April 15, 2016 Edition of ASAP

ASAP

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

Legislative Issues  Public Policy

HCA Draws Out Post-Budget Strategy Advocacy to target implementation of budget achievements and continued legislative action on priorities In the aftermath of the enacted 2016-17 State Budget, HCA and our government-relations team, Hinman Straub, have begun formalizing an aggressive advocacy plan for the coming weeks and months to ensure success on a number of HCA advocacy priorities.

HCA has already begun talks with our Board of Directors, as well, for direction on this series of next See STRATEGY p. 5

QIVAPP Allocations Announced Money expected to be released within a month Last Friday (April 8), after ASAP was published, the state Department of Health (DOH) shared with HCA a list of home care providers who will be receiving or are asked to return Quality Incentive Vital Access Provider Pool (QIVAPP) monies for the period April 1, 2014 to March 31, 2015.

Inside ASAP

News

Volume 21, No. 15 April 15, 2016

Launching Your Campaign to Build Body Intelligence with Dr. Joe Cardillo at HCA’s Annual Conference on May 4 to 6 Who in the home care industry couldn’t use higher energy every day; greater physical, mental, and emotional strength; better focus, memory and sleep; as well as releasing anxiety and stress?

Join best-selling author, inspirational speaker and sought-after body-energy expert, Joseph Cardillo, PhD for his presentation at the HCA Annual Membership Conference (May 4-6) modeled on his critically acclaimed new book, Body Intelligence — Harness Your Body’s Energies for Your Best Life.

Open the door to a vivacious life in the matterover-mind way by learning how to tap into your energetic “sweet spot”!

Michael Strahan (of The Kelly and Michael Show) has named Dr. Joe the “energy guru” in his book Wake Up Happy: The Dream Big, Win Big Guide to Transforming Your Life.

See CARDILLO p. 2

See QIVAPP p. 3

HCA Draws Out Post-Budget Strategy...............................................1 QIVAPP Allocations Announced...........................................................1 Build Body Intelligence at HCA’s Annual Conference.........................1 Monday Deadline for Hotel Reservations at HCA’s Conference.........2 Acquaint Your New Staff with HCA, Plus $300 Conference Discount...3 Member Hiring Announcements...........................................................4 Managed Care Mtg. Updates on Min. Wage, QIVAPP, Enrollment......6 Council Approves Physician Order Flexibility for Home Care............8 Late FLSA Attestations Should Still be Submitted............................9 State Announces Mandatory Emergency Preparedness Drill............10 HCA Comments on DOH MLTC $245M Workforce Initiative...................10 Register Today for Palliative Care Conference: June 6 to 7..............12 HCA Posts 2013 Medicare Home Health Utilization, Payment Data......13 Office of Civil Rights has Begun Phase 2 HIPAA Audits................13 FIDA FAQs Posted.......................................................................14 NYS Health Foundation Conference Sponsorship Opportunity.......14 CMS Provides Hospice Quality Reporting Updates.........................15 Upcoming NGS Education Programs................................................15

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Helping New Yorkers Feel Right At Home

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

Volume 21, No. 15 April 15, 2016 

CARDILLO from p. 1 With forthcoming features in “O” (Oprah) Magazine (May 2016) and AARP, Dr. Cardillo combines Western science, technology, psychology, and holistic wellness to show how to help eliminate daily energy drains and increase our energy gains. We’re thrilled to have him at our Annual Conference, joining an exceptional lineup of first-rate presenters. Register at the links below today!

Download the brochure: http://hca-nys.org/wp-content/uploads/2016/04/2016-HCA-AnnualConference-Detailed-Brochure.pdf Register Online: https://www.eventville.com/Catalog/EventRegistration1.asp?EventId=1011878

Monday is the Deadline for Hotel Reservations at HCA’s Annual Conference Monday, April 18, is the deadline to make your reservations at the Saratoga Hilton for HCA’s Annual Conference by calling the hotel at 1-888-866-3596 or reserving online at https://resweb.passkey.com/go/ HomeCareNY2016.

After this date, higher rates will prevail, so make your reservations as soon as possible and please also register for the conference at the links below.

