February 27, 2015 ASAP by Home Care Association of New York State

ASAP

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

Legislative Issues  Public Policy



News

Volume 20, No. 8 February 27, 2015

HCA Drives Budget Initiatives for Home Care Financing, Infrastructure, Quality Innovation HCA continued at full throttle this week working to create critically needed opportunities and support for home care in the proposed 2015-16 state budget. Following up on HCA’s advocacy meetings and proposals, HCA presented state health leaders with enabling budget and legislative language to include core home care investments and provisions in the new budget. HCA’s timing was well-synched to the process for negotiation and adoption of a new state budget. This week, legislators returned to session following February recess and moved toward their development of one-house budget bills and resolutions. See DRIVES p. 2

Workgroup Continues to Debate Unresolved ‘Advanced Home Health Aide’ Issues A state Department of Health (DOH) workgroup continued this week to grapple with major questions and issues on the Governor’s Advanced Home Health Aide (AHHA) proposal. DOH convened the group to examine criteria that would guide an AHHA level of service. Members include HCA, other health and consumer representatives, clinicians, labor organizations, DOH and additional parties. Areas being examined include possible Inside ASAP tasks, qualifications, training, competency testing, assignment, supervision and other criteria for HCA Drives Budget Initiatives for Home Care ...................................1 Workgroup Continues ‘Advanced Home Health Aide’ Debate.........1 AHHAs. OMIG Resumes TPL Case Requests....................................................5 U.S. Senate Intros Bill Allowing NPs to Certify Home Health.............5 QIVAPP Awards Made to MLTCs..........................................................6 LHCSA Forum Held..............................................................................6 2015 Wage Parity Certification Forms Posted.....................................7 HCA Offers Webinars on OASIS-C1, ICD-10 & Care Transitions.........8 Sen. Schumer Presses Feds on Provider VAP Funds..............................8 FIDA Roll-out Delayed for Region Two...............................................9 Open Call for HCA’s 2015 Award Nominations...................................9 DOH Value-Based Payment Discussions Proceed.............................10 DSRIP Update.....................................................................................12 UAS Upgrade Coming.......................................................................12 CMS Conducts Special Forum on IMPACT Act of 2014....................13 Gov. Signs Amendments to Wage Theft Prevention Act....................14 CNY Coalition Reminds Providers of Emergency Prep Training.......14 Revised Rule Issued on Immediate Need for Personal Care...........15 OPWDD Posts Revised HCBS Settings Transition Plan......................16 Proposed Updates to Medicare Managed Care and Drug Plans.....17 Coverage for Pneumococcal Vaccine Extended.................................19 NGS Updates.....................................................................................19 Publications..............................................................................................20

See ADVANCED p. 4

Helping New Yorkers Feel Right At Home

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

Volume 20, No. 8 February 27, 2015 

DRIVES from p. 1 The agreed-upon plan by the Legislative Leaders calls for adoption of these one-house bills in the next two weeks (by March 12), followed by the convening of joint conference committees and negotiation with the Executive toward budget adoption by the April 1 new budget due date. HCA’s proposals submitted this week make actionable the needed supports for home care, as HCA has urged in our advocacy document ‘Driving Health Care Improvement and Savings Through Home Care,’ and as supported by HCA’s 2015 financial condition report. In addition, the HCA package includes language that either amends or proposes parallel language to a series of health care investments the Governor has proposed in the budget for other sectors’ needs but not for home care. HCA has met with and asked the Governor’s office to consider these additions, which are critical to the state’s own health care policies and new models. HCA’s language submitted this week includes: •

Funding for home care within the Executive’s proposed health budget investments – HCA drafted and submitted amendments and parallel provisions to include home care in the Executive’s proposed health care investments for essential, sole and rural health providers, as well as for capital and quality support. (See also “Technology” and “Quality” provisions on next page.)

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Payment adequacy for managed care plans and home care agencies – HCA has drafted and submitted amendments to the Managed Long Term Care (MLTC) and home care reimbursement statutes (including

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

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

Volume 20, No. 8 February 27, 2015 

Continued from p. 2 the episodic payment system, or “EPS”) requiring payment adequacy for managed care plans and providers, covering critical service, operational, and infrastructure needs (e.g., wage/benefit mandates, health information technology, quality, public health and other requirements). The amendments also authorize the establishment of and incentivize the use of a system for efficient billing (e.g., uniform codes, standardized claims, etc.) and prompt payment (established in consultation with MLTCs and home care providers). •

Home care health information and clinical technology investment – HCA has drafted and submitted an initiative entitled “The Home Care Health Information and Clinical Technology Act.” The act directs the implementation and financing of a series of home care technology investments and initiatives. It includes financing through capital grants (tapping into the Executive’s $1.8 billion health care capital fund in the budget), payments to MLTCs for contracted home care providers, base or rate enhancements to EPS, financing through the Health Care Reform Act (HCRA) pools, financing through the Medicaid Global Cap shared-savings reinvestment program, incentive payments through the managed care quality incentive pool, as well as other elements to support home care technology.

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Home care quality innovation and improvement – HCA has drafted and submitted a parallel provision for home care in response to the Executive’s “hospital quality pool” proposal. The home care language provides funding and incentives for an extensive series of quality initiatives developed by HCA and the HCA Quality Committee including: agency implementation of the Quality Risk and Compliance Tool; specialized staff training; participation in quality innovations and public health improvement through population care coordination, falls prevention, sepsis identification and intervention; partnerships with hospitals, physicians, behavioral health organizations; incorporation and expanded use of evidencebased practice, clinical guidelines, clinical pathways and best practices; and other.

