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The Pulse: February 10, 2012


Governor Kasich's 2012 State of the State Address

This week, Governor Kasich delivered his "State of the State" address from Wells Academy in Steubenville, Ohio. The Governor told the packed auditorium he wanted to get out of Columbus for his speech to highlight the successful performance of Wells Academy. While there were no major announcements about new initiatives, he spoke about the accomplishments in his first year, including an increase in the Rainy Day Fund from 89 cents when he took office to over $247 million today. He emphasized the accomplishments in the area of health care reform as lead by Director Greg Moody of the Office of Health Transformation. The Governor believes the transformation efforts will lower health care costs in Ohio, which will attract more businesses here.

The Governor touted Ohio's success in creating new jobs, sighting Ohio as the #1 job creator in the Midwest and 9th in the country. He cited several of the economic development initiatives that have been announced over the past few months, including Ford's recent announcement to invest $1 billion in Ohio. He focused his speech around the pillars of job creation, including education and workforce development, and the next steps for Ohio's economy to prosper. These next steps include:  

  • Increase OARnet, Ohio's high-speed broad band network, from 10 gigabits per second to 100 gigabits per second in an effort to increase the speed of research around the state, allowing researchers to share large files electronically, and making Ohio a technology leader
  • Promote Energy Expansion, including clean coal, natural gas drilling, and cogeneration
  • He called on Ohio universities to work closer together and graduate more students
  • Creation of a "Workforce Training Reform Plan" which will work with technical and vocational schools to match workers with jobs
  • He challenged Ohio to be the leader on urban education, sighting Cleveland Mayor Jackson's initiative that proposes to change teacher pay and layoffs.

Please click here for a complete transcript of the Governor's speech.

Ohio Medicaid Seeks Input on Dual Eligible Population and Single Waiver

Ohio Medicaid recently released concept papers on how to Integrate Medicare and Medicaid Benefits for those dually eligible for Medicare and Medicaid, as well as Expand and Streamline Medicaid Home- and Community-Based Services into one unified single waiver. The concept papers are for discussion, input and testing and are not finished products. Input from consumers and family caregivers is essential to the process and will be used to develop the final proposals that Ohio will submit to the federal Centers for Medicare and Medicaid Services.

To that end, Ohioans receiving both Medicare and Medicaid or enrolled in a Medicaid home- and community-based services (HCBS) waiver program are invited to complete this online questionnaire. The purpose of the questionnaire is to better understand what services Ohioans are receiving today, how well those services are coordinated, and what additional services are needed to maintain or improve health and quality of life. Please share this information with your patients and their families.

In addition, the Olmstead Taskforce is sponsoring a statewide conference call on February 17, 2012 for consumers and family caregivers to learn about and provide input on the concept papers. For more information about how to participate in the conference call please contact, Mary Butler (440-864-3495 or or Maria Matzik (937-341-5202 ext. 20# or

Midwest Care Alliance continues to participate in provider and stakeholder meetings regarding the concept papers, and will also provide written comment. It is the intent of Ohio Medicaid to continue to engage stakeholders as the concept paper moves into a more definitive proposal, and MCA is a part of those conversations. If you have questions, please contact Jeff Lycan at or Katie Rogers at

Hospice Payment Included in Nursing Facility Quality Payment

In previous issues of the PULSE, Midwest Care Alliance shared how hospice reimbursement rates are included in the new nursing facility quality payment. Click here to read a letter for members explaining the new payment.  This letter was also sent to the three senior services associations and the Ohio Department of Job and Family Services.

Medicaid Pediatric Stakeholder Group

Last week, Jeff Lycan and Katie Rogers attended a meeting of pediatric stakeholders regarding children with disabilities moving to managed care. The meeting featured discussion between Director of Medicaid, John McCarthy, and the stakeholders, including several parents who want to ensure that benefits will be consistent after the move to managed care. There were several examples of inconsistent care as well as transportation issues.  Director McCarthy voiced concern over the inconsistencies and discussed his belief that more concentrated care coordination could create better outcomes and reduce duplication of services.  House Bill 153, which was passed last year, made changes to Medicaid and in particular the population of children with disabilities who before HB 153 could choose Medicaid fee for service and opt out of managed care. The state shared a “Medicaid Managed Care Program map” for this meeting which splits the state into three regions; the Northeast, Central/Southeast and West.  For more information, please contact Jeff Lycan at  or Katie Rogers at

Opiate Epidemic Overview and Status Update

Activities in the state continue to attack concerns around opiate abuse and misuse.  Ohio Health Department Medical Director Ted Wymyslo announced successful efforts to close over a dozen pill mills since Prescription Drug bill HB 93 took effect.  On February 1, Jeff Lycan attended the Governor’s Cabinet Opiate Action Team overview and status update on Ohio’s opiate epidemic.  Dr. Gary Franklin, medical director for the Department of Labor and Industries in the state of Washington, discussed successful efforts in his state to decrease the overall opioid deaths following the creation and implementation of a modernized set of Opioid Dosing Guidelines, “the first attempt in the U.S. to reduce the high doses associated with unintentional overdose."  The Governor’s Opiate Action Team has several sub groups working on similar guidelines.

