February 19, 2016 Edition of ASAP

ASAP

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

Legislative Issues  Public Policy



News

Volume 21, No. 7 February 19, 2016

HCA Continues to Press Home Care Investments, Wage Funding Following 30-Day Budget Amendments For members hearing various wage impact estimates, HCA explains figures used by a coalition of five allied associations Late last week, after ASAP went to press, the Governor released his 30-day budget amendments.

HCA and association partners have appealed for urgent investments in health care as part of these amendments; yet, the Governor’s 30-day proposals only make technical changes to his Paid Medical Leave plan and to areas that don’t directly impact home care or other health care providers.

The 30-day amendments are an important milestone.

They complete the Governor’s proposal phase and pave the next stages of Legislative negotiations, which will be escalating quickly.

Overwhelmed by Home Care Finance Issues? Attend our March 9 Senior Financial Managers Summit

As earlier reported, HCA and a coalition of allied health associations sent a joint letter to Governor Cuomo urging appropriations in the 30-day amendments to cover his proposed minimum wage mandate, specifically. However, the Governor’s amended budget, regrettably, continues to leave this mandate unfunded.

By now you are probably overwhelmed already by the flood of new reimbursement issues and challenges being thrust your way.

Inside ASAP

See FUNDING p. 2

A proposed multi-billion-dollar minimum wage mandate; new reimbursement notices related to the Fair Labor Standards Act; overdue Quality Incentive Vital Access Provider Pool funds; Medicaid and Medicare rebasing; and other ongoing reimbursement challenges are all See SUMMIT p. 4

HCA Continues to Press Home Care Investments, Wage Funding.....1 Attend our March 9 Senior Financial Managers Summit.....................1 Education Update...............................................................................5 Registration Open for NGS Conference in Rochester: 3/29................6 DOH Posts 2016 Wage Parity Certification Forms..............................6 FLSA Funding Advocacy Continues.....................................................7 HCA Fighting for Release of QIVAPP Funds........................................8 HCA Presses Home Care Planning, Delivery Flexibility......................8 MLTC Forum Takes up Budget, Legislative, Program Priorities..........9 HCA Partners With Wound Care Institute on Training Courses ........ 10 Next Opt-Out of DSRIP Data Sharing To Be Held...............................10 DOH, Steering Committee Mark Status, Next Steps in VBP.............11 CMS’s Medlearn Matters Enrollment Revalidation Call: 3/1............12 Process Announced for Accountable Health Community Applicants..12 DOH Requests Information on PACE Model.....................................13

Helping New Yorkers Feel Right At Home

Volume 21, No. 7 February 19, 2016

ASAP – a publication of the Home Care Association of New York State FUNDING from p. 1

These calls for investment are among several other specific requests, including wage funding, that HCA is continuing to press with the Legislature and Governor’s office as part of our appropriations and Article VII language.

For HCA’s Policy team, much of this past week was devoted to two separate, but related, work activities on the budget. These include: •

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Finalizing HCA budget language for home care investment proposals (including wage funding to meet all applicable mandates such as minimum wage, overtime, wage parity, etc.) for adoption by the Legislature; and Communicating the devastating impact of an unfunded wage mandate, while urging timely and appropriately directed funding, should any such mandate be adopted.

By week’s end, HCA was finalizing a package of appropriations and Article VII budget language for the next steps of negotiations. These efforts further sync with our calls as part of a coalition of allied community health providers. This coalition notes that past investments ($2 billion last year) have gone to facilities, and that it is time for proportionate funding to the home and community-based sector – monies which are desperately needed now.

Vigorous Wage Advocacy – and Clarification on Impact Estimates Like our community-based investment advocacy, HCA is similarly involved in a strong health provider coalition approach to the minimum wage question, realizing the power of numbers and a unified front. The coalition is communicating a unified message – on the desperate need for wage funding – while also providing state officials with sector-specific impacts and concerns.

The Governor’s proposal, because it is unfunded, has devastating consequences for home care.

Thus it is drawing intense focus from our policy and government-relations teams at all levels.

