“649 Days Until Medicaid Managed Care Go-live” – Will Medicaid Meet Its Goal in NC?

Submitted by Lee Dobson, Area Director, NC Government Affairs (GAO)

 Last week, I attended the Medical Care Advisory Council (MCAC) meeting where Jay Ludlam the new NC Department of Health and Human Services (DHHS) Assistant Secretary for Medicaid Transformation presented the department’s program design for taking Medicaid into a managed care environment.  Having been on the job for less than three weeks, Ludlam said, “649 days until the Medicaid Managed Care go live date!”  While many steps need to occur before “go live”, including formal approval by Centers for Medicare and Medicaid Services (CMS), the department is aggressively working towards that goal.  I spoke with Mr. Ludlam after the meeting, not only to introduce BAYADA but also to express our concerns with the fast pace, and lack of details for how long-term services and supports will be incorporated into reform.  As you may recall, BAYADA formed a review team and has already submitted comments to the program design. The Government Affairs Office (GAO) will continue to participate in the discussion as the state formulates its plan.  Click to read Jay Ludlam’s complete bio.

Photo of Jay Ludlam link to his bio
Photo of Jay Ludlam link to his bio

Aides Cried Tears of Joy for Much-deserved Raises throughout North Carolina’s Assistive Care State Programs Offices

Submitted by Lee Dobson, Area Director, NC Government Affairs (GAO) and Shannon McCarson, Regional Director, Dogwood Group (DOG)

We worked together and made it possible. After many years of advocating for higher reimbursement rates within the state Medicaid programs, we finally received an increase in the hourly rate for personal care services (PCS). This achievement was made possible through the persistent advocacy efforts of our employees, clients, families, and government affairs team. Our Hearts for Home Care Advocates participated in email campaigns, home visits, legislative roundtables, home care lobby days in Raleigh, and professional lobbying efforts.

As a result of working together, this week assistive care state programs directors throughout the state were thrilled to pass along an increase to our deserving CNAs and HHAs who care for our Medicaid clients and have stuck with us through thick and thin.

Directors have been personally speaking to staff to share the great news. “One by one, as I spoke to our aides, I heard the same thing – gratitude, appreciation, tears of joy, and, yes relief, too,” said Mimosa (MIM) Division Director Joe Seidel. “The low Medicaid reimbursement rate made it impossible to pay more. I am glad to do it now.” This rate increase is a good place to start, and more needs to be done.

Let’s keep the momentum going by joining to be a Hearts for Home Care Advocate. We believe our aides deserve even more for the important work they do in keeping our clients safe at home. If you are not already part of our advocacy group, join today at heartsforhomecare.com to receive alerts that could influence future efforts to increase pay rates.

 

When “Talking Back” Informs Future Direction in North Carolina

Submitted by Lee Dobson, Area Director, NC Government Affairs (GAO)

Over the last month, our BAYADA ad hock regulatory and legislative review teams, comprised technical experts from our various practices, have been busy reviewing proposed Medicaid clinical policies and a managed care model to craft recommendations.  A formal comment is BAYADA’s opportunity to provide substantive feedback to inform changes in regulatory oversight and payment reform.  Click to read BAYADA’s comments:

 

[Call out box]

Special thanks to our review BAYADA teams for sharing their insight and operational experience.

Medicaid Transformation Workgroup
  • Joe Seidel, ACSP
  • Rup Kelly, NEM
  • Nick Bellomo, HAB
  • Jessica Bogdanoff, HAB
  • Allison Swisher, Ped
  • Suzanne Cook, AN
  • Ali Genthner, AN

 

  • Shannon McCarson, ACSP
  • Kerry Meabon, ASP
  • Paul Seugling, CMO
  • Diane Turner, CMO
  • Jen Vranick
  • Kelly Lawson, ICO
  • Louise Lindenmeier, GAO-NJ
  • Lee Dobson, GAO-NC
  
