Tag: MassHealth

Massachusetts Medicare Program.

“Did You See That” – May 2024

Federal Outlook

Tariffs? We are Talking About Tariffs?

This topic has absolutely nothing to do with health care in any way, but it could have an surprising impact on the presidential election race.

President Biden announced recently that United States Trade Representative (USTR) plans to increase tariffs significantly on $18 billion on imports of clean-energy goods from China. The increases will apply to imported steel and aluminum, legacy semiconductors, electric vehicles, battery components, critical minerals, solar cells, cranes, and medical products. The new tariff rates – which range from 100% on electric vehicles, to 50% for solar components, to 25% for all other sectors – will be implemented over the next two years.

As a refresher, because 2018 feels as close as to when the pyramids were built, in 2018 President Trump implemented sweeping tariffs, up to 25%, on over $300 billion in goods from China. These products stretched from washing machines, to apple chargers, to steel and aluminum. Trump’s goal was to pressure US manufacturers to move their supply chains out of China back to the US.

The Biden administration came to their decision after “reviewing” Trumps tariffs on China. I put “reviewing” in quotes because from my experience, the word “review” means nothing. The call for increases also came after signs that China is looking to increase production and exportation of their clean-energy goods, which has been a focal point of the Biden administration. Over the last 4 years, the Biden administration has handed out hundreds of millions in grants to increase production of EV vehicle and charging stations in the US. The early results are as good as my blood pressure after stepping on a Lego barefoot, pitiful. Demand for EVs has steadily dropped over the years, Multiple EV startups have gone under due to lack of sales, multiple automakers have rolled backed their EV development, and Tesla, the leading charging station producer, announced plans to drastically roll back their production of charging stations.

In response to Bidens tariff announcement, Trump, who calls himself the “tariff man”, said at a rally in New Jersey that if he was reelected, he would increase tariffs “200% tax on every car that comes in from those plants.” Trump would not only increase tariffs on Chinese automakers, but all cars coming imported into the US.

This sets up trade wars being a potential hot topic on the campaign trail for both Biden and Trump, who both believe in increasing tariffs on foreign goods. Now the one thing that both these men fail to realize is that the tariffs, for the most part, have not had the affect they hoped. US producers have not moved their supply chains out of China and back to the US. At best they have moved production to other countries like India; Or they passed on their increased costs of production to consumers, which hurts the consumer the most.

Alternative ideas that they should look at is creating additional tax breaks for companies that open plants in U.S., especially those that are moving production back to the US. Give out grants to teach workers to work in these types of plants, that can be making multiple products in one facility. Look to offset China’s currency manipulation by buying the Yen, making the Yen buying power stronger and the US dollar weaker, and in turn making US good cheaper and Chinese goods more expensive. Lastly, the U.S. should go back to embracing truly free trade. Free trade helps our economy grow, increases access to higher-quality, lower-priced goods, improves efficiency and innovation, and increases competition.

Federal Recap

Medicaid 80/20 Rule

Well after over a year of speculation, the Biden Administration announced their plans to make major change to the home and community services under Medicaid. CMS released their final Medicaid access rule in late April, which includes substantial changes to many Medicaid services. Some of the changes are positive, including creating a new HCBS quality reporting system and increasing payment rate transparency. But on the other side, the rule including language would require home-based care providers to use 80% of the Medicaid reimbursements they receive toward direct care worker compensation. It’s like finding out that you must work overtime the whole week for no extra pay, but at least your boss throws you a pizza party.

CMS originally released their proposed rule in April of 2023, in response to massive home care workforce shortage across the country, that have led to long wait times, with nearly 700,000 Americans languishing on waiting lists every year since 2016 according to one estimate. The rule would apply to direct care workers that provide homemaker, home health aide; personal care services, that fall under select Medicaid 1915 waiver services (MA Frail Elder Waiver & the MA Community Living Waiver) and the 1115 waiver services (MassHealth). CMS defines a direct care worker as a worker that:

  • Provide nursing services
  • Assist with ADLs and IADLs
  • Provide behavioral supports, employment supports, or other services to promote community integration.

Specifically includes:

  • Nurses (RNs, LPNs, NPs, Clinical Nurse Specialists) • Licensed or certified nursing assistants
  • Direct support professionals
  • Personal care attendants
  • Home health aides
  • “Other individuals” paid to directly provide Medicaid services that address ADLs/IADLs, behavioral supports, employment supports, or other services to promote community integration, including nurses and other staff providing clinical supervision.

CMS defines compensation as:

  • Salary;
  • Wages;
  • Other remuneration as defined by the Fair Labor Standards Act;
  • Benefits: health and dental benefits, life and disability insurance, paid leave, retirement, tuition reimbursement.
  • The employer share of payroll taxes for direct care workers, specifically including FICA taxes, unemployment insurance, and worker compensation.

The final rule allows providers up to 6 years to demonstrate compliance with the new rules, an increase from 3 from the proposal, and states have the option to offer “hardship exemptions” and give small providers a lower threshold than the 80% mandate. CMS hopes that the new rule will help to lure workers to the field and bring stability to the workforce.

HCA, along with providers across the nation, could not disagree more with the proposed 80/20 rule. HCA, along with others, submitted comments to CMS highlighting the dangerous effect that the proposed rule could have on already strapped agencies across the country. “This is a misguided policy that will result in agency closures, force providers to exit the Medicaid program, and will ultimately make access issues worse around the country. As NAHC and our partners across the home care industry have demonstrated, such a provision is not only unworkable due to the varied nature of Medicaid programs across the country, but CMS also lacks statutory authority to impose this mandate.” Said The National Association for Home Care and Hospice (NAHC). Jennifer Sheets, co-chair of the NAHC Medicaid Advisory Council (MAC) reiterated the same sentiment about the rule, “We know that CMS has good intentions and a desire to improve the lives of workers, but this policy is ill-advised and will have serious negative impacts on providers and their clients around the country.”

