Home Care Commission Denied in Budget, Cuts Handed to Elder Services

June 30, 2016

The merits of protecting consumers, setting minimum standards for companies and agencies providing in-home care, and controlling state costs were not enough to advance a Home Care Oversight Commission through the state budget.

The state’s FY17 Conference Committee released their final budget proposal on behalf of the legislature after regrouping in light of declining revenue projections. The Home Care Commission, which was included in the Senate budget, but not in the House, had to survive a “conference committee” of House ma budget pie chart picand Senate budget leaders that negotiated a fiscal plan between the two sides.

With Massachusetts being one of only five states without state oversight of home health care, and also with a goal to place some standards on private-pay home care, the commission would have convened legislators, home health agencies, private-pay home care, state officials, consumer groups and trade associations to recommend solutions. The language stipulated that there be separate sets of recommendations for home health and private pay home care.

Elsewhere in the budget, the declining revenue projections filtered through to hit the elder services network. Based on FY16 spending levels, a $2 million cut was made to “Elder Home Care Purchased Services” and $2.6 million reduction in the “Elder Home Care Case Management and Administration” account.

Two pieces of good news came in that Elder Protective Service got a boost of $4.5 over FY16 spending and the Pediatric Palliative Care Network received a boost of $404,578, but the Nursing and Allied Health Workforce Initiative remained leveled out at $200,000.

More silver lining came with a $1 million pilot program to test expanding income eligibility standards for services ordered by Aging Service Access Points.

In terms of MassHealth line items, the expected trends continued with the conference committee reducing the “Fee-for-Service” account by $161.7 million while increasing the accounts tied to MassHealth Managed Care ($71.1 million) and MassHealth Senior Care ($160.4 million).

Nursing Home Supplemental Rates also saw a raise with $45 million over FY16 spending.

The $39.15 billion budget now moves to the Governor for final approval and any further updates will be shared as they become available.

Return to www.thinkhomecare.org.


HCA Breaks Down MassHealth 1115 Waiver Proposal

June 29, 2016

Months of stakeholder meetings and public engagement by MassHealth has resulted in a long-awaited draft proposal that aims to completely restructure the state’s Medicaid program.

Known as the Section 1115 Waiver, the 90-plus page document outlines a possible multi-year agreement  with the federal Centers for Medicare and Medicaid Services (CMS). The focus of the proposal is a move towards accountable care organizations (ACOs) and alternative payments while better addressing the needs of MassHealth members and putting in place a financially sustainable system of health care and support services.

Before the agreement can be made with CMS, however, there is a public comment period that runs until July 17th. The Home Care Alliance created a breakdown of the proposal so that members and advocates can better understand the key provisions.

MassHealth also provided a more basic fact sheet available on their 1115 Waiver Proposal webpage that also includes the full document and slide decks from previous public meetings.

The proposal attempts to seize an opportunity for new funding streams to support the creation of three types of ACOs that are required to partner with existing providers of behavioral health (BH) and long-term services and supports (LTSS). The state aims to rearrange provider and managed care relationships to set forth a better coordinated and integrated set of networks.

The first “pilot ACOs” are expected by MassHealth to come online later in 2016, while the full roll-out of the three ACO models, enhanced funding, and BH/LTSS integration will take place in October 2017.

The Alliance was appointed to several of the MassHealth stakeholder groups and plans to submit comments on the proposal on behalf of home care.

Return to www.thinkhomecare.org.

 


National Fraud “Hot Spots” Revealed in Largest-Ever Operation Announced by US DOJ

June 24, 2016

The US Department of Justice announced that 301 individuals have been charged with falsely billing Medicare a total of approximately $900 million in what is being called the largest coordinated Medicare fraud take down in history.

Home health services were among a list of services involved in the fraud schemes that also included physical and occupational therapy, durable medical equipment (DME) and prescription drugs. In the process, the HHS Inspector General released a data brief titled “Nationwide Analysis of Common Characteristics in OIG Home Health Fraud Cases.”

