The Rundown – April 2023

Federal Recap

HCA Travels to DC to advocate for Home Care

To end the month, HCA along with member agencies, Care Central VNA & Hospice and Seraphic Springs Health Care Agency traveled to DC to meet with members of the Massachusetts congressional delegation. HCA updated congressional staff about the ongoing worker shortage that the industry is currently facing and the immense impact that further cuts by CMS for home health rate would have on the industry. We noted that if any further cuts are applied it could result in up to 50% of home health agencies across the country having a net margin below zero.

HCA would like to say a special thank you to Care Central VNA & Hospice and Seraphic Springs Home Care Agency, and Renee Walsh for taking the time to come down to DC to advocate for our industry.  HCA will continue to work with the Massachusetts congressional delegation to help prevent CMS from applying further cuts to home health rates. If you would like to join HCA on any future advocacy efforts in DC or at the state house, please reach out to Harrison Collins,

SVB Collapse

The month started slowly with the usual twitter beefs between members of Congress and the media continuing to speculate who will run for President in a year, and then…. Suddenly….. All HELL BROKE LOOSE!! Out of what seemed like nowhere, in a matter of 48hours, Silicon Valley Bank (SVB) collapsed, marking the biggest bank failure since 2008, and the second largest of all time. At the time the bank collapse, SVB’s total assets were over $220 billion, making them the 16th largest commercial bank in the US. Which was honestly more shocking to hear than the news that they collapsed. Learning the news that a bank that I barely knew about was that large was like finding out that the 16th biggest food chain in the US is Tatte Bakery & Cafe! And at-least they have delicious pastries.

for a quick rundown, SVB was originally founded over a poker game, wild story, in 1983, Silicon Valley Bank became the go-to lender for tech startups that appeared too risky in the eyes of larger, more traditional banks. Eventually, Silicon Valley Bank would come to do business with nearly half of all U.S. tech startups backed by venture capitalists, including businesses such as Spotify, Pinterest, and Fitbit. SVB grew and grew and looked unstoppable. During the beginning of the pandemic with interest were low and egg cartons only cost $1.50, tech stocks exploded, which led to a surge in deposits at the bank, which then invested a large chunk of the cash into long-term U.S. government securities. But when interest rates started to sky rocket last year, not only did egg prices jumped up to $3.50, the huge amount of bonds they bought became worthless high, resulting in a 1.8 billion loss. The increase interest rates also resulted in a contraction in funding for startups, pushing startups to withdraw more and more money from their accounts to pay their debts. This meant that SVB had to cover the money for startups to withdraw, this pushed SVB to announce that they were selling $2.25 billion in new shares to plug the hole in its finances, and that they were holding a new funding round, which is not usual for big time banks. This made people LOSE THEIR MINDS. On a Wednesday March 8th, startups, and venture capital firms in droves started to withdraw all their money from SVB, fearing it was the 2008 bank collapse all over again, causing SVB stock to drop 60% on Thursday, March 9th. By Friday, March 10th, trading in SVB shares was halted and it had abandoned efforts to raise capital or find a buyer. California regulators intervened, shutting the bank down and placing it in receivership under the Federal Deposit Insurance Corporation, which typically means liquidating the bank’s assets to pay back depositors and creditors. In the matter of 3 days one of the biggest banks in the US failed, mainly because they failed to watch the Big Short. If only they watch past the scene with Margot Robbie in the bathtub, they would have learned NOT TO PUT ALL YOUR EGGS IN ONE BASKET.

Democrats were quick to point the blame at President Trumps for lifting of bank regulations during his administration, and the Feds failure to prevent the collapse. In a speech right after the collapse Massachusetts own, and vocal advocate for banking reform, Sen. Elizabeth Warren, called out former President Trump, for rolling back parts of Dodd-Frank act, which provides oversight over banks. One part of the act that was rolled back is the minimum amount banks had to keep on hand at any one time, which would give banks more money to invest and spend. Warren argues that this led to SVB to pump more money than they should have been able to into long-term U.S. government securities, which eventually collapsed. Sen. Warren and California Rep. Katie Porter, introduced a bill that would re-instate the parts of the Dobbs-Frank act that were rolled back.

Republicans, were also quick to blame federal regulators, but for the opposite reason, going to far. Some prominent Republicans including President Trump, slammed the Fed for stepping in to ensure that depositors – including the nearly 90% of whom had funds in SVB that exceeded the $250,000 limit of what is insured by the Federal Deposit Insurance Corporation (FDIC) – would have access to all of their money on Monday. The move represents the biggest federal intervention in the financial market since the 2008 economic collapse. GOP members believe that the government shouldn’t be in the act of bailing out banks for their bad practices, especially if those practices are “woke” polices. Likely presidential candidate Florida Governor Ron DeSantis used the news of SVB’s failure to further criticize corporations so called “woke” policies. DeSantis said “I mean, this bank, they’re so concerned with DEI and politics and all kinds of stuff. I think that really diverted from them focusing on their core mission,”. I don’t know about you, but I don’t know how having diversity in your business can lead to a bank spending too much money on government securities, but that’s just me.