Additionally, the Ohio Injury Prevention partnership and its subgroups continue to meet quarterly.  MCA is involved in the Prescription Drug Abuse Action Sub-Group which formed to focus specifically on the epidemic of prescription drug overdoses.  Three main focuses of the group is the education of the public, of health care providers and identifying needed regulatory changes.  The partnership has been involved in many of the drug take back programs around the state as well as multiple educational initiatives such as the media campaign “Don’t Get Me Started” and the expansion of the Drug Free Action Alliance and SOLACE.  Another effort of the group is to support rule changes that allows for wider expansion of SBIRT (Screening, Brief Intervention and Referral to Treatment).  This is a comprehensive public health approach to the delivery of early intervention and treatment for individuals who have or are at risk for substance abuse disorders.

MCA’s continues to participate and monitor these activities as well as be a voice and advocate for chronic pain and end of life patients.  Due to the prevalence of issues surrounding prescriptive drug abuse and the energy of many individuals and groups to tackle this devastating social issue, the organization’s concerns are heightened that many efforts of the past ten-fifteen years such as “pain as the fifth vital sign” and protections for those with chronic pain and at end of life could be reversed.  So far our work following the passage of HB 93 has preserved and strengthened language exempting hospice and the terminally ill.  MCA expects that the State Medical Board will begin discussions around the Chronic Pain rules within the next month or two and we have submitted the names of two individual representatives to be part of this review committee.


Click here for a list of key legislation Midwest Care Alliance is monitoring and its status, as well as news from around the state that affects legislation, regulations, and policy.


Obama Vows to Control Entitlement Program Costs

In his third State of the Union address before Congress and the nation, President Barack Obama said he would make reforms to control the costs of federal entitlement programs but stressed that a change in the tax code was necessary. “I'm prepared to make more reforms that rein in the long-term costs of Medicare and Medicaid and strengthen Social Security, so long as those programs remain a guarantee of security for seniors,” the President said. “But in return, we need to change our tax code so that people like me, and an awful lot of members of Congress, pay our fair share of taxes.” To view the President's State of the Union address, please click here.

Gov. Mitch Daniels, in the Republican response to the President’s address, said it was time to reconstruct the decades-old programs. To view Governor Daniels response, please click here..  The President’s comments came as the White House and congressional Republicans continue to be at odds over how best to reduce the federal deficit and revamp the tax code to make it more equitable. That fight also extends to implementing the new health reform law which now faces a constitutional challenge in the Supreme Court over the requirement that individuals purchase health insurance coverage or face a penalty.  (NAHC, 1/24/12)

Home Care Survey Conducted in Response to DoL Proposed Rules

A survey was conducted in December 2011 as a joint project between the Private Duty Homecare Association (PDHCA), an affiliate of the National Association for Home Care & Hospice (NAHC) and the National Private Duty Association (NPDA). Nearly 1500 responses from home care companies in all 50 states, the District of Columbia, U.S. Virgin Islands, and Puerto Rico were received.  The two articles below, discuss the findings of the survey.

Proposed Rule Change by Department of Labor Would Harm the Frail Elderly and Adversely Impact Home Care Workers, the Businesses that Employ Them and the Government Programs that Allow Aging at Home

January 30, 2012 (Washington D.C.) - The Private Duty Homecare Association of America (PDHCA) and the National Private Duty Association (NPDA) today released the results of a national survey of home care agencies on the impact of the U.S. Department of Labor's (DoL) proposed rule which effectively eliminates the companionship services’ overtime exemption in private pay home care and live-in services. The survey results demonstrate the negative consequences which would occur for employed caregivers, the clients/patients they serve, and the home care companies if the exemption is eliminated. 

The greatest negative impact on clients/patients reported by respondents is the loss of continuity of care brought on by the need to assign multiple caregivers to control overtime costs. A common belief is that clients are then driven into the underground economy, hiring workers "under the table" where quality control and oversight that an agency worker provides is lost, exposing the elder client to greater chances of abuse, fraud and inconsistency in care.

