Current Actions

Support ASAP Home Care Funding Line Items

Mon, 28 Apr 2025 04:00:00 GMT

The Massachusetts State Legislature is in the midst of its Fiscal Year 2025 State budget deliberations. The Senate proposed budget does not include adequate funding for key home care line items 9110-1630 and 9110-1633, which fund home care services provided through Aging Services Access Points (ASAPs) in Massachusetts.

Sen. Patricia Jehlen submitted two amendments to fully fund these line items to sufficient levels for FY26. Jehlen's amendments would raise funding for line item 9110-1630 to $293,655,704 and $115,205,880 for line item 9110-1633, to cover the actual utilization in these line items. It is imperative that these line items be adequately funded to continue the important work that the Administration, the Legislature, the ASAP and provider networks have done to increase our direct care workforce and to ensure that we will not have to create pending referral lists for these important services.

Please use this action alert below to write to your legislator to urge your Senator to support Amendments #464 and #466 to the FY26 Senate Budget.

Oppose Cuts to Medicaid Federal Funding

Wed, 26 Feb 2025 05:00:00 GMT

The House of Representatives passed their budget proposal that proposes devastating cuts to Medicaid, which would result in millions losing access to Medicaid services across the country and especially in Massachusetts. Medicaid is the lifeline that keeps disabled people and children in their homes and communities—yet Congress is considering proposals that would slash funding, impose work requirements, and limit access to critical services, including home-based care services.

These proposed changes would threaten over 1.7 million members of the Commonwealth who are currently enrolled in Medicaid; removing their access to life saving home-based care services they need/deserve.

Please use this action alert to contact your members of Congress today to urge them to oppose any cuts and work requirements.

Urge Your State Legislature to Support a Cap on Temporary Staffing for Home Health and Hospice Services

Fri, 24 Jan 2025 05:00:00 GMT

In recent years, we have seen temporary nurse staffing (TNS) agencies become increasingly active in the home health and hospice care delivery arena. Historically – home health and hospice agencies have utilized TNS’ on an emergency basis. But more recently, provider agencies have faced an influx of interest in the home-based care space by these TNS’. Because these entities demand contracts that far exceed what is currently reimbursed to home health and hospice agencies, they pose a threat to providers' ability to recruit and retain its workforce. This will threaten older adults' access to available home health and hospice services. Currently, there is a Department of Public Health (DPH) regulation which sets caps on temporary nurse staffing rates. However – the underlying Massachusetts General Law (MGL) which gave DPH authority and directed them to establish this regulation, did not include home health and hospice.

Because of this, Senator John Velis and Representative Paul Donato have introduced legislation which would amend the MGL to include home health and hospice and which would give DPH the authority to set caps temporary nurse staffing rates for home health and hospice services.

Use this action alert to urge your legislator to co-sponsor H.2408/S.1633, An Act Relative to Staffing at Home Health and Hospice Agencies.

Urge Your Legislator to Support Licensure of Home Care Services

Thu, 23 Jan 2025 05:00:00 GMT

Massachusetts remains one of a handful of states without a licensure structure as a condition to provide home care services. In 2017, Governor Baker signed into law a framework for the Department of Public Health to establish a licensure structure for 'skilled' home health services. This framework did not include non-medical personal care services.

For many years, the Home Care Alliance has supported and advocated for legislation which would establish a licensure structure in Massachusetts. It is our vision that this regulatory structure would establish a baseline set of standards for home care agencies to comply with in order to lift up the industry at large and protect consumers.

Take action today by writing to your state legislators urging them to co-sponsor SD.1036/HD.1449, an Act to Improve Massachusetts Home Care, which would create a licensure system that would establish baseline standards for agencies, to ensure a quality network of providers for consumers and keeping services affordable for those who rely on them.

Urge Legislator to Support Extension of Telehealth Flexibilities

Tue, 17 Dec 2024 05:00:00 GMT

Congress is once again working to pass a final fiscal budget before the March 14th deadline. With crucial telehealth flexibilities set to expire on March 31st, it is imperative that a provision is included in any budget package that would extend the telehealth flexabilites.

