Key Issues

CALL your Congressman to PROTECT the Home Health Benefit!!
CMS is Proposing Deep Cuts to Payments. 
 
Last year, Congress passed the Bipartisan Budget Act (BBA) of 2018 which included various reforms to the Medicare home health benefit. One such provision called for budget neutrality in any change to the payment model, so that future spending would remain consistent with projections of current spending levels. Additionally, Congress authorized the Centers for Medicare & Medicaid Services (CMS) to make changes in reimbursement rates based on assumptions of provider behavior in response to the payment model reforms.
 
CMS has since taken this authority and incorporated behavior based rate-reductions to take effect in 2020 as included in the final FY 2019 Medicare home health rule. These reductions are based on the assumptions that providers will up-code and also add additional visits to Low Utilization Payment Adjustment cases to obtain the full episodic payment. It is notable that these projections significantly differ from their 2017 assumptions in the proposed, but never finalized Home Health Groupings Model.  In the FY 2019 final payment rule for skilled nursing facilities (SNFs) rule, CMS states that the agency did “not have any basis on which to assume the approximate nature or magnitude of these behavioral responses,” as it relates to the new SNF payment model.  We believe that it is wildly inconsistent for assumptions to be made about one provider type, but not another.
 
Both the U.S. House and the Senate have filed legislation (H.R. 2573) / S 433 respectively that seeks to remedy these inconsistencies by removing the ability to adjust rates based on assumptions, but rather in response to observed evidence of behavioral changes. By requiring the payment model to utilize observed evidence of behavioral changes, the bills would hopefully ensure a smoother transition to the new payment system.  The Senate legislation would also allow Medicare Advantage (MA) plans to waive the “homebound” requirement for home health services when the plan or payment model determines that providing care in the home would improve patient outcomes and reduce spending on patient care.
H.R. 2573 has three Texas original cosponsors already, Rep. Kenny Marchant (TX – 24), Rep. Jodey Arrington (TX-19), and Rep. Mac Thornberry (TX-13).  If you live in their districts, please call their office and thank them for their support!
 
Call your Representative today and ask him/her to Co-Sponsor H.R. 2573. 

Information

Texas home care and hospice members may learn more about our positions or take action on a state or federal issue by clicking on the links below.

State Issues

CALL NOW!!!! Support Therapy Rate Restoration in HB 1 Article II

The Art. II Conferees, Rep. Sarah Davis and Senator Lois Kolkhorst, completed their work this past Friday.  In our conversations with the budget writers on Friday, it appears that the Senate is not inclined to add any funding to therapy rates but would rather leave it to HHSC to manage network adequacy.   Essentially, HHSC would be directed to work with MCOs to ensure network adequacy.  We are short on exact details, but it’s our understanding that HHSC would direct the MCOs to increase rates with existing funds, or HHSC could allocate additional funds from within its existing budget to increase rates.  

Unfortunately, as we have all experienced, the commission has demonstrated that it is unable to successfully manage network adequacy.  In addition, HHSC has been unable to successfully manage Rider 57, the access to care data collection last interim in order to produce a required report to the legislature.  HHSC was only able to retrieve data from 4 MCOs in one service area in two years.  Collecting access data is the minimum requirement to manage network adequacy.   

We need you to call NOW to let Senators Nelson and Kolkhorst know the impact of not restoring the funding for rates for pediatric therapy. 

Please also contact the offices of Lt. Governor Dan Patrick (512.463.0001) and Governor Greg Abbott (512.463.2000) and ask them to weigh in with Senator Nelson supporting funding on this critical issue.  The legislature must act now!

The good news is that we still have strong support for rate restoration in the House.  Your calls will support the House’s efforts to restore rates as final negotiations continue between Rep. Zerwas and Senator Nelson.

ACTION NEEDED! Support restoration of the rate for Mediciaid Private Duty Nursing in HB 1
Private duty nursing (PDN) is a cost-containment solution to health care for medically complex children, who would otherwise reside in a hospital or institution.  The rate has not been adjusted in over 13 years and decreased in 2011.  The workforce for PDN nurses is shrinking as nurses in general are in high demand in other settings that pay more.
 
