March 20, 2015 ASAP

ASAP

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

Legislative Issues  Public Policy



News

Volume 20, No. 11 March 20, 2015

HCA Pushes F2F Fix in Congressional Doc-Fix Negotiations Next week’s HCA Federal Advocacy Day, on March 24, is well timed as Medicare financing debate continues As leaders in Congress this week worked towards a deal to fix the physician fee schedule – or Sustainable Growth Formula (SGR) – HCA continued to push hard for adoption of measures to relieve home care providers from the onerous Medicare face-to-face documentation requirement. We also pressed New York’s Congressional Delegation to resist any further cuts to home care as part of the funding offsets that would be needed to pay for the SGR-fix and as part of emerging Congressional budget actions. The SGR “pay-fors” were not released with the initial text but are expected early next week. See F2F p. 5

HCA Presses Home Care Support in Senate-Assembly Budget Positions HCA continued our full-press advocacy this week for support of home care and community-based care in the 2015-16 state budget. These priority areas have been extensively shared with the membership in HCA documents, statewide budget calls, member alerts, HCA advocacy guidance and a host of related HCA communications.

Inside ASAP

See BUDGET p. 3

HCA Pushes F2F Fix in Doc-Fix Negotiations.......................................1 HCA Presses Home Care Support in Budget Positions.......................1 Become a Stronger Leader, Gain CEUs!................................................1 QIVAPP Funds Sent to MLTCs for Home Care........................................6 DOH Compiles “Guidance” for “Advanced Aides” Concept..............7 PHHPC Committee Agenda Includes LHCSA Applications.................7 Home Care/Managed Care Billing, Telehealth Legislation See Action....8 Value Based Payment Proposals Draw Intense Focus...........................9 Next Generation ACO Model Open Door Forum Announced.............9 State Makes Determinations on Regulatory Waivers for DSRIP..........11 Managed Care Timetable Updates Posted........................................12 HCA’s CFO Forum: Valuable Takeaways.............................................12 HCC/HCA Forum Brings HRA, State Policy Updates.........................14 HCA Lends Support to Universal Broadband....................................14 UAS Upgrade Begins Tonight............................................................15 MedPAC Recommends Copays, Expedited PPS Rebasing................16 Sign up by April 17 to Volunteer for ICD-10 Testing in July.................17 Medicare Claim Risk-Assessment Tool Coming for Home Health......18 Spanish Language Home Care Training Manuals Available.............18 Medicare-Medicaid Coordination Office Issues Report.....................19 Publications......................................................................................19

Become a Stronger Leader, Gain CEUs: Attend Post-Conference Leadership Institute for HCA Members! Don’t miss this rare opportunity: register today for May 8 leadership program and HCA Annual Conference (May 67) to achieve greatest savings Now is a great time to reinvest your savings from this year’s reduced HCA Annual Conference registration rate by also registering for a rare opportunity to gain continuing education credits (CEUs) and learn leadership skills from the esteemed American College of Healthcare Executives (ACHE). See ACHE p. 2

Helping New Yorkers Feel Right At Home

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

Not only is our regular Annual Conference fee lower than last year’s rate, but you will also further save on conference costs when you bundle your conference registration and your registration for the ACHE-run Leadership Institute, both of which are held at the Saratoga Hilton on May 6-8.

Practice ways to recognize and reward employee contributions and build a winning team.

This program is presented by Jody Rogers, PhD, FACHE, visiting professor in the health care administration graduate program, Trinity University, San Antonio, TX. He has more than 30 years of experience as a health care executive in public and private health care organizations and is a certified master facilitator of The Leadership Challenge.

It’s a veritable trifecta: cost savings, valuable leadership skills, and the opportunity to gain CEUs! In this half-day leadership training, designed for health care leaders at all levels of their careers, you will gain proven tools and techniques to identify and develop your leadership philosophy and strengthen your leadership skills. You will also learn how to:

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ACHE from p. 1

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Volume 20, No. 11 March 20, 2015

Register today by visiting the following links on HCA’s Annual Conference website (www.hcaannualconference.com):

Create an action plan using course content through an illustrative case study, leadership tools and integrative discussions.

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Download the PDF registration form at http://www.hca-nys.org/documents/ 2015HCAAnnualConferenceBrochure.pdf

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Increase your influence and effectiveness by becoming a quiet but strong leader.

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

President: Editor:

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

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BUDGET from p. 1 They have included provisions with language drafted and directly advanced by HCA for: •

Adequate home care and managed care funding for fundamental operational and service costs (including wages and benefits, federal and state mandates, training and other core infrastructure expenses) and adjustments to the episodic payment system to likewise ensure payment adequacy for core operational and service costs;

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Regulatory streamlining, including streamlined billing, coding and payment of claims;

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Home care/managed care technology investment;

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Quality innovation;

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New model development;

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Modernization of home care insurance coverage.

HCA priorities have also included our response to Executive Budget proposals for: •

Health care capital financing (HCA has advocated inclusion of home care in the proposed investment initiatives);

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Authorization of Advanced Home Health Aides (HCA supports, with modifications identified by HCA and others for successful implementation);

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Value Based Payment (HCA is working with a continuum of associations on modifications and input);

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Financing of transportation within Managed Long Term Care (MLTC) plan premiums (HCA is urging restoration of financing and rejection of the Executive’s proposed funding cut and carve-out of transportation from MLTC premiums).

State budget table developments In the wake of Senate and Assembly adoption of their one-house budget bills and resolutions last Thursday, legislators immediately commenced reconciliation planning and discussions. This process moved into high gear this week as Joint Legislative Budget Committees were convened to further delineate priority areas and concerns, and associated areas of both commonality and differences between the houses. The process further escalated yesterday with the assignment of “budget table targets.” These are the amounts assigned by legislative leaders for restoration and/or addition of funding to the Executive’s proposed levels for each budget area. The health table was assigned an overall funding restoration target of $55 million, apart from Medicaid, which functions under the “global cap.” The health table’s joint chairs, Senator Kemp Hannon and Assemblyman Richard Gottfried, along with fellow legislators serving on this committee, gave indications of some of their priority areas, which include: provision for capital financing and technology support across sectors (including home care); restoration of “final-say” authority for physicians/prescribers in drug coverage decisions for Medicaid recipients; establishment of a task 3

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force to recommend avenues for modernization of coverage for types of health services and technology “frozen” under baseline coverage terms of the Affordable Care Act; restoration of funding for Alzheimer’s Disease programs; funding for rural hospitals; concerns over the Executive’s Value Based Payment proposal; rejection of insurance taxes to pay for costs for the state’s Health Insurance Exchange; and others. Next steps The health budget conference committee announced yesterday that the committee and staff will work throughout the weekend to reconcile budget positions. HCA met with key offices to review each area of recommendation and concern, including our home caremanaged care budget language submitted by HCA for consideration, and we will remain in steady contact with the committee participants to provide any further information, respond to any questions or assist with any issues as they work throughout the night and weekend. The Senate and Assembly health conference committee membership is listed below. Every HCA provider and MLTC should contact these members to urge support for our sector’s priority budget proposals and concerns. Immediate follow-up is necessary as the Legislature’s timetable will continue to move swiftly. Senate Health Conference Committee Members Kemp Hannon (Co-Chair) David Valesky William Larkin Cathy Young Martin Golden Gustavo Rivera Kevin Parker

Assembly Health Conference Committee Members Richard Gottfried (Co-Chair) Kevin Cahill Steven Cymbrowitz Anthony Brindisi Maritza Davila Roxanne Persaud Andrew Raia Raymond Walter

HIRING VNA Home Care: Quality Assurance/Performance Improvement Manager The Quality Assurance/Performance Improvement Manager is responsible for the direct implementation of the Corporate Quality Improvement Plan including the identification of care outcomes and the development of appropriate intervention action plans throughout the Certified Home Health Agency (CHHA), Licensed Home Care Services Agency (LHCSA), Managed Long Term Care (MLTC) plan, and Social Adult Day Center (SADC). Qualifications: Current license as a Registered Nurse, Physical Therapist, or Occupational Therapist in New York State; Bachelor’s degree from an approved school, acceptable to the state Department of Health, Master’s Degree preferred; Two years of experience as a clinician in home and community based services. To learn more about the position and to apply, please visit http://477home.org/2015/02/quality-assuranceperformance-improvement-manager-syracuse-ny/.

