2015 Private Care Guides Now Available

Three editions, for your convenience.

Every day, home care agencies help tens of thousands of Bay Staters live safely – and better – at home. Though health insurance and public programs like Medicare often pay for home care following hospitalizations or during acute illnesses, they do not typically cover chronic or supportive home care services. Private duty home care agencies, however, specialize in these situations.

In order to help connect agencies who provide private home care with the families who need their services, the Alliance is pleased to announce the publication of the 2015 editions of the Guide to Private Home Care Services, which will begin shipping next week.

As like last year, the Guide is split into three regional editions:

The county-by-county cross-references help you easily find local care, and the short essays inside will give you all the information you need to make the best decision for those you love.

All members will receive copies in the mail over the next few weeks. Additional copies are available for order through the links above, and — as always — at no charge for orders of 50 or fewer. Anyone needing a more detailed directory of home care agencies might consider our 2015 Resource Directory, which includes a detailed town-by-town index of 187 agencies from every corner of the state.

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.

Advocacy Alert: Urge FY16 Budget Conference Committee to Support Home Care

The House and Senate have formed a six-member “conference committee” that will merge the two budget proposals into a final fiscal plan for the state. Agencies and advocates can help get home care included in the reconciled budget by sending a message to the committee.
Work is ongoing, but must be completed by the beginning of the new state fiscal year on July 1st so time is limited to send an email. The House Conference Committee members are Representatives Brian Dempsey (D-Haverhill), Stephen Kulik (D-Worthington), and Todd Smola (R-Warren) while the Senate  members include Senators Karen Spilka (D-Ashland), Sal DiDomenico (D-Everett), and Vinny deMacedo (R-Plymouth).
Specifically, the Home Care Alliance is pushing the inclusion of a special commission to study state oversight options and minimum standards for private pay home care agencies. The Alliance is also supporting other amendments to expand access to home care services for seniors and also to create a comprehensive and collaborative state plan for Mobile Integrated Health.
The message itself can be viewed before sending and outlines the items that the Alliance is supporting. They include the following:
  • Senate Outside Section 90 as amended: Private Home Care Agency Study
    • Private-pay home care agencies across the state that provide mostly non-medical support services in the home have no state oversight and a study commission is needed to determine the best solution.
    • This commission will make recommendations on licensure standards and potential quality measures that will protect consumers and create a level playing field in the industry.
  • House Amendment #336: Mobile Integrated Healthcare
    • Recognizing the success and utility of existing “community paramedicine” programs on a smaller scale, this language ensures that the Department of Public Health and stakeholders in the public safety and healthcare communities convene to determine the best possible model of “mobile integrated health” for Massachusetts.
  • Senate Amendment #747: Expanding Eligibility for Home Care Services
    • This language raises the Elder Affairs home care program income eligibility limit to 300% of the federal poverty level ($35,010 in CY 2014), and requires all home care enrollees who are not on MassHealth to make a copayment towards the cost of their services on a sliding fee basis.
    • The program currently has a top income limit set at 224% of the FY 15 federal poverty level ($26,561). Raising home care to 300% of FPL allows the program to serve the “near poor” who are currently excluded.

Return to www.thinkhomecare.org.

Senate Ways & Means Budget Includes Wins for Home Care

The Home Care Alliance is proud to announce that the Senate Committee on Ways & Means included language for one of the organization’s priority issues that will help strengthen private-pay home care.

An “outside section” in the Senate Ways & Means Committee budget establishes a Commission to study and make recommendations for state oversight options for private-pay home care agencies. The language closely mirrors what the Alliance proposed. Also, it represents a huge step towards attaining not just minimum standards and consumer protection, but greater recognition that private pay home care is an option for families and individuals who need assistance.

Other positive notes came from the Senate’s proposed budget as well. The line item funding the Pediatric Palliative Care Program was increased by $250,000 over what the House approved. The Mass. Department of Higher Education’s “Nursing and Allied Health Workforce” line item was allotted $200,000 after being zeroed out by the Governor and matches the House’s appropriation.

ma budget pie chart picThe Senate also included $150,000 in funding for the “Home and Community-Based Services Policy Lab,” which aims, in part, to study the effectiveness and value of state-funded community-based services.

In the elder services category, the Senate’s proposed budget ups the House in the Home Care Purchased Services account by $3 million along with an additional $866,677 in the Home Care Case Management and Administration account. The other notable increase from the Senate Ways & Means budget is in the elder nutrition program (meals on wheels), which came in $121,889 above the House.