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Home care-managed care regulatory realignment and streamlining – HCA has drafted and submitted language authorizing and directing the state Department of Health (DOH) to expeditiously implement recommendations provided by the Home Care Regulatory Workgroup through the granting of specific regulatory waiver authority for managed care-home care, through amendments to the MLTC waiver authority to coordinate MLTC and home care regulatory waivers, and by providing authority for subsequent conforming regulatory changes through emergency adoption.

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Modernization of home care insurance coverage – HCA has drafted and submitted legislation updating the home care insurance coverage provisions under the State Insurance Law for group policies, including commercial, Blue Cross and HMO-based policies. The update replaces long outdated coverage provisions for home care with coverage reflecting home care’s current role and usage in the health care system (e.g., including roles in care transition, medical management, etc.). The language updates the provisions for access to home care, updates the covered service list, and replaces arbitrary limits on the number of covered home care visits with newer approaches used in the Insurance Law, which controls the cost/use of benefits using basic managed care techniques, now the tools used in nearly all insurance.

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Home care participation in new care models – The Hospital-Homecare-Physician Collaboration Program legislation (S.1110) co-drafted by HCA and the Iroquois Healthcare Alliance, and sponsored by Health Committee Chairman Senator Kemp Hannon, is on the Senate Calendar positioned for Senate passage; the Assembly bill is introduced by Assemblywoman Aileen Gunther and referred to the Assembly Health Committee. HCA is also submitting supplemental language for inclusion in the budget to address other areas of new model development. 3

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

Volume 20, No. 8 February 27, 2015 

ADVANCED continued from p. 1 The Executive state budget proposal for 2015-16 includes legislation to create an AHHA level through a carve-out of the Nurse Practice Act (NPA). It would insert regulatory authority into the NPA and the Public Health Law to direct the Commissioners of Education and Health to establish the parameters for AHHA, which would include duties (such as medication administration) that cross into the practice of nursing. The legislation requires consultation with “a workgroup,” which DOH has convened in advance. Beyond technical areas, HCA and other workgroup members continue to raise major operational questions, needs and concerns related to implementation. Such concerns include: •

Compatibility to the managed care-home care model;

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The need for financing the proposal’s major new costs;

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The proposal’s workability within the day-to-day operation of home care agencies, nursing duties, practical care planning and service delivery;

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The proposal’s effect on nursing resources;

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Protection of the nurse’s discretion and implications for liability;

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Equitable access for agencies to conduct/participate in AHHA training;

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Quality assurance, compliance and audits; and

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Relationship of the proposed AHHA to other NPA exemptions.

Additional issues surfacing this week included questions on the regulatory structure. These include whether AHHA services, as modeled in the Governor’s proposal, would trigger federal home health Conditions of Participation, including biweekly supervision, OASIS assessment and reporting, mandatory use of Certified Home Health Agencies or Long Term Home Health Care Programs for Medicaid or Medicare patients, and/or other program requirements or limitations. DOH is exploring its response to these questions, which ultimately will determine the added complexity and cost of AHHA services. HCA has again requested from DOH a description of the proposed parameters for AHHA in a format that facilitates vetting with the provider community. We have also raised significant concern to DOH about the brief timetable for vetting this proposal and resolving issues as part of the budget deliberations, due to end by the April 1 start of the fiscal year. For further information, please contact Al Cardillo at acardillo@hcanys.org.

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

Volume 20, No. 8 February 27, 2015 

OMIG Resumes Semiannual TPL Case Requests Using Traditional Appeals The state Office of the Medicaid Inspector General (OMIG) is resuming its semi-annual demand billing process for claims for the second half of Federal Fiscal Year (FFY) 2014. Details are outlined in a letter that most Medicare-certified home care providers (Certified Home Health Agencies and Long Term Home Health Care Programs) should have received from OMIG and its Third Party Liability (TPL) contractor, the University of Massachusetts Medical School (UMMS). The letter identifies which cases have been selected to undergo appeals. The “Case Selection Report” accompanying the OMIG/UMMS letter will seek demand bills for cases that occurred in the third and fourth quarter of FFY 2014 only (April 1, 2014 through September 30, 2014). If your agency is selected for future quarterly initiatives, a separate notification letter and “Case Selection Report” will be sent at that time. HCA members interested in knowing whether they should have received a letter from OMIG can e-mail HCA at: info@hcanys.org. HCA has begun hearing from members who have already received letters from OMIG; they report that, similar to the first half of FFY 2014, the number of cases selected for demand billing in this most recent request remains significantly higher than the number of TPL cases selected by OMIG and UMMS in FFY 2013. For specific questions about the letters, contact UMMS’s Laurie Burns at (866) 626-7594. HCA has and will continue to stress to federal officials that a permanent solution is needed to mitigate the burden of this traditional appeals process. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

U.S. Senate Introduces Bill Allowing Nurse Practitioners, Other Advanced Practice Professionals to Certify Home Health Plans of Care Senators Charles Schumer and Susan Collins have introduced a bill, known as the “Home Health Planning Improvement Act of 2015” (S.578), which has been a longtime priority of HCA. Similar legislation has been introduced in past years at the urging of HCA and the National Association for Home Care and Hospice (NAHC). This legislation would permit nurse practitioners, physician assistants, clinical nurse specialists and other advanced practice health professionals to certify Medicare home health plans of care and to document the Medicare face-to-face encounter. Further background on this legislation can be read in HCA’s briefing paper here: http://www.hca-nys.org/NPCertification.pdf. In the paper, HCA states: “Currently, nurse practitioners and other specified advanced practice health professionals work closely with physicians to ensure that patients receive necessary care for many Medicare 5

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

covered services. They are increasingly providing services to Medicare beneficiaries in rural and underserved areas and serve a vital need in communities where there are physician shortages.” The flexibility afforded by this legislation would be especially helpful in expediting the required paperwork to ensure that home health care to beneficiaries will be initiated and continued and that agencies receive timely payments. NAHC this week circulated a link where individuals can write to Congress in support of this bill. Simply visit http:/ /p2a.co/W71Tpux and send your message today. For more information, please contact a member of HCA’s Policy staff.

