Both Delaware and Maryland have opened their 2018 legislative sessions and our advocacy work is in full swing. Delaware’s legislature will be open until June 30 in the second year of its two-year legislative session. The Maryland General Assembly is already nearly 20% over—as of today, there are 74 days left in the 90-day session.
Both sessions have been very busy already. Delaware and Maryland Hearts for Home Care Ambassadors and I have been working hard to reach legislators to educate and inform them about what home care means to our clients and families, and about what can be done to address the issues our industry faces every day.
BAYADA will again be supporting the Pennsylvania Homecare Association’s (PHA) Lobby Day in Harrisburg on May 22nd!
BAYADA office staff, field employees and clients will be joining industry colleagues to show state legislators just how large and impactful the home care industry is and, as in years past, we are committed to maintaining BAYADA’s historically large “sea of red” presence throughout the day.
Whether or not you’ve participated in a lobby day before, this is your chance to share your voice about issues that affect home care and let legislators know what can be done to alleviate some of the pressures that industry staff, clients families face daily. If you have any questions about what the day entails or how you can play a role, email email@example.com.
Thank you to all PA staff, clients and families for your commitment to advocacy and for your participation in lobby days past and future.
Save the Date–May 22 is PHA Lobby Day in Harrisburg!
Each year the PA Department of Aging and the Pennsylvania Homecare Association select one home health aide to be named Pennsylvania’s Direct Care Worker of the Year.
Last year BAYADA nominated 14 Home Health Aides (HHAs) and one of our nominees, Anne Pannone, was selected at PA’s Direct Care Worker of the Year. Since her selection, Anne was awarded a cash prize of $1,000 and has been invited to several statewide events to discuss the meaning of being a HHA and the value it provides to the state.
To help ease our service offices’ workloads, GAO is working with EMP to submit this year’s HHA nominations using information provided through our Hero program. To date, over 15 home health aides have been nominated to be this year’s Direct Care Worker of the Year.
All nominees will be invited to the 2018 Direct Care Worker Forum, which includes a luncheon and half-day training program on March 28. A stipend will be given to all HHAs attending the Forum.
Shortly after the new year the PA Department of Human Services (DHS) announced that the state will be moving forward with electronic visit verification (EVV) compliance by means of anopen system with a clearinghouse. BAYADA advocated on behalf of adoption of an open system and we are extremely pleased with DHS’s announcement. The open system encompasses the best of both worlds for providers within the state: An open system will enable providers that currently have an EVV system to use their system to “talk” to DHS’s clearinghouse. At the same time, it will also enable providers who do not currently use an EVV system to use the clearinghouse system as their provider.
Next, BAYADA plans to participate in a survey DHS will be releasing for the Department to better understand how home and community based providers are currently using EVV systems. DHS is also in the process of developing a request for information (RFI) to understand the features, challenges, and remedies in implementing the EVV clearinghouse. If applicable, BAYADA plans to participate in the RFI as well.
2017 proved to be another eventful year for home care in Pennsylvania. Notably, MCO implementation of the increased pediatric rate went into effect on January 1, 2017. As a result, our pediatric offices have been able to implement various programs for our nurses including increased wages, benefits, and bonuses throughout the year.
Early in 2017 the PA Government Affairs Office (GAO) worked with NJ GAO Director Louise Lindenmeier to lobby against New Jersey Governor Christie’s intent to end the NJ/PA tax reciprocity agreement. We were successful in getting the over 40-year agreement reinstated, thus saving BAYADA employees over $6 million in taxes.
Throughout the year we were active participants in PA’s move towards full implementation of Community Health Choices (CHC). Our participation, as well as that of others in the industry, resulted in a temporaryrate floor for personal assistance services. The rate floor ensures that implementation of CHC will not result in rate cuts for services within the program.
In May we submitted comments in favor of an “open” electronic visit verification (EVV) system, which would be more beneficial to our employees and to BAYADA than a closed system. The administration heard our concerns and is now planning to implement an open system. See our next article to learn more about PA’s EVV system.