Download the brochure: http://hca-nys.org/wp-content/uploads/2016/04/2016-HCA-AnnualConference-Detailed-Brochure.pdf Register Online: https://www.eventville.com/Catalog/EventRegistration1.asp?EventId=1011878

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

QIVAPP from p. 1 The final QIVAPP list is broken down by MLTC plan and includes: the home care agency’s prior state-share award; the total new award amount, including federal share; the amount, if any, to be recovered; and the reconciled amount to be paid or returned. (See related p. 6-7 story for a sample chart that DOH shared with managed care plans showing some examples using generic numbers.)

DOH has informed HCA that it expects the MLTC plans to receive the monies within about one month; DOH has not decided when the plans will have to pass it through to their qualified home care providers. Providers who are expected to return funds will have to send those funds back to the appropriate plan, but again DOH has not made a decision on when the monies will have to be returned. HCA will continue to press DOH for this information and report any news to you immediately.

HCA has also inquired about the status of QIVAPP funds for the April 1, 2015 to March 31, 2016 period and thereafter and is awaiting a meeting with DOH on this issue.

We have begun to send out notifications to HCA members of how much money is expected to be received/owed; if you have not heard from us, please contact Alex Blais at ablais@hcanys.org or Andrew Koski at akoski@hcanys.org.

As covered over the past two years, QIVAPP was intended to help agencies in New York City to pay for new wage and benefit expenses under the state Wage Parity Law. However, the restrictive eligibility criteria that DOH established led to many home care providers not

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Get Your Newest Staff Acquainted with HCA, Plus a $300 Discount to Attend HCA’s Annual Conference on May 4-6 For past participants at our Annual Conference, HCA extends a special invitation and a great $300 discount offer for your organization … if you bring a first-time colleague to our 2016 Annual Conference (on May 4 to 6).

Your organization is eligible for the $300 discount if: 1) it is a provider member of HCA; 2) you or another past participant registers for the conference again; and 3) you register a newcomer from your organization who has never attended HCA’s Annual Conference before. The discount will be applied to the first-time attendee’s rate.

Maybe you have new people at your organization who would benefit from getting acquainted with HCA’s team or with colleagues from other organizations. Or maybe they would like to hear the policy discussion at our Board of Directors meeting, learn more about value-based payments, meet with vendors, gain fresh ideas about marketing and grant opportunities, or see the possibilities for Health Information Technology?

These are just some of the session topics we have in store at HCA’s 2016 Annual Conference in Saratoga Springs on May 4 to 6.

To take advantage of this great discount, all you have to do is complete the PDF registration form at the link below and fax or e-mail it back to HCA. On the last page, in the bottom-right corner, you’ll see a check-box for the first-time attendee rate, along with a line to indicate that you or another past participant from your organization is joining.

Download the brochure: http://hca-nys.org/wpcontent/uploads/2016/04/2016-HCA-AnnualConference-Detailed-Brochure.pdf.

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HIRING qualifying for QIVAPP. HCA took strong issue against the criteria that 30 percent of the agency’s workforce be enrolled in the employer’s health plan and that the agency had to provide comprehensive health insurance benefits that were similar to the largest home care workers’ union, but DOH did not change its policy. We have also pressed for funding to all providers affected by wage parity, not just in New York City, including Long Island and Westchester.

The awarding of necessary funds is all the more urgent at a time when providers are subject to Fair Labor Standards Act costs (also being reconciled through a cumbersome distribution method) and while a new minimum wage hike goes into effect on January 1 statewide with an as-of-yet undefined distribution method for recently budgeted appropriations incorporated into the Medicaid Global Cap.

Job Position: Director of Performance Improvement and Staff Development (Winthrop University Hospital Home Health Agency) Winthrop seeks a Director of Performance Improvement and Staff Development for the CHHA, which services Nassau, Suffolk and Queens. The PI Director is responsible for the quality assessment/assurance program, compliance with DOH regulations and The Joint Commission standards, as well as overseeing the educational programs of the agency.

Minimum qualifications include: BSN, NYS RN license, two years professional nursing experience, two years supervisory experience in a CHHA or related home health program; working knowledge of Performance Improvement/ Quality Assurance, The Joint Commission standards and DOH regulations. Master’s degree preferred. Send résumés to Anne Calvo via e-mail to acalvo@winthrop.org

Job Position: Director of Patient Services (Montefiore Home Health Agency) The Director is responsible for directing, planning, coordinating and evaluating patient care services, providing supervision of professional staff, and recruiting/ hiring an adequate number of professional staff to ensure quality. The Director will evaluate the performance of Patient Service Managers and support staff supervisors at stated intervals. The Director will participate in administration of the annual budget and personnel policies. The ideal candidate will manage all clinical functions.

