The New Jersey state legislature avoided a government shutdown when Governor Murphy signed the proposed budget into law late Sunday, July 1. The approved budget sets the state fee-for-service rate at $19.00 per hour and establishes a rate floor, which requires MCOs to reimburse home health care providers at no less than $16.00 an hour for personal care services.
GAO is continuing to work closely with legislators to further clarify the Personal Care Assistant (PCA) increase, which passed last year (A320). This clarification will address the direct and indirect costs that were overlooked by Governor Christie’s conditional veto last session. For more information, don’t hesitate to reach out to email@example.com.
On March 20, Steve Tunney and his team members from New Jersey Medicaid made the trip to the Contract Management Office (CMO) in Parsippany, NJ to present on the state’s Medicaid program, including Managed Long-Term Services and Supports (MLTSS), respite care, and provider relations.
This thoughtful and thorough presentation was helpful in ensuring that we continue to efficiently navigate state regulations and resources in our pursuit of delivering compassionate and reliable care to our clients and communities. Thank you to Steve Tunney, Joe Bongiovanni, and Geralyn Molinari for joining us!
Dozens of NJ Hearts for Home Care Ambassadors gather for a day of advocacy training.
In the beginning of March, New Jersey Hearts for home Care Ambassadors gathered for 2018 Ambassador Training to brainstorm and reflect on the many ways in which we can effectively advocate on behalf of our field employees, our clients, and their families. Whether it was discussing phases of grassroots advocacy, the local and federal landscapes and initiatives, or specific lobbying strategies, ambassadors made one thing clear: They are passionate, dedicated, informed, and ready to be the advocates that BAYADA needs.
Throughout Ambassador Training, ambassadors approached legislative issues with many perspectives in mind. Three such perspectives were that of the client, the client’s family, and the field employee. While there are needs and priorities specific to each category, ensuing discussions made it increasingly clear just how connected each of these perspectives are. For example, by advocating for a higher reimbursement rate and living wages for nurses and aides, we are directly advocating
for higher quality care for our clients. In other words, ambassadors stressed the need to understand and believe that when it comes to improving access to and quality of home health care, we are in this together.
Katie Macklin of the Alzheimer’s Association joined us to further reinforce our connectedness. Providing our ambassadors with information about advocacy at the Alzheimer’s Association, Katie identified the impact of organizing and mobilizing across organizations working for a common purpose: providing help and care to those who need it.
To tie in political and legislative perspectives, we were joined by New Jersey Assemblywoman Carol Murphy and lobbyists Gene Mulroy and Paul Crupi. Each provided ambassadors with thoughtful and useful strategies for meeting with and educating legislators.By far the most effective tool we have, they argued, was the power of storytelling.
No one illustrated this point better than Dana Isley, a BAYADA client and parent to a medically complex child. Dana delivered a phenomenal and incredibly moving speech about her home visit with a legislator during which she detailed some of the challenges that she and her daughter, Abi, face. Incredibly impacted by Dana and Abi’s story during this home visit, her legislator acted quickly to provide them resources and support. Dana’s story reiterates a vital point: Your stories make the biggest difference.
At the heart of this collaborative event was an understanding that relationships drive advocacy. Ambassadors’ motivation to advocate stemmed from their sense of dedication and deep closeness to those they care for. With this motivation, they are driven to form relationships with their legislators to advocate for their staff and clients. Our ambassadors continue to show that it only takes one person and one action to make a difference.
Assemblywoman Shanique Speight is new to the state legislature, which makes it all the more important to introduce her to home care right away.
Essex County State Assistive Care (ESS) Director Lisa Minnella and her Clinical Manager Bonnie Caterson arranged for the assemblywoman to meet one of their special clients, 92-year-old Ms. Tisdale. Ms. Tisdale lives in Assemblywoman Speight’s district and has no family in the area. She needs certified home health aide (CHHA) services to assist her with the tasks she cannot do and help her be as independent as she can be in her own home.
The assemblywoman was very happy to meet Ms. Tisdale and spend time learning more about how home care services benefit her constituents and keep so many seniors in their homes.
