ASAP
A Weekly Publication Of HCA Home Care Association of New York State
Legislative Issues Public Policy
News
Volume 21, No. 8 February 26, 2016
As HCA Presses Budget Asks, Members Must Provide Groundswell of Advocacy – Now and Over Next Two Weeks The Legislature is working on state budget language for the next phase of the negotiations. It’s officially crunch time. HCA continues to meet with key legislative staff and committees to present our budget proposals and urge their inclusion in the Assembly and Senate bills, including several meetings we held this week. Our priority focus is on the minimum wage proposal and the imperative for full funding of home care if the Governor’s (or any other such) proposal is adopted. We have provided the evidence and believe we See GROUNDSWELL p. 2
All Your Home Care Reimbursement, Payment & Bench-marking Needs Answered at HCA’s March 9 Summit HCA’s Senior Financial Managers Summit on March 9 in Albany (less than two weeks away!) will provide all the answers you need on all things home care finance. The timing and location of this program are designed purposely for the involvement of state reimbursement officials and others who will be on hand to give you the latest updates related to the state budget and other vital finance issues. Nowhere else will your finance teams get such breadth of information – all at one time and in one place – for a modest fee. This program is open to HCA members only; so be sure to take advantage of this important member benefit. Inside ASAP Members Must Provide Groundswell of Budget Advocacy.....1 All Your Home Care Finance Needs Answered at March 9 Summit...1 Member Hiring Announcement......................................................4 HCA Visits Congress for Medicare, Medicaid Home Care Advocacy...5 HCA Presses for Priority Release of FLSA Funding............................7 QIVAPP Desk Audits Continuing Until March 17...............................8 New Bootcamp Program on Leadership Essentials for LHCSAs....8 ‘Vote Home Care’ at HCA Annual Conference: May 4-6....................9 State Outlines TALs Requirement, More Webinars on 3/11............9 Award Nominations Due 3/ 8 for HCA Annual Conference ............10 DOH Outlines Financial, Compliance Monitoring of Managed Care.......11 Quality of Patient Care Star Ratings Panel Being Convened.........12 CMS Proposed Rule to Strengthen Provider Enrollment Process...13 Funding for Chronic Disease Self-Management, Falls Prevention...14 CMS Publishes Medicare FFS Utilization Data Tool.......................14 ONC Examples of Permitted Health Info Exchange under HIPPA...15 Update on NHTD/TBI Waiver Transition Workgroup.....................15 Publications................................................................................16
See SUMMIT p. 4
Helping New Yorkers Feel Right At Home
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ASAP – a publication of the Home Care Association of New York State GROUNDSWELL from p. 1
minimum wage, workers compensation or other such expenses.
are achieving recognition that, across all sectors, home care would be most impacted and in need of full support for wage funding.
What You Need to Do These efforts all coincide with other groups and organizations making similar requests for investment in health care and other sectors, as the Senate and Assembly work to print their one-house budget bills by the week of March 11. It is expected that the Legislature will aim to pass these bills during the week of March 14.
We have also focused heavily on the need for basic investments in critical areas of the home care and MLTC system. These include premium and rate payment adequacy for providers and plans, and for investment in essential infrastructure and optimization of home care’s role and capacity. Our proposals call for investment appropriations, reimbursement fixes and program support, accompanied by demands that the state commit to full, timely, and direct funds for any minimum wage proposal that would be included in the budget, now estimated at a $2.19 billion impact for home care (at full implementation of a $15-per-hour wage floor).
With all this activity, we need members to continue ramping up their grassroots advocacy with the Legislature to make sure that HCA’s budget asks are included in the one-house budget bills. Earlier this week, we e-mailed and texted some members to take action using our Legislative Action Center. The response was swift, but it needs to be far bigger! At ASAP press time, approximately 440 email messages and phone calls were made to the Legislature … but you must keep them coming. With thousands of people employed at HCA member agencies, your connections to the Legislature must
HCA’s proposed Article VII language also addresses labor costs holistically: by requiring state reimbursement levels to match mandated costs, whether it’s Wage Parity, the Fair Labor Standards Act overtime increases, a higher
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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approach this full potential for many hundred more contacts.
Budget Talking Points
If you haven’t done so, please send a message to your legislator by clicking http://p2a.co/ cEX2Twq. Once there, select the envelope icon, enter your contact information and hit “send.” All of your staff should be doing the same, since it is quick and easy, but we also need home care leaders to do more.
When you call your legislator’s office, please ask to speak to the legislator or a member of his or her staff involved in budget or health care matters. Some talking points are below.
