ASAP
A Weekly Publication Of HCA Home Care Association of New York State
Legislative Issues Public Policy
News
Volume 21, No. 13 April 1, 2016
Additional Budget Details Released, Wage Hike Approved, Analysis Ongoing New wage-related bill introduced for adoption with budget; HCA fields recent state requests for wage impact data as discussions continue As reported to the membership in two alerts late yesterday and today, the Governor and Legislature have reached a deal on the budget provisions affecting home care. The Legislature passed some portions of the budget deal last night, with the remainder of the budget bills acted on today. Yesterday, we reported that the budget has an HCA-sought $200 million infrastructure pool (including at least $30 million for community-based providers) as well as some minimal home-care managed care rate language. See BUDGET p. 2
HCA and Partners Oppose CMS Prior Authorization Proposal HCA this week submitted a strongly worded comment letter opposing a prior authorization demo for Medicare home health services being floated by the U.S. Centers for Medicare and Medicaid Services (CMS). We are also part of a nationwide effort, in collaboration with partner state associations throughout the country, weighing in jointly on the rule, all calling for the rule to be rescinded. See OPPOSE p. 5
HCA’s Comments Voice Strong Support for Physician Signature, Billing Flexibility Proposal Reflecting HCA Recommendations HCA this week submitted comments in strong support of long-sought proposed changes to the state’s physician order and billing deadlines for home care. These proposed changes, initiated and drafted by HCA, have been a long time in the making, and HCA this year succeeded in getting the Department of Health to consider these vitally needed changes.
Inside ASAP More Budget Details: Wage Hike Approved, Analysis Ongoing..........1 HCA and Partners Critique CMS Prior Authorization Proposal..........1 HCA Voices Strong Support for Doc Signature, Billing Flexibility........1 Supreme Court to Decide Whether to Hear FLSA Lawsuit Case..........8 Urgency Continues on FLSA Advocacy..................................................8 U.S. DOL Releases FLSA/Home Care Guide.........................................9 Member Hiring Announcements..........................................................10 HCA Ed Director Street Appointed to State’s Social Work Board.....11 HCA Brochure Announces Full Annual Conference Lineup................11 OIG: Hospices Inappropriately Billed Over $250M in Claims............12 ePACES To Add New Feature on June 1, 2016....................................12 MLTC Plans and Counties Advised of CDPAP Change........................14 Gold STAMP Webinar Eyes Physician Engagement on Pressure Ulcers..15 NGS Updates.......................................................................................15 Publications............................................................................15
See COMMENTS p. 7
Helping New Yorkers Feel Right At Home
Volume 21, No. 13 April 1, 2016
ASAP – a publication of the Home Care Association of New York State BUDGET from p. 1 Today, more information was disclosed about the minimum wage outcome, though the details remain incredibly opaque and there are reports of some possible funding. (One funding chart from the Legislature points to a possible home care allocation of $211 million state-share over two years). HCA remains guarded when it comes to these funding reports until there is official confirmation surrounding the dollar level, mechanism and timing for distribution. HCA will be meeting with the State Medicaid Director and officials at the Departments of Budget and Health to learn more details about this provision and other elements affecting home care on Tuesday. Throughout the past several months, HCA and partners engaged in an all-out advocacy push on the wage issue, crunching the impact data, meeting with all key staff of the Legislature and Executive, sending advocacy messages and press releases, garnering media coverage, and using the force of our coalition
partnerships to call for the rejection of this wage hike if it is not fully funded. The final outcome and impact of the wage hike is still being assessed. While HCA and partners called for full funding or rejection of the wage hike, the aggressive advocacy led the Legislature to partially mitigate the impact of the Governor’s wage hike in the final budget through a modest phase-in and at least some apparent funding in the final budget. What we know about the wage deal Under the deal, New York City’s minimum wage will increase to $15 per hour in three years (four years for employers with 10 or fewer employees) and in Long Island and Westchester over six years. For upstate, the minimum wage will go up to $12.50 over the next five years and would be indexed to $15 thereafter based on a Division of Budget index to be determined. (See charts on page 3). Additionally, the Senate this morning adopted separate legislation that was originally part of the Assembly’s one-house budget bill, requiring the minimum wage to
ASAP is a weekly publication of the Home Care Association of New York State (HCA). Unless otherwise noted, all articles appearing in ASAP are the property of the Home Care Association of New York State. Reuse of any content within this newsletter requires permission from HCA. President: Editor:
Joanne Cunningham, jcunningham@hcanys.org Roger L. Noyes, Director of Communications, rnoyes@hcanys.org Al Cardillo, Executive Vice President, Policy & Programs, acardillo@hcanys.org Patrick Conole, Vice President, Finance & Management, pconole@hcanys.org Andrew Koski, Vice President, Program Policy and Services, akoski@hcanys.org Alexandra Blais, Director of Public Policy, ablais@hcanys.org Laura Constable, Senior Director, Membership & Operations, lconstable@hcanys.org Celisia Street, Director of Education, cstreet@hcanys.org Mercedes Teague, Finance Manager, mteague@hcanys.org Jenny Kerbein, Director of Governance and Special Projects, jkerbein@hcanys.org Billi Hoen, Manager, Meeting and Events, bhoen@hcanys.org Teresa Brown, Administrative Assistant, tbrown@hcanys.org 388 Broadway, 4th Floor, Albany, NY 12207 Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org
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Minimum Wage Effective Dates
be enacted on top of worker parity benefits. This action reflects direct support for a top priority of the state’s health care workers union, further devastating home care providers already deeply affected by the worker parity requirements. This legislation is expected to be approved by the Assembly shortly. HCA is strongly opposed to this component of the Assembly budget bill because it again increases mandatory compensation without commensurate funding for home care providers. Some follow-up wage discussions and new information In the aftermath of this outcome, HCA has been engaged throughout the day with state officials who have requested additional home care wage impact data for possible wage funding provisions. In addition, the State Operations budget does include adjustments to the Medicaid Global Cap, increasing it to $18.778 billion from the Governor’s $18.54 billion proposal, but it is not clear whether this cap adjustment is to account for the wage proposal, and to what degree, if any. HCA has also identified budget language in the “aid to localities” bill referring to unspecified amounts that: “shall support direct salary costs and related fringe benefits within the medical assistance program associated with any minimum wage increase that takes effect during the timeframe of these appropriations, pursuant to section 652 of the labor law. Each eligible organization in receipt of funding made available by these appropriations may be required to submit written certification, in such form and at such time the commissioner may prescribe, attesting to the total amount of funds used by the eligible organization, how such funding will be or was used for purposes eligible under these appropriations.”
It is not clear whether there are actually new Medicaid funds for these purposes, or whether this language targets existing Medicaid funds. Details, follow-up measures, and the intricacies of the various bills will be analyzed over the next several hours and HCA will obtain necessary clarifications. Investment Pool Includes at Least $30M for Community-based Providers The health provisions also reveal versions of HCAdeveloped priorities in some areas for home care which have been adopted in the final health care budget bills, including an appropriation of up to $200 million for health care infrastructure funding, a minimum of $30 3
ASAP – a publication of the Home Care Association of New York State million being earmarked for community-based providers, including home care. HCA had aggressively worked with a coalition of community providers for inclusion of such dedicated funding. A core part of HCA’s advocacy message this year was the need for specific appropriations to support the capital needs of home care providers at a time when providers must ramp up for new delivery models like the Delivery System Reform Incentive Payment Program, Value Based Payments, and others. These appropriations are a step in the right direction after years of underfunding for home and community-based capital needs, although we had requested and provided a compelling case for much more substantial funding. Without support from the Governor, the Legislature’s ability to further supplement these funds for home care was limited. Scaled-Back Home Care-Managed Care Rate Adequacy Language HCA this year also authored home caremanaged care rate adequacy language, which was substantially included in the Assembly’s initial budget language several weeks ago but dramatically scaled back by the Administration in this final agreement. The final rate adequacy language was diminished by the push-back of the Governor’s negotiators resulting, essentially, in a state provision mirroring federal standards. The resulting language merely adds that actuarially sound rates for MLTC “shall comply with all applicable laws and regulations, state and federal, including regulations as to the actuarial soundness for Medicaid managed care.” Auxiliary Wage-related Issues Remain Murky HCA is still determining all of the various pieces of the wage component, its correspondence with the global cap, and any further measures related to it. We are continuing to comb through and analyze the