Picture: ESS Director Lisa Minnella and Assemblywoman Speight with Ms. Tisdale
NJ Senator Troy Singleton and Assembly Committee on Human Services Chairwoman Assemblywoman Joann Downey have introduced legislation S1820/A3632 to further clarify the Personal Care Assistant (PCA) increase to direct care workers.
The legislation will simplify the process for the PCA direct care worker’s rate increase and will take provider costs into account. GAO is currently meeting with members of the legislature to ask for their support for this clarification bill.
As background, New Jersey’s PCA program has had historically low reimbursement rates under the state’s fee-for-service. Over the last three years, GAO was successful in increasing the state -fee-for-service rate from $15.50 to $18.00 per hour and last year, to $19.00 per hour. Unfortunately, when the PCA program transitioned to Managed Medicaid, managed care companies did not follow the same reimbursement rates and continued to pay, in many cases, less than $15.50 per hour.
In the last legislative session, GAO was successful in passing legislation which set a reimbursement floor in managed care for PCA at $19.00 per hour. However, Governor Christie conditionally vetoed the legislation with a stipulation requiring all increases pass directly through to direct care workers.
The legislation introduced by Senator Singleton and Assemblywoman Downey will further clarify the PCA increases to account for direct and indirect provider costs. If you have any questions about this bill or any other bills in NJ, please feel free to email me at firstname.lastname@example.org.
In many of the state’s concentrated communities, parking has presented nurses and the state’s most medically fragile individuals with a sincere barrier to care. In many cases, our nurses must possess a parking permit to park legally. However, even with these permits, our nurses often receive tickets or even have their cars towed.
During a recent conversation with Assemblywoman Carol Murphy, the Government Affairs Office (GAO) explained that nurses are reluctant to serve clients in these areas, which has led to recruitment and retention issues for BAYADA and other home care providers.
As a result, the assemblywoman introduced legislation A3683, which would allow home care providers to obtain parking placards, comparable to handicapped parking placards, from the Motor Vehicle Commission, for our nurses. We are currently waiting for the bill to be heard in the Transportation Committee.
Last summer, as lawmakers in Washington, DC debated health care reform, Tara Montague had cause for concern. The proposed legislation included significant cuts to Medicaid, which for Tara and her family, could have been disastrous.
Tara and her husband, Jim, rely on home care nursing for their daughter Mary, 20, who has spinal muscular atrophy (SMA). They know that many families turn to Medicaid to cover the cost of home care and feel fortunate to have private insurance for Mary’s nurses. However, they depend on Medicaid for Mary’s prescriptions and medical equipment, which total in the thousands each month.
“Mary is on numerous medications, and her medical equipment includes a ventilator, oxygen, a wheelchair and hospital bed, feeding pump supplies, a nebulizer, pulse oximeter machine, and more,” said Tara. “Without Medicaid, I don’t know what we’d do, and that’s why I fight so hard to get Mary the benefits she needs.”
Giving families a voice
As a parent of a child with special needs, Tara can understand and empathize with our clients’ daily struggles because she lives it, every day. Last year, she joined BAYADA’s Government Affairs office as manager of client and family advocacy. Here, she continues to fight for Mary, and for every pediatric and adult client who depends on home health care to live with comfort, independence, and dignity.
“Last summer I worked with BAYADA clients who were willing to share their stories with federal legislators to help prevent the Medicaid cuts,” said Tara. “As I continue to grow in this new role, I hope to encourage more and more families to speak up, to have a voice, and to know that they can make a huge difference in the legislative process.”
Getting involved is quick and easy
Tara knows all too well that for clients and families, the biggest obstacle to getting involved is time. That’s why she encourages them to register with BAYADA’s Hearts for Home Care Advocacy Center at heartsforhomecare.com.
“We are not looking for a huge time commitment, it’s whatever they feel comfortable with doing,” she said.
The mission of Hearts for Home Care is to be a voice for BAYADA employees, clients, and their families. Through education, advocacy, research, and community service, BAYADA advocates for policies that support the highest quality of home health care services. The online advocacy center keeps clients and families informed about legislative issues at the state and federal level that can impact the home health care industry, and their access to care.
