ASAP
A Weekly Publication Of HCA Home Care Association of New York State
Legislative Issues Public Policy
HCA’s Comments on Medicare CoPs Urge Funding, Better Alignment with System Changes
News
Volume 20, No. 1 January 9, 2015
In Memoriam
HCA this week submitted our formal comments on proposed changes to the Medicare Home Health Conditions of Participation (CoPs). If enacted, these would be the first sweeping changes to the CoPs since 1989. As reported in prior editions of ASAP, the U.S. Centers for Medicare and Medicaid Services (CMS) issued the proposed CoP changes in October. They include several new requirements in the areas of quality improvement (requiring home health agencies to maintain a Quality Assessment and Performance Improvement, or QAPI, program); infection control measures; changes in the responsibilities and oversight for aide services; and extensive new changes, written policies, and notification and documentation requirements for assuring patient’s rights; among many other provisions governing the operation of virtually all home health agencies nationwide. See CoPs p. 2
Inside ASAP HCA Submits Comments on Medicare CoP Changes......................…1 Last Call for Responses to HCA Financial Survey..............................…3 Court Issues Restraining Order on Companionship Changes..............4 Hiring Announcement.......................................................................….4 Court Rules that NAHC’s F2F Lawsuit Can Proceed….........................5 HCA Offers ICD-10 Prep Workshop…...................................................6 Nurse Practitioner Rule Finalized…......................................................6 Join Us for HCA’s Annual Conference, Leadership Institute…..............7 Bills on Telehealth Coverage, Wage Theft Prevention Act Signed.......8 Congress Acts on Bill Redefining Full-Time Threshold for ACA..........8 DSRIP Update….....................................................................................9 ACO Final Rule Promulgated...........................................................….9 Hospice Providers Should Continue to Submit HIS Data in 2015.......11 Managed Care Update…....................................................................11 CMS Announces Process for Hospice CAHPS Exemption..................14 CMS Posts Materials on Certifying Patients for Home Health...........14 Reminder: HCA to Hold 1/13 Forum for HCC Members....................14 Quality Strategy Approved for Medicaid Managed Care.................15 Volunteer Opportunity Extended for ICD-10 End-to-End Testing.....15 Capital Restructuring Financing Program Q&As Posted....................16 CMS Change Requests for Home Health Go Into Effect................…17 NGS Updates......................................................................................19 Medicare Care Choices Model Update..............................................20 Funding Available for Geriatrics Workforce Enhancement Program.......20 Home Health, Hospice and DME RAC Contract Awarded.................21 Care At Home Case Management Guidance Issued…........................21 Publications..........................................................................................................22
New Yorkers from every corner of the state this past week mourned the January 1 death of former New York Governor Mario Cuomo – a statesman in the truest sense – who served as the state’s chief executive for three terms, from 1983 to 1994. HCA sends our condolences to Governor Andrew Cuomo, the entire Cuomo family, and the many dedicated colleagues and staff who served the Governor during his distinguished tenure. Pictured here with the Governor is HCA Vice President for Program Policy and Services Andrew Koski (far left).
Helping New Yorkers Feel Right At Home
ASAP – a publication of the Home Care Association of New York State CoPs continued from p. 1 HCA’s comments are based on input from the membership, zeroing in on specific areas of concern or recommendation. While we express general support for CMS’s focus on patient-centered, datadriven, outcome-oriented process changes, we note three broad areas of concern in the proposed CoPs: 1) the addition of new unfunded costs at the same time that CMS has implemented dramatic cuts; 2) the regulatory conflict between the proposed CoPs and CMS-approved waivers allowing states to enroll patients into managed care; and 3) the significant feasibility challenges and resource dislocation that these changes may cause for overstretched home care agencies. We write: “ HCA urges a comprehensive reconsideration of the proposed rule to: balance goals with agency feasibility and impact; to ensure commensurate adjustments in Medicare and Medicaid rates to home care agencies, as well as adjustments to Medicare and Medicaid managed care premiums for home care, to cover the cost of agency implementation; and to reconcile the
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jurisdictional and procedural conflicts between the proposed expanded standards and the rapid shift to the provision of Medicare and Medicaid home care through managed care.” HCA also requests a delay in the implementation of these extensive new requirements – at least until January 2016 – to allow for provider readiness, including the dissemination of training and guidance to home health agencies, the development of internal compliance protocols, staff education, and other preparatory efforts. HCA’s comments can be downloaded at http://www.hca-nys.org/documents/ MedicareCoPsproposedcommentsDec2014.pdf. When the CoPs were first posted, we also prepared a detailed Public Policy Memorandum on them. The Memorandum can be downloaded at http://www.hca-nys.org/documents/ HomeHealthCoPsMemo102413.pdf. For more information, please contact the HCA Policy staff.
ASAP is a weekly publication of the Home Care Association of New York State (HCA). Unless otherwise noted, all articles appearing in ASAP are the property of the Home Care Association of New York State. Reuse of any content within this newsletter requires permission from HCA.
President: Editor:
Joanne Cunningham, jcunningham@hcanys.org Roger L. Noyes, Director of Communications, rnoyes@hcanys.org Al Cardillo, Executive Vice President, Policy & Programs, acardillo@hcanys.org Patrick Conole, Vice President, Finance & Management, pconole@hcanys.org Andrew Koski, Vice President, Program Policy and Services, akoski@hcanys.org Laura Constable, Senior Director, Membership & Operations, lconstable@hcanys.org Lynda Schoonbeek, Director of Education, lschoonbeek@hcanys.org Mercedes Teague, Finance Manager, mteague@hcanys.org Jenny Kerbein, Director of Governance and Special Projects, jkerbein@hcanys.org Billi Hoen, Manager, Meeting and Events, bhoen@hcanys.org Teresa Brown, Administrative Assistant, tbrown@hcanys.org 388 Broadway, 4th Floor, Albany, NY 12207 Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org
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Last Call for Member Responses to HCA Financial Survey HCA is at 80% of our response goal – please help us reach 100% As stressed in an E-alert to the membership earlier this week, today is the due date to submit responses to HCA’s financial condition survey. However, HCA has decided to keep the survey open at least through next week (January 16) so that we can ensure as many responses as possible. We are very close to reaching our response goal and will need the most statistically valid sample of response data possible. To help with this effort, please take time to complete this important survey as soon as possible. Your aggregate survey answers will be presented in a report for our 2015 Advocacy Day on January 26, a date which puts us ahead of the Governor’s budget release, scheduled for January 27. Your survey results will allow us to communicate with top lawmakers and state officials about the current financial status of home care as elected officials begin the process of negotiating a budget. As previously reported, HCA’s Advocacy Day will focus on engaging our Board of Directors for strategic meetings in Albany. We’ve developed a proactive agenda on behalf of the home care community that we will be unveiling in the coming days, so please stay tuned for details. In addition to our proactive agenda, HCA’s advocacy message will also need to account for any health-care-related initiatives that the Governor will be outlining in his State of the State Address on January 21.
