With April 1 come and gone, HCA is focusing our energy on post-budget legislative solutions – some measures already introduced as standalone bills; some which gained an initial foothold in the early stages of the budget; and others geared up for new introduction.
Below are some of HCA’s core post-budget priority areas, including bill numbers (where assigned), as well as areas for which we have legislation ready for introduction.
Reimbursement
Most pressingly, HCA is seeking sponsorship of legislation to achieve the following much-needed and long-overdue home care and MLTC financial stabilizing actions:
- An increase in the rates for Certified Home Health Agencies (CHHAs), including a modification of the state’s Episodic Payment System methodology to enable the coverage of costs not currently represented in the base rates. (HCA pressed for similar rate language during the state budget process; we also offered a complementary revenue option to pay for it, through an asthma management program that the Senate included in its one-house budget measure. We are working to progress on these areas post-budget.)
- Accountability in the state’s setting of rates for Managed Long Term Care (MLTC) plans and providers, including transparency in the actuarial soundness of rate calculations for MLTCs/providers, and relief from the continuing cascade of unfunded mandates. (A version of this measure was included in the Senate’s one-house budget bill, and HCA will be pursuing it as a standalone measure post-budget).
CHHAs are especially vulnerable in the current rate structure, not having had a fee-for-service update in over ten years, while subjected to rate rebasing reductions, unfunded mandate costs, and contractual rate instabilities and accounts-receivable balances that have caused extensive and serious operating losses.
Meanwhile, the recent closure of two MLTC plans, a reported 64% of MLTCs shouldering operating losses, and similar losses reported by Licensed Home Care Services Agencies (65%) and CHHAs (72%), all validate the need for accountability in the rate structure for core operational costs in home care and MLTC.
Workforce
HCA has already advanced a package of workforce bills, including S.1420 (Serino)/A.6768 (Bronson) and S.1359 (Serino)/A.6901 (Bronson). (To learn more about some of the crushing workforce challenges in home care, see the statistics from our annual state of the industry report). We urge your co-sponsorship of our existing workforce bills and legislative introduction of proposals that:
- Provide a new rate adjustment for home care, hospice and MLTCs targeted to workforce shortage areas and disciplines.
- Promote pipeline development in schools, professional programs and the broader workforce to increase entrance into the home care/hospice fields.
- Make structural changes to enable home care/hospice competitiveness for workforce in the overall labor market.
- Direct state promotion of home care and hospice as valued careers.
- Facilitate workforce efficiencies, such as allowing home care providers to use the Home Care Worker Registry to input/track mandatory annual in-service hours of home health aides and personal care aides.
In addition to the bill numbers referenced above, we will report back to you soon on new, complementary measures that support our workforce proposals and agenda.
Home Care Reinvestment and Pay-For Options
HCA has already advanced the following bills that are good for patients while also providing potential financing options for our rate and workforce funding proposals. Please consider cosponsoring and supporting these measures on their own merit and/or to achieve budget-neutrality and provide a fiscal base in support of home care rate stabilization and workforce investment as outlined above. Among the proposals are: home care asthma management, mental health collaboration, sepsis intervention, and health disparities measures:
- S.1816 (Rivera)/A.3836 (McDonald): Supports incorporation of home care in the state’s public health, prevention and primary care strategies.
- S.1817 (Rivera)/A.3839(McDonald): Supports implementation of home care sepsis screening and intervention (learn more about this endeavor and sepsis mortality/morbidity statistics here), as well as cross-sector sepsis collaboration by home care, physicians, hospitals, EMS, et al, along with collaborative community health education to address this top nationwide killer and number-one driver of hospital readmissions.
- S.3872 (Carlucci)/A.6566-A (Gunther): Provides state waiver authority to support reimbursement and services for mental health-home health provider collaboration under HCA’s and the Office of Mental Health’s (OMH) home health-mental health collaboration law signed by the Governor last fall.
- S.4742 (Sanders)/A.6772 (Peoples-Stokes): Promotes home care-physician-hospital collaboration models to address health care disparities.