Advocacy can be a simple as taking five minutes to log onto the Hearts for Home Care Advocacy Center website and sending a pre-written email to local, state, and federal legislators. If clients and families want to do more, they can share their stories on the Hearts for Home Care Advocacy Center website; attend a lobby day at their state capital, a legislative round table, or a town hall; they can visit a legislator’s office; or invite a legislator into their home to see, first hand, how home health care professionals help improve lives.
Connecting with families and sharing stories
Tara has a degree in political science and extensive experience in marketing. In her previous role as a community liaison with a BAYADA Pediatrics office in New Jersey, she educated physicians about home health care, started a parent support group, coordinated a family resource fair, and helped families navigate through insurance challenges.
In her new role she hopes to develop training materials and tools for clients and families who want to become more active in advocacy efforts. But even more, she is looking forward to getting to know clients and families from across the country, and helping to share their stories – just like Mary’s.
To learn more about Hearts for Home Care, how you can get involved with advocacy, or how you can share your story, contact Tara at email@example.com.
Client advocacy matters more than that of home care industry professionals. While home care professionals can share facts and figures about home care with legislators, it is clients’ stories that truly paint the picture of what home care means to legislators’ constituents.
Whether a home care client is an infant, senior, or any age in-between, it is very likely that the nursing or aide services that they rely on is from a Medicaid or Medicare program. What this means is that government officials are the ones making the decisions on care regulations and reimbursement rates rather than those who are regularly affected by home care. Home care providers must accept these rates and regulations and provide care to the best of their abilities based on what the government has set forth rather than on what is actually best for clients and their families.
Home care employees regularly see that many of the government reimbursement rates for home care are low and have not been increased in years. This has a domino effect in that if providers can’t bring more revenue in, they can’t pay higher rates to attract more staff to care for current clients or for new clients who will need care in the future.
Many areas of our country are starting to age and will need caregivers to allow people to live in their homes instead of in facilities, yet projections indicate fewer people want to be professional caregivers due to the industry’s low wages. Additionally, more nurses are choosing employment in other types of settings, which makes it difficult for many home care clients to have adequate nursing coverage because facilities such as hospitals can pay nurses a higher wage.
As elections come and go, we see changes in our government leaders and with these changes come the possibility of healthcare policy changes. These changes can be sudden and unpredictable, and these changes often threaten funding cuts to important programs such as Medicaid or Medicare. Any funding cuts to these programs would be devastating to home care providers and to program beneficiaries.
The interesting thing is that the representatives and senators who we vote for at the state and federal level make these decisions, and few of them have strong healthcare backgrounds. In addition, it is their job to represent all of the people from their respective districts to the best of their abilities. While provider employees can share their voices through legislative meetings, clients’ and their family members’ advocating and sharing their stories matter most.
Clients who benefit from home care and their family members have their own special stories to tell. As the end users of nursing and aide services, clients and family members have the first-hand knowledge of how the Medicaid and Medicare programs are working and what could be done to improve them. Clients names, faces, and shared stories paint a far more detailed picture of home care than industry professionals can with facts and figures. When legislators vote on issues related to home care, clients stories are better-remembered, and legislators are much more likely to vote for favorable home care policies with these in mind.
“I’ve been an advocate for my wife, who is 100 percent dependent, for 16 years,” said Mike Pollock, the husband of a client who advocates to protect home care for his wife and all who need services. “Thanks to Medicare and Medicaid and BAYADA, I’ve been able to care for her at home. Although Medicare and Medicaid are excellent resources, they have their issues. An excellent resource for solving these issues are our elected officials,” Pollock said. “In fact, elected officials are the only people capable of fixing issues that arise within Medicare and Medicaid. But they can’t help if they don’t know what we as family caregivers are dealing with every day. Never hesitate about reaching out to them. It’s been my experience they are eager to help,” Pollock concluded.
By putting advocacy into action and connecting our clients to their elected officials, there is a far better chance that Medicaid and Medicare will be protected and grow with the needs of our clients. Please email me at firstname.lastname@example.org for more information related to client and family advocacy and what you can do to help protect and strengthen the home care industry in your state and at the federal level.
In December at the BAYADA Home Health Care Champion Awards we reflected on a year of many victories and looked ahead to a new year with new challenges. Speakers, awardees and nearly 100 guests celebrated the successful increase of NJ’s fee-for-service rate for personal care assistants to $19 per hour. We also acknowledged employees’, clients’ and home care industry friends’ commitment to advocacy. These efforts led to the passage of A320/S1018, which was signed by Governor Christie earlier this year. Effective this July, A320/S1018 requires Managed Medicaid reimbursement rates for home health aide services to be at or above the state’s fee-for-service rate.