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We recommend that you print the survey first, enter the information by hand, and then complete (or have your staff complete) the online version of the survey. You can obtain a printable PDF of the survey at http:// www.hca-nys.org/documents/ 2014financialsurvey.pdf.
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The entire survey should take about 30 to 40 minutes to complete. You may want to have different staff complete certain sections. (This is yet another reason why it’s best to print the survey first.)
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Please use the reference guide in section two. It will help you locate data fields from your cost reports and/or statistical reports.
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If it’s easier, you can always fax or e-mail us a printed/PDF version of the survey and we’ll input the data by hand, or you can enter the data through our online survey process.
Thank you for your assistance in this important effort. If there is any way we can help facilitate your completion of the survey, or if you need technical assistance, please consult HCA’s Communications Director Roger Noyes at rnoyes@hcanys.org or (518) 810-0665. As a reminder, here are some things to keep in mind before starting the survey: •
Follow all instructions carefully for inputting data so that you don’t experience any error messages. (Remember to round your numbers and avoid using any special characters like $ or %.)
Survey Links Download a PDF of the survey to print and/or fill out by hand: http://www.hca-nys.org/documents/ 2014financialsurvey.pdf Enter the survey results online: https://www.surveymonkey.com/r/ 2015FinancialConditionSurvey Download the Reference Guide for part two of the survey: http://www.hca-nys.org/documents/ 2015HomeCareSurveyCostStatReportReferences.pdf 3
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Court Issues Restraining Order on Companionship Exemption Changes Court hearing to be held today On December 31, a U.S. District Court issued a temporary restraining order (TRO) blocking the U.S. Department of Labor (DOL) from enforcing its proposed new definition of “Companionship Services” under the Fair Labor Standards Act (FLSA) for home care. The restraining order was requested by the National Association for Home Care and Hospice (NAHC), plaintiffs in the case. Today, the court is scheduled to have a late afternoon hearing on whether a preliminary injunction should be issued. (HCA will know more about this outcome after ASAP press time and will notify the membership, as needed, via an E-alert.) A temporary restraining order can be in force for no more than 14 days while a preliminary injunction can be in effect until a final ruling on the case. Regardless of the outcome, an appeal by DOL is expected, and the future status of the companionship exemption for home care remains a big question. According to a press release issued by NAHC: “During the time in which the temporary restraining order is in effect, home care companies can continue to pay home care aides and personal care attendants without added overtime compensation except where state law requires it. Home care companies are advised to consult competent counsel to determine if they qualify to use the exemption. If the requested injunction is granted on January 9, the exemption from overtime will continue until the Court’s final ruling or the Court of Appeals reverses the injunction. DOL has previously indicated that it would appeal any adverse ruling of the court.” As HCA has stressed in prior communications, New York State law already requires a minimum wage for home care workers, plus overtime at time-and-a-half of the minimum wage ($8.75 per hour in 2015). Thus, while the TRO is in effect, home care agencies can continue to pay overtime at time-and-a-half of the minimum wage. For New York State, DOL’s regulation disallowing a companionship exemption in home care would require that overtime be calculated based on the regular rate of pay, not time-and-a-half of the minimum wage. New recordkeeping requirements would also be required as a result of the rule. We will keep the membership further apprised of new developments, including the status of today’s hearing and other updates.
Hiring Job Title: Controller – JASA Care Name of organization: JASA Not just a “keeper of the books,” the JASA Care Controller will be a member of the senior administrative team. The individual will direct all of JASA Care’s finance functions including financial reporting and centralized billing/collection for all JASA programs and services. Must be a hands-on strategic thinker; process-oriented problem solver; strong communicator able to understand issues and explain accounting needs; organized; motivated. Must have solid managerial accounting experience including: entire accounting cycle (processes, closing and reporting cycles, reconciliations and controls); working with external constituents (funders and auditors). For full job description and how to apply, visit www.jasa.org/careers
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Court Rules that NAHC’s F2F Lawsuit Can Proceed A federal court this week ruled that an industry-led lawsuit challenging the Medicare home health face-to-face (F2F) rule can proceed. Federal District Court Judge Christopher Cooper ruled in favor of the plaintiffs, the National Association for Home Care and Hospice (NAHC), denying a motion by the federal Medicare program to have NAHC’s lawsuit dismissed. Two of Medicare’s claims were denied by the court: 1) the argument that home health agencies needed to pursue administrative appeals before a court had power to hear the case; and 2) Medicare’s insistence that the narrative requirement of the F2F rule was a valid interpretation of the Affordable Care Act (ACA). In its lawsuit, NAHC takes aim, specifically, at the narrative requirement of the F2F rule. The burdensome narrative requirement of F2F was in effect up until a week ago, on January 1, 2015, when it was replaced with new F2F documentation/certification requirements established by the U.S. Centers for Medicare and Medicaid Services (CMS) in its 2015 Home Health Prospective Payment System (HHPPS) rule. Even though the burdensome narrative requirement is no longer in effect, providers are nevertheless still subject to narrative-based retroactive reviews and recoupments for services rendered prior to January 1, 2015, thus prompting NAHC to continue to press its claims in the suit. As the provider community is well aware, the narrative requirement of the F2F mandate has long been a major administrative burden to home health providers and physicians and an access-to-care barrier for home health services. This week’s court ruling is an important recognition of the home care community’s valid claims regarding the lingering impact of the narrative requirement. Ever since the narrative requirement was introduced, HCA has worked with NAHC, the Visiting Nurse Associations of America and colleague state associations to engage Congress and CMS on a fix for this issue. Our work has included the advancement of legislation and Congressional letters of opposition to the narrative requirement, provider survey findings on the financial and service impact of F2F, and other efforts that ultimately led CMS to modify the F2F rule for 2015. While the new F2F changes, now in effect, eliminate the narrative requirement of F2F, they do retain the requirement for a F2F encounter to occur. CMS also reiterates in the final 2015 HHPPS that the certifying physician must have sufficient documentation within his or her patient record to support the physician’s determination as to a patient’s eligibility for coverage, creating still further problems for compliance in the coordination of documentation with physicians. The Forum of State Associations, which is chaired by HCA President Joanne Cunningham, has sent a letter to CMS in which the Forum seeks a phase-in of these new F2F changes. The letter, cosigned by Forum Vice Chair Patricia Kelleher of The Home Care Alliance of Massachusetts (and signed by over 50 organizations nationally), notes the complexity of these changes which will require appropriate education of the home care community. As it stands, the only significant CMS briefing on the new F2F changes was during a provider call on December 16, giving little time for preparation and implementation. Amid all of these F2F-related developments, a recent Congressional budget measure is expected to bring further scrutiny to the F2F mandate. The bill, signed by the President, includes non-binding ‘report language’ requesting 5
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that CMS “quantify and explain how the policy directing physicians to conduct face-to-face certifications for home health care has prevented fraud, increased access to health care, and impacted costs to the Medicare and Medicaid programs. The agreement requests that CMS include in the budget request how provider documentation for face-to-face encounters can be simplified. In addition, CMS should provide a public analysis related to rebasing Medicare home health agencies within 90 days of enactment of this act.” The policy implications of this report language, coupled with the continuation of NAHC’s lawsuit and the home care community’s request for a phased-in approach to the new F2F requirements, will all have an impact on the future of the F2F rule as well as the status of past claims. Going forward, NAHC, in its press release announcing the decision, advises home health agencies “to consider appealing any narrative-related claim denials while the lawsuit is progressing. Such action will preserve the opportunity to have the claims reviewed by the Administrative Law Judges and also allow for easy identification of claims that may be the subject to reopening if the lawsuit is successful.” HCA will keep the membership apprised of further updates as they occur.