The DoL proposal has the potential to cut employed caregiver hours and compensation by imposing unaffordable overtime pay on the voluntary hours they work in excess of 40 per week. In addition to losing continuity of care, the cost for care will also increase. The survey indicates that 81.8 percent of companies expect to increase their private pay billing charges with 23.7 percent anticipating a need to scale back their availability of care. These expectations are warranted as 45.2 percent of companies currently required to pay overtime under state laws have increased their charges and 10.4 percent reduced care access.

Shelle Womble, Chairman of PDHCA commented, "As an industry we believe that eliminating the companionship exemption will force many seniors and people with disabilities into assisted living or institutional care because of the increased cost of in-home care. It will increase federal spending by adding cost to in-home care provided through federal programs, and by increasing utilization of government-funded institutional care."

Kevin D. Turner, Executive Director of NPDA, stated, “One of the consistent findings referenced by agencies was restricting or expecting to restrict overtime hours for employees. So, instead of making more money through overtime wages, the average home care worker will simply work for multiple agencies to get the hours they want to work in a week. This makes it harder for the home care employee who will have to match total hours desired with piecing together schedules that will also include additional expenses for travel to more locations.”

The predominant impact on the employed caregivers is the restriction in working hours. Nearly 63 percent of the respondents currently obligated to pay overtime under state law report that they restrict overtime hours. More than 86 percent of the companies that will face a new overtime requirement if the proposed rule takes effect report that they will restrict the hours worked by staff to prevent overtime costs.

Over 93 percent of the home care companies reported an expectation of a moderate to significant increase in business costs. This mirrors the actual experiences of companies with a current overtime requirement where nearly 69 percent report moderate to significant business cost increases. The primary cost increases are in human resources, 67.4 percent expected/38.2 percent actual, and staff training costs, 67.9 percent expected/38.3 percent actual.

Some of the potential tactics and adjustments that companies are or will make as a result of the ruling, should it be put into place, include cutbacks on employee benefits and pay increases, withdrawal from Medicaid services, terminating live-in care, and reduction of current base pay of personal care workers.

Click here to view results of the Home Care Survey. 

Home Health Agencies Battle Against Worker Overtime Proposal
By Jane Norman, CQ HealthBeat Associate Editor

A survey by the home health care industry released Monday suggests that under an Obama administration proposal, sick people who need in-home care will turn to under-the-table providers and legal workers’ overtime pay will be cut.

In addition, the proposed rule “will force many seniors and people with disabilities into assisted living or institutional care because of the increased cost of in-home care,” Shelle Womble, chairwoman of the Private Duty Homecare Association of America, said in a statement.

Her industry group and the National Private Duty Association released the survey in what’s a first shot at an attempt by the administration to develop new regulations for a 1.8-million-member health care workforce that provides care in the home.

President Obama announced in December that a Department of Labor proposed rule would for the first time extend minimum-wage and overtime protections to in-home workers employed by staffing agencies. For decades, such “companionship” aides have been considered the equivalent of occasional baby sitters, even if they provide health services such as wound care or tube feeding.

While some states regulate these workers’ overtime and minimum-wage pay, not all do, and Democrats believe the industry has been unfairly excluded from federal pay protection.

The industry does not agree. Business costs would rise and be passed on to elderly and ill clients, says the survey, which was conducted in December by a company called Home Care Pulse. “Clients/patients will seek out services from the underground economy through untrained, unsupervised and unskilled workers creating risk of elder abuse and mistreatment of people with disabilities,” it warns.

The survey included more than 1,400 home care agencies and says most of them are small businesses with annual revenues of $5 million or less. Some provide services paid for by family members out of pocket or by insurance, while others are paid by Medicare and Medicaid or the Veterans’ Health Administration. More than half say they don’t now pay overtime, and a majority of those agencies say they will cut workers’ overtime hours if the rule goes into effect.

“We cannot afford to pay overtime,” one survey respondent was quoted as saying. “Patients and workers are not going to be happy with the restrictions we will impose, and ultimately patient care will suffer.”

If agencies have to pay overtime, they will have to hire more staff members, and that will affect continuity of care for the sick, the survey says. Agencies might also cut back on benefits and pay increases, drop out of Medicaid, or stop offering live-in services, the survey says.

It recommends that implementation of the proposed rule be suspended until the full impact of it can be assessed.  Jane Norman can be reached at

Medicare releases new hospice condition code for out of service area discharges

On February 6, CMS released MLN CR 7677 which requires hospices to discontinue the use of occurrence code 42 for situations when a provider initiates the termination of hospice care.  Click here for more information on the new hospice condition code.