January 29, 2016 Edition of ASAP

ASAP

A Weekly Publication Of HCA Home Care Association of New York State

Legislative Issues  Public Policy



News

Volume 21, No. 4 January 29, 2016

HCA Testifies on State of Home Care Industry & Budget Asks Holds member conference call on budget, releases key reports for Tuesday’s HCA State Advocacy Day – there’s still time to register! This week HCA President Joanne Cunningham presented testimony before a joint hearing of the Legislature on the Medicaid and health care components of the Governor’s proposed 2016-17 state budget, which has now entered the legislative negotiation phase. Monday’s hearing set the stage for next week’s HCA State Advocacy Day on February 2 (with a Political Action Committee fundraiser the night before) where we’ll be presenting our budget agenda and legislative plan to the Legislature. See BUDGET p. 2

CMS Issues Rule on Medicaid F2F for Home Health HCA continues efforts for repeal of existing Medicare F2F requirement, with advocacy aimed at new Medicaid regulation as well The U.S. Centers for Medicare and Medicaid Services (CMS) has issued a final rule regarding a new physician face-to-face (F2F) documentation requirement for Medicaid home health services. The final rule (CMS-2348-F) goes into effect on July 1, 2016; however, CMS acknowledges that states and providers may need more time. As a result, CMS is delaying compliance for up to one year in states like New York, and possibly two years for those states where the Legislature meets every other year. HCA has already reached out to state Department of Health (DOH) officials to discuss the implications of this new proposed rule and will be advocating to minimize any effect on New York home care providers. See F2F p. 5

Inside ASAP HCA Testifies on State of Home Care Industry & Budget Asks...........1 CMS Issues Rule on Medicaid F2F for Home Health...........................1 LTHHCP FLSA Rate Adjustment..........................................................6 2016 Poverty Levels Released..............................................................7 DOH Files HCA-proposed M.D. Order Flexibility.............................8 Member Hiring Announcements...................................................8, 9 Uniform Managed Care Billing Codes Update..................................9 Reminder: Statistical Reports Due Feb. 8...................................... 9 CMS Releases Patient’s Experience of Care Star Ratings................10 MLTC Forum: Feb. 18.........................................................................10 $165.9M in DSRIP Performance Payments Made...............................11 Update on NHTD/TBI Transition to Managed Care........................12 Nov. Medicaid Cap Report: Spending $35M Over Projections........14 UAS Update......................................................................................15 Publications.............................................................................15

Helping New Yorkers Feel Right At Home

ASAP – a publication of the Home Care Association of New York State

Volume 21, No. 4 January 29, 2016 

BUDGET from p. 1 This plan was outlined for the membership during a statewide member conference call on Tuesday, where HCA’s Policy team presented the principal items in the budget affecting home care, along with next steps, and our government-affairs team at Hinman Straub offered political insights. Ms. Cunningham’s testimony at Monday’s hearing began with highlights of HCA’s just-finalized report on the fiscal condition of New York’s home care industry. This brand-new report is based on HCA member survey responses coupled with an HCA analysis of cost, statistical report, and managed care operating data. We thank the 85 HCA member organizations who responded to this critical survey which populated our report. In her testimony, Ms. Cunningham specifically noted the glaring absence of critical supports or investments in the Governor’s budget to overcome the financial struggles of New York’s home care providers at the same time that the budget includes an unfunded minimum wage mandate projected to cost a stunning $1.7 billion, among other added costs, to home care providers. These costs, she noted, also come at the same time that the state is otherwise investing billions of dollars directly into other sectors for achieving health system reform goals. Legislators Question State Officials on Wage, Health Policy Issues Throughout the hearing, several legislators pointedly questioned state health officials about the Governor’s wage mandate – specifically the need for monies to properly reimburse providers and other human services organizations that are limited by state Medicaid funding in their ability to comply. Continued on next page

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 Alexandra Blais, Director of Public Policy, ablais@hcanys.org Laura Constable, Senior Director, Membership & Operations, lconstable@hcanys.org Celisia Street, Director of Education, cstreet@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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ASAP – a publication of the Home Care Association of New York State

