ASAP
A Weekly Publication Of HCA Home Care Association of New York State
Legislative Issues Public Policy
News
Volume 21, No. 14 April 8, 2016
More Details Assessed on Budget Outcome for Home Care Learn more about minimum wage funding, home care-managed care rate language, and infrastructure dollars in HCA memo, Monday conference call In last week’s ASAP we provided you with an immediate but still-inconclusive update on the state budget (finalized on April 1). This week we have much more information from our analysis of the budget language and meetings with state officials on key components affecting home care. To start, our most complete analysis of the budget is contained in a memo that HCA sent to members earlier today. It can be downloaded at http://hca-nys.org/wp-content/uploads/2016/04/StateBudgetOutcome040816.pdf. Rather than duplicate the information in this memo, which we encourage all members to view, we are providing some highlights from our analysis and briefings with state officials, much of which has been reported to you in e-mail alerts on Wednesday and in this morning’s memo. We also remind you that HCA is holding a membersonly budget conference call on Monday, April 11 at 3 p.m. Please register for this important call and read our memo in advance so that you can compile any questions you may have for the HCA team during the call. To register, simply complete the online form at https:// www.surveymonkey.com/r/2016BudgetOutcome.
Inside ASAP
See DETAILS p. 2
More Details on Budget Outcome for Home Care...............................1 HCA Conference Hotel Deadline Extended........................................1 Member Hiring Announcement..........................................................4 Supreme Court Delays FLSA Hearing Decision....................................6 CMS Approves OPWDD Waiver...........................................................6 MLTCs Begin Distributing FLSA Dollars; HCA Presses Advocacy........7 QIVAPP Final Awardees Expected Soon...............................................8 MLTC Reports Issued...........................................................................8 Flu Vaccination Report Due in One Month..........................................9 HCA Gives Input on MLTC Quality Incentive Payment Program.......10 CMS to Correct Home Health Pricer Program.................................11 OASIS C2 Available for Preview..........................................................11 Medicare Revalidation Resources Posted........................................12 Round 2 DOH Responses on DSRIP Regulatory Waivers..................13 New DSRIP Timeline Posted.............................................................14 Emergency Preparedness Sessions Begin in WNY............................14 OMIG 2016-17 Work Plan Now Available..........................................15 NYC HRA Releases New Authorization Form...............................15 Updated Medicaid Levels Posted.....................................................15 IPRO Sepsis Initiative Involves HCA Tool, Home Care Training.........16 Feb. Global Cap Report: Spending $56M Over Projections............17 Publications......................................................................18
Great News: HCA Conference Hotel Deadline Extended; Check Out Our Brochure to“Vote Home Care” Great news! The hotel deadline for HCA’s Annual Conference is extended until April 18, giving you a bit more time to make your reservations at the discount rate. HCA has also finalized our conference brochure with all the details you need to know about our premier May 4-6 program in Saratoga, called “Vote Home Care!” Please visit our See GREAT p. 5
Helping New Yorkers Feel Right At Home
ASAP – a publication of the Home Care Association of New York State
Volume 21, No. 14 April 8, 2016
DETAILS from p. 1 Minimum Wage The final outcome and impact of the wage hike are still being assessed and will require extensive follow-up work. While HCA and partners called for full funding or rejection of the wage hike, this aggressive advocacy led the Legislature to at least partially mitigate the impact of the Governor’s wage hike in the final budget through a modest phase-in and some funding. Those funding levels were shared with the membership in an e-mail alert on April 5 following a meeting that same day with State Medicaid Director Jason Helgerson and other state officials. The state’s plan (outlined in a document at http://hca-nys.org/wp-content/uploads/2016/04/Stateminwageplan0040516MeetingwithHelgerson.pdf ) includes a state-share appropriation of $13 million for all sectors for the last quarter of the 2016-17 state fiscal year, and an $88 million appropriation for all sectors in state fiscal year 2017-18 (April 1, 2017 to March 31, 2018), with the vast majority of this allotment needed for home care. While state officials did not provide sector-specific allocations, HCA has also shared with members a spreadsheet from the Senate which is consistent with the aggregate numbers presented by Mr. Helgerson but is also inclusive of sector-specific allocations. That spreadsheet is available at http://hca-nys.org/wpcontent/uploads/2016/04/SenateMinimumWageBreakout.pdf. It shows:
A $12.284 million state-share allocation for home care/personal care in the last quarter of fiscal year 2016-17 (out of a total state-share allocation of $12.704 million for all of health care). Continued on next page
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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that appropriately address core needs for infrastructure support throughout the home care continuum. Moreover, HCA will continue to work post-budget on additional infrastructure investment through existing and newly proposed funding sources.
An $84.798 million state-share allocation for home care/personal care in fiscal year 201718 (out of a total state-share allocation of $87.96 million for all of health care).
