February 13, 2015 ASAP

ASAP

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

Legislative Issues  Public Policy



News

Volume 20, No. 6 February 13, 2015

As HCA Presses Advocacy Message in Albany, We Need Your Voice of Support in the Home District Next Week HCA’s Policy team and our contract government affairs representatives, at Wilson Elser and Albany Strategic Advisors, met on Monday with the Governor’s office, the Senate and Assembly leadership, and legislators representing all regions of the state to discuss our state budget priorities.

Monday’s meetings were originally arranged for state officials and legislators to meet with HCA’s Board of Directors to discuss advocacy needs in home care. But as the state got hit with yet another severe winter storm – requiring providers’ attention to the needs of affected patients and critical operations back at their home offices – HCA Policy staff took the opportunity to meet in small groups with nearly 20 offices representing an important cross-section of leadership and committee members who have a direct impact on state budget outcomes.

See ADVOCACY p. 2

HCA Leads Home Care Quality Initiatives with Beta Test of Risk Tool HCA this week launched a beta test of our new, foundational Home Care Quality Risk and Compliance Tool, developed through the HCA Quality Committee, and, in particular, though the leadership of HCA Board and Quality Committee member Laurie Neander, President and CEO of Basset Healthcare At Home. HCA members who attended our Quality Symposium in November will remember seeing a preview of the tool.

See TOOL p. 5

Inside ASAP HCA Presses Advocacy Message in Albany........................................1 HCA Leads Quality Initiatives with Beta Test of Risk Tool..................1 HCA Memos Provide NGS Home Care & Hospice Updates..............5 Developments in Home Care Emergency Preparedness....................6

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!

DOH Posts Hospice Medicaid Rates for 2014-15..............................7 CMS Holds Forum on Electronic & Paper Templates for F2F.............8 LHCSAs: Join Us For Feb. 25 LHCSA Forum..........................................8 QIVAPP Update.................................................................................9 MLTC and FIDA Transition Updates..................................................10 DSRIP Update....................................................................................12 EO 38 Materials Revised...................................................................13 DOH Posts Statewide Transition Plan for HCBS...............................13 Updates on Transition to Electronic CON........................................14 Medicaid Alert Issued on ‘Substantial Home Equity’.......................15 CMS Posts 2015 HHPPS Mainframe PC Pricer Software...................15 HRA Issues Alert on Consumer Health Coverage............................16 2015 Medicare Savings Programs Levels Released...........................16 Publications..........................................................................................17

Helping New Yorkers Feel Right At Home

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

Volume 20, No. 6 February 13, 2015 

ADVOCACY from p. 1 In each of the meetings, HCA stressed core needs for home care, as outlined in our advocacy strategy document previously shared with the membership. We placed particular emphasis on the need for: state officials to move promptly on home care-managed care regulatory relief and realignment measures already in the cue as part of the state’s Home Care Regulatory Workgroup process; home care capital and vital-access financing for Health Information Technology and other purposes, parallel to the kinds of financial investments otherwise proposed in the budget for other sectors; and increased funding for the managed care-home care payment model to reflect core community support needs in an environment of increasing financial fragility. On this latter point, we particularly stressed the need for reforms to create efficiencies in the claim, billing and reimbursement process, including timely payment.

HCA also raised other key areas for support which were of particular interest to state officials, such as our proposals for modernization of the commercial insurance law and new opportunities for partnership models, similar to legislation introduced by Senator Kemp Hannon and Assembly Member Aileen Gunther to establish a hospital-home care-physician collaboration program in the Department of Health. The Senate version of this bill (S.1110/A.2011) has advanced to third-reading on the Senate Calendar.

Meanwhile, reforms to the decades-old insurance law, we contend, would better reflect the current core role of home care by enhancing the minimum coverage standards. New coverage standards on the commercial side would also likely promote state Medicaid cost savings, as recipients with more updated commercial insurance coverage for home care would less frequently reach a threshold that would require them to spend-down to Medicaid in order to receive needed services.

The insurance updates are also vital for enhanced access to home telehealth services. As recently reported in ASAP and other communications, the Legislature is working on chapter amendments to a telehealth bill (S.2405/ A.2552-A) that would provide for commercial insurance coverage of telehealth at a level parallel to what would 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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otherwise be covered for the same types of services delivered without telehealth. In the case of home care, the outmoded commercial insurance standards would set a limited framework for telehealth service levels delivered in the home under commercial insurance, thus incentivizing telehealth in non-home-care settings.

