|Last week, the Massachusetts Senate Ways and Means committee released its fiscal year 2019 state budget totaling $41.4 billion dollars. Senators had a deadline of Monday to file amendments to the bill, and it will be debated next week. Three Alliance priorities have been filed as amendments. Below are brief descriptions of each, with a link to send a pre-drafted email to your state legislator. The Alliance encourages you to send an email for all three amendments.
Amendment #589: EMAC Assessment Hardship Waiver:
Amendment #560: Enough Pay to Stay Amendment:
Amendment #620: Continuous Skilled Nursing Funding
Do you ever wonder if your phone calls into legislator’s offices’ ever do anything? I certainly do. The feeling that you care so deeply about an issue and fight so hard for it, but that the effort isn’t reciprocated by our elected officials.
Or how about when you hear legislators say, “I’m waiting to hear from constituents on this issue.”… Are they really? Do they actually want to hear from us?
When advocates ask me this, I’m always one to say ‘yes, they do want to hear from you.’ But I also understand how people feel when they see common sense solutions seemingly receive no consideration.
Before I go on, I need to disclose that we have to keep fighting for this particular issue. The legislature could reject the Governor’s proposal. But the advocacy behind the recently proposed Home Care Worker Registry should answer all of these questions above and serve as a model.
As you’ve heard numerous times from the Alliance, the Massachusetts Legislature has proposed and included in its final version of the FY18 budget a Home Care Worker Registry. This registry would require agencies to submit its worker’s private information like gender and home address to the Department of Elder Affairs. We have raised numerous legal and privacy implications for this legislation and have fought throughout the budget process to defeat and modify the language.
Last week, we sent out two advocacy action alerts asking you all to send emails into Governor Baker’s office requesting him to amend this registry language and insert an opt-in option for home care workers to chose whether they want this private information disclosed to agencies, ASAP contractors or employer organizations.
In total, Alliance members sent nearly 150 emails to the governor’s office, and yesterday afternoon we found out that the Governor sent back this section to the legislature offering an opt-in amendment. It was one of 9 sections in the over $40 billion budget that he chose to amend. Think about that for a second…
This is a clear accomplishment that proves these emails and phone calls do matter. That working with coalition partners in sync can make a difference.
But remember, we have work to do on this issue, so please keep an eye out for another advocacy alert that will urge the legislature to adopt the Governor’s suggestions and protect our workers!!
The Home Care Alliance participated in several calls with MassHealth and Health and Human Services on planned budget cuts from Governor Baker’s administration. In total, the Governor announced $98 million in cuts from the $39.25 billion state budget.
Although there are reductions in home health, there are positive rates increases to report.
After years of advocacy by the Alliance and more recent efforts from a coalition of continuous skilled nursing providers as well as a family-based network called the Mass. Pediatric Nursing Campaign, MassHealth informed the HCA that payment rates for Continuous Skilled Nursing will increase by 2.6%. According to MassHealth, this equates to a $2.2 million bump in rates, which will become effective January 1st, 2017.
For the RN and LPN day and night rates, the increase hovers around a $1 boost in what those agencies currently receive. The Alliance, along with the provider coalition and family-based campaign, will continue to advocate for further adjustments to continuous skilled nursing rates in the upcoming FY18 state budget cycle.
As for home health skilled nursing rates outside of CSN, payment will be reorganized by the length of service of the MassHealth member. As of July 1, 2017, MassHealth is planning to break up the current skilled nursing rate for home health agencies into three separate tiers. The first tier will be for patients on services from day 1 through 30, which will be increased from $86.99 to $89.21. The second rate tier will be 31-180 days and the third rate tier is any home health service beyond 180 days.
MassHealth has indicated that the rates in the second tier will remain relatively static and the third tier will be decreased, but post 30-day rates as of 7/1/17 will be budget neutral from the changes taking effect on January 1st. An announcement from EOHHS will specifically outline the new tiered rates, but according to MassHealth, anything regarding rates that is seen before the New Year is not finalized and therefore subject to change.
The other notable decrease will take effect on January 1st when MassHealth plans to approximate the budget impact of those proposed second and third rate tiers into the current post 60-rate. The cut in the post 60-day rate from 1/1/17 to 7/1/17 will be a 6.75% reduction. This means the current post 60-day rate of $69.59 will be roughly $64.89 for the first six months of 2017. (This rate remains higher than the medication administration rate originally considered by MassHealth.)