Our Legislative Action Center has an option for calling your legislators directly. You don’t need to look up a phone number. You just need to open a link on your smartphone (http://p2a.co/ cEX2Twq), select the phone icon, and enter your contact information. You will then receive a call with pre-recorded instructions from HCA’s Communications Director, Roger Noyes, patching you through to your lawmaker’s office. You can also call the Senate and Assembly directly at the follow switchboard numbers: Senate (518-455-2800) and Assembly (518-455-4100). For members who have already used our Legislative Action Center, HCA has sent follow-up text messages and will continue to do so until we are assured of a strong advocacy response in support of our budget asks.
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I am a provider of home care in your district and am calling for your support during the budget process.
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Home care desperately needs investment and reimbursement fixes to stay viable and to continue to provide services to the frail-elderly and disabled residents of your community.
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Two-thirds of certified home health agencies are operating in the red. Half of all home care providers are borrowing money to stay afloat.
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On top of this, the Governor’s $15 wage mandate will be catastrophic for home care without full funding.
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While laudable in its goal, this wage proposal alone would impose $2.19 billion in new costs on home care.
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The Home Care Association of New York State (HCA) is urging that the Legislature and Governor fully fund any minimum wage increase that may be adopted. In addition, HCA has provided specific budget language to ensure that home care’s reimbursement covers the cost of care and keeps with past pledges to cover mandates for state-imposed labor expenses and program services.
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These proposals also support home care’s participation in DSRIP, Value-Based Payments and other models developed by the state.
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These necessary funds and investments, however, must be joined by a commitment to cover the Governor’s $2.19 billion wage mandate if this mandate is included as part of the budget.
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Please encourage your legislative colleagues to support home care in this year’s budget and adopt the proposals advanced by the Home Care Association of New York State.
Some talking points are in the sidebar (at right). Please familiarize yourself with the messaging and get ready to send messages and make calls next week. HCA will send you further instructions as new developments arise. Monday’s Conference Call Meanwhile, if you need more coaching or information, we are also holding a special conference call on Monday, February 29, at 2 p.m. This call will include the latest HCA estimates of the wage impact and other developments with the budget, including a detailed description of our proposals. If you want the dial-in information, please e-mail Billi Hoen at bhoen@hcanys.org. 3
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SUMMIT from p. 1 We know there are countless finance issues creating anxiety or confusion, and this session will provide answers, whether you are a LHCSA, CHHA, LTHHCP or MLTC. This includes answers about the status of: •
Quality Incentive/Vital Access Provider Pool (QIVAPP) funds and the state’s attempts to fund Fair Labor Standards Act costs (for overtime, travel and other expenses).
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The state budget process, including HCA’s calculations and strategy for the $2.19 billion proposed minimum wage mandate as well as our investment requests for billing, coverage and infrastructure support across the entire continuum of home care.
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Reimbursement and premium rates under fee-for-service, the Episodic Payment System (EPS) and MLTC.
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A new analysis of Medicare post-acute payment trends and bench-marking data for the Medicare Home Health Prospective Payment System and EPS.
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Federal reimbursement updates; DSRIP; Value Based Payments; and more.
Every item on this agenda touches your agency’s financial operation and its participation in the state’s health care system, very directly or indirectly. We strongly urge all home care providers to send their finance staff to this important, must-attend session. Please make sure that your CFOs and senior finance teams see this important announcement. HCA’s Senior Financial Managers Summit March 9, 2016 9 a.m. to 3:15 p.m. Albany Download the registration form at http://hca-nys.org/wp-content/uploads/2016/01/ 2016CFOForum.pdf. Job Position: Director of Patient Services (Montefiore Home Health Agency)
HIRING
The Director is responsible for directing, planning, coordinating and evaluating patient care services, providing supervision of professional staff, and recruiting/hiring an adequate number of professional staff to ensure quality. The Director will evaluate the performance of Patient Service Managers and support staff supervisors at stated intervals. The Director will participate in administration of the annual budget and personnel policies. The ideal candidate will manage all clinical functions. Required Qualifications: Current NYS RN License and Registration; Master’s in Nursing or Health Related Field; five years of senior and direct management experience within a CHHA. Additional Qualifications: Knowledge of clinical documentation protocols, home health regulations and standards; skill in training, working with building high performance teams; ability to develop and lead strategic plans; strong written and verbal communication skills. Please send résumé & cover letter to chenley@montefiore.org with “Director of Patient Services” and your name in the subject line. Résumés without cover letters and applicants who do not meet requirements won’t be accepted. No phone calls, please. MMC is an equal opportunity employer and will not discriminate against any employee or applicant for employment because of race, color, religion, gender, sexual orientation, or national origin.
