At the end of June, 2017, through the efforts of our Ambassadors, our industry partners, our clients, and our legislative champions, the Rate Floor Bill passed the Delaware General Assembly.
This year, in the second year of Delaware’s two-year legislative session, our major legislative goal is to achieve an increase in the Medicaid fee schedule for RN and LPN hourly care. These two rates have stagnated since 2006. We are asking the legislature to update both according to the Consumer Price Index. Doing so would move LPN care from $46.14 to $56.01 and RN care from $51.50 to $62.51 per hour.
Our initial meetings with key members of the Joint Finance Committee have been very positive. We are working with them to include increased funding for this request in this year’s budget. If successful, our MCO contracts would have to be renegotiated so that reimbursement would be equal to or greater than the new fee schedule amounts.
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.
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.
Submitted by Louise Lindenmeier, Director, NJ Government Affairs (GAO)
Chief Government Affairs Officer Dave Totaro, State Assistive Care Practice Leader Eric Thul, and Director, Strategy & Value-Based Partnerships Matt Lippitt met with New Jersey Governor Chris Christie to discuss the recently signed law which sets a floor for minimum reimbursement under managed Medicaid for Personal Care Assistant Care. Our team explained the challenges under managed Medicaid, how reimbursement is used to support personal care services, and the wage needs of the home health aides. The meeting was very informative for both the Governor and us, and served as an excellent start towards addressing the unintended consequences of the Governor’s conditional veto.
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)
On August 16, Representative John Fraley visited with staff from our Lake Norman adult office before heading to meet with his constituent, our client, Mr. Bachner. Associate Lauren Keys, the Hearts for Home Care Ambassador who organized the home visits, commented “Rep. Fraley came prepared with good questions about home care and Medicaid reform. While he doesn’t sit on a health committee, he wanted to learn about our issues.” Clinical Manager Mary Hope Milligan and Client Services Manager Lucas Reives both described our recruiting challenges.
Mr. Bachner, a 90-year old WWII, Korean, and Vietnam vet, was a delight. He shared many stories of his life, his children, and his service to our country. It was especially heartwarming to hear how he met his wife, Cora, and after a week proposed marriage – a marriage that lasted 60-year.
While Mr. Bachner is satisfied with his Veterans Administration (VA) benefits, we took this opportunity to share with Rep. Fraley the disparity between VA and Medicaid and how difficult it is to staff under Medicaid because the rates are so low. As a retired businessman, Rep. Fraley understood and said, “Thank you for opportunity to meet with BAYADA staff and Mr. Bachner. This was a good learning experience for me, as well as, a treat!“ As our meeting concluded, he commented that all he needed to remember was that we’re looking to get to $17.00 per hour next session.
Submitted by Louise Lindenmeier, Director, NJ Government Affairs (GAO)
Governor Chris Christie conditionally vetoed A320/S1018, which sets a minimum managed care reimbursement rate for the Personal Care Assistant program at the state’s fee for service rate. His veto addresses a wage pass through, budget funding for fiscal year 2019, removal of the Consumer Price Indices adjustment every 5 years and included an audit process for the increase in reimbursement. On July 31, the bill went back to the Assembly where it received unanimous support by the legislature. The Senate will vote on the bill when they reconvene for it to become law. The Government Affairs Office (GAO) will work with the industry on how to address the new stipulations within the bill.
Submitted by Shannon Gahs, Director, MD Government Affairs (GAO)
Over the last two weeks, the Government Affairs Office (GAO) has been busy behind the scenes, building a coalition to advocate together for increased reimbursements in pediatric care. Working together, we show that this is an issue that matters not only to us as a potential provider in this area, but to clients, their families, our trade association, and current providers. We are stronger together than we are individually!