Tag: MassHealth

Massachusetts Medicare Program.

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.

 

Conference Committee Announces Final Budget With Little Support for Home Care

The legislature’s state budget conference committee, made up of six members of the House and Senate’s respective Ways & Means Committees, decided on a final version of the fiscal year 2016 Massachusetts budget.ma budget pie chart pic

The $38.1 billion plan that is being sent to the Governor for his approval does not include the Home Care Alliance’s priority language that created a special commission to study and recommend licensure options for private care agencies. The commission language was included in the Senate’s version, but not the House, which left the conference committee to decide its fate.

The conference committee also did not include an expansion of income eligibility for services ordered through Aging Service Access Points (ASAPs) that the Alliance also supported.

One bright spot was that an advisory council on “mobile integrated healthcare” (MIH) was passed and includes a representative of the Home Care Alliance. The language defines MIH as:

a health care program approved by the department [of public health] that utilizes mobile resources to deliver care and services to patients in an out-of-hospital environment in coordination with health care facilities or other health care providers. Such medical care and services include, but are not limited to, community paramedic provider services, chronic disease management, behavioral health, preventative care, post-discharge follow-up visits, or transport or referral to facilities other than hospital emergency departments.

Other notes from a preliminary analysis of the Conference Committee’s budget include the following:

  • The MassHealth Managed Care line item continued to grow by another $770 million while MassHelath Senior Care, which governs the Senior Care Options program, dipped by more than $10 million.
  • In the Elder Affairs line items, State Home Care Program “Purchased Services” was set by the conference committee at about $2 million below FY15 spending, although the Enhanced Community Options Program (ECOP) grew by nearly $5.6 million.
  • Thanks to the efforts of home care supporter Senator Sal DiDomenico, the funding for the Pediatric Palliative Care Network was raised to $1.8 million from $1.5 million in FY15, but that’s still inadequate to serve the number of children currently on a waiting list for such care.
  • The Department of Higher Education’s “Nursing and Allied Health Workforce” line item ended up being level funded at $200,000 after being zeroed out by the Governor earlier this year.

Return to www.thinkhomecare.org.

PCA Contract Spurs Clarifying Statement from the Alliance

Prior to the June 30th deadline for the state to negotiate a new contract with independently-hired and consumer-directed Personal Care Attendants (PCA), a deal was struck with the Governor’s administration for an immediate 30-cent raise and a “pathway” towards a $15 per hour wage in three fiscal years. Those annual contracts for future fiscal years still have yet to be negotiated.

With this announcement, the Home Care Alliance released the statement below to legislators clarifying that this wage boost is only for PCAs and not for homemakers or home health aides paid via agencies by MassHealth.

We encourage home health agencies and advocates to forward this to their legislators to highlight the fact that MassHealth has not increased home health aide rates, nor has it increased skilled visiting nurse rates.

Contract is a Win for Personal Care Attendants, Not Home Health Care

HCA Seeks Better Pay for All Home Health Aides

BOSTON, MA – This week, workers in the state-funded Personal Care Attendant Program (PCA) negotiated a new contract with the Commonwealth that gives them an immediate 30-cent raise and puts PCAs on a path to $15 per hour. This contracted raise will not apply to home health aides or personal care homemakers that work in the MassHealth program or the State Home Care Program administered by the Executive Office of Elder Affairs (EOEA).

“The Home Care Alliance supports any direct care workers getting a higher wage, but people should know that home health aides are paid through home health agencies via rates set by MassHealth. MassHealth has not increased home health aide payment rates in eight years,” said Home Care Alliance Executive Director Patricia Kelleher. “Home health aides generally have a higher level of education and training than PCAs and care for medically complex patients. Yet, they are on a path to earn less because of the state’s inaction on payment rates.”

Even though they are paid by state funds, PCAs are hired directly by the individuals they serve and primarily provide assistance with activities of daily living for disabled adults. Home health aides work for home health care agencies that provide similar services, often as part of a care team that includes a nurse managing a plan of care overseen by a physician.

The Home Care Alliance has long advocated for higher payment rates from MassHealth to home health care agencies. Despite not getting an increase since 2007, most agencies have been increasing worker wages and already provide benefits to their home health aides.