Required Qualifications: Current NYS RN License and Registration; Master’s in Nursing or Health Related Field; five years of senior and direct management experience within a CHHA. Additional Qualifications: Knowledge of clinical documentation protocols, home health regulations and standards; skill in training, working with building high performance teams; ability to develop and lead strategic plans; strong written and verbal communication skills.

Please send résumés and cover letters to: www.montefiore.org/careers. Résumés without cover letters and applicants who do not meet the requirements will not be accepted. No phone calls, please.

Job Position: Director of Finance (Montefiore Home Health Agency) 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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STRATEGY from p. 1 steps. We will also be enlisting the support of HCA’s entire membership to drive our strategy on the core issues outlined below.

Minimum Wage Implementation As you know, the budget includes some appropriations for minimum wage costs. In principle, these funds were made possible by the vigorous advocacy of HCA and New York’s entire health care association community. In practice, the state controls the procedural application and levels of funding. As a result, we have untold work ahead of us to ensure that the implementation of these allocations are workable for home care’s sustainability.

While the distribution process and sector-specific allocations for minimum wage remain to be established, HCA will be working to garner support of the Legislature to assist in a strategy that assures accountability and payment adequacy to cover this staggering new cost imposed on providers.

State health officials expect to assemble a series of workgroups on the implementation of minimum wage funding. In these workgroups, we will press to assure that the minimum wage funding targeted toward home care providers is distributed smoothly, timely, expeditiously and transparently.

HCA will also keep up the pressure on state officials to obtain timely and proportionate federal-share Medicaid dollars from the U.S. Centers for Medicare and Medicaid Services to better complete the gap, while we engage in a federal strategy to press for Medicare payment coverage.

Infrastructure Support for Home Care One important HCA budget success this year is the inclusion of a $200 million pool with at least $30 million in infrastructure funds targeted to home care and other community-based providers. Now that the budget promises these funds, our efforts will now shift to an implementation strategy to assure that the funding levels and eligibility standards are maximized for home care.

Much like the priority need for minimum wage funding, this new pool of infrastructure dollars must also be applied and distributed through mechanisms that are flexible and responsive to the enormous needs of home care providers for a range of purposes, be it capital and restructuring support, workforce development, or readiness for new models of care.

HCA will also separately pursue the introduction of legislation to assist home care in the evolving health care system: by streamlining regulations, investing in health information technology (HIT), promoting quality innovation, and fostering home care-primary care and other initiatives.

Payment Adequacy for Home Care and MLTC As we previously reported, the state budget includes new generic language for payment adequacy. In contrast, the initial Assembly budget bill contained much of the broader HCA language which was more reflective of home care’s discrete needs in this area. We will build on these initial proposals and the more streamlined

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payment adequacy language adopted in the final budget as an element of comprehensive language that HCA had submitted.

Our follow-up work will ensure that the baseline language in the budget is expanded to reflect the array of specific needs requiring proper rate coverage, from workforce compensation to recruitment and retention to regulatory compliance costs to direct service costs across the spectrum of home and community-based services.

The remainder of the Legislative Session offers an important opportunity to further advance these and other HCA initiatives and advocacy goals, many of which gained a foothold in this budget but require a lot of direction, carefully crafted implementation language, and corrective pressure from the home care industry.

Please be on the lookout for more specifics on the vehicles we will be using to achieve these aims and, as always, we will keep you informed of key phases in the development of these initiatives and budget measures.

DOH Managed Care Planning Meeting Includes Updates on Minimum Wage, QIVAPP and Enrollment Statistics At yesterday’s managed care planning and advisory meeting, state health officials provided updates to the managed care community on a range of issues affecting home care providers, including the Quality Incentive Vital Access Provider Pools (QIVAPP), rate adjustments for minimum wage, as well as other issues.

According to DOH, the minimum wage adjustments will be included in the October 2016 rates to managed care plans. As announced to the membership, post-state budget, the state is adjusting the Medicaid Global Cap to reflect its projections of the minimum wage impact on Medicaid providers, but little detail is yet known about the distribution method.

