ASAP
A Weekly Publication Of HCA Home Care Association of New York State
Legislative Issues Public Policy
News
Volume 20, No. 14 April 10, 2015
Extended Hotel Deadline Is One Reason to Register Now for HCA’s Annual Conference, With an Eye Toward all of the Great Benefits! Registration is still being accepted for our signature Annual Conference and Leadership Summit on May 6-8; and the Saratoga Hilton, the site of the conference, has increased our block of discount rooms and extended the deadline for reservations to April 17. While the hotel deadline is a very good reason to act now, here are some even better reasons why you’ll want to register to attend this signature program: •
You’ll learn about new ideas, perspectives and approaches on an assortment of topics that affect home health, including: how to analyze and address the health care needs of your See HOTEL p. 3
DOH to Hold April 15 QIVAPP Program The state Department of Health (DOH) has scheduled a program on April 15 (11 a.m. to noon) to provide information about the Quality Incentive Vital Access Provider Pool (QIVAPP) program in response to questions raised by HCA and other organizations. As HCA has repeatedly advised members who provide aide services in New York City, all home care providers who are receiving QIVAPP monies as part of the initial state-share payment to Managed Long Term Care Inside ASAP (MLTC) plans – as well as providers who expect to Extended Hotel Deadline for HCA’s Annual Conference......................1 DOH to Hold April 15 QIVAPP Program..............................................1 Senate Leader, Others Lend Support to NAHC FLSA Suit....................4 Value Based Payment Roadmap Enters Next Phase..............................5 Managed Care Update..........................................................................5 eMedNY Posts Transportation Guidance.............................................5 DAL Posted on HHA Training Programs................................................6 DSRIP Update.........................................................................................7 NYS Home Health and Hospice Care Profile Website Updated...........7 OMIG Issues DSRIP Compliance Guidance...........................................8 NGS: Resubmit TPL Demand Claims Rejected with Code 38308...........9 Update on Hospice Election Form, Revocations, Attending Physicians...9 ePOC to Resume Soon.........................................................................10 Important Initiative on Cardiovascular Health: Join Today................10 Member Hiring Announcement...........................................................11 April 2015 Home Health Compare Update..........................................12 Emergency Preparedness Developments and Activities....................12 Next Generation ACO Model Open Door Forum Announced............14 Clarification: Rescinding 2% Cut to TBI and NHTD Providers............14 Clarification on NHTD QA Reviews and Vehicle Modification............15 State Releases January Medicaid Global Cap Report........................15 Publications..............................................................................................16
See QIVAPP p. 2
Helping New Yorkers Feel Right At Home
ASAP – a publication of the Home Care Association of New York State
Volume 20, No. 14 April 10, 2015
QIVAPP from p. 1 receive QIVAPP funds when federal approval is granted – should be sending attestation forms and updated aide hour data to their contracted MLTC plans. The plans have until May 1 to submit this information to DOH. Home care providers that don’t submit the required information will not be eligible for further or initial QIVAPP monies. HCA has raised questions with DOH about the process by which home care providers were selected to receive the initial state-share QIVAPP funds, particularly why agencies that sent the required information to MLTC plans in August and/or December were not part of the recently announced awards. HCA has also sought to ensure that those selected to receive the share of QIVAPP monies pending federal approval will receive the same proportionate amount of funding (based on the number of documented aide services) as the initial awardees. HCA will continue to advocate for a fair distribution of the funds. Registration for the April 15 Webinar is at https://iproevents.webex.com/iproevents/onstage/g.php?d=667837100&t=a. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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
2
ASAP – a publication of the Home Care Association of New York State
Volume 20, No. 14 April 10, 2015
HOTEL from p. 1 entire patient population; understanding what is important to caregivers as they apply for jobs at your organization; the mechanics of value based payment models; and strategizing on how to become a valued partner with physicians. •
Take your learning yet a step further by attending the Leadership Institute that follows the Annual Conference at the same location. Members have regularly asked us for more leadership skills-enhancement programming, so HCA has arranged for the American College of Healthcare Executives (ACHE) to bring its half-day workshop on “The Courage to Lead: Critical Skills for Healthcare Leaders” right to your door at an affordable cost. Whether you’re an experienced leader or just starting out in management, this workshop will help you uncover your leadership style and build a winning team. In addition, you’ll earn ACHE face-to-face credits as well as contact hours from the National Association of Long Term Care Administrator Boards (NAB).
•
You’ll also learn about new products and services from a number of vendors who will be with us throughout the conference. HCA realizes you have little time to visit with all the vendors who contact you each week, but, at the Annual Conference, you’ll have the opportunity to get acquainted with several exhibitors offering quality products and services.
