February 20, 2015 ASAP

ASAP

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

Legislative Issues  Public Policy



News

Volume 20, No. 7 February 20, 2015

HCA State Budget Advocacy This Week Focuses on Bill Drafts to Support Legislative Priorities for Home Care The State Legislature was adjourned this past week for the President’s Day recess, giving HCA the opportunity to work with the staff of Legislative and Executive leaders on our budget priorities.

Over the past several days, HCA has been following up with Legislative and Executive offices in the wake of last week’s state advocacy visits. (See the p. 1 story in the February 13 ASAP.) During last week’s meetings, budget, health and executive leadership officials invited HCA’s input on the budget, including our intended submission of draft legislative language to support New York’s home care system.

See ADVOCACY p. 2

HCA Seeks Your Input on Clinical Template for F2F as We Advocate Solutions The home health industry nationwide continues to express major concerns with the federal government’s efforts to reshape the Medicare face-to-face (F2F) requirements, which have long been problematic.

As reported in last week’s ASAP, the U.S. Centers for Medicare and Medicaid Services (CMS) recently held an Open Door Forum to outline for home care providers CMS’s proposed clinical template that physicians may use as a guide in completing the clinical documentation to meet the F2F requirement.

Inside ASAP HCA State Budget Advocacy This Week Focuses on Bill Drafts.......1

The clinical template is designed to help satisfy recent changes in the F2F requirement that place enforcement of the F2F in the physician’s record,

HCA Seeks Your Input on New Clinical Template for F2F.................1

See TEMPLATE p. 5

HCA, Health Foundation Hold Veterans’ Home Care Roundtable...3 Register Today for HCA’s CFO Forum................................................4 DOH Seeks Workgroup Input on Second Draft of VBP Roadmap.....6 ePOC Coming Soon...........................................................................6 Check Out the Latest in HCA Learning Opportunities....................7 DSRIP Update.........................................................................8 CMS Posts Technology Survey...........................................................9 CMS Releases Two New ICD-10 Videos.........................................10 NGS Updates.................................................................................10 CMS Forum to Highlight Data Requirements of IMPACT Act...........11 Publications...................................................................12

Helping New Yorkers Feel Right At Home

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

Volume 20, No. 7 February 20, 2015 

ADVOCACY from p. 1 At this stage of the process, much of HCA’s state-budget-related activity this week was devoted to crafting bill language and legislative mark-ups that reflect the main priority areas of our policy agenda. This agenda includes the need for: increased funding for the managed care-home care payment model to reflect core community support needs in an environment of increasing financial fragility; prompt action on home care-managed care regulatory relief and realignment measures; home care capital and vital-access financing as well as funding for Health Information Technology; support for HCA quality initiatives; among other issues.

Our draft budget legislation seeks to address all of these policy areas, as previously identified in our advocacy agenda paper entitled “Driving Health Care Improvement and Savings Through Home Care.” These priority areas were developed on a proactive basis in the lead-up to this year’s state budget process; however, since the release of the state budget proposal in late January, and in response to it, HCA has identified yet-further areas in the Governor’s plan that demand amendments. Therefore, our draft budget bills also seek to amend certain aspects of the Governor’s proposals in a responsive way, foremost by including home care more explicitly in the health investment opportunity areas otherwise afforded for other sectors.

Reinforcing our call to action in last week’s ASAP, HCA again urges the membership to continue calling the offices of your Senate and Assembly representatives to promote their support for HCA’s budget language and proposals as the HCA legislative language gets submitted and as the Legislature negotiates a bill with the Governor. We need your support to ensure that the Legislature includes our proposals in each one-house budget bill and, ultimately, in the final consensus budget.

Continued on next page

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

President: Editor:

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

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

Volume 20, No. 7 February 20, 2015 

Continued from p. 2 As we near the end of February, state budget negotiations will escalate substantially. According to a schedule released by the Senate and Assembly, each house plans to release its economic and revenue reports next week, by February 26, when the two houses will also meet for a joint revenue forecasting conference.

Budget Resource Downloads

The Joint Senate and Assembly Budget Committees are expected to begin deliberations on March 12, with all eyes on the April 1 deadline to complete the budget by the start of the fiscal year.

