NAHC describes in detail the flaws related to this recommendation released by MedPAC. Read the NAHC article HERE. (NAHC Login Required)

AAHC, along with our national partner The National Association for Home Care and Hospice (NAHC) strongly disagrees with this recommendation and will advocate against it in Congress. 

Join us in ensuring an adequate rate for the invaluable services and care delivered by home health agencies in Arizona.

 Use this link to share your thoughts directly with your elected leaders in congress.  

Not yet a Member of AAHC? Join Today! and stay informed about this and other important issues through our Regulatory Alerts and Home Care Updates as they become available.

Advocacy In Action

This crucial bill aims to revolutionize home health care by allowing occupational therapy (OT) to be ordered as a stand-alone service for Medicare beneficiaries. Passage of the bill would mean that the need for occupational therapy would allow a beneficiary to receive home health care services without having to also receive nursing, physical therapy, or speech services as is now required under current Medicare (Part A) policy.

Read More (NAHC Member Login Required)

MedPAC unanimously voted Thursday, January 11, 2024, to recommend cutting the home health base payment rate by 7% in CY2025 and freezing the hospice update to 2024 Medicare base payment rates for FY2025.

Significant cuts in spending will result if the MedPac recommendations are accepted by Congress. Home health spending would fall between $750 million and $2 billion in one year and $5 billion to $10 billion over five years. Spending on hospice would fall from $250 million to $750 million over a year and between $1 billion and $5 billion over five years, if the recommendation to freeze hospice rates in FY 2025 are enacted.

Read More on this vitally important issue. (*NAHC Login Required.)

AAHC and our national partner NAHC are passionate about this important issue and will continue to actively advocate for spending and payment rates that ensure access to quality home health and hospice care for all who need and want it.

Not yet a Member of AAHC? Join Today! and stay informed about this and other important issues through our Regulatory Alerts and Home Care Updates as they become available.

Patients could leave the hospital and recover at home with a mix of expanded skilled nursing, therapy, personal care, telehealth services and more.

The Arizona Association for Home Care (AAHC) supports this legislation which has broad support from the following national organizations:

• National Association for Home Care & Hospice and the Forum of State Associations 
• AARP
• Partnership for Quality Home Healthcare
• Leading Age
• Allies for Independence
• National Council on Aging
• Council of State Home Care & Hospice Associations
• Moving Health Home, an Alliance to Advance Home-based Policy

To add your voice and ask your elected officials in Congress to be a co-sponsor of this important legislation with an easy-to-use advocacy tool available through the National Association for Home Care & Hospice (NAHC) - membership is not required to use the tool.

Access the tool which includes information, fact sheet, FAQ and talking points.

To learn about other public policy issues for home health and in-home care providers and the patients and families they serve, visit the AAHC Advocacy Center.

This bill was a priority issue for AAHC and one we have advocated for since it was first introduced in 2007.

Join us in Thanking Congress for passing this much needed legislation with this quick easy-to-use tool (will take less than 2 minutes).

Good to Know:

The Centers for Medicare & Medicaid (CMS) will still need to issue regulation for the change to be implemented.

NAHC has requested an expedited regulation implementation from CMS; however they are advising that during the Public Health Emergency Declaration, CMS will be using their discretion to not enforce the prohibition on NPPs writing orders for home health services.

Arizona's Rules for Home Health Agencies already reference a Registered Nurse Practitioner and they are permitted to practice to their full scope as identified in the Arizona Revised Statutes and licensing boards. Additional clarification and guidance will be needed on the other providers identified in the federal legislation: physician's assistants (PAs) and Clinical Nurse Specialists (CNS).

For more information, please reference the Alert sent to Members on April 3. 

Visit this Link to Contact Senators and Representatives:

https://p2a.co/J7kJz7h

Healthcare started in the home.

In the wake of the COVID-19 pandemic, the home care and hospice communities are coming together and doing our part to provide critical, quality care, and services to Americans at home, in a national effort to keep each other safe.

We want to thank, our members of Congress, for recognizing the important role of home care and hospice during the pandemic and  supporting emergency funding and resources that will help keep patients at home and slow the spread of COVID-19.

But, during this unprecedented challenge, the unsung heroes of the home care and hospice communities continue to need their support to:

• Access and receive Personal Protective Equipment (PPE). Doing so will enable the care of virus-afflicted care to be delivered in the home freeing up beds for more severe cases.
• Permit the full scale use of home telehealth visits, including telephonic, as a substitute for in-person services whenever clinically acceptable. This change would apply for benefit eligibility and payment purposes.

Healthcare began in the home and was cultivated out of pressing social need. Today, that social need has returned, and we need you to ask your members of Congress  to continue to support the home care and hospice communities with funding and resources.  

Visit this easy-to-use tool to identify your elected representatives in DC and share your perspectives.

https://p2a.co/J7kJz7h

Thanks to the incredible efforts of members of the Arizona Association for Home Care and our colleagues around the country, several of the provisions we advocated for are a part of the package but more work is needed to ensure patients and clients continue to have access to high quality care and agencies are positioned to overcome the extreme challenges facing them.

Safeguard your resources and access to the information, education and advocacy you need to be successful in 2023!

Join or Renew your memberships in both AAHC and NAHC today so we can continue to work together supporting a vibrant home care community and high-quality, cost-effective care experience for patients, caregivers and their families in Arizona!

Originally published by NAHC on June 12, 2015

The U.S. House of Representatives today overwhelming passed by a vote of 392-32 a provision removing Medicare cuts from a separate bill reauthorizing the Trade Adjustment Assistance (TAA) program.  The National Association for Home Care and Hospice (NAHC) was among the first organizations to voice its strong opposition to the Medicare cuts.  With many lawmakers expressing opposition, earlier this week House leaders announced their intentions to find a replacement offset.

NAHC President Val J. Halamandaris praised the House action in a statement released today.

“Today’s vote was an important victory for home care and hospice, as well as for Medicare patients and advocates nationwide,” said Halamandaris.  “Congress received our message and opposed raiding Medicare to fund non-health care legislation.  I want to thank House Speak John Boehner and Minority Leader Nancy Pelosi for helping to negotiate an alternative, as well as the lawmakers who bravely stood up to prevent using Medicare as a piggy bank for unrelated legislation.”

The provision removing the Medicare cuts from the TAA legislation was included in a separate trade preferences bill passed by the House on Thursday.  The Senate will need to pass the trade preferences bill as well before it becomes law but it is likely to do so.  The House plans to vote Friday on the TAA and Trade Promotion Authority legislation.  Please stay tuned to NAHC Report for further updates.

Originally published by NAHC on June 24, 2015

The Congressional Budget Office (CBO) this week released an estimate that the 21st Century Cures Legislation, which aims to spur medical innovations, would cost $106.4 billion over five years. The number was much higher than expected due to the fact that CBO included in its estimate the budget for the National Institutes of Health (NIH) through 2019.

Previously Congressional aides had estimated the cost of the legislation to be roughly $12 billion, but the new CBO score has caused Congress to take a fresh look at the cost of the legislation.

As previously reported, the House Energy and Commerce Committee last month released the legislation and unanimously passed it out of the Committee. The bill already faced challenges due to concerns about provisions being used to offset the cost of the legislation, particularly a provision that would delay payment to private Medicare Part D plans. CBO estimated that specific provision would offset $5 billion of

the legislation’s cost, while the total offsets amounted to $12 billion.

