Home Care Commission Denied in Budget, Cuts Handed to Elder Services

The merits of protecting consumers, setting minimum standards for companies and agencies providing in-home care, and controlling state costs were not enough to advance a Home Care Oversight Commission through the state budget.

The state’s FY17 Conference Committee released their final budget proposal on behalf of the legislature after regrouping in light of declining revenue projections. The Home Care Commission, which was included in the Senate budget, but not in the House, had to survive a “conference committee” of House ma budget pie chart picand Senate budget leaders that negotiated a fiscal plan between the two sides.

With Massachusetts being one of only five states without state oversight of home health care, and also with a goal to place some standards on private-pay home care, the commission would have convened legislators, home health agencies, private-pay home care, state officials, consumer groups and trade associations to recommend solutions. The language stipulated that there be separate sets of recommendations for home health and private pay home care.

Elsewhere in the budget, the declining revenue projections filtered through to hit the elder services network. Based on FY16 spending levels, a $2 million cut was made to “Elder Home Care Purchased Services” and $2.6 million reduction in the “Elder Home Care Case Management and Administration” account.

Two pieces of good news came in that Elder Protective Service got a boost of $4.5 over FY16 spending and the Pediatric Palliative Care Network received a boost of $404,578, but the Nursing and Allied Health Workforce Initiative remained leveled out at $200,000.

More silver lining came with a $1 million pilot program to test expanding income eligibility standards for services ordered by Aging Service Access Points.

In terms of MassHealth line items, the expected trends continued with the conference committee reducing the “Fee-for-Service” account by $161.7 million while increasing the accounts tied to MassHealth Managed Care ($71.1 million) and MassHealth Senior Care ($160.4 million).

Nursing Home Supplemental Rates also saw a raise with $45 million over FY16 spending.

The $39.15 billion budget now moves to the Governor for final approval and any further updates will be shared as they become available.

Return to www.thinkhomecare.org.

HCA Breaks Down MassHealth 1115 Waiver Proposal

Months of stakeholder meetings and public engagement by MassHealth has resulted in a long-awaited draft proposal that aims to completely restructure the state’s Medicaid program.

Known as the Section 1115 Waiver, the 90-plus page document outlines a possible multi-year agreement  with the federal Centers for Medicare and Medicaid Services (CMS). The focus of the proposal is a move towards accountable care organizations (ACOs) and alternative payments while better addressing the needs of MassHealth members and putting in place a financially sustainable system of health care and support services.

Before the agreement can be made with CMS, however, there is a public comment period that runs until July 17th. The Home Care Alliance created a breakdown of the proposal so that members and advocates can better understand the key provisions.

MassHealth also provided a more basic fact sheet available on their 1115 Waiver Proposal webpage that also includes the full document and slide decks from previous public meetings.

The proposal attempts to seize an opportunity for new funding streams to support the creation of three types of ACOs that are required to partner with existing providers of behavioral health (BH) and long-term services and supports (LTSS). The state aims to rearrange provider and managed care relationships to set forth a better coordinated and integrated set of networks.

The first “pilot ACOs” are expected by MassHealth to come online later in 2016, while the full roll-out of the three ACO models, enhanced funding, and BH/LTSS integration will take place in October 2017.

The Alliance was appointed to several of the MassHealth stakeholder groups and plans to submit comments on the proposal on behalf of home care.

Return to www.thinkhomecare.org.

 

Senate Advances Home Care Commission in Budget

In a $39.5 billion budget, the Senate advanced Home Care Alliance priorities, namely a special commission that will study and make recommendations for state oversight of home care.

The commission would create a separate set of recommendations for certified home health and also private pay agencies. The group would include three representatives from each type of agency (certified and private-pay) as part of the membership along with policymakers, administration officials, and many others. During the Senate’s deliberations on more than 1,300 amendments, the Massachusetts Nurses Association and the MA Chapter of the National Academy of Elder Law Attorneys.

Unfortunately, efforts to gain payment increases for home health aides and homemakers were not approved despite collaboration with the Home Care Aide Council, Mass Home Care, and several dedicated Senate offices. Senator Joan Lovely (D-Salem) spoke well in debate on behalf of a home health payment review and Senator Barbara L’Italien (D-Andover) fought for inclusion of home health aide payment, in particular. Senator Patricia Jehlen (D-Somerville) and Senator Sal DiDomenico (D-Everett) also helped lead an effort to advance home care rates.

On a positive note,an amendment was defeated that would have created a publicly-available registry of home care workers that aimed to list private information.

In addition, the Senate approved a pilot program of just over $1 million that expands income eligibility standards for services coordinated through Aging Service Access Points.