The bill passed the Assembly on February 9.

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

HCA’s Policy staff also engaged legislative and Executive offices on key budget proposals such as the Governor’s call to permanently extend, rebase, and reduce funding for the Certified Home Health Agency Episodic Payment System, the continuation of prioryear Medicaid cuts (i.e. the Medicaid Trend Factor elimination, Administrative & General caps, and others), and the Governor’s ‘Advanced Home Health Aide’ proposal, among other provisions.

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

The purpose of Monday’s meetings was to discuss our main advocacy requests, as supported by data and other provider insights from HCA’s financial condition report and member survey. (See link in the sidebar to the right.)

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

HCA’s next step is to immediately deliver specific legislative language that reflects these core advocacy requests for consideration by health and budget committee leaders.

http://www.hca-nys.org/documents/ HCATestimonyCardillo201516ExecutiveBudget.pdf

HCA State Budget Testimony (February 2, 2015)

Memo: 2015-16 Executive State Budget Analysis (January 27, 2015)

Your message

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

The Legislature is adjourned next week for the President’s Day holiday. HCA is asking members to schedule meetings next week in the home district to advance our advocacy goals. It is absolutely critical for all members to contact your legislators’ district offices and schedule these meetings so that the Legislature not only hears from HCA but also you, their constituents.

When you meet with legislative offices, please be sure to share a copy of HCA’s legislative agenda, entitled Driving Health Care Improvement and Savings Through Home Care (see link in sidebar to the right), and deliver the following message points: •

Through Medicaid Redesign and the federal waiver process, the state has launched several major health care system reforms, all of which 3

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Volume 20, No. 6 February 13, 2015 

require a strong, viable home health care safety net to succeed.

•

•

•

•

•

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.

Whether it’s the move to managed care, Delivery System Reform Incentive Payment models or other partnership models sought by the state, home care is ready-made to meet the new system’s core goals of: reducing hospitalizations, achieving population health needs, and reducing costs.

•

To meet the state’s laudable goals, we clearly need a strong home care system. To have a strong home care system, the Legislature needs to include in its budget some critical supports and investments – similar to the $1.4 billion in investments already earmarked for hospitals and other areas of health care but largely inaccessible to the home care system.

The Home Care Association of New York State has drafted legislative language in all of these vital areas and is preparing this language for consideration in the Senate and Assembly budget committees. I ask that you voice support for these proposals on behalf of your home care constituency as negotiations proceed.

If you need assistance with any of these advocacy messages, or help with the logistics of reaching out to your legislators, do not hesitate to contact any of the HCA Policy staff.

70 percent of home care providers are operating in the red, according to a recent financial condition report by the Home Care Association of New York State. Managed care plans are their main source of payment; however, those plans are increasingly experiencing negative operating margins that have eroded the contracted rates received by providers to deliver care in an environment of increased costs. On average, home care providers who have negotiated Managed Long Term Care contracts are receiving Medicaid rates 13 percent below their fee-forservice rates.

Budget schedule Leaders of the Assembly and Senate have issued an agreed-to budget schedule for 2015 as follows: February 26 (on or before) Senate & Assembly Economic/Revenue Reports Released February 26 Joint Revenue Forecasting Conference March 1 (on or before) Revenue Consensus Report

Increased costs and reduced rates have accompanied a lack of infrastructure investment in home care – investments that have otherwise been enjoyed by other sectors of health care. State and federal policies have long overlooked home care providers as part of these vital Health Information Technology (HIT) investments, even though field-level home care providers serve as important spokes in the exchange of patient data, which is vital to improved outcomes in an integrated system.

March 12 Joint Senate & Assembly Budget Conference Committees Commence March 19 Final Report of the Joint Conference Committee March 23-26 Joint Legislative Budget Bills Taken Up by Senate & Assembly

To overcome these challenges and critical system needs, the home care provider community has developed a six-point plan this budget year calling for HIT support, modernization of the health insurance coverage statute, the need for adequate

For more information, please contact a member of HCA’s Policy staff.

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TOOL continued from p. 1 To initiate the beta test, Ms. Neander and HCA Executive Vice President Al Cardillo conducted a webinar to review for agencies the structure and content of the tool, the procedures for the beta test, and any preliminary questions, clarification needs, and recommendations.

