“Did You See That” – March 2024

Federal Outlook

America is Having a Severe Case of Déjà Vu

As we know, history tends to repeat its self-time and time again. Many of you may have heard about the weird parallels between Lincoln and JFK, such as that both presidents were shot in the back of the head, on the Friday before a major holiday, while seated beside their wives, who both married socially prominent twenty-four-year-old woman who spoke French fluently, the list goes on and on. The same may be happening for 2020 and 2024. The Super Bowl in 2020 was between the 49ers and the Chiefs, same as in 2024, where the Chiefs won both games, Taylor Swift won Grammy awards in both 2020 and 2024, both years were leap years, and just like in 2020, we will see the same two candidates face off during the presidential election.

I am going to take a second to say, to be crystal clear, that I do not care who you vote for. That is your business, and it is your right as an American to believe what you want and vote how you want. Okay now back to the mess at hand

President Joe Biden, who was born before the invention of duct tape, penicillin, and the color TV, will once again face off against former President Donald Trump, whose skin looks like what happens if you eat too many carrots. I think we can all agree that this was the last matchup that we wanted to see, but here we are. This is the first presidential election rematch since 1956, which saw then President Dwight Eisenhower defeat for a second time in a row Democratic candidate, Adlai Stevenson, who could put a rock to sleep.

While it may be the same matchup, the sentiment around the election is very different. For one, we are no longer experiencing life as it was during COVID, where we saw state by state lockdowns, high unemployment numbers and a dire lack of live sports to watch. Contrast to the current climate we are living in, a world of high interest rates, unaffordable housing, and multiple military conflicts across the globe, and more sports betting than ever before.

The candidates, their political parties, the media, and really everyone are really focusing on one aspect when it comes to electability of the candidate, who is more “fit” to hold the office. I put fit in quotations because how that word is defined is different depending on who you ask. When it comes to President Biden “fitness” for office, people argue that he is too old to be president. Biden is 82 years old, which already makes him the oldest president in our history. If Biden were to win the election, he would be 86 when his term is over, which is even high for a golf score for a professional. Many have questioned his mental fitness at his current age, and are doubly concern that it will get worse as time goes on. Even the special counselor assigned to a case involving Biden’s storing classified documents after he was VP, expressing concern for his memory. Saying that he could not convict Biden beyond a reasonable doubt because “Mr. Biden would likely present himself to a jury, as he did during our interview of him, as a sympathetic, well-meaning, elderly man with a poor memory.” That report also comes after 4 years of President Biden mis-saying names of countries and people, on a weekly basis. There are countless examples of Biden having mental gaffes. It shows something that people were genuinely happy to hear that Biden got it right at a town hall when he said he was president of the U.S. and not another country. people are also worried that with his “advanced age” he can’t relate with younger populations and their concerns. I mean we come from two different times, Biden grew up when a fun activity as a kid was playing with string and skipping rocks, while my generations and people younger than me idea of fun is killing zombies in a video games and catfishing people online.

When it comes to former President Donald Trumps “fitness” for office, the considerations are less around his mental state, but more around his actions as president and his belief on the power of presidency. People especially his actions surrounding the January 6^th insurrection and potential election interference. The former president has been indicted by a special counsel on felony charges for working to overturn the results of the 2020 election in the run-up to the violent riot by his supporters at the U.S. Capitol on Jan. 6, 2021. The four-count indictment includes charges of conspiracy to defraud the United States government and conspiracy to obstruct an official proceeding: the congressional certification of Joe Biden’s victory. by saying that the election was stolen and trying to persuade state officials, then-Vice President Mike Pence and finally Congress to overturn the legitimate results. He was also indicted in Georgia along with 18 others, for violating the state’s anti-racketeering law (RICO) by scheming to illegally overturn his 2020 election loss. RICO charges are better known for being used by law enforcement to down the Mafia in the 80s and 90s. It is important to note that the former President is yet to be convicted of any charges. People are also concerned because Trump has shared his belief publicly that a president should have immunity from any actions they take as president, which many believe goes against the original intent of the constitution and the separation of powers. Trump said on Truth Social in all-caps “A PRESIDENT OF THE UNITED STATES MUST HAVE FULL IMMUNITY, WITHOUT WHICH IT WOULD BE IMPOSSIBLE FOR HIM/HER TO PROPERLY FUNCTION”. Trump is effectively arguing that a president can do whatever he wants while president and cannot be held liable. This is response to charges that were filed against him for illegally holding onto classified documents and allegedly trying to move/destroy evidence. People are concerned that a candidate that has allegedly worked to fix and overturn an election, as well as believes that a president should have full immunity to do whatever they want while president, is not “fit” to hold the country’s highest office.

In the end, we can all agree that this election season is going to be exhausting. Thank god we have the Olympics to distract us for parts of it.

Federal Recap

Biden Unveils Budget Proposal for FY25

On Monday, President Biden unveiled his proposed budget for FY25, which looks to cut the deficit by $3 trillion over a decade, by increasing taxes for companies and the wealthy. The proposals calls for raising the corporate tax rate to 28 percent from 21 percent, which is the level that was set by the 2017 Tax Cuts and Jobs Act. It also calls for increasing what’s known as the corporate minimum tax to 21 percent from 15 percent. That tax, which was passed by Democrats in 2022, applies to corporations that report annual income of more than $1 billion to shareholders on their financial statements but use deductions, credits and other preferential tax treatments to reduce their effective tax rates well below the statutory 21 percent. In addition to quadrupling a 1 percent surcharge on corporate stock buybacks to 4 percent. White House economists estimate increasing the tax could yield $137 billion in new tax revenue over a decade.

For taxing the wealthy, the proposal includes language that would raise the capital gains tax rate for earner who make more than $400,000 a year to 39.6 percent, and close the so-called carried interest loophole that allows wealthy hedge fund managers and private equity executives to pay lower tax rates than entry-level employees. The most progressive policy included in the proposal would create a 25 percent “billionaire tax” on individuals with wealth, defined as the total value of their assets, of more than $100 million, with the goal is to prevent the wealthiest Americans from employing tax strategies that allow them pay lower tax rates than those of middle-class households.

Last Thursday, before the President’s State of the Union Address, House Republicans advanced their FY25 budget proposal, which would take a vastly different approach to balancing the budget, by cutting over $14 trillion in federal spending in such areas as green energy subsides and student loan forgiveness while reducing taxes. The House Budget Committee adopted the blueprint in a 19-15 party line vote last Thursday, with Budget committee chairman Jodey Arrington saying that the budget plan would reduce the federal debt, which stands at over $34 trillion, create a $44 billion budget surplus in fiscal 2034 and stir economic growth by lowering taxes. The budget postpones severe spending cuts until fiscal 2026, after the November election that will determine control of the White House and Congress. Committee documents show 2026 basic discretionary spending falling by more than $100 billion to $1.5 trillion.

To put it mildly, FY25 budget negotiations are expected to be turbulent, like a flight trying to fly through a hurricane. HCA will be watching the budget process closely as it unfolds.

Government Avoids Partial Government Shutdown, Still More to Do

Late on Friday, the Senate passed a government funding bill, funding roughly 30 percent of the federal government for the next six months, mere hours before the deadline. The legislation — which passed by a 75 to 22 vote — devotes $459 billion to the departments of Agriculture, Commerce, Energy, Housing and Urban Development, Interior, Justice, Transportation, and Veterans Affairs, as well as the Environmental Protection Agency and Food and Drug Administration, for the rest of the fiscal year, which ends Sept. 30. President Biden signed the packaged shortly after it cleared the Senate. Biden thanked Congressional leadership for working together to avoid a partial shutdown. The passing of the funding package came more than five months into the current budget year after congressional leaders relied on a series of stopgap bills to keep federal agencies funded for a few more weeks or months at a time while they struggled to reach agreement on full-year spending.

Through the funding package, non-defense spending will remain relatively flat compared with the previous year. Supporters say that’s progress in an era when annual federal deficits exceeding $1 trillion have become the norm. But many Republican lawmakers were seeking much steeper cuts and more policy victories. The funding packaged also includes over 6,000 earmarks requested by individual lawmakers with a price tag of about $12.7 billion. Earmarks, which were previously banned in 2011, but was recently voted to reinstate earmarks in 2021 by Democrats, with Republicans soon following suit.

Congress still needs to tackle tricker funding packages for remaining departments, including the Departments of Defense, Financial Services and General Government, Homeland Security, Labor-HHS, Legislative Branch, and State and Foreign Operations. Those bills are typically much more controversial and are at greater risk of failure than the bills that passed this week.

State Outlook

Where The Money At?

For the 9^th straight month, state tax collections fell short once again in February. This extends what was already the longest streak of below-benchmark months in more than two decades, tax revenue remains down compared to a year ago. State House News reported that the Department of Revenue reported Tuesday that it collected $2.007 billion last month — $27 million or 1.3 percent more than actual collections in February 2023 but still $11 million or a slim 0.6 percent shy of the administration’s revised monthly benchmark of $2.018 billion. The Healey administration in January lowered the monthly benchmark for February from the $2.137 billion it originally projected for the month prior to the governor’s fiscal year 2024 revenue downgrade. The last time tax collections came in at or above the administration’s monthly benchmark was June 2023, nine months ago. The Healey administration didn’t establish fiscal 2024 benchmarks until August last year, so there was no official expectation set for July 2023. But each month since — now seven in a row — has seen collections fall short of the administration’s projections.

The Executive Office of Administration and Finance said the administration is not planning to make additional budget moves in connection with the below-benchmark February revenue report. A spokesman said the budget office’s outlook on fiscal 2024 has not changed. DOR is due to report revenue collections for March by Wednesday, April 3. The monthly benchmark for March, which DOR said is usually “a mid-size month for revenue collections, ranking sixth of the 12 months in eight of the last 10 years,” is set at $3.935 billion. That would be $52 million more than what was collected in March 2023.

State Recap

Massachusetts Health Care Costs Rose in 2022

The Center for Health Information and Analysis (CHIA), created under a 2012 cost containment law, released its annual report Wednesday examining health care spending trends in 2022. The detailed report covers a year that started with record-high reporting of COVID-19 cases, followed by gradual decline throughout the year.

CHIA’s annual report estimated total health care spending in Massachusetts at $71.7 billion in 2022, and a per capita health care expenditure of $10,264 per resident. Total health care spending was up $3.9 billion (up 5.8 percent on a per capita basis) over 2021’s level — well in excess of the state’s 3.1 percent benchmark for health care cost growth. CHIA said the 5.8 percent growth rate in 2022 represents the largest one-year jump since measurement began in 2012, aside from the “anomalous spending growth in 2021 driven by the pronounced effects of the pandemic.” Health care spending shot up 9 percent in 2021 after posting a 2.3 percent decline in 2020.

The 2022 growth in health care spending was below both the rate of growth in the Massachusetts economy broadly (7.2 percent) and regional inflation (7.1 percent), CHIA said, but outpaced growth in both national wages and salaries (5.1 percent) and national health care spending measured by the Centers for Medicare & Medicaid Services (4.1 percent). The largest contributors to the 2022 expenditure increases were pharmacy spending and non-claims payments, CHIA said.

Other medical services, which includes long term care and home health services, was the largest component of MassHealth spending, totaling $3.4 billion in 2022. Other medical services spending increased 10.1% overall, but only 0.8% on a PMPM basis. Its important to note that the CHIA report does not specifically mention how much was spent on home health services amongst the “other medical service” category.