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Continued from previous page Senate Finance Committee Chair Catharine Young had specific questions for the State Health Commissioner on how the proposed minimum wage hike “would be addressed in the context of the budget,” as did Senator Diane Savino who was especially pointed in her remarks. “All of us expected that at some point in this budget we would see funding” for minimum wage, Senator Savino said. “There is no allocation for [providers] to pay that minimum wage.” Legislators also questioned state health officials about the budget’s lack of investments in communitybased organizations (for health information technology and other purposes) at the same time that other sectors are receiving direct investments under the Delivery System Reform Incentive Payment (DSRIP) program. “You talked about the state’s recent efforts to invest resources in hospitals,” Assemblyman Gottfried told State Health Commissioner Howard Zucker. “I think there is widespread understanding that if we are going to help control the cost of health care and improve outcomes, we need to shift more and more of our resources into primary and preventive and non-hospital care.” He added: “What is the state doing to increase investment in those community-based providers that are not hospitals? What percentage of DSRIP money and capital restructuring money and other programs are going to community-based providers?” Senate Health Committee Chairman Kemp Hannon raised issues with the broader scope of the Governor’s health care agenda, noting: “As I’ve gone through the budget, which is notably short, what struck me was not so much what’s in there ... but what’s struck me was what’s not in there.” “Millions of dollars have gone out, but as I look at those programs,” referring to DSRIP and others, “I don’t see a coherent whole.” While all of these issues are important, media coverage specifically honed in on the minimum wage impact on health care, quoting data from HCA and other groups. HCA has collected these press reports and posted them to our website at: http://hca-nys.org/category/ hca-in-the-news. HCA’s “Asks” HCA presented legislators with two core areas of need in home care aimed at addressing the state’s underinvestment in, and enormous new cost mandates imposed on, home care. These two areas are detailed in Ms. Cunningham’s testimony as well as in a two-page document, also shared with the panel, entitled HCA’s Priority Asks: Position Home Care to Meet the State’s Policy Goals. These priority “asks” boil down to two main principles: 1) The need for home care reimbursement fixes; and 2) Statutory or budget language to optimize home care participation in the new health care environment. For each of these core principles, HCA has drafted more specific proposals, along with

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ASAP – a publication of the Home Care Association of New York State

accompanying legislative language, for consideration by the Legislature and the Governor’s office during the budget process. Ms. Cunningham’s testimony as well as HCA’s newly released financial condition report (entitled Risk Factors: What You Need to Know about the Financial Condition of New York’s Home Care Community) are posted at http://hca-nys.org/general-news/ 2016-budget-and-session-advocacyresource-documents. There you will also find perhaps the most important resource to assist you on advocacy messaging. This document, entitled Advocacy Day and Home Care’s “Asks” Made Simple, provides succinct tips and messaging on HCA’s advocacy asks and how to conduct your legislative visits next week. HCA members are advised to view all of these resource documents as a preview for our State Advocacy Program (February 1-2). Still Time to Register for HCA’s State Advocacy Day! Our Advocacy Day is next week (on February 2) but there’s still time to register and join us in legislative visits. The program includes a Political Action Committee reception on February 1 for Senator Hannon, and a day of legislative visits on February 2. Registration and logistical details have been shared with you on several previous occasions, but this information is all posted at the following link, along with HCA’s reports and resource documents: http://hcanys.org/general-news/2016-budget-andsession-advocacy-resource-documents. If you have any question, please do not hesitate to contact any of the HCA Policy staff.

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HCA Budget and Advocacy Documents HCA has shared with you several documents and resources related to the state budget and our advocacy. To help you keep track of these documents and how to use them, please see the links below:

HCA’s Priority Asks: Position Home Care to Meet the State’s Policy Goals (http://hca-nys.org/wp-content/uploads/2016/01/ AsksStrengtheningNYHomeCaretoMeetPolicyGoals2016.pdf) This document summarizes our principal requests of the Legislature and the Governor in this year’s budget.

HCA Resource Guide: Advocacy Day and Home Care’s “Asks” Made Simple (http://hca-nys.org/wp-content/uploads/2016/01/ HCAQandAAdvocacyDayAsks.pdf) Similar to our “Priority Asks” piece, this document presents our “asks” in a simple format geared for providers, giving tips on what to tell legislators during Advocacy Day.

HCA’s 2016-17 State Budget Testimony (http://hca-nys.org/wp-content/uploads/2016/01/ HCA2016TestimonyJoint-LegislativeHearingFinal.pdf) As reported on page 1, HCA President Joanne Cunningham’s budget testimony gives a pretty good summary of the issues facing home care.

“Risk Factors”: What You Need to Know about the Financial Condition of New York’s Home Care Community (http://hca-nys.org/wp-content/uploads/2016/01/ RiskFactors2016HCAFinancialConditionReport.pdf) Every year, HCA produces a financial condition report of the home care industry based on a data analysis and provider survey. Many of you responded to this survey, and now is your chance to read the results for the entire industry in New York.

HCA’s Memo on the State Budget (http://hca-nys.org/policy-memos/memo-governors2016-17-executive-state-budget-proposal) HCA has prepared a detailed policy memo telling you what’s in the proposed state budget as well as what’s not in it.

