New CMS Care Transitions Program Q&As, Open Door Forum

April 29, 2011

The Centers for Medicare and Medicaid Services (CMS) have released a new round of Questions & Answers in regards to the Community-Based Care Transitions Program.

See the full list of these helpful Q&A’s here, and below are a couple of the newest posts that may be of interest to home health agencies. One in particular about whether some of the responsibilities of the lead applicant can be subcontracted to other entities.

There is also an “open door forum” scheduled for May 5 and the Home Care Alliance strongly encourages all interested agencies to register and participate.

Yes that is acceptable; however, the applicant would need to demonstrate that each proposed subcontractor possessed expertise in the delivery of care transition services.

Experience with chronic care management/disease management is not synonymous with care transitions experience. The per eligible discharge rate is meant to cover a relatively short term intense intervention around admission to and discharge from an acute care hospital. This rate would not support an ongoing chronic care management program which usually requires a per member per month payment for an indefinite period.

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

April 28, 2011

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

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

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

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

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

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

Aside from Adult Day Health, the House approved:

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

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

Return to www.thinkhomecare.org.


Advocacy Alert: Help Support Home Health Budget Amendments

April 25, 2011

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

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

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

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

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

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

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

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

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

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

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

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

Return to www.thinkhomecare.org.


HCA Welcomes New Member: Nurses-At-Home

April 22, 2011

The Alliance is pleased to welcome its newest member, Nurses-At-Home, a private care agency in Wobrun, Massachusetts.

Return to www.thinkhomecare.org.


HCA Welcomes New Member: Happier In My Home, Inc.

April 22, 2011

The Alliance is pleased to welcome its newest member, Happier In My Home, Inc., a private care agency in North Dighton, Massachusetts.

Return to www.thinkhomecare.org.


Help Support Home Health Amendments in MA House Budget

April 21, 2011

A new email message is available on the HCA Legislative Action Center that anyone can send to their local state representatives to help support amendments to the FY12 House budget proposal benefiting home health care.

For those unfamiliar with the Alliance’s advocacy emails, the messages are pre-written and will automatically go to the legislator based on the contact information submitted. Once that information is entered, the message is available for review and can be sent and shared with colleagues, friends, and anyone else interested in taking action.

For those preferring to call their elected officials, but may not have their contact information or know who their state rep is, you can type in your information here to find out.

Below is a list of amendments the Home Care Alliance is supporting:

  • Amendment 529: Pediatric Home Care Services, filed by Rep. Michael Brady.

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

  • Amendment 554: Patient Care Transitions, filed by Rep. Kevin Honan.

~This amendment establishes a special MassHealth rate to reward home health agencies that are successful in helping patients discharged from acute care to avoid a costly re-hospitalization for the same condition for which they were originally hospitalized.

~The hospitalization would have to be avoided for at least 30 days in order for the payment to be administered. The Secretary of Health and Human Services shall determine the rate, which will be based on a nurse-led team model.

  • Amendment 339: Home Health Payment Rates, filed by Rep. David Sullivan.

~The MassHealth home health payment rate was cut by 20 percent to patients receiving skilled nursing care past 60 days of care in December of 2008. This created a new payment category for patients that require longer periods of care and who are at a greater risk of inpatient facility admissions or readmissions. This amendment would restore that rate.

  • Amendment 681: Telehealth Reimbursement, filed by Rep. John Mahoney.

~This amendment would establish MassHealth reimbursement for telehealth (remote patient monitoring) technology.
~Telehealth and remote care management programs are not only proven to reduce admissions to hospitals and nursing homes, but also reduce the frequency of home health visits.

  • Amendment 131: Adult Day Health Services, filed by Rep. Alice Wolf.

~A $55 million cut to ADH services was proposed in the Governor’s budget and this amendment would freeze the level of reimbursement to prevent that from occurring. The amendment would also impose a moratorium on new ADH facilities.

See the full list of House budget amendments here.

Return to www.thinkhomecare.org.


Helpful Q&As Posted on Care Transitions Program

April 20, 2011

The Centers for Medicare and Medicaid Services (CMS) has recently posted new Question & Answers regarding the Community-Based Care Transitions Program.

One such question that has emerged from multiple home health agencies concerns what constitutes a “community-based organization” or CBO.  See below for a pair of Q&A’s offering guidance:

  • Q: Does a home health provider qualify as a Community-Based Organization (CBO)? 
  • A: A home health agency would only qualify as a CBO if it was based in the community it proposed to serve and had a governing body with broad community representation of multiple health care stakeholders, including consumers. To ensure broad stakeholder involvement, 50% of the board representation should come from outside the home health agency.  Please also see our response to FAQ# 10418 for guidance on consumer representation.
  • Q (#10418 from above): Does a coalition representing a collaboration of community healthcare providers (medical centers, Federal Qualified Health Centers (FQHCs), health plans, educational leaders and local government) qualify as a Community-Based Organization (CBO)?
  • A: If the coalition is (1) a legal entity, such as a 501(c) (3) organization or other organization that has a taxpayer identification number and can accept payment, (2) has a governing body that includes broad community representation of multiple health care stakeholders, including consumers and (3) is physically located in the community it proposes to serve, then it could qualify as a CBO.  In addition, there must be adequate consumer representation on the governing board with voting rights. The consumers may not be providers or immediate family members of providers to satisfy this requirement.

See the full list of Q&A’s relative to this program here.

Return to www.thinkhomecare.org.


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