Talking Home Care: NAHC’s Calvin McDaniel on the 2018 Midterm Elections

November 19, 2018

Kelleher and McDaniel

On this week’s edition of Talking Home Care, we are joined by Calvin McDaniel, Director of Government Affairs for the National Association for Home Care & Hospice (NAHC). Calvin oversees NAHC’s legislative priorities on Capitol Hill, and collaborates with the Alliance and other state associations on shared, industry-wide priorities.

Our discussion recaps the 2018 Midterm Elections and what to expect in the 116th Congress, which will be seated in January 2019. Enjoy!


You may listen to the podcast by clicking the play button below, downloading it directly, or subscribing through iTunes or Google Play. (Length: 29 minutes; Size: 23.2 MB). If you enjoy it, please give us a five-star review so others can find it.

Host: Patricia Kelleher is the Executive Director of the Home Care Alliance of Massachusetts.

GuestCalvin McDaniel, Director of Government Affairs for the National Association for Home Care & Hospice (NAHC).

2018 Midterm Elections Recap (Updated Monday, 11/19):

  • Democrats regained control of the US House of Representatives, gaining 37 seats so far and holding a majority of 233 seats to Republicans’ 198 seats.
  • Republicans held control of the US Senate picking up two seat as and expanding their Senate Majority to 52 seats to Democrats’ 47 seats. The Mississippi senate seat is heading toward a run-off election on November 27th.
  • On the state level: Democrats flipped nearly 400 state legislative seats nationwide, flipped seven Republican-held governor seats, and took full control of the legislature and Governors’ mansion in seven states.
  • Lastly, three states: Idaho, Nebraska and Utah voted to expand Medicaid. And a fourth state, Maine, elected a democratic governor, who will likely do the same.
  • Overall, nearly 116 million voters cast ballots, representing over 40% of eligible voters and represents the largest midterm voter turnout in 104 years.
  • It is expected that Representative Richard Neal (D-MA) will become the Chairman of House Ways & Means, and Representative Jim McGovern (D-MA) will become the new Chairman of the Rules Committee. This greatly increases the Massachusetts’ Congressional Delegation influence on Capitol Hill.

The most important takeaway from our conversation with Calvin is that HCA members should prepare for an incredibly active two years of advocacy. Take hold of your responsibility to engage your elected officials on behalf of your organization and join us in the fight on the many issues facing our industry. Be it an email to a legislator, inviting them to your offices for a tour or on a home visit, or taking time to join us in D.C. for one of the many fly-in events, it takes an army of voices to accomplish a common goal. To get involved, email Jake Krilovich.

Return to www.thinkhomecare.org.


Talking Home Care: Amanda Oberlies on “No on MA Ballot Question 1”

October 31, 2018

The Alliance’s Pat Kelleher &
ONL’s Amanda Oberlies

Should health care facilities have their nurse-to-patient ratios defined by law? That’s the question put to Massachusetts voters this coming Tuesday. Amanda Oberlies of the Organization of Nurse Leaders joins us to discuss why her organization (and the Alliance) oppose Massachusetts Ballot Question #1. Their conversation covers:

  • Who’s behind the ballot question and why?
  • What is the intersection of staffing-ratios and quality?
  • How does California’s experience with a similar law correlate to the MA proposal?


You may listen to the podcast by clicking the play button below, downloading it directly, or subscribing through iTunes or Google Play. (Length: 30 minutes; Size: 24 MB). If you enjoy it, please give us a five-star review so others can find it.

Host: Patricia Kelleher is the Executive Director of the Home Care Alliance of Massachusetts.

Guest: Amanda Stefancyk Oberlies, PhD, MBA, RN, CENP, is the Chief Executive Officer of the Organization of Nurse Leaders (ONL).

Resources:


Talking Home Care LogoDon’t want to miss the next episode of Talking Home Care? Subscribe through iTunes, Google Play, or accessing its feed directly.

Return to www.thinkhomecare.org.


HCA Submits Comment on Medicare Changes; Submit Your Comments Now!

August 30, 2018

On July 1st, 2018, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule which includes several changes to the home health benefit for 2019 and beyond. The public comment period closes this Friday August 31, 2018, at 11:59 p.m. As of this blog posting, 760 comments have been submitted to CMS which is encouraging, but far from the more than 1,300 comments submitted last year in response to the HHGM proposal which was ultimately withdrawn.

You can view the HCA’s written comments here and can download the word document here.

You may submit your own comments to CMS here.

