2020 Legislative Priorities: An Exciting & Anticipatory Year for GAO States & the National Home Care Industry

2020 is gearing up to be a monumental year for BAYADA’s Government Affairs Office (GAO). GAO directors and Chief Government Affairs Officer Dave Totaro have worked diligently with BAYADA leadership to agree upon this year’s legislative priorities. Check out GAO’s state-by-state priorities below! To find out more about your state’s issues and how you can get involved, see the list of state GAO directors and associates within the article.

FEDERAL
Chief Government Affairs Officer Dave Totaro
Federal Affairs Associate Victoria DeLone

#1: Support PQHH and NAHC to pass the Home Health Payment Innovation Act

  • Eliminates behavioral assumptions to set reimbursement rates and limits changes in reimbursement to +/- 2% in any year
    • BAYADA impact: $12-15 million
    • Practice: Home Health

#2: Support the passage of the Home Health Care Planning Improvement Act

  • Allow non-physician providers to certify a patient’s eligibility for coverage – including face to face requirements
    • BAYADA impact: TBD (awaiting score from CBO)
    • Practice: Home Health

#3: Introduce and pass the Home Care Access and Savings Act (H-CASA)

  • Modernizes the Medicaid program through quality, efficiency, and integrity improvements
    • BAYADA impact: Policy only
    • Practices: ACSP and SNU

NORTHEAST REGION
Area Director Louise Lindenmeier (NJ, RI, NY, MA)
Director Ashley Sadlier (RI, NY, MA)
Associate Marissa Fogal

NJ

#1: Secure increase for PCA to offset minimum wage increases in 2021 by $3 per hour

  • BAYADA impact: $7.2 million
    • Practice: ACSP

#2: Increase the state fee for service rate for RNs and LPNs by $10 per hour in Private Duty Nursing and set a minimum rate floor for managed Medicaid.

  • LPN increase of 26.3% from $38 per hour to $48. RN increase of 20% from $50 to $60.
    • BAYADA impact: $19.1 million
    • Practice: SNU

#3: Pass legislation to mandate commercial insurance to cover PDN

  • Impact: Potential savings of $50-70 million for state Medicaid dollars
    • Practice: SNU

NY

#1: Gain NYC Department of Education’s Request for Proposal to achieve status of “approved vendor” to provide school nursing services in the New York City boroughs

  • BAYADA impact: $429,000
    • Practice: SNU

RI

#1: Pass legislation to ensure clients turning 21 have continuity of care 

  • BAYADA impact: $1.1 Million
    • Practices: SNU and ACSP

#2: Defend Cost of Living Adjustment (COLA) for Medicaid Home Care/Hospice rates

  • Governor has proposed an additional 5.9% increase for skilled nursing and CNA services in the 2020-2021 budget, effective 7/1/2020
    • This proposal must still go through the legislative decision-making process, with the final budget set to be signed by the end of June 2020. GAO will continue to monitor its progress and advocate for this increase
    • CNA Current Average: $25.51 à $27.02 (+$1.51)
    • LPN Current Average: $47.79 à $50.61 (+$2.82)
    • RN Current Average: $54.20 à $57.40 (+$3.20)
    • BAYADA impact: $219,791
    • Practices: SNU and ACSP

#3: Secure an increase for Medicaid FFS reimbursement rates

  • 16.3% increase from $25.52 to $29.67
    • BAYADA impact: $431,912
    • Practices: SNU and ACSP

#4: Secure a rate floor for Managed Medicaid rates so they cannot be below the set Medicaid FFS rates

  • BAYADA impact: $163,000
    • Practices: SNU and ACSP

MID-ATLANTIC REGION
Area Director Laura Ness (PA, DE, MD, IN)
Associate Director Rob Lattin (DE, MD, IN)
Senior Associate Maggie Tracy

DE

#1: Secure an increase for PDN LPN and RN reimbursement rates

  • 21% increase from $46.14 to $56.01 for LPNs, and 21% increase from $51.50 to $62.51 for RNs
    • BAYADA impact: $5.3 million
    • Practice: SNU

MD

  • Protect the yearly rate increase for LPNs providing private duty nursing.
  • BAYADA impact: Unknown
  • Practice: SNU