Of interest to home care and hospice, the legislation contains language requiring the Centers for Medicare & Medicaid Services (CMS) to conduct research supporting innovations with regards to electronic health records, interoperability, and telehealth. The bill instructs CMS to report to committees of jurisdiction in Congress on means of expanding telehealth as well as barrier to its expansion in Medicare. However, it does not require CMS to make any changes to current telehealth services. The bill also includes a section on ensuring the interoperability of health information

The bill provides $10 billion over five years for an NIH Innovation Fund, as well as $1.5 billion in additional funding under the normal appropriation for NIH. This additional funding is intended to boost the nation’s research efforts. It also directs NIH to establish a research network devoted to pediatric diseases and birth defects.

In addition to research provisions, the legislation includes proposals to improve the development and coordination of private and public efforts towards new treatments and cures, including antibiotic drugs and vaccines. With the inclusion of new drug development requirement, some lawmakers argued the legislation should provide additional resources to the Food and Drug Administration in order to carry out the requirements.

In its 2015 Legislative Blueprint for Action, NAHC provides several recommendations for Congress to ensure the appropriate use of technology in home care. The recommendations include: 1) establish telehomecare services as distinct benefits within the scope of Medicare and federal Medicaid coverage guided by the concepts embodied in the FITT Act, including all present forms of telehealth services; 2) allow for sufficient flexibility to include emerging technologies; 3) clarify that telehomecare qualifies as a covered service under the Medicare home health services and hospice benefits and provide appropriate reimbursement for technology costs; 4) eliminate the list of authorized originating sites for telehealth services by physicians so that the home residence would be a covered telehealth site; 5) ensure that all health care providers, including HHAs and hospices, have access to appropriate bandwidth so that they can take full advantage of advances in technology appropriate for care of homebound patients; and 5) include telehealth equipment and service delivery as allowable costs in home health and hospice. In addition, Congress should work with the Administration to provide financial incentives to HHAs to encourage the adoption and use of electronic health records by home care and hospice providers.

NAHC Report will continue to provide updates regarding the status of this legislation.

Originally published by NAHC on June 29, 2015

Four members of the U.S. House of Representatives—Greg Walden (R-OR), Ron Kind (D-WI), Lynn Jenkins (R-KS), and Jan Schakowsky (D-IL)—sent a letter this week to their House colleagues encouraging them to cosponsor the House version of the Home Health Care Planning Improvement Act of 2015, following a similar letter by U.S. senators last month to recruit support for the Senate version of the

legislation, as reported by the National Association for Home Care & Hospice (NAHC).

“The Home Health Care Planning Improvement Act of 2015 would ensure that our Medicare beneficiaries get the home health care they need in a timely manner by allowing NPs [nurse practitioners], CNSs [clinical nurse specialists], CNMs [certified nurse midwives], and PAs [physician assistants], to order home health services, if their state allows it,” Representatives Walden, Kind, Jenkins, and Schakowsky wrote in the letter.

So far, the House bill has 112 cosponsors including an impressive 15 bipartisan original cosponsors from key committees with jurisdiction over the legislation. The Senate bill now has 33 bipartisan cosponsors. Most recently, Sen. Baldwin (D-WI), Sen. Schatz (D-HI), and Sen. Kirk (R-IL) joined as cosponsors. 

NAHC in coordination with other organizations supporting the bill has set the goal of achieving 40 cosponsors for the Senate bill and as many as possible for the House bill. NAHC is working with key champions in Congress to receive a Congressional Budget Office score of the legislation and technical assistance from the Centers for Medicare & Medicaid Services so that the bill can move forward in the Committee process. More Congressional cosponsors would increase the likelihood of the bill being included in a future Committee markup.

Please click here to see if your senators have cosponsored the bill and click here to see if your Representative has done so. If not, please use the Legislative Action Center to contact them to cosponsor the bill right away.

Nurse practitioners and physician assistants are currently authorized to either work in states independently or in coordination with physicians to treat, diagnose and prescribe medicine.  However, they are unable to order home health care services.

The fact that non-physician health professionals are unable to certify home health services is increasingly a problem because more and more people are receiving home-based care from non-physician health professionals. As a result, patients face the burden of visiting an unknown physician first in order to receive home health care. 

NAHC strongly supports this legislation, which will reduce expensive hospitalizations and nursing home stays. NAHC Report will continue to provide updates regarding the status of the bill.

Originally published by NAHC on May 22, 2015

Two leading members of the U.S. Senate are urging their colleagues to cosponsor bipartisan legislation endorsed by the National Association for Home Care & Hospice (NAHC) that would allow Nurse Practitioners (NP) and Physician Assistants (PA) to certify Medicare home health plans of care.  U.S. Senators Susan M. Collins (R-ME) and Chuck E. Schumer (D-NY) sent a letter to their Senate colleagues this week encouraging them to cosponsor the Home Health Care Planning Improvement Act of 2015 (S. 578), which they introduced earlier this year.

“We are writing to urge you to join us as cosponsors of the Home Health Care Planning Improvement Act of 2015 (S. 578) to ensure that our senior and disabled citizens have timely access to home health services under the Medicare Program,” Senator Collins and Schumer said to their colleagues in the letter.

S.578 would allow NPs, PAs, clinical nurse specialists, and certified nurse midwives to order home health services for Medicare beneficiaries.  Currently, these clinicians are authorized to perform many services for Medicare beneficiaries, including ordering nursing home care and prescribing medicine. However, they are unable to order less costly and less intrusive home health care services.

NAHC President Val J. Halamandaris has praised the legislation.  “Studies have shown that the expanded use of these professionals can result in dramatic decreases in expensive hospitalizations and nursing home stays,” he said.

Non-physician health professionals are playing an increasingly important role in the delivery of our nation’s health care, especially in rural and underserved areas.  However, as a result of this burdensome restriction, those who use non-physician medical professionals as their primary care providers often face the burden of an additional office visit with an unknown physician in order to receive home health care. 

According to a separate letter supporting the legislation from the Leadership Council of Aging Organizations to the senators, “outside experts assessed the impact of the bill earlier last year and projected a Medicare savings of $7.1 million in 2015 and up to a ten-year savings of $252.6 million. This analysis also notes the potential to reduce beneficiary admissions to and lengths of stay in institutional settings under the policy change.”

Currently 23 senators have cosponsored the bill.  For the current list of cosponsors, please click here.  If one or both of your senators have not yet cosponsored the bill, please encourage them to do so by using NAHC’s Legislative Action Center.

Originally published by NAHC on May 14, 2015

The Obama Administration is making good on its promise to significantly change worker rights to minimum wages and overtime compensation. On May 5, 2015, the U.S. Department of Labor submitted a proposed rule for review by the Office of Management and Budget (OMB). That proposal would modify the standards for the application of overtime exemptions for professional and executive personnel who are paid on a salary basis. While the specifics of the proposal are not public, it is expected that the rule change would raise the minimum salary level required for an application of the exemptions and tighten the standards for determining whether and employee is a “professional” or “executive.”

The current minimum salary necessary to qualify for the exemptions is $455 per week. That level was set in 2004. Previous to 2004, the minimum salary level was $155 or $250 per week depending on the employee’s duties. The Administration had expressed concerns that individuals with wages less than $24,000 a year were being required to work an extensive amount of hours without additional compensation.  In March last year, President Obama indicated that he wanted the standards to be updated and ordered the Department of Labor to begin work on a revision of the rules.

Speculation abounds on the content of the proposed rules, but many observers expect that the minimum salary level for qualification for the exemptions will likely double. A number of Washington think tanks have called for increases much higher and some Members of Congress have called for a salary level of $69,000.

