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 firstname.lastname@example.org
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.
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.
Last month I attended an event honoring StateRepresentative 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.
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.
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.