HCA will reconvene the beta-test participants in early March to discuss the test results and experiences, assess the need for refinements and receive any further recommendations for improvement, and determine next steps toward statewide launch.

Meanwhile, HCA this week discussed with state health and legislative leaders our proactive initiatives in quality innovation, including the Quality Risk Tool. (See related p. 1 story about HCA’s advocacy meetings.) HCA is working to advance proposals in the state budget process to support this effort and other quality innovation initiatives formulated by the HCA Quality Committee.

HCA extends special thanks to Ms. Neander; Maria DeMott, also of Basset At Home, who has been a major player in this effort; and to the beta-test agencies who are volunteering their time, resources and energy to benefit home care statewide. Please stay tuned for more information on this exciting initiative.

HCA tapped by NCQA HCA has been tapped by the National Committee for Quality Assurance (NCQA) to provide experience, information and perspective on quality developments in long term care – in particular, home and community based care in the context of managed care and other health system changes.

In an extensive interview this week, Mr. Cardillo, on behalf of HCA, provided details to NCQA on system changes, the implications for quality, initiatives by the HCA Board and Quality Committee, and initiatives of the state Department of Health.

NCQA specifically offered assistance and possible collaboration on HCA’s initiatives and concerns. HCA suggested some initial areas and will be soliciting the recommendations of the HCA Quality Committee, as well as the full membership.

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

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HCA Memos Provide NGS Reimbursement, Benchmarking Updates for Home Care & Hospice Late this week, National Government Services (NGS), New York’s Medicare Administrative Contractor, held two advisory meetings: one for hospice and one for home care.

The meetings provide key updates on reimbursement and payment issues, upcoming education programs, medical review data and comprehensive error rate testing (CERT) findings, utilization and benchmarking data and more.

HCA has prepared two Public Policy Memos on each of the meetings with detailed updates.

The Home Health memo is available at http://www.hca-nys.org/ policy_memos/documents/ 021315NGSHomeHMemoFINAL.pdf.

The Hospice memo is available at http://www.hca-nys.org/ policy_memos/documents/ 021215NGSHospiceMtgSummaryFINAL.pdf.

HCA members are urged to read the memos carefully for critical updates relevant to your organization.

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

Volume 20, No. 6 February 13, 2015 

Developments in Home Care Emergency Preparedness HCA had a unique opportunity this week to support health emergency preparedness (EP) by presenting to the New York State Emergency Managers Association (NYSEMA) at its Annual Meeting in Syracuse.

HCA was invited to present following a Health Emergency Preparedness Coalition meeting in the fall. HCA’s Executive Vice President Al Cardillo opened Thursday’s Annual Meeting. His presentation included: 1) an overview of New York’s home care system; 2) key changes taking place in the health care field, home care’s role and importance in these changes, and consequences for EP; 3) HCA’s and providers’ roles in EP; and 4) the array of EP challenges, needs and initiatives for home care.

Mr. Cardillo’s PowerPoint presentation is at http://www.hca-nys.org/documents/CardilloPPTEMAStatewideConferenceFeb122015.ppt.

The session also allowed the two associations to explore EP collaboration. NYSEMA participants shared perspectives on potential gaps and ideas for confronting these challenges, focusing heavily on the value of home care-emergency management connections.

Mr. Cardillo and NYSEMA President Kevin Niedermaier discussed further education and programming collaboration, as well as mutual ideas for building on local home care-emergency management connections, a component of HCA’s emergency preparedness legislation (see next section).

HCA appreciates and looks forward to further work with NYSEMA. “Essential Personnel” bill reintroduced Legislation providing for “essential personnel” status for home care and hospice personnel in emergencies was reintroduced this week in both the state Senate and Assembly.

The legislation, S.3482/A.5125, was reintroduced by Senator Andrew Lanza and Assemblyman Michael Cusick, who have championed and shepherded this issue through the Legislature.

As a reminder, the legislation, originating and developed with HCA and the Home Based Care Alliance, provides for: •

Inclusion of home health agencies and hospices among the local officials, agencies and other entities whose “cooperation, advice and assistance” is to be sought in the development of each locality’s emergency management plan.