Swiftly after CMS released the 80/20 Medicaid access rule, Congress moved to introduce legislation that would block implementation. Rep. Cammack (R-FL-3). The bill would prevent the Department of Health and Human Services from finalizing the “80/20” rule and to prevent the Department from promulgating, implementing, enforcing, or giving effect to any substantially similar rule requiring a minimum percentage of Medicaid spending on home and community-based services (HCBS) providers be spent on compensation for direct workers. Click the link HERE like to write to your Representative urging them to support HR.8114.

State Outlook

A Billion Here, A Billion There

Budget season is officially upon us. The House recently passed their proposed$58 billion budget for FY25, that invests in K-12 education, childcare and public transit. The House proposal does not call for tax increases, seeks to push overall state spending up by about 3.3 percent, or $2 billion, and aims to drive up the state rainy day fund balance to nearly $9 billion.

Two weeks later Senate leadership released their proposed $57.9 billion budget bill for FY25. The Senate budget is similar to the House’s proposal in many ways, but also stretches to propose a pair of novel ideas: free community college and regional transit authority trips. The Senate proposal would cover another year of free school meals, pay for another year of the multi-year K-12 funding law known as the Student Opportunity Act, and direct more money to strained emergency family shelters without seeking additional systemic reforms.’ All three budget proposals — Healey’s, the House’s and the Senate Ways and Means Committee’s — seek $325 million for the emergency family shelter system. That amount would level-fund the line item compared to fiscal 2024, though Beacon Hill already agreed via a bill Healey signed in April to allow the use of $175 million from savings on shelter costs in fiscal 2025.

The Senate proposal calls for $100 million less in spending than the final $58 billion House-approved budget. That annual rate of growth would rank close to the bottom over the past decade, and it represents a marked shift from the spending spree Democrats enacted in the past two years — 9.1 percent spending increase in fiscal 2023, 6.9 percent in fiscal 2024 — with the support of Republican Gov. Charlie Baker and then Healey. The fiscal conservation comes after months of lacking revenue collection for the state.

HCA is working with our legislative champions to insert the rate clarifying bill language in the outside section of the Senate budget proposal through the amendment process. Please use THIS LINK to write to your State Senator, to urge them to co-sponsor Amendment #535, Clarifying Rate Setting Processes for Home Health and Home Care Services.

An amendment was submitted that would require quarterly reporting on wages provided through the chapter 257-line item, 1599-6903. HCA is working with our legislative champions and the Senate Ways and Means committee to block the amendment from being passed.

State Recap

HCA Licensure Bill Moved to Health Care Financing

HCA Licensure bill that would create licensure system for non-medical home care services was voted our favorably by the Committee on Rules and was sent to House Health Care Financing. HCA has continued to advocate to committee staff for the importance of passing this bill this session. HCA will provide further updates as the bill progresses through the legislative process.

State House Unveil Expansive Hospital and Industry Reform Bill

In the wake of the ongoing Steward Hospital fiasco, on Tuesday, House leadership unveiled their highly anticipated hospital oversight and industry reform bill. The Legislature’s Health Care Financing Committee on Tuesday moved to advance a redrafted, 97-page proposal that combines lessons learned from the Steward Health Care crisis, major changes to how state regulators work to contain health care spending, and new tools to deal with facility expansions and closures. Officials in House Speaker Ron Mariano’s office pitched the wide-ranging bill as the biggest effort to contain health care costs since the 2012 law that established the Health Policy Commission, the Center for Health Information and Analysis and an annual benchmark representing a goal for spending growth.

A key component of the bill aims to strengthen data-reporting requirements and consequences. Hospitals would need to disclose audited financial statements about out-of-state operations for their parent organizations, certain private equity investors, real estate investment trusts, and management services organizations. They would also face much higher fines for falling short of those requirements, boosted from $1,000 per violation to $25,000 per violation with no maximum cap. The bill additionally empowers DPH to block certain licensure or expansion approval against a system that has failed to submit appropriate financial data to the state. The redrafted legislation would also overhaul health care cost containment and management at the state level, including by changing the existing one-year benchmark to a three-year cycle. Mariano’s office said a longer time period would better account for dips and spikes in spending by individual entities.

Senate President Karen Spilka did not commit to taking up the bill in the Senate. The Senate will likely look to expand upon the proposed bill or propose their own bill that would include more prescription drug legislation and/or strengthen the Health Policy Commissions authority.

“Did You See That” – March 2024

Federal Outlook

America is Having a Severe Case of Déjà Vu

As we know, history tends to repeat its self-time and time again. Many of you may have heard about the weird parallels between Lincoln and JFK, such as that both presidents were shot in the back of the head, on the Friday before a major holiday, while seated beside their wives, who both married socially prominent twenty-four-year-old woman who spoke French fluently, the list goes on and on. The same may be happening for 2020 and 2024. The Super Bowl in 2020 was between the 49ers and the Chiefs, same as in 2024, where the Chiefs won both games, Taylor Swift won Grammy awards in both 2020 and 2024, both years were leap years, and just like in 2020, we will see the same two candidates face off during the presidential election.

I am going to take a second to say, to be crystal clear, that I do not care who you vote for. That is your business, and it is your right as an American to believe what you want and vote how you want. Okay now back to the mess at hand

President Joe Biden, who was born before the invention of duct tape, penicillin, and the color TV, will once again face off against former President Donald Trump, whose skin looks like what happens if you eat too many carrots. I think we can all agree that this was the last matchup that we wanted to see, but here we are. This is the first presidential election rematch since 1956, which saw then President Dwight Eisenhower defeat for a second time in a row Democratic candidate, Adlai Stevenson, who could put a rock to sleep.