Many big questions remain unanswered, especially the exact methodology and timing for the distribution of funds. Mr. Helgerson indicated that the state intends to have its rate levels for minimum wage loaded by January 1, 2017 when the wage increases go into effect. Another big question is the status of federal-share amounts, which require approval from the U.S. Centers for Medicare and Medicaid Services (CMS). Also unknown is the prospect of any future funding under Medicare for wage costs, which Mr. Helgerson said would be the subject of discussions with federal officials. HCA will weigh in with CMS and the Congressional Delegation on this need, as shown in our own impact estimates for Medicaid and Medicare combined; both payor sources must be addressed for a complete funding of this mandate.
Some of the eligibility criteria to receive these new funds include the extent to which: 1) the proposed capital project will contribute to the integration of health care services and long term sustainability of the applicant or preservation of essential health services in the community; 2) the proposed project is aligned with the goals and objectives of the Delivery System Reform Incentive Payment (DSRIP) program; 3) the applicant has access to alternative financing; and other factors. Home Care-Managed Care Rate Adequacy The Legislature and Governor also agreed to include some scaled-back language for rate adequacy under MLTC and (consequently) for home care coverage. The adopted language mostly requires consistency with federal guidelines in determining rate adequacy and, unfortunately, does not enumerate the various cost coverages for providers and plans, as reflected in HCA’s language.
Please read our memo for more details, including HCA’s follow-up advocacy strategy. Infrastructure dollars One important component of HCA’s proposals, included in the adopted budget, is a new infrastructure pool for home care and other community based providers. While HCA’s proposal urged significantly more dollars, the final budget includes a $200 million infrastructure pool with at least $30 million dedicated for community-based providers. The inclusion of these new funds is a direct result of efforts by HCA and community health care coalition partners, as well as the wide and vocal support of individual agencies. While this pool is promising, the implementation process will require significant work on HCA’s part to assure a clear path of adequate distributions for home care providers and qualification requirements 3
This final language nevertheless establishes a rough outline for “actuarial soundness” of the rates that HCA will seek to further hone through administrative and legislative refinements in the remainder of the legislative session. With regard to MLTC payments specifically, the Governor had introduced a series of proposals which would have reduced payments to MLTCs. These include a carveout of transportation from MLTC payment that was rejected in the final budget. However, the final budget does include
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HIRING language related to limits on premium gains, penalties for late or inaccurate reporting of encounter data and Medicaid Inspector General audit/recovery actions. Please see our memo for details. HCA’s memo includes many other details including further insights on the core issues summarized for this article, the continuation of prioryear reimbursement actions for home care and other prominent home and communitybased care issues discussed in the budget context (or named as past priorities) but either tabled, rejected or adopted only in portions.
Job Position: Director of Performance Improvement and Staff Development (Winthrop University Hospital Home Health Agency)
Please be sure to join us for Monday’s conference call at 3 p.m. to discuss all of these major issues and next steps as the legislative session resumes throughout the next several months, demanding post-budget advocacy on these and other core issues.
Job Position: Director of Finance (Montefiore Home Health Agency)
For more information, please contact the HCA Policy staff.
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 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.
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.
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GREAT from p. 1 conference website for registration, the brochure and other details at www.hcaannualconference.com. We are thrilled to announce some of the exceptional speakers and topics we have lined-up, including:
A pre-conference session on value-based payment with Robert Mechanic of Brandeis University.
A keynote address from pundit Reid Wilson on the current political environment and its impact for health care.
“Think-tank” sessions on psychological first aid; nine ways to maximize your use of health information technology (HIT); and a forecast of grant opportunities on the horizon to invest in resource efficiencies and more.
“Focus-group” sessions on palliative care; HCA’s quality measurement, risk and compliance tool; and home care-behavioral health collaboration.
Forecasting expert Dan Gardner, who will explain how organizations like yours can get serious about forecasting for determining the future of service delivery and business management.
A “Pancake Breakfast and Town Hall Meeting” where the floor is open for you to ask the HCA policy team any questions about payment issues, regulations, advocacy, new models of care, and more.
Invaluable information from award-winning marketing expert Matt Seiden offering practical tips for showcasing the value proposition of home care.
A closing session with Dr. Joseph Cardillo, who is a best-selling author and expert on “body intelligence,” providing you with insights on how to feel more energized, improve your focus and boost physical and emotional strength and energy – a perfect way to end the conference and get ready to head home replenished and inspired.
This “A” list of speakers includes some giants 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. You won’t want to miss being a part of the action! You are also invited to attend our annual conference Board of Directors meeting, our annual awards ceremony, a fun Political Action Committee “Stars and Stripes” party, and plenty of other excellent networking opportunities with colleagues and vendors at this year’s conference. See the links to our brochure and online registration below and make your plans (including hotel reservations) now to join us on May 4-6. Download the brochure at: http://hca-nys.org/wp-content/uploads/2016/04/2016-HCA-Annual-Conference-Detailed-Brochure.pdf. Register online at https://www.eventville.com/Catalog/EventRegistration1.asp?EventId=1011878. 5
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Supreme Court Delays Decision Whether to Hear FLSA Lawsuit Case
CMS Approves OPWDD Waiver
The U.S. Supreme Court has not yet decided whether to review a lower court’s decision on a challenge to the Fair Labor Standards Act (FLSA) final rule despite expectations that the Supreme Court would make such a decision on April 1. (See last week’s ASAP.)
