Tag: MassHealth

Massachusetts Medicare Program.

Governor Patrick Announces Proposed Budget

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

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

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

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

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

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

Return to www.thinkhomecare.org.

HCA Submits Comments on Telehealth for EOHHS Budget Hearing

An article in the January 3rd edition of the Boston Globe highlighted the trouble that Massachusetts and many other states are experiencing when it comes to managing the Medicaid program.

The Massachusetts Executive Office of Health and Human Services had two public hearings on the upcoming fiscal year 2012 budget and how services can be made more efficient while lowering cost. The Home Care Alliance submitted comments on behalf of agencies currently utilizing or interested in becoming involved in home telehealth. HCA’s comments suggested that if MassHealth, the state’s Medicaid program, reimbursed home health agencies for administering the remote patient monitoring service, a significant cost savings could be realized.

See HCA’s comments here. To submit your own comments to EOHHS, see this previous blog post for more information and guidance. Comments can be sent via email to eohhshearings@massmail.state.ma.us or sent by regular mail to:

Secretary JudyAnn Bigby, EOHHS
One Ashburton Place, Room 1109
Boston, MA 02108

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EOHHS to Hold Hearings on FY12 Budget

The Massachusetts Executive Office of Health and Human Services will be holding a special hearing on the Fiscal Year 2012 budget and the Home Care Alliance wants to take the opportunity to offer testimony.

This will NOT be a chance to talk about MassHealth rates, but rather ideas on how home health care can help the state offer services more efficiently. The Alliance would like to set up a panel to present oral testimony so please contact us if you are interested in speaking on subjects like expanding telehealth, or anything else you believe addresses the three key questions in the notice below.

Of course, HCA would welcome the submission of written testimony and are willing to collect and submit materials on behalf of agencies.

Another hearing will be announced shortly for Western Massachusetts. See the notice from EOHHS below.

The Executive Office of Health and Human Services (EOHHS will be conducting a public hearing on the upcoming Fiscal Year 2012 budget. Secretary JudyAnn Bigby, M.D., and the Assistant Secretaries at EOHHS are looking forward to hearing the views of members of the community regarding the agencies under their purview.

Gardner Auditorium, Massachusetts State House
Monday, December 13, 2010
Boston, MA 02133
1:30 p.m. – 5:30 p.m.

The hearing will be tentatively divided as follows:

  • 1:30 to 2:30              Disabilities & Community Services – MCDHH, MCB, MRC, DDS
  • 2:30 to 3:30              Veterans, Elder Affairs, Soldiers’ Homes
  • 3:30 to 4:30              Health Services – DMH, DPH, DHCFP, MassHealth
  • 4:30 to 5:30              Children, Youth and Families – DCF, DYS, ORI, DTA

 

Since the start of the budget crisis, the Governor’s Administration has worked with you to solve deficits totaling nearly $13 billion.  As FY12 approaches, we are facing the expiration of federal stimulus funds and reduced rainy day funds and even though revenues started to grow in FY11, revenue collections historically lag behind national economic growth and will remain moderate over the next two fiscal years.

To overcome this budget challenge, we will need to work together to reexamine all public services and their delivery and find innovative solutions so that we can continue our mission with minimal disruption. Governor Patrick, Secretary Bigby and all of us at EOHHS are seeking your input to identify potential efficiencies, cost-saving initiatives and partnership opportunities that will preserve core services to the fullest extent possible without additional expenditures.

Due to the number of individuals anticipated to attend, oral testimony will be limited to three minutes. Following are three questions we want you to address in your testimony or as a supplement to your testimony.  Please do your best to address each question specifically.

  • Are there areas where you believe EOHHS can regionalize, consolidate or streamline services, programs or offices to better serve clients, increase efficiencies and achieve savings?
  • Are there areas where you believe EOHHS can use technology to better serve clients, increase efficiencies and achieve savings?
  • Are there ways you believe EOHHS can reduce expenditures while maintaining essential and core services?

In the interest of time, representative panels are welcome.  If you need accommodations please call 617-573-1600 and let the receptionist know. In addition, written testimony is strongly encouraged and may be mailed to:

Secretary JudyAnn Bigby, EOHHS
One Ashburton Place, Room 1109,
Boston, MA 02108

Or emailed to:  eohhshearings@massmail.state.ma.us

Return to www.thinkhomecare.org.

State Selects 46 Physician Practices as Medical Homes

The Massachusetts Executive Office of Health and Human Services (EOHHS) announced that it has selected 46 primary care physician practices to participate in a new Patient-Centered Medical Home initiative (PCMH) designed to promote comprehensive, coordinated, patient-centered care delivered by teams of primary care providers.

