April 2, 2015 Edition of ASAP

ASAP

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

Legislative Issues  Public Policy



News

Volume 20, No. 13 April 2, 2015

State Budget Includes Important HCA Priority Areas, But More Work Still Needed The State Legislature has finalized a budget for 2015-16 that includes some important aspects of HCA’s advocacy agenda, though more work is clearly needed post-budget to ensure the strongest possible support for New York’s home care system. Especially considering where matters stood at the onset of the budget process – with an Executive State Budget proposal containing virtually no unique investments for home care compared to other sectors – the See BUDGET p. 2

Hotel and Half-Price Discounts for HCA Annual Conference Soon to Expire! If you haven’t yet registered for HCA’s Annual Conference (May 6-7) and Leadership Institute (May 8), now is the time to do it, so that you can take advantage of the lower hotel rate and a special discount for your staff who are joining us for the first time. Both of these special offers expire in a matter of days! See the details below. • •

April 5 is the deadline to get the HCA discount hotel rate. After that date, prevailing rates will apply.

April 6 is the deadline to receive a special discount for your organization – bring along a member of your staff who has never attended the HCA conference before, and we’ll cut his or See DISCOUNT p. 7 Inside ASAP NY Budget Includes Important Priorities, But More Work Needed....1 Act Now for Annual Conference Hotel and Half-Price Discounts........1 Member Hiring Announcement............................................................3 Home Care Regulatory Reform Workgroup Considers Array of Issues...6 OMIG Posts New Compliance Guidance.............................................7 Hold June 4 for Executive Order 38 Program.......................................7 Major Questions Prompt DOH Webinar on QIVAPP Updates.............8 May 13 Program to Eye DOH Survey Process, Compliance Manuals...8 Companionship Exemption Lawsuit Update......................................9 NYSHealth Announces Funding Opportunity......................................9 New Revalidation Info Posted.............................................................9 Flu Vaccine Report Due May 1............................................................10 Managed Care Update.......................................................................10 HCA Provides Input on Proposed Fiscal Intermediary Policy.............11 DSRIP Update................................................................................12 HCA Working to Support Falls Prevention through Home Care.......13 DOH to Review All Pended Claim Types for Edits 00127 & 01283.....14 CMS Seeks Approval for the OASIS C1/ICD-10 Data Item Set..........15 Upcoming Hospice PEPPER Includes New Target Areas.................15 Mandatory e-Prescribing Effective Date Extended to 2016..............16 Beneficiary Notices Need QIO’s New Contact Information...............16 Publications..........................................................................................................17

HCA is sending ASAP today because our offices are closed tomorrow for the holiday weekend. We will reopen Monday il 6. Monday,, Apr April

Helping New Yorkers Feel Right At Home

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

Volume 20, No. 13 April 2, 2015 

BUDGET from p. 1 final health care agreement provides some areas of important added support for home and community based care, reflecting parts of HCA’s core advocacy agenda. Earlier this week, HCA shared with members a preliminary chart listing more than a dozen priority issue areas in the budget, our position on each issue, and how the final budget outcome compares with our positions. The chart is published on pages 4 and 5. In several cases, the home care community’s advocacy resulted in some very important successes, including the adoption of: provisions for payment adequacy in managed care rate-setting; uniform billing codes and electronic claims payment; the preservation of transportation services under Managed Long Term Care; HCA’s HospitalHomecare-Physician collaboration program; expedited procedures for approving personal care services upon immediate need; and other important supports. In some of these cases – especially the payment adequacy and capital investment provisions – further work is needed to achieve language that is as specific and comprehensive as possible in its treatment of home care. It is also unclear to what degree the final budget provides capital funding support across sectors in health care, specifically whether the budget addresses our call for more encompassing investments. HCA is gathering further information on this front. These issues aside, HCA is also pleased to report the exclusion of some provisions from the Governor’s original budget that were problematic in their design. Among these are the exclusion of value based payments (VBP) – which requires far more though examination and development work – and no new specific provisions for

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

President: Editor:

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

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

Volume 20, No. 13 April 2, 2015 

Certified Home Health Agency rebasing (though the budget does continue the Episodic Payment System through 2019 and appears to allow rebasing per the original 2011 statute). Also, the budget removes the Governor’s Advanced Home Health Aide proposal. HCA supports this proposal in concept but feels more work is needed to address outstanding regulatory, practice, and financing issues that a state-led workgroup has already been examining, and should continue to review, in an effort to reach a consensus plan. The budget also modifies or time-limits some of the cuts and cost-savings measures that the Governor had otherwise sought to make permanent. In most cases, the Senate and/or Assembly pursued a more limited two-year extension of these cuts (such as the trend-factor elimination) and a more limited one-year reauthorization of the Medicaid Global Cap, rather than making these cuts permanent structures of the Medicaid financing system. One high-priority area that appears not addressed is the need for home care regulatory realignment. HCA has pushed for budget language that would compel the Department of Health to act on provisions advanced by a state regulatory workgroup to reflect the practical realities of a post-fee-for-service marketplace. The regulatory workgroup remains a forum for continuation of these discussions and HCA will be working with allied associations and members on the panel to bring these regulatory realignment provisions to fruition. HCA is continuing our review of the budget. We will provide a more detailed and complete analysis in an upcoming memo to the membership.

VNA Homecare Positions

HIRING

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. VP of Performance Excellence and Compliance Officer contributes to our success by implementing and leading global programs to maximize quality of client outcomes, efficiency of utilization, and to ensure compliance with Federal, State, and local regulations as well as the VNA Homecare’s Code of Conduct; promotes ethical behavior, facilitates proper decision-making, and provides our partners with the tools and resources to do what is right in any context; models and acts in accordance with company guiding principles. This position supports the continuous improvement of VNA Homecare services by working with providers, collecting and analyzing data related to the quality and quantity of services provided and the effectiveness of those services in meeting clients’ needs and facilitating implementation of improvement activities. Qualifications: Master’s Degree Required (MBA, MPH, Health Service Administration or similar field); 5+ years ethics, compliance and/or business conduct experience, international program rollout and support experience; 5+ years formal quality management training/background; Home/Community Based and/or Managed Care experience preferred. To apply or learn more about these and other positions, please visit: http://477home.org/category/positions-available/

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

Volume 20, No. 13 April 2, 2015 

State Budget Outcome: a Comparison to HCA’s Positions Budget Issue/Item

Capital Funding

HCA Position HCA advocated and submitted language for inclusion of home care in capital funding.