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

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

HCA’s 2015 Home Care Financial Condition Report: Home Care Financial and Program Support Vital for Success of New Care-Delivery Models (January 2015)

Please see last week’s ASAP for a series of bulleted talking points to guide your advocacy with state legislators. It is imperative that all members take a few minutes to call your elected representatives in support of home care in the coming days. If you have any questions, do not hesitate to contact HCA’s Communications Director Roger Noyes for resources or assistance.

http://www.hca-nys.org/documents/ 2015HCAFinancialConditionReport.pdf HCA State Budget Testimony (February 2, 2015)

HCA, Health Foundation Hold Veterans’ Home Care Roundtable

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

HCA and the New York State Health Foundation collaborated last Friday on a roundtable in support of veterans’ home care.

Memo: 2015-16 Executive State Budget Analysis (January 27, 2015) http://www.hca-nys.org/policy_memos/ documents/ HCAMemo2015ExecutiveBudget.pdf

The session harnessed the experiences and insights of home care agencies in each of the state’s regions (including members of the HCA Board); HCA executive staff; Foundation executives and Board members; representatives of IAVA (IraqAfghanistan Veterans Association) in Washington; the National Association for Home Care and Hospice (NAHC); and others.

The discussion delved into the current experiences and status of veterans’ home care, including: a review of the available home care benefit options and their lack of coordination or integration; access, coverage and continuity challenges; issues specific to new and senior veterans, as well as to male and female veterans; and the lack of comprehensive, routinely collected and useful data to better assess needs and areas for support, or even to ensure veterans are 3

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

Volume 20, No. 7 February 20, 2015 

identified when engaging with the health care system outside of the U.S. Department of Veterans Affairs (VA).

HCA and Foundation representatives will be following up on next steps, including the anticipated receipt of VA data on home care from the U.S. Secretary of Veterans Affairs. As reported in the January 30 ASAP (see p.

1 story), this data was requested – in support of our effort – by New York Rep. Lee Zeldin (Long Island), the newest member on the House Veterans Affairs Committee. HCA is also following up with the chairs of the state Senate and Assembly Veterans Committees, NAHC, and other leaders to explore possible initiatives in support.

HCA greatly appreciates this collaborative opportunity with the Foundation, and we extend special thanks to HCA member providers, the IAVA and NAHC for joining in this effort for veterans’ home care. HCA looks forward to further work with all concerned to seize what may be a unique and well-timed opportunity to progress on this important area. Stay tuned for our updates.

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

Register Today for HCA’s CFO Forum HCA’s CFO Forum, on March 18 in Albany, is a must-attend program for home care financial managers, CFOs and other executive staff to hear from HCA finance and reimbursement experts, state Department of Health (DOH) officials, and industry consultants on home care fiscal issues.

Registration is now open. Please download the registration form at the back of this week’s ASAP for details.

Kicking off the Forum, HCA staff will highlight the many finance-related advocacy areas where we are working on your behalf: from the federal and state budget fronts … to our work on the many rate packages and payment-model implementation efforts occurring internally at DOH … to the complex Medicare payment issues under federal rebasing and the home health Prospective Payment System (PPS).

DOH reimbursement officials will provide yet further details on all of the state-level issues, including updates on: provisions in the 2015-16 Executive State Budget that impact providers and plans; the upcoming rebasing of the Certified Home Health Agency Episodic Payment System (EPS); the Medicaid Global Cap; premium rate adjustments to Managed Long Term Care (MLTC) and Mainstream Medicaid Managed Care plans; Wage Parity adjustments to plans and home care providers; the Long Term Home Health Care Program and Personal Care fee-for-service Medicaid rates; the 2014 Medicaid cost reports and other Medicaid reimbursement issues.

Robert Simione will provide participants with the latest aggregate benchmarking data for Medicare and Medicaid to help you make sense of how the various federal and state fiscal policy levers are affecting your bottom-line and operational practices related to your peers. Participants will also hear from two former executives at MVP Health Plan, based in the Capital District, who will share tips on successful relationships with managed care organizations, drawing from their many years of experience in the plan world.

Please do not miss out on this robust program which delves into several important areas relevant to your agency’s fiscal health.

