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1. Does Acton Nursing Services charge for the home health care services it provides?

Yes, with a few exceptions. Acton Nursing Services accepts Medicare, Medicaid/Mass Health and insurance from most major insurance carriers and bills these carriers at contracted rates for services provided in accordance with an agreed course of treatment and support. In rare instances and at the agency’s discretion, services may be provided to uninsured or underinsured residents of Acton experiencing financial hardship without expectation that the full cost of providing these services will be reimbursed.

2. Who establishes the rates charged by Acton Nursing Services for the home health care it provides?

Reimbursement rates are determined by the payer (Medicare, Medicaid/Mass Health, the Veterans Administration or insurance companies according to their contracts). Medicare reimbursement rates are not negotiable: they are established by Medicare on a national level. Medicaid and Mass Health rates are also non-negotiable and are generally less generous than Medicare.

3. Does Acton Nursing Services accept patients who pay for themselves or whose families/others pay for them? And if so, does ANS have a published price list for patients not covered by insurance?

ANS accepts private patients and charges them at published Medicare rates (per visit, per course of treatment or per outcome, as appropriate). In cases of financial hardship, ANS will accept some percentage of Medicare rates from the patient (determined by ability to pay) with the balance being covered by charitable contributions made to ANS.

4. Does Acton Nursing Services provide subsidized care to Acton residents?

Yes, in some instances. Acton Nursing Services has access to funds created by generous private donations to cover the cost of services provided to a resident of the Town who is unable to pay for part or all of the services prescribed for that resident. Free care is carefully tracked and reported, consistent with HIPAA requirements.

5. What charitable funds are available to residents of Acton who face financial hardship and cannot pay ANS in full for services provided?

Limited funding is available to ANS to cover certain home health care costs for residents of Acton facing financial hardship, including money to pay for prescriptions and equipment and to pay the balance of ANS service bills above the percentage that the patient is able to meet. The Friends of Acton Nursing Services has also provided funds for necessary equipment and other support that an ANS patient needs but cannot afford. The Town does not directly budget funds for ANS to provide services for residents facing financial hardship.

6. Which private insurance carriers cover services provided by ANS?

As of October 2017, ANS has contracts directly or through VNANE (Visiting Nurse Association of New England) with the following insurance companies. Please check with your insurance carrier or with ANS for updates.

Aetna
BCBS of Massachusetts
CareCentrix
Cigna of Massachusetts
Commonwealth Care Alliance
Unicare State Indemnity Plan
Connecticare
Fallon Community Health Plan
Harvard Pilgrim Health Care
Health New England
Masshealth
MultiPlan
Neighborhood Health Plan
Network Health
Oxford Health Plan
Prime Health Services
Senior Home Health
Tufts Health Plan
Veterans’ Administration

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1. Who can Choose Acton Nursing Services as their home health care provider?

Acton Nursing Services can be chosen by any patient. In most cases, Medicare, Medicaid and most commercial insurance companies cover the cost of services provided to their covered patients by Acton Nursing Services.

2. Can Medicare patients choose Acton Nursing Services as their home health care provider?

In general, yes. One of the important rights granted to Medicare patients is the right to select the provider they prefer. This right applies to Medicare patients who have traditional Medicare or a Medigap policy through an insurance company (such as Core and Supplement 1 Medigap policies offered in Massachusetts). Some Medicare Advantage plan members may also use ANS but coverage and acceptance should be confirmed.

3. Can Medicaid patients choose Acton Nursing Services as their home health care provider?

Yes. Medicaid and Mass Health patients can choose ANS as their home health care provider subject to the rules and reimbursement rates established by those entities.

4. Is Acton Nursing Services required to accept all patients referred to the agency?

In practice, yes, provided ANS has the capacity to serve (in other words, has the skills, time and resources to accept and successfully treat a patient). As a Medicare certified agency, ANS is expected to accept referrals irrespective of source of reimbursement (government insurance, private insurance, etc.).

5. Can a health care provider (physician, nurse, administrator, discharge planner, etc.) direct a patient to a specific home health care provider?

In most cases, no, because patients have the right to choose their provider. With Medicare, Medicaid and many insurance plans the patient’s right to choose their home health care provider is specifically spelled out. Patients seeking home health care on discharge from a hospital or nursing home or at the recommendation of their physician or other health care professional should be provided with a comprehensive list of appropriate local providers. Patients are encouraged to review the providers with their families, insurance carrier and medical professionals and choose which agency is most likely to best serve their needs; they should make their own decision without undue influence.