Final Outcome Positive Action: At last report, Legislature was adamant about making capital dollars available to all sectors. (Less specific than we requested, but positive) Positive Action: Requires commissioner in managed care and MLTC rateͲsetting to consider the plan’s “costs for actuarially sound and adequate rates of payment to ensure quality of care.” (Not as comprehensive as was requested or needed, but a positive step) Positive Action: Requires use of universal billing codes approved by the department or a nationally accredited organization as approved by the department, with coding to be consistent with the UAS; requires managed care plans to reimburse via electronic funds transfer. Also requires mainstream managed care plan payments to be subject to independent review for actuarial soundness (similar to MLTC) and for plans to be provided actuarial data 30 days prior to submission for federal approval.

Payment Adequacy

HCA advocated and submitted comprehensive language for payment adequacy (both managed care and CHHA Episodic payments), covering wage and other programmatic mandates, sufficient and quality staffing, training, and other fundamental costs for infrastructure support and service delivery. Advocated and submitted language to establish efficiencies in billing and payment, including standardized billing codes, claiming and adherence to prompt pay requirements, developed by the commissioner with input from managed care plans and providers.

HospitalͲHome CareͲ Physician Collaboration Program

HCA advocated and submitted language establishing this collaboration program, to improve patient care access and management, patient health outcomes, costͲeffectiveness in the use of health care services and community population health. Provides for initiatives such as service integration, care transitions, physician home visiting, specialty staff training, telehealth/telemedicine, clinical pathways, prevention of avoidable acute inpatient/ER, and other.

Positive Action: Included in final budget.

Advanced Home Health Aide (AHHA)

HCA expressed support for Executive’s AHHA proposal, with provisions addressing issues (e.g., financing, flexibility, workability, other) for successful implementation by agencies, RNs, aides and patients.

Mixed Result: Removed from budget; Senate and Assembly rejected Executive’s proposal. Likely to be pursued as standalone legislation after budget adoption.

Value Based Payments (VBP)

HCA and other state associations commented extensively on issues and needs related to VBP.

Positive Action: Removed from budget; Senate and Assembly rejected Executive’s proposal. Likely to be further pursued through state workgroup, with further statutory authority granted only as necessary.

Continued on next page

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

Volume 20, No. 13 April 2, 2015 

State Budget Outcome (continued from previous page) Budget Issue/Item

HCA Position

Final Outcome Positive Action: (not comprehensive as was requested or needed, but a positive step)

(A) Expands charge to state HIT infrastructure workgroup.

Health Information Technology (HIT)

HCA advocated and submitted comprehensive language for home care HIT and clinical HIT development, connectivity and financing.

(B) Creates Medicaid Evidenced Based Benefit Review Advisory Committee to provide advice and recommendations regarding coverage of health technology or service.

(C) Requires the commissioner to: (i) support DSRIP health information exchange and data requirements; (ii) increase RHIO participation by providers at reasonable cost.

(D) Anticipate HIT funding in Capital Bill.

CHHA Episodic Pricing System (EPS) and EPS Rebasing

HCA advocated and submitted language for rebasing adjustments to ensure adequacy for wage/labor mandates, regulatory mandates, training, quality, technology and other critical operational and service delivery purposes.

appears to allow rebasing per original 2011 EPS statute, but the new budget language does not specifically address. HCA to continue to urge adjustments and reinvestment postͲbudget.

MLTC Transportation CarveͲout

HCA advocated rejection of carveͲout and restoration of MLTC funding.

Positive Action: Senate and Assembly rejected carveͲout and restored MLTC funding.

Permanent Continuation of Prior Cost Saving Actions

HCA opposed permanence of cuts; stressed home care sector’s need for financial stability and increases.

Mixed Result: Senate and Assembly rejected Executive’s proposed permanence of prior cuts; in most cases, provided for 2 year extension, including zero trend factor and 1 year extension for global cap.

Mixed Result: Continues EPS through 2019;

Positive Action: Requires managed care, Expedited Personal Care Services Access Program (New Insert by Legislature)

MLTCs and “other LTC programs” to adopt expedited procedures for approving personal care services or CDPAP services upon immediate need.

HCA supports

Positive Action: Requires PPSs lead entities to establish a project advisory committee to consider and advise on system operations, service delivery issues, elimination of health care disparities, measurement of project outcomes, goal progression and the development of any plans or programs.

DSRIP (New Insert by Legislature)

HCA supports

Home Care Quality Innovation

HCA advocated and submitted comprehensive language for Quality Innovation and Improvement.

however legislature interested in advancing postͲbudget; HCA to pursue.

HCA advocated and submitted language

Mixed Result: Not addressed in budget;

Modernization of Insurance modernizing Insurance Law coverage Coverage for Home Care provisions for home care.

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Mixed Result: Not addressed in budget;

however Legislature is interested in advancing postͲbudget; HCA to pursue.

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

Volume 20, No. 13 April 2, 2015 

Home Care Regulatory Reform Workgroup Considers Array of Issues, Next Steps The state Department of Health (DOH) Home Care Regulatory Reform Workgroup met this week to discuss developments and next steps on an array of issues that the workgroup has explored over the past two years. Although last year’s budget charged the workgroup to report this February (which, to date, only the February 2014 workgroup recommendations were filed), the newly adopted budget contains no additional charge to the group. As a result, future activity of the workgroup, beyond that described below, is uncertain at this time. At this week’s meeting, DOH officials, workgroup members and invited association representatives, including HCA, addressed the following critical developments and issues. CMS Response to Workgroup Regulatory Flexibility Inquiry In February 2014, DOH wrote to the U.S. Centers for Medicare and Medicaid Services (CMS) conveying a set of questions and issues raised by members of the workgroup seeking clarification and potential areas of flexibility and efficiency in federal regulations, particularly as they would relate to the federal Conditions of Participation (COPs) for home care. CMS provided, just this week, a set of responses which were shared with the workgroup. The letter and CMS response can be viewed at http://www.hca-nys.org/ documents/CMSletterregrelief1.pdf. CMS’s responses essentially: map out how Certified Home Health Agencies (CHHAs) and Long Term Home Health Care Programs (LTHHCPs) may be permitted to provide certain services, such as care management, without applicability of the COPs; stipulate that “CMS does not have authority to waive COPs for providers”; stipulate that in order for a Licensed Home Care Services Agency (LHCSA) to meet COPs, the state would need to have a licensing process whereby COPs were met without Medicare certification; require that home health agencies providing services to the Program of All-Inclusive Care for the Elderly (PACE) must meet the CoPs.

