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.

Return to www.thinkhomecare.org.

HCA Succeeds with Amendments to Senate Health Care Payment Reform Bill

The Massachusetts Senate spent the past week debating their landmark health care payment reform proposal, which included 265 amendments that were filed after Senate leadership released the bill to all Senators and the general public.

The Home Care Alliance worked to have several amendments filed and advocated for other amendments that were seen as beneficial.

The Alliance saw victories in the adoption of the following amendments:

• Amendment #43, which instructs insurers to cover telemedicine.
• Amendment #13, which allows employers to count a spouse or parent’s insurance coverage to qualify their employee under the state’s “fair share contribution” regulation.
• Amendment # 223, which adds community-based behavioral providers to the e-Health Institute’s spectrum of care.
• Amendment # 121, which requires hospitals, nursing homes, and assisted living facilities to provide appropriate patients with information regarding the availability of palliative care and end-of-life options.
• An amendment installing a representative of a certified home care agency on an e-Health Commission.

The focus on health care payment reform will move to the House although the timing on that debate and process has not yet been formally announced. Stay tuned to our UPDATE newsletter and the HCA blog for the latest information. If members or advocates have any questions related to payment reform, please contact James Fuccione at the Alliance.

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.

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.

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.

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.

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.