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Volume 21, No. 4 January 29, 2016 

F2F from p. 1 CMS indicates that the new rule is “intended to promote program integrity and provide clear guidance on the parameters of the home health benefit in Medicaid which will enable beneficiaries to receive high quality care in the community, rather than rely on care in more expensive institutional settings.” However, as most HCA members can attest, CMS’s current F2F documentation requirements for Medicare home health services have generated enormous confusion among physicians, home health agencies, and other parties involved. While CMS has attempted to mitigate this confusion in various ways, the current Medicare F2F requirements remain duplicative, confusing and costly. A new F2F requirement under Medicaid, we believe, will only serve to add cost and duplicative regulations to the Medicaid system as well as have the potential to exacerbate an access-to-care barrier presently the case under Medicare F2F regulations, as physicians become reluctant to utilize home health services for patients. The following are some key highlights of CMS’s final rule: •

It aligns the new Medicaid requirements with the current Medicare timeframes for the physician F2F encounter. For initial ordering of home health services (nursing and home health aide), the physician must document that a F2F encounter (related to the primary reason the beneficiary requires home health) has occurred no more than 90 days before or 30 days after the start of services. The encounters may occur via an approved telehealth delivery service.

•

The F2F encounter may be performed by the physician or certain authorized non-physician practitioners (NPPs). The rule also maintains the role of the physician in ordering Medicaid home health services and medical supplies, equipment, and appliances.

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The final rule does not prescribe how Medicaid F2F documentation must be captured. It does state that the documentation should support the need for what was ordered, but each state will provide specific details on what they will require.

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There is no “homebound” requirement in Medicaid to receive home health services.

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It clarifies that services cannot be restricted to the home.

CMS’s final rule can be found at https://s3.amazonaws.com/public-inspection.federalregister.gov/201601585.pdf. CMS has also provided a two-page fact sheet at https://www.medicaid.gov/medicaid-chip-programinformation/by-topics/benefits/downloads/health-home-factsheet.pdf. HCA has long advocated with Congress for a repeal of the Medicare F2F rule and we will now also target the Medicaid F2F requirements to ensure that they are not implemented in a duplicative and onerous way for providers. Continued on next page

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Continued from previous page We will also continue to devise more constructive ways of securing physician involvement in home health care. HCA will strongly urge Congress to require CMS to do one or more of the following: •

Have CMS modify this requirement so the F2F mandate can be met through the completion and collection of the separately signed and perhaps modified 485 form;

•

Establish exceptions to the requirements for patients who have been recently discharged from an inpatient setting, individuals in rural areas where access to a physician or NPP is limited, and individuals for whom a physician attests to the patient’s inability to leave the home for a physician encounter and is unable to have a physician perform a home visit;

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Provide financial protection to home health agencies that admit a patient in good faith with the reasonable expectation that a qualified F2F encounter has or will occur on a timely basis with appropriate documentation that is compliant with standards in the event of noncompliance through no fault of the home health agency; and

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Allow an NPP to perform the encounter, certify that the encounter occurred, and compose all necessary documentation of the findings from the encounter.

In our outreach to DOH, we will also be stressing the problems experienced in the Medicare implementation of F2F to ensure that the state does not duplicate practices that have otherwise imperiled access to care, disallowed payments for duly authorized and rendered services, and imposed confusing and duplicative administrative cost obligations on providers. The proposed rule also would: •

Require a physician or authorized NPP encounter no more than six months prior to the start of Medicaid-covered medical supplies, equipment and appliances.

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Add definitions for medical supplies, equipment and appliances.

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Prohibit absolute exclusions on coverage of medical supplies, equipment and appliances, but allow states to have a list of preapproved medical equipment, supplies and appliances for administrative ease but not as an absolute limit on coverage, and states must make available a procedure for individuals to request items not on the list and inform individuals of their right to a fair hearing.

HCA will be reviewing CMS’s final rule more closely and will provide additional information to our members as it becomes available.

LTHHCP FLSA Rate Adjustment The state Department of Health (DOH) released a Dear Administrator Letter (DAL) today regarding the Fair Labor Standards Act (FLSA) Rate Adjustments for LTHHCPs. A similar letter for CHHAs is expected very soon. This letter and accompanying rate adjustment are retrospective and apply to services rendered between October 13, 2015 and December 31, 2015. HCA anticipates a second series of rate adjustments to be released in the coming weeks regarding services provided during the 2016 calendar year. As previously reported, the U.S. Department of Labor (DOL) issued a final rule amending the FLSA regulations in October 2013, but it took effect on October 13, 2015 due to numerous court challenges. The 6

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rule requires payment of overtime based on time and-a-half of the aide’s regular rate of pay versus time and-a-half of the current state minimum wage. Additionally, employers must compensate employees for travel time during the workday. Finally, agencies are now allowed to bill hours on 24-hour live-in cases above the previous 13-hour limit if aides’ meal periods, sleep time, or other break times are interrupted by a patient’s needs.

