ASAP
A Weekly Publication Of HCA Home Care Association of New York State
Legislative Issues Public Policy
News
Volume 20, No. 4 January 30, 2015
HCA’s Budget Memo, Feb. 4 Conference Call and Other Resources Aim to Prepare, Inform You In our continued effort to inform you about the state budget and equip you with state advocacy resources, HCA has prepared a detailed preliminary memo on the Governor’s proposed budget plan. We are also holding a statewide conference call on the budget, scheduled for February 4 at 10:30 a.m. Members can download our new budget memo at http://www.hca-nys.org/policy_memos/documents/ HCAMemo2015ExecutiveBudget.pdf. (Please note that this preliminary memo is subject to change as we learn more about the intricacies of the budget.) See INFORM p. 3
HCA Veterans Home Care Efforts Draw Support from Congressman Zeldin HCA and the New York State Health Foundation continue collaborating on a project delving into home care under the Veterans Administration (VA) benefit plan. The project aim is to assess the current status of veteran home care access and experience under the VA plan, identify gaps, and recommend ways of further supporting the patients, the needed services, and home care agencies’ ability to provide them. Inside ASAP HCA’s Budget Resources Aim to Prepare, Inform You.......................1 HCA Veterans Home Care Efforts Draw Support from Rep. Zeldin...1 Silver to Step Down as Assembly Speaker..........................................3 PHHPC Committee Meeting Held......................................................4 Feb. 12 HCA Program to Focus on Labor Law....................................5 Hotel Block for Feb. 25 ICD-10 Bootcamp Closing Soon..................5 Home Care Confronts Challenges of Winter Storm...........................6 DOL Pursues Appeal on Companionship Exemption Lawsuit..........8 Some Insights, Recommendations on New Face-to-Face Rules.........8 CMS to Study Medicare Home Health Fraud.....................................9 HRA Posts New Forms......................................................................10 HCA Meets with Legislators on Telehealth Law Amendments.......12 In Shift Shown in NYS Budget, HHS Motions Away from FFS...........13 DSRIP Update.......................................................................14 OMIG Posts Compliance Guidance for Medicaid Revalidation.......15 OMIG Issues New Compliance Alert................................................15 CMS to Hold Forum on Home Health Star Rating Proposal ............16 UAS Update.....................................................................................16 Senate Health Committee to Vote on HCA Collaboration Bill.......17 Managed Care Update.....................................................................18 MedPAC Finalizes Recommendations for Home Health, Hospice......20 Update on HCBS Federal Rule.........................................................21 2015 Medicaid Transfer Penalty Rates Announced...........................22 NGS Updates: PS&R Application Changes Forthcoming...............23 Publications......................................................................24
This week, the data-gathering portion of this effort received a major boost from New York Congressman See ZELDIN p. 2
Helping New Yorkers Feel Right At Home
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Volume 20, No. 4 January 30, 2015
ZELDIN from p. 1 Lee Zeldin (R-Long Island), the state’s newest member of the U.S. House Veterans Committee. After being briefed by HCA, Congressman Zeldin immediately wrote directly to U.S. Veterans Affairs Secretary Robert McDonald requesting VA data supporting the HCA-Health Foundation inquiry. We look forward to this data and its potential contribution to our analysis and goals. In addition to the VA data, HCA and the Foundation have also been gathering data and descriptions of experiences from a sample of HCA providers which will help form the basis of a planned analysis and perspective exchange in a jointly hosted HCA-Foundation meeting being held in the next two weeks. Providers and practitioners have responded with open-armed enthusiasm and dedicated engagement at the prospect of supporting the veteran community. HCA appreciates this great response by our home care providers and this week’s added support by Congressman Zeldin. Home care’s veteran patients increasingly include not only senior veterans but, very much, those who are returning from current deployment with multiple physical, psychosocial and family needs. Home care is critical to rendering and managing the care where veterans most prefer it: at home and in community-based settings. HCA believes that home care, further incorporated and utilized, can increase the cost-effectiveness and quality outcomes under the VA structure, and, most importantly, support the quality of care and life for the nation’s veterans. HCA is pleased and honored to commit this effort on behalf of the veteran community and will keep the membership apprised of our progress with this effort. For further information, please contact Al Cardillo at acardillo@hcany.org. 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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ASAP – a publication of the Home Care Association of New York State INFORM continued from p. 1 To register for the February 4 conference call, please complete the form at https:// www.surveymonkey.com/r/2015-16Budget and dial-in instructions will be sent to you in advance of the call. HCA’s budget memo follows our prior summary reports in last week’s ASAP, where we also circulated two other important state legislative resources related to the budget and HCA’s advocacy. These resources include an HCA publication outlining our legislative/ budget agenda as well as our 2015 home care financial condition report, both of which show how home care financial, regulatory and program support are needed for the success of existing and new care-delivery models envisioned in the Governor’s budget. We encourage you to review these resources as you prepare your advocacy outreach to state officials. Please see last week’s ASAP for details. HCA advocacy strategy As highlighted in recent HCA communications, our advocacy strategy this year involves a multitiered approach. We are specifically prompting all members to schedule meetings soon and make calls to your Senate and Assembly representatives to urge support for home care in the budget. This outreach is especially important during the week of President’s Day (February 16) when the Legislature is not in session and members of the Senate and Assembly are usually back in their district offices. HCA and our Board of Directors have worked to craft a proactive advocacy agenda urging budget provisions that would: finance and incentivize home care technology; update the insurance law for home care; amend the managed care-home care payment system; authorize regulatory flexibility; amend the law
Volume 20, No. 4 January 30, 2015
Silver to Step Down as Assembly Speaker Long term successor not yet resolved, though Morelle to serve as Interim Speaker until Feb. 10 Speculation abounded this week at the Capitol regarding who would ultimately fill the Assembly Speaker post now that Sheldon Silver has announced he would step away from his role as Assembly leader amid federal legal charges. (See last week’s ASAP.) Assembly Majority Leader Joseph Morelle of Rochester will serve as Interim Speaker until February 10 when Members of the Assembly will vote on a more permanent leader. Several candidates have thrown their hats in the ring for the Speaker’s post; it is unclear whether the Democratic majority will coalesce around a leading candidate in the lead-up to the February 10 vote. Most of the Assembly Democratic Majority represents New York City, a coalition whose voice will weigh heavily in the selection of a new leader. Indeed, the Assembly hasn’t had an upstate Democratic Speaker in 100 years, reflecting the regional demographic makeup of the conference and the Assembly as a whole. The leadership changes come amid budget negotiations and a bumpy start to the legislative session. Uncertainty about the Speaker’s post – and this week’s severe winter weather – was among the reasons that HCA delayed our Board of Directors advocacy meetings on January 26. We have since rescheduled this program for February 9. (See related p. 1 story.) The ultimate outcome of the Assembly Speaker vote will have profound implications for the budget negotiations and the overall arc of this year’s legislative session. The Speaker is one of three principal negotiators in this process, representing the prerogatives of the Assembly Majority agenda in deliberations with the Governor and the Senate Majority Leader. HCA will keep the membership closely apprised of important developments on the Assembly leadership issue.
