Tag: State Budget

Governor Releases State Budget Proposal With MassHealth Savings

In his first budget as governor, Charlie Baker’s administration made sizable shifts within Health and Human Services, which accounts for 53 percent of the overall budget proposal. These shifts were done without negatively impacting most provider rates, including home health services.

In a conference call with provider and advocacy organizations, Executive Office of Health and Human Services Secretary Marylou Sudders announced that there was a 5.6 percent growth over FY15 in the total EOHHS budget and that line items in the Elder Affairs accounts governing the Aging Service Access Point network saw a 2.1 percent increase overall. This includes the following highlights:ma budget pie chart pic

  • A nearly $5.6 million increase over FY15 spending in the Elder Enhanced Home Care Services Program.
  • Level funding for the Home Care Purchased Services line item ($106.6 million), which governs contracts with home care providers.
  • A reduction of $13.7 million in the MassHealth Senior Care Account that includes, among other things, the Senior Care Options or SCO program. On the call with Secretary Sudders, it was explained that this was an adjustment on caseloads after re-determinations.
  • A continued reduction ($68,360,305) in MassHealth Fee-for-Service payments to “meet projected need.”
  • An increase of $768,713,676 in MassHealth Managed Care spending.
  • Level funding of grants to councils on aging and to the elder nutrition program.
  • A nominal increase in spending over FY15 on Pediatric Palliative Care.

For more information on the Governor’s proposed budget, visit the administration’s FY16 budget webpage.

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HCA Blasts Governor for Pulling MassHealth Rate Increase

After years of working with MassHealth on an update to home health care payment rates, and after learning that the rate increase was set, the Governor pulled the payment boost as part of his recent budget-balancing plan.

The Home Care Alliance delivered a letter to the Governor blasting the decision as part of a “failure to recognize home health care as a vital part of the health care continuum.” The letter noted that rates have not been increased since 2007 and were cut in 2008 for some of the state’s most vulnerable patients that receive home health care services. At that time, payment was cut by 20 percent for services lasting beyond 60 calendar days of care. This, according to the letter, essentially means that “agencies are being reimbursed in 2014 at rates set in 2007 and cut in 2008.” Moreover, the rates were already well below the cost of providing care that brings MassHealth savings by preventing or delaying costlier facility-based care.

Part of the hand-off to incoming Governor-elect Charlie Baker was to slash a state budget deficit of $239 million. From that amount, $68.5 million came from MassHealth services. Although MassHealth home health services were not directly cut, the payment rate being pulled was a blow to agencies and advocates that heard only a week earlier that the rate increase was set for March 1, 2015.

The administration had planned for a $8 million increase, although it was unclear how that funding was going to be implemented.

“Due to recent revenue shortfalls, agencies across state government were required to make difficult choices in order to maintain a balanced budget,” said Health and Human Services spokesman Alec Loftus in a statement to State House News Service. “We took a thoughtful approach to ensure that our most critical programs that help children, families, veterans and our most vulnerable populations are protected.”

As with 2008, the “thoughtful approach” did not include the cost-efficiency home health services bring to the table. Nor does it take into account the money agencies lose every time a nurse goes to a patient’s home to provide care because the cost of providing services far exceed reimbursement.

The Home Care Alliance will continue to make MassHealth payment a policy priority through the state budget process.

Return to www.thinkhomecare.org.

Home Care Impacted by Governor’s Budget Cuts

With a new Governor coming into office in January and a $329 million budget shortfall, the Patrick Administration was forced to make reductions to close the deficit.

A large chunk of those cuts came at the expense of MassHealth, which makes up slightly more than half of the state’s $36.5 billion fiscal year 2015 budget. MassHealth officials contacted the Home Care Alliance to report that $68.5 million in reductions had to come from MassHealth alone and that a rate increase for home health agencies is no longer on the table for FY15.

The Home Care Alliance had seen hints that there finally would be a review of MassHealth home health care rates after years of being passed over. Rates were frozen in 2007 and one of the Patrick Administration’s first cuts were from home health services past 60 calendar days of care. The rate inexplicably dropped by 20 percent for patients who require longer-term home health care and that cut has not been revisited.

Also cut was $1.52 million from the Elder Affairs’ “Home Care Purchased Services” line item that will go into effect on December 1st at which time the waiting list for Aging Service Access Point (ASAP) services could go back into effect. Officials from Elder Affairs indicated the lowest priority level would be the only one impacted, which preserves those in the greatest need for care.

