Tag: MassHealth

Massachusetts Medicare Program.

Governor Releases FY2011 Budget

Governor Deval Patrick released his budget blueprint for fiscal year 2011 and the proposal is kind to most health services, including home care, despite a bleak fiscal forecast.

Medicaid Director Terry Dougherty led a MassHealth budget briefing and revealed that Health and Human Services was one of two secretariats (Along with Veterans’ Services) that saw an increase in funding under the Governor’s budget. Chief among the line items that are of importance to the Home Care Alliance is the MassHealth Senior Care (4000-0600), which was increased $374 million, and MassHealth Fee for Service (4000-0700), which was increased $113 million.

Under the state’s Aging Service Access Points program (ASAP), items were level funded, including Purchased Services, Home Care Case Management, and the Enhanced Community Options Program.

Also of note is a $99 million increase for Personal Care Attendants, Adult Foster Care, Adult Day Health and Day Habilitation programs.

In all, Dougherty said they are assuming an increase in FMAP by $607 million and anticipating a 3 percent increase in MassHealth total enrollment. The Governor also filed a $200 million supplemental budget for MassHealth, as well.

However, the proposed budget relies heavily on new revenue sources to balance accounts, which is a troubling trend since the Legislature must pass new taxes and remove tax incentives to continue the funding the Governor proposes.  In an election year, this may prove to be a difficult effort, and we hope that legislators will recognize the benefit the Home Care industry offers to the health care system as they deliberate upon what will likely be a more lean FY11 budget. House Speaker Robert DeLeo has already indicated through the media that his House budget, due in the spring, will not include a tax increase.

Some of the proposed new revenues include removing sales tax exemptions for “other tobacco products” along with candy and soda. The soda and candy tax ban, in particular, is meant to raise nearly $52 million for public health services.

Even with that hurdle, this Governor’s budget is relative good news for the Home Care Alliance who will begin advocacy directed at the legislature as they formulate their own budget proposal. The Alliance will also be pushing legislative priorities such as Nurse Delegation of Medication Administration, Falls Prevention, and telehealth along with our work on payment reform.

The Alliance will push for these and other initiatives that are cost-saving or cost-neutral while improving patient care and making easier the work of HCA members.

Return to www.thinkhomecare.org.

MassHealth Budget Update

Last week MassHealth announced their plans to address a $300 million budget gap with cuts to, among other things, adult dental benefits, limitations to the personal care attendant program, and increases in generic drug co-pays. The Boston Globe reported on this issue on November 14 and noted in the story’s headline that the cuts “hit” home care, which bears clarifying.

The cuts that the Globe was referencing as reductions in home care are the following:

  • Personal care attendant benefits will no longer be available to patients who require PCA’s for less than 15 hours per week.
  • The entire budget for the Aging Service Access nursing home pre-screening initiative was eliminated. This was a relatively new line item that paid the ASAPs to educate (primarily hospitalized) clients about their options between nursing home care and care at home. While unfortunate, the cut does not directly effect the in-home services of ASAP funded home care.

The Home Care Alliance is pleased that any further damaging cuts to the home care funding and to home health rates were avoided in this round. We appreciate all the members who took the time to contact the Governor with information about the fragility of services and agencies under the current MassHealth reimbursement structure.

With no positive budget information in site, visibility and advocacy remains essential. Please check back to our blog for updates, send messages from our legislative action page, and check our special YouTube site for new videos on our home care visits with legislators for National Home Care Month and other advocacy efforts.

In these very challenging times, the Alliance will continue to strongly advocate for the interests of home care, home health and the patients they care for.

Return to www.thinkhomecare.org.

sHealth announced their plans to address a $300 million budget gap with cuts to, among other things, adult dental benefits, limitations to the personal care attendant program, and increases in generic drug co-pays. The Boston Globe reported on this issue on November 14 and noted in the story’s headline that the cuts “hit” home care, which bears clarifying.

The cuts that the Globe was referencing as reductions in home care are the following:

  • Personal care attendant benefits will no longer be available to patients who require PCA’s for less than 15 hours per week.
  • The entire budget for the Aging Service Access nursing home pre-screening initiative was eliminate. This was a relatively new line item that paid the ASAPs to educate (primarily hospitalized) clients about their options between nursing home care and care at home. While unfortunate, the cut does not directly effect the in-home services of ASAP funded home care.

The Home Care Alliance is pleased that any further damaging cuts to the home care funding and to home health rates were avoided in this round. We appreciate all the members who took the time to contact the Governor with information about the fragility of services and agencies under the current MassHealth reimbursement structure.

With no positive budget information in site, visibility and advocacy remains essential. Please visit our website and check our special YouTube site for new videos on our home care visits with legislators for National Home Care Month and other advocacy efforts.

In these very challenging times, the Alliance will continue to strongly advocate for your interests and we hope you will keep us informed of any issues your agency or organization is facing.

New Study on Insuring Direct-Care Workers

The Paraprofessional Healthcare Institute (PHI) released a report, prepared in collaboration with Tufts University Department of Health and Family Medicine, on the impact of Massachusetts health care reform on direct-care workers.

