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.     

NC Clients Make Their Voices Heard

To achieve our legislative priorities, we utilize a variety of tactics to ensure our legislators are educated about the obstacles our clients’ and employees’ face and the urgency of increasing funding for home care. We are grateful to our many Hearts for Home Care Ambassadors, and office employees who have participated in these important advocacy efforts; whether you’ve met with your legislator at a Legislative Day, helped organize a home visit or legislative round table, or taken the time to respond to one of our several action alerts this session, your continued advocacy is vital to achieving our goals.

Further, many of our clients have gone above and beyond in making advocacy a priority and have articulated the obstacles, challenges, and hardships they and their families must confront due to chronically low reimbursement. We have shared these powerful stories directly with legislators to educate them on the value of home care. It is important they recognized the need for adequately funding the Medicaid, including the Private Duty Nursing (PDN) and Personal Care Services (PCS) programs, and the various Community Alternative and Innovation Waivers.  Introducing lawmakers to their constituents who are most directly affected by the decisions they make is an excellent way to share their stories and make an impact.

See below to meet several of our client advocates! If you are interested in becoming more involved in advocacy, or have a client who is interested in sharing their story, please contact advocacy@bayada.com.

NC Client Spotlight: Meet six BAYADA clients that have engaged in advocacy this quarter!

North Carolina Legislative Day 2019 Photo Gallery

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.

Client Spotlight: Read About our NJ Clients and their Beloved Caregivers

ACSP Clients Jessie and Marie, and the impact their caregivers Indira and Marie make in their lives

HHA Indira (right) has made monumental changes in Jessie’s life

GAO and many other advocates are fighting for increased funding for New Jersey’s Personal Care Assistant (PCA) program. This program enables thousands of vulnerable New Jersey residents stay at home, and we are hoping that our advocacy efforts lead to fairer wages for caregivers like Indira and Michele.

Indira & Jessie

Indira is at Jessie’s home every morning at 5:00 without fail. After taking on Jessie’s case and learning that she spent most of her time in bed, it became Indira’s mission to consistently challenge her to get out of bed and get active. Now, every morning before dawn, Jessie starts her morning with a smile, anxiously waiting for Indira to arrive.

While helping Jessie, who is 31 and diagnosed with cerebral palsy, with her activities of daily living, Indira also incorporates games, crafts, dancing, and singing. After a few short months with her beloved caregiver, Jessie now has a newfound confidence in her physical abilities and communication and language skills. Indira has quickly ingrained herself as part of Jessie’s family, whose loved ones call Indira “a Godsend.”

Marie & Michele

CHHA Michele (left) is “like a daughter” to her beloved client, Marie

CHHA Michele has been with her client Marie since January of 2017, but you would think they have known each other forever. They share a special bond, and Marie even says that Michele is “like a daughter” to her. Marie lives alone, and if not for Michele’s visits, would be lonely and potential in danger. In addition to the personal care services that Michele provides to keep Marie safe and healthy, you see their bond shine when Michele frequently makes puzzles and quizzes to stimulate Marie’s mind—or as they like to call it, “using our noodles.”

Marie says that without Michele, she would not be fully able to take care of herself. But As soon as Marie arrives at Marie’s door, the time flies as Marie keeps her on her toes—both figuratively and literally. In addition to regularly stimulating Marie’s mind, Michele makes sure that Marie is safe and on balance as she moves around her apartment.

We need your help in supporting dedicated caregivers like Indira and Marie through advocacy. To find out ways you can get involved, email advocacy@bayada.com today.

“Parents deserve to be parents, not skilled nurses, and more importantly, children deserve to be children—not patients.” Two moms share how PDN impacts their families’ lives

This year, our major focus in New Jersey is to fight for higher reimbursement rates for New Jersey’s Private Duty Nursing (PDN) program. One of the most impactful ways to influence legislators is to engage clients and families into advocacy through testimony, which is delivered by these clients to legislators who are in key positions to influence legislators. Below, find powerful excerpts from two moms who support a PDN increase on behalf of their children and their families.

Dana I. – Mother to BAYADA Client, Abi

PDN services help Abi stay safe and healthy, and helps her whole family stay together at home

“There is truly no way to explain on how much caring for a medically fragile child impacts a family. Every errand, every event, every move of your day becomes centered around their care. Abi has been authorized for skilled nursing care by our insurance company, yet she still has five or more unfilled shifts every week.

Lapses in nursing coverage put tremendous pressure on our entire family—we often have to miss work and stay home to provide for her care, putting strain on the family finances. Lost nursing hours also means the entire focus of our time becomes all about our medically-fragile child, and the balance between the other children becomes strained and we often miss beloved activities or events.

Abi is not a child that we can just hire a babysitter for. Her high level of care and constant need for monitoring makes it impossible to have any sense of normalcy without capable & consistent nursing support. There are simply not enough nurses in home care to cover all of the needs of my family and the needs of many, many others.