MassHealth Proposes Significant Increase to CSN Rates

In February, MassHealth released their proposed rates for CSN services. In summary, MassHealth proposed a 32.4% increase to RN weekday rates, and an 11% increase to LPN rates. They have also added a high-tech rate for members with Trachs/Vents/Central lines, these rates have a $2/unit ($8/hr) add on/UA modifier, as well as increased the rate for the 60-day supervisory visit of CCA services by 32.4% as well. If these rates take effect, we will have realized nearly 100% rate increases to this program since 2017 when HCA’s members and CCM Families teamed together on advocacy efforts. An incredible feat.

HCA provided verbal testimony in favor of the rate increase at a public hearing last week, in addition to submitting written testimony.

Massachusetts Health Care Costs Rose in 2022

The Center for Health Information and Analysis (CHIA), created under a 2012 cost containment law, released its annual report Wednesday examining health care spending trends in 2022. The detailed report covers a year that started with record-high reporting of COVID-19 cases, followed by gradual decline throughout the year.

CHIA’s annual report estimated total health care spending in Massachusetts at $71.7 billion in 2022, and a per capita health care expenditure of $10,264 per resident. Total health care spending was up $3.9 billion (up 5.8 percent on a per capita basis) over 2021’s level — well in excess of the state’s 3.1 percent benchmark for health care cost growth. CHIA said the 5.8 percent growth rate in 2022 represents the largest one-year jump since measurement began in 2012, aside from the “anomalous spending growth in 2021 driven by the pronounced effects of the pandemic.” Health care spending shot up 9 percent in 2021 after posting a 2.3 percent decline in 2020. The 2022 growth in health care spending was below both the rate of growth in the Massachusetts economy broadly (7.2 percent) and regional inflation (7.1 percent), CHIA said, but outpaced growth in both national wages and salaries (5.1 percent) and national health care spending measured by the Centers for Medicare & Medicaid Services (4.1 percent).

Other medical services, which includes long term care and home health services, was the largest component of MassHealth spending, totaling $3.4 billion in 2022. Other medical services spending increased 10.1% overall, but only 0.8% on a PMPM basis. It’s important to note that the CHIA report does not specifically mention how much was spent on home health services amongst the “other medical service” category.

“Did You See That” – February 2024

Federal Outlook

Senate Passes $95.3 Billion Foreign Aid Bill, DOA in House

The Senate passed a $95.3 billion foreign aid bill with assistance for Ukraine and Israel, setting up a showdown with the House. The foreign aid package includes billions of dollars to support Ukraine and for security assistance for Israel, as well as humanitarian assistance for civilians in Gaza, the West Bank and Ukraine, among other priorities. The Senate vote was 70 to 29 with 22 Republicans voting in favor, including Senate Minority Leader Mitch McConnell. “History settles every account,” McConnell said in a statement following the vote. “And today, on the value of American leadership and strength, history will record that the Senate did not blink.” The bill includes $60 billion to support Ukraine in its fight against Russia, $14.1 billion in security assistance for Israel, $9.2 billion in humanitarian assistance and $4.8 billion to support regional partners in the Indo-Pacific region in addition to other policy provisions, according to the Senate Appropriations Committee.

The bill passed the Senate despite Speak Mike Johnson’s, who looks like the type of person that would side with the parents that banned dancing in footloose, criticism of the legislation and former President Donald Trump signaling opposition to the bill by arguing the US should stop providing foreign aid unless it is in the form of a loan. Johnson has said that he has no plan to take up the bill currently.  “Right now, we’re dealing with the appropriations process, we have immediate deadlines upon us and that’s where the attention is in the House in this moment.” Johnson also said that we, Congress, need to focus on the border first, and not on foreign aid. Johnson has said in the past that he would not support a foreign aid package unless the House’s hardline border bill is attached, which Senate leadership on both sides of the aisle have said in the past is a nonstarter. The Senate previously announced that they have agreed on a border bill that has bipartisan support, but the House and Speaker Johnson argue that it does not go far enough. But what the House did not say is that presidential candidate Donald Trump has pushed for Congressional republicans to block any border deals so that democrats cannot campaign on the border during the upcoming election cycle. President Joe Biden called on House Republicans to hold a vote on the bill in remarks from the White House, saying that a “minority of the most extreme voices in the House,” should not be permitted to block the bill.

House Impeaches Homeland Security Secretary Alejandro Mayorkas

After an embarrassing failure in January, the GOP led House succeeded in impeaching Homeland Security Secretary Alejandro Mayorkas for his handling of increased migration at the southern border, making him the first cabinet secretary since 1876 to be impeached. The vote tally was 214 to 213. Three Republicans voted with Democrats against the measure. Speaker Johnson said Homeland Security Secretary Alejandro Mayorkas needed to be impeached because he refused to do his job. “From his first day in office, Secretary Mayorkas has willfully and consistently refused to comply with federal immigration laws, fueling the worst border catastrophe in American history,” Johnson said in a statement after the impeachment vote Tuesday. Johnson accused Mayorkas of undermining the public’s trust “through multiple false statements to Congress.” He also said the homeland security secretary “obstructed lawful oversight of the Department of Homeland Security, and violated his oath of office.” Constitutional experts have said the evidence does not reach that high bar of impeachment and three Republicans voted with Democrats against the resolution.

Republican Rep. Ken Buck voted against the impeachment of Homeland Security Secretary Alejandro Mayorkas last week — and did so again tonight. Buck said he did not reconsider his vote because he does not believe that the circumstance qualifies as a high crime and misdemeanor. “You can try to put lipstick on this pig, it is still a big, and this is a terrible impeachment. It sets a terrible precedent,” Buck told CNN on Tuesday after the vote. Sen. Ken Cramer (R-N.D.), an ally of former President Trump, slammed House Republicans actions, calling it “the worst, dumbest exercise and use of time.” The impeachment now moves to the Senate where Democrats have a majority, all but killing any GOP hope of Mayorkas being fully impeached. The Senate is required to hold an impeachment trial, Senate Majority Leader Chuck Schumer’s office said House impeachment managers will present the articles of impeachment to the Senate following the state work period. Senators will be sworn in as jurors in the trial the next day. Senate President Pro Tempore Patty Murray will preside. The key part of the trial is that during an impeachment trial in the Senate, no other official business can be done till the trial is completed. It is widely expected for the Senate to push through the trial to acquit Mayorkas as quickly as possible so they can get back to budget negotiations for a full year budget.

State Outlook

It’s All About the Benjamins

In a crushing blow for Governor Healey’s budget plans, for the seventh straight month Massachusetts failed to hit projected tax revenue. This comes on the heals of Governor Healey implementing emergency 9c cuts of up to $375 million and the Healey administration significantly lowering monthly tax revenue benchmarks. State House News reported that The Department of Revenue reported collecting $3.594 billion last month (January) — $268 million or 6.9 percent less than actual collections in January 2023 and $263 million or 6.8 percent below the administration’s revised monthly benchmark of $3.858 billion. The Healey administration last month lowered the monthly benchmark for January from the $4.121 billion it projected for the month prior to the governor’s fiscal year 2024 adjustments.

Since fiscal year 2024 started in July, DOR has collected $21.460 billion, 1.2 percent less than what the Healey administration projected last month that it would have hauled in by this point in the calendar. The administration last month slashed the year-end revenue estimate by $1 billion after it was reported in December that tax revenue was running $769 million behind projections. Reducing the revenue estimate by $1 billion was meant to address the existing $769 million shortfall while also providing some breathing room for the second half of the budget year, when Administration and Finance Secretary Matthew Gorzkowicz said he expected additional months of below-benchmark collections. The administration also said it thought its January actions would be enough to avoid further 9C cuts this year. Now, after the governor cut $375 million in spending and newly tapped $625 million in non-tax revenues to account for the $1 billion revenue downgrade, the state still finds itself in a hole. Gorzkowicz told reporters that the administration does not have any plan to implement any additional 9c cuts to account for lowering tax revenue.

Lagging tax revenue is a major problem for Governor Healey, who has lofty goals for 2025, and the legislature as they try to craft a FY’25 budget. In late January, Governor Healey released her proposed $58.15 billion budget for FY2025, an over $2 billion or 3.7% increase when compared to the final FY2024 budget she signed back in August.  The proposed budget suggests that she and her budget team expect a growth in revenue compared to last year. The bill does not propose any new tax increases to generate additional revenue, nor does it recommend tapping into the state’s more than $8 billion “rainy day” savings account. Further details on her proposed budget can be found below.

With lagging tax revenue and Governor Healey laying out an ambitious budget proposal in January, the legislature is left to be the bad guy. Governor Healey said in her State of the Commonwealth address that she wants to continue to pay for the migrant crisis, increase spending on infrastructure, such as the T, address the housing crisis and expand access to free community college for Massachusetts residents. All these things will cost an exuberant amount of money to be done properly. Want to know how much? So much so that I had to check a thesaurus to find a better word for a “crap ton”. But in all seriousness, they will all cost billions of dollars. It has been reported that to properly address the migrant crisis it could cost over $2 billion a year. That’s more than what the state spends on free school lunches, free community college, and energy and environmental affairs combined. It’s going to be tough for the legislature to look at current revenue trends and propose a budget that could further exacerbate the ever-growing revenue dilemma and result in an unbalanced budget half-way through the fiscal year.

This concerns me especially because we have already seen the health care sector be cut by Governor Healey when she implemented her 9c cuts to balance the budget. The largest cut proposed by Governor Healey was a $294 million cut to MassHealth fee for service. The explanation that was given for why they can afford to cut $294 million was due to “members using fewer services than we had originally budgeted.” This leads me to worry that the legislature will look to make cuts to the health sector and home care specifically to offset additional spending for Governor Healey initiatives. HCA is closely tracking the legislature’s budget process and has already spoken with the House about the importance of properly and sufficiently funding home care line items in the FY25 budget. HCA plans to continue outreach to the Senate side as the budget process moves along.

Now, like a weatherman, my prediction could be completely wrong. We have seen in the past many times that governments can basically create money out of nowhere and make a budget shortfall go away while also increasing spending, look at Congress every year. But HCA won’t take that chance that they will continue their trend of higher spending till proven otherwise and will continue to fight for funding for home care.

State Recap

HCA Holds State House Advocacy Day

HCA along with members of the Enough Pay to Stay Coalition (EPTS), held a highly attended State House Advocacy Day at the Massachusetts State House. Over 18 people from 8 agencies attended the State House Event. The day started with remarks from Jake Krilovich, Julie Watt Faqir, ED, Home Care Aide Council, and Betsy Cummings, ED, Mass Home Care, followed about remarks from some of our biggest legislative champions, Senator Patricia Jehlen, Representative Thomas Stanley & Representative Carmin Gentile.

Over a full day a meetings HCA members met with over 12 legislative offices, where we discussed the struggles agencies face on a day-to-day basis due to a workforce shortage and how passing H.1195/S.755 – An Act Clarifying Rate Setting Processes for Home Health and Home Care Services would help increase transparency of the rate setting process, as well as, update the rate setting methodology to account for all the costs of that go into providing these services, which will help to create a more adequate rate that will allow agencies to properly compete for workers. We also discussed the crucial need to pass H.649 – An Act to Improve Massachusetts Home Care, which would establish a licensure system for non-medical home care services 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. HCA would like to give a special shoutout to all the members that attended, their valuable insight into the importance of Home Care and what we need to do to grow the sector will go a long way to help pass these two key pieces of legislation. If you would like to read more about the event, check out State House News coverage of the event HERE.

