This session, our major legislative goal in Maryland is to increase the Medicaid LPN rate across all programs and client groups from $34.16 to $42.81. It is an ambitious goal—initial budget estimates place the cost to the state at $26 million per year. With neighboring states reimbursing LPN care at $45, $46.14 and $50 per hour, it is easy to see why there is such a problem of access to care across Maryland. The low reimbursement simply does not support a sufficient wage to be able to consistently recruit and retain the skilled nurses that we need to be able to commit to serving a larger number of clients.
Problems within the Maryland Department of Health and a general lack of transparency have hindered this effort in past months. There have been a few targeted data points essential to such a large budget ask that BAYADA and Maryland-National Capital Homecare Association (MNCHA) through our best efforts, have been unable to obtain.
We started this session asking key legislative champions to help us get this information, using their political pressure to get information from the Department of Health or to introduce legislation that would establish an oversight working group to investigate the issue. Several legislators have been deeply troubled by the idea of children and adults with disabilities being unable to access the skilled nursing care they need to remain at home safely and have stepped up to help. This information, and the support we are gaining from those in key positions to move this effort through to becoming law, is a key step in increasing this LPN rate.
Thank you to Ambassadors Dan Guidebeck, Nikita Mutter, and Matt Paske for joining in legislative meetings and sharing the stories of how this issue impacts our clients and employees. Your commitment to advocacy reminds me of why we do what we do every day.
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 temporaryrate 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.
On Thursday, October 26, the BAYADA NJ PAC hosted a fundraising event in Trenton honoring 7th District Assemblyman Troy Singleton. Attendees included 7th District Assembly candidate Carol Murphy, representatives from the home care industry and other industries supportive of Assemblyman Singleton, who is currently running for the 7th District Senate seat.
Chief Government Affairs Officer David Totaro welcomed Assemblyman Singleton and thanked the many sponsors and attendees who contributed over $13,000 in support of the Assemblyman’s campaign. Assemblyman Singleton has been a supporter home care, our clients, and employees for many years. He recently sponsored legislation that will mandate managed care companies to reimburse the Personal Care Assistant (PCA) Program at no less than the state’s fee-for-service rate.
In July, Assemblyman Singleton introduced new legislation to increase the reimbursement rate under state fee-for-service for private duty nursing by $10 per hour. During the event, BAYADA recognized Assemblyman Singleton as the “Legislator of the Year” for his ongoing commitment to making home care better and stronger, as clients and families deserve the care they need in the setting they prefer: their own homes.
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 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.
On July 13, Assemblyman Troy Singleton and Senate Majority Leader Loretta Weinberg introduced legislation A5089/S3400 which increases the New Jersey private duty nursing rate under State Fee-For-Service Medicaid by $10 per hour for registered nurses and licensed practical nurses. The last rate increase for private duty nursing was in 2008. BAYADA has been working with the Home Care Association and other providers discussing the need for a rate increase as it is difficult to recruit and retain nurses. BAYADA did an internal study and found of the scheduled hours, only 72% of those hours were filled, leaving clients and families without care.
Submitted by Lee Dobson, Area Director, NC Government Affairs (GAO)
Legislative successes, like the Medicaid rate increase for nursing last year and the home health aide increase this 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 ambassadors 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 ambassador.
Submitted by Lee Dobson, Area Director, Government Affairs (GAO)
Republican Sen. Tommy Tucker of Union County announced that he won’t seek a fifth term in 2018. Sen. Tucker co-chairs the influential Senate Finance Committee. “I have long believed in term limits for judges and politicians,” he said in a statement to the Charlotte Observer. “After serving four terms in the N.C. Senate, the time has come for me to allow others to step in and serve Union County and our state.”
Our relationship with Sen. Tucker started back in 2011 when Hearts for Home Care Ambassador John Morris and I visited with him in his district office to introduce him to BAYADA and home care. That visit led to a home visit where he was able to see first-hand the impact home care has on his constituent. Over the years and as he rose through the ranks, we met with Sen. Tucker numerous times, attended legislative receptions for him, as well as, visited with him at Lobby Days. His door is always open for BAYADA. He was instrumental in ensuring the CAP-C rate increase for nursing was put in the Senate’s budget and that it was ultimately passed. Sen. Tucker was BAYADA’s Legislator of the Year 2016. We thank Sen. Tucker for his commitment and support of our staff and clients. His vision and leadership will be missed.
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.
Submitted by Lee Dobson, Area Director, NC Government Affairs (GAO) and Shannon McCarson, Regional Director, Dogwood Group (DOG)
We worked together and made it possible. After many years of advocating for higher reimbursement rates within the state Medicaid programs, we finally received an increase in the hourly rate for personal care services (PCS). This achievement was made possible through the persistent advocacy efforts of our employees, clients, families, and government affairs team. Our Hearts for Home Care Advocates participated in email campaigns, home visits, legislative roundtables, home care lobby days in Raleigh, and professional lobbying efforts.
As a result of working together, this week assistive care state programs directors throughout the state were thrilled to pass along an increase to our deserving CNAs and HHAs who care for our Medicaid clients and have stuck with us through thick and thin.
Directors have been personally speaking to staff to share the great news. “One by one, as I spoke to our aides, I heard the same thing – gratitude, appreciation, tears of joy, and, yes relief, too,” said Mimosa (MIM) Division Director Joe Seidel. “The low Medicaid reimbursement rate made it impossible to pay more. I am glad to do it now.” This rate increase is a good place to start, and more needs to be done.
Let’s keep the momentum going by joining to be a Hearts for Home Care Advocate. We believe our aides deserve even more for the important work they do in keeping our clients safe at home. If you are not already part of our advocacy group, join today at heartsforhomecare.com to receive alerts that could influence future efforts to increase pay rates.