DOH indicated that it is still reviewing CMS’s responses and determining next steps, including the need for further correspondence with/clarification from CMS on these items. Signed Physician Orders DOH reported that its proposed regulatory revision to extend from 30 to 60 days the maximum timeframe for signed physician orders for home care has hit a delay. The update prompted HCA to re-raise the concern that the proposal, while appreciated, was not a sufficient solution to the challenge of obtaining physician signatures and the consequences to agencies for physician delays. In response, DOH offered to reexamine its regulatory proposal and to consider recommendations for more effective remedy. DOH invited HCA and a subgroup to work with the Department to accomplish this goal. County/Local Public Health Provision of “Home Care Services” DOH had previously raised with the workgroup the issue that county health and/or local public health nursing departments – which discontinued their practice of being direct providers as CHHAs and LTHHCPs – had inadvertently also disconnected themselves from the ability to bill public payors (e.g., Medicaid) for the public health services which they provide their communities that fall under Article 36 (home health services). The problem was compounded by the Department’s elimination (several years ago) of other sources of public funding for local public health departments for home care services. Over the past year, DOH has explored options for the counties, including Article 36 changes, but none were identified that avoided the creation of new conflicts with home care. DOH reported to the workgroup that the practical solution of recommending that counties contract with existing CHHAs for these services would be pursued pending any other, more permanent measure. See REGULATORY p. 17

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Volume 20, No. 13 April 2, 2015 

DISCOUNT from p. 1 her registration fee in half! This is a great way to reward a member of your team who will benefit from all of the great learning and networking at HCA’s premier conference. Information about these special offers is provided in the newly updated Annual Conference Brochure at http://www.hcanys.org/documents/2015HCAAnnualConferenceBrochureNewEvents.pdf. New offerings As reported in last week’s ASAP, we’ve changed the conference schedule a bit – all with the goal of adding even more value to an already exceptional program! This year’s conference fee was already lower than last year’s, and we’ve been encouraging members to reinvest that savings by attending a first-of-its-kind Leadership Institute session, offered as a supplement to the conference on May 8. That program will award continuing education credits while providing you with expert leadership training from the esteemed American College of Healthcare Executives. To inject further value into this special post-conference program, we’ve also added a segment on value-based payments to precede the Leadership Institute, during breakfast. Value-based payments are an area of major discussion at the state and federal policy levels, with implications for home care programming, services and financing. And, as further enticement, we’ve also added some more fun for those staying to attend the Leadership Institute. On the evening of May 7, the night before the Leadership Institute, we invite you to join the HCA team for Pat’s Pub Crawl, led by HCA Vice President Patrick Conole – a chance to relax over drinks with the HCA team at several of the great establishments that Saratoga has to offer. Drink coupons will be offered to participants as well. HCA’s Annual Conference has never before offered this much value: special discounts, an opportunity to obtain continuing education credits, a lower registration fee and a streamlined program. While these are great offerings to save you time and money, the conference sessions and workshops alone offer unbeatable value, with exciting keynotes by thought-leaders in the field who will inspire you, as well as special workshops on everything from population health to staff-retention to home health physician certification and more. 7

OMIG Posts New Compliance Guidance The state Office of the Medicaid Inspector General (OMIG) has posted Compliance Guidance 2015-02, entitled Mandatory Compliance Program Requirement: Holding Company and Joint Venture Structures – Employee Vested with Responsibility for Day-to-Day Operation of the Compliance Program. This Guidance addresses the requirement that a compliance officer be an employee of the Medicaid provider that is required to have a compliance program. Compliance Guidance 2015-02 and prior Compliance Alerts are available at: http://www.omig.ny.gov/generalguidance.

Hold June 4 for Executive Order 38 Program HCA will be holding a members-only program on June 4, 2015, from 11 a.m. to noon on Executive Order 38. HCA’s Counsel, Frank Fanshawe, Attorney At Law at Wilson Elser Moskowitz Edelman & Dicker LLP, will provide an update, including an overview of the requirements, the disclosure form that most agencies have to submit by June 30, and any new legal developments. As extensively reported to members, Executive Order 38 places limits on executive compensation and administration costs for entities, including home care and other health providers that receive state funds directly or indirectly. HCA will be providing registration details soon.

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

Volume 20, No. 13 April 2, 2015 

Major Questions Prompt DOH Webinar on QIVAPP Updates Due to lots of questions raised by HCA and others about the Quality Incentive Vital Access Provider Pool (QIVAPP) program, the state Department of Health (DOH) plans to hold a webinar sometime in the next two weeks to update Managed Long Term Care (MLTC) plans and home care providers on QIVAPP. As HCA has advised members, all home care providers who are receiving QIVAPP monies as part of the initial state-share payment to MLTC plans, as well as providers who expect to receive QIVAPP funds when federal approval is granted, should be sending attestation forms and updated aide hour data to their contracted plans. If they don’t provide the required information, they won’t be eligible for further or initial QIVAPP monies. DOH has extended the deadline for the MLTC plans to submit this information – until May 1. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.

May 13 Program to Eye DOH Survey Process and Compliance Manuals HCA is excited to announce our next Home Care Survival Bootcamp program on May 13 in Manhattan, which will cover the state Department of Health (DOH) survey process for Licensed Home Care Services Agencies (LHCSAs) and compliance manuals. Numerous DOH staff from the Division of Home and Community Based Services will cover the survey process for LHCSAs, including: • • • • • •

The steps of a survey; Timeframes for agency responses; Types of documents and records that DOH needs; How to properly address deficiencies through plans of correction; Any upcoming changes in the survey process; and Recent survey findings and problematic areas.

Rachel Hold-Weiss, RPA-C, J.D., Associate General Counsel and Corporate Compliance Officer at HCAmember Personal Touch Home Health Services, will also present a program on Establishing Effective Compliance Manuals. She will highlight: • • • • • • • •

Why a compliance manual is required; State and federal requirements for the compliance manual; Components of an effective compliance manual; Who needs to be trained and be familiar with the compliance manual; How compliance training should be conducted; How to test the effectiveness of the information contained in the compliance manual; How the compliance manual relates to other agency compliance initiatives and activities; and How the relationships with managed care plans impact an agency’s compliance activities.