President Trumps Arrest

Things continued to go off the walls when a week and a half later it was released that the Manhattan District Attorney Office invited President Trump to testify to the grand jury for his alleged role in the 2016 hush money payments to former porn star Stormy Daniels, which legal experts said was a sign that he would be indicted. This obviously send obviously sent the twitter world and Truth Social into a frenzy! President Trump jumped what I can only assume is an old blackberry to say on Truth Social, that he expects to be arrested on March 21 and calls on his supporters to protest (obviously in all caps), even though he hadn’t been notified that he would be. He later went on to warn of potential “death and destruction” if he is charged with a crime. All news coverage quickly changed to exclusively following the Trump potential arrest. And then finally on March 30 it was made aware that the President had indeed been indicted. This marked the first time that a former president was indicted for criminal charges. Which is honestly shocking if you look back at all our presidents including, Nixon, Clinton, Harding, and VP Spiro Agnew.

Maybe it’s just me but while I know its huge news that a former President was indicted is massive news, it just doesn’t feel like it really is. After how crazy the world has been for what feels like 20 years but has really only been 7, I just feel numb to all big news. I mean a former president is charged with a crime and it weirdly felt like less of a big deal than when a rival team loses their starting QB.

Look Ahead

Congress is out of session for the first two weeks of April for Easter Recess. In the meantime, and even when they get back all the focus will be President Trumps criminal probe and his arrest. Now since his actual arrest happened in April, I will cover his arrest in further detail in the next rundown. But other than that, there is not much else to look ahead for over the month of April at the federal level

State Recap

Traveling Nurses

The Health Policy Commission reported in late March that an increasing reliance on travel nurses is contributing to high turnover rates among nurses in Massachusetts.  The report even prompted the Health and Human Services Secretary Kate Walsh, to say that the hospital industry has to “get rid of these usurious travel agency contracts that hurt everybody,” and the attorney general has put temporary nursing agencies on warning of violating rate payment rules. Registered nurse vacancy rates in Massachusetts hospitals doubled from 6.4% in 2019 to 13.6% in 2022, with especially high vacancy rates in community hospitals, the HPC report says.

The report also showed that the widespread industry shortage does not appear to be caused by fewer people wanting to become nurses, but rather nurses leaving the field after they had already begun working. The number of people completing nursing programs did not change during the pandemic and, in fact, there was an increase in the number of people earning advanced nursing degrees in 2020. As of 2021, contracted workers (travel nurses) represented about 5% of hospital patient care labor costs in the state, the report says. Across Massachusetts, health care facilities paid $1.5 billion to these workers in fiscal 2022 — a 154% increase over the previous year.

The increase of traveling nurses has had an impact not only on Hospitals but on home care agencies. With more and more nurses choosing to work for hospitals for short contracts for more pay, it has left the pool of potential nurses for home care agencies scarce. HCA has been working to increase nurse reimbursement rates to attract more people to the home care sector.

HCA Spends Week at State House Advocating for Legislative Priorities

Last week, HCA spent the week at the State House with HCA member agencies to meet with their state legislators to advocate for our legislative priorities. HCA talked to legislators about two bills that we strongly support, H.649/S.380, An Act to Improve Massachusetts Home Care and H.1195/S.755, An Act Clarifying Rate Setting Processes for Home Health and Home Care Services. Both bills will help aid in improving the home care industry and help to bring stability to our sector as a whole. HCA wants to say a special thank you to Maxim, Bayada, and Visiting Angels for taking the time to come to the state house to advocate for these vital pieces of legislation. If you too would like to participate in state legislative meetings, please reach out to Harrison Collins,

Look Ahead

Elder Affairs Committee to Hold Hearing on Licensure

On Monday, April 10, at 9:30am EST, the Joint Committee on Elder Affairs will be holding a public hearing on several pieces of legislation, including H. 649/S.380, An Act to Improve Massachusetts Home Care. H.649/S.380 would create a licensure system that would establish baseline standards for agencies, to ensure a quality network of providers for consumers and keeping services affordable for those who rely on them. This hearing will give member agencies the change to persuade legislators as to why they should pass this bill and the benefit it would have for the industry.

If you would like to listen in on the hearing use the link HERE. HCA will be testifying in person, if you would like to testify for the hearing, either in-person or virtually, please use the link HERE to sign up to testify. HCA will also draft a template for agencies to use to submit written testimony for hearing. please let me know if you plan to testify for the hearing by emailing me at

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