That data brief reveal some trends in outlier patterns among home health agencies and affiliated physicians, but also identifies 27 “hot spots” in 12 states where home health care fraud is prevalent. Massachusetts is not among the states shown in the map below where much of the home health fraud activity is occurring.

Recently, Massachusetts has been included in a planned “pre-claim review” demonstration starting “no earlier” than January 2017 that will, according to CMS, test whether such a process improves methods for the identification, investigation, and prosecution of Medicare fraud occurring among Home Health Agencies. Among the five states involved in the demonstration, Massachusetts is the only one not on any target list for the Medicare Fraud Task force known as HEAT (Health Care Fraud Prevention & Enforcement Action Team). For many years, the Home Care Alliance has repeatedly advocated for a temporary moratorium on new Medicare home health providers in response to recent growth in the number of new agencies, but such efforts have been denied by Medicare.

2016 HHA Fraud Hotspots

According the to HHS Inspector General, these are areas where characteristics commonly found in OIG-investigated cases of home health fraud were prevalent. The report states that “many of these hotspots are areas already recognized as having high rates of Medicare fraud, which suggests that home health fraud in these areas is an ongoing concern and that enforcement and program integrity efforts should continue.”
Return to www.thinkhomecare.org.

2016 “Our Time to Shine” Innovation & Star Awards a Success!

June 16, 2016

HCA-assets(1)The Home Care Alliance of MA hosted their Annual “Our Time to Shine” event on Tuesday, June 14, 2016 at the Granite Links Golf Club in Quincy, MA. With 10 Star Award winners, 3 Innovation winners, and over 150 in attendance it was a great day to celebrate home care!

*Preview just some of the pictures for the event below. More photos to come!*

Congratulations to our winners:

 

Clinicians of the Year:
Anne Luippold, RN, BSN, ONC, Salmon VNA & Hospice, Milford
Michelle Michaud, RN, Circle Home Care, Lowell
Mary NDegwa, RN, Comfort Home Care, Methuen

Aide of the Year:
Jane Rizza, Home Care Inc., (Home Health VNA), Westwood

Leadership & Collaboration Award:
Roxanna Harper & Jo Ann Wagner, Baystate VNA & Hospice, Springfield

Manager of the Year:
Darlene Connolly, RN, Steward Home Care, Lawrence

Physician of the Year:
Dr. David Green, Emerson Hospital Home Care, Concord

Legislator of the Year:
Senator Barbara L’Italien, D-Andover

Home Care Champion:
Meg Doherty, NVNA & Hospice, Norwell

Innovation in Staff Development:
Comfort Home Care, Psychiatric Nursing Board Certification Program

Innovation in Patient Care Deliver:
Partners Health Care at Home, Mobile Observation Unit

Commitment to an Innovation Culture:
South Shore Hospital Home Care Department, The MakerNurse Project

Here’s just a preview of pictures from this great event!


Advocacy Alert: Gain Support for the Home Care Oversight Commission

June 6, 2016

The roughly $40 billion that will make up the legislature’s FY17 proposal must first go through a six-member “conference committee” that will negotiate on differences between the House and Senate budget versions.

Included in the Senate version was a special commission that will study, discuss, and make recommendations on separate policies for state-based oversight of home health and private-pay home care agencies. It will take advocacy to ensure that this important provision is included in the conference committee’s negotiated budget, and action can be taken through the HCA’s Advocacy Center.

Simply fill out the contact forms and hit “send” to help gain support for the Home Care Commission!

The Commonwealth is one of five states without either licensure or a “certificate of need” process for home health care services. Massachusetts has also recently experienced rapid growth in the number of “certified” home health agencies. The related and significant spike in MassHealth spending has forced the state to establish program integrity measures on these agencies.

Likewise, private-pay home care agencies across the state that provide mostly non-medical support services in the home have no state oversight and a study commission is needed to determine the best solution.

The Alliance will continue to update it’s members on this proposal.

Return to www.thinkhomecare.org.


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