Please email the Article II Conferees of the HB 1 Conference Committee and let them know you support the restoration of the PDN rate by 2.5%. You can simply click the link.
 
Additionally, you can reach out to the conferees directly with your own story. The following is the contact for each conferee. 
 
Speaker of House: 
Dennis Bonnen
dennis.bonnen@speaker.texas.gov 
512-463-1000
 
Chairman John Zerwas
john.zerwas@house.texas.gov
512-463-0657 
 
Chairwoman Sarah Davis
sarah.davis@house.texas.gov
512-463-0389
 
Lt. Governor Dan Patrick
dan.patrick@ltgov.texas.gov
512-463-0001
 
Chairwoman Lois Kolkhorst
lois.kolkhorst@senate.texas.gov 
512-463-0118 
 
Chairwoman Jane Nelson
jane.nelson@senate.texas.gov
512-463-0112
 
 
ACTION NEEDED to Support an Increase in Community Care Attendant Wages in HB 1!
Community care programs, including personal attendant services (PAS), allow individuals who are aging and have disabilities to live in their homes, instead of institutions, at a significant cost savings to the state.  The continual underfunding of the attendant wage and the agency service support/operational cost portions of community care program rates, contributes to agencies closing and forces more individuals into higher cost settings.  The attendant workforce is suffering a significant decrease as alternative employment options are available offering more pay per hour ($12-$15/hr.) and benefits including; paid time off and healthcare. Additionally, according to Texas HHS, almost 12% of Texans (3.2 million people) are 65 and older and the number is growing. By 2050 that figure is expected to increase to almost 20%.  
 
Support increasing the attendant wage and the service support/operational portion of the rate in Article II of HB 1 by contacting the Article II Conferees of the HB 1 Conference Committee to let them know the impact of not acting this session. You can simply click the link.
 
Additionally, you can reach out to the Article II conferees directly with your own story. The following is the contact for each conferee. 
 
Speaker of House: 
Dennis Bonnen
dennis.bonnen@speaker.texas.gov 
512-463-1000
 
Chairman John Zerwas
john.zerwas@house.texas.gov
512-463-0657 
 
Chairwoman Sarah Davis
sarah.davis@house.texas.gov
512-463-0389
 
Lt. Governor Dan Patrick
dan.patrick@ltgov.texas.gov
512-463-0001
 
Chairwoman Lois Kolkhorst
lois.kolkhorst@senate.texas.gov 
512-463-0118 
 
Chairwoman Jane Nelson
jane.nelson@senate.texas.gov
512-463-0112
 
 
 
 
 
ACTION NEEDED to Support Funding Pediatric Therapy in HB 1
Home health therapy services treat children with complex medical conditions, ameliorate developmental delays, improve quality of life, assist with school entry, and reduce hospitalizations, special education costs, and current and future Medicaid spending.  These services are largely not covered by private insurance.   Years of reductions have disproportionately targeted home health, and therapists and therapy assistants are leaving the industry, causing significant access to care issues.
 
Please email the Article II Conferees of the HB 1 Conference Committee letting them know to adopt a scaled version of the therapy rider in HHSC’s bill pattern that provides for a unique rate methodology for home health, a rate increase of 14% for speech therapy and 22% for physical/occupational therapy, and an increase in the rates paid to therapy assistants to 90% of the therapist rates.  Additionally, ask that they adopt the House changes to therapy reporting rider to improve the quality of information available to the Legislature on access to care.
 
Please email the Article II Conferees of the HB 1 Conference Committee and let them know you support the restoration of the funding increases for Medicaid pediatric therapy. You can simply click the link.
 
Additionally, you can reach out to the conferees directly with your own story. The following is the contact for each conferee. 
 
Speaker of House: 
Dennis Bonnen
dennis.bonnen@speaker.texas.gov 
512-463-1000
 
Chairman John Zerwas
john.zerwas@house.texas.gov
512-463-0657 
 
Chairwoman Sarah Davis
sarah.davis@house.texas.gov
512-463-0389
 
Lt. Governor Dan Patrick
dan.patrick@ltgov.texas.gov
512-463-0001
 
Chairwoman Lois Kolkhorst
lois.kolkhorst@senate.texas.gov 
512-463-0118 
 
Chairwoman Jane Nelson
jane.nelson@senate.texas.gov
512-463-0112
 
 
Tweet to your legislators: Be a hero & fight for funding home therapy.
Big decisions that will impact therapy funding are happening in the Capitol RIGHT NOW.
The Article II conference committee is finalizing funding for Medicaid. 
 