In MassHealth, both the Managed Care and the Senior Care accounts were level-funded. The Senate increased the MassHealth Fee-for-Service line item, which has traditionally governed home health nursing rates, by $481.5 million over the House. However, without specific language for home health included, it would appear an amendment needs to be proposed to raise those MassHealth payment rates.

Outside sections that are mentionable include language to create a “MassHealth savings report” that aims to find savings and cash management strategies in the Executive Office of Health and Human Services budget by October 1, 2015. There is also a commission established to oversee the Center for Health Information and Analysis, whose mission it is to be the clearinghouse for quality, affordability, utilization, access, and outcomes information of the state’s health care system.

The Alliance will look to propose amendments to increase MassHealth rates for home health aides along with restoring skilled nursing rates from the 2008 payment cut. The Alliance also plans to play a supporting role in raising wages for homemakers and creating transparency on federal healthcare reform funding.

Stay tuned for advocacy alerts with details on sending emails urging your state senator to support home care in the state budget.

Return to www.thinkhomecare.org.

House Approves Budget Plan with Little Support for Home Care

This week, the Massachusetts House of Representatives quickly buzzed through nearly 1,100 amendments to their FY2016 budget proposal and came out with roughly $38.1 billion spending plan.

The House included little from all corners of the advocacy spectrum and the same was true for home care. None of the Home Care Alliance’s priority items and many of those the organization supported were not advanced so HCA will be among many groups relying on the Senate to step up when their budget plan comes out early next month.

Among the items that were approved and supported by the HCA was an initiative to shape a comprehensive Mobile Integrated Health plan for the state, which named the Alliance to an advisory panel for that effort.

Also, $200,000 was approved for the Department of Higher Education’s “Nursing and Allied Health Workforce” account that has, in the past, spurred a home care nurse residency program. The Governor’s budget had zeroed out that line item.

Other notable items approved in the House budget include the following:

  • $8.8 million increase for MassHealth Nursing Home Supplemental Rates.
  • $500,000 for a pilot program in the “greater Quincy area” to implement a model of field triage of behavioral health patients under medical control by specially-trained emergency medical services providers and transport of appropriate, non-medically complex patients to a behavioral health site of care for most effective treatment rather than to an acute hospital emergency department.
  • $50,000 to establish Financial Abuse Specialist Teams (FAST) to improve the ability of elder protective services programs to investigate and respond to reports of financial exploitation.
  • $750,000 for the Meals on Wheels program, which brought that item to $7.1 million – still below the Governor’s proposed funding for that initiative.
  • A prospective, global payment pilot program established under MassHealth under which Medicaid contracts with risk-bearing provider organizations for the provision and coordination of health care services for their attributed members beginning not later than September 1, 2016. The pilot would require that such risk-bearing provider organizations shall be able to provide coordinated care through the provider’s network of primary care providers and that such providers shall have experience and demonstrated capabilities to provide behavioral health services including psychiatric and substance abuse beds. Under the proposed program, Medicaid shall reimburse such providers on a prospective monthly basis provided that these organizations obtained a risk certificate or a waiver from the Division of Insurance.

Stay tuned to learn more about HCA’s advocacy around the Senate budget process and how you can weigh in to support better rates for visiting nurses, home health aides, and other workers along with establishing a commission to study private pay home care oversight options.

Return to www.thinkhomecare.org.


Paid Sick Time Proposed Regs Need Comments from Home Care Agencies

The Attorney General’s office released proposed regulations for the paid sick time law passed via ballot question and due to be effective on July 1, 2015.

The law essentially states that workers employed by companies with eleven or more employees can earn and use up to 40 hours of paid sick time per calendar year, while employees working for smaller employers can earn and use up to 40 hours of unpaid sick time per calendar year.

A full summary of the law, along with the proposed regulations and a list of public hearing dates are available on a special “Earned Sick Time” webpage on the Attorney General’s website. Associated Industries of Massachusetts (AIM) conducted a quick analysis of the draft regulations posted on their blog.

The Alliance will be testifying on these regulations at the Boston hearing on May 18th so the Alliance strongly encourages home care agencies to review the draft regulation and send comments to James Fuccione so the HCA can formulate testimony. We further encourage agencies to attend and comment at the other hearings and listening sessions to be held across the state and to notify HCA if you’re planning to do so in order for the comments to be consistent.

