FED: Home Health to See Rate Decrease in January 2020. What Can You Do?

CMS recently finalized calendar year 2019 and 2020 payment changes for home health agencies. The new payment model, also known as the Patient Driven Groupings Model (PDGM), was finalized on October 31, 2018. There is some good news: We will see Medicare payments increase by 2.2%–or $420 million–based on finalized policies this year. The reimbursement rate increase is the first the home health industry has received in a decade. Unfortunately, the final rule addresses that home health will see a decrease of payments by 6.42% based on the use of “behavioral assumptions” which will take effect January 2020.

Luckily Congress is working with the industry and has introduced corrective legislation into the House and Senate that counteracts this measure. Several of our legislative champions, including Vern Buchanan (R-FL), sponsored one of the three bills introduced, each of which would serve to counteract the “behavioral assumptions” by requiring Medicare to implement adjustments to reimbursement rates only after improper behavioral actions by home health agencies are actually observed affecting Medicate spending rather than assuming those improper activities will occur. While this is a great first step, we need more legislative support to ensure that one of these bills crosses the finish line.

How can you help? The Government Affairs Office (GAO) has been working diligently to meet with key legislators and introduce them to our issues and those of our staff and clients, but we can’t do it alone. BAYADA has been asked to take the lead of home visits for our industry and we need office staff to help us communicate the importance of home care and proper Medicare reimbursement for our services.

To join in our advocacy efforts, please consider meeting with your federal Congressman or Senator through an office visit or home visit. Contact GAO Federal Associate Lindsey Wright today to learn more and to coordinate. The Federal Affairs team has a busy first month of the year and will be making visits to Home Health offices the year to hear what is most important in your office and how we can help.

Upcoming Events

Date Event Location
January 17 Home Health Office Visits CO
January 21-23 Home Health Office Visits AZ
January 24 NHPCO/HAN Board Meeting Phoenix, AZ
January 27-29 Home Care 100 Phoenix, AZ
January 30 HCAOA Board Meeting Tucson, AZ
February 7 PMHC Board Meeting Washington D.C.

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

Building Relationships with Federal Legislators and Community Partners in Delaware

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

Wilmington (WIL) Director and Hearts for Home Care Ambassador Kim Roman and I joined the Alzheimer’s Association Delaware Valley Chapter for coffee with Senator Tom Carper (D-DE).  Healthcare issues, including funding for Medicare and eligibility for Medicaid, are increasingly in the federal spotlight and up for debate in Congress.  It is important to build relationships with our federal legislators and to make sure they know how important home health care is in their states!

 

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.

 

Why Client Advocacy Matters

Submitted By Rick Hynick, Director, Government Affairs, Client and Family Advocacy

At BAYADA, we often see that many of the government reimbursement rates for programs such as Medicaid are low and have not been increased in long periods of time.  The difficult effect this has on our revenue then carries over on our ability to offer pay rates that are attractive to nurses and aides seeking employment.  They sometimes accept other offers because of this, making recruitment a challenge and also making open shifts more prevalent.

There are ways that we can work together to combat this challenge.  Our service offices have wonderful relationships with our clients and family members. It is these people who we provide services to who have the best understanding of what it is like to live minute-by-minute with complex medical needs.  Government Affairs and service office staff working together have the best opportunity get the voices and real-life experiences of our clients out to our legislators who can make a difference.

Our legislators have the responsibility to represent the people who live in their districts and also to control the reimbursement and regulatory matters of most of our government funded programs. Our goal is to show the true needs that exist by getting voices of the clients to them so when it is time to vote or make a decision about an important topic such as reimbursement, they will do so with the best information possible at hand. -Over time, this will lead to higher reimbursement rates and better living wages for our staff allowing us to better align with The BAYADA Way and help more people.

A BAYADA client advocates for better HHA wages with legislators and families looking on.

The daughter of a BAYADA client and a BAYADA nurse at an advocacy event.

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.