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to encourage innovation; and finance and incentivize advances in innovation and quality. All of these ideas are rooted in the argument that home care is a vital driver of the state’s broader health policy goals; thus, changes in the financing, incentives and structures of home care services are necessary to help actualize these state initiatives and models. This is the message that HCA is asking members to voice in your outreach to elected officials. To learn more about these HCA proposals, please be sure to participate in our February 4 statewide call, and, especially, read our agenda summary posted in last week’s ASAP and circulated to the membership in an e-mail alert earlier this week. In your legislative advocacy, we recommend that members select just a few items from this agenda that you are best equipped to speak with lawmakers about. We’ll also be providing additional background and action items during our February 4 conference call, so please stay tuned. Judging from our preliminary analysis of the budget, HCA’s advocacy proposals appear to complement some of the health care investment areas already set in place within the Governor’s plan. However, these areas do not adequately or expressly address the needs of home care providers specifically. HCA will be seeking the Legislature’s support for including more dedicated home care investments in these budget areas, consistent with the issue items identified in our advocacy resources and the investment domains already staked out by the Governor. In addition to grassroots advocacy by all members, state officials and legislative leaders will be meeting with the HCA Board of Directors and Policy Team to discuss home care needs and priorities. Those meetings were originally scheduled for Monday; however, the winter storm forecast and the Assembly’s need to shift to leadership questions (following news that Assembly Speaker Sheldon Silver faces federal charges; see p. 3 story) prompted HCA to reschedule that event for February 9. Meanwhile, HCA will be testifying before the Joint Legislative Committee Hearings on the Health and Medicaid Budget this coming Monday, February 2. As a next step, we urge the membership to read our advocacy resource documents and be sure to register for our statewide call to learn more about HCA’s budget and advocacy strategy for 2015. In case you missed last week’s ASAP, where these resource documents are linked, you can read it in the archives section of our website or go to our online Resource Library, accessible from www.hca-nys.org. For more information, or to have resources e-mailed to you, contact HCA’s Communications Director Roger Noyes at rnoyes@hcanys.org. 4
PHHPC Committee Meeting Held On January 29, the Public Health and Health Planning Council (PHHPC) Committee on Establishment and Project Review met to consider health care provider applications. The materials are at http:// www.health.ny.gov/ facilities/ public_health_and_health_planning_council/ meetings/2015-01-29/. The agenda included applications by one Certified Home Health Agency for a change in ownership; 28 entities to establish new Licensed Home Care Services Agencies (LHCSAs); and 6 LHCSAs for a change in ownership. All of these applications were approved and forwarded to the full PHHPC. The next meeting of the full PHHPC is February 12. For more information, contact Andrew Koski at akoski@hcanys.org or (518) 810-0662.
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Feb. 12 HCA Program to Focus on Labor Law Part Three of HCA’s Home Care Survival Bootcamp series will focus on labor law issues on February 12 in New York City. To register for this important program, please complete the form at the back of this week’s ASAP and secure your spot today. Topics will include information on the New York City Paid Sick Leave law and an array of other labor laws and regulations related to wages and record-keeping. Officials from the City’s Department of Consumer Affairs’ Paid Sick Leave Division will provide information explaining which employees are covered and exempt from the Paid Sick Leave Law, the accrual process, tracking tools, the interaction of the law with collective bargaining agreements, and other intricacies of the law. In addition, the state’s Department of Labor will present on wage calculation requirements, payment rules for individuals who work on overnight cases but are not “sleep-in” cases, record-keeping requirements, any wage notification requirements, state Department of Labor findings related to home care, and much more. This topic is especially important in light of recent court decisions related to the companionship exemption rule change for home care, which was vacated by a federal court stemming from a lawsuit by the National Association for Home Care and Hospice. (See related p. 8 story for updates.) The U.S. Department of Labor has indicated it plans to appeal the court’s ruling. We stress that most of the issues keyed for discussion on February 12 are based on current regulations and are applicable regardless of the court’s ultimate ruling in the case and the status of the companionship exemption for home care.
Hotel Block for Feb. 25 ICD-10 Bootcamp Closing Soon: Register Today! Are you prepared for the transition to ICD-10-CM in October? An eMedNY survey late last year found that many New York State providers are not, and this will impact your payments. According to the survey results, 83 percent of providers responded to eMedNY that they have not yet assessed the impact of migrating to ICD-10 codes. And just over 70 percent have not reviewed the ICD-10 information available at www.emedny.org, nor have they tested transactions with eMedNY. This is why HCA is offering an important ICD-10 Readiness workshop, presented by Trish Tulloch, Senior Consultant with HCA member RBC Limited. This workshop will be held at the Holiday Inn in Albany on February 25. The room block at the Holiday Inn ends on February 3, so get your registrations in as soon as possible! 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 ICD-10 readiness with your agency staff will be offered as well. A brochure and registration information is provided in the flyer at the back of this week’s ASAP. Seating is limited. Register today!
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Home Care Confronts Challenges of Winter Storm Providers activate emergency response plans; Executive Order suspends, modifies health care regs in areas affected by winter storm Areas of New York and New England were blanketed this week by a winter storm bringing not only snow, ice and high winds, but also the many and often severe challenges of delivering and managing home care in emergency conditions. Based on the advanced forecast, agencies moved quickly into action: mobilizing their agency emergency preparedness and response plans; prioritizing resources and patient emergency-level protocols; and proceeding to navigate the ensuing emergency conditions and needs in order to provide and manage care. Providers again reported practitioner barriers to accessing patients due to the absence of “Essential Personnel” status for home care and hospice – an issue which would have been previously remedied under legislation coauthored by HCA, Assemblyman Michael Cusick and Senator Andrew Lanza. That legislation, which unanimously passed the State Assembly and Senate in June, was vetoed in December by Governor Cuomo. Operating on the belief that this veto stemmed from a misread of the bill, the sponsors are already reintroducing this legislation, planning engagement with the Governor, and, at HCA’s request, looking for quick repassage. This week’s storm reinforced the imperative for reintroducing and repassing this important legislation, especially considering reports from agencies about staff who could not access their patients – a barrier which would have been prevented had the bill been approved and implemented. Throughout the week, HCA, Assemblyman Cusick and Senator Lanza’s offices exchanged further relevant information about the bill and helpful revelations from the storm compelling support for the bill. HCA will be informing the home care community when the reintroduced bill is assigned Senate and Assembly numbers and will be following up with guidance for communicating support to the sponsors, leaders and members of the Senate and Assembly, and, of course, to the Governor. HCA will also be coordinating with the Home Based Care Alliance (HBCA), with whom HCA has worked closely toward the development, introduction and passage of this measure. Executive order for regulatory waivers and flexibility In other storm-related news, the Governor this week issued Executive Order No. 141 suspending and modifying certain health statutes and regulations in counties affected by this week’s winter storm. Executive Order No. 141 is available at the link below: http://www.governor.ny.gov/news/no-141-declaring-disaster-and-temporary-suspension-and-modificationhealth-statutes-and Continued on next page
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Continued from p. 6 The Executive Order temporarily suspends (until February 2) the following home care provisions“if compliance with such provisions would prevent, hinder or delay action necessary to cope with the disaster” in the affected counties: •
Paragraph (7) of subdivision (h) of section 763.4 and paragraph (1) of subdivision (d) of section 766.5 of Title 10 of the NYCRR, to the extent necessary to permit Certified Home Health Agencies, Long Term Home Health Care Programs, AIDS home care programs, and Licensed Home Care Services Agencies serving individuals affected by the disaster emergency to conduct in-home supervision of home health aides and personal care aides as soon as practicable after the initial service visit;
•
Subdivision (a) of section 763.5 of Title 10 of the NYCRR, to the extent necessary to permit initial patient visits for Certified Home Health Agencies, Long Term Home Health Care Programs and AIDS home care programs serving individuals affected by the disaster emergency to be made within 48 hours of receipt and acceptance of a community referral or return home from institutional placement;
•
Subparagraph (ix) of paragraph (5) of subdivision (b) of section 505.14 and subdivision (f ) of section 505.28 of Title 18 of the NYCRR, to the extent necessary to permit an additional 15 days for reauthorizations of personal care and consumer directed personal assistance program services for individuals affected by the disaster emergency, where the authorized period of services otherwise would terminate during the period of the disaster emergency declared pursuant to the Executive Order;
•
Subparagraph (ii) of paragraph (2) of subdivision (e) of section 505.14 of Title 18 of the NYCRR, to the extent necessary to permit training for personal care workers serving individuals affected by the disaster emergency to be held as soon as practicable after the conclusion of such period, where such training otherwise would be required during the period of the disaster emergency declared pursuant to the Executive Order, provided that such workers have sufficient competence to provide such services; and
•
Paragraph (3) of subdivision (f ) of section 505.14 of Title 18 of the NYCRR, to the extent necessary to permit nursing supervision visits for personal care services provided to individuals affected by the disaster emergency to be made as soon as practicable.