The Department Labor under the Obama Administration has frequently shown interest in heightening worker wage protections. Along with the DoL effort to eradicate the companionship services and live-in domestic services exemptions, a more restrictive standard for the salaried executive or professional exemptions would be consistent with the President’s goals.

Home care and hospice, like many other industries, makes use of the salaried executive and professional exemptions. For instance, many companies pay professional clinical staff a base salary equivalent to the minimum exemption level and then add compensation on a per visit basis to incentivize productivity. If the salary minimum is raised significantly, home care and hospice companies will be handicapped in using this compensation method effectively.

The proposed rule will likely be released by OMB in a matter of weeks. At that point, the opportunity for public review and comment will begin. NAHC encourages its members to get prepared to evaluate the impact of the rule change on their business so that effective comments can be prepared. Gaining a full understanding of the number and makeup of staff currently subject to an exemption along with the number of hours worked by such staff is a good starting point. When the proposed rule is issued, providers can then evaluate the impact on an employee by employee basis.  

NAHC will provide updates on any developments involving the proposed rule.

Originally published by NAHC on May 18, 2015

Bipartisan legislation was introduced in the House of Representatives that would expand access to remote monitoring and telehealth. Introduced by Rep. Gregg Harper (R-MS-03) and co-sponsored by Rep. Mike Thompson (D-CA-05), Rep. Diane Black (R-TN-06), and Rep. Peter Welch (D-VT-01), the Telehealth Enhancement Act of 2015 (H.R. 2066) would make major changes in federal laws pertaining to remote monitoring and telehealth.

Rep. Harper’s telehealth legislation builds off a previous bill, the Telehealth Enhancement Act of 2013, which sought to adjust Medicare home health payments to account for remote patient monitoring and to expand coverage to all critical access and sole community hospitals.  “Telehealth is health care, and it should be a tool in every doctor's toolbox,” said Thompson about the legislation in 2013.  “By expanding Medicare and Medicaid telehealth coverage through this legislation, we can make sure more people can get high-quality care no matter where they live or how far away they are from a doctor.  Patients and providers want telehealth health, and the reason is simple - it saves money and saves lives. This bill is a big step in the right direction, and we need to keep working until telehealth is an option for everyone.” 

The major provisions in the bill include:

• Incentives for Medicare’s hospital readmission reduction program;
• Ensuring the use of telehealth in health homes and medical homes;
• Allow flexibility in ACO coverage of telehealth; and
• Add additional sites to be considered originating sites for purposes of payments for telehealth services under Medicare such as a ‘home telehealth site.’

The National Association for Home Care & Hospice’s (NAHC’s) Home Care Technology Association of America (HCTAA) worked closely with the sponsors of the bill to ensure that telehealth services for both hospice care and home health services were included in the bill.  “We support HR 2066 (and its Senate companion bill) because inclusion of a ‘home telehealth site’ and for the telehealth services related to hospice care and home health services,” stated Richard Brennan, NAHC’s VP of Technology Policy.

Originally published by NAHC on April 27, 2015

On Thursday evening, the House Ways & Means Committee approved legislation that would divert Medicare dollars in order to pay for the reauthorization of the Trade Adjustment Assistance (TAA) program.  As previously reported, the Senate Finance Committee approved the same measure on Wednesday.  The trade legislation includes a 0.25 percent cut to Medicare providers for the last six months of 2024 to offset the cost of the legislation.

Earlier in the week, NAHC and three other organizations—the American Hospital Association, American Medical Association, American Health Care Association—sent a letter to members of the US Senate and House opposing the provision in the TAA bill that would include cuts to Medicare as a pay-for to offset the cost of the legislation. Senior groups, including the National Committee to Preserve Social Security & Medicare, also criticized the Medicare cuts.

NAHC worked behind the scenes with committee members to advance efforts to replace the Medicare cuts.  Several members of Congress in both the House and the Senate raised concerns about the cuts to Medicare.  Due to those efforts, House Ways & Means Committee Chairman Paul Ryan (R-WI-1) expressed his willingness moving forward to consider more acceptable alternatives to pay for the trade legislation before it becomes law.  

“I understand people have concerns about one of the pay-fors, which is the Medicare sequester. I share those concerns,” Chairman Ryan said. “I’m willing to explore options for replacing it between now and when this gets into law, or when it gets to the floor perhaps. So I’m willing to work with the Minority on that.”

During the House Ways & Means Committee session, several Democrats raised concerns about the Medicare cuts and eventually voted against the overall trade legislation specifically in opposition to the Medicare provision. The Committee approved the trade measure, with 13 Democrats voting in opposition. 

“I think the sequester to start with is a bad policy,” said Committee Ranking Member Sandy Levin (D-MI-9).  “I think it’s a bad precedent to extend it beyond its current expiration. I think it’s also very concerning to use Medicare money to pay for trade.  And I think, finally, we just passed SGR and now what we’re going to do is to essentially ask for some additional monies from providers.”

Congressman Joseph Crowley (D-NY-14) introduced an amendment that would have replaced the Medicare cuts with a pay-for that would improve tax compliance.  Committee Republicans raised a procedural motion against the amendment, arguing that the proposed pay-for was out of the Committee’s jurisdiction.

“We can’t keep talking about taking from these critical health providers and expect it not to have the negative effects on our seniors and access to care,” said Congressman Crowley.  “If doctors stop practicing, or hospitals or nursing homes are forced to close, or home care agencies have a longer wait list, that hurts our seniors.”

Congressman Crowley also reiterated a concerned expressed by NAHC regarding the precedent of using Medicare funding for non-Medicare legislation.  “We can’t expect our health care providers to be used as a piggy bank for every bill that comes before us,” he said. “If we’re going to tell our doctors and other health care providers that they should constantly be worried about facing cuts to pay not just health care bills but trade bills, or anything else that needs funding, that undermines those very same goals.”

Congressman Ron Kind (D-WI-3) also offered an amendment to remove the Medicare cuts.  Congressman Kind withdrew his amendment with the “assurance” from Chairman Ryan that they would “continue working on an appropriate offset.” Congressman Kind also stated his opinion that it would be difficult for Congress to achieve enough votes to pass the trade legislation with the Medicare cuts included.  “Calling for further Medicare sequester cuts in order to pay for a trade measure just doesn’t fly,” he said. “I think it’s unfair and the policy is wrong.”

Other Democrats expressed similar concerns about Congress diverting funds designated to serve Medicare patients for other purposes.  “It’s not fair and it’s not right to rob the most vulnerable segment of our society,” said Congressman John Lewis (D-GA-5).

During the Senate Finance Committee mark-up of the trade legislation on Wednesday, Senator Mark Warner (D-VA) also introduced and then withdrew an amendment that would have replaced the Medicare cuts with a provision that would fund the trade legislation by altering mortgage reporting requirements.  Senate Finance Committee Ranking Member Ron Wyden (D-OR) committed to working with Senator Warner moving forward.

“One thing that I think most of us agree on both sides of the aisle is sequestration is stupidity on steroids,” said Senator Warner.  “I think that Medicare sequestration disproportionately hurts our rural hospitals and health centers is unfortunate.”

Currently, the sequester cuts to Medicare are set to expire at the end of the first six months of 2024.  Members of Congress established a 4 percent cut to Medicare providers for the first six months of 2024, in order to average 2 percent for the entire year.  The trade legislation, however, would impose a 0.25 percent cut to Medicare providers for the last six months of 2024, thereby increasing the overall sequester cut to Medicare providers in 2024 above the current 2 percent level included in the Budget Control Act.  According to estimates by the Congressional Budget Office, the legislation would increase the sequester cut to Medicare by $700 million.