While it may be the same matchup, the sentiment around the election is very different. For one, we are no longer experiencing life as it was during COVID, where we saw state by state lockdowns, high unemployment numbers and a dire lack of live sports to watch. Contrast to the current climate we are living in, a world of high interest rates, unaffordable housing, and multiple military conflicts across the globe, and more sports betting than ever before.

The candidates, their political parties, the media, and really everyone are really focusing on one aspect when it comes to electability of the candidate, who is more “fit” to hold the office. I put fit in quotations because how that word is defined is different depending on who you ask. When it comes to President Biden “fitness” for office, people argue that he is too old to be president. Biden is 82 years old, which already makes him the oldest president in our history. If Biden were to win the election, he would be 86 when his term is over, which is even high for a golf score for a professional. Many have questioned his mental fitness at his current age, and are doubly concern that it will get worse as time goes on. Even the special counselor assigned to a case involving Biden’s storing classified documents after he was VP, expressing concern for his memory. Saying that he could not convict Biden beyond a reasonable doubt because “Mr. Biden would likely present himself to a jury, as he did during our interview of him, as a sympathetic, well-meaning, elderly man with a poor memory.” That report also comes after 4 years of President Biden mis-saying names of countries and people, on a weekly basis. There are countless examples of Biden having mental gaffes. It shows something that people were genuinely happy to hear that Biden got it right at a town hall when he said he was president of the U.S. and not another country. people are also worried that with his “advanced age” he can’t relate with younger populations and their concerns. I mean we come from two different times, Biden grew up when a fun activity as a kid was playing with string and skipping rocks, while my generations and people younger than me idea of fun is killing zombies in a video games and catfishing people online.

When it comes to former President Donald Trumps “fitness” for office, the considerations are less around his mental state, but more around his actions as president and his belief on the power of presidency. People especially his actions surrounding the January 6th insurrection and potential election interference. The former president has been indicted by a special counsel on felony charges for working to overturn the results of the 2020 election in the run-up to the violent riot by his supporters at the U.S. Capitol on Jan. 6, 2021. The four-count indictment includes charges of conspiracy to defraud the United States government and conspiracy to obstruct an official proceeding: the congressional certification of Joe Biden’s victory. by saying that the election was stolen and trying to persuade state officials, then-Vice President Mike Pence and finally Congress to overturn the legitimate results. He was also indicted in Georgia along with 18 others, for violating the state’s anti-racketeering law (RICO) by scheming to illegally overturn his 2020 election loss. RICO charges are better known for being used by law enforcement to down the Mafia in the 80s and 90s. It is important to note that the former President is yet to be convicted of any charges. People are also concerned because Trump has shared his belief publicly that a president should have immunity from any actions they take as president, which many believe goes against the original intent of the constitution and the separation of powers. Trump said on Truth Social in all-caps “A PRESIDENT OF THE UNITED STATES MUST HAVE FULL IMMUNITY, WITHOUT WHICH IT WOULD BE IMPOSSIBLE FOR HIM/HER TO PROPERLY FUNCTION”. Trump is effectively arguing that a president can do whatever he wants while president and cannot be held liable. This is response to charges that were filed against him for illegally holding onto classified documents and allegedly trying to move/destroy evidence. People are concerned that a candidate that has allegedly worked to fix and overturn an election, as well as believes that a president should have full immunity to do whatever they want while president, is not “fit” to hold the country’s highest office.

In the end, we can all agree that this election season is going to be exhausting. Thank god we have the Olympics to distract us for parts of it.

Federal Recap

Biden Unveils Budget Proposal for FY25

On Monday, President Biden unveiled his proposed budget for FY25, which looks to cut the deficit by $3 trillion over a decade, by increasing taxes for companies and the wealthy. The proposals calls for raising the corporate tax rate to 28 percent from 21 percent, which is the level that was set by the 2017 Tax Cuts and Jobs Act. It also calls for increasing what’s known as the corporate minimum tax to 21 percent from 15 percent. That tax, which was passed by Democrats in 2022, applies to corporations that report annual income of more than $1 billion to shareholders on their financial statements but use deductions, credits and other preferential tax treatments to reduce their effective tax rates well below the statutory 21 percent. In addition to quadrupling a 1 percent surcharge on corporate stock buybacks to 4 percent. White House economists estimate increasing the tax could yield $137 billion in new tax revenue over a decade.

For taxing the wealthy, the proposal includes language that would raise the capital gains tax rate for earner who make more than $400,000 a year to 39.6 percent, and close the so-called carried interest loophole that allows wealthy hedge fund managers and private equity executives to pay lower tax rates than entry-level employees. The most progressive policy included in the proposal would create a 25 percent “billionaire tax” on individuals with wealth, defined as the total value of their assets, of more than $100 million, with the goal is to prevent the wealthiest Americans from employing tax strategies that allow them pay lower tax rates than those of middle-class households.

Last Thursday, before the President’s State of the Union Address, House Republicans advanced their FY25 budget proposal, which would take a vastly different approach to balancing the budget, by cutting over $14 trillion in federal spending in such areas as green energy subsides and student loan forgiveness while reducing taxes. The House Budget Committee adopted the blueprint in a 19-15 party line vote last Thursday, with Budget committee chairman Jodey Arrington saying that the budget plan would reduce the federal debt, which stands at over $34 trillion, create a $44 billion budget surplus in fiscal 2034 and stir economic growth by lowering taxes. The budget postpones severe spending cuts until fiscal 2026, after the November election that will determine control of the White House and Congress. Committee documents show 2026 basic discretionary spending falling by more than $100 billion to $1.5 trillion.