The Executive Order outlines several regulatory modifications applicable to other health sectors as well. As reported in alerts this week to the membership, HCA and health association colleagues collaborated on a guidance document identifying an array of regulatory requirements that may be considered for modification and waiver on a case-by-case basis during declared emergencies. Those waivers or modifications not already encompassed by the Governor’s Executive Order must be requested formally by providers in a process outlined in the Provider Guide on Temporary Suspension or Modification of Statutes and Regulations in New York State During Emergencies. The guide is available at http://www.hcanys.org/documents/EmergRegsModificationGuidebook.pdf. HCA encourages members to keep us informed of particular issues or difficulties that should be reported to the state Department of Health for remediation during this event and/or future disasters, in terms of patient care, access to patients, regulations, logistics, safety issues, or others. For further information, please contact Al Cardillo at acardillo@hcanys.org. 7
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DOL Pursues Appeal on Companionship Exemption Lawsuit Stay on implementation of the rule remains in effect As reported in last week’s ASAP, the U.S. Department of Labor (DOL) filed an appeal to the U.S. Court of Appeals for the District of Columbia Circuit in the lawsuit that challenges the Fair Labor Standards Act final companionship exemption rule. That rule, vacated by a lower court, would effectively eliminate the “companionship exemption” for aides employed by home care agencies. DOL requested and the Court of Appeals has ordered that the appeal proceed on an expedited schedule, which calls for briefing to be completed by April 2. After briefs have been submitted, the court will then schedule oral arguments, likely in May. Thereafter, the court will issue its decision, possibly in June or July. The “stay” on implementation of this rule that was previously granted by the court, based on motions by the National Association for Home Care and Hospice (NAHC), will remain in effect. New York requires that those working more than 40 hours receive overtime, and overtime is calculated at timeand-a-half of minimum wage ($8.75 x 1.5 = $13.13 per hour). HCA will be holding a February 12 program on labor law, and we advise agencies to attend and ensure compliance with the current regulations. (See related p. 5 story.) The registration flyer is at http://www.hca-nys.org/documents/SurvivalBootcamp-Feb122015Brochure.pdf. For more information, contact Andrew Koski at akoski@hcanys.org or (518) 810-0662.
Some Insights, Recommendations on New Face-to-Face Rules As extensively reported in past months, the U.S. Centers for Medicare and Medicaid Services (CMS) revised the face-to-face (F2F) physician encounter requirements for 2015, specifically eliminating the narrative component, which required the certifying physician to provide a detailed explanation on why the patient was homebound and in need of skilled services. CMS still requires a F2F encounter no more than 90 days prior to the start-of-care date or within 30 days of the start of home health care. CMS has also changed its medical review process for determining patient eligibility for home health services. Not only will Medicare Administrative Contractors (MACs) request the agency’s medical record when additional documentation is warranted, but they will also be looking for evidence from the physician’s medical record to support eligibility. CMS will require that the home health agency (HHA) obtain and submit relevant sections of the certifying physician’s medical record when an agency’s claim is requested for review. If the documentation in the physician’s record is insufficient to support eligibility, the home health agency’s claim will be denied. Criteria for patient eligibility are described at Section 424.22(a)(1) and Section 424.22(b). Agencies are permitted to inform the certifying physician of findings in the comprehensive assessment that support the patient’s eligibility for home health care. The certifying physician will need to sign the additional information 8
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and incorporate it into his or her medical record. CMS adds: “The certifying physician must review and sign off on anything incorporated into his or her medical record for the patient that is used to support his/her certification/recertification of patient eligibility for the home health benefit.” In addition, any information from the home health agency (including the comprehensive assessment) that is incorporated into the certifying physician’s and/or the acute/post-acute care facility’s medical record must corroborate the certifying physician’s and/or the acute/post-acute care facility’s own documentation/medical record entries. CMS explained that it eliminated the narrative requirement “to simplify the face-to-face encounter regulations, reduce burdens for HHAs and physicians, and to mitigate instances where physicians and HHAs unintentionally fail to comply with certification requirements.” However, CMS’s revisions seem to have replaced the regulations with overly complicated procedures for arranging and securing documentation. In addition, CMS has thus far provided guidance only once: through a National Provider call held on December 16, 2014. During this call, CMS reiterated the regulatory requirements and provided some examples of appropriate, as well as inadequate, physician F2F encounter notes and discharge summaries. HCA members can download this CMS presentation at: http://www.cms.gov/Outreach-andEducation/Outreach/NPC/Downloads/2014-12-16HHBenefit-HL.pdf. In cases where the documentation is insufficient, CMS permits agencies to fill in the “gaps” by supplying the physician with information from the agency’s assessment that supports eligibility. CMS also stated that the agency could add the information to the plan of care (POC) that is sent to the physician for review and signature. CMS failed, however, to address how agencies are expected to operationalize many other aspects of the new requirement, particularly as they relate to patients who have a F2F encounter conducted by a physician from an acute/post-acute care facility. Furthermore, there has been no indication of what the Medicare medical review contractors will be looking for in the physician’s record that substantiates eligibility. In December, the National Association for Home Care and Hospice (NAHC) as well as NAHC’s Forum of State Home Care Associations, which is chaired by HCA President Joanne 9
CMS to Study Medicare Home Health Fraud The U.S. Centers for Medicare and Medicaid Services (CMS) has posted a notice seeking information about developing the first nationally representative estimate of the extent of probable fraud in home health by conducting the Probable Fraud Measurement Pilot (PFMP). While HCA has been strongly proactive in promoting compliance, program integrity and quality advancement, we have major concerns with the design and potential for inaccurate and/or mis-application this initiative. Unfair “extrapolation” methods that agencies are already subjected to further contribute to our concerns and wariness. This new activity adds to the current, already compounded layers of governmental audit and enforcement. HCA will will be discussing advocacy on this issue with our partners at the National Association for Home Care and Hospice, and fellow state home care associations. The pilot will estimate the incidence of probable fraud in the Medicare home health fee-for-service program. The goal of this Pilot is to describe an approach to estimate the fraction of Medicare payments for home health services that exhibit behavior consistent with fraudulent activities. The plan is to conduct a pre-test of the larger pilot, in order to test the instruments, procedures, and methods ensuring that the design is sound and replicable to a larger study. Interested parties able to meet this scope of work were requested to submit capability statements by January 28. HCA will keep members informed about the status of this project as we learn more.