PA

#1: Secure an increase for Personal Assistance Services under Community Health Choices

  • 8% increase (dollar amount depends on MCO)
    • 2019 goal was a 10% increase, and a 2% increase was secured. Thus, the 2020 goal is to obtain the remaining 8%
    • BAYADA impact: $3.2 million
    • Practice: ACSP

#2:  Pass legislation to allow Deemed Eligibility for home care

  • BAYADA impact: Unknown
    • Practices: ACSP and AN

#3:  Eliminate the requirement for nurses to call home health aides every two weeks

  • BAYADA impact: Unknown
    • Practice: PED

SOUTHEAST REGION
Area Director Lee Dobson (NC, SC, GA, MO)
Director Melissa Allman (GA, SC, MO)
Senior Associate Lindsey Wright

GA

#1: Secure a 6% increase for all Medicaid nursing services

  • BAYADA impact: $426,862
    • Practice: SNU

NC

#1: Secure an increase for nursing under Medicaid’s PDN Program–

  • 13.6% increase from $39.60 to $45
    • BAYADA impact $8.4 million
    • Practice: SNU

#2: Secure an increase for aide wages under Personal Care Services, Community Alternatives Program, and CAP for Children

  • 18.6% increase from $15.60 to $18.50
    • BAYADA impact: $1.89 million
    • Practice: ACSP

SC

#1: Secure a 10% PDN rate increase, effective July 1, 2020

  • The state recommended a 15% increase effective July 1, 2020. After further advocacy efforts focused on the urgent need for an immediate increase, DHHS issued the initial 5% increase, effective January 1, 2020. DHHS is committed to including the remaining 10% to be effective July 1, 2020. If the provision is passed into law as planned, then PDN services will see a total 15% increase from 2019 levels (5% increase effective January 1, 2020, and an additional 10% targeted for July 1, 2020).
    • BAYADA impact: $690,000
    • Practice: Skilled Nursing

#2: Secure 24% for RN and 35% for LPN increase for Medicaid nursing waivers

  • BAYADA impact $1.16 million
    • Practice: Skilled Nursing

#3: Secure a 10% increase for Personal Care Waivers

  • BAYADA impact: $158,000
    • Practice: ACSP

GRASSROOTS ADVOCACY & PUBLIC AFFAIRS
Grassroots Advocacy Senior Manager Mike Sokoloski
Public Affairs Senior Manager Alisa Fox

Grassroots Advocacy: In 2020, the GAO Grassroots Advocacy team is seeking to further enhance the Ambassador program by creating a new “Senior Ambassador” role in order to have seasoned advocates guide and mentor newer advocates. Senior Ambassadors will also be able to attend special and strategic events in order to hone their skills and to advise GAO on issues their office(s) see. If you would like to learn more about the Ambassador and/or the Senior Ambassador program, or how you can get involved in advocacy, contact the Grassroots Advocacy team at msokoloski@bayada.com.

Public Affairs: Following the success seen in 2019, BAYADA has expanded its public affairs program to open up resources for smaller states that may benefit from a public affairs campaign. In first quarter, BAYADA has employed three campaigns thus far: A campaign to increase PDN and PCA rates in New Jersey, a campaign to further increase PDN rates in South Carolina, and a campaign to create regulations in Rhode Island to ensure that medically-complex children aging out of the pediatrics program can continue to seamlessly access care. Other states that may soon be seeing public affairs campaigns are: Florida, Indiana, Massachusetts, Missouri, and Pennsylvania.

Two Workgroups Formed to Explore Changes in the State Medicaid Reimbursement Model

Recent conversations with MCC Waiver Administrator Michelle White have revealed that the time is right to explore making significant changes in the nursing reimbursement model.  GAO has formed two workgroups to analyze and evaluate options to address Medicaid policy and its reimbursement model for nursing.

First, we’ve formed a BAYADA technical expert group representing the relevant practices and leadership to help inform BAYADA’s recommendations.  The second group is a larger provider workgroup within the SC Association for Home Care & Hospice. As a SCAHHC Board member, I have been asked to co-chair this workgroup to draft industry recommendations.  BAYADA will draw from its internal workgroup to inform the conversation with the industry and Medicaid.  This is a great opportunity to address the challenges and recommend a unified solution to DHHS that can be a win-win for providers, the state, and ultimately- clients.