Given past complications with add-on distributions for other labor costs (i.e., QIVAPP and the Fair Labor Standards Act costs), HCA’s next phase of work will require a major push and collaborations with partner associations to demand a direct, timely (prospective versus retrospective), transparent and unencumbered distribution methodology.

The wage appropriations thus far known (and previously shared with the membership) include a state-share amount of $13 million for all health care sectors (not including behavioral health and developmental disability providers in planned “cash outlays”) for the first quarter of the 2016-17 state fiscal year, and an $88 million appropriation for all sectors in 2017-18. No additional specifics on the sector-by-sector breakout were provided in this week’s managed care advisory meeting; state Medicaid Director Jason Helgerson referred to a set of workgroups being assembled with associations to examine the adjustments over the coming months. The higher wages begin going into effect on January 1.

Department staff also provided four sample scenarios on the QIVAPP award and reconciliation process between managed care plans and providers for Wage Parity-related costs. A total of $70 million in QIVAPP funds are designated for providers serving New York City following a reconciliation process conducted by IPRO to review the qualified hours for each provider.

An initial half of the $70 million was already distributed, with plans and providers now expected to reconcile this initial payment amount with the remaining $35 million pool based on IPRO’s audit – a process that will result in some plans recouping dollars from providers, some plans providing additional funds to providers on top of the prior state-share award, or some plans providing funds to providers who did not receive initial 6

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state-share awards and are receiving funds for the first time. This arrangement has been highly problematic and complicated in its flow of payments and qualification requirements.

DOH yesterday shared the following chart which presented four possible scenarios in which managed care plans would be distributing or recouping payments from their network providers. HCA members who have been notified of their distributions will likely see some version of these methods in the recently announced final, reconciled amounts.

To clarify, as the process has been confusing, the chart shows the amount that was already distributed to providers from the initial $35 million pool (column second from left). The next column shows the amount that providers are to be awarded out of the entire $70 million pool, which includes the initial $35 million.

Thus, the final reconciled amount (shown in the last column) reflects the difference between these two columns.

As reported elsewhere in this week’s ASAP (see page 1 story), HCA has obtained a list of home care providers who will be receiving or are asked to return QIVAPP monies for the period April 1, 2014 to March 31, 2015. We have begun to send out notifications to HCA members of how much money they are expected to receive/owe; if you have not heard from us, please contact Alex Blais at ablais@hcanys.org or Andrew Koski at akoski@hcanys.org.

Officials told the managed care plans this week that they have the discretion to negotiate with providers over the distribution or collection method of QIVAPP funds, but to exercise flexibility within the parameters allowed in their contracts. No further details were provided regarding the timetable for provider receipt or recoupment of funds.

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.

This week’s managed care advisory meeting also included enrollment and activity updates, including: 

162,719 individuals are enrolled in MLTC, with 145,984 in partially capitated plans; 5,566 in Fully Integrated Duals Advantage (FIDA) plans; 5,661 in Medicaid Advantage Plus (MAP); and 5,508 in 7

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the Program of All-Inclusive Care for the Elderly (PACE). The state reported that a FIDA advertising campaign is underway, involving digital, print, outdoor and radio advertisements. 

There are 63 MLTC plans operating statewide, with 31 partially capitated plans; 17 FIDA plans in the demonstration counties; 9 PACE plans; and 7 MAPs.

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The Conflict-Free Evaluation and Enrollment Centers have had an average call volume of 854 per day, with 155 nurses on staff, 71,776 evaluations conducted and an approval rate of 97 percent (denial: 3 percent).

FIDA-IDD The meeting also provided updates on the Fully Integrated Duals Advantage (FIDA) program for those with intellectual and developmental disabilities (FIDA-IDD).

Partners Health Plan is the single IDD plan and will be enrolling individuals in New York City, Long Island, Westchester and Rockland. The plan will be responsible for coordination of all the individual’s services, including Medicare primary and acute (physician, hospitalization, drugs), Medicaid (care management, long term care, behavioral health), Office for People with Developmental Disabilities (OPWDD) waiver services if already enrolled in 1915(c) waivered services, transportation, and dental.

Enrollment will be voluntary and there will be no phased implementation and no passive enrollment. The FIDA-IDD demonstration period is from April 2016 to December 2020.

New York Medicaid Choice sent “heads-up” mailings to the target population starting March 15. These were followed up about 15 days later with full packet mailings.

A list of information sessions is at http://phpcares.org/events-news For more information, please contact a member of the HCA Policy staff.