ASAP – a publication of the Home Care Association of New York State Cunningham, sent letters to CMS seeking a phased-in delay in CMS’s enforcement of these new documentation changes. The Forum of State Home Care Associations letter was cosigned by Ms. Cunningham and Forum Vice Chair Patricia Kelleher of The Home Care Alliance of Massachusetts (and signed by over 50 organizations nationally). It notes the complexity of the new F2F documentation changes which will require appropriate education of the home care community beyond the initial information provided during CMS’s call on December 16 – a mere two weeks before implementation of the changes on January 1. Since then, NAHC and the Forum of State Home Care Associations have made multiple attempts to get answers from CMS. Only recently did a CMS official indicate serious discussions within CMS to develop an appropriate approach for implementation; however, nothing is concrete at this time. NAHC has recently offered the following recommendations: •
•
• •
•
•
Agencies should submit to the certifying physician a summary of the clinical finding from their assessment that supports the need for skilled services and reason for homebound status, including the pertinent sections of the comprehensive assessment and the OASIS to substantiate the findings. Include a statement at the end of the summary that will serve as an attestation that the physician agrees with the summary and is incorporating the information into his or her medical record. Request that the physician sign and date the document and return it to the agency. Both the summary and attestation statement can be included on the POC that is sent to the physician. However, keep in mind that the elements required on a home health POC alone do not provide adequate information to support eligibility for home health services. CMS will look at the physician’s medical record in determining that the certification requirements have been met; therefore, the physician should also keep a copy of any document that contains the certification statement. CMS will review the physician’s encounter note/discharge summary for the date of the encounter, confirm that the encounter is related to the primary reason for home health service, and that the encounter was conducted by the physician or an allowed NPP. If the documentation on the encounter note is insufficient to support eligibility, CMS will look to other documents or evidence in the physician’s record to support home 10
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HRA Posts New Forms The New York City Human Resources Administration has posted new forms. These include: •
HCSP-3026 ALP Medicaid Cover Sheet
•
HCSP-3027 Notice of Admission/ Discharge for the Assisted Living Program
•
HCSP-3046 Home Care Services Program Cover Sheet
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HCSP-3047 MLTC Cover Sheet
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HCSP-3047a MLTC/Provider Relations Unit Cover Sheet
•
HCSP-3047b MLTC/Nursing Home Eligibility Division Cover Sheet
The forms are available at http://a069-marc.nyc.gov/ marc/default.aspx (password needed).
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health eligibility. Therefore, it is very important that the agency supply the physician with any information that supports eligibility so that it may be incorporated into the physician’s record as soon as possible. CMS will not require that the agency obtain the physician’s medical record prior to billing. However, agencies will still need to be assured that the F2F encounter occurred as part of the certification prior to billing. Agencies can accomplish this in several ways: •
Agencies may continue to use the F2F encounter document form, or a modified form, that has been in place since the beginning of the F2F encounter requirement. Continuing to use the form will provide the agency with tangible evidence that a F2F encounter had been conducted. However, CMS will look for the actual visit note/discharge summary that the information is based on.
•
The agency could include a statement on the POC or documentation that is sent to the physician to serve as an attestation that: a F2F encounter was conducted within the required timeframe; the encounter was related to the primary reason for home health services; and the encounter was conducted by the physician or an allowed NPP.
•
Request the actual note from the physician.
However, agencies should still obtain as much information from the physician as soon as possible. Unfortunately, there are still many unanswered questions regarding how agencies are to adequately comply with the new F2F rules. NAHC and the Forum of State Home Care Associations have submitted many still-unresolved questions to CMS. We will continue to work with CMS to arrive at a reasonable resolution. HCA will update the membership as additional information becomes available. CMS weighs voluntary F2F clinical template to be used by physicians In related news, CMS is considering a voluntary paper clinical template that could be completed by physicians during their face-to-face (F2F) examination of a Medicare patient. Once a physician completes the template, the resulting document would become a progress note or clinic note that would be part of the medical record. In addition to developing a paper clinical template for documenting a home health F2F examination, CMS is also developing an electronic clinical template. CMS will be hosting a series of Special Open Door Forum calls beginning in February 2015 for physicians, home health agencies and/or other interested parties to provide feedback on both the paper and the electronic clinical template. HCA will notify the membership when CMS schedules those forum calls. CMS will be seeking public comment on the voluntary paper clinical template under the 5 CFR 1320.3(h)(8) exemption to the Paper Reduction Act. Comments can be sent to HomeHealthTemplate@cms.hhs.gov. For further information, contact the HCA Policy staff.
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HCA Meets with Key Legislators on New Telehealth Law Amendments Over the past two weeks, HCA has met with key state legislators on proposed amendments to the new telehealth/ telemedicine insurance coverage law signed by the Governor in December. The December legislation, S.7852/A.9129-A, establishing the new law and signed as Chapter 550 of 2014, provides that health insurance policies may not exclude coverage for telehealth – to the extent that the type of service provided through telehealth would otherwise be covered under the policy. The legislation applies to most forms of health insurance, as well as Medicaid. In approving the Legislation in December, the Administration called for amendments rephrasing and reformatting much of the original bill. The now-introduced amendments, however, also eliminate provisions beneficial to home care that were contained in the original legislation, and also leave unaddressed a series of other problematic issues. Some of the most serious issues in the signed bill – and carried forward in the proposed amendments – emanate from the way in which the new coverage provisions would interact with the baseline law that governs health insurance coverage for home care in New York. For example, the severe and outdated limits for home care coverage in the baseline insurance, if unchanged, would simply be carried over into the new, intended expansion for home telehealth, while other sectors (i.e., hospitals, physicians) without these arcane coverage limits would not face such telehealth conflicts. Existing health insurance coverage laws for home care include parameters and restrictions that originate in the early 1970s based on the structure of the health system at that time, following a much narrower role that home care played in that structure. This is vastly different from today’s system and models of care which heavily depend on home care. The recently introduced amendments are S.2405 by Senator Catharine Young and A.2552-A by Assemblywoman Adie Russell (both also sponsors of the December law). S.2405 is currently on the Senate Calendar where it is positioned for a vote; A.2553-A is in the Assembly Health Committee. HCA this week met and spoke with key staff assigned to these bills, as well as with the staff of Interim Assembly Speaker Joseph Morelle (likewise a strong telehealth and home care supporter in the Legislature) about the fixes and elements necessary for home care under the new law. HCA will continue our dialogue with their offices and with Administration officials for the requisite amendments to address home telehealth needs. In the larger picture, HCA has already called for modernization of the state’s health insurance coverage for home care in our 2015 state legislative and budget advocacy priorities. HCA members should reference the 2015 HCA advocacy document Driving Health Care Improvement and Savings Through Home Care for further information, and to further guide your own outreach to your legislators on this important issue. The HCA Board and Policy Staff have scheduled meetings on February 9 with state health and legislative leaders to discuss this issue and our other 2015 priorities. For further information, please contact Al Cardillo at acardillo@hcanys.org.
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Volume 20, No. 4 January 30, 2015
In Shift Shown in NYS Budget, HHS Motions Away from Fee-for-Service Payments The U.S. Department of Health and Human Services (HHS) has set goals to move away from fee-for-service (FFS) payments and toward value-based purchasing that links provider reimbursement to the health and wellbeing of patients. This is similar to a proposal in the Governor’s 2015-16 State Budget to utilize reimbursement methodologies that are value based (see the January 23 ASAP). The “value-based purchasing” (VBP) proposal requests broad authority for the Commissioner to “utilize reimbursement methodologies that are value based,” as well as to authorize implementation of VBP by managed care plans, Performing Provider Systems operating under the Delivery System Reform Incentive Payment (DSRIP) program, and combinations of participating contracting providers. Under DSRIP, all managed care organizations must employ non-FFS systems that “reward value over volume” for at least 90 percent of their provider payments by the end of 2019. HHS has adopted a framework that categorizes health care payment according to how providers receive payment to provide care, as follows: •
Category 1: fee-for-service with no link of payment to quality.