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HCA’s Federal Advocacy Aims to Prevent Cuts and Copays, Secure F2F Relief, Protect Medicaid and Raise the Profile of New York’s Home Care Providers This week, HCA President Joanne Cunningham and Director of Public Policy Alex Blais visited Washington to participate in advocacy activities with numerous state home care associations to raise the profile of the home care community’s concerns in New York State and the nation. The advocacy activities included the following. HCA discussed this initiative with HCA members during our regional Meet-ups this past fall and received strong encouragement from the membership regarding their participation. BTVH was first promoted by a national home health advocacy organization called the Partnership for Quality Home Health Care. It is now being launched by numerous state associations along with HCA. It aims to assist home care agency caregivers in facilitating the participation of their patients and families in the elections process by registering to vote and voting by absentee ballot.
New York Congressional Delegation Meetings HCA Public Policy Director Alex Blais and HCA’s Washington-based contract lobbyist, Brett Heimov of En-vision Strategies, met with the NY Delegation Offices of Representatives Peter King (R2), Nita Lowey (D-17), Joe Crowley (D-14) and Chris Collins (R-27) to press for strong opposition against Medicare home health copayments for Medicare beneficiaries. The New York Congressional Delegation has traditionally been strong supporters of HCA and steadfastly opposed to home health beneficiary copayments. In addition, HCA discussed the precarious financial condition of New York’s home care community, presenting the findings of HCA’s 2016 financial condition report, which indicates that two-thirds of New York’s agencies are operating in the red, with reimbursement not meeting the costs of providing care to patients.
HCA will be conducting a full launch of the BTVHNY program, which HCA has tailored to meet the needs of New York’s home care community. Expect to learn more about this initiative in the spring and at the HCA Annual Membership Conference on May 4-6, 2016. We have already launched a website for this campaign with a video that you can show your staff at http://www.bringthevotehomeny.org/. National Meeting of the Partnership for Medicaid Home Based Care
In addition, HCA discussed the continued problems with the Medicare face-to-face regulation, providing information about the enormous difficulty and financial burden of compliance.
HCA also was asked to participate in a national board meeting of the Partnership for Medicaid Home Based Care, a group of organizations and nationally-based agencies that have come together to advocate for a coordinated national strategy to improve the Medicaid home based care programs, educate lawmakers about the importance of Medicaid, and develop education programs and strategies to enhance home-based Medicaid programs.
National Meeting on Bring the Vote Home HCA staff also participated in a national meeting of numerous state home care associations that are participating in an initiative which we are soon introducing more formally to the HCA Membership called Bring the Vote Home New York (BTVH).
For more information about our federal advocacy efforts, please contact Alex Blais at ablais@hcanys.org. 5
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HCA Presses for Priority Release of FLSA Funding on All Home Care Aide Hours This week, HCA continued our vigorous efforts to get the state Department of Health (DOH) to release appropriate and timely funding to home care providers for new costs under the Fair Labor Standards Act (FLSA). These funds are for the period of October 1, 2015 through March 31, 2016. These efforts have commanded significant, dedicated policy staff time aimed at ensuring a workable process that meets providers’ cost obligations. To push the issue further, HCA scheduled a recent meeting with DOH and other associations where we called for a pass-through of funds from managed care plans to their contracted home care providers based on all home care aide hours. This approach, we argued, would be similar to the way that DOH distributed the funds under Medicaid fee-for-service home care. It would also align with DOH’s written instructions and conversations about the fund distribution. We stressed that this call for funding of all home care aide hours would ensure an uncomplicated and workable process for both plans and providers. It would also address the inherent difficulty providers have faced when it comes to documenting their FLSA costs per plan while recognizing the multitude of new expenses (travel, overtime, recordkeeping, recruitment of new aides, staff training, and payroll changes, etc.) incurred by home care agencies. For payments after March 31, DOH could construct a distribution process based on the results of a survey that DOH is developing with the associations, as long as this survey appropriately captures the costs incurred by home care providers. This week, HCA forwarded comments to DOH on the most recent draft version of the survey after obtaining feedback from members. HCA has already sent about twenty questions to DOH about the FLSA funding for inclusion in DOH’s soon-to-be released Questions and Answers (Q&As) document. Just today, we received a draft of the Q&As and will be providing immediate input to DOH. HCA has told the Department that its guidance (in the Q&A or elsewhere) must clearly explain the distribution process – from the state to managed care plans and then to CHHAs and LHCSAs. It also must cover the attestation process, allowable uses of funds by providers, and other issues. HCA will be reviewing the draft Q&As closely to ensure that it is not only consistent with past promises and assurances regarding the distribution of funds but also to further press language recommendations that ensure providers are paid timely, proportionately, without undue burdensome documentation requirements, and commensurate with all of their FLSA-related costs. HCA will keep members informed on any new developments on the funding distribution.