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HCA Offers Workshop on Preparing for ICD-10 On February 25, HCA will offer a one-day ICD-10-CM Readiness Boot Camp to support members and potential members as they prepare for the transition to this new coding update taking effect on October 1. The workshop is being presented by Trish Tulloch, Senior Consultant with HCA member RBC Limited. It will be held at the Holiday Inn in Albany. Coders, coding supervisors, educators and clinicians will want to attend to learn the critical terminology and diagnoses updates that impact assessment, care planning and accurate reimbursement. Tips and program tools to support ICD10 readiness with your agency staff will be offered as well. A brochure and registration information are available at www.hcanys.org/events.cfm. Seating is limited, and early registration is encouraged. For further information, contact Lynda Schoonbeek at (518) 8100656 or lschoonbeek@hcanys.org.
Nurse Practitioner Rule Finalized The State Education Department (SED) has finalized a rule to change the collaborative requirements between nurse practitioners and physicians, as directed under a provision of the state budget. According to SED, the purpose of this law, which became effective January 1, 2015, is to increase service access by establishing criteria for qualified nurse practitioners to practice under collaborative relationships with one or more licensed physicians, or a hospital licensed under Article 28 of the Public Health Law (Article 28 hospital), in lieu of practicing in collaboration with a physician in accordance with a written practice agreement and written practice protocols. This law also amends the Education Law to establish recordkeeping and documentation requirements for nurse practitioners practicing pursuant to collaborative relationships and establishes specific unprofessional conduct provisions for all nurse practitioners. A notice about the final rule, its text, comments received on the draft rule, and SED’s responses are at http://docs.dos.ny.gov/ info/register/2014/dec31/pdf/rulemaking.pdf (page 35).
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Catch the Wave: HCA’s Annual Conference and New Leadership Institute As we turn the page on 2014, now’s the time to plug HCA’s 2015 Annual Membership Conference into your calendar. The conference will be held on May 6 and 7 in Saratoga Springs. Yes, you are reading that right – the Annual Conference is going to be just a two-day event this year, jammed packed with learning and networking opportunities, exhibits and more. This more compact approach is being made to accommodate the busy schedules of our members, and to allow for a lower registration fee. While you have your calendar open, you’ll also want to take note of HCA’s new Leadership Institute that will be held on May 8, in Saratoga Springs as well, coinciding with the conference. Members can attend the Annual Conference plus the Leadership Symposium or just attend one of these signature events. This year’s conference theme is Catch the Wave: Are You Ready for The Turn-Around? We’ll kick off the conference on May 6 with the annual meeting of HCA’s Board of Directors which all HCA members are welcome to attend. This allows members to see first-hand the dedicated work of our Board and view how HCA’s advocacy, policy and education agenda will be shaped for the coming year. The official start of the conference will be at 1:30 p.m. followed by a reception with our vendors who will be showcasing their products and services at the end of the day. Attendees will then have time to dine at one of Saratoga’s many fine restaurants for dinner, followed by HCA’s PAC fundraiser beach party and trivia night – which is certain to be a splash of fun. On May 7, we will start the second day of HCA’s premier event by recognizing our outstanding award winners over a gourmet breakfast. The rest of the day will include an address by HCA President Joanne Cunningham, a series of dynamic speakers and several workshops that will allow members to take away valuable information and tools to support their organization’s continued success in 2015. If you have a suggestion for a workshop or speaker, please send your idea to Lynda Schoonbeek, Director of Education, at Lschoonbeek@hcanys.org by January 16. Also, if you are willing to conduct a workshop at the Annual Conference, or at another HCA event or webinar, send us an outline of your presentation by using our “Call for Presentations” form at http://www.hca-nys.org/documents/CallforPresentations2014.pdf. Leadership Institute Details Whether you are a leader of a home health agency or the leader of your clinical unit, you will not want to miss HCA’s new Leadership Institute being conducted by the American College of Healthcare Executives (ACHE). The Courage to Lead: Critical Skills for Healthcare Leaders is a full-day program where participants will learn how to utilize proven tools and techniques to identify and develop your leadership philosophy. This program, regularly offered in Chicago at the American College, is being brought to Saratoga exclusively for HCA. It’s an opportunity not to be missed. Watch for more details coming soon on HCA’s Annual Membership Conference and Leadership Institute. Mark your calendars and be ready to Catch the Wave! For further information, contact Lynda Schoonbeek at (518) 810-0656 or at lschoonbeek@hcanys.org. 7
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Bills on Telehealth and Changes to the Wage Theft Prevention Act Signed Into Law As HCA notified members in a recent E-alert, Governor Cuomo has signed two important health care bills into law: one providing for expanded telehealth coverage (S.7852/A.9129-A) and another bill (S.05885-B/A.8106C) that modifies certain provisions of the Wage Theft Prevention Act, including the requirement that employers annually provide employees with written notice of wage information. The chapter amendments to the Wage Theft Prevention Act under S.05885-B/A.8106-C would specifically accelerate the effective date for removing the burdensome notification requirement in calendar year 2015. Under this requirement, now removed for existing employees, employers had to give employees at the time of hire and on or before February 1 of each year, written notice of: the employee’s rate of pay; overtime rate of pay, if the employer is subject to overtime; bases of wage payment (per hour, per shift, per week, etc.); regular pay day; the employer’s name, address of the main office, and phone number; and other information. This burdensome notification requirement has long been a target of HCA’s advocacy. More information is at http://www.labor.ny.gov/workerprotection/laborstandards/employer/wage-theft-prevention-act.shtm. Telehealth Bill and Chapter Amendments Expansion of telehealth coverage has long been an HCA priority, including our spearheading of legislation for the State Medicaid program to provide reimbursement for telehealth. HCA has been working extensively with Senator Young, Assembly Member Addie Russell and other telehealth supporters to advance further innovations in home telehealth. S.7852/A.9129-A provides a step in the right direction, although additional refinements are needed. This is why HCA has been involved in a chapter amendment process which will provide further clarification of the coverage requirements for telehealth. HCA will keep the membership closely apprised of this process and our further analysis of this legislation.