•
Category 2: fee-for-service with a link of payment to quality.
•
Category 3: alternative payment models built on fee-for-service architecture
•
Category 4: population-based payment
CMS estimates that 20 percent of Medicare reimbursements in 2014 have shifted from FFS payments to category 3 and 4 payments. HHS has set a goal to have 30 percent of Medicare payments in alternative payment models (categories 3 and 4) by the end of 2016 and 50 percent in categories 3 and 4 by the end of 2018. This will be achieved through investment in alternative payment models such as Accountable Care Organizations (ACOs), advanced primary care medical home models, new models of bundling payments for episodes of care, and integrated care demonstrations for beneficiaries that are Medicare-Medicaid enrollees. Overall, HHS seeks to have 85 percent of Medicare FFS payments in value-based purchasing categories 2 through 4 by 2016 and 90 percent by 2018. HHS has also announced the establishment of the Health Care Payment Learning and Action Network whose goal is to accelerate the transition to more advanced payment models by fostering collaboration between HHS, private payers, large employers, providers, consumers, and state and federal partners. Learning and Action Network partners will: •
Serve as a convening body to facilitate joint implementation and expansion of new models of payment and care delivery. Continued on next page 13
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Continued from p. 13 •
Identify areas of agreement around movement toward alternative payment models and define how best to report on these new payment models.
•
Collaborate to generate evidence, share approaches, and remove barriers.
•
Develop common approaches to core issues such as beneficiary attribution, financial models, benchmarking, and risk adjustment.
•
Create implementation guides for payers and purchasers.
More information on this HHS initiative is at http://www.cms.gov/Newsroom/MediaReleaseDatabase/ Fact-sheets/2015-Fact-sheets-items/2015-01-26-3.html. HCA will be exploring and making recommendations on value-based payments as part of a new state Health Department workgroup that we were invited to join; it met for the first time late last Friday. A copy of the DOH slide presentation to the workgroup can be viewed at http://www.hca-nys.org/ documents/VBPWorkingGroupSlides.pdf and a roadmap plan is posted at http://www.hca-nys.org/ documents/RoadmapFirstDraftVBPWorkgroup01202015.pdf.
DSRIP Update The Delivery System Reform Incentive Payment (DSRIP) Project Approval and Oversight Panel (PAOP) will meet for the second time on February 17 through February 20 in Albany. February 17 will be a full day of public comment and the meeting is open to the public with limited seating available. No pre-registration is required. The February 18 to February 20 meetings are full-day meetings and are structured work sessions for the panel members. There will be no public comment period on these days. The panel will be reviewing Performing Provider System (PPS) Project Plan Application scores as presented by the Independent Assessors. The February meetings will be available via webcast and can be viewed at http://www.health.ny.gov/events/webcasts/. Prior to the February PAOP review sessions, the Independent Assessor will release PPS Project Plan Executive Summaries as well as a recorded webinar for the purpose of providing an example of how PPS Project Plans will be reviewed. The Independent Assessor will present a prototype application that has been made available to the public. More information on the PAOP is at http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/project_approval_oversight_panel.htm. Questions about the panel may be directed to dsrip@health.ny.gov.
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Volume 20, No. 4 January 30, 2015
OMIG Posts Compliance Guidance for Medicaid Revalidation Recently, state Office of the Medicaid Inspector General (OMIG) posted on its website a Compliance Guidance (2015-01) for Medicaid Providers revalidating enrollment with the state Department of Health (DOH). Some Medicaid providers who are revalidating their Medicaid enrollment with DOH must adopt and implement a compliance program that meets the requirements of Social Service Law Section 363-d and Part 521. The guidance is at: http://www.omig.ny.gov/images/stories/compliance_alerts/ 20150127_Compliance_Guidance_2015_01_final_1_27_15.pdf. It provides information on what revalidating providers must submit to DOH, if they are required to have a compliance program, and to certify that they meet New York State legal and regulatory requirements. Upcoming webinars OMIG has also recently posted the following two new webinars to its website (at http://www.omig.ny.gov/ resources/webinars): •
Webinar No. 24 – Mandatory Compliance Program and Certification Obligation. This webinar provides an overview of New York’s mandatory compliance program obligation and the compliance program certification obligation for Medicaid providers. It also provides an overview of the federal Deficit Reduction Act of 2005 (DRA) and the annual certification requirement for those Medicaid providers subject to the DRA.
•
Webinar No. 25 – OMIG’s Compliance Certification process for Mandatory Compliance Programs: Enrolling Provider or Revalidating Provider. This webinar introduces the form that must be used by Medicaid providers to certify that their compliance program meets the requirements of New York’s mandatory compliance program law and regulations.
Please note: providers who completed the certification process in December 2014 do not need to recertify at this time. For questions on this Compliance Guidance, or any compliance issue under New York State’s mandatory compliance program obligation, contact OMIG’s Bureau of Compliance at (518) 408-0401 or compliance@omig.ny.gov. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
OMIG Issues New Compliance Alert The state Office of the Medicaid Inspector General (OMIG) has posted an alert to “Medicaid Providers Who Failed to Certify in December 2014.” The Compliance Alert is at: http://www.omig.ny.gov/images/stories/compliance_alerts/ 20150123_compliance_alert_2015-01.pdf. The Alert states that in January, 2015, OMIG sent letters to many Medicaid providers who did not meet their annual December Certification obligation. The mailing reminded 15
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these providers of the mandatory compliance requirement and the annual certification requirement for their compliance programs. The Resources section of the Compliance Alert can be used by those receiving the January 2015 letter or others who wish to learn more about New York’s mandatory compliance program obligation and the certification requirement. Under state law, home care and other health care providers must complete and submit a state form, the New York State Social Services Compliance Program Certification (by December 31 of each year), to certify that a compliance program is in place that meets the state’s requirements, including eight elements outlined at http:// www.omig.ny.gov/mandatory-provider-compliance-programs-faqs. In addition, providers who receive or make at least $5 million in state Medicaid payments (not including Medicaid managed care payments) during a federal fiscal year (October 1 to September 30) are required to certify on or before January 1 of each year that they are in compliance with the federal Deficit Reduction Act (DRA). More information is at http://www.omig.ny.gov/compliance/certification.
CMS to Hold Forum on Home Health Agency Star Rating Proposal On February 5, from 1:30 to 3 p.m., the U.S. Centers for Medicare and Medicaid Services will host a second Special Open Door Forum call to give additional input and feedback on the planned addition of star ratings to the Home Health Compare website at medicare.gov. The call follows an earlier presentation and will include a summary of the comments received thus far, a presentation of CMS’s revised methodology and plans for next steps. The call will offer an opportunity to ask questions. A link to materials for this call will soon be posted on the Home Health Quality Initiative Spotlight page at http://www.cms.gov/Medicare/Quality-Initiatives-PatientAssessment-Instruments/HomeHealthQualityInits/HHQISpotlight.html. Comments about the star ratings system can be submitted by e-mail after the call to the following address: HHC_Star_Ratings_Helpdesk@cms.hhs.gov. The dial-in number is 1-800-837-1935. The Conference ID is 73412220. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
UAS Update The state Department of Health (DOH) has announced that the “UAS-NY User Test” application will be unavailable from the close of business Friday, January 30 until the week of February 9. DOH will work to make the environment available as soon as possible the week of February 9. This outage will have no impact on the UAS-NY application. During this time, users will click on “UAS-NY” to access the: •
UAS-NY Training Environment to complete the training courses; and 16
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Continued from p. 16 •
UAS-NY online and offline applications.