We understand that HCA members may be hearing different impact estimates for minimum

ASAP is a weekly publication of the Home Care Association of New York State (HCA). Unless otherwise noted, all articles appearing in ASAP are the property of the Home Care Association of New York State. Reuse of any content within this newsletter requires permission from HCA. President: Editor:

Joanne Cunningham, jcunningham@hcanys.org Roger L. Noyes, Director of Communications, rnoyes@hcanys.org Al Cardillo, Executive Vice President, Policy & Programs, acardillo@hcanys.org Patrick Conole, Vice President, Finance & Management, pconole@hcanys.org Andrew Koski, Vice President, Program Policy and Services, akoski@hcanys.org Alexandra Blais, Director of Public Policy, ablais@hcanys.org Laura Constable, Senior Director, Membership & Operations, lconstable@hcanys.org Celisia Street, Director of Education, cstreet@hcanys.org Mercedes Teague, Finance Manager, mteague@hcanys.org Jenny Kerbein, Director of Governance and Special Projects, jkerbein@hcanys.org Billi Hoen, Manager, Meeting and Events, bhoen@hcanys.org Teresa Brown, Administrative Assistant, tbrown@hcanys.org 388 Broadway, 4th Floor, Albany, NY 12207 Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org

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Volume 21, No. 7 February 19, 2016

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

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Importantly, such funding, for minimum wage or other critical investments in home care, must also be timely and appropriately directed: to ensure that LHCSAs, CHHAs, LTHHCPs and other participating providers receive funds for their direct costs, as well as appropriate coverage for managed care payment to home care.

wage. These estimates warrant further explanation and clarification.

To start, the allied coalition of provider associations is reporting a $2.19 billion impact for home care which represents the impact at the final, highest year, as a basis for this year’s budget discussions.

As HCA President Joanne Cunningham recently wrote in a Times Union op-ed, the state’s past promises to cover mandates “have either fallen short or been unevenly distributed,” as is the case with funds for Wage Parity and costs stemming from changes under the Fair Labor Standards Act; we are working strenuously to ensure that those methods are not repeated by the state.

That coalition includes the Healthcare Association of New York State (HANYS), LeadingAge New York, the New York State Health Facilities Association (NYSHFA) and the New York State Association of Health Care Providers (HCP) whose materials all report the same number.

Just this week alone, HCA’s Policy team and the coalition met with Senate Minority Finance and Budget staff, the Senate Majority Health and Counsel staff, the Health and Medicaid team at DOB, the Assembly Minority Ways and Means Committee and the Assembly Majority Ways and Means Committee – all on the wage issue.

While using this particular number, we are also taking pains to appropriately present it in multiple frames, as there are several ways of looking at the impact.

Our $2.19 billion number is the impact at full phase-in during just the final year of implementation, the highest year, while other numbers being reported use a similar methodology but a different frame of reference for cumulative effect.

IDC Report Meanwhile, in a new development, the Senate Independent Democratic Conference, or IDC, has just issued a report on the wage issue for home care.

“The IDC not only fully supports raising the wage to $15 per hour,” the report says, “but it also understands the state’s responsibility and calls on the state government to do its part by fully compensating providers for this wage increase as it gets phased in.”

Indeed, our spreadsheets show this cumulative effect over time – so that it is clear to Legislators and the Division of Budget how this wage hike would be a pile-on across many years, even if our consensus number reflects just the highest year for purposes of a single, fiscal year budget.

We need to report one annual number. And that coalition consensus number, at full phase in for the final highest year, is $2.19 billion, which we’ve been further explaining to state officials with year-by-year breakouts.

HCA has met with the IDC on the imperative of full funding to home care should such a mandate be adopted. While HCA appreciates IDC recognition of the need for funding, we are deeply concerned that home care services will be mortally affected without assurance of full and continued funding for this mandate through all of the state’s various methods that cap, control or otherwise direct Medicaid and other public funding. Areas of the report raise these very concerns, including the report’s characterization of the home care economic

Over the past several weeks, HCA and the coalition have met repeatedly with key members of the Legislature, Governor’s office, the state Division of Budget (DOB) and others to convey the massive, unsustainable impact of the unfunded wage hike and to urge funding as part of our broader budget advocacy.

