State Budget Cuts Impact Home Health Care

December 8, 2016

The Home Care Alliance participated in several calls with MassHealth and Health and Human Services on planned budget cuts from Governor Baker’s administration. In total, the Governor announced $98 million in cuts from the $39.25 billion state budget.

Although there are reductions in home health, there are positive rates increases to report.

After years of advocacy by the Alliance and more recent efforts from a coalition of continuous skilled nursing providers as well as a family-based network called the Mass. Pediatric Nursing Campaign, MassHealth informed the HCA that payment rates for Continuous Skilled Nursing will increase by 2.6%. According to MassHealth, this equates to a $2.2 million bump in rates, which will become effective January 1st, 2017.

For the RN and LPN day and night rates, the increase hovers around a $1 boost in what those agencies currently receive. The Alliance, along with the provider coalition and family-based campaign, will continue to advocate for further adjustments to continuous skilled nursing rates in the upcoming FY18 state budget cycle.

As for home health skilled nursing rates outside of CSN, payment will be reorganized by the length of service of the MassHealth member. As of July 1, 2017, MassHealth is planning to break up the current skilled nursing rate for home health agencies into three separate tiers. The first tier will be for patients on services from day 1 through 30, which will be increased from $86.99 to $89.21. The second rate tier will be 31-180 days and the third rate tier is any home health service beyond 180 days.

MassHealth has indicated that the rates in the second tier will remain relatively static and the third tier will be decreased, but post 30-day rates as of 7/1/17 will be budget neutral from the changes taking effect on January 1st. An announcement from EOHHS will specifically outline the new tiered rates, but according to MassHealth, anything regarding rates that is seen before the New Year is not finalized and therefore subject to change.

The other notable decrease will take effect on January 1st when MassHealth plans to approximate the budget impact of those proposed second and third rate tiers into the current post 60-rate. The cut in the post 60-day rate from 1/1/17 to 7/1/17 will be a 6.75% reduction. This means the current post 60-day rate of $69.59 will be roughly $64.89 for the first six months of 2017. (This rate remains higher than the medication administration rate originally considered by MassHealth.)

Laid out in another way, this will be how rates are currently planned to change:

January 1 – July 1:

Home health services post 60-day rate will be roughly $64.89 (6.75% reduction)

July 1:

Service days 1-30: $89.21

Service days 31-180: Rates will remain roughly the same, but are not yet finalized

Service days 180: Rates will be slightly reduced from the current post 60-day rate, but are not yet finalized.

MassHealth is also streamlining enrollment in the Independent Nursing program to cut their application process from 8 weeks down to one week.

The net state cut for home health is approximately $3.8 million out of $758 million in MassHealth spending on home health care services.

Most of the other cuts announced by the administration are restoring vetoes previously proposed by the Governor in the FY2017 budget, but that were overridden by the legislature. At that time, the Governor vetoed $255 million and the legislature overrode $231 million. Included in these cut overrides are certain hospital supplementary payments (particularly to pediatric and Western MA hospitals) as well as $1.1 million in cuts to public health hospitals.

Other impacted accounts include supplemental payments to nursing homes, which will be reduced by $2.8 million, as well as a $2.8 million cut to adult foster care (AFC).

The Pediatric Palliative Care account (4590-1503) is being reduced by $400,000.

The legislature has already announced their view that Governor Baker went too far with some of the announced cuts and they will be working on restoring some of the funding reductions.

HCA of MA has an upcoming meeting with MassHealth to review the Governor’s proposal.  Also on the agenda are issues with ICD-10 changes that are impacting agency billing and payment.

Return to www.thinkhomecare.org.


Proposed Changes Prep Mass. for Nurse Delegation

September 6, 2016

The Massachusetts Board of Registration in Nursing (BORN) has released proposed regulations that sets guidelines for, among other activities, delegation by nurses to “unlicensed personnel.” These guidelines are NOT a change in the nursing scope of practice around medication delegation, which requires a law  approved by the legislature and signed by the Governor.

The BORN is merely aiming to establish a nurse delegation framework inclusive of much more specificity in areas such as training, supervision and documentation should nurse delegation practices become allowable in Massachusetts.

The proposed regulations also protect nurses by setting criteria for delegation that includes the following:

  • Ensuring that the delegating nurse would not bear any responsibility for any deviation by the unlicensed personnel from the nursing directive, instruction, or plan of care.
  • Formalizes the nurse’s role in knowing what is within the ability of the unlicensed personnel to carry out and what can be delegated that would not require judgment or assessment by the unlicensed personnel.
  • The final decision to delegate is made by the nurse and not the employing healthcare provider.
  • The employing healthcare provider must have the competencies of the unlicensed personnel documented for each nursing activity along with periodic validation of those abilities.
  • The nurse can determine at any time that an activity can no longer be delegated based on the health status of the patient, the unlicensed personnel’s performance of the activity, or any other reason the nurse believes would jeopardize the health and safety of the patient.

The proposed regulation follows years of discussion and a BORN subcommittee report on the state’s readiness for potential changes to nursing practice.

One of the possible changes is a longstanding policy priority of the Home Care Alliance, which is to allow home health care nurses to delegate certain medication administration tasks to a trained and certified home health aide. The HCA has dubbed the proposed policy as the “Nurse Delegation Bill.”

This bill will not pass in the current legislative session that ends with the New Year in 2017, but the HCA plans to continue pursuing a change that would allow – not mandate – that home health and home care agencies can implement proper training and procedures to maximize the efficiency of their direct care staff.

