Tour of NC: Offices Celebrate Successes, Look to Future Goals

Every yearour Government Affairs Office (GAO) makes an in-person outreach to our service offices, traveling throughout the country to connect with staff about advocacy at BAYADA. This past month, GAO visited approximately 20 offices in North Carolina, from the mountains to the low country, to provide a legislative update, share advocacy information, and hear directly from staff on issues that matter most to them and our clients.

In conversations with staff, we had the opportunity to share our operating model, which utilizes a three-pronged approach in achieving our legislative goals: direct lobbying, supporting our champions, and grassroots advocacy. While GAO works to lobby our elected officials to educate them about issues impacting the home care industry, we rely on the efforts of our employee advocates to support our legislative champions through PAC contributions and to participate in grassroots efforts, such as hosting a home visit or responding to a legislative action alert.

As an Ambassador, I’m proud of the work that we do to be a voice for those who may not always have the chance to advocate for themselves. Advocacy has taught me that there are so many things we can do, big and small, to make an impact on the people we serve.

—Michele Hoke, Hearts for Home Care Ambassador and HHI Client Services Manager

These efforts truly add up, whether you attend a lobby day, host a home visit, respond to an action alert, or simply register as an advocate on the Hearts for Home Care website. With the help of our client and employee advocates in NC, together this past session we:

  • Secured a much-needed rate increase for aide services
  • Ensured an increase from Partners Behavioral Health
  • Protected certificate of need (CON) for our Medicare offices

The impactful grassroots efforts from our Ambassadors and advocates through home visits, legislative roundtables, and our annual Legislative Day make a difference!

Beyond sharing the power of advocacy, this trip gave GAO the opportunity to reconnect with staff and listen to learn more about the issues that matter most to clients and employees. As we traveled from office to office, we heard of all the wonderful things our offices are doing, the special relationships you have with each other and with our clients, and the persisting challenges our offices face in providing compassionate, excellent, and reliable care at the current reimbursement rates. We look forward to working together to ensure our legislators understand and address these challenges.

Collaborating like this to make sure we are being the best advocates we can be is so important to the work that we do. The more we work to get our clients and field staff engaged in advocacy, the more we can ensure their voices are being heard and represented.

Bryan Borchard, RAN Director

Quotes from our Advocates: The Power of Advocacy and PAC by the Numbers

Election season is in full swing and our legislators are busy rallying support from organizations and constituents in their districts. BAYADA staff and members of our Political Action Committee (PAC) have taken full advantage of these opportunities to connect with our legislators by attending legislative receptions in their communities.

These events, whether they are fundraisers, dinners, or meet-and-greets, give BAYADA an opportunity, beyond our direct lobbying and grassroots efforts, to engage with the legislators who are making laws that that affect our clients, employees, and the home health care industry in general.

Our NC PAC membership is 126 (33%) of eligible employees with a retention rate of 99%. The NC PAC Board has distributed year-to-date $14,050 to 25 home care supporters. Further, the Board has approved another $30,625 to be distributed to some 42 lawmakers and candidates within the next two months. As a non-partisan PAC, we distribute proportionally to members from both sides of the isle–52% Republican / 48% Democrat–and focus our limited funds on members who are in a leadership position, or a relevant committee (health, appropriations, aging, insurance, etc.), AND who are supporters of home care.

See below to hear directly from our PAC members and legislators about the importance of getting involved in the legislative process.

Timothy Peterkin with Senator Joyce Waddell

 

I really enjoyed getting involved and meeting Senator Waddell. She really wants to help. Sharing our stories gets the point across and helps lawmakers understand home care. It is worthwhile for us to advocate.

Timothy Peterkin, Area Director (GP)

 

Paige Downing, Rep. Cynthia Ball, Ryan Halas

If you think that lawmakers understand or know everything on which we are voting, you are wrong. We, as lawmakers, can’t know everything. We rely on people and organizations we know and trust, like BAYADA, to help us understand the issue. It is great to be able to get feedback from experts on issues before we cast our vote.

Rep. Cynthia Ball

While this is my first time attending an event with BAYADA, it is not my first time getting involved in advocacy. I was pleased to learn that BAYADA has a strong advocacy program and is working with lawmakers to ensure they understand the importance of home care.