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ASAP – a publication of the Home Care Association of New York State picture and its estimates of the wage impact on providers.

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SUMMIT from p. 1

HCA is reaching out to the IDC leadership to reinforce these concerns. HCA will similarly continue to address these concerns in our ongoing meetings with Senate and Assembly leadership.

Members can read the report at http://hca-nys.org/ wp-content/uploads/2016/02/IDC-Taking-Care-ofCaretakers-Report.pdf. HCA will further analyze the report and provide feedback to the IDC on its position.

Hear more during 2/29 Conference Call As reported in an alert this week to the membership, HCA will hold a free members-only conference call on February 29 to discuss the urgent minimum wage issue and other state budget matters affecting all home care providers.

The call is at 2 p.m. To register, please complete the online form here: https://www.surveymonkey.com/r/ wagebudget. Dial-in information will be sent to you by the day of the call.

The February 29 call will present our wage calculations and advocacy strategy to date. We’ll also brief you on other state budget developments and advocacy requests as we pursue investment needs otherwise longneglected, absent a wage mandate, and the need for reimbursement fixes.

While the wage issue is major, our advocacy for funding is part of a broader advocacy effort urging appropriate reimbursement in home care to cover labor and non-labor costs at a time when two-thirds of certified agencies are operating in the red, and as all providers are subject to billing and reimbursement challenges.

HCA has fashioned budget language in these areas, aimed at reimbursement fixes and investment support for the home care infrastructure, and we will offer you further information about these developing proposals during our call. Please join us in this important discussion.

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weighing the tables of home care finance managers.

This is why you should attend HCA’s Senior Financial Managers Summit. This program is on March 9, and your finance teams can’t miss it.

This program is open to members only, a benefit of your continued membership in HCA. At this program, you’ll gain updates from HCA’s policy staff, Department of Health officials, and expert consultants and analysts on such topics as: •

The State Budget, now under negotiation, and its impact on all home care providers.

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Next Steps with the Quality Incentive Vital Access Provider Pool (QIVAPP) for home care labor costs.

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Medicare Home Health Prospective Payment System (HHPPS) and Medicaid Episodic Payment System (EPS) benchmarking data.

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Medicaid rate-setting and recent adjustments for QIVAPP, Wage Parity, and overtime costs.

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New data on Medicare post-acute payments.

More details are in the flyer at the link below.

HCA’s Senior Financial Managers Summit March 9, 2016 9 a.m. to 3:15 p.m.

Albany Download the flyer at http://hca-nys.org/ wp-content/uploads/2016/01/ 2016CFOForum.pdf.

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

Volume 21, No. 7 February 19, 2016 

2016 EDUCATION UPDATE JAN. 26, FEB. 9, MARCH 15: REACH FOR THE AIDE STARS WITH DATA DRIVEN RECRUITMENT: A NEW WEBINAR SERIES. At a time when everyone is looking at your agency’s quality and client outcomes, you need to focus on star recruitment! Reach this goal by having the volume of applicants, interviewees and on boarding best practices to be successful. The session topics are: • Data Driven Recruitment: Tips to Get More Aide Applicants (January 26) • Data Driven Recruitment: Increasing Interview Show Ups (February 9) • Data Driven Recruitment: 90 Day Caregiver On boarding Best Practices (March 15) MARCH 9: SENIOR FINANCIAL MANAGERS SUMMIT (Formerly CFO Forum) (Albany, NY).

Hear from HCA policy staff, finance and reimbursement managers from the state Department of Health, and industry consultants on home care fiscal issues. This is a must attend program.

MARCH 16: BIOETHICAL ISSUES ENCOUNTERED IN HOSPICE AND PALLIATIVE CARE (WEBINAR).

This program will provide attendees a working knowledge of principles, considerations, and strategies used to prevent and manage ethical challenges involving hospice and palliative care patients and their families.