In the letter to members of Congress, NAHC and the other associations stated that Medicare providers have already made significant sacrifices and raised concerns about the use of Medicare cuts to fund non-Medicare legislation. 

Please use NAHC’s Legislative Action Center to dissuade your members of Congress from using Medicare cuts to fund the trade legislation.

Originally published by NAHC on April 1, 2015

Last week, the US Senate passed a budget resolution that included an amendment, introduced by Senator Susan Collins (R-ME), addressing the definition of full-time employment under the Patient Protection and Affordable Care Act (ACA). Budget amendments do not have the force of law. However, the amendment’s success demonstrates the strong support in Congress to amend the ACA’s definition of full-time employment.

Senator Collins (R-ME), in January, also introduced stand-alone legislation, the “Forty Hours Is Full Time Act” (S. 30), with bipartisan original cosponsors: Senators Donnelly, Manchin, and Murkowksi.

The Collins amendment was adopted as part of the Senate budget resolution by unanimous consent. Due to parliamentary rules for budget amendments, the amendment is different than S. 30. Rather than specifically changing the definition from 30 to 40 hours, the amendment expresses support for restoring a “sensible” definition of a full-time employee.

The purpose of the budget resolution is to establish the level of discretionary spending for the coming fiscal year. It also provides an opportunity for Congress to voice its priorities through nonbinding policy proposals, such as the Collins amendment.

The National Association for Home Care & Hospice (NAHC) strongly supports both Senator Collins’s amendment and S. 30.

Currently, the ACA imposes penalties on employers with more than 50 full-time equivalent employees that do not provide health insurance for a “full-time” worker—defined as those working just 30 hours or more a week. NAHC believes this definition is out-of-keeping with standard employment practices, and that it will harm many home care agencies and the patients they serve.

While the vast majority of home care agencies are small businesses according to the Small Business Administration, the ACA defines them as “large employers” based on the fact that they have 50 or more employees. Many home care agencies do not provide health insurance to home care workers for reasons that are fairly unique to the industry. The agencies are reliant on government programs such as Medicaid, which provides low payment rates that do not cover the costs of providing health insurance. Home care workers typically work widely varying hours, based on the needs of their home care clients.

Of concern, home care agencies that are unable to provide health insurance or pay the ACA penalties will be forced to cut their employees’ hour to less than 30 in order to avoid the health insurance requirement.

According to a NAHC survey from December 2014, the full-time definition in the ACA would weaken patient access to care, reduce wages and working hours of home care staff, and force home care companies to restructure their operations to rely on part-time caregivers:

• 82.54% of home care and hospice companies do not provide health insurance to all of their employees because of reliance on government program payments and service to individuals with limited incomes
• 46.2% of those companies face a financial penalty under the employer mandate ranging as high as $4.5 million
• 73.3% of the companies would reduce the working hours of employees to under 30 per week in order to avoid the cost of health insurance or financial penalties that they cannot afford
• 22.16% of the businesses expect to close because of the financial penalties
• 83.2% of the companies expect that access to home care in their community would be reduced with fewer providers of care, more restrictive patient admission criteria to fit a part-time workforce, and restrictions on service areas.
• 88.46% expect that access to Medicaid home care will no longer be sufficient to meet client’s needs

Please contact your members of Congress using NAHC’s Legislative Action Center to cosponsor legislation defining 40 hours as full-time.

Originally published by NAHC on April 10, 2015

The U.S. Senate Majority Leader, Mitch McConnell, was among 10 leading members of Congress last week who submitted a “friend of the court” brief, also known as amicus curiae brief, supporting NAHC’s position in its lawsuit against the U.S. Department of Labor (DOL) over new regulations that would redefine the “companionship services” and “live-in” exemptions under the Fair Labor Standards Act (FLSA).  Also submitting amicus briefs supporting NAHC last week were nine state Attorneys General, as well as two leading disability groups—ADAPT and the National Council on Independent Living (NCIL)—and the Consumer Directed Personal Assistance Association of New York State.

“The DOL’s amended regulations relative to the companionship and live-in exemptions ignore the plain statutory language and subvert Congressional intent, with potentially devastating effects to the aged and infirm and their families,” wrote the members of Congress in their amicus brief.  “There are no ‘winners’ to be found in this new regulatory scheme.  The effects Congress clearly sought to avoid in 1974 by creating this limited exemption from the FLSA [Fair Labor Standards Act] and in maintaining the status quo on the exemption after the decision in Coke in 2007—namely, increased costs and institutionalization of our elderly and infirm populations—will clearly be the end result if the District Court’s Orders are overturned and these regulations are reinstated.  These policy decisions have already been made by Congress, and the DOL cannot undo those decisions and substitute its own judgment in their place.”

The members of Congress submitting the amicus brief supporting NAHC included:

• Sen. Mitch McConnell, Senate Majority Leader and a member of the Committee on Appropriations;
• Sen. Pat Roberts, Member of the Committee on Health, Education, Labor, and Pensions (HELP);
• Sen. Lamar Alexander, Chairman of the HELP Committee, and Member of the Committee on Appropriations;
• Sen. Roy Blunt, Member of the Committee on Appropriations and Chairman of the Subcommittee on the Department of Labor, Health and Human Services Subcommittee;
• Sen. John Boozman, Member of the Committee on Appropriations;
• Sen. Mike Enzi, Chairman of the Committee on the Budget and Member of the HELP Committee;
• Sen. Johnny Isakson, Member of the HELP Committee;
• Senator Marco Rubio, Member of the Committee on Small Business and Entrepreneurship;
• Representative Tim Walberg, Member of the House Committee on Education and Workforce; and
• Representative Lynn Jenkins, Member of the House Committee on Ways & Means.

As previously reported, in January, DOL appealed the U.S. District Court’s ruling that invalidated multiple regulations issued by DOL that would eliminate the “companionship services” exemption from minimum wage and overtime compensation requirements under the FLSA.  The court also invalidated a DOL rule that would prohibit home care companies from applying the companionship services and live-in domestic services exemptions to their workers.  The Court of Appeals for the District of Columbia will consider the appeal with oral arguments before a three-judge panel scheduled for May 7, 2015.

DOL filed its initial brief for the appeal on February 20.  NAHC submitted its reply brief on March 30.  One of the differences from the original action before the District Court is that other parties have the opportunity to submit amicus briefs in which the parties clearly express to the court which side of the litigation they support.

The amicus briefs supporting NAHC responded forcefully to claims made by DOL in its initial brief filed to the court on February 20.  DOL has claimed that the district judge made errors in interpreting the FLSA and in ruling whether a regulation is within the power of a federal agency.  The central argument by DOL is that the U.S. Supreme Court established that it is within DOL’s discretion to define and delimit the FLSA exemptions at issue, and that the only grounds for invalidating its discretionary action is if that action is found to be arbitrary and capricious.  DOL claims a reasonable basis to change the 40 year old rule based on changes in the home care industry, the “professionalization” of home care aide work, and the shift of the work to a vocation rather than an avocation. The lower district court rejected these same DOL arguments.

In response to DOL, NAHC and its supporters have highlighted significant concerns ignored by DOL about eliminating the companionship exemption.  The members of Congress emphasized that DOL is disregarding Congressional intent and authority in such a way that will result in increased costs and institutionalization of elderly and infirm populations.  The ten state Attorneys General, led by Kansas, stated that the DOL rules would negatively affect their states’ fiscal interests in administering home care programs under Medicaid and raise constitutional concerns regarding the states’ sovereign interests.  “In short, the Department’s new regulations expose States to an unfunded liability for overtime wages under the FLSA,” the states wrote in their brief.