2016 Poverty Levels Released

In an effort to help providers implement these new FLSA requirements, DOH issued a “Dear Colleague Letter” on November 9, 2015 that outlined upcoming adjustments of $0.34 per hour to Medicaid fee-for-service and managed care. These adjustments assume that 10 percent of all home care hours worked are associated with overtime, and take into consideration the additional costs associated with the new compensation for employee travel and live-in changes.

The U.S. Department of Health and Human Services has posted the 2016 poverty levels.

The January 29 DAL also makes note of the previously announced FLSA survey that will be sent to home care agencies soon in an effort to evaluate the true impact of these changes on providers. HCA and other provider and plan associations have been working diligently on developing a workable survey. (See last week’s ASAP.) HCA placed an inquiry with DOH this morning for clarification on one related item: While the DAL notes the $0.34 adjustment, several of the rate sheets show inconsistent adjustments below the $0.34 amount. This may have been an error, but HCA will offer further information once a response is provided. Personal Care FLSA Funding Similar to the LTHHCP FLSA DAL, the state today also issued on the Health Commerce System a DAL for personal care providers about the $0.34 FLSA funding. Furthermore, HCA has learned that the New York City Human Resources Administration (HRA) has received DOH notification that the $0.34 FLSA factor has been added to the Medicaid fee-for-service HRA vendor rates effective October 13, 2016; HRA will be sending a rate notice to its vendors soon. Lastly, HCA reminds LTHHCP and all other affected providers that, as per the DAL, the additional funding is provided under the recruitment, training and retention methodology and if the funding is not used to meet new overtime and travel requirements, agencies much use such funds for recruitment, training and retention of non-supervisory direct care workers only and agencies are prohibited from using such funds for any other purpose. HCA will update you as similar information is released for CHHAs and also for managed care 2016 rates. To read the DAL, please click http://hca-nys.org/wpcontent/uploads/2016/01/DALLTHHCPFLSARate-Adjustment0129161.pdf. HCA has also been working to expedite related FLSA monies for managed care plans so that their contracted home care providers can receive funding to help them with new costs due to the FLSA rule. We will update members once we have information on those monies. 7

They, along with prior years, are at https:// aspe.hhs.gov/ povertyguidelines The annual levels are: $11,880 for one (up from $11,770 in 2015); and $16,020 for couples (up from $15,930 in 2015). These levels are used to calculate one of the charity care requirements for CHHAs and to determine eligibility for the Medicare Savings Programs and other federal benefits. For more information, contact Andrew Koski at (518)

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DOH Files HCA-proposed Flexibility in Signed M.D. Order Rules, Billing Deadlines for Home Care HCA this week learned that the state Department of Health has moved forward on our proposal to provide flexibility in signed physician-order and Medicaid billing deadlines for home care services under Medicaid, allowing a full year to obtain physician orders and then bill. If implemented, as we proposed, this change will have a positive impact on home care’s collaboration with physicians, compliance with medical orders, and ability to obtain timely signed orders for payment. It will help alleviate both administrative and Medicaid billing challenges at a time when HCA is otherwise advocating for reimbursement and regulatory relief. This issue alone has resulted in millions of dollars in annual losses for home care providers due to late signed orders under the current 30-day timeline for physician orders and 90-day Medicaid billing limits. State health officials told us that the regulations were filed on January 22. Those regulations are expected to be published in the February 10 State Register for a 45-day comment period. The regulations will also reportedly be presented to the Public Health and Health Planning Council on February 11. Flexibility in the physician order time constraints has been a major, long-needed goal of HCA’s efforts for regulatory-billing relief. Several months ago, HCA succeeded in getting initial agreement from the state to consider HCA-drafted regulatory language

to align state deadlines for signed physician orders with the broader time constraints allowed by Medicare, replacing the current 30-day limit for signed orders (and 90-day deadline to bill Medicaid) with a one-year outside window for signed orders and billing. This does not change the requirements for having physician orders for start of care or revisions in care plans, most often secured verbally, with documentation of the orders in patients’ medical records. The rule change applies specifically to the signed order requirements, which form the basis for the state’s current 30-day and 90-day billing compliance standards. We’ve been working closely with the Department on this draft regulation change that will provide significant billing and administrative relief, and we welcome the filing of these new regulations implementing this important change. HCA extends appreciation particularly to Rebecca Fuller Gray, Director of the Division of Home and Community Based Services, and to Mark Kissinger, Director of the Division of Long Term Care, for their support and engagement with HCA on this important change which is especially timely for facilitating home care’s participation in the myriad new state programs and models of care (like the Delivery System Reform Incentive Payment and Value Based Payment initiatives). HCA will immediately inform the membership once the regulations are formally posted for review.