Laid out in another way, this will be how rates are currently planned to change:
January 1 – July 1:
Home health services post 60-day rate will be roughly $64.89 (6.75% reduction)
Service days 1-30: $89.21
Service days 31-180: Rates will remain roughly the same, but are not yet finalized
Service days 180: Rates will be slightly reduced from the current post 60-day rate, but are not yet finalized.
MassHealth is also streamlining enrollment in the Independent Nursing program to cut their application process from 8 weeks down to one week.
The net state cut for home health is approximately $3.8 million out of $758 million in MassHealth spending on home health care services.
Most of the other cuts announced by the administration are restoring vetoes previously proposed by the Governor in the FY2017 budget, but that were overridden by the legislature. At that time, the Governor vetoed $255 million and the legislature overrode $231 million. Included in these cut overrides are certain hospital supplementary payments (particularly to pediatric and Western MA hospitals) as well as $1.1 million in cuts to public health hospitals.
Other impacted accounts include supplemental payments to nursing homes, which will be reduced by $2.8 million, as well as a $2.8 million cut to adult foster care (AFC).
The Pediatric Palliative Care account (4590-1503) is being reduced by $400,000.
The legislature has already announced their view that Governor Baker went too far with some of the announced cuts and they will be working on restoring some of the funding reductions.
HCA of MA has an upcoming meeting with MassHealth to review the Governor’s proposal. Also on the agenda are issues with ICD-10 changes that are impacting agency billing and payment.
Return to www.thinkhomecare.org.
With $256 million in spending reductions, the Governor approved his final approved FY17 state budget and it’s now up to the House and Senate to now discuss overrides before formal sessions conclude at the end of July.
Among the items preserved was a $200,000 item for the Department of Higher Education that funds the Nursing and Allied Health Workforce Initiative. The Home Care Alliance is among a large group of stakeholders that advocates for funding that supports grants to teams of colleges, health care providers, and workforce investment boards to advance training and education for nurses and direct care workers.
The governor did, however, reduce the legislature’s funding recommendation for the pediatric palliative care network by $400,000. The remaining $1.8 million is essentially a level-funding from previous years. It was one of 303 line items that saw reduced funding.
The largest reduction the Governor recommended was a $17.8 million drop in Nursing Home Supplemental Rates. The House and conference committee had recommended a total of $337.9 million while the Senate had suggested $332.9 million, but the number being sent by the Governor back to the legislature currently sits at $330.1 million.
Details on the Governor’s FY17 budget can be found on the “Governor’s FY17 Vetoes” webpage.
Return to www.thinkhomecare.org
The merits of protecting consumers, setting minimum standards for companies and agencies providing in-home care, and controlling state costs were not enough to advance a Home Care Oversight Commission through the state budget.
The state’s FY17 Conference Committee released their final budget proposal on behalf of the legislature after regrouping in light of declining revenue projections. The Home Care Commission, which was included in the Senate budget, but not in the House, had to survive a “conference committee” of House and Senate budget leaders that negotiated a fiscal plan between the two sides.
With Massachusetts being one of only five states without state oversight of home health care, and also with a goal to place some standards on private-pay home care, the commission would have convened legislators, home health agencies, private-pay home care, state officials, consumer groups and trade associations to recommend solutions. The language stipulated that there be separate sets of recommendations for home health and private pay home care.
Elsewhere in the budget, the declining revenue projections filtered through to hit the elder services network. Based on FY16 spending levels, a $2 million cut was made to “Elder Home Care Purchased Services” and $2.6 million reduction in the “Elder Home Care Case Management and Administration” account.
Two pieces of good news came in that Elder Protective Service got a boost of $4.5 over FY16 spending and the Pediatric Palliative Care Network received a boost of $404,578, but the Nursing and Allied Health Workforce Initiative remained leveled out at $200,000.
More silver lining came with a $1 million pilot program to test expanding income eligibility standards for services ordered by Aging Service Access Points.
In terms of MassHealth line items, the expected trends continued with the conference committee reducing the “Fee-for-Service” account by $161.7 million while increasing the accounts tied to MassHealth Managed Care ($71.1 million) and MassHealth Senior Care ($160.4 million).
Nursing Home Supplemental Rates also saw a raise with $45 million over FY16 spending.