To put it mildly, FY25 budget negotiations are expected to be turbulent, like a flight trying to fly through a hurricane. HCA will be watching the budget process closely as it unfolds.

Government Avoids Partial Government Shutdown, Still More to Do

Late on Friday, the Senate passed a government funding bill, funding roughly 30 percent of the federal government for the next six months, mere hours before the deadline. The legislation — which passed by a 75 to 22 vote — devotes $459 billion to the departments of Agriculture, Commerce, Energy, Housing and Urban Development, Interior, Justice, Transportation, and Veterans Affairs, as well as the Environmental Protection Agency and Food and Drug Administration, for the rest of the fiscal year, which ends Sept. 30. President Biden signed the packaged shortly after it cleared the Senate. Biden thanked Congressional leadership for working together to avoid a partial shutdown. The passing of the funding package came more than five months into the current budget year after congressional leaders relied on a series of stopgap bills to keep federal agencies funded for a few more weeks or months at a time while they struggled to reach agreement on full-year spending.

Through the funding package, non-defense spending will remain relatively flat compared with the previous year. Supporters say that’s progress in an era when annual federal deficits exceeding $1 trillion have become the norm. But many Republican lawmakers were seeking much steeper cuts and more policy victories. The funding packaged also includes over 6,000 earmarks requested by individual lawmakers with a price tag of about $12.7 billion. Earmarks, which were previously banned in 2011, but was recently voted to reinstate earmarks in 2021 by Democrats, with Republicans soon following suit.

Congress still needs to tackle tricker funding packages for remaining departments, including the Departments of Defense, Financial Services and General Government, Homeland Security, Labor-HHS, Legislative Branch, and State and Foreign Operations. Those bills are typically much more controversial and are at greater risk of failure than the bills that passed this week.

State Outlook

Where The Money At?

For the 9th straight month, state tax collections fell short once again in February. This extends what was already the longest streak of below-benchmark months in more than two decades, tax revenue remains down compared to a year ago. State House News reported that the Department of Revenue reported Tuesday that it collected $2.007 billion last month — $27 million or 1.3 percent more than actual collections in February 2023 but still $11 million or a slim 0.6 percent shy of the administration’s revised monthly benchmark of $2.018 billion. The Healey administration in January lowered the monthly benchmark for February from the $2.137 billion it originally projected for the month prior to the governor’s fiscal year 2024 revenue downgrade. The last time tax collections came in at or above the administration’s monthly benchmark was June 2023, nine months ago. The Healey administration didn’t establish fiscal 2024 benchmarks until August last year, so there was no official expectation set for July 2023. But each month since — now seven in a row — has seen collections fall short of the administration’s projections.

The Executive Office of Administration and Finance said the administration is not planning to make additional budget moves in connection with the below-benchmark February revenue report. A spokesman said the budget office’s outlook on fiscal 2024 has not changed. DOR is due to report revenue collections for March by Wednesday, April 3. The monthly benchmark for March, which DOR said is usually “a mid-size month for revenue collections, ranking sixth of the 12 months in eight of the last 10 years,” is set at $3.935 billion. That would be $52 million more than what was collected in March 2023.

State Recap

Massachusetts Health Care Costs Rose in 2022

The Center for Health Information and Analysis (CHIA), created under a 2012 cost containment law, released its annual report Wednesday examining health care spending trends in 2022. The detailed report covers a year that started with record-high reporting of COVID-19 cases, followed by gradual decline throughout the year.

CHIA’s annual report estimated total health care spending in Massachusetts at $71.7 billion in 2022, and a per capita health care expenditure of $10,264 per resident. Total health care spending was up $3.9 billion (up 5.8 percent on a per capita basis) over 2021’s level — well in excess of the state’s 3.1 percent benchmark for health care cost growth. CHIA said the 5.8 percent growth rate in 2022 represents the largest one-year jump since measurement began in 2012, aside from the “anomalous spending growth in 2021 driven by the pronounced effects of the pandemic.” Health care spending shot up 9 percent in 2021 after posting a 2.3 percent decline in 2020.

The 2022 growth in health care spending was below both the rate of growth in the Massachusetts economy broadly (7.2 percent) and regional inflation (7.1 percent), CHIA said, but outpaced growth in both national wages and salaries (5.1 percent) and national health care spending measured by the Centers for Medicare & Medicaid Services (4.1 percent). The largest contributors to the 2022 expenditure increases were pharmacy spending and non-claims payments, CHIA said.

Other medical services, which includes long term care and home health services, was the largest component of MassHealth spending, totaling $3.4 billion in 2022. Other medical services spending increased 10.1% overall, but only 0.8% on a PMPM basis. Its important to note that the CHIA report does not specifically mention how much was spent on home health services amongst the “other medical service” category.

MassHealth Proposes Significant Increase to CSN Rates

In February, MassHealth released their proposed rates for CSN services. In summary, MassHealth proposed a 32.4% increase to RN weekday rates, and an 11% increase to LPN rates. They have also added a high-tech rate for members with Trachs/Vents/Central lines, these rates have a $2/unit ($8/hr) add on/UA modifier, as well as increased the rate for the 60-day supervisory visit of CCA services by 32.4% as well. If these rates take effect, we will have realized nearly 100% rate increases to this program since 2017 when HCA’s members and CCM Families teamed together on advocacy efforts. An incredible feat.

HCA provided verbal testimony in favor of the rate increase at a public hearing last week, in addition to submitting written testimony.

Massachusetts Health Care Costs Rose in 2022

The Center for Health Information and Analysis (CHIA), created under a 2012 cost containment law, released its annual report Wednesday examining health care spending trends in 2022. The detailed report covers a year that started with record-high reporting of COVID-19 cases, followed by gradual decline throughout the year.

