Mid-January 2018 Newsletter
Executive Director's Message
Vermont's 2018 legislative session has convened at a time of tremendous uncertainty about the federal dollars on which Vermont's health care system relies. Of greatest immediate concern to the VNAs of Vermont is the expiration of the home health rural add-on on January 1, 2018. The loss of the rural add-on is a significant cut, in the range of 2.5 to 3 percent.
Our national advocacy partners are hopeful the U.S. Senate will consider a rural add-on extension proposal late next week. While that sounds like good news, one of the proposals under consideration would phase out the rural add-on in three to five years, depending on the state. The VNAs of Vermont are urging Congress to support a "clean" extension of the rural add-on. We are grateful to Vermont's congressional delegation for their consistent support for the rural add-on. If you would like to make your voice heard on this important issue, please click here to participate in the National Association for Home Care and Hospice (NAHC) grassroots campaign.
Closer to home, the first two weeks of the legislative session are behind us. Because it is the second year in Vermont's two-year biennium cycle, bills that were introduced last year are still active, and legislator committee assignments are relatively unchanged. This allows committees to pick up issues where they left off last year. A few bills have already been sent to the Governor, including most notably a marijuana legalization bill.
At this writing, the two most significant issues for home health agencies are the Medicaid budget and a proposal to raise the minimum wage to $15 per hour at some point in the future. While the budget debate will not begin in earnest until the Governor's Budget Address, scheduled for January 23, 2018, the Senate Committee on Economic Development, Housing and General Affairs will be taking testimony on the minimum wage this week. I will be weighing in on behalf of members on Friday morning. My testimony will focus on the inextricable link between the wages our members are able to pay their staff and the Medicaid budget. As always, I will urge lawmakers to invest in the Vermonters that we serve. 

Jill Mazza Olson
Executive Director
Vermont Update
The Department of Vermont Health Access (DVHA) will soon release a directive to implement the "face-to-face" requirement in the Medicaid program. Until relatively recently, Vermont was exempt from this federal requirement, which requires physicians to see patients in person before ordering home health services. Changes to Vermont's program recently eliminated that exemption. The implementation of Medicare face-to-face has challenged agencies across the country. While home health agencies support the concept of physicians visiting with patients prior to ordering home health services, the documentation requirements and audit process are deeply flawed. We have been working closely with DVHA on this issue and are hopeful the Medicaid implementation will be smoother and less burdensome. We appreciate the spirit of collaboration with which DVHA officials have approached this issue.
Federal Update
The new Home Health Conditions of Participation went into effect on January 13, 2018. These are wide-ranging federal regulations that are required for agencies that care for individuals under the Medicare and Medicaid programs. The rollout has been frustrating for home health agencies. The Centers for Medicare and Medicaid Services (CMS) was slow to release the "Interpretive Guidance" document that clarifies the rule and guides the surveyors who determine whether an agency follows the regulation. In fact, the rule is going into effect with only a draft interpretive guideline in place. In our view, CMS officials have downplayed the significance of the Interpretive Guidance. That said, they did agree to defer the imposition of civil monetary penalties for a year, except in "immediate jeopardy" situations. 
Upcoming Events
Web Event Hosted by National Association for Home Care & Hospice (NAHC)
January 17, 3:30pm - 4:30pm
Many states are mandating the use of an electronic visit verification system to track time and attendance for the staff providing care. There are many items to consider when beginning the search and purchase process. This webinar is geared to helping those with limited experience with this type of purchase. It has been specifically designed to help you avoid the pitfalls, providing tips to help you purchase the right product for your agency. The right system will become an enhancement to your organization's performance by avoiding retractions, improving quality, and providing a return on your investment.
January 17, 1pm 
Montpelier, VT 
January 24, 1pm 
Montpelier, VT 

hosted by NHPCO  
February 8, 2pm 
brought to you by VNAVT
January 18, 11:30am 
January 31, 1pm 
Montpelier, VT

February 13, 11:30am 
hosted by HHQI 
January 18, 2pm  
brought to you by VNAVT
February 7, 11:30am 

February 15, 2pm  
brought to you by VNAVT
January 23, 11:30am 
February 8, 10am 
Waterbury, VT

February 28, 11:30am 

Upcoming Conferences
J6/JK Home Health and Hospice Medicare Summit 2018:
Maintaining a Healthy Compliance Program
hosted by National Government Services
September 19 & 20 | The Orleans, Las Vegas, NV 
Save the Date! Registration opens in February.
VNAs of Vermont | www.vnavt.com | info@vnavt.org | 802-229-0579