– Ryan Halas, Client Services Manager (DRP)

Adam Brooks with Rep. Bill Brawley

It is vital we connect with our elected officials. They make decision that impact our ability to serve clients in their homes. These events allow us to building relationships locally and to share The BAYADA Way with them. It was worthwhile for me to attend and represent BAYADA.

– Adam Brooks, Director (MAG)

 

As I’m campaigning across the state I’ve attended numerous events for various members, I’ve seen BAYADA everywhere. Your red stands out! Thank you for supporting our efforts to improve North Carolina.

–   Speaker of the House Tim Moore

Attending PAC events is a chance to market BAYADA and our services in a different venue. Theses PAC events are worthwhile and allow us to showcase the scope of services and the need we’re filling for clients.

–   Trip Smithdeal, PAC Board Chairman

Amy Boardwine, Keeley Tharpe, and Rep. Jeffrey Elmore

This PAC event gave us the opportunity to thank Rep. Elmore for his strong and constant support. Educating our legislators at events like these is so important in making sure our legislators truly understand the challenges that our employees, our clients, and their families face on a daily basis.

Amy Boardwine, Director (FHP)

Ryan Halas, Paige Downing, Lee Dobson, and Rep. Gale Adcock

I enjoyed the PAC legislative breakfast. I would definitely go again. It is super important, especially for my office which relies on Medicaid, for lawmakers to hear from us. We need their support if we are to get a rate increase.

Paige Downing, Client Services Manager (SPR)

As lawmakers, we need to hear directly from our constituents. Demystify the process. Sharing your story is an excellent way to advocate.

 – Rep. Gale Adcock

Thank you to the many other PAC members, including Stephanie Zananiri, Timothy Peterkin, Melissa Zuzolo, Paulette Troy, and others who made the time to connect with our legislators and to advocate on behalf of our clients and employees. If you want to join our PAC or have questions about how you can get involved, contact advocacy@bayda.com.

Medicaid Enters a “Period of Silence” as Medicaid Reform Moves Forward

In 2015, the North Carolina General Assembly enacted legislation (Session Law 2015-245), directing the transition of Medicaid from predominantly fee-for-service to a managed care structure.  The North Carolina Department of Health & Human Services (DHHS) seeks to implement Medicaid Managed Care (MMC) in such a way that advance high-value care, improves population health, engages and supports providers, and establishes a sustainable program with predictable costs.

As our state works toward implementation, the North Carolina Department of Health & Human Services (DHHS) has released the Medicaid Managed Care (MMC) Prepaid Health Plans (PHPs) request for proposals (RFP) and the department has entered a “period of silence” until contracts are awarded through a competitive bidding process. This period of silence has been implemented to avoid unfair advantage to any one submitter and is expected to last until contracts are awarded this month.

While the Centers for Medicare & Medicaid (CMS) has not yet approved the state’s request to implement Medicaid Managed Care (MMC), that approval is expected. The state continues to move forward with MMC with a phased-in approach, targeted for early 2019. DHHS has awarded Maximus Inc. the enrollment broker contract for the state.

GAO and our internal advisory workgroup continue to provide feedback to Medicaid to protect and ensure access to quality home care as North Carolina moves toward Medicaid Managed Care.

If you have any question or concerns about Medicaid reform, contact  me at ldobson@bayada.com.

CMS Proposes Program Integrity Demonstration in North Carolina

The Centers for Medicare & Medicaid Services (CMS) has issued a second proposed rule for a 30-day public comment on the Home Health Pre-Claim Review Demonstration. This demonstration seeks to prevent and identify fraud, waste, and abuse in the Medicare home health services through either pre-claim or post-payment review.

The proposed rule calls for a demonstration in five states starting on December 10, 2018 in Illinois. The other states slated to be phased in every 60-90 days include Ohio, North Carolina, Florida, and Texas, with the option of expanding to other states. Providers will have three options: 100% pre-payment review, 100% post-payment review, or a 25% rate reduction and up to 100% reviews by the Recovery Audit Contractor.

Leaders from the Home Health Practice, along with GAO, have submitted formal comments calling for CMS to evaluate and release results from the previous program integrity (PI) demonstration before initiating this new demonstration, and to develop a targeted review approach to PI efforts. BAYADA wants to be a strong partner in rooting out fraud, waste, and abuse, with complete transparency.

Offices should pay close attention to their documentation to ensure referral paperwork, nursing and therapy notes clearly paint the medical necessity picture.  Areas of focus include appropriate documentation pertaining to:

  • Face to face
  • Homebound status
  • Therapy SMART goals
  • Skilled service needs

Questions should be directed to MAG Regional Director Richard Hopson at rhopson@bayada.com.