Originally created during the first Trump administration, these telehealth flexibilities expanded the types of practitioners eligible to offer telehealth services and allow Medicare beneficiaries to receive virtual care in their homes and through audio-only calls. home-based care patients and providers have benefited immensely from authorized telehealth flexibilities for the Face to Face (F2F).

If these flexibilities are not extended, the consequences will be dire for patients. This would leave only doctors and NPs the ability to conduct the F2F encounter, straining limited staff resources. These would lead to a lowering in overall care for patients who need it them most. Providers cannot return to spending time traveling and accruing the costs and risks involved. Providers need to be given the ability to provide care to those who need it in a way that is most convenient.

We need your help! Please use this action alert to urge Members of Congress to support the telehealth extension provision by voting to pass this stopgap package or for the telehealth extension to be included in any final package or CR.

Support Supplemental Budget to Fund ASAP Home Care Rates

Fri, 29 Nov 2024 05:00:00 GMT

This week, the Healey Administration introduced a supplemental budget which includes over $60 million in funding for ASAP Home Care line items for FY25. The State Home Care Program is a program of the ASAP (Aging Services Access Point) network across Massachusetts, and it incorporates services such as homemaking, personal care, home-delivered meals, day programs, complex care oversight by a nurse, and so much more. These services are critically important to help older adults remain at home and prevent or delay more costly nursing home stays, while enhancing quality of life, and lowering healthcare costs.

The Massachusetts State Home Care Program is funded through two primary line items in the state budget. Both of these items were woefully underfunded in the FY25 budget. The accounts will run a deficit even based on current utilization, and this deficit grows even more alarming when looking at anticipated growth in the case load throughout the coming fiscal year:

Line Item 9110-1630 (Elder Home Care Purchased Services); Expected FY25 deficit: If no additional program growth: anticipated deficit of $35,218,056; Based on current utilization trends of 8% growth: anticipated deficit of $46,107,642;
Line Item 9110-1633 (Elder Home Care Case Management); Expected FY25 deficit: If no additional program growth: anticipated deficit of FY25 of $4,028,366 Based on current utilization trends of 8% growth: anticipated deficit of $8,622,226;

The supplemental budget would help to mitigate the a potential deficit for both line items for the rest of FY2025. Please use this action alert to write to your legislator urging them to support the supplemental budget proposal!

Tell CMS to pull the 80/20 provision from the Medicaid Access Rule

Mon, 29 Apr 2024 04:00:00 GMT

In the Medicaid Access Rule, CMS finalized a requirement that no less than 80% of all Medicaid payments, including but not limited to base payments and supplemental payments, be spent on compensation to direct care workers, for homemaker services, home health aide services, and personal care services. This requirement applies to services delivered under sections 1915(c), (i), (j), (k), and potentially also 1115 of the Social Security Act as well as those delivered through managed care contracts. Notably, it would not apply to 1905(a) State plan personal care and home health services.

The rule defines “compensation” narrowly as:

Salary and wages;
Benefits (such as health and dental benefits, paid leave, and tuition reimbursement);
The employer share of payroll taxes for direct care workers; and
Other remuneration as defined by the Fair Labor Standards Act

Importantly, the rule’s definition neglects to include other crucial costs necessary to provide services.

There are significant negative outcomes that would occur if the 80-20 provision is finalized, including:

This provision will reduce, not increase, access. Individuals who rely on HCBS to live their lives in home-based settings will lose services, particularly if providers cannot meet these new requirements or are forced to restrict innovative, value-added care supports.
The provision appears to have been arbitrarily created and not based on data or an explained rationale.
The restrictive threshold definitions will serve to limit resources for caregiver support and other enhanced care-focused operations, resulting in reduced quality, health and safety, and oversight in HCBS.
The blanket approach undermines state autonomy, creates stark inequities across and within states, limits the ability to modify program requirements, and penalizes providers and states that have more regulation and oversight.
The provision seeks to establish precedent that CMS/HHS has the authority to dictate how state Medicaid dollars are spent by private entities.
CMS imposes this mandate with no existing or planned infrastructure for collecting and reporting out accurate information, financing to support added resource needs, or data to ensure that the dollars are being distributed as intended.

