Tag: Medicare

Health Care Reform and Home Care: What We Know Today

On Sunday, March 21st the US House of Representatives passed historic Health Care Reform Legislation.   The bill that passed is that which emerged from the Senate Finance Committee and that passed the Senate at the end of 2009.   As has previously been reported,  the Senate version of reform has been – for home care – less damaging than bills that had previously passed the House. While indications are that there may be some changes to Medicare provisions in the “reconciliation” bill being debated this week in the Senate, there is no indication that there will be changes to the home care language.  What we should expect for home care will be:

• A delayed and phased approach to rebasing of home health payments (rebasing would begin in 2014 and be phased in over four years, as compared with the House’s proposal of complete rebasing in 2011);

• Rejection of the Medicare Payment Advisory Commission’s proposed acceleration to 2010 of the 2011 case-mix creep adjustment;

• Preservation of the full market basket update for 2010, with 1 percentage point reductions off the market basket in 2011, 2012, and 2013

• Reinstatement of the rural payment differential (add-on) at 3 percent from April 1, 2010 until Jan. 2, 2016.

The federal long term care program – the CLASS act – is in,  as are demonstration and pilot programs for providing chronic care management, transitions in care, and post-acute care management.  All of these should involve home care.

Additionally, effective in 2014, employers of more than 50 people will be required either to provide coverage or pay a penalty for not offering health insurance to employees. (It is unclear at this point how federal insurance mandates will be handled in relation to the Massachusetts mandates already in place.)

The National Association for Home Care has called the bill “a combination of new opportunities for home care — and threats to the viability of the home health services community.”

With many of the home care cuts  delayed, and demonstration projects to help shape, we will need every voice in Washington to make sure our issues continue to be heard above the continuing health care reform roar.

MA Home Health Agencies Excel in Medicare Demo Project

As a result of their efforts to achieve measurable improvement goals in patient health and quality of life, eighteen Massachusetts home health agencies received a share of a federal performance pool of $15.4 million, which is also the national Medicare savings attained through the project.

For more information, see the Alliance’s press release.

Return to www.thinkhomecare.org.

McGovern Sends Delegation Letter Requesting Meeting with CMS on TPL

Congressman Jim McGovern has sent a letter to CMS Acting Director Cyndy Mann with a request that Mann meet with him and the Home Care Alliance on continuing the Third Party Liability (dual eligible) demonstration project.

The demonstration allows decisions about the appropriate payer for home health services to Medicare/Medicaid dual eligible elders to be handled by a 200 case sampling rather than a case by case review.

“Annual review of two hundred cases per state has been a better systemic solution than previous practices in which thousands of cases, with immense red tape, make their way through multiple levels of review and appeal,” said the McGovern letter.

Joining Congressman McGovern in signing on from the Massachusetts Congressional Delegation were Representatives Capuano, Delahunt, Frank, Lynch, Markey, Olver and Tsongas.

MassHealth administrators have also written to CMS this week, urging that the demonstration project be extended.

The demonstration has been a tri-state effort with New York and Connecticut, whose associations have been working hard advocating for an extension as well.

Return to www.thinkhomecare.org.

NAHC Opposes So-Called Super MedPAC in Senate Bill

The National Association for Home Care & Hospice (NAHC) reported that the recently-approved Senate version of health care reform, the Patient Protection and Affordable Care Act, includes a provision to establish an Independent Payment Advisory Board (IPAB).

According to NAHC, the 15-member board’s primary task would be to make recommendations to Congress on extending the solvency of and slowing cost growth in Medicare, beginning in 2015 and forward. The Congressional Budget Office (CBO) estimates that the IPAB proposal would save $28.2 billion over 10 years.

Based on conditional Medicare spending triggers, IPAB recommendations would take effect unless Congress proposed an alternate plan. The provision in the Senate bill also requires that IPAB submit proposals to contain Medicare cost growth to the president, who in turn must submit proposals to Congress for immediate consideration. IPAB would be prohibited from submitting proposals that would ration care, increase revenues, or change benefits, eligibility, or Medicare beneficiary cost-sharing (including Parts A and B premiums). NAHC believes  it is likely that the reductions would have to come from reimbursement rates for health care providers.

NAHC stated that they oppose this provision because it gives IPAB too much power and the 15-member board, appointed by the President, would be unlikely to have strong representation from home care and hospice. Nahc also stated that they have expressed their concerns to Senate and House leadership.

Visit our Legislative Action Center to write your own message to your federal representatives to voice your thoughts on this provision and send one of the pre-written messages to oppose cuts to home care.

Return to www.thinkhomecare.org.

Senate Passes Health Reform

See the following reports, including a video from CNN, on the Senate passing health reform. The vote was 60-40 along party lines as the Democrats were able to secure their necessary majority.

