NJ Legislative Update: Private Duty Nursing (PDN) and Personal Assistance Services (PCA) Rate Increase Efforts

Private Duty Nursing (PDN) Update

Dana Insley, mom of Pediatrics client Abi, testifies at a bill hearing

The Private Duty Nursing (PDN) Bill was introduced in early February and passed the Senate Health Committee unanimously (9-0) on June 3, 2019. The bill, which proposes to increase the PDN reimbursement rate by $10 to $60 for RNs and $48 for LPNs while setting a rate floor such that managed care entities can reimburse no less than the state fee-for-service, has been double-referenced to the Senate Budget and Appropriations Committee. The PDN bill will likely be heard in committee during the fall.

Thank you to the more than ten clients and families, including Dana Insley who testified in-person, who have submitted testimony detailing the challenges and obstacles they face as a result of chronically low reimbursement. With more than a decade without an increase to the PDN program reimbursement rate, this much needed increase will ensure home health care providers can recruit enough reliable, highly skilled nurses so that our clients never have to go without the care they need.

GAO will continue to keep office staff and clients updated as the bill continues to move throughout the remainder of the year.

PCA – Minimum Wage Bill Update:

The New Jersey legislature narrowly avoided a government shutdown when Governor Murphy signed the $38.7B fiscal year 2020 budget into law on Sunday, June 30. The governor used his line-item veto power to cut nearly $50 million from the legislature’s proposed budget.

Included in this next year’s budget is an increase to the reimbursement rate for the Personal Care Assistant (PCA) program. Lawmakers have provided funds to increase the rate from $16 to $18 per hour effective July 1, 2019.

On the same day as Governor Murphy signed the budget, he also conditionally vetoed the PCA Bill, which, in addition to a rate increase, proposed a five-year rate increase structure and eliminated language which required 100% of realized increases to be passed directly to home health aides. Governor Murphy’s conditional veto eliminates the proposed rate increase structure, sets the PCA reimbursement rate at $18 (as in the budget), and retains language to eliminate the pass-through requirement.

To become law, the bill must be voted on once more by both the House and the Senate. The legislature will convene to vote in late July or early fall. We will continue to provide timely updates as we learn more about the legislature’s voting schedule.

Thank you to our many clients and Hearts for Home Care Ambassadors who went above and beyond to ensure we received this important increase. Moving forward, advocating for ongoing increases to the PCA reimbursement rate in conjunction with the rising minimum wage will be instrumental in ensuring providers can continue to provide personal care services in New Jersey and to keep vulnerable New Jerseyans where they belong – safe and at home.

If you have any questions about our PDN and PCA legislative priorities, please contact advocacy@bayada.com.

PA Approves a 2% PAS Increase! Thank You for Your Advocacy

A true team effort: The PA PAS increase happened as a result of strong advocate engagement and industry-wide advocacy from clients, families, and home care workers across the state

On June 28, Pennsylvania Governor Wolf signed the 2019-2020 budget into law. Included in the $34 billion budget was a 2% increase for Personal Assistance Services (PAS) under the Office of Long-Term Living (OLTL). This increase will go into effect January 1, 2020 and will predominantly affect our Assistive Care State Programs (ACSP) offices. This increase will result in an additional $700,000 in annualized revenue and an additional $625,000 in operating surplus.

The GAO office would like to thank our many wonderful Ambassadors and leadership that advocated for our clients, families, and staff. This increase was over five years in the making, and these advocates made home care a priority through countless meetings with legislators in their district and at the Capitol, writing op-eds for local papers, and helping to host over 20 legislators in clients’ homes. GAO would like to thank a few of our advocates who went above and beyond to ensure our legislators knew the necessity of this increase.

A Big Thank You to our BAYADA Advocates!

Chris Bender– Chris has consistently advocated our clients and families through office visits and lobby days. She hosted a PIT office legislative visit to show the village it takes to provide such complex and necessary care to our clients. Chris also worked with the public affairs branch of GAO to find clients and field staff to advocate for this rate increase as well in the media. As a result, Chris and two aides from her office were featured in a front page Pittsburgh Post-Gazette article, and CM Melissa Donatore’s op-ed was published in a later edition of the Gazette. Additionally, client Vanessa R. was featured on a WPXI broadcast piece that covered the need for higher wages for home health aides. Go Pittsburgh!

