Mass. EOHHS Holding FY15 Budget Hearings

A pair of public hearings will take place in Amherst and Boston this month to help guide the state’s Executive Office of Health and Human Services as they look to shape their fiscal year 2015 budget.

It is well documented that approximately half of the state government’s budget goes to health and human services so the department is constantly encouraged to find ways to do more with less.

HCA members and advocates are encouraged to email written comments to by the time of the Boston hearing on December 11th. Subjects should include and focus on the following:

  • Raising MassHealth rates for skilled nursing
  • Encouraging a certificate/determination of need process for home health agencies
  • Urging formal support for S.1064, An Act Relative to Home Health and Hospice Aides, which allows nurses to delegate limited medication administration tasks to home health aides and CNA’s. With the hearings focusing on the EOHHS budget, commenters should focus on potential cost savings potential of “nurse delegation” issue.
  • Highlighting your agency’s efforts to reduce readmissions and other cost-effective programs.

For those interested in attending the hearings, the Amherst hearing will take place on December 6th from 10:00am to 2:00pm at Commonwealth Honors College while the Boston hearing will take place from 2:00pm to 6:00pm on December 11th at the UMass Boston Campus Center.

Any questions can be directed to James Fuccione at the Alliance.

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Today’s ODF Cancelled

Centers for Medicare and Medicaid (CMS) sent notice yesterday that due to unforeseen circumstances, the June 26, 2013 Home Health, Hospice and DME Open Door Forum (ODF) is postponed until July 9, 2013. A separate notification with a full announcement and agenda will be sent prior to the July 9th call.

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Advocacy Alert: Send a Message to Support Home Health Care in Senate Budget

A new advocacy message has been posted on the Home Care Alliance’s Legislative Action Center webpage and is ready to be sent off to state senators to support home health care in the senate’s FY14 budget.

HCA has three priority amendments in the Senate Budget that would create a home health care “certificate of need” process (amendment #517), establish MassHealth reimbursement for home telehealth services (amendment #718), and improve payment for pediatric home health agencies (amendment #593). The Alliance needs emails to senators to gain support for these important amendments so see the new advocacy message, fill out your contact info, and the message will automatically be sent to the senator representing you! It only takes a minute of your time and every email counts.

The Alliance is also supporting three other amendments. One would create an FMAP Trust Fund (#634) that will set up a special fund for payments from the federal government relative to health care reform, rather than having the money go into the state’s General Fund, which is less transparent. The other two amendments HCA supports would provide a rate add-on for personnel providing homemaker and personal care homemaker services to elderly clients (#544) and an amendment to boost funding for pediatric palliative care by $674,000 (#629).

Help advance home care in the state budget and send a message TODAY!

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Home Care & Telemedicine

NPR’s Talk of the Nation had a lengthy segment on the growing use of telemedicine, especially in home care.  In addition discussing the benefits to patients with limited mobility or access to specific services they need and Medicare’s current refusal to reimburse for remote doctor consultations, the segment included a letter from the Alliance’s own James Fuccione, starting at 19’09”:

[HOST NEAL] CONAN: Here’s an email question that has some aspects of that that I wanted to ask you about, this from James [Fuccione] in Massachusetts: The Home Care Alliance of Massachusetts is advocating for Mass Health, [the] state Medicaid program, reimbursement of telehealth used by home health agencies.

Many agencies part of our association use telehealth already because it improves their quality and efficiency. They use wireless weight scales, blood oximeter, blood pressure cuffs, et cetera, and depending on their condition. So in other words you can collect data over these same circuits.


CONAN: Do you use that as well?

EDISON: Yes, so we do a lot of telehome care and remote monitoring here in Missouri. One of our large home health agencies in the southwest part of the state is probably the leader in that area. One of the challenges, of course, is the inter-operability of the health information systems. So as health information technology matures, and the companies become more inter-operable, they can talk to each other and transmit information easily.

You know, as that gets – as that whole industry matures, this is going to get easier and easier so that instead of the home health agency monitoring those patients, actually the patients – patient-centered health care home or medical home, their actual health providers would be monitoring those patients on a daily basis.

You may download the entire show by clicking here.