A full list of the hearing dates and locations are below:

Friday, May 8, 2015
Brockton Listening Session
Location: Brockton Public Library
(304 Main Street, Brockton, MA 02301)
Time: 10:00 am – 1:00 pm

Monday, May 11, 2015
Salem Listening Session
Location: City Hall Annex Building, 3rd Floor Conference room
(120 Washington Street, Salem, MA)
Time: 10:00 am – 1:00 pm

Friday, May 15, 2015
Lowell Listening Session
Location:  Lowell  Lowell Federal Building
(50 Kearney Square, Lowell, MA)
Time: 10:00 am – 1:00 pm

Monday, May 18, 2015
Boston Public Hearing
Location: Saltonstall Building, 2nd floor Conference Rooms C & D
(100 Cambridge Street,  Boston, MA)
Time- 10:30 am – 1:30 pm

Friday, May 22, 2015
Framingham Public Hearing
Location: Framingham Town Hall, Memorial Building, Ablondi Room
(150 Concord Street,  Framingham, MA 01702)
Time: 10:00 am – 1:00 pm

Friday, May 29, 2015
Springfield Public Hearing
Location: 1350 Main Street – 3rd Floor Community Room
Time: 10:30 am to 1:30 pm

Friday, May 29, 2015
Pittsfield Public Hearing
Location: Pittsfield City Hall – Council Chambers
(70 Allen Street, Pittsfield, MA)
Time: 10:00 am – 1:00 pm

Monday, June 1, 2015
Fall River Public Hearing
Location: City Hall: 1 Government Center – The Hearing Room
(1 Government Center, Fall River, MA 02722)
Time: 1:30 pm – 4:30 pm

Friday, June 5, 2015
Worcester Public Hearing
Location: Main Library- Saxe Room
(3 Salem Square, Worcester, MA 01608)
Time: 10:00 am – 1:00 pm

Return to www.thinkhomecare.org

MA Minimum Wage Regs Clarified by DLS

Responding to comments from the Home Care Alliance, among a list of other interested organizations, the Massachusetts Department of Labor Standards (DLS) released changes and clarifications to the revised minimum wage regulation (454 CMR 27.00).

The full list of comments from advocacy and business groups as well as the official response from the state was made available through the DLS website and in a notice to those that commented.

Here is a summary of comments from the HCA and the repsonses from DLS:

HCA Comment:

Concerning the proposed promulgation of 454 CMR 27.00 and repeal of 455 CMR 2.00, our agencies seek clarification on Hours Worked under section 27.04. It is noted that the employer and the employee may agree in writing to exclude meal periods and a sleeping period of not more than eight hours. It is unclear, however, if those meal periods are in addition to the eight hours of sleeping time. If a home care worker is in the home for a 24-hour period, it should be clearly defined outside of any written agreements pertaining to what time for meals and sleeping is counted and compensable.

DLS Response:

Meal periods are separate from sleeping time. The“not more than eight hours” refers to sleeping time.

HCA Comment:

We would also appreciate clarification of a reasonable length of those meal periods and whether they are permissible even though the worker is required to remain at the work site during the meal break.

DLS Response:

A meal period is bona fide if the employee is completely relieved from duty and is able to leave the
premises. The DLS will respond to inquiries regarding particular circumstances where the employee is unable to leave the work site for reasons outside the employer’s control. If the employee is able to eat a meal but is not relieved from duty, the time must be paid.

HCA Comment:

We have concerns relative to section 27.07 relative to Notice and Recordkeeping. The
discussion about posting a notice in the primary language of a cohort of any 5% or more of the employers workforce raises a question: How do employers discover employees’ primary languages? This appears to violate the rules of the MA Commission Against Discrimination, and moreover, an employee may have the right to refuse to answer.

DLS Response:
In response to comments from employer’s, the section is modified to require the translated notice if the language is commonly spoken among employees at the worksite. The requirement is not overly burdensome for employers since notices in different languages are only required if the translation is available from the Commonwealth.

DLS Change to Regulation:
27.07 is amended: The workplace notice shall be posted in English, and in any other language that is commonly spoken by five percent (5%) or more of the employer’s workforce and for which a translated notice in that language is available from the Commonwealth.

Other comments, responses and changes can be viewed in the DLS summary of testimony.

DLS Posts Notice for Long-Term Care Insurers

As of December 19, the Massachusetts Department of Labor Standards (DLS) no longer requires private-pay home care agencies to register for licenses. Several Alliance members report that DLS has already rejected and returned their licensure renewal applications.  DLS has also posted a notice to long term care insurers on their website in response to concerns raised about recent regulations proposed separately by the Division of Insurance (DOI).

In the absence of a licensure or registration standard, the DOI regulators have indicated they will issue a regulation that leaves the door open to future state oversight policies. The Alliance has spoken with one major long-term care insurance company that has said this change would not have an impact on getting their clients the home care services they need since many states they operate in lack licensure standards as well. The insurer said that they would simply seek a general business license through the Secretary of State’s office and may potentially look to other accreditations and credentials.