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

Volume 20, No. 7 February 20, 2015 

TEMPLATE continued from p. 1 as distinct from the previous regulatory requirement for F2F (prior to 2015), in which home care providers were required to obtain a signed narrative from the physician to document the F2F encounter, putting the onus on home health providers and their clinical records in regards to enforcement activity.

As previously and extensively reported to the membership, this relocation of documentation enforcement to the physician’s record was prompted by industrywide protests against the prior physician narrative requirement, which had placed an enormous burden on physicians and home care providers, triggering audits and recoveries on the basis of technical deviations from the confusing and difficult-to-obtain standards.

In response to these industry protests, CMS removed the narrative requirement beginning on January 1 as part of its 2015 Home Health Prospective Payment System rule, and replaced the narrative with the new requirement which basically compels home care providers to provide as much clinical information as possible to the physician and ensure that the physician is: 1) maintaining records which support Medicare home health eligibility, and 2) documenting the occurrence of a F2F encounter with the patient. Otherwise, payment to the home care provider remains at risk.

While the idea of a clinical template to assist the physician in this effort is conceptually helpful, the extensive multi-page form introduced by CMS during last week’s Open Door Forum call only multiplies the burden on physicians and, thus, increases the risk of noncompliance. Meanwhile, the underlying changes to F2F that the form seeks to support are themselves problematic, in putting the responsibility on the physician record for home care service compliance, with financial risk to the home care provider.

In comments this week to the trade publication Inside Health Policy, the National Association for Home Care and Hospice (NAHC) expressed the need for more guidance on the degree to which home care providers can assist physicians in completing this new form.

NAHC’s Vice President for Law, Bill Dombi, also raised concerns about the narrative portions of the clinical template, which merely serve to resurrect the problematic model for documentation that CMS was attempting to mitigate in the first place. “Given the years of difficulty with the narrative, why would they make the form a narrative?” Mr. Dombi stated in the article.

A copy of the electronic template and the handouts from the February 11 CMS Forum are at https:// www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-and-Systems/Electronic-ClinicalTemplates/HomeHealthHHElectronicClinicalTemplate.html. The paper template is at https:// www.cms.hhs.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFSCompliance-Programs/Medical-Review/Home_Health_Medical_Review_Update.html.

HCA asks the membership’s feedback on these templates which we will use as part of our advocacy to simplify the F2F documentation requirements. Comments can be sent to HCA at info@hcanys.org with the subject line “F2F Clinical Template Comments.”

Meanwhile, HCA continues to advocate for a much simpler approach, utilizing space on the existing 485/Plan of Care for documentation of the F2F encounter. NAHC also continues to press its case in the courts via a lawsuit in an effort to simplify the mandate and obtain relief for providers whose reimbursement was previously denied under the prior versions of the rule.

Please stay tuned for further updates as they emerge.

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

DOH Seeks Workgroup Input on Second Draft of VBP Roadmap

Volume 20, No. 7 February 20, 2015 

ePOC Coming Soon

The state Department of Health (DOH), working with KPMG, is seeking input on a second draft of the Department’s proposed Roadmap to Value Based Payment (VBP) in the state.

As discussed in HCA’s budget analyses and in recent editions of ASAP, the state agreed to terms and conditions with the U.S. Centers for Medicare and Medicaid Services (CMS) for receipt of waiver reinvestment funds to move 90 percent of payments to VBP. The Department’s far-reaching aim for VBP would be enacted in the Executive’s state budget proposal, now under review by the Legislature, and would seek to include all payors – Medicaid, Medicare and commercial.

DOH will be reviewing this second Roadmap draft with the VBP workgroup next Tuesday. HCA is a workgroup member, along with state associations representing the other major health care sectors, including hospitals, nursing homes, clinics, health plans, behavioral health providers and others.

HCA previously shared with the membership our comments on the first draft Roadmap. These include our joint comments submitted with the other state associations, as well as our own, separate, comment letter specific to home and community-based care.

Members can refer to those comments in the “Policy Positions” page of our website at http://www.hca-nys.org/polpos.cfm.

