Two Workgroups Formed to Explore Changes in the State Medicaid Reimbursement Model

Recent conversations with MCC Waiver Administrator Michelle White have revealed that the time is right to explore making significant changes in the nursing reimbursement model.  GAO has formed two workgroups to analyze and evaluate options to address Medicaid policy and its reimbursement model for nursing.

First, we’ve formed a BAYADA technical expert group representing the relevant practices and leadership to help inform BAYADA’s recommendations.  The second group is a larger provider workgroup within the SC Association for Home Care & Hospice. As a SCAHHC Board member, I have been asked to co-chair this workgroup to draft industry recommendations.  BAYADA will draw from its internal workgroup to inform the conversation with the industry and Medicaid.  This is a great opportunity to address the challenges and recommend a unified solution to DHHS that can be a win-win for providers, the state, and ultimately- clients.

Thank you to the SC Advisory Council and the workgroups! I look forward to working with you to develop recommendations that will lead to better outcomes for our staff, clients and their families!

Advocacy Efforts in Massachusetts Gaining Publicity

Submitted by Rick Hynick, Director, Client and Family Advocacy (GAO)

As advocacy efforts continue to progress toward a State Medicaid rate increase for nursing services, to help individuals with complex medical needs, excitement around the movement throughout Boston and much of the state is starting to build.  On July 30, the Boston Globe featured a lead article about one of the families most effected by the matter.  The article showed how this family has not had nursing coverage in more than 100 consecutive days because of the low Medicaid reimbursement rates.  Two days later, WGBH-TV of Boston ran an on-air piece featuring the Mom from the Globe article and another Mom who is a leading advocate showing the urgency that the 900 plus Massachusetts families needing home care nursing services are facing on a daily basis.

MassHealth Announces Second Rate Increase In The Face Of Budget Deficit

Submitted by Laura Ness, Director, Government Affairs (GAO)

Last week, Chief Government Affairs Officer Dave Totaro, Boston Pediatrics Director Emery Hughes, and other industry leaders and families gathered together to meet with MassHealth.  MassHealth had asked for the meeting, in regards to the Continuous Skilled Nursing (CSN) program.  During the meeting, MassHealth stated that they recognized that low reimbursement rates were a major problem within the program.  They have planned to increase the rates by 2.25% effective July 1, 2017.  This is the second reimbursement increase we have been notified about within three months.  The organizations working to increase this rate were pleased with this movement but recognized that this is a fraction of what is needed to stabilize the rates.  We look forward to continuing our efforts to increase the CSN rates by a total of $15 per hour.

Supporting Home Care at the Rhode Island State House

Submitted by Rick Hynick, Director of Client and Family Advocacy

On Tuesday, April 11, a crowd of people gathered at the state room in the Rhode Island State House to thank those in our state government who support the many children, adults, and their families who rely on home care. The gathering was part of an event planned on behalf of BAYADA and the Rhode Island Partnership for Home Care.

“We’re here today to thank those legislators who have listened to your conversations and heard your challenges, and have become steadfast supporters to make your lives and the lives of your children better,” said BAYADA Chief Government Affairs Officer Dave Totaro. Dave and other representatives from GAO partnered with Rhode Island Skilled (RIS) pediatrics Director Ashley Sadlier and her staff to make the event a success.

State Representative Gregg Amore was presented with a 2017 Legislative Advocacy Award for his tireless work to back the needs of his constituents and the many other residents of the state who use home care services on a daily basis. Senator Hannah Gallo was also recognized but could not be present. Additionally, Lieutenant Governor Daniel Mckee spoke about the important role home care plays in the lives of many Rhode Island residents.

Mr. Mckee and Rep. Amore continued to discuss the positive impact of home care, to the great interest of our clients and their families who were present in the audience. These families—the very people who rely on having nurses to provide clinical care to their loved ones—can offer firsthand testimony as to why home care is so vital.

Eric Olson—the father of client Liam and a long-time home care advocate—explained that the nurses who work with his son have such a connection with him. They understand that many of Liam’s movements are actually the way he communicates what kind of care he needs from moment to moment. He went on to explain that, without the close connection that the nurses have with his son, Liam would not be where he is today. With their help, he has thrived, despite his dependence on many mechanical devices. Eric went on to underscore how important it is that the families work with the elected officials, as they have the ability to make positive change.

“Our goal today was to bring enough of these voices together so we can start to make a difference.  Not just for families in this room, but for all families who want to keep their loved ones at home,” Dave said.  Side by side, BAYADA and the Rhode Island Partnership for Home Care provide significant support to the goals of legislators and families who depend on home care. We are working together for a better tomorrow for all home care services in Rhode Island.