The flyer is at http://www.hca-nys.org/documents/SurvivalBootcamp-May132015Brochure.pdf and at the end of this ASAP. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org. 8

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

Companionship Exemption Suit Update

Volume 20, No. 13 April 2, 2015 

NYSHealth Announces Funding Opportunity

The National Association for Home Care and Hospice (NAHC) has informed HCA that NAHC and other plaintiffs in the Companionship Exemption lawsuit, including the Home Care Association of America, et al., have filed their brief in the case.

The New York State Health Foundation (NYSHealth) has announced that its 2015 Special Projects Fund Request for Proposals (RFP) is available. It is at http://tinyurl.com/p4p7zlz.

The plaintiffs are waiting to review the various amicus briefs that are expected to be submitted in support of their position, including from U.S. Senators, State Medicaid programs, and Consumer Directed Personal Assistance Services providers in New York State.

Applicants must submit an online inquiry form to determine whether a proposed project fits the funding criteria. The deadline for the online inquiry form is April 23, 2015. Selected organizations will be invited to submit full applications, which will be reviewed on a rolling basis with a deadline of June 9, 2015.

The amici briefs are due on April 6. The next step is for the U.S. Department of Labor (DOL) to submit its brief, due on April 13. Oral arguments are scheduled for May 7.

NYSHealth Special Projects Fund awards are onetime, nonrenewable funding opportunities consistent with the Foundation’s mission to improve the health of all New Yorkers but outside of its three priority areas.

NAHC had earlier reported that it is very hard to predict the timing of a possible ruling, specifically whether a decision would be rendered by the time the court goes on its recess in July.

More information is on the RFP Frequently Asked Questions at http://nyshealthfoundation.org/ faq-spf-rfp-2015.

As indicated in the March 13 ASAP, numerous parties filed amicus briefs supporting DOL in its defense of the rule on February 27. These parties include: unions; four states, including amici curiae by New York, Massachusetts, Illinois and New Mexico; advocacy organizations representing seniors and persons with disabilities; Members of Congress; and various advocacy groups.

New Revalidation Info Posted eMedNY has posted updated information on the revalidation requirements for home care and other health care providers under Medicaid. The document is at https://www.emedny.org/ info/ProviderEnrollment/revalidation/ Revalidation_of_Medicaid_Providers.pptx.

The states, in particular, support DOL’s arguable contention that extending wage and hour protections to home care workers will not vastly inflate state Medicaid costs but, rather, reduce long-term Medicaid expenditures for states by enhancing the quality of care. HCA has taken issue with this contention and pointed out that New York State, one of the amicus filers, has in the past acknowledged that the final rule will actually lead to increased Medicaid costs, prompting the state to seek HCA’s assistance in sharing cost estimates from a member survey we conducted on the impact of the rule.

Some changes from a prior document were made to the application fee information section and contacts for those who have questions. The Affordable Care Act requires that all Medicaid providers must be revalidated every five years. Revalidation includes providing information on the provider’s ownership, managing employees, agents, persons with a control interest, as well as providing current addresses, specialties, etc.

For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org. 9

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

Volume 20, No. 13 April 2, 2015 

Flu Vaccine Report Due May 1 This week, the state Department of Health (DOH) sent another informational message to remind home care and other health care providers that the Healthcare Personnel Influenza Vaccination Report must be submitted on the Health Electronic Response Data System (HERDS) by May 1. As mentioned in numerous editions of ASAP, this year’s report covers personnel employed by or affiliated with your agency from October 1, 2014 through March 31, 2015. Agencies are required to submit a single, longitudinal report that is open from November 19, 2014 through May 1, 2015. Detailed guidance on how to access, complete, and submit the report on HERDS, including instructions and a Frequently Asked Questions (FAQ) document, are available at www.health.ny.gov/FluMaskReg. Under the ‘flu mask’ requirement – in effect since December 11, 2014 for this current influenza season – home care and other health providers are mandated to ensure that their aides and other designated personnel who are not vaccinated against influenza wear a surgical or procedure mask while in areas where patients are present. Questions about the report should be directed to the DOH Bureau of Immunization at either (518) 473-4437 or immunize@health.ny.gov. Technical questions about HERDS should be directed to the Health Emergency Preparedness Program at (518) 408-5163 or hseppny@health.ny.gov. Questions about the flu mask regulation should be directed to flumaskreg@health.ny.gov.

Managed Care Update The state Department of Health (DOH) has posted a revised timeline for the implementation of Conflict-Free Evaluation and Enrollment Centers (CFEEC) and a Frequently Asked Questions (FAQs) document on the CFEECs. The new CFEEC rollout schedule is at http://www.health.ny.gov/health_care/medicaid/redesign/docs/201503-26_updated_cfeec_timeline.pdf; the FAQs are at http://www.health.ny.gov/health_care/medicaid/redesign/ docs/2015-03-27_cfeec_faq.pdf. Starting, April 2015 the CFEEC will be operational in some counties within: the Southern Tier (Tompkins, Cortland, Tioga, Broome, Chenango, Otsego, Delaware); the Finger Lakes (Wayne, Ontario, Livingston, Cayuga, Steuben); and Western New York (Cattaraugus, Wyoming, Genesee, Orleans, Niagara). In May, the state intends to start CFEEC in the Central New York counties of Oswego, Oneida, Herkimer and Madison. In June, CFEEC will be implemented in the remaining counties of: Northern New York (St. Lawrence, Franklin, Clinton, Essex, Hamilton); the Finger Lakes (Seneca, Yates, Schuyler, Chemung); Central New York ( Jefferson, Lewis); and Western New York (Chautauqua, Allegany). Under the CFEEC, all new individuals who require more than 120 days of community-based long term care services must be assessed, using the Uniform Assessment (UAS-NY) tool, by the Medicaid Enrollment Broker, 10

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

Volume 20, No. 13 April 2, 2015 

Maximus, to determine their eligibility for Medicaid community based long term care and eligibility for enrollment in a Medicaid Managed Long Term Care (MLTC) plan. MLTC plans can no longer enroll an individual unless they have first completed a CFEEC UAS in those regions where the CFEEC policy is in effect. The CFEEC is already operating in New York City, Long Island, Westchester, Albany, Columbia, Dutchess, Putnam, Rockland, Orange, Ulster, Greene, Sullivan, Warren, Washington, Saratoga, Fulton, Montgomery, Schoharie, Schenectady, Rensselaer, Erie, Monroe and Onondaga. CFEECs Some highlights from the FAQs on CFEECs are: •

MLTC plans are required to complete a UAS assessment for consumers that have a completed CFEEC UAS evaluation.

