BAYADA Chief Government Affairs Officer Successfully Delivers MLTSS Implementation Presentation to MACPAC

Dave Totaro served as a panelist to inform Commissioners about lessons learned from Managed Care and MLTSS implementation in BAYADA states.

Last Thursday BAYADA Home Health Care’s Chief Government Affairs Officer Dave Totaro served as a panelist during the Medicaid and CHIP Payment and Access Commission’s (MACPAC) public meeting in Washington, DC. This opportunity was especially unique and important for BAYADA because MACPAC serves to provide policy and data analysis and make recommendations to Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on a wide array of issues affecting Medicaid and CHIP. We are optimistic that Dave’s insights will help shape the Commission’s future recommendations on state and federal Managed Care and MLTSS policies and procedures.

MACPAC extended the invitation to Dave to serve as the panel’s provider representative due to BAYADA’s experience with Managed Long Term Services and Supports (MLTSS) and managed care implementation across a number of states. Dave accepted the opportunity and successfully delivered his presentation in front of the 17-person Commission and a public audience, which included a number of congressional staffers and CMS representatives.

Aside from Dave, participating panelists were Dennis Heaphy, a MLTSS beneficiary and expert on public health from Massachusetts’s Disability Policy Consortium, and Michelle Bentzien-Purrington, Vice President of MLTSS and Duals Integration at Molina Healthcare. Dave’s presentation focused on BAYADA’s experience in implementing Managed Care across multiple states, particularly the lessons learned that can translate to better implementation in future states looking toward managed care and MLTSS.

tactics for Managed Care Long Term Services and Supports MTLSS implementation success

Dave presented MLTSS implementation as a three-legged stool: Adequate rates, state supports, and federal process changes must all be in place for a successful rollout. Should one of the legs be faulty, then the entire operation is set to fail. The presentation described for the Commission:

  • The need for the state to set adequate reimbursement rates and why inadequate rates affect providers’ ability to recruit, retain, and compete, which can lead to an unhealthy provider network and, ultimately, an access to care issue
  • The need for states to protect a set adequate rate via a rate floor, and the need to regularly review and adjust this rate
  • The need for state oversight and regulation of MCOs so that providers can focus on care delivery rather than managing the administrative burdens and variable practices of each MCO
  • The importance of the federal government equalizing Home and Community Based Services with nursing home care to solve for the institutional bias that currently allows LTSS individuals to access facility care more easily than home and community-based care
  • The need for the federal government to collect uniform data so that MCOs and providers can work together to close care gaps and save the state money

Each section was accompanied by BAYADA-state specific examples, and the presentation concluded with a series of recommendations related to each of the above points. Throughout Dave’s presentation, the Commissioners and audience were engaged and following along to the accompanying PowerPoint. After his presentation, Commissioner Leanna George—the mother of a child currently living in an Intermediate Care Facility—positively commented that rate floor setting was as avenue towards ensuring adequate reimbursement rates that she had not heard of before.

During the Q&A portion of the meeting, Commissioner Brian Burwell asked that each panelist state which area of MLTSS the Commission should focus their research and attention. The other panelists echoed Dave’s sentiments regarding federal changes to rebalance HCBS with nursing home care to remove institutional biases that continue to affect beneficiaries who wish to remain at home.

After the panel wrapped up, Commission Chair Penny Thompson approached Dave to compliment him on his presentation, and Dave has already been contacted by MACPAC’s Executive Director Anne Schwartz regarding his future support and counsel on MLTSS. GAO is ready to work with the Commission on next steps and is excited to be at the table to help recommend policies that are favorable to home care providers.

Thank you to all BAYADA colleagues that assisted Dave in the research and creation of this presentation:

  • Alisa Borovik
  • Melissa Burnside
  • Lee Dobson
  • Linda Hughes
  • Kelly Lawson
  • Louise Lindenmeier
  • Matthew Lippitt
  • Kerry Meabon
  • Tara Montague
  • Laura Ness
  • Jennifer Vranich

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.

Ambassador Spotlight – KSP recruiting manager has the “Wright” stuff when it comes to Advocacy!

Submitted by Mike Sokoloski, Manager, Grassroots Advocacy

Lindsey Wright is the Ambassador that is always looking to help, like the first time I met her. -GAO Director Laura Ness and I were on our way to the PA Art Museum, next to the PA State Capitol. As we approached, there was Lindsey.  She was waiting on the sidewalk and on the phone talking and guiding a colleague to the building for our PA Legislative Day.

At the 2017 PA Legislative Day, Lindsey was able to spend 45 minutes with Senator Daylin Leach.  -It was a very candid conversation addressing all of our concerns, but specifically presumptive eligibility and an increase in the PAS rate for home care employees who work so hard for our clients.  Lindsey fostered this relationship with the senator.  She kept in touch with the district office director for Senator Leach, Judy Trombetta.  Lindsey worked diligently with two BAYADA Pediatric offices (PAO and WGP) to provide sponsorship for Senator Leach’s Kids Fair in Philadelphia, and Lindsey volunteered at the event!