QIVAPP Awards Made to MLTCs Plans have until April 15 to pass payment to providers HCA previously confirmed that the state Division of Budget has approved the initial $35 million of the Quality Incentive Vital Access Provider Pool (QIVAPP) monies. Today we learned that the award notifications were made to Managed Long Term Care (MLTC) plans and the plans should receive the funds in a March 18 check. As mentioned in numerous past ASAP stories, these funds are to be passed through directly to their eligible home care contractors. State officials indicated that the plans have until April 15 to do so. Plans are expected to contact their contracted home care providers who are eligible for QIVAPP to discuss the amount of the payments. Meanwhile, HCA has confirmed with DOH that the $70 million for QIVAPP (which includes the $35 million federal share that the state has to secure approval for) is a “oneshot” infusion and will not be included in future MLTC rates. This differs from the $300 million that was added to the MLTC plan premiums for 2014-15 to assist providers impacted by the wage parity mandate. DOH confirmed that these additions will remain part of the base rate within MLTC premiums for 2015-16. For more information, contact Andrew Koski at (518) 8100662 or akoski@hcanys.org. 6

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LHCSA Forum Held This week, HCA held a Forum of over 30 Licensed Home Care Services Agencies (LHCSAs) members in New York City. The meeting covered a multitude of topics that are vital to the operation of LHCSAs. These included: the proposed state budget and 30-day amendments, including in-depth coverage of value-based payment and the Governor’s ‘advanced home health aide’ provisions; HCA’s positions and advocacy; companionship exemption lawsuit; record-keeping requirements for sleep-in cases and agency tracking of aide time; LHCSA members’ participation in the Delivery System Reform Incentive Payment (DSRIP) and Fully Integrated Duals Advantage (FIDA) programs; technology needs of agencies; wage parity; and Quality Incentive Vital Access Provider Pool (QIVAPP) monies update. Participants made some excellent recommendations for regulatory relief related to wage parity, sleep-in cases and pre-claim review by verification organizations; HCA will be taking these suggestions to the appropriate officials to advocate for such relief. HCA thanks: the LHCSA Forum CoChairs, Susan Brett, Chief Operating Officer/Senior VP, People Care, Inc., and Russell Lusak, Senior Vice President, Selfhelp Family Home Care, Inc. We additionally thank Selfhelp for its site accommodations and the LHCSA members for attending and providing valuable feedback.

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

Volume 20, No. 8 February 27, 2015 

2015 Wage Parity Certification Forms Posted Yesterday the state Department of Health (DOH) posted the 2015 wage parity certification forms for agencies providing aide services in New York City, Long Island and Westchester. . The forms are available in four attachments on DOH’s website at http://www.health.ny.gov/health_care/medicaid/redesign/2014-02-12_wage_parity_alert.htm. For people who have visited this site before, you may need to refresh your browser or use a different browser to access the updated forms. HCA has also posted the forms on our website at the following links, which may be the most direct route for obtaining them: • • • •

Attachment Attachment Attachment Attachment

A-1 (http://www.hca-nys.org/documents/wage_parity_att_a_1.pdf ) A-2 (http://www.hca-nys.org/documents/wage_parity_att2.pdf ) A-3 (http://www.hca-nys.org/documents/wage_parity_att_a_3.pdf ) A-4 (http://www.hca-nys.org/documents/wage_parity_att_a_4.pdf )

DOH has advised HCA that entities need to submit a certification using the new 2015 forms even if they already submitted a revised version of the 2014 certification forms with an edit to reflect the current year. HCA has indicated that this resubmission effort will create an administrative hardship, especially for agencies with multiple contracting partners, and we will urge a more efficient approach in the overall certification process. Attachments A-1, A-2 and A-3 As communicated to members in an Alert last week, the next round of state-required Home Care Worker Wage Parity Law certification forms is due March 1 for Certified Home Health Agencies (CHHAs), Long Term Home Health Care Programs (LTHHCPs), managed care organizations (MCOs), Licensed Home Care Services Agencies (LHCSAs) and other entities that contract with CHHAs, LTHHCPs and/or MCOs who serve New York City, Long Island and Westchester. CHHAs, LTHHCPs, and MCOs must certify prospectively to DOH, on an annual basis, their compliance with the Wage Parity Law. This set of certification forms is due to the Department on March 1, 2015 for the March 1, 2015 to February 29, 2016 period. The CHHA, LTHHCP and MCO forms are sent to DOH at HCWorkerParity@health.state.ny.us. Attachment A-4 Meanwhile, CHHAs, LTHHCPs and/or MCOs that contract with LHCSAs are required to obtain a written certification on a quarterly basis from the LHCSA or other entity which attests to the LHCSA’s (or other entity’s) compliance with the state’s Home Care Worker Wage Parity Law for defined certification periods and on a prospective basis. The form, also due March 1, 2015, covers the period March 1, 2015 through May 31, 2015 and is sent to the CHHA, LTHHCP and/or MCO, not to DOH. In completing the form, HCA recommends adding a date after the signature and noting the certification period on the form. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org. 7

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

Volume 20, No. 8 February 27, 2015 

HCA Offers Webinars on OASIS-C1, ICD-10 Coding and Care Transitions HCA is offering several important webinars in March related to OASIS-C1, ICD-10 Coding and care transitions. Webinars allow you to listen to an education program along with your colleagues over one connection, by speaker phone, providing convenience and affordability. Here’s what’s coming up: •

OASIS-C1 Basics – Choose one or all of the programs in this series (March 5 to March 26) that will cover each section of the OASIS and discuss the problematic areas. This program is designed for home health clinical staff, quality improvement coordinators and supervisors who want to increase their knowledge of OASIS completion.