The state Office for People with Developmental Disabilities (OPWDD) has announced that the U.S. Centers for Medicare and Medicaid Services (CMS) has approved the renewal of the 1915(c) OPWDD Comprehensive Home and Community Based Services (HCBS) Waiver.
According to the National Association for Home Care and Hospice (NAHC), the earliest date is now April 15 on which the Court could announce whether it will accept or reject the home care industry’s petition challenging the rule. Each year, the Supreme Court agrees to review only a small percentage of 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. 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 communications with members, HCA has taken a strong stand against the then-proposed U.S. DOL rule because it increases without commensurate funding the cost of overtime for providers in New York State (which already has a minimum wage law – one that is increasing substantially in 2017 with an even higher impact on corresponding overtime calculations without accompanying funding in Medicaid and Medicare payment). Before the rule was implemented, we testified at public meetings, provided written comments on various draft versions of the rule, and offered many education programs for members so that they could prepare for the FLSA changes. Since the rule’s implementation in October 2015, HCA has vigorously worked to get the state to provide funding to compensate home care agencies for their new FLSA-related costs, which is especially important in the context of new labor costs (i.e., minimum wage hike) in the recently enacted state budget. For FLSA and any other labor-related rate appropriations and add-ons, HCA continues to drive the message that the fund-flow must be corrected to ensure payments to providers are direct, timely, all-encompassing of FLSArelated costs, and unencumbered. (See related p. 7 story.) 6
This agreement with CMS, OPWDD and the state Department of Health (DOH) is retroactive to October 1, 2014 and will span over the course of a five-year period through September 30, 2019. In the Waiver renewal, OPWDD and DOH commit to an additional amendment which will occur later in 2016. In preparation for this future amendment, OPWDD will work with stakeholders to begin the implementation of reforms stemming from the work of the Commissioner’s Transformation Panel. A copy of the approved Waiver Renewal can be viewed at http:// www.opwdd.ny.gov/ node/6546/.
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MLTCs Begin Distributing FLSA Dollars; HCA Continues to Pursue Simpler State Distribution Procedures HCA also provides further input on FLSA survey expected to be finalized in two months HCA advises members to act as soon as possible if you have not yet submitted your Fair Labor Standards Act (FLSA) attestation to the state Department of Health (DOH) by the April 1 deadline. There has been some confusion because DOH originally instructed agencies to submit the attestations for their managed care business to their managed care partners and then later changed its policy. The attestations, available at http://www.health.ny.gov/health_care/medicaid/redesign/ fair_labor_standards_act.htm, should be sent to FLSA@health.ny.gov. Home care providers need to indicate on the attestation whether the submission is for fee-for-service (Medicaid) and/or managed care. This week, in order to comply with an April 8 deadline, some MLTC plans started to send FLSA payments to their contracted home care providers. Some divided up the money based on the number of aide hours of all their providers during the October 13, 2015 to March 31, 2016 period; another plan sent money for overtime attributed to that plan. HCA has been advocating to DOH that the plans distribute the funds as an additional $0.34 per each aide hour delivered during this period instead of having plans seek documentation and base payments on overtime and travel expenses as these costs are difficult to divide cleanly from one plan versus another. This is because an aide often provides care to patients in different plans, and it is difficult to attribute overtime to any one plan. HCA presented our proposed distribution method as one that would be better for plans and providers, but there was not consensus among the MLTC plans; state officials have been open to the idea of changing the distribution methods but only in the event of consensus among all stakeholders. HCA has been working at all levels to bring the various health plan representatives to consensus. As mentioned in last week’s ASAP, DOH has posted the amount of FLSA funding each MLTC plan received. (See http://www.health.ny.gov/health_care/medicaid/redesign/2016/2016-03-11_flsa_add_info.htm.) HCA asks that members let us know how the plans are distributing the funds, including the amounts and what they are based on, so we can continue to assess the experiences of providers and plans alike. Survey to be finalized within two months Also, at a meeting this week, HCA provided further input on a draft FLSA survey that DOH and its actuary, Mercer, are developing to ascertain the new costs faced by home care agencies due to the recent FLSA changes. As discussed in many previous editions of ASAP, DOH is making available some funding to compensate agencies for their new FLSA costs for the period October 13, 2015 to March 31, 2016, and it plans to survey providers on their actual costs to determine the need for future funding. Continued on next page 7
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Continued from previous page This week’s meeting with DOH, Mercer and other associations was the culmination of many prior meetings and drafts that HCA shared with some members for their feedback. HCA suggested final revisions in the sections covering overtime, live-in cases and travel expenses and advocated for shortening the questions on travel, mileage and travel expenses. Mercer hopes to finalize the survey in the next two months and then release it for completion. The exact delivery of the survey, how it will be publicized, or the tool to complete it have not been finalized yet. The associations have advocated that DOH/Mercer hold a webinar on the final survey to educate home care providers on how to complete it. Once the survey is final, HCA will encourage its completion since DOH will be depending on survey results to determine the need for any future funding under fee-for-service and managed care to agencies for their FLSA expenses.
