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.

 


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

 


Conference Committee Budget Includes Telehealth, Homemaker Wage Increase

June 30, 2014

With the new state fiscal year technically arriving, the legislature’s budget conference committee released their compromise version between the House and Senate funding proposals that comes in at $36.5 billion.

With the delay in negotiations, the legislature recently approved a $4.6 billion budget to fund the government and related services through the end of July. The Governor, meanwhile, will have 10 days to review the conference committee’s budget and send recommended vetoes, which can be overturned with a two-thirds vote in both the House and Senate.ma budget pie chart pic

Among the priority items of the Home Care Alliance and others of benefit and interest is language allowing MassHealth to continue their work on implementing home telehealth service rates and rules. This is the second year in a row that the Alliance has achieved getting language that continues the association’s work with the state on an important service that is currently not reimbursed.

Another major win for home care came with the approval of the Homemaker Wage Increase that will amount to $6.1 million, if the funding makes it through the remainder of the budget process. According to the Home Care Aide Council, this appropriation would provide an annualized wage increase of approximately 75 cents an hour to more than 17,000 homemakers and personal care homemakers.

Among other notable items, the conference committee’s budget accomplishes the following:

  • Funding the “Home and Community-Based Services Policy Lab,” ($250,000) which seeks to study the cost-effectiveness and value of home and community-based care. It is expected that services provided by members of the Home Care Alliance that contract with Aging Service Access Points will be included in an initial phase and other Medicaid and Medicare home health services will be included in subsequent phases.
  • The state’s elder services network’s “purchased services” line item received the higher funding amount in the compromise budget of $104,411,964.
  • The Elder Nutrition Program covering “Meals on Wheels” received even more funding ($7.37 million) than the higher amount awarded by the House ($7.12 million).
  • The MassHealth Senior Care line item received slightly increased funding, which came from the House, at $3.197 billion while the MassHealth Managed Care account was level funded throughout the budget process at $4.792 billion.
  • The Human Services Salary Reserve was given $8 million to fund better wages for human service workers.
  • Pediatric Palliative Care gained a slight increase with $1.55 million.
  • The Board of Registration in Pharmacy will establish four new specialty licenses for retail sterile compounding pharmacy, retail complex non-sterile compounding, and institutional pharmacy license to apply to hospitals and an out-of-state pharmacy license for those doing business in Massachusetts.

For more information, the conference committee’s budget can be viewed here.

Return to www.thinkhomecare.org.


Governor’s Budget Gives Big Support to ASAP, Home Care Programs

January 23, 2014

Despite having his state of the Commonwealth address delayed by a snowstorm, Governor Deval Patrick was required to release his budget proposal this past Wednesday to officially kick off budget deliberations for fiscal year 2015.

A huge win for elder home care services came in line items that support the Aging Service Access Points and state Home Care Program, which received an additional $16.9 million, according to Executive Office of Elder Affairs Secretary Ann Hartstein. Among those funds are increases of $9.8 million for the Enhanced Community Options Program (ECOP) and $7.5 million for the “basic” category of services.

Combined, according to Secretary Hartstein, those two line item increases will eliminate waiting lists through the end of fiscal year 2015. The funding boost works out to an additional hour of homemaking services per consumer per month on average, but Secretary Hartstein stressed that, in reality, the money would pay for whatever services people may need when they need them.

The Governor also put a $1.3 million increase to the Senior Supportive Housing account, which will expand “assisted living facility-type services” for seniors in public housing. Specifically, the money will add another 10 public housing sites where senior residents will be supported by home care services.

Another $1.2 million was added in a new line item titled “Home Care Workforce Training Fund.” This new account will support workforce training for Aging Service Access Points, although the administration is not yet clear on which workers will receive training. Case management, protective services and direct care workers are all on the table as potential recipients.

MassHealth experienced major changes in the budget, mostly related to federal healthcare reform. Since the MassHealth Basic and Essential programs were eliminated, a combined $706.3 million is now in populations with expanded coverage and in the new MassHealth plans.   The MassHealth Senior Care account was granted another $271.4 million by the Governor and the MassHealth Managed Care account saw an additional $336.7 million. The MassHealth Fee-for-Service line item was raised by $205 million. It is unclear how these increases might result in better reimbursement rates for home health agencies. A formal rate reassessment hearing is still being eagerly awaited.

Other items of note from the Governor’s budget include the following:

  • Applying the state sales tax to candy and soda. The administration estimates that would raise roughly $57 million for health promotion and prevention programs.
  • The Governor’s budget cuts the MassHealth Nursing Home Supplimental Rates by $20.7 million
  • Pediatric Palliative Care is essentially level funded at just over $1.5 million
  • The Governor’s budget includes a special fund for federal assistance (FMAP) relative to health reform and healthcare access expansion called the Health Insurance Expansion Fund.
  • The DPH budget gets an overall increase of 1% with details in Commissioner Cheryl Bartlett’s “Mass Public Health” blog post.

Stay tuned for more  budget-related news and advocacy alerts.

Return to www.thinkhomecare.org.


State Senate Releases FY14 Budget Proposal

May 15, 2013

The Senate Committee on Ways & Means continued the state budget-making process today by releasing their version of the FY14 budget, which will be debated before the full Senate next week.

The $33.92 billion proposal is a $1.4 billion increase over estimated FY13 spending, but $904.3 million less than what the Governor proposed. The Senate Ways & Means version is also $67.5 million less than what the full House of Representatives approved in their budget last month.

