Tag: Medicaid

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:

BCBSMA BMCHP CCA FTC NHP Network Health
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.

Return to www.thinkhomecare.org.

Home Care Alliance, National Organizations Make Statements on Supreme Court Decision

In light of the Supreme Court’s decision to uphold the Affordable Care Act, the Home Care Alliance of Massachusetts and other organizations representing health care providers and consumers had this to say:

“Today’s decision of the US Supreme Court has established the Affordable Care Act as the law. With their ruling, the Supreme Court has removed enormous uncertainty – particularly in states other than Massachusetts and for those involved in ACA funded demonstrations – as to whether to move forward. They now can, and we think they must.  While some parts of the law will impact Massachusetts far less directly than other states, there is evidence that our state has already benefited by some provisions. Most notably, 62,000 seniors and people with disabilities in Massachusetts have seen significant savings on their prescription drugs because the law was upheld.

All providers, including home health care, were subject to Medicare rate reductions in the ACA in order to expand coverage and pay for reform demonstrations.  These cuts have not been easy to absorb. With this ruling, we must now get to work to deliver on the promise in our state not just of universal access to insurance, but to a better coordinated, and ultimately more cost effective delivery system.”

-Patricia Kelleher, HCA Executive Director

Statement from the National Association for Home Care & Hospice (NAHC):

“NAHC has long supported reforms that increase access to health care for all in the United States and supports health delivery reforms and the expansion of Medicaid eligibility. The ACA rightly shifts the focus of care from inpatient services and institutional care to the community setting, which home health agencies and hospices have effectively served for decades.

NAHC believes that the Affordable Care Act can and should be improved. Accordingly, NAHC will continue to work with both Democrats and Republicans to improve the legislation. NAHC will ask that its implementation date be delayed for two years so that states have the time to prepare for implementation, including the creation of exchanges. This delay will also save approximately $200 billion, which can be applied to deficit reduction, extending the SGR “doc fix” and avoiding the need for any further cuts to Medicare. NAHC will continue to argue that home health care has been cut disproportionately and will oppose the imposition of copayments or additional cuts. NAHC believes that a good case can be made for expanding the scope of Medicare home health services to reduce hospitalization costs and improve services for the 5 percent of Americans who are responsible for 50 percent of total U.S. health care costs.”

-Val Halamandaris, NAHC President

Here are other statements from the following organizations:

And statements from political leaders:

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Dual Eligible Services Demo RFR Now Available

The state’s Executive Office of Health and Human Services (EOHHS) has released the Request for Responses relative to the demonstration project to integrate care for dually eligible individuals.

The RFR is a solicitation for potential Integrated Care Organizations, or ICO’s, that will manage the integration of services and payment for dual eligibles aged 21-64. The Home Care Alliance is holding a special event for all agencies interested in this initiative. Please see the event in our Calendar section titled “Building Partnerships with Managed Care Plans for Dual Eligible Care” where special guest speakers will educate attendees on the demonstration and how agencies can play a key role. Potential ICO’s have also been invited for discussion and networking.

For those interested in viewing the  solicitation and corresponding materials, the instructions are below:

1)  In your browser, enter the URL for the Commonwealth’s procurement web page: www.comm-pass.com.

2)  Near the bottom of the page, click on the hyperlink that reads: “Search for Solicitations.”

3)  When the Search page comes up, scroll down to the section that says “Search by Specific Criteria” and in the document number box, enter the following: 12CBEHSDUALSICORFR.

4)  The Search result will appear as a hyperlink at the top of the new page. It should read: “There is 1 solicitation(s) found that match your search criteria.”  Click on this sentence and it will take you to the Comm-PASS listing for this solicitation.

5)  Click on “view” (the eyeglasses on the right) and you will get the summary page for the Request for Responses for Integrated Care Organizations.

6)   Click on the blue folder-type tab called “Specifications” and you will see the RFR documents and appendices that have been posted for this topic. In addition, the required forms that Respondents to the RFR will need to provide are available under the “Forms and Terms” tab.  To view the documents, click on the eyeglasses to the right of the title of each document,  .

The documents will also be posted shortly on our duals demonstration website, www.mass.gov/masshealth/duals, under “Information for Organizations Interested in Serving as ICOs.”

Responses to the RFR will be due to MassHealth by 4:00 PM (EDT), July 30, 2012.

Return to www.thinkhomecare.org.

HCA Achieves Gains for Home Care in House Health Care Bill

With the passage of a major health care payment reform bill by both the state’s senate and house of representatives, the Alliance will advocate for the successes gained in each version as the proposals advance.

In the recently passed House version, the Alliance was successful in advocating that home health and hospice services are included in the definition of “health care services” under an Accountable Care Organization able to accept global payments.

Other provisions achieved, include:

  • An amendment to strengthen the relationship between Patient-Centered Medical Homes and federally-certified home care agencies by ensuring that those agencies are available through the medical home to provide “after-hours” availability to home care patients.
  • An amendment that  improves the state’s “fair share contribution” calculation for determining an employer’s percentage of insured workers. With this amendment, any employee insured through a spouse, parent, Medicare/Medicaid, a veterans’ plan or disability plan would NOT be counted towards the employer’s test by the state and thus reduces the chance the employer would have to pay the “fair share contribution” penalty ($295 per employee).
  • An amendment adding “a community-based organization or group of community-based organizations” to those entities available to receive funding from the Prevention and Wellness Trust Fund.
  • An amendment ensuring that community-based behavioral health providers are included in the state’s health information technology planning process and that providers who serve high proportions of public payer clients will be given priority in receiving funding through a “health information technology revolving loan fund.”