Working on a Solution for the Retro Rate Increase

Submitted by Lee Dobson, Area Director, NC Government Affairs (GAO)

GAO, working collaboratively with the Association for Home & Hospice Care (AHHC) and Matt Wolfe, AHHC’s legal counsel, continues to work with Medicaid Director Dave Richard and key lawmakers, including Senators Ralph Hise and Tommy Tucker, and Representatives Nelson Dollar and Josh Dobson to resolve a technical issue with the retroactive rate increase for CAP-C nursing. As you may recall the General Assembly appropriated funds last session to increase the nursing rate by 10% effective July 1, 2016. The Department is supportive and is seeking a solution with the Centers for Medicare & Medicaid Services (CMS). GAO will keep you informed as things develop.

Expanding Our Reach Through A NC Home Visit

Submitted by Lee Dobson, Area Director, NC Government Affairs (GAO)

When freshman NC Representative Andy Dulin expressed an interest in home health care, Charlotte Personal Care (CPC) Hearts for Home Care Ambassador and Client Service Manager Shayla Jemmott, and Clinical Manager Deborah Batts jumped into action. They hosted a home visit with CJ, a 24-year old young man with cerebral palsy, and his family. CJ’s mom explained how the three hours per day of certified nursing assistant services allows her to work and gives them a sense of peace knowing CJ is happy and healthy. Rep. Dulin asked great questions and was surprised to learn that the aide rate, at $13.88, is only $0.44 cents higher than back in 2001. He indicated he is willing to help us garner support for the increase.

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Representative Dulin with CJ

A Day in the Life of a Massachusetts Mom/Advocate

Submitted by Rick Hynick, Director, Client and Family Advocacy

On February 27, several BAYADA employees, home health care family members and others working toward getting a patient bill of rights passed, gathered at the state house in Boston to meet with legislators.  Lisa B. was en-route with her son, an adult home care client in his early 30s, and his son’s nurse.  Their goal for the day was to speak with different elected officials about the need for a rate increase for continuous skilled nursing services and to advocate for a patient bill of rights that is making its way through the legislative system toward becoming a law.  Just four miles from the state house, Lisa and the nurse saw that her son’s medical condition had changed and they quickly pulled their van over near the outskirts of a public park to help him.  He was struggling to breath due to a mucous plug.  In addition to this, he had lost control of his bowels.  As they pulled off the road, it happened to be near where an undercover police officer was working.  Startled by their presence, the officer approached them.  It took a bit, but Lisa and the nurse were able to clear the plug and get him back to a normal status.  They also changed his clothing and got everything back to normal.  The police officer was so motivated to help the family that he provided them with a police escort to the state house.  As a result of their dedication to the greater cause of helping people with special medical needs, they were still able to meet with senators and representatives and discuss the importance of home care nursing and the patient bill of rights from the perspective of the family.

Home Visit Shows Need For Home Care To NJ Legislator

Submitted by Tara Montague, Manager, NJ Client and Family Advocacy (GAO)

Through the efforts of Hearts for Homecare Ambassador and Director Rose Sample, State Senator Nilsa Cruz-Perez made a visit to the home of Cherry Hill Pediatric client, Lindsay H. The Senator had the opportunity to meet Lindsay and her mother, Debbie, as well as some of the Pediatric Cherry Hill office staff and Susan Stout, one of the nurses who helps to take care of Lindsay.

According to Rose, both the client’s mom Debbie and nurse Susan were just blown away by the Senator’s compassion and concern.  The Senator and Lindsay’s mom connected on a number of levels.  Senator Cruz-Perez thanked everyone repeatedly and said it made her week to be there.  In follow-up from the meeting with Lindsay’s mom, Debbie shared that, “She seemed like a wonderful and sincere person, and I feel so fortunate to have had the chance to get to know her and share stories.”

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Senator Nilsa Cruz-Perez, our client’s mother Debbie H., Rose Sample, Clinical Manager Kara Leahy (pink jacket), Nurse Susan Stout, and our client Lindsay H.

Setting A Rate Floor Gains Traction in Delaware

Representative Debra Heffernan, Vice Chair of the House Health and Human Development Committee, has offered to sponsor and draft a bill that would set a reimbursement rate floor for skilled nursing care for all payers under the state’s Medicaid equal to what Medicaid pays directly.  This bill would go a long way in helping home health care providers have consistency in their plans.  Rep. Heffernan represents an area north of Wilmington along the Delaware River, east of Fairfax.   Two other representatives have offered to sponsor the bill as well, and an additional representative has offered to co-sponsor the bill.

BAYADA Sponsors Second Lobby Day in Massachusetts

Submitted by Laura Ness, Director, Government Affairs (GAO)

The Government Affairs Office (GAO) organized a second lobby day for continuous skilled nursing providers and parents to discuss our Patient Bill of Rights.  With over 27 meetings scheduled, we focused on meeting with our legislators that sit on important committees and introduced our need to file a budget amendment to support the increased reimbursement rate needed to compete for a median of nurses.  The day was successful, as we lined up House and Senate budget amendment sponsors and additional co-sponsors for the bill.  As stated by the lobbyists from the Home Care Alliance of Massachusetts, we “have set a solid foundation to build upon.” Next, we wait to see where the House will assign the bill and wait for a budget hearing.