Other notable items in the Senate’s budget include the following:

  • A feasibility study on allowing spouses to be paid caregivers under MassHealth.
  • Allowing a leave of absence for nursing home residents under MassHealth (20 medical leave days and 10 non-medical leave days).
  • A fund created from fines and penalties relative to patient abuse in nursing homes that funds the prevention of such action through staff training and education, enhanced inspections, and relocating residents to other facilities.
  • $20.5 million for the Nursing Home Quality Jobs Initiative as part of SNF Supplemental Rates.
  • $200,000 for Geriatric Mental Health Services.

The HCA thanks its members for the hundreds of emails and phone calls to Senators during the past two weeks. The state budget process moves on to a conference committee process where the House and Senate negotiate differences between their two FY17 proposals. The Alliance will continue to push for the commission to establish oversight measures as well as other items to strengthen home care.

Return to www.thinkhomecare.org.

 

Advocacy Alert: Help Gain Support for Home Care in the Senate Budget

ma budget pie chart picThe Massachusetts Senate is taking their turn in the fiscal year year 2017 state budget process with a $39.49 billion proposed starting point.

Senators have filed just over 1,100 amendments seeking to add a combination of funding and policy language that will be debated next week, but advocacy is needed to gain support for the issues critical to home care agencies.

The Home Care Alliance’s Advocacy Center features prepared emails focused on these issues that can automatically be sent to your state senator. Click here to send a message on all of HCA’s priorities – OR send a specific message to urge support for improved home health aide reimbursement or a study of MassHealth reimbursement for all home health services.

Here are explanations of the Alliance’s priority items:

MassHealth Reimbursement to Home Health Aides – Amendment #596 (Senator Barbara L’Italien)

  • Home Health Aide Rates have not been reviewed since 2007.
  • This amendment raises the rate MassHealth reimburses home health agencies for home health aide services by 12% at a cost to MassHealth of $3.66 million which after federal match becomes $7.32 million.
  • This increase would also effect the purchase of home health aide services ordered through the state network of Aging Service Access Points (ASAPs) at a cost of $5.25 million.

MassHealth Home Health Reimbursement Review – Amendment #470 (Senator Joan Lovely)

  • Home health care is a cost-effective service that allows people of all ages – from maternal-child health services and pediatric patients to the elderly –to remain independent in their homes where they are most comfortable and at a lesser expense to their families and the Commonwealth.
  • Payment rates have not been reviewed since 2007. Current rates are based off of 2005 data and were cut in 2008.

Homemaker Wage Increase – Amendment #591 (Senator Michael Barrett)

  • On average, this request will provide an increase of $.50 per hour to homemakers and personal care homemakers providing care to clients enrolled in the Elder Home Care Program
  • This budget request will include language to raise the EOEA average compensation mandate in ASAP contracts from $12.69 per hour to $13.19 an hour for FY17

The Home Care Alliance appreciates that the Senate Committee on Ways & Means included language for the Home Care Oversight Commission, which seeks to convene legislators and stakeholders to recommend separate standards for licensure for private-pay home care and Medicare-certified home health.

The HCA is also supporting amendments, including #597 (Sen. L’Italien) to expand eligibility for in-home elder services and #622 (Sen. Humason) to bring Massachusetts into the Nurse Licensure Compact.

Other noteworthy items in the Senate budget include the following:

  • $2.6M for Pediatric Palliative Care, an increase of $800K over FY 2016 funds to meet the needs of terminally ill children and their families and eliminate the wait list for these critical services.
  • $200,000 for the Nursing and Allied Health Workforce initiative through the Mass. Department of Higher Education. Senator Michael Moore has proposed an amendment (#136) to raise the amount to $400,00, but this item from Senate Ways & Means goes a long way to ensuring that the item will be funded at previous levels.
  • Following the Governor’s lead, the Senate consolidated the Elder Enhanced Home Care (ECOP) line item and moved that funding to other accounts.
  • Nursing Homes secured $30 million (half of which will come from an added assessment on facilities) for added CNA reimbursement.
  • Nursing Home Supplemental Rates matched the Governor’s FY17 proposal at $332.9 million, which is $15 million below what the House approved.
  • The Home & Community Based Services Policy Lab also received funding not included in the House budget, which will help the state study the cost-effectiveness of certain long-term services and supports.

Return to www.thinkhomecare.org.

House Budget Denies Several Home Care Programs

Although the House budget process has yet to officially conclude, state representatives voted on items related to Health and Human Services, Public Health and Elder Affairs with barely any home care-related initiatives approved.