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QIVAPP Desk Audits Continuing Until March 17 Today is the deadline for home care providers who were contacted by IPRO, the state’s contractor, to send documentation regarding their eligibility for the Quality Incentive Vital Access Provider Pool (QIVAPP) program. The requested information included documentation that 30 percent of the total workforce is enrolled in the home care agency’s health benefits plan. When this criteria was first announced, HCA objected strongly because there are sound reasons why aides may have declined health benefits, including having health coverage from a spouse or Medicaid or making a decision to opt for a higher wage rate (without health insurance). According to a state Department of Health (DOH) letter, IPRO’s desk audits should be completed by March 17. HCA has been assisting members with their responses to the multiple requests by IPRO for documentation. HCA has also been pressing the state to complete the desk audit process timely so that agencies can obtain their long-overdue QIVAPP monies. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
New Bootcamp Program on Leadership Essentials for LHCSAs Separate policy-focused LHCSA Forum also coming up on March 29 As part of HCA’s education for LHCSA members, we are excited to announce a new April 12 (9:30 a.m. to 12:30 p.m.) program on Leadership Essentials for LHCSAs in the Changing Health Care Environment in New York City. This program is part of our popular home care Bootcamp series, so please register soon to get a seat. As members know, the U.S. Centers for Medicare and Medicaid Services (CMS) has initiated Medicare value based reimbursement, and New York State is committed to value based payments for Medicaid. LHCSAs have a rich history of providing vital care, but fast-changing regulations and standards create new challenges in this landscape. This three-hour program, presented by Trish Tulloch of RBC Limited, is designed to identify, detail and refine the knowledge and skill set required for the clinical leadership of LHCSAs and to show how your peers are adapting practices to meet this challenge. The program is targeted to agency clinical leadership, including Directors of Patient Services; Supervisors; Quality Managers; and Educators that support clinical staff providing care. To learn more, download the registration form at http://hca-nys.org/wp-content/uploads/2016/02/ April12SurvivalBootcampLeadershipforLHCSAs.pdf and make sure your LHCSA staff are aware of this important opportunity for clinical leadership education. Forum for Downstate LHCSA leaders Please also note that HCA is holding our Downstate LHCSA Forum on March 29 in New York City, which is more policy focused and includes a range of HCA updates for our downstate LHCSA members on: fiscal 8
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issues such as the budget, the Governor’s minimum wage proposal, Fair Labor Standards Act (FLSA) and Quality Inventive/Vital Access Provider Pool (QIVAPP) adjustments, regulatory updates, and program developments. Registration for this Forum is at http://hca-nys.org/wp-content/uploads/2016/02/ HCADownstateLHCSAForumMarch292016Registration.pdf.
Save The Date to ‘Vote Home Care’ at HCA Annual Conference: May 4-6 HCA’s 2016 Annual Conference is coming up soon in scenic Saratoga Springs. It’s an energetic election year, so we’ve decided to use that theme for our Annual Conference, as we all ”Vote Home Care!” Earlier this week, HCA sent you the first ballot opportunity: a chance to elect your staff or a colleague to receive one of our Annual Awards, which will be presented at the Conference. Learn more at http://hca-nys.org/wp-content/uploads/2016/02/Award-Nomination-Form-2016.pdf. We have a lot of fun, informative events and sessions planned, so be on the lookout for conference registration information soon on our conference website at www.hcaannualconference.com. We are also updating the sponsor and exhibitor information at this link, but there’s still time to support our conference and education programming throughout the year as a sponsor or exhibitor. If you are interested in these great opportunities at the HCA Annual Conference or other events, please download our Marketing Prospectus on the conference website or contact Billi Hoen at bhoen@hcanys.org. We look forward to seeing you on May 4-6 in Saratoga! Stay tuned for more information soon.
State Outlines Transportation Assistance Level Requirement, With Two More Sessions on March 11 On Thursday, the state held its first WebEx guidance sessions for home care agencies and hospices on implementation of the Transportation Assistance Levels (TALs) initiative in home care. If you missed the program, the state is holding two other sessions on March 11 at 10:30 a.m. and 2 p.m. TALs aim to assist with evacuation transport needs for vulnerable individuals preparatory to an emergency. TALs, already in effect for other sectors, are coming soon for home care. Documentation and reporting of TALs must be communicated to the state Department of Health (DOH) during an emergency event by means of the HERDS Home Care Emergency Response Survey on the Health Commerce System (HCS). Information for the March 11 sessions is in the flyer at http://hca-nys.org/wp-content/uploads/2016/02/ 61e8afb2-9a73-45ef-8305-87f722e915cb.pdf.