•

How to Plan and Package Care Transitions: A Provider’s Perspective (March 19) – This program will review the elements in developing a care-transitions program in partnership with hospitals to improve outcomes and reduce re-hospitalization rates. The program covers the preparation necessary to facilitate transitions in care, including the metrics for assessing a program’s effectiveness and financial viability, and selling the advantages to potential partners. A recording of this program will be available for purchase as well.

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Understanding Coding & Documentation Requirements for ICD-10: Disease Specific Categories – Choose any or all of the programs offered in this six-part series from March 26 through May 7. Each week, participants will learn two diagnosis-specific categories with the documentation needed to code accurately. You’ll also learn how the General Equivalence Mappings (GEMS) work for the diagnostic categories and how Electronic Health Records may assist in diagnostic coding.

More information on each of these programs is available at www.hcanys.org/events.cfm along with other learning opportunities. For more information, contact Lynda Schoonbeek at (518) 810-0656 or Lschoonbeek@hcanys.org.

Sen. Schumer Presses Feds for Approval of VAP Funds Needed to Support Home Care Provider Sustainability New York Senator Charles Schumer this week wrote to the U.S. Centers for Medicare and Medicaid Services (CMS) urging CMS’s release of federal matching dollars for a state-approved Vital Access Provider (VAP) award to a New York home care provider. The funds are long overdue to the agency and vital to its operations. As explained in a press release issued by Senator Schumer’s office on Wednesday, the Visiting Nurse Association (VNA) of Long Island, an HCA member, has been awaiting approval of the federal-share of VAP funds for over a year. The agency has already “expended its own reserves to implement state-backed agency initiatives and contingencies necessary for VAP application,” the press release states. In his letter – written and sent at the urging of the VNA of Long Island and HCA – Senator Schumer calls on the federal agency to work with New York State “quickly to approve and release” the funds that are due 8

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

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to this agency. New York State has already disbursed its share of the funds but the federal share has been held up due to technical issues.

Open Call for HCA’s 2015 Award Nominations

“The Visiting Nurse Association of Long Island provides invaluable services to hundreds of sick and needy Long Islanders, especially seniors,” Senator Schumer adds. “We should do everything possible to ensure they can provide professional and compassionate care to our sick and seniors for years to come.”

HCA invites you to nominate colleagues, staff, peers or mentors for the Ruth F. Wilson, Caring or Advocacy Awards. Candidates for each of these award categories should be those who have made significant contributions to the home care industry by demonstrating notable professional accomplishments.

HCA appreciates Senator Schumer’s support as well as the receptivity of state officials to assist in this effort on behalf of the Senator’s home care provider constituency as we continue to work on the reconciliation of critical payments for the sustainability of providers, as part of the current state budget process and in our outreach to federal officials. The Senator’s press release can be read at http://tinyurl.com/kajjfmd. For more information, please contact a Member of HCA’s Policy staff.

FIDA Roll-out Delayed for Region II Late this afternoon, the state Department of Health (DOH) announced that the roll-out of the Fully Integrated Duals Advantage (FIDA) program in Westchester and Suffolk counties (Region Two), originally scheduled for April 1, has been postponed. This is being delayed due to deficiencies in plan-provider networks. Individuals eligible for Medicare and Medicaid in New York City, Long Island and Westchester who require more than

Deadline to submit draws near, on March 6

This year, HCA has assembled an Awards Selection Committee comprised of past Ruth F. Wilson Award winners. The committee will identify, select and help us honor exemplary individuals in home care who have made significant contributions to the industry or the patients they serve, through their outstanding leadership, advocacy or clinical care. The Awards Selection Committee will meet this March to review the nominations and make its winning selections. Winners will be honored during a special ceremony at HCA’s Annual Conference in early May. Also new this year – we’ve made the nominations process much easier by providing an online nomination form. Simply click on the link below, complete the form electronically, and you’re done! No need to copy, scan, attach documents or fax any longer! This process is streamlined and a nomination can be completed and submitted within 5 minutes! We hope you will take these few minutes to really consider the good work being done by your staff, your colleagues and peers, and nominate them for consideration. Tell us their success stories so we can recognize the outstanding work they do each and every day for home care. Past award winners have garnered media attention, too, which helps your agency broadcast the great work it is doing for your community. To submit a nomination, please go to the online form here: https://www.surveymonkey.com/r/2015HCAAwards. If you have any questions, contact HCA’s Jenny Kerbein at jkerbein@hcanys.org.