Training In addition, DOH has announced a program entitled, “What’s New in the UAS-NY? – Iteration 7,” on February 17 (2 p.m.),February 19 (10 a.m.), February 24 (10 a.m.) and February 26 (2 p.m.). It will cover: improvements to the layout of the interface; recording enrollments; processing an assessment or reassessment; and updates to the aggregate reports functionality. Registration is at the links below: http://tinyurl.com/nuwo4cp (February 17) http://tinyurl.com/p78w9zj (February 19) http://tinyurl.com/lncsmrh (February 24) http://tinyurl.com/pw3kfym (February 26) If you need additional information or have any questions, write to uasny@health.ny.gov.
Senate Committee to Vote on Hospital-Homecare-Physician Collaboration Bill The New York Senate Health Committee’s February 3 meeting agenda will include legislation developed by HCA and the Iroquois Healthcare Alliance establishing the Hospital-Homecare-Physician Collaboration Program. The legislation, just reintroduced this year as S.1110, is sponsored by Senator Kemp Hannon, chairman of the Senate Health Committee. Assemblywoman Aileen Gunther, chair of the Assembly Mental Health Committee, has reintroduced the Assembly version, A.2011. The legislation narrowly missed inclusion in last year’s final state budget. It subsequently passed the State Senate unanimously, but the Assembly did not act on the bill prior to the legislative recess in June. The bill would establish a specific section of the Public Health Law devoted to programmatic, financial and regulatory flexibility support for collaboration programs. The programs could consist of hospital, home care, physician, nursing home and/or other partners working together for improved care delivery, infrastructure and/ or cost-effectiveness. The now-launched Delivery System Reform Incentive Payment (DSRIP) program in fact borrowed elements of this bill which HCA and Iroquois brought to state leaders back in 2013. The partnership initiatives under the bill would be flexible and diverse. HCA’s 2015 priority areas for legislative and budget advocacy include support for home care participation in new models and partnerships for care. This legislation provides one of a number of vehicles for pursuing this goal. HCA will be regularly reporting on the bill’s progress, and providing guidance on voicing support for its passage. Continued on next page
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Continued from p. 17 Additional Bills on Senate Health Agenda The following additional bills of importance to home care agencies and patients are also scheduled for consideration at Tuesday’s Committee meeting: S. 676 by Senator Hannon – Establishes the “CARE ACT” (Caregiver Advise, Record and Enable Act). Would require a general hospital to: (i) allow a patient an opportunity to designate, upon admission to a hospital, a caregiver in the patient’s medical record; (ii) notify and offer to meet with the designated caregiver to discuss the patient’s plan of care prior to the patient’s discharge or transfer to another facility; (iii) offer to adequately train the designated caregiver in certain aftercare tasks upon a patient’s discharge to his or her current residence. S2486 by Senator Hannon – Postpones Implementation Date for E-Prescribing Requirement. Provides additional time necessary for implementation of the electronic prescription requirement in New York set to go into effect on March 27, 2015; provides an additional year to March 27, 2016. For further information, please contact Al Cardillo at acardillo@hcanys.org.
Managed Care Update The state Department of Health (DOH) has provided additional information on the transition of the nursing home benefit and population into managed care. Starting February 1, 2015, in New York City (NYC), nursing home residents who become “permanent” residents will be required to enroll in mainstream Medicaid Managed Care (MMMC) or Managed Long Term Care (MLTC) plans. Different transition dates apply to nursing home residents living in other counties. All eligible NYC recipients over age 21 in need of long term/custodial placement will be required to enroll in an MMMC or MLTC plan. Custodial care beneficiaries currently in a skilled nursing facility in NYC prior to February 1, 2015 will remain fee for service and will not be required to enroll in a managed care plan. For outside of NYC, see the transition schedule below. On January 22, 2015, DOH conducted a webinar on this transition. The materials are at http://www.health.ny.gov/health_care/medicaid/redesign/docs/2015-01-22_nh_transition.pdf. DOH has issued revised policies and procedures at http://www.health.ny.gov/health_care/medicaid/redesign/ docs/nursing_home_transition_final_policy_paper.pdf and an FAQ at http://www.health.ny.gov/health_care/ medicaid/redesign/docs/formatted_nh_faq_part_a.pdf. The schedule for the transition of the nursing home population and benefit to managed care plans is: Phase 1: February 1, 2015 •
New York City
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Continued from p. 18 Phase 2: April 1, 2015 •
Nassau, Suffolk and Westchester
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, Warren, Washington, Wayne, Wyoming, Yates
Phase 4: October 1, 2015 •
Voluntary enrollment in Medicaid managed care becomes available to individuals residing in nursing homes in all counties who are in fee-for-service Medicaid.
The transition policy is: •
Existing MMMC enrollees will not be disenrolled if they require long term custodial placement.
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MMMC plans will be responsible for the nursing home benefit after January 31, 2015 for enrolled members.
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No individual will be required to change nursing homes resulting from this transition.
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New placements will be based on the individual’s needs and the plan’s contractual arrangements.
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Plans must ensure that placement is in the most integrated, least restrictive setting available to meet the enrollee’s needs.
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For at least three years after a county is deemed mandatory for the nursing home population and benefit, plans will be required to pay contracted nursing homes either: a benchmark (fee-for-service) rate or a rate negotiated between both parties.
•
After the three-year transition period, plans and nursing homes will negotiate a rate of payment.
Individuals residing in nursing homes prior to February 1, 2015 will not be passively enrolled into Fully Integrated Duals Advantage (FIDA) plans; however, an individual new to custodial status in nursing homes as of February 1, 2105 will be passively enrolled into a FIDA plan on or after August 1, 2015. For more information, contact Andrew Koski at akoski@hcanys.org or (518) 810-0662.
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MedPAC Finalizes 2016 Payment Recommendations for Home Health, Hospice The Medicare Payment Advisory Commission (MedPAC) met recently to finalize recommendations for its annual March Report to Congress on Medicare payment policy. In arriving at its recommendations, MedPAC considered a payment adequacy, beneficiary access to care, the capacity and supply of providers, care utilization, quality of care, provider access to capital, and financial margins. In December MedPAC staff also examined issues related to hospice payment adequacy. For both home health and hospice, MedPAC will recommend that Congress eliminate the inflationary updates for the 2016 payment year, and will reprint recommendations from previous reports that have not been implemented. Elimination of the payment updates for 2016 would require legislative action. MedPAC states its continuing concerns that previous recommendations have not yet been implemented related to hospice payment reform and oversight of hospices that have a high proportion of long-stay patients. For this reason, MedPAC plans to reissue its prior hospice recommendations. It should also be noted that, as part of its 2014 March Report to Congress, MedPAC recommended the inclusion of hospice as part of the Medicare Advantage benefit package. In addition to its recommendation for no market basket update, MedPAC is expected to include the following home care recommendations: •
Implementation of the remaining two years of home health payment rebasing during the 2016 payment year;
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Revision of the home health case-mix model to rely on patient characteristics to set payment levels and redistribute monies to non-therapy services;
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Having CMS identify the types of patients that might best benefit from home health services and develop quality outcome measures for each such category;
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A per-episode copayment for home health care for services that were not preceded by a hospital or skilled nursing facility stay (dual eligible patients would not be subject to the copay) at a recommended copay level of $150 per episode; and
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A reduction in payments to home health agencies with relatively high risk-adjusted rates of hospital readmissions.