House Passes, Senate Introduces Bill Redefining ACA Thresholds for Full-Time Work The U.S. House of Representatives has passed legislation to change the 30-hour-per-week definition of ‘full-time’ work under the Affordable Care Act (ACA). The bill would restore the traditional definition of ‘full-time’ as 40 hours per week for purposes of ACA insurance coverage provisions. Known as the ‘Save American Workers Act,’ H.R. 30 passed the House by a vote of 252 to 172 this week. A companion bill was introduced yesterday in the Senate, though it will not likely be acted upon until later in the month, starting with a January 22 hearing. Even if passed by the Senate, the legislation faces an expected veto by the President. This legislation is designed to change the threshold for the ACA health insurance mandate. Under ACA, employers have to provide health insurance coverage (or else pay a penalty) based on calculations that account for the number of their full-time employees; however, the ACA law sets the current definition of ‘full-
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time’ at 30 hours per week. This bill would raise the threshold to 40 hours per week, as is the standard definition, allowing more flexibility for employers and ensuring stability in the number of hours that employees are assigned. Senator Susan Collins (R-ME), sponsor of the bill in the Senate, summed up the impact of the bill during a press conference to introduce it:“The ACA law creates a perverse incentive for businesses to cut their employees’ hours so they are no longer considered ‘full time.’ Our concerns are not hypothetical; more than 450 employers have already cut work hours or staffing levels in response to the law as of September 2013. Employees of for-profit businesses are not the only ones who are threatened by this illogical definition of full-time work. In Maine, I have heard from organizations like home care agencies, hospitals, and school departments. Our goal is simple. We want to protect part-time workers from having their hours reduced and their paychecks cut because of the definition in this law.” HCA will keep the membership informed about further developments with this legislation.
DSRIP Update The state Department of Health (DOH) has recently provided updates to the Delivery System Reform Incentive Payment (DSRIP) Program, including updates related to the Vital Access Provider (VAP) exception appeals, as well as the Certificate of Public Advantage (COPA) and Accountable Care Organization (ACO) applications. DOH also announced the first meeting of the Project Approval and Oversight Panel. VAP appeals DOH has sent the VAP exception appeal recommendations to the U.S. Centers for Medicare and Medicaid Services (CMS) for review and approval on November 21 (leads only) and on December 5. DOH has
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ACO Final Rule Promulgated The state Department of Health (DOH) has finalized a rule that would establish Accountable Care Organizations (ACOs). The announcement is at http:// docs.dos.ny.gov/info/register/2014/ dec31/pdf/rulemaking.pdf (page 68). Under the final rule, an ACO is defined as “an organization comprised of clinically integrated independent health care providers that work together to provide, manage, and coordinate health care (including primary care) for a defined population; with a mechanism for shared governance; the ability to negotiate, receive, and distribute payments; and to be accountable for the quality, cost, and delivery of health care to the ACO’s patients and has been issued a ‘certificate of authority’ by the Commissioner.” The regulations address the criteria for ACOs to obtain and maintain certificates of authority, including governance, leadership and management structure; population to be served; network adequacy; performance standards and measures; character, competence and fiscal responsibility and soundness of an ACO and its principals; and mechanisms for providing, managing and coordinating quality health care, receiving and distributing payments to providers, quality assurance, and others. State legislation required the establishment of an ACO workgroup, which has included participation from HCA.
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recommended that CMS approve 503 providers for DSRIP safety net status through the VAP exception process. The packet can be viewed at http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/safety_net_definition.htm. Approval of these exception appeals is contingent upon obtaining final approval from CMS. Once approval is received from CMS, DOH will update the safety net lists. HCA had assisted members in filing VAP exception and safety net provider appeals. Questions related to the VAP Exception or DSRIP safety net process should be directed to BVAPR@health.ny.gov. All other questions can be directed to DSRIP@health.ny.gov. COPA and ACO As previously noted in the December 12 ASAP, COPA and ACO applications submitted by Performing Provider System (PPS) Lead Applicants on or before December 22, 2014 should expect to be notified of DOH’s determination by April 1, 2015. In addition, COPA and ACO applications submitted by PPS Lead Applicants on or before February 1, 2015 should expect to be notified by June 30, 2015. Applications will be accepted on a rolling basis after February 1, 2015, but notification may not be made until after June 30, 2015. The COPA revised Frequently Asked Questions (FAQs) are now posted at http://www.health.ny.gov/health_care/medicaid/redesign/copa/docs/faqs.pdf. The opening paragraph and questions 1 and 16 through 21 on the COPA FAQs have been revised to reflect that a notice of adoption has been filed in the State Register for the COPA regulations (see http://docs.dos.ny.gov/ info/register/2014/dec17/toc.html). The regulations took effect December 17, 2014 and are available at http:/ /www.health.ny.gov/regulations/recently_adopted/docs/2014-12-17_certificate_of_public_advantage.pdf. Additional revisions have been made to questions 5 and 15 and a new question 23 has been added. The revised ACO FAQs are at http://www.health.ny.gov/health_care/medicaid/redesign/aco/docs/faqs.pdf. Questions 4 and 12 on the ACO FAQs have been revised and new questions 14 and 15 have been added. Project approval and oversight panel The DSRIP Project Approval and Oversight Panel will meet for the first time on Monday, January 12 in Albany, from 10:30 a.m. to 2 p.m. This meeting is open to the public (though seating is limited). The meeting is a work session for the panel members, and there will be no public comment period. The panel will meet again in February, in Albany, at which point there will be a public comment period. More detail will be provided in early February on the meeting details and opportunity for public comment. The February meetings will be webcast and can be viewed live at http://www.health.ny.gov/events/webcasts/. The panel was authorized in last year’s state budget to review recommendations for DSRIP and Capital Restructuring Finance Program awards.
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Hospice Providers Should Continue to Collect and Submit HIS Data in 2015 The U.S. Centers for Medicare and Medicaid Services (CMS) reminds hospice providers that December 31, 2014 marked the close of the Fiscal Year (FY) 2016 data collection cycle for the Hospice Item Set (HIS). For the FY 2016 data collection cycle, hospices were required to report HIS data (and HIS-Admission and HIS-Discharge records) for each patient admission to their hospice from July 1, 2014 to December 31, 2014. These data submissions will be used by CMS to determine compliance with Hospice Quality Reporting Program (HQRP) requirements for the FY 2016 Annual Payment Update (APU) determination. Hospice providers should continue to complete and submit HIS records for patient admissions occurring after December 31, 2014. (Patient admissions occurring January 1, 2015 to December 31, 2015 will impact the FY 2017 APU determination.) For more information on HIS requirements, visit the “Hospice Item Set (HIS)” portion of the CMS HQRP website at http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospiceQuality-Reporting/Hospice-Item-Set-HIS.htm, or contact the Quality Help Desk at: HospiceQualityQuestions@cms.hhs.gov. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
Managed Care Update The state Department of Health (DOH) over the past few weeks has provided updates on the Fully Integrated Duals Advantage (FIDA) program; transition to Managed Long Term Care (MLTC) plans in the rest of the state; issues related to MLTC enrollees who are also in Health Homes; and the phase-in of the nursing home benefit into managed care. FIDA Some new developments with FIDA include: •
100,000 Program Announcement letters were mailed in December.
