February 6, 2015 ASAP

ASAP

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

Legislative Issues  Public Policy



News

Volume 20, No. 5 February 6, 2015

HCA Budget Call Presses Membership into Action on Advocacy Priorities On Wednesday, HCA held a statewide call to brief the membership on elements of the Governor’s budget proposal and on our related state advocacy agenda.

In addition to outlining some key provisions in the budget, HCA Policy staff especially stressed the need for members to engage in grassroots advocacy by contacting your legislators, scheduling meetings with them, and using this face-to-face time to identify a few items from our six-point advocacy agenda that you feel you are best equipped to discuss, with some examples from your own experiences.

As reported in prior editions of ASAP, HCA’s advocacy agenda is laid-out succinctly in a document entitled Driving Health Care Improvement and Savings Through Home Care.

See ADVOCACY p. 2

HCA Delivers Budget Testimony, Comments on Value-Based Payment Proposal Twice this week, HCA pursued the opportunity to deliver key responses and recommendations on state fiscal policies, during our testimony before a joint legislative budget hearing on Monday and in a comment letter to Cuomo Administration officials on one major, sweeping feature of the budget: a proposal to move system-wide reimbursement methodologies toward value-based payment, or VBP. See TESTIMONY p. 4

Inside ASAP HCA Budget Call Presses Membership into Action.............................1 HCA Delivers Budget Testimony, Comments on VBP Proposal…........1 DOH Explores Training Criteria for “Advanced Aides”…....................5 HCA Collaboration Bill Ready for Senate Passage….........................6 President Releases Proposed Budget for FY 2016…..........................7 LHCSAs: Join us For Feb. 25 LHCSA Forum…......................................9 DOH Posts Independent Assessor Scores for DSRIP….....................11 HCA, HBCA Debrief on Storm Response, Preparedness Needs…...11 Home Health Star Ratings Update….................................................12 HCA & VNAA Offer Clinical Procedures Manual at Discount…........12 HCA Offers OASIS-C1 Basics Webinar Series…................................13 Hospice Providers Reminded to Participate in CAHPS Dry Run…......15 HCA, Council Send Home Health Compare Report to Providers…..15 CMS to Update Home Health Pricer Software on April 1…................15 CMS to Present Templates for M.D. Documentation of Home Care.......17 New Instructions Posted for Using Notice of Non-Coverage..........17 Managed Care Update.....................................................................18 Nov. Medicaid Global Cap Spending Report Released..........…......19 Livanta QIO Update…...................................................................20 NGS Updates….................................................................................21 Publications...................................................................................................…22

Attention CFOs and Finance Leaders: Save the Date for HCA’s CFO Forum on March 18 at the Albany Hilton. A brochure and registration are coming soon, so stay tuned – and be sure to mark your calendars!

Helping New Yorkers Feel Right At Home

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

Volume 20, No. 5 February 6, 2015 

ADVOCACY from p. 1 In this piece you will find HCA’s requests for: Heath Information Technology (HIT) support, modernization of the health insurance coverage statute, the need for adequate and efficient managed care-home care provider payment, improved alignment and streamlining of home care-managed care regulations, financing of home care quality initiatives, and provisions to facilitate home care innovation and participation in new models and partnerships for care.

This agenda was developed prior to the Governor’s release of a 2015-16 budget in late January; however, each item in our agenda addresses long-standing support needs for home care – anticipating the continuation of these needs in the latest budget environment – while complementing some of the broad themes of the Governor’s plan.

For instance, the Governor’s budget includes new capital and vital-access investments for the health care system, but with little mention of home care in these investment areas. We are using out advocacy plan to request extension of these investments to home care.

We need members to similarly use our advocacy agenda requests to start a conversation with your legislators about the need to include home care investments in these areas already staked out by the Governor, whether it’s HIT support, or vital-access financing and capital investment to continue or strengthen your operations, insurance coverage changes that allow you to more fully participate in an evolving health care landscape, or other items.

The main message of all of these proposals is positive and proactive: In order for new models of care to flourish and succeed in New York State, as envisioned by state policymakers, home care needs vital support so that it can be a driver of quality/improved health outcomes in these new arenas.

Please schedule your appointments today. We especially ask members to schedule appointments with legislators during President’s Day week, from February 16 to 20, when Assembly and Senate members will be in their 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

2

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

Volume 20, No. 5 February 6, 2015 

Budget Resource Downloads

district offices during the break from legislative session. In those meetings, we ask you to identify an item or two from HCA’s six-point agenda and provide specific examples supporting the importance of these items.

HCA’s 2015 Budget/Legislative Agenda: Driving Health Care Improvement and Savings Through Home Care (January 2015)

Please also present a copy of our agenda (attached to this week’s ASAP) to the legislator and/or his or her staff.

http://www.hca-nys.org/documents/ 2015HCADrivingHealthCareImprovement andSavingsthroughHomeCare.pdf

To help you with key messages and background perspectives, please also read HCA’s budget testimony and our financial condition report, which will give you some aggregate data on the financial condition of home care agencies in New York State to support your agency-specific data. (See sidebar for resource links).

HCA’s 2015 Home Care Financial Condition Report: Home Care Financial and Program Support Vital for Success of New Care-Delivery Models (January 2015) http://www.hca-nys.org/documents/ 2015HCAFinancialConditionReport.pdf

Monday advocacy meetings to drive further outreach

HCA State Budget Testimony (February 2, 2015)

On Monday, February 9, HCA is holding Albany meetings with Senate and Assembly leaders as well as key Cuomo Administration health officials on HCA’s budget and legislative agenda.

http://www.hca-nys.org/documents/ HCATestimonyCardillo201516ExecutiveBudget.pdf Memo: 2015-16 Executive State Budget Analysis (January 27, 2015)

We need you to help reinforce these strategic discussions by conducting advocacy at the district level, especially if your legislator occupies a key committee leadership position or is one of the officials we will be meeting with on Monday.

http://www.hca-nys.org/policy_memos/ documents/ HCAMemo2015ExecutiveBudget.pdf

Early next week, HCA will provide an update on the outcome of our advocacy discussions, especially any key interest areas or concerns expressed by specific legislators whom we will ask you to reach for further reinforcement of our advocacy goals.

Please stay tuned, and let HCA know how we can further assist you with information or resources.

For more information, please contact any of the HCA Policy staff

3

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

Volume 20, No. 5 February 6, 2015 

TESTIMONY continued from p. 1 As reported in recent editions of ASAP, the Governor’s 2015-16 budget proposal starts the process of implementing VBP in New York to meet a condition of the state’s $8 billion reinvestment waiver agreement with the federal government.

infrastructure improvements and provide additional tools to stabilize health care providers to advance health care transformation goals,” not to mention the continuation of Delivery System Reform Incentive Payment (DSRIP) and other integrated payment models for which home care is primarily a downstream recipient of investments.

This state-level effort tracks with a nationwide pivot away from fee-for-service and toward VBP for Medicare and Medicaid payments under a framework recently announced by the U.S. Department of Health and Human Services. (See last week’s ASAP.)

For VBP, in particular, HCA’s comment letter emphasized the need for substantive infrastructure investment in home care that would equip community-based providers with the resources and tools to achieve outcome measures that are at the core of VBP’s success.

In New York State, Governor Cuomo is calling for a model in which all managed care organizations must employ non-fee-for-service payments that “reward value over volume” for at least 90 percent of their provider payments by the end of 2019.

“Many providers would need substantial infrastructure support to reach a point of readiness, and the system currently has nowhere near sufficient capacity (for VBP) without such initial support,” wrote HCA Executive Vice President Al Cardillo in the letter to State Medicaid Director Jason Helgerson. Along with broad infrastructure and payment support, Mr. Cardillo cites a ten-point HIT support plan for home care that HCA already submitted to the Department. He also calls for design flexibility, transparency and an appropriate implementation timetable for any VBP plan.

HCA’s comments on the home care impact of VBP follow a joint letter signed by HCA and partner associations addressing more global VBP concerns.

