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

PA GAO: 2017 Wrap Up and 2018 Planning

2017 proved to be another eventful year for home care in Pennsylvania.  Notably, MCO implementation of the increased pediatric rate went into effect on January 1, 2017. As a result, our pediatric offices have been able to implement various programs for our nurses including increased wages, benefits, and bonuses throughout the year.

Early in 2017 the PA Government Affairs Office (GAO) worked with NJ GAO Director Louise Lindenmeier to lobby against New Jersey Governor Christie’s intent to end the NJ/PA tax reciprocity agreement. We were successful in getting the over 40-year agreement reinstated, thus saving BAYADA employees over $6 million in taxes.

Throughout the year we were active participants in PA’s move towards full implementation of Community Health Choices (CHC).  Our participation, as well as that of others in the industry, resulted in a temporary rate floor for personal assistance services. The rate floor ensures that implementation of CHC will not result in rate cuts for services within the program.

In May we submitted comments in favor of an “open” electronic visit verification (EVV) system, which would be more beneficial to our employees and to BAYADA than a closed system. The administration heard our concerns and is now planning to implement an open system. See our next article to learn more about PA’s EVV system.

Finally, PA took unprecedented steps by introducing legislation which would allow deemed eligibility for home care.  This legislation takes a big step toward equalizing access to home and community based services as it would allow those who appear to financially qualify for nursing home services to be deemed eligible for home care services as well.  After the legislation was introduced it was voted unanimously out of the House Public Health and Appropriations Committees and was voted out of the full House unanimously. Next up in the long and winding legislative process: The bill will now be considered in the Senate.

Towards the end of 2017 the PA GAO conducted a needs assessment with our PA division directors. Upon completion of the needs assessment our PA GAO Advisory Council met and recommended the following priorities for 2018:

  • Increase the personal assistance service rate by an average of 10%, creating a statewide reimbursement rate of $20.58 by 6/30/18.
  • Pass deemed eligibility for home care through legislation by 4Q18 (continuation of 2017 goal).
  • Allow physician signatures to be obtained within 30 days instead of 7 days.
  • Include requisite reimbursement increases in any state minimum wage increase.
  • Pass drug disposal legislation for Hospice.
  • Support the passage of Pennsylvania Orders for Life-Sustaining Treatment (POLST) legislation.
  • Lay the foundation for rate floor legislation in Pennsylvania.

Our PA legislative priorities have been approved by BAYADA’s Chief Executive Officer. We are looking forward to an exciting and challenging year ahead! Thank you to all PA staff, clients and families for your support and commitment to advocacy. Your efforts are paramount to our efforts to ensure that all Pennsylvanians can live a safe home life with comfort, independence, and dignity.

 

NJ GAO 2017 Year in Review

As I reflect on 2017 and what we have accomplished, the first thing that comes to mind is Thank You. Thank you for your support, your engagement and your advocacy efforts — all of which made a difference in the lives of our clients, families and employees.

2017 was the “Year of Client Advocacy and Engagement.” Clients and families engaged lawmakers and the community at-large through home visits, family support group meetings, and phone calls and meetings with lawmakers in Trenton. These efforts ensured that our aides, nurses, and the importance of home care remained top of mind to New Jersey representatives and senators.

2017 was successful in many ways and set us up for even bigger wins in 2018. Below, please find a summary of 2017’s priorities and accomplishments:

• The Managed Medicaid Rate Floor bill was signed into law, effective July 1, 2018. The new law mandates a 100% pass-through of increased reimbursement to aides. In 2018 we will introduce a new bill which will be more reflective of a competitive wage environment and will mirror the original bill with no mandated pass-through.

• The Personal Care Assistant (PCA) fee-for-service rate was raised from $18.00 per hour to $19.00 per hour through a budget resolution, effective July 1, 2017.

• We successfully lobbied against Governor Christie’s intent to end the NJ/PA Reciprocity Tax agreement. This accomplishment saved our employees and BAYADA thousands of dollars in taxes.

• In July, the Private Duty Nursing (PDN) bill was introduced. This bill’s aim is to raise the PDN reimbursement rate by $10 per hour for RNs and LPNs. While the bill did not ultimately pass the state legislature in 2017, it brought awareness to the need for higher reimbursement rates within the program. We will continue to pursue this bill’s passage as a major goal for 2018.

• In conjunction with NJ’s Home Care Association, we successfully lobbied for legislation that permits physical therapy aides to practice in clients’ homes as long as the aides are supervised by a licensed physical therapist every two weeks.

• The BAYADA Champion Awards were held in December. This year we honored Lieutenant Governor-elect Sheila Oliver, Assemblywoman Nancy Munoz, Assemblyman Paul Moriarty and Senator-elect Declan O’Scanlon for their unwavering support of home care.

• BAYADA hosted a fundraiser for Senator-elect Troy Singleton, raising over $13,000 for his election fund.

• BAYADA reviewed and submitted comments to the state regarding the new 10:60 home care regulations.

Looking ahead to 2018, we will be working with Governor-elect Murphy and NJ legislators new and old to continue to advance home care and community-based services for our state’s neediest populations. GAO seeks to push for new laws to improve reimbursement rates within the PDN program, introduce legislation to provide technical changes to the current PCA managed care law, pursue minimum wage law changes, address parking challenges for our nurses and, of course, continue to advocate on behalf of our employees, clients and their families.