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The 90-day passive enrollment letters (for an April 1, 2015 effective date) were sent for those non-SSI individuals with an annual coverage date of June to August 2015 and for the SSI population with a birthday between January and March.
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This 90-day letter is the first of three reminders (90, 60 and 30 day notice) that individuals will receive prior to being passively enrolled.
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372 people (as of December 20, 2014) have enrolled into FIDA plans for the enrollment effective date of January 1, 2015; 3,853 have chosen to “opt out.”
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The Participant Ombudsman program, known as the Independent Consumer Advocacy Network (ICAN), was launched on December 1, 2014 and has received 1,674 calls in December. Continued on next page 11
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Total MLTC enrollment as of December 1 is 139,204, with 118,352 in New York City and 20,852 in the rest of the state.
The following are some updates related to the MLTC transition:
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MLTC Transition
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Networks for the counties that started transitioning in December (Genesee, Orleans, Otsego and Wyoming) were approved by the U.S. Centers for Medicare and Medicaid Services (CMS).
Announcement notices were mailed to the enrolled population starting the week of December 29, 2014.
As of January 5, 2015, consumers seeking community-based long term care services are being directed to NY Medicaid Choice.
Letters also went out on January 5, 2015 advising those already enrolled in MLTC plans that they cannot opt out of their plan and return to Medicaid fee-forservice.
The remaining counties that await CMS approval for the MLTC transition include: Allegany, Cattaraugus, Chautauqua, Chemung, Schuyler, Seneca, and Yates ( January 2015); and Clinton, Essex, Franklin, Hamilton, Jefferson, Lewis, and St. Lawrence (February 2015). The Evaluation and Enrollment Center (EEC) – which evaluates an individual’s eligibility for Medicaid community-based long term care and enrollment in an MLTC plan – is operational in the five counties of New York City and Nassau county; it will start in February for Westchester and Suffolk counties. The EEC receives an average of about 400 calls per day. 12
The EEC approval rate is 95 percent; the denial rate is 1 percent, and 4 percent of consumers did not show for the evaluation.
Health Homes and MLTC Enrollment DOH has provided the following clarifications about the coordination of services between Health Homes and MLTCs: •
Eligible individuals enrolled in MLTC plans may also be enrolled in a Health Home, but services must be coordinated.
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The MLTC plans and Health Homes must enter into an Administrative Service Agreement (ASA) that clearly defines the respective care manager roles and a collaborative working relationship.
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An ASA template allocates a primary role for the service coordination of long term care services to the MLTC plan and a primary role for the service coordination of behavioral health care and other services and supports that are outside of the MLTC benefit package to the Health Home.
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Health Home care management services are carved out of the MLTC benefit package; thus both the MLTC Plan and the Health Home may bill for their respective services.
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MLTC plans are responsible for coordination with the Health Home and are not responsible for Health Home management or performance or any services outside the scope of their benefit package.
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Health Homes and MLTCs must establish clearly defined roles in providing collaborative care management – the MLTC is responsible only for coordination and not for Health Home management or performance.
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It will be the responsibility of the Health Home and the MLTC plan to determine
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which care manager will serve as the lead care manager for each individual client. This decision will be based on the primary needs of the client and must be documented using the Care Planning and Coordination form or similar format.
Warren, Wayne, Washington, Wyoming, and Yates counties. Phase 4: October 1, 2015 •
Nursing Home Transition DOH has announced the revised Phase-In Schedule for the transition of the Nursing Home Benefit and Population into Mainstream Medicaid Managed Care and MLTC plans. According to the New York Legal Assistance Group, this requirement will apply only to people who, after February 1, 2015, are approved for permanent nursing home placement and institutional Medicaid (after the 60-month look-back review is completed). Enrollment will not be required into an MLTC or mainstream plan upon admission to a nursing home. It will be required later, after the nursing home resident applies for and is accepted for institutional Medicaid. What follows is the schedule for the nursing home transition. Phase 1: February 1, 2015 •
New York City – Bronx, Kings, New York, Queens, and Richmond counties
Phase 2: April 1, 2015 •
As the three-way contract for FIDA indicates, voluntary and passive enrollment for eligible individuals in nursing homes will take place on or after August 1, 2015. More information will be forthcoming on the exact timeline. DOH has also revised its chart of populations and benefits that have and will become part of Mainstream Medicaid managed care plans. It is at http://www.health.ny.gov/health_care/ medicaid/redesign/docs/ mrt1458_timeline.xls. Some important draft dates, subject to approval by CMS, include the following populations that will be transitioned to managed care plans: •
September 2015: Nursing Home Transition and Diversion and Traumatic Brain Injury waiver programs.
•
January 2016: Assisted Living Program residents (dual and non-dual eligible); Care At Home Waivers 1, 2, 3, 4 and 6.
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December 2016: Medicaid recipients with spenddowns.
Nassau, Suffolk and Westchester counties
Phase 3: July 1, 2015 •
Albany, Allegany, Broome, Cattaraugus, Cayuga, Chautauqua, Chemung, Chenango, Clinton, Columbia, Cortland, Delaware, Dutchess, Erie, Essex, Franklin, Fulton, Genesee, Greene, Hamilton, Herkimer, Jefferson, Lewis, Livingston, Madison, Monroe, Montgomery, Niagara, Oneida, Onondaga, Ontario, Orange, Orleans, Oswego, Otsego, Putnam, Rensselaer, Rockland, St. Lawrence, Saratoga, Schenectady, Schoharie, Schuyler, Seneca, Steuben, Sullivan, Tioga, Tompkins, Ulster, 13
All counties – voluntary enrollment in Managed Long Term Care, Fully Integrated Duals Advantage (FIDA) and Mainstream Medicaid Managed Care becomes available to individuals residing in nursing homes who are in fee-for-service Medicaid.
According to the chart, individuals who are in hospice at the time of their Medicaid application will remain in fee-for-service Medicaid. For more information, contact the HCA Policy staff.