•

Inclusion of procedures within local emergency management plans for deployment of physicians, nurses, medical professionals and personnel of Certified Home Health Agencies, Long Term Home Health Care Programs, Licensed Home Care Services Agencies, hospices, and other “essential personnel” in emergencies. This would include provisions for access to patients in areas otherwise restricted or subject to curfew.

The Senate bill was referred to the Committee on Homeland Security; the Assembly bill was referred to the Committee on Government Operations. Both committees, along with the full Senate and Assembly, voted 6

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unanimously in favor of the legislation last year; however, despite overwhelming support, Governor Cuomo, surprisingly, vetoed the bill in December.

HCA urged and now thanks the sponsors for their prompt reintroduction of the legislation, and we look forward to working toward resolution of any questions or issues with the Governor.

Members: please complete HCA ‘hotwash’ survey If you have not already done so, please take a moment to respond to HCA’s recent winter storm ‘hotwash’ survey, available at https://www.surveymonkey.com/r/EPFeb2015.

The survey is a critical opportunity for providers and HCA to provide important feedback and recommendations to public officials. Responses have already underscored the need for HCA’s essential personnel bill, and we need providers to similarly reinforce any other vital areas of need.

According to one provider coping with the winter storm, “Staff were repeatedly stopped by police and many times not allowed to continue traveling to patients’ homes. One nurse was stopped six times and it was four days after the storm.” HCA immediately shared this particular report with state officials.

HCA, DOH meet to discuss EP collaborative initiatives and issues Also this week, HCA and state Department of Health Office of Emergency Preparedness and Office of Primary Care and Health Systems Management officials met to discuss progress on HCA-DOH collaborative initiatives in EP as well as new and emerging issues.

Included among the initiatives and issues discussed were: the integration of emergency preparedness activities across the continuum and with local and state coalitions; planned roll-out of the Transportation Assistance Levels initiative (already reported to the membership), currently targeted for spring; efforts to support provider “situational awareness” in emergencies and plans for drills and exercises with the home care community; and initial results from HCA’s ‘hotwash’ survey.

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

DOH Posts Hospice Medicaid Rates for 2014-15 The state Department of Health (DOH) Bureau of Long Term Care Reimbursement released a Dear Administrator Letter (DAL) this week notifying hospice providers of their 2014-15 rates. The DAL includes the base rates as well as add-ons for Worker Recruitment and Retention (WRR) funding and for Recruitment, Training and Retention (RTR) funding.

The rate period is for October 1, 2014 through September 30, 2015. According to DOH, the rate formula is in accordance with Article 40 of the Public Health Law (PHL) and Subpart 86-6 of Title 10 of the Commissioner’s Administrative Rule and Regulations.

The base rates have also been posted to the Department’s public website at http://www.health.ny.gov/facilities/long_term_care/reimbursement/hospice/.

Continued on next page 7

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Continued from p. 7 For providers that have provided DOH with a certification for RTR, the published rates include a 3 percent add-on payment authorized by Section 4013 of the PHL and a payment of $9.92 per day as the allocable portion of the payments authorized by Section 3614.9 of the PHL. These funds are solely for the purposes of improving recruitment, training and retention of non-supervisory personnel with direct patient care responsibility; providers are prohibited from using the funds for any other purposes.

DOH states that the rates have been forwarded to the Division of Program and Operation and System for payment.

For specific questions on these rates, contact DOH’s Russ Smith at (518) 473-4421.

For further information, contact Patrick Conole at (518) 8100661 or pconole@hcanys.org.

CMS Holds Forum on Electronic and Paper Clinical Templates for F2F On February 11, the U.S. Centers for Medicare and Medicaid Services (CMS) held an Open Door Forum on its draft Home Health Electronic and Paper Clinical Template forms.

As home health agencies continue to struggle to understand how the face-to-face (F2F) documentation requirements have changed since the issuance of the final 2015 Home Health Prospective Payment System (HHPPS) rule, CMS is considering the development of a voluntary home health electronic and paper clinical template to assist physicians in their documentation of F2F. The HHPPS rule modified the F2F physician encounter requirements for 2015, specifically eliminating the narrative requirement. (See the January 30 ASAP for more information.) Since the narrative is no longer required, CMS will look within the physician’s record for enforcement of Medicare home health eligibility.

If a physician chooses to use the CMS electronic template (or any other paper template) to assist in documenting a 8

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

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visit with a patient, the resulting progress or clinic note would be part of the physician’s medical record for that patient.