QIVAPP Final Awardees Expected Soon The state Department of Health (DOH) has informed HCA that it will soon release the list of awards that certain home care providers will receive under the Quality Incentive Vital Access Provider Pool (QIVAPP) program. The program applies to New York City agencies subject to the Wage Parity Law. In mid-March, DOH sent HCA a final list of those home care providers who qualify for QIVAPP for the period April 1, 2014 through March 31, 2015, but it did not include the funding amounts. DOH won’t publicly release this list with the QIVAPP levels but will send it to us so that we can notify our members. As soon as we receive it, we will inform our providers and ask them to contact Andrew Koski at akoski@hcanys.org or (518) 810-0662 for information. As communicated to members on many occasions, since there is a finite amount of funds to be distributed ($70 million), the amount that each qualifying agency will receive is dependent on the number of awardees, how much they 8
MLTC Reports Issued The state Department of Health has posted the “2015 Managed Long Term Care Report” and “A Consumer’s Guide to Managed Long-Term Care” for various regions of the state. The 2015 Report is at http:// www.health.ny.gov/health_care/ managed_care/mltc/pdf/ mltc_report_2015.pdf and the consumer guides are at http:// www.health.ny.gov/health_care/ managed_care/mltc/ consumer_guides/. The 2015 Managed Long Term Care (MLTC) Report provides information on MLTC enrollment; types of plans; member satisfaction; the Medicaid Redesign Team; Uniform Assessment System; utilization and patient safety; enrollee functioning and activities of daily living; enrollee continence, neurological and behavioral status, living arrangements and emotional status; and plan performance, including enrollee quality of life, access and experience of care, effectiveness of care and emergency room visits, and potentially avoidable hospitalizations. The consumer guides list the plans available in each region; provides a brief summary of MLTC coverage; offers “star ratings” by plan on a variety of indicators for preventive care, satisfaction with care and stability or improvement; and offers an overall star rating.
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may have already received, and how much they are eligible for. Some agencies will receive additional funds, while others may be asked to return funds already received. HCA has inquired with DOH about its plans to provide QIVAPP monies for the period from April 1, 2015 to March 31, 2016 and has been told that no decisions have been made. We expect to participate in a meeting soon with DOH to discuss this issue. Since QIVAPP’s conception, HCA has strenuously advocated that the funds be distributed to all agencies in New York City who have been affected by the state’s Wage Parity law, as well as funds for similarly affected Long Island and Westchester County agencies, and we’ve strongly objected to restrictive qualifying criteria imposed by DOH. We will continue to make these arguments in any discussions about the distribution of future QIVAPP monies.
Flu Vaccination Report is Due in One Month The state Department of Health (DOH) has issued a notification to remind home care and other health care providers that the Healthcare Personnel Influenza Vaccination Report is due by May 2, 2016. The Vaccination Report is a required report of your agency’s influenza vaccination rates. This year’s report covers personnel employed by or affiliated with a facility or agency from October 1, 2015 through March 31, 2016. Note that if personnel work in or are affiliated with more than one agency, then these individuals must be counted in the total number of personnel for each agency where that individual works. DOH advises providers that: Some users may find data from the 2014-15 season preloaded in their report. However, all facilities and agencies regulated under the flu mask regulation are legally mandated to submit a report EACH flu season. The 2015-16 report opened on November 2, 2015; therefore, data submitted prior to November 2, 2015 will NOT count toward compliance with report submission in the 2015-16 season. Users can check the date their report was last submitted by clicking the “Review and Submit” button at the top or bottom of the form. If the date of the report was before November 2, 2015, then the user should click the “Enter or Modify Data” button to edit and resubmit their data. After updating the data, the user should click “Save All” and then “Review and Submit.” Finally, the user must click the “Submit to DOH” button. A report is not complete until the “Submit to DOH” button has been clicked.
The vaccination report, open since November 2, is similar to last year’s. It is a single, longitudinal report for which agencies should enter data when available and resubmit data as often as necessary as new personnel join the agency and/or as they submit documentation of vaccination. The vaccination report is on the Health Commerce System under the Health Electronic Response Data System (HERDS) at https://commerce.health.state.ny.us. Questions about the Healthcare Personnel Influenza Vaccination Report should be directed to DOH’s Bureau of Immunization at either (518) 473-4437 or immunize@health.ny.gov. Step-by-step instructions for completing the report are online at www.health.ny.gov/flumaskreg. Technical questions about the 9
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report or on the use of HERDS should be directed to the Health Emergency Preparedness Program at (518) 408-5163 or hseppny@health.ny.gov. Influenza has been declared prevalent since February 11. This status triggers the requirement that home care and other health care workers who are not vaccinated against influenza must wear surgical or procedure masks in areas where patients are typically present. The mask requirement remains in effect until the DOH Commissioner declares that influenza is no longer prevalent in the state.
