several Alliance members report that DLS has already rejected and returned their licensure renewal applications.  DLS has also posted a notice to long term care insurers on their website in response to concerns raised about recent regulations proposed separately by the Division of Insurance (DOI).

In the absence of a licensure or registration standard, the DOI regulators have indicated they will issue a regulation that leaves the door open to future state oversight policies. The Alliance has spoken with one major long-term care insurance company that has said this change would not have an impact on getting their clients the home care services they need since many states they operate in lack licensure standards as well. The insurer said that they would simply seek a general business license through the Secretary of State’s office and may potentially look to other accreditations and credentials.

The fear that private pay home care agencies would not receive long-term care insurance reimbursement in the void left by the recent DLS regulations appears to be less of a concern that previously believed. However, the Home Care Alliance will continue to monitor the situation and will work with private-pay home care members, the Home Care Aide Council and other organizations in pushing for a solution at the legislative level.

Return to www.thinkhomecare.org.

Palliative, End-of-Life Care Options Regulation Finalized

A provision  included in the state’s 2012 Health Care Cost Containment Law (Chapter 224) on palliative and end-of-life care options is being realized through a final regulation issued by the Department of Public Health.

It is now a patients legal right to receive information about palliative care and hospice from a facility as well as their full range of options for treatment, if the condition warrants either approach. Massachusetts hospitals, clinics and long-term care facilities are expected to comply.

The Home Care Alliance helped advocate for the inclusion of this provision in the law and also commented with several other provider groups and organizations at a public hearing when the regulations were proposed. At that time, the definition of palliative care in the proposed regulation was more in line with hospice services. The Alliance, among many other groups, expressed concern that palliative care is a team-based approach to an advanced illness, but not necessarily linked to the expected outcome of that illness as with hospice.

DPH has released a guide explaining the right to these options in several languages for consumers, a summary of what was changed from the proposed to the final regulation, and the regulation language itself. The list of resources can be viewed here on a DPH webpage.

Return to www.thinkhomecare.org.

MA Cancer Prevention & Control Network Readying Palliative Care Survey for Home Care

The Massachusetts Comprehensive Cancer Prevention & Control Network (MCCPCN) is putting the finishing touches on a survey on palliative care geared towards treating cancer patients.

The Home Care Alliance is a part of an MCCPCN task force that built the survey, which will be distributed to agencies via email form DPH.  Agencies are strongly encouraged to take the time to respond. MCCPCN is under the Department of Public Health and a cover letter from Commissioner Cheryl Bartlett explains the reasoning and background to the survey as well as how it will help advance palliative care services.

Questions on this issue can be directed to James Fuccione at the Alliance.

Return to www.thinkhomecare.org.

 

Alliance Comments on Proposed LTC Insurance Regulations

Fresh off the heels of the Department of Labor Standards’ decision to drop private-pay home care licensing, the state’s Division of Insurance is accepting comments on regulations related to long-term care insurance.

The Home Care Alliance offered oral and written testimony on proposed amendments to 211 CMR 65.00 at a public hearing on August 1st. The regulations aim to set new standards for long-term care insurance policies, rate setting and cost controls and creates various consumer protections.

More importantly for home care agencies, they propose that home care agencies must meet standards set by the Executive Office of Elder Affairs in order to be covered under long-term care insurance plans. Given the impending gap in state oversight with DLS’ new regulations, the fact that those agencies with elder services contracts represent a fraction of private pay home care agencies, and that many agencies relying on long-term care insurance do not work with Aging Service Access Points, the Alliance suggested the following measures:

  • The Home Care Alliance’s Accreditation Program and unexpired DLS licenses should be placeholder requirements for long-term care insurance coverage until the state and advocates can pass meaningful licensure measures.
  • Home Care Alliance Accreditation allows workers who are not home health aides/certified nursing assistants to provide certain services in the home and DOI’s regulations should reflect that flexibility.
  • In the “sample definitions,” the Activities of Daily Living do not include “grooming and personal hygiene,” which is a traditional ADL and one that is vital to the well-being of people wishing to avoid facility-based care.

More details are available in the full copy of HCA’s comments, which can be obtained by contacting James Fuccione at the Alliance.

