Senate Passes $32.4 Billion Budget with Telehealth Reimbursement

Building off the success of getting a telehealth amendment in the Senate’s Health Care Payment Reform bill, the Home Care Alliance earned a victory with the Senate also passing a telehealth amendment during their budget deliberations.

The amendment establishes MassHealth reimbursement for telehealth services provided by home health agencies through regulations that have yet to be determined. The next step for the initiative, though, is to get through a conference committee where the House and Senate meet to hammer out the differences in their separate budget proposals. That final product is then sent to the Governor for his approval.

The Alliance will have new advocacy messages available on the Legislative Action Center once the legislature’s budget conference committee is named.

The Alliance’s other priorities pertaining to Certificate of Need, home health nursing rates past 60 days of care, and relative to pediatric home care were not passed, although the certificate of need issue is seeing increased interest. This and the passage of telehealth owe credit to the hundreds of emails sent out by HCA members and advocates through the Legislative Action Center.

The other major item that the Senate approved was the Human Service Salary Reserve worth $20 million. This account to provide a slight increase in pay for 31,500 human service workers in the state was not approved by the House and will be a huge bargaining chip in conference committee negotiations. If passed, the increase in pay would amount to about $12 per week, per worker.

Other amendments of note that passed the Senate budget include a special commission to study causes, prevention and treatment strategies pertaining to Chronic Obstructive Pulmonary Disorder (COPD). This would present an opportunity for home care to promote their chronic disease management programs and telehealth services. Also passed was an amendment that would create an advisory committee on long-term services and supports. If passed in the state’s final budget, home care agencies would have a chance to be on the committee or at least to submit data and recommendations.

Finally, other rejected amendments from the Senate included items from the state’s Home Care Program from the Executive Office of Elder Affairs that funds the ASAP programs. Specifically, the amendments for Home Care Purchased Services, Enhanced Community Options, and Case Management were all denied.

Return to www.thinkhomecare.org.

Advocacy Alert: Contact Your State Senator to Support Home Care in the FY13 Budget

The Massachusetts senate is set to debate what will become their version of the state’s FY13 budget this week. Several senators have filed amendments to the budget proposal on behalf of the Home Care Alliance that reflect industry priorities and agency members and advocates are encouraged to contact their senator to urge their support.

Below are prepared emails that can be sent simply by clicking the issue of concern, filling out the contact information form, reviewing the message and clicking “send.” Fact sheets are available by clicking the “read about this issue” link below each heading.

Support Certificate of Need for Home Care in FY13 Budget

»  Write Your Legislators    »  Read About This Issue

Support Telehealth in the FY13 Budget

»  Write Your Legislators    »  Read About This Issue

Please Support Home Health Rates in the FY13 Budget

»  Write Your Legislators    »  Read About This Issue

Support Pediatric Home Care in the FY13 Budget

»  Write Your Legislators    »  Read About This Issue

Senate offices can also be contacted by phone and a listing of each senator is available here. For those who are unsure who represents them in the senate, go to wheredoivotema.com and type in your address.

When calling, ask that they support the following amendments (mention the amendment number, name, and who sponsored the amendment).

# 559               Certificate of Need                                          Offered by Sen. Michael Moore

• Massachusetts is one of five states without either licensure or a CON requirement for home care and the proper oversight will ensure a level of quality assurance for patients without adding cost to the Commonwealth.

# 692               Telehealth Reimbursement                              Offered by Sen. Richard Moore

• Instructing MassHealth to reimburse home health care providers for telehealth remote patient monitoring would save costs by not having to pay for unnecessary nursing visits, is used in many other states, and the service is reimbursed by Medicare.

# 554               Home Health Rates                                        Offered by Sen. Michael Moore

• 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 amendment would restore that rate and would strengthen agencies that keep at-risk MassHealth clients out of costlier settings.

# 682               Pediatric Home Care Services             Offered by Sen. Thomas Kennedy

• This amendment does not increase any rate, but merely shifts existing payment recognizing a home health agency’s administrative requirements over independent nurses who have no such requirements.