Finally, PA took unprecedented steps by introducing legislation which would allow deemed eligibility for home care. This legislation takes a big step toward equalizing access to home and community based services as it would allow those who appear to financially qualify for nursing home services to be deemed eligible for home care services as well. After the legislation was introduced it was voted unanimously out of the House Public Health and Appropriations Committees and was voted out of the full House unanimously. Next up in the long and winding legislative process: The bill will now be considered in the Senate.
Towards the end of 2017 the PA GAO conducted a needs assessment with our PA division directors. Upon completion of the needs assessment our PA GAO Advisory Council met and recommended the following priorities for 2018:
Increase the personal assistance service rate by an average of 10%, creating a statewide reimbursement rate of $20.58 by 6/30/18.
Pass deemed eligibility for home care through legislation by 4Q18 (continuation of 2017 goal).
Allow physician signatures to be obtained within 30 days instead of 7 days.
Include requisite reimbursement increases in any state minimum wage increase.
Pass drug disposal legislation for Hospice.
Support the passage of Pennsylvania Orders for Life-Sustaining Treatment (POLST) legislation.
Lay the foundation for rate floor legislation in Pennsylvania.
Our PA legislative priorities have been approved by BAYADA’s Chief Executive Officer. We are looking forward to an exciting and challenging year ahead! Thank you to all PA staff, clients and families for your support and commitment to advocacy. Your efforts are paramount to our efforts to ensure that all Pennsylvanians can live a safe home life with comfort, independence, and dignity.
As I reflect on 2017 and what we have accomplished, the first thing that comes to mind is Thank You.Thank you for your support, your engagement and your advocacy efforts — all of which made a difference in the lives of our clients, families and employees.
2017 was the “Year of Client Advocacy and Engagement.” Clients and families engaged lawmakers and the community at-large through home visits, family support group meetings, and phone calls and meetings with lawmakers in Trenton. These efforts ensured that our aides, nurses, and the importance of home care remained top of mind to New Jersey representatives and senators.
2017 was successful in many ways and set us up for even bigger wins in 2018. Below, please find a summary of 2017’s priorities and accomplishments:
• The Managed Medicaid Rate Floor bill was signed into law, effective July 1, 2018. The new law mandates a 100% pass-through of increased reimbursement to aides. In 2018 we will introduce a new bill which will be more reflective of a competitive wage environment and will mirror the original bill with no mandated pass-through.
• The Personal Care Assistant (PCA) fee-for-service rate was raised from $18.00 per hour to $19.00 per hour through a budget resolution, effective July 1, 2017.
• We successfully lobbied against Governor Christie’s intent to end the NJ/PA Reciprocity Tax agreement. This accomplishment saved our employees and BAYADA thousands of dollars in taxes.
• In July, the Private Duty Nursing (PDN) bill was introduced. This bill’s aim is to raise the PDN reimbursement rate by $10 per hour for RNs and LPNs. While the bill did not ultimately pass the state legislature in 2017, it brought awareness to the need for higher reimbursement rates within the program. We will continue to pursue this bill’s passage as a major goal for 2018.
• In conjunction with NJ’s Home Care Association, we successfully lobbied for legislation that permits physical therapy aides to practice in clients’ homes as long as the aides are supervised by a licensed physical therapist every two weeks.
• The BAYADA Champion Awards were held in December. This year we honored Lieutenant Governor-elect Sheila Oliver, Assemblywoman Nancy Munoz, Assemblyman Paul Moriarty and Senator-elect Declan O’Scanlon for their unwavering support of home care.
• BAYADA hosted a fundraiser for Senator-elect Troy Singleton, raising over $13,000 for his election fund.
• BAYADA reviewed and submitted comments to the state regarding the new 10:60 home care regulations.
Looking ahead to 2018, we will be working with Governor-elect Murphy and NJ legislators new and old to continue to advance home care and community-based services for our state’s neediest populations. GAO seeks to push for new laws to improve reimbursement rates within the PDN program, introduce legislation to provide technical changes to the current PCA managed care law, pursue minimum wage law changes, address parking challenges for our nurses and, of course, continue to advocate on behalf of our employees, clients and their families.