(HCA is also on a state Department of Health workgroup with partner associations to examine the Governor’s proposal.)

Budget testimony

HCA’s VBP comments and budget testimony share key alignments

Our budget testimony on Monday likewise cites HCA’s call for reimbursement support as well as our ten-point plan for helping to advance home care IT connectivity with hospitals and other partners, which we urged the legislature to include in the budget “to promote health care quality, cost-effectiveness, care management and integration of home care within provider systems, between sectors and with regional and statewide health information systems.”

HCA’s comments on VBP, specifically, and our testimony on the budget, globally, had a consistent aim: 1) to make the case that home care is a vital contributor to health outcomes goals, especially under system reform models like MLTC, FIDA, DSRIP and, now, the pivot towards VBP; and 2) in order to support these reform models, we contend that home care providers need to be included among the multi-billion-dollar health system investments already staked out in the Governor’s budget but which don’t expressly include home care providers.

Much of HCA’s budget testimony reflected the core recommendations of our budget agenda previously shared with the membership, entitled Driving Health Care Improvement and Savings Through Home Care.

(See the back of this week’s ASAP.)

Such investments include $12 million for sole community hospitals; a $7.5 million vital access care carve-out for clinics; $10 million in vital access provider funding for rural institutional providers; and $1.4 billion in new capital investments to “make

In addition to HIT support, our agenda calls for modernization of the health insurance coverage 4

ASAP – a publication of the Home Care Association of New York State Continued from p. 4 statute, the need for adequate and efficient managed care-home care provider payment, alignment and streamlining of home caremanaged care regulations, financing of home care quality initiatives, and provisions to facilitate home care innovation and participation in new models and partnerships for care.

HCA also provided comments on specific provisions like the Governor’s plan for Certified Home Health Agency (CHHA) Episodic Payment System rebasing, the Executive’s proposed “Advanced Home Health Aide” designation (see related story, this page), the rolling financial impact of continued Medicaid Redesign Team cuts, and, of course, VBP, for which HCA is seeking: more flexible state timetables and target goals; more indepth pre-analysis, testing and identification of necessary infrastructure support; design flexibility; mutually viable payment formulas through bilateral negotiations between payors and providers; and other considerations.

Volume 20, No. 5 February 6, 2015 

DOH Explores Training Criteria for “Advanced Home Health Aide” The state Department of Health (DOH) convened a meeting this week of its “Advanced Home Health Aide” (AHHA) workgroup to further explore training criteria for the proposed, new level of aide service.

As HCA has detailed in our 2015-16 state budget materials (see page 1 story and links), the Executive budget proposal seeks legislative approval for authorization of AHHAs through designation in the Public Health Law and a carve-out to the Nurse Practice Act, under the Education Law. AHHA tasks, qualifications, procedures for service and training are proposed to all be formulated via State Health and Education department regulation.

This week, the DOH AHHA workgroup focused on the possible additional training – over the current base home health aide level of training – needed for the advanced level tasks (such as medication administration) that could be carried out by the AHHA. HCA and other workgroup members raised numerous issues with regard to the proposed training and the design and workability of the AHHA proposal overall. DOH is currently updating an evolving matrix that shows possible AHHA tasks, linked to possible training criteria for those tasks. HCA is requesting the update as soon as it is completed in order to vet it with the HCA membership for feedback.

Along with training and discernment of tasks for AHHAs, additional issues we have put on the workgroup table include: financing of the necessary implementation/operation costs for both home care agencies and managed care plans (neither the proposed budget nor the DOH payment methodologies currently evidence any support for AHHAs); regulatory and procedural complexity; ability to seamlessly and compatibly implement AHHA (as designed), either within managed care or in relation to the Nurse Practice Act exemptions; implications for agency/RN liability and compliance; and other.

As reflected in our legislative testimony this week, HCA strongly supports efforts to expand roles for home health aides, especially as commensurate with the evolving health care system. The outstanding issues with the AHHA proposal must be addressed, however. In this regard, HCA looks forward to continued collaboration with the Executive, and close work with the Legislature, to arrive at a workable, funded and compatible proposal and implementation plan.

Providers should stay tuned for further details from HCA and your response to the draft DOH task and training criteria as soon as we have it available to distribute to you. Your feedback will be essential.

For further information, please contact Al Cardillo at acardillo@hcanys.org.

5

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

Volume 20, No. 5 February 6, 2015 

HCA Hospital-Homecare-Physician Collaboration Bill Ready for Senate Passage require a general hospital to: 1) allow a patient an opportunity to designate, upon admission to a hospital, a caregiver in the patient’s medical record; 2) 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; 3) offer to adequately train the designated caregiver in certain aftercare tasks upon a patient’s discharge to his or her current residence.

The state Senate Health Committee voted this week to report to the Senate Calendar legislation sponsored by Senator Kemp Hannon to establish the HospitalHomecare-Physician Collaboration Program.

The legislation, S.1110, was developed in conjunction with HCA and the Iroquois Healthcare Alliance. As indicated in last week’s ASAP, the legislation, just recently reintroduced, unanimously passed the State Senate last year. It also narrowly missed inclusion in last year’s final state budget.

The bill is now positioned for Senate action as soon as next week. The Assembly version of the bill, A.2011, is sponsored by Assemblywoman Aileen Gunther, chair of the Assembly Mental Health Committee. Assembly bill 2011 is in the Assembly Health Committee.

•

The bill would advance one of HCA’s important legislative and budgetary priorities for 2015, which is to support home care’s participation in new models and partnerships for care. It 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.

HCA appreciates Senator Hannon’s and Assemblywoman Gunther’s support and leadership on this issue.

Additional, Just-Introduced Legislation: •

S.2902 Senator Hannon, or the Home Care Stabilization Act: establishes standards for the prompt, fair and equitable settlement of claims for payments for personal care, home health care services, consumer directed personal assistance services and long term care services (referred to Senate Health Committee on January 30, 2015).

•

S.2913 Senator Hannon: requires those who contract through Licensed Home Care

HCA’s memorandum of support for the bill can be viewed in the Policy Positions section of our website at http://www.hca-nys.org/polpos.cfm.

Additional Senate Health Committee action This week the Senate Health Committee also voted forward the following bills: •

S.676 by Senator Hannon – This legislation would establish the “CARE ACT” (Caregiver Advise, Record and Enable Act). The bill would 6

S.2486 by Senator Hannon – This legislation would postpone the implementation date for the e-prescribing requirement for practitioners in New York State. The bill would provide an additional year, to March 27, 2016, for implementation of the requirements (now set to go into effect March 27, 2015). A broad coalition is supporting the additional implementation period. There are wide concerns about practitioner readiness for the 2015 date, as well as particular concerns in the case of nursing home and adult care facility residents due to additional system issues. Ultimately, the extension is sought to preclude potentially harmful disruption in patients’ access to their prescription medications.

See BILLS p. 23

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

Volume 20, No. 5 February 6, 2015 

President Releases Proposed Budget for FY 2016 This week, President Obama released his proposed budget for fiscal year 2016.

The proposed budget includes a series of Medicare provisions that would reduce and/or yield savings of $423.1 billion over 10 years, including through major reductions to Medicare home health and other long term care providers.

Some parts of the budget resemble proposals that were made before by the President but not approved by Congress. While Congress may likely again decline or reject major proposals in the budget process, it is possible that the proposals could nevertheless appear in other legislation such as the “physician fix” to the sustainable growth formula (SGR) that is needed to prevent large reductions in Medicare physician payments.

HCA will be working with our Washington government affairs firm, the National Association for Home Care and Hospice (NAHC), and the Forum of State Home Care Associations to oppose further funding reductions and new costs at a time when home care is coping with rebasing cuts, regulatory mandates like the face-to-face requirement, and other enormous strains on the system.

On the positive side, the President does propose to eliminate the 2 percent sequestration cuts for Medicare payments and other programs, but, again, Congress may advocate to pay for this proposal through further provider payment reductions or other offsets.

