Delaware Sets Grassroots Advocacy Records in 2019!

More than 50 home care employees, clients, and family members attended the DE Association for Home and Community Care Legislative Day!

Delaware Ambassadors and employees have set participation records at two key annual advocacy events this year—The Delaware Association for Home and Community Care (DAHCC) Legislative Day and our annual testimony in front of Delaware’s Joint Finance Committee (JFC).

The first, the Delaware Association for Home and Community Care (DAHCC) Legislative Day on March 13, had a record attendance of more than 50 attendees! 41 registered for the event, which would have been a record itself, but the larger-than-expected turnout was an impressive surprise. Seven providers, including BAYADA, were represented, and the crowd included six families advocating for themselves and their nurses. Everyone wore their own company’s branded gear but united behind Hearts for Home Care buttons that proclaimed, “Home Health Care Matters to Me.” Legislators heard our message was heard loud and clear.

BAYADA employees made their voices heard in front of the DE Joint Finance Committee

In another first for Delaware, two legislators spoke in support of a large rate increase for Delaware’s home care RNs and LPNs at the DAHCC Day Press Conference. To make it even better, the two were none other than the Senate Majority Leader, Senator Nicole Poore, and the House Majority Leader, Representative Valerie Longhurst. Both spoke passionately about the importance of home care in our communities and the need to increase reimbursement to ensure that this vital care is available to those who rely on it.  They were joined in speaking by the Executive Director of DAHCC, Jean Mullin, and BAYADA client Haley Shiber.

A week later, on March 20, Delaware advocates broke another record when 15 members of our community testified before the powerful Joint Finance Committee (JFC) in support of increasing Medicaid home care reimbursement rates. Led by Jean Mullin, participants included Torie Carter, Jenny Scott, Mandy Brady, Judeth Smith, Ali Knott, Danielle Myers, Shannon Gahs, Dave Totaroand representatives from Epic/Aveanna and Maxim/Aveanna.  Client Haley Shiber was unable to attend in person but sent a powerful testimony video to the JFC members before the hearing. The Joint Finance Committee hears budget requests from all state agencies and testimony from the public before making an annual budget recommendation to the full General Assembly. The General Assembly frequently follows the majority of those recommendations. Members of the committee told BAYADA in the days following the hearing that they had never before seen such a large contingent testifying on a single issue!

The industry-wide coalition led by BAYADA and DAHCC is pushing the Delaware legislature for a 21% increase in the Medicaid home care RN and LPN rates, which would impact our Skilled Nursing practices—Pediatrics and Adult Nursing. Because of the home care Rate Floor passed two years ago mandating that Medicaid MCOs pay no less than Medicaid fee-for-service, these new higher rates would have to be paid not only for “straight Medicaid” hours but also those funded by managed care in Delaware. These two rates currently remain at their 2006 levels, harming our ability to recruit and retain the highly-skilled RNs and LPNs that are so important to the lives and welfare of our clients.

Thank you to our advocates who turned out and made sure that Delaware’s decision makers know that we are here to advocate on behalf of our staff and clients, and that home care makes a difference in the lives of so many Delawareans!

Maryland Receives Major Medicaid Rate Increase- 30% Over the Next Six Years!

Great things happen when we advocate together! After years of advocacy from BAYADA, our partners, and many parents and home care employees, the Maryland General Assembly recently passed two pieces of legislation that collectively will increase all Medicaid home and community-based services reimbursement rates by more than 30% over the next six years. Though initially met with opposition from Governor Larry Hogan, the Maryland General Assembly heard our voices and overwhelmingly voted to override his veto of one of the bills.

The first bill, the state’s annual budget, provides a rate increase of 3% that will go into effect July 1, 2019. The second bill, also effective July 1, 2019, contains an amendment which will increase reimbursement rates by 4% each year between July 1, 2020 and July 1, 2025.

Currently, Marylanders who rely on in-home nursing care have only 83% of their authorized hours filled, meaning that families struggle to fill their medically complex loved ones’ skilled home nursing care nearly 20% of the time! We have found that Medicaid rates have stagnated below the cost of living and below wages seen in other settings—such as hospitals and facilities—and surrounding states—and that families were struggling to fill these hours. We are hopeful that these access-to-care issues will be alleviated as providers will be able to recruit and retain nurses within the home care industry, and that more of Maryland’s most medically complex will be able to stay safe where they want to be—in their own homes.

