North Carolina’s Efforts Towards Medicaid Transformation Continue to Move Forward

The General Assembly passed two bills, H. 403  and H. 156,  which work together to clarify the implementation of the Standard and Behavioral Health/Intellectual-Developmental Disability (BH/I-DD) Tailored Plans and the licensure requirements for Prepaid Health Plan (PHP) managers under Medicaid Transformation.

In a historic move, legislators voted to move Medicaid recipients with mild-to-moderate behavioral health needs under the Standard Plan for Medicaid services. Individuals with a serious mental illness, a serious emotional disturbance, a severe substance use disorder, an intellectual/developmental disability, US DOJ settlement consumers, or individuals who have survived a traumatic brain injury are the defined population that will fall under the Tailored Plan.

The BH/I-DD Tailored Plan will begin one year after the Standard Plan with the LME/MCOs as the lead plan managers working with another PHP to offer the physical healthcare services for Tailored Plan Medicaid recipients for four years after that. The timelines incorporated in these bills push for North Carolina to complete the transition to the Standard and Tailored Plans as well as moving other specialty populations under managed care within five years of CMS approval.

GAO and our internal advisory workgroup continues to provide feedback through stakeholder involvement to ensure access to quality care as North Carolina moves toward Managed Care. If you have any questions about this process or the future of Medicaid in our state, please email me at ldobson@bayada.com.

12.37% Rate Increase for Community Alternatives Program for Disabled Adults (CAP-DA)

Great news for BAYADA clients and the many North Carolinian disabled adults that wish to remain at home with the help of in-home caregivers! The Medicaid CAP-DA program will see a rate increase from $13.88 to $15.60, effective January 1, 2019.  This increase brings parity between the three Medicaid aide programs, Personal Care Services (PCS), CAP-C for Children and CAP-DA for disabled adults.

This much needed increase will  enable BAYADA to hire and retain more quality caregivers to serve the many adults with disabilities in North Carolina. Thus, our service offices that serve CAP-DA eligible clients will be able to staff the necessary cases and keep families together and keeping clients whether they want to be – at home.

BAYADA’s Government Affairs Office (GAO), collaboratively with the Association for Home & Hospice Care, worked behinds the scenes with both Medicaid and key lawmakers to ensure this provision was adopted this session. Additionally, we made great strides towards this increase during our 2018 Legislative Day in which several client advocates came to share their stories with lawmakers and talk about the necessity of such increases. Thank you to those who came and shared their voices! We will continue to fight for higher rates to ensure that all North Carolinians will be able to access high-quality, reliable in-home care.

 

Unusual Adjournment Grants Republican Super-Majority One Last Session in November

This year has proven to be anything but normal at the General Assembly. Instead of adjournment with sine die, which indicates that no future business schedule this session, the Republican majority passed House Joint Resolution 1101, which calls back lawmakers on November 27.  This political power move gives the Republican super-majority one last session no matter what happens on election day.

Despite this unusual legislative session, BAYADA managed to accomplish the following legislative priorities:

  • Secured a 12.37% aide rate increase for CAP-DA, effective Jan 2019
  • Protected Certificate of Need from elimination for our Medicare offices
  • Secured a 9% rate increase from Partners Behavioral Health for our Habilitation offices, effective August 1, 2018

Thank You to our many ambassadors and advocates that helped us achieve these goals. We could not have done it without your passionate voices coming together to support all of North Carolina’s home care employees and clients.

Ambassadors Spring into Action! NC 2018 Ambassador Training Day

GAO and our North and South Carolina Ambassadors met in Charlotte, NC on March 14th for a day packed with thoughtful discussion about the scope, significance, and impact of our advocacy efforts. Whether they discussed legislative priorities, advocacy strategies and techniques, or the relationships that drive the work they do, our Ambassadors made it increasingly clear that they are passionate and prepared to be the voice for their clients, for their client’s families, and for themselves.

Among the day’s highlights was a visit from Representative Carla Cunningham, a former hospice nurse who represents North Carolina’s 106th district. Representative Cunningham has been a staunch advocate for health care, mental health, seniors, women, and children. Representative Cunningham offered our ambassadors a window into the legislative process and encouraged them to be dedicated, prepared, collaborative, and respectful. We were joined also by Wilburn, who has been a BAYADA client for 11 years. Wilburn spoke of the deep connections he shares with his caregivers and with the people he has met in his own advocacy efforts.