Support Funding for Home Care Line Item 9110-1630

Thu, 11 Apr 2024 04:00:00 GMT

The Massachusetts State Legislature is in the midst of its Fiscal Year 2025 State budget deliberations. The Senate proposed budget does not include additional funding for line item 9110-1630 which funds home care services provided through Aging Services Access Points (ASAPs) in Massachusetts. Mass Home Care, who represents ASAPs, requested an additional, $34,738,085.00 for line item 9110-1630, to cover the actual utilization in this line item. It is imperative that this line item be adequately funded to continue the important work that the Administration, the Legislature, the ASAP and provider networks have done to increase our direct care workforce and to ensure that we will not have to create pending referral lists for these important services.

Please use this action alert below to write to your legislator to urge your Senator to support Amendment #539 to the FY25 Senate Budget.

Support Rate Clarifying Language Budget Amendment

Thu, 11 Apr 2024 04:00:00 GMT

The Massachusetts State Legislature is in the midst of its Fiscal Year 2025 State budget deliberations. HCA along with the Enough Pay to Stay Coalition worked with our legislative champions to submit an amendment to the Senate budget that would include the bill language from H.1195/S.755 - An Act Clarifying Rate Setting Processes for Home Health and Home Care Services.

This amendment would insert language that would bring clarity, transparency, and fairness to the rate setting process that directly impacts and determines providers ability to retain and recruit sufficient staff to meet the Commonwealth's need to ensure the provision home health and home care services to those who need and qualify for it.

Please use this action alert below to write to your legislator to urge them to co-sponsor Amendment #535, Clarifying Rate Setting Processes for Home Health and Home Care Services.

Urge Your Legislator to Support Enough Pay to Stay (EPTS) Rate Add-on Amendment

Thu, 20 Apr 2023 04:00:00 GMT

The Massachusetts State Legislature is in the midst of its Fiscal Year 2024 State Budget deliberations. HCA reported last week that the EPTS rate add-on was not included in the House Ways and Means proposed budget for FY24. HCA along with the Enough Pay to Stay Coalition moved quickly to work with our legislative champions to submit an amendment to the House budget that would include EPTS rate add-on funding for one quarter of Fiscal Year 2024 rather than a full fiscal year. As we approach the end of April, we do not see how implementation of new home care purchase of service rates will be achieved by the end of FY'23, which would result in a cliff effect and significant drop in reimbursement rates and workforce wages.

This amendment would provide a critical short-term bridge to prevent a cliff effect until the new rates are implemented. We need your help to get as many House legislators as possible to support this amendment. Please use this action alert to write to your legislator to urge them to support amendment #578, EPTS Rate Bridge Amendment.

Submit Written Testimony in Support of Licensure Bill for Non-Medical Services

Mon, 10 Apr 2023 04:00:00 GMT

In early April, The Home Care Alliance provided verbal testimony during a hearing held by the Joint Committee on Elder Affairs on H.649/S.380, An Act to Improve Massachusetts Home Care, which would create a licensure system for non-medical home care services.

For many years, the Home Care Alliance and our members have advocated for home care licensure, as we believe that agencies should be held to a baseline set of standards that would protect consumers and workers. We believe that this bill has the framework to do just that, without overburdening providers, and driving consumers to seek services in the unregulated, underground market.

We need your help to get this bill over the finish line. Please use this action alert to submit pre-written testimony to the committee in support of the bill. By submitting written testimony we show legislators and committee staff how much support this bill has amongst the industry and Massachusetts at-large. This would increase the chance that the bill is voted out of committee and potentially voted and passed by the entire legislature. Your voice matters and we want you to use it!