Melanie Brewer – With a background in the field of politics, Melanie advocated for our clients and staff through her current and previous relationships and connections. She quickly established herself as a trusted resource on home health care to Erie area legislators, and reinforced why home health care matters to so many.

Donna Buhosky – Donna attended many district office visits in her area, as well as a variety of community events hosted by legislators. She became a constant advocate for Pennsylvania’s most vulnerable populations at these events, reiterating the need to increase the reimbursement rate.

Tom Johnson-Medland– Tom not only attended many legislative visits and community events but was able to secure his office’s license through his legislative contacts. He worked with two area legislators and the Department of Health to keep his office compliant. Their willingness to work with Tom is a testament to his relationship with the legislators and his reputation as a trusted provider of home care. Tom also encouraged his fellow employees to take action on the alerts sent out by GAO, resulting in 100% participation from his office employees.

Donna Pierantoni – Clinical Manager Donna Pierantoni advocated for a PAS increase by lending her name to an additional op-ed penned to the Tribune-Review.

Candice Poole – Candice attend a multitude of events in her area hosted by the local legislators to ensure they knew just how important adequately funding home health care is to their communities. Additionally, she fostered advocacy within her office and encouraged her fellow employees to get involved. She helped identify and prepare clients for our public affairs efforts, and authored an op-ed that was featured in PennLive.

These advocates demonstrated how important advocacy is to living The BAYADA Way. They demonstrated that our clients come first by working to make sure our legislators understand how important home health care is to their constituents in addition to their current positions at BAYADA. These advocates, along with many others, went above and beyond their job description to help our clients access the care they need and continue to foster the growth of BAYADA.

If you are interested in becoming an Ambassador, email Mike Sokoloski at msokoloski@bayada.com.

Three Steps Forward, One Back—NC Lawmakers make Strides Towards Helping the State’s Most Vulnerable

Earlier this month three separate pieces of legislation moved forward to support some of North Carolina’s most vulnerable citizens, and one may have put them in jeopardy.  First, lawmakers are closing the coverage gap with the design of a health care program that addresses the needs of citizens who are ineligible for Medicaid due to their income levels but who are otherwise unable to afford health insurance. HB 655 will ensure hundreds of thousands of North Carolinians have access to health care.

Second, lawmakers set aside $2.7 million for the Division on Aging to help address the 11,000 persons on waiting lists for services across the state. The most heavily funded services are in-home aide services, home delivered meals, and transportation assistance. This is a great first step to address the service gaps within our Block Grant programs and supporting individuals to stay home.

Lastly, the state added 1,000 new waiver slots for individuals living with intellectual and developmental disabilities (I/DD). These slots will help address the more than 11,000 persons on waitlists across the state. The provision also calls for a study on rates and wages of direct support personnel. GAO is encouraged with these provisions and will look for opportunities to provide input on the wage study. Our top priority is to ensure enough reimbursement and program funds to address staffing shortages resulting from low wages so BAYADA can take care of more people at home.

The “oh no” provision, if passed, that will jeopardize our Medicare offices and clients comes in the form of changes to Certificate of Need (CON) laws (HB126).  Hearts for Home Care Ambassador Neal Luther took a stand by sending a personalized message to Senate Republicans which read, “As an occupational therapist working with Medicare seniors, my priority is to ensure seniors get the care they need in the most cost-effective setting – home. HB126 causes me great concerns because it allows continuing care retirement communities (CCRC) to go around the CONs rules. As a therapy professional I follow the rules, CCRCs should be expected to follow them too.”  While it is likely that this bill will pass the Republican-led Senate, GAO will continue to garner support to solidify the House’s opposition on changes to CON laws that will help us keep Medicare seniors safe at home. 

As of publication, 66% of Medicare directors have taken action.  Thank you for being an advocate for our staff and clients. Your advocacy voice is important. 