In July, GAO coordinated a Client and Family Day at Temple University Kiva Auditorium.  GAO staff, CRO Division office and field employees, clients, and families had interactions with Philadelphia area elected state government legislators and discussed the pressing needs of our field staff, clients, and families.  The first person at the auditorium that day to assist with anything we needed: Lindsey Wright.

 

Presumptive Eligibility Legislation Introduced in the House and Senate

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

The work of the Pennsylvania Homecare Association, Pennsylvania Health Law Project, and the Elder Law Attorneys has led to presumptive eligibility legislation being officially introduced in Pennsylvania’s General Assembly. The bill numbers are S.912 and H.1829.  The legislation will allow individuals to be presumed financially eligible for home care services. This will greatly expedite the process and allow individuals to access the care they want when they want it. Since being introduced GAO has been working to obtain additional co-sponsors for both pieces of legislation. So far, we have 24 House sponsors and 16 Senate sponsors.

More work is still needed.  Please take a moment to email your state legislators and ask them to support the legislation.

Click here to tell your legislators to support equalized access to home and community based services.

See the full list of sponsors here:

 

 

 

 

Lotus Ladies Connect with the Republican Women of the PA House of Representatives

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

Government Affairs Office (GAO) Senior Associate Alisa Borovik, Senior Manager Emilie Bartolucci and I spent an evening at the Pennsylvania Homecare Association headquarters near Harrisburg with house republican Representatives.  During the event, we had the opportunity to thank our current sponsors of our presumptive eligibility legislation and discuss the need to increase the personal assistant services rate for our aides.  The event was well attended by over 10 republican legislators.

PA Legislators: Co-sponsor Presumptive Eligibility

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

Recently, Senator Michele Brooks and Representative Aaron Berstine have circulated co-sponsor memos for legislation they are introducing.  The legislation allows individuals to be presumed eligible for home health care; a practice commonly known as “presumptive eligibility”.  This bill will help to increase access to care for potential and current BAYADA clients who don’t want to wait for their full applications to be processed before receiving care at home.  Specifically, the bill allows home health care agencies to presume that a client will be eligible for Medicaid and to start providing services while the full application is pending.  These clients need care as soon as possible, and this legislation will help give them that care.  The more support we can garner for this important legislation, the easier it will be to get the legislation passed.  I urge you to email your state legislators and encourage them to become co-sponsors of the presumptive eligibility bill by clicking here.

 

Advocacy to Equalize Access Continues in Pennsylvania

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

Last week, the Pennsylvania Homecare Association (PHA) and I met with House Public Health Chairman Matt Baker to discuss the best path forward regarding our legislation, which begins to equalize access to presumptive eligibility. During the discussion, we considered potential bill sponsors, a potential legislative hearing, and potential today blocks. The bill language will now go to the Legislative Reference Bureau for approval and formatting. This is the final step before a co-sponsor memo is released and we can activate our advocates and ask for legislative sponsors. More updates coming soon.

Government Affairs Office Completes Harrisburg, PA Office Blitz

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

This week, Chief Government Affairs Officer Dave Totaro and I met with more than 15 different legislators and staff in Harrisburg. The intent was to follow up from our lobby day to answer any additional questions and concerns they may have regarding the personal assistant services (PAS) increase and the pending presumptive eligibility language. Although it is a tough budget year, legislators understood our need to increase the PAS rate and pass presumptive eligibility. In the coming weeks, the Government Affairs Office (GAO) plans to follow up with all legislators as they begin budget negotiations.

Legislative Roundtable and Ambassador Relationship Leads to Action in PA

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

Recently, Community Liaison and 2016 BAYADA Ambassador of the Year Mike Sokoloski hosted a roundtable with PA Representative Aaron Kaufer.  BAYADA started building a relationship with Representative Kaufer before he was elected to the General Assembly.  As a result of our relationship, Representative Kaufer took an interest in our issues early on and learned more about the state’s human services programs.

During the roundtable, we spoke about our need for increased reimbursement rates for personal assistant services under the Office of Long-Term Living and the need to equalize access to home and community based service by allowing presumptive eligibility*.  Equalizing access was an issue of great interest to Representative Kaufer, and since the roundtable, the Government Affairs Office (GAO) has been in touch with the Representative multiple times to determine next steps in the process.

GAO looks forward to working with Representative Kaufer and others to ensure presumptive eligibility is allowed for home health care in the state.

*Presumptive eligibility: Individuals can be presumed eligible for Medicaid services while their full application is being processed.  Presumptive eligibility grants greater access to care and allows the individual to receive medically necessary treatment.