Job Position: Director of Patient Services (Montefiore Home Health Agency) The Director is responsible for directing, planning, coordinating and evaluating patient care services, providing supervision of professional staff, and recruiting/hiring an adequate number of professional staff to ensure quality. The Director will evaluate the performance of Patient Service Managers and support staff supervisors at stated intervals. The Director will participate in administration of the annual budget and personnel policies. The ideal candidate will manage all clinical functions. Required Qualifications: Current NYS RN License and Registration; Master’s in Nursing or Health Related Field; five years of senior and direct management experience within a CHHA. Additional Qualifications Qualifications: Knowledge of clinical documentation protocols, home health regulations and standards;

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HIRING

skill in training, working with building high performance teams; ability to develop and lead strategic plans; strong written and verbal communication skills. Please send résumé & cover letter to: chenley@montefiore.org with “Director of Patient Services” and your name in the subject line. Résumés without cover letters and applicants who do not meet requirements won’t be accepted. No phone calls, please.

MMC is an equal opportunity employer and will not discriminate against any employee or applicant for employment because of race, color, religion, gender, sexual orientation, or national origin.

ASAP – a publication of the Home Care Association of New York State

Volume 21, No. 4 January 29, 2016 

HIRING

Uniform Managed Care Billing Codes Update

Title: Director of Performance Improvement and Staff Development at Winthrop University Hospital Home Health Agency

This week, the state Department of Health (DOH) sent to managed care plans a list of home care services along with uniform billing codes for their review.

Winthrop seeks a Director of Performance Improvement and Staff Development for the CHHA, which services Nassau, Suffolk and Queens. The PI Director is responsible for the quality assessment/assurance program, compliance with DOH regulations and The Joint Commission standards as well as corporate compliance and the educational programs of the agency.

The requirement for uniform billing codes was included in the 2015-16 final state budget and was a priority of HCA’s to help home care agencies and their contracted managed care plans simplify their billing procedures.

Minimum qualifications include: BSN, NYS RN license, two years professional nursing experience, two years supervisory experience in a CHHA or related program. Knowledge of Performance Improvement and Quality Assurance, as well as a working knowledge of Joint Commission standards and DOH regulations, are a must. Master’s degree preferred.

HCA has been part of a workgroup with health plans, LeadingAge NY and the New York State Association of Health Care Providers (HCP) that was established to help DOH to implement this requirement. HCA had sought feedback from members on billing codes and worked diligently with LeadingAge NY and HCP to develop draft codes.

Send résumés to Anne Calvo via e-mail to acalvo@winthrop.org. Regional Program Director (RPD) – Albany Area

The codes cover: personal care, consumer directed care, home health aides, nursing, therapy, telehealth, medication dispensers, waiver services and adult day health care.

Position Description: The RPD is responsible for the regional delivery and supervision of care management services provided for enrollees within the Managed Long Term Care Program (MLTC) in the Capital Region, in accordance with agency policy and procedures, and under the direction of the Senior Director of Care Management. The RPD provides leadership and direction to the regional team ensuring that high quality, culturally sensitive and cost-effective services and benefits are provided.

DOH has requested that managed care plans review the draft codes and provide feedback by February 22. It is hoped that any revisions will be made timely so that the new codes can be finalized and put to use. HCA thanks DOH staff for working with us on this important project to simplify and streamline the billing process.

Requirements: Bachelor’s degree from an approved school, acceptable to New York State Department of Health. Masters in Health degree in health-related field preferred

For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.

2 years’ experience as home care nurse in a health agency. Current New York State driver’s license and automobile insurance.

Reminder: Statistical Reports

Knowledge and/or experience in Long Term patient care and Chronic Disease Management.

The 2014 LHCSA Statistical Report and 2014 Hospice Cost and Utilization Report are both due February 8, 2016.

Please sent résumés to Mary Cavanagh, Human Resources Manager, VNA Homecare at mcavanagh@477home.org.