Those agencies or advocates wishing to comment have until 5:00pm on Friday, August 15th. Comments can be emailed to doidocket.mailbox@state.ma.us and the subject line should read “Docket No. G2014-0.”

Return to www.thinkhomecare.org.

Alliance Presents Comments on DLS Proposal to Drop Private Home Care Agencies

A gap in the state’s oversight of private pay home care agencies will result from regulatory changes proposed by the Massachusetts Division of Labor Standards (DLS), a division within the Executive Office of Labor and Workforce Development.

Currently, DLS registers private pay home care agencies and has been falsely classifying them with employment and staffing agencies. After years of advocacy, DLS recognizes the misrepresentation and makes the appropriate change in their proposed regulatory changes.

The Home Care Alliance offered written and verbal comments at a public hearing in Boston held by DLS, which is making changes sparked by a mandate to update regulations relative to the “Temporary Workers Right-to-Know” Law, which became effective more than a year ago.

In addition to incorporating provisions of the new law into the Staffing Agency regulations, DLS is updating all of their regulations and proposing to drop home care agencies from their definition of “Employment Agencies” and to redefine “Domestic Employee” as a worker paid directly by a household or a family, among other changes.

The Alliance’s Private Care Advisory Committee reviewed the implications of this change for member agencies an approved comments on behalf of the association. These comments include the following:

The proposed changes from the Department of Labor Standards (DLS) recognize that home care agencies do not belong in the same oversight structure as employment, staffing and placement agencies. As much as this shift is welcomed, we must also acknowledge that Massachusetts lacks any other licensure or state oversight for home care agencies. The certified sector is subject to oversight from the Department of Public Health in their role as a federal quality and compliance agent. With an aging population, private-pay home care is a rapidly-growing sector with a rapidly growing workforce. In fact, the federal Bureau of Labor Statistics places home care aides as one of the fastest growing occupations over the next decade.

With these significant factors in mind, and the gap in state oversight, we urge a commitment from and partnership with DLS and the Executive Office of Labor and Workforce Development (EOLWD) to collaborate with the Home Care Alliance, its private pay agency membership, and other organizations to help transition away from DLS registration.

As part of the partnership and collaboration proposed by the Alliance with DLS is joint education and outreach to agencies regarding current state rules and regulations, information for agencies about the Alliance’s Home Care Accreditation Program, helpful information for consumers, and assistance in advocating other state offices and the legislature on the need for agency oversight.

The proposed regulations and a summary are available on the DLS website. Any home care agency interested in commenting can request the Alliance’s full comments and send a supporting letter to James Fuccione at the Alliance who will collect and submit any comments received. If agencies wish to submit comments directly, they can be mailed to Heather Rowe, Director, Department of Labor Standards, 19 Staniford Street, 2nd floor, Boston, MA 02114.

Return to www.thinkhomecare.org.

 

 

State Senate Proposes $36.2 billion Budget Plan with New Opportunities for Home Care

The Massachusetts Senate’s Ways & Means Committee took their turn in the state budget-crafting process with a $36.2 billion proposal that increases total state spending by almost $1.7 billion from this year.

Although some programs in the Elder Services line items took a hit, as did the MassHealth Senior Care Account, the Senate proposed other new items that pose potential opportunity.

In what is known as an “outside section,” which is a section of an appropriation bill that can create new policies, the Senate created a Home and Community-Based Services Policy Lab. According to the language, the policy lab would start with $500,000 of state funds to evaluate and analyze the outcomes and effectiveness of home and community-based services under the Secretary of Elder Affairs. This includes the state Home Care Program administered through Aging Service Access Points (ASAP’s) that contract with Home Care Alliance members.

This “policy lab,” which appears to be a program evaluation of state government-funded home and community-based services, could be the beginning of proving the effectiveness of services such as those provided by home care agencies. More information on this will be released as details are released.

Also, in another “outside section,” the Senate Ways & Means Committee created a new Community First Trust Fund, which is intended for enhanced federal financial participation (FFP) funding for the state that is tied to the Balanced Incentive Payment program (BIP), among other programs. In a previous blog post, the HCA reported on the state’s intentions around the BIP initiative that will bring more support to non-institutional long-term care services.