•

Individuals interested in a FIDA plan will be required to go through the CFEEC for their initial evaluation.

•

An MLTC plan can speak with a consumer about plan benefits prior to redirecting the consumer to the CFEEC for next steps.

•

Individuals already receiving a Medicare-covered post-acute care service, such as from a Certified Home Health Agency (CHHA), may also contact the CFEEC to enroll into an MLTC plan or wait until they receive a letter indicating that enrollment is mandatory.

•

MLTC plans do not have permission to view an individual’s UAS prior to receiving the referral of that individual.

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

HCA Provides Input on Proposed Fiscal Intermediary Policy HCA has provided input to the state Department of Health (DOH) on its proposed requirements for entities that want to provide fiscal intermediary (FI) services to Managed Long Term Care (MLTC) plans in counties where “mandatory enrollment” is in effect. The “mandatory” counties include those where individuals must enroll into an MLTC plan if they need more than 120 days of community-based long term care services. HCA has supported efforts to allow such entities to provide FI services without being required to obtain a Memorandum of Understanding (MOU) with the local department of social services (LDSS), given that the LDSS, in its changed role, no longer administers the personal care benefit; the MLTC does. Under DOH’s proposed policy, entities that want to provide FI services in mandatory counties would have to apply for a discrete Medicaid provider identification number, meet the requirements in the Consumer Directed 11

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Personal Assistance Services (CDPAS) regulations (18 NYCRR, section 505.28) and enter into an administrative agreement with the managed care plan or contract with the LDSS for the provision of CDPAS. HCA supports DOH’s draft policy that an MOU with the county is not required and thanks the Department for taking into consideration our position on this issue. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.

DSRIP Update In the past week, the state Department of Health (DOH) has posted information about Design Grant awards; value based payments; revised time deadlines for the Delivery System Reform Incentive Payment (DSRIP) program; and the status of federal approval of Performing Provider System (PPS) Plan Applications. As supported in the DSRIP Partnership Plan Special Terms and Conditions (STCs), New York State awarded $69 million of planning payments to providers from a designated Design Grant Fund. These grants enabled providers to develop specific and comprehensive DSRIP Project Plans. The final DSRIP Project Design Grant planning payments were made in February 2015. The payment summary is now available at http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/design_grant_appl.htm. Questions related to these payments or the DSRIP safety net process should go to BVAPR@health.ny.gov. All other questions can be directed to DSRIP@health.ny.gov. Value Based Payments DOH has made available the latest in its White Board series: Five Themes of Value Based Payment in Five Minutes. During the White Board presentation, New York State’s Medicaid Director Jason Helgerson describes the principles and goals of Value Based Payment reform. The video can be viewed at https://www.youtube.com/ watch?v=WHIuV_LWcIg. The Roadmap and other details related to Value Based Payment Reform can be accessed at: https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/vbp_reform.htm. Timeline The DSRIP Year 0 timeline has been updated to reflect recent date changes for several Year 0 deliverables, including the extension of the deadline for submitting Implementation Plans, which is now May 1. In addition, a DSRIP Year 1 timeline, which begins April 1, has been posted to the DSRIP website. The Year 1 timeline will continue to be updated as new deliverable dates are determined. Both timelines can be accessed at http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/timelines/ index.htm. Continued on next page

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Continued from p. 12 PPS Applications The U.S. Centers for Medicare and Medicaid Services (CMS) has accepted DOH’s recommendations with respect to the PPS Project Plan Application scores. With this acceptance, CMS reserves the right to provide further review of all aspects of the scoring review process. The accepted scores include adjustments made by the Project Approval and Oversight Panel, which convened in late February to review the Project Plan Applications and Independent Assessor’s scores. For more information about the Department’s final recommendations, please visit: https://www.health.ny.gov/ health_care/medicaid/redesign/dsrip/docs/memo_to_cms_on_dsrip_scores-final.pdf. For specifics related to the Project Plan scores, please visit: https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/docs/ pps_final_scores_and_recommendations.pdf.

HCA Working to Support Falls-Prevention through Home Care HCA is working on ways to support falls-prevention efforts and intervention through home care. The National Safety Council (2015) cites falls as occurring annually in one out of three persons aged 65 and older, with 20 to 30 percent of falls resulting in injury. These falls are not only injurious, but are often medically and financially catastrophic. Beyond the major challenges of recovery and rehabilitation, fall-risk patients continue to present special complexities and resource intensity in their care needs. The HCA Quality Committee has included support for falls-prevention as one area of its quality innovation and improvement planning, and HCA has specifically included falls-prevention within the quality proposals of our 2015 Driving Health Care Improvement and Savings through Home Care advocacy agenda. As falls-prevention is critical to the life, health and safety of individuals, it is also significantly aligned with the clinical and cost-savings goals of virtually all of the emerging new models of care and coverage. As part of our efforts, HCA has been engaging with the state Department of Health (DOH) and, this week, participated in a statewide falls-prevention initiative hosted by DOH. The Department convened a diverse group of individuals across a continuum of providers and practitioners to discuss falls-prevention and explore ideas for promoting awareness, prevention and collaboration activities. DOH invited HCA to join this effort, which also included several HCA provider members participating in agency and/or local falls-prevention activities. The DOH initiative also included a focus on evidenced-based models effective in falls-prevention and ideas for adoption and use within the health care and aging services system. While the messaging of the DOH program has been statewide, the scope of its funded, clinical/service activity is currently limited to several localized regions within the state. HCA and DOH program leaders are discussing ways of collaboration between the falls-prevention program and our statewide home care network. The HCA Quality Committee will be discussing further possibilities at its next meeting later this month. Stay tuned for further progress on opportunities and support for home care that we hope to create for addressing this critical and well-timed public health problem. For further information, please contact Al Cardillo at acardillo@hcanys.org. 13

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DOH to Review All Pended Claim Types for Edits 00127 & 01283 The state’s Medicaid claims processing system announced this week that, effective April 1, all claims that result in eMedNY edits 00127 (“Medicare Paid Amount Reported Less Than Reasonable”) and 01283 (“Upper Dollar Limit Exceeded”) will automatically be pended to the state Department of Health (DOH) for review. The corresponding HIPAA on the 835 remittance will be: • •

00127: Adjustment Reason Code 23 with no Remittance Remark Code; and 01283: Adjustment Reason Code 16 and Remittance Remark Code M54.