The 2 percent sequestration cut for Medicare payments has combined with other cuts to impose widespread Medicare operating losses on home health providers, especially in New York State where the average Medicare margin has been negative for more than twelve years in a row; HCA will press Congress to abandon the sequestration cuts, pursue a more sound approach to rebasing, and reject further disastrous reductions to an already financially fragile home care system, as conveyed in HCA’s recent home care financial condition report.

The Medicare proposals include the following: •

Reduce market basket updates by 1.1 percent in each year from 2016 through 2025 for home health, inpatient rehabilitation facilities and long term care hospitals ($15 billion reduction for home health agencies over ten years). According to NAHC, these payment reductions would be in addition to the rebasing of home health, home health productivity adjustments, and other actions. This proposal is coupled with a reduction in market basket updates for skilled nursing facilities, and the expecting savings is $102.1 billion over ten years.

•

Establish a copayment of $100 per home health episode, starting in 2019, for episodes with five or more visits not preceded by a hospital or inpatient post-acute stay ($830 million savings over ten years).

Similar copayment proposals have been floated in the past and later rejected during negotiations following a major advocacy push by the home care industry. The continual reemergence of copays as an issue will demand aggressive advocacy to ensure that these beneficiary costs are again removed from the bargaining table during budget debates or during negotiations over SGR legislation.

•

Implement bundled payments for home health and other post-acute care providers, starting in 2020.

Payments would be bundled for at least half of the total payments for post-acute care providers ($9.3 billion savings over ten years).

Continued on next page 7

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

Volume 20, No. 5 February 6, 2015 

Continued from p. 7 •

•

•

•

•

•

Implement a budget neutral valuebased purchasing program for additional provider types, including home health agencies, skilled nursing facilities and others, starting in 2017.

At least two percent of payments must be tied to the quality and efficiency of care in the first two years of implementation and at least five percent beginning in 2019 (no budget impact).

returned to appellants who receive a fully favorable appeal determination (no budget impact, as monies collected would be invested in the appeals system).

•

Allow HHS to retain a portion of Recovery Audit Contractor recoveries to fund appeals at the Office of Medicare Hearings and Appeals and the Departmental Appeals Board ($1.3 billion in costs over ten years).

• Include an additional $201 million to address health care fraud, waste and abuse (expected to save $21.7 billion over ten years).

Allow the Office of Medicare Appeals to issue decisions without holding a hearing if there is no material fact in dispute (no budget impact).

•

Allow the U.S. Department of Health and Human Services (HHS) to institute penalties against providers that fail to update their enrollment records ($29 million savings over ten years).

Increase the minimum “amount in controversy” required for adjudication by an Administrative Law Judge ($150) to the Federal Court amount in controversy ($1,460 in 2015). Appeals not meeting this threshold will be adjudicated by a Medicare magistrate (no budget impact).

•

Increase the surety bond amount for Medicare home health agencies to not less than $50,000 and commensurate with the volume of payments (no budget impact). According to NAHC, although CMS has the authority under the Affordable Care Act to impose a surety bond, it has not chosen to do so.

Remand an appeal to the first level of review when new documentary evidence is submitted into the administrative record at the second level of appeal or at a higher level. Exceptions may be made if evidence was provided to the lower level adjudicator but erroneously omitted from the record, or an adjudicator denies an appeal on a new and different basis than earlier determinations (no budget impact).

•

Allow HHS to adjudicate appeals through the use of sampling and extrapolation (no budget impact).

•

Lower the target rate for triggering action by the Independent Payment Advisory Board/IPAB ($20.9 billion savings over ten years). IPAB is charged with recommending Medicare savings if expenditures exceed certain levels.

•

Increase income-related premiums under Medicare Parts B and D, starting in 2019 ($66.4 billion savings over ten years).

•

Establish a new Medicare Part B surcharge for new beneficiaries who purchase near first-dollar

Allow the U.S. Centers for Medicare and Medicaid Services (CMS) to retain and invest civil monetary penalties assessed on home health agencies for activities to “improve the quality of care of patients receiving home health services” ($10 million costs over ten years).

Institute a per-claim filing fee for providers, suppliers and state Medicaid agencies at each level of Medicare appeal. Fees will be

8

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

Volume 20, No. 5 February 6, 2015 

Medigap coverage, starting in 2019 ($4 billion savings over ten years).

•

•

Increase the Medicare Part B deductible by $25 in 2019, 2021, and 2023 respectively for new beneficiaries beginning in 2019 ($3.7 billion savings over ten years).

Increase the minimum coding intensity adjustment for payments to Medicare Advantage managed care plans (savings of $36.2 billion over ten years).

Medicaid The proposed budget includes legislative Medicaid proposals that would cost $3.7 billion dollars. These include: •

Increase the Medicaid Integrity Program by $580 million over ten years.

•

Proposals to strengthen HHS’s and states’ ability to fight fraud, waste and abuse in Medicaid ($700 million savings over ten years).

•

Allow state Medicaid Fraud Control units to receive federal matching funds for the investigation or prosecution of abuse and neglect in non-institutional settings, such as home-based care, in which a beneficiary may be harmed while receiving health care services (no budget impact).

•

Create a pilot in selected states to expand eligibility for the Program of All-Inclusive Care for the Elderly (PACE) to individuals between 21 and 55, instead of the current requirement that enrollees be at least 55 (no budget impact).

•

•

Create a comprehensive long-term care state plan option (eight year pilot) for up to five states.

Participating states would be authorized to provide home and community-based care at the nursing facility level of care, creating equal access to home and community-based care and nursing facility care ($4.1 billion in costs over ten years).

Allow states to target their Health Home programs by age ($1 billion cost over ten years).

Continued on next page 9

LHCSAs: Join us For Feb. 25 LHCSA Forum With the Governor’s new budget, recent legal developments related to the ‘companionship exemption’ for home care, and other big issues, the time is right for LHCSAs to gather with HCA’s Policy staff and your colleagues for our next Downstate LHCSA Forum, on February 25 in New York City. A registration form is attached to the back of this week’s ASAP. HCA’s members-only forums are an important benefit of your membership.

These meetings invite HCA’s members for an exclusive discussion on issues of direct consequence to your organization.

Please join your LHCSA colleagues, HCA staff and Board Members for this valuable exchange of information, advocacy and recommendations on such issues as: the proposed state budget, the regulatory structure related to managed care integration with home care, the legal status of the companionship exemption, FIDA, QIVAPP funding, the progress of a state workgroup examining ‘advanced home health aide’ designation, DSRIP and more.

HCA Policy staff will provide LHCSAspecific information on all of these issue areas, offering a direct line for your input and questions.

Further details are below.

HCA’s Downstate LHCSA Forum February 25 10 a.m. to 2 p.m.

Selfhelp Family Home Care, Inc. 520 Eighth Avenue 5th Floor New York, NY 10018

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

Volume 20, No. 5 February 6, 2015 

Continued from p. 9 •

Extend the Medicare Savings Programs that pay the Medicare Part B premiums for certain low-income individuals for one year (cost of $975 million).

•

Extend the Money Follows the Person demonstration and modify the program to allow funds to be used to prevent individuals from entering an institution in addition to transitioning out of an institution; also would reduce the institutional requirement from 90 to 60 days and allow skilled nursing facility days to count towards this threshold (No budget impact).

•

Expand eligibility under the Community First Choice (CFC) Option by providing states with the option to make Medicaid available to individuals who would be eligible under the state plan if they were in a nursing facility ($3.6 billion cost over ten years). CFC is a state plan option to provide home and community based attendant services, along with a six percent increase in the federal medical assistance percentage (FMAP) to participating states.

•

Allow HHS to implement an integrated appeal process for individuals dually eligible for Medicare and Medicaid (no budget impact).

