Talking Home Care Episode 2: Tim Rowan on New Tech All Agencies Need

Pat Kelleher discusses how home care agencies can leverage the latest technologies to their advantage with Tim Rowan, editor of the Home Care Technology Report.

Tim Rowan of <a href="" target="_blank"></a>.In the second episode of Talking Home Care, Pat Kelleher talks with Tim Rowan, editor of the Home Care Technology Report. Topics include:

  • The (continuing) implications of the Affordable Care Act;
  • How even smaller agencies can benefit from use new, video-based telehealth;
  • How technology can help you compete for business from accountable care organizations; and
  • How predictive analytics can improve patient outcomes.

You may directly download the podcast here (Length: 21’23”; Size: 10.3 MB).

Host: Patricia Kelleher, Executive Director of the Home Care Alliance of Massachusetts.

Guest: Tim Rowan, Editor of the Home Care Technology Report. You can also follow Tim at:, and Alternatively, you can text  “homecaretech” to 22828.

To subscribe to this podcast, enter the following field in your podcast app: We hope to have the feed available in the iTunes store shortly.

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Talking Home Care Episode 1: Tim Ashe Previews the State of the State of the Industry

Pat Kelleher talks with Tim Ashe about Fazzi Associates’ upcoming “National Home Care and Hospice State of the Industry Study,” a nationwide survey of more than 700 home care and hospice agencies.

The Home Care Alliance is pleased to announce its new podcast series, Talking Home Care. In our first episode, Pat Kelleher talks with Tim Ashe about Fazzi Associates’ upcoming “National Home Care and Hospice State of the Industry Study,” a nationwide survey of more than 700 home care and hospice agencies.

Topics they discuss include: Telehealth, point-of-care technology, Medicare & Medicaid reimbursements, and becoming an “invincible” agency. The report is expected to be published later this month and will be available both from Fazzi and the Alliance.

You may directly download the podcast here.

Host: Patricia Kelleher, Executive Director of the Home Care Alliance of Massachusetts

Guest: Tim Ashe, Partner, Director of Operational Consulting Fazzi Associates

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HCA Applauds Tele-monitoring Support from MassHealth

After years of advocacy with the legislature and working collaboratively with MassHealth, the Home Care Alliance proudly testified at a public hearing on proposed remote patient monitoring (RPM) payment rates and regulations this week.

Alliance Legislative and Public Affairs Director James Fuccione commented that reimbursement for RPM will strengthen the ability of home health agencies to carry out their mission of keeping people healthy at home and commended MassHealth for including a broad definition that will allow agencies to be creative in their use of the service. Dana Sheer, NP of Partners Healthcare at Home, also submitted comments in support of RPM and offered recommendations on clarifying language.

The Alliance asked for clarification on a number of points, including whether an “installation/removal” fee of $50 would be paid by MassHealth for both or on each end of the set-up and removal of RPM equipment. HCA suggested that the fee be raised to $75 and paid on both ends. Additionally, the Alliance asked for guidance on how to proceed when multiple patients in the same setting could benefit from RPM services. Comments from the Alliance suggested that RPM could go a long way in assisting patients with behavioral health and substance abuse issues as well.

In his testimony, Mr. Fuccione raised the ongoing concern regarding MassHealth rates for nursing, therapy, and home health aide visits, and urged MassHealth to expedite a review and update of those rates.  He noted that the Alliance has had several recent meetings with MassHealth staff focusing on that very subject. However, the hearing was centered on the tele-monitoring proposal and the Home Care Alliance is thrilled to have spearheaded the push for reimbursement.

Massachusetts is one of only a few state Medicaid programs with financial support for RPM, which will be effective this November. MassHealth explained at the hearing that they expect a savings just within the home health program of $1.4 million.

The Alliance’s comments are available here and more updates on any changes MassHealth may make based on our comments will also be sent to member agencies.

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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 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.

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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:

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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.

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National Association Provides Update on Rebasing, SGR

The National Association for Home Care & Hospice (NAHC) held a conference call revealing a frantic final week of advocacy activity before Congress takes its holiday recess until the New Year.

The major part of that activity for home health agencies centered around the attempt to delay the impacts of Medicare “rebasing” cuts through an amendment to the Medicare Sustainable Growth Rate (SGR) fix – also known as the physician fix.

Senator Debbie Stabenow (D-MI) offered an amendment on behalf of home care that would delay the cuts for one full year and give the industry the chance to lobby CMS to change their methodology with more updated and accurate data. Unfortunately, part of the compromise of the short -term physician fix was that it was a “clean” bill, which means no outside amendments. According to NAHC, even the hospital industry had amendments that were proposed and then withdrawn because of that agreement between Democrats and Republicans.

The short-term SGR fix will last for three months and must be offset by $7 billion. The good news there is that none of the offset is coming from the home health industry. Some of the hit is being hit is being absorbed by cuts to Long Term Care Hospitals and Disproportionate Share Hospital rates, but copays and additional reductions for home care  were avoided.

