House Releases FY17 Budget Plan and Rearranges Elder Services Funding

With a $39.4 billion FY17 state budget plan, the House Committee on Ways & Means kick-started the legislature’s budget deliberations.

As always, a significant portion of that total – $15.4 billion in proposed spending – is allocated for MassHealth programs. In their executive summary, House budget writers noted that MassHealth spending growth has been limited to 5%. They also mention that their budget plan “supports enhancements to the eligibility systems, caseload management and program integrity efforts, especially in the area of long term care, which ensures that our significant investments are being well spent, which is crucial to providing healthcare to some of the Commonwealth’s most vulnerable residents.”ma budget pie chart pic

That “support” could be part of the $8 million increase in the EOHHS administration line item (400-0300) as it does not show up in the line item specifically set aside for audits of MassHealth providers and utilization review (4000-0301). That item was actually set by the House at $413,000 less than FY16 spending.

Meanwhile, the House restored the Enhanced Home Care Services Program (ECOP) that Governor Charlie Baker consolidated into other items. With ECOP funded at $74.3 million, it comes in at $3.7 million above the FY16 spending level. That leaves some items noticeably lower than Governor Baker’s budget plan, but it also falls below what the state spent in FY16.

For example:

  • Elder Home Care Purchased Services is $3.1 million below FY16 spending
  • Elder Home Care Case Management and Administration is $2.6 million below FY16 spending
  • Elder Nutrition (Meals on Wheels) is more than $746,000 below what was even set in the FY16 budget

Other newsworthy items from the House Ways & Means budget proposal include the following:

  • $250 million assessment on hospitals that will support new MassHealth accountable care organization (ACO) incentive payments, which the Hospital Association supports with certain conditions.
  • $5.7M for the Supportive Senior Housing Program, an item not included in budgets of previous years.
  • $15 million above the Governor’s proposed spending for Nursing Home Supplemental Rates.
  • $4.5 million above FY16 spending for Elder Protective Services.

The entire House Ways & Means budget can be found here. The Home Care Alliance will be working with State Reps to sponsor amendments creating a home care licensure commission, increasing MassHealth reimbursement for home health aides, and for EOHHS to conduct a full review of home health reimbursement. The Alliance will be fully partnering with other organizations to push a homemaker wage increase, expanding income eligibility for elder home care services, and other items.

More information on advocacy efforts will be released soon and the budget items will be a focus of HCA’s lobby day at the state house on April 28th. Contact James Fuccione at the Alliance for details.


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Breakdown of Governor Baker’s FY17 State Budget for Home Care

Confronting a $635 million budget gap and steep spending increases in several areas, including MassHealth, Governor Charlie Baker’s administration released a $39.5 billion budget plan that aims to reduce growth while investing in more efficient programs.

On a conference call with stakeholders, state Health and Human Services Secretary Marylou Sudders thanked the Home Care Alliance for collaboration on a package of proposed solutions that are slated to go into effect by March 1st. As noted in previous newsletters and emails to HCA members, MassHealth is seeking to establish a prior authorization process, a moratorium on new home health providers, and a conflict-free physician referral process. This includes a closer scrutiny on medication administration visits and clients with a high utilization rate of home health aides.

Secretary Sudders reported on the call that audits will be conducted effective immediately. She also explained that there are currently 195 certified home health agencies in the Commonwealth and 12 were referred to the MassHealth Fraud Unit under the state’s Attorney General’s Office. The HCA will continue to monitor audit activity and provide pertinent updates.

More generally in the Health and Human Services budget, MassHealth Managed Care and MassHealth Senior Care are receiving funding increases while the Fee-for-Service line item continues to decrease reflecting a move to programs like Senior Care Options (SCO), OneCare and other managed care services.

In the elder services line items, the Enhanced Home Care or ECOP program was consolidated into several line items by the Baker administration. The bulk of what was a $70 million line item went to Home Care Purchased Services and Case Management under the Aging Service Access Points (ASAPs).

Below are some other notable items related to home care in the Governor’s FY17 budget:

  • Nursing Home Supplemental Rates increased by $30 million. This is due to an increase to assessments on SNFs.
  • The line item for MassHealth Managed Care increases $149.1 million and the MassHealth Senior Care account rises by $160.4 million, while the MassHealth Fee-for-service item goes down by $113.7 million.
  • Elder Protective Services funding was increased by $4.9 million.
  • DPH’s Pediatric Palliative Care Network was essentially level-funded at $1.8 million.
  • Elder Nutrition (Meals on Wheels) was also nearly level funded at $7.2 million.
  • The Nursing and Allied Health Education Workforce Development item was eliminated. Last year it was funded at $200,000 by the legislature after being zeroed out by the Governor.

The budget process moves on to the House and Senate and further updates  – on both the budget as well as the HCA’s work with MassHealth on program changes to home health services – will be shared as information becomes available.

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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 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.

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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.”

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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.