On behalf of DOH, project staff at KPMG contacted HCA to schedule a lengthy follow-up meeting (planned for this coming Monday) to delve deeper into our comments and recommendations on VBP. The VBP workgroup next meets the following day, on Tuesday at 10:30 a.m., in Albany. HCA members can direct comments on VPB in advance of this meeting to HCA Executive Vice President Al Cardillo at acardillo@hcany.org; comments post-meeting are also welcome, but any feedback received prior can be incorporated into Tuesday’s input.

We emphasize the sweeping significance of this proposal, which has prompted concerns that we also addressed in testimony earlier this month at the Joint Legislative Committee Public Hearings on the proposed Executive Budget.

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

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The state Department of Health (DOH) has advised HCA that it will be resuming the Health Commerce System (HCS)-based Electronic Plan of Correction (ePOC) for home care providers in the near future.

DOH plans to issue a Dear Administrator Letter (DAL) and will be sending an e-mail notification to providers prior to the DAL posting with the announcement and links to some training resources.

A live training webinar is planned, probably in March, open to home care providers.

HCA will keep members informed of any webinars and updated information. ePOC will automate the distribution of Statements of Deficiency (SODs) to home care providers and the receipt of Plans of Correction (POCs) from home care providers and eliminate the sending of hardcopy SODs and POCs. ePOC was supposed to go live in 2014 but has been delayed.

HCA and DOH are scheduling a meeting to discuss DOH’s intentions and to afford an opportunity for advance comments.

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

Volume 20, No. 7 February 20, 2015 

Check Out the Latest in HCA Learning Opportunities HCA is pleased to bring you a variety of learning opportunities for every staff role at your agency.

Beginning on March 19, HCA is offering a webinar on How to Plan and Package Care Transitions: A Provider’s Perspective from 11:30 a.m. to 1 p.m. This program will review the elements for developing a care transition program in partnership with hospitals to improve outcomes and reduce re-hospitalization rates.

Participants will also learn to identify the metrics for assessing the effectiveness of your care transitions program, as well as some potential pitfalls to look out for.

For the cost of one phone line connection, you can affordably gather your clinical leaders, executive team and financial managers to participate in this program. (An audio recording of the program will also be available for those unable to participate on March 19.)

Also, via webinar, HCA is offering a five-part series on OASIS-C1 Basics. This series will cover the OASIS section by section, discuss problematic areas, and bring your staff up-to-date on guidance by the U.S. Centers for Medicare and Medicaid Services (CMS). You can participate in any or all of the teleconferences in this series. The weekly series will begin on February 26 (3 to 4 p.m.) and will include segments on OASIS data collection requirements, patient history and diagnoses, and several disease-specific items.

Education for home health aides Heart-failure prevention is a major component of federal quality initiatives in cardiovascular health. Your home health aide staff are an important front-line resource for identifying risks in this area so that timely interventions can be made. Ensure that your aides have this important knowledge by inviting them to participate in a webinar on The Aide’s Role in Working with Clients with Congestive Heart Failure on March 12 from 3 to 4 p.m. Kathie Smith, RN, will cover the anatomy of the heart, what happens to the heart in heart failure, how heart failure affects a person’s day-to-day functioning and how to assist clients in managing this chronic condition.

In addition to these webinars, HCA will offer a two-day workshop on the popular Blueprint for OASIS Accuracy on June 23 and 24 in Albany, followed by the optional Certificate for OASIS Specialist-Clinical (COS-C) exam on June 25. This comprehensive workshop to help you master OASIS items is offered by two expert presenters from OASIS Answers, Inc. The program provides up-to-the-minute education for field data collectors, their supervisors and those preparing for the COS-C exam. Early registration is encouraged in order to guarantee your seat at this program that is generally a sell-out. A Blueprint for OASIS Accuracy program downstate is planned for October; information on this program will be available in late spring.

Further information on each of these programs and how to register is available on HCA’s website at www.hcanys.org/events.cfm. Our education page is updated weekly with learning opportunities, including upcoming programs such as the HCA Annual Conference (on May 6 to 7) and the ACHE Leadership Institute (on May 8) that you will want to mark on your calendar.

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

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

Volume 20, No. 7 February 20, 2015 

DSRIP Update This week, the Project Approval and Oversight Panel (PAOP) met to discuss the twenty-five Performing Provider Systems (PPS) applications.

