NC Legislative Update: Looking Back, Planning Forward

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.

Saying Goodbye to a Champion

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

Republican Sen. Tommy Tucker of Union County announced that he won’t seek a fifth term in 2018.  Sen. Tucker co-chairs the influential Senate Finance Committee. “I have long believed in term limits for judges and politicians,” he said in a statement to the Charlotte Observer. “After serving four terms in the N.C. Senate, the time has come for me to allow others to step in and serve Union County and our state.”

Our relationship with Sen. Tucker started back in 2011 when Hearts for Home Care Ambassador John Morris and I visited with him in his district office to introduce him to BAYADA and home care.  That visit led to a home visit where he was able to see first-hand the impact home care has on his constituent.  Over the years and as he rose through the ranks, we met with Sen. Tucker numerous times, attended legislative receptions for him, as well as, visited with him at Lobby Days.  His door is always open for BAYADA.  He was instrumental in ensuring the CAP-C rate increase for nursing was put in the Senate’s budget and that it was ultimately passed.  Sen. Tucker was BAYADA’s Legislator of the Year 2016. We thank Sen. Tucker for his commitment and support of our staff and clients.  His vision and leadership will be missed.

LaToya, Jackie, Tanner, and Melissa at Legislative Day with Sen. Tucker receiving the BAYADA Legislator of the Year Award

Reporting Success with Help from our Hearts for Home Care Advocates

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

With active engagement from our Ambassadors and other Hearts for Home Care advocates, together we accomplished the following legislative wins:

·         Obtained an Aide Rate Increase                                  
Lawmakers passed a rate increase for aides services in two (2) Medicaid program – Personal Care Services (PCS) and the Community Alternatives Program for Children (CAP-C) – taking the rate from $13.88 to $15.52, effective July 1, 2017, and to $15.60, effective January 1, 2018.  Due to a technical issue around budget neutrality, an increase was not passed for CAP for disabled adults (CAP-DA). However, we have the commitment of both the General Assembly as well as the Department to institute a fix in the 2018 session.     
Provision successfully passed the General Assembly
·         Protected Certificate of Need (CON) Once Again
There were as many as four bills introduced, but not passed, related to CON to either eliminate or modify CON law. As any change to remove or minimize CON law will negatively impact our existing Medicare offices, GAO will continue to work collaboratively with other health care settings behind-the-scenes to prevent the erosion of CON. Educating lawmakers on its implications is key.  
Provision successfully excluded
·         ID/DD Individuals to Access Services
A budget provision added some 400 slots to the Innovations Waiver program. Originally the provision included 250 slots. After lobbying, discussion, and debate that number was increased. While it won’t completely address the 900 individuals on the waiting list, these additional slots will help our HAB practice provide services to individuals in need.    
Provision successfully passed the General Assembly
·         Medicaid Reform Remains In Play
GAO was invited to a meeting with Secretary Mandy Cohen and Medicaid Director Dave Richard to discuss their plans to align mental health and physical health more quickly than 3 years after transition to managed care. In the development of this new waiver, they intend to include stakeholders as well as other protections. 
Bill is eligible to be taken up during a Special Session

North Carolina Budget Released

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

On June 19, lawmakers released a $23 billion budget for 2017-2019. Below are some of the provisions impacting us:

  • Increased Personal Care Services Rate: This provision increases the Medicaid rate for aide services under the Personal Care Services (PCS) program and the Community Alternatives Program for Children (CAP-C). The rate will increase from $13.88 to $15.50 (July 1, 2017) and $15.60 (January 1, 2018) pending approval from the Centers for Medicare & Medicaid Services (CMS). Much to our disappointment, CAP-DA was left out of the budget. A technical issue made it difficult to increase the CAP-DA rate within the established budget neutrality requirement. A rate increase would have meant fewer authorized hours for clients to stay within overall program requirements. BAYADA’s Government Affairs Office continues to work on a solution.
  • Protected the certificate of need (CON) for home health care from being eliminated.
  • Expanded Innovations Waiver slots: This provision added 400 additional Innovations Waiver slots across the state.

NC Budget Writers are Behind Closed Doors

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

Budget negotiations are underway between the House and Senate to iron out the differences between their respective budget bills. Both contain funds for an increase to the Personal Care Services (PCS) program aide rate from $13.88 to between $15.52 and $15.78. BAYADA’s Government Affairs Office (GAO) continues to work with key lawmakers to garner support for an amendment to add funds to cover aide services under the Community Alternative Programs for Children (CAP-C) and Disabled Adults (CAP-DA). Language has been drafted and is being circulated. Budget writers are working behind closed doors as House Speaker Tim Moore and Senate President Pro Tempore Phil Berger have instructed conference chairs to have their committee reports completed by the end week.

Making The Rounds in North Carolina

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

BAYADA Chief Government Affairs Officer Dave Totaro and I met with key lawmakers this past week, seeking their support for a rate increase for aide services under three Medicaid programs – Personal Care Services, Community Alternatives Program for Disabled Adults (CAP-DA), and CAP for Children (CAP-C)- in two different settings: in-home care and adult care homes.  While the lift is heavy, $47.8 million to bring the rate from $13.88 to $17.00 over two years, our conversations were positive.  We also met with the newly appointed but not yet confirmed Secretary of Health & Human Services, Dr. Mandy Cohen.  A good round of meetings!

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Dave Totaro, Lee and Dobson Rep. Carla Cunningham, who is a nurse