HCA Provides Input on MLTC Quality Incentive Payment Program The state Department of Health (DOH) convened its workgroup on the MLTC Quality Incentive Payment Program to review the status, prospective revisions and issues related to the methodology. HCA is a participant on the workgroup. DOH reported that, for the 2016 quality incentive payments, many of the measures will remain the same as for 2015. The incentive payments are derived from quality, satisfaction, compliance and performance efficiency measures. Further breakdown of the metrics, methodology and prospective changes is provided in the DOH meeting slide deck available at http://hca-nys.org/wp-content/uploads/2016/04/ MLTCQIApr16.pdf. During the meeting, HCA provided specific input on both existing and potentially new quality metrics, results and implications for rating/payment. HCA was invited to provide further insights post-meeting, and will be garnering the input of the HCA Quality Committee and HCA MLTC Forum. Our committees have similarly contributed to the input on prior iterations of the state’s process and methodology. The state’s quality incentive payment program expects to allocate about $144 million to MLTCs and Program of All-Inclusive Care for the Elderly (PACE) programs in 2016. The funds for 2015 were just announced today. The program functions as the state’s mechanism to further incentivize quality and performance in MLTChome care. Less than ideally, however, the state funds the program by first carving funds from MLTCs and then redistributing back based on performance, rather than providing the funds as a fundamentally “positive” adjustment. The program nevertheless carries important implications for areas of focus, core aspects of performance and incentives in the current and evolving system. HCA continues to look at how the program’s design and benefits can be maximized for plans, providers and, most importantly, the patients. For example, in this year’s budget, HCA proposed enhancements for additional ways the program could support key elements of MLTC-home care quality. HCA encourages the MLTC and home care agency membership to provide feedback on your experiences – and in response to the attached slide deck – so that HCA may use your feedback for broader planning and comment to the state. For further information, please contact Al Cardillo at acardillo@hcanys.org.
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CMS to Make Correction in the Home Health Pricer Program The U.S. Centers for Medicare and Medicaid Services (CMS) announced this week, via Change Request (CR) 9608, that it has identified an error in the Home Health (HH) Pricer program causing incorrect original Medicare payments to home health agencies. As a result of this error, claims that were recoded to a different payment group were assigned incorrect Health Insurance Prospective Payment System (HIPPS) codes. The HH Pricer program routinely validates whether the HIPPS code on a claim is supported by the appropriate number of therapy services. If the number of therapy services is higher or lower than what’s reflected in the HIPPS code, the HH Pricer re-codes the claim and a HIPPS code corresponding to the actual therapy services is paid. Beginning with the January 2016 update to the HH Pricer, the program performed this action incorrectly when the provider-submitted HIPPS codes begin with 5 or when 20 or more therapy visits are provided and the provider-submitted code is recoded to a HIPPS code beginning with 5. CMS has revised the HH Pricer to correct these errors. The revised HH Pricer will be implemented on April 25, 2016. Then, Medicare Administrative Contractors (MACs) will adjust affected home health claims in order to correct payments. CR 9608 can be accessed at https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/ Downloads/R3487CP.pdf. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
OASIS C2 Available for Preview The Outcome and Assessment Information Set (OASIS) C2 is now available in the “Downloads” portion of the OASIS Data Sets website at https://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/HomeHealthQualityInits/OASIS-Data-Sets.html. This item set version will be effective as of January 1, 2017 and includes three new standardized items, along with the modification and renumbering of select medication and integumentary items in order to standardize with other post-acute care settings. In addition, the look-back period has been modified for five items, and there are several formatting changes throughout the item set. Additional details on the OASIS C2 data specifications can be found within the “Data Specifications” portion on the OASIS website at https://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/OASIS/DataSpecifications.html. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
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Medicare Revalidation Resources Posted Check your status regularly to ensure timely revalidation and active status for Medicare billing The U.S. Centers for Medicare and Medicaid Services (CMS) has posted resources, including a slide presentation and Frequently Asked Questions (FAQs), to help CHHAs and other providers and suppliers with their Medicare revalidation. The slides are at https://www.cms.gov/Outreach-and-Education/Outreach/NPC/National-Provider-Calls-andEvents-Items/2016-03-01-Enrollment.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending; the FAQs are at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/ MedicareProviderSupEnroll/Downloads/Reval_Cycle2_FAQs.pdf. CHHAs are required to revalidate or resubmit and recertify the accuracy of their Medicare enrollment information every five years. CMS is completing Revalidation Cycle 1 under which revalidation notices were sent by March 23, 2015; Revalidation Cycle 2 began last month. Medicare Administrative Contractors (MACs) will send a revalidation notice within two to three months prior to the provider’s revalidation due date, either by e-mail or regular mail. Providers can utilize the Medicare Revalidation Lookup Tool, located at https://data.cms.gov/revalidation, to determine their revalidation due date. The list will include all enrolled providers and suppliers. Those due for revalidation will display a revalidation due date; all other providers not due for revalidation will display a “TBD” (to be determined) in the due-date field. This means that you do not yet have a due date for revalidation and should not submit a revalidation application. The lookup tool will be updated every 60 days. CHHAs should periodically check to see if a due date has been listed for their agency. Providers who are within two months of their listed due dates on the lookup tool are encouraged to submit their revalidation application even if they have not received a notice from their MAC to revalidate. If your application is not received timely, or if you provide additional requested information after the due date, your provider enrollment record will be deactivated. You would then be required to submit a full and complete application in order to reestablish your provider enrollment record and related Medicare billing privileges. In such cases, providers will maintain their original Provider Transaction Access Number (PTAN); however, an interruption in billing will occur during the period of deactivation resulting in a gap in coverage. Providers are also required to revalidate their Medicaid enrollment every five years. More information on that process is at www.emedny.org/info/ProviderEnrollment/revalidation/index.aspx.