Governor Healey Proposes Increasing FY25 Budget by Over $2.1 Billion

Governor Healey is proposing a $58.15 billion budget for FY2025, an over $2 billion or 3.7% increase when compared to the final FY2024 budget she signed back in August.  The proposed budget suggests that she and her budget team expect a growth in revenue compared to last year.  State House News reported that Healey’s team balanced their plan by trimming $450 million from various line items, proposing to prevent about half a billion dollars in other spending growth, and deploying $1.25 billion other available state resources. The bill does not propose any new tax increases to generate additional revenue, nor does it recommend tapping into the state’s more than $8 billion “rainy day” savings account. Cost controls include closure of the MCI-Concord medium security prison and changes at MassHealth, which typically reflects the largest share of the budget. The budget will propose “flat spending” for MassHealth’s personal care attendant (PCA) program.

Governor Healey proposed several increases in funding as compared to FY24, to line items that affect home care services. Including but not limited to:

• 1599-6903 – Chapter 257 and Human Service Reserve – $173,000,000 to $390,000,000.
• 9110-1630 – Home Care Services Provided Through ASAPs – $215,556,634 to $236,582,945.
• 4000-0700 – MassHealth Fee for Service Payments – $3,601,016,357 to $4,232,605,645.

In addition, unlike the FY2024 final budget, Governor Healey’s proposed budget did not include language for a pass-through requirement for Chapter 257 rates under line item 1599-6903. The pass-through requirement included in the FY24 budget amended the Chapter 257 Rate Reserve line item 1599-6903 as follows, by inserting after the words “any human service provider receiving revenue under said Chapter 257” the following: “, and any home care agency subcontracting with such human service providers to provide home care services,”. This language specifically requires home care providers under chapter 257 to comply with a 75% pass-through requirement that is stipulated in line item 1599-6903. We would like to note that this pass-through requirement is much broader than a pass-through amendment that SEIU tried to pass during the House budget debate, that HCA along with the Home Care Aide Council successfully blocked. Next, Governor Healey’s budget will be taken into consideration by the House and the Senate. The legislature is not required to include anything that is proposed by the Governor in her budget proposal. HCA will work with our legislative champions at the state house to make sure that no pass-through language is included in either of the proposed budgets from the House and the Senate.

Joint Rule 10 Deadline Extended for Select Committees

On Monday, The State House of Representatives voted to extend the Joint Rule 10 deadline, which is the deadline for committees to report on bills (favorable, non-favorable, or further study), was extended to May for select committees including the Committee on Advanced Information Technology, the Internet and Cybersecurity; the Committee on Agriculture; the Committee on Children, Families and Persons with Disabilities; the Committee on the Judiciary; and the Committee on Transportation. This does not affect the two bills (H.649 – An Act to Improve Massachusetts Home Care & H1195/S755- An Act Clarifying Rate Setting Processes for Home Health and Home Care Services) that were introduced by HCA along with the Enough Pay to Stay Coalition (EPTS Coalition). Both these bills are currently before the Joint Committee on Health Care Financing, whose deadline to report out bills is March 27^th. HCA will continue to provide updates as both bills move through the legislative process.

Infectious Disease Bill Sent For Study

The Joint Committee on Elder Affairs announced yesterday that it is recommending that H.640/S.397 – An Act to improve infection control in Massachusetts home, which would establish a mandatory infection control training program for personal home care attendants, be given a study order. A study order authorizes the Committee to sit during recess and study this measure and similar ones and file a narrative report of its findings.  However, for the vast majority of bills sent to a study order, no further Committee activity takes place, it is mainly seen as a quiet way to kill a bill.

HCA does not support the bill. We raised our concerns about a bill during a hearing on a bill in June of 2023. HCA provided testimony in person that raised amongst other concerns that home care agencies under contract with Aging Service Access Points already have infection control requirements as part of their contracts in the home care program. These require training during employee onboarding and on an annual basis as part of their in-service requirements. In addition, federally certified home health agencies also have infection control requirements as part of the Federal CMS Conditions of Participation. We proposed adding an amendment that would exclude home care agencies contracting with ASAP entities and exclude home health agencies as defined in the Massachusetts general laws section 51K.

Did You See That?!? – January 2024

Quick Note

I hope everyone had a great holiday break! I know I did!! This may just be my negative winter northeastern mind kicking in, but I might be the only person who really doesn’t enjoy “year in review” look back segments. Weather its friends posting their year in photos on Instagram, CNN covering all the horrific news events of the year that made everyone sad, or ESPN replaying every winning play in sports, I think they are all kind of pointless and a waste of time. Other than Spotify yearly wraps. I personally find it really fun and interesting because I get to see firsthand how my wife’s love for Taylor Swift is so deep, that it affects my top 5 artists of the year.

Besides that! It’s 2024, it’s time to move on to the present and the future. So rather than rehashing for the 30^th time what happened in 2023, I’m going move forward and update everyone on what to expect in 2024.

*I would also like to say that all opinions raised in this piece are my own and do not represent HCA’s opinions and thoughts.*

Federal Outlook

Now We Have TWO BUDGET DEADLINES!!!

Congress loves budget season and the immense amount of press that comes with it so much, that they broke the yearly budget into two deadlines. For a small recap, (I know, the hypocrite I am) Congress previously failed to pass a full year spending package that would fully fund all 12 regular appropriations bills by the original continuing resolution (CR) November 17^th deadline, newly elected House Speaker Mike Johnson crafted and passed a two-step CR, with four of 12 appropriations bills expiring January 19, and the remaining eight expiring February 2. While this buys Congress time to discuss appropriation levels, it also creates a series of funding deadlines that, if not met, will shut down parts of the government.

Now the first deadline, January 19^th, is quickly approaching for Congress to pass four of 12 appropriations bills, which include budgets for the FDA, Energy and Water Development, Military Construction and Veterans Affairs, and Transportation, Housing and Urban Development. “The Hill” reported that there are four different avenues that Congress could take when it comes to dealing with the budget.

Option one: Congress passes all their funding bills by each deadline. Now this Option is looking less and less likely as days pass.  “It’s going to be very difficult to get all of the appropriations bills we have to get done in time if we don’t have the [top-line] number, and we don’t have the number right now,” Rep. Tom Cole who heads the House subcommittee that crafts the annual funding bills for the departments of Transportation (DOT) and Housing and Urban Development (HUD). “So, we’re going to have to make some tough decisions in early January.” To date, the House has passed seven GOP-crafted spending bills while the Senate has passed a so-called maxibus of three bills. But the bills passed look vastly different between chambers, which means there is still a long way to go for Senate and House leaders when it comes to an agreement on a final package.

Option Two: Congress passes another stopgap for the budgets due on January 19^th. This is becoming the more likely option as discussions between lawmakers continue to stall. There have already been doubts raised by legislatures in the House and in the Senate before the Holiday break on Congresses ability to pass any budget pieces, with one saying that if a deal was not made before the break, the odds of any deal happening by the deadline were very slim. It is yet to be seen how a 3^rd CR would be drafted and when the next deadline would be. It is important to note that Speaker Johnson has said he will not push through another short-term stopgap. “A CR is simply unacceptable for a year,” Senate Minority Leader Mitch McConnell (R-Ky.) said before the Senate left for their end-of-year recess. “It’s devastating, particularly for defense, and we’ve got all of these wars going on. So, we need to reach an agreement on the top line and get about getting an outcome as soon as possible.”

Option Three: Parts of the government shut down as negotiations continue through the February 2^nd deadline. I personally believe that this will not happen, as it would be a major blow to Speaker Johnson reputation if he fails to pass any sort of a budget or a CR by the 19^th.

Option Four: Congress passes and omnibus spending package funding all budgets at once. This is something that hardline Republicans were trying to prevent when they pushed for the two-step CR. Former Speaker Kevin McCarthy, during his fight to keep his spot, promised conservatives he wouldn’t resort to a single massive spending package, and Speaker Johnson backed that vow, telling reporters in November that they “broke the omnibus fever — we call it the ‘omni fever.’”

But with limited options on the table, I would not put it out of the realm of possibility that the Biden Administration along with Senate Democrats propose a full year omnibus package to Republicans at the last minute that entices them to support rather than a government shutdown.

Regardless of which option comes to fruition, we can all agree that this will be an absolute shit show. It’s unbelievable to me that Congress continues to fail to recognize that literally no one wins when they fight over the budget, and it only pisses off the vast majority of the public. The public is forced to witness stupid cat fights between media hungry, empty-suit politicians that only care about themselves and only try to show that they care about leading when it’s best for them.

It’s the same dog and pony show every year, where one side demands X and the other demands Y, they both say they wont budge even though in the end they always do. I understand why Speaker Johnson broke up the appropriation budgets into different deadlines, but in the end won’t change how they negotiate overspending. We are already hearing discussions about a single omnibus budget being negotiated which basically makes the two deadlines useless. What holds up the budget process every year, isn’t mundane budget features such as payroll or resources. It always comes down to year specific budget proposals (i.e. border crisis, Ukraine aide, Israel aide, etc.) which cause the whole budget process to hault. These politicians walk around like there are no ramifications for delaying a budget or even failing to pass a budget resulting in a government shutdown. So many businesses, non-profits, charities, non-profits rely on government funding to survive and when they fail to advance the budget, they all get hurt. I think, every time there is a CR, members of Congress should not be paid for the extended amount of time, and if there is a government shutdown, they should owe money for every day it is not open.

Presidential Election

It’s the most horrible time of the year!!! With so much despair and with everyone crying, giving you great fear!!!! It’s the most horrible time of the year!!! (single with cadence of it’s the most wonderful time of the year by Andy Williams).

Yes, sadly it’s finally here. The race to be elected president is right around the corner, haunting us all like the Babadook in the shadows, with election day this November. I’m not going to spend much time on this because, as history has shown, no one can accurately predict what will happen. Right now, it is looking like we will have to live through the worst rematch in history between Donald Trump and Joe Biden. The only outside candidate that I believe has a shot to challenge either candidate is former South Carolina Governor Nikki Haley, who is the type of person that reminded her teachers when homework wasn’t collected. She has gotten the most support out of all the challengers to Donald Trump in the Republican primary.

As the year goes on Congress will become less and less active as the election day draws closer. So, I would plan for Congress to basically stop once August recess comes around.

State Outlook

Second Session Is Here

New year, same business. January 3^rd marks the beginning of the second session of the 193^rd general court of the Commonwealth of Massachusetts. The second session is when the legislature is usually the most active, with it being the last time to act on a piece of legislation that were introduced during the first session. This year, legislative leadership will have their handful with trying to pass legislation on hot button issues, such as gun control, climate, housing crisis and growing health care costs. The legislature will also need to pass a budget for FY25, which will come with its own headaches as Massachusetts looks to address the migrant shelter crisis.

HCA will be very active this year as we look to advance two key pieces of legislation that we filed, H.649 – 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. The licensure bill was recently voted favorably out of committee by the Joint Committee on Elder Affairs, referring the bill to the Committee on Health Care Financing. The Licensure bill will now move to the next step of the legislative process, which involves three occasions (known as “readings”) in each branch in which a bill is considered. The first “reading” will come from the from the Joint Committee on Health Care financing. Please use this ACTION ALERT to write to members on the Joint Committee on Health Care Financing urging them to give the bill a favorable report. HCA will provide updates on the licensure bill as they unfold.

We expect that H.1195/S.755 – An Act Clarifying Rate Setting Processes for Home Health and Home Care Services, will be given the same treatment soon as the deadline for the Joint Committee on Health Care Financing to report bills out of their committee is the fourth Wednesday of February.

Did You See That?!? – November 2023

Federal Recap

And the Winner Is!?!?!?!