Continued on next page
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Continued from previous page During the February 25 session this past week, DOH reviewed the final TAL 1, 2 and 3 designations. Home care and hospice providers will be required to implement TALs likely beginning in June 2016. A forthcoming Dear Administrator Letter (DAL) will provide the final implementation date, at which time CHHAs, LHCSAs, LTHHCPs and hospices must maintain a current TAL status for each patient on roster. TALs should be reassessed with any changes in patient status. The Department emphasized that TALs are for use only in planned evacuations not for events such as a fire. The HERDS Home Care Emergency Response Survey will be deployed in emergencies of large scope 96 hours before the anticipated event. The survey contains four components: •
Agency Form: this needs to be completed once at the onset of the emergency.
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Capacity Form: this is completed at the onset and one or more times daily throughout the event.
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Evacuation Form: this form denotes if the patient is the sole responsibility of the reporting agency or if the patient is the shared responsibility with another provider for the purposes of avoiding duplicate patient data.
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Repatriation Form: indicates when a patient is returned to temporary or permanent housing.
There will be a mandatory emergency response drill in spring 2016. Details will be provided in an upcoming DAL. Providers can find a HERDS Quick Reference Card and other related guidance documents on the HCS. HCA encourages all home care staff involved in emergency preparedness or planning activities to participate in one of the March 11 sessions, especially those staff normally responsible for emergency preparedness reporting activities like those described above for the new TALs initiative.
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Award Nominations Due March 8 for HCA Annual Conference Ceremony HCA’s Annual Conference is coming up on May 4 to 6. As part of this program, HCA presents our annual awards to staff of HCA’s home care members, and we’re ready to receive your nominations. We are offering three award categories, similar to past years: our Ruth F. Wilson Award, our Caring Award and our Advocacy Award. The categories and criteria are spelled out in the nomination form at http://hcanys.org/wp-content/uploads/2016/ 02/Award-Nomination-Form2016.pdf. You can use this form to send us your nominations by March 8. You can also enter your nominations using an online survey form, also by March 8, at https://www.surveymonkey.com/r/ 2016HCAAwards. This is a great way to recognize your staff, with the possibility of media coverage through HCA’s communications department. The awards ceremony is a featured event of our annual conference: one of the most touching reflections on the great work your staff does each day to care for patients, to advocate on behalf of home care, and to lead New York’s home care system at the provider level. Please nominate one of your staff or a colleague today and be ready to join the celebration at our Annual Conference.
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DOH Outlines Financial, Compliance Monitoring Processes for Managed Care At this week’s meeting of the Medicaid Managed Care Advisory Review Panel (MMCARP), the state Department of Health (DOH) provided information on the challenged financial condition of some MLTCs and other managed care plans. It also summarized the state’s financial and compliance monitoring processes for such plans. DOH reported that: •
Two MLTC plans were financially insolvent as of September 30, 2015. The plans were issued statements of deficiency (SODs) and placed on monthly financial reporting.
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One MLTC plan was financially impaired and was issued an SOD. The plan’s parent organization made a capital infusion to cure the impairment.
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Four plans had net worth deficiencies.
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Two plans were identified for closer monitoring due to a deteriorating net worth.
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Five plans reported a quick ratio below $1.00 (explained on next page) and were flagged for potential liquidity issues.