Momentum Going Strong: RI Offices Continue with Legislative and Home Visits

Rose Jones, Director of the RI Division of Elderly Affairs (DEA), recently visited BAYADA in Rhode Island to learn about the important work we are doing to ensure “people have a safe home life, with comfort, independence and dignity.” She toured the RSP, RIS, and RSP office spaces – including our training & simulation (SIM) labs, and held a roundtable discussion where office employees and GAO reviewed:

DEA Director Rose Jones visits RI Offices and SIM labs

     ✔ How clients receive home care services from a licensed agency through DEA,

     ✔ Process of recruiting/training/retaining our workforce, including CNAs, LPNs, & RNs,

     ✔ Opportunities to ensure everyone has access to safe, affordable and quality care at home when they need it

During her visit, she said “it takes a village to provide care to Rhode Islanders needing assistance so they can remain at home”… and we couldn’t agree more!  We truly appreciate Director Jones taking the time and asking questions to dig deeper into home care, and for meeting with some of our passionate staff who truly #LoveWhatTheyDo. We look forward to connecting her with clients and field staff through a home visit in the coming months!

RI Home Visits with Reps. Julie Casimiro and Camille Vella-Wilkinson

Recently, Zachary, his mom, Lee Ann Quinn—a BAYADA clinical manager— and their family graciously opened their doors to Representative Julie Casimiro to educate her about high acuity home care services Zach receives. Zach’s nurse and CNA were there along with his dad, Mike, and little sister, Olivia. Mom Lee Ann said, “Thank you all for coming to meet us today. It was a true pleasure! My family and I are passionate about keeping Zach right where he is at home where he belongs and it is so important for him to be heard!”

The RI offices and GAO also took Representative Camille Vella-Wilkinson on a home visit to meet Bob, a very inspirational Vietnam Vet who appreciates his home care services. Bob was able to share his story with Rep. Vella-Wilkinson so that she better understands how CNA services keep Rhode Islanders safe at home and out of costlier nursing homes.

Shout out to our amazing BAYADA leadership and GAO Hearts for Home Care Advocacy ambassadors from RSP, RIS and RSP. Special thank you to Lee Ann Quinn (Clinical Manager), Wendy Milot (Director), Richard Boschwitz (Director), Lindsey Jamiel (Director), Cristina Viveiros Gomes (CM II), Elizabeth Schenck, (CSM) Alex Brown (RSP), and Dana Medeiros (Area Director) for helping to coordinate and host these important and impactful visits!  

RI Budget Sees First-in-the-Nation COLa for Home Care Services!

It takes a village: GAO, RI office staff, industry partners, and clients from across the state advocated for rate increases and the first-ever COLa adjustment

Rhode Island’s home care advocates scored big when they received their monumental across-the-board increases for home care services last year. That’s because, in addition to the increases, an accompanying provision called for regular yearly cost-of-living adjustments (COLa) for services provided through licensed home care agencies. This means that each year, home care rates must be adjusted to reflect real market changes. On July 5, Governor Raimondo signed the budget, which included the first-of-its-kind 1.9% COLa for CNA and nursing services!

Significantly, this 1.9% increase represents the fifth increase for home care that the state has received in the past four years. Also significant is the fact  that, while home care rates have stagnated throughout most other states in recent years, Rhode Island has found a unique way of ensuring that home care staff and clients now can rely on the COLa to ensure they are not left in the lurch each year.

Thank you to the General Assembly and Governor Riamondo for investing in home care and supporting the work we do to keep Rhode Islanders safe at home.     

Help us access the nursing care we need: Indiana Mom Annie Shares Her Voice with RTV6, and wih Lawmakers

Indiana families like the Goellers are struggling to access the in-home nursing care they need to keep their medically-complex children safe at home

Indiana moms are coming out to share their message with State decisionmakers: “Help us access the nursing care we need!” Recently, RTV6—Indianapolis’s ABC affiliate—aired coverage of mom Annie and her daughter Emma. Emma, and more than 14,000 like her across the state, rely on skilled nursing to live safely at home, but often struggle to access it. The State has until June 30 to make a decision to help alleviate families’ struggles by increasing funding for state programs that pay for in-home nursing coverage.

The issue lies in State funding for programs that allow families like the Goellers to access the skilled in-home nursing they need. Because nurses can make more money in hospitals, rehab centers, and other facilities, nurses are more attracted to those settings rather than home care. The constant turnover creates a revolving door of nurses. In the past six years, Emma, who has cerebral palsy, has had dozens of different nurses. “I would say probably at least 20 or 25,” said mom Annie.