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

Volume 20, No. 8 February 27, 2015 

120 days of community-based long term care services are required over a certain time period to enroll in a FIDA plan or exercise their option to opt out and enroll in a partially capitated Managed Long Term Care plan. The FIDA plan will provide all Medicare and Medicaid covered services, including physical health, behavioral health, and long term care. With this new schedule, FIDA plans are instructed to not begin marketing in Region Two on March 1, 2015 as previously required. No opt-in enrollments will be accepted in Region Two and the U.S. Centers for Medicare and Medicaid Services and DOH will continue to review networks in those counties. The state is urging FIDA plans and other stakeholders to concentrate their activities in New York City and Nassau (Region One), including marketing, education, and other activities. Approximately 100,000 announcement letters have been sent to FIDA-eligible recipients since December in Region One, where the FIDA roll-out has already begun. Recipients in this region have until March 31 to make a decision to enroll or opt-out, at which point passive enrollment will begin in April. DOH has sent out a series of notices at the 90-day (end of December) and 60-day (end of January) and 30-day mark (expected in February) to communicate the passive enrollment date. As of early February, 698 individuals have been enrolled in FIDA since the December 1, 2014 implementation date for Region One. DOH officials at a February Managed Care Policy and Planning Meeting did not readily have current data on the number of FIDA opt-outs; in January DOH reported that 3,853 individuals had chosen to opt out. Training Program Requirements for FIDA Network Providers HCA members who are contracted to provide services under FIDA are advised to check with their contracted FIDA plan about the deadline to complete a required training program. Under FIDA, participating plans must ensure the completion of provider training on a number of key subjects. The training offers education on FIDA and addresses the special needs of the targeted, vulnerable population, with the goal of ensuring the delivery of quality care to FIDA participants. Once providers have completed each uniform training module, they will have fulfilled the training requirement for all health plans in the FIDA demonstration. Notifications will be sent as newly required training modules become available. Plans will also offer separate trainings on topics, as needed, specific to each FIDA health plan’s processes and requirements. FIDA plans have set different deadlines to complete the training so members should check with each plan. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.

DOH Value-Based Payment Discussions Proceed to Roadmap 2 The state Department of Health (DOH) initiative to convert Medicaid – and, eventually, all other payors – to a Value Based Payment (VBP) system proceeded to a second, revised Roadmap this past week. This second iteration of the VBP Roadmap was presented to a state-convened workgroup comprised of HCA and other major health sectors meeting for a second time. HCA was given an advance copy of this second iteration late last week, which we shared with HCA members in last week’s ASAP (page 6 story). Under the terms and conditions 10

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of the state’s $8 billion Medicaid reinvestment waiver, DOH agreed to require that 90 percent of all payments under managed care and the Delivery System Reform Incentive Payment (DSRIP) program be based on VBP, rather than volume-based methods, by the fifth year of the waiver. As framed in the current draft Roadmap, VBP levels would range from Level I (shared savings without provider risk), Level II (assumption of partial risk, with increased share of savings), and Level III (greater assumption of risk, greater share of savings). HCA members can view the second draft Roadmap along with HCA and joint association comments on the first iteration of the roadmap at http://www.hca-nys.org/documents/VBPdocs.pdf. Also accessible at this link are DOH’s slides presented this week to the state workgroup as well as the Governor’s proposed VBP budget language. Responding to health industry comments and recommendations, DOH has now incorporated several new areas of flexibility for VBP options and arrangements under the Roadmap. DOH has also emphasized its “commitment” to adequate reimbursement for community based providers under a VBP system, although it is not yet clear how this “commitment” might be actualized concretely under VBP. DOH also added additional weeks to its timeline for submitting the Roadmap to the U.S. Centers for Medicaid and Medicare Services, now targeted for April 15 – still an extremely tight window given VBP’s complexity and high-stakes. At this week’s meeting, HCA and workgroup members continued to urge flexibility, workability, infrastructure investment, payment adequacy, realistic timeframes, and other parameters that would enable the health system to reasonably and prudently enter into VBP models and arrangements. Workgroup members further urged an ongoing ability to revisit and modify any “final” Roadmap to address issues identified upon and during implementation. We also raised questions on the Executive’s budget language which, as currently submitted to the Legislature, would authorize the Commissioner of Health to establish and authorize VBP under managed care and under the DSRIP program. Specifically, we asked whether the intent is for DOH to actually set methodologies and rates (as the budget language contemplates) or, instead, to articulate broader VBP policies and parameters. DOH indicated that while it does not currently plan to “set” actual rates, it may proceed with “greater or lesser prescription” based on particular sectors or providers the state feels may require tighter parameters. Should the state proceed, VBP would introduce far-reaching and sweeping changes in health care payment and coverage in New York State. Stakeholders need to contemplate both the risks and the opportunities – both sides being very real and highly consequential. VBP carries important opportunities for better connecting payment with outcomes. VBP also provides concrete avenues for crediting and returning to providers the value and savings they are producing for the system. Home care should be among the leaders in this regard. At the same time, there are vast and serious areas of risk associated with such a move, which would further remove the process from rate negotiation, and still-further away from cost-based payment. As it is, negotiated rates are already a major challenge for providers under the existing conditions in managed care and, now, DSRIP as well. HCA invites and encourages members to continue to review the Roadmap and submit comments on, which we will, in turn, convey in the workgroup process. Please send comments to HCA Executive Vice President Al Cardillo at acardillo@hcanys.org. The workgroup next meets on March 13. For further information, please contact Al Cardillo. 11