The states further argued that the rule will “threaten the operational viability of this program, both in letter and spirit”—harming not only consumer care, but also workers by forcing employers to cap hours in order to stay within the constraints of Medicaid rates.

The state Attorneys General submitting the amicus brief are: Kansas, Arizona, Georgia, Michigan, Nevada, North Dakota, Tennessee, Texas, and Wisconsin.

The other amicus briefs similarly expressed concerns about the negative consequences of the rules on both workers and patients.  ADAPT and NCIL highlighted concerns specifically about the consequences for disabled people

“The new rule will also have highly disruptive effects on the lives of disabled people,” the disability groups wrote.  “In many cases, people will lose services which enable them to live in at home, resulting in forced institutionalization.  DOL’s action will, therefore, harm both attendants – the very workers it intended to assist – and people with disabilities.”

The Court of Appeals for the District of Columbia will hear oral arguments before a three-judge panel on May 7, 2015.  NAHC will continue to provide updates regarding the lawsuit.

Originally published by NAHC on April 10, 2015

Two bipartisan members of the U.S. House of Representatives—Congressman James McGovern (D-MA-2) and Congressman Walter Jones (R-NC-3)—have re-launched the Home Health Caucus in order to advance the role of home health in delivering quality, cost-effective health care.  In a letter to their colleagues, Congressmen McGovern and Jones invited all members of the U.S. House of Representatives to join the caucus.

Members of the U.S. Congress can establish caucuses—officially known as Congressional Member Organizations—in order to advance awareness about a particular topic or issue and to pursue relevant legislative priorities.  Members of Congress are able to join an established caucus in order to demonstrate their support for its issues and agenda.  The first Home Health Caucus was launched over a decade ago during the 107th Congress in the U.S. House.

“We are reconvening the bipartisan Home Health Caucus to further the role of home health in our nation’s health care delivery system and we invite you to join,” the Representatives wrote in the letter inviting their colleagues to join the Home Health Caucus.

The National Association for Home Care & Hospice (NAHC) strongly supports the Home Health Caucus, which educates lawmakers about the increasingly important role of home health and pursues legislative goals that would advance the delivery of quality home health care.  NAHC encourages members of Congress to join the Home Health Caucus.

“Congressman James McGovern and Congressman Walter Jones are passionate home health advocates on behalf of the ill, aged and disabled,” said NAHC’s President Val J. Halamandaris.  “I want to thank them for re-establishing the Home Health Caucus and for continuing to build Congressional support for home health as the center of delivering quality, cost-effective health care.”

In their letter to colleagues, Congressmen McGovern and Jones emphasized the need “to build on home and community-based care as a means to take care of our rapidly growing senior population.”  They also stated that home health has been at the “leading-edge” in pioneering communications and technological innovations to improve the delivery of care.

“Today’s home health care industry offers one of the most effective and cost-efficient delivery systems of comprehensive, high-quality health care services,” the Representatives wrote.  “With the communication and technological advances over the last several years, the home health community has pioneered leading-edge models and therapeutics to deliver comprehensive, high-quality, patient-centered care across the health care delivery system.  These models lead to better patient care coordination, medication management, disease and chronic care management, and behavioral and preventative education.  The innovative approaches of today’s home health care show great promise in addressing many of the concerns associated with disparities in health care and access in rural communities.”

NAHC will continue to provide updates regarding efforts by the Home Health Caucus.  Please click here to use NAHC’s Legislative Action Center to urge your U.S. Representative to join the Home Health Caucus today.

Originally published by NAHC on April 15, 2015

Two U.S. House Subcommittees—the Ways & Means Health Subcommittee and the Education & the Workforce Subcommittee on Health, Employment, Labor, and Pensions—convened hearings today that focused on the impact of the employer mandate included in the Affordable Care Act (ACA).  The hearings received testimony from business owners, think tanks, and trade associations about the negative consequences of the mandate on both employers and employees, as well as other aspects of the ACA.

In his opening statement, House Subcommittee on Health, Employment, Labor, and Pensions Chairman David P. Roe (R-TN) gave specific example of employers that have reduced hours or altered staffing in order to avoid penalties under the employer mandate.

“More than 450 employers have publicly stated they are cutting hours or making other staffing changes to avoid the law’s punitive mandates, including the University of Colorado in Colorado Springs, Trig’s Supermarkets and Coach’s Fast Food in Wisconsin, Shari’s restaurants in Oregon, and the Henrico County School District – as well as other school districts – across the Commonwealth of Virginia,” Chairman Roe stated.

Roe explained that the employer mandate has negative consequences not only for employers but also workers.  “The Congressional Budget Office estimates the law will result in two million fewer full-time workers.  Many of these difficult changes are taking place in the service industry, which means lower-wage workers are bearing the brunt of the ObamaCare burden.  Schools are also cutting hours, undermining the quality of education America’s students deserve.  We’ve heard time and again from the administration that these are mere anecdotes or, in the words of then-Secretary Sebelius, ‘speculation.’ Yet even those who supported the health care law have no choice but to recognize its harmful consequences.”

House Ways & Means Health Subcommittee Chairman Kevin Brady (R-TX) recounted stories from business owners about the impact of the mandate.  “I have a local restaurateur who has instructed his four store managers they will never again hire a full time worker,” Brady said.  “He has been advised by his accountants that he would—because of the ACA—would actually be more profitable by closing three of the stores and going with one, which is exactly what he doesn’t want to do. He wants to have a pizza small business in Willis, TX, and would like to expand to two neighboring communities. But primarily because of this, he can’t afford to do so.”

In a sign of bipartisan support for addressing some of the issues with the employer mandate, Congressman Jim McDermott (D-WA), who has been critical of efforts to repeal the ACA, indicated willingness to consider legislation that would ease the reporting requirements on employers for offering coverage to workers.

The testimony and statements during the hearing reflect concerns expressed by the National Association for Home Care & Hospice (NAHC) that many home care agencies will be unable to provide health insurance or unable to pay the ACA penalties.  As a result, home care agencies will be forced to cut their employees’ hours to less than 30 in order to avoid the health insurance requirement.  In its 2015 Legislative Blueprint for Action, NAHC recommends Congress should: modify the employer responsibilities in the ACA to address home care specific needs; exempt home care providers from the employer responsibilities; fund the cost of health insurance for full time workers; help the states ensure that low wage home care workers have health insurance through Medicaid or otherwise; provide subsidies or tax credits to cover the increased cost of care as a result of the employer mandate. Consumers of private duty care should not need to pay higher rates of care.  

Another proposal that NAHC strongly supports would amend the definition of full-time work from 30 hours or more per week to 40 hours or more per week.  The House passed this legislation earlier this year in January, and similar legislation has been introduced in the Senate.  The ACA imposes penalties on employers with more than 50 full-time equivalent employees that do not provide health insurance for “full-time” workers, which it defines as those working just 30 hours or more a week.

NAHC plans to submit a statement for the record for the Committee hearing.

NAHC conducted a survey in December 2014 that found the employer mandate would negatively impact home care and hospice agencies.  The results found it would weaken patient access to care, reduce wages and working hours of home care staff, and force home care companies to restructure their operations to rely on part-time caregivers.  Here are the results of the study:

• 82.54% of home care and hospice companies do not provide health insurance to all of their employees because of reliance on government program payments and service to individuals with limited incomes.
• 46.2% of those companies face a financial penalty under the employer mandate ranging as high as $4.5 million.
• 73.3% of the companies would reduce the working hours of employees to under 30 per week in order to avoid the cost of health insurance or financial penalties that they cannot afford.
• 22.16% of the businesses expect to close because of the financial penalties.
• 83.2% of the companies expect that access to home care in their community would be reduced with fewer providers of care, more restrictive patient admission criteria to fit a part-time workforce, and restrictions on service areas.
• 88.46% expect that access to Medicaid home care will no longer be sufficient to meet client’s needs.