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budget bills, field requests from state officials on wage impact data and gain additional information. We also hope to learn more in our meeting with state officials on April 5 that will review the health and minimum wage provisions. HCA is also in the process of planning and executing follow-up steps to the budget process to better secure support for home care, so please stay tuned for more information and follow-up activity. Other items In other items, the Legislature successfully rejected the Governor’s proposal to restrict MLTC eligibility to a nursing-facility-level-of-care, as well as the Governor’s proposed carve-out of transportation services from MLTC. HCA advocated rejection of both. Also rejected in the final bill was the Governor’s proposed elimination of spousal refusal and a reduction in the community spouse resource allowance. The final bill delays, until January 1, 2018, the transition of the Traumatic Brain Injury and Nursing Home Transition and Diversion waiver programs into managed care and mandates that these benefits, when offered under managed care, be substantially comparable to the services participants received as of January 1, 2015. The budget agreement includes a paid family leave program. When fully phased- in, employees will be eligible for 12 weeks of paid family leave when caring for an infant, a family member with a serious health condition or to relieve family pressures when someone is called to active military service. Benefits will be phased-in beginning in 2018 at 50 percent of an employee’s average weekly wage, capped to 50 percent of the statewide average weekly wage, and fully implemented in 2021 at 67 percent of their average weekly wage, capped to 67 percent of the statewide average weekly wage. This program will be funded entirely through a payroll deduction on employees with no direct costs to business, though HCA has to confirm what administrative costs will be incurred by employers. Employees are eligible to participate after having worked for their employer for six months. HCA will provide additional information as we learn of material developments in our continued analysis. 4
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OPPOSE from p. 1 As part of the proposed demonstration, CMS would perform prior authorization before processing claims for home health services in five identified demo states: Florida, Texas, Illinois, Michigan and Massachusetts, though it is possible that this pilot could be extended to New York and other states as well. More information on the proposed demo is at https://www.cms.gov/Regulations-and-Guidance/ Legislation/PaperworkReductionActof1995/PRA-Listing-Items/CMS10599.html?DLPage=4&DLEntries=10&DLSort=1&DLSortDir=descending. As HCA explains in our comment letter, “this proposal would create altogether unnecessary obstacles in access to care, increase system-wide costs, and jeopardize the quality of care that patients receive.” We also take aim at the justifications and inherent contradictions of this proposed rule compared to other federal regulations and initiatives. HCA’s letter can be read at http://hca-nys.org/wp-content/uploads/2016/04/Medicare-Home-HealthPrior-Authorization-Comments-Final.pdf. Our core arguments against the rule are summarized below: •
Access to care threatened. Mandatory prior-authorization programs can negatively impact beneficiary access to care by imposing significant delays in receiving needed services. Such delays can result in patients being kept in hospitals unnecessarily or discharged home without the services and supports they need, risking unnecessary and costly rehospitalizations. It can also impede the timely delivery of vital home health services to individuals living at home who did not have a prior inpatient stay but who – in the professional judgment of physicians and care planners – are deemed to need home care to remain safe and healthy in their community setting.
•
Prior authorization will not address integrity issues. According to Comprehensive Error Rate Testing reports, the vast majority of claims errors in home care (90 percent) are for insufficient documentation, predominantly in the face-to-face (F2F) narrative requirement. F2F disallowances are technical and bureaucratic in nature, rather than resulting from evidence that services were not needed or provided.
•
Under prior authorization, all agencies are scrutinized and subject to service delays, when CMS should target entities or regions that pose greatest risk. This initiative unfairly and arbitrarily scrutinizes and delays service authorizations for all home care agencies in the demo states, even those who have a long-established record of compliance with existing rules and regulations. As it is, CMS has a range of existing audit entities able to conduct this work, including Recovery Audit Contractors (RACs), Zone Program Integrity Contractors (ZPICs), state-level surveillance agents (targeting Conditions of Participation adherence), third-party liability payment auditors, the Office of the Inspector General, the Medicare Administrative Contractors’ ’ “Probe-and-Educate” audits, and others. CMS’s time and resources would be better allocated targeting those specific home health agencies, regions, or utilization bands suggesting fraudulent activity, rather than punishing all agencies.
•
The byproducts of prior authorization contradict CMS’s goals and innovations. The bottleneck created by prior-authorization contradicts the very goals, procedures and technical designs of CMS’s 5
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own innovations, be it value-based payment, bundling initiatives, Accountable Care Organizations or other specific new pilots by delaying timely care transitions. •
This demonstration process redirects care-planning decisions from the patient’s care team to the Medicare contractors. These government contractors are not directly liable for the timely initiation of care at the clinical level and they are not intimately involved in urgent clinical decisions where time is of the essence, especially during discharge from hospitals on weekends and evening hours and in other critical circumstances.