Here are some of the key changes proposed, and an overview of HCA’s response:

Home Health Wage Index Changes

  • The 2019 proposed payment rates increase by 2.1% which represents a $400 million increase.
  • HCA of MA has long expressed concerns to CMS over inequities in how the wage index is calculated for home health agencies compared to hospitals. HCA urges CMS to adjust the 2019 home health agency wage index to reflect a policy to limit the wage index disparity between provider types within a given CBSA.

Proposed Patient Driven Groupings Model (PDGM) for CY 2020

  • Implementation: As the proposed PDGM would mark a major change in the way home health agencies will be reimbursed, the HCA urges CMS to delay implementation by one year to ensure that there is no disruption in access to services for beneficiaries and evaluate the accuracy of the model and its effect.

  • LUPA Thresholds: CMS proposes to set the LUPA visit threshold at the 10th percentile for each payment group. HCA believes this is complex and will complicate the care planning process for home health agencies. HCA urges CMS to retain the current LUPA thresholds and revisit them in future years.

  • Behavioral Assumptions: CMS proposed three ‘behavioral assumptions’ in the PDGM totaling -6.42%. However, these assumptions are not based in data or evidence. HCA believes that two of the three assumptions already exist in the current PPS methodology including; that agencies are already incentivized to both report the highest playing diagnosis codes and to develop and deliver plans of care that exceed the LUPA threshold. This could result in an over estimated impact of behavioral assumptions and the HCA urges CMS to eliminate the Clinical Group Coding and LUPA threshold assumptions.

  • Split percentage payment approach: HCA believes that changing from a 60 to 30 day billing period will be very disruptive to agencies’ operations and increase back-office costs. Therefore, HCA urges CMS to continue the split payment approach at the current 60/40 and 50/50 splits for early and late periods, respectively, to give agencies cash flow breathing room.

  • Certification and Re-certification of Patient Eligibility: HCA has long advocated for regulatory language to align with sub-regulatory guidance as it relates to documentation of the patient’s eligibility. HCA is encouraged by CMS’ proposal to eliminate the requirement that the physician provide an estimate of how much longer skilled services are required and we request that CMS consider revisions to the physician’s burden of the F2F encounter as a condition of payment. 
  • Remote Patient Monitoring: HCA strongly supports the proposal to recognize remote patient monitoring costs as an administrative cost on the HHA cost report. HCA does recommend however that CMS remove the regulation that does not allow remote patient monitoring to be used as a substitute for in-person home health services. 
  • Home Health Value Based Purchasing Model: HCA has long supported the HHVBP model aiming to improve quality by giving HHAs incentives to provide better quality care. However, HCA urges CMS to modify the HHVBP to recognize stabilization in the scoring because in many cases, stabilization (instead of improvement) is an appropriate goal for some patients.

Advocacy Alert: Email Senators Urging Support for HCA Budget Priorities

May 18, 2018
Last week, the Massachusetts Senate Ways and Means committee released its fiscal year 2019 state budget totaling $41.4 billion dollars. Senators had a deadline of Monday to file amendments to the bill, and it will be debated next week. Three Alliance priorities have been filed as amendments. Below are brief descriptions of each, with a link to send a pre-drafted email to your state legislator. The Alliance encourages you to send an email for all three amendments.

Amendment #589: EMAC Assessment Hardship Waiver:

  • This amendment would authorize the Department of Unemployment Assistance to establish a hardship waiver for employers that provide services to EOHHS/EOEA clients, or services in the public interest, who have a financial burden as a result of their EMAC tax liability. Take Action.

Amendment #560: Enough Pay to Stay Amendment:

  • This amendment would provide $28.8 million in increased funding for the State’s home care system front-line workforce. Take Action.

Amendment #620: Continuous Skilled Nursing Funding

  • This amendment would provide a $16 million increase for the Commonwealth’s Continuous Skilled Nursing program to address the workforce shortage resulting in unfilled service hours. Take Action.

MA Legislative/Regulatory Preview for 2018

January 11, 2018
On Wednesday January 3rd , the Massachusetts Legislature returned for the second year of its two-year session. After a seven-week recess, the body is looking at a traditionally busier second half than the first. The nearly 170 bills that passed in 2017 marked the lowest total in twenty years.

Lawmakers have until July 31 to complete all substantial legislative debate. In addition, all 200 members are up for election in 2018, which is expected to be a distraction from normal legislative work as a result of a polarized political landscape. Here’s what the Alliance will be focused on in 2018:

Workforce Issues:

Prior to the Holiday break, the Alliance met with its ‘Enough Pay to Stay’ partners to strategize coordinated efforts to attain wage relief for direct care workers and ASAP case managers. The coalition has pending legislation which would take steps toward this initiative, but we will pursue other legislative vehicles to fight for our workforce.