QIVAPP Update HCA obtained the following update on the status of the Quality Incentive Vital Access Provider Pool (QIVAPP) monies.

CMS has been developing an electronic template for a while and, based on feedback from providers, is now considering a paper template too.

The rate increase for the initial $35 out of $70 million in QIVAPP monies has been finalized and sent to the state Division of the Budget for its approval. Once approved, the monies are ready to be sent to the Managed Long Term Care (MLTC) plans.

CMS stated that the electronic template is intended to be a “skip-template” where not all sections are relevant for all patients and therefore can be skipped.

A copy of the electronic template and the handouts from the February 11 Open Door Forum are at https://www.cms.gov/ResearchStatistics-Data-and-Systems/Computer-Dataand-Systems/Electronic-Clinical-Templates/ HomeHealthHHElectronicClinicalTemplate.html.

The state Department of Health (DOH) will then notify each plan of the amount of its award and how much is due to each plan’s contracted home care provider(s). The plans will be responsible for notifying their providers and passing the funds through.

The paper template is at https:// www.cms.hhs.gov/Research-Statistics-Dataand-Systems/Monitoring-Programs/MedicareFFS-Compliance-Programs/Medical-Review/ Home_Health_Medical_Review_Update.html.

HCA requested and DOH agreed to provide us with a list of the amount given to each MLTC plan and how much is targeted to each of its home care providers.

According to CMS, some of the feedback it has received so far is that the electronic template should be lengthened and the paper template shortened.

DOH staff is still reviewing the further information it requested from plans about their home care contractors that was incomplete and once this review is completed it will submit a request to the U.S. Centers for Medicare and Medicaid Services for approval of the $35 million federal share. It is not known how long it will take CMS to make a decision.

Comments on the electronic and paper templates can be submitted to CMS at HomeHealthTemplate@cms.hhs.gov or given to CMS at future Open Door Forums on March 11, April 8, and May 6 (all from 1 to 2 p.m.).

As reported in prior editions of ASAP, HCA is concerned about the extensive documentation burden of these new clinical templates and of the changes to F2F documentation generally, which continue to put home care providers at risk for physician recordkeeping. HCA has and will continue to advocate for documentation of F2F on the 485/plan of care as an alternative or other ways to minimize the requirement.

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

For more information, contact the HCA Policy staff.

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MLTC and FIDA Transition Updates The state Department of Health (DOH) has requested permission from the U.S. Centers for Medicare and Medicaid Services (CMS) to mandate transition into Managed Long Term Care (MLTC) plans in February for Cattaraugus County residents who require more than 120 days of non-institutional community based long term care services.

The following remaining upstate counties will move to mandatory MLTC enrollment upon CMS approval: Allegany, Chautauqua, Chemung, Schuyler, Seneca, Yates, Clinton, Essex, Franklin, Hamilton, Jefferson, Lewis, and St. Lawrence.

These are the remaining final counties for statewide implementation of mandatory MLTC enrollment for this population.

Approximately 139,000 individuals are now enrolled in MLTC plans statewide, including in 33 partially capitated plans, 8 Program of All-Inclusive Care for the Elderly (PACE) plans and 8 Medicaid Advantage Plus plans.

DOH has indicated that the total MLTC enrollment number has not changed substantially in recent months.

And the Department is specifically seeing little change attributable to the migration of cases to Fully Integrated Duals Advantage (FIDA) plans, a care-management model being demonstrated in downstate counties to serve a similar population as do MLTCs, though the service package integrates both Medicare and Medicaid benefits.

(See next section.)

FIDA Approximately 100,000 announcement letters have been sent to FIDA-eligible recipients since December in Region I, where FIDA roll-out has already begun (New York City and Nassau County).

Recipients in this region have until March 31 to make a decision to enroll or opt-out, at which point passive enrollment will begin in April. DOH has sent out a series of notices at the 90-day (end of December) and 60-day (end of January) mark to communicate the passive enrollment date. The 30-day notice will be mailed in February, according to DOH. As of last week, 698 individuals have been enrolled in FIDA since the December 1, 2014 implementation date for Region I. DOH officials at a recent Managed Care Policy and Planning Meeting did not readily have current data on the number of FIDA opt-outs; in January DOH reported that 3,853 individuals had chosen to opt out.