DOH said that it is working with these plans to address their financial concerns and ensure that sufficient resources exist to pay providers. These findings, along with HCA’s recent financial condition report, demonstrate the importance of rate and payment adequacy for MLTCs as well as home care providers, a major component of our budget advocacy asks. As our own report shows, 63 percent of MLTC plans had negative premium incomes in 2014 (up from 57 percent in 2013 and 42 percent in 2012). In response to a request by one MMCARP member, DOH said that it could not provide the name of any plans that are facing financial difficulties. In the past, HCA has advocated that the state create some mechanism to address unpaid claims from home care providers for services provided to managed care plans that become insolvent. Legislation (S.6667, Valesky/A.9311, Gottfried) has been proposed to establish a Health Insurance Guaranty Fund to protect consumers and providers from the financial failure of a health insurer. HCA believes that this would cover the insolvency of a managed care plan and is reviewing the legislation. How the Financial and Compliance Monitoring Processes Work DOH further explained the financial and compliance monitoring process at the panel meeting. According to DOH, all MLTC plan cost reports are reviewed both quarterly and annually for solvency and compliance with statutory reserve requirements for minimum net worth requirements and contingent reserve requirements. Plans that are deemed financially impaired or insolvent are issued an SOD and required to: 1) develop a plan of corrective action to cure the impairment or insolvency and submit it to DOH for review and approval; and 11
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2) submit monthly financial statements to enable the Department to monitor plan financial performance for at least one year post restoration. Additional metrics are reviewed to determine potential financial distress. This includes calculating each plan’s “Quick Ratio” – measured in terms of the value of the plan’s assets to cover its liabilities – to ascertain its liquidity and ability to meet current liabilities. DOH also computes a plan’s “net worth,” the plan’s net worth in excess of minimum net worth requirements, to determine the potential for the plan’s distress. DOH flags any plan whose percent of excess net worth over the minimum net worth required is 10 percent or less. In addition, DOH assesses a plan’s access to additional capital if needed. DOH looks at each plan’s corporate affiliation (system-based, provider-sponsored or independent) to determine potential capital resources. Compliance monitoring of Medicaid Managed Care Plans DOH also issues SODs for violations of statutes and/or regulations and statements of findings (SOFs) for plan non-compliance with Medicaid contract provisions. SODs or SOFs are identified in routine surveys; ad hoc state surveys; comprehensive operational reviews; routine/ongoing monitoring activities; or other reviews. Plans are required to submit plans of correction (POCs) that describe: the activities the plan will take to resolve the deficiency/finding and ensure future compliance; time frames for implementing the POC activities; and the plans’ staff responsible for implementing the POC as well as monitoring of ongoing compliance. POCs must be submitted within 15 days of an SOD/SOF. POCs submitted for a deficiency and/or finding are reviewed by the state staff responsible for issuing the SOD/SOF. Staff may consult with other staff/subject matter experts prior to determining if the POC is acceptable or unacceptable. When a POC is deemed unacceptable, a written determination and reasons are transmitted to the managed care plan; the plan must revise and resubmit the POC until an acceptable POC is received by the Department: within ten days for a first revision, five days for a second revision and immediately for any subsequent revisions. When a POC is deemed acceptable, written notice is provided to the managed care plan.
Quality of Patient Care Star Ratings Panel Being Convened Abt Associates, under a contract with the U.S. Centers for Medicare and Medicaid Services (CMS), is seeking individuals to join a panel of stakeholders and experts for input on the Quality of Patient Care Star Ratings that appear on the Home Health Compare website. A technical expert panel is being convened to review the first year of data on the performance of the Quality of Patient Care Star Ratings, and to gather feedback on potential refinements to the rating system, 12
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including usability of the system for patients and advocates. The panel nomination period opens on February 24, 2016 and closes on March 18, 2016.
Technical Expert Panel Time Commitment The time commitment for the panel is expected to include: 1) an in-person meeting lasting approximately two days on May 2 to 3, 2016 in the Baltimore area; 2) time to review materials prior to the meeting; and 3) up to two post-meeting teleconferences. Travel expenses will be reimbursed by Abt Associates. For more information, visit https://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/MMS/TechnicalExpertPanels.html#29. If you wish to nominate yourself or other individuals for the panel, please e-mail materials to QPCStarRatingsTEP@abtassoc.com by the closing date March 18, 2016.
CMS Issues Proposed Rule to Strengthen Provider Enrollment Process The U.S. Centers for Medicare and Medicaid Services (CMS) this week issued a proposed rule with new provider enrollment provisions of the Affordable Care Act (ACA). According to CMS, this rule seeks to assure that entities and individuals who pose risks to the Medicare program and beneficiaries are kept out of or removed from Medicare for extended periods. CMS’s proposed rule, entitled “Program Integrity Provider Enrollment Process (CMS-6058-P),” can be currently viewed at: https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-04312.pdf. It will be posted to the Federal Register on March 1 at: http://federalregister.gov/a/2016-04312. CMS believes that these program integrity enhancements, if finalized, would allow removal or prevented enrollment of health care providers and suppliers that attempt to circumvent Medicare’s enrollment requirements through name and identity changes as well as through elaborate, inter-provider relationships. The proposed provisions also intend to address other program integrity issues and vulnerabilities, such as cases where providers and suppliers avoid paying their Medicare debts by reenrolling as a different entity. Some major provisions of the proposed rule include: •
Disclosure of Affiliations. This would require health care providers and suppliers to report affiliations with entities and individuals that: 1) currently have uncollected debt to Medicare or Medicaid; 2) have been or are subject to a payment suspension under a federal health care program or subject to an Office of Inspector General (OIG) exclusion; or 3) have had their Medicare or Medicaid enrollment denied or revoked. CMS could deny or revoke Medicare or Medicaid enrollment if CMS determines that the affiliation poses an undue risk of fraud, waste, or abuse.
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Different Name, Numerical Identifier, or Business Identity. CMS could deny or revoke Medicare enrollment if a provider or supplier is currently revoked under a different name, numerical identifier, or business identity.