This was a true team effort led by BAYADA and the Maryland National-Capital Area Home Care Association (MNCHA) and including MNCHA member providers, several individual families, parent advocacy organizations and disease-specific advocacy organizations. Special thanks to JoAnn Saxby, Patrick O’Malley, Eddie Dyer, Patty Watson, and Susan Ingalls who all played important parts in making this happen and to BAYADA Delaware employees Mandy Brady, Kristyn Kelsch, and Taylor Kosinski who went above and beyond to advocate in their sister state. Mike Sokoloski, Tara Montague, and Nicole Onofrio were instrumental in supporting two Town Halls and Legislative Day, and Alisa Fox coordinated timely articles in The Baltimore Sun, The Washington Post, and on WDVM TV in Western Maryland. Maggie Tracy managed countless logistical hurdles and supported direct lobbying and grassroots efforts.

Thank you to everyone who played a role in this major achievement! Advocacy cannot succeed if only one voice is heard, and your advocacy has contributed to the well-being of so many Marylanders in need of home care.

For more information on this increase, or how you can get involved in advocacy in Maryland, please contact Shannon Gahs at sgahs@bayada.com.

Legislation Close to our Hearts: NJ Mobility Bill Named after Hearts for Home Care Advocate’s Daughter, Mary!

Mom Tara Montague (left) and daughter Mary (center) during a home visit with Asw. Carol Murphy. Asw. Murphy recently introduced “Mary’s Law.”

Home care supporter and New Jersey Assemblywoman Carol Murphy recently introduced a bill which will address unequal access to the purchase of modified vans through the Catastrophic illness in Children Relief Fund.

Assemblywoman Murphy was alerted to the issue after Hearts for Home Care manager and advocate Tara Montague told her about the issue, and how it has impacted her daughter, Mary, and many of New Jersey’s medically fragile children. Mary and Tara have utilized the fund, and have been important advocates in ensuring the fund is both adequately funded and accessible for the many New Jersey residents that need it.

Currently, families can apply to the Catastrophic Fund to purchase a modified van so that they can safely transport their medically fragile child. However, current regulations require that families pay for the van upfront and wait to be reimbursed by the Fund. This stipulation presents a sincere barrier to transportation for families that cannot afford to front tens of thousands of dollars while they wait to be reimbursed.

Mary’s Law addresses this issue by requiring the Catastrophic Fund to provide direct payments for the purchases of specialized, modified motor vehicles. In addition, this legislation will increase the annual surcharge for New Jersey employers from $1.50 to $3.00 per employee to insure the Catastrophic Fund is adequately funded to meet the its purpose and demands.

“Medically fragile children like Mary deserve to travel safely and freely. This legislation ensures that children and their families receive the help they need regardless of their financial situations. Ever since Mary was born, I’ve been a staunch advocate for her needs and for better laws and policies, but I never thought advocacy could hit so close to home–Mary and our family are ecstatic that we can bring about change for all New Jersey’s children and families that need it,” said Tara.

Thank you to Tara and Mary for continuing to be effective advocates on access to transportation. Hearts for Home Care will continue to provide updates as the legislation progresses through New Jersey committees and chambers. If you have questions about this legislation or how to get more involved in advocacy on behalf of yourself, a loved one, or your staff and clients, please contact advocacy@bayada.com today.

Top Participating Divisions with Recent Federal Action Alerts

BAYADA’s Government Affairs Office (GAO) offers employees and clients many ways to get involved in advocacy through our Hearts for Home Care program. One of the very easiest ways to get involved with advocacy right from your cell phone or desk is by taking action on an Action Alert. Generally, GAO will send out an action alert email to all employees, or employees in a certain state, when a piece of legislation requires support or opposition from our elected officials. Action alerts take two minutes to complete and most of the work is done for you—All you need to do is click a couple of buttons in order to send a pre-written email to your legislators to encourage their action!

During the previous quarter, GAO sent out two federal action alerts to all BAYADA office staff. The first alert was sent on February 14 and requested that employees take action to urge their officials to support a bill to counteract certain sections of the Patient Driven Groupings Model (PDGM) that would be harmful to our Home Health staff and clients. The second alert was sent on February 27, and asked that employees urge their federal legislators to support action to revise an outdated Medicare requirement to allow non-physician practitioners (NPPs), such as nurse practitioners and physician assistants, to certify a patient’s eligibility for coverage of home health services. You can still take action on this alert here.

See the results of both action alerts below. Congratulations to the Firewheel and Flame Lily divisions, which had the most participation in these two alerts! We are proud of your commitment to advocacy and your dedication to speaking to our many clients that do not have the voice to speak for themselves!