•
The Annual Conference is a chance to recharge your batteries in beautiful Saratoga Springs. We also have several world-class presenters to inspire you, including Tom Clynes, an author and photographer who contributes regularly to National Geographic and Popular Science magazines. You’ll also regain that “can-do” attitude after hearing T.R. Reid, author of the national best-seller “The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care,” about what he has uncovered when it comes to improving the quality of care while containing costs even in small communities across America.
•
HCA has built in some fun time, too, as you network with your peers during the Beach and Trivia Night PAC fundraiser and make the rounds at several establishments throughout town during Pat’s Pub Crawl, led by HCA’s own Patrick Conole.
So, take a break from your daily routine, learn new things to bring back to your organization, have fun with your peers, explore new opportunities and enhance your leadership skills on May 6 to 8 in Saratoga Springs. Learn more at www.hcaannualconference.com. Here you’ll find the hotel and registration information as well as full descriptions of the programs and biographies of the presenters. This program is a sound investment of your time – register today! For more information, contact Lynda Schoonbeek at (518) 810-0656 or Lschoonbeek@hcanys.org.
3
ASAP – a publication of the Home Care Association of New York State
Volume 20, No. 14 April 10, 2015
Senate Leader and Advocacy Groups Lend Support to NAHC Companionship Exemption Suit as DOL Sends Compliance Letter to States The National Association for Home Care and Hospice (NAHC) has reported that U.S. Senate Majority Leader Mitch McConnell was among 10 leading members of Congress last week who submitted a “friend of the court” brief, also known as an amicus curiae brief, supporting NAHC’s position in its lawsuit against the U.S. Department of Labor (DOL) over new regulations that would redefine the “companionship services” and “live-in” exemptions under the Fair Labor Standards Act (FLSA). Also submitting supportive briefs were nine state Attorneys General, as well as two leading disability groups — ADAPT and the National Council on Independent Living (NCIL) — and the Consumer Directed Personal Assistance Association of New York State. The Congressional amicus brief states: The DOL’s amended regulations relative to the companionship and live-in exemptions ignore the plain statutory language and subvert Congressional intent, with potentially devastating effects to the aged and infirm and their families. There are no ‘winners’ to be found in this new regulatory scheme. The effects Congress clearly sought to avoid in 1974 by creating this limited exemption from the FLSA [Fair Labor Standards Act] and in maintaining the status quo on the exemption after the decision in Coke in 2007—namely, increased costs and institutionalization of our elderly and infirm populations—will clearly be the end result if the District Court’s Orders are overturned and these regulations are reinstated. These policy decisions have already been made by Congress, and the DOL cannot undo those decisions and substitute its own judgment in their place. As previously reported to members, DOL appealed the U.S. District Court’s ruling that invalidated multiple regulations issued by DOL to eliminate the “companionship services” exemption from minimum wage and overtime compensation requirements under the FLSA. The court also invalidated a DOL rule that would prohibit home care companies from applying the companionship services and live-in domestic services exemptions to their workers. The Court of Appeals for the District of Columbia will consider the appeal with oral arguments before a three-judge panel scheduled for May 7, 2015. DOL Sends Letter on Companionship Exemption Issue Meanwhile, on March 20, the DOL commissioner sent a letter to state governors about compliance with changes in the FLSA “companionship exemption” rule that are on hold pending a court decision expected sometime in July. DOL’s letter encourages states to conduct an analysis of all their home care programs to determine whether any changes must be made to comply with the rule and still be in compliance with a state’s obligation under federal regulations to “administer services, programs and activities in the most integrated setting appropriate to the needs of qualified individuals with disabilities.” States are advised to “consider whether reasonable modifications are necessary to avoid placing individuals who receive home care services at serious risk of institutionalization or segregation.” The letter mentions that some states are planning to comply with the new rule by setting limits or capping direct care workers’ hours or travel time and reinforces that implementation of across-the-board caps risks violating 4
ASAP – a publication of the Home Care Association of New York State
Volume 20, No. 14 April 10, 2015
the Americans with Disabilities Act if the caps do not account for the needs of individuals with disabilities and places them at serious risk of institutionalization or segregation. The letter is at http://www.hca-nys.org/documents/dolletter03202015.pdf. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
Value Based Payment Roadmap Enters Next Phase The state Department of Health’s (DOH) draft Roadmap for a value based payment (VBP) system in New York State is entering a next, critical phase.