Neighborhood Health Plan Drops Out of Dual Eligible Demonstration

Neighborhood Health Plan announced to partnering providers and organizations that they are withdrawing from the Dual Eligible Demonstration Project as an ICO, or Integrated Care Organization.

NHP was one of six groups that were working to become an ICO, but dropped out due to concern about payment rates conveyed from the state’s Executive Office of Health and Human Services (EOHHS) and the federal Centers for Medicare and Medicaid Services (CMS).

“EOHHS and CMS have acted in good faith to mitigate many of the factors involved in the rate discussions and unfortunately, for NHP, the final proposed rate structure, as projected, would result in substantial losses for NHP,” stated the emailed announcement.  “We feel that it is in our best interest at this time not to pursue the Duals demonstration further.”

The Home Care Alliance  spoke with NHP and met with other potential ICO’s with most expressing concern about the rates of payment. For months, stakeholders have been told that providers will receive no less than Medicare payments for Medicare services and no less than Medicaid payments for Medicaid services, but it is unclear if that is the case.

The Home Care Alliance will be attending the next “open stakeholder” meeting on April 19th in Shrewsbury to obtain more information.

“We strongly believe in the potential of truly integrated care models to improve care for the dually eligible and all Medicaid populations,” the NHP statement continued. “We wish your organization and the remaining ICOs much success.”

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NAHC Holding Virtual Lobby Day on Feb 6

The National Association for Home Care & Hospice (NAHC) is holding a virtual lobby day for its members on Wednesday, February 6 to continue the mission to keep issues important to home health on the minds of elected leaders. Virtual lobby days are essentially using phone calls and emails to advocate for important issues without traveling to the nation’s capital.

The virtual lobby day is centered around potential co-pays to Medicare home health services, which remain on the table as deficit talks continue. There have been a range of proposals since recent federal budget deficit talks began. They include a uniform 20 percent copay for all Medicare services, which NAHC estimates would amount to as much as $600 to access a Medicare episode of home health services. Other proposals include one by the Medicare Payment Advisory Commission (MedPAC) of $150 per Medicare episode and another from President Obama in a past year’s budget blueprint that was $100 per episode, but not preceded by a hospital or nursing home stay and beginning in 2017 for newly eligible Medicare beneficiaries.

NAHC members can help fight these proposals by sending a message using the NAHC Legislative Action Network (LAN). Click here for a sample message opposing home health copays and payment cuts. The message will be more impactful if you personalize it with your background and experience and describe the harm that copays and payment cuts will cause patients and providers in your state and district. For hospice messages, click here and here.

You may also deliver the message by phone. You may obtain contact information here: Contact Your Elected Officials. When calling, ask the receptionist to connect you with the staffer who handles health care issues. For talking points on home health copays, go here; for payment cuts, go here. For hospice, go here and here.

For those who are not members of NAHC, you can still contact your US Senators and Representatives through their respective websites. If you need assistance finding who represents you, go to

NAHC also hosts a facebook page called “No Sick Tax” that is meant to bring advocates and home care agencies together around the issue of fighting copays.

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HCA Sets Improved State Policy Agenda

With a new two-year state legislative session, the Home Care Alliance has set an improved policy agenda that would strengthen the industry and asks for assistance from member agencies and fellow advocates in gathering legislative support.

boston-statehouseThe Alliance’s legislative priorities include re-filed items like the “Nurse Delegation” bill, which would allow visiting nurses to delegate certain medication administration tasks to home health and hospice aides in the home setting only. New items include establishing a “certificate of need” process for certified home health care and a state program allowing cities to grant parking leniency to clinicians visiting patients in those communities.
HCA members, friends, and advocates can assist our mission by contacting their local state senators and state representatives and ask that they cosponsor these bills. If you are unsure who represents your agency or place of residence, please visit and type in your address, or contact James Fuccione at the Alliance.

Over the coming weeks, HCA will be alerting members about bills filed by other organizations and interest groups and will be asked to weigh in. The Alliance will, of course, continue to monitor and provide updates on the state’s health care payment reform law as it is implemented. Alliance staff and several member agencies sit on key boards, commissions and advisory groups and important information will be provided as it becomes available on those issues.