Advocacy Efforts Persist Despite Unusual Legislative Session

Although the General Assembly typically adjourns legislative session by end of June or early July, this year has proven to be anything but normal. Instead of adjournment with sine die, which indicates no further business is scheduled this session, the Republican majority has called back lawmakers after November’s  mid-term elections. Beyond campaigning, lawmakers continue to hold committee meetings to move legislative business forward. Despite this unusual legislative session, the Government Affairs Office (GAO) continues our efforts to educate legislators on our home care priorities.  Building relationship never stops–in or out of session.

Looking ahead, the GAO Advisory Council–comprised of NC leadership representing every practice–is scheduled to meet on October 23 to identify BAYADA’s legislative priorities for 2019. While rate increases are top priority, the Advisory Council will consider other issues that impact our ability to deliver quality care to clients in their homes. If you have an idea or concern regarding legislative or regulatory issues that impact BAYADA, we’d love to hear from you!

Thank you to our ambassadors and advocates who continue to advocate on behalf of BAYADA’s clients and employees. If you’d like to learn more about our goals, or would like to get involved in advocacy, contact advocacy@bayada.com.

Home Visits in North and South Carolina Show Legislators Importance of Home Care

North and South Carolina legislators visit with home care clients to discuss Medicaid reimbursement rates and other issues related to the home care industry
Left: Former state senator and current candidate for North Carolina’s 119th district Joe Sam Queen discusses home care with Mike G. Right: South Carolina representative Richard Yow visits Mitchell H. and his family to learn about the benefits of home care in keeping families together.

The southern heat isn’t stopping our advocates from going above and beyond for home care. Recently, Hearts for Home Care has seen an influx of activity from our home care employee advocates, who have been scheduling meetings with legislators, coordinating in-office legislative roundtables, and most importantly, demonstrating home care’s impact by hosting home visits, in which legislators come in to a client’s home. Home visits are the most impactful way to demonstrate the importance of home care to legislators because it gives them a chance to see firsthand how their constituents receive services. When our state decisionmakers see the impact of home care on local residents, they are more likely to support policies that benefit the home care industry.

Last month, BAYADA Home Health Care’s Rock Hill Skilled Nursing Office hosted South Carolina state Representative Richard Yow, who visited his constituent Mitchell H. in Lancaster, SC. Mitchell relies on home care to stay at him with his mother, Tammy, and his son, Allen. Seeing how home care allows Mitchell to watch his son grow and thrive impacted Rep. Yow, who stated, “Spending time with Mitchell’s family puts a different perspective on the state’s home care situation. Its past time that we in South Carolina hold insurance companies accountable and do what we can do to ensure that families wanting to take care of their loved ones at home have the necessary equipment and support to do so.” Rep. Yow even assisted the family in securing a spot at a local summer camp!

Last week, Lee Dobson and service office director Taylor McClure led former senator and current candidate for North Carolina’s 119th district Joe Sam Queen on a visit to client Mike G. Mike, who lives alone with no immediate family in the area, relies on his certified nursing assistant (CNA) Kassie to stay at home. Kassie, who has been with Mike since 2016, said, “Mike has become like family to me. I’m glad I can help him stay as independent as possible.” Queen stated, “It is clear serving folks at their home and out of higher-cost settings is better for the individual and better for North Carolina. Access to health care, including Medicaid, is critical as our state grapples with rising healthcare costs. We should be using our tax dollars wisely to help our citizens while creating quality local jobs and providing that much needed care.”

Hearts for Home Care’s home visit program has been recognized by our federal partners for its effectiveness in demonstrating the impact home care has to state legislators. Recently, the Partnership for Quality Home Health (PQHH), asked us to begin a federal home visit campaign to further educate our representatives and senators in Congress on home care’s effectiveness in keeping residents safe and independent at home. In addition to the above mentioned home visits, Hearts for Home Care advocates have conducted additional home visits in North and South Carolina, and home visits in New Jersey, Pennsylvania, and Rhode Island.

It is clear how impactful home visits can be in influencing our legislators’ perception of home care. To learn about how you can get involved in advocacy and how you can plan a home visit, email advocacy@bayada.com today!