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CMS Releases Patient’s Home Health Experience of Care Star Ratings The U.S. Centers for Medicare and Medicaid Services (CMS) released this week the first patient experience of care star ratings on Home Health Compare (at https://www.medicare.gov/homehealthcompare/ search.html). The measures evaluate patients’ experiences with home health agencies through the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) Survey. These HHCAHPS survey star ratings are in addition to CMS’s Quality of Patient Care star ratings that rate agencies on nine quality measures. The HHCAHPS Survey star ratings report patients’ experiences of care ranging from one star to five stars using data from patients (or the family or friends of patients) that have been treated by the agency. Five stars is the highest rating. There are over 11,000 agencies with data on Home Health Compare, and more than 6,000 now have patient care experience star ratings. Beginning this week, an individual is able to view the following five HHCAHPS Survey star ratings for each home health agency listed on the website: 1) Care of Patients; 2) Communication Between Providers and Patients; 3) Specific Care Issues; 4) Overall Rating of Care Provided by the Home Health Agency; and, 5) Survey Summary star rating. Some home health agencies may not have enough data right now to calculate and display star ratings. However, CMS regularly updates Home Health Compare. Additional information on CMS’s announcement can be found at: https://www.cms.gov/Newsroom/ MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/ 2016-01-28.html. HCA members can also find additional information about the HHCAHPS Survey at: https://homehealthcahps.org. For further information, contact the HCA Policy staff. 10

MLTC Forum: February 18 in NYC As payment issues become a big focus of the state budget, HCA invites MLTCs for a special forum meeting on MLTC issues and needs on February 18 in New York City from 11 a.m. to 2 p.m. This meeting is well timed with HCA’s advocacy for the budget, the legislative session, and other programs and policy developments affecting MLTCs. Given the focus of discussion, we are limiting the program only to MLTCs and those providers who have direct responsibility in their agency for MLTC functions and operations. The agenda will include discussions of the 2016-17 State Budget and related legislation; plan reimbursement; and state policy issues. To register and find location details, download the flyer at http://hca-nys.org/wpcontent/uploads/2016/01/ HCAMLTCForumFeb182016.pdf. The flyer is also published at the back of this week’s ASAP.

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$165.9M in DSRIP Performance Payments Made Panel meets with DSRIP systems on payment flow to downstream providers and other issues On January 21 and January 22, the Delivery System Reform Incentive Payment (DSRIP) program Project Approval and Oversight Panel (PAOP) met with the 13 downstate Performing Provider Systems (PPSs) in New York City. This meeting followed the PAOP’s progress review of the 12 upstate PPSs in Albany in November. The downstate meeting agenda, a recorded webcast of the full meeting, as well as PowerPoint presentations are available at http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/paop/2016-01-2122_paop_meetings.htm. Prior to the PPS presentations, Public Consulting Group (PCG), which serves as the DSRIP Independent Assessor (IA), announced the completion of its review of the Second Quarterly Reports of DSRIP Year 1, covering all PPS activity through September 30, 2015. The Second Quarterly Report for each PPS can be accessed through the PPS Quarterly Reports section of the DSRIP website at http://www.health.ny.gov/ health_care/medicaid/redesign/dsrip/quarterly_rpts/index.htm. Performance Payments Overall, the state’s 25 PPSs earned $165,965,413 out of a possible $168,387,230 (98.5 percent) in DSRIP performance payments, based on meeting required metrics for the second quarter. The results of PCG’s reviews and the breakdown of performance payments earned for each PPS can be found in the Achievement Value (AV) Scorecards posted to the PPS Quarterly Reports section of the DSRIP website at the previous link. At this point, all Achievement Values are pay for reporting, consisting of process-related metrics and many pass/fail categories. Accordingly, most PPSs budgeted that they would substantially meet all of their Achievement Values and receive virtually all of the incentive funding available for them at this early stage, as this is considered the “easy money” of the program, allowing PPSs to make necessary investments to ramp up for pay for performance or simply add to their reserves or operational funds before project implementation gets under way. Once the program shifts to pay for performance primarily in DSRIP Years 3-5 (year 3 begins April 1, 2017), the expectation is that incentive payments will be much harder to earn and a less reliable source of revenue. The DSRIP payments earned by PPSs for the second quarterly report will soon flow to PPSs, and represent the second of three payments the PPSs may earn in DSRIP Year 1. PPSs received their first payments in DSRIP Year 1 for the approval of the DSRIP Project Plan Application. PPSs will be eligible for the third performance payments of DSRIP Year 1 following the completion of the Fourth Quarterly Report of DSRIP Year 1. PAOP Comments The 13 downstate PPSs reported to the PAOP regarding progress to date. The primary focus of panel member questions and discussions related to similar themes presented to the upstate PPSs, including: •

Ensuring PPS dedication to meaningful engagement of community based organizations (CBOs), including a commitment by the PAOP to develop a clear definition of a CBO, as well as definitions of “integration”, “diversity” and “cultural competency”; and Continued on next page

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Continued from previous page •

A desire by the PAOP to ensure that DSRIP funds are flowing to downstream providers, and also to ensure close monitoring of the requirement that the “5 percent cap” on funds flow to nonsafety-net providers. In addition, the panel renewed its request to PCG to develop a clearer explanation of funding categories, so that the panel can closely follow the distribution of DSRIP funds to downstream providers.