More budget analysis will come out in the coming days, including the Home Care Alliance’s budget amendment priorities where HCA members can help by contacting their state senators. The Alliance plans on repeating proposals to advance telehealth in home care, better MassHealth rates, and a study commission of home health care services and possible oversight recommendations.

Return to www.thinkhomecare.org.

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.

Return to www.thinkhomecare.org.

HCA Executive Director Named to Key Health Policy Advisory Group

Home Care Alliance Executive Director Patricia Kelleher has been named to the Health Policy Commission Advisory Council joining a list of other health care leaders  who will help guide the implementation of the state’s Health Care Cost Containment Law.

Better known as Chapter 224, (“An Act Improving the Quality of Health Care and Reducing Costs through Increased Transparency, Efficiency and Innovation”) the law requires the Health Policy Commission’s (HPC) Executive Director to establish the Advisory Council and designate members with diverse perspectives on the health care system to two-year terms. The Council will advance Chapter 224 implementation by advising on the HPC’s overall operations and policies, providing feedback on a grant program to support new system delivery and payment reform methods, and encouraging public and stakeholder engagement in the HPC’s work.

“This is an impressive group that promises to enrich the HPC’s work,” said Executive Director Seltz. “They are part of the coalition that made the first chapter of Massachusetts health care reform such a resounding success and the passage of our nation-leading cost containment law possible. Each member will bring a different and important perspective to our work to implement Chapter 224. I am grateful for their willingness to serve.”

The Advisory Council includes the following members from across the state:

  • Christine Alessandro, Executive Director, BayPath Elder Services, Inc.
  • Dianne Anderson, RN, President & CEO, Lawrence General Hospital
  • Michael Caljouw, Vice President, Government & Regulatory Affairs, Blue Cross Blue Shield of Massachusetts
  • JD Chesloff, Executive Director, Massachusetts Business Roundtable
  • Cheryl Clark, MD, Director of Health Equity Research & Intervention, Brigham & Women’s Hospital
  • John Cox, President, Cape Cod Community College
  • Karen Day, Executive Director, US Policy, AstraZeneca
  • Ralph de la Torre, President & CEO, Steward Health Care System
  • Vicker “Vic” Digravio, President & CEO, Association of Behavioral Health
  • Ronald Dunlap, MD, South Shore Hospital, President-Elect, Massachusetts Medical Society
  • John Erwin, Executive Director, Conference of Boston Teaching Hospitals
  • Julian Harris, MD, Director, Office of Medicaid
  • Jim Hunt, President & CEO, Massachusetts League of Community Health Centers
  • Jon Hurst, President, Retailers Association of Massachusetts
  • Dan Keenan, Senior Vice President, Government Relations, Sisters of Providence Health System
  • Patricia Kelleher, Executive Director, Home Care Alliance of Massachusetts
  • Gene Lindsey, MD, President & CEO, Atrius Health
  • Geoff MacKay, President & CEO, Organogenesis
  • David Martin, Senior Director, Health Policy, Covidien
  • David Matteodo, Executive Director, Massachusetts Association of Behavioral Health Systems, Inc.
  • Dolores Mitchell, Executive Director, Group Insurance Commission
  • Abraham “Ned” Morse, President, Massachusetts Senior Care Association
  • Joyce Murphy, Executive Vice Chancellor, Commonwealth Medicine, University of Massachusetts Medical School
  • Lynn Nicholas, President & CEO, Massachusetts Hospital Association
  • Cheryl Pascucci, APRN, FNP-C, Commonwealth Care Alliance
  • Lora Pellegrini, President & CEO, Massachusetts Association of Health Plans
  • Julie Pinkham, Executive Director, Massachusetts Nurses Association
  • Donald Thieme, Executive Director, Massachusetts Council of Community Hospitals
  • David Torchiana, MD, President & CEO, Massachusetts General Physicians Organization
  • Celia Wcislo, Vice President, 1199 SEIU of Massachusetts
  • Brian Wheelan, Executive Vice President for Corporate Strategy & Development, Beacon Health Strategies
  • Amy Whitcomb Slemmer, Executive Director, Health Care for All

Return to www.thinkhomecare.org.