Client Resource: Pennsylvania Health Law Project (PHLP): A Free Resource for Families Who Need Help Appealing Service Denials

By Danna Casserly, Staff Attorney, Pennsylvania Health Law Project

The Pennsylvania Health Law Project (PHLP) is a statewide center of legal expertise and advocacy devoted to increasing access to publicly-funded health care coverage and services. PHLP provides free advice and representation to individuals across the state who are experiencing problems with their Medical Assistance (MA) services, including their home health services.

If MA denies, reduces, or terminates a client’s home health services, the client has a right to challenge that denial by filing an appeal.

The MA appeal process can be complicated. There are multiple levels of appeal, including a grievance, an external review, and a fair hearing. PHLP understands that families often don’t have the time to take on these appeals on their own, or they may feel confused, daunted, or frustrated by the

process. PHLP will work with families, along with their home health agency, doctors, and other providers to try and get the denial overturned through the appeal process.  In some cases, PHLP may even go with the family to the appeal hearing.

There is no income limit to qualify for help from PHLP and all services are completely free of charge.

If your client’s MA services are denied, please urge them to call PHLP’s Helpline at 800-274-3258 for assistance. More information can be found on PHLP’s website at www.phlp.org.

BAYADA Honors Direct Care Workers at the Direct Care Worker of the Year Awards

 

 

 

 

 

 

 

BAYADA Staff at the Direct Care Worker of the Year Awards

Each year the PA Department of Aging and the Pennsylvania Homecare Association (PHA) request nominations for the Direct Care Worker (DCW) of the Year Awards.  The DCW is an individual who goes above and beyond in their work and provides essential services to older Pennsylvanians and disabled adults.

This year there were over 195 nominations. BAYADA nominated 16 aides from our offices.

The award was given at PHA’s Direct Care Worker Forum in Harrisburg. Each aide that was nominated was invited to attend. The day consisted of professional development, a motivational speaker and a DCW survey on the challenges of the profession.

This year GAO also hosted a pre-event for our aides to educate them about BAYADA’s Hearts for Home Care program and to honor BAYADA’s Home Health Aide 2017 Hero and 2017 PA Department of Aging DCW of the Year Anne Pannone.

Although, one of our BAYADA aides did not win the award in 2018 each aide felt recognized, energized and supported.  Thank you to all our office who submitted nominees.

Thank you to all of our home health aides for the important work that you do!

BAYADA Submits Comments on Electronic Visit Verification (EVV) to the Department of Human Services (DHS)

GAO recently worked with the Partnership for Medicaid Home-Based Care and internal stakeholders to submit comments to the Department of Human Services (DHS).

DHS released a Request for Information (RFI) to receive feedback on the technical specifications that should be considered when establishing an electronic visit verification (EVV) system.  DHS reinforced the message we had heard before stating that the state is moving towards an open implementation system with a standard clearing house.

BAYADA’s comments reinforced our position that an open system is imperative to foster innovation and enhance client care.  We look forward to continuing to work with the state to support the implementation of an open EVV system within the state.

If you have any questions about EVV or other mandates, please do not hesitate to reach out to me at lness@bayada.com.

PA Commonwealth Court overturns HealthChoices Contracts

HealthChoices—Pennsylvania’s managed care program for physical health, which includes our pediatrics practice—announced its newly rebid contracts in early 2017. For the past several years, this rebid process has been fraught with issues due to Managed Care Organizations’ (MCOs) protests. The newly announced contracts proved to be no different, as United submitted a contract bid protest shortly after this announcement.

United submitted this protest due to their belief that the state made an improper contract decision. Recently, Pennsylvania’s Commonwealth Court took up this protest and ruled in favor of United. The Court found that DHS met with MCOs during the black out period, thus ruling in favor of United’s protest.

DHS has not yet announced its next steps, but it is possible that the department will have to rebid all of HealthChoices’s contracts again. Because HealthChoices represents over $12 billion in contracts for potential MCOs, this ruling has created unprecedented waves in the state’s healthcare community. GAO will continue to monitor the outcomes of this ruling and will update the pediatric practice as more information becomes available.

Save the Date: PHA Lobby Day is May 22nd!