Medicare and Medicaid •

Expand the current authority to exclude individuals and entities from federal health programs if they are affiliated with a sanctioned entity by: eliminating the provision in current law that allows an officer, managing employee, or owner of a sanctioned entity to evade exclusion by resigning his or her position or divesting his or her ownership; and extending the exclusion authority to entities affiliated with a sanctioned entity ($70 million savings over ten years).

Other provisions •

Extend and expand voluntary, evidence-based home visiting services through the Maternal, Infant, and Early Childhood Home Visiting program by providing $500 million in 2016, and $15 billion over the next ten years. These services enable nurses, social workers, and other professionals to meet with atrisk families and connect them to assistance to support children’s health, development, and learning ability.

•

Provides $15 million for a new Family Support Initiative to support family members caring for older adults and/or people with disabilities of all ages. It is intended for the development and expansion of promising and evidence-based state and local approaches to supporting families. According to HHS, families are the largest provider of long-term care.

More information is at http://www.whitehouse.gov/omb/budget/.

HCA will provide further updates and analysis as developments occur. We will also keep the membership apprised of advocacy opportunities at critical milestones in the budget process to urge action in support of home care.

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

10

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

Volume 20, No. 5 February 6, 2015 

DOH Posts Independent Assessor Scores for DSRIP The state Department of Health (DOH) has posted the Independent Assessor Performing Provider System (PPS) Project Scores without 2.d.i Bonus for each project seeking Delivery System Reform Incentive Payment (DRSIP) awards.

See https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/docs/ independent_assessor_pps_project_scores_without_2.d.iBonus.pdf.

The Independent Assessor noted that most Project Plan Applications submitted were of extremely high quality.

These scores represent the final assessment by the DSRIP Independent Assessor on the project applications.

An Executive Summary for each PPS application has also been posted at http://www.health.ny.gov/ health_care/medicaid/redesign/dsrip/independent_assessor_scoring_summaries/. These summaries cover the overall scoring, reviewer comments, and a project-by-project summary.

Capital restructuring financing program HCA reminds members that February 20 is the deadline for Capital Restructuring Finance Program (CRFP) applications. The grants will be awarded to capital projects that further the objectives of DSRIP. More information on CRFP, including applications, is at http://www.health.ny.gov/health_care/medicaid/redesign/ dsrip/capital_restructuring_financing_program.htm.

HCA, HBCA Debrief on Storm Response and Preparedness Needs The Home Based Care Alliance (HBCA) Executive Committee members and HCA debriefed this week on the impact of the recent winter storms affecting regions of the state. HBCA is a network (largely situated in the downstate major metropolitan area) of direct care providers, local and state government entities and trade organizations that support homebound, elderly and disabled New Yorkers, with a focus on emergency preparedness.

Among the issues shared were reports of access barriers for home care and hospice staff due to the continued lack of “essential personnel” designation for this sector. The HCA-HBCA essential personnel legislation has been submitted for reintroduction by Assemblyman Michael Cusick and Senator Andrew Lanza, and merely awaits assignment of new bill numbers for the 2015 Legislative Session. (See the January 30 edition of ASAP for further background on the bill and status.)

Providers commended the state Department of Health for its efforts to assist the home care community, including the fact that it refrained from imposing simultaneous surveys and report requests (as was seen with Hurricane Sandy) that would have diverted priority resources and attention from direct response efforts.

Providers reported challenges with regard to preparedness and response coordination with managed care plans.

HCA and HBCA are planning follow-up efforts to promote improved and coordinated managed care planhome care agency emergency preparedness planning and response.

Continued on next page 11

ASAP – a publication of the Home Care Association of New York State Continued from p. 11 Please Participate in brief HCA Post-Storm Survey HCA asks each home care agency, hospice and managed long term care plan to please take a few moments to complete a brief three-question online survey conveying your experiences and recommendations stemming from the recent winter storm emergencies – including the November storm emergency in Buffalo and Western New York, and this more recent storm emergency as it affected your region.

The survey is available at https://www.surveymonkey.com/r/EPFeb2015.

The results of the survey will be extremely valuable to HCA as we work to advocate for home care emergency preparedness legislation and budget support. The results will also support our ongoing efforts in conveying home care emergency preparedness and response challenges and needs to state and regional emergency coalition partners.

For further information, please contact Al Cardillo at acardillo@hcanys.org.

Home Health Star Ratings Update The U.S. Centers for Medicare and Medicaid Services (CMS) held an Open Door Forum this week on its proposed Home Health Compare Star Ratings initiative and posted a revised Frequently Asked Questions (FAQs) document and background information.

As mentioned in previous editions of ASAP, CMS proposes to establish a star rating for home health agencies (HHAs) on Home Health Compare, starting about July 2015.

According to CMS, HHAs will have an opportunity to see their star ratings several weeks prior to posting on Home Health Compare and to give feedback if they identify crucial errors.

All Medicare-certified HHAs will be eligible to receive a star rating. Currently, HHAs must have at least 20 complete quality episodes for data on a measure to be reported on Home Health Compare. Completed episodes are defined as paired start or

12

Volume 20, No. 5 February 6, 2015 

HCA & VNAA Offer Clinical Procedures Manual to Members at Discount HCA has partnered with the Visiting Nurse Associations of America (VNAA) to offer members a discount on the 19th edition of the VNAA Clinical Procedures Manual. The manual, available in both paper and electronic download, offers more than 300 step-by-step standardized procedures that put the latest best practices at your fingertips. The 19th edition includes the latest in technologies, as well as new procedures for cardiology, infection control, mental health and more.

The retail cost of one manual, either in paper or digital format, is $1,800.

However, HCA members can receive one manual for only $1,530.

Substantial discounts are available for multiple purchases of digital licenses for electronic devices. As an example, 10 digital licenses would cost $2,210 total, bringing the fee down to $221 per manual. Members of VNAA receive an even greater discount.

To learn more about the content and to purchase the manual online, visit http://vnaa.org/cpm and include HCA’s code 19NY2014. You can also download the order form that includes the HCA code at www.hcanys.org/events.cfm and mail or fax it to VNAA. For more information, contact Lynda Schoonbeek at (518) 810-0656 or Lschoonbeek@hcanys.org.

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

Volume 20, No. 5 February 6, 2015 

resumption of care and end of care Outcome and Assessment Information Set (OASIS) assessments.

Episodes must have a discharge date within the 12-month reporting period regardless of admission date. To have a star rating computed for Home Health Compare, HHAs must have reported data for 6 of the 10 measures used in the calculation.

The proposed measures include the following: •

Process Measures – Timely Initiation of Care; Drug Education on all Medications Provided to Patient/ Caregiver; Influenza Immunization Received for Current Flu Season; and Pneumococcal Vaccine Ever Received.

•

Outcome Measures – Improvement in Ambulation; Improvement in Bed Transferring; Improvement in Bathing; Improvement in Pain Interfering With Activity; Improvement in Dyspnea; and Acute Care Hospitalization.

CMS provided the following new information in its revised FAQs: •

CMS is working to incorporate patient experience-of-care measures (Consumer Assessment of Healthcare Providers and Systems/CAHPS data) into the star ratings now and is considering how to include additional information such as survey results and consumer complaints in the future.

•

The star ratings will have the same 12-month reporting period as the rest of the quality measures reported on Home Health Compare.

•

The measures for star ratings are different from the criteria to be used for value-based purchasing and, therefore, valuebased purchasing would require a separate evaluation process.

HCA Offers OASIS-C1 Basics Webinar Series HCA is offering a series of five affordable webinars on OASISC1 Basics, beginning February 26.

The series will focus on assisting home health clinical staff, QI coordinators and supervisors on federal requirements for collection of OASIS items on home health patients at several time points. You may participate in one or all of the teleconferences that run through March 26. This program will also prepare participants for a future COS-C exam.

Part one, on February 26, will cover the OASIS data collection requirements, general conventions and CMS resources. The patient tracking, clinical record items and OASIS credentialing opportunities will also be discussed. The remaining teleconferences will review specific diagnoses.

A brochure with further details and registration information is at www.hcanys.org/events.cfm.