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

Volume 20, No. 8 February 27, 2015 

DSRIP Update Under the Delivery System Reform Incentive Payment (DSRIP) program, the state has extended the date for Performing Provider Systems (PPSs) to submit their new partner templates. The new date is March 9 at 4 p.m. This extension will provide PPSs with additional time to finalize DSRIP partnerships before attribution for performance is run. If you are interested in reaching out to a PPS regarding a potential partnership, the state has released the most recent list of PPS contacts at http://www.hca-nys.org/documents/DSRIPPPSContactList.pdf. Effect on attribution Any partners added to a PPS’s network through this process will not have an effect on the DSRIP’s attribution for valuation. However, the addition of partnering providers using this process will have an impact on the PPS’s attribution for performance and the calculation of the PPS’s performance baselines. Attestation Any affiliate that a PPS includes in its submitted new partner template will need to adhere to the same DSRIP attestation guidelines as previously established, meaning a signed attestation (electronic form is acceptable) from the partnering provider stating its participation in the network of the given PPS. These attestations will need to be on file with the PPS lead entity and made available upon request from DOH, the Office of the Medicaid Inspector General, the U.S. Centers for Medicare and Medicaid Services or any other organization with oversight in DSRIP. Applications DOH has posted a revised compilation of public comments received on PPS Plan Applications at http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/pps_applications/public_comments/. The scoring given to each PPS application by the Independent Assessor is at http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/independent_assessor_scoring_summaries/. Questions can be directed to dsrip@health.ny.gov.

UAS Upgrade Coming On Friday evening, March 20, the Uniform Assessment System (UAS-NY) online system will be upgraded to version 7. According to the state Department of Health (DOH), this version will provide additional functionality. This upgrade process means that the UAS-NY will not be available from March 20 until Saturday, March 21. Agencies should refer to the “UAS-NY Upgrade to v7” document which is available in the References and Resources Section of the UAS-NY Training Environment for additional information about this upgrade. Continued on next page 12

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

Volume 20, No. 8 February 27, 2015 

Continued from p. 12 Offline application In conjunction with this upgrade, a new version of the UAS-NY Offline Application (v7) will be made available. After the online upgrade on March 20, version 7 of the Offline Application will be required in order to synchronize offline data. While users may continue to work offline using their previously installed version of the Offline Application (6.30) after the online upgrade, they will not be able to perform a synchronization until they upgrade to version 7 of the Offline Application. Required Training Courses for UAS-NY Roles 30, 35, 40, and 45 Due to the nature of the application changes, all users will be required to complete Course1300-A “Using the UASNY to Conduct Assessments.” This course is a supplement to Course 1300 and will provide a review of the changes in the UAS-NY application related to conducting assessments. DOH recommends that users complete Course 1300-A as soon as possible. From March 9 through March 19, this course will be listed as a required course for UAS roles 30, 35, 40, and 45. During this time period, all users who did not yet complete Course 1300-A will be required to complete this course in order to access the UAS-NY application. On March 20, a replacement to the 1300 “Using the UAS-NY to Conduct Assessments” will be instituted and will include all new material. On March 20, Course 1300-A will be removed permanently from the UAS-NY Training Environment. Those users who did not complete the 1300-A supplement course by March 19 will be required to complete the entire new Course 1300 which will be available March 20, 2015. Questions about any of these changes should be directed to the UAS-NY Support Desk at (518) 408-1021 or uasny@health.ny.gov.

CMS Conducts Special Open Door Forum on IMPACT Act of 2014 This week, the U.S. Centers for Medicare and Medicaid Services (CMS) hosted a call on the standardized data required under the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. Under IMPACT, several post-acute providers – including home health agencies (HHAs), skilled nursing facilities (SNFs), long term care hospitals and inpatient rehabilitation facilities – will be required to provide standardized data. The data must also be interoperable to allow for exchange and, thus, better coordinated care. This data includes standardized assessment data (OASIS for HHAs), data on quality measures, and data on resource use and other measures. The quality measures, at a minimum, would include the following quality domains: 1) functional status and changes in function; 2) skin integrity and changes in skin integrity; 3) medication reconciliation; 4) incidence of 13

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

Volume 20, No. 8 February 27, 2015 

major falls; and 5) communicating the existence of, and providing for the transfer of, health information and care preferences. Standardized assessment data will be required no later than January 1, 2019 for HHAs and no later than October 1, 2018 for all other post-acute providers. HCA members can download CMS’s PowerPoint in the “Downloads” section at: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Post-Acute-CareQuality-Initiatives/IMPACT-Act-of-2014-and-Cross-Setting-Measures.html. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

Governor Signs Chapter Amendments to Wage Theft Prevention Act On February 23, Governor Cuomo signed legislation (Chapter 2 of the Laws of 2015) that, among other provisions, amends the “Wage Theft Prevention Act” to clarify that the annual wage notice is not required for 2015. Prior legislation, passed in December, had eliminated the requirement that employers annually provide employees with written notice of wage information; but since the law was not effective for 60 days, the annual notice would have still been required to be given by February 1 of 2015. When the Governor signed the bill, he stated that the Legislature and Governor agreed on a chapter amendment to remove the notice requirement for 2015. Based on this agreement, the state Department of Labor did not require the annual notice for 2015 and a chapter amendment was introduced by the Legislature and signed by the Governor this week. This burdensome notification requirement has long been a focus of HCA’s advocacy. More information is at http://www.labor.ny.gov/workerprotection/laborstandards/employer/wage-theft-prevention-act.shtm.

Central New York Coalition Reminds Providers of Upcoming Health Emergency Prep Training The Health Emergency Preparedness Coalition (HEPC) in the Central New York Region is sponsoring several emergency preparedness meetings for providers in the coming weeks. There are still openings in many of the upcoming March programs, which are free of charge, including “Hazmat For the First Receiver” (March 10 webinar); “Social Media for Disaster Response and Recovery” (March 12 in Bath, NY); “Continuity of Operations Planning” (March 17, 20 and 23 at multiple locations); and others. These are just some of the more than 30 sessions listed at https://www.urmc.rochester.edu/ emergency-preparedness/Training.aspx, where you can register. To get the latest updates from the HEPC on upcoming health emergency preparedness trainings, join the listserv at listserv@lists.rochester.edu.