Here are some items of note:

  • $4.5 billion for the MassHealth Managed Care line item – $39.5 million over the final House budget.
  • $2.9 billion for the MassHealth Senior Care line item – $42.5 million over the final House budget.
  • $187.2 million to fully fund the elder home care programs, an additional investment of $6.2M over FY 2013, to eliminate the current waitlist of 1,500 seniors. This includes $98.7 million for Home Care Purchased Services.
  • $10.5 million for Grants to Councils on Aging, increasing support to $8 per elder, marking the highest ever level of state support for councils on aging.
  • $2.1 billion for the MassHealth Fee-for-Service line item – $7.2 million LESS than the final House budget.
  • Level-funding the Pediatric Palliative Care Program.

The Home Care Alliance will again be working with Senators to file three budget amendments to create a home health certificate of need program, establish MassHealth reimbursement of home telehealth, and strengthening pediatric home health.

As the Alliance works over the next few days to submit these amendments, association members and advocates should be on the lookout for “advocacy alerts” with message templates that can be sent to Senate offices. Of course, more information on budget development will be released as it becomes available.

Return to www.thinkhomecare.org.


House Begins Budget Process with Reductions from Governor, Improvements Over FY13

April 10, 2013

The House Committee on Ways & Means released their proposed version of the FY 2014 state budget today and although many items are reduced from what Governor Deval Patrick proposed, most items are still an improvement over fiscal year 2013.

House Ways & Means’ $33.8 billion budget reduces the MassHealth Senior Care, MassHealth Managed Care and MassHealth Fee-for-Service line items by a total of $205.8 million from what the Governor proposed, but those items still represent a collective increase of $625.1 million above the FY13 budget.

Meanwhile, most Elder Affairs line items that fund the State Home Care Program, administered by the Aging Service Access Point network, received slight reductions. One item, Home Care Case Management and Administration, saw a $478,097 increase over what the Governor proposed, but $593,317 less than the FY2013 number.

Below are the line items, the House Ways & Means funding level, and their difference (+ or -) from the Governor’s proposal and the FY2013 budget. Also included is a brief explanation of what the line item covers.

  • MassHealth Senior Care: $2,861,335,505 (-$50 million from Governor’s budget, +$105.2 million from FY2013)

The MassHealth Senior Care item funds services for seniors on MassHealth as well as the Senior Care Options, or SCO, Program.

  • MassHealth Managed Care: $4,499,411,804 (-$53.5 from Governor’s budget, +$331.9 million from FY2013)

MassHealth Managed Care is for services provided to medical assistance recipients under the Executive Office of Health and Human Services’ primary care clinician, mental health and substance abuse plan or through a health maintenance organization under contract with the executive office and for MassHealth benefits provided to children, adolescents and adults

  • MassHealth Fee-for-Service: $2,145,499,061 (-$102.3 million from Governor’s budget, +$188 million from FY2013)

MassHealth Fee-for-Service covers other MassHealth recipients not under Senior Care or Managed Care.

  • Home Care Purchased Services: $97,780,898 (-$8,891 from Governor’s budget, NO change from FY2013)
  • Home Care Case Management: $53,145,060 (+$478,097 from Governor’s budget, -$593,317 from FY2013)

Home Care Purchased Services and Home Care Case Management fund the operation of the state’s Home Care Program and its related contracts.

The Home Care Alliance will be working with state representatives to file amendments seeking MassHealth reimbursement of home telehealth services, a certificate of need process for home health agencies in the state, and an adjustment to pediatric home health care rates.

Budget amendments will be submitted by April 12th and the Home Care Alliance will send advocacy alerts looking for emails and phone calls asking state representatives for support on our amendments the week of April 15th. The full House of Representatives will debate the budget the following week.

Stay tuned for more information and for advocacy alerts on how you can help gain support.

Return to www.thinkhomecare.org.


Governor Patrick Announces State FY14 Budget Proposal

January 23, 2013

Governor Patrick gave several hints about what his fiscal year 2014 state budget proposal might entail in his State of the Commonwealth address last week, but the announcement of his full budget plan sheds light on a bold plan.

220px-Official_portrait_of_Deval_PatrickThe Governor is proposing that the state sales tax be reduced from 6.25 to to 4.5 percent, which would give the state the eleventh lowest sales tax among those states that levy a sales tax. The Governor also proposes, however, that the state income tax be increased from 5.25 to 6.25 while doubling personal exemptions and eliminating deductions that benefit select taxpayers. According to the Boston Globe, the proposal, if approved, would raise taxes on about 50 percent of residents, beginning in January 2014, with the biggest increases on upper-income earners. This would all go to support transportation and education costs as the Governor alluded to in his State of the Commonwealth address.

For general health care and home care-related items, the Governor’s budget increased funding in three MassHealth accounts (MassHealth Managed Care, MassHealth Senior Care, and MassHealth Fee-for-Service Payments) to meet projected need for those services. Such a move is in line with past years where more of a demand in MassHealth services has been a product of a recovering economy, continued expansion of state Medicaid coverage, and other factors. One item, MassHealth Nursing Home Supplemental Rates, has been decreased from the FY2013 appropriation by more than $20 million.

In terms of the Elder Affairs line items that fund the Aging Service Access Points and State Home Care Program, the Governor proposes a sizable increase to Elder Protective Services over FY13 by $4.8 million. The Prescription Advantage line item amount was reduced, according to Elder Affairs Secretary Ann Hartstein, due to changes in Medicare Part D that will absorb the state’s share. The Elder Home Care Case Management and Administration account was dropped by more than $1 million, but all other Elder Affairs accounts remained relatively level funded.

Other notable items include the elimination of the $20 million Human Services Salary Reserve. The comment on that line item is “eliminated funding due to reform,” which HCA is assuming means that the funding, or at least part of it, will be implemented elsewhere. The Alliance will continue to monitor that account and provide further information as it is released.

To see the Governor’s budget proposal and learn more about the above items, visit his FY2014 Budget webpage.

Return to www.thinkhomecare.org.


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