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F2F from p. 1 Each year, Congress has been compelled to enact a short term SGR-patch (also known as the “docfix”) to stem major Medicare cuts that physicians are scheduled to receive as part of the SGR formula (which has been in place since 1997). The latest short-term SGR patch expires at the end of the month, and members of Congress have recently resurrected a bipartisan plan to correct the SGR more permanently – albeit with a high price tag, of about $213 billion for the current SGR-fix agreement. Barring a fix, physicians nationwide face a 21.2 percent cut in payments on April 1, and, given the stakes, there is a lot of momentum driving toward some kind of deal on SGR by month’s end, with action likely next week. In a press statement to the media and shared with Congressional offices this week, HCA raised concerns that the emerging SGR legislation failed to include other necessary policy actions to support home care – specifically the need for a fix to the face-to-face rule – at a time when Congress was opening up the debate about physician payments and other Medicare financing issues. “The SGR bill now being negotiated in Congress rightly fixes the chronic issue of physician underpayment,” said HCA President Joanne Cunningham in her statement. “Unfortunately, it appears that the measure, at present, declines to address another longstanding concern that has plagued the home care industry, complicated its relationship with physicians, and left access to care hanging in the balance.” She continues: “The history of the physician ‘faceto-face’ rule for Medicare home health is a contorted one. While HCA supports the rule’s intent in a broad sense – to better involve physicians in the planning and oversight of home care services – both Congress and the home care industry agree that the execution of this rule by the U.S. Centers for Medicare and Medicaid Services (CMS) has been confusing, administratively duplicative, costly, an undue burden on access to care, and well outside the statutory expectations of the Affordable Care Act,

as 75 Members of Congress so stated in a letter to CMS in 2013.” She adds: “Short of repealing this problem regulation, the home care industry has asked, at a minimum, for Congressional action compelling CMS to streamline the face-to-face certification process. We have repeated this call in the most recent SGR negotiations as Congress considered a fix to the physician fee schedule.” As of ASAP press time, negotiations remained in flux and will likely remain that way into next week when HCA Policy staff are headed to Washington for the National Association for Home Care and Hospice Policy Conference. Coinciding with the conference, we will be meeting on Capitol Hill with New York Congressional Delegation offices on the F2F issue as well as an array of other federal concerns that need redress, including: home health prospective payment system rebasing, the advent of a damaging home health copayment proposal, the risk of payment cuts as offsets to fund the SGR patch, the need for Congress to reauthorize the Medicare rural addon, and our call for passage of legislation permitting nurse practitioners, physicians assistants and other specified advance practice health professionals to certify Medicare home health plans of care and to document the Medicare face-to-face encounter (S.578/H.R.1342). Meanwhile, both the U.S. House and Senate budget committees have passed their one-house budget plans. These plans are non-binding and serve largely to stake out each chamber’s budget position including proposals to repeal the Affordable Care Act (in both houses) and a premium support (aka voucher) proposal for Medicare in the House bill, as has been proposed in the past. HCA will be analyzing these proposals for further details on items of direct impact to home care providers, and will advocate on these issues in Washington next week as well. HCA has created a set of advocacy documents for all of these issue areas. We will be sharing these with Congressional offices during our visits in Washington next week. They can be downloaded at http://www.hcan y s . o r g / d o c u m e n t s / March2015FederalAdvocacyDocumentsl.pdf. For more information, please contact a member of HCA’s Policy staff. 5

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QIVAPP Monies Sent to MLTC Plans, Due to Home Care Providers April 15 As reported in previous ASAP stories, the state Department of Health (DOH) has sent Managed Long Term Care (MLTC) plans a state-share lump-sum payment in cycle 1958 (on March 18) for their Quality Incentive Vital Access Provider Pool (QIVAPP) monies. The plans have been instructed to pass through the entire amount of these funds to eligible providers as identified by DOH by April 15, 2015. DOH has also sent MLTC plans a spreadsheet with their original list of QIVAPP-eligible home care contractors and is asking plans to update the actual aide hours for the period April 1, 2014 through February 28, 2015 and to project the hours for March 1 to March 31, 2015. These hours will be used to update and reconcile the final QIVAPP payment of $35 million subject to approval by the U.S. Centers for Medicare and Medicaid Services. DOH has also asked plans to submit an attestation form for each provider with updated hours for reconciliation purposes. Plans are to include any providers who were omitted during the original submission if they qualify for QIVAPP. The attestation asks MLTC plans to verify that all QIVAPP requirements have been met. The information is due March 27, including updated aide hours and attestation forms; therefore, HCA home care provider members are being asked to submit additional information to their contracted MLTC plans. HCA raises question about QIVAPP eligibility standard Also this week, HCA contacted DOH after noticing that the requirement for home care provider to participate in a specialty training program has been interpreted more restrictively on the attestation form than in DOH’s previous guidance, an August 6 Frequently Asked Questions (FAQs) document. One document includes hours in excess of training program requirements to count for QIVAPP eligibility, while the other limits eligibility to those exceeding the annual in-service requirements. The FAQs state: “Only training programs that exceed the current Department of Health training requirement and/or the in-service requirements will meet the ... eligibility requirement.” However, the attestation form limits eligibility to those providers who exceed the minimum number of in-service training hours per year (12 hours for home health aides and 6 hours for personal care aides). DOH has agreed to issue a clarification for MLTC plans indicating that training programs exceeding the 75 hours of home health aide training or 40 hours of personal care aide training and/or exceeding the required inservice training would meet this requirement. HCA thanks DOH for hearing our concerns and addressing this issue on a timely basis. DOH has already sent the plans a list of QIVAPP-eligible providers and the amount of their allocations. Plans should be contacting their home care contractors with this information. HCA will request a list of all MLTC plans and home care providers that qualify for QIVAPP so we can assist members. More QIVAPP information is at http://www.health.ny.gov/health_care/medicaid/redesign/mrt_61.htm. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org. 6

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

DOH Compiles “Guidance” for Potential “Advanced Home Health Aides” The state Department of Health (DOH) has culled input from a stateconvened workgroup to compile a “guidance document” for consideration by the Department, the Legislature and other potential parties for upcoming budget and post-budget deliberations to establish a new level of “Advanced Home Health Aide” (AHHA) within home care and hospice. In ASAP and elsewhere, HCA has written extensively about the issue, the workgroup and the Governor’s budget proposal to authorize AHHA. In addition to summarizing the Executive’s AHHA budget proposal and topics discussed by the workgroup, the DOH document examines an array of tasks – many based on those currently allowed only under “special circumstances” or under RN-delegation via exemption to the Nurse Practice Act – along with associated perspectives on additional training, competency and supervision necessary for carrying out those tasks under the Executive’s proposed model. The document also highlights areas for further consideration raised by participants on the workgroup, including HCA and other health care associations, consumer advocates, the New York State Nurses Association, 1199 SEIU, individual RNs, and others. The document does not address these in depth, but signals items such as financing, regulatory streamlining, alignment between managed care and home care, flexibility, liability, and other issues that will need to be part of the discussion as the proposal is deliberated in the budget and in ensuing phases of implementation. HCA has a longstanding record of support and has authored proposals for providing home care aides with flexibility for performing additional care tasks, commensurate with RN and patient/family instruction as well as care plan goals. HCA has communicated strong support for achieving flexibility, and has likewise identified and is requesting incorporation of critical elements necessary for proper implementation. The Assembly one-house budget bill includes its own version of an AHHA proposal that embodies additional regulation, including staffing ratios, which have been the subject of both support and opposition. The Senate one-house bill declined to include the Executive’s proposal (or the Assembly proposal), and instead favors a process of receiving and analyzing the comments from the workgroup and the affected constituencies, including the providers, consumers, workers, health plans and others. HCA will keep members closely apprised of the developments on this critical issue for home care. 7