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

Volume 20, No. 8 February 27, 2015 

Revised Rule Issued on “Immediate Need for Personal Care Services” The state Department of Health (DOH) has issued a revised rule for the procedures by which Medicaid applicants may establish presumptive eligibility for “immediate temporary personal care services.” The proposed revised rule is at http://tinyurl.com/q85ylur. A Medicaid applicant is presumptively eligible for immediate temporary personal care services when: •

The social services district determines, based only on the Medicaid application and the DOH4495A (“Access NY Supplement A”), that the Medicaid applicant appears to be financially and otherwise eligible for Medicaid;

•

The social services district determines that the physician’s order documents that the Medicaid applicant needs assistance in the home with toileting, transferring from bed to chair or wheelchair, turning or positioning in bed, walking, or feeding and that the Medicaid applicant has a stable medical condition and can be cared for safely at home;

•

The physician’s order recommends the hours be authorized as immediate temporary personal care services; and

•

The Medicaid applicant is in receipt of Protective Services for Adults (“PSA”) or has been referred to PSA and the social services district’s PSA staff have determined that a PSA investigation and assessment are necessary.

If a Medicaid applicant is determined to be presumptively eligible but is subsequently determined to be financially or otherwise ineligible for Medicaid, any sums expended for such services during the Medicaid applicant’s presumptive eligibility period may be recovered from the individual. Any sums expended for such services that are unable to be recovered from the individual are a charge upon the social services district for which state reimbursement is not available. The rule includes provisions on: the timeframe for districts to arrange for immediate temporary personal care services; other district responsibilities; when the presumptive eligibility ends; appeal rights for applicants; and others. According to the announcement, the rule is being proposed to comply with State Supreme Court Justice Madden’s July 2010 and March 2014 Orders, which directed regulations setting forth the steps for requesting immediate temporary personal care services, and to also provide for expedited assessments. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.

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

Volume 20, No. 8 February 27, 2015 

OPWDD Posts Revised HCBS Settings Transition Plan The state Office for People with Developmental Disabilities (OPWDD) has posted its revised plan for meeting the federal home and community based settings (HCBS) rule which requires home and community based services to meet certain settings requirements, as defined according to criteria below. The plan, along with webinar materials, is at http://www.opwdd.ny.gov/opwdd_services_supports/HCBS/announcement-for-public-content. As covered in previous editions of ASAP, the final federal rule establishes criteria for what is considered a home and community setting under the following Medicaid waiver programs: 1915(c), 1915(i) and 1915(k). It will also apply to 1115 waiver programs (managed long term care and mainstream Medicaid managed care). New waivers or state plan amendments are also covered by the rule. The rule was effective March 1, 2014 but allows for transition plans over five years: until March 17, 2019. The purpose is to establish qualities and characteristics of settings where recipients of HCBS Long Term Services and Supports (LTSS) live and/or receive services to ensure that the setting maximizes the individual’s autonomy and independence and his or her integration into and interaction with the broader community. Appropriate settings are those that: 1) ensure an individual’s rights of privacy, dignity and respect and freedom from coercion and restraint; 2) optimize autonomy and independence in making life choices; and 3) facilitate choice about services and who provides them. Nursing homes, hospitals, intermediate care facilities (ICF), and institutes for mental disease (IMD) are among the settings not included as meeting the criteria. OPWDD’s initial transition plan included only residential settings; now that CMS has issued non-residential setting guidance, OPWDD has to revise its plan. According to the revised transition plan: •

OPWDD’s HCBS Waiver includes 71,519 participants, over half of whom (37,839) reside in their own home or the home of a family member, relative or friend and, thus, already meet HCBS settings requirements.

•

An additional 9,218 participants reside in a supportive certified apartment program (2,441), a Family Care home (2,293), or a group home with 4 or fewer individuals (4,484). These settings are more likely to already meet the HCBS settings requirements.

•

24,462 HCBS waiver participants currently reside in group homes with more than 4 individuals. OPWDD considers these group homes to be in “partial compliance” at this time while it implements its HCBS Settings Assessment process.

•

OPWDD recognizes that revisions to its regulatory framework as well as licensing and certification requirements for ongoing monitoring will be necessary for full compliance with the HCBS Settings 16

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

Volume 20, No. 8 February 27, 2015 

requirements and to enforce these requirements. These remediation activities are described within the transition plan. •

OPWDD also recognizes that some programmatic enhancements and clarifications may be necessary for Day Habilitation and Prevocational services/settings to achieve full compliance with the settings requirements. These remediation actions, including work with stakeholders, are outlined in the transition plan.

The plan describes OPWDD’s efforts to increase competitive employment opportunities and options; increase self-direction; enhance person-centered planning, service delivery and outcomes; enhance provider performance expectations; develop guidance and a toolbox for providers; and integrate HCBS regulations into managed care requirements. OPWDD is taking comments on the transition plan until April 18. OPWDD is holding a March 10 webinar on the revised plan (1 to 2:30 p.m.). To register, go to https://meetny.webex.com/meetny/onstage/g.php?d=640465742&t=a. In mid-February, the state Department of Health posted its statewide transition plan. Information on the plan is at http://www.health.ny.gov/health_care/medicaid/redesign/home_community_based_settings.htm. According to that plan, the state intends to ensure that providers and participants are aware of the HCBS requirements and monitor programs to ensure that the programs are in compliance. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.