Thank you to the many employees that took action and encouraged their peers to do so as well. As you can see from the below charts, both alerts—which both impact our Home Health employees and clients the most—continue to see relatively low participation. It’s important that we share our voices wherever possible, and particularly for Action Alerts that are easy to complete. We are hoping that all BAYADA employees recommit to advocacy. During the next federal action alert we hope to see 50% or more office staff participation.

25 BAYADA Advocates Gather for Inspiring and Record-Breaking Legislative Day in Columbia, SC

Top left & bottom right: 25 BAYADA employees and clients joined the South Carolina Home Care and Hospice Association’s second annual Legislative Advocacy Day
Top right: Stephanie Black, Vickie Nelson, Dave Totaro, and Melissa Allman meet with Senator Thomas Nelson (center)
Bottom left: BAYADA Rock Hill (ROC) office employees pose in front of the SC capitol. Left to right: Nurse Michelle Ghent, Director Jenni Cairns, and nurse Cathy Medeiros (2017 LPN National Hero)

On March 6, 24 energetic BAYADA employees and one BAYADA Assistive Care State Programs (ACSP) client gathered in South Carolina’s state capitol for a day of meaningful and heartfelt advocacy. The South Carolina Home Care and Hospice Association (SCHCHA) hosted its second annual Legislative Advocacy Day, and this year, a record-breaking total of nearly 60 advocates attended!

BAYADA’s advocates joined other attendees and walked the halls with a clear message: Investing in our Nursing Medicaid Waiver programs will save the state money and keep our medically fragile children, disabled adults, and seniors home with their loved ones and out of higher cost facilities.  We care about home care, and so should you!

With their passionate message in hand, advocates spoke with over 50 legislators about the importance of home care. This year we were able to speak to all key lawmakers in both the House and Senate to ensure our message was heard by as many ears–and the right ears–as possible.

“Advocacy can’t be effective with only one person working towards a goal–one voice can only go so far! That’s why I am so proud to work in South Carolina, where so many of our office employees, field employees, and clients recognize the importance of sharing their voices too. The more impassioned people we have involved, the more of a difference we can make on behalf of all South Carolinians that rely on home care,” said GAO director Melissa Allman.

BAYADA employees were excited and inspired by the impact they made that day. Thank you to the many participants for the difference you make on behalf of all South Carolinians that rely on home care to stay independent in their communities!

GAO Jetsetters: Making the Rounds in Washington, D.C., Arizona, and Colorado

Left: GAO Ambassadors Anthony D’Alonzo and David Mead, and GAO Grassroots Senior Manager Mike Sokoloski in front of the US Capitol
Right Top: Senator Tom Carper (D-DE) poses with GAO Senior Associate Lindsey Wright and Chief Government Affairs Officer Dave Totaro
Right Bottom: Advocates, including GAO Director Shannon Gahs (second from right), join in NAHC’s March on Washington

BAYADA’s Government Affairs Office (GAO) staff members often say, “Advocacy never sleeps.” For the GAO federal affairs team—Government Affairs Officer Dave Totaro and Senior Associate Lindsey Wright—we can also say “Advocacy never stays put.” Over the past quarter, GAO has traveled to Washington, D.C. several times, as well as to Massachusetts, Florida, Indiana, Arizona, and Colorado—among other places.

Most often, GAO travels specifically to meet with legislators in D.C. and around the country to educate them about home care and the benefit it has in keeping millions of America’s seniors and individuals with disabilities independent and in their communities. Most recently, the federal affairs team has also taken to visiting BAYADA’s Home Health service offices to get employees involved in advocacy.

In late February, Dave and Lindsey traveled to D.C.’s Capitol Hill to meet with 11 key congressional members and their staff. On April 2, they traveled back to the Capitol along with two Hearts for Home Care Ambassadors—Anthony D’Alonzo (MHH) and David Mead (NLP)—and other GAO staff—to participate in the National Association for Home Care and Hospice’s (NAHC) annual March on Washington. This year, marchers were asked to educate legislators on two important bills: The Patient Driven Groupings Model bill, which if passed will eliminate reimbursement cuts based on behavioral assumptions, and the Home Health Improvement Planning Act, which if passed will allow non-physician practitioners to sign off on care plans. The visits were successful and resulted in additional cosponsors for both bills.  

GAO’s Dave Totaro and Lindsey Wright visited four Home Health service offices in Arizona and Colorado. Clockwise from top left: GAO and HH office staff in the SVV, FCV, GLF/VGL, and DNF/DNV offices.