6. Does ANS provide services to patients covered by long term care agreements?

Generally, no, because home care under long term care insurance focuses on assistance with daily living (ADL) which is typically a personal care service (bathing, cooking, housekeeping, shopping, companionship) rather than a skilled medical service. ANS does not provide ADL services because these are not within its defined scope but stands ready to provide skilled medical/nursing services to these patients if the need arises. In some instances skilled nursing services delivered at home may be covered by long term care insurance but this should be confirmed.

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1. What is Acton Nursing Services?

Acton Nursing Services is a home health care agency delivering skilled services to patients in their own homes. As part of the Town of Acton’s Health Department, Acton Nursing Services has been included in the Operations Budget of the Town of Acton since 2014.

2. Does Acton Nursing Services provide public health services?

Yes, Acton Nursing Services provides public health services such as flu prevention and other wellness programs. There are separate budgets for Acton Nursing Services and Acton’s public health activities. In those instances where Acton Nursing Services skilled staff are called upon to work on public health activities, their time is paid for out of the health department budget. ANS’s goal in coordination with APH is to "Keep Acton Healthy".

3. What public health services does Acton Nursing Services provide?

Acton Nursing Services provides skilled staff to help deliver the town’s public health services. Public health services include state-mandated disease surveillance and reporting, membership in the state’s Vaccine Program, and a variety of educational and outreach programs established in Acton to benefit the overall health of the community. These outreach efforts take place in nursing homes, over-55 communities, the Council on Aging center, schools and other public places. Outreach includes Wellness Clinics and Discussions, Blood Pressure Clinics, Flu Clinics, Podiatry Clinics, Childhood Immunizations, Base-line Concussion assessments and responses to community health needs through timely recognition and, if necessary, intervention.

4. Does Acton Nursing Services provide services outside Acton?

Although Acton Nursing Services’ focus is principally on residents of Acton it also provides fee-based home health care services to residents of surrounding communities who exercise their statutory right to choose their home health care provider and select Acton Nursing Services. In recent years, ANS has responded to requests for services from residents of Boxborough, Carlisle, Concord, Littleton, and Stow.

• Although Acton Nursing Services’ focus is principally on residents of Acton it also provides home health care services to residents of surrounding communities who exercise their statutory right to choose their home health care provider and select Acton Nursing Services. In recent years, ANS has responded to requests for services from residents of Boxborough, Carlisle, Concord, Littleton, Maynard and Stow.

5. What are the benefits to Acton of having a Home Care Agency as a Town Department?

The Town of Acton has had a home care agency since 1923, gaining Medicare certification in 1966. It has been a valued resource for Acton residents who have required skilled care after acute hospitalization, for chronic illness, or for other specialty medical needs. Home care services are provided in addition to the state-mandated Public Health Services that are provided to Acton citizens.

Acton residents gain the benefit of being able to access help from dedicated professionals who are familiar with the Town. ANS’ dual-role of providing care at home and public health preventative care is beneficial to residents who may be aging or have aging family members living with them.

Acton’s population is projected to continue to “grey” as an increasing percentage of residents fall in the over-60 age range and ANS will serve an important role in keeping our community vibrant as more residents decide to age-in-place. Having home care services as an integral part of the town’s infrastructure also provides important insulation against the high level of churn seen in the home care provider system.

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1. What home health care services does Acton Nursing Services provide?

Acton Nursing Services provides a range of skilled services tailored to the needs of its clients. Services include all those required to qualify as a certified Medicare home health care agency. These include:
• Nursing (assessing patient needs, developing an appropriate plan of care and providing skilled nursing services)
• Physical Therapy (assisting with an individual program designed to regain strength and use of muscles weakened by illness or injury)
• Occupational Therapy (helping patients to regain their ability to resume activities of daily living)
• Speech Therapy (assisting with speaking, communications and swallowing that may have been affected by stroke or other illness or injury)
• Medical Social Work (helping the patient and family adjust to illness or injury and providing information about community resources)
• Home Health Aide (providing assistance with bathing, dressing and light meal preparation for patients receiving skilled care)

2. What services doesn't ANS provide?

ANS provides the range of services required of a Medicare certified skilled home care agency. ANS does not offer custodial care or assistance with chores, housekeeping, shopping, transportation, etc. (ANS has a contract with Minuteman Senior Services to support a limited number of personal care clients).

