Lawmakers Told Home Health Care Rules Needed
Home health agencies are inadequately regulated by the federal government and unregulated by the state, creating risks for patients, according to a health care lobbyist.
"Essentially what we're trying to do is have a sort of gatekeeper bill, which is this, but we're also lobbying on the federal level to have tougher re-certification standards," James Fuccione, director of legislative and public affairs at the Home Care Alliance of Massachusetts, told the Joint Committee on Health Care Financing on Tuesday.
Legislation backed by the alliance, which Fuccione said is not aimed at protecting existing businesses, would require the agencies regulated by the Centers for Medicare and Medicaid Services to additionally receive a certificate of need from the state, which would show compliance and service area.
The lack of regulation for the agencies, which send medical workers to patients' homes, has the potential for health risks, Fuccione said after the hearing. He said, "One agency had a 50-percent re-hospitalization rate. Now that means half the patients you see go into the hospital. And most agencies are around 17 to 20 percent. That's the state and national average. So these agencies are not doing what they're supposed to."
"We are only one of five states without either licensure or certificate-of-need process for home-health," Rep. Kate Hogan, D-Stow, told the committee.
Meanwhile, Rep. Alan Silvia, D-Fall River, argued in favor of a bill that would modify the crime of bribery so that, he said, it would not penalize adult foster care providers who are paid for referrals to care agencies.
"The agencies, to assist the caregivers financially, have often given bonuses or referral fees to the caregiver if they refer a potential client that eventually is approved by the state for services. The amount paid ranges from $50 to $150 at most," said Silvia, who told the committee most caregivers are friends or family of the client and the costs of care greatly outweigh the amount they make. "It provides the caregiver, who at most receives $600 per month, a little extra money occasionally."
In a meeting that included only scant questioning from the committee members and no testimony in opposition to the bills under consideration, Rep. Ruth Balser, D-Newton, and others argued in favor of legislation that would speed up a provision included in last year's health care reform law that requires insurance companies' review of the clinical necessity and efficiency of health services to include criteria that is "scientifically derived and evidence-based," and makes that criteria accessible to patients and doctors.
As it stands, that provision is set to take effect Oct. 1, 2015, but Balser and others are hoping to speed up the timeline.
"Back in the day, we relied on our doctors to determine what was medically necessary for a given patient. And more and more often, insurance companies are saying, 'Well, the doctors can't do it; we're going to use our own criteria sets that are scientifically based, and we're going to say that doctors have to rely on our criteria for what's medically necessary.' The problem is that, right now, the insurance companies are not legally required to tell either the doctors or the patients what those criteria are," said Dr. Karen Spangenberg Postal, president of the Massachusetts Neuropsychological Society. "Also, there's no requirement that they be scientifically based, or that they disclose what the science is behind their criteria sets . . . We're basically telling the insurance companies that they can have secret scientific criteria."
After the hearing, the Massachusetts Association of Health Plans said the delay would allow time to properly implement the change.
"The effective date included in the Payment Reform Law recognized that plans would need time to implement this new requirement and that the state's Division of Insurance would need time to develop guidance to ensure consistency across all health plans," MAHP executive Eric Linzer said in a statement to the Statehouse News Service. "Given the other requirements on health plans and the health care system, as well as new requirements under the Affordable Care Act for plans to have in place over the next few months, the current effective date established by the Legislature is both reasonable and appropriate and should not be changed."
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