BAYADA will again be supporting the Pennsylvania Homecare Association’s (PHA) Lobby Day in Harrisburg on May 22nd!

BAYADA office staff, field employees and clients will be joining industry colleagues to show state legislators just how large and impactful the home care industry is and, as in years past, we are committed to maintaining BAYADA’s historically large “sea of red” presence throughout the day.

Whether or not you’ve participated in a lobby day before, this is your chance to share your voice about issues that affect home care and let legislators know what can be done to alleviate some of the pressures that industry staff, clients families face daily. If you have any questions about what the day entails or how you can play a role, email lness@bayada.com.

Thank you to all PA staff, clients and families for your commitment to advocacy and for your participation in lobby days past and future.

Save the Date–May 22 is PHA Lobby Day in Harrisburg!

PA Offices Submit Home Health Aide Nominations to PA’s Direct Care Worker of the Year

2017 BAYADA Direct Care Worker of the Year Nominees

Each year the PA Department of Aging and the Pennsylvania Homecare Association select one home health aide to be named Pennsylvania’s Direct Care Worker of the Year.

Last year BAYADA nominated 14 Home Health Aides (HHAs) and one of our nominees, Anne Pannone, was selected at PA’s Direct Care Worker of the Year.  Since her selection, Anne was awarded a cash prize of $1,000 and has been invited to several statewide events to discuss the meaning of being a HHA and the value it provides to the state.

To help ease our service offices’ workloads, GAO is working with EMP to submit this year’s HHA nominations using information provided through our Hero program.  To date, over 15 home health aides have been nominated to be this year’s Direct Care Worker of the Year.

All nominees will be invited to the 2018 Direct Care Worker Forum, which includes a luncheon and half-day training program on March 28.  A stipend will be given to all HHAs attending the Forum.

PA Department of Human Services Announces Electronic Visit Verification Direction

Shortly after the new year the PA Department of Human Services (DHS) announced that the state will be moving forward with electronic visit verification (EVV) compliance by means of an open system with a clearinghouse. BAYADA advocated on behalf of adoption of an open system and we are extremely pleased with DHS’s announcement. The open system encompasses the best of both worlds for providers within the state: An open system will enable providers that currently have an EVV system to use their system to “talk” to DHS’s clearinghouse.  At the same time, it will also enable providers who do not currently use an EVV system to use the clearinghouse system as their provider.

BAYADA voiced its opinion in favor of an open system and discussed the detractors of a closed system during DHS’s comments period in May. Click here to read the EVV comments that BAYADA submitted to the state.

Next, BAYADA plans to participate in a survey DHS will be releasing for the Department to better understand how home and community based providers are currently using EVV systems.  DHS is also in the process of developing a request for information (RFI) to understand the features, challenges, and remedies in implementing the EVV clearinghouse.  If applicable, BAYADA plans to participate in the RFI as well.

Equalizing Access Legislation Approved in PA House Health Committee

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

On November 21, the House Health Committee met and unanimously voted to approve HB 1829. HB 1829 allows individuals to be presumed eligible for home health care. This practice is currently allowed for nursing homes but is not extended to home care. Because of this, Pennsylvanians often go without the help they need or are unnecessarily placed in a nursing home. The legislation approved included two amendments, which changes the name “presumptive eligibility” to “deemed eligibility”. It also extends this process to allow adult day centers to do presumptive eligibility as well. We are very pleased with this outcome. Next the bill will go to the House Appropriations Committee. The Government Affairs Office (GAO) is working to set up meetings with Appropriations Committee members to ask them to support this legislation.

PA Client Visit to Discuss BAYADA’s Advocacy Program

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

 On Friday, October 20, Chief Government Affairs Officer Dave Totaro and I met with adult Home Health Aide client, William Bezdziecki at his home near Wilkes Barre to discuss the BAYADA Hearts for Home Care program and different client advocacy opportunities.  Also, present at the meeting were William’s parents, Jack and Mary Lou Bezdziecki, Wilkes-Barre/Scranton (WBS) Clinical Manager Susan Youells, WBS CSM Kristie Spinello and Certified Nursing Assistant Gerald Stevenson.