|On Wednesday January 3rd , the Massachusetts Legislature returned for the second year of its two-year session. After a seven-week recess, the body is looking at a traditionally busier second half than the first. The nearly 170 bills that passed in 2017 marked the lowest total in twenty years.
Lawmakers have until July 31 to complete all substantial legislative debate. In addition, all 200 members are up for election in 2018, which is expected to be a distraction from normal legislative work as a result of a polarized political landscape. Here’s what the Alliance will be focused on in 2018:
Prior to the Holiday break, the Alliance met with its ‘Enough Pay to Stay’ partners to strategize coordinated efforts to attain wage relief for direct care workers and ASAP case managers. The coalition has pending legislation which would take steps toward this initiative, but we will pursue other legislative vehicles to fight for our workforce.
In November, Governor Baker signed into law the Home Care Worker Registry. This law will establish a worker registry that requires agencies contracting with ASAPs to submit workers’ private information to the state. The law is enacted and subject to regulations. The Alliance and its partners are in active communication regarding next steps toward protecting our members and their workers’ rights.
The FY 2018 State Budget included language that will establish a licensure process for home health agencies providing skilled services. It is unclear at this point when the process to promulgate regulations will begin, but the Alliance will be providing input to the Department of Public Health as these parameters are developed. In addition, Alliance-sponsored legislation that would license private care agencies is still making its way through the legislative process. Under procedural rules, the legislature has until February to report legislation out of committee. The Alliance will continue to advocate for passage of this legislation.
Continuous Skilled Nursing:
In late 2017, MassHealth announced two rate increases for the Continuous Skilled Nursing (CSN) program that totaled nearly 11 million. This was welcomed news, but there remains work to be done. The CSN provider/parent coalition will continue to advocate for the CSN Bill of Rights legislation that would mandate bi-annual reviews of the workforce to ensure safeguards against future crises.
The Alliance has been informed that MassHealth will conduct a long-overdue review of rates for per-visit nursing, therapies, and home health aide services. The Alliance will be working to gather data to demonstrate that the current low rates are interfering with agencies’ ability to attract and retain enough workers to meet the demand for services.
MassHealth’s initiative to enroll the majority of members into managed care programs this coming spring will dramatically change the way MassHealth members access home health services, and disrupt many existing provider referral relationships. The Alliance will continue to work to ensure that MassHealth members retain access to needed home health services, and that agencies are adequately reimbursed for those services.
House of Representative Health Care Bill:
Late last year the Senate passed a health care cost containment bill aimed at curbing costs while maintaining access. It has long been rumored that the House will be embarking on similar initiatives. Though the details are scarce, this legislation could be a vehicle for many of the Alliances priorities in 2018 and we will continue to advocate where necessary.
If you have any questions about the year ahead for advocacy or would like to get involved, reach out to Jake Krilovich, the Alliance’s Director of Legislative and Public Affairs.
This week, the Alliance’s parent-provider skilled nursing campaign received national media coverage. The campaign seeks higher reimbursement rates from MassHealth for continuous skilled nursing services. Currently, agencies are unable to compete for nurses with area hospitals, and has led to a 37% nurse turnover rate, and nearly 24% of MassHealth-Authorized service hours going unfilled.
On Sunday, The Boston Globe featured a front-page story into the life of one of the parents caring for a child in the Massachusetts Continuous Skilled Nursing Program. Noelia Ferreira has gone over 100 days without a skilled nurse coming to her home to care for her daughter Abi. The article beautifully explains Noelia’s struggles to find adequate care and her commitment to keeping Abi safe at home.
As a result of this front page feature, WGBH invited Noelia and MA Pediatric Home Nursing Care Campaign founder, Angela Ortiz, to be interviewed by host, Jim Braude. Footage of the interview can be viewed here.
The campaign is leveraging this exposure to raise awareness and momentum in our fight for adequate reimbursement rates. Please visit www.mychildcantwait.com to write or call Governor Baker urging action.
While demand for home based health and supportive care continues to grow in Massachusetts, the home care industry struggles to recruit and retain essential front line caregivers. New data collected last fall through a survey of home care agencies that contract with the state’s Aging Service Access Points (ASAPs) found that on average 25% of a home care agency’s direct care workforce changes every three months leading to intense instability within the organization.
Please click the link below to write or call your Representatives urging them to sign onto Representative Aaron Vega’s amendment #148 which begins to address the underlying causes for the growing home care worker shortage in Massachusetts and takes steps to assure that their will be workers to meet the demand.