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State Budget Update: Senate Ways and Means Releases Proposal for Debate

The Senate Committee on Ways and Means released their recommendations for the state’s fiscal year 2013 budget. The full 40-member Senate will introduce amendments by the end of this week and will debate the proposal beginning next week. Here are some of the highlights concerning home care:

MassHealth Line Items:

• The MassHealth Managed Care account (line item 4000-0500) dips $6 million below what the House approved in their version at $4.158 billion.
• The MassHealth Senior Care account (line item 4000-0600) comes in at $7,230,000 below what the House proposed at $2.756 billion.
• The MassHealth Fee-for-Service Payments account (4000-0700) saw a bigger slash from the House version of $26.8 million, coming in at $1.927 billion.

Elder Affairs/State Home Care Program Line Items:

• Elder Enhanced Home Care Services (9110-1500) saw a decrease from the House version of $1,327,853 set at $46.4 million.
• The Home Care Purchased Services account (9110-1630) was also set below the House’s budget version by $497,837 at a total of $97.2 million.
• The Elder Nutrition account (9110-1900) does not match the House’s version, but still restores a cut to that program made by the Governor. The Senate Ways and Means version is set at $6.325 million.

In summary, the Senate Ways and Means budget proposal chips down all MassHealth and Elder Affairs line items. These amounts may be restored at least partially after the full Senate concludes their debate and also following when the Senate and House name members to a conference committee to work out differences between the two budgets.

The Home Care Alliance will continue to advocate for a MassHealth nursing rate increase, Certificate of Need, Telehealth, and strengthening pediatric home care services.

Check back to the blog to find out how you can support HCA’s budget priorities.

Return to www.thinkhomecare.org.

Advocacy Alert: Contact Your State Rep. Today to Support Home Care in FY13 Budget

The Massachusetts House of Representatives begins work on their version of the FY13 State Budget today and the Home Care Alliance needs your help sending emails to support home care’s priorities!

Visit our Legislative Action Center or see the issues below to send any of the pre-written messages that concern you and your agency. It only takes ONE MINUTE to enter your contact information, review your information, and the system will automatically send the message to the state representatives for your area.

Urge your state representative to support the following issues:

Restore Home Health Rates

»  Write Your Legislators    »  Read About This Issue  

Support Telehealth Reimbursement from MassHealth

»  Write Your Legislators    »  Read About This Issue  

Support Certificate of Need for Home Care

»  Write Your Legislators    »  Read About This Issue  

Support Pediatric Home Care

»  Write Your Legislators    »  Read About This Issue 

OR

Compose Your Own Message

»  Write Your Legislators

 

Return to www.thinkhomecare.org.

State Budget Update: House Ways and Means Releases Budget Proposal

The House Committee on Ways & Means released its proposal for the state’s fiscal year 2013 budget and while there are few changes in dollar amounts, here are the initial highlights:

• The MassHealth Managed Careaccount (line item 4000-0500) follows the Governor’s proposal by increasing $183,988,029 over FY12 spending to $4,164,475,376.
• The MassHealth Senior Care account (line item 4000-0600) also followed Governor’s budget blueprint by increasing $196,976,192 over FY12 spending to $2,763,630,662 .
• The MassHealth Fee-for-Service Payments account (4000-0700) maintained the Governor’s proposal of increasing $129,850,745 over FY12 spending to $1,939,680,126.
• Elder Enhanced Home Care Services (9110-1500) was given a bigger increase by House Ways & Means of $827,853 – as opposed to the Governor’s $672,147 – to a total of $47,289,340.
• The Home Care Purchased Services account (9110-1630) is level funded at $97.8 million.
• The Elder Nutrition account (9110-1900) is level funded at $6.3 million, which would restore a cut of $1.5 million made by the Governor.

This all essentially means that House Ways & Means followed the Governor when it came to the MassHealth accounts, which were increased with funding, but only to account for anticipated increases in enrollment. This budget proposal also shows a commitment to the state’s Home Care Program and restores the Elder Nutrition Program that funds “meals on wheels.”

