Client Spotlight: BAYADA NJ Client Jim Davies Turns Home Visit into an Opportunity to Fight for Nursing Coverage

BAYADA client Jim Davies (center, seated) hosted a home visit with Assemblyman Benson (upper left)

When BAYADA Home Health Care client Jim Davies received a notice in the mail last year that his insurance would be transitioning to another agency, he tried not to panic. After all, the letter stated there would be no change, he would still receive coverage for his home health care nursing and personal care home health aide services.

However, Jim was not convinced. The 66-year-old, who suffered a spinal cord injury as a result of a diving accident 20 years ago, is nearly paralyzed from the neck down. He relies on his nurses for his complex medical needs, which include wound care, range of motion exercises, mechanical transfers to and from bed, medication administration, catheter care, and care to prevent a serious complication called autonomic dysreflexia, which can lead to seizures, stroke, or even death.   

As a former sheriff and local fire commissioner, Jim is used to working collaboratively with others to make things happen. That’s why he immediately called a case manager at the insurance company, who reiterated what was explained in the letter, his home health care coverage would not change.

Coverage denied

Fast forward to the end of the year when Jim received another letter, this time from the new insurance company. Despite written and verbal assurance that his coverage would not change, the new company denied his home health care services, insisting Jim was stable enough and no longer needed nursing care.

Jim reached out to his BAYADA Mercer County Adults (MCA) office Director Meghan Hansen and Clinical Manager Sharon Wheelock who appealed the decision on his behalf, to no avail. That’s when they turned to BAYADA Government Affairs Area Director Louise Lindenmeier, who suggested Jim reach out to New Jersey Assemblyman Daniel Benson, a member of the state Health and Senior Services Committee.

Legislative home visit leads to positive change

“When I called Assemblyman Benson’s office, I wasn’t sure what the response was going to be, but I was pleasantly surprised,” says Jim. “The assemblyman made me feel that as his constituent, my problem was a major concern, and he owned it.”

Assemblyman Benson visited Jim and his wife of 40 years Rosemary at their home to witness, first-hand, the critical role home care nurses play in Jim’s health and well-being. During the visit, Assemblyman Benson also learned about the catastrophic medical consequences of stopping Jim’s nursing care and BAYADA’s unsuccessful efforts to appeal the denial from the insurance company.

Following the visit with Jim, Assemblyman Benson jumped into action. He joined BAYADA Managed Care (MCO) Director Pamela Soni, BAYADA Area Director for Pediatrics Managed Care (MCP) Stephanie Perna, and Louise for a meeting with the NJ Department of Banking and Insurance to discuss Jim’s case. In addition, he personally contacted the insurance company to negotiate the contract, resulting in a reversal of the denial. Thanks to his efforts, the issue was resolved within two weeks.

“It is really important to educate politicians on how insurance changes can impact their constituents,” says Jim, who encourages others in similar situations to reach out to legislators who may be more than willing to help. “Assemblyman Benson should be recognized for his prompt and professional response to my needs.”

Assemblyman Benson considered it a privilege to play a role in helping Jim. “It was my honor to work with Mr. Davies to ensure that he received the care he needs and deserves,” he says. “As legislators, it is our sworn duty to represent our constituents, and that means lending our assistance whenever possible, whether by simply cutting through red tape or elevating a situation to a higher level so that it is promptly addressed. I would encourage those in need to reach out to their elected representatives to learn what they can do for them.”

Want to Help Make a Difference: Register for Hearts for Home Care

Whether you can give a minute, an hour, or a day, there are many ways to get involved in advocacy. It can be as simple as sending a pre-written email to your local legislators, hosting a legislator in your home, or attending an event at a legislator’s office or your state capitol.To learn more, consider becoming a “Heart for Home Care” advocate. It only takes five minutes to register at heartsforhomecare.com. You’ll receive email updates about current issues and opportunities to make your voice heart.

GAO PA: 2% Increase to Pennsylvania’s ACSP Practice to Help Vulnerable Residents Access Care

HHAs Antwain and Markeeta Lewis were featured in the Pittsburgh Post Gazette to bring public and legislative awareness to low PA PAS rates

Throughout 2019 GAO, Pennsylvania office & field employees, clients, and industry partners banded together to secure a 2% increase for Personal Assistant Services (PAS) under Pennsylvania’s Office of Long-Term Living (OLTL), effective as of January 1, 2020.  This increase will result in an additional $700,000 in annualized revenue, as well as an additional $625,000 in operating surplus and will predominantly affect our Assistive Care State Programs (ACSP) offices.

In addition to increased revenue for Pennsylvania’s ACSP offices, this rate hike will also benefit the state’s most medically fragile and vulnerable adults and seniors. GAO anticipates that service offices will be able to recruit and retain more home health aides and fill more shifts that are currently going uncovered. 

In addition to traditional lobbying and advocacy efforts, GAO and state ACSP service offices worked together on an aggressive public affairs campaign that resulted in several articles regarding BAYADA clients’ struggles with accessing care, and opinion pieces authored by Clinical Managers (CMs). This campaign further added pressure to the state legislature to begin to solve the access to care issue. In 2020, GAO is seeking to increase the PAS rate even more—an additional 8% to reach a 10% total increase over 2018’s reimbursement rate for PAS services.

GAO Makes Progress on Rate Increase During Meeting with Senator Scott Wagner

Submitted by Laura Ness, Director, PA Government Affairs (GAO)

On April 6th BAYADA Leaders, including Practice President David Baiada, Chief Government Affairs Officer Dave Totaro, Assistive Care State Programs (ACSP) Practice Leader Eric Thul, Crocus Division Director Kevin Kuzmick, PCA Director Donna Russell-Kane, and I  met with Senator and Gubernatorial Candidate Scott Wagner.  This meeting was a result of a previous meeting that Dave Totaro and I had with Senator Wagner introducing the need to increase the personal assistant services (PAS) rate under the Office of Long-Term Living (OLTL) by an average of 10%.

The meeting took place in the BAYADA PCA office. We discussed the ACSP business, its challenges and advantages, as well as the wage issues associated with the program.  Senator Wagner also heard first-hand about what it’s like to be a home health aide from PA Department of Aging’s Direct Care Worker of the Year, BAYADA aide Anne Pannone. 

The conversation was productive, and Senator Wagner understands the value of home care and the cost savings it can provide to the Commonwealth. He has agreed to help us in our legislative priority of increasing the PAS rates and would also like to spend a day in the field with Anne to see the work first-hand.

We look forward to continuing to work with Senator Wagner.

Home Visits Outreach

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

This quarter, our Hearts for Home Care Ambassadors have completed two home visits with assistive care state program clients. In both instances, members were able to visit with a constituent who relies on aide services under Medicaid and heard directly from families on the value our certified nursing assistants (CNAs) play in keeping their family together. Keep up the great work.

• MON Client Services Manager (CSM) Rachel Cauble hosted Representative Dean Arp

• CPC CSM Shayla Jemmott and Deborah Batts hosted Representative Andy Dulin

CRO Division Uniting With Philadelphia Families In Advocacy

Submitted by Rick Hynick, Director, Client and Family Advocacy

Director of Government Affairs in Pennsylvania Laura Ness and I met with Division Director Kevin Kuzmick and several of the service office directors from the CRO division at the Government Affairs Office (GAO) this past Wednesday.  The meeting focused on the development of advocacy efforts for the clients and families who receive assistive care services from the Office of Long Term Living waiver in the Philadelphia area service offices.  An exciting outcome from the meeting was the idea of having a “family day” in the Philadelphia area where our families and staff can advocate for a better tomorrow.