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PHHPC Committee Agenda Includes LHCSA Applications, but No CHHA Proposals The state Department of Health (DOH) has posted the agenda for the March 26 meeting of the Public Health and Health Planning Council (PHHPC) Committee on Establishment and Project Review. (See https:// www.health.ny.gov/ facilities/ public_health_and_health_planning_council/ meetings/2015-03-26/.) On the agenda are thirty two applications by entities to establish Licensed Home Care Services Agencies (LHCSAs), including eight that would serve patients outside of New York City, Long Island and Westchester, and five applications by LHCSAs for a change of ownership (including three outside of the New York City metropolitan area). There are no applications to establish or expand a Certified Home Health Agency (CHHA) or a change in ownership of a CHHA. For more information, contact Andrew Koski at (518) 8100662 or akoski@hcanys.org.

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Home Care/Managed Care Billing Efficiencies, Telehealth among Key Legislative Action This Week Legislation to establish uniform coding and other billing efficiencies in the home care-managed care model, along with the signing of a new law providing for coverage of telehealth/telemedicine services, were among the prominent state legislative activities this week for home care, as summarized below. Uniform Coding/Billing Efficiencies for Home Care-Managed Care (S.4297-A Hannon) This bill, reported to this week from the Senate Health Committee to the floor calendar, would require the Department of Health to establish universal billing codes that will be used by managed care plans and providers with whom they have contracts or agreements; it would also further require payments to be made via electronic funds transfer. This legislation is also the same or very close to that included in the Senate one-house budget bill. Billing efficiencies through uniform coding and other standardized practices has been a focus of the home care community especially in the wake of the state’s mandatory managed care enrollment policies. Both HCA member providers and Managed Long Term Care plans have supported the advancement of billing efficiencies. HCA and fellow health care associations have advanced such recommendations to the Legislature, the state Department of Health and the State Home and Community Based Services Regulatory Reform Workgroup. HCA has advanced language for adoption of home care-managed care billing efficiencies for the past several years in the state budget, including this year, as part of a multi-tiered home care-managed care payment adequacy and billing/payment efficiency proposal. S.4297-A does not include the payment adequacy provisions that are included in the HCA language, and it also approaches the uniform coding provision slightly differently, but HCA strongly supports and commends Senator Hannon’s efforts to promote a policy solution for this critical area. Separate legislation sponsored by Senator Hannon seeks to improve payment adequacy in response to HCA advocacy. Coverage for Telehealth/Telemedicine Services (Signed into Law as Chapter 6 of 2015) The Legislature has passed and the Governor has signed legislation, A.2552-A (Russell)/S.2405 (Young), now Chapter 6 of the Laws of 2015, to provide for group insurance coverage, as well as bolstering Medicaid coverage, for telehealth/telemedicine services in New York State. The bill is not intended to affect the existing Medicaid home telehealth program or reimbursement established in 2007 and operating through approved home care agencies. The bill is a major progressive effort in telehealth and telemedicine under the leadership of Senator Young and Assemblywoman Russell; HCA worked with Senator Young and the Legislative Commission on Rural Resources on the development of the original legislation several years ago. This new chapter law amends and substantially rewrites a bill passed in June by the Legislature. The amendments were formulated with the Governor’s office, Health Department and Department of Financial Services (formerly the Insurance Department) in December, and the rewrite was the contingency for the Governor’s signature of the chapter. However, as formulated, the new chapter is inadvertently limiting for home care. The bill’s coverage provisions for telehealth/telemedicine are based on an insurance policy’s existing level of coverage for the type of care (e.g., a physician visit, a home care visit, a hospital diagnostic procedure, etc.) that 8

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will otherwise now be covered under telehealth or telemedicine. The problem is that commercial coverage for home care, upon which telehealth coverage would be based under this new law, is so limited as to be minimally available to the beneficiary or the provider. The state’s insurance law coverage for home care was written in 1972, when the health system functioned under entirely different terms, including home care. HCA repeatedly urged the bill sponsors and the Administration to revise the telehealth coverage bill to work around the antiquated provisions of the Insurance Law, but their timetable for agreement on amendments concluded before they could remedy the bill. HCA has prepared new language for consideration that would correct the bill’s deficiency for home telehealth. More globally, we have also advanced an insurance coverage modernization proposal for home care overall as part of the budget process. For more information, please contact HCA’s Policy staff.

Value Based Payment Proposals Draw Intense Focus from All Sides Value Based Payment (VBP) proposals are emanating and receiving intense focus from all sides – payors, providers, policy and research analysts, and state and federal officials. VBP is currently a major subject of the state budget deliberations, the state’s Medicaid waiver, a special state advisory group, and is soon to be the intense focus of state legislative committees. HCA has already provided the membership with extensive background on VBP developments and proposals. Those currently in play are summarized here. •

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The state Department of Health (DOH) has negotiated waiver terms with the U.S. Centers for Medicare and Medicaid Services (CMS) to move a targeted 90 percent of the state’s managed care and Delivery System Reform Incentive Payment (DSRIP) funds to VBP by the end of 2019, and the state is likewise looking to move the entire public and private payment system in the same direction. The state is currently also pursing the twin path of an Executive state budget proposal that would 9

Open Door Forum Announced for Next Generation ACO Model Last week, HCA reported on a newly announced Next Generation Accountable Care Organization (ACO) Model. This week, the U.S. Centers for Medicare and Medicaid Services (CMS) Innovation Center announced a series of open door forums focusing on various aspects of the model. The forum will be held on Tuesday, March 17 from 4 to 5 p.m. To participate, call 1-877-267-1577 and enter ID no. 990507079. As highlighted in last week’s ASAP, the Next Generation ACO is for organizations with experience in coordinating care for populations of patients. It will allow these provider groups to assume higher levels of financial risk and reward than are available under the current Pioneer ACO Model and Shared Savings Program (MSSP). According to CMS, the model’s goal is to test whether strong financial incentives for ACOs, coupled with tools to support better patient engagement and care management, can improve health outcomes and lower fee-for-service expenditures. Additional information on this model and open door forum is at http://innovation.cms.gov/ initiatives/Next-Generation-ACOModel/.

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authorize the Commissioner of Health to establish VBP methodologies for managed care and DSRIP, while simultaneously working with a state-convened VBP advisory group (on which HCA represents home care) to assist in developing and submitting to CMS a Roadmap to VBP for the state and industry. •

CMS has separately announced national plans to move Medicare to VBP.

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Meanwhile, health plans and providers are also at this time developing and implementing alternative service/payment models and packages in their own pursuit of VBP.

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Now, late yesterday, the state Senate Health and Insurance Committees announced plans to delve deeply into the current status, issues, concerns and ideas with respect to VBP, particularly in the wake of the Executive’s budget proposal and VBP Roadmap development.

Justifiably, VBP was a major topic at this week’s HCA-sponsored forum for our member CFOs. (See related p. 12 story.) State VBP Advisory Group updates The state VBP workgroup met last Friday for the third in a series of meetings to discuss DOH concepts for advancement of VBP. Highlights of the discussion included: •

A review of workgroup member comments on the DOH draft Roadmap;

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Revisions to the draft Roadmap document itself;

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Discussion of ongoing workgroup concerns for provider infrastructure support in order for VBP participation to be feasible;

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Discussion of quality alignment needs, in which HCA described our “Quality Risk Tool” and the critical role it would play in a VBP model; and

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A revised DOH timetable and targets being negotiated with CMS, wherein the five year target would be provided as a range from 80 to 90 percent VBP, and would be extended through the first quarter of 2020.