After what has felt like an eternity, the House has finally elected a new Speaker of the House……. Rep. Mike Johnson (R-LA-4). Now I imagine that a lot of you said…. Who?!?!?! When he was elected. Well, you are not alone. After multiple weeks and several unsuccessful speaker bids from some more well-known republicans, such as controversial house member, Jim Jordan and Majority Whip Steve Scalise, the GOP seemed to be running out of people to choose from, in comes Rep. Johnson. Johnson, who is a relatively new member, only in his 4^th term, is not a very well-known member amongst people outside the beltway.

Johnson, who looks like a live rendition of the men’s bathroom sign figure, previously served as Vice Chair of the House Republican Conference. But Johnson is most well-known for his hardline stance on abortion, being a hardcore supporter of former President Donald Trump, and for not certifying the 2020 election. Many political pundits have noted that previous candidates, such as Jordan and Scalise, had something that Johnson did not. Political enemies within the GOP. Due to their very public personas and appetite for making media catching comments, Jordan and Scalise both have made a few hard-core enemies with the GOP, that have publicly said that they would never vote for them no matter what. Johnson seems to not have that problem; his biggest appeal was that he has limited beef with fellow GOP members. Mix that with support from Trump, voting fatigue, and I would hope some embarrassment, led to Johnson being named the 56^th Speaker of the House, which also makes him one of the most important GOP members in Congress.

CMS Releases Final Rule for Home Health Payments

A couple weeks ago, CMS released its CY 2024 home health final payment rule. The final rule institutes an estimated aggregate increase to 2024 home health payments of 0.8 % ($140M) compared to 2023 payments. This is a reversal from the proposed rule issued in June that would have cut home health payments in the aggregate by 2.2%. The 0.8% increase reflects a payment update of 3% and fixed dollar loss ratio (FDL) increase of 0.4%. These increases are offset by a -2.89% permanent behavioral assumption adjustment (which was originally proposed as a -5.1% cut).

All told, in the short term, this final rule offers significant relief to the industry for 2024. However, CMS and MedPAC continue to maintain their assertion that home health agencies were overpaid from 2020-2022 which leaves potential for future claw backs in the coming years.

The reversal of the proposed cuts would not have been possible without all of you. The Alliance is greatly appreciative of all the members that join our advocacy efforts over the last year, which include sending hundreds of advocacy emails to members of Congress and submitting comment letters to CMS proposed rule. We are especially grateful to the members that traveled with Alliance staff to Washington, D.C. twice in the last six months to participate in over 20 meetings with members of Congress and their staff. As proved by the final rule, your persistence and collective voice was heard. Obviously, there is more work to be done to prevent future cuts or claw backs – but for today, we breathe a sigh of relief.

House Subcommittee on Health Holds Hearing on Medicaid 80/20 Proposed Rule

Last Wednesday, the House Energy and Commerce Subcommittee on Health held a hearing on Medicaid 80/20 proposed rule and nursing home staffing requirements. As a refresher, in June, Centers for Medicare and Medicaid Services (CMS) proposed requiring at least 80% of Medicaid payments to home health agencies for personal care, homemaker and home health aide services go toward direct care workers, rather than company overhead or profits. The Subcommittee on Health held a hearing to examine the potential impact of the proposed rule.

Chairman Rep. Brett Guthrie (R-KY-2) lead the charge during the hearing, arguing that the proposed rule would cause an undue burden on agencies and in the end would impact patient access to vital care. “Biden’s unfunded mandates would restrict access to care for vulnerable population” said Chairman Guthrie. He went on to say that “finalizing the Access Rule would also force 93 percent of all home care agencies to reduce or limit their ability to accept new referrals.” Other committee members along with multiple witnesses that were brought in to testify before the committee, backed up Chairman Guthrie’s comments. Only a few committee members argued for the proposed rule, arguing that the rule would help to increase pay for workers thus encouraging more workers to come to the field. If you would like to see a recording of the hearing, please use this LINK.

Look Ahead

Time to Balance the Budget

Late on Tuesday night, in a surprising turn of events, the House of Representatives passed Speaker of the House, Mike Johnson proposed two-step continuing resolution (CR). The plan does not include budget cuts or aid for Israel. Under the two-step strategy — which Johnson and others have dubbed a “laddered CR”, would keep the government funded at current funding levels until Jan. 19, while the remaining spending bills would go on a CR until Feb. 2.

The passing of this bill marks a pretty big victory for the newly elected Speaker. But, while the bill garnered broad support from both sides of the isle, passing 336-95, with more Democrats voted for the measure than Republicans, some far-right members of the GOP voiced their frustration with the proposal. They are unhappy that Johnson worked with Dems and that the CR did not include the steep spending cuts and border-security measures they sought. These members are the same members that in September ousted former Speaker Kevin McCarthy after he made a similar deal with Democrats to fund the government through mid-November.

They’re not looking to oust Johnson over it. But some conservatives are privately entertaining other ways to retaliate. One tactic under discussion is the same one they used against McCarthy: holding the House floor hostage by tanking procedural votes. “There is a sentiment that if we can’t fight anything, then let’s just hold up everything,” said Rep. Ralph Norman (R-S.C.), one of several frustrated Freedom Caucus members who has huddled with the speaker multiple times this week.

The spending package now heads to the Senate, where Democratic and Republican leaders have voiced support. To prevent a shutdown, the Senate and Republican-controlled House must enact legislation that President Joe Biden can sign into law before current funding for federal agencies expires at midnight on Friday.

State Recap

Healey Administration Unveils Comprehensive Housing Plan

On Wednesday, Governor Healey unveiled a five-year, $4.12 billion housing bond bill.  The Affordable Homes Act is filled with funding and policy reforms aimed at spurring much-needed production of new units, upgrading the aging and neglected public housing stock, and converting state land into housing-ready plots. Governor Healey previously campaigned on addressing the state’s growing housing crisis.

In a summary of the bill that was provided to reporters, the bill includes substantial investment to support the production, preservation and rehabilitation of more than 65,000 homes statewide, as well as 28 policy riders. One of the biggest changes it proposes is letting local officials charge transfer fees of 0.5% – 2% on property sale, that would be paid by the seller, which would be used fund affordable housing development. The threshold would be either $1 million or the median single-family home sales price for the county, whichever is greater. Healey’s office estimated the fee, if adopted, would affect “fewer than 14 percent of all residential sales.” In addition, the bill would create a new Homeowner Production Tax Credit, which aims to incentivize construction of homes targeted at potential middle- and low-income owners. It would also make permanent the Community Investment Tax Credit while boosting its cap on donations from $12 million to $15 million. Healey’s office estimated that all together the housing package could lead to creation of more than 40,000 new housing units, chipping away at a shortage that has previously been estimated at roughly 200,000.

Many of the plan’s key provisions will be controversial in the eyes of municipal governments that prize local control of zoning, as well as in some corners of the real estate community. It will need to navigate a gantlet of committees and leaders on Beacon Hill, many of whom have been skeptical of big-ticket housing reform in the past. Healey plans to complement the legislation with a trio of executive orders creating a housing advisory council, standing up a commission to examine streamlining housing production, and calling for a study to identify surplus public land that can be used for housing.

Look Ahead

Holiday Slumber

Yesterday marked the last day of formal session for 2023, which means that state legislators will go into their holiday slumber till 2024. After a pretty chaotic couple of months, with the state legislature acting like college students trying to cram for finals, legislators will now be in informal session until at least January 3^rd, 2024. Legislation is rarely passed during informal session, because under state rules, it only takes a single no vote for a bill to fail. During this time the legislature will continue their discussions on a supplemental budget package and a long term care bill focused around nursing homes and prescription costs.

HCA will use this time to educate members about our legislative priorities. HCA will be holding a State House Advocacy Day on January 30, 2024, where will be inviting legislators to meet with member agencies to learn about home care and the vital work that you all provide. If you would like to participate, please email Harrison Collins, at hcollins@thinkhomecare.org.

Did You See That? – October 2023

Federal Recap

Making History Isn’t Always a Good Thing

So……. Who had the U.S. Congress ousting Speaker McCarthy on their 2023 bingo board? In a crazy turn of events, in a historic vote, the U.S. House of Representatives voted 216-to-210 to oust Republican Speaker Kevin McCarthy, marking the first time a speaker has been removed from their position. The vote was forced by a contingent of hard-right conservatives, led by Rep. Matt Gaetz of Florida, who called for a motion to vacate McCarthy earlier this week. In the end 8 Republicans joined all Democrats in voting to removed McCarthy as speaker, throwing the House and its Republican leadership into chaos.

To make matters worse, apparently, the Problem Solvers Caucus is close to collapsing because of the Speaker drama. The Problem Solvers Caucus is made up of moderate Republicans and Democrats, whose main goal is to find common ground on many of the key issues facing the nation. According to Politico, Democrats in the Caucus proposed a possible arrangement whereby a bloc from their party would vote to save McCarthy in return for a more expansive role in operating the House. Some ideas included giving the two parties an equal number of seats on the powerful Rules Committee and changing the rules of the House to make it harder for a splinter faction to eject a speaker. Democrats asked McCarthy to delay the vote, in order to continue negotiations, as well as a clearer promise that he would be willing to actually work across the aisle. Republicans in the Caucus believe that the Democrats were negotiating in bad faith since the rest of their party had decided to vote to oust McCarthy because it would thrust the GOP into chaos. In the end, the roughly 30 Democrats in the Problem Solvers stuck with House Minority Leader Hakeem Jeffries and voted to oust McCarthy. Republican Caucus Chair Rep. Brian Fitzpatrick (R-Pa.) told Fox News that he asked a group of Dems to vote present on a procedural vote, allowing Republicans to temporarily kill Rep. Matt Gaetz’s move against McCarthy. Gaetz (R-Fla.) would surely have tried again, he noted. Rep. Fitzpatrick and over 10 Republicans in the Caucus have said that they are now considering breaking up the group in frustration, due to the lack of cooperation during the speaker fight.

I mean come on. At some point we have to put the good of the country above politics and optics. While we all may not agree with McCarthy’s politics, we can all agree that it only weakens our country overall when we continue to have such disarray in Congress. Congress only has a month and a half to pass a spend bill, which will need to include not only aid for Ukraine, but aid for Israel. At the rare everything is going, there is little chance that Congress will succeed in coming to any sort of agreement. This is like expecting a football team to play well without a head coach. Please tell a time when any sports team/country/company, literally any operation succeeded with a power vacuum at the top.

In the meantime, Rep. Patrick McHenry, Majority Deputy Whip, takes over as interim Speaker until a new one is named. In a closed-door meeting, Republicans elected House Majority Leader, Steve Scalise to be their candidate for Speaker. Scalise won the election 113-99 over House Judiciary Committee Chair, Jim Jordan. The vote came after Republicans killed a proposal to change the nominating process that was intended to avoid a messy floor fight. Though Scalise won the GOP speaker election, at the moment he does not have the votes to win the entire House vote, if all Democrats vote against Scalise, like they did during the McCarthy Speaker election. Scalise needs to win a majority from the full House.

Senate Finance Committee Hold Hearing on Importance of Home Care

On Monday, the Senate Finance Subcommittee on Health Care held a hearing on home health and the vital role of home health in access to care. This hearing was unlike most hearings I have watched over my career. Usually, you see committee members battle each other over their opposite beliefs on the subject of the hearing. that was not the case this time. Senators on both sides of the isle seemed to agree on one major topic, the importance of home-based care, and the need for more investments.