The bright spot is that the Home Care Alliance’s efforts to gain MassHealth reimbursement for telehealth provided by home health agencies is not impacted and plans to implement rates and guidelines is going on as planned. Moreover, home health rates are, more or less, remaining status quo and are not being reduced further. Nursing Home Supplemental Rates, for example, were slashed by $9.1 million.

A rate review for home health services remains a top priority and the HCA will continue to work with the legislature and MassHealth on improving payment.

Return to www.thinkhomecare.org.

Conference Committee Budget Includes Telehealth, Homemaker Wage Increase

With the new state fiscal year technically arriving, the legislature’s budget conference committee released their compromise version between the House and Senate funding proposals that comes in at $36.5 billion.

With the delay in negotiations, the legislature recently approved a $4.6 billion budget to fund the government and related services through the end of July. The Governor, meanwhile, will have 10 days to review the conference committee’s budget and send recommended vetoes, which can be overturned with a two-thirds vote in both the House and Senate.ma budget pie chart pic

Among the priority items of the Home Care Alliance and others of benefit and interest is language allowing MassHealth to continue their work on implementing home telehealth service rates and rules. This is the second year in a row that the Alliance has achieved getting language that continues the association’s work with the state on an important service that is currently not reimbursed.

Another major win for home care came with the approval of the Homemaker Wage Increase that will amount to $6.1 million, if the funding makes it through the remainder of the budget process. According to the Home Care Aide Council, this appropriation would provide an annualized wage increase of approximately 75 cents an hour to more than 17,000 homemakers and personal care homemakers.

Among other notable items, the conference committee’s budget accomplishes the following:

  • Funding the “Home and Community-Based Services Policy Lab,” ($250,000) which seeks to study the cost-effectiveness and value of home and community-based care. It is expected that services provided by members of the Home Care Alliance that contract with Aging Service Access Points will be included in an initial phase and other Medicaid and Medicare home health services will be included in subsequent phases.
  • The state’s elder services network’s “purchased services” line item received the higher funding amount in the compromise budget of $104,411,964.
  • The Elder Nutrition Program covering “Meals on Wheels” received even more funding ($7.37 million) than the higher amount awarded by the House ($7.12 million).
  • The MassHealth Senior Care line item received slightly increased funding, which came from the House, at $3.197 billion while the MassHealth Managed Care account was level funded throughout the budget process at $4.792 billion.
  • The Human Services Salary Reserve was given $8 million to fund better wages for human service workers.
  • Pediatric Palliative Care gained a slight increase with $1.55 million.
  • The Board of Registration in Pharmacy will establish four new specialty licenses for retail sterile compounding pharmacy, retail complex non-sterile compounding, and institutional pharmacy license to apply to hospitals and an out-of-state pharmacy license for those doing business in Massachusetts.

For more information, the conference committee’s budget can be viewed here.

Return to www.thinkhomecare.org.

State Budget Process Moves to Conference Committee

As expected, the House and Senate Chairs of their respective Committees on Ways and Means will co-chair a six-member conference committee that will work out the differences between the House and Senate budget plans.

The House-approved plan calls for $36.32 billion while the Senate plan was set at $36.4 billion. Although they are similar in terms of total amounts, there are some important differences in both funding support and policy changes.

The Home Care Alliance sent a letter outlining those differences as they pertain to home care services in a letter to each conference committee member.

Here are the main bullet points from that letter where the HCA is asking for support:

  • Senate Amendment #929: Home Telehealth
    • This language was passed in the FY14 budget and allows MassHealth the policy support necessary to continue work on establishing rates and guidelines for home telehealth services.
    • Home Telehealth involves remote vital signs monitoring equipment. This service offers immediate cost savings by reducing the frequency of home health visits paid for by MassHealth, along with reduced hospitalizations through improved medication adherence, patient self-management and timely follow-up care.
  • Senate Amendment #683: Homemaker Wage Increase
    • Approved by a unanimous roll call vote in the Senate, this amendment increases pay by approximately $.75 cents per hour for homemakers and personal care homemakers serving clients enrolled in the Executive Office of Elder Affairs Home Care Program.
  • Senate Outside Section Relative to the Home and Community-Based Services Policy Lab
    • This language and corresponding funding would support the study of the cost-effectiveness of state-funded home and community-based services.
  • House Support for Elder Services Home Care Purchased Services (9110-1630)

The Alliance encourages home care agency members and advocates to contact the conference committee this week to ask for their support using the bullet points above. Here are the names and contact info for conference committee members:

Return to www.thinkhomecare.org.

Advocacy Alert: Call and Email Your State Senator TODAY!