3. What is the significance of being “Medicare Certified”?

For a home health care agency to be Medicare Certified it has to provide a range of services laid out by the Centers for Medicare and Medicaid Services (CMS), submit detailed operating reports covering performance and outcomes, and be subject to oversight and inspection. Only Medicare Certified agencies can be reimbursed by Medicare for services provided under Medicare and Medicaid insurance. In many instances, commercial health insurance policies cover only services provided by Medicare Certified agencies. Acton Nursing Services has been a Medicare Certified agency since 1966. Home care agencies that are not Medicare certified generally focus on other home support activities including housekeeping, shopping, meal preparation and companionship.
Patient satisfaction statistics, published by CMS, are compiled from patient questionnaires returned to a third-party research organization.

4. What is the significance of published ratings for home health care agencies?

There are almost 10,000 Medicare Approved home health care agencies in the United States (plus an estimated 25,000 additional entities including Medicare Certified hospices and non-Medicare agencies providing some form of care in the home). The performance of these 10,000 agencies – based on patient and agency reports – is published regularly by CMS (Centers for Medicare and Medicaid Services) in their on line Home Health Compare system. ANS earned a 4 (out of 5) star rating for Quality of Patient Care for the period January 1 – December 31, 2017, compared to the Massachusetts average rating of 3 stars and the National average rating of 3.5 stars.
Detailed patient survey results data published by CMS also show ANS Patient Satisfaction levels consistently exceeding Massachsuetts and National average performance levels for the most recent reporting period, April 1, 2017 – March 31, 2018.
Another organization - ABILITY Network/ Decision Health - publishes an annual compilation of the most successful home care providers in the United States based on CMS data combined with additional information. Acton Nursing Services has been recognized as being among the Home Care Elite for 2018 – the top 25 percent of agencies in home health performance. ANS also held this distinction in 2009 and 2011-2015.

5. Who or what is FANS?

FANS is the Friends of Acton Nursing Services, registered in 1983 as a 501(c)3 non-profit volunteer organization that raises funds for supplies and equipment for Acton Nursing Services and funds and staffs various outreach events and activities to promote the agency.

6. How do ANS patients rate the performance of ANS?

ANS patients give ANS very high performance ratings according to the Centers for Medicare and Medicaid Services (CMS) Patient Satisfaction Surveys. For the latest reporting period, 98% of patients who responded would recommend ANS to friends and family. On all measures, ANS performed better than the Massachusetts average, which is usually better than the national averages. Check the ANS website for the most recent published performance ratings.

PATIENT SATISFACTION SURVEY – CENTERS FOR MEDICARE AND MEDICAID SERVICES

Patient Satisfaction Measure ANS / Massachusetts Avg / National Avg

How often the home health team gave care in a professional way?
97% / 88% /88%
How well did the home health team communicate with patients?
95% / 85% / 85%
Did the home health team discuss medicines, pain, and home safety with patient?
91% / 84% /83%
How do patients rate the overall care from the home health agency?
98% / 85% / 84%
Would patients recommend the home health agency to friends and family?
98% / 81% /78%
Source: Medicare.gov website - Home Care Compare, April, 2016 – March, 2017

ANS did not get a CMS star rating for the period because the number of surveys returned did not reach the required threshold. ANS did have a high percentage (52%) of patients who did return their surveys.

7. How is ANS funded? Does ANS accept charitable donations?

As part of the Town of Acton’s Health Department, Acton Nursing Services has been included in the Operations Budget of the Town of Acton since 2014. The Town budget for ANS takes account of fees paid by patients, commercial insurance companies, Medicare/Medicaid and other third-party payers related to skilled health care services delivered to Acton residents in their homes.
In addition to the budget – and to the extent funds allow - charitable donations are used to pay for some or all of the health-related expenses of any resident of the Town facing financial hardship who has unmet medical needs. Usually, residents in these circumstances are referred to the Director of the nursing service by other Town departments (e.g. police, social workers). Funds used for these activities are kept in a special Town account managed by the Town Accountant and available to the Director, Nursing Services, that is fed by donations made specifically for this purpose. Donations can be made on-line, by mail or in person. Planned donations in the form of bequests and/or permanent Trust Funds should be discussed in advance with the Town Finance Department.
Separately, ANS also continues to receive significant assistance from FANS (the Friends of Acton Nursing Service) which, at the request of the Director, Nursing Services, contributes to the cost of skilled and ancillary medical services for eligible ANS clients who remain in need. FANS also purchases and donates medical equipment and non-disposables used by ANS in serving its clients and the community (e.g. telemedicine and professional podiatry equipment, thermometers, blood pressure cuffs) and purchases marketing materials that promote ANS to the community. Since 1983, FANS has been a 501 (c) 3 non-profit volunteer organization with an independent Board. Charitable donations to FANS are generally tax-deductible.