ASAP – a publication of the Home Care Association of New York State
CMS Announces Process for Hospices to Seek CAHPS Size Exemption The U.S. Centers for Medicare and Medicaid Services (CMS) has created a process for smaller hospices to request an exemption from participation in the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey. For the 2015 data collection period, Medicare-certified hospices that have served fewer than 50 survey-eligible decedents/caregivers in CY 2014 ( January 1, 2014 through December 31, 2014) can apply for an exemption from CAHPS Hospice Survey CY 2015 data collection and reporting requirements. To request the exemption, hospices must submit a Participation Exemption for Size Form. This form is now available on the CAHPS Hospice Survey website at www.hospicecahpssurvey.org and must be submitted by August 12, 2015. Hospices are encouraged to submit this form online via the CAHPS Hospice Survey website as soon as possible. Exemptions on the basis of size are active for one year only. If a hospice remains eligible for this exemption in subsequent years, the organization will need to again request the exemption. It is anticipated that the exemption form for 2016 data will be available in January 2016. For further information, contact Patrick Conole at (518) 8100661 or at pconole@hcanys.org.
CMS Posts Materials on Certifying Patients for Medicare Home Health Benefit The U.S. Centers for Medicare and Medicaid Services (CMS) has posted materials from its national provider call on certifying patients for the Medicare home health benefit. The materials, including the handouts and a written transcript, are at http://tinyurl.com/obtxvy6. During the call, CMS reviewed the new patient certification requirement for home health agencies effective January 1, 2015, as part of the final home health prospective payment 14
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Reminder: HCA to Hold Jan. 13 Forum for Home Care Council Members Attention Home Care Council of HCA members: please join us on January 13 in New York City for a special member forum to engage you on issues of importance to your organization. As HCA continues the 2015 member renewal process, we especially want to take the opportunity to hear your feedback and learn how best to serve you in the new year. Some of the issues to be covered at the Forum include: the companionship exemption changes for home care, Quality Incentive/ Vital Access Provider Pool (QIVAPP) monies; Human Resource Administration (HRA) contracts and other HRA updates; Fully Integrated Duals Advantage (FIDA); Managed Long Term Care plan issues; and education programs. More details are below. To register, please complete the form at the back of this week’s ASAP. Home Care Council of HCA Member Forum January 13, 2015 10 a.m. to 1 p.m. Hunter College Brookdale Campus 425 East 25th Street (between 1st and FDR Drive) The Osborn Room (Mezzanine Level) New York, New York 10010
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system rule. CMS also covered the general requirements for home health eligibility, recertification requirements and included sample case examples. CMS has also posted a Medicare Learning Network article on the new physician certification requirements at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/ Downloads/SE1436.pdf. For more information on this issue, see the article in the December 19 ASAP.
Quality Strategy Approved for Medicaid Managed Care On December 24, 2014, the U.S. Centers for Medicare and Medicaid Services (CMS) approved the 2014 Quality Strategy for the New York State Medicaid Managed Care Program. Pursuant to the Special Terms and Conditions for New York’s Federal-State Health Reform Partnership and Partnership Plan section 1115(a) Demonstrations, the state is required to maintain a Quality Strategy for all Medicaid Managed Care programs. The Quality Strategy for the New York State Medicaid Managed Care program delineates the updated and expanded goals of the Medicaid managed care program and the actions taken by the state Department of Health (DOH) to ensure the quality of care delivered to Medicaid managed care enrollees. For more information, visit https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/cms_official_docs.htm. HCA has been working with a Quality Committee of our members to compare quality measures used by the state and federal governments for managed care plans with those that apply to home care providers, and to develop measures that enhance the delivery of home care services to managed care enrollees. During our Quality Conference in November, HCA presented the initial parameters of our benchmarking initiative in which we have brought together provider and plan representatives on developing a document that aligns priority quality and performance metrics between home care and managed care. This work and similar quality initiatives will be further discussed with the membership and state Department of Health officials in a DOH workgroup now underway to explore these issues. For more information, please contact the HCA Policy staff.
Volunteer for ICD-10 Testing in April – Deadline Extended to Jan. 21 During the week of April 26 through May 1, 2015, a second sample group of providers will have the opportunity to participate in ICD-10 end-to-end testing with Medicare Administrative Contractors (MACs) and the Common Electronic Data Interchange (CEDI) contractor. The goal of end-to-end testing is to demonstrate that: •
Providers and submitters are able to successfully submit claims containing ICD-10 codes to the Medicare Fee-For-Service (FFS) claims systems. Continued on next page 15
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Continued from p. 15 •
U.S. Centers for Medicare and Medicaid Services (CMS) software changes made to support ICD-10 result in appropriately adjudicated claims.
•
Accurate remittance advices are produced.
Approximately 850 volunteer submitters will be selected to participate in the April end-to-end testing. To volunteer as a testing submitter: •
Complete the volunteer form (available at www.ngsmedicare.com) by January 21.
•
CMS will review applications and select the group of testing submitters.
•
By February 13, the MACs and CEDI will notify the volunteers selected to test and provide them with the information needed for the testing.
If selected, testers must be able to: •
Submit future-dated claims.
•
Provide valid National Provider Identifiers (NPIs), Provider Transaction Access Numbers (PTANs), and beneficiary Health Insurance Claim Numbers (HICNs) that will be used for test claims. This information will be needed by your MAC by February 20, 2015, for set-up purposes; testers will be dropped if information is not provided by the deadline.
An additional opportunity for end-to-end testing will be available during the week of July 20 through 24, 2015. Any issues identified during testing will be addressed prior to ICD-10 implementation. Educational materials will be developed for providers and submitters based on the testing results. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
Capital Restructuring Financing Program Q&As Posted The state Department of Health (DOH) has posted the Questions & Answers and attachment forms for the Capital Restructuring Financing Program (CRFP) Request for Applications (RFA). The Q&As, along with the RFA, are at: http://www.health.ny.gov/funding/rfa/1410100351/index.htm. The Q&As cover: funding for electronic medical records, telehealth equipment, tablets, lease payments, downsizing expenses; issues unique to for-profit health care providers; existing Certificate of Need (CON) applications; matching funds; the state’s gateway process for grants; minimum and maximum funding amounts; providers included under assisted living; compliance with Executive Order 38; and others. Under the CRFP RFA, up to $1.2 billion is being made available to “support capital projects to help strengthen and promote 16
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access to essential health services, including projects to improve infrastructure, promote integrated health systems, and support the development of additional primary care capacity.” CRFP grants will be awarded to capital projects that further the objectives of the Delivery System Reform Incentive Payment (DSRIP) program. These include: •
Improve population health.
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Support transformational change to the health care delivery system.
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Reduce costs of health care services.
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Increase access to appropriate and high quality health care for all New Yorkers.
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Reduce avoidable hospital use and improve other health and public health measures at both system and state levels.
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Ensure that delivery system transformation continues beyond the waiver period through managed care payment reform.
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Preserve essential safety net providers across the state.
Individual CRFP applications from organizations participating in DSRIP must be submitted by the Performing Provider System (PPS) lead entity, while applications will also be accepted from organization not participating in DSRIP.