Unfortunately, MedPAC continued to base proposed payment cuts and its assertions about the financial health of home care agencies on a faulty analysis of home care operating margins. MedPAC’s analysis – which projects an 11.4 percent average home health operating margin nationally in 2014 – persists in excluding institution-based home care providers (whose margins trend substantially lower than non-hospital-based agencies) while utilizing weighted data which misrepresents the financial health of
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home health agencies nationally and, especially, in New York State, where the average Medicare operating margin has been negative for over ten years in a row. Furthermore, CMS recently projected that the number of home health agencies with negative margins nationally would increase from about 30 percent in 2011 to 43 percent by 2017. As part of our ongoing federal advocacy efforts, HCA will inform New York’s Congressional Delegation that such reductions, coupled with the ongoing two-percent sequestration cuts, cannot be endured by home care agencies in New York State whose average operating margins are negative, due to past payment cuts, and whose volume of intensive service load is reflected in the 10 to 11 percent of New York Medicare episodes involving outlier payments. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
Update on HCBS Federal Rule Last week, the state Department of Health (DOH) provided an update on the state’s transition plan to comply with a federal home and community based settings (HCBS) rule. The materials are posted at http://www.health.ny.gov/health_care/medicaid/redesign/docs/ hcbs_final_rule_transition_plan_presentation_1.22.15.pdf. The rule establishes criteria for what is considered a home and community setting under the following Medicaid waiver programs: 1915(c), 1915(i) and 1915(k). It will also apply to 1115 waiver programs (managed long term care and mainstream Medicaid managed care). New waivers or state plan amendments are also covered by the rule. The rule was effective March 1, 2014 but allows for transition over five years until March 17, 2019. According to DOH, the purpose of the setting requirements is to establish qualities and characteristics of settings where recipients of HCBS Long Term Services and Supports (LTSS) live and/or receive services to ensure that the setting maximizes the individual’s autonomy and independence and his or her integration into and interaction with the broader community. Appropriate settings are those that: ensure an individual’s rights of privacy, dignity and respect and freedom from coercion and restraint; optimize autonomy and independence in making life choices; and facilitate choice about services and who provides them. Settings not included as meeting the criteria are: nursing homes, hospitals, intermediate care facilities (ICF), and institutes for mental disease (IMD). States are required to file a Statewide Transition Plan (STP) by March 16, 2015 or within 120 days of submission to the U.S. Centers for Medicare and Medicaid Services (CMS) of any 1915(c) or 1915(i) amendment or renewal, whichever is earlier. Continued on next page
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Continued from p. 21 DOH issued a draft transition plan in July at http://www.health.ny.gov/health_care/medicaid/redesign/docs/hcbs_proposed_state_transition_plan.pdf. States have up to five years to comply with their own STP once it is approved by CMS. The STP must include: 1) a review of state rules/regulations, standards, policies, licensing requirements and other provider requirements to ensure that settings comport with the final rule; 2) an assessment of whether current settings where individuals live and/or receive Medicaid-funded HCB LTSS meet the HCBS requirements; and 3) specific goals, timelines and deliverables to remediate any settings that are not fully compliant with the rule. The state currently provides some HCBS LTSS in settings that are presumed to be institutional under the federal rule. These include day programs in institutional settings like nursing homes, hospitals or ICFs. DOH is seeking comment on the evidence the state should include in its submission to allow HCBS LTSS, like adult day care, to be provided in a nursing home, for example. DOH intends to post a revised STP very soon at http://www.health.ny.gov/health_care/medicaid/redesign/ home_community_based_settings.htm. For more information, contact Andrew Koski at akoski@hcanys.org or (518) 810-0662.
2015 Medicaid Transfer Penalty Rates Announced The state Department of Health (DOH) has released the Medicaid regional rates for calculating penalty periods due to transfer of assets made for those who apply for Medicaid in 2015. The penalty periods apply to individuals who transfer assets during the 60-month “look-back period” and require institutional services. The 2015 monthly rates are: •
New York City: $11,843
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Long Island: $12,390
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Northern Metropolitan: $11,455 (Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster and Westchester)
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Northeastern: $9,414 (Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren and Washington)
•
Central: $8,768 (Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tioga and Tompkins)
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Rochester: $10,660 (Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne and Yates)
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Western: $9,442 (Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans and Wyoming)
DOH’s notice is at http://www.health.ny.gov/health_care/medicaid/publications/docs/gis/15ma001.pdf. For more information, contact Andrew Koski at akoski@hcanys.org or (518) 810-0662.
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NGS Updates: PS&R Application Changes Forthcoming National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), has recently posted the following information to its website. •
PS&R Users: EIDM Transition Notification – Beginning February 9, 2015, the existing system for controlling access to the PS&R application hosted by CMS-IACS will be replaced by Enterprise Identity Management (EIDM). The PS&R is a tool used to prepare and process Medicare cost reports. Individuals seeking to create new accounts, manage their existing accounts or log into PS&R will no longer use IACS, but will instead use EIDM. Existing IACS accounts will be converted into EIDM accounts, retaining the existing user ID, password, profile information, and access rights. The address for PS&R (https://psr-ui.cms.hhs.gov/psr-ui) will not change as a result of this transition. Between January 30 and February 8, the following will occur: individuals will be unable to create new IACS accounts for accessing PS&R; changes to existing IACS accounts will be allowed by the system, but none of these changes will be carried over to the new EIDM accounts; migration activities will take place ensuring that users with existing IACS accounts are transitioned over to the EIDM system; and access to PS&R will continue to be available using existing IACS accounts. NGS encourages all PS&R users to log-in to their IACS account prior to January 30, 2015 to change their password. (The “Change Password” option can be found at https://idm.cms.hhs.gov/idm/user.) For support, please contact EUS between 7 a.m. and 7 p.m. at 1-866-484-8049 or at the Helpdesk at: eussupport@cgi.com.
•
Update to the Hospice Notice of Election: Timely Filing of Hospice Elections Job Aid – With the implementation of CMS’s Change Request 8877(http://www.cms.gov/Regulations-and-Guidance/ Guidance/Transmittals/Downloads/R3032CP.pdf ) for claims with dates of service on or after October 1, 2014, a hospice Notice of Election (NOE) must be submitted within five calendar days after the date of admission. If hospices submit an NOE and realize that there is a billing error, they do not have to wait for the NOE to be returned in status/location T B9997 before submitting the correct NOE. Effective immediately, a new NOE can be submitted while an NOE with errors is still in suspension. The new NOE will be accepted by FISS and CWF. NGS will also be updating the NOE job aid titled, “Notice of Election: Timely Filing of Hospice Elections.” For the entire job aid on this topic, visit NGS’s website at www.ngsmedicare.com and go to the Education/Job Aids & Manuals section.
•
Claims Are Receiving Reason Codes U5233, U5234, U5235 & U5236 in Error – Claims receiving Reason Codes U5233, U5234, U5235 & U5236 are not processing correctly due to a Fiscal Intermediary Standard System (FISS) system issue. These claims are returning in error to providers or rejecting in error with the reason code narratives stating services were provided within Health Maintenance Organization (HMO) or Group Health Organization (GHO) enrollment periods. Other claims are also affected by these issues. No provider action is required at this time. Fixes are scheduled to be installed on February 23, 2015 and March 9, 2015. Please watch the Production Alerts section of NGS’s website and e-mail updates for additional information.