While the House has already passed a bill changing the full-time definition in the employer mandate, the Senate has not yet passed the legislation.  Senate leaders have indicated they will bring the bill to a vote if there are enough votes to pass it.  Please contact your Senators using NAHC’s Legislative Action Center to cosponsor legislation defining 40 hours as full-time.

Originally published by NAHC on February 12, 2015

Each year the policy staff of the National Association for Home Care & Hospice (NAHC) develops its Legislative Blueprint for the coming year. The process of compiling the 2015 Legislative Blueprint for Action has been completed. Subsequently, NAHC’s Legislative Blueprint has been approved by the NAHC Board.

NAHC’s policy staff sought input from the organization’s Membership and affiliated organizations to help develop these blueprints, which lay out the action plan and basis for advocacy efforts for the coming year. Throughout the year as issues develop, NAHC gathers additional ideas for these agendas from members, state association affiliates, advisory committees, and the NAHC Board of Directors.

With potential big changes on the legislative and regulatory horizon for this year on Capitol Hill, NAHC is planning ahead as always with strategies to protect the continued viability of home care and hospice.

Please take some time to review the 2015 Legislative Blueprint. 

NAHC’s key Legislative Priorities will be printed in a booklet that will be distributed to all Congressional offices before the upcoming NAHC March on Washington, March 22-25.

While NAHC’s positions on hospice-specific issues are included in the Blueprint, a separate Hospice Blueprint document is also being developed. NAHC also completes a Regulatory Blueprint, which will be available in a future issue of NAHC Report.

To view NAHC’s 2015 Legislative Blueprint for Action, as well as Blueprints from past years, please click here.

To register to attend the March on Washington, please click here.

Originally published by NAHC on February 27, 2015

The Home Health Planning Improvement Act of 2015 (S. 578) was introduced in the Senate earlier this week by Senators Susan Collins (R-ME) and Chuck Schumer (D-NY). The bill seeks to allow health care professionals other than physicians to sign home health plans of care. S.578 is identical to legislation that was introduced in the last Congress – and previous Congresses – by Senator Collins, Senator Schumer, and other supporters.

Senator Collins, who became Chair of the Senate Aging Committee at the start of this Congress, has been one of the home care and hospice community’s biggest legislative champions. She has spoken at a record sixteen consecutive March on Washingtons. It was at NAHC’s 2013 March on Washington that Senator Collins pledged to reintroduce the Home Health Care Planning and Improvement Act during the 113th Congress, which she did along with Senator Schumer in July of that year.

S.578 will allow physician assistants (PA), nurse practitioners (NP), clinical nurse specialists, and certified nurse midwives to order home health services for Medicare beneficiaries.Currently, Medicare recognizes PAs, NPs, clinical nurse specialists, and certified nurse midwives as authorized providers who are able to perform many services for Medicare beneficiaries, including ordering nursing home care and prescribing medicine. They are not, however, able to order less costly and less intrusive home health care services.

Seniors and disabled citizens who see these medical professionals as their primary care providers often need an extra office visit with an unknown physician in order to get the care they need. In such situations, this impediment merely amounts to an extra administrative and paperwork burden, and creates an unnecessary step that fails to recognize current training and scope-of-practice guidelines. As a result, patients in need of home health care services are either placed in more expensive health care settings, or experience a delay in receiving the care they need.  This legislation will relieve that burden for our most vulnerable citizens.

NAHC strongly supports this legislation, and encourages all of its members to contact their lawmakers and urge them to support this legislation.

Additionally, the Leadership Council of Aging Organizations sent a letter to Senators Collins and Schumer stating that:

“This critical change would improve access to important home health care services, and potentially prevent additional hospital, sub-acute care facility and nursing home admissions—all of which are costly to the consumer, the taxpayer and Medicare…

The Home Health Care Planning Improvement Act would help to ensure that Medicare beneficiaries in need of home health care services whose providers are nurse practitioners, clinical nurse specialists, certified nurse midwives, and physician assistants would be able to directly access home health care by referral from their providers.  This bill would provide beneficiaries continued access to care and increase the likelihood that they would experience better health and a higher quality of life.  Additionally, outside experts assessed the impact of the bill earlier last year and projected a Medicare savings of $7.1 million in 2015 and up to a ten-year savings of $252.6 million.  This analysis also notes the potential to reduce beneficiary admissions to and lengths of stay in institutional settings under the policy change.”

To take action and urge your lawmakers to support S. 578, please click here.

To read the Leadership Council’s full letter to Senator Collins and Schumer, please click here.

Originally published by NAHC on January 19, 2015

The National Association for Home Care & Hospice (NAHC) today launched its new Legislative Action Center with additional tools for advocates that makes participating in grassroots action simpler, and broadens NAHC’s messages by contacting policymakers and elected officials via the most popular social media sites. The Legislative Action Center will enhance NAHC’s current Legislative Action by bringing new and better ‘call to action’ tools to all of its members on federal policy issues - ensuring that home care and hospice advocates have an optimum reach to advocate for legislation and action on crucial issues.

Since 2013, President Obama, all 100 Senators and over 90 percent of House members were on Twitter. These numbers were similar for elected officials on Facebook. NAHC’s Legislative Action Center allows home care and hospice advocates to communicate with lawmakers directly on these platforms. However, the traditional calls to action via phone calls and email will still be deployed when needed.

As NAHC saw that more and more decision-makers were using social media platforms, the organization decided to invest in enhancing the scope and reach that its advocates could achieve. As a result, NAHC upgraded its advocacy tools, yet wants to ensure that its membership has all the information that it needs to fully participate in the new Legislative Action Center - and to insure that this transition is smooth for home care and hospice advocates around the country.

About NAHC’s Partnership with Phone2Action

Phone2Action is a digital grassroots platform that makes it easy for NAHC members to connect with elected officials, and to take action on issues that matter to home care and hospice providers directly from their mobile devices. Today, more than 90 percent of Americans own a cellphone. Phone2Action places social action within reach of all mobile devices. By working with Phone2Action, NAHC members, consumers, friends and associated advocacy groups will be using the tools to amplify their voices and reach elected officials utilizing traditional email, but also Twitter, Facebook, and phone calls.

By using mobile technology for advocacy, NAHC is being responsive to providers and meeting them where they are: on their mobile phones. Together, NAHC and its members will write a new chapter in the story of home care and hospice advocacy as it moves further into the digital era.

Phone2Action was introduced at NAHC’s Annual Meeting in Phoenix last year.  At the meeting, NAHC leadership completed a live call-to-action engaging its members, and encouraging them to take action from their mobile phones in support of home care and hospice services. Attendees sent hundreds of emails, tweets, and Facebook posts to officials in support of legislation that would improve the delivery of home care services. Participants also thanked Senators Wyden and Portman for their presentations at the meeting, and their ongoing advocacy for home care and hospice.   

What the Changes Mean for Home Care and Hospice Advocacy

While Legislative Action Center will allow home care and hospice advocates to broaden their reach and further their engagement on key issues, much of the background information that advocates are familiar with through the previous NAHC Legislative Action Network will remain the same, and can be found here.