Sponsored in part by:

APRIL 7 AND 21: ICD 10 HOSPICE WEBINAR SERIES. Increased coding requirements are coming for hospices – coding of not just the terminal diagnosis but related and unrelated comorbidities. This two part webinar series will include the following topics: • Top Ten Issues for Hospice Coding – April 7 • What Hospice Medical Directors Need to know About Coding – April 21 APRIL 12: LEADERSHIP ESSENTIALS FOR LHCSAS IN THE CHANGING HEALTH CARE ENVIRONMENT (NYC). This program, presented by Trish Tulloch, is designed to identify, detail and refine the knowledge and skill set required for the clinical leadership of LHCSAs and to learn how your peers are adapting practices to meet this challenge.

JUNE 22 23: BLUEPRINT FOR OASIS ACCURACY – OASIS C1 DATA SET (ROCHESTER) JUNE 24: OPTIONAL COS C EXAM (ROCHESTER) This effective up to the minute education is targeted for field data collectors, their supervisors, and those preparing for the optional Certificate for OASIS Specialist Clinical (COS C) exam. Two day workshop, on June 22 and 23, is followed by an optional COS C exam at the same location on June 24.

JULY 13 14 THE ART OF ICD 10 CM CODING FOR HOME HEALTH (Nanuet, NY).

Appropriate for all levels of coders, this critical foundational knowledge, along with application through workshop exercises and coding scenarios, will lead to coding accuracy and regulatory compliance.

Click on the “Events and Education” tab on our website for event details & registration. www.hca-nys.org

SEVERAL DATES THROUGH JUNE 2016: TELECONFERENCES FOR HOME HEALTH AND HOSPICE AIDES (Teleconference). An investment in staff education is an investment in quality customer service and quality care. Topics covered in this series include the aide’s role in: disaster preparedness; legal aspects of documentation; transferring clients safely; and communication. Visit our website for a full brochure.

SAVE THE DATES MAY 4 6 ANNUAL MEMBERSHIP CONFERENCE (Saratoga Springs, NY) SEPT. 8 9 SENIOR FINANCIAL MANAGERS RETREAT (New Paltz, NY) OCT. 6 CORPORATE COMPLIANCE SYMPOSIUM (Albany, NY) NOV 16 17 QUALITY AND TECHNOLOGY CONFERENCE (Saratoga Springs, NY)

Rev. February 17, 2016

www.hca nys.org 5

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

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Registration Open for NGS Spring Conference in Rochester: March 29 On March 29, National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), will be hosting its national Spring Conference in Rochester, New York at the Rochester Marriot Airport hotel from 9 a.m. to 4 p.m.

While other Medicare Part A providers will be invited, a significant portion of the event will focus on the following home health specific issues: an update on the Medicare face-to-face “Probe and Educate Audits”; five elements of home health certification; determining adequate clinical documentation; billing basics and best practices; and ordering and certifying home health services.

The cost is $75 per registrant and includes breakfast and lunch. Registration is at www.ngsmedicare.com.

Website users will need to enter their User ID and Password and make sure they are in the Jurisdiction 6 ( J6) Home Health and Hospice (HH&H) home page before clicking on the “Education” tab and then “Webinars, Teleconference, Events.”

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

DOH Posts 2016 Wage Parity Certification Forms The state Department of Health (DOH) has posted the 2016 state-required Home Care Worker Wage Parity Law certification forms. These are all due March 1. One form must be completed by CHHAs, LTHHCPs and managed care organizations (MCOs), and it is sent to DOH. Another form must be completed by LHCSAs and other entities that contract with CHHAs, LTHHCPs and/or MCOs. It is sent to the CHHA, LTHHCP or MCO with which the LHCSA contracts. These requirements are for entities that serve New York City, Long Island and Westchester only. The forms are at http://www.health.ny.gov/ health_care/medicaid/redesign/2016/2016-02-17_wage_parity_alert.htm.

As covered in an Alert yesterday, and in last week’s ASAP, the CHHA, LTHHCP and MCO forms due to DOH (at HCWorkerParity@health.state.ny.us) are for the March 1, 2016 to February 28, 2017 period.