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Abusive Ordering/Certifying. This provision would allow CMS to revoke a physician or eligible professional’s Medicare enrollment if he or she has a pattern or practice of ordering, certifying, 13
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referring, or prescribing Medicare Part A or B services, items, or drugs that are abusive, represent a threat to the health and safety of Medicare beneficiaries, or otherwise fail to meet Medicare requirements. •
Increasing Medicare Program Re-enrollment Penalties. CMS would raise the existing maximum reenrollment penalty from three to ten years and add three more years to the provider or supplier’s reenrollment penalty if the provider attempts to re-enroll in Medicare under a different name, numerical identifier, or business identity. It would also impose a maximum 20-year reenrollment penalty if the provider or supplier is being revoked from Medicare for the second time.
HCA will be reviewing the proposed rule further. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
Funding Available for Chronic Disease Self-Management and Falls Prevention The Administration on Aging’s Office of Nutrition and Health Promotion recently published two new Funding Opportunity Announcements (FOAs) – one for Chronic Disease Self-Management Education programs and the other for Falls Prevention programs. The goals of these programs are to: •
Significantly increase participation of older adults and adults with disabilities in these evidence-based programs; and
•
Implement innovative funding arrangements (e.g., contracts with integrated health care systems) to support these programs beyond the grant period, while embedding the programs into an integrated, sustainable, evidence-based prevention program network.
The deadline for each FOA is April 6, 2016. Please see the links below for more information: •
Falls Prevention: http://www.grants.gov/view-opportunity.html?oppId=281349
•
Chronic Disease Self-Management Education: http://www.grants.gov/viewopportunity.html?oppId=281361
CMS Publishes Medicare FFS Provider & Supplier Utilization Data Tool The U.S. Centers for Medicare and Medicaid Services (CMS) has recently published a Provider and Supplier Services and Utilization Data Tool that includes interactive maps and a dataset showing national, state, and county-level provider and supplier services and utilization data for selected health service areas, including home health. CMS’s data tool provides information on the number of Medicare home health providers servicing a geographic region, with regions at the state and county level clearly indicated, and the number of Medicare beneficiaries using those services. The data can also be used to reveal the degree to which use of these services is 14
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related to the number of providers and suppliers servicing a geographic region. Provider and supplier services and utilization data by geographic regions can be compared using CMS’s interactive maps. The tool uses paid Medicare claims data from the CMS Integrated Data Repository (IDR). The IDR contains Medicare and Medicaid claims, beneficiary data, provider data, and plan data. Claims data are analyzed for a 12-month reference period, and results are updated quarterly to reflect a more recent 12-month reference period. The tool is available at https://data.cms.gov/moratoria-data. All information presented graphically in the data maps is available for download. Future updates may include comparable information on additional health service areas. Additional information on CMS’s Data tool can be found at: https://www.cms.gov/Newsroom/ MediaReleaseDatabase/Press-releases/2016-Press-releases-items/2016-02-22.html For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
ONC Releases Practical Examples of Permitted Health Information Exchange under HIPPA The Office of the National Coordinator for Health Information Technology (ONC) recently released two fact sheets summarizing permitted electronic health information exchange for treatment and health care operations. ONC’s fact sheets can be accessed at: •
Permitted Uses and Disclosures: Exchange for Treatment (https://www.healthit.gov/sites/default/files/exchange_treatment.pdf )
•
Permitted Uses and Disclosures: Exchange for Health Care Operations (https://www.healthit.gov/sites/default/files/exchange_health_care_ops.pdf )
ONC also released a brief, which provides practical examples of exchange for treatment and health care operations under the Health Insurance Portability and Accountability Act (HIPAA). ONC’s brief is at: https://www.healthit.gov/buzz-blog/privacy-and-security-of-ehrs/real-hipaa-care-coordination-careplanning-case-management-examples/ For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
Update on NHTD/TBI Waiver Transition Workgroup The Nursing Home Transition and Diversion (NHTD)/Traumatic Brain Injury (TBI) Transition Workgroup continues to meet weekly to discuss pressing issues in the transition to managed care (planned for January through April 2017). Last week, the state Department of Health posted a Questions and Answers (Q&As) document that covers: role of Regional Resource Development Centers; continuity of care protections; housing support under the 15
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waivers now and under managed care; status of individuals who don’t meet the nursing home level of care on the Uniform Assessment System (UAS) tool; provider qualifications; and rates. The Q&A and other materials about the planned transition are at http://www.health.ny.gov/health_care/medicaid/redesign/mrt90/index.htm. This week’s meeting of the Transition Workgroup discussed proposed provider qualifications for service coordination; community integration counseling; independent living skills training; positive behavioral interventions and supports; and structured day program. The state hopes to release for public comment a Waiver Transition Plan on April 1.
