BAYADA Submits Opposition Letters to a Certificate of Need (CON) Carve-out

Last month, 100% of our Medicare offices advocated for maintaining a level-playing field and allowing patient choice by opposing a CON carve-out petition. After their four failed legislative attempts last session to receive a CON carve-out, LeadingAge Inc. – the association representing the Continuing Care Retirement Communities (CCRCs) – submitted a petition to the State Health Coordinating Council (SHCC) requesting CCRCs be allowed to open a Medicare home health office without meeting the requirements outlined in North Carolina statute regarding CON. LeadingAge contend their CCRC residents would rather receive home health services from someone with a CCRC name badge than an “outside” Medicare provider, like BAYADA. In their testimony, LeadingAge indicated that there is no access to care for their residents. Further, LeadingAge indicated they wanted to restrict choice to their on-site agency. The Department received comments to the petition and record 88 letters in opposition, 10 of which were from BAYADA. Each director submitted unique comments. SHCC will consider the comments before rendering a decision later this month.

If you have any questions about CON or what you can do to help advocate for policies beneficial to BAYADA and the home care industry in North Carolina, email me at ldobson@bayada.com.

Special High Five to our directors for taking a stand to maintain patient choice!

CAV – Rochelle Harbick
CV – Rochelle Harbick
DAV – Tonya Wishon
FSV – Alexa Ciancia
GAV – Tonya Steelman
GUV – Chelsea Nedwick
PRV – Kathleen Hanline
RV – Trekelia Chavis
SV – Alicia Wyatt

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.

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.

In North Carolina, Timing Couldn’t be Better

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

Next week, more than 65 BAYADA employees and one client will be descending upon the state capitol advocating for an increase to the aide reimbursement rate under Medicaid. We seek to go from $13.88 to $17 per hour over two years ($15.50 in year one, and $17.00 in year two), which will allow us to hire and retain more quality aides. Our advocates are poised to share their stories on why investing in home health care is necessary and the right thing to do for their constituents. Also, we will be advocating to preserve the certificate of need (CON) process. Any erosion in CON will negatively impact our Medicare offices. Our timing couldn’t be better, as the Senate is finalizing their budget bill. Donning our BAYADA red, our staff will speak from the heart.

Bills in Motion at the NC General Assembly

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

  1. Certificate of Need (CON) under Attack  In the course of 48 hours 4 bills related to CON were filed to either eliminate or modify CON law. As any changes to CON will negatively impact our existing Medicare offices, our GAO Advisory Council identified protection of CON as a 2017 legislative goal. GAO continues to meet with the various bill sponsors to educate them the negative impact such changes would have on the home health industry. We continue to work behind-the-scenes to prevent their enactment.
  2. Medicaid Reform under Review  While the Medicaid Reform 1115 c Waiver application is being reviewed by the Centers for Medicare & Medicaid Services (CMS), there is discussion of a new model emerging from Governor Roy Cooper’s office in conjunction with the General Assembly. GAO continues to work with legislative leaders and the department to ensure quality access to care exists in whatever model emerges.
  3. Trillium LME/MCO Proposed CAP-C/DA Pilot  Senator Michael Lee sponsored a bill to allow Trillium Local Management Entity/Managed Care Organization (LME/MCO), a managed mental health, substance use and intellectual/developmental disability payor, to administer a CAP-C/DA pilot in the coastal area. Analysis of the bill indicates this pilot would have a negative impact on recipients. GAO is working with the bill sponsor to explain the pitfalls of moving coastal recipients into a pilot when these individuals are currently transitioning into a new waiver.
  4. Opioid Bill’s Unintended Consequence  Representative Gregory Murphy sponsored a bill to tighten opioid prescriptions. While we support increased oversight for misuse of prescriptions drugs, the bills language, in its current state, will create a safe-haven for pillpushers. AHHC is taking the lead to work with the bill sponsor to modify the language to eliminate the loop-hole and craft a meaningful bill, as intended.