The two-person federal affairs team can only make so much headway alone. GAO relies on advocates like you to make sure that all legislators hear our messages loud and clear. Dave and Lindsey have begun traveling to Home Health service offices around the country to tell employees what they can do to get themselves and their clients involved in advocacy, and the importance of doing so.

“As much as I travel to spread our message to our country’s decision makers, it’s important that I also use my time to get our staff involved. Home Health employees and clients are affected by what our legislators and regulators in D.C. make decisions on every day. The more our people mobilize and advocate, the more those decision makers will see how their choices affect real people’s lives,” said Dave Totaro.

During their trip to four Home Health service offices across Arizona and Colorado, Dave and Lindsey focused on Medicare policies, current bills, and how employees can get involved to make a difference. They also listened to each office’s unique challenges in delivering care to clients, and how policy changes could alleviate some of those issues. Thank you to the many BAYADA service offices that welcomed GAO with open arms and open minds, as well as to the employees who signed up to become Ambassadors. To learn about ways you, your staff, and your clients can advocate, contact Lindsey Wright at lwright@bayada.com. We look forward to working with you!

Home Health Aides Deserve Better Wages! If Done Right, Mandatory Minimum Wage Increases Will Help

Home health aides provide a lifeline to millions of Americans, but low wages make it difficult to recruit and retain enough to keep up with the demand. If done thoughtfully, mandatory minimum wage increases can help support these valuable workers

It’s undisputable: Home health aides provide a lifeline to millions of Americans that need assistance living where they want to be—at home. But low wages often disincentivize home care workers from staying in the field. The problem lies in Medicaid reimbursement rates: Home health aides rely largely on state-determined Medicaid reimbursement rates for their wages, and those rates have stagnated well below the cost of living—and many states have not addressed this in years.

Luckily, many states have proposed increasing the mandatory minimum wage. And while many businesses often oppose such measures—many home care industry leaders have come out in support of it because they recognize the importance of aides in helping keep people at home and earning a fair wage for doing so. But we must ensure that minimum wage increases are done with the recognition that many home care programs rely on state funding to pay their workers. And if that funding isn’t increased in tandem with mandatory minimum wage increases, the state could unintentionally be putting vulnerable residents at risk.

Simply put, if Medicaid reimbursement rates for home care services are not increased at all, or at a rate too low to cover new minimum wage standards, then many home care providers will need to consider whether they can afford to keep their doors open. If providers do decide that they cannot remain sustainable and do decide to forgo providing Medicaid-based home care services, then the real loser is the millions of Americans that rely on that provider to live independently at home. Down the line, this could result in more people who can live at home with help from a home health aide into being forced into nursing homes.  

“People want to live at home. And it’s the most cost-effective option for states. Home health aides are the backbone of our industry and we absolutely support wage increases for our workforce, but states need to be thoughtful in their approach to protect the many seniors and individuals with disabilities that rely on home and community-based services. We are working with state legislatures to make sure that they understand the relationship between rates and wages, and the potential risk to vulnerable residents who need home care,” says BAYADA Chief Government Affairs Officer Dave Totaro.

So far this year, 18 states have started the year with higher minimum wages than the year before. If you live in a state where the minimum wage is set to increase, then you have a unique opportunity to advocate and tell your legislators about the importance of home care and of paying home health aides a living wage. Contact advocacy@bayada.com to find out ways you can play a role in ensuring that home care is accessible to the many that want to stay at home, and that home care workers continue to be attracted to a field that helps them do just that.

NJ: GAO Hits the Road to Meet with Service Offices Across the State

GAO Director Louise Lindenmeier (center) meets with the PAS office to learn about their struggles recruiting and retaining quality aides

Every year, the Government Affairs Office (GAO) travels the state to connect with our service offices about our legislative priorities and the importance of advocacy. Not only do these visits give us the opportunity to share the work we do to improve the state of home health care in New Jersey, but they also give us the unique chance to hear about the challenges you all often face in attempting to deliver the compassionate, excellent, and reliable care that our clients deserve.

Throughout our visits so far, we have been able to celebrate our collective successes and accomplishments. In 2018, our GAO Ambassadors and service office employees attended a number of district office visits and legislative receptions, and participated in phone banks, letter writing campaigns, and action alerts all in support of accomplishing legislative priorities that support our nurses, aides, clients, and families. Without your partnership and collaboration, we would be unable to deliver on our promise to act as the voice for BAYADA and its clients and employees.

GAO gets groovy with the PER office!

In addition to celebrating last year’s successes, we have worked together to identify ongoing challenges and to form our 2019 legislative priorities and strategies. As we’ve formed these priorities, it is clear that our grassroots efforts and your continued commitment to advocacy will be integral to achieving our goals.