Managed Care Update The state Department of Health (DOH) has posted an updated timeline of mainstream Medicaid managed care transition at http:/ /www.health.ny.gov/ health_care/medicaid/redesign/ docs/mrt1458_timeline.xls. As reported in the prior, March 13, version, the following will transition to managed care: •
January 1, 2016: Nursing Home Transition and Diversion; Care At Home Waivers 1 and 2; and Office for People with Developmental Disabilities Care At Home Waivers 3, 4 and 6
•
April 1, 2016: Traumatic Brain Injury
•
December 1, 2016: Individuals with a “spend-down”
This phase will include: final edits to the Roadmap draft; submitting the draft to the U.S. Centers for Medicare and Medicaid Services (CMS); and convening expert subcommittees to analyze it. DOH has now produced a fourth draft of the Roadmap document, with revisions addressing comments from VBP workgroup members (including HCA), other interested parties and the broader public. The latest DOH timeline will: •
Receive a last round of workgroup member edits by April 15;
•
Submit a “final” document to CMS during the week of April 20;
•
Receive CMS approval by mid-to-late May;
•
Convene the VBP workgroup on next steps in late May; and
•
Convene subcommittees in June – or soon thereafter – to address such areas as: technical design; regulatory impact; social determinants of health; community based organizations; communications; and integrated care services.
The slide deck to this week’s workgroup meeting and the fourth Roadmap are at the following links: •
http://www.hca-nys.org/documents/ VBPWorkgroup4Meeting.pdf Continued on next page 5
eMedNY Posts Transportation Guidance eMedNY has posted an updated transportation manual for providers at https:// www.emedny.org/ ProviderManuals/ Transportation/PDFS/ Ordering_Guidelines_Manual.pdf.
ASAP – a publication of the Home Care Association of New York State
Volume 20, No. 14 April 10, 2015
Continued from p. 5 •
http://www.hca-nys.org/documents/VBPRoadmapFourthDraftClean.pdf
HCA’s representative at the workgroup meeting, Al Cardillo, Executive Vice President, stressed the need for: •
A flexible model design and timing to accommodate home care readiness.
•
An examination of how VBP models should be fashioned to enable, incentivize and/or ensure participation of community-based providers in the delivery reforms that will produce the desired savings and reinvestment. HCA and other workgroup members noted that both the DSRIP (Delivery System Reform Incentive Payment) program and VBP still incentivize hospital-centric solutions, whereas hospital collaboration with and among physician groups, home and community-based providers and other disciplines has long been the vision for cross-sector partnerships.
•
Infrastructure investment in home and community based care to support capacity, readiness and successful implementation of VBP. Neither DSRIP, nor the enacted budget, adequately address this for home care.
•
The need for health information technology investment and interoperability for VBP in order to support data exchange and analysis.
•
Regulatory flexibility aimed at alignment and efficiency for all collaborating partners’ participation in VBP.
•
State agencies to do their part to examine state-driven or enabled inefficiencies in the system. HCA has urged a review and mitigation, wherever possible, of regulatory mandates and other conditions creating high input costs to providers and managed care plans that, if addressed, would further enable efficiency, savings and reinvestment back into the provider-health plan system.
DOH said it is considering, in connection with VBP, potential expansion of the functions/coverage of Managed Long Term Care plans as well as a particular role for Long Term Home Health Care Programs. DOH indicated that it would be reaching out specifically to HCA in this effort. HCA will be submitting additional recommendations on VBP and the draft Roadmap in particular. Further comments on the draft are due by April 15; HCA invites any members to share comments or edits via e-mail. Please submit any such comments to Al Cardillo at acardillo@hcanys.org.
DAL Posted on HHA Training Programs The state Department of Health (DOH) has posted a Dear Administrator Letter (DAL) to the Health Commerce System/HCS (under ‘Newsroom Highlights’) to remind home health agencies that conduct Home Health Aide Training Programs (HHATPs) about two requirements and to request evaluation information. The DAL notes that, per the “Guide to Operation of a Home Health Aide Training Program” (pages 11 and 12), all HHATPs are required to have policies and procedures describing their quality management program and the annual evaluation of the training program. Quality management processes need to focus on the overall operation of the training program. Program monitoring must be conducted on at least a quarterly basis; documentation of this monitoring must be included in the quality assurance minutes of the sponsoring agency. In addition, an annual evaluation report must 6
ASAP – a publication of the Home Care Association of New York State be submitted to the sponsoring agency’s governing authority and to the applicable DOH Regional Office with the re-approval application. This year, to ensure statewide compliance with the program monitoring component, the Division of Home and Community Based Services is requiring all HHATPs to provide a copy of the 2014 (or 2013) annual evaluation report by April 30, 2015 to: Marjorie Brier-Lynch, RN, NYS Department of Health, Division of Home and Community Based Services, 875 Central Avenue, Albany, NY 12206. Training Class Schedules The DAL also reminds HHATPs, as described on page 14 of the Guide, to provide the applicable DOH Regional Office with a schedule of anticipated classes every six months (each April 1 and October 1). Any changes to the submitted schedule should be reported as soon as they occur. The schedule must include the dates, times and location of each class and the name of the approved Nurse Instructor for each class. DOH has posted a form and instructions to transmit information about training classes to the Regional Office and a list of these offices. Any questions about the DAL should be directed to homecare@health.ny.gov.