CHIA’s annual report estimated total health care spending in Massachusetts at $71.7 billion in 2022, and a per capita health care expenditure of $10,264 per resident. Total health care spending was up $3.9 billion (up 5.8 percent on a per capita basis) over 2021’s level — well in excess of the state’s 3.1 percent benchmark for health care cost growth. CHIA said the 5.8 percent growth rate in 2022 represents the largest one-year jump since measurement began in 2012, aside from the “anomalous spending growth in 2021 driven by the pronounced effects of the pandemic.” Health care spending shot up 9 percent in 2021 after posting a 2.3 percent decline in 2020. The 2022 growth in health care spending was below both the rate of growth in the Massachusetts economy broadly (7.2 percent) and regional inflation (7.1 percent), CHIA said, but outpaced growth in both national wages and salaries (5.1 percent) and national health care spending measured by the Centers for Medicare & Medicaid Services (4.1 percent).

Other medical services, which includes long term care and home health services, was the largest component of MassHealth spending, totaling $3.4 billion in 2022. Other medical services spending increased 10.1% overall, but only 0.8% on a PMPM basis. It’s important to note that the CHIA report does not specifically mention how much was spent on home health services amongst the “other medical service” category.

The Rundown – July 2023

State Recap

HCA Provides Testimony at Elder Affairs Hearing

On June 19th, HCA provided verbal testimony (Add Testimony HERE) at a Massachusetts state Elder Affairs Committee Hearing. HCA provided testimony on H.640/S.397, An Act to Improve Infection Control in Massachusetts Home Care, which would direct EOHHS to establish a mandatory infection control training program for personal home care attendants and all home care employees.

During the hearing we made it clear that we do not support the bill and raised our concerns with bill as drafted. We explained that this bill would prove to be duplicative with existing infection control requirements established at the federal level and in ASAP contracts. In addition, we strongly encouraged that the bill be re-written so that the text clearly clarifies that home care agencies should be allowed to conduct the training, if infectious control training is required.

If you would like to submit your own written comments on the bill, testimony may be submitted to the Committee via email to committee joseph.russo@mahouse.gov and victoria.halal@masenate.gov.

Budget, What Budget? No Movement on State Budget

I think state legislators are taking The Kink’s song “Sunny Afternoon” a little too seriously. Once again state legislators failed to pass an annual state budget for FY24 by the June 30th deadline, resulting in the state legislator passing a supplemental budget to fund the government through July. This has become a common practice for the legislature, as they have not passed an annual budget on time since 2011. For reference of how long ago that was the last Harry Potter movie came out that year, Instagram had just come out, and Osama Bin Laden was killed. to summarize, THAT’S A LONG TIME AGO. Hell, I was still in school in 2011, I won’t say what level of school, but I’ll just say that I was 4 inches shorter in 2011 than I am now.

The legislature has taken a more relaxed approach in recent years with the budget usually being passed in mid-late July. Last year, the annual budget was not formally signed into law by then Governor Charlie Baker till July 28th. Legislators are still ironing out key discrepancy between the House proposal and the Senate proposals. At the rate they are at, I don’t expect a budget to be agreed and passed till late July at the earliest.  

Look Ahead

Joint Health Finance Committee to Hold Hearing on Rate Setting Legislation

The Joint Health Finance Committee plans to hold a hearing on Tuesday, July 25th, on numerous bills that pertain to home care services. One of the bills that is being considered is H.1195/S.755 – An Act Clarifying Rate Setting Processes for Home Health and Home Care Services. As a refresher, this bill would clarify the rate setting processes that are already in place for both home health and home care services. It would NOT set the rates or dictate the amount for future rates set by Mass Health and EOHHS. It does make the rate setting process more transparent and ensures rates set by the state follow the rate setting laws and reflect the actual operating costs incurred by home health and home care providers. In addition, it articulates the cost factors that should be included in the methodology and rate setting process including new regulatory costs and governmental mandates. Recent examples include changes in the state’s minimum wage, the Paid Family and Medical Leave Act, health insurance, employee benefits and training, and increased technology costs.

This bill has been a major focus of our advocacy efforts for the last couple years, and we would like everyone to provide testimony if possible. In all seriousness, it will only take 3 minutes of your time. I will draft a template for members to use to write their testimony to either send to the committee or to provide verbally on the day of. The more people the provide testimony, verbally or written, the stronger our voice. I will be there in person to speak to the committee on behalf of the association and if anyone would like to join me, please email me at hccollins@thinkhomecare.org.

House Proposes Nearly $700 Mil in Supplemental Spending (State House News)

House Democrats are preparing to bring forward a $693 million spending bill that would steer financial support to vulnerable hospitals, allow state energy regulators to update contracts related to a key hydroelectric transmission project in Quebec, and extend horse race simulcasting for another half-decade.

The House Ways and Means Committee on Wednesday morning opened a poll on a redrafted supplemental budget (H 3869), one day before the chamber is set to meet in its first formal session since April 26.

Of note, House Speaker Ron Mariano’s office said the bill calls for spending $180 million to support hospitals still facing pandemic-related impacts, including those that serve a high percentage of Medicaid patients.

Mariano’s office said the bill would also give the Department of Public Utilities the flexibility to approve amended transmission contracts related to the New England Clean Energy Connect (NECEC) project, which would carry hydroelectric power generated in Quebec through Maine to end points including Massachusetts.

Representatives on the House Ways and Means Committee were given until 11 a.m. Wednesday to indicate their support or opposition for the spending bill. The bill is a supplemental budget for fiscal year 2023, which ended June 30. House and Senate negotiators have not come to terms on a compromise annual budget for fiscal year 2024, which began July 1.

