Tag: MassHealth

Massachusetts Medicare Program.

Governor Releases FY13 Budget Blueprint

Governor Deval Patrick released his proposal for the state’s fiscal year 2013 budget, which sets the stage for the legislature to work out their own versions and come to an eventual agreement over the next six months.

The Governor’s budget does not include any projected increases or cuts for home health, as is the case with most programs (MassHealth Nursing Home Supplemental Rates are reduced from FY12 spending by more than $300 million in the Governor’s proposal).  The MassHealth line items are almost all increased to “meet projected need,” which just translates to level funding. Here is a list of the line-items of note, including the MassHealth accounts.

  • MassHealth Managed Care (line item 4000-0500) increased $183,988,029 over FY12 spending to $4,164,475,376
  • MassHealth Senior Care (line item 4000-0600) increased $196,976,192 over FY12 spending to $2,763,630,662 .
  • MassHealth Fee-for-Service Payments (4000-0700) increased $129,850,745 over FY12 spending to $1,939,680,126.
  • Home Care Purchased Services (9110-1630) had a short increase just over $2,000 to $97,783,061.
  • Elder Enhanced Home Care Services (9110-1500) increased $672,147 to $46,461,487 .

The Governor’s office provides more details on health care costs and reasoning for those decisions here. The Home Care Alliance will continue to provide more information as further analysis is completed. The Alliance will once again be advocating for line items of concern as the budget process moves forward, including on issues like payment rates and telehealth reimbursement from Medicaid.

For more general information, several articles from sources like Boston.com and MassLive.com are available that explain some of the Governor’s budget as well.

Return to www.thinkhomecare.org.

 

NewMMIS Announcement of Grace Period for Electronic Claims Submission Policy

All Provider Bulletins 212  from May 2011 (“Important Claims Submission Policy Changes”) and 217  from September 2011 (“Waiver Policy for Claim Submissions”) both announced an important change in the claims submission policy. Effective January 1, 2012, all MassHealth claims must be submitted electronically unless a provider has an approved electronic claim submission waiver.

Effective January 1, 2012, MassHealth will implement a 90-day grace period of the claims submission policy to allow providers additional time to convert to electronic claims submission and to apply for the electronic claim submission waiver. MassHealth will issue an all provider bulletin in January that further explains this grace period.

Questions can be directed to MassHealth Customer Service at providersupport@mahealth.net or 1-800-841-2900.

Return to www.thinkhomecare.org.

EOHHS Hosting FY2013 Budget Hearings

The Home Care Alliance is collecting written testimony and encouraging those interested to present oral testimony for upcoming hearings being hosted by the Executive Office of Health and Human Services (EOHHS) on the upcoming Fiscal Year 2013 budget.

Indications have been made that the upcoming budget will be just as difficult as those in previous years so it is important that home care agencies show up and submit written comments to convey the significance and value of the services they provide. EOHHS is seeking input about the best ways to preserve core services to the fullest extent possible without additional expenditures. As such, the Alliance suggests that agencies promote work in care transitions, disease management, and the general value of keeping people independent at home. The Alliance is also pushing for MassHealth coverage of telehealth technology as well as legislation on nurse delegation of medication administration, which we encourage people testifying to include in their comments.

Secretary JudyAnn Bigby, M.D., and the Assistant Secretaries at EOHHS will be on hand for both hearings so comments should begin by addressing them accordingly. The two hearings will be held this week and next week at the following dates and locations:

Friday, December 2, 2011 from 3:00-6:00 p.m.
Department of Mental Health Western Massachusetts Area Office
Northampton Haskell Building
1 Prince Street
Northampton, MA 01061

Friday, December 9, 2011 from 2:00–6:00 p.m.
Agganis Arena at Boston University
Francis D. Burke Club Room
925 Commonwealth Avenue
Boston, MA 02215-1204

Due to the number of individuals anticipated to attend the hearings, oral testimony will be limited to three minutes per individual. In the interest of time, representative panels are welcome and will be limited to a total of five minutes of oral testimony. If a number of home care agencies are interested, they will be added to a panel as HCA will be attending and testifying at the Boston hearing on December 9th. HCA asks that you also inform us if you sign up to attend or submit written comments on your own.

If you need accommodations please call 617-573-1600 and let the receptionist know.  Additionally, if you are planning to present oral testimony at the Boston hearing, please note that you must be in the building by no later than 5:50 p.m.

Written testimony can be sent to the Home Care Alliance to be submitted collectively, or 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 Bill Filed to Expand Hospice Coverage

According to a report by State House News Service, a bill was recently filed by a group of legislators that would expand hospice coverage to about 120,000 more residents on MassHealth.

Senate Bill 1999, An Act extending hospice care to the MassHealth basic and MassHealth essential programs was filed by Senator Patricia Jehlen and seeks what its title states. Hospice coverage, according to State House News, is available to about 1 million MassHealth recipients, but not to roughly 120,000 who are on more restrictive plans known as MassHealth Basic and MassHealth Essential.