Massachusetts has been successful at rebalancing the long-term care system, and appropriately diverting consumers from nursing facilities to community care. Between FY12 and FY16, MassHealth has experienced a -5.8% reduction in annual bed days. The movement of care from nursing homes to the community has not been been met with the necessary reinvestments in workforce to ensure the workforce is available to support consumers in need of services. MassHealth has not raised the rate of reimbursement for a home health aide in almost a decade.
Return to www.thinkhomecare.org.
The Home Care Alliance participated in several calls with MassHealth and Health and Human Services on planned budget cuts from Governor Baker’s administration. In total, the Governor announced $98 million in cuts from the $39.25 billion state budget.
Although there are reductions in home health, there are positive rates increases to report.
After years of advocacy by the Alliance and more recent efforts from a coalition of continuous skilled nursing providers as well as a family-based network called the Mass. Pediatric Nursing Campaign, MassHealth informed the HCA that payment rates for Continuous Skilled Nursing will increase by 2.6%. According to MassHealth, this equates to a $2.2 million bump in rates, which will become effective January 1st, 2017.
For the RN and LPN day and night rates, the increase hovers around a $1 boost in what those agencies currently receive. The Alliance, along with the provider coalition and family-based campaign, will continue to advocate for further adjustments to continuous skilled nursing rates in the upcoming FY18 state budget cycle.
As for home health skilled nursing rates outside of CSN, payment will be reorganized by the length of service of the MassHealth member. As of July 1, 2017, MassHealth is planning to break up the current skilled nursing rate for home health agencies into three separate tiers. The first tier will be for patients on services from day 1 through 30, which will be increased from $86.99 to $89.21. The second rate tier will be 31-180 days and the third rate tier is any home health service beyond 180 days.
MassHealth has indicated that the rates in the second tier will remain relatively static and the third tier will be decreased, but post 30-day rates as of 7/1/17 will be budget neutral from the changes taking effect on January 1st. An announcement from EOHHS will specifically outline the new tiered rates, but according to MassHealth, anything regarding rates that is seen before the New Year is not finalized and therefore subject to change.
The other notable decrease will take effect on January 1st when MassHealth plans to approximate the budget impact of those proposed second and third rate tiers into the current post 60-rate. The cut in the post 60-day rate from 1/1/17 to 7/1/17 will be a 6.75% reduction. This means the current post 60-day rate of $69.59 will be roughly $64.89 for the first six months of 2017. (This rate remains higher than the medication administration rate originally considered by MassHealth.)
Laid out in another way, this will be how rates are currently planned to change:
January 1 – July 1:
Home health services post 60-day rate will be roughly $64.89 (6.75% reduction)
Service days 1-30: $89.21
Service days 31-180: Rates will remain roughly the same, but are not yet finalized
Service days 180: Rates will be slightly reduced from the current post 60-day rate, but are not yet finalized.
MassHealth is also streamlining enrollment in the Independent Nursing program to cut their application process from 8 weeks down to one week.
The net state cut for home health is approximately $3.8 million out of $758 million in MassHealth spending on home health care services.
Most of the other cuts announced by the administration are restoring vetoes previously proposed by the Governor in the FY2017 budget, but that were overridden by the legislature. At that time, the Governor vetoed $255 million and the legislature overrode $231 million. Included in these cut overrides are certain hospital supplementary payments (particularly to pediatric and Western MA hospitals) as well as $1.1 million in cuts to public health hospitals.
Other impacted accounts include supplemental payments to nursing homes, which will be reduced by $2.8 million, as well as a $2.8 million cut to adult foster care (AFC).
The Pediatric Palliative Care account (4590-1503) is being reduced by $400,000.
The legislature has already announced their view that Governor Baker went too far with some of the announced cuts and they will be working on restoring some of the funding reductions.
HCA of MA has an upcoming meeting with MassHealth to review the Governor’s proposal. Also on the agenda are issues with ICD-10 changes that are impacting agency billing and payment.
Return to www.thinkhomecare.org.
Though a statement published in a Boston Globe online article, MassHealth revealed that their first round of home health agency audits uncovered $22.5 million in improper billing.
Nine home health agencies were involved in the initial audits conducted in response to steep spending growth in the MassHealth home health program. As the Globe article points out, the majority of that spending growth is driven by 62 companies that have come online since 2013.
In response, the Home Care Alliance is making its statement on the audits available. The full text of the statement is copied below:
Home Care Alliance of MA Statement on MassHealth Audits
BOSTON, MA – MassHealth announced today that audits of home health providers have uncovered more than $22 million in improper payments. The audits were initiated in an effort to identify the sources of recent dramatic spending growth on MassHealth home health services.
