In 2019, GAO and industry advocacy led to the successful renewal of the Cost of Living Adjustment (COLA) of 1.9% for Medicaid reimbursement rates for Certified Nursing Assistant (CNA) and Skilled Nursing services. This adds an additional $232,941 to BAYADA’s annual revenue, and $26,535 to the company’s annual operating surplus.
The first-in-the-nation COLA adjustment was included in 2018 state legislation as a result of the advocacy efforts of GAO, client and employee Ambassadors and advocates, and Rhode Island industry partners, as well as a public affairs campaign that led to local print and broadcast media coverage on the need for regular rate reviews to ensure that reimbursements for home care services were adjusted annually to keep up with real costs of living and conducting business.
By continuing to advocate for the renewal of the COLA increase every year, then Rhode Island service offices will be able to—at their discretion—increase field staff wages, thereby increasing caregiver recruitment and retention rates and enabling clients to experience less missed shifts.
BREAKING:Due to GAO, BAYADA, and industry advocacy, RI Governor Raimondo has already proposed a 5.9% increase for skilled nursing and CNA services in the 2020-2021 budget! If successfully passed through both chambers in the state house, effective July 1, 2020, this increase will add $219,791 to BAYADA’s yearly revenue, and $65,937 to BAYADA’s annual operating surplus.
Thank you to our RI staff and clients for your continued commitment to advocacy on behalf of all of Rhode Island’s caregivers, and the medically fragile and vulnerable populations!
For most people, turning 21 is a milestone to celebrate. But the State of Rhode Island is putting undue pressure on medically complex Rhode Islanders who are turning 21. For those who receive home care services under Medicaid, such as the Katie Beckett waiver, their medical coverage changes on their 21st birthday, which affects who pays for their services, the types of services available to them, and their state-authorized hours and funding levels. Without proper planning and communication, these changes can result in uncertainly of continuity of care and access to home care services.
For young adults like Zach, Corinna, Brandon, and their families, turning 21 has been a source of significant stress and uncertainty rather than the celebration it deserves to be. Upon “aging out” of Medicaid, they have received word from the state that their care would be changing without much warning. Parents of medically complex individuals tend to be lifelong advocates on behalf of their children, and so all three have been able to retain their services on a month-to-month basis. “This is just a band-aid that covers the issue,” says BAYADA Home Health Care’s Government Affairs Director Ashley Sadlier. “Each month, they don’t know whether that band-aid will stay on or get ripped off. Everyone deserves to stay at home if it’s their wish to do so, and it’s arbitrary that a birthday is basically a penalization in Rhode Island.”
The interesting fact is that the State has already created a policy stating that home care children and their families are to be educated on their options by the age of 17. But Rhode Island has not upheld its end of the bargain: Families find that they receive little to no communication from the State, and that when they reach out to find out their children’s care options, the State is slow to respond and typically unable to provide proactive guidance to help families navigate this change . “Modern medicine and advances in home care have allowed for many children to live past the age of 21. That should be a reason to celebrate, not a reason to cut an individual’s services off suddenly,” says Corinna’s mother Michelle. “Home care saves the state money, and it keeps families together. Why would you put a child in danger when it’s clear that home care has enabled them to live their best life?”
Families, home care providers, and and other organizations across the state are currently working with the State to identify a solution. Without home care, clients stand a greater risk of infection, hospitalization, or even a permanent move to a skilled nursing facility. Parents know that a child doesn’t stop being your child when they reach adulthood, but it’s time that Rhode Island recognize this as well.
Last year was Rhode Island’s first year with a full-time Government Affairs Office (GAO) program—And what a year it was. Together with our Rhode Island office staff, field staff, clients, and families, we were able to band our voices together in advocacy to achieve monumental increases on behalf of our staff and clients.
As a result of our efforts, the State increased Medicaid rates for certified nursing assitants (CNAs), and to the State’s private duty nursing (PDN) program. These increases allow BAYADA to raise field workers’ wages and better compete for a larger segment of the workforce. As a result, BAYADA is in a better position to recruit and retain the staff necessary to keep up with demand, and Rhode Islanders are poised to see increased access to reliable, consistent care.