Volume 20, No. 14 April 10, 2015
NYS Home Health and Hospice Care Profile Website Updated The state Department of Health (DOH) has recently updated the data on its Home Health and Hospice Care Profile website: http:// homecare.nyhealth.gov/. DOH has created this site for consumers and providers seeking information about home health agencies and hospice programs in New York. This latest data update includes quality data published and reported through September 2014 as well as: •
Updated facility names, addresses, counties served, available services, and branches data;
•
Added deemed status for two facilities; and
•
Updated enforcement actions through March 10, 2015.
DSRIP Update The state Department of Health (DOH) has updated its information on Certificates of Public Advantage (COPA) and posted a revised Measure Specification Manual for the Delivery System Reform Incentive Payment (DSRIP) Program. DOH has posted summaries of COPA applications at: https://www.health.ny.gov/health_care/medicaid/redesign/copa/. The Public Health Law establishes a process for providers to apply for a COPA for their collaborative arrangements such as mergers and clinical integration agreements. Parties that have received a COPA are provided state action immunity under federal antitrust laws and immunity from private claims under state antitrust laws and may negotiate, enter into, and conduct business pursuant to a Cooperative Agreement or a planning process covered by a duly issued COPA. Before granting a COPA, DOH will consult with the Office of the Attorney General and, if appropriate, the Office of Mental Health, 7
For further information, contact Patrick Conole at (518) 8100661 or pconole@hcanys.org.
ASAP – a publication of the Home Care Association of New York State
Volume 20, No. 14 April 10, 2015
the Office of Alcoholism and Substance Abuse Services and/or the Office for People With Developmental Disabilities, and receive a recommendation from the Public Health and Health Planning Council (PHHPC). The following COPAs have been posted: •
Staten Island Performing Provider System
•
Advocate Community Providers Performing Provider System
•
Adirondack Health Institute Performing Provider System
DOH is accepting comments on these applications until April 22. Measure Specification Manual DOH has posted the DSRIP Measure Specification Manual which was submitted to the U.S. Centers for Medicare and Medicaid Services on April 3, 2015 for its review and approval. A draft manual was originally released in October 2014 for public comment. The revised manual is at http://www.health.ny.gov/health_care/medicaid/ redesign/dsrip/cms_official_docs.htm. The manual contains information about the reporting requirements for performance measures associated with projects. The manual describes the data sources, measure steward, resources, reporting timeframes, required information to be provided by the Performing Provider Systems, and file layouts. The manual also contains the performance goals for the measures in Domain 3, the methodology for establishing the annual improvement target, and the mechanism for achieving high performance funds for the ten measures identified for the extra payment.
OMIG Issues DSRIP Compliance Guidance The state Office of the Medicaid Inspector General (OMIG) has posted on its website DSRIP Compliance Guidance 2015-01: Special Considerations for Performing Provider System (PPS) Leads’ Compliance Programs. The Delivery System Reform Incentive Payment (DSRIP) Compliance Guidance is available at: http://www.omig.ny.gov/dsrip-compliance-guidance. It is specific to the mandatory compliance programs that must be in place for PPS Leads. OMIG notes that PPS Leads must meet all of the mandatory compliance program obligations in New York Social Services Law Section 363-d and 18 New York Code of Rules and Regulations Part 521. DSRIP Compliance Guidance 2015-01 lists some special considerations that PPS Leads should incorporate into their compliance programs, including eight elements. Some of these include: •
PPS Leads must have policies and procedures that describe compliance expectations specifically related to DSRIP funds. Continued on next page 8
ASAP – a publication of the Home Care Association of New York State
Volume 20, No. 14 April 10, 2015
Continued from p. 8 •
The PPS Lead is responsible for training and education of all affected employees, persons associated with the PPS network providers, and persons associated with the PPS Lead, including executives and governing body members on compliance issues and expectations.