Urge Your Member of Congress to Delay 2025 Home Health Rate Cuts

Tue, 06 Dec 2022 05:00:00 GMT

The home health community is seeking support for legislation to curb dire cuts to Medicare home healthcare services. The Preserving Access to Home Health Act of 2023 (S.2137/H.R. 5159), introduced by Senators Debbie Stabenow (D-MI) and Susan Collins (R-ME) and Representatives Terri Sewell (AL-7) and Adrian Smith (NE-3), would safeguard access to essential home-based, clinically advanced healthcare services for America’s older adults and people living with disabilities by preventing the Centers for Medicare & Medicaid Services (CMS) from implementing devastating cuts. Passage of this legislation is imperative to ensure the continued functioning of the Medicare Home Health Program.

What does the legislation do?

Stops CMS from imposing certain permanent and temporary payment cuts. In 2020, CMS updated the Medicare Home Health payment system. The new system – the Patient-Driven Groupings Model (PDGM) – is supposed to be budget neutral compared to the old system. Congress charged CMS with ensuring budget neutrality, and gave the agency authority to permanently and temporarily change payment rates to account for provider behavioral changes associated with the new system. Despite stakeholder input, the agency’s interpretation of its budget neutrality mandate has unfortunately led to significant reductions in payment, essentially resetting base payment rates at much lower, unsustainable levels, which will deepen in future years. The bill repeals CMS’s authority to make these permanent and temporary payment cuts based on its misguided budget neutrality methodology.
Instructs MedPAC to analyze the Medicare Home Health Program. Under current law, the Medicare Payment Advisory Commission (MedPAC) is allowed to review the effect of Medicare payment policies on the delivery of healthcare services outside of Medicare. This provision would require MedPAC to report on aggregate trends under Medicare Advantage, Medicaid, and other payers, and consider the impact of all payers on access to care for the Medicare population. It also requires MedPAC to be transparent in its calculations, and it updates the Commission’s Medicare home health cost reports to include data on visit utilization and total payments by program.

What Is Important to Know about CMS Cuts to Home Healthcare

The New Home Health Payment System: In 2018, Congress directed CMS to change the Medicare home health payment system beginning in 2020. In doing so, Congress required the new payment system be budget neutral compared to the old system, intending that post-2020 payments should be as if the new system had not been enacted. To achieve budget neutrality, CMS was authorized to make certain payment adjustments on both permanent and temporary basis that allowed for a reconciliation of assumed behavior changes and actual behavior changes.

Cuts to Home Health are Massive: This November, CMS finalized a flawed methodological approach for calculating the impact of provider behavior under PDGM, which resulted in a permanent -9.48% cut to Medicare home health payments. Based on the same methodology, CMS plans to implement at least $3.5 billion in temporary “claw back” cuts to home health payments. In total, the permanent and temporary cuts are now estimated to reduce home health payments by more than $20 billion over the next ten years. CMS’ recalculations result in more devastating and deeper cuts to home health each year, making for an impossible environment for home health providers.

We need your help once again and there is no time to spare! Last year, your support helped to convince Rep. Jim McGovern (D-MA-02) to sign onto the bill and helped to get the proposed cut dropped from 7% to 3%. We must keep going to block another rate cut from being implemented.

Please use the action alert below to write to your Member of Congress urging them to co-sponsor S.2137/H.R.5159, Preserving Access to Home Health Act of 2023.

Support A Bill to Reform Home Care Rate Setting Processes

Fri, 05 Mar 2021 05:00:00 GMT

Currently, agencies have been heavily reliant on non-guaranteed supplemental rate add-ons that have been passed by legislators through the state budget process. The Alliance has been actively working to pass legislation that would end the need for the Legislature to fund these supplemental rate add-ons for home care and home health workers every year. The goal is to ensure the existing rate setting process works and provides consistent rates that accurately reflect the true cost of providing home care and home health services to consumers across the Commonwealth.