The Home Care Alliance of Massachusetts, a nonprofit trade association representing home health and home care providers, has been working side-by-side with the state Medicaid office staff since these audits were announced. The Alliance supported and continues to support MassHealth’s efforts to ensure appropriate services are being provided. This includes a temporary moratorium on new providers, and a prior authorization process for approving home health care services. In the months since the latter measure was put in place, both sides are in constant communication to relay concerns and suggestions. After years of lax oversight, Governor Baker’s administration has put a long-overdue emphasis on program accountability to assure that only eligible MassHealth members receive the in-home services they need to preserve their health and well-being.
“Massachusetts is fortunate in having some the best home health providers in the country and we support MassHealth in these efforts because we want to preserve the high standards of quality that patients and their families should expect,” said Patricia Kelleher, Executive Director of the Home Care Alliance of MA. “These audits only help to prove what our organization has been saying for years: There needs to be better state oversight as well as a higher bar of entry into the market.”
“Many of the MassHealth enrollees that our member agencies see have severe and persistent mental illnesses, and the multiple medications that they take can cause additional medical problems that require ongoing medical attention,” added Kelleher. “The agencies who do this work feel that they are a huge part of the health care safety net, providing valuable services to patients and families who otherwise would be placed in costlier care settings and/or become a detriment or even threat to their communities.”
The decision to add new management controls was driven by growth in utilization of the benefit particularly between FY 2013 and FY 2015. At present approximately 32,000 MassHealth enrollees are using home health services on an annual basis. Of these approximately 7,000 are receiving home health to assist in managing a mental or behavioral health condition, 4,000 are under age 21 and 9,300 are over age 61.
“Although MassHealth has not shared the specific audit results with us, we will continue to push for better standards and support program integrity efforts on behalf of all agencies that are playing by the rules and providing great care,” said Kelleher.
Return to www.thinkhomecare.org.
Both the state and federal governments are extending moratoria on new home health providers.
MassHealth will be extending the six-month moratorium on new home health providers, which will become effective on August 12 for an additional six months, according to MassHealth. The Home Care Alliance has been supportive of the measure and has collaborated with the state Medicaid office on program integrity efforts, but attempts to kick-start a state oversight policy for home care agencies have been unsuccessful.
In a letter requesting the initial stoppage on new providers from Massachusetts Health and Human Services Secretary Marylou Sudders to federal HHS Secretary Sylvia Mathews Burwell, it was noted that home health spending under MassHealth increased 41% from fiscal years 2014 to 2015. The letter continued to explain that 85% of that growth was driven by providers that were new to the MassHealth program since 2013.
Meanwhile, the Centers for Medicare and Medicaid Services (CMS) announced that they will be not only extending their temporary moratoria on enrollment of specific locations within Florida, Illinois, Michigan, Texas, Pennsylvania, and New Jersey, but will also be broadening moratorium across each of those states.
Below is an excerpt from the Federal Register with CMS’ reasoning in announcing the extension and expansion:
CMS has determined that the factors initially evaluated to implement the temporary moratoria show that a high risk of fraud, waste, and abuse exists beyond the current moratoria areas, which may suggest that a high risk of fraud, waste, or abuse exists due largely to circumvention of the moratoria by some providers and suppliers.
The primary means of circumvention includes enrolling a new practice location outside of a moratorium area and servicing beneficiaries within the moratorium area. Additionally, CMS has continued to see areas of saturation that exceed the national average in the moratoria states. As a result, CMS, in consultation with the OIG, has determined that it is necessary to expand the temporary moratoria on a statewide basis, by implementing temporary moratoria on all newly enrolling HHAs in the remaining counties in Florida, Illinois, Michigan, and Texas, and on all newly enrolling Part B non-emergency ground ambulance suppliers in the remaining counties in Texas, New Jersey, and Pennsylvania, in order to combat fraud, waste, or abuse in those states.
MassHealth announced that the One Care Program for individuals dually eligible for Medicare and MassHealth and between the ages of 21 and 64 has been extended through 2018.
Part of this new agreement with the Centers for Medicare and Medicaid Services (CMS) is that MassHealth will be accepting letters of intent (LOI) from entities interested in becoming One Care Plans effective January 1, 2018.
Beginning in 2013, the One Care program included several plans that were whittled down to what is now Commonwealth Care Alliance and Tufts Health Plan, which began participation in the initiative as Network Health. Funding issues were at the center of why other plans could not sustain covering One Care enrollees, although adjustments have been worked out that are intended to help plans better predict costs and assess financial risk. Fallon Total Care was the latest to drop their participation in June 2015.
