|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:
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.
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.
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.
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’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.
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)
- H.350/S.352 An act Relative to Home Care
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:
- 7/31: HCA Testimony on Worker Registry Legislation
- 7/31: HCA Testimony on H.350 Section 1: Enough Pay to Stay
- 7/31: HCA Member Testimony on H.350 Section 1: Enough Pay to Stay
- 7/31: HCA Testimony on Licensure Legislation
- 7/31: HCA Member Testimony on Licensure Legislation Part 1
- 7/31: HCA Member Testimony on Licensure Legislation
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 email@example.com.
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.
The Home Care Alliance of Massachusetts is deeply saddened by the passing of Val J. Halamandaris, president of the National Association for Home Care & Hospice (NAHC).
Val dedicated most of his professional life to public service, and transformed the home care industry over the last five decades by fighting for elderly, disabled, and dying Americans. For 20 years, he served as counsel to the Senate and House Committees on Aging before founding NAHC and serving as its president for the last 30 years.
When Val started at NAHC, home care wasn’t what it is today. Institutionalization of the elderly was the standard, and Val sought to change the United States’ policy on this fundamental issue.
“The home care industry suffered an enormous loss this week. Val Halamandaris’ dedication to fighting for Americans’ rights to age in their homes and receive the care that they deserve was unprecedented.We all mourn this loss, but celebrate his 50 years of commitment to our most vulnerable,” said Alliance Board Chair, Holly Chaffee.
Val is survived by his wife, Kathleen, three sons, their wives, six grandchildren, and his brother. A funeral mass will be held for him at 10:00 am on Saturday at St. Peter’s Roman Catholic Church on Capitol Hill in Washington, D.C. In lieu of flowers, memorial contributions may be made to the Caring Institute.
Do you ever wonder if your phone calls into legislator’s offices’ ever do anything? I certainly do. The feeling that you care so deeply about an issue and fight so hard for it, but that the effort isn’t reciprocated by our elected officials.
Or how about when you hear legislators say, “I’m waiting to hear from constituents on this issue.”… Are they really? Do they actually want to hear from us?
When advocates ask me this, I’m always one to say ‘yes, they do want to hear from you.’ But I also understand how people feel when they see common sense solutions seemingly receive no consideration.
Before I go on, I need to disclose that we have to keep fighting for this particular issue. The legislature could reject the Governor’s proposal. But the advocacy behind the recently proposed Home Care Worker Registry should answer all of these questions above and serve as a model.
As you’ve heard numerous times from the Alliance, the Massachusetts Legislature has proposed and included in its final version of the FY18 budget a Home Care Worker Registry. This registry would require agencies to submit its worker’s private information like gender and home address to the Department of Elder Affairs. We have raised numerous legal and privacy implications for this legislation and have fought throughout the budget process to defeat and modify the language.
Last week, we sent out two advocacy action alerts asking you all to send emails into Governor Baker’s office requesting him to amend this registry language and insert an opt-in option for home care workers to chose whether they want this private information disclosed to agencies, ASAP contractors or employer organizations.
In total, Alliance members sent nearly 150 emails to the governor’s office, and yesterday afternoon we found out that the Governor sent back this section to the legislature offering an opt-in amendment. It was one of 9 sections in the over $40 billion budget that he chose to amend. Think about that for a second…
This is a clear accomplishment that proves these emails and phone calls do matter. That working with coalition partners in sync can make a difference.
But remember, we have work to do on this issue, so please keep an eye out for another advocacy alert that will urge the legislature to adopt the Governor’s suggestions and protect our workers!!
The United States Senate released its version of a new health care bill on June 22nd. Titled the Better Care Reconciliation Act (BCRA), the bill was met with energized advocacy groups immediately dispelling the measure. Earlier this week Congress’ nonpartisan budget referee, the Congressional Budget Office (CBO), estimated that 22 million people would be without insurance by 2026, 1 million less than the House bill which was passed in early May. Facing defeat in a floor vote, with nearly 8 Republican Senators coming out against the bill, Majority Leader Mitch McConnell (R-KY) delayed the vote until after the 4th of July Recess.
Here is a brief analysis of key provisions of the Senate Bill:
- Medicaid Funding: The bill, like its House counterpart, vastly rolls back Medicaid expansion and phases out federal funding between 2021 and 2023 and further reductions would begin in 2025. The CBO estimates that Medicaid enrollment would fall by more than 15 million people by 2026. Like the House version, this bill would create a block grant mechanism calculated on a per capita basis. Governor Charlie Baker has expressed concern for this and noted that it could cost Massachusetts billions in federal Medicaid funding and leave nearly 264 thousand residents without insurance. The Governor also estimates that the state could face a $8.2 billion shortfall by 2025.
- Pre-Existing Conditions: Unlike the House bill, insurance companies would be required to accept all applicants regardless of health status. That said, the bill allows states to ask permission to reduce required coverage of essential health benefits. This could result in massive increases for people who want to purchase a plan with essential health benefits. While the CBO estimates that some will see lower premiums, they will also see fewer benefits.
- Adults Over 50: The Affordable Care Act (ACA) prevented insurers from charging older people more than 3 times what younger enrollees pay. Under the Senate Plan, insurers can charge five times more than younger people and ACA subsidies to help the lower income and elderly pay for insurance would be drastically lower.
What to watch? Since Congress is going through this process under a budget reconciliation rule, the Senate Bill must only have the same amount of savings on the deficit as the House version. Thus, since the Senate version saves over $320 billion over the next 10 years, and the House version saves approximately $100 billion over ten years, the Senate has roughly $200 billion to spend in order to build support with current ‘no’ vote Senators. Keep an eye on states that rely heavily on Medicaid funding, or states heavily impacted by the opioid epidemic. These are some of the Senators currently opposed to the bill, and Leadership may direct additional funding to their states to bring them to a ‘yes’ vote.
For more information or any questions, please contact Jake Krilovich at firstname.lastname@example.org
Please send your legislators a message urging them to sign onto Representative Paul Donato’s budget amendment #769 which would provide funds to increase the pay of these nurses and ensure that our most medically complex citizens have access to the care they need.
Issue Background: The Massachusetts Continuous Skilled Nursing program provides in-home skilled nursing care to support and keep people with medically complex needs safe at home. While MassHealth has recently proposed a very small increase to the rates for this service, the increase does not make up for more than ten years with no increases.
Home care providers find that they are increasingly unable to compete with hospitals and other facilities for nurses; as a result, hours of needed and authorized care are going undelivered, leaving the patients vulnerable to expensive hospitalizations.
In 2016, home health providers reported a 37% turnover rate of their nurses, 53% of them left for higher pay at hospitals.
Return to www.thinkhomecare.org.