Witnesses for the hearing included: William A. Dombi, the president of the National Association for Home Care & Hospice; Carrie Edwards, the director of home care services at Mary Lanning Healthcare; Judith Stein, the executive director of the Center for Medicare Advocacy; and David Grabowski, a professor and researcher at Harvard Medical School.

The main topic of the hearing was CMS’s proposed rate cut to home health repayment rates. Witnesses were given the opportunity to share how these proposed cuts will be detrimental to the industry. They were also able to discuss the dangers of skyrocketing referral rejection rates, the impact of further Medicare Advantage (MA) penetration and the issues the provider community takes with Medicare Payment Advisory Commission’s (MedPAC) reports on home health care.

If you would like to watch a recording of the hearing, use this LINK.

Look Ahead

Always About the Dolla’s

I’ll keep this short. The only thing that Congress will be working on for the next couple months, outside of picking a House Speaker, is trying to pass a full-year budget. On October 1^st, President Biden signed a continuing resolution (CR) that funds the government until November 17. The next Speaker, whoever it is, first task will be to pass a CR to allow for more time for a final spending package to be passed, because the odds that both chambers can come to an agreement on a final spending package are as low as my chances of getting a date with Margot Robbie.

This budget will be even more contentious given the recent war that broke out in Israel and the ongoing Ukraine war. Democrats will be looking to provide federal aid to both countries which will likely cause a massive battle with their Republican counter parts. While support for Israel is coming from both sides of the isle, support for Ukraine is lacking in House, which will likely hold up much of the negotiations on a budget. The House GOP under former Speaker Kevin McCarthy did not include any aid to Ukraine in their spending package, which differed from the Democrat led Senate budget proposal. This stalled the last budget negotiations until a CR was agreed upon which included no aid to Ukraine.

In the end, it’s going to be a lot of late nights in DC for staffers, as they try to hammer out an agreement on a CR. Lets hope they can finally get something done, though I’m not gonna hold my breathe.

State Recap

Massachusetts Takes First Steps towards Passing Salary Transparency Legislation

Massachusetts is on its way to becoming the 9^th state to pass salary transparency laws. Today, the House of Representatives passed H.4109, An Act Relative to Salary Rance Transparency, which mandates any public or private employer with at least 25 employees include a projected salary or wage alongside any job listing and requires employers with 100 or more full-time Massachusetts employees to submit wage data reports. The Executive Office of Labor and Workforce Development will publish aggregate wage data on an annual basis. The passing of this bill comes after House Speaker Ron Mariano’s office said the chamber’s top Democrats were making it a priority to bring forward salary transparency legislation.

Rep. Josh Cutler of Duxbury and Sen. Patricia Jehlen of Somerville, co-chairs of the Joint Committee on Labor and Workforce Development, proposed the bill as a way to build on the state’s equal pay law by better empowering workers. They dubbed the bill the Frances Perkins Workplace Equity Act, commemorating a Massachusetts native who was the first woman to serve as U.S. labor secretary. HCA will provide updates as the Senate takes up the legislation.

Governor Healey Signs Tax Relief Package

Today, Governor Maura Healey signed a $1 billion tax relief plan that aims to put more money in taxpayers’ wallets and make Massachusetts more competitive. The signing of the bill marks the first Massachusetts tax cut in over 20 years. Twenty months elapsed between Republican Gov. Charlie Baker using his final State of the Commonwealth address in January 2022 to ignite debate about slashing taxes and the final enactment of the package. Legislative leaders said the total impact of the measure for fiscal year 2024 will be $561.3 million. By 2027, when the changes are fully phased in, they say the total impact will be $1.02 billion.

The package will beef up tax credits for caregivers, renters, and seniors, and appease the business community as well. The package’s largest item, worth about $165 million this year and up to $307 million once fully implemented, is an overhauled child and dependent tax credit. To relieve pressure on individual taxpayers, the package would more than double a tax credit available to parents, those who care for dependent seniors, and those who care for a disabled dependent. That credit would rise from $180 per dependent to $310 per dependent in fiscal year 2023, then again to $440 per dependent in fiscal years 2024 and beyond. More than 565,000 Massachusetts families would qualify for the credit, according to a bill summary. Changes to the senior circuit breaker tax credit could save some taxpayers up to $1,200 per year, while renters are in line for an extra $50 annually thanks to an increase to the maximum rent deduction. Additional reforms include changes to the estate tax threshold, and short-term capital gains tax rate.

Joint Committee Holds Hearing on Raising State Minimum Wage Bill

On Tuesday, the Joint Committee on Labor and Workforce Development held a hearing on a number of bills that pertain to minimum wages. These bills covered wages for everything from state minimum wage, the minimum wage for workers who also earn tips, to wages for overtime work, and more. The headline bill that was raised in front of the committee was An Act Relative To The Minimum Wage (S.1200 / H.1925), which would increase the state minimum wage by $1.25 per year until it reaches $20 in 2027 and index it to inflation. It would also increase the sub-minimum wage for tipped workers to $12 by 2027 and set it at 60 percent of the full minimum wage in future years, and stipulate that the minimum wage applies to municipal workers.

This hearing marks the reopening of discussion as to what is considered a livable wage in Massachusetts. It is important to note that the state minimum wage was increased to $15 an hour in 2023. Proponents for raising the minimum wage argue that with rising inflation and housing prices, that not only is a $15 minimum wage not a “liveable wage”, a rise to $20 an hour would still not be making a “living wage.” MIT’s Living Wage Calculator estimates that an adult with no children would need to make $21.35 per hour to support themselves in Massachusetts. For an adult with one child, the living wage would rise to $45.57 an hour, and two working adults would each need to make $24.72 an hour to support themselves and one child in Massachusetts. National Federation of Independent Business Massachusetts state director argues that “raising the base wage to $20 is not only unsustainable for Massachusetts employers who are already raising compensation to counteract the state’s labor shortage and attract workers into the workforce, but additionally, these types of one-size-fits-all mandates hurt smaller, Main Street businesses that cannot absorb the cost the most.” HCA will be sure to provide updates on the minimum wage legislation as it progresses.

Look Ahead

All For The Headlines

After successfully passing a tax relief package, the legislature has a new target in their sights, gun reform. For the last couple of years, legislatures and party leadership have been discussing sweeping gun reform legislation. Last week, House Democrats re-introduced/re-drafted an old gun reform bill that previously caused intense infighting. An Act Modernizing Firearm Laws, HD.4607, seeks to rein in the spread of untraceable “ghost guns,” update the state’s assault weapons ban, limit the presence of firearms in certain public spaces and streamline the licensing process.

House Speaker Ron Mariano said the latest bill penned by Judiciary Committee Co-chair Rep. Michael Day is “significantly different” than one he unsuccessfully tried to advance over the summer, when gun owners groups mounted vociferous opposition and some representatives appeared to balk.

This is not going to be an easy package to pass. At a House hearing on gun reform, gun control and gun safety groups threw their support behind the bill. While gun owners contended the legislation represents an unconstitutional infringement on their Second Amendment rights without offering much, if any, upside to public safety. History has shown that the two sides could not be farther apart on beliefs than when it comes to gun control. The gun lobby is going to fight this bill hard, as they do in every state that tries to pass gun reform legislation.

The gun reform legislation is just the beginning as the state government looks to pass big ticket legislation after basically doing nothing for the first 10 months of the year. The legislature has signaled that they are also looking to pass a climate package and salary transparency legislation. I believe the sudden urgency is a result of the continuous crap that the press has been giving leadership for the lack of legislation that has been passed this session. Hell, it took a record amount of time for them to agree on a budget. I personally find it to be very frustrating and a little patronizing for the legislature to think its okay to just bulldoze through big ticket items and forget about “smaller” less significant legislation like the home care licensure bill. They are supposed to be passing legislation regularly, not just when they are called out for not doing anything. This is exactly what annoys people about politics, when politicians only do their job when it’s most beneficial for them.

Did You See That? – September 2023

If politicians at the state and federal level have all of August off, why can’t I! rather than cover very little news in the August version of the rundown, I decided to take a break like everyone else in politics did, to re-group, recharge my batteries and watch my Mets season completely fall apart.

The Rundown is back under a new name “Did You See That?!?”, which I think is a better title my original choice which sounded like an 80s Sylvester Stallone action movie. This edition will be shorter than usual due to the lack of political news over the last month. But hey…. At least I’m here.

State Recap

Governor Healey Signs FY24 State Budget, Over a Month Late

Shockingly, August started off with some actual business being done. On August 10^th, Governor Healey signed a $56 billion annual state budget for fiscal year 2024, marking her first annual budget signing since taking office in January. The signing of the annual budget comes over a full month into the fiscal year it covers, making Massachusetts one of the last states to pass a FY24 budget. This budget is the budget the second latest to land on a governor’s desk in 22 years. The budget will increase spending by 7% compared to FY23 budget, and for the first time, distribute at least $1 billion in revenue raised from a new tax on the state’s wealthiest residents.

The spending plan includes many policy provisions such as, making a pandemic-era program providing free school meals to all students permanent, supports in-state tuition and financial aid at public colleges and universities for undocumented immigrants, and offers assistance to help Bay Staters ages 25 and older attend community college for free. Due to substantial rate increases for home care services, unlike the FY23 budget, this budget does not include funding for the Enough Pay to Stay rate add-on.

Overall, Healey gave her approval to 103 of 112 outside policy sections, returned eight with amendments, and vetoed one authorizing the use of $205 million in one-time funding. She also reduced the budget’s bottom line by the same amount.

AG Campbell Confirms, these are Not Dumb Questions

Attorney General Andrea Campbell’s office said this week that it had certified almost all of the 42 potential election ballot questions (proposing 38 laws that could be decided at the 2024 ballot and four constitutional amendments that could be decided in the 2026 election) that had been filed by the August deadline. Thirty-four proposals (in some cases representing multiple proposed versions of a potential question) were certified, seven were not certified and one was withdrawn by its sponsor, according to Campbell’s office.

Some key ballot questions revolve around rights and benefits for Uber drivers, rent control, voter identification and the auditor’s ability to audit the state Legislature. The latter being the most interesting in my opinion. Auditor Diane Dizoglio, who is a former state Rep and Senator, has been in a consistent battle with the state legislature to have them open up their books to show exactly how much every state legislator makes.

Dizoglio filed a ballot question that would establish a state law explicitly permitting the auditor’s office to audit the Legislature. Top Democrats have resisted, arguing she does not have the authority and that doing so would violate the “separation of powers” required by the Constitution. In late July, DiZoglio appealed to Campbell for the attorney general’s support in a move toward litigation.

How is the STATE AUDITOR overstepping their authority when they are auditing the state, which is literally her job. That is like saying a chef cannot make food for staff because their job is to make food for customers. It just makes no sense.

Look I understand the concept of separation of powers, but we have seen over the years corruption, and just common bad practices by legislators not only in Massachusetts has increased to Whitey Bulger setting levels. We need our legislators and government officials to be held to a higher standard, and the best way for that to happen is for everyone to see what they are doing/what they have done.

Also, I’m not a detective, but it’s suspicious how aggressively they are trying to keep their books closed. I mean this is the same state leadership that literally changed term limit rules to allow the Karen Spilka to keep her leadership position of Senate President, even though her term limit ran out. Also, it says a lot that a person who was both a state representative and a state senator is so keen on auditing their books, I only imagine, she knows exactly what’s in their books, that needs to be released to the public.