•
This demo will escalate costs throughout the system. By denying an expeditious discharge or referral to cost-effective home care settings, this proposal will substantially escalate the cost of services while patients await approval for services in the home, where post-acute care is most cost-effective. This demonstration will also significantly raise administrative costs for agencies tasked with new paperwork requirements.
•
The demo will also result in many additional requests for administrative appeals from beneficiaries, further increasing an already massive backlog of appeals at a time when it takes about five months for entering new appeals cases into the Administrative Law Judge docket and when the average processing time for an appeal in fiscal year 2015 was about 550 days.
•
Prior authorization runs counter to and contradicts quality measures and regulatory requirements for timely initiation of services, undermining patients’ satisfaction with care as measured by CMS “Star Ratings” and required by CMS’s own Conditions of Participation (CoPs).
Given that documentation is the key area of alleged noncompliance being targeted by this initiative, HCA calls on CMS to opt for education, clear guidelines and compliance standards, and provider support in place of this prior-authorization proposal, which will have many adverse and unintended consequences including the jeopardizing of access to care, the increase of system and operational costs, and a negative impact on quality of care.
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HCA will keep the membership apprised of this issue and our advocacy arguments which we are sharing with New York’s Congressional Delegation to apply pressure against this misguided policy proposal.
Stay tuned for additional details to come.
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COMMENTS continued from p. 1 The proposal would align the state’s deadlines with the broader timetables allowed under Medicare. The proposed changes were further recommended and advanced by the Home and Community-Base Care Workgroup. They would apply to CHHAs, LHCSAs and LTHHCPs. As HCA President Joanne Cunningham said in a statement to Crain’s Health Pulse in February, when the proposed rule was posted, “We appreciate the state’s support for a sensible timeline that has worked under Medicare. This proposal ensures that providers and physicians can focus on the initiation or modification of the care itself.” The proposal has been extensively reported to the membership. What follows is a summary of the current requirements and what the new proposal does. Current requirements Providers currently must obtain signed physician orders within 30 days of the start of home care. Meanwhile, state regulations require a provider to obtain these orders prior to billing, and the state’s billing system itself does not allow for claims to be submitted after 90 days of the service date. “This leaves providers with a double-jeopardy situation,” says HCA Vice President of Finance & Management Patrick Conole in this week’s formal comments: “First, a 30-day window for [physicians] to provide their signatures … and second, a total 90-day deadline from the service date to have the physician signature and, following, the preparation submission of the claim for billing.” No exception code currently exists to allow for home care billing after the 90-day window in cases where the physician signature is obtained late, even with the due-diligence of the home care provider to get the signatures timely. What the proposed rule does This proposed rule aligns with Medicare, requiring the signature prior to billing; Medicare allows a one-year window to bill. The rule will be joined by a separate, anticipated guidance for a new exception code allowing home care agencies to bill after 90 days when the physician signature is not obtained in that time. Further recommendations HCA expressed strong support, and also made three additional recommendations. The first calls on the Department to accelerate its issuance of the separate guidance allowing for a billing exception code when signatures are not received in the 90-day billing timeline, allowing for flexibility on the billing end that is commensurate with the flexibility allowed on the physician signature end of the equation. Secondly, we also request that the Department work with the Office of the Medicaid Inspector General to incorporate the rule change in its documentation for compliance assumptions, audit standards and procedures. Thirdly, we reiterate our call for home care health information technology support to allow for better record exchange between home care and physicians for orders and other coordination. HCA’s comments are at http://hca-nys.org/wp-content/uploads/2016/04/ DOHsProposal_90DayPhysicianOrderFlexibilit-March28.pdf. We will immediately inform the membership of any next steps on finalization of this rule and accompanying guidance on the billing exception codes. 7
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Supreme Court to Decide Whether to Hear FLSA Lawsuit Case The U.S. Supreme Court is expected to decide today during a conference session whether to review a lower court’s decision on a challenge to the Fair Labor Standards Act (FLSA) final rule. New York’s home care providers have already incurred significant unreimbursed costs associated with the rule’s implementation – an issue for which HCA continues to vigorously advocate. The court is expected to announce on April 4 whether it will accept or reject the home care industry’s petition that challenged the rule. However, each year, the Supreme Court agrees to review only a small percentage of the cases submitted for consideration. Last August, the U.S. Court of Appeals for the District Columbia Circuit ruled that the U.S. Department of Labor (U.S. DOL) acted within its authority when it extended minimum-wage and overtime protections to home care workers. The implementing federal rule went into effect in October 2015. The National Association for Home Care and Hospice (NAHC) and other plaintiffs representing the home care industry appealed the lower court’s decision to the Supreme Court last November, a month after their request for a stay of the decision was rejected by U.S. Chief Justice John Roberts. In February, attorneys representing the federal government submitted a brief arguing that the Supreme Court should not take up the case. As covered in past editions of ASAP and communications to members, HCA has taken a strong stand against the then-proposed U.S. DOL rule, testifying at public meetings, providing written comments on various draft versions of the rule and offering many education programs for members so that they could prepare for the FLSA changes. Meanwhile, HCA has continues to work with colleagues in an effort to make the state’s approach provide funding to compensate home care agencies for their new FLSA-related costs. (See related story below for details.)