•
The PPS Lead’s policies and procedures must include disciplinary policies and procedures to encourage good-faith participation in the compliance program by all affected individuals, including those from PPS network providers.
•
The PPS Lead must develop and implement a system for routine identification of compliance risk areas specific to their provider type (i.e., PPS Lead). The PPS Lead’s system should include a plan for auditing/monitoring how network partners are utilizing DSRIP funds.
Since the PPS Lead is dependent upon the actions of their network partners for the compliance program to be fully implemented and effective, OMIG recommends that support of the compliance program requirements be incorporated into any contract the PPS Lead has with network partners.
NGS: Resubmit Home Health TPL Demand Claims Rejected with Claim Level Code 38308 National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), has identified a system issue that specifically impacts some home health Third Party Liability (TPL) demand bill claims submitted by agencies in New York. According to NGS, TPL demand bill claims properly submitted with condition code 20 were not suspended for additional document review (ADR) but were rejected with claim level reason code 38308. NGS is asking impacted home health agencies to resubmit any rejected TPL demand bill claims without going through the ADR process (i.e., your agency did not receive a request for medical records and the demand claim was not reviewed by Medical Review). NGS notes that if an agency’s request for anticipated payment (RAP) has been cancelled by the system, the agency should resubmit the RAP and TPL demand bill claim. HCA understands that these resubmitted claims will not be rejected again if the claim is past the timely filing period to submit claims. HCA has asked impacted provider members to contact Patrick Conole at pconole@hcanys.org if any of the resubmitted TPL demand bill claims are rejected for being submitted untimely. 9
Update on Hospice Election Form, Revocation and Attending Physician The U.S. Centers for Medicare and Medicaid Services (CMS) has issued Change Request (CR) 9114 which informs Medicare Administrative Contractors (MACs) about the implementation of changes finalized in the Fiscal Year 2015 hospice final rule regarding hospice election, revocation, and designation of attending physician. These changes are detailed in the revised portion of the “Medicare Benefit Policy Manual,” which is attached to CR9114 and can be downloaded at: http://www.cms.gov/ Outreach-and-Education/ Medicare-LearningNetwork-MLN/ MLNMattersArticles/ Downloads/ MM9114.pdf. Hospices should make sure their billing staffs are aware of these changes. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
ASAP – a publication of the Home Care Association of New York State
ePOC Resumes on May 1 The state Department of Health (DOH) has issued a Dear Administrator Letter (DAL) announcing the resumption of the Electronic Plan of Correction (ePOC) for home health agencies staring on May 1. ePOC is an application to automate the distribution of Statements of Deficiency (SODs) to home care providers and the receipt of Plans of Correction (POCs) from home care providers. This application will ultimately eliminate the sending of hard copy SODs and POCs by surface mail, streamlining the communications between the Department and providers. The ePOC application is accessible via the Health Commerce System (HCS). Provider access to the application will be governed by HCS roles, some currently existing but also some new ones. The current roles used by the system are Administrator, Director of Patient Services, Governing Body Chair or Member and HCS Coordinator. In addition, to support the application, two new roles have been created: Operator and ePOC Editor. Individuals who have been assigned the Administrator, Director of Patient Services, HCS Coordinator, ePOC Editor, Governing Body Chair or Member, and Operator roles will be able to read SODs for their agency and the corresponding POCs. Those designated as Administrators, Directors of Patient Services, HCS coordinators, and ePOC Editors will be able to write POCs for their agency. Only those
Volume 20, No. 14 April 10, 2015
individuals in the Administrator role will be able to submit POCs to DOH on behalf of their agency. The new Operator role represents a change in DOH policy. In the past, SODs have been sent directly to agency operators and the agency administrators have been secondary recipients. With ePOC the agency administrators will be the primary recipient of the SODs. It will be the responsibility of the agency to communicate SODs to any governing authority or operating organization; agencies must develop the necessary policies and procedures to ensure that such communication occurs. According to DOH, the Operator role was created to facilitate agencies with providing access to the SODs and POCS by individuals representing the governing authority or operator. The DAL references links to training and resources documents including a set of Questions and Answers (Q&As). According to the Q&As: •
Almost all survey types are included in ePOC, including recertification, complaint surveys and revisit surveys.
•
Agencies will be notified of a SOD by email. Upon receipt, the agency should then check the ePOC system. Due dates will be displayed on the right-hand column for each citation.
•
Agencies should submit POCs one by one instead of waiting for all completed POCs before submitting.
Questions about ePOC should be directed to homecare@health.state.ny.us.