Institutionalized care is not the answer. My precious daughter brings many challenges to our home, but it would be heartbreaking to have to put her in an institution for lack of nursing support. So here I am prayerfully putting a name and a face to those of you who have the power to make a real difference in this area. Competitive wages would bring stability to her home care nursing and allow our family and families like us to stay together and thrive.” -Dana Insley, Abi’s mom   

Emma K. – Mother to BAYADA client, Lili

Client Lili (left) loves her compassionate and reliable nurse Barbara

“While I count my blessings that we have the right nursing team in place, I often think of the families across the state that can’t fill their nursing shifts. It takes me back to the last time our scheduled nurse had a family emergency and there was no other nurse available to cover her shift. As a single mother of a medically-complex, ambulatory child with no family in the area, you can imagine how it plays out when there isn’t a nurse available for Lili: I have to call out of work myself and cancel any commitments I’ve made for the day. I can’t get the groceries that I was planning to pick up or even do a load of laundry since I can’t leave Lili alone for even a minute. And I have to again plan to do these things during the times I’m expecting to have a nurse to stay with Lili because I can’t get them done otherwise.

We as a society have developed a system of reliability for our communities: Teachers help children learn, police keep our streets safe, ER doctors save lives, and pharmacists fill our prescriptions. But we are failing in keeping home nursing readily available. Just as a prescription, Lili’s care is prescribed by her doctor and authorized by the state. But we cannot rely on its availability. I hope that our state decision makers prioritize home care, if solely for the fact that it keeps children like Liliana at home and keeps families together. Parents deserve to be parents, not skilled nurses, and more importantly, children deserve to be children—not patients.” -Emma K., Liliana’s mom

Dana and Emma exemplify the power of sharing your story. If you’d like to highlight the powerful story of your experience in a home care office, or the story of a client, their loved one, or a caregiver, contact advocacy@bayada.com.

New Jersey’s Legislative Goals and How You Can Help Make an Impact

BAYADA’s Government Affairs Office (GAO) is proud to join with fellow advocates like you to continue to advocate for better wages for our caregivers and increased access to home health care for the tens of thousands of New Jersey residents that rely on this care to stay safe and independent at home. Thank you to our many employees, clients, and families who have advocated on behalf of yourselves, your loved ones, your staff, and your clients regarding our two major 2019 issues:

1. Personal Care Assistant (PCA) Program – Increased Reimbursements for Increased HHA Wages

GAO is advocating for HHAs like Indira (right) and clients like Jessie

GAO is working in collaboration with other providers and the New Jersey Home Care and Hospice Association to educate our legislators on the importance of adequate funding for the Personal Care Assistant (PCA) program.This is especially important as the State recently mandated an increased minimum wage. BAYADA supports a wage increase for all of our home health aides (HHAs) for the incredible, lifechanging work they do—but additional advocacy is necessary so state legislators understand the importance of proportional PCA program funding so that providers like BAYADA can comply with the new mandate and stay sustainable.

Click here to check out how HHA Indira helps her client Jessie stay at home, and about CHHA Michele’s special bond with her client Marie. We are hopeful that our advocacy efforts can lead to a fairer wage for aides like Indira and Michele, as well as better recruitment and retention rates across the ACSP practice so that all New Jersey residents who need this important service can access it. To find out how you can get involved, email advocacy@bayada.com today.

2. Private Duty Nursing (PDN) Program—Increased Reimbursements for Increased Nursing Wages

Increased PDN rates are important to ensure clients like Lili (left) can continue to have reliable nurses like Barbara (right)

GAO is working with the New Jersey Home Care and Hospice Association to educate our legislators on the importance of adequate funding for the Private Duty Nursing (PDN) program. Current PDN program funding makes it difficult for providers like BAYADA to recruit and retain the nurses necessary to care for New Jersey’s most medically complex and residents. This difficulty results in significant access to care issues, as only 85% of scheduled hours are currently filled, and vulnerable New Jersians are going without the care they need to stay safe and healthy at home.

We are lucky to have home care supporters in the legislature who understand the struggles our caregivers and skilled nursing clients face—Recently, Bill S1733/A4575, which proposes a $10 per hour increase for RN and LPN home care services, was introduced. In addition to the increase, this bill also seeks to establish a “rate floor” so that managed Medicaid providers reimburse no less than the state fee-for-service rate for in-home skilled nursing services.

But we need your help in getting this bill to the finish line. Soon, this bill will be up for a hearing, and clients’ and employees’ testimony make the most impact in showing legislators the challenges that arise from inadequate funding and the associated access-to-care issues.

Click here to read excerpts from two clients’ testimonies regarding the importance of PDN in their lives. Powerful stories like the ones Dana and Emma share help our advocacy efforts and show legislators the impact of home care in making a real difference in vulnerable New Jersey residents’ lives. To find out how you can get involved, email advocacy@bayada.com today.