The light at the end of the tunnel comes from the fact that the Senate is working on a permanent SGR fix and the Stabenow amendment will still be in play for that effort. In addition, NAHC was successful in getting language from the FITT Act into the Senate’s proposal. The FITT Act essentially establishes a national pilot program for home-based telemonitoring provided by home health agencies. It will not be straight reimbursement, but is meant to be a shared savings approach where the providers and Medicare will share in any efficiencies gained. Moreover, if the program is successful, NAHC indicated that the program could be expanded by Medicare without going back to Congress for approval since it is a pilot and not a demonstration.

In terms of hospice care, NAHC also reported that another amendment would allow physician’s assistants to serve as the attending physician for hospice patients.

All of these wheels will be in motion in the New Year, but the main idea is that Democrats and Republicans compromised on a two-year deal that keeps the federal government running and it was done without implementing co-payments for home care. The 2% sequester cuts are extended for an additional two years, but those are not “new” cuts and are simply to make the budget scoring work. By the time the extended years are reached, the sequester could potentially be a thing of the past.

The Home Care Alliance thanks agencies for sending nearly 200 messages to the Massachusetts Congressional Delegation in two days. That education and advocacy will be critical as we move forward to fight rebasing in the New Year. Of course, further information will be provided as it becomes available.


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Budget Passes With Telehealth, Pediatric Palliative Care Funding

After years of advocacy and passing budget items with weak language that did not compel MassHealth to act, the Governor signed off on the $33.6 billion FY2014 state budget with a provision that recognizes home telehealth as a reimbursable service.

There is still plenty of work to be done with MassHealth, but passing the telehealth language in the budget is the furthest the Home Care Alliance has gone towards achieving reimbursement for an established service known to create efficiencies, improve care, and reduce costs.

The Alliance will be including a push for telehealth in comments on the state’s proposed home health regulation changes. Any agencies or advocates interested in commenting with HCA in an attempt to have the state include telehealth reimbursement in regulation to ensure its permanence should have a letter in to MassHealth by the July 26th deadline. Agencies can contact James Fuccione at the Alliance for details.

Also included in the the final budget is $1.5 million for the Pediatric Palliative Care Network, which serves the unmet physical, emotional, social and spiritual needs of children in Massachusetts with life-limiting illnesses. This is more than $670,000 of additional funding over previous budgets.

The Alliance would like to thank all the agencies and advocates who sent emails, made phone calls, met with legislators and otherwise supported telehealth and the pediatric palliative care funding. These items passing in the final budget represent a huge victory for home care and prove that persistent advocacy pays off.

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Advocacy Alert: Send a Message to Support Telehealth and Pediatric Palliative Care

The Massachusetts House and Senate have named members of a select “conference committee” that will work to negotiate differences between the House and Senate budgets for a final version to be sent to Governor Patrick.

Please visit the Home Care Alliance’s Legislative Action Center and send a message to the conference committee members to support two important budget amendments. The message will automatically be sent to conference committee members.

The first (Senate Amendment #718) would create MassHealth reimbursement for telehealth services provided by a certified home health agency.  Language was included in previous budgets with weaker language that did not compel MassHealth to act. This year we again seek the inclusion of this cost-saving service with the words “the commonwealth shall recognize telehealth remote patient monitoring provided by home health agencies as a service to clients otherwise reimbursable through Medicaid” as stated in Senate amendment #718.

The second amendment (Senate amendment # 629) would add $674,789 to the state’s pediatric palliative care program, which serves the unmet physical, emotional, social and spiritual needs of children in Massachusetts with life-limiting illnesses.

Since both of these amendments were approved in the Senate budget, but not the House, advocates have to urge that conference committee members support the inclusion of the amendments in their negotiated version. If you live in the area of one of the conference committee members and would like to advocate for these amendments directly, the committee members are listed below with link to their profile pages (including contact info) on the state legislature’s website.

It only takes a minute to send a message and advocate for these important issues!

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State Senate Releases FY14 Budget Proposal

The Senate Committee on Ways & Means continued the state budget-making process today by releasing their version of the FY14 budget, which will be debated before the full Senate next week.

The $33.92 billion proposal is a $1.4 billion increase over estimated FY13 spending, but $904.3 million less than what the Governor proposed. The Senate Ways & Means version is also $67.5 million less than what the full House of Representatives approved in their budget last month.

Here are some items of note:

  • $4.5 billion for the MassHealth Managed Care line item – $39.5 million over the final House budget.
  • $2.9 billion for the MassHealth Senior Care line item – $42.5 million over the final House budget.
  • $187.2 million to fully fund the elder home care programs, an additional investment of $6.2M over FY 2013, to eliminate the current waitlist of 1,500 seniors. This includes $98.7 million for Home Care Purchased Services.
  • $10.5 million for Grants to Councils on Aging, increasing support to $8 per elder, marking the highest ever level of state support for councils on aging.
  • $2.1 billion for the MassHealth Fee-for-Service line item – $7.2 million LESS than the final House budget.
  • Level-funding the Pediatric Palliative Care Program.

The Home Care Alliance will again be working with Senators to file three budget amendments to create a home health certificate of need program, establish MassHealth reimbursement of home telehealth, and strengthening pediatric home health.

As the Alliance works over the next few days to submit these amendments, association members and advocates should be on the lookout for “advocacy alerts” with message templates that can be sent to Senate offices. Of course, more information on budget development will be released as it becomes available.

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