Proposed Updates to Medicare Managed Care and Drug Plans Last week, the U.S. Centers for Medicare and Medicaid Services (CMS) released proposed changes to Medicare Advantage (MA) managed care and Part D prescription drug plans. The changes are at http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Pressreleases-items/2015-02-20-3.html and www.cms.hhs.gov/MedicareAdvtgSpecRateStats. According to CMS, the changes include a 0.9 percent cut in MA payments and an expected “coding trend” increase of 2.0 percent resulting in an average change in revenue of 1.05 percent. Two provisions of interest to home care providers are the inclusion of value-based contracting and in-home enrollee risk assessments. In the “2016 Call Letter,” CMS states that it will be contacting MA plans to discuss how they are using physician incentive payments (payments based on quality of care and patient satisfaction) and value-based contracting of provider services. CMS indicates that it may consider future rulemaking to require MA plans to report their use of alternative payment models. CMS has already set goals to move away from fee-for-service payments and orient payment toward value-based purchasing that links provider reimbursements to the health and well-being of patients in the traditional, nonmanaged care Medicare program. Continued on next page 17

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

Volume 20, No. 8 February 27, 2015 

Continued from p. 17 In addition, as described in numerous past editions of ASAP, the state will require all managed care organizations to utilize non-fee-for-service systems that “reward value over volume” for at least 90 percent of their provider payments by the end of 2019. To meet this mandate, the Governor’s proposed 2015-16 budget includes a provision to use reimbursement methodologies that are value based. HCA is serving on a state workgroup to provide feedback on the state’s pathway to a value-based payment system. Another area of interest to home care providers in the 2016 Call Letter are guidelines for in-home assessments that some MA plans conduct with physicians or non-physician practitioners. In the past, CMS has raised concerns that such visits were being used to report more diagnosis codes and increase payments for enrollees and questioned if members’ regular providers were receiving and using the information collected at the visits and using this to improve care. CMS, however, does recognize that in-home assessments can have a significant value for care planning and coordination. Thus, CMS is encouraging plans to adopt as a best practice a core set of components for in-home assessments they perform. These best practices would include: •

In-home assessments being performed by physicians, or qualified non-physician practitioners, specifically advanced practice registered nurses, nurse practitioners, physician assistants or certified clinical nurse specialists;

•

Medication review and reconciliation;

•

Scheduling appointments with appropriate providers and making referrals and/or connections for the enrollee to appropriate community resources;

•

Conducting an environmental scan of the enrollee’s home for safety risks, and need for adaptive equipment;

•

A process to verify that needed follow-up care is provided;

•

A process to verify that information obtained during the assessment is provided to the appropriate plan provider(s);

•

Provision to the enrollee of a summary of the information, including diagnoses, medications, scheduled follow-up appointments, plan for care coordination, and contact information for appropriate community resources; and

•

Enrollment of assessed enrollees into the plan’s disease management/case management programs, as appropriate.

HCA is in contact with the National Association for Home Care and Hospice on any ways that home care providers may be able to partner with physicians and other non-physician practitioners, given that the home care provider already furnishes these services.

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

Volume 20, No. 8 February 27, 2015 

Coverage for Pneumococcal Vaccine Extended The U.S. Centers for Medicare and Medicaid Services (CMS) has announced that, effective February 2, 2015 for dates of service on or after September 19, 2014, Medicare Part B will cover a second pneumococcal vaccine one year after the first vaccine was administered. This is in addition to covering an initial pneumococcal vaccine to all Medicare beneficiaries who have never received the vaccine under Medicare Part B. This new coverage is based on the recommendations of the Advisory Committee on Immunization Practices. More information is at http://cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNMattersArticles/Downloads/MM9051.pdf.

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

Claims Editing in Error for Reason Codes 36602 and 36381 – NGS has identified an issue where claims with HCPCS code G0279 (diagnostic digital breast tomosynthesis) are editing in error for reason codes 36602 and 36381, looking for a fee for this service. This is scheduled to be corrected on April 6, 2015. No provider action is needed. Claims will be held in Location SMP717 until a fix can be implemented in April. Impacted providers should monitor the Production Alerts section of NGS’s website as well as NGS’s e-mail updates for additional information.

•

CMS Revises MM8581: Automation of the Request for Reopening Claims Process – The U.S. Centers for Medicare and Medicaid Services (CMS) recently revised Medlearn Matters (MM) article 8581 originally issued on December 19, 2014. The revisions were made regarding the relationship of re-openings to timely filing and also to certain denied claims lines and to clarify the need for a “Remarks” field code for certain re-openings. In addition, the effective and implementation dates are revised. All other information remains the same. The article informs NGS and other MACs about changes that will allow providers and their vendors to electronically request re-openings of claims. MM8581 can downloaded at: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-NetworkMLN/MLNMattersArticles/Downloads/MM8581.pdf.

•

Reminder: ICD-10 Testing Week March 2-6, 2015 – Trading Partners, billing services, software vendors, and clearinghouses will be able to send test claims to NGS for the ICD-10 Acknowledgement Testing Week with Electronic Data Interchange (EDI) from March 2 through March 6, 2015. This testing week allows CMS to analyze testing data. Registration is not required for the Acknowledgement Testing Week. Remember: 

Test claims with ICD-10 diagnosis codes must be submitted with current dates of service.



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. Continued on next page 19

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

Volume 20, No. 8 February 27, 2015 

Continued from p.19



Testing will not confirm claim payment or produce remittance advice.



All test files must have the “T” in the ISA15 field for Test files.

NGS’s EDI Help Desk is available for questions at (877) 273-4334. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

Publications •

“Chronic Care Management Services” Fact Sheet,” by the U.S. Centers for Medicare and Medicaid Services http://www.cms.gov/Outreach-and-E ducation/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.