Thank you to the SC Advisory Council and the workgroups! I look forward to working with you to develop recommendations that will lead to better outcomes for our staff, clients and their families!

BAYADA Chief Government Affairs Officer Successfully Delivers MLTSS Implementation Presentation to MACPAC

Dave Totaro served as a panelist to inform Commissioners about lessons learned from Managed Care and MLTSS implementation in BAYADA states.

Last Thursday BAYADA Home Health Care’s Chief Government Affairs Officer Dave Totaro served as a panelist during the Medicaid and CHIP Payment and Access Commission’s (MACPAC) public meeting in Washington, DC. This opportunity was especially unique and important for BAYADA because MACPAC serves to provide policy and data analysis and make recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on a wide array of issues affecting Medicaid and CHIP. We are optimistic that Dave’s insights will help shape the Commission’s future recommendations on state and federal Managed Care and MLTSS policies and procedures.

MACPAC extended the invitation to Dave to serve as the panel’s provider representative due to BAYADA’s experience with Managed Long Term Services and Supports (MLTSS) and managed care implementation across a number of states. Dave accepted the opportunity and successfully delivered his presentation in front of the 17-person Commission and a public audience, which included a number of congressional staffers and CMS representatives.

Aside from Dave, participating panelists were Dennis Heaphy, a MLTSS beneficiary and expert on public health from Massachusetts’s Disability Policy Consortium, and Michelle Bentzien-Purrington, Vice President of MLTSS and Duals Integration at Molina Healthcare. Dave’s presentation focused on BAYADA’s experience in implementing Managed Care across multiple states, particularly the lessons learned that can translate to better implementation in future states looking toward managed care and MLTSS.

tactics for Managed Care Long Term Services and Supports MTLSS implementation success

Dave presented MLTSS implementation as a three-legged stool: Adequate rates, state supports, and federal process changes must all be in place for a successful rollout. Should one of the legs be faulty, then the entire operation is set to fail. The presentation described for the Commission:

  • The need for the state to set adequate reimbursement rates and why inadequate rates affect providers’ ability to recruit, retain, and compete, which can lead to an unhealthy provider network and, ultimately, an access to care issue
  • The need for states to protect a set adequate rate via a rate floor, and the need to regularly review and adjust this rate
  • The need for state oversight and regulation of MCOs so that providers can focus on care delivery rather than managing the administrative burdens and variable practices of each MCO
  • The importance of the federal government equalizing Home and Community Based Services with nursing home care to solve for the institutional bias that currently allows LTSS individuals to access facility care more easily than home and community-based care
  • The need for the federal government to collect uniform data so that MCOs and providers can work together to close care gaps and save the state money

Each section was accompanied by BAYADA-state specific examples, and the presentation concluded with a series of recommendations related to each of the above points. Throughout Dave’s presentation, the Commissioners and audience were engaged and following along to the accompanying PowerPoint. After his presentation, Commissioner Leanna George—the mother of a child currently living in an Intermediate Care Facility—positively commented that rate floor setting was as avenue towards ensuring adequate reimbursement rates that she had not heard of before.

During the Q&A portion of the meeting, Commissioner Brian Burwell asked that each panelist state which area of MLTSS the Commission should focus their research and attention. The other panelists echoed Dave’s sentiments regarding federal changes to rebalance HCBS with nursing home care to remove institutional biases that continue to affect beneficiaries who wish to remain at home.

After the panel wrapped up, Commission Chair Penny Thompson approached Dave to compliment him on his presentation, and Dave has already been contacted by MACPAC’s Executive Director Anne Schwartz regarding his future support and counsel on MLTSS. GAO is ready to work with the Commission on next steps and is excited to be at the table to help recommend policies that are favorable to home care providers.

Thank you to all BAYADA colleagues that assisted Dave in the research and creation of this presentation:

  • Alisa Borovik
  • Melissa Burnside
  • Lee Dobson
  • Linda Hughes
  • Kelly Lawson
  • Louise Lindenmeier
  • Matthew Lippitt
  • Kerry Meabon
  • Tara Montague
  • Laura Ness
  • Jennifer Vranich