Cheers to an exciting year ahead! If you would like to get more involved in New Jersey’s advocacy program, sign up to become a Heart for Home Care Advocate.

It’s In DE Governor John Carney’s Hands

Submitted by Shannon Gahs, Director, DE Government Affairs (GAO)

The rate floor bill we’ve worked so hard on, now sits on Governor John Carney’s desk.  Many bills passed in the last days of session, at the end of June, each requiring his consideration before he signs them into law or vetoes them.  HB200, which sets a “rate floor” or minimum reimbursement rate for Registered Nurse (RN) and Licensed Practical Nurse (LPN) level nursing care equal to the Delaware Health and Social Services (DHSS) fee for service rates, would help ensure home health care clients across the state have access to care.  We have sent him information about why this bill is so important to our clients and employees and we await his decision.  The bill becomes law and is effective upon his signature.

 

Delaware Rate Floor Bill Passes

Submitted by Shannon Gahs, Associate Director, DE Government Affairs (GAO)

The General Assembly, in the wee hours of the morning on the last day of session, passed the rate floor bill! This measure will ensure that Managed Care Organizations (MCOs) hourly home health care rates for registered nursing (RN) and licensed practical nursing (LPN) care will never fall below Delaware Health and Social Services (DHSS) hourly rates. This will help to ensure access to home health care for Delawareans with disabilities, and giving providers the ability to make informed business decisions. Dedicated effort by our BAYADA team of clients and employees, in partnership with the Delaware Association for Home and Community-Based Care and other home health care providers, made this possible. Thank you for your emails, phone calls, and attendance at Advocacy Day in Dover. This bill will go into effect when Governor John Carney signs it.

Delaware Rate Floor Bill Passes House Committee

Submitted by Shannon Gahs, Associate Director, DE Government Affairs (GAO)

Following compelling testimony by clients Nancy and Christopher Lemus, Delaware Association for Home and Community-based Care (DAHCC) President Bob Bird, Delaware Pediatrics (DP) Associate Director Mandy Brady, and myself, the House Health & Human Development Committee passed a bill that would set a minimum reimbursement rate paid by Medicaid managed care organizations (MCOs) to home health care providers for skilled nursing services.
Representatives asked probing questions, sparking true debate over the measure. The vote was 10-0 with 4 additional members absent. The bill must still pass the full House, the Senate Health, Children & Social Services Committee, and the full Senate. The legislature closes on June 30. If this bill passes, MCOs would not be able to pay any less than the Department of Health and Social Services (DHSS) pays for the same care, giving DHSS the ability to ensure access to needed services.

Nancy Lemus giving testimony at the hearing

Rate Floor Bill Introduced in Delaware

Submitted by Shannon Gahs, Associate Director, DE Government Affairs (GAO)

Following a concerted education effort and participation by many members of the home health care industry, HB200, which sets a “rate floor” for skilled nursing paid by Medicaid managed care, has been introduced. Nine members of the legislature have said that home health care matters to them, and are sponsoring the bill. Every home health care provider who answered an industry-wide survey said their number of unfilled hours has increased over last year. HB200 would go a long way toward ensuring access to skilled nursing for home health care clients across the state. If the bill becomes law, managed care organizations would not be able to pay less than the Department of Health and Social Services pays directly for similar services.

Delaware PAC makes amazing gains at Awards Weekend 2017

Submitted by Shannon Gahs, Associate Director, MD Government Affairs (GAO)

The Delaware PAC is BAYADA’s newest PAC, with Awards Weekend being the first major push for members.

The DE PAC recruited 16 new members during Awards Weekend, pulling in an annual total of over $3,800! GAO is doing a lot of work educating legislators about the impact home health care has in DE by keeping families together and helping clients remain at home instead of using more costly nursing facilities and hospitals. In Delaware this year, we are asking the legislature to set a rate floor for skilled nursing services paid for by MCOs. PAC members make a personal statement that BAYADA in Delaware matters to them.

PA Office of Long-Term Living Announces Temporary Rate Floors

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

Last week, during the Pennsylvania Homecare Association Annual Conference, Deputy Secretary for the Office of Long-Term Living (OLTL) Jen Burnett announced Managed Care Organizations (MCOs) will be required to reimburse providers at least the state posted fee-for-service reimbursement rate for personal assistant services. This “rate floor” will be in effect for the first 36 months post transition of each region. After the announcement, I had the opportunity to speak with Deputy Secretary Burnett, and she stated the reason OLTL made that decision was to provide stability for providers. During our conversation, I asked that her office consider extending the temporary rate floor to registered nurse (RN) and licensed practical nurse (LPN) services as well for the same reason. She invited us to meet with her formally to discuss. BAYADA’s Government Affairs Office (GAO) will work to set up a meeting with OLTL to lobby for the inclusion of RN and LPN services in the 36-month rate floor.

Delaware: Now’s The Time for Advocacy!

Submitted by Shannon Gahs, Associate Director, DE Government Affairs (GAO)

The Delaware General Assembly has recessed until April 25, making now the perfect time to reach out to your legislators to schedule a visit with one of our clients or a discussion in your office.  Support for our rate floor bill is growing.  This bill would strengthen home health care across the state, ensuring that reimbursement rates from Medicaid-contracted organizations would be no lower than Medicaid pays directly.  This would enable all home health care providers to make informed business decisions, with the assurance that private rates would never fall below that “floor.”  We already have bipartisan support in the House.  We’re meeting with additional representatives and moving to build support with senators on both sides of the aisle as well.