CMS Announces Independence At Home Demonstration Program

CMS continues to roll out initiatives from the Affordable Care Act in an attempt to test new ways to improve health care and lower cost.

The latest in this line of programs and funding opportunities is the Independence At Home Demonstration (Section 3024 of the ACA), which aims to test a service delivery model that utilizes physician and nurse practitioner-directed primary care teams to provide services to certain Medicare beneficiaries with multiple chronic illnesses in their homes.

According to the Independence At Home (IAH) Program Solicitation, in order to be involved in the Demonstration, “practices must be individual physicians or nurse practitioners or interdisciplinary teams composed of various members such as physicians, nurse practitioners, physician assistants, pharmacists, social workers, and other supporting staff.” The program itself is designed to provide comprehensive, coordinated, continuous and accessible care to high-need patients and to coordinate health care across all treatment settings.

Even though primary care is the lead in the IAH demo, the focus is on delivering care to patients in their homes and getting beneficiaries what they need to remain independent. In other words, the program could actually be of significant benefit to the home care industry as a whole because primary care practitioners will be making check-ups in the home and witnessing how patients function in their day-to-day environment. Based on those visits, the practices will be identifying services – like home care and other community based services – that help keep people out of costlier settings and the ER.

Practices are required to use electronic health systems and remote patient monitoring, both of which are used by many home health agencies. Also, practices must be available 24 hours per day, seven days per week to carry out plans of care. Applicable beneficiaries must have at least two chronic illnesses, must need human assistance with two or more Activities of Daily Living (ADL’s), have had a non-elective hospital admission within the last 12 months and have used acute or sub-acute rehabilitation services within the last 12 months.

HCA encourages agencies to see the other guidelines, which are laid out in the IAH Solicitation and a summary is provided in a PowerPoint provided on the IAH program webpage.

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EOHHS Hosting FY2013 Budget Hearings

The Home Care Alliance is collecting written testimony and encouraging those interested to present oral testimony for upcoming hearings being hosted by the Executive Office of Health and Human Services (EOHHS) on the upcoming Fiscal Year 2013 budget.

Indications have been made that the upcoming budget will be just as difficult as those in previous years so it is important that home care agencies show up and submit written comments to convey the significance and value of the services they provide. EOHHS is seeking input about the best ways to preserve core services to the fullest extent possible without additional expenditures. As such, the Alliance suggests that agencies promote work in care transitions, disease management, and the general value of keeping people independent at home. The Alliance is also pushing for MassHealth coverage of telehealth technology as well as legislation on nurse delegation of medication administration, which we encourage people testifying to include in their comments.

Secretary JudyAnn Bigby, M.D., and the Assistant Secretaries at EOHHS will be on hand for both hearings so comments should begin by addressing them accordingly. The two hearings will be held this week and next week at the following dates and locations:

Friday, December 2, 2011 from 3:00-6:00 p.m.
Department of Mental Health Western Massachusetts Area Office
Northampton Haskell Building
1 Prince Street
Northampton, MA 01061

Friday, December 9, 2011 from 2:00–6:00 p.m.
Agganis Arena at Boston University
Francis D. Burke Club Room
925 Commonwealth Avenue
Boston, MA 02215-1204

Due to the number of individuals anticipated to attend the hearings, oral testimony will be limited to three minutes per individual. In the interest of time, representative panels are welcome and will be limited to a total of five minutes of oral testimony. If a number of home care agencies are interested, they will be added to a panel as HCA will be attending and testifying at the Boston hearing on December 9th. HCA asks that you also inform us if you sign up to attend or submit written comments on your own.

If you need accommodations please call 617-573-1600 and let the receptionist know.  Additionally, if you are planning to present oral testimony at the Boston hearing, please note that you must be in the building by no later than 5:50 p.m.

Written testimony can be sent to the Home Care Alliance to be submitted collectively, or may be mailed to:

Secretary JudyAnn Bigby, EOHHS
One Ashburton Place, Room 1109, Boston, MA 02108
Or emailed to:

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Gov. Patrick Signs FY12 State Budget

Governor Deval Patrick signed the state’s fiscal year 2012 budget amounting to $30.6 billion with a victory for home health.