It should be noted that this bill includes protections, such as the fact that delegation is limited to medications which are NOT controlled substances and are administered in the following methods:

  • Oral
  • Ophthalmic
  • Otic
  • Topical
  • Internasal
  • Transdermal
  • Suppository
  • prefilled auto-injectables designed for self-administration
  • Products which are administered by inhalation.

The legislation states that “delegation of intramuscular, subcutaneous, intradermal, intraosseous or intravenous administration of medication shall not be permitted.”

Although the Alliance has comments and suggestions for the BORN’s proposed regulations, HCA fully supports the move to ensure the state is prepared for laws that promote nurses practicing at the top of their licenses. The Alliance appreciates the BORN’s thoughtful approach that further solidifies the importance of nurses in healthcare delivery.

The BORN will hold a public hearing on October 4th and will accept written comments until October 11th.

Return to www.thinkhomecare.org.


One Care Program Extended Through 2018

July 25, 2016

MassHealth announced that the One Care Program for individuals dually eligible for Medicare and MassHealth and between the ages of 21 and 64 has been extended through 2018.

Part of this new agreement with the Centers for Medicare and Medicaid Services (CMS) is that MassHealth will be accepting letters of intent (LOI) from entities interested in becoming One Care Plans effective January 1, 2018.

Beginning in 2013, the One Care program included several plans that were whittled down to what is now Commonwealth Care Alliance and Tufts Health Plan, which began participation in the initiative as Network Health. Funding issues were at the center of why other plans could not sustain covering One Care enrollees, although adjustments have been worked out that are intended to help plans better predict costs and assess financial risk. Fallon Total Care was the latest to drop their participation in June 2015.

Out of 103,041 eligible individuals, MassHealth reports that 13,038 are covered by the two One Care Plans. Commonwealth Care Alliance covers the bulk of that total with 10,050 enrollees as of June 1, 2016. According to the latest enrollment report, more than 30,000 individuals have “opted out” of the One Care Program.

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What the Senate’s Economic Development Bill did for Home Care

July 15, 2016

Late Thursday night, the Senate wrapped up debate on more than 200 amendments to legislation promoting economic and workforce development and the Home Care Alliance was active on several issues.

Senate Bill 2423, “An Act relative to job creation, workforce development and infrastructure investment,” created a a special commission to investigate and report on barriers to meeting labor market demands in the commonwealth. The commission’s report can include a broad range of industries, but according to the legislation, it must consist of cyber-security, high technology and biotechnology, early education and care, home care and home health. Despite this focus, the “labor commission,” as it was labeled, did not have a member that represented the home care industry.

Working together with the Home Care Aide Council, and Senator Patricia D. Jehlen’s office, an amendment was adopted to get a home care agency representative on that commission. If the Senate’s legislation advances and is passed, this commission will be shining a light on home care workforce issues on a level of importance that places it with other industries.

The other amendment, which was of great concern, was an effort that would have created a publicly-available registry with the personal information of home care workers. It was the same provision that showed up in legislation and FY17 budget amendments – all of which were defeated.

In this particular iteration, the result was a redrafted amendment to create a registry of home care workers that does NOT include personal information, but rather certifications and whether that worker has ever committed abuse, mistreatment or neglect of an elderly patient or consumer.

The Alliance thanks the many agencies that weighed in quickly with their state senator by phone and email on both of these matters.

The Senate’s legislation now must pass a conference committee process where differences between S.2423 and the House’s version of the bill must be worked out.

Further updates will be shared when they become available.

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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.

 


Senate Advances Home Care Commission in Budget

May 27, 2016

In a $39.5 billion budget, the Senate advanced Home Care Alliance priorities, namely a special commission that will study and make recommendations for state oversight of home care.

The commission would create a separate set of recommendations for certified home health and also private pay agencies. The group would include three representatives from each type of agency (certified and private-pay) as part of the membership along with policymakers, administration officials, and many others. During the Senate’s deliberations on more than 1,300 amendments, the Massachusetts Nurses Association and the MA Chapter of the National Academy of Elder Law Attorneys.

Unfortunately, efforts to gain payment increases for home health aides and homemakers were not approved despite collaboration with the Home Care Aide Council, Mass Home Care, and several dedicated Senate offices. Senator Joan Lovely (D-Salem) spoke well in debate on behalf of a home health payment review and Senator Barbara L’Italien (D-Andover) fought for inclusion of home health aide payment, in particular. Senator Patricia Jehlen (D-Somerville) and Senator Sal DiDomenico (D-Everett) also helped lead an effort to advance home care rates.

On a positive note,an amendment was defeated that would have created a publicly-available registry of home care workers that aimed to list private information.

In addition, the Senate approved a pilot program of just over $1 million that expands income eligibility standards for services coordinated through Aging Service Access Points.

Other notable items in the Senate’s budget include the following:

  • A feasibility study on allowing spouses to be paid caregivers under MassHealth.
  • Allowing a leave of absence for nursing home residents under MassHealth (20 medical leave days and 10 non-medical leave days).
  • A fund created from fines and penalties relative to patient abuse in nursing homes that funds the prevention of such action through staff training and education, enhanced inspections, and relocating residents to other facilities.
  • $20.5 million for the Nursing Home Quality Jobs Initiative as part of SNF Supplemental Rates.
  • $200,000 for Geriatric Mental Health Services.

The HCA thanks its members for the hundreds of emails and phone calls to Senators during the past two weeks. The state budget process moves on to a conference committee process where the House and Senate negotiate differences between their two FY17 proposals. The Alliance will continue to push for the commission to establish oversight measures as well as other items to strengthen home care.

Return to www.thinkhomecare.org.

 


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