House Releases FY17 Budget Plan and Rearranges Elder Services Funding

April 13, 2016

With a $39.4 billion FY17 state budget plan, the House Committee on Ways & Means kick-started the legislature’s budget deliberations.

As always, a significant portion of that total – $15.4 billion in proposed spending – is allocated for MassHealth programs. In their executive summary, House budget writers noted that MassHealth spending growth has been limited to 5%. They also mention that their budget plan “supports enhancements to the eligibility systems, caseload management and program integrity efforts, especially in the area of long term care, which ensures that our significant investments are being well spent, which is crucial to providing healthcare to some of the Commonwealth’s most vulnerable residents.”ma budget pie chart pic

That “support” could be part of the $8 million increase in the EOHHS administration line item (400-0300) as it does not show up in the line item specifically set aside for audits of MassHealth providers and utilization review (4000-0301). That item was actually set by the House at $413,000 less than FY16 spending.

Meanwhile, the House restored the Enhanced Home Care Services Program (ECOP) that Governor Charlie Baker consolidated into other items. With ECOP funded at $74.3 million, it comes in at $3.7 million above the FY16 spending level. That leaves some items noticeably lower than Governor Baker’s budget plan, but it also falls below what the state spent in FY16.

For example:

  • Elder Home Care Purchased Services is $3.1 million below FY16 spending
  • Elder Home Care Case Management and Administration is $2.6 million below FY16 spending
  • Elder Nutrition (Meals on Wheels) is more than $746,000 below what was even set in the FY16 budget

Other newsworthy items from the House Ways & Means budget proposal include the following:

  • $250 million assessment on hospitals that will support new MassHealth accountable care organization (ACO) incentive payments, which the Hospital Association supports with certain conditions.
  • $5.7M for the Supportive Senior Housing Program, an item not included in budgets of previous years.
  • $15 million above the Governor’s proposed spending for Nursing Home Supplemental Rates.
  • $4.5 million above FY16 spending for Elder Protective Services.

The entire House Ways & Means budget can be found here. The Home Care Alliance will be working with State Reps to sponsor amendments creating a home care licensure commission, increasing MassHealth reimbursement for home health aides, and for EOHHS to conduct a full review of home health reimbursement. The Alliance will be fully partnering with other organizations to push a homemaker wage increase, expanding income eligibility for elder home care services, and other items.

More information on advocacy efforts will be released soon and the budget items will be a focus of HCA’s lobby day at the state house on April 28th. Contact James Fuccione at the Alliance for details.

 

Return to www.thinkhomecare.org

 


MHA, ONL & HCA Publish Latest Quality Measures for Hospitals, Home Health Agencies

February 18, 2016

The Massachusetts Hospital Association (MHA), Organization of Nurse Leaders of MA, RI, NH & CT (ONL) and Home Care Alliance of Massachusetts have publicly posted the latest available key national care quality performance measures for both hospitals and home healthcare agencies in Massachusetts. Data from Medicare’s Hospital Compare and Home Health Compare are now available on the PatientCareLink website for 77 Bay State hospitals and 89 Bay State home health agencies.Patientcarelink logo

Reported measures for hospitals include best practices for heart attack or chest pain, heart failure, pneumonia care, influenza prevention, surgical care improvement, stroke care and blood clot prevention and treatment. For home care agencies, the reported measures include timely initiation of care, patient/family medication education, depression assessment, and more.

To view the updated reports, visit www.patientcarelink.org and click on the “Healthcare Provider Data” tab and then either the “Hospital Data” or “Home Health Agency Data” link, then “Individual Hospital Performance Measures” or “Select an Agency.”

The home health agency reports now incorporate data for the period June 2014 – July 2015 for all measures, and the hospital reports cover April 2014 – March 2015. In addition to each facility’s individual performance, the PCL pages also provide a comparison to state and U.S. “peer” facility averages.