Language that would move MassHealth one step closer to reimbursing home health agencies for telehealth services was included in the “MassHealth Managed Care” line item:

…for purposes of long-term health care cost savings and enhanced patient care, the commonwealth may recognize telehealth remote patient monitoring provided by home health agencies as a service to clients otherwise reimbursable through Medicaid

The key word in this language is “may.” MassHealth is not directly instructed in the budget to reimburse for telehealth (as if the word “shall” was used), but it presents the state with the option to do so, which means that continued advocacy will be required to push the state towards that end. This is a solid victory for the Alliance’s budget advocacy thanks to the hundreds of emails that were sent from the HCA website’s Legislative Action Center and to the office of Senator Richard Moore.

Another item of interest is in regards to Adult Day Health where the Governor approved a budget that makes “no changes prior to December 31, 2011 in the clinical eligibility or level of reimbursement paid to providers of adult day health services for basic and complex levels of care.”  The budget also imposes a temporary moratorium on enrollment of new Adult Day Health providers until such time that a study is completed by the Executive Office of Health and Human Services. The study, due to the Legislature by December 31, 2011, will provide a basis for new licensure and rate structure and also will provide a needs assessment of ADH services going forward.

For more information, the full budget is available on

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Advocacy Alert: Send an Email to Budget Conferees to Support Telehealth

A new advocacy message is available to click and send to legislators who are part of the FY 2012 Budget Conference Committee, which is charged with compromising the House and Senate versions of the state budget before it’s sent to the Governor.

The Home Care Alliance, thanks to State Senator Richard Moore, saw a Senate budget amendment pass that would bring MassHealth reimbursement for telehealth services provided by a home health agency.

You can help support this issue by visiting the HCA’s Legislative Action Center and clicking on the telehealth message. Simply fill out your contact information and click “send messages” to email each member of the conference committee.

Here is the language of the telehealth budget amendment (# 593) that passed in the Senate:

Messrs. Moore, Montigny and Tarr moved that the bill be amended, in Section 2, in item 4000-0500, by adding the following words:- “; provided further, that for purposes of long-term health care cost savings and enhanced patient care, the commonwealth shall recognize telehealth remote patient monitoring provided by home health agencies as a service to clients otherwise reimbursable through Medicaid”.

You can also call the conference committee members and ask that they support Senate budget amendment # 593 relative to telehealth. Contact info for the conferees is below:

  • Sen. Stephen Brewer – 617-722-1540
  • Sen. Steven Baddour – 617-722-1604
  • Sen. Michael Knapik – 617-722-1415
  • Rep. Brian Dempsey – 617-722-2990
  • Rep. Viriato Manuel deMacedo – 617-722-2100
  • Rep. Stephen Kulik – 617-722-2380

If you have any questions or would like to learn more, please contact the Alliance.

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State Senate Budget Includes Telehealth

The state senate this week passed a $30.5 billion state budget for FY 2012 that included a major priority of the Home Care Alliance.

An amendment instructing MassHealth to reimburse for telehealth remote patient monitoring provided by a home health agency was adopted by the Senate.  That provision must now survive a conference committee made up of House and Senate members who will work out differences between the House and Senate budget proposals and send the finished version to the Governor for his approval.

The amendment passage is a victory for home health care and reflects a greater understanding from the state legislature on issues important to the industry. Moreover, the adoption of the telehealth amendment, while only a first step in the process, is also recognition of the cost savings that home health agencies and the use of technology can provide.

Most of the 599 budget amendments proposed in the Senate did not make it through, including restoration of MassHealth rates of payment for home health past 60 days, a pediatric home care amendment, and another that would have established a special care transitions rate for home care agencies.

Two amendments regarding adult day health were also adopted.  One would establish licensure standards for adult day health providers and the other would require MassHealth to notify the legislature of any changes to rates or clinical eligibility criteria for adult day health services.