Federal Recap

CMS Proposes Massive Cuts to Home Health Payment Rates

On the last Friday of June, CMS published its FY 2024 home health proposed payment rule. First before I get into the proposed rule, I have to vent really quickly about how annoying it is that both federal agencies tend to release major regulations/proposed rules on Fridays, especially before holiday breaks. CMS released their proposal (though it was accidentally leaked early) in the afternoon on the FRIDAY BEFORE JULY 4th WEEKEND. Not only did this ruin my plan to leave work a little early to get a jumpstart of the long weekend, but it ruined the entire weekend because I had to read and analyze the entire proposal. Listen I understand that they do this because they want to bury proposals like this so that it doesn’t get major new coverage, but for us professionals, whose entire job are affected by these releases, it is such a slap in the face. I don’t pay my taxes that help to pay CMS staffs salaries for them to turn around and basically pull a beer out of my hand and throw a big regulatory rule at my face. It’s rude, inconsiderate, and ill argue it hurts the economy by keeping my hard-working (relative) people stuck inside reading, rather than out spending money at bars, restaurants and stores. It should be legally required that federal agencies have to release regulations/proposed rules on Mondays or at least 5 business days before a holiday break.

Alright, back to the proposal. CMS is proposing a 2.2% decrease aggregate home health payments, or an estimated $375 million less compared to 2023 levels. The proposed update would bump payments 2.7%, or $460 million, but that is completely undermined because home health agencies are being forced to absorb a 5.1% decrease, or a decrease of $870 million. As a refresher, last year CMS originally proposed a 7.85% permanent rate adjustment based on the conclusion that HHAs were overpaid in 2020 and 2021 due to provider behavior changes in coding and services provided. In the end, CMS only applied a 3.925% permanent rate reduction after objection from agencies and home care associations. At the time, CMS explained that the lower adjustment would be applied because “we recognize the potential hardship of implementing the full -7.85 percent permanent adjustment in a single year.” The 5.1% proposed rate reduction represents the remainder of the original 7.85% rate reduction that CMS calculated as warranted under its methodology for 2020 and 2021 along with an additional 1.636% for 2022, totaling 9.36% overall from the beginning of PDGM.  An early analysis indicates that the additional 2022 element to the proposed permanent adjustment is due to further visit decreases in a 30-day episode, particularly with therapy services. For an in-depth summary of the proposal rule, CLICK HERE.

CMS will accept comments on the proposed rule through Aug. 29. HCA will be submitting comments, and we strongly encourage members to submit comments as well. We will provide further updates as they develop on the proposed rule.

NAHC Files Lawsuit Against CMS and HHS

After the CMS proposed rule was released, The National Association for Home Care and Hospice (NAHC) filed a lawsuit against the Centers for Medicare and Medicaid Services (CMS) and the United States Department of Health and Human Services (HHS) challenging the validity of a change in Medicare home health payment that reduced rates by 3.925% in 2023 with significant additional cuts expected over the next several years. The lawsuit, which was filed in the District of Columbia, comes just a couple days after CMS released their proposed rule for 2024 which includes an addition additional 5.653% permanent rate cut in 2024.

In the lawsuit, NAHC argues that the methodology used to calculate the rates is flawed, and that the rate adjustment will worsen home care staffing shortages and patients’ access to care. In a statement released today by NAHC Until recently, nearly 3.5 million Medicare beneficiaries received home health services annually. Since the new payment model began in 2020, over 500,000 fewer Medicare patients have accessed home health services. According to a statement released by NAHC, they are seeking declaratory and injunctive relief including a reversal of the rate adjustments in the 2023 rule and requirement that Medicare implement the budget neutrality mandate consistent with the law. It should be noted that it could take months for the case to be heard with no timetable set. HCA will be closely following the court case and will provide updates as they unfold.

Look Ahead

With August recess right around the corner, July is usually a slower month where Capitol Hill wraps up last minute things before takin a month break. But not this year, Congress decided they wanted to set off some last second fireworks before everyone left. The big piece of legislation that everyone is talking about is the NDAA, the National Defense Authorization Act. The NDAA is a massive $886 billion must-pass bill that details the annual budget and expenditures of the U.S. Department of Defense. The NDAA is one of few pieces of legislation that usually passes with bipartisan support, and with minimal debate, but this year is very much different.

House Republicans have chosen the NDAA as the next battle ground in the culture war. Far Right Republicans have been adding countless poison pill amendments that risk driving away any chance of Democratic support. The most controversial amendment being Rep. Ronny Jackson (R-TX) proposal that would remove a Pentagon policy that allows service members to take up to three weeks of leave to travel out of state for an abortion and other “non-covered reproductive health care services.” The policy also states the Department of Defense will reimburse members for any expenses related to that travel. This rule was established in the wake of the Supreme Court decision that stripped abortion rights and left them up to individual states. Republicans argue that the new rule circumvents laws barring taxpayer money for the procedure in most cases, but language to undo this new policy could be a red line for Democrats. The abortion rule has been a major sticking point for Republicans in both the House and the Senate. In the Senate Sen. Tommy Tuberville (R-AL), who looks like the human version of Squidward, has been holding up high level defense appointments until the rule is taken out, leaving many key positions unfilled.

Other poison pill provisions revolve around Ukraine, NATO, sea-launched cruise missiles, and Buy American provisions. House Democratic leadership has signaled that if Republicans choose to move forward with any or some of these amendments (especially the abortion proposal) they would pull their support for the bill. that would leave Republicans with little wiggle room to pass the bill.

In the end the NDAA will be the central focus till they leave for August recess, with the Senate needing to pass the NDAA once it finally moves through the House. So there is still an opportunity for these people to say stupid stuff, like that being a white nationalists doesn’t make you racists, that will get everyone on Twitter and Thread (what ever that is) into a frenzy.

The Rundown – March 2023

I would apologize for not writing a February edition of “The Rundown”, but honestly there wasn’t enough to write about at the state and mainly the federal level to justify a rundown.