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ASAP – a publication of the Home Care Association of New York State
Volume 21, No. 14 April 8, 2016
Round 2 DOH Responses to DSRIP Regulatory Waiver Requests The state Department of Health (DOH) recently published results from Round 2 of the Delivery System Reform Incentive Payment (DSRIP) Regulatory Waiver Requests and Responses. DSRIP Waiver requests were submitted by nine Performing Provider System (PPS) networks this round, including Finger Lakes PPS, Suffolk PPS, Samaritan Medical Center PPS, New York Hospital Medical Center-Queens PPS, Millennium Collaborative Care PPS, Alliance for Better Health Care PPS, CNY Care Collaborative PPS, Westchester Medical Center PPS, and The New York and Presbyterian Hospital PPS. Previous home care-related waivers requested during Round 1 included allowing: Nurse Practitioners (NPs) and Physician Assistants (PAs) to sign physician orders for home health services; CHHAs and/or LHCSAs to expand into additional counties; establishment of new CHHAs; additional types of clinicians to supervise home health aides and to provide supervision other than on-site; waiver of hospice need and geographic limitations; exceptions to the 90-day time limitation for Medicaid billing due to late signed physician orders; use of the Uniform Assessment System instead of the Outcome and Assessment Information Set (OASIS); hospices to bill for palliative care; hospice residences in Article 28 facilities; and Article 28 providers to serve patients at home. During Round 2, PPS networks made several similar requests including: CHHA and LHCSA expansion; allowing Article 28 providers to serve patients at home and be reimbursed for those services; and permitting additional clinician types to supervise aides. Also, PPS Networks asked to: allow NPs/PAs to sign off on Medical Orders for Life-Sustaining Treatment (MOLST); modify evaluation frequency for physical therapy patients; broaden supervision of aides by licensed therapists; and lengthen the timeframe allowed for initial assessment of a new home care patient. To see the full list of Round 2 waiver requests and DOH responses for each PPS request, visit http:// www.health.ny.gov/health_care/medicaid/redesign/dsrip/regulatory_waivers_round2/index.htm; similar information on the Round 1 waiver requests are at http://www.health.ny.gov/health_care/ medicaid/redesign/dsrip/regulatory_waivers/index.htm. Waiver requests can be submitted on a quarterly basis by PPS networks to DOH. If home care providers are interested in exploring regulatory waivers to facilitate more robust DSRIP participation, they are encouraged to discuss this with their PPS network(s). HCA is happy to work with members to explore areas where regulatory waivers may be helpful and appropriate. If you have further questions, please contact Alex Blais at ablais@hcanys.org.
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ASAP – a publication of the Home Care Association of New York State
Volume 21, No. 14 April 8, 2016
New DSRIP Timeline Posted The state Department of Health (DOH) has posted an updated timeline for the Delivery System Reform Incentive Payment (DSRIP) program. It is at http://www.health.ny.gov/health_care/medicaid/redesign/ dsrip/timelines/index.htm. DSRIP Year 2 began on April 1, 2016 and the timeline has been updated to reflect the recent announcement of public comment days on New York’s 1115 Waiver programs. Also updated were the dates for the Performing Provider System (PPS) Regional Learning Symposiums and the deadline for the Value Based Payment Roadmap Public Comment period. The downstate public comment day is May 4 in New York City, at the NYU Kimmel Center (60 Washington Square Park South), from 9:30 a.m. to 2:30 p.m. The upstate public comment day is June 10 in Albany at the Empire State Plaza, meeting room no. 6. That meeting will go from 10:30 a.m. to 3:30 p.m. More details and logistical information will be circulated as the events draw closer. These meetings will be webcast live and will be open to the public. No pre-registration is required. Individuals who wish to provide comment will be asked to register on site. Any questions should be sent to DSRIP@health.ny.gov.