Join Important, Timely Initiative on Cardiovascular Health through Home Care If you have not already done so, please consider joining your peers in the U.S. Centers for Medicaid and Medicaid Services Home Health Cardiovascular Improvement Initiative (HHCII). This initiative gives home care some important visibility on this high-profile, priority health concern. It also demonstrates at all levels home care’s effectiveness in collaborative health management, including its role in primary and secondary prevention. HCA has teamed with our region’s Quality Improvement Organization, IPRO, and the Home Health Quality Improvement Campaign (HHQI) to promote agency participation in this program, and, ultimately, adoption of related protocols and practices. As the state and federal payment systems begin to move rapidly toward value 10
ASAP – a publication of the Home Care Association of New York State
Volume 20, No. 14 April 10, 2015
and consultation, free of charge, to agencies who agree to participate in this effort.
based payment (see related p. 5 story), and as the state proceeds with Delivery System Reform Incentive Payment (DSRIP) and related reforms, home care agencies have a critical opportunity to demonstrate their contribution to cardiovascular health care.
The HHCII has, at its core, the Home Health Cardiovascular Data Registry (HHCDR) which focuses on the ‘A BC ’ metrics and provides participating agencies with powerful cardiovascular health reports that are unique to HHQI.
HCA has previously provided background and resource opportunities for providers interested in stepping ahead in this effort, including numerous informational pieces in ASAP, featured presentations at our November 2014 Quality Symposium, support through our Quality Committee, and inclusion within our current legislative proposals.
To learn more, visit the HHQI Website at: h t t p : / / w w w. h o m e h e a l t h q u a l i t y . o r g / Cardiovascular-Health/CardioLAN.aspx. If you are interested in working with the implementation team on this initiative, please complete the Memorandum of Understanding (at h t t p : / / w w w. h c a - n y s . o r g / d o c u m e n t s / MemorandumofUnderstandingIPROCardio.pdf) and return it via fax or e-mail to Susan Hollander (who is spearheading this project for IPRO) at (516) 4035979 or SHollander@ipro.org as soon as possible.
This project aligns with the national Million Hearts initiative, focusing on the ‘A BCs’ (aspirin as appropriate; blood pressure control; cholesterol management, and smoking cessation) of preventive cardiovascular care. It is being implemented with the support of IPRO in collaboration with the HHQI national campaign, and focuses on home health and cross-setting resources that address four categories: education, data, networking and assistance. IPRO will provide quality improvement technical assistance
If you have questions, please contact Ms. Hollander at the above e-mail address or at (516) 209-5241, or also e-mail Al Cardillo at acardillo@hcanys.org.
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/
11
ASAP – a publication of the Home Care Association of New York State
Volume 20, No. 14 April 10, 2015
April 2015 Home Health Compare Update IPRO, New York’s Quality Improvement Organization (QIO) this week provided HCA with the following Home Health Compare grid: http://www.hca-nys.org/documents/HomeHealthCompareQuarterlyGridApril2015.pdf. The grid is updated as of April 2015 and reflects the October 2013-September 2014 OASIS reporting period for the quality and process measures and the July 2013-June 2014 OASIS reporting period for the two utilization measures. As of this quarter, IPRO has also added the Patient Survey measures. The Home Health Compare data for New York must always be read with the understanding of its downward bias. The federal measures understate the performance of agencies serving statistically significant proportions of chronically ill individuals, including contracted services provided to these patients in managed care/managed long term care, the Long Term Home Health Care Program, and other long term/chronically ill patients maintained through Certified Home Health Agencies. Mindful of this important qualifier, for the April 2015 update, home health agencies in New York have performed better than or equal to the national average for 14 of the measures and below the national average for the remaining 8 measures. In comparison to the last quarter, New York State improved in 4 of the measures (ambulation, bathing, dyspnea, improvement in pain) and did not decrease in any of the measures. The national average improved for 1 outcome measure (ambulation) and decreased in one process measure (doctor-ordered action for pressure ulcer prevention). For the Patient Survey measures, New York State exceeds the national average for one measure (care provided in a professional way) and the national average is better than New York State for the remaining 4 measures. Members of the IPRO quality team participate in the HCA Quality Committee and work routinely with HCA on translating data and issues into proactive quality steps for the Association and providers. HCA will be reviewing the results of these latest Home Health Compare measures in the Quality Committee, which is meeting later this month. In a related update, the Committee will also be discussing the new, soon-to-take-effect federal “Five Star” rating system for home care, as well as next steps in preparation for launching the HCA Quality Risk and Compliance Tool, which will further assist agencies in proactive quality efforts. For further information, contact HCA Policy staff.