If the claim(s) is pended, the corresponding claim status response codes will be: • •

00127: Claim status code 182; and 01283: Claim status code 585.

DOH staff will review the documentation and adjudicate the claim(s) through the regular claim processing system. Adjudicated claims will appear on the provider’s remittance statement. DOH reminds providers that when billing Medicaid for a service reimbursed by Medicare, the provider’s National Provider Identifier (NPI), procedure code, all modifiers and dates of service should appear exactly the same on the claim to Medicaid as on the Medicare claim. Also, the NPI submitted on a provider’s claim to Medicare must be enrolled with New York State Medicaid. In addition, providers must reduce the Medicare Allowed Amount by any sequestration payment reduction (CO 253) amount to obtain the correct coinsurance payment. eMedNY Edit 02015 will Pend for Manual Review Also DOH also reminds providers about compliance requirements for properly reporting correct Coordination of Benefits (COB) information on claims submitted for beneficiaries who have primary insurance through Medicare. The COB claim to Medicaid must accurately reflect Medicare’s adjudication of the claim as reported in the Medicare Explanation of Medicare Benefits (EOMB). Effective April 1, 2015, claims triggering “edit 02015: Medicare Coinsurance Greater than Zero and Medicare Payment Equals Zero” will pend to DOH for manual review. For claims submitted on paper with the EOMB attached, DOH will compare the EOMB to the information on the pending paper claim. If it doesn’t match, the claim will be denied for the edit. Most claims should be corrected and resubmitted to avoid triggering this edit. The corresponding HIPAA codes that will be reported on the 835 remittance are: Claim Adjustment Reason Code 129 and Remittance Remark Code N48. While the claim(s) is pended, the corresponding claim status response codes will be 286. For specific questions on both of these announcements, contact the State’s Medical Pended Claims staff at 1 (800) 342-3005, option 3. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

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CMS Seeks Approval for the OASIS C1/ICD-10 Data Item Set The U.S. Centers for Medicare and Medicaid Services (CMS) is requesting approval by the Office of Management and Budget (OMB) for an Outcome and Assessment Information Set (OASIS) data set to accommodate the International Classification of Diseases (ICD)-10. The new version of the OASIS is referred to as the OASIS C1/ICD-10 data item set. Legislation on April 1, 2014 prohibited the Secretary of the U.S. Department of Health and Human Services from adopting ICD-10 prior to October 1, 2015. As a result, the OASIS-C1 data item set, which was created mainly because of the need to enable the coding of diagnoses using the ICD-10, could not be implemented as scheduled on October 1, 2014. Since ICD-10 had been delayed until at least October 1, 2015, CMS made interim changes to the OASIS-C1 data item set to accommodate the continuation of the ICD-9 diagnosis codes. Five of the data items which required the use ICD-10 codes were modified. The current version of the data item set – OASIS-C1/ICD-9 – is in use until the implementation of the ICD-10 coding. The OASIS C1/ICD-10 version replaces the five items that were modified in the OASIS C1/ICD-9 version. The OASIS C1/ICD-10 is essentially the OASIS C1 with a few technical and typographic corrections and a new name. CMS’s Federal Register notice can be downloaded at: http://www.gpo.gov/fdsys/pkg/FR-2015-03-25/pdf/2015-06884.pdf. HCA members interested in reviewing the OASIS C1/ICD10 and supporting documentation can do so at: http://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-ListingItems/CMS-10545.html?DLPage=1&DLFilter=oasis&DLSort=1&DLSortDir=descending. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

Upcoming Release of Hospice PEPPER Includes New Target Areas The next release of the Hospice Program for Evaluating Payment Patterns Electronic Report (PEPPER), scheduled for April 13, will include four new target areas, added in response to the recently-released Office of Inspector General (OIG) report identifying concerns with hospice services provided to beneficiaries residing in an assisted living facility (ALF). OIG found that “Medicare payments for hospice care in ALFs more than doubled in five years, totaling $2.1 billion in 2012.” PEPPER is a free educational tool available to providers to help them proactively monitor their claims and work to prevent improper Medicare payments. PEPPER summarizes a hospice’s Medicare claims data in areas that may be at risk for improper Medicare payments (target areas). It compares the hospice’s statistics with aggregate statistics for the nation, Medicare Administrative Contractor (MAC) jurisdiction and the state. If a hospice’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. PEPPER, however, cannot identify the presence of improper payments. To date, the Hospice PEPPER has included two target areas: “Live Discharges” and “Long Length of Stay.” The new Hospice PEPPER will include four new target areas: Continuous Home Care Provided in an ALF;

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Routine Home Care Provided in an ALF; Routine Home Care Provided in a Nursing Facility; and Routine Home Care Provided in a Skilled Nursing Facility. The new Hospice PEPPER (version Q4FY14) summarizing statistics for fiscal years 2012, 2013 and 2014 will be available on April 13, 2015 through the PEPPER Resources Portal at https://securefile.tmf.org/Default.aspx?ReturnUrl=%2f. As reported in last week’s ASAP, the PEPPER monitoring tool will be available for home care too. A webinar on home care PEPPER is scheduled for April 30 at 1:30 p.m. To participate in the free April 30 event, visit https://tmfpepper.webex.com/tmfpepper/onstage/ g.php?d=923918378&t=a and use the following log-in information: • •

Event number: 923918378 Event password: lantana

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

Mandatory Electronic Prescribing Effective Date Extended to 2016 On March 13, 2015 Governor Cuomo signed legislation to extend the implementation date for mandatory electronic prescribing, from March 27, 2015 to March 27, 2016. Even though the mandate is extended, e-prescribing of both controlled and non-controlled substances is currently permissible in New York prior to the mandate going into effect. For compliance purposes, practitioners should work with their software vendors to implement the additional security requirements needed for e-prescribing of controlled substances, and registering their certified software applications with the Bureau of Narcotic Enforcement. Information regarding e-prescribing, including Frequently Asked Questions, may be accessed at http://www.health.ny.gov/professionals/narcotic/electronic_prescribing/.