Federal Recap

At the federal level, over the last month and a half, Members of Congress have basically spent their time creating sounds bites for news stations and click bate twitter posts. For an example, On Presidents Day, Georgia Rep. Marjory Taylor Greene, wrote a tweet saying “We need a national divorce. We need to separate by red states and blue states and shrink the federal government. Everyone I talk to says this. From the sick and disgusting woke culture issues shoved down our throats to the Democrat’s traitorous America Last policies, we are done.” And she doubled down after on Fox news saying that a national divorce would be better than a civil war. Now as a child of divorced parents I can say from experience that while it’s great in the beginning for the child (U.S. citizens) beginning when both parents fight to show that they love their kids more by showering them with presents (tax cuts, tax relief etc.), that part ends quickly and the child is just left with a broken home (divided country) and a new bike. Have we not learned from history that, that never works. Yugoslavia in the 90s, Korea and Ireland in the early 1900s, and let us not forget……. The U.S. and the civil war. How would it even work? Where would purple states like Georgia, Arizona and Nevada, go?? What about interstate commerce. Anyway, I feel like that sums up what Members of Congress have been up to the last month and a half.

Look Ahead

Having to think about what lies ahead at the federal level honestly scares me The Republican will continue to use their majority in the House to hold hearing after hearing on topics that would make the Biden administration and Democrats look bad in the run up to the next presidential election. Democrats will continue to get nothing passed in the Senate where they hold a slim majority, and we will probably continue to hear rumors about more people entering the field for the Republican presidential race. Which all means more hearings and sounds bites from members such the human equivalent of a rat with hair gel, Rep. Matt Gaetz, and the growing example for why we need mandatory cognitive test for senior members, Sen. Dianne Feinstein.

I would recommend that people stay away from the news for a couple of months and just enjoy that both the Celtics and the Bruins are the best teams in their sports. As for me, as a born and raised New Yorker I can’t enjoy Mass sports teams so I will keep track of the non-sense and will keep you all updated if anything is noteworthy. I will be using the federal section over the next couple of months to vent my frustrating that we actually pay these people 100,000s of dollars to do nothing but be on fox news and MSNBC. So keep that in mind and maybe just skip to the State section of these rundowns

State Recap

Finally, to the state level where for the first time this year things are actually happening. For a brief recap before we get to the Governor’s budget and tax relief packages, the legislature finalized leadership and committee position in the Senate and the House. It took the legislature almost a full 2 months to finalize the positions, which means that the legislature could finally get down to business and start voting on bills that could have a real impact and not just legislation that names a bridge.

The House passed its first significant bill of the session, voting 153-0 to pass a House Ways and Means redraft of Governor Healey’s FY2023 supplemental budget, includes elements of her $1 billion “immediate needs” bond bill. The $353 million billon, which also includes $585 million worth of bond authorizations, temporarily extends pandemic-era programs such as enhanced food assistance and free school meals. It also gives $44 million to the emergency shelter system to help offset medical costs for migrant families. The Bond authorizations include $400 million for the MassWorks grant program and $104 million for the Clean Water Trust, among other initiatives. 27 amendments were filed but quietly disregarded behind closed doors, which included $50 million in bond authorization for the Massachusetts Technology Park Corporation.

Governor Healey Tax Relief Package

Governor Healey jumped into the game as well in the end of February when she released an aggressive $859 million tax relief proposal, restarting a heated debate on Beacon Hill on tax relief. The plans main focus is to help keep people in the state by relieving the growing cost of living in Massachusetts and boost the state’s economic competitiveness. Healey included in her package a couple of proposals that were previously recommended by former Republican Governor Charlie Baker, including lowering the short-term capital gains tax from 12% to 5% and creating a new estate tax credit of up to $182,000, which would effectively eliminate the estate tax for all estates valued up to $3 million, higher than the current level of $1 million.

The largest share of the proposed relief, about $458 million, would come in the form of a new child and family tax credit, which would create a $600 refundable credit for each qualifying dependent, including children younger than 13 years old, adults who are disabled, and seniors. To help with rising rent and housing cost in Massachusetts, Healey is reviving a proposal to boost the maximum rental deduction from $3,000 to $4,000, which would affect 880,000 renters, and to double the maximum allowable credit for the senior circuit breaker credit, assisting 100,000 households. The package also includes a number of smaller proposals including increasing the apprenticeship tax credit to $5 million, including an exemption for employer assistance with student loan repayment, expanding the dairy tax credit from $6 to $8 million, expanded commuter transit benefits, and more.

Healey’s office said the tax package would carry a total cost in fiscal year 2024 of $859 million. It said the measure has a net cost of $742 million because the $117 million in affected short-term capital gains tax revenue by law would need to be placed into reserves and could not be spent as part of the annual budget. Healey also said that the relief package will be factored into her recently released budget proposal for FY24. It is now up to the legislature to decide if they want to increase or decrease the Governor’s tax proposal. The legislator previously shut down their own tax relief bill last year after they realized that Massachusetts owed nearly $3 billion in excess tax revenues back to taxpayers under a voter-approved law known as Chapter 62F. Since then, the legislature has shown little interest to re-address a tax relief package.

Governor Healey FY24 Budget Proposal

To kick off the month of March with some flare, Governor Healey released her first state budget proposal. Healey’s administration described the proposal as a “downpayment” on its goals of making Massachusetts a more affordable place to live, tackling climate change, and preparing students for careers in an evolving economy. The $55.5 billion budget proposal would increase spending by 4.1% over the current year (FY23) budget, which would account for the expected the growth rate in state revenues in FY2024 when accounting for $1 billion from the state’s new millionaire income surtax. Healey plans to use the $1 billion from the new surtax to increase funding for education ($510 million), including $100 million in childcare grants to providers, and transportation ($490 million), which includes $181 million in MBTA capital investments. The budget would also pump new money towards energy and environment initiatives, human service provider rates, housing programs and much more.