Emergency Preparedness Developments and Activities This article summarizes a number of new emergency preparedness developments and activities. Nation’s first emergency preparedness college The Governor announced the allocation of $15 million in funds in the new state budget to establish a first-inthe-nation “College of Emergency Preparedness, Homeland Security and Cybersecurity.” The new college will operate within the State University at Albany, and include a satellite campus in Oriskany (Central New York). The school, anticipated to open in the fall, will grant advanced degrees in both academic and 12
ASAP – a publication of the Home Care Association of New York State
Volume 20, No. 14 April 10, 2015
professional aspects of law enforcement, security, public and international affairs, counterterrorism, emergency management, cybersecurity and forensics. HCA engages with OMH on “Disaster Mental Health” HCA has engaged with the state Office of Mental Health (OMH) on “disaster mental health” programs and assistance offered or otherwise facilitated through OMH. Such programing offers valuable training and assistance to health professionals in their emergency response planning, execution and recovery activities. HCA is exploring with OMH opportunities to facilitate training and educational offerings for home care agencies and staff. HCA will be following up with a very brief survey next week to more specifically gauge potential participation levels in the provider community, and to plan next steps with OMH. Education and Training Opportunities The state’s Regional Training Centers for emergency preparedness and the state Department of Health have published the April “Aware Prepare” bulletin announcing education and training sessions. View the bulletin at http://www.hca-nys.org/documents/2015AprilAP.pdf. Long Island Subregional Health Emergency Preparedness Coalition The Metropolitan Area Health Emergency Preparedness Coalition (HEPC) convened this week for its quarterly Long Island subregional meeting. HCA is a participating partner in this and other regional HEPCs throughout New York State. HCA provided a report and update on our emergency preparedness activities to the coalition, including our outreach efforts to all sectors and coalition partners, our Primer on Home Care Emergency Preparedness in New York State (http://www.hca-nys.org/documents/HomeCareEPPrimer.pdf ) and the status of the HCA “Essential Personnel” legislation in the state Senate and Assembly. The state Office of Emergency Management (OEM) offered a presentation on “citizen preparedness” education and training, which HCA offered to explore from the in-home perspective. The Community Health Care Association of New York State (CHCANYS) presented on emergency preparedness activities of federal qualified health centers. Breakout sessions explored: continuation of operation planning (“COOP”), exercises, communications and other components. For further information, please contact Al Cardillo at acardillo@hcanys.org.
13
ASAP – a publication of the Home Care Association of New York State
Volume 20, No. 14 April 10, 2015
Next Generation ACO Model Open Door Forum Announced The U.S. Centers for Medicare and Medicaid Innovation will host its final Open Door Forum on various aspects of the Next Generation Accountable Care Organization (ACO) Model. The forum, scheduled for April 14, 2015 at 4 p.m., will focus on the letter of intent (LOI) and application process. As covered in past editions of ASAP, the Next Generation ACO is for organizations with experience in coordinating care for populations of patients. It will allow these provider groups to assume higher levels of financial risk and reward than are available under the current Pioneer ACO Model and Shared Savings Program (MSSP). Additional information on this Model, including materials from four previous forum sessions, is at http://innovation.cms.gov/initiatives/Next-Generation-ACO-Model/.
Clarification: Rescinding 2% Cut to TBI and NHTD Providers eMedNY has reminded Traumatic Brain Injury (TBI) and Nursing Home Transition and Diversion (NHTD) providers that the planned 2% across-the-board reduction affecting most Medicaid payments, as mandated in the 2011-12 State Budget, was rescinded for TBI and NHTD Waiver Program Providers. This eMedNY notice was issued to rectify misinformation and address confusion regarding these previously anticipated cuts. A previous notice on the state Department of Health (DOH) website and on the DOH eMedNY listserv indicated that cuts would be enacted. However, due to savings found in other areas at that time, 2% reductions in payment to waiver providers were not deemed necessary. Questions about the waiver programs can be sent to TBI@health.ny.gov or nhtdwaiver@health.ny.gov. You may also call Lydia Kosinski of the Bureau of Home and Community Based Waivers at (518) 474-5271. HCA continues to raise with DOH the need for action on a budget provision enacted last year to rescind the 2% across-the-board reduction for other home care providers, retroactive to April 1, 2014. The state submitted a state plan amendment to the U.S. Centers for Medicare and Medicaid Services in June 2014 to eliminate the 2% reduction but has not received federal approval yet, and we have pressed DOH for resolution on this reconciliation of the cut.