Meanwhile, the LHCSA forms are required for CHHAs, LTHHCPs and/or MCOs to comply with requirements that they obtain written certification on a quarterly basis from their contractor entities which attest to the contractors’ compliance with wage parity for defined certification periods and on a prospective basis. The LHCSA form covers the period March 1, 2016 through May 31, 2016 and is sent to the contacting partner, not to DOH. HCA had requested that DOH post the 2016 certification forms as soon as possible and thanks them for their prompt action. Please note that these certification forms are different from the attestations that MLTC plans are asking their contracted home care providers to complete related to funding for the Fair Labor Standards Act changes. (See next page.)

Please also read the page 8 story in last week’s ASAP for further details, including the latest wage parity levels and further instructions about the certification process.

Also, at this week’s HCA MLTC Forum (see p. 9 story), HCA discussed with MLTCs and LHCSAs some models/proposals we could develop to streamline this duplicative, inefficient process.

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FLSA Funding Advocacy Continues HCA Secures DOH Meeting for Next Week HCA has obtained a meeting on February 22 with the state Department of Health (DOH) and other associations to discuss the distribution of the funding intended to assist agencies with new costs that result from the Fair Labor Standards Act (FLSA) final rule.

Despite DOH guidance in November 2015 and this month, it remains unknown how the funds will pass through from the managed care plans to their contracted home care – a concerning issue.

HCA has been advocating that the entire monies received by MLTC plans be given to their home care providers for all aide hours while DOH appears intent on leaving it unguided and up to the plans on how they distribute the funds.

At last week’s DOH Managed Care Policy and Planning meeting (see the February 12 ASAP), DOH said that it would not specify how the funds were to be distributed and would leave it to discussions between both parties. HCA objected to any layers or added conditions by plans or the state that would further compromise the distribution of the funds.

Late last week and this week, HCA members have started to receive FLSA attestation forms from their contracted MLTC partners with a request for completion by this week or next; HCA is not aware of any DOH communications to the plans about when the forms must be completed. Home care providers are also expected to submit separate attestations for their Medicaid fee-for-service cases.

HCA has received many questions from members about the forms and the FLSA funds distribution process.

HCA has already submitted over a dozen questions to DOH for inclusion in an upcoming Questions and Answer document that DOH hopes to release by early March.

HCA will keep members informed on any new information we obtain at next week’s meeting with DOH. FLSA Survey DOH has shared another version of a draft survey that it is developing to ascertain the actual costs faced by home health providers due to the FLSA changes.

HCA had submitted comprehensive comments, along with other associations, to DOH on a prior version and has had numerous meetings with DOH and its actuary, Mercer, on the survey. HCA had sent a prior draft to some members and has also sent the most recent version to additional members for their feedback.

While the survey initially was intended to estimate new costs due to overtime, travel and live-in cases, HCA advocated and DOH has agreed to account for additional administrative expenses faced by agencies.

Once the survey is finalized, DOH intends to disseminate it to providers and use the findings to determine necessary adjustments to Medicaid fee-for-service payments and managed care capitation rates.

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

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Volume 21, No. 7 February 19, 2016 

HCA Fighting for Release of QIVAPP Funds HCA continues to press the state Department of Health (DOH) to issue the next round of funds under the Quality Incentive Vital Access Provider Pool (QIVAPP) program – funds promised and urgently needed by providers In response to HCA’s query this week, DOH said that it is still completing reviews of home care agencies to determine who is eligible and for how much money.

IPRO is still conducting desk audits and some HCA members received letters this week asking for documentation by February 26 that at least 30 percent of their total New York City workforce is enrolled in the agency’s health benefits coverage, as indicated by QIVAPP eligibility requirements. The letter indicates that IPRO’s desk audits must be completed by March 17.

When the QIVAPP eligibility criteria were announced back in April 2015, HCA objected strongly against this arbitrary and artificial threshold. We pointed out that it precludes agencies from qualifying for QIVAPP who are otherwise eligible if large numbers of their aides decline the offered health coverage because they are already covered under another family member’s plan or Medicaid, or decline coverage and opt for a higher hourly wage.

We also voiced strong concerns about the original criteria outlined in the April 23, 2014 Dear Administrator Letter and questioned how the eligibility criteria demonstrated what the state considers a quality program.

During the QIVAPP deliberations, HCA has provided information to members on their status to receive the initial funds and helped many to submit required documentation through various levels of DOH review and IPRO audits.