Private Duty Nursing (PDN) Clinical Policy Workgroup
  • Robin McCarson, Ped
  • Allison Swisher, Ped
  • Kathryn Hawley, Ped
  • Virginia Steelman, Ped
  • Rup Kelly, NEM
  • Suzanne Cook, AN
  • Ali Genthner, AN
  • Lee Dobson, GAO

 

 

 

Meeting a Constituent was a Treat for NC Representative John Fraley

Submitted by Lee Dobson, Area Director, NC Government Affairs (GAO)

On August 16, Representative John Fraley visited with staff from our Lake Norman adult office before heading to meet with his constituent, our client, Mr. Bachner.  Associate Lauren Keys, the Hearts for Home Care Ambassador who organized the home visits, commented “Rep. Fraley came prepared with good questions about home care and Medicaid reform.  While he doesn’t sit on a health committee, he wanted to learn about our issues.”  Clinical Manager Mary Hope Milligan and Client Services Manager Lucas Reives both described our recruiting challenges.

Mr. Bachner, a 90-year old WWII, Korean, and Vietnam vet, was a delight.  He shared many stories of his life, his children, and his service to our country.  It was especially heartwarming to hear how he met his wife, Cora, and after a week proposed marriage – a marriage that lasted 60-year.

Photo (left to right): Lauren Keys, Mr. Bachner, Rep. Fraley, and Tim Bachner

While Mr. Bachner is satisfied with his Veterans Administration (VA) benefits, we took this opportunity to share with Rep. Fraley the disparity between VA and Medicaid and how difficult it is to staff under Medicaid because the rates are so low.  As a retired businessman, Rep. Fraley understood and said, “Thank you for opportunity to meet with BAYADA staff and Mr. Bachner.  This was a good learning experience for me, as well as, a treat!“  As our meeting concluded, he commented that all he needed to remember was that we’re looking to get to $17.00 per hour next session.

Photo 2: Rep. Fraley with BAYADA staff

Medicaid Transformation Underway in North Carolina

Submitted by Lee Dobson, Area Director, NC Government Affairs (GAO)

 On August 8, Secretary Mandy Cohen released her Program Design for Medicaid Managed Care. This is the first step in transforming the state’s Medicaid system to address both the physical and behavioral health of North Carolinians.  The proposed program design seeks to implement changes that advances high-value care, improves population health, engages and supports providers, and establishes a sustainable program with predictable costs.  BAYADA has formed a review workgroup to draft a formal comment to the program design, due September 8, and later the waiver application.  The goal is to improve health by creating an innovative and well-coordinated Managed Care environment to address the whole-person.

 

Whirlwind Tour Through the Carolinas

Submitted by Lee Dobson, Area Director, NC Government Affairs (GAO)

Last week, Chief Government Affairs Officer Dave Totaro and I started our three-day trip across the Carolinas in Columbia with a productive meeting on rates with Bryan Kost, Chief Legislative Liaison SC Department of Health & Humans Services.  We are looking for support for a rate increase for next session.  Further, as a way to connect with staff on issues and share our advocacy message, we visited our offices in Columbia, Charleston, Southport, and Fayetteville.  These round table discussions help us better understand care delivery challenges and identify ways we can help.  Lastly, we were thrilled to have met Brock, an adorable 18 month-old boy, and his family near Charleston.  After 9 months in the hospital, he was ready to come home with the support of nursing.  Home visits remind us why we go to work every day and how important it is for each of us to advocate for quality home health care.