DOH plans to create multiple workgroup subcommittees to drill more deeply into specific areas. Drafts of the VBP Roadmap have been shared by HCA for review and comment by the membership in addition to the posting of roadmaps by DOH for general comment. DOH reported this week that it has shared a preliminary draft with CMS, incorporating some of the comments received to date. Further iterations will be developed based on comments received. State Budget VBP developments Both the Senate and Assembly have thus far excluded the Executive’s VBP proposal from their one-house budget bills. In comments this week, joint legislative health budget conference committee members appeared to 10

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dismiss any notion (that had been reportedly suggested by certain state administration officials) of independent Executive authority to implement or regulate VBP for private coverage absent legislative authorization. State Legislative VBP Roundtable The Senate Health and Insurance Committees announced late yesterday plans to convene a special VBP roundtable to “ensure New York State has a clear understanding of the trend toward value based payment arrangements between Medicaid managed care plans, health care providers, performing provider systems under DSRIP, as well as commercial insurers and what role(s) the state should play in such arrangements.” The roundtable is planned for Monday, April 27 in Albany. Participation will be by invitation only; however, the proceedings are planned for public telecast viewing, and public comments may be directly provided to the committee chairmen. The chairs have indicated that: “A payment transformation of this scale requires a systemwide analysis, as have all other payment reforms in state history. This roundtable will bring together stakeholders including health care providers, health care plans and administrators to discuss the needs, effects and impacts that this transformation may have on all aspects of the state’s health care industry.” HCA will provide further information as it becomes available, including information on our own participation in the roundtable. For further information, please contact Al Cardillo at acardillo@hcanys.org.

State Makes Determinations on Regulatory Waivers for DSRIP Last week, the state Department of Health (DOH) made determinations on several regulatory waiver requests from Performing Provider Systems (PPS) seeking to operate under the Delivery System Reform Incentive Payment (DSRIP) program. The list is posted at http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/docs/ regulatory_waivers.pdf. State agencies approved 243 waivers, out of 536 requests, although many approvals came with conditions. Determinations are pending on 23 requests, and more information was needed on 47 requests. Waiver approval letters will be sent to each provider that was issued a waiver. DSRIP-related regulatory flexibility was included in last year’s state budget at the suggestion of HCA. It allows DOH and other specified state agencies to waive certain regulatory requirements for DSIRP and capital projects associated with DSRIP. State agencies can grant waivers, consistent with applicable law, so that applicants may avoid duplication of requirements and achieve efficiencies. However, the state may not waive regulations involving patient safety or the risk to patient safety, nor can they waive federal regulations. Waivers are also limited to the life of the project or a shorter time period determined by the Commissioner. Some of the pending waiver areas affecting home care include: •

Allowing Certified Home Health Agencies (CHHAs) to extend their geographic service areas beyond their operating certificate so that they can provide services throughout a PPS’s service area. Continued on next page 11

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Continued from p. 11 •

Allowing hospices to expand their service area.

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Allowing physician assistants (PAs) to issue and sign home care orders.

According to the DOH document, determinations for all of these areas are pending. In some of these areas, HCA has in the past requested regulatory changes more broadly for home care agencies operating in the larger health system, irrespective of DSRIP. Regulatory realignment is a key component of our state-level advocacy agenda where we have urged the Legislature to compel state Department of Health action on a matrix of related regulatory relief and realignment areas advanced by HCA and allied associations. Also, New York State Health Commissioner Dr. Zucker has accepted all of the DSRIP Project Approval and Oversight Panel recommendations to the Project Plan Application scores. The revised scores have been submitted as a memo to the U.S. Centers for Medicare and Medicaid Services (CMS) for final approval and the memo is at http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/docs/memo_to_cms_on_dsrip_scoresfinal.pdf. The final Project Plan scores that were submitted to CMS are at https://www.health.ny.gov/ health_care/medicaid/redesign/dsrip/docs/pps_final_scores_and_recommendations.pdf.

Managed Care Timetables Updates Posted The state Department of Health (DOH) has posted an updated “MRT Managed Care Benefit and Population Expansion” timeline at http://www.health.ny.gov/health_care/medicaid/redesign/docs/mrt1458_timeline.xls. The chart includes: the rollout of the nursing home benefit and population into mainstream Medicaid managed care from April to October 2015; Care at Home recipients, Nursing Home Transition and Diversion (NHTD) recipients and Assisted Living Program residents and benefits ( January 2016); Traumatic Brain Injury (TBI) recipients (April 2016); and the Medicaid spend-down population (December 1, 2016). A previous chart included the transition of NHTD and TBI recipients into managed care starting September 2015.

HCA’s CFO Forum: What You May Have Missed, What You Should Take-Away HCA held our annual CFO Forum on Wednesday for home care and Managed Long Term Care (MLTC) CFOs and executive-level finance leaders to help them prepare for their budget forecasting and strategic planning as the state fiscal year draws to a close, and as fiscal issues continue to dominate activity in Washington and Albany. If you are a finance leader and didn’t attend the Forum, here’s what you missed or, if you did attend, here are some important takeaways. •

HCA policy staff provided an inside look at all of the hot-button Medicare and Medicaid reimbursement issues, including: the finance-related elements of our budget advocacy agenda; implications of the Governor’s value-based payment proposal; other aspects of the proposed state budget, including the specific Medicaid reimbursement actions that would be continued from prior years; an update on thirdparty liability billing audits; HCA’s federal advocacy efforts on the face-to-face rule, home health prospective payment system rebasing and copayments; the status of Quality Incentive Vital Access Pool

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funds, the companionship exemption and wage parity mandates; and other pressing issues that finance leaders need to know about. •

•

•

State Department of Health (DOH) officials provided an update on the Medicaid global cap, the episodic payment system (EPS), fee-for-service rates and other Medicaid payment issues, specifically: what to expect from the pending restoration of the 2 percent Medicaid cut as it relates to Medicaid program accountsreceivable and payment flow; the specific level of reduction expected in the base rate for Certified Home Health Agency rebasing under Medicaid EPS; planned changes to the grouper, clinical and functional elements, and the interim payment structure being considered to implement rebasing on a transitional basis beginning April 1; and other Medicaid finance details of direct impact to your agency’s fiscal planning (Tim Casey, DOH’s Bureau of Long Term Care Reimbursement). DOH officials also provided Managed Long Term Care (MLTC) and Fully Integrated Duals Advantage (FIDA) rate updates, specifically: a region-by-region analysis of quality-pool allocations and payment distributions; the status of Quality Incentive Vital Access Provider pool funds; the rate update schedule and expectations for MLTCs and FIDA plans in fiscal year 2016 to reflect methodological changes, nursing home transition add-ons, risk-adjustment models and other ingredients; and other managed care finance issues that are vital for plans and providers as they forecast their budgets for the year ahead (Dan Carmody, DOH’s Bureau of Managed Care Reimbursement). Participants got a look at Medicaid and Medicare benchmarking data and strategies, including national and state data 13

on: gross/net margins; payer mix; average case-mix, therapy, outlier, Low Utilization Payment Adjustment (LUPA) and other episode benchmarks for the Medicare home health Prospective Payment System; visit and service discipline data; direct-cost distributions; and additional benchmarks that are invaluable in determining your agency’s productivity, cost profile, mix of direct and indirect costs, and other critical factors as you budget for the future and negotiate with system partners (Rob Simione, Simione Consultants). •

The Forum also provided tips for successfully brokering shared risk arrangements and value-based payment (VBP) models with managed care plans to meet state and federal level movement toward VBP. In this session, consultant Mark Fish and HCA General Counsel Frank Fanshawe, both of whom held positions at a prominent commercial health plan, presented: “scorecard” methods for measuring and demonstrating value relative to your peers using evidencebased metrics and cost information; a drill down into the service cost components of a typical plan’s per-member-per-month premium to identify opportunity areas for home care to influence cost factors and, thus, demonstrate financial value to plans; and the specific considerations and recommended model designs for bundled payment, capitation payment and shared-savings methodologies in home care negotiations with plans and other payers.

