Due to GAO’s advocacy efforts and that of our clients, employees, and industry partners, the Maryland legislature voted to increase Medicaid reimbursement rates for all home- and community-based services by 30% over the course of six years! In addition to traditional lobbying and grassroots advocacy efforts, the skilled nursing unit collaborated with GAO to deploy a public affairs campaign that led to home care clients’ stories being published in the Washington Post and Baltimore Sun, thus further showing legislators and the public the dire need for a Medicaid rate increase.
This monumental increase will enable BAYADA to compete for approximately 50% of the state’s LPNs, who are currently more attracted to hospitals and other settings where wages are higher. This in turn will enable BAYADA to better fulfill its vision of serving millions of people worldwide.
GAO anticipates that, as a result of this increase, the skilled nursing unit will open an office in 2020.
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.
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:
2017 proved to be another eventful year for home care in Pennsylvania. Notably, MCO implementation of the increased pediatric rate went into effect on January 1, 2017. As a result, our pediatric offices have been able to implement various programs for our nurses including increased wages, benefits, and bonuses throughout the year.
Early in 2017 the PA Government Affairs Office (GAO) worked with NJ GAO Director Louise Lindenmeier to lobby against New Jersey Governor Christie’s intent to end the NJ/PA tax reciprocity agreement. We were successful in getting the over 40-year agreement reinstated, thus saving BAYADA employees over $6 million in taxes.
Throughout the year we were active participants in PA’s move towards full implementation of Community Health Choices (CHC). Our participation, as well as that of others in the industry, resulted in a temporaryrate floor for personal assistance services. The rate floor ensures that implementation of CHC will not result in rate cuts for services within the program.
In May we submitted comments in favor of an “open” electronic visit verification (EVV) system, which would be more beneficial to our employees and to BAYADA than a closed system. The administration heard our concerns and is now planning to implement an open system. See our next article to learn more about PA’s EVV system.
Finally, PA took unprecedented steps by introducing legislation which would allow deemed eligibility for home care. This legislation takes a big step toward equalizing access to home and community based services as it would allow those who appear to financially qualify for nursing home services to be deemed eligible for home care services as well. After the legislation was introduced it was voted unanimously out of the House Public Health and Appropriations Committees and was voted out of the full House unanimously. Next up in the long and winding legislative process: The bill will now be considered in the Senate.
Towards the end of 2017 the PA GAO conducted a needs assessment with our PA division directors. Upon completion of the needs assessment our PA GAO Advisory Council met and recommended the following priorities for 2018:
Increase the personal assistance service rate by an average of 10%, creating a statewide reimbursement rate of $20.58 by 6/30/18.
Pass deemed eligibility for home care through legislation by 4Q18 (continuation of 2017 goal).
Allow physician signatures to be obtained within 30 days instead of 7 days.
Include requisite reimbursement increases in any state minimum wage increase.
Pass drug disposal legislation for Hospice.
Support the passage of Pennsylvania Orders for Life-Sustaining Treatment (POLST) legislation.
Lay the foundation for rate floor legislation in Pennsylvania.
Our PA legislative priorities have been approved by BAYADA’s Chief Executive Officer. We are looking forward to an exciting and challenging year ahead! Thank you to all PA staff, clients and families for your support and commitment to advocacy. Your efforts are paramount to our efforts to ensure that all Pennsylvanians can live a safe home life with comfort, independence, and dignity.
Submitted by Shannon Gahs, Associate Director, DE Government Affairs (GAO)
The Governor’s Commission on Building Access to Community-based Services, Health Committee, determined its new agenda last week. With support of representatives from Family Voices and Family SHADE, the committee will work on ensuring that all Delawareans eligible for community-based services know what they qualify for and how to access care. At the suggestion of a representative from Nemours A.I. DuPont Hospital for Children and me, the committee will also be working to ensure that all Delawareans, especially children, have access to quality home health care.
Submitted by Laura Ness, Director, PA Government Affairs (GAO)
As a result of a legislative roundtable planned by 2015 Hearts for Home Care Ambassador of the Year Mike Sokoloski, Representative Aaron Kaufer became very interested in helping us equalize access to home and community-based services. Since then, Representative Kaufer has arranged meetings with executive directors from various legislative committees and made the first attempt at legislation. He also spoke with the chair of the Public Health Committee Representative Matt Baker. Due to our consistent follow-up, Representative Baker has decided to take up our issue himself with the support of Representative Kaufer. We are working with him to craft legislation and look forward to working with him throughout the legislative process.
Submitted by Shannon Gahs, Associate Director, MD Government Affairs (GAO)
On Wednesday, State Senator Gail Bates, who represents portions of Howard and Carroll Counties, joined Area Director David Pareja (BWV) on a home visit to meet a physical therapy client. They discussed the many types of services that can be provided in home and community based settings, the differences between home-based care and facility-based care, as well as current issues facing our practices in Maryland.