“Collaborating on Emergency Preparedness” Sessions Begin in WNY HCA and state partners in emergency preparedness – the New York State Association of Health Care Providers (HCP), the state Department of Health (DOH), regional DOH offices, and the state Department of Homeland Security Services – began major local collaboration meetings this week for home care providers, hospices, local public health and county emergency managers. The first two of these meetings were held Tuesday, April 5, in Rochester and Williamsville. Each site hosted providers and emergency managers from six surrounding counties, with 12 counties (total) covered in these opening meetings. HCA and HCP teamed to provide (especially for the local managers) an overview of home care and hospice, emergency preparedness protocols and challenges for home care/hospice providers, the roles of our associations in emergency preparedness and other important takeaways. A copy of the slide deck (this particular version citing the Rochester county grouping) can be viewed at http://hca-nys.org/wpcontent/uploads/2016/04/EP-SlideDeck-HCAHCP-WNY-Sessions-Rochester.pdf. Emergency managers teamed to provide the home care and hospice participants with core background on their roles, jurisdictions, services, and challenges in emergency preparedness. The presentations promoted excellent questions, discussions and insights for critical ways of collaboration. Breakout sessions then followed, with each county’s providers and emergency managers meeting separately to further exchange information, needs and ideas, which were then brought back into general discussion to create a summary of major points, recommendations and next steps. The next session is planned for April 26, to be hosted in Elmira for the surrounding counties of Chemung, Schuyler, Seneca, Steuben and Yates. The registration/background/agenda flyer can 14
ASAP – a publication of the Home Care Association of New York State be viewed at http://hca-nys.org/wp-content/ uploads/2016/04/Collaborating-on-EmergencyPreparedness-Meeting-Elmira-April-26-2016.pdf. All home care and hospice providers serving these counties are urged to attend. The link to register is found at the end of the flyer.
Volume 21, No. 14 April 8, 2016
NYC HRA Releases New Authorization Form The New York City Human Resources Administration (HRA) has posted a revised form, “Authorization for Release of Health Information Pursuant to HIPAA,” to replace its existing form, “Authorization for Disclosure of Health Information.”
HCA, HCP, DOH and other partners will be compiling an action plan in follow-up to these sessions aimed to further support local collaboration efforts, and, particularly, the further and effective integration of home care patients and providers into the local emergency management planning, preparedness and response processes.
The new form is at http://www.wnylc.com/ health/entry/140/. It is also on the MAP Authorized Resource Center (MARC) at http://a069-marc.nyc.gov/marc/ default.aspx (log in required) under Medicaid Alerts; the prior form won’t be accepted after April 30.
Similar sessions are planned progressively region-toregion, until we have covered the entire state. Stay tuned for more information and detail on these sessions, our follow-up, and overall home care and health care emergency preparedness developments.
The form is used when consumers are authorizing a third party to represent them and/or to receive a copy of their Medicaid records.
For more information, contact Al Cardillo (acardillo@hcanys.org) or Alex Blais (ablais@hcanys.org).
HCA recommends that New York City providers register with MARC so that they can obtain access to a variety of helpful resources.
OMIG 2016-17 Work Plan Now Available HCA provides more details in a longer article on our website
Updated Medicaid Levels Posted
OMIG has released its 2016-17 Work Plan, detailing the areas of focus in the Medicaid program for State Fiscal Year April 1, 2016 to March 31, 2017.
The state Department of Health (DOH) has posted updated levels for various Medicaid and Medicaid-related programs for 2016. The guidances are at http:// www.health.ny.gov/health_care/medicaid/ publications/pub2016gis.htm (see GIS 16 MA/07).
According to OMIG, this year’s Work Plan continues a focus on organizing work according to categories of service. Building on the 2015-16 Work Plan, OMIG continues to utilize its Business Line Teams across a number of areas, including but not limited to the Delivery System Reform Incentive Payment (DSRIP) program, Managed Long Term Care, Transportation, Home and Community Care Services, and Managed Care.
These include new levels for the Medicare Savings Programs that help to pay for Medicare premiums, deductibles and copayments and also qualify recipients for low-income assistance with Medicare’s Part D drug benefit.
Further, OMIG will continue to emphasize provider outreach and education, particularly focusing on 15
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ASAP – a publication of the Home Care Association of New York State
providers having proactive compliance programs that will prevent or, when necessary, detect and address abusive practices. The 2016-17 Work Plan, and plans from previous years, are at: https://www.omig.ny.gov/index.php/ information/work-plan. It outlines several areas of focus in home care, LTHHCP and CHHA rates, compliance program review and managed care. To learn more about these focus areas, download the report or read a longer version of this article posted to our website, highlighting key categories of OMIG focus. HCA has posted this article in our General News section of the website at http://hca-nys.org/category/general-news.