Livanta QIO Update: Medicare Beneficiary Notices Need to Reflect Livanta’s New Contact Information Since August 1, 2014, Livanta LLC has been conducting all Medicare quality review cases, appeals, and complaints as the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for New York and some other states. During this time from August 1, 2014 to the present, Livanta has been forwarding the previous QIO’s HelpLine phone numbers (at IPRO) to Livanta’s HelpLine. Last week, those lines were updated to include a message

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ASAP – a publication of the Home Care Association of New York State stating that the number will no longer be in service as of April 30, 2015 in addition to listing Livanta’s HelpLine number. Because of this change, Livanta QIO requests that home health agencies and other providers update their Medicare Beneficiary Notices to reflect Livanta’s current contact information. Providers can access the notices for updating on CMS’s website at www.cms.gov/bni. The contact information for Livanta in Area 1 (which includes New York) is: • • • •

Toll-free telephone number: 1-866-815-5440 TTY number: 1-866-868-2289 Fax number for Appeals: 1-855-236-2423 Fax number for all Other Reviews: 1-844-4206671

The address for mailing hard-copy medical records is: BFCC-QIO Program, Area 1; 9090 Junction Drive, Suite 10; Annapolis Junction, MD 20701. Please note that medical records for discharge appeals should be faxed. Do not mail appeal records to the Maryland address, as this will delay the process. Livanta is also the Comprehensive Error Rate Testing (CERT) contractor for New York health care providers, so HCA advises members to review any correspondence from Livanta to determine if the correspondence is QIO or CERT related. For specific questions regarding this request, contact Livanta’s Area 1 Communication Lead Laura Dugan at BFCCQIOArea1@livanta.com or at (717) 450-5781. For further information, contact the HCA Policy staff.

Publications •

“Medicaid Spend-Down,” by the New York Legal Assistance Group http://www.wnylc.com/health/entry/46/

For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org. 17

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REGULATORY continued from p. 6 Managed Care-Home Care Regulatory Matrix HCA and association partners provided an update on our joint association efforts to create a matrix delineating, clarifying and streamlining regulations and procedures for the managed care-home care delivery model. We presented a draft set of principles for consideration by DOH and the workgroup which we proposed serve as the foundation for clarifying and streamlining all of the functional areas (i.e., contract fundamentals, assessment, care planning, supervision, care management, physician orders, etc.) for managed care-home care delivery that are outlined in the matrix. We will be reviewing the draft principles and matrix in light of CMS’s recent clarifications and plan to work further with providers, managed care plans and DOH to arrive at an effective guidance document. Workgroup members stressed to DOH their recommendation that, upon finalization, the matrix be issued under a Dear Administrator Letter (DAL) to ensure state sanctioning of the contents. New Draft DALs DOH shared for preliminary comment two draft DALs for managed care-home care. One draft would address the emergency preparedness issue – in particular, coordination of reporting requirements. HCA reinforced the importance of emergency preparedness in the managed care-home care model and indicated that, beyond reporting, there were many critical issues for plans and providers that require clarification and support, such as care plan adjustments and other decisions requiring flexibility and fast action in emergencies. The second DAL draft addresses the issue of care management services provided to managed

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care plans by CHHAs and LTHHCPs. It seeks to provide guidance on the requirements (e.g., COPs) that apply when care management services are provided in these circumstances. The draft contemplates, based on CMS policy, that CHHAs and LTHHCPs could establish separate business lines for care management that could function without regard to the COPs, and offers guidance from the CMS State Operations Manual in creating and operating such a distinct line. Next Steps HCA will be following up promptly with DOH on the status of the CMS responses and requisite providermanaged care plan guidance on options and implications. HCA will also be following up with DOH to work together on a real solution to timely, signed physician orders and appropriate relief for providers, as well as to provide DOH with input and recommendations on the two new proposed DALs. In addition, HCA will following up with partner associations, providers, managed care plans and DOH on refinement and resubmission of the draft managed care-home care regulatory matrix for ultimate approval, sanction and issuance by DOH. DOH will report further to the home care community on all material developments with these issues. HCA thanks all of the members of the workgroup, including HCA Board Members Ann Frisch and Joseph Twardy, for their endless contributions and leadership on this effort. For further information, please contact Al Cardillo at acardillo@hcanys.org.

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Establishing Effective Compliance Manuals & Understanding the NYS Department of Health Survey Process Location: The Conference Center 130 East 59th Street 7th floor New York, NY 10022

HCA is offering a series of Home Care Survival Bootcamps throughout the coming months to provide tools, tips and strategies that will help home health providers thrive in an increasingly challenging marketplace and regulatory environment. This series focuses on specific issue areas, offering practical ideas and methods for skill building.

Fee: $99 for HCA members; $199 for Non-members

Part IV in this series, on May 13, offers vital information on establishing effective compliance manuals and understanding the NYS Department of Health survey process. This educational series will provide the opportunity to retool, refocus and re-energize your agency. All programs in the series will be held at the Conference Center in New York City and will include expert presenters, valuable handout materials and lunch.

Registration Deadline: May 6, 2015

May 13, 2015 – Part Four Establishing Effective Compliance Manuals & Understanding the NYS Department of Health Survey Process We recommend that you review your compliance manual before the program and prepare any questions and issues you have to raise in the question and answer part. 9:00 – HCA Welcome 9:15 – 10:45

Establishing Effective Compliance Manuals and Compliance Program Activities

Location: The Conference Center 130 East 59th Street 7th floor New York, NY 10022

This program will highlight: • why a compliance manual is required; • state and federal requirements for the compliance manual; • components of an effective compliance manual; • who needs to be trained and be familiar with the compliance manual; • how compliance training should be conducted; • how to test the effectiveness of the information contained in the compliance manual; • how the compliance manual relates to other agency compliance initiatives and activities; and • how the relationships with managed care plans impact an agency’s compliance activities. Rachel Hold-Weiss, RPA-C, J.D., Associate General Counsel and Corporate Compliance Officer, Personal Touch Home Health Services 11:00 to 12:45