The inspiration for this bill comes from a report assembled by the Massachusetts Commission on End-Of-Life Care, which was established by the legislature in 2009 to study issues surrounding end-of-life care and how such care is provided in the state.

The Home Care Alliance applauds the initiative to expand hospice coverage so that people can fulfill their preference to receive end-of-life care in their homes. While approximately 67 percent of Massachusetts residents say they would prefer to die at home, only 24 percent actually do, according to statistics compiled by the commission, the Massachusetts chapter of AARP, and the state Department of Public Health.

The legislation has been referred to the Joint Committee on Health Care Financing and the Alliance will continue to provide updates on this proposal as it becomes available.

Return to www.thinkhomecare.org.

Alliance Meets with New Medicaid Director

photo of Julian HarrisThe Governor appointed a new Director of Medicaid in June and the Alliance has had the opportunity to meet with Dr. Julian Harris (pictured left) twice since he began acclimating to his new role.

HCA staff joined other advocates in a meeting that involved personal and organizational introductions to the new Director as well as a mention of a few top issues for each organization as it pertains to MassHealth activity. Prior to that, Alliance staff was among a small group of providers meeting with Health and Human Services Secretary JudyAnn Bigby and other officials on the Dual Eligibles Care Integration Project, which Dr. Harris sat in on.

According to a press release issued by the Governor’s office, Dr. Harris currently practices primary care at the Southern Jamaica Plain Community Health Center and hospitalist medicine at the Cambridge Health Alliance, both of which serve populations with high levels of participation in MassHealth and other state health programs. He is a clinical fellow on the faculty at Harvard Medical School and a senior resident in internal medicine and primary care at the Brigham and Women’s Hospital and its affiliated Southern Jamaica Plain Community Health Center. He formerly served at the World Bank, where he was charged with day-to-day management of the World Bank Institute’s AIDS program. He also worked on national health payment and delivery system reform for an international client at McKinsey & Company.

The Alliance looks forward to working with Dr. Harris on the challenges and opportunities for home care and MassHealth members.

Return to www.thinkhomecare.org.

Gov. Patrick Signs FY12 State Budget

Governor Deval Patrick signed the state’s fiscal year 2012 budget amounting to $30.6 billion with a victory for home health.

Language that would move MassHealth one step closer to reimbursing home health agencies for telehealth services was included in the “MassHealth Managed Care” line item:

…for purposes of long-term health care cost savings and enhanced patient care, the commonwealth may recognize telehealth remote patient monitoring provided by home health agencies as a service to clients otherwise reimbursable through Medicaid

The key word in this language is “may.” MassHealth is not directly instructed in the budget to reimburse for telehealth (as if the word “shall” was used), but it presents the state with the option to do so, which means that continued advocacy will be required to push the state towards that end. This is a solid victory for the Alliance’s budget advocacy thanks to the hundreds of emails that were sent from the HCA website’s Legislative Action Center and to the office of Senator Richard Moore.

Another item of interest is in regards to Adult Day Health where the Governor approved a budget that makes “no changes prior to December 31, 2011 in the clinical eligibility or level of reimbursement paid to providers of adult day health services for basic and complex levels of care.”  The budget also imposes a temporary moratorium on enrollment of new Adult Day Health providers until such time that a study is completed by the Executive Office of Health and Human Services. The study, due to the Legislature by December 31, 2011, will provide a basis for new licensure and rate structure and also will provide a needs assessment of ADH services going forward.

For more information, the full budget is available on Mass.gov.

Return to www.thinkhomecare.org.

State Seeks Comments on Accountable Care Organizations Through New RFI

The state’s Executive Office of Health and Human Services has released a Request for Information regarding the formation of Accountable Care Organizations (ACO’s) and are seeking comments from “all interested partComm-PASS logoies.”

The RFI includes an introductory letter from Health and Human Services Secretary Dr. JudyAnn Bigby and a thorough explanation of the state’s intentions for the transition to a new payment system. A response template is included in “Attachment A” of the document and comments should be submitted electronically through the Commonwealth Procurement Access and Solicitation System (Comm-PASS). Instructions are available in the RFI and the Home Care Alliance encourages home care agencies to submit comments as they see fit.

Return to www.thinkhomecare.org.

Payment Rate Change Announced for Hospice

The state’s Division of Health Care Finance and Policy (DHCFP) announced an adjustment in the rate of payment for hospice services “in accordance with CMS requirements.”

The full announcement is available here.

The change is estimated by DHCFP to increase the MassHealth budget by $184,274 or 2.68%, which translates to a slight increase and not a cut as is sometimes meant when the state uses the word “adjustment.” According to the announcment, each rate is composed of a non-wage component and a wage component, in which the latter is adjusted by a county-specific, Massachusetts wage index, in accordance with CMS guidelines.

Depending on the service, the rates in these county-groupings change within the following ranges:

  • 3.5-3.7% for Norfolk, Suffolk, and Plymouth,
  • 3.0-3.2% for Middlesex,
  • 2.6-2.7% for Essex,
  • 2.4-2.5% for Bristol, 3.2-3.4% for Berkshire and Pittsfield,
  • 1.7-1.9% for Hampden, Hampshire, and Franklin,
  • 3.4-3.6% for Worcester,
  • 1.6-1.9% for Barnstable
  • 1.9-2.2% for Nantucket and Dukes.