The budget amendments important to home care are up for debate today in the MA-State-HouseMassachusetts Senate.

The Home Care Alliance’s priority amendments include restoring the 20-percent rate cut for MassHealth home health visits past 60 days, creating a commission to study home health services and recommend oversight measures, and allowing MassHealth to continue their work to establish telehealth services provided by home care agencies.

We need calls and emails to be made NOW to senators to get support for the following amendments:

  • #684 – Senator Patricia D. Jehlen: Study Commission for Home Health Care Services and Oversight

Purpose: The Commonwealth is one of only five states without either licensure or a “determination of need” process for oversight of home health care. In recent years the Commonwealth has experienced rapid growth in the number of certified home health agencies. This proposal is in response to that growth and would help to identify the current number of home health agencies, services provided and available by region, and create recommendations for state oversight and quality standards.

  • #839 – Senator Kathleen O’Connor-Ives: Restoring Home Nursing Rates

Purpose: This budget language seeks to restore the MassHealth rate for home health nursing visits past 60 days of care to the payment level prior to the rate cut of December 1, 2008 so that patients with the most severe conditions can have their care continued and remain independent at home. This amendment creates a consistent rate for as long as an individual on MassHealth requires home health care.

  • #929 – Senator Richard T. Moore: Establishing Reimbursement for Telehealth Services Provided by Home Health Agencies

Purpose: Maintain language from the FY2014 budget that established MassHealth reimbursement for home telehealth services provided by a home health agency, immediately providing cost savings and more efficient care. MassHealth is in the process of building corresponding rates and guidelines.

The Alliance is also supporting the Homemaker Wage Increase (#683) and increased funding for the state’s elder services programs (#687).

A full update will be available when the Senate completes debate, but HCA members and advocates can still send an email to their state senator here and follow the Alliance on Twitter (@thinkhomecare) for updates.

Return to www.thinkhomecare.org.

State Senate Proposes $36.2 billion Budget Plan with New Opportunities for Home Care

The Massachusetts Senate’s Ways & Means Committee took their turn in the state budget-crafting process with a $36.2 billion proposal that increases total state spending by almost $1.7 billion from this year.

Although some programs in the Elder Services line items took a hit, as did the MassHealth Senior Care Account, the Senate proposed other new items that pose potential opportunity.

In what is known as an “outside section,” which is a section of an appropriation bill that can create new policies, the Senate created a Home and Community-Based Services Policy Lab. According to the language, the policy lab would start with $500,000 of state funds to evaluate and analyze the outcomes and effectiveness of home and community-based services under the Secretary of Elder Affairs. This includes the state Home Care Program administered through Aging Service Access Points (ASAP’s) that contract with Home Care Alliance members.

This “policy lab,” which appears to be a program evaluation of state government-funded home and community-based services, could be the beginning of proving the effectiveness of services such as those provided by home care agencies. More information on this will be released as details are released.

Also, in another “outside section,” the Senate Ways & Means Committee created a new Community First Trust Fund, which is intended for enhanced federal financial participation (FFP) funding for the state that is tied to the Balanced Incentive Payment program (BIP), among other programs. In a previous blog post, the HCA reported on the state’s intentions around the BIP initiative that will bring more support to non-institutional long-term care services.

More budget analysis will come out in the coming days, including the Home Care Alliance’s budget amendment priorities where HCA members can help by contacting their state senators. The Alliance plans on repeating proposals to advance telehealth in home care, better MassHealth rates, and a study commission of home health care services and possible oversight recommendations.

Return to www.thinkhomecare.org.

Advocacy Alert: Help Gather Support for Home Care Budget Amendments

The Home Care Alliance’s priority amendments in the House budget now have numbers, which means you can email or call your state representative and easily ask that they support these important policies to advance home care services!

  • Amendment #968: Rep. Sean Garballey’s amendment to restore the MassHealth rate for home health nursing visits past 60 days of care to the payment level prior to December 1, 2008 so that patients with the most severe conditions can have their care continued and remain independent at home. MassHealth cut the rate once a person was receiving home nursing for more than 60 days, which runs counter to the state’s goal of keeping people in the community and driving down the cost of care.
  • Amendment #89: Rep. Kate Hogan’s amendment to study home health service capacity in the Commonwealth and recommend policy strategies for better state oversight of home care agencies. Massachusetts is one of only five states without either licensure or a “determination of need” process for home health agencies. In recent years the Commonwealth has experienced rapid growth in the number of certified home health agencies. This proposal is in response to that growth and would help to identify the current number of home health agencies and their licensure and ensure high levels of quality home care.
  • Amendment #491: Rep. John Mahoney and Rep. Mark Cusack’s amendment that would establish MassHealth reimbursement for telehealth services provided by home health agencies. This amendment was successfully passed in last year’s budget and this year’s version will ensure MassHealth is statutorily able to finish their work in creating a regulatory and reimbursement structure.
  • Amendment #775: Rep. James O’Day’s amendment to reestablish the Homemaker Wage Increase account. This appropriation would provide an annualized wage increase of approximately 75 cents an hour to over 17,000 homemakers and personal care homemakers.