Understanding the NYS Department of Health Survey Process Learn from state Department of Health (DOH) staff about the survey process for Licensed Home Care Services Agencies, including: • the steps of a survey; • timeframes for agency responses; • types of documents and records that DOH needs; • how to properly address deficiencies through plans of correction; • any upcoming changes in the survey process; • recent survey findings and problematic areas; and more. Rebecca Fuller Gray, RN, Director, Division of Home and Community Based Services

Lunch Sponsored by:

Diane Jones, RN, Medical Assistance Specialist, Division of Home and Community Based Services Rita Cedar, RN, Home Care Program Manager, Capital District Regional Surveillance Division of Home and Community Based Services 12:45 to 1:30 – Lunch

REGISTRATION – (Deadline May 6)

REGISTRATION FEE

Name: _________________________________________________

HCA Members

Title:__________________________________________________

PAYMENT

Agency:________________________________________________

____MasterCard

Address:_______________________________________________

*Make checks payable and mailed to:

City/State/Zip:___________________________________________ Phone:______________________________ Ext._______________ Email: _________________________________________________ Cancellations received by May 6 are refundable less a 25% administrative fee. Cancellations must be received in writing via e-mail to info@hcanys.org. No refunds after that time or for no shows. Substitutions are permitted.

FAX TO: (518) 426-8788

$99 ________

____VISA

Non-Members

$199 ________

____ American Express

________ Check*

HCA Education and Research 388 Broadway, 4th Floor, Albany, NY 12207

Credit Card #: _______________________ Exp. Date:_______ Security Code: ________ _________________________________________________________________________ Name and/or Company Name on Card _________________________________________________________________________ Billing Address of card (including City, State and Zip Code) _________________________________________________________________________ Authorized Signature

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 This educational offering has been reviewed by the National Continuing Education Review Service (NCERS) of the National Association of Long Term Care Administrator Boards (NAB) and approved for 12.25 clock hours and 8.25 participant hours.

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

We also extend a special thanks to HCA’s Board of Directors who donate their time and talents for the success of HCA.

Hotel Information 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.

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 Susan Caputo, Individual Member Northport, NY 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

Additional Sponsors Arthur J. Gallagher Risk Management Services, Inc. Bassett Healthcare Network, At Home Care Brookhaven Memorial Hospital Medical Center Byram Healthcare Dominican Sisters Family Health Service, Inc. Hinman Straub, P.C. People Care, Inc. RBC Limited Healthcare and Management Consultants VNS Westchester Winthrop University Hospital

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 Laurie Neander Basset Healthcare Network: At Home Care Karen O’Kane, Brookhaven Memorial Hospital Medical Center

Exhibitors AccuPoint, LLC Avanti Health Care Services Black Tree Healthcare Consulting Bosch Healthcare Brinster & Bergman, LLP Cardiocom, a Medtronic Company ContinuLink The Corridor Group Delta Health Technologies, LLC Fazzi Associates Forcura Friedlander Group Grassi & Co. CPA’s Homecare Homebase

Homecare Software Solutions. LLC LCG Community Trust Mobile Health MobilexUSA Mom’s Meals Nourish Care MyCNAjobs Philips Hospital to Home Quality in Real Time Senior Planning Services MLTC Simione Healthcare Consultants Stay at Home Solutions TSG Financial Total Program Management United Healthcare Community Plan

Mary Kate Rolf, VNA Homecare Paul Rosenfeld, CenterLight Health System 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

Sponsorship and Exhibitor opportunities are still available. Visit

Mary Zagajeski Dominican Sisters Family Health Service

www.hcaannualconference.com

Elizabeth Zicari, HCR Homecare

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

Wednesday, May 6 10:00am – 5:00pm Hotel Lobby

HCA Registration Opens At the registration desk, you will obtain your conference program, name badge and directions to your first session. 1:00pm to 1:30pm

HCA Annual Meeting of the Corporation (Note New Time) All HCA members are invited to attend the Annual Meeting of the Corporation. This brief meeting of the HCA corporation will include membership review and passage of the 2014 audit and financials, a synopsis of the year’s activities, and ratification of the Slate of Board of Directors members. (The HCA Board of Directors meeting, which all members are encouraged to attend, will be held on Thursday, May 7, from 4:15pm to 6:00pm.) 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 multilevel care coordination can help your organization be best positioned to improve clinical and financial outcomes by increasing communication across settings, effectively analyzing patterns and addressing health care needs for your entire patient population. Sharon Rushton, MSN, MS, RN, CCM is Assistant Professor at Duke University School of Nursing. Her interests include care coordination of complex patients, transitions of care, resource utilization and patient/family education.

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.

4:15pm to 6:00pm – HCA Annual Board of Directors Meeting All HCA members are encouraged to attend the HCA Board of Directors meeting, which will focus on Board discussion and debate of federal and state policy and advocacy strategy as well as organizational and operational priorities. This event is an important tradition and includes an invited guest speaker from the public policy arena. Dinner is on your own this evening at one of the many fine restaurants Saratoga Springs has to offer.

8:00pm – Pat’s Pub Crawl After dinner, join HCA Staff and your peers for our first-ever Saratoga Pub Crawl. Visit a variety of venues that offer something for every taste including the upscale atmosphere of wine bars, authentic brew pubs and jazzy lounges. Free drink coupons for all pub crawl participants. Watch for further details coming soon.

Friday, May 8 - Bonus Session! 7:30am to 8:45am

Value Based Payment Workshop and Breakfast Enjoy a full buffet breakfast and the opportunity to learn more about an emerging policy and payment priority at both the State and the National level focusing on value-based payment. Hear from expert faculty on how value based payments are developed, and how home health agencies can position themselves to benefit in value based payment models.

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

Program Agenda Friday, May 8 7:30am to 8:45am

Breakfast and Value Based Payment Workshop Enjoy a full buffet breakfast and the opportunity to learn more about an emerging policy and payment priority at both the State and the National level focusing on value-based payment. Hear from expert faculty on how value based payments are developed, and how home health agencies can position themselves to benefit in value based payment models. (Coffee will be available beginning at 7:00 am.) 9:00am to1:00pm

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.

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.

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: $__________

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

I will attend the HCA PAC Fundraiser



My personal donation will be submitted separately.

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 Pat’s Pub Crawl

FAX THIS FORM TO (518) 426-8788



388 Broadway Fourth Floor Albany, New York 12207