Take one minute out of your day and let the 6 Conferees know that YOU want THEM to be a hero and fight for funding home therapy. 
 
 

Federal/National Issues

CMS is Proposing Deep Cuts to Payments. Tell Congress to Protect the Home Health Benefit!
 
Last year, Congress passed the Bipartisan Budget Act (BBA) of 2018. Included in this law were various reforms to the Medicare home health benefit. One such provision called for budget neutrality in any change to the payment model, so that future spending would remain consistent with projections of current spending levels. Additionally, Congress authorized the Centers for Medicare & Medicaid Services (CMS) to make changes in reimbursement rates based on assumptions of provider behavior in response to the payment model reforms.
 
CMS has since taken this authority and incorporated behavior based rate-reductions to take effect in 2020 as included in the final Medicare home health rule. These reductions are based on the assumptions that providers will up-code and also add additional visits to Low Utilization Payment Adjustment cases to obtain the full episodic payment.It is notable that these projections significantly differ from their 2017 assumptions in the Home Health Groupings Model. Further, in their finalized rule for the skilled nursing facilities payment rule, CMS states that they did “not have any basis on which to assume the approximate nature or magnitude of these behavioral responses.” It is wildly inconsistent for assumptions to be made about one provider type, but not another.
 
Legislation (S.433) introduced in the U.S. Senate seeks to remedy these inconsistencies by removing the ability to adjust rates based on assumptions, but rather in response to observed evidence of behavioral changes. The legislation would also allow for waivers to the homebound requirement for beneficiaries in Medicare Advantage plans and innovative Medicare payment models such as Accountable Care Organizations.
 
Please urge Senators John Cornyn and Ted Cruz to support S.433 to protect the Medicare home health benefit!
 
 
Support the Palliative Care and Hospice Education and Training Act (HR 647)
In 2010, the American Academy of Hospice and Palliative Medicine estimated an existing need for 6,000 or more full time physician equivalents to serve current needs in hospice and palliative care programs.  However, at maximum capacity, the current system would produce only about 5,300 new hospice and palliative medicine certified physicians over the next 20 years.  This falls far short of the projected growing needs of the rapidly aging population and does not address the growing need for similarly trained non-physician professionals, including palliative nurses.
This legislation would:
  • Amend the Public Health Service Act to increase the number of permanent faculty in palliative care at accredited allopathic and osteopathic medical schools, nursing schools, social work schools, and other programs (including physician assistant education programs).
 
  • Promote education and research in palliative care and hospice and support the development of faculty careers in academic palliative medicine.
Contact your Congressman today to take action and support the Palliative Care and Hospice Education and Training Act (HR 647)
Protect the Medicare Home Health Rural Add-on
The longstanding Medicare rural add-on for home health services will be phased out over the next 2-4 years, threatening the provision of medically necessary home health in rural areas.  This three percent payment modifier to reimbursements for services provided in rural areas continues to be crucial to maintaining access to care.
 
Congress has repeatedly determined, with bipartisan support, that the home health rural add-on is needed to maintain care access and quality in rural areas since the 1980s because:
  • There are higher costs for home care in rural areas primarily due to travel time;
     
  • Home care is often the substitute for primary care in rural areas with the shortage of physicians;
     
  • A loss of access to care in rural areas negatively impacts patients and Medicare as care and its costs shift to institutional care;
Rural home care brings great value to rural residents as it helps prevent the need for urgent care, inpatient hospitalizations, and institutional care.  Home health agencies have demonstrated that the combination of highly skilled staff and modern health care technologies brings high quality of care to rural residents.
 
What can Congress Do?
  • Extend the 3% rural add-on for three years;
     
  • Require a study on its application and any needed reforms to ensure its ongoing success.
Contact your Congressman today to take action and support Medicare Home Health Rural Add-on. 

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