HCA will continue to keep members updated on the status of the QIVAPP monies.

HCA Presses Home Care Planning, Delivery Flexibility at Federal & State Levels for Home Care Nurse Practitioners, Certification Purposes HCA is continuing efforts on the national and state levels to facilitate the participation of non-physician practitioners in the ordering of home health services, as well as opportunities for increased nurse practitioner involvement in home care to assist with primary care and help reduce avoidable emergency room visits and hospitalizations.

As extensively reported in the past, HCA has long backed a bill (S.578/H.R. 1342) to allow non-physician practitioners to certify Medicare home health services. The bill is called the “Home Health Care Planning Improvement Act” and has been gaining some ground in Congress recently, according to reports.

HCA’s Legislative Action Center offers a message that you can send to Congress on this issue with a push of the button. It calls the bill a “commonsense measure” that “is long overdue for easing current restrictions on home health care access.”

The bill would allow nurse practitioners, physician assistants, clinical nurse specialists and other advance practice professionals to order and certify Medicare home health services. “It makes no sense to prevent these 8

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capable and highly trained staff from ordering or certifying home health services,” says HCA’s Legislative Action Center message, “consistent with their current professional roles in the system.”

You can send this message to your Congressional representative quickly and easily by following the instructions at https://p2a.co/z6HUax7.

State-level efforts Meanwhile, HCA is working at the state level to further broaden opportunities for home care providers to incorporate nurse practitioners in home care, facilitate increased access to primary care, and prevent hospitalization/ER visits.

Among the many provisions in our proposed state budget language is an item that would offer special rate/MLTC premium support to allow home care providers and MLTCs to further incorporate the services of nurse practitioners in “house calls” and primary care measures aimed at hospital avoidance.

Avoidance of unnecessary hospital use is a core outcomes goal of the Delivery System Reform Incentive Payment (DSRIP) program and value-based payments. It is also a cost saver, and provides new opportunities for multi-disciplinary home care. These are among the many reasons why HCA is pursuing this positive initiative in the state budget context, along with rate changes to support this special program.

To learn more about our budget proposals, please join us for HCA’s February 29 statewide conference call on the budget. (See related p. 1 story for details.)

HCA MLTC Forum Takes up Budget, Legislative, Program Priorities HCA’s MLTC Forum met yesterday delving into priority budget, legislative and program areas.

Issues taken up included: •

The status and implications of the Governor’s proposed minimum wage increase;

•

The Governor’s proposed structural and reimbursement changes to MLTC;

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Status and concerns with the state Department of Health’s approach and funding level for increased Fair Labor Standards Act costs to plans and providers, as well as the status and continuing severe problems with the Department’s Quality Incentive Vital Access Provider Pool (QIVAPP) distribution;

•

Overall payment adequacy and key infrastructure support for MLTC plans and home care providers; and

•

HCA’s comprehensive legislative/budget packages to support these areas.

Some new initiatives include: the Forum’s work with the State Medical Society to strengthen MLTC-home care engagement with physicians; a new legislative/budget proposal based on the Forum’s recommendations for 9

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enhancing a primary care/house-calls component with MLTC-home care; and new areas for regulatory streamlining. All of these were discussed at the Forum.

LHCSA representatives at the session suggested that HCA hold a future, joint meeting of HCA’s MLTC and LHCSA forums together to further delve into these issues. HCA agrees and intends to schedule one of these meetings in the future.

The Forum’s input is invaluable to HCA’s budget and legislative advocacy and will directly assist in HCA’s meetings next week with the Executive and Legislature on these top-tier issues.

HCA Partners With Wound Care Institute on Clinical Training Courses HCA members can use a code for free, on-demand webinars, as well as discounts for on-site training The Wound Care Education Institute is offering an array of on-demand webinars, free of charge for HCA members using a special code. It is also hosting a set of on-site courses, also co-sponsored by HCA, to help clinicians stay current with skin and wound care management.

Over two dozen free webinars are accessible through the following page: http://hca-nys.org/wp-content/uploads/2016/02/hcanys-webinar-flyer-2-16.pdf.