The $39.15 billion budget now moves to the Governor for final approval and any further updates will be shared as they become available.
Return to www.thinkhomecare.org.
The roughly $40 billion that will make up the legislature’s FY17 proposal must first go through a six-member “conference committee” that will negotiate on differences between the House and Senate budget versions.
Included in the Senate version was a special commission that will study, discuss, and make recommendations on separate policies for state-based oversight of home health and private-pay home care agencies. It will take advocacy to ensure that this important provision is included in the conference committee’s negotiated budget, and action can be taken through the HCA’s Advocacy Center.
Simply fill out the contact forms and hit “send” to help gain support for the Home Care Commission!
The Commonwealth is one of five states without either licensure or a “certificate of need” process for home health care services. Massachusetts has also recently experienced rapid growth in the number of “certified” home health agencies. The related and significant spike in MassHealth spending has forced the state to establish program integrity measures on these agencies.
Likewise, 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.
The Alliance will continue to update it’s members on this proposal.
Return to www.thinkhomecare.org.
In a $39.5 billion budget, the Senate advanced Home Care Alliance priorities, namely a special commission that will study and make recommendations for state oversight of home care.
The commission would create a separate set of recommendations for certified home health and also private pay agencies. The group would include three representatives from each type of agency (certified and private-pay) as part of the membership along with policymakers, administration officials, and many others. During the Senate’s deliberations on more than 1,300 amendments, the Massachusetts Nurses Association and the MA Chapter of the National Academy of Elder Law Attorneys.
Unfortunately, efforts to gain payment increases for home health aides and homemakers were not approved despite collaboration with the Home Care Aide Council, Mass Home Care, and several dedicated Senate offices. Senator Joan Lovely (D-Salem) spoke well in debate on behalf of a home health payment review and Senator Barbara L’Italien (D-Andover) fought for inclusion of home health aide payment, in particular. Senator Patricia Jehlen (D-Somerville) and Senator Sal DiDomenico (D-Everett) also helped lead an effort to advance home care rates.
On a positive note,an amendment was defeated that would have created a publicly-available registry of home care workers that aimed to list private information.
In addition, the Senate approved a pilot program of just over $1 million that expands income eligibility standards for services coordinated through Aging Service Access Points.
Other notable items in the Senate’s budget include the following:
- A feasibility study on allowing spouses to be paid caregivers under MassHealth.
- Allowing a leave of absence for nursing home residents under MassHealth (20 medical leave days and 10 non-medical leave days).
- A fund created from fines and penalties relative to patient abuse in nursing homes that funds the prevention of such action through staff training and education, enhanced inspections, and relocating residents to other facilities.
- $20.5 million for the Nursing Home Quality Jobs Initiative as part of SNF Supplemental Rates.
- $200,000 for Geriatric Mental Health Services.
The HCA thanks its members for the hundreds of emails and phone calls to Senators during the past two weeks. The state budget process moves on to a conference committee process where the House and Senate negotiate differences between their two FY17 proposals. The Alliance will continue to push for the commission to establish oversight measures as well as other items to strengthen home care.
Return to www.thinkhomecare.org.
The Massachusetts Senate is taking their turn in the fiscal year year 2017 state budget process with a $39.49 billion proposed starting point.
Senators have filed just over 1,100 amendments seeking to add a combination of funding and policy language that will be debated next week, but advocacy is needed to gain support for the issues critical to home care agencies.
The Home Care Alliance’s Advocacy Center features prepared emails focused on these issues that can automatically be sent to your state senator. Click here to send a message on all of HCA’s priorities – OR send a specific message to urge support for improved home health aide reimbursement or a study of MassHealth reimbursement for all home health services.
Here are explanations of the Alliance’s priority items:
MassHealth Reimbursement to Home Health Aides – Amendment #596 (Senator Barbara L’Italien)
- Home Health Aide Rates have not been reviewed since 2007.
- This amendment raises the rate MassHealth reimburses home health agencies for home health aide services by 12% at a cost to MassHealth of $3.66 million which after federal match becomes $7.32 million.
- This increase would also effect the purchase of home health aide services ordered through the state network of Aging Service Access Points (ASAPs) at a cost of $5.25 million.