As part of the Delivery System Reform Incentive Payment (DSRIP) program requirements outlined by the U.S. Centers for Medicare and Medicaid Services, the state is required to create a panel to review DSRIP applications scored by an independent assessor and advise the Commissioner of Health whether to accept, reject or modify those recommendations.

The Panel discussed each application extensively, and some changes were recommended to the application scores that were assigned by the Independent Assessor.

The PPS applications are at https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/ pps_applications/.

Members who are part of PPSs can review important information related to their PPSs, including: distribution of DSRIP funds, bonus payments, the process to sanction poor performing providers, areas requested for regulatory relief, and plan governance.

In addition, the state Department of Health (DOH) has released the DSRIP program implementation plan template, posted public comments on PPS Project Plan Applications, and updated its timeline.

The following are some key considerations about the implementation plan template and the implementation plan process: •

This template is to be used for PPSs to submit their DSRIP implementation plans by the April 1, 2015 deadline.

•

All the information that PPSs enter into this implementation plan template must align with the commitments they made in their DSRIP Project Plan and Organizational Applications.

•

There are some elements of this implementation plan template that will not be required for the April 1 deadline but which PPSs will be required to submit at a later date, such as revised workforce transformation numbers and committed provider lists for each project. DOH will shortly publish a detailed schedule of submission requirements.

•

The period between March 1 and April 1 is an opportunity for PPSs to draw on the support of the KPMG DSRIP Support Team to help them finalize their implementation plan submissions.

The implementation plan template requires PPSs to set target completion dates for each of the milestones prescribed within the template and to set out the steps they will take in order to achieve those milestones.

These milestones are not intended to be an exhaustive list of all the activities a PPS will be undertaking in a

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Volume 20, No. 7 February 20, 2015 

given area; they are the key process milestones and deliverables on which DOH and the Independent Assessor want further clarity and insight into PPSs’ plans and timelines.

A soon-to-be-released “AV policies and procedures guide” will provide more detail on how the Independent Assessor will assess PPS implementation plans and quarterly reports and how associated Achievement Values (AVs) will be calculated.

Public comments DOH has released the public comments it received on DSRIP PPS Project Plan Applications. As required by CMS, DSRIP PPS Project Plan Applications were open for public comment for a 30-day period, which ended on February 15.

The entire collection of public comments and a summary are at http://www.health.ny.gov/health_care/ medicaid/redesign/dsrip/pps_applications/ public_comments/.

The summary covers: community engagement; PPS Project Plan Applications; regulatory waivers; flow of DSRIP funds; workforce; public comments; technology resources; governance; and ongoing and expanded project evaluation.

Updated timeline Several updates and deliverables were incorporated into the year-zero DSRIP Timeline available at http:// www.health.ny.gov/health_care/medicaid/redesign/ dsrip/docs/dsrip_timeline.pdf. The updates pertain to items due in late February through March. Some important dates include: •

Early March – final attribution for performance results released; PPS member roster released to PPS leads; and DSRIP Project Plan awards made.

•

April 1 – implementation plan due from PPSs; and DSRIP year one begins.

•

Mid-April – first year-one payments made to PPSs. 9

CMS Posts Tech Survey The U.S. Centers for Medicare and Medicaid Services (CMS) has posted a voluntary survey for home care and other post-acute providers to “help CMS understand the role technology is playing in the delivery of health care services.”

The survey is at https:// www.surveymonkey.com/s/ 3T9MV3J and must be completed by March 3.

According to CMS, the goal of the survey is to learn more about the adoption rate of health information technology (HIT) and engagement in electronic health information exchange (HIE) in long term and post-acute settings and the extent to which HIT and HIE are used in these settings.

The information will help CMS understand where such technology may be playing a role in the delivery of health care services in such settings. It will also identify both the benefits and the gaps hindering provider participation in programs that promote care coordination, such as the participation in HIE. This survey is fully voluntary, and there is no penalty for not responding.

Individual survey responses will not be made public. The estimated time to complete the survey is 20 minutes.

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

Volume 20, No. 7 February 20, 2015 

CMS Releases Two New ICD-10 Videos The U.S. Centers for Medicare and Medicaid Services (CMS) has released two animated shorts that explain key ICD-10 concepts.