“Providing high quality, safe patient care is a top priority for Massachusetts hospitals,” said Pat Noga, PhD, RN, Vice President of Clinical Affairs for MHA. “Our hospitals are also committed to publicly posting important quality and staffing information to provide patients and caregivers alike additional confidence in their care.”

Patricia Kelleher, Executive Director of the Home Care Alliance of MA, added that the partnership between hospitals and home health agencies on PCL furthers positive working relationships along the entire continuum of care, which can only improve patient safety and quality overall.

“Choosing in-home services can be a daunting task and that’s why we’re proud that PatientCare Link (PCL) website allows patients and their families to find high-quality care in the home setting that fits their needs,” Kelleher said. “PCL includes Medicare-approved agencies that meet certain federal health and safety requirements, and provides patients, caregivers, and families the tool to easily access home health agency quality data to take control of their care and their health.”

Massachusetts was the first state to voluntarily make hospital staffing and nursing-sensitive quality information public starting in 2006. Home Care Alliance of Massachusetts joined the PCL quality and patient safety transparency effort in 2013. The PatientCareLink website is a great resource and gives patients an open and transparent view of the hospitals providing them care.

Hospitals and home care agencies welcome transparency about their performance when performance measures are grounded in good science and are designed to make fair comparisons across institutions. Publicly reported performance data can offer several benefits, including:

  • Offering useful information for making decisions about where to obtain healthcare
  • Helping healthcare professionals and institutions improve the care they deliver; and
  • Providing extra motivation to improve performance.

Return to www.thinkhomecare.org.


Earned Sick Time Final Regulation Summary and Analysis for Home Care Agencies

June 25, 2015

The final regulations on paid Earned Sick Time were released by the Attorney General’s Office (AGO) on Friday, June 19th with a number of substantial changes from the proposed regulations.   (The AG was charged with developing regulations to implement the new law – which was passed via a binding ballot question in 2014.)

The Home Care Alliance is pleased that most of the association’s comments were taken into consideration and the HCA thanks member home care agencies for their questions, concerns and suggestions. It is such involvement that allows the Alliance to better represent agencies and work for better results through our advocacy efforts.

Below is a basic summary of changes that home care agencies inquired about that were made between the proposed and final regulation.

Additionally, the Boston law firm Donahue, Barrett & Singal posted an analysis available to the public that is an excellent guide to the Earned Sick Time regulations. The Alliance has also partnered with Kurker Paget, LLC on a webinar for HCA members and further details and interpretation may become available.

Summary of Regulation Changes:

Section 33.01: Purpose, Scope and Other General Provisions

  • AGO added that “employees may choose to use, or employers may require employees to use, concurrent earned paid sick time…to receive pay when taking other statutorily-authorized leave that would otherwise be unpaid.”

Section 33.02: Definitions

  • AGO explained that “benefit year” is used interchangeably with “calendar year.”
  • The term “Calendar Year” was simplified to stand for any consecutive 12-month period as determined by the employer.
  • The term “Date of hire” was simplified to mean the employees “first date of actual work.”
  • Much more detail of employees and employers exempt from the law. Clarification that PCA’s are covered.
  • Regular hourly rate is newly defined as “the amount that an employee is regularly paid for each hour of work.”
  • “Same hourly rate” is clarified to mean employees regular hourly rate or, for employees earning varying rates from the same employer, either
    • The wages the employee would have been paid for the hours absent during the use of earned sick time if the employee had worked, or
    • A blended, weighted average of all regular rates over the previous pay period.
    • A clarification made in response to HCA’s comments for employees paid “fee-for-service,” the same hourly rate means a reasonable calculation of the wages or fees the employee would have received for the piece work, service or part thereof, if the employee had worked.
  • A clarification relative to “overtime, holiday pay, or other premium rates” that states “where an employee’s hourly regular hourly rate is a ‘differential rate,’ meaning  a different wage rate paid for the same work performed under differing conditions (e.g. a night shift), the ‘differential rate’ is not a premium.