Region II FIDA enrollment (Suffolk and Westchester) will begin April 1. Approximately 10,000 announcement letters will be mailed to FIDA-eligible recipients in this region at the end of February. CMS is still reviewing FIDA networks for these counties.

Conflict-Free Evaluation and Enrollment Center Related to the managed care transition, DOH continues to roll-out a federal requirement for conflict-free assessments into MLTC plans. Under an agreement with CMS, the state has initiated a program where individuals

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must first be assessed by a Conflict-Free Evaluation and Enrollment Center (CFEEC) before enrolling into an MLTC plan.

CFEEC has begun in New York City and Long Island (from October to December 2014) and Westchester and Suffolk counties in February.

Under this process, all new MLTC plan enrollees must now have a Uniform Assessment System (UAS) entry on record prior to enrollment in the counties where CFEEC goes into effect. New enrollees will now contact the CFEEC instead of going directly to plans for enrollment. (This policy does not apply to individuals transferring from one plan to another or from one MLTC product to another.) Maximus is the independent and conflict-free entity providing evaluation, education and enrollment services.

At Thursday’s Managed Care Policy and Planning Meeting, DOH officials indicated little change in the rate that CFEECs have been approving individuals for MLTC enrollment: approximately 99 percent of evaluations were approved for enrollment, 1 percent were denied, and there was a 4 percent no-show rate.

The average call volume to the CFEEC is 442 to 464 calls a day. According to DOH, the wait time from the date of the call to the appointed assessment is 5 to 7 days for the vast majority of cases.

Here’s the roll-out schedule going forward: •

CFEEC will be a requirement, starting March 1, in Albany, Columbia, Dutchess, Putnam, Rockland, Orange, Ulster, Greene, Sullivan, Warren, Washington, Saratoga, Fulton, Montgomery, Schoharie, Schenectady, Rensselaer, Erie, Monroe and Onondaga.

•

In April, the CFEEC will operate in Tompkins, Cortland, Tioga, Broome, Chenango, Otsego, Delaware, Wayne, Ontario, Livingston, Seneca, Cayuga, Yates, Schuyler, Chemung, Steuben, Chautauqua, Cattaraugus, Allegany, Wyoming, Genesee, Orleans, and Niagara counties.

•

In May, the CFEEC will operate in Jefferson, Oswego, Lewis, Oneida, Herkimer, Madison, St. Lawrence, Franklin, Clinton, Essex, and Hamilton counties.

More information, including webinar handouts, a Frequently Asked Questions (FAQs) document and fact sheet, is at http://www.health.ny.gov/ health_care/medicaid/redesign/mrt_90.htm.

CFO Forum March 18, 2015

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

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DSRIP Update The state Department of Health (DOH) has released a “near-final” draft of the Delivery System Reform Incentive Payment (DSRIP) implementation plan template.

In finalizing this template, DOH states that it has sought to address the comments that it received on the Implementation Plan Structure document. The final template will be released on Tuesday, February 17.

Performing Provider Systems (PPSs) will use the DSRIP Implementation Plan template to submit their DSRIP Implementation Plans by the April 1, 2015 deadline.

The Implementation Plan template requires PPSs to set target completion dates for project milestones and the steps required to achieve those milestones. It is designed to create the baseline information that the Independent Assessor will need for ongoing monitoring and scoring of Domain 1 process measures.

All the information that PPSs enter into this implementation plan template must align with the commitments the PPSs made in their DSRIP Project Plan and Organizational Applications. These milestones are not intended to be an exhaustive list of all the activities a PPS will be undertaking in a given area; they are the key process milestones and deliverables for which DOH and the Independent Assessor will seek further clarity and insight.

Some elements of this implementation plan template will not be required for the April 1 deadline, though PPSs will be required to submit these elements at a later date through the MAPP portal, including revised workforce transformation numbers and committed provider lists for each project.

Project Approval and Oversight Panel On Tuesday (February 17) through Friday (February 20), the DSRIP Project Approval and Oversight Panel (PAOP) will meet in Albany to review the 25 DSRIP Project Plan applications. These applications include lists of network providers, information on distribution of DSRIP funds and areas of requested regulatory relief. At a Managed Care Policy and Planning Meeting this week, state Medicaid Director Jason Helgerson indicated that the majority of regulatory relief requests have been deemed appropriate, with some requiring only some modifications. The majority of regulatory relief requests are in the area of behavioral health and physical health integration.