Legislative successes, like the NC Medicaid rate increase for nursing in 2015 and 2016 and the home health aide increase this past year, don’t magically happen. Legislative successes start with an identified need — low Medicaid rates made it impossible to pay people what they are worth — and end with legislators supporting jobs in the community and keeping families together by investing in home health care. Every step along the way our Hearts for Home Care Advocates carried our unified message to decision-makers. Our cumulative actions over the years, including home and district visits, legislative round tables with lawmakers, responding to calls to action, attending lobby days, etc., made all the difference. Individually and collectively our shared voices got results. Join us to be a Heart for Home Care Advocate.
Last month the North Carolina Department of Health and Human Services (DHHS) submitted an amendment to the 1115 demonstration waiver application, originally submitted in June 2016. This amendment is the next step in the transformation of NC Medicaid and NC Health Choice programs to managed care, driving the state’s goal to implement reform. This system will 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. Our BAYADA workgroup, made up of technical experts and leadership from across the organization, has reviewed and provided formal comments to both the program design and waiver application. Our comments focus on: ensuring beneficiary access to care; the viability of the provider network; minimizing administrative burden, and establishing meaningful metrics that support and reward quality.
Special thanks to our review BAYADA teams for sharing their insight and operational experience.
Last month I attended an event honoring StateRepresentative Dean Arp (R-Union). Rep. Arp serves as Chairman of the House Appropriations Committee, the committee responsible for crafting North Carolina’s state budget. Chairman Arp will be critical in allocating sufficient funds to the Medicaid budget for the increases we are seeking this legislative session. During the event we discussed the importance of getting the rates up prior to Medicaid’s transition to managed care, which is targeted for July 2019. In addition to supporting our issues in the past, Rep. Arp has been on a home visit and understands the importance of home care in the continuum.
With Sen. Tucker’s recent retirement announcement, it is critical we have allies in the Senate to help carry our message as well. Senator Joyce Krawiec is next in line. To educate her on our issues, we are in the process of identifying a client in her district to host a home visit early in 2018.
Last month the GAO Advisory Committee met to evaluate our 2017 efforts and to plan for 2018. The Advisory Committee is made up of representation of every practice in NC as well as representation from CMO and GAO. Below is a summary of their findings and the priorities for 2018.
2017 Legislative Accomplishments With your help we accomplished the following:
• Secured an increase for Medicaid aide services under the Personal Care Services (PCS) Program and the Community Alternatives Program for Children (CAP-C) from $13.88 to $15.52, effective August 1, 2017, and to $15.60 effective January 1, 2018. BAYADA impact: $300K annually. These increases will allow us to hire and retain more quality staff. • Protected Certificate of Need (CON) and prevented its elimination from health care. Also prevented the Continuing Care Retirement Communities (CCRCs) from operating a home health agency without a CON. The CCRCs were seeking a carve-out from CON statute. Four separate bills were filed to eliminate this statute. BAYADA impact: Protected 5 service offices that serve Medicare clients. This issue is likely to re-surface in 2018. • Secured a 7.5% tax exclusion for health care services on all revenue. BAYADA impact: All 54 NC service offices will save a collective $12.6M annually.
2018 Key Legislative Priorities:
• Amend the Community Alternatives Program for Disabled Adults (CAP-DA) budget neutrality language to allow the aide rate to be increased from $13.88 to $15.60 to align with the PCS and CAP-C rate increases effective Oct. 1, 2018, by Q4-2018. • Secure a $1.40 increase for all Medicaid aide services from $15.60 to $17.00 effective Jan. 1, 2019, by Q3-2018. • Prevent the elimination of Certificate of Need (CON) for home health or hospice by Q3-2018. • Ensure that the Medicaid Transformation waiver includes a rate floor provision and language that ensures access to quality care and minimal administrative burden by Q4-2018.