Urgency Continues on FLSA Advocacy DOH Posts FLSA Plan Payments While today is the deadline for home care agencies to submit the Fair Labor Standards Act (FLSA) attestations to the state Department of Health (DOH), HCA is giving increased urgency to our advocacy request that the attestations be revised in a way reflecting use of the FLSA funds for all FLSA-related costs. HCA and members have taken issue with the current attestation form that pledges the agency to pass the funding “through to the home care worker, in its entirety.” This week, HCA reached out again to Jason Helgerson, the state Medicaid Director, and other DOH officials to advocate for changes to the attestation and the funding distribution process. Continued on next page
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Continued from previous page HCA also continued to seek support from the managed care sector for our proposal that FLSA funding be passed through to home care providers based on $0.34 per each hour for all aide services provided from October 13, 2015 to March 31, 2016. This proposal must be instituted in a timely manner, as MLTC plans are requesting documentation on overtime and travel from their home care contractors, despite our advocacy that other FLSA-related costs also be considered, including: changes in recordkeeping, payroll and employer/employee agreement documents; aide initial training and annual in-services; 24-hour live-in cases where the aides work more than 13 hours; and other expenses. HCA will alert our members of any new developments as we press for a more workable DOH approach. Meanwhile, HCA advises members to submit the attestations to DOH and suggests that they include the above FLSA-related expenses when replying to documentation requests from their MLTC partners. FLSA Payment List In response to HCA’s request during our March 18 meeting with Mr. Helgerson, DOH yesterday posted the list of MLTC plans and the amounts of FLSA funding that they recently received. The list is at http:// www.health.ny.gov/health_care/medicaid/redesign/2016/2016-03-11_flsa_add_info.htm. FLSA Survey Meanwhile, HCA will be meeting with DOH next week to finalize our comments on its draft FLSA survey that Mercer, DOH’s actuary, has been developing to measure the actual costs faced by agencies due to the FLSA changes. Once finalized, agencies will be asked to complete it and the results will be used to inform DOH about any need for continued funding. Supreme Court Consideration In a related development, the Supreme Court is considering whether to take up a case filed in the court to challenge the FLSA changes. (See related p. 7 story.) For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
U.S. DOL Releases FLSA/Home Care Guide The U.S. Department of Labor (U.S. DOL) has issued a guide called Paying Minimum Wage and Overtime to Home Care Workers: A Guide for Consumers and their Families to the Fair Labor Standards Act. The guide is at http://www.dol.gov/whd/homecare/homecare_guide.htm. According to U.S. DOL, the guide explains who needs to follow the Fair Labor Standards Act (FLSA) rules and how to follow them. The guide provides examples of situations involving hiring a home care worker directly, using a home care agency, and arranging care through a self-directed program. It discusses paid providers who are family members of the consumer and who are live-in workers. Other helpful resources from U.S. DOL are at http://www.dol.gov/whd/homecare/. 9
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HIRING Job Position: Director of Finance (Montefiore Home Health Agency) Position Summary: The Director of Finance is responsible for the financial and reimbursement functions of the Montefiore Home Health Agency, managing accounts receivable/payable, billing, third party payers, cost reports, annual budget, grants and special funds. The Director will work closely with the Executive Director and Agency Management to: set financial operation and effectively manage financial resources; ensure efficient work flow process and effective billing compliance with all regulatory and accrediting bodies; and provide financial analysis and recommend plan of action. The Director is responsible to uphold compliance with agency policies and procedures, standards and regulatory requirements. Required Qualifications: Bachelor of Science in Accounting required (MBA and or CPA preferred); minimum of two years’ experience in home health financing/accounting or three years’ hospital finance plus two years’ administrative management experience, preferably in a health care setting. Additional Qualifications: Demonstrated skill in training and working with building high performance teams; high levels of analytical ability; leadership and creativity in management/ development of staff; ability to develop and lead the strategic plans; strong written and verbal communication skills. Please send résumés and cover letters to: www.montefiore.org/ careers. Résumés without cover letters and applicants who do not meet the requirements will not be accepted. No phone calls, please.