Other amendments of note include:

  • An amendment was adopted that would require MassHealth to annually notify each beneficiary over 65 about their options regarding enrollment in voluntary programs, including Program of All Inclusive Care for the Elderly (PACE) plans, MassHealth Senior Care Options, Frail Elder Home and Community Based Waiver Program and “any other voluntary elected benefit to which such beneficiary is entitled to supplement or replace such beneficiary’s MassHealth benefits.”
  • An amendment was rejected that would allow nursing homes to place a hold on beds for residents who are transferred to the hospital for emergency care.
  • An amendment was adopted to provide an additional $1 million for elder protective services (total amount: $16,250,554).
  • An amendment was adopted to provide an undisclosed amount of funding to elder pre-admission options counseling.
  • An amendment was adopted providing an additional $4 million for Day Habilitation Services
  • The Salary Reserve for human service workers was not approved, but the Senate did approve a substitute amendment enable human service provider agencies to purchase health insurance through the Commonwealth Health Insurance Connector for their employees earning less than $40,000/year.

For any questions or further information on the state budget, contact James Fuccione at the Alliance.

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Advocacy Alert: Help Support Home Health Budget Amendments

The Massachusetts House of Representatives begins debate on the FY12 budget TODAY!

Please see the pre-written email messages below that are available to send to your legislators. All you have to do is click “write your legislators” under the issue you care about, fill in your contact info and the message will automatically be sent to the State Representative who represents YOU.

HCA is trying to gain support for these important amendments so please send a message and forward this email to colleagues and friends who may be interested in taking action.

Support Pediatric Home Care
»  Write Your Legislators   
 Amendment # 529: Pediatric Home Care Services (Offered by Rep. Michael Brady)

  • This amendment does not increase any rate, but merely shifts existing payment recognizing a home health agency’s administrative requirements. Also, this amendment ensures safety and quality by allowing only registered nurses to care for multiple patients in a single setting.

Support Enhanced Care Transitions
»  Write Your Legislators 
 Amendment # 554: Patient Care Transitions (Offered by Rep. Kevin Honan)

  • This amendment establishes a special MassHealth rate to reward home health agencies that are successful in helping patients discharged from acute care avoid a costly re-hospitalization for the same condition for which they were originally hospitalized.
  • The hospitalization would have to be avoided for at least 30 days in order for the payment to be administered. The Secretary of Health and Human Services shall determine the rate, which will be based on a nurse-led team model.
  • This provision would increase the efficiency of care and save costs for the state in avoiding rehospitalizations.

Restore MassHealth Payment Rates to Home Health
»  Write Your Legislators 
Amendment  # 339: Home Health Rates    (Offered by Rep. David Sullivan)

  • The MassHealth home health payment rate was cut by 20 percent to patients receiving skilled nursing care past 60 days of care in December of 2008. This created a new payment category that goes from $86.99 to $69.59 for patients that require longer periods of care and who are at a greater risk of inpatient facility admissions or readmissions.  Since all of MassHealth’s home health services receive a 50 percent federal match, the actual state expenditures reflect only half of a $7.1 million budget increase.

Support Telehealth in the FY12 Budget
»  Write Your Legislators      
 Amendment # 681: Telehealth Reimbursement (Offered by Rep. John Mahoney)

  •   In recent years, several states have all moved forward with incorporating coverage of telehealth into their state plan, waiver home care programs, or have authorized funding for demonstration projects to support telemonitoring equipment purchases.
  •   The Centers for Medicare and Medicaid Services also recognize and define telehealth billing and reimbursement practices.
  •   Telehealth and remote care management programs are not only proven to reduce admissions to hospitals and nursing homes, but also reduce the frequency of home health visits.
  •   Such lower cost services increase communication with physicians and caregivers, which contributes to the enhancement of care. It also increases patient self-management and is widely regarding as a cost savings measure supported by a number of studies and pilot programs.

Support Home Health in FY12 Budget
»  Write Your Legislators      
 This email message supports all of the above amendments.

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