Our work is far from done. BAYADA’s GAO, along with the continued advocacy of so many of you, is focusing on four key issues at this time:
Priority #1: Continued COLa Adjustments
The 2018 increases also included a first-in-the-nation Cost of Living adjustment (COLa), which will provide additional increases to Medicaid rates every year based on the Bureau of Labor Statistics’ Cost of Medical Services annual adjustment. Our first majority priority for 2019 is to ensure that the state keeps its commitment to COLa and includes it in the state budget each year. If passed, this year’s COLa will add an additional 1.9% to current rates to ensure they remain consistent with actual, determined cost of living increases. In March, GAO director Ashley Sadlier testified in support of this important adjustment in front of the House and Senate Finance Committees alongside other supporters. At this time, we see no opposition and continue to monitor COLa through the state’s budget process.
Priority #2: High Acuity Skilled Nursing Rate Modifier
One major issue that Rhode Island’s skilled nursing offices often face is recruiting the specialty-trained nurses necessary for more complex, high acuity clients. Luckily, home care supporters in the House agree. Recently, representatives Patricia Serpa and Mia Ackerman introduced House Bill 5621, which calls for a 10% increase to Medicaid reimbursement rates for nursing services provided to clients with tracheostomies and/or ventilators. The bill has taken the next step in the legislative process by being referred to the House Finance Committee. Currently, GAO is awaiting a date for the bill to be heard. If you, a loved one, or your staff or clients would benefit from such a bill, please reach out to email@example.com! We hope to have a strong showing of support at the state house when the bill moves forward and we would love your help.
Priority #3: Helping Pediatric Clients Transition to Adult Clients
BAYADA has collaborated with the Rhode Island Partnership for Home Care (RIPHC) to advocate for additional resources for pediatric clients currently receiving home nursing services who are transitioning to adult services. Currently, clients that are transitioning face many challenges navigating the system, especially when determining what programs and services they are eligible for. BAYADA and the Partnership have met with the Executive Office of Health and Human Services (EOHHS), the Department of Behavioral Healthcare, and Developmental Disabilities and Hospitals (BHDDH) and Managed Medicaid, to create plans on how to streamline the process for this population and expand eligibility options for families. To date, several BAYADA clients have transitioned to a more appropriate program for the level of care that they require. GAO looks forward to continuing to help our partners at the State to develop plans to ensure parents, caregivers, caseworkers, schools, and agencies are equipped with the resources necessary to assist families in navigating the challenges of transitioning from pediatric to adult home care services.
Priority #4: Continued relationship-building
While 2018 brought success to Rhode Island’s home care front, GAO continues to build relationships to ensure that legislators and regulators understand the importance of home care to so many of Rhode Island’s families, and support policies that ensure its accesibility. Recently, alongside the Partnership, GAO director Ashley Sadlier met with Rep. Joseph McNamara, the Chairman of the Rhode Island House of Representatives Committee on Health, Education and Welfare. Rep. McNamara is in a key role to influence legislation, and BAYADA looks forward to continuing to be a valuable partner to Chairman McNamara—and many other key legislators and regulators—on issues such as employee training and supervision, access to care, and challenges that providers, employees, and families see within the home care industry.
BAYADA’s Government Affairs Office (GAO) always seeks new ways to accomplish BAYADA’s legislative goals. In the past two years, GAO solidified a grassroots advocacy team to engage staff, clients, and families in advocating for better home care rates and policies. Even more recently, GAO has begun to see how much media attention on home care issues can further our message and help us reach our legislative goals.
Earlier this year, BAYADA contracted with Regan Communications to bring attention to the need for a state Medicaid reimbursement rate increase. Regan helped BAYADA gain the media coverage necessary to reveal Rhode Island families’ access to care issues and the bleed-out of in-home nurses, who are better paid to do similar work in other settings and neighboring states. Regan was able to assist BAYADA in gaining the momentum necessary to successfully bring the increase across the finish line!
GAO is pleased to announce that BAYADA has extended our contract with Regan through the end of the year. Additionally, GAO is exploring a more extensive contract with Regan across our major media markets, and has expanded our in-house public affairs program with Public Affairs Manager Alisa Borovik.