In response to concerns expressed by HHAs and associations that consumers have negative feelings about an entity with three stars, CMS states that it will explain what the stars signify (that they are a comparison to other agencies) and will test the presentation of the star ratings to confirm that consumers comprehend the information.

Also on HCA’s education web page, you will find additional learning opportunities such as the ICD-10-CM Readiness Boot Camp that will be held in Albany on February 25 and the newly announced webinar on How to Plan and Package Care Transitions: A Provider’s Perspective on March 19, and more.

In its background material, CMS states that the updated proposed methodology addresses several stakeholder concerns including the difficulty in distinguishing differences in quality for the large number

For more information, contact Lynda Schoonbeek at (518) 810-0656 or Lschoonbeek@hcanys.org.

•

13

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

Volume 20, No. 5 February 6, 2015 

of agencies falling in the middle (3 star) category (over 50 percent) and the need to allow for finer distinctions than whole star ratings by reporting results based on half star increments.

Other adjustments include: •

An initial ranking of agencies by deciles, rather than quintiles.

•

An adjustment of the initial ranking by comparing each agency’s measure scores to the national agency median, rather than the national average. This is intended to provide a more balanced distribution for measures that are skewed.

•

The initial rankings are adjusted by half stars instead of a full star based on the results of the statistical significance test based on comparison to the national median agency value.

•

CMS has updated the algorithm for translating the composited adjusted star rating into an overall star rating. The algorithm is now designed to assign half star ratings on a scale from one to five stars.

The Open Door Forum included a summary of the comments received on the material presented at a December call and other aspects of the methodology; an overview of the revised methodology; and plans for next steps.

Additional information presented during the Forum included: •

July 2015 star ratings will reflect OASIS data from January through December 2014 and claims data from October 2013 through September 2014.

•

Star ratings will be updated quarterly.

•

CMS expects the star rating methodology to be evaluated and refined over time.

•

HHAs will receive preview reports around the end of March that show their star rating and how it was derived and will have several weeks to review and provide feedback.

CMS is taking comments on the revised star rating structure until February 13.

The FAQs, background information and CMS webinar materials are posted at http://www.cms.gov/Medicare/ Q u a l i t y - I n i t i a t i v e s - Pat i e n t - A s s e s s m e n t - In s t ru m e n t s / Ho m e He a l th Q u a l i t y In i t s / HHQIHomeHealthStarRatings.html.

HCA has long advocated for changes in the Home Health Compare rating system which, problematically, lumps together data both for Certified Home Health Agency and Long Term Home Health Care Program populations and, therefore, does not distinguish outcome measures for cases involving chronic-care services where maintenance and stability may be a foremost goal over improvement.

As the system continues its transition to managed care, these chronic-care-based outcomes measures remain captured in the assessments performed by Medicare-certified agencies serving the chronic-care population, as compared to other states whose community-based long term/chronic care system is not as robust. HCA will continue to examine this issue in light of the new star-rating system.

14

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

Volume 20, No. 5 February 6, 2015 

CMS Reminds Hospice Providers to Participate in CAHPS Survey Dry Run

HCA, Council Send Home Health Compare Report to Providers

The U.S. Centers for Medicare and Medicaid Services (CMS) reminded eligible hospice providers to get started with the Consumer Assessment of Healthcare Providers and Systems (CAHPS) hospice survey.

HCA, in conjunction with the Council of State Home Care Associations, this week sent our Medicare-certified provider members updated Home Health Compare reports using the provider’s OASIS-C data from July 2013 through June 2014.

February is the second month of the Hospice CAHPS Dry Run. Eligible hospices must participate in at least one month of the Hospice CAHPS Dry Run ( January, February, or March 2015), followed by ongoing monthly participation starting April 2015. To get started with Hospice CAHPS, hospices must contract with a CMSapproved vendor, authorize the vendor, and send them lists of patients for the sampled months.

Successful participation in Hospice CAHPS can impact hospices’ Medicare Annual Payment Update for fiscal year 2017.

The reports contain individual agency dashboard data provided by Healthcare First, a contributing vendor for HCA and the Council, including a comparison to outcomes of providers in each agency’s market and a snapshot of the provider’s outcomes history.

Also included is the quarterly update of an individual agency’s OASIS percentile data: an agency-specific report that provides the agency’s outcome percentile in the state and nationally.

At this time, the reports, which are issued three or four times annually, can only be sent to one person per agency. If you would like to change who receives the reports at your agency, please email HCA’s Vice President for Finance and Management Patrick Conole at: pconole@hcanys.org

Additional information, including the criteria which make hospices eligible to participate in the CAHPS survey, can be found at the Hospice CAHPS survey website at: www.hospicecahpssurvey.org. For technical assistance, hospices can send an e-mail to: hospicecahpssurvey@hcqis.org or call toll free at: 1-844-472-4621.

CMS to Update Home Health Pricer Software on April 1

Home Health CAHPS Reminder CMS also encourages all Medicare-certified HHAs to participate in the Home Health CAHPS Survey (HHCAHPS). Home Health Agencies (HHAs) can find additional information on the CAHPS survey at https://homehealthcahps.org.

The next annual payment update (APU) for HHCAHPS participation is from April 2015 to March 2016, and counts towards the Calendar Year 2017 APU. For questions or assistance about HHCAHPS, send an e-mail to hhcahps@rti.org or homehealthcahps@cms.hhs.gov.

The U.S. Centers for Medicare and Medicaid Services (CMS) has identified two errors in the 2015 home health Pricer. A corrected Pricer will be installed on April 1, 2015.

The corrections affect certain claims where the Pricer recodes are being returned to the provider incorrectly, using FISS reason code 37224.

Affected home health agencies may resubmit the returned claims after April 1.

For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

15

CFO Forum March 18, 2015

9:00am – 3:30pm Albany Hilton Albany, New York 12207

16

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

Volume 20, No. 5 February 6, 2015 

CMS Forum to Highlight Electronic & Paper Template to Assist Physicians Document Patient Eligibility The U.S. Centers for Medicare and Medicaid Services (CMS) will host a Special Open Door Forum on Wednesday, February 11, 2015, from 1 to 2 p.m. to assist physicians/practitioners in thoroughly documenting patient eligibility for the Medicare home health benefit.

CMS is considering the development of a voluntary home health paper clinical template while a voluntary home health electronic clinical template remains in the development process for the past year. According to CMS, the purpose of these templates is to help reduce the documentation burden on physicians and practitioners who order home health services.

In fiscal year 2014, the Comprehensive Error Rate Testing (CERT) program found that more than half of home health claims were paid improperly, and inadequate face-to-face documentation was a big driver of these CERT errors. Of the 630 CERT-reviewed claims found to include errors, 564 (89.5 percent) did not have documentation meeting the face-to-face requirement.

The participant dial-in number for this call is 1-866-501-5502. The conference ID number is 76792263.

Additional calls on the templates will be held on March 11, April 8 and May 6, all at 1 p.m.

CMS’s presentation will soon be posted to: https://www.cms.gov/Research-Statistics-Data-and-Systems/ Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-Review/ Home_Health_Medical_Review_Update.html.

Feedback and questions on the templates can be sent to HomeHealthTemplate@cms.hhs.gov. A transcript and audio recording will be posted at: http://www.cms.gov/OpenDoorForums/05_ODF_SpecialODF.asp.

For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

New Instructions Posted for Using Notice of Non-Coverage Forms The U.S. Centers for Medicare and Medicaid Services (CMS) has posted new instructions for using the Notice of Medicare Non-Coverage (NOMNC) and the Detailed Explanation of Non-Coverage (DENC) forms.

The new instructions, along with the existing forms, are at http://www.cms.gov/Medicare/Medicare-General-Information/BNI/FFSEDNotices.html.

Home health agencies (HHAs), skilled nursing facilities, hospices and comprehensive outpatient rehabilitation facilities are required to give their patients a NOMNC at least two days in advance of when all their Medicarecovered services will end. If the patient appeals the decision to the Quality Improvement Organization (QIO), the HHA or other provider must give the patient a DENC by the close of business of the day that the QIO notifies the agency that an appeal was made.

