Announcing New England Home Care Career Center
The Rhode Island Partnership for Home Care (RIPHC) is pleased to announce the creation of the New England Home Care Career Center, a new, full-function career center for our members to use to find the best talent for their agencies.
Through the beginning of April, members of RIPHC who enter the coupon code ALLIANCERI (75DollarCoupon) will be able to purchase 30-day listings for just $100 (a savings of 43%). Members may also use the ALLRI20 coupon code (20percentcoupon) to receive a 20% discount on any Career Center purchase – including bulk packages – both during and after the introductory period.
Get started today by creating a FREE Employer or Job Seeker profile (pre-existing profiles on the Career Center will operate as before). Packages of 5 and 10 jobs are available, as are 60 and 90-day listings, as well as a variety of extras to ensure maximum exposure for your listings.
October Home Health Measures Released by Medicare on October 13th
OASIS-C Home Health Process Measures Chart
Governor to issue executive order to establish health-benefits exchange
08:14 AM EDT on Monday, September 19, 2011
By Felice J. Freyer
Journal Medical Writer
Governor Chafee on Monday will issue an executive order creating a health-benefits exchange, the centerpiece of the federal health-care law as it rolls out in Rhode Island.
He has also chosen the exchange’s board of directors, which will be chaired by former U.S. Attorney Margaret E. “Meg” Curran.
The exchange will be a marketplace of health insurance for small businesses and individuals, intended to ensure that nearly all Rhode Islanders have access to health coverage they can afford. Many will be eligible for federal subsidies to help pay premiums. Under Chafee’s order, the exchange will become a new division of state government.
The Rhode Island Commission on Healthcare Reform had urged the governor to issue the executive order after the General Assembly failed to establish an exchange, amid a stalemate over abortion language.
“It’s very important, as we are approaching the deadline for filing the next application for funding,” said Lt. Gov. Elizabeth H. Roberts, who chairs the commission. “We wanted to make sure that Rhode Island didn’t miss this opportunity.”
(The commission will receive the executive order at its meeting Monday morning. Roberts provided an advance copy to The Journal.)
But the executive order may face some challenges. The Rhode Island Right to Life Committee, which wants to bar the exchange from selling health insurance that covers abortion when state or federal subsidies are used, intends to go to court to block the executive order.
And while House Speaker Gordon D. Fox applauded the governor’s move, Senate President M. Teresa Paiva Weed said that it should be a temporary measure until the legislature acts.
The state faces a Sept. 30 deadline to apply for tens of millions in federal money to develop the exchange, but needed to first establish the authority to create, govern and finance the exchange.
The federal law gives states considerable leeway in deciding how their exchanges will function. But every state must have an exchange designed by 2013 and operating by 2014, or the federal government will step in and do it.
The failed legislation would have created a quasi-public corporation to run the exchange, but Chafee doesn’t have the power to do that on his own. Instead, his executive order positions the exchange as a division within the Executive Department, which encompasses his office and the lieutenant governor’s office.
But Chafee did draw directly from the legislation’s language about the composition of the governing board and the conflict-of-interest rules.
The exchange board has 13 members appointed by the governor, 4 from the government and 9 from the public, with at least 2 representing consumer organizations and 2 representing small businesses.
No board member can be a practicing health-care provider or connected with: an insurer, a health insurance agent or broker, or a health facility, clinic or provider. To tap the knowledge of those barred by these conflict-of-interest rules, the exchange will also form an advisory committee of health-industry experts.
The concept of a health insurance exchange has been compared to travel sites, such as Travelocity, where people can comparison shop for flights and hotels. But Roberts said the exchange will provide more active assistance to people choosing health insurance. It may also set standards for the types of health insurance products offered.
Indeed, the executive order also explicitly calls for “payment reforms and innovative benefit designs” that promote quality and efficiency.
“One of the goals of this executive order is to create the infrastructure with some early goals,” Roberts said. “A lot of those bigger issues are very appropriately going to be discussed by the board going forward.
“I am particularly impressed with some of the people who are willing to take on this challenge … for no compensation,” Roberts added.