The traditionally conservative House budget process saw just over $12 million in additional money for all health care-related initiatives in general. The Home Care Alliance was itself asking for $8.9 million for home health aides, $10 million for homemaker wages and benefits – in conjunction with the Home Care Aide Council – and supported a number of amendments that were either low-cost or had no cost associated.

Beginning with the positive, an amendment creating a publicly-available home care workforce registry was denied. The Home Care Alliance was opposed to allowing the public access to the personal information of home care workers proposed in this amendment, including full legal name, date of birth, home address and gender of these workers.

Also, $200,000 was reinstated for Nursing and Allied Health Workforce Development that has funded improved access to education and training for direct care workers as well as nurses. One such example of a program funded through this item was the Home Health Nurse Residency Program that is run by VNA of Boston/VNA Care Network.

In the elder services category, $750,000 was provided to “meals on wheels” and the House approved a study of expanding income eligibility standards for home care services contracted through Aging Service Access Points.

Meanwhile, the House denied a commission to study oversight options for home health and private-pay home care, a raise for both home health aides and homemakers, a study of home health rates from MassHealth, and a boost in funding for pediatric palliative care.

The budget discussion and focus will turn to the Senate and the Alliance will be sending advocacy alerts to inform members and advocates about how they can help advance important policy priorities.

Return to www.thinkhomecare.org.

Contact Your State Rep to Support Home Care in the FY17 State Budget

The Massachusetts House is preparing for debate next week on their $39.4 billion state budget proposal and the 1,307 amendments that were filed on a range of different issues from home care to homelessness.

Please visit the Home Care Alliance’s Advocacy Center and send a message to your state rep to urge their support of the HCA’s priority issues. Simply click on any of the top four issues on the Advocacy Center, fill out your contact information, hit SEND, and an email will automatically be sent to the legislator representing you!

The top message (“Please Support Home Care in the FY17 Budget”) includes all the HCA’s priorities, or you can choose from other single-issue messages. There are explanations of each message and you can read the actual message before sending.

The Alliance posted a summary of the House budget proposal that will be debated next week and other updates will be posted as they become available.

Return to www.thinkhomecare.org.

House Releases FY17 Budget Plan and Rearranges Elder Services Funding

With a $39.4 billion FY17 state budget plan, the House Committee on Ways & Means kick-started the legislature’s budget deliberations.

As always, a significant portion of that total – $15.4 billion in proposed spending – is allocated for MassHealth programs. In their executive summary, House budget writers noted that MassHealth spending growth has been limited to 5%. They also mention that their budget plan “supports enhancements to the eligibility systems, caseload management and program integrity efforts, especially in the area of long term care, which ensures that our significant investments are being well spent, which is crucial to providing healthcare to some of the Commonwealth’s most vulnerable residents.”ma budget pie chart pic

That “support” could be part of the $8 million increase in the EOHHS administration line item (400-0300) as it does not show up in the line item specifically set aside for audits of MassHealth providers and utilization review (4000-0301). That item was actually set by the House at $413,000 less than FY16 spending.

Meanwhile, the House restored the Enhanced Home Care Services Program (ECOP) that Governor Charlie Baker consolidated into other items. With ECOP funded at $74.3 million, it comes in at $3.7 million above the FY16 spending level. That leaves some items noticeably lower than Governor Baker’s budget plan, but it also falls below what the state spent in FY16.

For example:

  • Elder Home Care Purchased Services is $3.1 million below FY16 spending
  • Elder Home Care Case Management and Administration is $2.6 million below FY16 spending
  • Elder Nutrition (Meals on Wheels) is more than $746,000 below what was even set in the FY16 budget

Other newsworthy items from the House Ways & Means budget proposal include the following:

  • $250 million assessment on hospitals that will support new MassHealth accountable care organization (ACO) incentive payments, which the Hospital Association supports with certain conditions.
  • $5.7M for the Supportive Senior Housing Program, an item not included in budgets of previous years.
  • $15 million above the Governor’s proposed spending for Nursing Home Supplemental Rates.
  • $4.5 million above FY16 spending for Elder Protective Services.

The entire House Ways & Means budget can be found here. The Home Care Alliance will be working with State Reps to sponsor amendments creating a home care licensure commission, increasing MassHealth reimbursement for home health aides, and for EOHHS to conduct a full review of home health reimbursement. The Alliance will be fully partnering with other organizations to push a homemaker wage increase, expanding income eligibility for elder home care services, and other items.

More information on advocacy efforts will be released soon and the budget items will be a focus of HCA’s lobby day at the state house on April 28th. Contact James Fuccione at the Alliance for details.