The forms and accompanying instructions apply to Medicare beneficiaries in the fee-for-service (FFS) system and those in Medicare Advantage managed care plans.

Continued on next page 17

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

Volume 20, No. 5 February 6, 2015 

 Continued from p. 17 CMS indicates that the forms have not been revised and the instructions were merely clarified slightly to cohere with instructions contained in Chapter 30 of the Claim Processing Manual.

The instructions include examples of situations when a NOMNC should not be delivered, including when: beneficiaries never received Medicare-covered care at home due to a face-to-face visit not conducted; services are being reduced (this would require an Advance Beneficiary Notice of Noncoverage, or ABN); beneficiaries move to a higher level of care, such as home health ends because the patient goes into a nursing home; and other cases.

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

Managed Care Update FIDA The U.S. Centers for Medicare and Medicaid Services (CMS) has posted a “Frequently Asked Questions for Providers” document about the Fully Integrated Duals Advantage (FIDA) program.

The FAQs are at http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-MedicaidCoordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/Downloads/ NYProviderFAQ.pdf.

The New York Legal Assistance Group has posted a consumer fact sheet at http://www.wnylc.com/health/ afile/166/520/ and additional information at http://www.wnylc.com/health/entry/166/.

As mentioned in previous editions of ASAP, New York started to send announcement notices about FIDA to New York City and Nassau dual-eligible participants in December and expects to send similar letters to Suffolk and Westchester individuals in March. Current Managed Long Term Care (MLTC) enrollees who have not already made an affirmative choice of a FIDA plan or opted-out of FIDA will be “passively” enrolled into a FIDA plan starting as soon as April 1, 2015 in New York City and Nassau and as soon as July 1, 2015 in Suffolk and Westchester counties.

The announcement letters are followed up with 90-day, 60-day and 30-day notices to those who did not join a FIDA plan.

Individuals who are enrolled in a FIDA plan can opt out any time and will then be enrolled into an MLTC plan that does not cover their Medicare benefits; these benefits would be obtained by returning to fee-for-service Medicare or a Medicare Advantage managed care plan. Individuals in a FIDA plan can also switch plans at any time.

More information on FIDA is at http://www.health.ny.gov/health_care/medicaid/redesign/mrt_101.htm.

Managed Care Technical Assistance Center The Managed Care Technical Assistance Center (MCTAC) has posted a Frequently Asked Questions (FAQs) document developed from the recent Behavioral Health Medicaid Managed Care Training Kick-Off Forums. It is at http://www.mcsilver.org/wp-content/uploads/2015/01/2014-1-23-MCTAC-Kick-off-FAQs.pdf. New 18

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

Volume 20, No. 5 February 6, 2015 

York contracted with MCTAC to provide training and intensive support on quality improvement strategies, including business, organizational and clinical practices to achieve the overall goal of preparing and assisting providers with the transition to Medicaid Managed Care.

MCTAC held a series of in-person forums across the state covering such topics as the children’s system, billing, home- and community- based services, housing, reimbursement, rates, and utilization management. In addition, MCTAC held four comprehensive sessions on managed care contracting and negotiation basics.

The FAQs, contracting video, and other materials are now available on MCTAC’s website at http://mctac.org/page/get-the-right-tools/resources/.

State Releases November Medicaid Global Cap Spending Report Home care and personal care spending slightly above projections The state Department of Health (DOH) has issued its November 2014 Medicaid Global Spending Cap report.

It shows spending to be $10 million less than projected for the current fiscal year through November. (The current state fiscal year began on April 1 and ends March 31, 2015.)

The actual spending amount for this seven-month period was $11.436 billion versus an estimated spending amount of $11.446 billion. The cap for the entire fiscal year is $17 billion.

DOH’s report is at: http://www.health.ny.gov/health_care/medicaid/regulations/global_cap/monthly/ sfy_2014-2015/docs/november_2014_report.pdf.

For DOH’s reporting purposes, home care services and personal care services are lumped into the category labelled “Other Long Term Care.”

According to the report, that category was $4 million below projections for the seven-month period ending November 30 – a difference between projected spending of $477 million and actual spending of $473 million.

Medicaid Managed Care was $3 million over the projection of $8.058 billion for this period, according to the report. More specifically: •

Mainstream Managed Care was $22 million, or 1.3 percent, over (or above) projections.

•

Long Term Managed Care was $19 million under projections through November. Total enrollment in the program is approximately 4.0 percent below expected levels (by a difference of 5,400 recipients).

Medicaid enrollment reached 5,991,834 at the end of November 2014, an increase of 287,397 enrollees (or 5.0 percent) since March 2014. The report breaks down this data by managed care and fee-for-service enrollment, and enrollment totals for New York City and the “Rest of the State.”

DOH’s report also provides other data on accounts receivable data, Medicaid rate adjustments, enrollment in the state’s health care exchange, and various state Medicaid savings initiatives.

As conveyed to members during a statewide budget conference call earlier this week (see related p. 1 story), HCA has expressed concerns to the Department of Health about the impact of retroactive payments on the 19

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

Volume 20, No. 5 February 6, 2015 

global cap. The state’s calculation of spending relative to the global cap is cash-based, meaning that any retroactive payments made to providers for services in one year could actually be measured against the cap in a later year, leaving the system vulnerable to spending overruns if the cap forecast doesn’t account for the payment delay.

Such could be the case for the 2 percent across-the-board cut, which the state is seeking federal approval to eliminate, retroactive to April 1, 2014. HCA has discussed this issue with the Department and will be carefully assessing the reconciliation of funds relative to the cap.

For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

Livanta QIO Update Since August 1, 2014, Livanta LLC has been conducting all Medicare quality review cases, appeals, and complaints as the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for New York and some other states.

Providers can visit Livanta’s website to check on case status by simply inputting the case number. Livanta’s Arrow system (at www.BFCCQIOArea1.com/checkyourcase.html) provides a real-time snapshot of the current status of your case: green arrows indicate completed steps, and gray arrows indicate steps that have yet to be completed.

Only high-level information is shared – no provider or patient information will be made available through the website.

Currently, Arrow can be used to check on the status of appeals and quality cases.

Home health agencies, hospitals, and other health care providers are required to sign a Memorandum of Agreement (MOA) with Livanta. The MOA form is at www.BFCCQIOArea1.com/provider.html.

For MOA assistance, contact Area 1 Communications Lead Laura Dugan at BFCCQIOArea1@livanta.com or (717) 450-5781.

Livanta is also the Comprehensive Error Rate Testing (CERT) Contractor for New York health care providers, so HCA advises members to review any correspondence from Livanta to determine if it is QIO or CERTrelated.

As part of the changes to the QIO program, medical case review was separated from quality improvement activities. Under this restructuring, Quality Innovation Networks (QIN)-QIOs now work with providers on data-driven quality initiatives.

Effective August 1, 2014, IPRO is the Medicare-funded QIN contractor for New York, South Carolina and the District of Columbia. Under a new arrangement, state-based QIOs have been replaced by regional QIN contractors, focusing on hospital and nursing home quality improvement, care transitions, drug safety, disease self-management and better primary care through enhanced health information technology. The IPRO-led entity is known as the Atlantic Quality Innovation Network or AQIN.

20

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

Volume 20, No. 5 February 6, 2015 

NGS Updates: Beginning April 1, HIPPS Codes on Home Health Claims to Be Matched Against OASIS National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), has recently posted the following information to its website.

•

CMS to Begin Matching OASIS With HIPPS Codes on Claims – Beginning on April 1, 2015, Medicare systems will compare the Health Insurance Prospective Payment System (HIPPS) code on a Medicare home health claim to the HIPPS code generated by the corresponding Outcomes and Assessment Information Set (OASIS) assessment before the claim is paid. If the HIPPS code from the OASIS assessment differs, Medicare will use the OASIS-calculated HIPPS code for payment.