The bill still includes tens of billions in cuts to Medicare home health payments, although re-basing is delayed until 2014 and Senator John Kerry’s amendment to reduce the cuts by nearly $5 billion was included.

The Boston Globe

Elated Senate Democrats won the first critical procedural vote required to advance major health care legislation just after 1 a.m. this morning, one of four votes required this week to pass the proposal by their self-imposed Christmas deadline.

New York Times

The Senate bill, once completed, must be reconciled with the bill adopted by the House last month, and there are substantial differences between the two. The House measure, for instance, includes a government-run health insurance plan, or public option, that was dropped from the Senate bill.

UPDATE: Senate officially passes reform on Christmas Eve. See this story for more details.

Return to www.thinkhomecare.org.

Alliance to Lead State in National Quality Campaign

With federal and local health reform efforts focused on improving quality and cutting costs, The Home Care Alliance of Massachusetts will be the state leader in a new national campaign to reduce avoidable hospitalizations and improve management of oral medications though home health care.

Performed in partnership with the Centers for Medicare & Medicaid Services (CMS), a new and improved Home Health Quality Improvement (HHQI) National Campaign will launch January 13, 2010. As a HHQI Local Area Network of Excellence (LANE), the Home Care Alliance of Massachusetts is the central hub of campaign activity in the state.

See the Alliance press release on the HHQI campaign.

In 2007 and 2008, more than 5,500 home health agencies enrolled in the first HHQI National Campaign. Together they learned, shared best practices, and improved the care provided to their patients.

Return to www.thinkhomecare.org.

CBS News: Elderly Fear Medicare Cuts

Focusing on the importance of home health care, CBS News reported on the potential cuts to services that help keep patients independent in their own homes.

The story points out how the proposed cuts disproportionately impact home health. According to the CBS News report, home health services make up less than 4 percent of Medicare spending but would account for about 10 percent of Medicare “savings” in both the House and Senate bills.

To send a message opposing these harmful cuts to your federal representatives, please visit our Legislative Action Center.

Return to www.thinkhomecare.org.

NY Times: Home Care Patients Worry Over Possible Cuts

An article front and center on the New York Times website on December 4 focused on the potential cuts to home health Medicare payments in the health care reform debate.

The story is an excellent summary touching upon the political, financial, and, most importantly, the human side of the issue. It also presents the confusion that is experienced by those who work in, and are served by, the home health industry who are aware of its cost-efficiency, among other benefits:

The proposed cuts appear to be at odds with other provisions of the giant health care bills. A major goal of those bills is to reduce the readmission of Medicare patients to hospitals. Medicare patients say that is exactly what home care does.

Return to www.thinkhomecare.org

More OASIS-C Updates

We’ve posted PDF-version of three PowerPoint presentations from CMS OASIS-C implementation calls on the OASIS-C page.

Return to www.thinkhomecare.org.

Fearless Caregiver Family Checklist

Gary Barg, Editor-in-Chief of Today’s Caregiver Magazine sent out the following article titled “The Most Loving Gift” in his latest newsletter. For more information on the magazine and caregiver issues, visit caregiver.com.

The Most Loving Gift

My dad retired at the age of 61 in 1990. He looked forward to working with my mom in the new business that they had just opened, traveling, singing with friends (not necessarily singing well, but enjoying every minute) and seeing what life had to offer. Unfortunately, life did not have much to offer past the first few months of his retirement. One summer day, my mom noticed a strange bump on my dad’s head and they went to the doctor to check it out. His doctor called a few days later and, although it was the beginning of the Fourth of July weekend, told them to check into the hospital immediately.  Dad had an aggressive case of multiple myeloma and passed a year later.  The first days after his diagnosis were hectic as Dad’s condition progressed rapidly and he was not able to communicate with us either his wishes or where his important documents were located.  We learned (as many families do) the hard lessons the hard way and developed a simple list to help start the conversation with loved ones.

Fearless Caregiver Family Checklist
The most loving gift a person can give to one’s family is to put your affairs in order before a disaster or medical emergency. To assist in providing that gift, we have compiled the following list. The information and documents you should have prepared include:

  • All bank accounts, account numbers and types of accounts, and the location of banks.
  • Insurance companies, policy numbers, beneficiary as stated on the policies and type of insurance (health, life, long-term care, automobile, etc).
  • Deed and titles to ALL property.
  • Loan/lien information, who holds them and if there are any death provisions.
  • Social Security and Medicare numbers.
  • Military history, affiliations and papers (including discharge papers).
  • Up-to-date Will in a safe place (inform family where the Will is located).
  • Living Will or other Advanced Directives appropriate to your state of residence.
  • Durable Power of Attorney.
  • Instructions for funeral services and burial (if arrangements have been secured, name and location of funeral home).

Happy Thanksgiving and may the easy lessons be yours.

Return to www.thinkhomecare.org.