 

Return to www.thinkhomecare.org

 

MassHealth Hosting One Care Outreach Events

This Spring, MassHealth is hosting several One Care outreach events to let individuals who may be eligible for One Care know about the benefits of the program.

One Care Presentations as well as Drop-In Events will be held throughout Suffolk and Worcester County between the dates of March 25th and April 13th. This is a great opportunity to learn more about One Care, particularly for clients who may have received notices indicating that they are being automatically assigned to a One Care plan. More information about One Care can also be found at: www.mass.gov/masshealth/onecare.

Please share this with individuals you serve who may be eligible for One Care and feel free to forward to colleagues and other providers.

Return to www.thinkhomecare.org.

MassHealth Releases Prior Authorization Presentation

The first in a series of education sessions administered by MassHealth on their newly implemented prior authorization process occurred on March 16th and the slides have been made available.

After a basic overview of home health regulations, the prior authorization portion begins on slide 20 with helpful information and links as well as the contact information for the MassHealth Prior Authorization Unit (PAU). With a limited number of spots for this webinar, the Home Care Alliance is continuing to work with MassHealth on offering additional sessions.

The Alliance continues to take questions from agencies and is actively and constantly in contact with MassHealth to address ongoing issues.

Next week, MassHealth will be offering separate one-hour sessions on utilizing the Provider Online Service Center, or POSC.

During this training, MassHealth will provide step-by-step instruction on how to submit a prior authorization via the POSC, including how to inquire on and view prior authorization decisions, as well as other POSC techniques.

As space is limited, agencies are encouraged to register soon, if they have not already.

The sessions will be held at UMass Medical School (333 South St, Shrewsbury, MA 01545) on the following dates.

  • Wednesday, March 23, 2016  1:00 PM – 2:00 PM
  • Friday, March 25, 2016 10:00 AM – 11:00 AM
  • Friday, March 25, 2016 1:00 PM – 2:00 PM

Register here for POSC Training

The official Public Notice of the regulatory change requiring prior authorization was published last Friday. The notice include an invitation for public comment, with all comments due by April 1, 2016. Agencies are encouraged to submit constructive comments.

Return to www.thinkhomecare.org

Breakdown of Governor Baker’s FY17 State Budget for Home Care

Confronting a $635 million budget gap and steep spending increases in several areas, including MassHealth, Governor Charlie Baker’s administration released a $39.5 billion budget plan that aims to reduce growth while investing in more efficient programs.

On a conference call with stakeholders, state Health and Human Services Secretary Marylou Sudders thanked the Home Care Alliance for collaboration on a package of proposed solutions that are slated to go into effect by March 1st. As noted in previous newsletters and emails to HCA members, MassHealth is seeking to establish a prior authorization process, a moratorium on new home health providers, and a conflict-free physician referral process. This includes a closer scrutiny on medication administration visits and clients with a high utilization rate of home health aides.

Secretary Sudders reported on the call that audits will be conducted effective immediately. She also explained that there are currently 195 certified home health agencies in the Commonwealth and 12 were referred to the MassHealth Fraud Unit under the state’s Attorney General’s Office. The HCA will continue to monitor audit activity and provide pertinent updates.

More generally in the Health and Human Services budget, MassHealth Managed Care and MassHealth Senior Care are receiving funding increases while the Fee-for-Service line item continues to decrease reflecting a move to programs like Senior Care Options (SCO), OneCare and other managed care services.

In the elder services line items, the Enhanced Home Care or ECOP program was consolidated into several line items by the Baker administration. The bulk of what was a $70 million line item went to Home Care Purchased Services and Case Management under the Aging Service Access Points (ASAPs).

Below are some other notable items related to home care in the Governor’s FY17 budget:

  • Nursing Home Supplemental Rates increased by $30 million. This is due to an increase to assessments on SNFs.
  • The line item for MassHealth Managed Care increases $149.1 million and the MassHealth Senior Care account rises by $160.4 million, while the MassHealth Fee-for-service item goes down by $113.7 million.
  • Elder Protective Services funding was increased by $4.9 million.
  • DPH’s Pediatric Palliative Care Network was essentially level-funded at $1.8 million.
  • Elder Nutrition (Meals on Wheels) was also nearly level funded at $7.2 million.
  • The Nursing and Allied Health Education Workforce Development item was eliminated. Last year it was funded at $200,000 by the legislature after being zeroed out by the Governor.

The budget process moves on to the House and Senate and further updates  – on both the budget as well as the HCA’s work with MassHealth on program changes to home health services – will be shared as information becomes available.

Return to www.thinkhomecare.org.

 

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