In addition, the PAOP raised new/additional areas of concern, which it will be looking for PPSs to address, including: •

Emphasizing the importance of PPS efforts to address addiction and distinguishing these from the broader category of behavioral health;

•

Increasing PPS attention to the needs of the developmentally disabled population; and

•

Developing plans for long-term sustainability of PPS efforts/projects.

The PAOP will continue to formally meet with PPSs on an annual basis. In future presentations, the panel indicated that it will expect PPSs to begin discussing the challenges they are facing – so that systemic solutions can be developed collaboratively with the state Department of Health (DOH). New MIX Materials DOH has posted new materials on the Medicaid Redesign Team (MRT) Innovation eXchange (MIX). These cover: cultural competency and structural competency; telemedicine; and workforce shortages. The MIX can be assessed at https://www.ny-mix.org/ (registration is required). This DSRIP update was based on information provided by our state Government Affairs firm Hinman Straub.

Update on NHTD/TBI Transition to Managed Care On January 27, the state Department of Health (DOH) held a meeting of the Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) Waiver Transition Workgroup. At this meeting, DOH released its draft plan to transition NHTD and TBI patients into managed care plans, which is scheduled for about April 1, 2017. The transition plan covers: services; transition timeline; continuity of care; initial plan assessment; and other points. Continued on next page

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Volume 21, No. 4 January 29, 2016 

Continued from previous page Some important information is: •

Upon approval by the U.S. Centers for Medicare and Medicaid Services (CMS), referral of new applicants to the NHTD/TBI waiver programs will cease on or about October 1, 2016.

•

NHTD/TBI waiver participants will receive an announcement notice in December 2016 indicating that the NHTD/TBI waiver programs will no longer be available effective on or about April 1, 2017.

•

Participants will receive a voluntary enrollment notice about the need to select a managed care plan 60 days before auto-assignment, on or about January 1, 2017, and a reminder notice 30 days before auto-assignment, on or about February 1, 2017.

•

Individuals required to mandatorily enroll that do not choose to voluntarily enroll by March 1, 2017 will be auto-assigned to a managed care plan –Mainstream Medicaid Managed Care (MMMC) or MLTC – for services effective on or about April 1, 2017.

•

The nine Regional Resource Development Centers (RRDCs) currently contracted to administer the daily operations of the NHTD/TBI waivers will assist participants as they move to managed care. These efforts will include, but are not limited to, issuing relevant correspondence, addressing phone calls, offering regional community forums, ensuring transition of services, records-retention and ensuring member choice of providers.

•

RRDCs will also assess an individual’s need for community integration services; independent living skills training; positive behavioral interventions and supports; and structured day program.

•

MLTC/MMMC plans must ensure that individuals transitioning from NHTD/TBI to managed care have continuity of the long term care services they are currently receiving for at least 90 days or until the plan of care is implemented, whichever is later.

•

Managed care plans will be required to contract with currently approved NHTD or TBI waiver providers for a two-year period if the waiver provider is serving five or more waiver participants at the time of transition. The provider is expected to serve participants unless a health/safety concern exists; and the service provider must ensure that there are appropriately licensed personnel to provide and/or supervise the provision of services.

The proposed NHTD/TBI transition plan will be posted on April 1, 2016 for 30 days of review and public comment prior to submission to CMS. Subsequent to the public comment period ending May 1, 2016, DOH will post its responses and Frequently Asked Questions. After holding a webinar for stakeholders and one for managed care plans, DOH will submit its final transition plan to CMS by June 30, 2016. Continued on next page

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Volume 21, No. 4 January 29, 2016 

Continued from previous page Some other materials distributed at this meeting included: “Crosswalk of Participant/Member Rights and Protections – NHTD, TBI, MLTC Partial Capitation, and MMC” and “Services to be Included in MLTC/ MMC Benefit Package.” DOH will be holding subsequent Workgroup meetings in February, every Wednesday (February 3, 10, 17, 24), from 10 a.m. to noon in Albany. The meeting will be open to the public (and available by webcast), but space is limited due to room capacity. If you plan to attend in person, please RSVP at waivertransition@health.ny.gov. Additional information on the NHTD/TBI transition and the workgroup is at http://www.health.ny.gov/ health_care/medicaid/redesign/mrt90/tbi-nhtd_waiver_trans_ingo.htm.