Previously, the transmission of assessment data and the submission of claims were entirely separate processes. The Fiscal Intermediary Shared System (FISS), which processes all Original Medicare home health claims, did not have access to the quality data repository. As a result, FISS could not validate the submitted HIPPS code against the associated OASIS assessment.

The U.S. Centers for Medicare and Medicaid Services (CMS) has planned for several years to create a file exchange interface with the national quality data repository to provide the infrastructure needed to validate HIPPS codes against OASIS assessments. During 2014, the Medicare Administrative Contractors (MACs) successfully began testing the home health OASIS and claim matching process.

Home health agencies (HHAs) are not required to make any changes to their billing systems. Claims will be suspended temporarily during processing to allow for the file exchange between FISS and QIES. The claims will be suspended with FISS reason code 37071 in status/locations SMFRX0SMFRX4. This will occur during the 14-day payment floor period and should not delay payments to HHAs. HCA members can go to the following CMS link for additional information on this issue: http:// w w w. c m s . g o v / O ut r e a c h - a n d - E d u c a t i o n / Me d i c a r e - L e a r n i n g - Ne t wo r k - M L N / MLNMattersArticles/Downloads/SE1504.pdf.

•

Implementation of the Intravenous Immune Globulin (IVIG) Demonstration and Processing for Home Health Service Overlap Editing – In 2014, CMS issued Change Request (CR) 8599 (http:/ /www. cm s.g ov/Re g ulat ions -and-Guidance/Guidance/Transmitt als/D ow nloads/ R115DEMO.pdf ) regarding the implementation requirements for the Intravenous Immune Globulin (IVIG) Demonstration. Under this demonstration, demonstration claims are not payable if the beneficiary is receiving home health services under a home health episode of care on the same date of service. In such situations, services related to the administration of IVIG in the home should be provided by the home health provider and covered under the home health payment system.

During the testing of CR 8599, a problem was identified in how the date editing was processed to identify when enrolled beneficiaries were also receiving home health services. The purpose of this CR is to correct the editing in the standard systems.

Continued on next page 21

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

Volume 20, No. 5 February 6, 2015 

Continued from p.21 •

Preventing Inappropriate Payments on Home Health Low Utilization Payment Adjustment (LUPA) Claims – CMS has recently issued CR 9027 (http://www.cms.gov/ Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3176CP.pdf ) which creates new edits in Original Medicare systems to ensure LUPA payments under the Home Health Prospective Payment System (HHPPS) are made appropriately. It also clarifies billing instructions for HHPPS claims

•

New Version of PC Print: February 2015 – Version 5.0.2 of PC Print is now available on NGS’s website. This version corrects a printing issue identified with a previous version of PC Print. When the Single Claims report was printed, the complete narrative associated with a CARC or RARC was not printing. This issue is resolved with PC Print version 5.0.2.

PC Print version 5.0.2 is not compatible with Windows 8. For Windows 8 users, there is an option for compatibility mode when installing the software. One can perform the installation by using the right click of the mouse over the executable, and then install the compatibility mode option. This may vary from system to system.

•

Reminder: New Fax Number for Credit Balance Submissions – As of July, 1, 2014, the number used for Jurisdiction 6 Credit Balance submissions was changed to 315-4424287. Credit Balance reports sent to the previous number (414-459-5700) will not be accepted.

For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

Publications •

“Summary of Medicare Provisions in the President’s Budget for Fiscal Year 2016,” by the Kaiser Family Foundation http://files.kff.org/attachment/issue-brief-summary-of-medicare-provisions-in-thepresidents-budget-for-fiscal-year-2016

•

“Importance of Checking for Medicare Advantage Organization Plan Coverage,” by National Government Services http://tinyurl.com/nojx2g2.

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

22

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

Volume 20, No. 5 February 6, 2015 

BILLS continued from p. 6 Services Agencies (LHCSA) for home care aide services to reimburse the LHCSA the total average hourly worker cost, including the current total compensation mandated and additional fringe and other statutory and benefit requirements, and an administrative and general cost factor (referred to Senate Health Committee on January 30, 2015).

•

S.3262 Senator Hannon/A.2332 Assemblyman Brindisi: Requires contracts with home care service providers to provide sufficient resources to ensure compensation to a qualified workforce providing high quality care; authorizes the commissioner of health to establish a program to provide loans, through the dormitory authority, to home care facilities to finance health care reform efforts (referred to Senate Health Committee on February 2, 2015 and Assembly Health Committee on January 16, 2015).

•

A.4655 Assemblyman Colton/S.3182 Senator Stavisky: permits licensed physician, visiting nurse, nurse, physical therapist or chiropractor to park where parking is prohibited if vehicle is identified by special placard (referred to Assembly Transportation Committee on February 5, 2015).

•

S.3100 Senator Ritchie/A.1127 Assemblywoman Gunther: restricts consecutive hours of required work by nurses in the home care setting except in emergencies; does not prohibit a nurse from voluntarily working overtime (referred to Senate Labor Committee on February 2, 2015 and Assembly Labor Committee on January 8, 2015).

•

A.1267 Assemblywoman Lupardo/S.1319 Senator Savino: amends the reporting requirements for employers which violate wage payment provisions and eliminates the duty of the Labor Commissioner to investigate such employers’ records for the previous 6 years; and repeals the Wage Theft Prevention Act enforcement account (referred to Assembly Labor Committee on January 8, 2015).

For further information, please contact a member of the HCA Policy staff.

23

DOWNSTATE LHCSA FORUM Please join your LHCSA colleagues, HCA staff and Board Members for this exchange of valuable information, advocacy concerns and recommendations for action.

Some of the vital issues to be covered include: • Proposed State Budget • Continued regulatory issues related to home care services delivered through managed care plans • Companionship Exemption lawsuit • Quality Incentive/Vital Access Provider Pool (QIVAPP) funding • Fully Integrated Duals Advantage (FIDA) • Advanced Home Health Aide Workgroup • Developments in HIT, Technology and Quality • DSRIP • Additional Issues or Concerns

February 25 10:00am – 2:00pm Location:

Selfhelp Family Home Care, Inc. 520 Eighth Avenue 5th Floor New York, NY 10018

$40 per person This is an HCA members-only forum.

Registration ____________________________________________________ Name ____________________________________________________ Title

This forum is for HCA Members Only.

There is a fee of $40 for attending the LHCSA Forum to cover the cost of meeting material, food and refreshments.

If registering multiple participants, please complete a registration form for each additional person.

____________________________________________________ Agency ____________________________________________________ Address ____________________________________________________ City/State/Zip ____________________________________________________ Phone/Ext. ____________________________________________________ Email (Required)

Cancellation Policy Cancellations received by February 15th are refundable less a 25% 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.

Payment of $40 per person ________ VISA

_________ MC

________ AM EX

Credit Card No._______________________________________ Expiration Date:_______________ Sec. Code:_______________ Card Billing Address:___________________________________ ____________________________________________________ Name on Card:________________________________________

Sponsored in part by:

Signature:____________________________________________ Or, make checks payable to: HCA and mail to 388 Broadway, 4th Floor, Albany, NY 12207

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

Driving Health Care Improvement and Savings Through Home Care Home Care’s Core Role in New Policies and Care Models State, national and health system leaders are all turning to home care to help drive an agenda of health improvement, quality and cost savings. Home care providers are being commissioned for this task through their vital partnerships with hospitals, physicians, and other stakeholders in achieving the ‘triple aim’ of better care for individuals, better care for health populations, and cost-effective service utilization.

This overall policy vision assumes a core role for home care in virtually every major care model and cost-savings initiative. Home care providers are being asked to: coordinate and provide services to high need/complex care cases, help improve patient care transitions, prevent avoidable hospitalizations and long term care institutionalization, provide service access to remote and under-served populations, and more. Policy leaders are counting on home care’s expertise and innovation for solving some of the most serious, costly and priority concerns plaguing the health system. The success of numerous priority initiatives hinges on a well-functioning home care system.