Worker Registry:

In November, Governor Baker signed into law the Home Care Worker Registry. This law will establish a worker registry that requires agencies contracting with ASAPs to submit workers’ private information to the state. The law is enacted and subject to regulations. The Alliance and its partners are in active communication regarding next steps toward protecting our members and their workers’ rights.

Licensure:

The FY 2018 State Budget included language that will establish a licensure process for home health agencies providing skilled services. It is unclear at this point when the process to promulgate regulations will begin, but the Alliance will be providing input to the Department of Public Health as these parameters are developed. In addition, Alliance-sponsored legislation that would license private care agencies is still making its way through the legislative process. Under procedural rules, the legislature has until February to report legislation out of committee. The Alliance will continue to advocate for passage of this legislation.

Continuous Skilled Nursing:

In late 2017, MassHealth announced two rate increases for the Continuous Skilled Nursing (CSN) program that totaled nearly 11 million. This was welcomed news, but there remains work to be done. The CSN provider/parent coalition will continue to advocate for the CSN Bill of Rights legislation that would mandate bi-annual reviews of the workforce to ensure safeguards against future crises.

MassHealth Rates:

The Alliance has been informed that MassHealth will conduct a long-overdue review of rates for per-visit nursing, therapies, and home health aide services.  The Alliance will be working to gather data to demonstrate that the current low rates are interfering with agencies’ ability to attract and retain enough workers to meet the demand for services.

MassHealth Reorganization:

MassHealth’s initiative to enroll the majority of members into managed care programs this coming spring will dramatically change the way MassHealth members access home health services, and disrupt many existing provider referral relationships.  The Alliance will continue to work to ensure that MassHealth members retain access to needed home health services, and that agencies are adequately reimbursed for those services.

House of Representative Health Care Bill:

Late last year the Senate passed a health care cost containment bill aimed at curbing costs while maintaining access. It has long been rumored that the House will be embarking on similar initiatives. Though the details are scarce, this legislation could be a vehicle for many of the Alliances priorities in 2018 and we will continue to advocate where necessary.

If you have any questions about the year ahead for advocacy or would like to get involved, reach out to Jake Krilovich, the Alliance’s Director of Legislative and Public Affairs.


Alliance Testifies on Home Care Legislation to Committee on Elder Affairs

August 29, 2017

The Massachusetts Legislature’s Joint Committee on Elder Affairs held a public hearing on July 31, 2017. Several of the bills heard are of interest to home care.

The committee heard testimony on bills relating to:

  • Home Care Licensure/Worker Registries:
    • S.364/H. 341 An Act Strengthening the Massachusetts Home Care Program
    • H. 344 An Act Relative to Consumer Protection and Home Care Services
    • H. 1187 An Act relative to home health and hospice aides
    • H. 2068 An Act Establishing a Home Care Aide Training Registry
    • H. 2889 An Act Strengthening Home Care Services
    • S.343 An Act Establishing a Home Care Aide Training Registry
  • Home Care Workforce Bill (Enough Pay to Stay Initiative)

The Home Care Alliance of Massachusetts and some of its members testified on all of the bills, and you can read that testimony at the links below:

If you have any questions, or would like any further information about these legislative proposals, do not hesitate to reach out to Jake Krilovich at jkrilovich@thinkhomecare.org.


Skilled Nursing Campaign Garners Media Attention

August 9, 2017

This week, the Alliance’s parent-provider skilled nursing campaign received national media coverage. The campaign seeks higher reimbursement rates from MassHealth for continuous skilled nursing services. Currently, agencies are unable to compete for nurses with area hospitals, and has led to a 37% nurse turnover rate, and nearly 24% of MassHealth-Authorized service hours going unfilled.

On Sunday, The Boston Globe featured a front-page story into the life of one of the parents caring for a child in the Massachusetts Continuous Skilled Nursing Program. Noelia Ferreira has gone over 100 days without a skilled nurse coming to her home to care for her daughter Abi. The article beautifully explains Noelia’s struggles to find adequate care and her commitment to keeping Abi safe at home.

As a result of this front page feature, WGBH invited Noelia and MA Pediatric Home Nursing Care Campaign founder, Angela Ortiz, to be interviewed by host, Jim Braude. Footage of the interview can be viewed here.

The campaign is leveraging this exposure to raise awareness and momentum in our fight for adequate reimbursement rates. Please visit www.mychildcantwait.com to write or call Governor Baker urging action.


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