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Patient Driven Groupings Model (PDGM) Legislative Fix
The first home health payment system overhaul in over 20 years is set to go in effect in January 2020. In 2018, the United States Congress passed the Bipartisan Budget Act which included a provision requiring CMS to make any reforms to the home health benefit budget neutral. As a result, CMS has taken this authority and incorporated behavior-based rate reductions to provider payment rates in a prospective manner. CMS estimates that this will result in 8.01% payment reduction in order to account for assumed up-coding and additional visits on LUPA cases.
S.433/HR2573 has been introduced by a bi-partisan group of legislators and would remove the ability of CMS to adjust provider payment rates based on assumptions and instead require any payment reduction to be based on actual observed behavior changes. Take action today urging the Massachusetts Delegation to co-sponsor this legislation and prevent cuts to the home health benefit!
Non-Physician Practitioner Certification of Home Health Services
Currently, federal law requires that a physician certifies a patient's eligibility for home health services. This means that a Nurse Practitioner is prohibited from certifying home health services and requires the NP to ‘hand-off' the patient and have a physician certify the order. This is leading to immense access barriers. With the health care delivery system constantly changing, primary care is increasingly provided by non-physician practitioners. H.R.2150/S.296 would permit non-physician practitioners to certify home health and improve the transition of care for patients into community based care.
Enough Pay to Stay – Workforce Initiative
Reimbursement rates for homemaker and home health aide services have not been adjusted since FY15 and FY07 respectively. As a result, workers are leaving home care agencies for higher paying jobs in other settings. The Enough Pay to Stay initiative would modify state law and change the method that home health reimbursement rates are reviewed at MassHealth, and change homemaker rates through the Elder Affairs Home Care Program. The initiative is also requesting $28.01 million in immediate wage/rate relief for these essential frontline professionals.
Licensure of Home Care Services
For many years, the Home Care Alliance has supported and advocated for legislation which would establish a licensure structure in Massachusetts. It is our vision that this regulatory structure would establish a baseline set of standards for home care agencies to comply with in order to lift up the industry at large and protect consumers. H. 611 would direct the Department of Elder Affairs to establish a licensure process for any entity or person providing home care services. The legislation creates a framework for EOEA to develop regulations on: 1. Background checks, 2. Minimum standards for consumer plans, 3. Training requirements, 4. Minimum workers comp & liability, 5. Consumer complaint processes.
Home health care agencies provide a wide-range of services, both clinical and supportive, to allow individuals throughout the Commonwealth to stay at home. Among the strengths of home health agencies is their ability to oversee medication reconciliation and administration. Skilled clinicians very effectively ensure that patients understand new prescriptions, dosages, and regimen. While the Nurse Practice Act allows Registered Nurses to delegate almost any nursing task to a home health aide, it prohibits the delegation of medication administration.
H.1939 An Act Relative to Home Health and Hospice Aides would give authority to registered nurses to delegate the administration of a limited scope of medications to home health aides (if the home health aide completes necessary training requirements). The registered nurse is not required to delegate these tasks, and is the ultimate arbiter of that delegation.
Continuous Skilled Nursing Data Collection
The Massachusetts Continuous Skilled Nursing (CSN) program serves over 900 medically complex individuals in their home so that they can be with their families while receiving high-quality skilled nursing services. Until 2017, MassHealth had not adjusted reimbursement rates for CSN services, making it difficult for CSN providers to compete with Boston-area hospitals who are able to offer much higher hourly wages for nurses. As a workforce shortage began to mount, families were facing less and less adequate coverage for services that MassHealth was approving. An astounding 24% of authorized services were going unfilled due to this workforce crisis.
One challenge for advocates and policymakers alike was the lack of regular data collection for this program in order to track trends in the program. The Home Care Alliance drafted and supported legislation this session which would require MassHealth to conduct a biennial review and report on the program with 6 key data points to inform policymakers of recent trends.
Update: The FY 2020 State Budget signed into law included a biennial report for MassHealth to complete and submit to the legislature. While this language was not the Home Care Alliance proposed legislation, we stand ready to work with MassHealth, CHIA and the legislature to ensure that these reports be as useful as possible moving forward.