For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org. 23
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Publications •
“Aiming for Fewer Hospital U-turns: The Medicare Hospital Readmission Reduction Program,” by the Kaiser Family Foundation http://files.kff.org/attachment/issue-brief-aiming-for-fewer-hospital-u-turns-the-medicarehospital-readmission-reduction-program
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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Understanding Labor Law Regulations to Ensure Compliance Location: Conference Center 130 East 59th Street (near Lexington Ave.) 7th floor New York, NY 10022 Fee: $99 for HCA members; $199 for Non‐members
HCA is offering a series of Home Care Survival Bootcamps throughout the coming months to provide tools, tips and strategies that will help home health providers thrive in an increasingly challenging marketplace and regulatory environment. This series focuses on specific issue areas, offering practical ideas and methods for skill building. Part III in this series, on February 12, offers vital information on labor law regulations for any home care agency operating in New York State. This educational series will provide the opportunity to retool, refocus and re‐energize your agency. All programs in the series will be held at the Conference Center in New York City and will include expert presenters, valuable handout materials and lunch.
Registration Deadline: February 6, 2015
February 12 – Part Three Understanding Labor Law Regulations to Ensure Compliance 9:30 am – HCA Welcome
Location: Conference Center 130 East 59th Street (Near Lexington Ave.) 7th floor New York, NY 10022
Lunch Sponsored by:
9:45 to 11:00 Paid Sick Leave Law for NYC This workshop will cover the Paid Sick Leave law, including: • covered and exempt employees; • accrual process; • employer tracking tools; • interaction with collective bargaining agreements; • retaliation; • effects of the law on agencies that employ themselves or contract for aides and professional staff (nurses, physical therapists, etc.); and other issues. Albert Wu, Legal and Policy Analyst, Paid Sick Leave Division, NYC Dept. of Consumer Affairs Tanjila Rahman, Outreach Coordinator, Paid Sick Leave Division, NYC Dept. of Consumer Affairs 11:15 to 12:15 Labor Law Rules for Home Care Agencies This presentation will cover a multitude of labor law issues that affect home care agencies, including: • any responsibility to notify aides of increases in the minimum wage; • how to compute hours worked by aides on sleep‐in cases; • recordkeeping requirements for home care agencies that provide sleep‐in cases; • payment rules for individuals who work on overnight cases that are not “sleep‐in” cases; • how to calculate an aide’s regular rate of pay when the aide is paid different hourly amounts in one week; • requirements related to reimbursement to aides for travel time and use of cell phones; • whether an agency can pay the same aide different hourly amounts for the same services but for different hours; • findings of NYS Department of Labor investigators related to home care; and more. Lety Escobar, Senior Labor Standards Investigator, Division of Labor Standards, New York State Dept. of Labor 12:15 to 1:00 – Lunch 1:00 to 2:00 – Labor Law – continued 2:00 to 2:15 – HCA Wrap Up and Adjourn
REGISTRATION – (Deadline February 6)
REGISTRATION FEE
Name: _________________________________________________
HCA Members
Title:__________________________________________________
PAYMENT
Agency:________________________________________________
____MasterCard
Address:_______________________________________________
*Make checks payable and mailed to:
City/State/Zip:___________________________________________ Phone:______________________________ Ext._______________ Email: _________________________________________________ Cancellations received by February 6 are refundable less a 25% administrative fee. Cancellations must be received in writing via e-mail to info@hcanys.org. No refunds after that time or for no shows. Substitutions are permitted.
FAX TO: (518) 426‐8788
$99 ________
____VISA
Non-Members
$199 ________
____ American Express
________ Check*
HCA Education and Research 388 Broadway, 4th Floor, Albany, NY 12207
Credit Card #: _______________________ Exp. Date:_______ Security Code: ________ _________________________________________________________________________ Name and/or Company Name on Card _________________________________________________________________________ Billing Address of card (including City, State and Zip Code) _________________________________________________________________________ Authorized Signature
ICD-10-CM Readiness Boot Camp February 25 8:30am – 4:30pm Registration opens at 7:45am Registration fee includes handout materials, breaks, and lunch
Holiday Inn 205 Wolf Road Albany, NY 12205 The HCA room rate is $111. Call 1800-HOLIDAY to make a reservation and ask for the HCA ICD Block rate (valid through February 3, 2015.)
***** Your presenter: Trish Tulloch, RN, BSN, MSN, HCS-D Trish is an AHIMA approved ICD10-CM trainer. She is also a seasoned clinician with more than thirty years in the healthcare industry, including fifteen years in home health and hospice clinical management and more than seventeen years as a Senior Consultant with RBC Limited.
Will you be prepared for the October 1 transition to ICD-10-CM? CMS predicts a 10% claim denial rate with the transition to ICD-10CM on October 1, 2015. This transition will expand diagnoses codes from just 13,000 codes to over 68,000 codes. Code proficiency ensures data integrity and accurate agency reimbursement. Sharpen clinicians and coders anatomy and physiology skill set to enhance documentation that supports ICD-10 diagnoses precision and verifies the consistency of the revised OASIS-C1. Prepare now to ensure your agency time to dual code and test for ICD-10 accuracy. Program Objectives: • Identify ICD-10-CM diagnosis most pertinent to the Home Health beneficiary • Detail critical terminology and diagnoses updates that impact assessment, care planning and accurate reimbursement • Practice dual coding and apply ICD-10-CM code updates to common and complex home health scenarios • Detail the pathophysiology that drives the accurate selection of each diagnostic code assignment • Discuss ICD-10-CM Code Convention when applying these diagnostic categories • Apply tips and program tools to support ICD-10-CM readiness with agency staff Who Should Attend: Coders; coding supervisors, educators and clinicians. Take Away Tools: ICD-10-CM Crosswalks Top 50 Home Health ICD-10-CM Reference Guide
Key Messages: • Jump start ICD-10 readiness with this one-day bootcamp • Dual code application to common home health scenarios • Practical take-a-way tools to support agency preparation training for ICD-10 on October 1, 2015 • Interactive forum to apply revised OASIS-C1 and 2015 PPS updates with ICD-10-CM coding.
IMPORTANT: Participants are required to bring an ICD-10 Manual to participate in all code activities. On-line ICD-10 coder will also be accepted.
www.hcanys.org
ICD-10-CM Readiness Boot Camp February 25 – Albany, NY
Register online at www.eventville.com/hcanys
REGISTRATION FORM Please register by February 17
Name: ____________________________________________________________________________________ Title:______________________________________________________________________________________
Agency:___________________________________________________________________________________ Address:__________________________________________________________________________________ City/State/Zip:______________________________________________________________________________ Phone:______________________________________ Ext._________ Fax: ____________________________ Email: _________________________________________________________________________________________ (Required)
REGISTRATION FEE HCA Member $199 per person HCA Member (three person team from same agency) $529 for team of three (online registration is not available for team discount – please fax or mail registration)
$_____________ $ ____________
Non-Member
$_____________
$349 per person
PAYMENT Please check method of payment: (Checks must be received by date of program).
____MasterCard
____VISA
____ American Express
____ Check*
*Make checks payable to: HCA Education and Research and mail to:
388 Broadway, 4th Floor, Albany, NY 12207
Please print clearly.
Credit Card #: ____________________________________ Exp. Date:__________ Security Code: ____________ _____________________________________________________________________________________________ Name and/or Company Name on Card _____________________________________________________________________________________________ Billing Address of card (including City, State and Zip Code)
_____________________________________________________________________________________________ Authorized Signature Cancellations received by February 11, are refundable less a 25 percent administrative fee. Cancellations must be received in writing via e-mail to info@hcanys.org. No refunds after this date or for no shows. Substitutions are permitted.
Fax to (518) 426-8788