For more on HCA’s legislative priorities and how you can help, contact James Fuccione at the Alliance.

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Timeline Updated for Dual-Eligible Care Demonstration

MassHealth and CMS have agreed to a new implementation timeline for the statewide demonstration to better integrate and coordinate health care services for dually eligible individuals between the ages of 21 and 64.

Obviously, the deadline for selectionselection of ICO’s, or Integrated Care Organizations, has come and gone, but the “readiness review” for those ICO’s has been extended. Previously, the demo was set to begin enrollment on April 1st, but it now appears that the state and CMS have agreed to have the first self-selected enrollments to become effective on July 1st.

See the updated timeline below and visit the state’s demonstration webpage for more info:

ICO Selection Announcement

November 2, 2012

Readiness Review

Nov. 2012 – March/April 2013

3-Way Contracts

March/April 2013

Learning Collaboratives

March 2013 – Ongoing

Implementation Activities


       Stakeholder Workgroups: Quality, Notices, Outreach, Admin. Simplification

Dec. 2012 – Ongoing

     Implementation Council

Feb. 2012 – Ongoing


May 2013 – Ongoing

Public Awareness Campaign

April 2013 – Ongoing

Member Outreach Activities

(Members can begin to select ICOs for effective date July 1, 2013)

May 2013 – Ongoing

Self-Selected Enrollments Begin

July 1, 2013

Auto-assignments Effective

(Members notified at least 60 days prior to the effective date)

Oct. 1, 2013; Jan. 1, 2014

State Reveals ICOs in Dual Eligible Care Demonstration

More than a month passed their anticipated announcement date of September 21st, the state’s Executive Office of Health and Human Services (EOHHS) named the Integrated Care Organizations, or ICO’s, that will be managing and directing both payment and care for the demonstration to integrate services for dual eligibles.

The six organizations are Blue Cross and Blue Shield of Massachusetts HMO Blue Inc. (BCBSMA), Boston Medical Center HealthNet Plan (BMCHP), Commonwealth Care Alliance (CCA), Fallon Total Care, LLC (FTC), Neighborhood Health Plan (NHP), Network Health, LLC. Only Network Health was picked to serve every county in the state and will be the only ICO in Nantucket and Martha’s Vineyard.

Aside from Network Health, all other ICO’s are listed in as few as three counties and as many as eleven.

These organizations were selected for full (F) or partial (P) Massachusetts counties as follows:

Barnstable F F F F
Berkshire F F
Bristol F F F F
Dukes F
Essex F F F F F
Franklin F F F F
Hampden F F F F F
Hampshire F F F F F
Middlesex F F F F F F
Nantucket F
Norfolk F F F F F
Plymouth F F P F F
Suffolk F F F F F F
Worcester F F F F

These organizations will now be engaged in a “readiness review” over the next two months. As part of the review, EOHHS and CMS will require that the organizations demonstrate full readiness and meet operational requirements.  An ICO will not be able to accept enrollments without successfully completing the joint Readiness Review, negotiating and executing a three-way contract, and receiving any necessary state and federal approvals.

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Request for Responses for Consumer Consultants

MassHealth released an RFR to recruit “consumer consultants” that will assist with the review of applications from potential Integrated Care Organizations managing care for dual eligible individuals.

The demonstration project to better integrate and coordinate care for dual eligibles is still set to begin in January 2013 and the state remains on an aggressive pace to get the initiative underway. The RFR for Integrated Care Organizations (ICO’s) is due at the end of the month, and this separate RFR for “consumer consultants” is due July 20th.

These “consumers” must receive medical services, behavioral health services and/or long term services and supports (LTSS) from the state and will form a paid advisory subcommittee that shares its experiences and expertise with MassHealth and the state’s Executive Office of Health and Human Services.

The RFR is available on the state procurement website Comm-PASS as Document Number 13CBEHSCONSUMERCONSULTANTRFR and at this site on the Integrating Medicare and Medicaid for Dual Eligibles website under Related Information.

For those home care agencies that have patients with positive experiences of the care and services that have been delivered to them and that may be interested, please encourage them to apply.

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