CMS Change Requests for Home Health Go Into Effect January 1, 2015 The U.S. Centers for Medicare and Medicaid Services (CMS) has issued some Change Requests (CRs) that provide guidance to the Medicare Administrative Contractors (MACs) on various home health policy and claims processing issues, which went into effect on January 1, 2015. As a reminder to members, here are some CRs issued by CMS and now in effect: •
Diagnosis Reporting on Home Health Claims (CR 8813). Effective January 1, 2015, MACs have implemented edits to reject home health claims that list a manifestation code as a primary diagnosis. An analysis of Outcome Assessment and Information Set (OASIS) records and claims for 2011 revealed that some agencies were not complying with the coding guidelines when reporting the primary diagnosis, in particular for certain codes that require the underlying condition be sequenced first followed by the manifestation. The principal diagnosis reported on the home health claim shall be the ICD-9-CM code that is most related to the current home health plan of care. HHAs shall not submit manifestation codes as the primary diagnosis. CR 8813 can be downloaded at: http://www.cms.gov/Regulations-and-Guidance/ Guidance/Transmittals/Downloads/R1405OTN.pdf. Continued on next page 17
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Continued from p. 17 •
Preventing Payment on RAPs When Home Health Beneficiaries are Enrolled in Medicare Advantage Plans (CR 8710). Current Medicare systems employ an edit to reject claims for home health episodes when a beneficiary is enrolled in a Medicare Advantage plan. However, Requests for Anticipated Payment (RAPs) for such episodes are currently being paid. Beginning January 1, 2015, edits will be put in place to ensure that RAPs with “From” dates falling within Medicare Advantage enrollment periods are processed but paid at zero percent. If a final claim is received, it will be rejected, as is currently the process. Additionally, the requirements add remittance advice coding to zero-paid RAPs processed in Medicare Secondary Payer situations, so that the two situations can be distinguished. In the future, CMS will seek a new remittance advice remark code to specifically identify the Medicare Advantage cases also. CR 8710 can be downloaded at: http://www.cms.gov/Regulations-and-Guidance/Guidance/ Transmittals/Downloads/R1405OTN.pdf.
•
Preventing Duplicate Payments When Overlapping Inpatient and Home Health Claims Are Received Out of Sequence (CR 8699) – CMS has instructed MACs to implement edits that will prevent home health claims from processing with dates of service that overlap an inpatient stay. In response to a 2012 Office of Inspector General (OIG) report that exposed claim vulnerabilities, CMS has identified two conditions where such overlaps have occurred:
The edit that rejects home health claims when they have dates overlapping an inpatient stay – other than the admission date, discharge date, or a date during an occurrence span code 74 period indicating a leave of absence – does not consider inpatient stays in a swing bed (Type of Bill 018x); and
Medicare systems only identify overlaps with inpatient stays when the inpatient hospital or skilled nursing facility (SNF) claim was received before the home health claim.
Effective January 1, 2015, Medicare systems will reject the home health claim if the Common Working File finds dates of service on the home health claim that fall within the dates of an inpatient, SNF or swing bed claim (not including the dates of admission and discharge, and the dates of any leave of absence). The agency may submit a new claim removing any dates of service within the inpatient stay that were billed in error. If the home health claim is received first and the inpatient hospital, SNF or swing bed claim comes later, but contains dates of service duplicating dates of service within the home health episode period, Medicare systems will adjust the previously paid home health claim to non-cover the duplicated dates of service. CR 8699 can be downloaded at: http://www.cms.gov/Regulations-and-Guidance/Guidance/ Transmittals/Downloads/R3005CP.pdf. For further information, contact HCA’s Patrick Conole at (518) 810-0661 or pconole@hcanys.org. 18
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NGS Updates National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), has recently posted the following information to its website. •
Certifying Patients for the Medicare Home Health Benefit – The U.S. Centers for Medicare and Medicaid Services (CMS) has recently revised Medlearn Matters (MLN) article SE 1436 which gives Medicare-enrolled providers an overview of the Medicare home health services benefit, including patient eligibility requirements and certification/recertification requirements of covered Medicare home health services. SE1436 can be downloaded at: http://www.cms.gov/Outreach-and-Education/MedicareLearning-Network-MLN/MLNMattersArticles/Downloads/SE1436.pdf.
•
New Interactive Voice Response (IVR) Enhancements – The IVR is an interactive self-service tool for providers to get general or common Medicare beneficiary and claim information. The IVR uses natural language and text-to-speech technology that responds to one’s voice. Touch-tone is also available throughout the application, as needed. NGS home health providers can hear some of NGS’s IVR enhancement by calling 1-877-567-7205.
•
2015 Provider Enrollment Application Fee – Home health and other providers must submit an application fee or hardship exception when initially enrolling, revalidating their enrollment, or adding a new Medicare practice location. The 2015 fee ($553) is required with any Medicare enrollment application submitted January 1 through December 31, 2015. MLN article SE 1130 (http://www.cms.gov/Outreach-and-Education/MedicareLearning-Network-MLN/MLNMattersArticles/downloads/SE1130.pdf ) provides further information.
•
Update to the Hospice Notice of Election Termination / Revocation (NOTR) Process – With the implementation of Change Request (CR) 8877, hospice providers are required to submit a timely-filed NOTR using type of bill 8XB, unless the hospice has already filed a final claim. The NOTR must be submitted the same way as a Notice of Election (NOE). This means that the NOTR must be submitted in Option 49 within FISS/DDE. System limitations caused an edit when trying to enter the discharge/ revocation date in the STMT DATES TO field. This system limitation has been corrected and the field is now available for all NOTRs submitted on or after January 5, 2015. Beginning January 5, 2015, providers will no longer follow the workaround by entering the date in remarks.
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New Redeterminations and Reopenings Forms – NGS encourages providers to use NGSConnex to submit redetermination and reopening requests.
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Home Visits Billed with Outpatient Evaluation and Management Codes – Evaluation and Management (E&M) services rendered in a private residence are correctly billed with CPT codes 9934199345 (new patient) and CPT codes 99347-99350 (established patient), home services. These CPT codes are only payable in home settings, e.g., place of service (POS) 12. NGS has seen many instances of providers billing outpatient/office codes in home settings. Home visits should not be reported with E&M codes 99201-99215, which represent office and outpatient services. Beginning February 25, 2015, NGS will deny claims if the place of service on the claim is not compatible with the service billed, including E&M codes 99201-99215 when billed with POS 12.
For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org. 19
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Medicare Care Choices Model Update On December 19, the U.S. Centers for Medicare and Medicare Services (CMS) announced that it is still conducting its review process of the many hospice programs that have applied to participate in the Medicare Care Choices Model (MCCM). To further assess the geographic and demographic diversity (rural and urban agencies, inclusion of hospices of all sizes), CMS will not announce the selected hospice programs until sometime early in 2015 – later than the original timetable of late fall 2014. Under MCCM, Medicare beneficiaries with advanced cancers, chronic obstructive pulmonary disease, congestive heart failure and HIV/AIDS who meet hospice eligibility requirements under the Medicare hospice benefit will be able to receive palliative care services from certain hospice providers while concurrently receiving services provided by their curative care providers. CMS will evaluate whether providing hospice services can improve the quality of life and care received by Medicare beneficiaries, increase patient satisfaction, and reduce Medicare expenditures. Applications were due on June 19. More information is at http://innovation.cms.gov/initiatives/Medicare-Care-Choices.