Below, please find the media coverage that Regan Communications helped BAYADA earn throughout our campaign for increased reimbursement rates for in-home skilled nursing services
GAO is excited to announce its first legislative accomplishment in Rhode Island: A Medicaid rate increase for personal care and skilled care services! The 10 percent increase to CNA services and 20 percent increase to nursing services are effective as of July 1, 2018. The State of Rhode Island intends to implement these rates by October 2018 and payments to services will be made retroactive. This increase will allow for BAYADA’s Rhode Island service offices to recruit and retain more quality caregivers and care for more Rhode Islanders that want to remain independent and healthy at home with their families.
We couldn’t have done it without you. BAYADA staff, clients, and families were instrumental in this win. Advocates submitted nearly 25 testimonies to legislators, spoke at hearings, and participated in online action alerts. While BAYADA’s Government Affairs Office (GAO) and our state partners supplemented your messages media coverage and direct lobbying to ensure continued pressure on legislators and governor, the quick and efficient mobilization of our office staff, field staff, was our secret sauce! It was inspiring to watch our advocates take initiative and transform their passion into action.
In addition to this monumental increase, the legislation included a Cost of Living adjustment (COLa), which is unprecedented. A COLa ensures that the governor and legislature must include yearly increases for these home care services in each budget going forward. The COLa will be dictated by a national database, specific to health care costs.
But our work isn’t done yet. Rhode Island’s reimbursement rates remain approximately 20-30 percent less than Massachusetts’s rates. Without additional increases, we will continue to face challenges with recruiting, training, and retaining high quality caregivers because they can make a higher wage in other settings.
This legislative session, we are continuing to educate our elected officials about why it is imperative that the state support and invest in home care services to keep our medically fragile Rhode Islanders at home. GAO has scheduled meetings with legislators, coordinated home visits and roundtable discussions with elected officials and regulators, and have developed the tools and resources necessary for our in-office and client advocates to take action.
Thank you to all our advocates – the progress Rhode Island has made is a direct reflection of your engagement and your willingness to share your stories! To learn about how you can get involved in advocacy, email firstname.lastname@example.org.
Submitted by Rick Hynick, Director of Client and Family Advocacy
On Tuesday, April 11, a crowd of people gathered at the state room in the Rhode Island State House to thank those in our state government who support the many children, adults, and their families who rely on home care. The gathering was part of an event planned on behalf of BAYADA and the Rhode Island Partnership for Home Care.
“We’re here today to thank those legislators who have listened to your conversations and heard your challenges, and have become steadfast supporters to make your lives and the lives of your children better,” said BAYADA Chief Government Affairs Officer Dave Totaro. Dave and other representatives from GAO partnered with Rhode Island Skilled (RIS) pediatrics Director Ashley Sadlier and her staff to make the event a success.
State Representative Gregg Amore was presented with a 2017 Legislative Advocacy Award for his tireless work to back the needs of his constituents and the many other residents of the state who use home care services on a daily basis. Senator Hannah Gallo was also recognized but could not be present. Additionally, Lieutenant Governor Daniel Mckee spoke about the important role home care plays in the lives of many Rhode Island residents.
Mr. Mckee and Rep. Amore continued to discuss the positive impact of home care, to the great interest of our clients and their families who were present in the audience. These families—the very people who rely on having nurses to provide clinical care to their loved ones—can offer firsthand testimony as to why home care is so vital.
Eric Olson—the father of client Liam and a long-time home care advocate—explained that the nurses who work with his son have such a connection with him. They understand that many of Liam’s movements are actually the way he communicates what kind of care he needs from moment to moment. He went on to explain that, without the close connection that the nurses have with his son, Liam would not be where he is today. With their help, he has thrived, despite his dependence on many mechanical devices. Eric went on to underscore how important it is that the families work with the elected officials, as they have the ability to make positive change.
“Our goal today was to bring enough of these voices together so we can start to make a difference. Not just for families in this room, but for all families who want to keep their loved ones at home,” Dave said. Side by side, BAYADA and the Rhode Island Partnership for Home Care provide significant support to the goals of legislators and families who depend on home care. We are working together for a better tomorrow for all home care services in Rhode Island.