Publications •
“Comprehensive Care for Joint Replacement Model (CJR) Provider Education,” by the U.S. Centers for Medicare and Medicaid Services https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNMattersArticles/Downloads/MM9533.pdf
•
“Provider Enrollment Revalidation – Cycle 2,” by the U.S. Centers for Medicare and Medicaid Services https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNMattersArticles/Downloads/SE1605.pdf
•
“Payment and Delivery System Reform in Medicare: A Primer on Medical Homes, Accountable Care Organizations, and Bundled Payments,” by the Kaiser Family Foundation https://kaiserfamilyfoundation.files.wordpress.com/2016/02/8837-payment-and-deliverysystem-reform-in-medicare1.pdf
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
16
SENIOR FINANCIAL MANAGERS
SUMMIT
(Formerly CFO Forum)
March 9, 2016 9:00am – 3:15pm Albany Hilton Albany, New York
Learn About 2016-2017 State Budget HCA Financial Condition Report Results Updates on Home Care Rates and Managed Care Premiums Minimum Wage Funding And much more!
SENIOR FINANCIAL MANAGERS SUMMIT March 9, 2016 9:00am – 3:15pm Albany Hilton Albany, New York
Join us! HCA’s Senior Financial Managers Summit (formerly CFO Forum) is a must‐attend program for home care financial managers, CFOs and other executive staff to hear from HCA policy staff, finance and reimbursement managers from the state Department of Health (DOH) and industry consultants on home care fiscal issues. Kicking off the Forum, HCA staff will highlight key areas in the Governor’s proposed 2016-17 Executive Budget as well as 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. Lastly, Ms. Audrey El-Gamil, from Dobson, DaVanzo & Associates, LLC. will provide highlights of an important study she conducted to identify the clinically appropriate and cost-effective placement of Medicare patients following discharge from the acute care hospital, and will offer suggestions on how home care can be utilized most effectively in the future. She has conducted extensive research on Medicare post-acute care payment policy and is a highly sought out expert. Please do not miss out on this robust program which delves into several important areas relevant to your agency’s fiscal health.
SENIOR FINANCIAL MANAGERS SUMMIT
AGENDA
March 9, 2016 9:00am – 3:15pm Albany Hilton Albany, New York
March 9, 2016 9:00am – 9:30am HCA Registration & Continental Breakfast 9:30am – 10:30am HCA Update HCA staff will provide a state legislative update, which will focus on the Governor’s proposed 2016‐17 Executive Budget and its impact on home care, along with an update on our advocacy efforts in Albany and in Washington. HCA staff will highlight our annual financial condition report as well as discuss the latest on Minimum Wage funding, DSRIP, Value Based Purchasing, QIVAPP and the 2016 Medicare Prospective Payment System (PPS). 10:30am – 11:30am 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 2016‐17 Executive State Budget that impact home care, personal care and Medicaid managed long term care plans; the Medicaid Global Cap; CHHA Episodic Payment System (EPS) utilization data; premium rate adjustments to Managed Long Term Care (MLTC); QIVAPP funding, Wage Parity and Overtime adjustments to plans and home care providers; the CHHA, LTHHCP and Personal Care fee‐for‐service Medicaid rates; the 2015 Medicaid cost reports and other Medicaid reimbursement issues. 11:30pm – 12:30pm 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 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. 12:30pm – 1:15pm – Lunch 1:30pm – 2:45pm Medicare Post-Acute Care Payment Prognosis Audrey El-Gamil, Senior Manager, Dobson, DaVanzo & Associates, LLC Ms. El-Gamil has significant experience in health policy analysis and health services research with the majority of her recent research on Medicare post-acute care payment policy. For the home health industry, Ms. ElGamil was the project manager of a data-driven study that aimed to identify the clinically appropriate and costeffective placement of Medicare patients following discharge from the acute care hospital. During the session , Ms. El-Gamil will provide highlights of this study which examined how the Medicare home health benefit is currently serving Medicare beneficiaries but also investigated how Medicare's use of home health could better meet beneficiary needs and improve the quality and efficiency of care. 2:45pm – 3:15 HCA Closing Remarks & Adjourn
SENIOR FINANCIAL MANAGERS SUMMIT
March 9, 2016 9:00am – 3:15pm Albany Hilton Albany, New York
This is an HCA Members Only Program.
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Become an HCA Member If you are not currently an HCA Member, but wish to become one so you can take advantage of this and other educational programming, please contact Laura Constable at (518) 810-0660 or at lconstable@hcanys.org.
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