The videos, less than 4 minutes each, are available at http://www.cms.gov/Medicare/Coding/ICD10/ ProviderResources.html.

They include: •

“Introduction to ICD-10 Coding,” which gives an overview of ICD-10 features and explains the benefits of the new code set to patients and to the health care community.

•

“ICD-10 Coding and Diabetes,” which uses diabetes as an example to show how the code set captures important clinical details.

Other videos and useful information are also at http://www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html.

NGS Updates National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), has recently posted the following information to its website.

•

ICD-10 Acknowledgement Testing Week: March 2 to 6, 2015. Trading partners, billing services, software vendors, and clearinghouses will be able to send test claims for the ICD-10 Acknowledgement Testing Week from March 2 to 6. This testing week allows CMS to analyze testing data. Registration is not required for the Acknowledgement Testing Week.

During testing: 1) test claims with ICD-10 diagnosis codes must be submitted with current dates of service since testing does not support future dated claims; 2) test claims will receive the TRN, 999 and 277CA acknowledgements as appropriate, to confirm if the claim would be accepted or rejected in the system; 3) testing will not confirm claim payment or produce a remittance advice; and 4) all test files must have the “T” in the ISA15 field for Test files.

Questions during testing week may be directed to NGS’s EDI Help Desk at (877) 273-4334.

•

Upcoming 2015 Annual User ID Recertification. All users who access the Direct Data Entry (DDE) and Durable Medical Equipment (DME)/Claim Status Inquiry (CSI) systems are required to recertify their access annually. NGS will distribute each active user’s access code by an e-mail communication to the authorized contact currently on file with EDI in March 2015. The notification will include instructions on how to recertify your access.

If anyone in your agency or offices is currently accessing either/both of these systems, please watch for further communications from NGS. Every user that has an active User/Login ID prior to December

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31, 2014 must complete the recertification. Users that were assigned a User ID or had their ID reinstated after December 31, 2014 will not need to recertify until the 2016 Recertification.

NGS’s Electronic Data Interchange (EDI) will provide more detailed information by e-mail as the beginning of the 2015 Annual User ID Recertification period approaches.

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

CMS Open Door Forum to Highlight Standardized Data Requirements of IMPACT Act The U.S. Centers for Medicare and Medicaid Services will host a Special Open Door Forum call on February 25 from 1:30 to 2:30 p.m. to provide an overview of standardized data in relation to the quality measures and standardized assessment domains required under the IMPACT Act of 2014.

For an HCA report on the IMPACT Act, please see the September 19, 2014 edition of ASAP (p. 14) at http://www.hca-nys.org/documents/ASAP091914.pdf.

The Improving Medicare Post-Acute Care Transformation Act (IMPACT) of 2014 was passed on September 18, 2014. The IMPACT Act, in general, states that the Secretary shall require the submission of standardized data (with domains as specified) using assessments submitted to CMS by Long-Term Care Hospitals (LTCH), Skilled Nursing Facilities (SNF), Home Health Agencies (HHA) and Inpatient Rehabilitation Facilities (IRF).

It further requires the submission of standardized data using such assessments for use in the quality measures for which the Act specifies five domains. It further requires that data be submitted on measures related to resource use, and other categories.

The Forum will provide a high level overview of the requirements related to the use of standardized data for both the quality measures and the assessment instrument domains.

Comments can be submitted to PACQualityInitiatives@cms.hhs.gov.

The IMPACT Act of 2014 can be found at: http://www.gpo.gov/fdsys/pkg/BILLS-113hr4994enr/pdf/BILLS-113hr4994enr.pdf PowerPoint Presentation slides for this call can be found at: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Post-Acute-CareQuality-Initiatives/IMPACT-Act-of-2014-and-Cross-Setting-Measures.html Participants are urged to dial-in about 15 minutes prior to the start of next week’s Open Door Forum call.

Dial-in information is below.