If you missed HCA’s CFO Forum and you would have liked to learn more about this kind of information, then be sure to plan ahead for your attendance at the next CFO Forum which is typically scheduled in midMarch. Senior and Financial Managers Retreat: Sept. 17-18 Those who did attend this week’s forum will also get a special $40 discount to attend our Senior and Financial Managers Retreat on September 17 and 18 at the

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Mohonk Mountain House in New Paltz using a rebate included in your packets at the Forum. This popular Retreat provides yet another opportunity for HCA member finance leaders to delve into vital home care and managed care finance issues. If the issues summarized in this article are of a kind that you need more information about, then you will not want to miss the September 17-18 retreat. Please save the date. For more information, please contact a member of HCA’s Policy staff.

HCC/HCA Member Forum Brings HRA, State Policy Updates This week, HCA held a Forum for its Licensed Home Care Services Agencies who are former members of the Home Care Council (HCC). The Forums are held bi-monthly to update these members on legislative, regulatory and other changes that affect their operations. Arnold Ng, Deputy Commissioner of the New York City Human Resources Administration (HRA) Office of Special Services-Home Care Services Program, provided a complete update on HRA home care-related activities. These included: the final HRA home care contracts; required corrective action plans; recoveries; closeout of current contracts; managed care emergency preparedness protocols; and the availability of air conditioners for vulnerable residents. Other issues discussed included: continued outstanding managed care payments; state budget deliberations; status of the companionship exemption lawsuit; documentation issues for sleep-in cases; Fully Integrated Duals Advantage (FIDA) program; Quality Incentive Vital Access Provider Pool (QIVAPP); Delivery System Reform Incentive Payment (DSRIP) program; and future educational programs. HCA thanks Arnold Ng for his very informative presentation and Joseph Campanella for working with HCC members and co-chairing the Forum meeting. The next HCC/HCA Forum will be held on May 27.

HCA Lends Support to Governor’s Campaign for Universal Broadband from Health IT Perspective HCA is among 30 providers and trade associations listed on a press release this week from the Governor’s office supporting his “Broadband For All” campaign. The purpose of the press outreach is to raise awareness about the benefits of expanded broadband from the health services angle, especially as home care and other providers are innovating in areas of health connectivity – with one another and to patients – through interoperable health systems records, home telehealth, telemedicine and other tools that rely on a strong broadband infrastructure. “For the long-term success of New York’s health care sector and services, the state’s current broadband landscape requires a significant upgrade,” the press release states. “The National Broadband Plan recently estimated that the minimum bandwidth required to support deployment of Health IT applications and telemedicine is 100 Mbps for hospitals. Yet nearly seven million New Yorkers – 70 percent of whom reside in Upstate New York – do not have access to broadband at 100 Mbps.” Continued on next page 14

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Continued from p. 14 The Governor’s campaign calls for universal broadband access by the end of 2018 using investments of $500 million from bank settlements “to incentivize the private sector to expand high-speed broadband access in underserved and unserved areas.” Health IT investment is a major prong of HCA’s 2015 legislative advocacy agenda and we will point to this important campaign as a measure of importance for further development of IT capital support in the home care arena so that providers can better connect with system partners and patients in providing quality, costeffective care. More information about the Governor’s campaign is here: https://www.governor.ny.gov/news/governorcuomo-launches-broadband4all-campaign-rallying-support-new-ny-broadband-program.

UAS Upgrade Begins Tonight As reported in the February 27 ASAP, the Uniform Assessment System (UAS-NY) online system will be upgraded to version 7 later this evening (March 20). According to the state Department of Health (DOH), this version will provide additional functionality. The UAS-NY will not be available from March 20 until Saturday, March 21 as the upgrade is installed. Agencies should refer to the “UAS-NY Upgrade to v7” (available in the References and Resources Section of the UASNY Training Environment) for additional information about this upgrade. A new version of the UAS-NY Offline Application (v7) will be made available and will be required in order to synchronize offline data following the system upgrade. While users may continue to work offline using their previously installed version of the Offline Application (6.30), they will not be able to perform a synchronization until they upgrade to version 7 of the Offline Application. For questions, contact the UAS-NY Support Desk at (518) 408-1021 or uasny@health.ny.gov. New users guide Also, DOH has issued a revised guide for new users with step-by-step information about how to access the UAS-NY. The guide is at http://www.hca-nys.org/documents/UASusersguideMarch2015.pdf. It includes information on web browser requirements; locating the UAS application; accessing trainings; and utilizing a test version of the UAS.

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MedPAC Report Recommends Home Health Copays, Expedited PPS Rebasing and Hospice Changes Last week, the Medicare Payment Advisory Commission (MedPAC) released its March 2015 Report to Congress which included similar recommendations from previous years for home health, such as a home health copayment and an expedited rebasing of home health rates. It also includes hospice recommendations.

Home health

services while no longer using the number of therapy visits as a payment factor.

In January, the Commission approved a plan to keep in place its home health recommendations from the previous three reports to Congress. These recommendations include significant reductions in the basic payment rate for Medicare home health services through an expedited rebasing of those rates in 2014, which HCA has aggressively opposed and will continue to oppose at our upcoming Federal Advocacy Day program on March 24. (See related p.1 story.)

•

On the issue of copayments, HCA has communicated to Congress that the additional Medicare charge would compel many chronically ill and disabled persons to apply for help from state Medicaid programs at a time when states, like New York, are making massive cuts to Medicaid. Going back to 1972, Congress rejected a home health copay proposal, reaffirming its longstanding belief that copays discourage proper use of home health services.

Some prominent home health recommendations include: •

Establishment of a $150-per-episode copayment for home health episodes that are not preceded by hospitalization or postacute care use.

•

Having Congress direct the U.S. Department of Health and Human Services (HHS) Secretary to eliminate the marketbasket update for a two-year period during rebasing.

•

Medical review activities by HHS, in conjunction with the Office of the Inspector General, in counties that have “aberrant” home health utilization. Under this recommendation, HHS would implement measures to suspend payment and enrollment of new providers if significant fraud is indicated.

•

Having Congress direct the HHS Secretary to reduce payments to home health agencies with relatively high risk-adjusted rates of hospital readmission.

The President’s current budget proposal includes a copayment measure that will continue to draw opposition from the home care community. Meanwhile, MedPAC’s proposals for rebasing and elimination of further market-basket updates come on top of over $300 million in reimbursement cuts between 1997 and 2013 in New York, where a vast majority of providers are operating in the red, across all payors, and where Medicare margins have been negative, on average, for the past 13 years. Each of these items is targeted in HCA’s federal briefing papers for next week’s Federal Advocacy Day. (See related p. 1 story.) Hospice For hospice, MedPAC recommends that Congress: eliminate the update to the hospice payment rates for fiscal year 2016; direct the HHS Secretary to institute focused medical review of hospice providers with

Revision of the home health case-mix system to rely on patient characteristics in setting payment for therapy and non-therapy 16

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many long-stay patients; and further directs HHS to change the Medicare payment system for hospice as follows: •

Relatively higher payments per day at the beginning of the episode and relatively lower payments per day as the length of the episode increases;

•

A relatively higher payment for the costs associated with patient death at the end of the episode;

•

Implementation of payment system changes that MedPAC first recommended in 2013, with a brief transitional period.

