August 2018 Newsletter
Executive Director's Message
Earlier this month, the Vermont Auditor released a  report examining one component of Vermont's Choices for Care (long-term care) Program. The report received some media coverage that got my phone buzzing and reminded me that many Vermonters ----       even those in the policy arena ----      don't fully understand the program unless they or someone they loved is being served by it. 
Many Vermonters may not realize that Vermont has many  long-term care optionsincluding an extensive program that allows individuals or their loved ones to hire their own caregivers under its long-term care Medicaid program. It was this service that was reviewed by the auditor. 
Vermont's Choices for Care Program is highly regarded. As, providers, policymakers and advocates, we have a lot to be proud of. A 2017  scorecard published by a coalition of consumer and policy groups ranked Vermont's long-term care program the third best in the country. Vermont scored well across an array of criteria that include affordability and access; choice of setting and provider; quality of life and quality of care; support for family caregivers; and effective transitions. 
But let me back up. Choices for Care is Vermont's long-term care Medicaid program. Long-term care is for people who need help with things that those of us who are not disabled or frail may take for granted - dressing, washing, meal preparation and other "activities of daily living." To receive Medicaid  health insurance, individuals must meet certain financial criteria. To receive Medicaid  long-term care , individuals must meet certain financial criteria  and need a "nursing home level of care." As with all Medicaid programs, program costs are shared by state and federal governments (and, I would argue, by providers, since Medicaid programs rarely cover costs).
While the term "Medicaid" is often associated with "low-income," many higher income families rely on long-term care Medicaid if their loved ones are elderly and frail and have spent their savings. When my step-mother died last year, we were in the process of enrolling her in Medicaid long-term care in her home state. 
As is true in many states, Vermont's long-term care program is large, relative to the rest of the Medicaid program. Vermont's FY2017  Medicaid Program Enrollment and Expenditures Report shows that, costing just over $225 million, the  Choices for Care program accounted for about 17 percent of the total Agency of Human Services Medicaid spending. 
The Department of Disability, Aging and Independent Living  reportsthat home health agencies provide about half of Vermont's personal care services. But the other half are hired by individuals who need services (or their loved ones). And they may hire their own family members. That's important ----        while self-directed care presents some additional oversight challenges to regulators, the reality is that in a tight labor market, finding individuals to provide personal care is hard, and a loved one may be the person the individual who needs services most wants. 
Scrutinizing the consumer or surrogate-directed home-based services option, the auditor identified about $150,000 of questionable charges over a 15-month period. The auditor looked for suspicious patterns - individuals receiving "home care" during a period when they were hospitalized, or caregivers working impossible hours. The report includes some specific recommendations that I'm sure the Agency of Human Services will consider and implement. At the same time, in the context of the size of the program, I see cause for some concern, but not alarm. 
When I think about long-term care in Vermont, what really worries me are these things: chronically low reimbursement rates (and the resulting losses to agencies) and a serious workforce shortage across all industries in Vermont, including health care. As I look ahead to the next legislative session, it is these issues that will remain at the center of our advocacy efforts. 

Jill Mazza Olson
Executive Director
Vermont Update
Over the last several weeks, the VNAs of Vermont worked with experts from member agencies to develop comments on several proposed state regulations that impact home health agencies. These include:
  • Home Health Medicaid Payment Update (Medicaid Face-to-Face and other changes) -----Click HERE for an annotated version and HERE for a clean draft. Comments were due August 13, 2018. Click HERE
    for our comments.
  • Telehealth (including telemonitoring) - Click HERE for this proposed new rule. Comments were due August 13, 2018. Click HERE for our comments.

Federal Update

Our national partners at the National Association for Home Care and Hospice report that the  Centers for Medicare & Medicaid Services (CMS) has released an  update  to hospice payment rates, the hospice cap, the hospice wage index and the hospice pricer for federal fiscal year 2019 which begins on October 1 that is consistent with the  FY2019 final hospice payment rule which updates base payment rates and the aggregate cap by 1.8 percentage points. Rates are different depending on whether or not hospices have met quality data reporting requirements. 
The final wage index file for FY2019 is available  HERE .  Prior to payment, the Medicare Administrative Contractor (MAC) will also apply the 2 percent sequester.
NAHC members can reference the complete article  HERE.

Upcoming Events
August 28 | 11:30 a.m. to 1 p.m. 
Hosted by VNAs of Vermont

August 29 | 1 p.m. to 2:30 p.m. 
Hosted by VNAs of Vermont

Second Thursday of each month  | 3 to 4 p.m.
Hosted by VNAs of Vermont
11:30 a.m. to 1 p.m.

Announcement for NAHC Members:

Call for n ominations for the NAHC Board of Directors A crucial component in the creation of NAHC 2.0 is a new streamlined Board of Directors to lead the National Association of Home Care & Hospice into the future. Accordingly, the Board is being restructured from 28 seats to 15 seats, with nine elected members and six appointed members. NAHC is now putting out a...

Upcoming Conference
VNAS of Vermont is proud to participate again in this year's Vermont Association of Hospitals and Health Systems conference. This year, we will lead a workshop, as will Judy Peterson, CEO of our member agency, VNA of Chittenden and Grand Isle Counties. We encourage health care professionals to join us at this worthwhile event.

VNAs of Vermont | | | 802-229-0579