Recognition and Fair Compensation for Frontline Home Care Workers—During COVID and Beyond

By: Dave Totaro, Chairman of the Partnership for Medicaid Home-based Care

Below, please find an opinion piece authored by Dave Totaro—Chairman of the Partnership for Medicaid Home-based Care (PMHC) and BAYADA Home Health Care’s Chief Government Affairs Officer. This was originally published in the Scranton Times-Tribune on May 10, 2020.

Our nation’s frontline healthcare workers have been recognized during the COVID-19 pandemic, arguably more than ever before—and rightfully so. These essential workers put their health and safety on the line in order to make sure that the most vulnerable populations are taken care of. But these workers—particularly the caregivers that keep these individuals at home and out of riskier settings like nursing homes—deserve more than cheers, front lawn signs, and complimentary cups of coffee. It is time that our federal and state governments fairly compensate these brave and compassionate workers for the sacrifices that they are making during this critical time through Hazard Pay—that is, temporary increases in hourly wages for workers who are risking the most yet earning the least.

Congress has passed three stimulus bills so far, and have done so quickly and commendably with an eye toward helping the economy and the unemployed. But these packages have not yet focused on compensation for those who are working—the essential employees that risk their safety to care for the many that can’t help themselves. And while many healthcare professionals within hospitals and institutions have been impacted, the federal government has not yet prioritized the caregivers that keep people healthy at home.

Congress is currently working on the fourth (and likely final) stimulus bill. This presents a vital opportunity to increase Hazard Pay for healthcare workers who put their safety on the line every day. While the first three stimulus packages have increased emergency funding for states, only a handful of states have used those funds to increase pay for frontline healthcare workers. Currently, there are three potential proposals that would serve to increase pay for these workers across the US—either of which would reward home care workers and incentivize many to begin or continue their career in a field that is much-needed during this time.

Home care workers—particularly home health aides—are largely females of color who are making slightly above minimum wage. Yet they are some of the most essential workers—caring for those who are unable to care for themselves. And not only is their job physically and emotionally tolling, but the prioritization of hospital care has made it increasingly harder for home care agencies to access personal protective equipment, such as masks, gloves, hand sanitizer, and gowns, for these workers. And, to top it all off, we are regarding them as heroes without considering fair compensation for their commitment and sacrifice.

Now more than ever, the potential dangers that go hand-in-hand with nursing home living are becoming a frightening reality and we as a nation need to consider the future of healthcare as our population continues to age. Nearly 20% of COVID-related deaths have occurred in nursing homes. Not only is in-home care the best way to ensure that the most at-risk populations—seniors and the medically fragile—stay as isolated as possible rather than be grouped in together, it also ensures that they are in the most cost-effective setting for their families and for the state and federal governments themselves.

COVID-19 has hit many Americans hard, and few are exempt from at least some negative consequences as a result. But it is clear that there are some who are risking more than others, and who are sacrificing their personal safety in order to keep others healthy and independent at home… both in times of crisis and times of normalcy. So while the recognition and support of frontline workers is certainly appreciated, it does little to truly show home care workers how valuable they are. Through the development of the fourth stimulus package, the federal government has the opportunity to meaningfully show at-home caregivers what they mean to America—both now and in the future. Home health care has been making headlines in recent media coverage.

In order to join those who are advocating for better home health care funding and policies on behalf of beneficiaries, their families, and frontline workers, contact us at advocacy@bayada.com

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

Government Affairs Office Hits the Road in North Carolina

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

Often we talk about sharing our message, making our point, and communicating our value proposition.  Those are things we, in the Government Affairs Office (GAO), must do as we seek support for our issues with lawmakers.  One such conversation was had with Representative Nelson Dollar earlier last week, where Chief Government Affairs Officer Dave Totaro and I thanked him for his past support on the rate increases and continued our conversation around our priorities for the year to come.

If we are to continue to be successful in building a strong advocacy base, it is not enough to build relationships with lawmakers.  We must also get to know our internal BAYADA customers–our staff and clients.  As such, we visited six home health offices on the I-85 corridor.  It was great to be able to provide a legislative update, share advocacy information, and solicit feedback.  It helps ground our efforts and put things into perspective.

Special thanks to Division Director Richard Hopson, Area Director Shad Morgheim, and the office directors for allowing us to visit. We really enjoyed visiting with staff at CV, CHF, GAV, CAV, SC, DAV, RV, and DRF.

Photo:  Area Director Lee Dobson, Rep. Nelson Dollar, and Chief Government Affairs Officer Dave Totaro
Photo: Area Director Lee Dobson, Rep. Nelson Dollar, and Chief Government Affairs Officer Dave Totaro

BAYADA Meets with NJ Governor Chris Christie

Submitted by Louise Lindenmeier, Director, NJ Government Affairs (GAO)

Chief Government Affairs Officer Dave Totaro, State Assistive Care Practice Leader Eric Thul, and Director, Strategy & Value-Based Partnerships Matt Lippitt met with New Jersey Governor Chris Christie to discuss the recently signed law which sets a floor for minimum reimbursement under managed Medicaid for Personal Care Assistant Care.  Our team explained the challenges under managed Medicaid, how reimbursement is used to support personal care services, and the wage needs of the home health aides.  The meeting was very informative for both the Governor and us, and served as an excellent start towards addressing the unintended consequences of the Governor’s conditional veto.