Out of 103,041 eligible individuals, MassHealth reports that 13,038 are covered by the two One Care Plans. Commonwealth Care Alliance covers the bulk of that total with 10,050 enrollees as of June 1, 2016. According to the latest enrollment report, more than 30,000 individuals have “opted out” of the One Care Program.
Return to www.thinkhomecare.org.
With $256 million in spending reductions, the Governor approved his final approved FY17 state budget and it’s now up to the House and Senate to now discuss overrides before formal sessions conclude at the end of July.
Among the items preserved was a $200,000 item for the Department of Higher Education that funds the Nursing and Allied Health Workforce Initiative. The Home Care Alliance is among a large group of stakeholders that advocates for funding that supports grants to teams of colleges, health care providers, and workforce investment boards to advance training and education for nurses and direct care workers.
The governor did, however, reduce the legislature’s funding recommendation for the pediatric palliative care network by $400,000. The remaining $1.8 million is essentially a level-funding from previous years. It was one of 303 line items that saw reduced funding.
The largest reduction the Governor recommended was a $17.8 million drop in Nursing Home Supplemental Rates. The House and conference committee had recommended a total of $337.9 million while the Senate had suggested $332.9 million, but the number being sent by the Governor back to the legislature currently sits at $330.1 million.
Details on the Governor’s FY17 budget can be found on the “Governor’s FY17 Vetoes” webpage.
Return to www.thinkhomecare.org
The merits of protecting consumers, setting minimum standards for companies and agencies providing in-home care, and controlling state costs were not enough to advance a Home Care Oversight Commission through the state budget.
The state’s FY17 Conference Committee released their final budget proposal on behalf of the legislature after regrouping in light of declining revenue projections. The Home Care Commission, which was included in the Senate budget, but not in the House, had to survive a “conference committee” of House and Senate budget leaders that negotiated a fiscal plan between the two sides.
With Massachusetts being one of only five states without state oversight of home health care, and also with a goal to place some standards on private-pay home care, the commission would have convened legislators, home health agencies, private-pay home care, state officials, consumer groups and trade associations to recommend solutions. The language stipulated that there be separate sets of recommendations for home health and private pay home care.
Elsewhere in the budget, the declining revenue projections filtered through to hit the elder services network. Based on FY16 spending levels, a $2 million cut was made to “Elder Home Care Purchased Services” and $2.6 million reduction in the “Elder Home Care Case Management and Administration” account.
Two pieces of good news came in that Elder Protective Service got a boost of $4.5 over FY16 spending and the Pediatric Palliative Care Network received a boost of $404,578, but the Nursing and Allied Health Workforce Initiative remained leveled out at $200,000.
More silver lining came with a $1 million pilot program to test expanding income eligibility standards for services ordered by Aging Service Access Points.
In terms of MassHealth line items, the expected trends continued with the conference committee reducing the “Fee-for-Service” account by $161.7 million while increasing the accounts tied to MassHealth Managed Care ($71.1 million) and MassHealth Senior Care ($160.4 million).
Nursing Home Supplemental Rates also saw a raise with $45 million over FY16 spending.
The $39.15 billion budget now moves to the Governor for final approval and any further updates will be shared as they become available.
Return to www.thinkhomecare.org.
Months of stakeholder meetings and public engagement by MassHealth has resulted in a long-awaited draft proposal that aims to completely restructure the state’s Medicaid program.
Known as the Section 1115 Waiver, the 90-plus page document outlines a possible multi-year agreement with the federal Centers for Medicare and Medicaid Services (CMS). The focus of the proposal is a move towards accountable care organizations (ACOs) and alternative payments while better addressing the needs of MassHealth members and putting in place a financially sustainable system of health care and support services.
Before the agreement can be made with CMS, however, there is a public comment period that runs until July 17th. The Home Care Alliance created a breakdown of the proposal so that members and advocates can better understand the key provisions.
MassHealth also provided a more basic fact sheet available on their 1115 Waiver Proposal webpage that also includes the full document and slide decks from previous public meetings.
The proposal attempts to seize an opportunity for new funding streams to support the creation of three types of ACOs that are required to partner with existing providers of behavioral health (BH) and long-term services and supports (LTSS). The state aims to rearrange provider and managed care relationships to set forth a better coordinated and integrated set of networks.
The first “pilot ACOs” are expected by MassHealth to come online later in 2016, while the full roll-out of the three ACO models, enhanced funding, and BH/LTSS integration will take place in October 2017.
The Alliance was appointed to several of the MassHealth stakeholder groups and plans to submit comments on the proposal on behalf of home care.
Return to www.thinkhomecare.org.