NAHC will continue to provide advocates with the most up-to-date information on federally elected officials and their staff names and contact information, as well as continuing to make available all of the detailed information on pending federal legislation - including talking points, briefings, analysis, and other resources developed and compiled by NAHC’s staff of experts.

Early Successes

NAHC’s pilot program with Phone2Action occurred at the 2014 Annual Meeting in Phoenix, AZ. At the meeting, NAHC staff walked attendees through the ease-of-use of participating in its new social campaigns. In the manner of minutes 549 messages were sent to lawmakers urging them to allow nurse practitioners to sign plans of care and to support, S.1332/H.R. 2504, the Home Health Care Planning and Improvement Act.

To further familiarize home care and hospice advocates with the new platform, a Day of Social Action was held in mid-November that also urged advocates to contact their elected officials and asked them to support the Home Health Care Planning and Improvement Act. The Day of Social Action saw advocates reach their lawmakers through Facebook and Twitter in support of this legislation.

Earlier this month, NAHC encouraged advocates to contact CMS Administrator Tavenner asking for a phase-in approach to the new Face-to-Face rules. In the span of just a few hours, close to 300 emails flooded Ms. Tavenner’s inbox.

NAHC has also asked home care and hospice advocates to contact their elected officials in support of the H.R. 30/ S. 30, the “40 Hours is Full Time Act.”

While in its early phases, NAHC has seen tremendous success in engaging elected officials and policy makers by utilizing this new social media platform.

To become familiar with NAHC’s new Legislative Action Center, please click here.   

To sign up to receive advocacy text messages directly to your mobile device, please click here.

Originally published by NAHC on January 9, 2015

The National Association for Home Care & Hospice (NAHC) applauded leaders in the House of Representatives for passing legislation that will change the Affordable Care Act’s (ACA) definition of full-time work from 30 to 40 hours. Twelve Democrats joined with the Republican majority to pass this important legislation.

NAHC President Val J. Halamandaris issued the following statement:

“We urge the members of the Senate to immediately follow suit and pass the companion bill, S. 30, introduced by Senator Susan Collins (R-ME), Chairman, Senate Special Committee on Aging, along with Senators Joe Donnelly (D-IN), Joe Manchin (D-WV), and Lisa Murkowski (R-AK) said Halamandaris. “The home care and hospice community has no better friend than Senator Collins, and her reintroduction of this bill further solidifies her reputation as a fighter for the infirm, disabled and elderly, not just in Maine but across the country.”

Home care workers, without relief, would have had to restrict employees to no more than 29 hours per week to ensure their workers are considered part time under the ACA. A survey that NAHC concluded in December 2014 shows that the employer mandate would weaken patients’ access to care, reduce wages and working hours of home care staff, and require home care companies to restructure their operations to rely on part-time caregivers.

NAHC praises the work of House of Representatives sponsors Todd Young (R-IN), Dan Lipinski (D-IL), Pete Olson (R-TX), Mike Kelly (R-PA), and Tim Walberg (R-MI) for their foresight and leadership.”

During the news conference held to reintroduce the Senate’s companion bill, S. 30, Lisa Harvey McPherson, a board member Home Care and Hospice Alliance of Maine, NAHC Board member, and chair of the NAHC affiliate, the Voluntary Nonprofit Home Care Association of America, spoke to illustrate the consequences the current 30 hour threshold is having on access to home care services. During her remarks, Ms. McPherson stated that:

“This legislation is critically important… The current definition of “full time employment” will have a devastating impact on home care workers and the patients that we serve… With the oldest population in the country, the demand for home care [in Maine] exceeds the capacity of the volume of workers that we have today. It is also important to note that many of the patients that we care for at home qualify to live in a nursing facility, but with home care support workers, home care aides and home care nurses, they can avoid or delay nursing home placement.

With passage in the House last week by a margin of 252 – 172, action on the bill is moving onto the Senate side. A hearing in the Senate’s Health, Education, Labor and Pensions Committee is scheduled for January 22. 

To urge your Senators to support this legislation - known as the “40 Hours Is Full Time Act” in the Senate - please go to the NAHC Legislative Action Center here.      

For more on S. 30, please see NAHC Report, January 8, 2015.

Originally published by NAHC on December 5, 2014

House Ways and Means Health Subcommittee Chairman Kevin Brady (R-TX) and Ranking Member Jim McDermott (D-WA) introduced the Protecting the Integrity of Medicare Act (PIMA) (H.R. 5780) this week.  Included in section 15 of the legislation is a provision that would impose a home health surety bond of not less than $50,000 that is “commensurate with the volume of payments to the home health agency.”  

CMS has the authority under the ACA to impose such a surety bond, but has not chosen to do so.  H.R. 5780 would make it mandatory.   Here is a link to the legislation: H.R.5780. 

This legislation could come to the House floor next week under suspension of the rules requiring a two-thirds majority vote.  If it passes the House, it would then go to the Senate.  If taken up by the Senate, it would likely be under a procedure called unanimous consent because of the short time remaining in the lame duck session.  This means one Senator can stop it from coming to a vote during the lame duck session.

NAHC is urging all of its members to send a message asking that their Representatives and Senators oppose this legislation unless the home health surety bond provision is removed.

Attached is a NAHC issue brief on surety bonds.  Some talking points to emphasize are: 

• it will hurt home health small businesses already struggling to comply with so many expensive and unreasonable regulatory burdens and thus threaten access to care;
• it’s in effect a tax on the vast majority of ethical providers to cover the cost of a few bad actors;
• it leaves wide discretion to CMS in setting the bond amount and implementing the requirement;
• there are so many better ways to protect the integrity of the Medicare home health program;
• any surety bond requirement should be time-limited and targeted to new providers only as rarely do longstanding providers present a risk to Medicare; and
• this legislation should not be rushed through Congress during the lame duck session without committee hearings and markup.

Please take a moment to urge your Representative and Senators to oppose the Protecting the Integrity of Medicare Act (H.R. 5780) unless the home health surety bond provision is removed.  For contact information, click here: Contact Your Elected Officials.  When calling, ask the receptionist to connect you with the staffer who handles health care issues. 

We are exploring other options for grassroots action to communicate concerns about the home health surety bond proposal, such as social media and emails.  However, because of the very short timeline, let’s get started with phone calls to the health staffers for your Representative and Senators. 

Further updates will be shared via future issues of NAHC Report.

Originally published by NAHC on December 11, 2014

A group of 51 organizations representing the interests of a wide range of shareholders – from elderly care advocacy groups to medical societies, religious organizations to those seeking to preserve Medicare and Social Security – recently sent a letter to the leading sponsors and cosponsors of both the House and Senate versions of the Home Health Care Planning Improvement Act. The letter was addressed to Senators Susan Collins (R-ME) and Chuck Schumer (D-NY) and Representatives Greg Walden (R-OR) and Allyson Schwartz (D-PA) and indicated the organization’s continued support of the legislation.

NAHC is one of the signatories to the letter that was sent, and has been a longtime supporter of allowing nurses to sign home health plans of care. Recently, NAHC held its first Social Media Advocacy Day, where it urged its members to contact their elected officials to support this legislation.