In addition to Curran, the chairwoman, the board’s public members will include Vice Chairman Donald Nokes, president and co-founder of the small business NetCenergy; Michael C. Gerhardt, a former health insurance executive; James Grace, president and CEO, InsureMyTrip.com; Linda Katz, policy director and co-founder, The Poverty Institute; Peter Lee, president and CEO, John Hope Settlement House; Dr. Pamela McKnight (not currently practicing); Tim Melia, UFCW New England Council; and Minerva Quiroz, case manager, AIDS Project RI.
The government members are: Steven M. Costantino, secretary of Health and Human services; Christopher F. Koller, health insurance commissioner; Richard A Licht, director of administration; and Dr. Michael D. Fine, director of health.
In a statement, House Speaker Fox called the executive order “a major step forward toward providing quality and affordable health coverage for all Rhode Islanders.… I commend Governor Chafee for establishing a diverse and qualified board.”
Senate President Paiva Weed, who had added the anti-abortion language to the proposed legislation, was more wary. “This new structure is satisfactory only if it is temporary and the board has no executive authority, pending action by the General Assembly,” she said in a statement. “It is my intention to work vigorously toward enactment of a more comprehensive and permanent quasi-public authority early in the next session.”
Meanwhile, the Rhode Island Right to Life Committee says it has retained lawyer Joseph S. Larisa Jr. to challenge the executive order in court.
“We don’t believe the governor can do this without legislative approval,” said Barth E. Bracy, the committee’s executive director.
PARTNERSHIP ADVOCATES WITH DHS MEDICAID OFFICE
Home Care Strategies to Kick Start the Global Waiver
Introduction
Improving patient outcomes, enhancing quality of services, promoting cross setting communication and resource integration and containing costs are mutual goals for both the State and the Home Care and Hospice industry.
When the Global Waiver was announced in 2009, among its articulated goals was to provide the right care, at the right time, in the right setting and to rebalance the provision of long term care. Combined with the Perry Sullivan Act and its mandate to transform the system it appeared that the shift to more home and community based care was underway and that a shared vision for the least restrictive, most effective, much preferred and lowest cost model for service delivery was on the horizon.
In a report delivered to the Senate from EOHHS regarding the Global Waiver for the period ending December 31,2010 Medicaid expenditures for institutional care was 85% of the total LTC costs and expenditures for home and community based care was 15%. Obviously there is considerable work yet to be done if RI is to realize its goal of rebalancing the long term care system to 50/50. In FY09 budget Article 17 directed the Department of Human Services to pursue home care rate reform. That effort has stalled at best and been ignored at worst. The Partnership sees these issues as opportunities to Kick Start the Waiver and we have identified a menu of strategic solutions which could easily save money and improve access, quality of care and accountability.
We are committed and determined to provide a pivotal role in the health care reform effort on both the national level and here in RI. In order to do that and address some the issues the Department has stated, there needs to be an investment by Medicaid in the home care system at the same time that there is increased scrutiny and expectations.
We intend to work closely and collaboratively with EOHHS and the Medicaid Office to retool and restructure the service delivery and reimbursement structure to better meet the needs of all stakeholders.
Concerns stated by DHS in RFI
In late 2010, DHS issued an RFI seeking input to Strengthen the Long Term Care Capacity.
The RFI made several points that relate to home care services and seem germane to our discussion. We reiterate them here as a point of reference and believe that each issues will be addressed in the strategies section of this proposal.
Following are several pertinent excerpts from the RFI:
2.1.2 Point 2: Increasingly in Need of Care
A survey conducted by Jane Griffin of MHC Evaluations found that Medicaid beneficiaries living in the community were encountering difficulty obtaining the level of care they needed to stay living independently. Particularly mentioned were evening, weekend and overnight assistance, getting ready for bed, dressing and overnight toileting.
The RFI also stated that there were insufficient connections to clinical providers, including therapies and medication management.
2.1.3. Hospital Discharge
Home based care may be precluded because of the complexity of needs and timing to establish a “full slate” of home care services. More people could return home if home care was in place at time of discharge.
The Quality Partners Safe Transitions Project for Medicare patients was noted as a best practice and the possibility of a similar initiative with a Medicaid focus was briefly alluded to.
Hospital readmissions was cited as an issue which affects Medicaid in that the ability to live independently may be undermined for these patients and they may require nursing home care at state cost. Expanding capacity of home care at point of discharge was described as a strategy.