MassHealth Home Health Reimbursement Review – Amendment #470 (Senator Joan Lovely)
- Home health care is a cost-effective service that allows people of all ages – from maternal-child health services and pediatric patients to the elderly –to remain independent in their homes where they are most comfortable and at a lesser expense to their families and the Commonwealth.
- Payment rates have not been reviewed since 2007. Current rates are based off of 2005 data and were cut in 2008.
Homemaker Wage Increase – Amendment #591 (Senator Michael Barrett)
- On average, this request will provide an increase of $.50 per hour to homemakers and personal care homemakers providing care to clients enrolled in the Elder Home Care Program
- This budget request will include language to raise the EOEA average compensation mandate in ASAP contracts from $12.69 per hour to $13.19 an hour for FY17
The Home Care Alliance appreciates that the Senate Committee on Ways & Means included language for the Home Care Oversight Commission, which seeks to convene legislators and stakeholders to recommend separate standards for licensure for private-pay home care and Medicare-certified home health.
The HCA is also supporting amendments, including #597 (Sen. L’Italien) to expand eligibility for in-home elder services and #622 (Sen. Humason) to bring Massachusetts into the Nurse Licensure Compact.
Other noteworthy items in the Senate budget include the following:
- $2.6M for Pediatric Palliative Care, an increase of $800K over FY 2016 funds to meet the needs of terminally ill children and their families and eliminate the wait list for these critical services.
- $200,000 for the Nursing and Allied Health Workforce initiative through the Mass. Department of Higher Education. Senator Michael Moore has proposed an amendment (#136) to raise the amount to $400,00, but this item from Senate Ways & Means goes a long way to ensuring that the item will be funded at previous levels.
- Following the Governor’s lead, the Senate consolidated the Elder Enhanced Home Care (ECOP) line item and moved that funding to other accounts.
- Nursing Homes secured $30 million (half of which will come from an added assessment on facilities) for added CNA reimbursement.
- Nursing Home Supplemental Rates matched the Governor’s FY17 proposal at $332.9 million, which is $15 million below what the House approved.
- The Home & Community Based Services Policy Lab also received funding not included in the House budget, which will help the state study the cost-effectiveness of certain long-term services and supports.
Return to www.thinkhomecare.org.
Although the House budget process has yet to officially conclude, state representatives voted on items related to Health and Human Services, Public Health and Elder Affairs with barely any home care-related initiatives approved.
The traditionally conservative House budget process saw just over $12 million in additional money for all health care-related initiatives in general. The Home Care Alliance was itself asking for $8.9 million for home health aides, $10 million for homemaker wages and benefits – in conjunction with the Home Care Aide Council – and supported a number of amendments that were either low-cost or had no cost associated.
Beginning with the positive, an amendment creating a publicly-available home care workforce registry was denied. The Home Care Alliance was opposed to allowing the public access to the personal information of home care workers proposed in this amendment, including full legal name, date of birth, home address and gender of these workers.
Also, $200,000 was reinstated for Nursing and Allied Health Workforce Development that has funded improved access to education and training for direct care workers as well as nurses. One such example of a program funded through this item was the Home Health Nurse Residency Program that is run by VNA of Boston/VNA Care Network.
In the elder services category, $750,000 was provided to “meals on wheels” and the House approved a study of expanding income eligibility standards for home care services contracted through Aging Service Access Points.
Meanwhile, the House denied a commission to study oversight options for home health and private-pay home care, a raise for both home health aides and homemakers, a study of home health rates from MassHealth, and a boost in funding for pediatric palliative care.
The budget discussion and focus will turn to the Senate and the Alliance will be sending advocacy alerts to inform members and advocates about how they can help advance important policy priorities.
Return to www.thinkhomecare.org.
The Massachusetts House is preparing for debate next week on their $39.4 billion state budget proposal and the 1,307 amendments that were filed on a range of different issues from home care to homelessness.
Please visit the Home Care Alliance’s Advocacy Center and send a message to your state rep to urge their support of the HCA’s priority issues. Simply click on any of the top four issues on the Advocacy Center, fill out your contact information, hit SEND, and an email will automatically be sent to the legislator representing you!
The top message (“Please Support Home Care in the FY17 Budget”) includes all the HCA’s priorities, or you can choose from other single-issue messages. There are explanations of each message and you can read the actual message before sending.
The Alliance posted a summary of the House budget proposal that will be debated next week and other updates will be posted as they become available.
Return to www.thinkhomecare.org.