What is not seen is increases to MassHealth home health rates or any language related to telehealth services, pediatric home care and a certificate of need process. The Home Care Alliance is pushing for amendments on these matters and will let member agencies, supporters and advocates know when they are officially submitted.

Additional items of note include a special commission to study elder protective services, increase public awareness of elder abuse, and establish reporting mechanisms.

Stay tuned as more information will be reported as it becomes available.

Return to www.thinkhomecare.org.

Governor Releases FY13 Budget Blueprint

Governor Deval Patrick released his proposal for the state’s fiscal year 2013 budget, which sets the stage for the legislature to work out their own versions and come to an eventual agreement over the next six months.

The Governor’s budget does not include any projected increases or cuts for home health, as is the case with most programs (MassHealth Nursing Home Supplemental Rates are reduced from FY12 spending by more than $300 million in the Governor’s proposal).  The MassHealth line items are almost all increased to “meet projected need,” which just translates to level funding. Here is a list of the line-items of note, including the MassHealth accounts.

• MassHealth Managed Care (line item 4000-0500) increased $183,988,029 over FY12 spending to $4,164,475,376
• MassHealth Senior Care (line item 4000-0600) increased $196,976,192 over FY12 spending to $2,763,630,662 .
• MassHealth Fee-for-Service Payments (4000-0700) increased $129,850,745 over FY12 spending to $1,939,680,126.
• Home Care Purchased Services (9110-1630) had a short increase just over $2,000 to $97,783,061.
• Elder Enhanced Home Care Services (9110-1500) increased $672,147 to $46,461,487 .

The Governor’s office provides more details on health care costs and reasoning for those decisions here. The Home Care Alliance will continue to provide more information as further analysis is completed. The Alliance will once again be advocating for line items of concern as the budget process moves forward, including on issues like payment rates and telehealth reimbursement from Medicaid.

For more general information, several articles from sources like Boston.com and MassLive.com are available that explain some of the Governor’s budget as well.

Return to www.thinkhomecare.org.

 

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:  eohhshearings@massmail.state.ma.us

Return to www.thinkhomecare.org.

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 Mass.gov.

Return to www.thinkhomecare.org.

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.

Return to www.thinkhomecare.org.

MA House Approves Adult Day Health Funding, Fixes Treble Damage Law

An evening vote to approve the Health and Human Services portion of the House FY12 budget brought with it a restoration in funding for adult day health services, at least until the end of 2011.

The Governor had proposed in his initial budget a $55 million cut to the program, which would have eliminated the “basic” level of service that provides for roughly 11,000 people. The Home Care Alliance was part of a coalition of advocates led by the Massachusetts Adult Day Services Association that attracted a whopping 94 cosponsors out of 160 state representatives.

The amendment did eliminate the Health Promotion and Prevention (HPP) level of service, which is technically less intensive than the Basic level. It also directs Health and Human Services to impose a temporary moratorium on the enrollment of new adult day health providers as well as expansion of the certified capacity of already approved adult day health providers.

Moreover, the amendment tightens cost reporting reviews, sets up a study group to review and recommend improvements in rate setting methodology and program structure and future needs.

Another major step taken with the House budget was to include language limiting the current punitive treble-damages law to “willful” violations of the wage and hour statute only. The Home Care Alliance supported the amendment to the House budget regarding the treble damage law offered by Associated Industries of Massachusetts (AIM).

According to AIM, the current law penalizes companies that have done nothing outrageous, have not acted with an evil motive, and have not acted with reckless indifference to employees’ rights.  The same would be true in the case of a good-faith dispute over whether an employer owes commissions.

Aside from Adult Day Health, the House approved:

• An additional $1 million (over the Governor’s proposed budget) for Elder Protective Services.
• An additional $1 million for grants to Councils on Aging

The budget process will move on to the Senate where the Home Care Alliance will continue to push for Adult Day Health, the Treble Damage Law fix and other home health-related measures that were unsuccessful in the House. MassHealth rate restoration past 60 days of care, MassHealth reimbursement for telehealth, improvements to pediatric home care services, and improving care transitions will all be on the agenda.

Return to www.thinkhomecare.org.