HCA Submits Comments to CMS Proposed CY2024 Home Health Payment Rule

In late August, HCA submitted comments to CMS’s proposed CY2024 Home Health Payment Rule. In June, the Centers for Medicare & Medicaid Services (CMS) released their annual proposed rates for Medicare home health services, which would reduce net home health payments by an estimated $375 million, or -2.2%, in calendar year 2024, compared to 2023 rates. With home care providers already facing an unprecedented workforce shortage, leading many to turn away patients due to lack of staff, inflation, and exceedingly high gasoline prices, now is not the time to cut payment rates.

Look Ahead

As I have written before, this state legislature has been one of the least active legislatures in years, and they seem to be keen on keeping that reputation. The state legislature is taking a slow approach to coming back from the Cape and isn’t planning on bringing up any major legislation anytime soon. I will keep everyone posted, when big pieces of legislation come up.

Federal Recap

August is an aggressively slow month on Capitol Hill, as members of Congress and their staff head back to their state/districts for some “needed R&R”. I put needed R&R because I honestly think its ridiculous that in modern times members of Congress basically get a full month off of work like they are teachers. It made sense when they had to go back to plant/harvest crops and tend to their local businesses in the 1800’s. But in a time when you can get from DC to San Diego in less than 6 hours, I don’t see why they need a full month off from passing bills (which they rarely do). Its just infuriating the more and more you think about it. But I digress.

The only noteworthy news event in August that pertains to the federal government, is that the first Republican primary was held. But honestly for everyone’s sake, and mainly for my sanity/respect for other people/my job. I’m going to bite my tongue and not share my opinion on that matter.   

Look Ahead

Heading to the Swamp

HCA will be heading to the D.C. swamp on September 20th with some member agencies to speak with members of the Massachusetts congressional delegation to educate them on the impact of the proposed rate cut and how they can help to stop CMS from implementing the proposed cuts. We will be asking these offices to sign onto The Preserving Access to Home Health Act of 2023, which would prevent CMS from implementing their cuts.

You can help our advocacy efforts by reaching out to your member of Congress urging them to sign onto the bill, by using this ACTION ALERT to write directly to them.

The Rundown – July 2023

State Recap

HCA Provides Testimony at Elder Affairs Hearing

On June 19^th, HCA provided verbal testimony (Add Testimony HERE) at a Massachusetts state Elder Affairs Committee Hearing. HCA provided testimony on H.640/S.397, An Act to Improve Infection Control in Massachusetts Home Care, which would direct EOHHS to establish a mandatory infection control training program for personal home care attendants and all home care employees.

During the hearing we made it clear that we do not support the bill and raised our concerns with bill as drafted. We explained that this bill would prove to be duplicative with existing infection control requirements established at the federal level and in ASAP contracts. In addition, we strongly encouraged that the bill be re-written so that the text clearly clarifies that home care agencies should be allowed to conduct the training, if infectious control training is required.

If you would like to submit your own written comments on the bill, testimony may be submitted to the Committee via email to committee joseph.russo@mahouse.gov and victoria.halal@masenate.gov.

Budget, What Budget? No Movement on State Budget

I think state legislators are taking The Kink’s song “Sunny Afternoon” a little too seriously. Once again state legislators failed to pass an annual state budget for FY24 by the June 30^th deadline, resulting in the state legislator passing a supplemental budget to fund the government through July. This has become a common practice for the legislature, as they have not passed an annual budget on time since 2011. For reference of how long ago that was the last Harry Potter movie came out that year, Instagram had just come out, and Osama Bin Laden was killed. to summarize, THAT’S A LONG TIME AGO. Hell, I was still in school in 2011, I won’t say what level of school, but I’ll just say that I was 4 inches shorter in 2011 than I am now.

The legislature has taken a more relaxed approach in recent years with the budget usually being passed in mid-late July. Last year, the annual budget was not formally signed into law by then Governor Charlie Baker till July 28^th. Legislators are still ironing out key discrepancy between the House proposal and the Senate proposals. At the rate they are at, I don’t expect a budget to be agreed and passed till late July at the earliest.  

Look Ahead

Joint Health Finance Committee to Hold Hearing on Rate Setting Legislation

The Joint Health Finance Committee plans to hold a hearing on Tuesday, July 25^th, on numerous bills that pertain to home care services. One of the bills that is being considered is H.1195/S.755 – An Act Clarifying Rate Setting Processes for Home Health and Home Care Services. As a refresher, this bill would clarify the rate setting processes that are already in place for both home health and home care services. It would NOT set the rates or dictate the amount for future rates set by Mass Health and EOHHS. It does make the rate setting process more transparent and ensures rates set by the state follow the rate setting laws and reflect the actual operating costs incurred by home health and home care providers. In addition, it articulates the cost factors that should be included in the methodology and rate setting process including new regulatory costs and governmental mandates. Recent examples include changes in the state’s minimum wage, the Paid Family and Medical Leave Act, health insurance, employee benefits and training, and increased technology costs.

This bill has been a major focus of our advocacy efforts for the last couple years, and we would like everyone to provide testimony if possible. In all seriousness, it will only take 3 minutes of your time. I will draft a template for members to use to write their testimony to either send to the committee or to provide verbally on the day of. The more people the provide testimony, verbally or written, the stronger our voice. I will be there in person to speak to the committee on behalf of the association and if anyone would like to join me, please email me at hccollins@thinkhomecare.org.

House Proposes Nearly $700 Mil in Supplemental Spending (State House News)

House Democrats are preparing to bring forward a $693 million spending bill that would steer financial support to vulnerable hospitals, allow state energy regulators to update contracts related to a key hydroelectric transmission project in Quebec, and extend horse race simulcasting for another half-decade.

The House Ways and Means Committee on Wednesday morning opened a poll on a redrafted supplemental budget (H 3869), one day before the chamber is set to meet in its first formal session since April 26.

Of note, House Speaker Ron Mariano’s office said the bill calls for spending $180 million to support hospitals still facing pandemic-related impacts, including those that serve a high percentage of Medicaid patients.

Mariano’s office said the bill would also give the Department of Public Utilities the flexibility to approve amended transmission contracts related to the New England Clean Energy Connect (NECEC) project, which would carry hydroelectric power generated in Quebec through Maine to end points including Massachusetts.

Representatives on the House Ways and Means Committee were given until 11 a.m. Wednesday to indicate their support or opposition for the spending bill. The bill is a supplemental budget for fiscal year 2023, which ended June 30. House and Senate negotiators have not come to terms on a compromise annual budget for fiscal year 2024, which began July 1.

Federal Recap

CMS Proposes Massive Cuts to Home Health Payment Rates

On the last Friday of June, CMS published its FY 2024 home health proposed payment rule. First before I get into the proposed rule, I have to vent really quickly about how annoying it is that both federal agencies tend to release major regulations/proposed rules on Fridays, especially before holiday breaks. CMS released their proposal (though it was accidentally leaked early) in the afternoon on the FRIDAY BEFORE JULY 4^th WEEKEND. Not only did this ruin my plan to leave work a little early to get a jumpstart of the long weekend, but it ruined the entire weekend because I had to read and analyze the entire proposal. Listen I understand that they do this because they want to bury proposals like this so that it doesn’t get major new coverage, but for us professionals, whose entire job are affected by these releases, it is such a slap in the face. I don’t pay my taxes that help to pay CMS staffs salaries for them to turn around and basically pull a beer out of my hand and throw a big regulatory rule at my face. It’s rude, inconsiderate, and ill argue it hurts the economy by keeping my hard-working (relative) people stuck inside reading, rather than out spending money at bars, restaurants and stores. It should be legally required that federal agencies have to release regulations/proposed rules on Mondays or at least 5 business days before a holiday break.

Alright, back to the proposal. CMS is proposing a 2.2% decrease aggregate home health payments, or an estimated $375 million less compared to 2023 levels. The proposed update would bump payments 2.7%, or $460 million, but that is completely undermined because home health agencies are being forced to absorb a 5.1% decrease, or a decrease of $870 million. As a refresher, last year CMS originally proposed a 7.85% permanent rate adjustment based on the conclusion that HHAs were overpaid in 2020 and 2021 due to provider behavior changes in coding and services provided. In the end, CMS only applied a 3.925% permanent rate reduction after objection from agencies and home care associations. At the time, CMS explained that the lower adjustment would be applied because “we recognize the potential hardship of implementing the full -7.85 percent permanent adjustment in a single year.” The 5.1% proposed rate reduction represents the remainder of the original 7.85% rate reduction that CMS calculated as warranted under its methodology for 2020 and 2021 along with an additional 1.636% for 2022, totaling 9.36% overall from the beginning of PDGM.  An early analysis indicates that the additional 2022 element to the proposed permanent adjustment is due to further visit decreases in a 30-day episode, particularly with therapy services. For an in-depth summary of the proposal rule, CLICK HERE.

CMS will accept comments on the proposed rule through Aug. 29. HCA will be submitting comments, and we strongly encourage members to submit comments as well. We will provide further updates as they develop on the proposed rule.

NAHC Files Lawsuit Against CMS and HHS

After the CMS proposed rule was released, The National Association for Home Care and Hospice (NAHC) filed a lawsuit against the Centers for Medicare and Medicaid Services (CMS) and the United States Department of Health and Human Services (HHS) challenging the validity of a change in Medicare home health payment that reduced rates by 3.925% in 2023 with significant additional cuts expected over the next several years. The lawsuit, which was filed in the District of Columbia, comes just a couple days after CMS released their proposed rule for 2024 which includes an addition additional 5.653% permanent rate cut in 2024.

In the lawsuit, NAHC argues that the methodology used to calculate the rates is flawed, and that the rate adjustment will worsen home care staffing shortages and patients’ access to care. In a statement released today by NAHC Until recently, nearly 3.5 million Medicare beneficiaries received home health services annually. Since the new payment model began in 2020, over 500,000 fewer Medicare patients have accessed home health services. According to a statement released by NAHC, they are seeking declaratory and injunctive relief including a reversal of the rate adjustments in the 2023 rule and requirement that Medicare implement the budget neutrality mandate consistent with the law. It should be noted that it could take months for the case to be heard with no timetable set. HCA will be closely following the court case and will provide updates as they unfold.

Look Ahead

With August recess right around the corner, July is usually a slower month where Capitol Hill wraps up last minute things before takin a month break. But not this year, Congress decided they wanted to set off some last second fireworks before everyone left. The big piece of legislation that everyone is talking about is the NDAA, the National Defense Authorization Act. The NDAA is a massive $886 billion must-pass bill that details the annual budget and expenditures of the U.S. Department of Defense. The NDAA is one of few pieces of legislation that usually passes with bipartisan support, and with minimal debate, but this year is very much different.

House Republicans have chosen the NDAA as the next battle ground in the culture war. Far Right Republicans have been adding countless poison pill amendments that risk driving away any chance of Democratic support. The most controversial amendment being Rep. Ronny Jackson (R-TX) proposal that would remove a Pentagon policy that allows service members to take up to three weeks of leave to travel out of state for an abortion and other “non-covered reproductive health care services.” The policy also states the Department of Defense will reimburse members for any expenses related to that travel. This rule was established in the wake of the Supreme Court decision that stripped abortion rights and left them up to individual states. Republicans argue that the new rule circumvents laws barring taxpayer money for the procedure in most cases, but language to undo this new policy could be a red line for Democrats. The abortion rule has been a major sticking point for Republicans in both the House and the Senate. In the Senate Sen. Tommy Tuberville (R-AL), who looks like the human version of Squidward, has been holding up high level defense appointments until the rule is taken out, leaving many key positions unfilled.

Other poison pill provisions revolve around Ukraine, NATO, sea-launched cruise missiles, and Buy American provisions. House Democratic leadership has signaled that if Republicans choose to move forward with any or some of these amendments (especially the abortion proposal) they would pull their support for the bill. that would leave Republicans with little wiggle room to pass the bill.