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Advocacy Alert: Email your Senator to Support Home Care in the Senate Budget

The Alliance has worked with home care champions in the Senate to file amendments to the Ways & Means budget to improve home health care services. The HCA now needs home care agencies and advocates to send a message to gain support these proposals TODAY by clicking here!

Below is a list of the items the Alliance will be leading on and supporting in the FY16 Senate budget process.

Restoring Home Nursing Rates: Senator Jennifer Flanagan

•    Purpose: This budget language seeks to restore the MassHealth rate for home health nursing visits past 60 calendar days of care to the payment level prior to the rate cut of December 1, 2008. This amendment creates a consistent rate for as long as an individual on MassHealth requires home health care.

Improved MassHealth Rates for Home Health Aide Services: Senator Barbara L’Italien

•    Purpose: Since 2007, home health aide rates to agencies from MassHealth have remained at $24.40 per hour, which is meant to cover aide salary, benefits, travel, supervision and administrative costs for the employing home health agency. This amendment seeks to raise the rate MassHealth reimburses home health agencies for home health aide services by 12% at a cost to MassHealth of $1.75 million.

Study of MassHealth Third Party Liability: Senator Anne Gobi

•    Purpose: A study is necessary because correct reimbursement coverage determinations for Medicare/Medicaid dual eligibles are far more complex in home health care than in other medical services as the services and program coverage rules are very similar. The process of submitting all or most MassHealth home health claims for review and re-review to Medicare is highly costly to both agencies and the state. The rate of Medicare coverage has also been steadily declining.

Homemaker Salary Reserve: Senator Michael Barrett

•    Purpose: Appropriate $3 million from the Community First Trust Fund for a FY16 Homemaker Salary Reserve.  This request will continue a campaign to support essential workers by providing an annualized wage and benefit increase of approximately 32 cents an hour to over 26,000 homemakers and personal care homemakers.

Community-Based Safety Net Adjustment: Senator Kathleen O’Connor Ives

•    Purpose: Treat non-profit home health agencies that provide a significant number of home health visits to MassHealth patients as safety-net providers eligible for upward rate adjustments.

FMAP Trust Fund: Senator Michael Rodrigues

•    Purpose: On January 1, 2014, Massachusetts began receiving an enhanced Federal Medical Assistance Percentage (FMAP) for certain Medicaid expansion populations through the ACA.  This amendment creates a trust fund to house this funding and dedicate it to Medicaid and low-income health programs.

Expand Elder Service Home Care Income Eligibility: Senator Barbara L’Italien

•    Purpose: Raise the income eligibility standard for State Home Care Program services funded by Elder Affairs to those below 300% of the Federal Poverty Level.

For more information on what was included in the Senate Ways & Means budget, visit this previous blog post.

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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.

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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.

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Advocacy Alert: Email State Reps to Gain Support for Home Care in the House Budget!

The Home Care Alliance has been busy working with state representatives to file amendments to the recently released House version of the state’s FY16 budget. Now that those proposals are submitted, it is time to gain crucial support by asking other reps to cosponsor these amendments.

The amendments include the following proposals:

  • An increase in MassHealth rates for visiting nurses (filed by Rep. Sean Garballey)
  • Creating a commission to study state oversight options for private-pay home care agencies (filed by Rep. Mark Cusack)
  • An increase in MassHealth rates for home health aide services (filed by Rep. Chris Walsh)
  • A study of MassHealth’s Third Part Liability Billing process (filed by Rep. Paul Brodeur)

Agencies and advocates can send an email through HCA’s Advocacy Center just by clicking on the message, filling out the contact info form, and hitting “send.” The message will automatically shoot off to the correct Representative based on the address you enter.

Private pay home care agencies can send their own message for just the Study Commission language here, or a message can be sent for all the Alliance’s priorities here.

Any questions can be directed to James Fuccione at the Alliance.

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FY16 State Budget Plan Released by House

The House Committee on Ways & Means released their version of the state’s fiscal year 2016 budget with most accounts important to home care level funded. Out of the $38 billion in the proposed budget, $15.3 billion is spent on MassHealth, the state’s Medicaid program.

Since language proposed by the Home Care Alliance to establish a commission to study options for agency oversight was not included, the HCA will be working with state representatives to file amendments to the budget for a number of items, including establishing commissions to study and make recommendations on state oversight options for private pay agencies and certified agencies. The Alliance will also be seeking an increase of $3.1 million in payment rates for home health aides as well as a restoration of MassHealth home health nursing rates.

The Alliance will also be supporting a number of budget amendments spearheaded by other organizations to raise home care worker wages, seek relief from the impending paid sick time mandate and restore the line item funding the Nursing and Allied Health Education Workforce Development program.

Additionally, the Alliance will support efforts to increase funding for elder home care purchased services from Aging Service Access Points. The House Ways & Means budget reduced that line item from what the Governor proposed earlier this year by more than $3 million.

Stay tuned as the Alliance will be sending out advocacy alerts on how agencies and advocates can urge support of these important issues.

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