Job Position: Director of Performance Improvement and Staff Development (Winthrop University Hospital Home Health Agency) Winthrop seeks a Director of Performance Improvement and Staff Development for the CHHA, which services Nassau, Suffolk and Queens. The PI Director is responsible for the quality assessment/assurance program, compliance with DOH regulations and The Joint Commission standards, as well as overseeing the educational programs of the agency. Minimum qualifications include: BSN, NYS RN license, two years professional nursing experience, two years supervisory experience in a CHHA or related home health program; working knowledge of Performance Improvement/ Quality Assurance, The Joint Commission standards and DOH regulations. Master’s degree preferred. Send résumés to Anne Calvo via e-mail to acalvo@winthrop.org
Job Position: Director of Patient Services (Montefiore Home Health Agency) The Director is responsible for directing, planning, coordinating and evaluating patient care services, providing supervision of professional staff, and recruiting/hiring an adequate number of professional staff to ensure quality. The Director will evaluate the performance of Patient Service Managers and support staff supervisors at stated intervals. The Director will participate in administration of the annual budget and personnel policies. The ideal candidate will manage all clinical functions. Required Qualifications: Current NYS RN License and Registration; Master’s in Nursing or Health Related Field; five years of senior and direct management experience within a CHHA. Additional Qualifications: Knowledge of clinical documentation protocols, home health regulations and standards; skill in training, working with building high performance teams; ability to develop and lead strategic plans; strong written and verbal communication skills. Please send résumé & cover letter to chenley@montefiore.org with “Director of Patient Services” and your name in the subject line. Résumés without cover letters and applicants who do not meet requirements won’t be accepted. No phone calls, please. MMC is an equal opportunity employer and will not discriminate against any employee or applicant for employment because of race, color, religion, gender, sexual orientation, or national origin.
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HCA Education Director Celisia Street Appointed to State’s Social Work Board HCA Director of Education Celisia Street, a Licensed Master Social Worker (LMSW), has been appointed by the New York State Board of Regents to serve on the State Education Department Social Work Board. The Board of Regents appoints a State Board for each licensed profession to advise and assist the Board of Regents and the State Education Department on matters of professional regulation. Professional board members must be New York State-licensed professionals who are residents of the state. Members of the board advise on licensing requirements, licensing examinations and practice issues, and provide community outreach, as well as participate in licensure disciplinary and/or restoration and moral character proceedings. A board or committee member is appointed for a five-year term. HCA congratulates Ms. Street on the prestigious appointment and recognition of her professional accomplishments in the field of social work.
Celisia Street, HCA's Director of Education
HCA Brochure Announces Full Annual Conference Lineup Register today for May 4-6 program in Saratoga HCA’s Annual Conference brochure is hot off the presses and ready for you to “Vote Home Care,” the fun, informative theme of this year’s conference. The brochure is available at http://hca-nys.org/wp-content/uploads/2016/04/2016-HCA-AnnualConference-Detailed-Brochure.pdf. Give it a glance and pull out the registration form at the back to reserve your spot as delegate! You can also register online at https://www.eventville.com/Catalog/ EventRegistration1.asp?EventId=1011878. Other conference details are on the conference website at http:// hcaannualconference.com/. Our “A” list of speakers includes some big names in the public sphere, with acclaimed book titles to their names and credits from the Huffington Post, the Washington Post and the New England Journal of Medicine, recent appearances on CNN and MSNBC, accolades from academic quarters, and prior speaking invites to companies like Google and Siemens. One important part of our program has politics in its very name – our Political Action Committee fundraiser – which we hope you plan on attending, along with some great “think-tank” and “focus group” sessions on home care and hospice topics, general sessions with an eye-opening focus for New York’s home care citizen activists, an exciting pre-conference session on value-based payments, our annual awards ceremony, networking opportunities with vendors and peers, and, of course, lots of fun! Please be sure to make your hotel reservations soon. The discount deadline is two days away, on April 3. See the brochure for further information. 11
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ePACES To Add New Feature on June 1, 2016
OIG Report on Hospice Billing The U.S. Office of the Inspector General (OIG) this week released its anticipated report on hospice use of General Inpatient Care (GIP).
eMedNY is installing a new feature that will impact ePACES users when signing on to the ePACES application.