The letter states that:
“Thank you for championing the bipartisan Home Health Care Planning Improvement Act (H. R. 2504/S.1332) legislation.  We, the undersigned groups, pledge our continued support of your efforts to obtain passage before the end of the year.  As you know, the bill authorizes nurse practitioners, clinical nurse specialists, certified nurse-midwives and physician assistants as eligible health care professionals who can certify patient eligibility for home health care services under Medicare.  This critical change would improve access to important home health care services, and potentially prevent additional hospital, sub-acute care facility and nursing home admissions—all of which are costly to the consumer, the taxpayer and Medicare…

Although current law has long recognized advanced practice registered nurses and physician assistants as authorized Medicare providers, and allows these clinicians to certify eligibility for nursing home care for their patients, it precludes these same practitioners from certifying patient eligibility for home health care services.  This is an unnecessary barrier to care and adds at least one more step in the process of accessing home health care services by requiring the provider to find a physician to certify eligibility…

Advanced practice registered nurses are often the only care providers available in health professional shortage areas such as urban, rural, and frontier regions.  Given the existing and future projected primary care physician shortages, and the coming of increased numbers of Medicare eligible patients, the need will be even greater for all qualified providers to be allowed to certify home health care eligibility.

The Home Health Care Planning Improvement Act would help to ensure that Medicare beneficiaries in need of home health care services whose providers are nurse practitioners, clinical nurse specialists, certified nurse midwives, and physician assistants would be able to directly access home health care by referral from their providers.  This bill would provide beneficiaries continued access to care and increase the likelihood that they would experience better health and a higher quality of life.  Additionally, outside experts assessed the impact of the bill earlier this year and projected a Medicare savings of $7.1 million in 2015 and up to a ten-year savings of $252.6 million.  This analysis also notes the potential to reduce beneficiary admissions to and lengths of stay in institutional settings under the policy change.

It is important that this legislation pass and be placed on the President’s desk for signature.  The time is now to ensure that patients have timely access to the quality, cost effective care they need.”

To read the full letter, please click here.

Originally published by NAHC on November 9, 2014

What the 2014 Midterms Elections Mean for Home Care & Hospice 

While partisans are either celebrating or lamenting the outcome of the recent Midterm elections – the GOP expanded its majority in the House by 13 additional seats and reclaimed control of the Senate by picking up at least seven seats – home care and hospice advocates can look at the makeup of the new Congress with optimism in the fact that access to home care and hospice is neither an ideological nor partisan issue, but one that is supported by members of both parties in both chambers of Congress.

Some of home care and hospice’s biggest champions will be at the helm of powerful committees that drive the nation’s agenda when the 114th Congress convenes. The challenge NAHC will face is working with these champions while fending off any proposals that would reduce Medicare to a voucher system, cut the federal contribution to Medicaid, or call for more payment cuts and copayments for home care and hospice.

NAHC congratulates all the new members of the House and Senate, and looks forward to working with the new Congressional leadership. With several Senate races still too close to call, this is what is known about the makeup of the new Congress:

Senate

The GOP picked up at least seven seats, and the majority, in the Senate. The race in Alaska is still too close to call, and the race in Louisiana is going to a runoff next month. While it is clear that the Republicans will control the Senate, the size of their majority is still in question. Since committee assignments are divided up proportionately between the parties, the ratio of seats between Democrats and Republicans is unknown at this point.

What is known is that the powerful Senate Finance Committee, which has jurisdiction over Medicare and Medicaid issues, will most likely be chaired by Senator Orrin Hatch (R-UT) when the 114th Congress convenes next January. Senator Ron Wyden (D-OR), the current Chairman, will become its Ranking Member.  NAHC’s positive and productive history with both Senator Hatch and Senator Wyden should allow for a continuing dialogue between home care and hospice advocates amongst both Democrats and Republicans on the Committee.

Senator Susan Collins (R-ME) will most likely chair another committee of interest to the home care and hospice community, the Special Committee on Aging, when the new Congress begins. Senator Collins has been one of the home care and hospice community’s strongest Senate allies over the years, and from her new position, she can be an even more forceful voice for some of NAHC’s key issues – including allowing nurses to write home health plans of care, extend the home health rural add on payment, and modifying the ACA to designate a “full time employee” as someone that works 40 hours a week for the purposes of the ACA employer mandate. Senator Collins currently holds the record for the most consecutive appearances at NAHC’s annual March on Washington with 14. NAHC believes that there couldn’t be a better champion of the nation’s elderly to take the helm at the Committee on Aging.

Republicans have stated that current Minority Leader Mitch McConnell (R-KY) will become the new Majority Leader. Senator McConnell has been a strong supporter of home care and hospice in the past – having spoken to NAHC members at past conferences and in drafting a scathing letter on the Center for Medicare and Medicaid Services’ (CMS) flawed rebasing rule. NAHC looks forward to continue its very constructive and positive working relationship with Senator McConnell in his new role as Majority Leader. Senator Lamar Alexander (R-TN), who has supported NAHC in its fight to preserve the companionship exemption, is slated to take over the Health, Education, Labor and Pensions Committee.

Another home care champion, Steve Daines (R-MT), who introduced a bill to delay implementation of the ACA employer mandate for Medicaid and Medicare providers, won his election to the Senate, where it is expected that he will continue to fight for relief. Senator Pat Roberts (R-KS), who has spoken at NAHC’s March on Washington, won the closest reelection of his Senate career. Many attribute Senator Roberts’ success, in part, to the last minute efforts by home care and hospice allies Jerry Moran (R-KS), who is the head of the National Republican Senatorial Committee, and former Senator Bob Dole (R-KS), who has served as NAHC’s champion for many years.

House

On the House side of Congress, Republicans added to their majority, meaning that there will not be a switch between the parties for power, but expanded committee assignments and a broader governing majority for the GOP. The entire House was up for reelection, and some of NAHC’s biggest House champions – such as Greg Walden (R-OR), Tom Price (R-GA), Walter Jones (R-NC), John Lewis (D-GA), Jim McGovern (D-MA), and Jim Langevin (D-RI) – were reelected. Langevin has led the fight on the House side to preserve the companionship exemption. House Speaker John Boehner (R-OH) is all but certain to retain his post. Speaker Boehner has worked with NAHC on several key issues in the past.

One of the most important Committees in the House – Ways and Means, which has jurisdiction over Medicare – will either be chaired by Rep. Paul Ryan (R-WI) or Kevin Brady (R-TX). Most observers are saying that Paul Ryan will most likely chair Ways and Means in the coming Congress. NAHC has shared its concerns over home health and hospice payment cuts and copayments with Rep. Ryan in the past.

Rep. Brady, who will likely continue to chair the Ways and Means Subcommittee on Health, has held several hearings during his tenure on issues that affect the home care and hospice community, and has supported NAHC on some of its key policy positions.

Rep. Fred Upton (R-MI) and Joe Pitts (R-PA) will continue to chair the Energy and Commerce Committee and its Subcommittee on Health respectively.  With jurisdiction over Medicaid and Medicare, each has been supportive of home care and hospice.  The ranking minority member of the Subcommittee on Health, Rep. Frank Pallone (D-NJ), a big champion of home care and hospice, is expected to vie for the ranking minority open position on the full committee. 

Outlook

NAHC welcomes the return of many of its champions on both sides of the aisle, and looks forward to building relationships with the newly elected Representatives and Senators of the 114th Congress. Before the new Congress convenes, the 113th Congress will meet one more time for a “lame duck” session beginning Wednesday November 12. It is likely to be a short session to fund the government past the December 11 deadline, either through a continuing resolution or an omnibus spending bill, before being gaveled out.

There has been talk of possible action by Congress on some other issues during the lame duck—such as changing the Affordable Care Act (ACA) definition of full time from 30 hours a week to 40 hours, delaying implementation of the ACA employer mandate, and replacing the flawed Medicare physician payment formula (SGR).  Stay tuned to NAHC Report for more on developments during the lame duck session.

As the new Congress gets acclimated to life in Washington, NAHC urges all of its members to continue to highlight the issues of importance to the providers and recipients of home care and hospice services.