Home Care is vital to: The state-mandated enrollment of individuals into managed care; Operation of the state’s new Fully Integrated Duals Advantage (FIDA) program, implemented on January 1, 2015; Implementation and operation of the Delivery System Reform Incentive Payment (DSRIP) program, beginning in April; Avoidance of state and federal financial penalties on hospitals for readmissions; Successful implementation of the state’s health home initiative; and more.

The dependence on home care in today’s policy environment is exceeded only by the direct and increasing needs of elderly, chronically ill and disabled individuals looking to home care as a means to remain independent and healthy at home, especially as the population ages.

For the sake of better health, lower costs and improved system operation, home care must be available, supported, and at the ready.

2015-2016 State Budget Actions Needed to Equip Home Care to Meet State Goals and Citizens’ Needs

388 Broadway Fourth Floor Albany, New York 12207 P: (518) 426-8764 F: (518) 426-8788

Driving Health Care Improvement and Savings Through Home Care Enabling Home Care to Fulfill the State’s Health Program Goals and the Needs of NYers New York’s home care community asks the Executive and Legislature to adopt the following support measures so that home care can best fulfill the state’s intended service, health outcome and cost-reduction policy goals, and ultimately the needs of New York’s citizens.

Health Information Technology and Clinical Technology Development – Connecting and Unleashing Home Care Innovation and Integration Requested State Action:

Finance and Incentivize Home Care Technology

Incorporate provisions in the 2015 state budget to invest in health information technology and integrated clinical technology for home care. Such technology investments should be targeted to promote health care quality, cost-effectiveness, care management, and integration of home care within provider systems, between sectors, and with regional and statewide health information systems.

These home care technology efforts can be accomplished through adjustments to managed care and managed long term care premiums, adjustments to provider fee-for-service rates, the addition of technology investment as a criterion for quality incentive payments to managed care plans, inclusion of home care technology investment as an explicit expectation of all Performing Provider Systems seeking DSRIP funds, and other measures.

Why it is needed:

Health information technology and clinical technology are at the core of every aspect of health facility/agency operation; they are integral to service delivery, quality evaluation and outcomes, cost-effectiveness and administration. However, state, federal and private payors have long overlooked home care in the health IT development arena, even though virtually every new state policy and care model requires this kind of technology infrastructure and interoperability to succeed.

Update Health Coverage/Payment Innovation to Reflect Home Care’s Current Role Requested State Action:

Update State Insurance Law Provisions for Home Care

Incorporate provisions in the 2015 state budget to modernize the long-outdated insurance law coverage provisions for home care, which would support patients, the overall system and Medicaid savings.

Why it is needed:

The current home care coverage provisions, adopted in the early 1970s, were designed for the health care system at that time. Back then, hospitals were reimbursed per diem and without today’s limitations on length of stay; nursing homes were the primary option for chronically ill patients who lacked family support; and home care itself occupied a very narrow niche versus its heavily relied-upon, core role in today’s system.

Simply put, the type of system that framed these original insurance provisions bears little resemblance to the health care system of today.

The time is ripe for insurance reforms to: eliminate artificial limitations; create a framework that reflects today’s home care service structure; and cover home care/partner innovations in care transitions, care management, telehealth, etc. These changes are essential to patient access, the efficient and effective operation of our health care system, the lowering of costs and the avoidance of Medicaid spend-down/long term institutionalization for many patients.

Ensuring Adequate and Efficient Managed Care-Provider Payment Requested State Action:

Amend the Managed Care-Home Care Payment System Incorporate provisions in the 2015 state budget to ensure that rate methodologies for managed care and managed long term care premiums, as well as the ensuing payments to providers, are adequate to meet plan/provider/patient needs and fulfill state public health goals and mandates. The same standard is also necessary in the state’s direct payment to providers.

Why it is needed:

The current state payment structure for the managed care-home care model is not adequately supporting service goals and requirements. It also does not incorporate the desired efficiencies for plans, providers and taxpayers, nor does it ensure workforce stability. Additionally, the Department’s direct payment methodologies for home care similarly need responsiveness to the changing system and both workforce and service needs.

Payment standards must be developed which ensure that managed care premiums and provider payment rates are adequate to meet the needs of: enrollee services, maintenance of a qualified home care workforce, and “public goods” (such as staff training, capital, public health, etc.). Payment standards must also cover the cost of essential supports formerly included under fee-for-service – but now relegated to rate negotiation – as well as the significant costs of state and federal mandates, such as the wage parity law, changes to the federal companionship exemption, the state’s pre-claim “visit verification” requirement, added supervision/training requirements associated with the anticipated new Advanced Home Health Aide designation, and other mandates. The managed care/home care financing system also must promote efficiency by: supporting the well-established and cost-effective home telehealth program; streamlining billing and payment procedures for providers and plans through standardized codes, uniform billing and/or other procedures; and addressing, through the managed care quality incentive pool criteria and other means, adherence to prompt-pay/cleanclaim payment standards.

With regard to direct agency payments, DOH will be rebasing the Medicaid payment methodology for certified home health agencies, the outcome of which (i.e., the payment level and responsiveness to critical needs) will be crucial for both these agencies and subcontracting licensed home care services agencies.

Facilitating Home Care Innovation & Participation in New Models Requested State Action:

Amend the Law to Encourage Innovation & Remove Barriers Incorporate provisions in the 2015 state budget amending Article 36 and respective portions of the Public Health Law to facilitate home care innovation and participation in new models and partnerships for care, such as: new types of home care partnership initiatives with hospitals, physicians, long term care facilities, behavioral health, and others; participation in ACOs and Health Homes; home care-housing/community service combinations; telehealth innovation; new innovations in care and agency service lines, and other.

Why it is needed: The state has created and encouraged formation of new models and partnerships for care.

Such partnerships include home care and behavioral health providers, physicians, nursing homes, hospitals and others. In keeping with the state’s assumption of a prominent role for home care in these designs, the governing statutes should be amended to better promote home care’s participation and innovation.

Quality Enhancement Requested State Action:

Finance and Incentivize Advances & Innovation in Quality Incorporate in the 2015 state budget some set-aside funds and programmatic provisions for quality innovation and enhancement for home care.

Why it is needed:

Aligning and Streamlining Home Care-Managed Care Regulation Requested State Action:

Authorize DOH Regulatory Flexibility & Fix for this Model Incorporate provisions in the 2015 state budget to add specific DOH waiver authority and directives to implement existing recommendations already made by the State Workgroup on Home and Community Based Care for streamlining and aligning managed care-home care regulations.

So many opportunities exist for the state to pursue quality advancement and cost-savings by fostering home care’s development of best practices, clinical protocols, clinical pathways, evidence-based practice, technology, staff training/specialty care development, quality risk assessment, quality benchmarking, and other initiatives. The HCA Quality Committee has developed groundbreaking proposals for home care quality advancement in all of these areas. However, no dedicated funding pool currently exists to help seed these quality innovations for home care, which would carry benefits to all sectors – and, above all, benefits to patients.

Why it is needed:

The State Legislature and Governor adopted a state policy that mandates enrollment of long term home care patients into managed care. The model calls for managed care plans and home care agencies to contract with one another for the delivery and financing of care. However, the regulatory provisions for managed care and home care continue to govern each respective sector in fragmented silos, rather than reflect the new contractual, integrated model enacted into statute. This lack of realignment has left in place overlapping, conflicting, confusing, excessive and costly duplication. In 2013, the Legislature and Governor created, and in 2014 renewed, a Home and Community Based Care Regulatory Workgroup to make recommendations on alignment and streamlining of regulations for the new system. Additionally, a coalition of state health associations has been working diligently to support this effort. The Department should be given the authority and directive to act promptly and thoroughly on the workgroup’s and provider/health plan/association recommendations.

HCA will be providing specific legislative, budget and/or administrative language as necessary for the adoption of these critical home care proposals.