In a patient-centered medical home, according to an EOHHS press release, a primary care provider and members of his or her team coordinate all of a patient’s health needs, including management of chronic conditions, visits to specialists, hospital admissions, and reminding patients when they need check-ups and tests. The medical home model supports fundamental changes in primary care service delivery, as well as payment reforms, with the goal of improving health care quality.

The intention of this initiative is that it will evolve, likely in congruence with other payment reform projects and initiatives, into a new and more efficient payment model.

The Home Care Alliance has written a position paper on the PCMH initiative and strongly encourages home care agencies working with the PCP practices listed below to reach out and offer collaborative efforts in order to be involved in their model.

The physician practices are listed by region:

Metro Boston:
Boston Health Care for the Homeless, Boston
Boston Medical Center, Family Medicine Center, Boston
Bowdoin Street Health Center, Dorchester
Broadway Health Center, Somerville
Cambridge Family Health, Cambridge
Codman Square Health Center, Dorchester
Dorchester House, Dorchester
East Boston Neighborhood Health Center, East Boston
Family Practice Group, P.C., Arlington
Geiger Gibson Community Health Center, Dorchester
Harvard Vanguard Medical Associates, Medford
Joseph M. Smith Community Health Center, Allston
Joseph M. Smith Community Health Center, Waltham
Malden Family Medicine Center, Malden
Manet Community Health Center, North Quincy
Neponset Health Center, Dorchester
Revere Family Health Center, Revere
South Boston Community Health Center, South Boston
South End Associates of Fenway Health, Boston
Southern Jamaica Plain Health Center, Jamaica Plain
Tufts Medical Center, Adult Primary Care, Boston
Union Square Family Health Center, Somerville
Whittier Street Health Center, Roxbury

Central Massachusetts:
Barre Family Health Center, Barre
Family Health Center of Worcester, Worcester
Fitchburg Community Health Center, Fitchburg
Foley Family Practice, P.C., Athol
Edward M. Kennedy Community Health Center, Worcester
Grove Medical Associates, P.C., Worcester
Greater Gardner Community Health Center, Gardner
UMass Memorial Pediatric Primary Care Associates, Worcester

Western Massachusetts:
Atkinson Family Practice, Amherst
Baystate High Street Health Center, Adult Medicine, Springfield
Baystate High Street Health Center, Pediatric Medicine, Springfield
Baystate Mason Square Neighborhood Health Center, Springfield
Fairview Pediatrics, Chicopee
Hilltown Community Health Centers, Worthington
Holyoke Health Center, Holyoke
Lee Family Practice, P.C., Lee
Pediatric Associates of Hampden County, Westfield

Northeastern Massachusetts:
Drum Hill Primary, LLC, Chelmsford
Greater Lawrence Family Health Center (Haverhill Street), Lawrence
Lynn Community Health Center, Lynn

Southeastern Massachusetts:
Brockton Neighborhood Health Center, Brockton
Greater New Bedford Community Health Center, New Bedford
Mid Upper Cape Community Health Center, Hyannis

Additionally, HCA encourages collaboration and outreach to the following participating payers:
Blue Cross Blue Shield of Massachusetts; Boston Medical Center HealthNet Plan; CeltiCare; Commonwealth Health Insurance Connector Authority; the Health Safety Net, administered by the Division of Health Care Finance and Policy; Fallon Community Health Plan; Group Insurance Commission; Harvard Pilgrim Health Care; Health New England; MassHealth Primary Care Clinician (PCC) Plan; Neighborhood Health Plan; Network Health; Senior Whole Health; Tufts Health Plan; and UniCare.

Return to www.thinkhomecare.org.

Mass. Medical Home Initiative Launched

Massachusetts is moving to the head of the pack in terms of service delivery realignment with the release on July 9th of the Patient Centered Medical Home (PCMH) RFR.    As many as 50 practice sites could be selected to participate in a model that includes enhanced payments for care coordination and care management and shared savings to be calculated based on experiences of a control group of practices.

The PCMH demonstration, which will be three years in length, involves both MassHealth and several commercial insurers; although according to HHS Secretary Judy Ann Bigby,  it is far more “Medicaid centric” than had been envisioned in earlier development stages.

With tremendous focus on each PCMH influencing what happens to the patient when she/he is not in the physicians office, the PCMH offers partnership opportunities for home health agencies. The RFR states that although  all PCMH practice sites must provide care coordination for high risk patients, these services can be handled through a contractual relationship – as long as it clearly reflects a team approach.  Additionally, with the shared savings component, practices will have a real financial stake in keeping patients out of hospitals and ERs.

Since small physician practices still dominate the  market in Massachusetts, the states hopes to see a good representation of these in the mix of selected PCMHs.  Home health agencies should be prepared to discuss this new opportunity with physician offices and to offer support and services to assist in their applications.