There will be a public comment period on Tuesday, February 17.

These meetings will be webcast live at http://www.health.ny.gov/events/webcasts/index.htm.

PPS applications are available at http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/PPS_applications.

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EO 38 Materials Revised The state website with information on Executive Order (EO) 38 has posted revised materials.

These include an updated (December 2014) guidance document at http://executiveorder38.ny.gov/content/ guidance and training guides at http://executiveorder38.ny.gov/training. A Frequently Asked Questions document is also posted at http://executiveorder38.ny.gov/faq-page.

The state holds webinars covering EO 38 on a regular basis; to register, go to http://executiveorder38.ny.gov/training.

As extensively reported, EO 38 places limits on executive compensation and administration costs for entities, including home care and other health providers, that receive state funds directly or indirectly.

Covered providers must submit an EO 38 Disclosure Form no later than 180 days after the close of their Covered Reporting Period. A covered provider’s reporting period must coincide with the annual period covered by its cost reports. If a provider does not submit cost reports, it may choose to have its reporting period coincide with a calendar year or the provider’s fiscal year.

For example, if a provider submits cost reports on a calendar year basis, its first reporting period begins on January 1, 2014 and ends on December 31, 2014. Its first report is not due, however, until June 30, 2015, 180 days after the close of the reporting period. Similarly, a waiver request for the 2014 period in this example is due no later than June 30, 2015.

There are a number of pending lawsuits against EO 38 that HCA has covered in previous newsletters and in member programs.

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

DOH Posts Statewide Transition Plan for HCBS The state Department of Health (DOH) has posted the Statewide Transition Plan (STP) as part of the process to comply with a federal home and community based settings (HCBS) rule.

The STP and materials from a recent webinar on this topic are at http://www.health.ny.gov/health_care/medicaid/redesign/home_community_based_settings.htm.

As reported in the January 30 ASAP, the federal 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) and 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 plans 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 13

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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: 1) ensure an individual’s rights of privacy, dignity and respect and freedom from coercion and restraint; 2) optimize autonomy and independence in making life choices; and 3) facilitate choice about services and who provides them.

Settings not included as meeting the criteria for Medicaid HCBS are: nursing homes; hospitals; intermediate care facilities (ICF); and institutes for mental disease (IMD).

States are required to file a Statewide Transition Plan (STP) 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 or by March 16, 2015, whichever is earlier.

The state’s STP states that a state interagency workgroup has determined that while the majority of participants in all waivers live in HCBS compliant settings, the largest number of individuals in partially compliant settings are participants in the 1915(c) HCBS waiver operated by the Office for People with Developmental Disabilities (OPWDD).

The state intends to ensure that providers and participants are aware of the HCBS requirements and monitor programs to ensure that the programs are in compliance.

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

Updates on Transition to Electronic CON The state Department of Health (DOH) is transitioning from paper forms and uploaded documents to electronic data collection for Certificate of Need (CON) applications.

The state has introduced a new tab in NYSE-CON labeled “Executive Summary,” which is designed to replace Schedule 1B, Abbreviated Executive Summary of the Full and Administrative Review Applications and to replace the Schedule LRA 1, Project Narrative of the Limited Review Application.

It will be a required field for all application submissions. Updates to Schedule 1B or LRA 1 would also be made through the Executive Summary Tab. The Executive Summary will be visible to the public upon application submission. DOH advises agencies that the Executive Summary should be a succinct description of the project conveying key aspects including, as appropriate, services to be provided, ownership proposed, an overview of construction, and/or other pertinent aspects of the proposal. Additionally, the Executive Summary must be revised any time elements of the summary change prior to project approval.

The Executive Summary field features rich text formatting (bold, italic, bullets, etc.). It is recommended that you compose your executive summary/project narrative on the Executive Summary tab in NYSE-CON rather than copying text from a word processing program to minimize formatting errors.

For NYSE-CON training documents, go to http://www.health.ny.gov/facilities/cons/nysecon/. For questions, contact DOH at cons@health.ny.gov.

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Volume 20, No. 6 February 13, 2015 

Medicaid Alert Issued on ‘Substantial Home Equity’ The New York City Human Resources Administration (HRA) has issued a Medicaid Alert (February 12) on the issue of “substantial home equity.”