14
ASAP – a publication of the Home Care Association of New York State
Volume 20, No. 14 April 10, 2015
Clarification on NHTD Quality Assurance Reviews and Vehicle Modification The Nursing Home Transition and Diversion (NHTD) waiver management team within the state Department of Health (DOH) has issued an alert on quality assurance reviews and vehicle modifications. Quality Assurance State DOH NHTD waiver staff will be conducting quality assurance activities during the upcoming months. Annual desk reviews will be completed for select NHTD waiver services that were provided to and billed for participants within the specific waiver years, as set forth in the waiver application approved by the U.S. Centers for Medicare and Medicaid Services (CMS). Waiver staff will be comparing services approved in the participants’ service plans against claims billed by the provider for the target dates. If discrepancies are discovered, the agency will be notified by DOH waiver staff. The notice will also specify the date by which an agency must remedy the discrepancy and/or submit a plan of correction/compliance. Vehicle Modification Claims for vehicle modifications submitted by approved environmental modification (eMod) providers must include the cost of the vehicle modification, a project management fee equal to ten percent (10%) of the final cost of the vehicle modification, and the cost of the pre and post evaluation. The cost of the pre and post evaluation is considered separate from the vehicle modification and project management fee. Vehicle modifications may not exceed a total of $20,000 for the term of the participant’s enrollment in NHTD; this amount is the sum of the vehicle modification, the project management fee, and the pre and post evaluation. Inquiries on this guidance may be sent to nhtdwaiver@health.ny.gov or at (518) 474-5271.
State Releases January Medicaid Global Cap Report Home care and personal care spending slightly above projections The state Department of Health (DOH) has issued its January 2015 Medicaid Global Spending Cap report. It shows overall spending to be $7 million less than projected for the current fiscal year through December. (The current state fiscal year began on April 1, 2014 and ended March 31, 2015.) The actual spending amount for this seven-month period was $14.110 billion versus an estimated spending amount of $14.117 billion. The cap for the entire fiscal year (FY) is $17 billion. DOH’s report is at http://www.health.ny.gov/health_care/medicaid/regulations/global_cap/monthly/ sfy_2014-2015/docs/january_2015_report.pdf. For reporting purposes, home care and personal care services are lumped into the category labelled “Other Long Term Care.” According to the report, that category was $14 million above projections for the nine-month period ending January 31 – a difference between projected spending of $573 million and actual spending of $587 million. The report does not reveal which component of “Other Long Term Care” is over-target; however, it indicates that the average is due to less-than-projected enrollment in Managed Long Term Care. Continued on next page 15
ASAP – a publication of the Home Care Association of New York State
Volume 20, No. 14 April 10, 2015
Continued from p.15 Medicaid Managed Care was $67 million over the projection of $10.236 billion for this period, according to the report. More specifically: •
Mainstream Managed Care was $119 million above projections, due to higher than expected paid claims through January.
•
Long Term Managed Care was $52 million below projections through January. Total enrollment in the program is approximately 6.2 percent below expected levels (by a difference of 8,765 recipients).
Medicaid enrollment reached 6,069,073 at the end of January 2015, an increase of 364,636 enrollees (or 6.4 percent) since March 2014. DOH’s report also provides other data on accounts receivable, Medicaid rate adjustments, enrollment in the state’s health care exchange, and various state Medicaid savings initiatives. HCA has expressed concerns to DOH about the impact of retroactive payments on the global cap. The state’s calculation of spending relative to the global cap is cash-based, meaning that any retroactive payments made to providers for services in one year could actually be measured against the cap in a later year, leaving the system vulnerable to spending overruns if the cap forecast doesn’t account for the payment delay. Such could be the case for the 2 percent across-the-board cut, which the state is seeking federal approval to eliminate, retroactive to April 1, 2014. HCA has discussed this issue with the Department and will be carefully assessing the reconciliation of funds relative to the cap. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
Publications •
“Medicaid Spend-Down,” by the New York Legal Assistance Group http://www.wnylc.com/health/entry/46/
•
“Updates on Hospice Election Form, Revocation, and Attending Physician,” by the U.S. Centers for Medicare and Medicaid Services http://www. cms.g ov/O utre ach- and-Education/Me dicare -Le arning-Ne two rk-MLN/ MLNMattersArticles/Downloads/MM9114.pdf
•
“Accountable Care in New York State: Emerging Themes and Issues,” by the United Hospital Fund https://www.uhfnyc.org/assets/1320
•
“New York’s Medicare ACOs: Participants and Performance,” by the United Hospital Fund https://www.uhfnyc.org/assets/1318
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
16