The full RFR is to be found on the state’s competitive bidding site Comm-Pass (search for (1LCEHSMEDICALHOMES).  General information about the project, including some dates and times of informational webinars to be held next week, can be found on the EOHHS medical Home page

HCA Board Sends FMAP Letter to Scott Brown

The Home Care Alliance Board of Directors has sent a letter to US Senator Scott Brown, joining advocates and health providers from across Massachusetts who are urging Congressional support for an extension of Federal Medical Assistance Percentage (FMAP) funds.

Massachusetts is one of 30 states relying on the federal matching funds for MassHealth and has already budgeted for the money as part of the state budgeting process. Many US Senators, including Massachusetts Sen. Scott Brown, are against the extension with a belief that it would add to the federal deficit.

Unlike the federal government, Massachusetts must present a balanced budget at the end of the fiscal year. Governor Deval Patrick announced that the budget would have to be reduced another 3.6% if the matching funds are not approved and state legislative leaders are preparing for a scenario where the federal matching funds would not be available.

The Federal Medical Assistance Percentages (FMAPs) are used in determining the amount of Federal matching funds for State expenditures for assistance payments for certain social services, and State medical and medical insurance expenditures. This year, such funds are worth at least $608 million to Massachusetts.

A message is available on the HCA’s Legislative Action Network that can be sent to federal elected officials. Just scroll down until you see the FMAP message under the “Medicaid” heading.

Contact Senator Brown’s office to urge that he support the FMAP extension.

Return to www.thinkhomecare.org.

Help Support HCA Senate Budget Amendments

Help us stand up for home health and home care!

The Home Care Alliance has two major priorities filed in the Senate budget, which will be debated this week.

Please call your State Senator today, or send them an email, and urge them to support the following amendments:

  • #607 filed by Senator Richard T. Moore to establish a telehealth pilot program that would care for 100 patients for one year and would promote the cost-saving and quality benefits of home monitoring technology for patients who have required or will require care of high frequency or long duration.

HCA has an email message uploaded to our Legislative Action page that are ready to be sent. All you have to do is type in your contact information and the advocacy system will identify your senator and show the message you can send.


Return to www.thinkhomecare.org.

Help HCA Gain Support for Budget Priorities in the House

The Home Care Alliance has two major budget priorities in the House and the push for gaining support from state representatives has begun!

Please visit our Legislative Action Center and send a pre-written message to your state representative. All you have to do is fill out the form with your contact information, click “submit” and the message you are sending will pop up with the legislator who will receive your email message. It takes less than a minute to help HCA gain vital support for amendments to:

  • Restore MassHealth home nursing rates past 60-days of care (House Amendment #135 submitted by Rep. Joseph Driscoll) and
  • Establish a tele-health demonstration project (House Amendment #289 submitted by Rep. Alice Wolf)

Last year, more than 1,000 email messages were sent during the House and Senate budget debates and you can help us beat that this year!

You can also call your state representative using our fact sheet as a guide to verbally ask for their support of HCA amendments. If you’re unsure who your state representative is, click here to find out.

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Revised Regulations and Billing Guide for MassHealth Hospice

MassHealth has revised their hospice regulations to reflect changes in CMS hospice rules. The new rules require hospice providers to coordinate their hospice services with the Medicaid personal care benefit, as appropriate. MassHealth members no longer have to waive their PCA services if they elect the hospice benefit.

Also, physicians signing the hospice certification statement will be required to personally compose a narrative explaining the clinical findings that support life expectancy of six months or less.

MassHealth has also revised the billing guide for the UB-04 which is posted on the MassHealth website.

Return to www.thinkhomecare.org.

McGovern Sends Delegation Letter Requesting Meeting with CMS on TPL

Congressman Jim McGovern has sent a letter to CMS Acting Director Cyndy Mann with a request that Mann meet with him and the Home Care Alliance on continuing the Third Party Liability (dual eligible) demonstration project.

The demonstration allows decisions about the appropriate payer for home health services to Medicare/Medicaid dual eligible elders to be handled by a 200 case sampling rather than a case by case review.

“Annual review of two hundred cases per state has been a better systemic solution than previous practices in which thousands of cases, with immense red tape, make their way through multiple levels of review and appeal,” said the McGovern letter.

Joining Congressman McGovern in signing on from the Massachusetts Congressional Delegation were Representatives Capuano, Delahunt, Frank, Lynch, Markey, Olver and Tsongas.

MassHealth administrators have also written to CMS this week, urging that the demonstration project be extended.

The demonstration has been a tri-state effort with New York and Connecticut, whose associations have been working hard advocating for an extension as well.

Return to www.thinkhomecare.org.