Thank you to the many offices who have made the time to meet with us. In 2019, we will continue our outreach effort to accomplish our goal of meeting with 100% of our New Jersey service offices. If you’d like to learn more about our road show, our 2019 legislative priorities, or getting more involved in advocacy at BAYADA, contact advocacy@bayada.com.

NC: Legislature Kicks Off 2019, Former Home Care Champion Nelson Dollar Joins Speaker’s Staff


Former Representative and home care Champion Nelson Dollar joins Speaker of the House Tim Moore’s staff as Senior Policy Advisor

Lawmakers returned to Raleigh on January 9 for the 2019-2021 long legislative session.  We expect to see some changes in committee assignments and leadership, especially in the House Appropriations for Health & Human Service (HHS), with the election defeat of Chairman Nelson Dollar.

Dollar–the former chairman of the House Appropriation Committee—has transitioned from the public sector to a senior policy advisor to the Speaker of the House Tim Moore. Dollar has been a home care champion for years and was named BAYADA’s Legislator of the Year in 2016 and 2018 for his efforts. He was instrumental in securing much needed Medicaid reimbursement rates increases for nursing and aide services. He has also been instrumental in protecting from elimination the Certificate of Need (CON) process for our Medicare offices.  His expertise and knowledge on complex issues at the statehouse will serve North Carolina well. As you may recall, Dollar lost his seat by 884 votes last November to Democrat Julie von Haefen.

While we are sad to see our former Champion lose this leadership position, there are other home care Champions that we anticipate seeing in key roles. We expect to see Representatives Donny Lambeth and Josh Dobson as co-chairs of HHS. Further, we anticipate Senators Ralph Hise and Joyce Krawiec in chair positions serving the Finance and/or Health Committees. All four legislators are well-versed in home care and the challenges our clients and staff regularly face throughout North Carolina due to our collective advocacy efforts. This puts BAYADA in a great position to move forward with our next round of asks.

Our major reimbursement priority this session is to increase the Medicaid private duty nursing (PDN) rate from $39.60 to $45.00 over the course of two years. This increase is necessary to help us recruit and retain the high quality, compassionate nurses we need to care for the many North Carolinians that need skilled care to stay at home.

Sharing your voice is key to achieving our goals: Be sure to look for opportunities to advocate as we seek to support our clients and staff. Of note, please save the date and be sure to look out for communications regarding our Legislative Day, which will be held in Raleigh on May 1.

FED: Home Health to See Rate Decrease in January 2020. What Can You Do?

CMS recently finalized calendar year 2019 and 2020 payment changes for home health agencies. The new payment model, also known as the Patient Driven Groupings Model (PDGM), was finalized on October 31, 2018. There is some good news: We will see Medicare payments increase by 2.2%–or $420 million–based on finalized policies this year. The reimbursement rate increase is the first the home health industry has received in a decade. Unfortunately, the final rule addresses that home health will see a decrease of payments by 6.42% based on the use of “behavioral assumptions” which will take effect January 2020.

Luckily Congress is working with the industry and has introduced corrective legislation into the House and Senate that counteracts this measure. Several of our legislative champions, including Vern Buchanan (R-FL), sponsored one of the three bills introduced, each of which would serve to counteract the “behavioral assumptions” by requiring Medicare to implement adjustments to reimbursement rates only after improper behavioral actions by home health agencies are actually observed affecting Medicate spending rather than assuming those improper activities will occur. While this is a great first step, we need more legislative support to ensure that one of these bills crosses the finish line.

How can you help? The Government Affairs Office (GAO) has been working diligently to meet with key legislators and introduce them to our issues and those of our staff and clients, but we can’t do it alone. BAYADA has been asked to take the lead of home visits for our industry and we need office staff to help us communicate the importance of home care and proper Medicare reimbursement for our services.

To join in our advocacy efforts, please consider meeting with your federal Congressman or Senator through an office visit or home visit. Contact GAO Federal Associate Lindsey Wright today to learn more and to coordinate. The Federal Affairs team has a busy first month of the year and will be making visits to Home Health offices the year to hear what is most important in your office and how we can help.

Upcoming Events

Date Event Location
January 17 Home Health Office Visits CO
January 21-23 Home Health Office Visits AZ
January 24 NHPCO/HAN Board Meeting Phoenix, AZ
January 27-29 Home Care 100 Phoenix, AZ
January 30 HCAOA Board Meeting Tucson, AZ
February 7 PMHC Board Meeting Washington D.C.