The onsite courses, meanwhile, are provided in two sets of five-day and four-day course formats at various locations throughout New York State. Both courses are designed for the same audience of LPN/LVNs, RNs, NPs, PAs and OTs who will benefit from wound care training and the opportunity to take a certification exam.

Members of HCA get a discount rate ($300 off standard rate) by using the code “HCANYS.” To learn more about the onsite courses, curricula, and locations, please download the flyers below.

The flyer for the four-day program is at: http://hca-nys.org/wp-content/uploads/2016/02/hcanys-4-daycourse-flyer-2-16.pdf. The flyer for the five-day program is at: http://hca-nys.org/wp-content/uploads/ 2016/02/hcanys-5-day-course-flyer-2-16.pdf.

Next Opt-Out of DSRIP Data Sharing To Be Held The state Department of Health (DOH) will be mailing approximately five million “Opt-Out” letters to Medicaid recipients (Phase II) beginning the week of February 22, 2016 through mid-March 2016 that explains the Delivery System Reform Incentive Payment (DSRIP) program and the individual’s opportunity to opt out of data sharing with Performing Provider Systems (PPS).

More information is at http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/consumers.htm.

This includes the Phase II Opt-Out Letter & Form, as well as updated Opt-Out Process FAQs. The FAQs were updated to reflect minor grammatical changes, and clarify data sharing information and the member’s choice to seek and obtain services under any PPS. Health information that will be shared – if individuals don’t opt out – includes medical conditions, prescription drugs, doctor visits, HIV/AIDS or mental health diagnoses.

A previous Phase I mailing was sent to about 700,000 Medicaid recipients in late October 2015.

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Volume 21, No. 7 February 19, 2016 

DOH, Steering Committee Mark Status, Next Steps in VBP Process Yesterday, the state’s core Value Based Payment (VBP) workgroup met in Albany to discuss a series of outstanding recommendations from the VBP subcommittee process, and mark next steps in the state’s planned VBP process.

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Clarification that in the “innovator” option of VBP, the amount of the managed care plan’s premium shared with the provider (up to 9095 percent of premium) will be determined based on the level of shared plan-provider functions that a provider agrees to take on.

The meeting slide deck can be viewed at http:// hca-nys.org/wp-content/uploads/2016/02/ VBPWorkgroupPresentationFeb182016.pdf.

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Deferral of a recommendation that would make changes to the Corporate Practice of Medicine doctrine (and related statutory changes) to permit more collaborative arrangements between primary care providers and other health care providers;

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Making it a standard that all Level 2 or 3 contractors engage with a minimum of one Tier 1 Community Based Organization where there is a CBO relevant to that intervention;

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Providers should have to implement interventions on a minimum of one Social Determinant of Health in Level 2 or 3 contracts, but will have flexibility to determine the type of intervention. Providers expressed that plans should be involved in the implementation and investment in this intervention, so this may be subject to change.

The committee reviewed changes the state Department of Health (DOH) is making to 15 of the VBP subcommittees’ recommendations that did not achieve complete consensus from members of the full Workgroup. With DOH’s revisions, these revised “non-consensus” recommendations will now be incorporated into the VBP Roadmap along with the remainder of the subcommittee recommendations, which address myriad technical, regulatory, and policy issues that are needed for the state to move forward with VBP implementation in the Medicaid program.

Each sub-committee had at least one nonconsensus recommendation that was revised, though the most, by far, came from the Social Determinants of Health and Community Based Organizations group, which had 9 nonconsensus recommendations that were modified by DOH. Most of these involved making a recommended “standard” or requirement for VBP contracting into a nonmandatory “guideline.” Some of the more noteworthy changes to the non-consensus recommendations include: •

DOH is accepting comments on the non-consensus recommendation changes, though is leaning toward technical corrections and revisions.

DOH next plans to share a revised version of the VBP Roadmap that includes all of the subcommittee recommendations in early March. DOH will also provide the Workgroup with a full list of all the Medicaid Model Contract changes that would implement the full set of VBP recommendations.