• •

Participant dial-in number: 1-800-837-1935 Conference ID number: 90762447

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Publications •

“Chronic Care Management Services Fact Sheet,” by the U.S. Centers for Medicare and Medicaid Services http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/ Downloads/ChronicCareManagement.pdf

•

“Long-Term Care Services in the United States: 2013 Overview,” by the National Center for Health Statistics http://www.cdc.gov/nchs/data/nsltcp/long_term_care_services_2013.pdf

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

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CFO Forum

March 18, 2015

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

CFO Forum

March 18, 2015 9:00am – 3:30pm Albany Hilton Albany, New York 12207

HCA’s CFO Forum is a must‐attend program for home care financial managers, CFOs and other executive staff to hear from HCA finance and reimbursement experts, state Department of Health (DOH) officials, and industry consultants on home care fiscal issues.

Kicking off the Forum, HCA staff will highlight the many finance‐related advocacy areas where we are working on your behalf – from the federal and state budget fronts to our work on the many rate packages and payment model implementation efforts occurring internally at the DOH and state Executive levels. DOH reimbursement officials will provide yet further details on all of these issues from the state’s perspective.

Robert Simione will provide participants with the latest aggregate benchmarking data for Medicare and Medicaid to help you make sense of how the various federal and state fiscal policy levers are affecting your bottom‐line and operational practices related to your peers. Participants will also hear from two former executives at MVP Health Plan, based in the Capital District, who will share tips on successful relationships with managed care organizations, drawing from their many years of experience in the plan world.

Please do not miss out on this robust program which delves into several important areas relevant to your agency’s fiscal health.

AGENDA 9:00am – 9:30am

HCA Registration & Continental Breakfast 9:30am – 10:15am

HCA Update HCA staff will provide a state legislative update, which will focus on the 2015‐16 proposed Executive State Budget and its impact on home care, along with an update on our advocacy efforts in Albany and Washington. HCA staff will highlight our annual financial condition report as well as discuss the latest on Vital Access Provider (VAP) funding, DSRIP, Wage Parity mandates, and the 2015 Medicare Prospective Payment System (PPS).

10:15am – 11:15am

Department of Health Update Tim Casey, Bureau of Long Term Care Reimbursement Daniel Carmody, Bureau of Managed Care Reimbursement Mr. Casey and Mr. Carmody will provide updates on the following: provisions in the 2015‐16 Executive State Budget that impact home care, personal care and Medicaid managed care; the upcoming rebasing of the CHHA Episodic Payment System (EPS); the Medicaid Global Cap; premium rate adjustments to Managed Long Term Care (MLTC) and Mainstream Medicaid Managed Care plans; Wage Parity adjustments to plans and home care providers; Value Based Purchasing; the LTHHCP and Personal Care fee‐for‐service Medicaid rates; the 2014 Medicaid cost reports and other Medicaid reimbursement issues.

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CFO Forum

March 18, 2015 9:00am – 3:30pm Albany Hilton Albany, New York 12207

AGENDA - Continued 11:15pm – 12:15pm

Simione Consultants – Medicare PPS and CHHA Medicaid EPS Benchmarking Data Robert Simione, CPA, Vice President, Simione Financial Monitor During this session, Mr. Simione will share the latest aggregate benchmarking data for the Medicare Home Health Prospective Payment System (PPS), Medicaid EPS and managed care using comparisons from clients of Simione’s Financial Monitor here in New York versus national averages. This data is especially useful in the context of federal rebasing under the Medicare home health PPS and the state Department of Health’s current rebasing efforts for CHHA EPS. Some benchmarking highlights will include: the volume of outliers, LUPAs, PEPs and full episodes; Medicare net and gross margin data; as well as average case‐mix weights and visits per discipline.

12:15pm – 1:15pm – Lunch 1:15pm – 2:45pm

Tips for Successful Relations with Managed Care Organizations Frank J. Fanshawe, Attorney At Law, Wilson Elser Moskowitz Edelman & Dicker, LLP Mark Fish, Managing Director, FTI Consulting Health care is experiencing dramatic change as the nation’s delivery system transitions to a value‐based system. Value‐based contracting will be critical to the ability of health care providers to establish themselves as essential in their markets with managed care organizations. During this session, Frank Fanshawe, Esq. and Mark Fish will discuss how managed care organizations approach contracting with current and prospective network providers, particularly in an evolving market where the focus is on value based contracting.

2:45pm – Adjournment

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