An inspirational highlight of the night, those in attendance were moved by Dana Insley’s touching speech. Dana is the mother of a young client who had a difficult start to life. Dana’s daughter was placed in foster care before being adopted by the Insley family. Dana spoke of the blessing home care has been in her family’s life and discussed the significant improvements her daughter has made with the support of her BAYADA nurses.
The evening’s honorees, Lieutenant Governor-elect Sheila Oliver, Senator-elect Declan O’Scanlon, and Assemblywoman Nancy Muñoz were visibly moved by Dana’s remarks and reiterated their support for home care during their acceptance remarks.
Also honored at the ceremony was Assemblyman Paul Moriarty, who represents New Jersey’s 4th District, which encompasses the Insley family’s home. Assemblyman Moriarty had visited the Insleys home in the past and was able to glean a full and meaningful understanding of the day-to-day life of a child receiving home care.
After a heartfelt evening that reminded everyone of our purpose and why we do what we do, Chief Government Affairs Officer David Totaro took the stage to remind all of those in attendance of the importance of advocacy and that, in addition to words, action is needed. He noted the huge impact of New Jersey advocates, who sent nearly one-quarter of all messages directed to federal legislators this summer from BAYADA’s network during the health care reform debate. Thank You for your commitment to advocacy.
As I reflect on 2017 and what we have accomplished, the first thing that comes to mind is Thank You.Thank you for your support, your engagement and your advocacy efforts — all of which made a difference in the lives of our clients, families and employees.
2017 was the “Year of Client Advocacy and Engagement.” Clients and families engaged lawmakers and the community at-large through home visits, family support group meetings, and phone calls and meetings with lawmakers in Trenton. These efforts ensured that our aides, nurses, and the importance of home care remained top of mind to New Jersey representatives and senators.
2017 was successful in many ways and set us up for even bigger wins in 2018. Below, please find a summary of 2017’s priorities and accomplishments:
• The Managed Medicaid Rate Floor bill was signed into law, effective July 1, 2018. The new law mandates a 100% pass-through of increased reimbursement to aides. In 2018 we will introduce a new bill which will be more reflective of a competitive wage environment and will mirror the original bill with no mandated pass-through.
• The Personal Care Assistant (PCA) fee-for-service rate was raised from $18.00 per hour to $19.00 per hour through a budget resolution, effective July 1, 2017.
• We successfully lobbied against Governor Christie’s intent to end the NJ/PA Reciprocity Tax agreement. This accomplishment saved our employees and BAYADA thousands of dollars in taxes.
• In July, the Private Duty Nursing (PDN) bill was introduced. This bill’s aim is to raise the PDN reimbursement rate by $10 per hour for RNs and LPNs. While the bill did not ultimately pass the state legislature in 2017, it brought awareness to the need for higher reimbursement rates within the program. We will continue to pursue this bill’s passage as a major goal for 2018.
• In conjunction with NJ’s Home Care Association, we successfully lobbied for legislation that permits physical therapy aides to practice in clients’ homes as long as the aides are supervised by a licensed physical therapist every two weeks.
• The BAYADA Champion Awards were held in December. This year we honored Lieutenant Governor-elect Sheila Oliver, Assemblywoman Nancy Munoz, Assemblyman Paul Moriarty and Senator-elect Declan O’Scanlon for their unwavering support of home care.
• BAYADA hosted a fundraiser for Senator-elect Troy Singleton, raising over $13,000 for his election fund.
• BAYADA reviewed and submitted comments to the state regarding the new 10:60 home care regulations.
Looking ahead to 2018, we will be working with Governor-elect Murphy and NJ legislators new and old to continue to advance home care and community-based services for our state’s neediest populations. GAO seeks to push for new laws to improve reimbursement rates within the PDN program, introduce legislation to provide technical changes to the current PCA managed care law, pursue minimum wage law changes, address parking challenges for our nurses and, of course, continue to advocate on behalf of our employees, clients and their families.