The fear that private pay home care agencies would not receive long-term care insurance reimbursement in the void left by the recent DLS regulations appears to be less of a concern that previously believed. However, the Home Care Alliance will continue to monitor the situation and will work with private-pay home care members, the Home Care Aide Council and other organizations in pushing for a solution at the legislative level.

Return to www.thinkhomecare.org.

Federal Judge Strikes Down Portion of DOL Companionship Rule

A federal court ruled yesterday that the U.S. Department of Labor (DOL) violated the Fair Labor Standards Act (FLSA) with its regulation that excluded third-party employers from the application of the “companionship services” and “live-in domestic services” overtime exemptions.

The lawsuit challenging DOL’s new narrowed interpretation of the companionship exemption was filed by the Home Care Association of America, the National Association for Home Care and Hospice (NAHC), and the International Franchise Association.  It was filed in US District Court for the District of Columbia.  The opinion was written by judge Richard J. Leon.  The full text of Judge Leon’s decision is available here.

Yesterday, NAHC’s Vice President for Law Bill Dombi drafted the following questions and answers, which provide further background on the implications of this ruling:

The Overtime Lawsuit: What Does the Court Ruling Mean?
(Source: NAHC)
The decision issued by the federal court on December 22, 2014 is a big win for home care, but much remains to be done to fully preserve the overtime exemptions for companionship services and live-in domestic services. Here are some of the most important things to know to understand the impact of the decision and what it means to home care.
Q.     What did the court rule?
A.     The court ruled that the US Department of Labor violated the plain language of the Fair Labor Standards Act (FLSA) with its regulation that excluded third-party employers from the application of the “companionship services” and “live-in domestic services” overtime exemptions. Home care companies are considered third-party employers. Home care workers employed by the direct consumer of the care or their family members acting as the employer are the only parties that could have used the exemptions under the rule that was invalidated by the court. This does not change any state laws that already limit the exemptions or their application.
Q. Does this mean that home care companies do not have to pay hourly home care aides overtime?
A. No. The regulation also redefined companionship services, limiting that definition to fellowship services and no more than 20% of time on personal care or housekeeping tasks. The lawsuit also challenges that part of the new regulation as well. However, that part of the case has not yet been presented to the court. We are now preparing to do so.
Q. Why wasn’t the definition of “companionship services” presented to the court earlier?
A. A tactical decision was made on how the case would be litigated. If the definitional issue was presented before or concurrent with the third-party employer issue there was a serious risk that the lawsuit could make matters worse for home care companies. If the court invalidated the definition of “companionship services,” but upheld the exclusion of third-party employers from the application of the exemption, home care companies would be outside an expanded exemption. Workers directly employed by the consumer would have qualified for the exemption. That would put home care companies at a cost disadvantage to consumer/employer care. Consumers (and state Medicaid programs) would have bypassed the agency model of care in favor of direct employment to save money.
Q. When will there be a court ruling on the definition of “companionship services?
A. A discussion of that will occur between legal counsel from both sides on December 23. It is hoped that the Department of Labor will agree to a temporary hold on the new rule consistent with its “policy action” under which the government will not enforce the rule for at least six months. To do so, the government only needs to agree that private enforcement will be put on hold as well.
Q. If the government does not agree to hold off on the rule, what happens next?
A. We will then need to go back into court to get a temporary injunction before January 1. That will require that we show that we are likely to succeed on the merits when the court fully hears the case and that home care companies will suffer irreparable harm if the court does not maintain the status quo with the current rule.
Q. What about live-in services?
A. The only substantive change that the new rule made to live-in services is the exclusion of workers employed by third-party employers from the exemption. “Live-in domestic services” is a much broader class of employees that would include personal care and housekeeping workers. As such, the court ruling effectively returns that exemption to it current state. Home care companies would not be required to pay live-in workers overtime unless state law requires such.
Q.     What should we do now in our company?
A.      The best advice we can offer is to “stay tuned” over the next week as much can and will happen to clarify things.  However, it would be prudent to continue to expect to trigger whatever action you planned to take on January 1 in the absence of the court’s decision. Things can change that dramatically, that quickly.
Q.     Will the government appeal?
A.      That is one option open to the Department of Labor. However, they would need to get the federal judge to stay his ruling pending any appeal. If the judge refuses to do so, the government would need to get the Court of Appeals to issue a stay.

While this ruling has no impact on Massachusetts law, we will inform members as additional developments occur in this court case.

Return to www.thinkhomecare.org.


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