Our Legislative Action Center makes it easy to advocate. Just click on the FY15 budget message, fill in your contact info, and hit send! The system will automatically send the message to your state representative.

You can also call 617-722-2000 and press “2” to speak to an operator in the House of Representatives to urge your State Rep to support amendments #89, #491, #775 and #968. You can use the talking points above when speaking to an aide or leaving a message.

Contact James Fuccione at the Alliance with any questions.

Return to www.thinkhomecare.org.

House Ways & Means Releases Budget; Call Now To Support Amendments!

The state’s House Committee on Ways & Means this week released its proposed $36.2 billion fiscal year 2015 budget.

The House budget closely follows the Governor’s budget proposal in most line items related to home care providers, with slightly smaller allocations for MassHealth Senior Care Plans,boston-statehouse and EOEA Administration, and slightly more funding for local Councils on Aging. The House budget does not include the $1.2M Home Care Workforce Training Fund that was in the Governor’s budget.

Several legislative champions will be submitting amendments to the budget at the request of the Alliance. HCA members are encouraged to contact your local state representative TODAY and urge them to co-sponsor the budget priorities listed below.

A pre-written email is available on the Alliance’s Legislative Action webpage. For those choosing to call their local Representatives, please use the information below. Reps can offer formal support by contacting the office of the Representatives that are filing the amendments. Continue reading “House Ways & Means Releases Budget; Call Now To Support Amendments!”

Governor’s Budget Gives Big Support to ASAP, Home Care Programs

Despite having his state of the Commonwealth address delayed by a snowstorm, Governor Deval Patrick was required to release his budget proposal this past Wednesday to officially kick off budget deliberations for fiscal year 2015.

A huge win for elder home care services came in line items that support the Aging Service Access Points and state Home Care Program, which received an additional $16.9 million, according to Executive Office of Elder Affairs Secretary Ann Hartstein. Among those funds are increases of $9.8 million for the Enhanced Community Options Program (ECOP) and $7.5 million for the “basic” category of services.

Combined, according to Secretary Hartstein, those two line item increases will eliminate waiting lists through the end of fiscal year 2015. The funding boost works out to an additional hour of homemaking services per consumer per month on average, but Secretary Hartstein stressed that, in reality, the money would pay for whatever services people may need when they need them.

The Governor also put a $1.3 million increase to the Senior Supportive Housing account, which will expand “assisted living facility-type services” for seniors in public housing. Specifically, the money will add another 10 public housing sites where senior residents will be supported by home care services.

Another $1.2 million was added in a new line item titled “Home Care Workforce Training Fund.” This new account will support workforce training for Aging Service Access Points, although the administration is not yet clear on which workers will receive training. Case management, protective services and direct care workers are all on the table as potential recipients.

MassHealth experienced major changes in the budget, mostly related to federal healthcare reform. Since the MassHealth Basic and Essential programs were eliminated, a combined $706.3 million is now in populations with expanded coverage and in the new MassHealth plans.   The MassHealth Senior Care account was granted another $271.4 million by the Governor and the MassHealth Managed Care account saw an additional $336.7 million. The MassHealth Fee-for-Service line item was raised by $205 million. It is unclear how these increases might result in better reimbursement rates for home health agencies. A formal rate reassessment hearing is still being eagerly awaited.

Other items of note from the Governor’s budget include the following:

  • Applying the state sales tax to candy and soda. The administration estimates that would raise roughly $57 million for health promotion and prevention programs.
  • The Governor’s budget cuts the MassHealth Nursing Home Supplimental Rates by $20.7 million
  • Pediatric Palliative Care is essentially level funded at just over $1.5 million
  • The Governor’s budget includes a special fund for federal assistance (FMAP) relative to health reform and healthcare access expansion called the Health Insurance Expansion Fund.
  • The DPH budget gets an overall increase of 1% with details in Commissioner Cheryl Bartlett’s “Mass Public Health” blog post.

Stay tuned for more  budget-related news and advocacy alerts.

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