MedPAC states that all of these hospice payment system changes should be implemented in a budget-neutral manner in the first year. MedPAC’s complete March 2015 report can be downloaded at http://medpac.gov/documents/reports/march2015-report-to-the-congress-medicare-payment-policy.pdf?sfvrsn=0. MedPAC’s home health recommendations are on pages 213-236 and the hospice recommendations are on pages 285-312. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

Sign up by April 17 to Volunteer for ICD-10 Testing in July From July 20 to 24, a third sample of providers will participate in voluntary ICD-10 end-to-end testing with Medicare Administrative Contractors (MACs) and the Common Electronic Data Interchange (CEDI) contractor. The U.S. Centers for Medicare and Medicaid Services (CMS) will select approximately 850 volunteer submitters. Volunteers will include a broad cross-section of provider, claim, and submitter types, including claims clearinghouses that submit claims for large numbers of providers. (Note: Testers who are participating in the January and April end-to-end testing weeks are able to test again in July without re-applying.) To volunteer, complete the online form at https://www.surveymonkey.com/s/ZTBTT3D by April 17. You will be notified by May 8 if selected. Eligible testers must be able to: •

Submit future-dated claims.

•

Provide valid National Provider Identifiers (NPIs), Provider Transaction Access Numbers (PTANs), and beneficiary Health Insurance Claim Numbers (HICNs) that will be used for test claims. This information will be needed by your MAC by May 29 for set-up purposes.

See additional information at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-NetworkMLN/MLNMattersArticles/Downloads/MM8867.pdf. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org. 17

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Medicare Claim Risk-Assessment Tool to be Available for Home Health in July Beginning in July, home health agencies (HHAs) will have access to a new, free tool to assist in assessing their risk for improper Medicare payments. TMF Health Quality Institute is developing the new Program for Evaluating Payment Patterns Electronic Report (PEPPER) for HHAs. PEPPER helps providers monitor claims and work to prevent improper Medicare payments by summarizing claims data in areas that may be at risk. It compares the HHA’s statistics with aggregate statistics for the nation, Medicare Administrative Contractor (MAC) jurisdiction and the state. If a provider’s statistics are at or above the national 80th percentile, the provider is identified as an “outlier” and may be at risk for improper Medicare payments, although PEPPER cannot identify the presence of improper payments. The six target areas for monitoring include: • • • • • •

Average Case Mix; Average Number of Episodes; Episodes with 5 or 6 Visits; Non-LUPA Payments; High Therapy Utilization Episodes; and Outlier Payments

PEPPER is currently under development but will likely be available in July through the PEPPER Resources Portal at https://securefile.tmf.org/Default.aspx?ReturnUrl=%2f. Providers are advised to look out for a PEPPER user’s guide which is expected to be made available in June at http://pepperresources.org/. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

Spanish Language Home Care Training Manuals Available from Select Publishing Select Copy Publishing, Inc. has informed us that the state Department of Health (DOH) has approved their Spanish language home care manuals for Home Health Aide Training Program (HHATP) use. The manuals are an exact translation of Select Copy’s English books which have previously been approved for training Personal Care Aides (PCAs) and Home Health Aides (HHAs). The textbooks are accompanied by a bank of 800 questions in both languages. In addition, the books are written specifically for the DOH required curriculum and follow the program exactly as it is taught. These manuals are an alternative to materials developed by Hartman Publishing and used by some members. For more information, contact Rich Weiner or Barbara Klein at (516) 377-4949 or visit Select’s website at www.selecthomecaremanuals.com.

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Medicare-Medicaid Coordination Office Issues Report The U.S. Centers for Medicare and Medicaid Services (CMS) Medicare-Medicaid Coordination Office has issued its 2014 report. The Affordable Care Act created the coordination office to bring together Medicare and Medicaid so as to more effectively integrate benefits, and improve coordination between the federal and state governments, and thus enhance access to services for dual-eligible recipients. The report is at https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-MedicaidCoordination/Medicare-Medicaid-Coordination-Office/Downloads/MMCO_2014_RTC.pdf. In the report, CMS continues to recommend the following three legislative proposals that were included in the Fiscal Year (FY) 2013 Report to the Congress, as well as the President’s FY 2015 and FY 2016 Budgets: •

Create a pilot to expand Programs of All-Inclusive Care for the Elderly (PACE) eligibility to individuals between ages 21 and 55;

•

Ensure retroactive Part D Coverage for newly-eligible low income beneficiaries; and

•

Establish an integrated appeals process for Medicare-Medicaid enrollees.

CMS also recommends the following new legislative proposal, which is in the President’s FY 2016 Budget: •

Allow for federal/state coordinated review of Duals Special Need plan marketing materials.

The report describes some activities of the Coordination Office, including innovative initiatives, data analytics, and streamlining of Medicare and Medicaid.

Publications •

“The Future of Home Health Care: Workshop Summary,” by the Institute of Medicine h tt p : / / w w w. i o m . e d u / R e p o r t s / 2 0 1 5 / Fu tu r e - Ho m e - He a l t h Care.aspx?utm_source=IOM+Email+List&utm_campaign=9f54885f0c3_18_15_New_WS_Future_of_Home_Health3_17_2015&utm_medium=email&utm_term=0_211686812e9f54885f0c-180152073

•

“MLTC Roll Out –Conflict-Free Assessment Updated Roll-Out Schedule,” by the NY Legal Assistance Group http://www.wnylc.com/health/news/41/

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

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2015 Annual Membership Conference May 6 & 7, 2015 ACHE Leadership Institute May 8, 2015 Saratoga Hilton – Saratoga Springs, NY

Dear Members and Friends of HCA,

Who Should Attend Chief Executive Officers, Executive Directors, Administrators, Finance Managers, Clinical Leaders or any other department leader who plays a key role in the success of your operation.

Why not use the HCA Annual Conference as an educational retreat for your team? Let us know if we can help make that happen!

NAB Continuing Education Clock Hours The HCA Annual Conference has been submitted, but not yet approved, for Continuing Education clock hours from the National Association of Boards of Examiners of Long Term Care Administrators (NAB/NCERS).

A sea of change is happening in health care, and we all have weathered its rough waters over the past two years. But with change comes renewed purpose. Today you are no doubt seeing this outcome as you run a tighter ship, diversify what you offer your community, and extend new lines of outreach well beyond the deck of your organization, engaging new players and partners in an increasingly coordinated system. On this new course, home care needs to ride the wave of opportunity, and avoid getting overwhelmed by the flow of new information, expectations and shifting currents. This takes skill, intelligence, strategic thinking, patience and courage. HCA’s 2015 Annual Membership Conference aims to support you in this effort by bringing you tips, tools and strategies to help you successfully point your ship in the right direction and embark on a course of positive change. Our conference is now a two-day event, on May 6 and 7, reducing the cost to you and limiting the amount of time spent away from your office while offering you the same caliber of excellent learning and networking opportunities that have always been a signature of our conference. Also new this year, we are adding a half-day Leadership Institute on May 8, brought to you by the American College of Healthcare Executives. You can choose to attend both programs – the HCA Annual Conference and the Leadership Institute – or only one. All programs will take place at the Saratoga Hilton, in Saratoga Springs, where we’ll have an exciting lineup of world-renowned speakers and industry experts offering thought-provoking ideas and valuable learning opportunities. The Annual Conference is an ideal setting to network with your peers, pay tribute to outstanding individuals in the industry through our awards program, and visit with an assortment of vendors who will be on hand showcasing their latest products or services. If you are new to home care, new to your agency or if your agency just recently joined HCA, the Annual Conference is a perfect way to get your feet wet, meet HCA’s team, make new contacts, and learn. To broaden your team’s learning experience, HCA is also offering one of your staff members the opportunity to attend the conference at half price and the leadership institute at the lowest price possible if they’ve never attended HCA’s conference before. To take advantage of this “first-timer” opportunity, you must register yourself and your staff person by April 6. This is a great way to show your appreciation to a valuable member of your staff. (Online registration for this offer is not available; please use the registration form in this brochure.) So what are you waiting for? Check out the agenda and register today! I look forward to seeing you there.