2.1.4. Nursing Home Discharge
Persons with a history of rehabilitative nursing home care stays should be contacted regularly to determine if there home care services are meeting their needs and providing sufficient support. Periodic assessment may preclude clinical and costly consequences.
2.2.2. Early Identification
The state anticipates use of predictive modeling tools to better understand what patient characteristics point to increased short term and midterm service needs.
Approvals and authorizations must be expedited to ensure that services are in place as soon as an individual returns home.
The state is interested in learning about options that guarantee authorized in-home services will be provided all day and on everyday that services is needed statewide.
Stabilizing the patient in a community based setting on short notice would over time reduce costs.
For the most part the Partnership agrees with the issues stated in the RFI. The solutions suggested below will address these issues and others and will strengthen the system, improve care making it more patients driven and ultimately, they will lower costs.
Challenges
Performance and financial incentives are not aligned among providers and with the best interests of the beneficiary in mind.
High ER visits, rehospitalization and unnecessary nursing home placement drive costs.
There are a few high service users who drive costs.
Overarching goal: To create dynamic, innovative systems of care and support that are driven by patient need and whose service providers are rewarded for delivering better value over time.
Solutions to Kick Start the Waiver and Provide Patient Centric Service Delivery
1. Develop a rational approach to home care rate adjustments based on a CPI type measure. Medicare uses the market basket. An example might be to tie rate increases to state employee increases. Until we can compete with nursing home salaries, provide competitive benefits and absorb gas costs for example, our ability to attract employee especially at night and on weekends will continue to be an issue.
2. Expedite a brief eligibility screening and authorization process so that care can be available at time of discharge and then complete the more detailed application once patient is home. Maybe have a DHS discharge Planner at RI Hospital or other high use hospital.
3. Review care authorizations on a more frequent basis so that patients might get a high number of hours of care when they first get home from the hospital and then be flexible with service plans as the patient needs change.
4. Institute a demonstration project for high users of home care services to be part of the health homes model.
5. Require providers to be accredited by one of the national home care accrediting bodies but give a 2- 3 year timeline for compliance.
6. Make the enhancements a requirement and adjust the base rate to address issues of access.
7. Contract with home care agencies that have certified chronic care management specialist staff to manage the care of a group of beneficiaries with 2 or more chronic diseases (high cost outliers) and evaluate effectiveness and cost savings.
8. Require that all providers have a signed contract and referral protocol with a Medicare Certified agency.
9. Require nursing involvement in utilization review of case manager authorized services.
10. Expand Co-pay program eligibility so more people can stay off Medicaid
11. Pay for medication reconciliation and patient education by paying for quarterly nursing visits.
12. Incentivize providers to use technology to monitor chronic conditions and intervene before more intensive and costly care is necessary. Create a reimbursement for telemedicine.
13. Increase the Community Need Living Allowance by $ 400.00 per month so more people would choose the waiver instead of nursing home.
Next Steps
The Partnership has scheduled a series of ongoing meetings with Medicaid Director Nicolella to discuss reforms to improve the system for both beneficiaries and for home care providers.
A Committee of Partnership members’ will review cost reports and actual Medicaid spending in order to specify recommended areas for cost savings.
Advocating for the elimination of the budget article as it relates to selective contracting continues to be our advocacy position.
New partnership offers powerful resources and e-learning discounts for our members
The Rhode Island Partnership For Home Care has teamed with CHAMP (Collaboration for Homecare Advances in Management and Practice) to bring valuable resources to our members. CHAMP is an innovative web-based initiative to advance home care excellence for older persons. CHAMP’s website, www.champ-program.org, offers a “go to” place where frontline clinicians can find relevant resources (tools, practical checklists, guides, reminders, patient and clinician education materials, etc.) for use in the home setting. CHAMP also provides e-learning courses tailored to the home care sector and a community blog with advice from colleagues on key topics for geriatric care. In addition, there is a growing inventory of evidence-based tools to help providers trying to make a real difference in the lives of older people who receive care at home. CHAMP’s free weekly eNewsletter keeps home care professionals and senior leaders informed about the latest CHAMP information and resources. Sign up today by clicking here.
CHAMP was developed by the Visiting Nurse Service of New York’s Center for Home Care Policy & Research with funding from the John A. Hartford Foundation and the Atlantic Philanthropies.