In the end the NDAA will be the central focus till they leave for August recess, with the Senate needing to pass the NDAA once it finally moves through the House. So there is still an opportunity for these people to say stupid stuff, like that being a white nationalists doesn’t make you racists, that will get everyone on Twitter and Thread (what ever that is) into a frenzy.

The Rundown – June 2023

State Recap

EOHHS Holds Hearing on Chapter 257 Rates for Certain Elder Care Services

On May 19^th, HCA testified at the EOHHS Chapter 257 rate review hearing. As a reminder, EOHHS has proposed increasing rates for Enhanced Community Options Program (ECOP) Direct Services from $749.47 to $976.08 per client per month and rates for Home Care Program Direct Services from $326.35 to $424.34 per client per month, which amounts to a 30% increase to the base rate for both ECOP and Home Care Program Services.

During our testimony, HCA highlighted our concerns with the lack of transparency when it comes to the rate review process and that EOHHS should use real-time inflation data rather than projected, expected inflation data when determining cost adjustment factors (CAF). HCA wants to thank all members that submitted written testimony for the hearing, your input is very important. EOHHS still plans to meet the July 1st, 2023, deadline to promulgate the new proposed rates.

Senate Starts Debate over Senate FY24 Budget Amendment

In the end of May, the Senate started debates over amendments to their proposed FY24 budget. After 2 days of debate, the Senate has added $65.4 million in line-item spending to its $55.8 billion plan. One amendment of note that is set to pass is Sen. Patricia Jehlen amendment # 400, which would amend the Chapter 257 Rate Reserve line item 1599-6903 as follows: “By inserting after the words “any human service provider receiving revenue under said Chapter 257” the following: “, and any home care agency subcontracting with such human service providers to provide home care services,”. This amendment would specifically single out that home care providers would need to comply with the 75% pass-through requirement that is stipulated in the line item. We would like to note that this pass-through requirement is much broader than a pass-through amendment that was floated during the House budget debate, that HCA along with the Home Care Aide Council successfully blocked. HCA along with the Home Care Aide Council drafted a letter to Senate Ways and Means staff and Senator Jehlen that stipulated our concerns with the amendment.

We emphasized that the amendment is redundant since home care is already mentioned in the line item and that it has the potential to create regulatory confusion. We also noted the by including the amendment language it would single out one provider group under Chapter 257 and would raise an issue of equity. We argued that the pass-through requirement should apply to chapter 257 requirements broadly and equitably to all providers. In the end the amendment was added to the Senate budget proposal that should be passed in the coming days. Once passed by the Senate the legislature will create a conference committee to debate the differences between the house and senate bills before sending a final bill for the governors signature. HCA will continue to advocate for the amendment to not be included in the final budget proposal.

Look Ahead

State Budget

In the beginning of June, the Senate should pass their state budget proposal for FY24. Once passed, the lengthy budget process will move to the next stop, conference committee debate. In June, after the senate passes their proposal a conference committee will be formed with legislators from both the House and Senate. The committee’s purpose is to iron out the differences between both budget proposals and create one final budget proposal for the legislator to pass.

While it seems like we are getting close to the finish line, that’s far from true. It could take a couple of weeks for the conference committee to debate the differences. Even then, once it’s created and passed by the legislature, it will still need to be reviewed and approved by Governor Healey, who is allowed to send back the proposal with suggested changes. Which is a common occurrence, last year former Governor Charlie Baker sent back the legislature proposal with amended language for an outside section.

Technically, the state has until June 30, 2023, when last year’s budget runs out, to pass a new budget and continue funding the government. The state never meets this deadline and passes a supplemental budget to extend FY23 funding until they are able to pass a new budget. Last year it took till July 28^th, for Massachusetts to pass their FY23 budget, making Massachusetts one of the last states to pass a budget.

I will provide another budget update next month when inevitably the FY24 budget has not been passed.

Federal Recap

Debt Ceiling Debate Rages On

The main focus of everyone on Capitol Hill has been the on-going debate surrounding increasing the debt ceiling. For a brief backstory, the debt ceiling is the maximum amount of money that the United States can borrow cumulatively by issuing bonds. The debt ceiling was created under the Second Liberty Bond Act of 1917 and is also known as the debt limit or statutory debt limit. If U.S. government national debt levels bump up against the ceiling, then the Treasury Department must resort to other extraordinary measures to pay government obligations and expenditures until the ceiling is raised again or risk a drop in the U.S. credit rating or defaulting on loans (which both would be disastrous). The debt ceiling has been raised or suspended over 78 times since 1917 with the most recent raise being in 2021. Treasury Secretary Janet Yellen has been sounding the alarms for the last couple of months that the U.S. is at risk of hitting the debt ceiling as soon as June 5, NEXT MONDAY, setting a deadline for Congress to vote to either raise or suspend the debt limit.

Since the end of April, there has surprisingly been progress in the negotiations. President Biden and Speaker of the House Kevin McCarthy struck a true compromise over Memorial Day weekend on a package to avert a disaster. The package would suspend the debt ceiling through Jan. 1, 2025, effectively moving any future debate till after the 2024 presidential election but would also reign in future government spending. Under the deal, non-defense spending, such as Medicare and Medicaid, would remain relatively flat in fiscal 2024 and increase by only 1% in fiscal 2025, 2% below a planned 3% increase in defense spending. After fiscal 2025, there would be no budget caps. One of the most contentious points of the deal is an increase to work requirements for adults that receive food stamps through SNAP. Lastly the deal stipulates that the student loan payment moratorium would be lifted this August.

While this is not exactly what both sides wanted, it is a true compromise between no cuts to spending that Dems wanted and massive cuts in spending that Republicans wanted. The biggest news is that this deal would prevent a potential economic meltdown that none of us have ever experienced. Just think about how hard life was when you had shitty credit. Now imagine if the U.S. credit rating was so bad that couldn’t even get pre-approved for a Kouls card. That is exactly what this deal would avert.

Look Ahead

Debt Ceiling

While there has been progress on the debt ceiling package, we are still not at the finish line. It wouldn’t be Congress without some superficial fanfare. Since Sunday, when text of the bill was released, Republicans and Democrats opponents of the bill in the House and Senate, mainly the house, have been SCREAMING for the last couple of days, calling this bill a shame. Republicans mad that they aren’t going farther with spending cuts, while Democrats hate the new work requirements and cuts to non-defense spending. There’s a lot of truly idiotic comments that I could write about, that just proved that there are a lot of members of Congress that only want the job for fanfare and notoriety and don’t even understand basic economics. But that would only give those members exactly what they want.

In the end all their shouting is as effective as a screen door in submarine. It’s a part of the game when both sides come to an actual agreement. The House passed the debt ceiling last night and Senate leadership on both sides has promised to move swiftly to pass the package before the June 5^th deadline. Opponents on both sides in the Senate will still vocalize their opposition while the Senate debates the bill, but in the end, I believe that a deal will be met before June 5^th. But when it comes to Congress you really never know what can happen, so, let’s all just hope for the best.

The main thing that we all need to keep a close eye on after the package is hopefully passed is now expected cuts to Medicare. With measly planned increases to all non-defense spending, there is a potential for deeper cuts to Medicare home care rates. CMS is already expected to propose further cuts and it could get a lot worse in the coming years. HCA is working closely with NAHC to stay up to date on any potential rate cuts that would directly impact our members. We will be sure to keep everyone updated if there are any potential cuts announced.

The Rundown – May 2023

State Recap

EOHHS Releases Proposed Chapter 257 Rates for Certain Elder Care Services

On Friday, Executive Office for Health and Human Services (EOHHS) released their proposed Chapter 257 Rates for Certain Elder Care Services. We are happy to report that EOHHS proposed increasing Enhanced Community Options Program (ECOP) Direct Services from $749.47 to $976.08 per client per month and Home Care Program Services Direct Services from $326.35 to $424.34 per client per month, which amounts to about a 30% increase to the base rate for both ECOP and Home Care Program Services.

While a 30% increase on the surface seems high, that percentage does not consider the temporary rate add-ons (EPTS, ARPA, and DALA appeal settlement) that agencies have become accustomed to. After accounting for all, the percent increase is closer to 7%. EOHHS still plans to meet their deadline of July 1st, 2023, to implement the new proposed rates.

EOHHS also announced that they will be holding a public hearing on the proposed rates on Friday, May 19, 2023, at 9:00am EST. HCA will be providing testimony at the hearing and encourage everyone to provide testimony as well. We will be sure to send around our draft testimony before and we are happy to help anyone with their testimony as well.

House Passes Budget Proposal

The House voted unanimously (156-0) to approve their $56.2 billion state budget for FY24, sending their spending plan to the Senate. The over $56 billion budget plan included significant increases in spending for education, childcare, environmental agencies, transportation, and hundreds of millions in tax relief. Not included in the Houses budget is the Enough Pay to Stay (EPTS) rate add-on. This didn’t come as a surprise since it was not included in their initial proposal and with new rates set to be released soon, we did not expect the house to include fully funding a rate add-on at this time.

Knowing that the House would not be inclined to fully fund the EPTS rate add-on at this time due to the rate review, HCA along with the EPTS coalition did submit an amendment to the house budget proposal that would fund a rate add on for 3 months or one quarter of FY24. We filed this language because we were concerned if EOHHS would meet the July 1^st, 2023, deadline to promulgate new Chapter 257 rates, and if they didn’t, we wanted to make sure there wouldn’t be a massive rate cliff since the EPTS and ARPA rate add-ons expire on the same date. The amendment was not included in the final house budget but did garner some co-sponsors during the amendment process. The budget process will now shift to the Senate.

Tax Relief Package

The House also passed their $1.1 billion tax relief package a month after Governor Healey released her $742 million tax relief package. The Houses tax package includes many of the same provisions that were included in the Governors tax relief package, such as;

• Decreasing the short-term capital gains tax from 12% to 5%.
• Combine the Child Care Expenses Credit with the Dependent Member of Household Credit to create one refundable $600 credit per dependent, while eliminating the current cap.
• Increase Estate Tax threshold from $1 million to $2 million (Healey proposed $3 million).
• Increase the rental deduction cap from $3,000 to $4,000.
• Double the Senior Circuit Breaker Tax Credit from $1,200 to $2,400.

Two proposals included that were not in the Governor’s proposal were 1.) increasing the Earned Income Tax Credit (EITC) from 30% to 40% of the federal credit. 2.) establishing a single factor apportionment in Mass based solely on receipts matching what 39 other states currently do. The tax proposal would also alter Chapter 62f of general law which triggers a tax refund if the state has excess revenue to adjust the credit to an equal amount per taxpayer rather than based on percentage of what taxpayer paid the commonwealth. The House tax proposal will tag along with the House budget proposal to the Senate side to be debated and most likely changed before going to vote.

HCA Provided Verbal Testimony on Licensure Bill for Non-Medical Services

The Home Care Alliance provided verbal testimony during a hearing held by the Joint Committee on Elder Affairs on H.649/S.380, An Act to Improve Massachusetts Home Care, which would create a licensure system for non-medical home care services.

For many years, the Home Care Alliance and our members have advocated for home care licensure, as we believe that agencies should be held to a baseline set of standards that would protect consumers and workers. We believe that this bill has the framework to do just that, without overburdening providers, and driving consumers to seek services in the unregulated, underground market.