OIG based its study on data from a medical record review of a stratified random sample of all Medicare hospice GIP stays in 2012. OIG analyzed the results of the medical record review to estimate the percentage of GIP stays that, it asserted, were billed inappropriately.
This new feature, commonly called CAPTCHA, is a program that can distinguish whether the user attempting to sign-on is a human or a computer, and is intended to make user data more secure and to improve system performance.
The OIG report is at http://oig.hhs.gov/oei/ reports/oei-02-10-00491.asp.
Effective June 1, 2016 when users attempt to sign-on to ePACES from the www.emedny.org website, they will be asked to verify that they are a person and not a computer by selecting specific images. Once users have successfully verified the correct images, they will be allowed to sign into the ePACES account. If the incorrect images are selected, the user will be asked to verify another set of images before being allowed access to ePACES.
OIG’s study also reviewed prescription drugs covered under Part D and made determinations about appropriateness of coverage, and examined quality of care and care planning provided by hospices. The report asserted that for-profit hospices were more likely than other hospices to have inappropriate billing.
To familiarize yourself with the new verification function, please go to https://www.google.com/ recaptcha/api2/demo.
The following are the OIG’s recommendations from the report, directed to the U.S. Centers for Medicare and Medicaid Services (CMS) and endorsed for action by CMS: •
Increase oversight of hospice GIP claims and review Part D payments for drugs for hospice beneficiaries;
•
Ensure that a physician is involved in the decision to use GIP;
•
Conduct prepayment reviews for lengthy GIP stays;
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Increase surveyor efforts to ensure that hospices meet care planning requirements;
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Establish additional enforcement remedies for poor hospice performance; and
According to the state Department of Health (DOH), this feature is being added to help secure your data, and to prevent unauthorized computer-automated access to ePACES that could adversely impact ePACES performance. Important note: All users will need to have installed Internet Explorer (IE) version 10 or greater or any alternative browsers including Google Chrome, Mozilla Firefox, or Apple Safari. IE versions 9 and below will NOT be supported. Please be sure to coordinate with your IT department to upgrade your internet browser, if necessary, before the effective date shown above. Questions about ePACES can be directed to the eMedNY Call Center at 800-343-9000.
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Continued from previous page •
Follow up on inappropriate GIP stays, inappropriate Part D payments, and hospices that have evidence of poor-quality care.
For further information, please contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
MLTC Plans and Counties Advised of CDPAP Change The state has posted guidance for MLTC plans and local departments of social services (LDSS) on state legislative changes, effective April 1, 2016, that modify who can work as a Consumer Directed Personal Assistance Program (CDPAP) personal assistant for an eligible participant. These changes permit parents of adult children to be hired and work as CDPAP personal assistants. The MLTC guidance is at http://www.health.ny.gov/health_care/medicaid/redesign/mrt90/mltc_policy/docs/16-02.pdf. The LDSS instructions are at http://www.health.ny.gov/health_care/medicaid/publications/docs/gis/16ma006.pdf. The new law bars persons from being hired as CDPAP assistants if they are legally responsible for the eligible individual’s care and support. Conversely, adults who are not legally responsible for the eligible individual’s care and support may be a CDPAP assistant for that eligible individual. In particular, this means that a parent of an adult child (21 years of age or older) may serve as that adult child’s CDPAP assistant. Parents of children who are younger than 21 cannot be hired as that minor child’s CDPAP assistant. Consistent with current regulations, spouses and “designated representatives” also cannot be hired as CDPAP assistants. Under the regulations (Title 18, section 505.28), “designated representative” means: an adult to whom a self-directing consumer has delegated authority to instruct, supervise and direct the consumer directed personal assistant and to perform the consumer’s responsibilities specified in subdivision (g) of this section and who is willing and able to perform these responsibilities. With respect to a non-self-directing consumer, a “designated representative” means the consumer’s parent, legal guardian or, subject to the social services district’s approval, a responsible adult surrogate who is willing and able to perform such responsibilities on the consumer’s behalf. The designated representative may not be the consumer directed personal assistant or a fiscal intermediary employee, representative or affiliated person.