The proposal also includes a $3 billion increase for funding for EOHHS, compared to what former Governor Charlie Baker proposed in his budget proposal last year. Though MassHealth, would be funded in Healey’s budget at $19.8 billion, which would have a net cost to the state of $7.9 billion. That’s a decrease of $1.9 billion on a gross basis or $254 million after reimbursements compared to fiscal year 2023 spending projections. The decrease is driven, the administration said, by “caseload decline and intentional distribution of funds across fiscal years to mitigate a revenue cliff due to the end of the federal COVID Public Health Emergency.” As expected, Healey’s proposal did not include funding for the Enough Pay to Stay rate add-on. The Enough Pay to Stay rate add-on has never been included in a Governor’s proposal, if it were to be included, it would be added in later by the legislature.

Look Ahead

The release of Governor Healey’s budget recommendations marks the beginning of a long budget cycle that will see a lot of Healey’s proposed budget items be either changed or taken out. The House generally puts out, debates, and passes its own budget proposal in April, followed by the Senate in May. Those two budgets then typically spend much of June in a conference committee before lawmakers agree to a compromise version. Fiscal year 2024 begins July 1, but Massachusetts lawmakers seldom have the budget done in time for it to be in place for the start of the fiscal year, which could result in supplemental budgets being passed till they pass a full budget for FY24.

It is also now up to the legislature to decide if they want to increase or decrease the Governor’s tax proposal. The legislator previously shut down their own tax relief bill last year after they realized that Massachusetts owed nearly $3 billion in excess tax revenues back to taxpayers under a voter-approved law known as Chapter 62F. Since then, the legislature has shown little interest to re-address a tax relief package. We will have to wait and see what happens next.

Home Care Providers Looking for Permanent Rate Boost

The Home Care Alliance was quoted in an article published by the CommonWealth that highlighted HCA’s and the Enough Pay to Stay (EPTS) Coalitions pursuit to make the EPTS rate add-ons permanent for home health aides. Below is an excerpt from the article.

Via CommonWealth, September 30, 2022

The Home Care Alliance was quoted in an article published by the CommonWealth that highlighted HCA’s and the Enough Pay to Stay (EPTS) Coalitions pursuit to make the EPTS rate add-ons permanent for home health aides. Below is an excerpt from the article.

Jake Krilovich, the executive director of the Home Care Alliance of Massachusetts, said one-year add-ons are not a great approach because they are temporary. “They go from state budget to state budget, and that leads to uncertainty for providers where they do not know if the add-on will continue past the next state budget,” said Krilovich. The rate add-ons went into effect as an emergency provision on September 2, and cover services from July 1 of this year through June 30, 2023. “We need the add-ons to try and pay workers more to attract more workers, but in the meantime, we’re working on bills that address structural reform and how rates are set,” said Krilovich.

Harrison Collins, the director of legislative and public affairs of the Home Care Alliance of Massachusetts, said the coalition is drafting a bill that would provide more secure rates for health and home care workers. “I couldn’t imagine my wage depending on a rate-add on every year, but that’s the world we live in, and that’s what goes on in this kind of sector,” said Collins. “It’s the people that need the service that end up getting hurt because the demand isn’t met.”

By Jusneel Mahal

Home Health Rate Bump Needs To Be Permanent

The Home Care Alliance was quoted in State House News Service’s coverage of an Executive Office of Health and Human Services public hearing on implementation of the Enough Pay to Stay rate add-ons. During the hearing HCA argued that the rate add-ons must be made permanent. Below is an excerpt from the State House News Service’s article.

Via State House News Services, September 29, 2022

The Home Care Alliance was quoted in State House News Service’s coverage of an Executive Office of Health and Human Services public hearing on implementation of the Enough Pay to Stay rate add-ons. During the hearing HCA argued that the rate add-ons must be made permanent. Below is an excerpt from the State House News Service’s article.

At an Executive Office of Health and Human Services public hearing on Wednesday to consider final regulations, Harrison Collins, director of legislative and public affairs at the Homecare Alliance of Massachusetts, said the rate add-ons would “minimize disruption on the providers and consumers” and said the increases need to be permanent, saying current rates are inadequate. “We hope the department will review these rates thoroughly this fall, as they are wholly inadequate to meet the current needs as evidenced by the number of [Executive Office of Elder Affairs] home care consumers who are awaiting all or partial services,” he said. The current base rates for home health aide services is $26.92 per hour, and the EOHHS hearing dealt with a $3.56 per hour addition on top of that base rate, Harrison told the News Service. The current average contracted rate for homemaker and personal care homemaker services through the Aging Service Access Points in the Executive Office of Elder Affairs Home Care Program is $29.14 per hour, he said. The hearing considered a $3.96 per hour rate add-on.

The Home Care Alliance of Massachusetts collaborated with other advocates, collectively calling themselves the Enough Pay to Stay coalition, for these add-ons to supplement the current base rates for home health aide and homemaker services through the MassHealth Home Health and EOEA Home Care programs. “This supplement is needed because the current base rates are not adequate to meet the current environment on the ground and demand for services,” Harrison told the News Service.

Sam Drysdale/SHNS

MA Legislative/Regulatory Preview for 2018

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:

Workforce Issues:

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.

Worker Registry:

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.

Licensure:

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.

MassHealth Rates:

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 Reorganization:

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.

Skilled Nursing Campaign Garners Media Attention

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.

Advocacy Alert: Budget Amendment to Support Home Care Workforce

MA-State-HouseWhile 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.

Take Action Here

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.

State Budget Cuts Impact Home Health Care

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)

July 1:

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.