Such turnover means that Emma doesn’t see reliable, consistent nursing coverage, which puts her at risk. For many families, this also means that shifts are missed and parents must bear the burden of providing care. Lack of sleep, calling out of work, and being unable to care for other family members are all unintended consequences that come from the lack of skilled in-home nurses.

No child deserves to grow up in a hospital or facility, and no parent deserves to be an untrained nurse for their child. When we unite our voices in advocacy, we can make sure that our message is heard and that decision-makers and key influencers are aware of the issues that they have the power to make changes on. Contact advocacy@bayada.com to learn about how you can share your story and make an impact today.

Delaware Hearts for Home Care Advocate Shares Heartfelt and Impactful Story with Legislators!

Recently, a Delaware pediatric licensed practical nurse (LPN), Charlene Chappell, signed up for Hearts for Home Care and wanted to get involved. And did she come out in full force!

After sharing powerful and heartfelt testimony in Dover, DE’s Legislative Hall about the impact she makes on families and the challenges low Medicaid rates bring to nurses who want to provide one-on-one care to families at home, Charlene listened to a radio show where host Joel Olsteen spoke about “an itch you just can’t scratch.”

That got Charlene thinking about more advocacy. Charlene said, “I feel that the majority of men and women that serve as elected officials have no clue what’s required of a family when they have a child that has special needs and is differently abled! They don’t understand that nurses need to be attracted to home care so that families can rely on this care to keep their medically-complex children at home.”

That inspired her to write the below story and send it to all Delaware legislators. Read Charlene’s powerful story below!

My Itch!

I have an itch! Mo matter how hard I try to let someone know, I can’t.  I’m 8 years old and I can’t tell Mommy where I itch! I can’t reach my itch! Its 2:30 in the morning and Mommy has fallen asleep in the chair next to my bed because she had to work today and then take my sister to her dance lesson. When she finally arrived home she threw some dirty laundry in the washer, and cooked dinner. After dinner she put the wash in the dryer, and then she loaded the dishwasher. She came in my room to check on me and feed me. Off she went to make sure my sister had done her homework and was in the shower. Oh no, an alarm is going off! Here comes Mommy. I wish I could tell her how much I love her for all she does and about my itch. She looks so tired. It’s almost 8:00 pm. The phone is ringing. Hurry Mommy before they hang up!

I can hear Mommy on the phone. “What! Oh no, please tell me it’s not true. I’m so tired tonight. I don’t know if I can stay up all night with him but I must. I have to make sure he’s ok on his ventilator and his medications are given at the right time, so he doesn’t have a seizure, and that the tube feeding is running properly. He has to be repositioned every two hours so his skin doesn’t break down. I have to check his diaper too. Well… thanks for the phone call.”

Oh no. Mommy just found out my favorite night nurse called out tonight, and the rest of forever. The agency is going to try and find a replacement as soon as possible, but that may take some time. Nurses aren’t as anxious to get into home health care nursing because they can make more money at a hospital. Mommy is going to miss work because she will have to stay up with me as Daddy’s gone from home with his job right now. Mommy may lose her job. I’m so sad my nurse left. She really knew me and she knew when I had an itch. She would gently scratch me all over till she found it, like Mommy does. She understands my cues and my facial expressions as I can’t talk, or walk, or move because of my illness. 

I heard Mommy talking to the lady at the agency about the nursing shortage in home health care. She told Mommy that the money provided for reimbursement by Medicaid, not Medicare, has not increased in 13 years! The last time there was an increase in Medicaid was in 2006! I wasn’t even born then! She also told Mommy that the companies are running out of their own funds to supply the raises the nurses deserve. God bless the nurses that do work in home health care, for a lesser wage then they deserve, and take care of not only me but my mommy and Daddy too. Without them my Mommy and Daddy would not get the proper rest, would have to quit work to care for me. It would not be a good thing for my family. We would all suffer. I don’t want to go anywhere but here in my room. What if we can’t find a new night nurse? Where will I go? I overheard the doctors and nurses at the hospital talking last time I was admitted for a bad seizure and they said that all children do better in the home setting for getting well once they can leave the hospital. They are less likely to get sick again from a disease they acquired while in the hospital, and all of us are more comfortable in our own bed!