This legislation would clarify the rate setting processes that are already in place for both home health and home care services. It does not set the rates or dictate the amount for future rates set by Mass Health and EOHHS. It would make the rate setting process more transparent and ensures rates set by the state follow the rate setting laws and reflect the actual operating costs incurred by home health and home care providers.

Use this action alert to write to your legislator urging them to co-sponsor SD.1034/HD.650, An Act Clarifying Rate Setting Processes for Home Care Services.

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Tue, 13 May 2025 04:00:00 GMT

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Tell Congress to stop the Medicaid HCBS 80/20 pass through!

Thu, 03 Oct 2024 04:00:00 GMT

In the Medicaid Access Rule CMS finalized a requirement that no less than 80% of all Medicaid payments, including but not limited to base payments and supplemental payments, be spent on compensation to direct care workers, for homemaker services, home health aide services, and personal care services. This requirement applies to services delivered under sections 1915(c), (i), (j), (k), and potentially also 1115 of the Social Security Act as well as those delivered through managed care contracts. Notably, it would not apply to 1905(a) State plan personal care and home health services.

The rule defines “compensation” narrowly as:

Salary and wages;
Benefits (such as health and dental benefits, paid leave, and tuition reimbursement);
The employer share of payroll taxes for direct care workers; and
Other remuneration as defined by the Fair Labor Standards Act

Importantly, the rule’s definition neglects to include other crucial costs necessary to provide services.

There are significant negative outcomes that would occur if the 80-20 provision is finalized, including:

This provision will reduce, not increase, access. Individuals who rely on HCBS to live their lives in home-based settings will lose services, particularly if providers cannot meet these new requirements or are forced to restrict innovative, value-added care supports.
The provision appears to have been arbitrarily created and not based on data or an explained rationale.
The restrictive threshold definitions will serve to limit resources for caregiver support and other enhanced care-focused operations, resulting in reduced quality, health and safety, and oversight in HCBS.
The blanket approach undermines state autonomy, creates stark inequities across and within states, limits the ability to modify program requirements, and penalizes providers and states that have more regulation and oversight.
The provision seeks to establish precedent that CMS/HHS has the authority to dictate how state Medicaid dollars are spent by private entities.
CMS imposes this mandate with no existing or planned infrastructure for collecting and reporting out accurate information, financing to support added resource needs, or data to ensure that the dollars are being distributed as intended.

Support the Credit for Caring Act (S. 3702/H.R. 7165): Empowering Family Caregivers

Thu, 03 Oct 2024 04:00:00 GMT

The caregiving community is rallying behind legislation aimed at alleviating the financial strain faced by millions of family caregivers across the nation. The Credit for Caring Act of 2024 (S. 3702/H.R. 7165), introduced by Senators Michael Bennet, Shelley Moore Capito, Elizabeth Warren, Susan Collins, Maggie Hassan, and Lisa Murkowski, alongside Representatives Linda Sánchez and Mike Carey, seeks to provide essential financial support to these unsung heroes. Passage of this legislation is critical to recognizing and valuing the invaluable contributions of family caregivers and ensuring their ability to continue providing quality care to their loved ones.

What does the legislation do?

Offers a federal tax credit of up to $5,000 for eligible working family caregivers, aiming to alleviate financial burden and enable caregivers to focus more on providing quality care.
Covers out-of-pocket expenses such as home care, adult day care, and transportation, providing tangible assistance to caregivers and reducing financial stress.
Provides a nonrefundable tax credit adjusted for inflation, ensuring ongoing support and recognition of caregivers' contributions to society.

Why is this important?

Family caregivers face significant financial strain due to the costs associated with caregiving, including expenses that often exceed 25% of their income. Many caregivers experience financial setbacks, including depleting personal savings and reducing retirement savings, while others are forced to leave the workforce or reduce their hours. The Credit for Caring Act of 2024 addresses these challenges by offering much-needed financial support to caregivers, enabling them to continue providing essential care to their loved ones while also acknowledging their invaluable contributions to society.

Factsheet: Link to File