The Alliance will continue to advocate for these provisions, in addition to those gained in the Senate, which can be seen in our blog post on the Senate’s passage of their payment reform bill.

Return to www.thinkhomecare.org.

 

House Releases Health Care Payment Reform Legislation

Nurses Hall in the State House was crowded with attendees eager to hear highlights of a long awaited bill on health care payment reform.

House Speaker Robert DeLeo and the Health Care Financing Committee’s House Chair Representative Steve Walsh announced their proposal that will be followed soon by a Senate version that will transition the state away from fee-for-service payments.

During his speech, Chairman Walsh said that the bill would save the state $160 billion over fifteen years and would bring full health IT interoperability to Massachusetts within five years. Accountable Care Organizations are not mandated, but are among options that providers can shift into from the current fee-for-service model. Chairman Walsh, in fact, mentioned four payment options that providers can choose: bundled, episodic, global and the patient centered medical home. He added that if there is an innovative model that does not include fee for service payments, a provider or provider group is welcome to bring that to the table as a proposal. Chairman Walsh also mentioned home health during his State House speech in reference to workforce development and although home care was not specifically mentioned in that section of the bill, it appears there would be an opportunity in the form of pilot projects and future policy recommendations.

At a quick glance, here are some other notable sections concerning home care:

  • Section 60: the Home Care Alliance is mentioned by name as having one representative on a special committee that will make recommendations on behavioral health services (page 67).
  • Section 105: Insurance coverage of physician assistant care is established “for purposes of health maintenance, diagnosis and treatment,” which includes “home care setting” as a covered benefit (page 128).
  • Section 109: The bill creates a new medical malpractice section that puts “home health agency” in the definition of a facility (page 133).

News outlets are beginning to release articles on the bill, including this story on Boston.com.

The Home Care Alliance will provide updates and more information as the bill continues to be examined.

Return to www.thinkhomecare.org.

Keeping It Legal, Part 2: Patient Choice

Building on a previous document called “Keeping It Legal” that focuses on what providers need to know when referring patients to home health care, the Home Care Alliance is releasing a series of documents on other legal issues related to the industry.

This new document in the series focuses on “Patient Choice” and what rights a patient has under the Medicare and Medicaid programs.

See the article: Respecting Patient Choice and the Rights of Medicare Patients

Drafted by Robert Markette, Jr., CHC – Of Counsel for Benesch Friedlander Coplan & Aronoff LLP, the Home Care Alliance is pleased to make this series of resource documents available. Agencies are encouraged to pass these documents along to partnering providers and pertinent agency staff to ensure that they are aware of the rules and regulations.

Return to www.thinkhomecare.org.

 

Advocacy Alert: Contact Your State Rep. Today to Support Home Care in FY13 Budget

The Massachusetts House of Representatives begins work on their version of the FY13 State Budget today and the Home Care Alliance needs your help sending emails to support home care’s priorities!

Visit our Legislative Action Center or see the issues below to send any of the pre-written messages that concern you and your agency. It only takes ONE MINUTE to enter your contact information, review your information, and the system will automatically send the message to the state representatives for your area.

Urge your state representative to support the following issues:

Restore Home Health Rates

»  Write Your Legislators    »  Read About This Issue  

Support Telehealth Reimbursement from MassHealth

»  Write Your Legislators    »  Read About This Issue  

Support Certificate of Need for Home Care

»  Write Your Legislators    »  Read About This Issue  

Support Pediatric Home Care

»  Write Your Legislators    »  Read About This Issue 

OR

Compose Your Own Message

»  Write Your Legislators

 

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New Web Resource Available on Dual Eligible Demonstration Projects

Massachusetts is leading the charge with a plan to integrate care for dually eligible individuals and most other states have plans to improve care for that population under an Affordable Care Act Program.

A new web resource has been made available from the National Senior Citizens Law Center (NSCLC) that is a one-stop shop for all information about all the states involved in creating a new service delivery plan for the dually eligible.

The new website is dualdemoadvocacy.org and it consists of recommended background reading, state profiles, and advocacy tools. All of these resources are meant to promote the position of NSCLC, but they are general views that are in the best interests of the individual receiving services. Additionally, those views are in line with preventing unnecessary hospital admissions and keeping people in the community whenever possible.

The site also allows people to comment on NSCLC’s specific recommendations.

The Home Care Alliance is continuing its advocacy on the Massachusetts proposal and will provide more information as it becomes available.

Return to www.thinkhomecare.org.

Reminder: Submit Direct Service Worker Survey to EOHHS

Any home care agency receiving Medicaid funding to deliver services under the state’s Home Care Program is encouraged to fill out the Direct Service Worker Employer Survey distributed by the Executive Office of Health and Human Services (EOHHS).

The survey is a collaborative effort between EOHHS, the Home Care Alliance and the Mass Council for Home Care Aide Services. The survey itself is intended to collect state-specific data on the home and community-based direct service workforce including volume, stability, wages and compensation.

An online version of the survey is available. To access the online survey please go to https://www.research.net/s/MA-DSW-Employer-FE and type in your unique survey ID as provided in packet mailed to agencies by EOHHS.

If you have lost your survey packet with your unique survey ID or if you have any questions about the survey, please contact the Direct Service Workforce Resource Center toll-free at 1-877-822-2647.

More information is also available in this newsfeed post announcing the survey.

Return to www.thinkhomecare.org.