I hope my story has helped you to understand why we need to increase the Medicaid budget. Not Medicare, but Medicaid. Mommy told me that some people get confused so that’s why I will say it one more time. Please increase the Medicaid funding for home health care nurses.

Thank you for reading this. Mommy thanks you as well as all the other children and their parents that require specialized home health care nursing.  And yes, Mommy found my itch!

Thank you, Charlene, for sharing your creative and passionate story with Delaware’s legislators. We must all share our voice to make an impact, and your advocacy highlights your deep commitment to your clients’ care.

Hearts for Home Care is seeking to advocate for higher reimbursement rates for skilled nursing services in Delaware so that nurses can be better attracted to home care, and so families that need this care to stay together at home can more easily and reliably access it. For information on how you can get involved, contact us today

Thank You for Keeping Me Home: A Message from an Advocate

North Carolina advocate Ari A. during a trip to Washington, D.C.

We often think of advocacy as sharing our stories, our challenges, and asking for legislative support in addressing those challenges. But advocacy is much more multi-faceted: It’s about building relationships by cultivating legislative connections so that they become home care supporters for life, and it’s certainly about saying Thank You when the support pays off by resulting in a law or policy that is beneficial to the individual and to the home care community at-large.

Below, find a Thank You note written by North Carolina home care recipient and Hearts for Home Care advocate Ari A. Ari has been able to thrive and stay independent at home because of the skilled nursing services he receives under North Carolina’s Medicaid program. Recently, he wrote to Medicaid staff to thank them for resolving a critical issue that enabled him to continue these services. Medicaid staff are committed to improving health and well-being of North Carolinians, and their transactions are often behind the scenes and receive little recognition. Hearts for Home Care applauds Medicaid staff across the country for their commitment to helping individuals stay at home, and we applaud Ari for his sincere thankfulness of their work.

To All I Work with in NC DHHS and Medicaid,

Some of you I’ve known for years and some a short time. Through it all, the one and most important factor that has been consistent has been the capacity to care. Time and time again over the years I have had to get battle ready in order to keep my life-saving services. However, instead having to scale cold-hard hearts, impenetrable like a fortress, you invited me into your hearts. You consistently agreed to provide for my intensive care in my home instead of a medical facility; which essentially would have been leaving me out in the cold to die. Instead of fighting me you have been my allies, always being there for me when I needed you the most.

These truths became ever more apparent a couple weeks ago. For the past two years, my mom and I have been getting things ready to transfer my medications, physical therapy, and supplies to Medicare without de-stabilizing my PDN services under Medicaid. It has been a mind numbing, complicated process. We have been hyper-vigilant not to miss any details that could easily be overlooked. We recently turned in sensitive paperwork to the Department of Social Services (DSS) well before the deadline. On November 30 we spoke with the Director of Policy and Procedures for Medicaid Sandy Terrell about how to safeguard my PDN even more during the transition. Ms. Terrell told Saunja Wilson from PDN to double check if everything was in order by the end of the month. Thank God, Ms. Wilson decided to check right away. The sensitive paperwork we emailed to DSS was present, but hadn’t been pulled up yet even though my caseworker had the paperwork in her email. One of the Supervisors at DSS had also confirmed that we had it turned in. We were told email or fax was equally acceptable for documentation.

The breakdown was that this particular caseworker did not use her email for business and preferred to have documents faxed to her. My caseworker tried to alleviate a little bit of pressure off my mom and I by telling us to ignore the ‘Termination of Medicaid Services’ notice in the mail. Yet, the absolute terror that rose up from the pits of our stomachs when we received the notice was totally indescribable! Despite the paperwork being directly faxed to my caseworker, we still waited for the approval. Thankfully over a week later, the situation was taken over by one of the Supervisors at DSS. She rose to the occasion and kindly brought the matter to a close so that my mom and I could peacefully go on with our lives.