Photo: Matt Lippitt, Eric Thul, Governor Christie and Dave Totaro

CMS Removes HHGM Proposal from Final 2018 Rule

Submitted by David Totaro, Chief Government Affairs Officer (GAO)

Our voices were heard. Thank you and high five to all of our BAYADA office and field employees who recently took action to voice concern about the federal Home Health Groupings Model (HHGM) proposal, which would have resulted in revenue reductions between 4.3% and 17% for BAYADA’s Home Health Specialty Practice. Such significant reductions would have impacted not only Home Health, but BAYADA as a whole.

Yesterday afternoon, the Centers for Medicare and Medicaid Services (CMS) formally indicated that 2018’s Payment Rule does not include the HHGM proposal. CMS indicated that it could not finalize the HHGM proposal at this time based on the comments received on the issue.

BAYADA employees sent more than 3,000 messages to members of Congress urging representatives and senators to take a stand against HHGM. BAYADA joined industry-wide action led by an unprecedented coordinated effort by the Partnership for Quality Home Health Care, Elevating Home and the National Association for Home Care and Hospice (NAHC). This effort spurred 50 US senators and 179 US representatives to reach out to CMS and the US Department of Health and Human Services (HHS) to caution against finalizing HHGM. Through BAYADA’s action on this issue and previous calls to action, BAYADA has shown itself to be one of the strongest advocacy teams in our industry.

While delaying the HHGM proposal does not indicate a permanent withdrawal, it is a clear victory for the home health and home care communities that took immediate action to stop the rule from becoming final. BAYADA and other industry stakeholders will continue to work with CMS to improve the payment model, including participating in discussions with the Congressional Committee on Ways and Means to finalize a potential legislative proposal.

Thank you for your reliability and your dedication to advocating on behalf of our staff and clients.

 

PA Client Visit to Discuss BAYADA’s Advocacy Program

Submitted by Rick Hynick, Director, Client and Family Advocacy (GAO)

 On Friday, October 20, Chief Government Affairs Officer Dave Totaro and I met with adult Home Health Aide client, William Bezdziecki at his home near Wilkes Barre to discuss the BAYADA Hearts for Home Care program and different client advocacy opportunities.  Also, present at the meeting were William’s parents, Jack and Mary Lou Bezdziecki, Wilkes-Barre/Scranton (WBS) Clinical Manager Susan Youells, WBS CSM Kristie Spinello and Certified Nursing Assistant Gerald Stevenson.

Government Affairs Delaware Office Tour

Submitted by Shannon Gahs, Director, DE Government Affairs (GAO)

All of our Delaware service offices kindly opened their doors to Chief Government Affairs Officer Dave Totaro, Manager of Grassroots Advocacy Mike Sokoloski, and me this week.  The Government Affairs Office (GAO) team was able to share current information about our state and federal advocacy efforts.  We had good conversations with office teams about what BAYADA’s official positions are and how office and field employees are getting more involved in advocacy for our clients.  Thank you all for such warm receptions!

Busy Week for the Government Affairs Office in Washington D.C.

Submitted by Dave Totaro, Chief Government Affairs Officer (GAO)

Last week, I was elected to the Board of the Partnership for Quality Home Health (PQHH) replacing Chairman and Founder, Mark Baiada, who stepped down upon his retirement.  PQHH is an alliance of major home health providers dedicated to the development of policy to improve the quality of life and care of all home health patients.  I am also a board member and Chairman of the Partnership for Medicaid Home-based Care (PMHC), an alliance of major Medicaid providers, managed care organizations, state and national home care associations and interested business affiliates dedicated to the development of policy to enhance Medicaid reform.

Also, following each Board meeting, the Partnerships held events to honor the support for Medicaid and Medicare shown by home health care champions U.S. Senator Bob Casey (D-PA) and U.S. Senator John Cornyn (R-TX).

And, last week, the Government Affairs Office supported the PQHH Action Alert to urge the Centers for Medicare and Medicaid Services (CMS) to withdraw their Home Health Groupings Model (HHGM), a proposed new payment model for home health services that would significantly cut home health revenues by more than 15%.  As of September 14,  759 BAYADA colleagues have sent 2334 messages to 156 legislators.  Thank you to everyone who took action and who participated in this very important and necessary alert.

Photo: Dave Totaro and Senator Bob Casey at the Partnership for Home-based Care Board Meeting in Washington, DC.

Whirlwind Tour Through the Carolinas

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

Last week, Chief Government Affairs Officer Dave Totaro and I started our three-day trip across the Carolinas in Columbia with a productive meeting on rates with Bryan Kost, Chief Legislative Liaison SC Department of Health & Humans Services.  We are looking for support for a rate increase for next session.  Further, as a way to connect with staff on issues and share our advocacy message, we visited our offices in Columbia, Charleston, Southport, and Fayetteville.  These round table discussions help us better understand care delivery challenges and identify ways we can help.  Lastly, we were thrilled to have met Brock, an adorable 18 month-old boy, and his family near Charleston.  After 9 months in the hospital, he was ready to come home with the support of nursing.  Home visits remind us why we go to work every day and how important it is for each of us to advocate for quality home health care.

Capital Day in Trenton, NJ

Submitted by Louise Lindenmeier, Director, NJ Government Affairs (GAO)

On June 15, 25 Hearts for Home Care Ambassadors met in Trenton for a Town Hall meeting hosted by our lobby group, Capital Impact Group. Chief Government Affairs Officer David Totaro and lobbyists Gene Mulroy and Paul Crupi discussed the upcoming election, budget, and what we will see in the next administration. Dave addressed what is happening in Washington with health care changes and possible impacts on our state. After a quick lunch, the group toured the State House, where they were able to meet legislators in the halls and gain an overview of the State House history. Everyone enjoyed the day.