November Medicaid Global Cap Report: Spending $35M Over Projections The state Department of Health (DOH) has issued its monthly Medicaid Global Cap report. This latest report, for November, covers the period of April 1 to November 30, 2015. It finds that overall spending for this period was $35 million above Medicaid Global Cap projections, across all sectors, a difference of $12.102 billion in actual spending versus $12.067 billion in estimated spending for the eight-month period. According to the report, the state has done a mid-year (six-month) update to the current Global Medicaid Spending Cap estimates based on experiences through September 2015. Specifically, DOH mentions the following two significant pressures on the Global Cap which have now been incorporated: •

Significant enrollment growth in the MLTC program. Year-to-date growth (through September) was 11,000 individuals, primarily in New York City (68 percent). The original estimates only assumed an annual growth of 10,000 and have been revised to reflect projected growth of 16,375 recipients; and

•

A recent court ruling on the Fair Labor Standards Act (FLSA) requiring overtime to be paid at time and one half of wage, travel time is compensable hours, and changes to live-in rules. (Please see related p. 7 story about payment adjustments to LTHHCPs for this new requirement.)

The category that includes home care (“Other Long Term Care”) was completely even with projections. The Department shows actual spending of $454 million versus projected spending of $454 million, which is a significant improvement from the September 2015 report which showed Other Long term Care services as being $34 million over estimated spending as a result of more recipients billed than anticipated in personal care. Medicaid Managed Care (MMC) was $7 million over projections, a difference of $8.336 billion (actual spending) versus $8.329 billion (estimated spending), which is also significantly better than the September report when MMC spending was $81 million over estimates. Medicaid total enrollment reached 6,343,388 enrollees at the end of November 2015. This reflects an increase of 167,321 enrollees, or 2.7 percent, since March 2015. Continued on next page 14

ASAP – a publication of the Home Care Association of New York State

Volume 21, No. 4 January 29, 2016 

Continued from previous page The full report is at: http://www.health.ny.gov/health_care/medicaid/regulations/global_cap/monthly/ sfy_2015-2016/docs/november_2015_report.pdf HCA is analyzing these reports carefully in an information gathering effort, combined with other data analysis, related to home care’s performance under the Global Cap. The Medicaid Global Cap for the current fiscal year (April 1, 2015 to March 31, 2016) is $17.7 billion for all sectors. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

UAS Update In conjunction with the February 1 upgrade of the UAS-NY online system to version 1.0.35, the state Department of Health (DOH) has released a guidance called, “What’s New UAS-NY Upgrade to Version 1.0.35.” That document is at http://hca-nys.org/wp-content/uploads/2016/01/ ctrlaccamstmpNotification19762.pdf. It describes the different features of the new online application and the revised offline application. HCA members should also review the January 22 ASAP for information on changes to the offline application. DOH will hold two seminars on “What’s New in the UAS-NY? Version 1.0.35.” The target audience for this program spans all UAS-NY roles. Registration information is: February 16 (11 a.m.); Event number: 644 423 777; Registration: http://tinyurl.com/zneyqpa February 18 (1 p.m.); Event number 648 474 238; Registration: http://tinyurl.com/zqhkfqr

Publications •

“Beneficiaries Dually Eligible for Medicare and Medicaid,” by the Medicare Payment Advisory Commission and the Medicaid and CHIP Payment and Access Commission http://medpac.gov/documents/publications/january-2016-medpac-and-macpac-data-bookbeneficiaries-dually-eligible-for-medicare-and-medicaid.pdf?sfvrsn=0

•

“Guide to Preventing Readmissions among Racially and Ethnically Diverse Medicare Beneficiaries,” by the U.S. Centers for Medicare and Medicaid Services https://www.cms.gov/About-CMS/Agency-Information/OMH/Downloads/ OMH_Readmissions_Guide.pdf

•

“Report on Early Implementation of Demonstrations under the Financial Alignment Initiative,” by the U.S. Centers for Medicare and Medicaid Services https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/ Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/Downloads/ MultistateIssueBriefFAI.pdf

For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org. 15

MLTC FORUM Please join your MLTC colleagues for this meeting on MLTC issues and needs. This meeting is timely with HCA’s advocacy for the budget, the legislative session , and other programs and policy developments affecting MLTC. The agenda will include: • 2016-17 State Budget and Related Legislation • Plan Reimbursement • State Policy Issues • Other

February 18, 2016 11:00am – 2:00pm Location:

VNS of New York 1250 Broadway, 7th Floor New York, NY 10001 Lunch will be served.

Payment of $40 per person Please check method of payment:

This forum is for HCA Members Only. If you are not currently a member of HCA, but would like to become one, please contact Laura Constable, Director of Membership at (518) 426-8764.

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Cancellation Policy Cancellations received by February 12 will receive a full refund less 25% of total due as an administrative fee. Cancellations received on February 13 or later will forfeit their registration fee along with those who register and do not attend. Substitutions are permitted. Please contact Teresa Brown at (518) 426-8764 or tbrown@hcanys.org to cancel.

Please FAX this completed form to: (518) 426-8788