Rate Increase Secured from Partners Behavioral Health–Work Continues

Great news for our NC Habilitation offices that operate under Partners Behavioral Health, a Local Management Entity/Managed Care Organization (LME/MCO) that oversees Medicaid’s Innovation Waiver in western North Carolina. After more than of a year of advocating for rate parity for like services, Partners announced yesterday rate increases for community-based services. The Community Living & Support rate will see a 9% increase, bringing it to $20.28 effective August 1, 2018.

This much-needed increase will allow BAYADA to hire and retain more qualified professionals and take care of more individuals at home and in the community. While this is a great step forward, our work is not done yet. BAYADA, along with our Hearts for Home Care advocates, will continue to push towards more rate increases so that we can ensure that North Carolina has enough high-quality caregivers to meet the growing demand for home care services. Our field staff deserve better wages, and our clients and all of those who wish to remain at home in North Carolina deserve better access to quality services.

Thank you to all our advocates who supported this increase through your input and your contact with legislators. We truly are #StrongerTogether.

North Carolina’s Efforts Towards Medicaid Transformation Continue to Move Forward

The General Assembly passed two bills, H. 403  and H. 156,  which work together to clarify the implementation of the Standard and Behavioral Health/Intellectual-Developmental Disability (BH/I-DD) Tailored Plans and the licensure requirements for Prepaid Health Plan (PHP) managers under Medicaid Transformation.

In a historic move, legislators voted to move Medicaid recipients with mild-to-moderate behavioral health needs under the Standard Plan for Medicaid services. Individuals with a serious mental illness, a serious emotional disturbance, a severe substance use disorder, an intellectual/developmental disability, US DOJ settlement consumers, or individuals who have survived a traumatic brain injury are the defined population that will fall under the Tailored Plan.

The BH/I-DD Tailored Plan will begin one year after the Standard Plan with the LME/MCOs as the lead plan managers working with another PHP to offer the physical healthcare services for Tailored Plan Medicaid recipients for four years after that. The timelines incorporated in these bills push for North Carolina to complete the transition to the Standard and Tailored Plans as well as moving other specialty populations under managed care within five years of CMS approval.

GAO and our internal advisory workgroup continues to provide feedback through stakeholder involvement to ensure access to quality care as North Carolina moves toward Managed Care. If you have any questions about this process or the future of Medicaid in our state, please email me at ldobson@bayada.com.

12.37% Rate Increase for Community Alternatives Program for Disabled Adults (CAP-DA)

Great news for BAYADA clients and the many North Carolinian disabled adults that wish to remain at home with the help of in-home caregivers! The Medicaid CAP-DA program will see a rate increase from $13.88 to $15.60, effective January 1, 2019.  This increase brings parity between the three Medicaid aide programs, Personal Care Services (PCS), CAP-C for Children and CAP-DA for disabled adults.

This much needed increase will  enable BAYADA to hire and retain more quality caregivers to serve the many adults with disabilities in North Carolina. Thus, our service offices that serve CAP-DA eligible clients will be able to staff the necessary cases and keep families together and keeping clients whether they want to be – at home.

BAYADA’s Government Affairs Office (GAO), collaboratively with the Association for Home & Hospice Care, worked behinds the scenes with both Medicaid and key lawmakers to ensure this provision was adopted this session. Additionally, we made great strides towards this increase during our 2018 Legislative Day in which several client advocates came to share their stories with lawmakers and talk about the necessity of such increases. Thank you to those who came and shared their voices! We will continue to fight for higher rates to ensure that all North Carolinians will be able to access high-quality, reliable in-home care.

 

Unusual Adjournment Grants Republican Super-Majority One Last Session in November

This year has proven to be anything but normal at the General Assembly. Instead of adjournment with sine die, which indicates that no future business schedule this session, the Republican majority passed House Joint Resolution 1101, which calls back lawmakers on November 27.  This political power move gives the Republican super-majority one last session no matter what happens on election day.

Despite this unusual legislative session, BAYADA managed to accomplish the following legislative priorities:

  • Secured a 12.37% aide rate increase for CAP-DA, effective Jan 2019
  • Protected Certificate of Need from elimination for our Medicare offices
  • Secured a 9% rate increase from Partners Behavioral Health for our Habilitation offices, effective August 1, 2018

Thank You to our many ambassadors and advocates that helped us achieve these goals. We could not have done it without your passionate voices coming together to support all of North Carolina’s home care employees and clients.