We need your help to get this bill over the finish line. Please Click this LINK to submit pre-written testimony to the committee. Submitting written testimony shows legislators and committee staff how much support this bill has amongst the industry and Massachusetts at-large. This increases the chance that the bill is voted out of committee and potentially be voted on and passed by the entire legislature. Your voice matters and we want to help you use it!

Look Ahead

Senates to Propose State Budget Proposal Soon

The Senate is expected to release their budget proposal next Wednesday, May 10^th with a budget amendment deadline of Friday, May 12^th. Since EOHHS released new chapter 257 rates that incorporate the EPTS, ARPA, and DALA settlement rate add-ons we do not expect the Senate to include an EPTS rate add-on.

We will still be keeping a close eye on their budget proposal and any amendments that are filed to the budget. During the House budget process an amendment was added that would require a 75% of rate payments to home care agency providers for the elder home care program be spent by such home care agency providers on direct care workforce wages and benefits. The amendment was not added to the House’s final budget proposal after HCA along with the EPTS coalition worked hard to educate legislators and committee staff about the issues with amendment and how the language is not needed. We will keep a close eye to see if the same amendment is added to the Senate budget proposal.

Federal Recap

CMS Proposes That 80% of Medicaid Payments for Home Care Go to Direct Care Workers

Recently, the Centers for Medicare & Medicaid Services proposed two rules surrounding access to Medicaid. Among the provisions is a requirement that at least 80% of Medicaid payments for personal care, homemaker and home health aide services be spent on compensation for direct care workers.

The two proposed rules are Ensuring Access to Medicaid Services (Access NPRM); and Managed Care Access, Finance, and Quality (Managed Care NPRM). The former, Access NPRM, also would call for the following related to home care and home- and community-based services:

• Require states to publish the average hourly rate paid to direct care workers delivering personal care, home health aide and homemaker services;
• Require states to establish an advisory group for interested parties to advise and consult on provider payment rates and direct compensation for direct care workers;
• Require states to report on waiting lists in section 1915(c) waiver programs; service delivery timeliness for personal care, homemaker and home health aide services; and a standardized set of HCBS quality measures;
• Promote public transparency related to the administration of Medicaid‑covered HCBS through public reporting of quality, performance, and compliance measures;
• Establish a new strategy for oversight, monitoring, quality assurance, and quality improvement for HCBS programs;
• Strengthen person‑centered service planning and incident management systems in HCBS; and
• Require states to establish grievance systems in fee-for-service HCBS programs.

“The Biden-Harris Administration has made clear where we stand: We believe all Americans deserve the peace of mind that having health care coverage brings,” Department of Health and Human Services Secretary Xavier Becerra said in a statement. “We are proposing important actions to remove barriers to care, engage consumers, and improve access to services for all children and families enrolled in these critical programs.”

Providers expressed a lukewarm reaction to the rule. While they were pleased that the Biden administration is addressing access challenges and rate transparency with HCBS, they did not appreciate that the rule does not confront actual payment rates. NAHC said in response to the proposal that “however, we are concerned that CMS is not proactively addressing the chronically woeful state payment rates for home and community-based services and instead is creating a new bureaucratic analysis that may or may not ever impact the wages of workers. We are further concerned that CMS has decided to forego ensuring adequate state payments in favor of applying an arbitrary requirement to pass through a proportion of the rates to direct care workers. This policy cannot be effective without consideration of the actual payment rates or the substantial administrative requirements that federal and state regulations place on providers.”

President Biden Issues Executive Order to Make Home Care More Affordable

On Tuesday, President Biden signed an Executive Order (EO) that includes 50 directives to Cabinet-level agencies with the goal to improve transparency and access for home care services, including for veterans, while boosting industry standards and expanding areas of federal coverage. Some of the provisions included in the EO include:

• Directs HHS to consider issuing several regulations and guidance documents to improve the quality of home care jobs, including by leveraging Medicaid funding to ensure there are enough home care workers to provide care to seniors and people with disabilities enrolled in Medicaid, as well as build on the minimum staffing standards for nursing homes and condition a portion of Medicare payments on how well a nursing home retains workers.
• Identify which of their grant programs can support long-term care for individuals working on federal projects, and consider requiring applicants seeking federal job-creating funds to expand access to care for their workers.
• Directs the Department of Veterans Affairs (VA) to improve access to home-based care for veterans who require support with activities of daily living, like bathing and getting dressed, by giving them more decision-making power over who delivers that care and when.

In addition, the EO notes that the Department of Labor will publish a sample employment agreement so domestic child-care and long-term care workers and their employers can ensure both parties better understand their rights and responsibilities. The purpose of this is to grow awareness of employee’s options when it comes to unionizing. This is a report that we will be closely watching for when it is released. If you have any questions, please don’t hesitate to reach out.

Possible Bagel?

For those that didn’t religiously watch the West Wing, a bagel is another term for a recession. Forecasters at the Federal Reserve in April, warn of a possible recession later this year, further stowing doubt in the U.S. economy. Even though inflation eased this last month, only up 5% compared to last year, which is the lowest rate in the last 2 years, some recent data spooked forecasters to raise the probability of a bagel. Data that was released in April showed that retail spending is down, grocery sales were flat (even though prices went down), and service inflation (price of services like restaurant meals and haircuts) increased to over 7%, an absurdly high number. This is what led the federal reserve to increase interest rates once again in the beginning of May. This data along with reports that banks have started to cut back lending due to high interest rates and the recent collapses of SVB, Signature and just this last week One Republic bank, led some forecasters to raise the probability of a mild bagel later this year….. I hate when they do that, say something will happen “later this year”, it’s already May, almost halfway through the year? Does that mean it could happen in October or November? Then just say that!

Anyway, not everyone is predicting a mild bagel, some predict the economy to just “slow down” but not to fall into a bagel. But that still means that everyday people will continue to suffer. For the economy to “slow-down” that would mean that unemployment would rise, wage growth would drop, and the housing market would get worse than it is. In plain English, the Fed is trying to FUCK over average American’s and continue to make regular life harder and harder. I already accepted that I won’t be able to buy a house right now, but the Fed has made it clear that their actual goal is to making owning property impossible for millions of Americans. Bagel or no Bagel, it is getting really rough out here in America. And a bunch of fat-cat, ivy league people are trying to convince me that they are on my side during all this. History has shown that that is never the case. In the end, the more powerful and rich will continue to become richer and more powerful. All I can say is please put your money in some high yield savings accounts and hope for the best.

Pentagon Leak

We have finally hit the time that Si-Fi movies were predicting in the 80s when top-secret government documents were being leaked through video games. Like something out of The Americans, 21-year-old Jack Teixeira, American airman in the 102nd Intelligence Wing of the Massachusetts Air National Guard, leaked top secret Pentagon documents in a group chat on the platform Discord. The leaked highly classified documents included details about the war in Ukraine, intercepted communications about U.S. allies such as Israel, South Korea and Egypt, and details of American penetration of Russian military plans, among other topics. Teixeira charges include unauthorized retention and transmission of national defense information and unauthorized removal and retention of classified documents or material. The bulk of documents that were leaked are thought to have originate from the CIA’s Operations Center and the Pentagon’s Joint Chiefs of Staff. The documents appear to have been printed and folded twice. In some images there are items clearly visible in the background, including a hunting magazine, a knife and a tube of Gorilla-brand glue.

What I find most interesting about this story is that he used Discord. Now I have only been in this job for a little over a year but from everyone I have met, I can imagine that over 95% of you have no idea what discord is, and those that do is because they have kids that are at least teenagers. For those that don’t know discord is a rapidly growing communication platform where gamers can join parties to talk to other gamers. Think of it as like having one platform for all your group chats. That chat rooms vary, they could be filled with close friends, or just with people that share similar interests. While Discord is rapidly growing, its user rate is far behind bigger communication platforms like Twitter and Facebook. While 150 million active users may seem like a lot, that is only a quarter of Twitter’s active users (450 million) and a fraction of Facebooks 2.96 billion users.

So, it begs the question why he would choose this platform to release the documents. If he wanted to blow the lid on the U.S.’s foreign activities he would have used a bigger platform to reach more people. Using Discord is equivalent to leaking a story to the Cape Cod times rather than the Boston Globe. Not a lot is known about his true reasoning for why he leaked the documents. What is known is that he was suspicious of law enforcement and the U.S. intelligence community and was prone to ranting about “government overreach,” one of the group members told the Post. It is reported that roughly half of the chat group members lived abroad and that those who appeared most interested in the classified material were primarily from the “Eastern Bloc and those post-Soviet countries.” I think he was just trying to show off to his friends in some sort of manner and didn’t care about the consequences. He forgot that real life isn’t like Call of Duty and that when you are caught, you can’t just start the level all over again.

Look Ahead

Debt Ceiling

Currently, all focus is on the debt ceiling negotiations. Congress is running out of time to increase the debt ceiling to avoid federal defaults. Treasury Secretary, Janet Yellen, recently announced that the U.S. could default on its debt as early as June 1 and must move quickly to avert disaster. A debt default could trigger an economic downturn, which would prompt a spike in unemployment.

House Republicans lead by Speaker Kevin McCarthy recently passed “The Breaking the Gridlock Act”, that would increase the debt ceiling but would also scale back a wide swath of annual government spending to last year’s levels, a cut of about 8%, and cap its growth by 1% each year after that. The package also includes provisions that would require certain adult Medicaid recipients to work, perform community service, or participate in an employment program for at least 80 hours per month or earn a certain minimum monthly income. It would apply to those ages 19 to 55, but not those who are pregnant, parents of dependent children, those who are physically or mentally unfit for employment or enrolled in education or in substance abuse programs, among other exceptions.

This is where a line has been drawn in the sand. Democrats strongly disagree with every aspect of the Republican bill, Democrats do not want to pass a debt ceiling bill that would require a cut in spending nor cap growth in any capacity, nor do they want to implement work requirements. With Democrats in control of the Senate by a super slim margin, they do not have any plan to pass the Republicans proposal as is. Publicly Democrats have railed against Republicans for their proposal, accusing Republicans of holding the country hostage to demand federal cuts that will hurt the poor. But behind close doors their are reports that senior Democrats and the White House are actively working with a group of Republicans on a last minute deal to either suspend or lift the debt ceiling. Little is known of what Democrats are willing to leave on the table from the Republican package. I do expect that a deal will be reached in some capacity by the end of the month that will increase the debt ceiling. Both political parties love the spectacle that these situations create, but at the end of the day the few actual adults on both sides will work out a deal to avoid a potential disaster.

2024 Presidential Election Race

There is a massive storm brewing that is expected to hit all of America, that storm is the 2024 presidential race. The race is getting closer and closer with each passing day, President Biden announced that he plans to run for office again, if elected he would 86 when his second term ends; making him the oldest president ever.

Reports are also speculating that Florida Governor DeSantis will soon announce a presidential exploratory committee and may even announce his candidacy in Mid-May. Cloudy skies are starting to form and before we know it, we will all once again experience the nausea that comes from the race for president.

Trump Arrest

Now many legal experts have said that the charges are not that strong, and that amongst the multiple cases he could be facing, this one is the weakest. This case will not go through the thick of the legal system, where expensive lawyers make their money filing motion after motion to delay and change the scope of the case. I do not imagine a final ruling on a case anytime soon. The arrests will not stop him from running from president. Political analysts are split on whether or not the arrest will hurt him politically. Trump has shown time after time that analyst know nothing and that anything can be true and false at the same time when it comes to Trump.

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, hcollins@thinkhomecare.org. 

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 16^th 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 16^th 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 8^th, 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 9^th. By Friday, March 10^th, 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, hcollins@thinkhomecare.org.

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 hcollins@thinkhomecare.org.