Our ambassadors are ready to move forward and be the competent, dedicated, and reliable voices that BAYADA needs to ensure that Wilburn and all our clients receive the care they deserve. It only takes one action, taken by only one person to make a difference. You can be that person today. Email advocacy@bayada.com to see how you can get involved!

Preparing for NC’s Short Legislative Session

BAYADA Government Affairs Area Director Lee Dobson (right) poses with North Carolina Representative Mitchell S. Setzer (left).

On May 16, lawmakers will return to Raleigh for North Carolina’s 2018-2019 Legislative Session.  Issues are likely to move very quickly as this is the second year in the legislature’s two-year cycle. Unlike the cycle’s first year, this year’s purpose is to make budget adjustments and finalize any carry-over bills. GAO has been meeting with key members in leadership to garner necessary support for our 2018 priorities (see below). GAO hopes that primary elections, redistricting, and Medicaid Transformation do not consume all the oxygen in the room so that legislators can get some work completed before concluding in June.

2018 Key Legislative Priorities:

  • Technical correction to increase the Community Assistance Program for Disabled Adults (CAP-DA) rate from $13.88 to $15.60, effective October 1, 2018
  • Increase the Personal Care Services (PCS), Community Assistance Program from Children (CAP-C), and Community Assistance Program for Disabled Adults (CAP-DA) rates to $17.00 effective January 1, 2019
  • Protect Certificate of Need (CON) from elimination.

If you have any questions about our 2018 priorities or how you can help advocate, please email me at ldobson@bayada.com

Together We Get Results

Speaker Tim Moore, Vickie Deyton, Amber Mitchell, and Rep. Kelly Hastings at a legislative event

Legislative successes, like the NC Medicaid rate increase for nursing in 2015 and 2016 and the home health aide increase this past year, don’t magically happen.  Legislative successes start with an identified need — low Medicaid rates made it impossible to pay people what they are worth — and end with legislators supporting jobs in the community and keeping families together by investing in home health care.  Every step along the way our Hearts for Home Care Advocates carried our unified message to decision-makers. Our cumulative actions over the years, including home and district visits, legislative round tables with lawmakers, responding to calls to action, attending lobby days, etc., made all the difference.  Individually and collectively our shared voices got results.  Join us to be a Heart for Home Care Advocate. 

Work Continues on Transforming Medicaid

 Last month the North Carolina Department of Health and Human Services (DHHS) submitted an amendment to the 1115 demonstration waiver application, originally submitted in June 2016. This amendment is the next step in the transformation of NC Medicaid and NC Health Choice programs to managed care, driving the state’s goal to implement reform.  This system will address both the physical and behavioral health of North Carolinians. The proposed program design seeks to implement changes that advances high-value care, improves population health, engages and supports providers, and establishes a sustainable program with predictable costs.  Our BAYADA workgroup, made up of technical experts and leadership from across the organization, has reviewed and provided formal comments to both the program design and waiver application. Our comments focus on: ensuring beneficiary access to care; the viability of the provider network; minimizing administrative burden, and establishing meaningful metrics that support and reward quality.

Special thanks to our review BAYADA teams for sharing their insight and operational experience.

Home Care Friend Named Appropriations Chairman

Rep. Dean Arp and Lee Dobson

Last month I attended an event honoring State Representative Dean Arp (R-Union).  Rep. Arp serves as Chairman of the House Appropriations Committee, the committee responsible for crafting North Carolina’s state budget. Chairman Arp will be critical in allocating sufficient funds to the Medicaid budget for the increases we are seeking this legislative session. During the event we discussed the importance of getting the rates up prior to Medicaid’s transition to managed care, which is targeted for July 2019.  In addition to supporting our issues in the past, Rep. Arp has been on a home visit and understands the importance of home care in the continuum.

With Sen. Tucker’s recent retirement announcement, it is critical we have allies in the Senate to help carry our message as well. Senator Joyce Krawiec is next in line. To educate her on our issues, we are in the process of identifying a client in her district to host a home visit early in 2018.

 

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.