Although the revisions were adopted by emergency regulation on May 27, they are still technically “proposed” and are subject to further change. DHCFP announced that there will be a hearing on July 7 in Boston for anyone interested in offering comments on the matter. See the full announcement for details.


Return to www.thinkhomecare.org.

Advocacy Alert: Send an Email to Budget Conferees to Support Telehealth

A new advocacy message is available to click and send to legislators who are part of the FY 2012 Budget Conference Committee, which is charged with compromising the House and Senate versions of the state budget before it’s sent to the Governor.

The Home Care Alliance, thanks to State Senator Richard Moore, saw a Senate budget amendment pass that would bring MassHealth reimbursement for telehealth services provided by a home health agency.

You can help support this issue by visiting the HCA’s Legislative Action Center and clicking on the telehealth message. Simply fill out your contact information and click “send messages” to email each member of the conference committee.

Here is the language of the telehealth budget amendment (# 593) that passed in the Senate:

Messrs. Moore, Montigny and Tarr moved that the bill be amended, in Section 2, in item 4000-0500, by adding the following words:- “; provided further, that for purposes of long-term health care cost savings and enhanced patient care, the commonwealth shall recognize telehealth remote patient monitoring provided by home health agencies as a service to clients otherwise reimbursable through Medicaid”.

You can also call the conference committee members and ask that they support Senate budget amendment # 593 relative to telehealth. Contact info for the conferees is below:

  • Sen. Stephen Brewer – 617-722-1540
  • Sen. Steven Baddour – 617-722-1604
  • Sen. Michael Knapik – 617-722-1415
  • Rep. Brian Dempsey – 617-722-2990
  • Rep. Viriato Manuel deMacedo – 617-722-2100
  • Rep. Stephen Kulik – 617-722-2380

If you have any questions or would like to learn more, please contact the Alliance.

Return to www.thinkhomecare.org.

Advocacy Alert: Help Support Home Health Budget Amendments

The Massachusetts House of Representatives begins debate on the FY12 budget TODAY!

Please see the pre-written email messages below that are available to send to your legislators. All you have to do is click “write your legislators” under the issue you care about, fill in your contact info and the message will automatically be sent to the State Representative who represents YOU.

HCA is trying to gain support for these important amendments so please send a message and forward this email to colleagues and friends who may be interested in taking action.

Support Pediatric Home Care
»  Write Your Legislators   
 Amendment # 529: Pediatric Home Care Services (Offered by Rep. Michael Brady)

  • This amendment does not increase any rate, but merely shifts existing payment recognizing a home health agency’s administrative requirements. Also, this amendment ensures safety and quality by allowing only registered nurses to care for multiple patients in a single setting.

Support Enhanced Care Transitions
»  Write Your Legislators 
 Amendment # 554: Patient Care Transitions (Offered by Rep. Kevin Honan)

  • This amendment establishes a special MassHealth rate to reward home health agencies that are successful in helping patients discharged from acute care avoid a costly re-hospitalization for the same condition for which they were originally hospitalized.
  • The hospitalization would have to be avoided for at least 30 days in order for the payment to be administered. The Secretary of Health and Human Services shall determine the rate, which will be based on a nurse-led team model.
  • This provision would increase the efficiency of care and save costs for the state in avoiding rehospitalizations.

Restore MassHealth Payment Rates to Home Health
»  Write Your Legislators 
Amendment  # 339: Home Health Rates    (Offered by Rep. David Sullivan)

  • The MassHealth home health payment rate was cut by 20 percent to patients receiving skilled nursing care past 60 days of care in December of 2008. This created a new payment category that goes from $86.99 to $69.59 for patients that require longer periods of care and who are at a greater risk of inpatient facility admissions or readmissions.  Since all of MassHealth’s home health services receive a 50 percent federal match, the actual state expenditures reflect only half of a $7.1 million budget increase.

Support Telehealth in the FY12 Budget
»  Write Your Legislators      
 Amendment # 681: Telehealth Reimbursement (Offered by Rep. John Mahoney)

  •   In recent years, several states have all moved forward with incorporating coverage of telehealth into their state plan, waiver home care programs, or have authorized funding for demonstration projects to support telemonitoring equipment purchases.
  •   The Centers for Medicare and Medicaid Services also recognize and define telehealth billing and reimbursement practices.
  •   Telehealth and remote care management programs are not only proven to reduce admissions to hospitals and nursing homes, but also reduce the frequency of home health visits.
  •   Such lower cost services increase communication with physicians and caregivers, which contributes to the enhancement of care. It also increases patient self-management and is widely regarding as a cost savings measure supported by a number of studies and pilot programs.

Support Home Health in FY12 Budget
»  Write Your Legislators      
 This email message supports all of the above amendments.

Return to www.thinkhomecare.org.