 Section 33.03: Accrual and Use of Earned Sick Time

  • The AGO clarified that 40 hours per benefit year is the cap under the law. Employees  cannot accrue more unless the employer’s policy allows.
  • Employees accrue sick time only on hours worked, not while on PTO.
  • AGO added “Earned sick time may not be invoked as an excuse to be late for work without an authorized purpose under the regulations.”
  • AGO added “An employee may not accept a specific shift assignment with the intention of calling out sick for all or part of that shift.”
  • AGO added “Employers and their fee-for-service employees may arrange to make up hours during the same or next pay period.
  • AGO clarified “If an employee is exhibiting a clear pattern of taking leave on days just before or after a weekend, vacation, or holiday, an employer may discipline the employee for misuse of earned sick time, unless the employee provides verification of authorized use” under the regulation.

Break in Service

  • Regarding “Break in Service,” the AGO heard the Home Care Alliance’s concerns and shortened the timeline an employee has a right to use any unused sick time following “a break in service of up to four months.” However, following a break in service of between four months and one year, “an employee shall maintain the right to use earned sick time accrued before the break in service” if the unused time equals or exceeds 10 hours.

Transition Year/Safe Harbor

  • AGO clarified the “Transition Year/Safe Harbor” provision for employers with part time staff and per diem staff.
    • These employees must either accrue paid time off at the same rate as covered full time employees or receive prorated “lump sums” of paid time off.
    • If an employee is compensated other than on an hourly or salaried basis, the employee must accrue or receive lump sum allocations based on “a reasonable approximation of hours worked.”

 Section 33.06: Documentation of Use of Earned Sick Time

  • AGO clarified that an employer may require written documentation for an employee’s use of earned sick time that:
    • Exceeds 24 consecutive scheduled work hours;
    • Exceeds 3 consecutive days on which the employee was scheduled to work;
    • Occurs within 2 weeks prior to an employee’s final scheduled day of work before termination of employment, except in the case of temporary employees;
    • Occurs after 4 unforeseeable and undocumented absences within a three-month period.
  • AGO clarified that “health care providers may require employees making any use of earned sick time during local, state or federally declared emergencies to provide written documentation from a medical provider substantiating its use and to follow additional notification procedures set forth by the employer.” The employer may discipline the worker if they fail in this regard.

Fitness for Duty

  • AGO clarified that “an employer may require an employee to provide a ‘fitness-for-duty’ certification, a work release, or other documentation from a medical provider before an employee returns to work after an absence during which earned sick time was used if such certification is customarily required and consistent with industry practice or state and federal safety requirements and reasonable safety concerns exist regarding the employee’s ability to perform duties.”
    • “Reasonable safety concerns” means a reasonable belief of significant risk of harm to the employee or others.

Section 33.07: Allowable Substitution of Employers’ Paid Time Off

  • AGO clarified that “an employer’s own paid time off, vacation, sick leave, or other policy may be substituted for earned sick time so long as 40 hours of time off is provided under the policy, or such lesser amount as each employee might earn if the employer were not using the substitute policy” and the employees can use PTO for the same purposes under the same conditions as outlined in the regulation.

Return to www.thinkhomecare.org.


MA Attorney General Announces Earned Sick Time ‘Transition Year’

May 18, 2015

At the first of a string of public hearings to provide input on proposed regulations on the forthcoming earned sick time law, Attorney General Maura Healey announced a “transition year” for employers already offering paid time-off.

The Attorney General explained that for the period of July 1 when the law goes into effect until December 31, 2015, “any employer with a paid time off policy in existence as of May 1, 2015, providing to employees the right to use at least 30 hours of paid time off during the calendar year 2015 shall be in compliance with the law with respect to those employees and to any other employees to whom the use of at least 30 hours of paid time off under the same conditions are extended.”

Further details are available on a bulletin released on the AG’s earned sick time webpage.

The AG also revealed the intent of her office to avoid a six-month delay in implementing the law, as has been requested by some business advocacy groups. With Healey holding firm on not delaying the law’s implementation, and with some major business groups endorsing the “transition year” move, it was very likely a compromise to grant some leniency to employers.