Funding Available for Geriatrics Workforce Enhancement Program The Health Resources and Services Administration (HRSA), Bureau of Health Workforce (BHW) is accepting applications for the Geriatrics Workforce Enhancement Program (GWEP). The program will establish and operate geriatric education centers that implement the GWEP project to develop a health care workforce that “maximizes patient and family engagement and improves health outcomes for older adults by integrating geriatrics with primary care.” Eligible applicants are accredited health professions schools and programs and health care facilities, including hospitals and home care agencies, hospice, nursing home, local department of health and others. Special emphasis will be on providing the primary care workforce with the knowledge and skills to care for older adults and on collaborating with community partners to address gaps in health care for older adults through individual, system, community, and population level changes. Focus areas for this announcement are: 1. Transforming clinical training environments to integrated geriatrics and primary care delivery systems to ensure trainees are well prepared to practice in and lead these kinds of systems. 2. Developing providers who can assess and address the needs of older adults and their families/caregivers at the individual, community, and population levels. Continued on next page 20
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Continued from p. 20 3. Creating and delivering community-based programs that will provide patients, families and caregivers with the knowledge and skills to improve health outcomes and the quality of care for older adult(s). 4. Applicants may also choose to address education on Alzheimer’s disease and related dementias (ADRD). Funding may be used to support training of individuals, including patients, families, caregivers, direct care workers, health professions providers, students, residents, fellows who will provide health care to older adults and the faculty who train these individuals. Funding may also be used to provide educational programs for patients, family members, and caregivers to afford them with the knowledge and skills for self-management or the care delivery of older adults. Preference will be given to applicants with projects that will substantially benefit rural or underserved populations, or help meet public health nursing needs in state or local health departments. Applications are due March 5, 2015. The project period is three years, with an expected start date of July 1, 2015 and expected completion date of June 30, 2018. More information is at http://apply07.grants.gov/apply/opportunities/instructions/oppHRSA-15-057cfda93.969-cidHRSA-15-057-instructions.pdf.
Home Health, Hospice and DME RAC Contract Awarded The U.S. Centers for Medicare and Medicaid Services (CMS) has announced that the Recovery Audit Contractor (RAC) for home health, hospice and durable medical equipment will be Connolly, LLC. CMS’s Provider Relations Coordinator, Latesha Walker, is available to work with providers on questions and concerns resulting from the Recovery Audit Region 5 Contract Award. Providers can contact Ms. Walker when issues arise that cannot be solved by discussions with the Recovery Auditor. She may be reached at (410) 7861101 or Latesha.walker@cms.hhs.gov. RACs are paid by CMS to identify overpayments and underpayments. For a grid of select issue areas that has been targeted by the RACs, please visit https://www.dcsrac.com/IssuesUnderReview.aspx. Some recent changes to the RAC program are outlined at http://www.cms.gov/Research-Statistics-Data-andSystems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/ Downloads/RAC-Program-Improvements.pdf.
Care At Home Case Management Guidance Issued eMedNY reminds Care at Home (CAH) I/II case management agencies that all applicants seeking CAH I/II waiver enrollment should first contact their Local Department of Social Services (LDSS), or the Human Resources Administration (HRA) in New York City, in order to apply for the waiver. The purpose of this process is to help ensure that all applicants are given freedom of choice to select the case management agency of their choosing, and to help ensure that Conflict Free Case Management is maintained in the waiver. LDSS/HRA referral will also help eliminate risk to the CAH I/II case management providers if the applicant is already receiving services under another case management program given that enrollment in duplicative case 21
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management programs is prohibited, and prior enrollment would jeopardize payment for services rendered by the secondary provider. For questions related to this directive, please contact the state Department of Health Office of Health Insurance Programs Division of Long Term Care CAH I/II Waiver staff at 518-474-5271.
Publications •
“Protecting New Yorkers With Special Needs: Annual Report to the Governor and Legislature – June 30, 2013 to June 30, 2014,” by the New York State Justice Center http://www.justicecenter.ny.gov/sites/default/files/documents/Justice_Center_201314_Annual_Report.pdf
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“Report to the Congress: Impact of Home Health Payment Rebasing on Beneficiary Access to and Quality of Care,” by the Medicare Payment Advisory Commission (MedPAC) www.medpac.gov/documents/reports/dec14_homehealth_rebasing_report.pdf
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“Medicaid Assisted Living Programs (ALP) in NYS,” by the New York Legal Assistance Group http://www.wnylc.com/health/entry/150/
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“FAQs – International Classification of Diseases, 10th Edition (ICD-10) Acknowledgement Testing and End-to-End Testing,” by the U.S. Centers for Medicare and Medicaid Services http://www.cm s.gov/Outreach-and-Education/Medicare -Le arning-Network-MLN/ MLNMattersArticles/Downloads/SE1501.pdf
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“Beneficiaries Eligible for Medicare and Medicaid,” by the CHIP Payment and Access Commission and the Medicare Payment Advisory Commission http://www.macpac.gov/publications/Duals_DataBook_2015-01.pdf?attredirects=0&d=1
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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HCC MEMBER Forum Notice Please join the staff of HCA and member colleagues from the Association and the home care community for the next Home Care Council of HCA MEMBER Forum. As we continue the 2015 membership renewal process, you now have the opportunity to once again elect to be part of New York’s premier home care association. As part of this process, we especially want to take the opportunity to hear your feedback, continue to learn how best to serve you and let you know about a number of offerings that are in store for both the Association and the Home Care Council Forum.
Home Care Council of HCA Member Forum Tuesday, January 13, 2015 10:00am to 1:00pm Hunter College Brookdale Campus 425 East 25th Street (between 1st and FDR Drive) The Osborn Room (Mezzanine Level) New York, New York 10010
Some of the vital issues to be covered include: • Companionship Exemption changes • Quality Incentive/Vital Access Provider Pool (QIVAPP) monies • HRA Contract and other updates • Fully Integrated Duals Advantage (FIDA) program • Managed Long Term Care plan issues • Education programs Please plan to join us for this important free‐of‐charge members‐only session by simply completing this registration form.
Registration Name:______________________________________________ Title: _________________________________________ Organization:_______________________________________________________________________________________ City State Zip:_______________________________________________________________________________________ Email:_______________________________________________ Phone:________________________________________ (Required for registration.)
FAX TO: (518) 426‐8788 For more information, contact Andrew Koski at (518) 810‐0662 or at akoski@hcanys.org