The Rundown – October 2022

Federal Recap

Jake Krilovich flew down to D.C. to meet with members of the Massachusetts delegation to gain their support for The Preserving Access to Home Health Act of 2022, which would delay CMS’s from implementing their proposed 7.69% payment cut, and an additional $2 billion in “clawback” cuts to home healthcare services. We are happy to report that Congressman McGovern will be signing onto the bill, marking the first member of the Massachusetts delegation to co-sponsor the bill. We want to thank everyone who took the time to reach out to their Member of Congress asking for their support of this important bill.

In superficial news, House Speaker Nancy Pelosi said in early September that the House would work to introduce and pass a bill that would place new restrictions on lawmakers stock trading abilities. To absolutely no one’s shock the bill that was introduced received weak support from legislators on both sides of the aisle, killing any prospect of a stock trading bill in the near future. Who would have thought that lawmakers who currently subjected too little to zero oversight/penalties for the stocks they purchase, would be open to more regulations on their actions. Both Republicans and Democrats have been under constant scrutiny over the last couple years for their sometimes-blatant conflict of interest when it comes to buying stocks. As an example, 4 legislators  sold stocks in early 2020 after private briefings on the risks of a coronavirus outbreak in the United States. An analysis by The New York Times showed that from 2019 to 2021, 97 representatives and senators or their immediate family members reported trades of stocks, bonds or other financial assets that could have been influenced by committees they were serving on. Abigail Spanberger (D-VA-7), leading proponent of banning trading by members of Congress called out party leadership for not supporting a stock trading bill more aggressively. Rep. Spanberger called the delay an example of why her party needed new leaders in Congress, branding it “a failure of House leadership.”

I’m livin’ life, do or die, what can I say I’m 23 now, but will I live to [own a home]? The way things is going, I don’t know”– Coolio (RIP the legend). The Biden administration and legislators have been closing following the Federal Reserve’s (Fed) continuous interest rate hikes, which they say is to combat rising inflation. The Fed raised the federal funds rate again in September by .75 percentage points, bringing the benchmark rate to a range between 3% and 3.25% for the first time since 2008. The increase interest rates have caused the housing and stock market to plummet over the last month, with the S&P tumbling down 9.3% in September and average mortgage rate to sky-rocket over 6%, the highest since 2008. Increased interest and mortgage rates have made the prospect of younger people owning homes a pipe dream with no immediate hope around the corner.

Finally, just before the end of school bell was about to ring, legislators quietly (maybe too quiet) struck an agreement on short-term spending measure before a midnight deadline to avoid a government shutdown. Only 10 Republicans voted in favor of the bill along with all Democratic members of the House. The Senate had approved the measure a day earlier, on September 29. The agreement funds the government through December 16th, when Congress would be hoping to pass an omnibus bill to fund the government for fiscal year 2023. The stopgap measure includes $12.3 billion in emergency economic and military aid for Ukraine, $1 billion in heating assistance for low-income families through the Low-Income Home Energy Assistance Program, $20 million for the water crisis in Jackson, Mississippi, billions in disaster aid, and over $112 million for federal court security.


As I walk through the valley of the shadow of death, I take a look at my life and realize [just the campaigns are left]” – Coolio (couldn’t resist). October marks the final stretch of campaigning for the upcoming midterm elections in November. One more month of having to endure annoying campaign ads during commercials breaks of the Patriots games (is it just me? or is everyone else also getting ads for New Hampshire races). A year ago, experts widely predicting a red wave to crash the elections with Republicans winning both the House and Senate easily, but that is no longer the case. Recent polls have shown that Democrats have scraped their way back in both the House and Senate races. Polls show that Republicans are only slightly favored to take back the House while in a shocking turn of events Democrats are slightly favored to hold control of the Senate (Herschel Walker has some explaining to do to his party). But if 2016 taught us anything it’s that we need to take all polls with a grain of salt. These are only projections; at the end of the day no one really knows what will happen on election day.

We are continuing to focus our attention on CMS’s annual proposed rule for Medicare home health services, that included a proposed 7.69% permanent cut, and an additional $2 billion in “clawback” cuts for CY2023. While we are excited that Congressman McGovern signed on, we need to keep the momentum going. HCA will continue to work with members of the delegation in hopes to get more members to sign on with Congressman McGovern. We need your help to get this bill over the finish line. Power comes in numbers. We are asking everyone to continue to reach out to their member of Congress to urge them to support this bill. Please use this action alert to write to your member of Congress urging them to support the Preserving Access to Home Health Act of 2022.

Lastly, Jerome Powell, Chair of the Fed, signaled the Feds plan to lift interest rates by another 1.25 percentage points before years end, which would bring the federal funds rate to 4.25-4.5% just in time for holiday shopping. Considering the Fed only has two meetings left, that could mean another 75-basis point hike in November followed by a half-point increase in December. Looking even farther into the future, the Fed is bracing to lift rates to 4.5-4.75 percent by next year. Six officials, however, see rates soaring to 4.75-5.0 percent in 2023, which would be the highest since 2007 if it comes to fruition. On Monday the United Nations warned that the Fed and other central banks risk pushing the global economy into recession followed by prolonged stagnation if they keep raising interest rates. The agency estimated that a percentage point rise in the Fed’s key interest rate lowers economic output in other rich countries by 0.5%, and economic output in poor countries by 0.8% over the subsequent three years.