Joanne Cunningham President HCA

NAB Continuing Education Clock Hours The HCA Annual Conference has been submitted, but not yet approved, for Continuing Education clock hours from the National Association of Boards of Examiners of Long Term Care Administrators (NAB/NCERS).

We also extend a special thanks to HCA’s Board of Directors who donate their time and talents for the success of HCA. Marie Andreacchio Allen Health Care Services Susan Brett, People Care, Inc. Maura Cahill-Bordas Hebrew Hospital Home, Inc. Anne Calvo, Winthrop University Hospital Home Health Agency

Hotel Information

Susan Caputo, Individual Member Northport, NY

The Saratoga Hilton, Saratoga Springs, NY is the site of the HCA Annual Conference. Rooms at the Saratoga Hilton are per night. This discounted rate is available until April 5. After this date, higher rates will prevail. Parking is $5 per night.

$162

To make a reservation, call 888-866-3596 or register online at https://resweb.passkey.com/go/HCANYS2015 The hotel’s check-in time is 4 p.m. and check out is 11 a.m. Luggage storage is available should your room not be ready prior to check-in time.

HCA graciously thanks those Sponsors and Exhibitors who have already committed to support you and this signature educational event.

Shelly Eggleton Lourdes At Home/Hospice At Lourdes Michael Feinman Any-Time Home Care, Inc. Ann Frisch, New York City HHC – Health & Home Care Bridget Gallagher Jewish Home Lifecare Ginger Hall, Jefferson County Public Health Services Pamela Joachim, Montefiore Medical Center Home Health Agency Orael Keenan Visiting Nurse Association of Long Island Kenneth Kilroy Progressive Home Health Services Sue Larman, VNA Home Health Russell Lusak Selfhelp Community Services Irina Mitzner, North Shore – Long Island Jewish Health Care Network

Sponsors Arthur J. Gallagher Risk Management Services, Inc. Hinman Straub, P.C. RBC Limited Healthcare and Management Consultants The Remington Report VNS Westchester

Laurie Neander Basset Healthcare Network: At Home Care

Exhibitors

Paul Rosenfeld, CenterLight Health System

Avanti Health Care Services Black Tree Healthcare Consulting Cardiocom, a Medtronic Company ContinuLink Delta Health Technologies, LLC Fazzi Associates Forcura Friedlander Group Homecare Software Solutions, LLC Mobile Health

MobilexUSA Mom’s Meals Nourish Care MyCNAjobs Philips Hospital to Home Quality in Real Time Senior Planning Services MLTC Simione Healthcare Consultants TSG Financial United Healthcare Community Plan

Sponsorship and Exhibitor opportunities are still available. Visit

www.hcaannualconference.com to learn about all the benefits you will receive as a supporter.

Karen O’Kane, Brookhaven Memorial Hospital Medical Center Mary Kate Rolf, VNA Homecare

Brian Schiel, Bestcare

Rae Szymanski, Visiting Nurse Association of Hudson Valley Vivian Torres-Suarez, Individual Member Bayside, NY Joseph Twardy, VNS of Northeastern NY Mary Wagner Metropolitan Jewish Health System Mary Zagajeski Dominican Sisters Family Health Service Elizabeth Zicari, HCR Homecare

Wednesday, May 6 8:00am – Hotel Lobby

HCA Registration Opens At the registration desk, you will obtain your conference program, name badge and directions to your first session. 9:00am to Noon

HCA Annual Board of Directors Meeting All HCA members are encouraged to attend the HCA Board of Directors Meeting and Annual Meeting of the Corporation to learn more about the governing bodies that shape the direction of HCA policy, education, advocacy and operational priorities. This event is an important tradition where HCA introduces newly elected members of the Board and opens the floor to a special invited guest speaker from the public policy arena. 1:30pm to 1:45pm – HCA Welcome 1:45pm to 2:45pm

The Healing of America: Opportunities for Home Care T.R. Reid, author of the national best-seller ‘The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care,’ will examine why all other industrialized democracies manage to provide high-quality universal health care but still spend half as much as the U.S. does. Mr. Reid’s PBS documentary, ‘U.S. Health Care: The Good News,’ reveals how some U.S. communities have found ways to improve the quality of care, and contain costs, by orchestrating their local health care providers to work together, rather than waiting for Washington to tell them what to do. T.R.Reid has become one of the nation’s best known reporters through his books, articles, and documentary films. His work includes reporting for the Washington Post, NPR’s Morning Edition and PBS. 3:00pm to 4:30pm

You Can Never NOT Communicate We all understand the importance of communicating effectively in the health care field. But do you realize that you can never NOT communicate? In this presentation, Janene Schneider will help you bring communication to the conscience level by focusing on nonverbal communication and providing you with tips to enhance your professional interactions. Janene Schneider is chair of the English Department for Franklin Academy in Wake Forest, NC. With a Master’s in Communication from the University of Iowa, she has developed a passion for nonverbal communication and is a frequent speaker for Duke University’s Population Care Coordinator Program. 3:00pm

Exhibit Gallery Opens HCA is pleased to have 31 exclusive vendors on hand to showcase the latest home health products and services expressly for HCA conference participants. Take advantage of this one-stop shopping opportunity – no appointment needed.

Wednesday, May 6 – continued 4:30pm to 6:00pm

Welcome Reception Before heading out to dinner at one of Saratoga’s many fine restaurants, be sure to take the time to visit with old friends and new, peruse the exhibits of our home health vendors and register for their great raffle prizes. Dinner is on your own this evening. 8:30pm to 11:00pm

PAC Beach Party and Trivia Night Join in the fun at this fundraiser for HCA’s Political Action Committee (PAC). Attendees who make a $50 minimum personal donation will get to enjoy drinks and light refreshments while making their best guesses for prizes in response to questions on pop culture, sports, geography, science, history and more. Anyone who has attended HCA’s popular PAC fundraisers in the past will know what a great time to expect at this year’s event, so please encourage your peers to join you.

Thursday, May 7 7:00am

Registration Opens The registration desk is open bright and early for those who haven’t yet obtained their conference program, name badge and directions. 7:30am to 8:30am

Exhibit Gallery Enjoy coffee while meeting with vendors to learn more about their latest products or services that support home health. 8:30am to 9:30am

HCA’s Breakfast of Champions During this morning’s breakfast, HCA pays tribute to recipients of the Ruth F. Wilson Award, the Caring Award and the Advocacy “Giraffe” Award – a highlight of our annual conference. Join your peers as we recognize these champions over an elegant breakfast. 9:30am to 10:00am

Catching the Wave – An Address by HCA’s President, Joanne Cunningham Home care is a vital line of support for the patients you serve, and HCA’s ongoing goal is to help you navigate potential obstacles, tie-up alongside partner organizations in integrated models, and keep home care in its flagship role as the driver of community-level support services. 10:15am to 11:15am

The Art of Audacity Can one person really change the world? National Geographic journalist Tom Clynes will bring us along on assignment to some of the most dramatic and intriguing places on Earth. Through his provocative stories and stunning photos, we’ll meet the extraordinary people who dared to challenge and change the status quo: The explorer whose Congo Basin expedition led to the biggest African conservation victory in decades … the “elephant whisperer” who rescued the animals in the Baghdad Zoo … as well as virus hunters, Ebola doctors, climatologists, and a pre-teen nuclear physicist. Along the way we’ll discover the life lessons behind the success of those who dared to follow their audacious dreams, and to shape once-ordinary lives into world-changing adventures. Tom Clynes is an author and photographer who covers the adventurous side of science, the environment and public health. He writes regularly for National Geographic and Popular Science where he is a contributing editor.