IPRO Sepsis Initiative Incorporates HCA Screening Tool, Home Care Training Upcoming April 15 Session in Glens Falls with More Regions to Come IPRO has begun conducting train-the-trainer programs in New York State under a two-year Community Based Sepsis Initiative, supported by the federal government, to tackle the number-one driver of readmissions in New York State and a leading cause of morbidity and mortality across the nation – sepsis. A key component of the IPRO training is the incorporation of the HCA-developed home care sepsis screen and algorithm for early sepsis recognition and intervention. Though yet to be formally launched by HCA, the innovative home care screen and algorithm is the first-of-its kind nationally and developed following more than a year of rigorous development and vetting with HCA home care clinicians, prominent physicians, the National Sepsis Alliance and other experts. The HCA tool has also been featured by the Federal Centers for Disease Control and Prevention (CDC) in its web posting. IPRO’s next regional training is scheduled for April 15 in Glens Falls and additional programs for home health and skilled nursing facilities will soon be scheduled in the Poughkeepsie, Utica and Syracuse regions. The objective of this project, targeted to the Syracuse and Albany hospital referring regions, is to reduce sepsis-related morbidity, mortality and complications through education and consistent use of protocols and best-practices among pre-hospital providers. In New York State, sepsis cases increased 68 percent from 2005 to 2011. Nationwide, sepsis is Medicare’s single most expensive condition. Yet a recent national survey revealed that less than half of all Americans have heard of sepsis. The state’s sepsis education is currently focused on acute care and emergency department care settings, which is why this IPRO initiative is important: to engage non-hospital organizations. IPRO has developed multiple setting-specific, evidence-based educational tools and materials to provide training to home health agencies and other non-hospital providers through a “Train-the Trainer” format. The program emphasizes early recognition of sepsis signs and symptoms, best-practice protocols for referral to the next level of care (when necessary) and improving care transitions. HCA is an important partner in this effort, having formed a sepsis workgroup – led by Amy Bowerman, RN, Director, Quality Improvement Officer for the Mohawk Valley Health System – to develop a sepsis screening tool in home health. This comprehensive and easy-to-use Home Care Services Adult Sepsis
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Volume 21, No. 14 April 8, 2016
Screening SBAR Tool is the first of its kind. It provides an assessment of the patient’s status with regards to vital signs, indications of organ dysfunction, and presence of confirmed or suspected infection. The tool has three parts, each with specific instructions for home health staff contingent upon responses to the elements on the tool. The tool, however, is not a form of standing orders and provides only recommended interventions. On April 5, IPRO held the first training session on the Home Care Services Adult Sepsis Screening SBAR Tool. It garnered a lot of positive feedback, and the IPRO sepsis team looks forward to upcoming training sessions. This article was prepared in conjunction with IPRO staff.
February Global Cap Report: Spending $56M Over Projections The state Department of Health (DOH) has issued its monthly Medicaid Global Cap report. This latest report, for February, covers the period of April 1, 2015 through February 29, 2016. It finds that overall spending for this period was $56 million above Medicaid Global Cap projections, across all sectors, a difference of $16.661 billion in actual spending versus $16.605 billion in estimated spending for the eleven-month period. Specifically, DOH mentions the following two significant pressures on the Global Cap:
Significant enrollment growth in the MLTC program. Year-to-date growth (through September) was 11,000 individuals, primarily in New York City (68 percent). The original estimates only assumed an annual growth of 10,000 and have been revised to reflect projected growth of 16,375 recipients; and
A recent court ruling on the Fair Labor Standards Act (FLSA) requiring overtime to be paid at time and one-half of wage, with travel time as compensable hours, and changes to live-in rules for home care. (See related p. 6 and 7 stories.)
While FLSA costs are, indeed, adding pressure, the final state budget process has added even newer pressures with the passage of a phased-in $15-per-hour statewide minimum wage. During a meeting on minimum wage this week with Jason Helgerson, the state’s Medicaid Director, state officials shared documents that show extra state appropriations in the Global Cap, some of which are to account for increased Medicaid rates due to the minimum wage increase. Those increases (for minimum wage and other factors not discussed at the meeting) include $58 million in fiscal year 2016-17, increasing to $160 million in fiscal year 2017-18. (See related p. 1 story for specifics on the minimum wage appropriations.) HCA will continue to urge the Governor’s office and lawmakers to make sure any adjustments to the Global cap match the true costs for providers impacted by the Governor’s new minimum wage mandate. According to the Global Cap report, the category that includes home care (“Other Long Term Care”) was $11 million over projected spending. The Department shows actual spending of $622 million versus 17
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projected spending of $611 million, a slight difference from the December 2015 report, which showed “Other Long term Care” services as being even with estimated spending. Medicaid Managed Care (MMC) was $19 million over projections, a difference of $11.878 billion (actual spending) versus $11.859 billion (estimated spending), which is still significantly better than the September 2015 report, when MMC spending was $81 million over estimates. Medicaid total enrollment reached 6,198,505 enrollees at the end of February 2016. This reflects an increase of 22,483 enrollees, or 0.4 percent, since March 2015. The full report is at http://www.health.ny.gov/health_care/medicaid/regulations/global_cap/monthly/ sfy_2015-2016/docs/february_2016_report.pdf. The Medicaid Global Cap for the current fiscal year (April 1, 2015 to March 31, 2016) is $17.7 billion for all sectors. HCA is surveying these global cap reports carefully in an information gathering effort, combined with other data analysis, to ensure accurate reflections of home care finances, with an eye toward any indication of rate or payment decisions stemming from the state’s analysis of home care’s performance. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
Publications
“Report on Early Implementation of Demonstrations under the Financial Alignment Initiative,” by the U.S. Centers for Medicare and Medicaid Services https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-MedicaidCoordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/ Downloads/MultistateIssueBriefFAI.pdf
“Long-Term Supports and Services as a Logical Next Step in the Evolution of Bundled Payments,” by Care at Hand, Inc. http://www.annalsoflongtermcare.com/print/4067
“The Role of Hospitals in Improving Non-Medical Determinants of Community Population Health,” by the United Hospital Fund http://nyshealthfoundation.org/uploads/resources/community-population-health-report-april2016.pdf
“Health Information Privacy – Overview,” by the New York Legal Assistance Group http://www.wnylc.com/health/entry/118/
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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