The report offers three main conclusions:

  1. The employer-based health insurance system is not meeting the needs of employers or their direct-care staff, largely because the current price of private health insurance in Massachusetts is prohibitive for many employers and their workers.
  2. As a result, public and publicly subsidized insurance programs are essential to this sector.
  3. Reform measures appear to have strengthened subsidized options for both employers and direct-care staff. However, access to these options is far from seamless, sometimes leading to “perverse” employment outcomes. For example, to qualify for MassHealth or Commonwealth Care workers often reduce their hours worked. Similarly, employers may limit eligibility for health benefits to those who work full-time, but then offer employees only part-time hours. These disincentives to work are particularly problematic for the home care industry, which is one of the Commonwealth’s fastest-growing employment sectors.

For more information, read the PHI report here.

Return to www.thinkhomecare.org.

Providers to Receive Letters for TPL Claims Beginning September 8, 2009

Providers should expect to see letters from “Commonwealth Medicine” representing the MassHealth TPL (Third Party Liability)  Unit on or about September 8, 2009. The letter, which will take the form of an “Initial Overpayment Notice,” will list those claims for dually-eligible beneficiaries that MassHealth has identified as requiring a Medicare determination of coverage. MassHealth is the payer of last resort and as the subrogee for these beneficiaries is requesting that you begin the demand bill process to determine if Medicare should have been billed for these services.    The claims in dispute are for Federal Fiscal Year 2008 or dates of service October 1, 2007 through September 30, 2008.

In preparation for this initiative, the Alliance in cooperation with MassHealth held 2 workshops for providers in July and August.  The process and expectations were discusses by representatives of the TPL Unit and the Provider Outreach and Education department of National Government Services reviewed the “demand bill” process.

For a copy of the TPL Powerpoint which includes an excellent timeline,  click here. For a copy of the NGS presentation discussing the demand billing process, click here

Alliance Submits Comments on Rate Cut Study Bill

In response to MassHealth’s 20 percent rate cut to skilled nursing visits past 60 days of care – administered as part of the Governor’s 9c cuts –  the Alliance filed legislation that would instruct the Executive Office of Health & Human Services to study the issue and then would establish a special commission to review those findings.

At a public hearing in front of the Joint Committee on Health Care Financing on Wednesday, June 24, the Alliance submitted written testimony in support of this legislative priority, titled House Bill 1072, An Act Ordering a Study of Home Health Service Rate Cuts.  The Alliance also enclosed letters from State Senate Majority Leader Frederick Berry and State Representative Christine Canavan written to the Division of Health Care Finance & Policy in late January when they held a public hearing on the rate cut, which took effect on December 1, 2008.

The bill was filed by State Representative Sean Garballey, who offered remarks at the recent public hearing. Rep. Garballey also circulated a sign on letter in opposition to the cuts, which was signed by 18 fellow legislators, and sent to Governor Deval Patrick.

To see the Alliance’s testimony on House Bill 1072, click here.

To learn more about the Alliance’s legislative priorities, please contact us or visit our News & Advocacy page.

Return to www.thinkhomecare.org.

State Rep. Garballey Letter Opposing MassHealth Rate Cut

Letter from State Rep. Sean Garballey to Gov. Patrick opposing cuts to home health rates past 60 days.

Return to www.thinkhomecare.org.

Alliance Fights Cut to Home Health Rates

Pat Kelleher’s testimony regarding the January 22 hearing in front of the Division of Health Care Finance & Policy on MassHealth’s cut to home health rates.

Despite a rate that barely covers average direct costs, the state is now asking that agencies absorb the expenses associated with a 20% rate cut on approximately 40% of visits.  It’s difficult for home health agencies to see equity in such a cut and freeze reflected across the long term care system.

Return to www.thinkhomecare.org.

Stimulus Letter to Gov. Patrick and State Officials

Letter to Governor Patrick and other state officials regarding stimulus funding for home health.

…it is troubling that once again, home health care agencies have been left off the list of essential providers to receive funds for rate relief. As you know, despite its cost-efficiency, the home health industry absorbed one of the most damaging MassHealth “9C” rate cuts last year in addition to an existing rate freeze. Additionally, home health care has been recognized by the U.S. Department of Labor as one of the fastest growing employment sectors. In light of these factors, it would appear that this money would more efficiently serve taxpayers and the health care system by including funds for the restoration of home health funding.

Return to www.thinkhomecare.org.

Kelleher Testimony on Equal Choice Law

Pat Kelleher’s testimony regarding the Joint Committee on Elder Affairs Oversight Hearing on the Equal Choice Law is available for download.

The Equal Choice Law was passed with the intention of saving patients, families and MassHealth millions of dollars by limiting the amount of admissions into inpatient facilities.  With that theory in mind, it would seem that Equal Choice and home health go hand in hand. A 2007 study conducted by Carnegie Mellon University and Blue Shield of California proved that a patient-centered management program (PCM) where home care was increased by 22 percent and hospice by 62 percent actually reduced hospital admissions by 38 percent, reduced hospital days by 36 percent, and reduced costs by more than $18,000 per patient. The article heralding this study is attached to my written testimony.

Despite the goals of Equal Choice and the proven track record of home health, the industry has seen little that would indicate an intention – or even recognition – of the need to expand capacity in the community care area. In fact, if anything, we have seen the reverse.

Return to www.thinkhomecare.org.

NewMMIS Powerpoint Presenation

A PDF of Ingelcia Annese’s PowerPoint presentation on the MassHealth NewMMIS is available for download.   Ms. Annese is from EDS/MassHealth Customer Service and her presentation was made on April 21.

Return to www.thinkhomecare.org.