Medicaid sets a limit on the amount of equity individuals can have in their homes and still be eligible for Medicaid nursing home or community-based long term care benefits. That amount, adjusted annually, is $828,000 in 2015.

The home equity value is calculated by subtracting any legal encumbrances (such as liens, mortgages etc.) from the fair market value of the home. Medical bills may not be used to offset the value of an individual’s equity interest in the home. However, consumers may reduce the home equity value through a reverse mortgage or a home equity loan.

The home equity limitation does not apply: •

If one or more of the following individuals lawfully resides in the home: spouse, minor child under 21, or certified blind or disabled child of any age.

•

To individuals who are in receipt of long term care services before January 1, 2006 and have not experienced a break in eligibility for such services thereafter.

This limit is not applied if it would create undue hardship that would deprive the consumer of: •

Medical care such that the individual’s health or life would be endangered; or

•

Food, clothing, shelter or other necessities of life, and there is a legal impediment that prevents the equity interest in the property.

Individuals seeking long term care services in New York City and whose primary residence is a house, condominium or co-op apartment may attest to the equity value by submitting form MAP-2050J along with an application or conversion package.

The Alert is at http://www.nyc.gov/marc (go to Managed Long Term Care Plans and then to Medicaid Alerts).

CMS Posts CY 2015 HHPPS Mainframe PC Pricer Software The U.S. Centers for Medicare and Medicaid Services (CMS) announced this week that the Calendar Year (CY) 2015 Home Health Prospective Payment System (PPS) PC Main Frame Pricer Software is now available on CMS’s HHPPS PC Pricer website (http://www.cms.gov/Medicare/Medicare-Fee-for-ServicePayment/PCPricer/HH.html) in the “Downloads” section.

The HHPPS Pricer Software makes all reimbursement calculations applicable under HHPPS, including percentage payments on requests for anticipated payments (RAPs), claim payments for full episodes of care,

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and all payment adjustments, including low utilization payment adjustments (LUPAs), partial episode payment (PEP) adjustments, significant change in condition (SCIC) adjustments and outlier payments.

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

HRA Issues Alert on Consumer Health Coverage The New York City Human Resources Administration (HRA) has issued an Alert to inform personal care providers, Certified Home Health Agencies, Managed Long Term Care (MLTC) plans, and others that the New York State of Health (health insurance exchange marketplace) has added information to eMedNY/ePaces to assist in distinguishing consumers who have Medicaid eligibility through the marketplace versus those whose eligibility is handled by HRA. On ePaces, the Office indicator field has been updated to show H78 for New York State of Health cases.

Any other number in the Office field indicates an HRA case.

Any request regarding changes for New York State of Health cases must be directed to the state Department of Health.

The Alert is posted at http://a069-marc.nyc.gov/marc/default.aspx (registration required).

2015 Medicare Savings Programs Levels Released The U.S. Centers for Medicare and Medicaid Services (CMS) has released the 2015 levels for the Medicare Savings Programs.

The Qualified Medicare Beneficiary (QMB) program pays for Medicare Part A and Part B premiums, deductibles, coinsurance and copayments. The 2015 eligibility levels are: $1,021 for individuals and $1,368 for couples.

The Specified Low-Income Medicare Beneficiary (SLMB) program and Qualifying Individual (QI) programs pay for the Medicare Part B premiums only. The SLMB eligibility levels are $1,217 for individuals and $1,633 for couples while the QI levels are $1,365 for individuals and $1,833 for couples.

There are no resource limits for any of the Medicare Savings Programs.

Individuals can be on Medicaid (if they meet the income and resource guidelines) and either QMB or SLMB, but cannot be on Medicaid if they are enrolled in the QI program.

More information is at: http://www.medicaid.gov/medicaid-chip-program-information/by-population/medicare-medicaidenrollees-dual-eligibles/seniors-and-medicare-and-medicaid-enrollees.html

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

Volume 20, No. 6 February 13, 2015 

Publications •

“Continuation of Systematic Validation of Payment Group Codes for Prospective Payment Systems (PPS) Based on Patient Assessments,” by the U.S. Centers for Medicare and Medicaid Services http://www.cms.gov/Outreach-and-E ducation/Medicare-Learning-Network-MLN/ MLNMattersArticles/Downloads/MM9016.pdf

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

17

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

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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