Government Affairs Office Provides Regulatory Support in North Carolina

Submitted by Lee Dobson, Area Director, NC Government Affairs (GAO)

 

While lawmakers are out of session, work continues on the regulatory front with two initiatives: Medicaid Reform and Licensure Rules Rewrites.  First, Secretary Mandy Cohen has been hosting stakeholder meetings and making the rounds with lawmakers garnering support for her Medicaid Reform Bill.  The Department is attempting to align physical health and behavioral health services by creating Special Needs Plans.  BAYADA has been invited to work with Medicaid and other stakeholders on this matter.  We will ensure level of services and provider adequacy remains central in the program design and waiver application.  Second, the Division of Health Service Regulations (DHSR) has published for public comment their proposed changes to the Home Care Licensure Rules.  The Government Affairs Office (GAO) has convened a review team of BAYADA experts to draft our formal comments, due August 15.

On the advocacy front, our Hearts for Home Care Ambassadors will commence their summer outreach efforts with lawmakers.

GAO Meets with NC Governor Roy Cooper

Submitted by Lee Dobson, Area Director, NC Government Affairs (GAO)

On July 10, Dave Totaro and I met with Governor Roy Cooper. We discussed state and federal issues related to health care delivery in NC. He recognized and applauded our recent federal call to action and indicated that type of outreach makes a difference. We also discussed Medicaid Reform, the LME/MCO system, CON, and Medicaid rates. It was a great conversation with a supporter of home care.

Reporting Success with Help from our Hearts for Home Care Advocates

Submitted by Lee Dobson, Area Director, NC Government Affairs (GAO)

With active engagement from our Ambassadors and other Hearts for Home Care advocates, together we accomplished the following legislative wins:

·         Obtained an Aide Rate Increase                                  
Lawmakers passed a rate increase for aides services in two (2) Medicaid program – Personal Care Services (PCS) and the Community Alternatives Program for Children (CAP-C) – taking the rate from $13.88 to $15.52, effective July 1, 2017, and to $15.60, effective January 1, 2018.  Due to a technical issue around budget neutrality, an increase was not passed for CAP for disabled adults (CAP-DA). However, we have the commitment of both the General Assembly as well as the Department to institute a fix in the 2018 session.     
Provision successfully passed the General Assembly
·         Protected Certificate of Need (CON) Once Again
There were as many as four bills introduced, but not passed, related to CON to either eliminate or modify CON law. As any change to remove or minimize CON law will negatively impact our existing Medicare offices, GAO will continue to work collaboratively with other health care settings behind-the-scenes to prevent the erosion of CON. Educating lawmakers on its implications is key.  
Provision successfully excluded
·         ID/DD Individuals to Access Services
A budget provision added some 400 slots to the Innovations Waiver program. Originally the provision included 250 slots. After lobbying, discussion, and debate that number was increased. While it won’t completely address the 900 individuals on the waiting list, these additional slots will help our HAB practice provide services to individuals in need.    
Provision successfully passed the General Assembly
·         Medicaid Reform Remains In Play
GAO was invited to a meeting with Secretary Mandy Cohen and Medicaid Director Dave Richard to discuss their plans to align mental health and physical health more quickly than 3 years after transition to managed care. In the development of this new waiver, they intend to include stakeholders as well as other protections. 
Bill is eligible to be taken up during a Special Session

NC Long Legislative Session Gaveled Out

Submitted by Lee Dobson, Area Director, NC Government Affairs (GAO)

Last week Speaker Tim Moore and President Pro Tempore Phil Berger ended the long legislative session after passing, along party lines, North Carolina’s 23 billion dollar budget. The budget contained a few provisions we asked for, but not everything. The budget was sent to Governor Roy Cooper for signature. As expected, the budget was vetoed and must be sent back to the General Assembly. Lawmakers plan to return in August where the Republican-majority has sufficient votes to override the veto. It is reported the General Assembly will reconvene for as many as three Special Sessions this year – on August 3rd to address any bills vetoed by Governor Cooper, and on September 6th and November 15th to address redistricting, as the US Supreme Court ruled that our current NC House and Senate maps unconstitutionally disenfranchised African American voters.

While members are back in their districts our Hearts for Home Care Ambassadors will be reaching out to schedule home visits and hosts legislative round table with their offices.   Watch for ways to get involved.