For more information on the earned sick time law as well as how you can submit comments and help the HCA comment, see this previous blog post.

Return to www.thinkhomecare.org.


Advocacy Alert: Urge Legislators to Co-sponsor HCA Priorities

February 2, 2015

Today (Monday, Feb. 2nd) is the deadline for legislators to officially co-sponsor legislation, so NOW is the time to contact your local state legislators and ask them to formally support bills of importance!

The Alliance has worked to file two bills with home health champions in the legislature. One bill is re-filed from past years and is known as the “Nurse Delegation” bill, which would improve the efficiency of home health care services and save state funding by allowing home health nurses to delegate certain medication administration tasks to a trained home health aide, hospice aide, or certified nurse assistant.
The other HCA legislative priority is called An Act Strengthening the Quality and Efficiency of Home Health Services. The bill would establish a commission to study oversight options for the Commonwealth that fit our unique and highly-regarded health care system. The commission will also study MassHealth payment rates and methods to determine if there is a more efficient way to reimburse for both traditional home health services like skilled nursing and therapy, but also palliative care, Alzheimer’s/dementia, behavioral health/substance abuse, and chronic disease management.

Please contact your local state representatives and senators to urge them to sign on as co-sponsors of these two measures. At this early point in the legislative session the proposals haven’t been assigned bill numbers. Right now they are identified as House Docket 3151 (Nurse Delegation) sponsored by Representative Kay Khan and House Docket 1864 (Home Health Commission) sponsored by Representative Kate Hogan. Ask your legislators to contact the main sponsor of each proposal to add their names as co-sponsors.

  • Suggested Phone Script: “Hello, My name is ___________ from [home care agency, city/town]. Please co-sponsor House Docket 3151 filed by Rep. Khan and House Docket 1864, filed by Rep. Hogan to advance the quality and efficiency of home care services. If you have any questions, please contact the Home Care Alliance at 617-482-8830.”

If you’re unsure who represents you, please visit www.wheredoivotema.com/ and enter your contact info or visit the state legislature’s website to search by name or location. You can also contact James Fuccione at the Alliance for for more information.

Return to www.thinkhomecare.org.


Federal Judge Strikes Down Portion of DOL Companionship Rule

December 23, 2014

A federal court ruled yesterday that the U.S. Department of Labor (DOL) violated the Fair Labor Standards Act (FLSA) with its regulation that excluded third-party employers from the application of the “companionship services” and “live-in domestic services” overtime exemptions.

The lawsuit challenging DOL’s new narrowed interpretation of the companionship exemption was filed by the Home Care Association of America, the National Association for Home Care and Hospice (NAHC), and the International Franchise Association.  It was filed in US District Court for the District of Columbia.  The opinion was written by judge Richard J. Leon.  The full text of Judge Leon’s decision is available here.

Yesterday, NAHC’s Vice President for Law Bill Dombi drafted the following questions and answers, which provide further background on the implications of this ruling:

The Overtime Lawsuit: What Does the Court Ruling Mean?
(Source: NAHC)
The decision issued by the federal court on December 22, 2014 is a big win for home care, but much remains to be done to fully preserve the overtime exemptions for companionship services and live-in domestic services. Here are some of the most important things to know to understand the impact of the decision and what it means to home care.
Q.     What did the court rule?
A.     The court ruled that the US Department of Labor violated the plain language of the Fair Labor Standards Act (FLSA) with its regulation that excluded third-party employers from the application of the “companionship services” and “live-in domestic services” overtime exemptions. Home care companies are considered third-party employers. Home care workers employed by the direct consumer of the care or their family members acting as the employer are the only parties that could have used the exemptions under the rule that was invalidated by the court. This does not change any state laws that already limit the exemptions or their application.
Q. Does this mean that home care companies do not have to pay hourly home care aides overtime?
A. No. The regulation also redefined companionship services, limiting that definition to fellowship services and no more than 20% of time on personal care or housekeeping tasks. The lawsuit also challenges that part of the new regulation as well. However, that part of the case has not yet been presented to the court. We are now preparing to do so.
Q. Why wasn’t the definition of “companionship services” presented to the court earlier?
A. A tactical decision was made on how the case would be litigated. If the definitional issue was presented before or concurrent with the third-party employer issue there was a serious risk that the lawsuit could make matters worse for home care companies. If the court invalidated the definition of “companionship services,” but upheld the exclusion of third-party employers from the application of the exemption, home care companies would be outside an expanded exemption. Workers directly employed by the consumer would have qualified for the exemption. That would put home care companies at a cost disadvantage to consumer/employer care. Consumers (and state Medicaid programs) would have bypassed the agency model of care in favor of direct employment to save money.
Q. When will there be a court ruling on the definition of “companionship services?
A. A discussion of that will occur between legal counsel from both sides on December 23. It is hoped that the Department of Labor will agree to a temporary hold on the new rule consistent with its “policy action” under which the government will not enforce the rule for at least six months. To do so, the government only needs to agree that private enforcement will be put on hold as well.
Q. If the government does not agree to hold off on the rule, what happens next?
A. We will then need to go back into court to get a temporary injunction before January 1. That will require that we show that we are likely to succeed on the merits when the court fully hears the case and that home care companies will suffer irreparable harm if the court does not maintain the status quo with the current rule.
Q. What about live-in services?
A. The only substantive change that the new rule made to live-in services is the exclusion of workers employed by third-party employers from the exemption. “Live-in domestic services” is a much broader class of employees that would include personal care and housekeeping workers. As such, the court ruling effectively returns that exemption to it current state. Home care companies would not be required to pay live-in workers overtime unless state law requires such.
Q.     What should we do now in our company?
A.      The best advice we can offer is to “stay tuned” over the next week as much can and will happen to clarify things.  However, it would be prudent to continue to expect to trigger whatever action you planned to take on January 1 in the absence of the court’s decision. Things can change that dramatically, that quickly.
Q.     Will the government appeal?
A.      That is one option open to the Department of Labor. However, they would need to get the federal judge to stay his ruling pending any appeal. If the judge refuses to do so, the government would need to get the Court of Appeals to issue a stay.

While this ruling has no impact on Massachusetts law, we will inform members as additional developments occur in this court case.

Return to www.thinkhomecare.org.

 


Home Care Impacted by Governor’s Budget Cuts

November 19, 2014

With a new Governor coming into office in January and a $329 million budget shortfall, the Patrick Administration was forced to make reductions to close the deficit.

A large chunk of those cuts came at the expense of MassHealth, which makes up slightly more than half of the state’s $36.5 billion fiscal year 2015 budget. MassHealth officials contacted the Home Care Alliance to report that $68.5 million in reductions had to come from MassHealth alone and that a rate increase for home health agencies is no longer on the table for FY15.

The Home Care Alliance had seen hints that there finally would be a review of MassHealth home health care rates after years of being passed over. Rates were frozen in 2007 and one of the Patrick Administration’s first cuts were from home health services past 60 calendar days of care. The rate inexplicably dropped by 20 percent for patients who require longer-term home health care and that cut has not been revisited.

Also cut was $1.52 million from the Elder Affairs’ “Home Care Purchased Services” line item that will go into effect on December 1st at which time the waiting list for Aging Service Access Point (ASAP) services could go back into effect. Officials from Elder Affairs indicated the lowest priority level would be the only one impacted, which preserves those in the greatest need for care.

The bright spot is that the Home Care Alliance’s efforts to gain MassHealth reimbursement for telehealth provided by home health agencies is not impacted and plans to implement rates and guidelines is going on as planned. Moreover, home health rates are, more or less, remaining status quo and are not being reduced further. Nursing Home Supplemental Rates, for example, were slashed by $9.1 million.

A rate review for home health services remains a top priority and the HCA will continue to work with the legislature and MassHealth on improving payment.

Return to www.thinkhomecare.org.


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