Frighteningly, the bottom line is that I am not exaggerating when I say my life would have been ‘Terminated’ if Saunja Wilson from PDN hadn’t been ‘quick on the draw’ to find the error. If Ms. Wilson had waited to check just two or three days later, I wouldn’t have been able to disregard the Termination notice and my life would have been ruined! I say again, Thank God for my champions in NC government. You always rises up out of the mist to do a heroic save! This is what the rest of America could be and should be as far as healthcare policy.

To my old and new friends in DHHS and Medicaid, I appreciate you always having my back. Also, my sincere gratitude to Saunja Wilson for catching a “Near-Miss” that would have been just as deadly to me as a medication overdose.

All of you keep doing a spectacular job and always keep your focus on the people you serve instead of the numbers, especially as NC transitions to Managed Care. If you ever need my help just let me know anytime! My best wishes in the coming year and Happy Holidays!

Sincerely,

Ari A. Charlotte, NC

New York State Budget Finalized with $550 Million Increase Restored for Medicaid Funding

Earlier this year, New York Governor Andrew Cuomo announced his plan for the 2020 state budget, including a 3.6% planned budgeted increase to overall health care spending. When proposed tax revenue estimates came in much lower than anticipated, the administration decided to cut approximately $550 million of this increase. But after strong advocacy efforts from many health care groups across the state, the Governor and his administration changed their position, keeping the $550 million Medicaid increase in the budget.

BAYADA’s Government Affairs Office (GAO) participated in several conference calls with the New York State Home Care Association (HCA) to learn more about Medicaid spending, which accounts for 42% of the budget, and what we and our office staff, clients, and families can do to advocate for higher wages for home care nurses through increased reimbursement rates. 

Currently, New York’s Medicaid reimbursement rates are well-below surrounding states, so many caregivers are discouraged from entering—or staying in—the home care industry due to abysmal wages. It also impacts BAYADA because the rates are currently so low that we are currently not be able to provide sustainable Medicaid-based home care in the state and pay caregivers an appropriate wage.

As part of a larger national trend, New York did vote to increase the statewide minimum wage to $15 per hour incrementally through 2021. New York understands that home care providers that do provide Medicaid-based services would not be able to comply with this minimum wage mandate and stay sustainable under current rates. The final budget did include an additional $1.1 billion to support the cost of raising minimum wage for health care workers. BAYADA is currently advocating for similar increases in other GAO states that have increased the mandatory minimum wage, but have not increased reimbursement rates in tandem. Medicaid rates must keep pace with the rising cost of living and increased wage mandates to ensure that providers can stay in business, and to ensure that vulnerable New Yorkers can have access to quality home care.

Advocates in Action: Dimpal Patel Inspires NC Ambassadors at Ambassador Symposium

Client Dimpal P. inspires Ambassadors during North Carolina’s Ambassador Symposium

On March 28, our annual North Carolina Hearts for Home Care Ambassador Symposium took place, where we provided tools and resources to our volunteer Ambassadors. The training focused on a variety of topics, including leading a legislative meeting and building relationships with lawmakers. 

In addition to special guests former Representative Bill Brawley, Senior Healthcare Campaign Director of MomsRising Felicia Burnett, Association for Home & Hospice Care’s VP of Government Affairs Tracy Colvard, and Staff Attorney with Charlotte Center for Legal Advocacy Louise Pocock, the shining star of the Symposium was client Dimpal, who inspired all of our Ambassadors with her story of her journey into advocacy.

Beyond detailing the specific challenges she and her family face as a result of low state Medicaid reimbursement rates, Dimpal also described the ways in which home care and her nurses have changed her life and granted her independence:

“Without my nurses, I wouldn’t have been able to go to college and to live a full life. Without them, I’d likely be stuck in a hospital or a nursing home,” said Dimpal.  

It was this gratitude for her nurses that propelled Dimpal to share her story and to advocate for others who rely on the state’s Private Duty Nursing (PDN) program to survive.

To hear more about Dimpal and the importance of advocacy, you can watch her full speech here. You can also read about her nursing care in the Gaston Gazette after a reporter came to her house to learn more about how her nurses impact her everyday life.

Special thanks to our Hearts for Home Care Ambassadors for volunteering their time and talents advocating for our staff and clients!

To learn about ways you can get involved in advocacy, email advocacy@bayada.com today