Thursday, May 7 – continued 11:15am to 3:00pm

Three Workshops in Two Sessions Session 1 (11:15am to 12:15pm) Session 2 (2:00pm to 3:00pm) All three of the programs summarized below are held concurrently from 11:15 a.m. to 12:15 p.m. (Session 1) and then repeated, again concurrently, from 2 to 3 p.m. (session 2). These workshops will help you gain further knowledge on: specific regulatory compliance issues like the Medicare face-to-face requirement, workforce recruitment and retention, and population health – all of which are vital to the success of your organization.

Session 1 & 2 Descriptions Certifying Home Health Services On January 1, the U.S. Centers for Medicare and Medicaid Services (CMS) changed the requirements for the face-to-face documentation mandate. New York’s Medicare Administrative Contractor, National Government Services (NGS), is your main point of interaction for Medicare payment and is empowered with enforcement activity related to face-to-face. Hear directly from a representative of NGS who will help you gain a greater understanding of patient eligibility, face-to-face encounters and certification requirements for home health. Attendees will receive NGS/CMS resources and the opportunity to ask questions. Shelly Bernardini, RN, CPHM, is the Medicare Home Health Clinical Consultant for Jurisdictions K and 6 at NGS where she provides outreach and education.

A Caregiver’s Perspective: Data-Driven Recruitment Get under the hood to discover the perspective of Certified Nursing Assistants and Home Health Aides on working in home care. This session will unveil key insights from a caregiver's point of view – gleaned from thousands of survey results – alongside key strategies to drive more caregivers to apply to your jobs, show up for the interview, entice them to want to work for you, and stay with your organization for the long run. Maggie Keen is Director of Customer Success for myCNAjobs. She is a national caregiver recruitment speaker, and key researcher behind The Caregiver Trend Report. Her team consults with home care recruiters across the country to optimize local recruitment efforts.

Population Health Explore how population health management can help your organization be best positioned to improve clinical and financial outcomes by coordinating care across settings, effectively analyzing patterns and addressing health care needs for your entire patient population. Sharron Rushton, MSN, MS, RN, CCM is Assistant Professor at Duke University School of Nursing. Her interests include case management of complex patients, multidisciplinary care coordination, patient navigation of the health care system and resource utilization.

Thursday, May 7 – continued 12:15pm to 1:15pm

Networking Buffet Lunch 12:30pm to 2:00pm

Desserts in the Exhibit Gallery While enjoying dessert, take advantage of this last opportunity to meet with vendors who are showcasing their products and services exclusively for you. 2:00pm to 3:00pm

Session 2 – Workshops Workshops from Session 1 (held at 11:15am) are repeated. Please refer to previous page for session descriptions. 3:00pm to 4:00pm

Physicians and Home Health: Partners in Care In this closing segment, you’ll discover new strategies for working more collaboratively with your local physician groups in achieving the same goals: better coordination of care for the patients you serve and reduced re-hospitalizations. Linda Lambert, CAE, is Executive Director for the New York Chapter of the American College of Physicians, the state's largest medical specialty organization representing over 12,000 internal medicine physicians dedicated to advancing the specialty of Internal Medicine and improving patient care through education, advocacy and quality improvement. 4:00pm Adjournment

Be sure to take advantage of HCA’s Leadership Institute on May 8!

Program Agenda Friday, May 8 7:30am to 8:30am

Breakfast Those attending HCA’s Leadership Institute can begin the day with a full breakfast buffet. (Coffee will be available beginning at 7:00 am.) 8:30am to 12:30pm

The Courage to Lead: Critical Skills for Healthcare Leaders This session, presented by the American College of Healthcare Executives (ACHE), is exclusively for HCA onlocation. Leadership is an applied skill, but too often it is left to chance as something to be picked up on the job. Progressing as a successful leader requires more. In this half-day session, designed for health care leaders at all levels of their careers, you will use proven tools and techniques to identify and develop your leadership philosophy and to develop your leadership skills even if you have little formal authority. You will also learn how to: • Create an action plan using course content through an illustrative case study, leadership tools and integrative discussions. • Increase your influence and effectiveness by becoming a quiet but strong leader. • Practice ways to recognize and reward employee contributions and build a winning team.

This program is presented by Jody Rogers, PhD, FACHE, visiting professor in the health care administration graduate program, Trinity University, San Antonio, TX. He has more than 30 years of experience as a health care executive in public and private health care organizations and is a certified master facilitator of The Leadership Challenge.

Accreditation Participants will receive ACHE Face-to-Face Education credits as well as contact hours from the National Association of Boards of Examiners of Long Term Care Administrators (NAB).

About the American College of Healthcare Executives The American College of Healthcare Executives is an international professional society of more than 40,000 health care executives who lead hospitals, healthcare systems and other healthcare organizations. ACHE offers its prestigious FACHEŽ credential, signifying board certification in healthcare management. ACHE's established network of 80 chapters provides access to networking, education and career development at the local level. In addition, ACHE is known for its magazine, Healthcare Executive, and its career development and public policy programs. Through such efforts, ACHE works toward its goal of being the premier professional society for healthcare executives dedicated to improving healthcare delivery. HCA’s Leadership Institute can be purchased in conjunction with the Annual Conference registration which offers the best value. The Leadership Institute is also available for purchase separate from the HCA Annual Conference. See the registration form for fees and discounts.

2015 ANNUAL CONFERENCE REGISTRATION Catch the Wave! Are You Ready for the Turn-Around? Return this completed registration form with your payment by fax to (518) 426-8788 or mail it to 388 Broadway, 4th Floor, Albany, NY 12207. You may duplicate this form for additional attendees. Please save a copy for your records.

Register online at: www.eventville.com/hcanys CONFERENCE PARTICIPANT REGISTRATION NAME ______________________________________________________________

TITLE ____________________________________________________

AFFILIATION ____________________________________________________________________________________________________________________ ADDRESS ______________________________________________________________________________________________________________________ CITY/STATE/ZIP _________________________________________________________________________________________________________________ PHONE _____________________________________________________________ FAX _____________________________________________________ E-MAIL ________________________________________________________________________________________________________________________

METHOD OF PAYMENT:

REGISTRATION FEE:

Please select your method of payment: ________MasterCard

________Visa

________American Express

Credit Card No.________________________________________________

We encourage you to attend both the Annual Conference and ACHE Leadership Institute for the best value. No credits can be given for meals not taken or unattended education programs.

REGISTRATION FEE Seven Registration Options Please indicate your registration choice below:

Name on Card_________________________________________________

Expiration Date __________________ Security Code _________________ _____________________________________________________________ Billing Address for Card _____________________________________________________________ City, State, Zip Authorized Signature____________________________________________

_____Check* Make payable to: HCA Education and Research Mail to: 388 Broadway, 4th Floor, Albany, NY 12207 Checks must be received by May 2.

1. HCA Member – Annual Conf. and Leadership Inst.

$768 

2. HCA Member – Annual Conference Only

$489 

3. Non-Member – Annual Conf. and Leadership Inst.

$948 

4. Non-Member – Annual Conference Only

$599 

5. Leadership Institute Only (Members and Non-Members)

$349 

6. *First Time Attendee HCA Member – Annual Conf. Only

$244 

7. *First Time Attended HCA Member – Ann. Conf. & Ldr. Inst. $523  *Must register by April 6.

TOTAL DUE: $__________ Cancellation Policy: Cancellations received by April 22 will receive a full refund, less 25% of total due as an administrative fee. Cancellations received on April 23 or later will forfeit their registration fee, as will those who register and do not attend. Substitutions are permitted.

Beach and Trivia Night HCA PAC Party Wednesday, May 6th – Saratoga Hilton Lounge

In accordance with the Americans with Disabilities Act or special meal needs, please let us know how we can accommodate you: ___________________________________________________________ ____________________________________________________________

I will attend the HCA PAC Fundraiser My personal donation will be submitted separately.

FAX THIS FORM TO (518) 426-8788



388 Broadway Fourth Floor Albany, New York 12207