State Recap

Extra! Extra! Read all about it! The Home Care Alliance was quoted in two recent articles that were published by State House News and the Commonwealth about the Enough Pay to Stay legislative add-on rates and the Home Care Alliances fight for better base rates through the upcoming rate review for home health aides. The Home Care Alliance is working tirelessly to grow awareness for the need for a proper rate review and for base rates to be increased to a level that can sustain the industry that allows for providers to meet growing demand for services.

Like the Red Sox, things in Massachusetts State House were mostly quiet in September. State legislators continue their never-ending negotiations on a final economic development bill. the $4 billion package includes amongst other provisions, $1 billion in tax rebates and reforms. Senate budget chief Michael Rodrigues told 1420 WBSM this week. “I do expect we will [be] able to pass an economic development bill in the neighborhood of maybe $2.5 billion,” Rodrigues said, forecasting a bottom line lower than the combined surplus and American Rescue Plan Act spending in the original bill.

Governor Baker has spent the last month on a press tour as he plans to leave office when his current term ends. This past week Baker made his final annual address to the Providers’ Council, highlighting all he has done over the last 8 years. Baker highlighted  the saga he went through as a candidate for governor and then as governor to increase Chapter 257 provider rates. “Chapter 257 was enacted in 2008 and it’s just a bunch of letters and numbers. But it was supposed to be a framework and that framework was supposed to ensure that human service organizations were adequately funded from that point forward. It didn’t get funded in 2009. It didn’t get funded in 2010 — by the way, those of you who have really long memories, when I ran for governor in 2010 I said we would fund Chapter 257,” Baker said. “It didn’t get funded in ’10, it didn’t get funded in ’11, it didn’t get funded in ’12, it didn’t get funded in ’13 and, in fact, by the time we were all running for office in 2014, the provider community was spending precious resources on a lawsuit to force the commonwealth to implement its own statute and live up to the requirements and the commitments that were made in Chapter 257.” By May of 2015, Baker said his administration had struck an agreement with providers that laid out the state’s commitments very specifically. “And that agreement has paid off,” Baker said, adding that his administration has overseen $813 million in incremental rate increase for human service providers through Chapter 257 since 2015.

Last month I reported that the MBTA shut down the orange and green line for a full month, and that I was highly skeptical that it would re-open in a month like they promised. Well I was wrong….. but not fully. Both the orange and green line re-opened a month after closure as promised, but with limited service. And by limited, I really mean limited. As someone who takes the orange line to work. Missing your train means the difference between being on time and being 20 minutes late to work. MBTA is still suffering from massive labor shortage which has caused them to reduce services. MBTA also has not thrown out the possibility of closing other lines for further repairs.  So technically things are better with the T, but I think that just goes to show how bad things have been recently.

A report released on in September by the Massachusetts Health Policy Commission (HPC), an independent state agency charged with monitoring health care spending growth in Massachusetts, showed a surprising drop in health care spending in Massachusetts in 2020 for the first time since implementation of a landmark cost control law in 2012. HPC report shows that from 2019 to 2020, statewide total health care spending per capita fell 2.4 percent, bucking seven straight years of annual growth, while total health care spending per capita also decreased nationally in 2020, but at a smaller drop of 0.3 percent compared to the 2.4 percent drop in Massachusetts. HPC officials contend that this downward trend is only an anomaly and that they do not view the shift as meaningful progress toward containing prices. The spending growth that dominated recent years is “likely to continue” on an upward trajectory in 2021 and beyond, HPC analysts wrote in their report.


Just like I reported in my piece last month, everyone will be focusing on the upcoming elections in November. Everyone will be watching the race between Democrat Maura Healey and Republican Geoff Diehl for Governor.

Healey, 51, currently serves as attorney general, a position she’s held since 2014. If elected Healey would be the first woman elected governor in the state’s history. Diehl, 53, is a former state House Representative, who unsuccessfully challenged Senator Elizabeth Warren for her Senate seat in 2018. Originally from Texas, Diehl has the backing of the state Republican party along with Trump’s. Diehl is considered a more moderate alternative for Republican voters in the primary.

With everyone focusing on the upcoming election and the state legislator currently in informal session, I do not expect much action to happen at the state house in October. At most we would see movement on the economic development bill and possibly (I can only hope) the announcement of when sports betting will becoming legal in Massachusetts.  It’s been two months sense a Governor Baker signed a bill allowing for sports better and regulators are yet to come up with a timeline for when legal wagering might start in Massachusetts. In the meantime, everyone will just have to survive on fantasy sports and survival pools.

HCA will continue to closely track bill that are important to our industry, including the Licensure bill (H.4471) and a rate setting bill (S.774). While the chances are low, HCA has been meeting with legislators and their staff to urge them to take up and pass these bills during informal session. We will provide updates on the bills as needed.

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