The creation of a formal review and appeal process to monitor the implementation of integrated primary care and total-care-for-totalpopulations arrangements and assist in mediating disagreements between primary care providers and hospitals;

The revised VBP Roadmap will be posted publicly for comment on March 15. DOH expects the revisions to be substantial.

The next full VBP Workgroup meeting will be in April to review the revised Roadmap. Members of the 11

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Workgroup will have an opportunity to comment, with the state planning to lock in all final changes to the Roadmap in May, in anticipation of sending the revised draft to CMS for review and approval in June.

VBP Boot Camp DOH also announced it plans to hold a series of regional meetings to discuss VBPs, which they are calling “VBP Boot Camp.” The Department expects to hold three different sessions in five different regions, and expects these sessions to be webcast as well. These are expected to begin this spring. More detail, dates and logistics to follow.

HCA thanks our Government-Affairs team at Hinman Straub for providing the content of this article.

CMS’s Medlearn Matters to Host Enrollment Revalidation Call: March 1 The U.S. Centers for Medicare and Medicaid Services (CMS) Medlearn Matters group will be hosting a conference call on Tuesday, March 1, from 2 to 3:15 p.m. on the Medicare enrollment revalidation process.

Participants will learn about new CMS resources to assist providers on the entire revalidation process. CMS will also discuss the timing, improvements, and updates for the second round of revalidations required by the Affordable Care Act (ACA). A question and answer session will follow CMS’s presentation.

To participate, you can register at http://www.eventsvc.com/blhtechnologies.

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

DOH Announces Process for Applying as Accountable Health Community The state Department of Health (DOH) has announced the state Medicaid contact person under the federal funding announcement for Accountable Health Communities (AHC).

The AHC Model, proposed by the U.S. Centers for Medicare and Medicaid Services (CMS), will examine whether systematically identifying and attempting to address health-related social needs of Medicare and Medicaid beneficiaries through referral and community navigation services can impact health care costs, reduce inpatient and outpatient health care utilization, and improve health care quality and delivery.

The AHC Model aims to identify and address beneficiaries’ health-related social needs in the following core areas: • • • • •

Housing instability and quality; Food insecurity; Utility needs; Interpersonal violence; and Transportation needs beyond medical transportation.

Applications are due March 31. More information is at https://innovation.cms.gov/initiatives/ahcm/.

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

Volume 21, No. 7 February 19, 2016 

Continued from previous page As detailed in the funding opportunity announcement, applicants are required to submit, along with their application, a contract, Memorandum of Understanding (MOU) or MOU equivalent from the state Medicaid agency.

The New York point of contact for this process is: Kalin Scott, Director of Project Management, Medicaid Redesign Team, at kalin.scott@health.ny.gov. Interested applicants need to send an e-mail to Kalin Scott indicating their intent to apply by 5 p.m. on Thursday, February 25.

Additional guidance will be provided directly to interested applicants late next week, and a conference call will be scheduled shortly thereafter to provide a brief overview and outline information that applicants will be required to submit in order to work toward a contract, MOU or MOU equivalent.

All questions on the ACH Model and funding opportunity should be directed to CMS through the link above. Questions on the state Medicaid agency role may be submitted to Kalin Scott.

DOH Requests Information on PACE Model The state Department of Health has posted a Request for Information (RFI) on future changes to the Program of All-inclusive Care for the Elderly (PACE) delivery model as a result of the new federal PACE Innovation Act. The RFI and a brief questionnaire are at http://www.health.ny.gov/health_care/medicaid/redesign/mrt90/hlth_plans_prov_prof.htm.

The PACE Innovation Act authorizes the Secretary of Health and Human Services (HHS) to waive requirements under section 1934 of the Social Security Act to design and test new models. As a result, CMS allows providers and other entities not currently PACE providers to consider adapting the model to serve new populations in innovative ways. The Act creates opportunity for these new populations previously not qualified for PACE programs to be served by this model. In addition, in June of 2015, CMS used its waiver authority to allow for-profit entities to operate PACE demonstration programs.

DOH intends to use the RFI responses to develop a comprehensive analysis of the impact of PACE on long term services and supports in New York and develop possible strategies to expand the current PACE model.

Any questions should be directed to BIP@health.ny.gov.

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