According to the above guidances, any other adult relative of the CDPAP-eligible individual may serve as the individual’s CDPAP assistant. In all cases, the CDPAP authorization is based on the eligible individual’s assessed needs. This applies regardless of whether the CDPAP assistant is a parent or other adult relative of the individual or not related to the individual. Continued on next page 13
ASAP – a publication of the Home Care Association of New York State
Volume 21, No. 13 April 1, 2016
Continued from previous page Under current regulations [18 NYCRR 505.28(b)(3)], if the parent lives with the consumer/child, the parent must reside “with the consumer because the amount of care the consumer requires makes such relative’s presence necessary.” This legislative change was also highlighted in the March Medicaid Update at http://www.health.ny.gov/health_care/medicaid/program/update/2016/mar16_mu.pdf.
Gold STAMP Webinar Highlights Physician Engagement on Pressure Ulcers Archived webinar coming soon for follow-up viewing Yesterday, HCA participated in the Gold STAMP Webinar entitled “Physician Engagement in Pressure Ulcer Prevention and Treatment” hosted by the University At Albany School of Public Health’s Gold STAMP Program Committee, of which HCA is an active member. The Gold STAMP Program to Reduce Pressure Ulcers is an evidenced-based, best-practices model with the goal of preventing pressure ulcers. The program operates through collaboratives comprised of home care agencies, hospitals and nursing homes, further working with physicians, toward prevention and reduction of pressure ulcers. Additionally, representatives of these sectors work in combination with the state Department of Health and the State University at Albany School of Public Health in a statewide coordinating committee to guide the collaboratives and the statewide program goals. The state project team provides education and resources via the GoldSTAMP website (www.goldstamp.org), such as sessions like this webinar, to individuals at all levels of the care continuum. Thursday’s webinar featured Dr. Jennifer Reckrey of Icahn Medical School at Mount Sinai. Speaking to the target audience of administrators and direct care staff across settings, including home care, she stressed the importance of true collaboration and communication in the prevention and management of pressure ulcers as well as making valuable suggestions regarding the inclusion and engagement of physicians in pressure ulcer prevention and treatment. The webinar was recorded and will be made available at the GoldSTAMP website. Providers with initiatives in pressure ulcer prevention and reduction can offer important contributions to many of the current health care reform models. HCA encourages providers to review and consider the resources and opportunities available through the GoldSTAMP program, particularly the homepage toolkit. For further information about the GoldSTAMP program, please contact the state project team via the GoldSTAMP homepage, or HCA’s Al Cardillo (acardillo@hcanys.org) or Alex Blais (ablais@hcanys.org). The archived webinar should be available soon.
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ASAP – a publication of the Home Care Association of New York State
Volume 21, No. 13 April 1, 2016
NGS Updates New York’s Medicare Administrative Contractor (MAC), National Government Services (NGS), has posted the following news to its website. •
Modifications to HCPCS Code Set – The scheduled release of modifications to the Healthcare Common Procedure Coding System (HCPCS) code set are available on the HCPCS Quarterly Update website at: https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/HCPCSQuarterly-Update.html. The changes are effective April 1, 2016.
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NGS Announces New Version of PC Print: April 2016 – This week, NGS made available on its website a new version of PC Print 5.1.2. HCA members can download the latest version of PC Print, by going to the EDI Software section, located within the Claims & Appeals tab on NGS’s website.
For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
Publications •
“Predicting 30- to 120-Day Readmission Risk among Medicare Fee-for-Service Patients Using Nonmedical Workers and Mobile Technology,” Perspectives in Health Information Management http://perspectives.ahima.org/predicting-30-to-120-day-readmission-risk-among-medicare-feefor-service-patients-using-nonmedical-workers-and-mobile-technology/#.VvViGfldV1C
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“Report to the President: Independence, Technology, and Connection in Older Age,” by President’s Council of Advisors on Science and Technology https://www.whitehouse.gov/sites/default/files/microsites/ostp/PCAST/ pcast_independence_tech__aging_report_final_0.pdf
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“Medicaid Consumer Directed Personal Assistance Program (CDPAP) in New York State,” by the NY Legal Assistance Group http://www.wnylc.com/health/entry/40/
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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