 “The Alliance believes that raising wages for direct care workers in the community strengthens the ability of people to remain at home no matter what their needs. However, the Alliance also believes that there is a continuum of home care and that the entire continuum should be equally recognized and supported, “added Kelleher. “MassHealth needs to support agencies that employ home health aides so that reality of state support for these workers matches the headlines.”

Return to www.thinkhomecare.org.

Fallon Total Care Dropping Out of ‘One Care’ Program

The state’s Executive Office of Health and Human Services (EOHHS) announced that one of the three health plans managing health care for dually eligible ages 21 to 64 through the One Care Demonstration Program will be dropping out.

As of September 30, 2015, Fallon Total Care will be parting ways with the capitated financial alignment program, which will leave Commonwealth Care Alliance and Network Health as the remaining plans. Fallon Total Care provides One Care coverage in Hampden, Hampshire, and Worcester counties to approximately 5,475 individuals and represented the second largest enrollment of the three plans. Commonwealth Care Alliance, as of the May 2015 enrollment report, was handling 10,305 dually eligible individuals.

“MassHealth assures members who are currently enrolled with Fallon Total Care (FTC) that we will work hard to ensure as smooth a transition as possible, working with current members, FTC, the other One Care plans, our partners at CMS, advocates, and the One Care Implementation Council,” stated MassHealth in a brief statement. “One Care members will not lose their MassHealth or Medicare, and all members will have continuous access to health care services, supportive services, and medications.”

MassHealth also promised further updates on the transition and did not share any reasoning for Fallon Total Care departing the One Care Program.

Return to www.thinkhomecare.org.

Advocacy Alert: Email your Senator to Support Home Care in the Senate Budget

The Alliance has worked with home care champions in the Senate to file amendments to the Ways & Means budget to improve home health care services. The HCA now needs home care agencies and advocates to send a message to gain support these proposals TODAY by clicking here!

Below is a list of the items the Alliance will be leading on and supporting in the FY16 Senate budget process.

Restoring Home Nursing Rates: Senator Jennifer Flanagan

•    Purpose: This budget language seeks to restore the MassHealth rate for home health nursing visits past 60 calendar days of care to the payment level prior to the rate cut of December 1, 2008. This amendment creates a consistent rate for as long as an individual on MassHealth requires home health care.

Improved MassHealth Rates for Home Health Aide Services: Senator Barbara L’Italien

•    Purpose: Since 2007, home health aide rates to agencies from MassHealth have remained at $24.40 per hour, which is meant to cover aide salary, benefits, travel, supervision and administrative costs for the employing home health agency. This amendment seeks to raise the rate MassHealth reimburses home health agencies for home health aide services by 12% at a cost to MassHealth of $1.75 million.

Study of MassHealth Third Party Liability: Senator Anne Gobi

•    Purpose: A study is necessary because correct reimbursement coverage determinations for Medicare/Medicaid dual eligibles are far more complex in home health care than in other medical services as the services and program coverage rules are very similar. The process of submitting all or most MassHealth home health claims for review and re-review to Medicare is highly costly to both agencies and the state. The rate of Medicare coverage has also been steadily declining.

Homemaker Salary Reserve: Senator Michael Barrett

•    Purpose: Appropriate $3 million from the Community First Trust Fund for a FY16 Homemaker Salary Reserve.  This request will continue a campaign to support essential workers by providing an annualized wage and benefit increase of approximately 32 cents an hour to over 26,000 homemakers and personal care homemakers.

Community-Based Safety Net Adjustment: Senator Kathleen O’Connor Ives

•    Purpose: Treat non-profit home health agencies that provide a significant number of home health visits to MassHealth patients as safety-net providers eligible for upward rate adjustments.

FMAP Trust Fund: Senator Michael Rodrigues

•    Purpose: On January 1, 2014, Massachusetts began receiving an enhanced Federal Medical Assistance Percentage (FMAP) for certain Medicaid expansion populations through the ACA.  This amendment creates a trust fund to house this funding and dedicate it to Medicaid and low-income health programs.

Expand Elder Service Home Care Income Eligibility: Senator Barbara L’Italien

•    Purpose: Raise the income eligibility standard for State Home Care Program services funded by Elder Affairs to those below 300% of the Federal Poverty Level.

For more information on what was included in the Senate Ways & Means budget, visit this previous blog post.

Return to www.thinkhomecare.org.