Council Approves Rule on Physician Order Flexibility for Home Care The Public Health and Health Planning Council (PHHPC) on Thursday approved a proposed rule, built on requests from HCA, to change the state’s physician order deadline for home care.

A now-final rule is expected to be published soon in the State Register, possibly as early as this month, depending on when the documentation is processed. The state Department of Health will be developing a Dear Administrator Letter which will inform providers of the effective dates and other details. The Department will soon also be informing their surveyors of the change. HCA has separately requested that the Department work with the Office of the Medicaid Inspector General (OMIG) to incorporate this rule change in OMIG’s documentation for compliance assumptions, audit standards and procedures.

These proposed changes, a long time in the making, were initiated and drafted by HCA, with further recommendation and advancement by the Home and Community-Based Care Workgroup.

Continued on next page

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Continued from previous page Providers currently must obtain signed physician orders within 30 days of the start of home care and prior to billing, but the state’s general billing system does not allow claims submitted after 90 days of the service date; nor does an exception code exist for late billing due to untimely physician orders.

“This leaves providers with a double-jeopardy situation,” wrote HCA Vice President of Finance & Management Patrick Conole in formal comments earlier this month supporting the rule change: “First, a 30-day window for [physicians] to provide their signatures ... and second, a total 90-day deadline from the service date to have the physician signature and, following, the preparation and submission of the claim for billing.”

This proposed rule aligns with Medicare, simply requiring the signature prior to billing. (Medicare allows a one-year window to bill.) The rule will be joined by a separate, anticipated guidance for a new exception code allowing home care agencies to bill after 90 days when the physician signature is not obtained in that time.

HCA appreciates the Department’s recognition of the problems and need for flexibility, and we are pleased that the changes have now received approval from the PHHPC. We will immediately inform the membership of any next steps, including when the final rule will be posted in the State Register, as well as the accompanying guidance explaining the implementation of this rule and the related issue of exception codes for billing.

Late FLSA Attestations Should Still be Submitted DOH posts list of providers with attestation status As HCA has advised members on numerous occasions, April 1 was the deadline for submitting the Fair Labor Standards Act (FLSA) attestations due to the state Department of Health.

The attestations are at http://www.health.ny.gov/health_care/medicaid/redesign/ fair_labor_standards_act.htm.

DOH has posted a list of home care providers (by name and license number) and information on whether they have submitted the attestations for their Medicaid fee-for-service and/or MLTC cases.

The list is at http://www.health.ny.gov/health_care/medicaid/redesign/2016/2016-0408_submitted_attestations.htm.

Agencies should review the list to ensure that DOH has received their attestations.

Though late, home care providers who have not submitted the attestations should still do so by sending them to FLSA@health.ny.gov. The attestations for both an agency’s fee-for-service and MLTC patients go to DOH, not to the plan.

HCA continues to advocate that the FLSA monies be distributed as a $0.34 increase per each hour of aide services and not be limited to only compensating agencies for their new overtime and travel expenses. Some MLTC plans are distributing the monies based on each hour of aide services while others are limiting funds to documented overtime and travel expenses.

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State Announces Mandatory Emergency Preparedness Drill from April 25 to 29 The state Department of Health (DOH) released a Dear Administrator Letter (DAL) from the Division of Home and Community Based Services (DHCBS) yesterday announcing an upcoming emergency response drill that will begin on April 25, 2016 and end on April 29, 2016. This will apply to all CHHAs, LTHHCPs, and LHCSAs. Participation is mandatory, and failure to participate will result in citation and potential further penalization.

This drill will simulate an emergency event with the goal of: familiarizing home care and hospice providers with communications methods established by DHCBS for use during emergencies; informing providers about the information required by DHCBS before, during and after emergencies; familiarizing providers with the Health Electronic Response Data System (HERDS) survey; and allowing DOH to test these systems and processes before an actual emergency event.

Additionally, Transportation Assistance Levels (TALs) of patients will be collected during the drill. The DOH WebEx training on TALs held earlier this spring, as well as a demonstration of the HERDS survey, are available at: https://meetny.webex.com/meetny/ lsr.php?RCID=f46f79c800124167b04959d771b9bd6c.

The incorporation of TALs within this drill is inconsistent with past notices indicating that the TALs initiative is not required to be in place until June 1. HCA will follow up with DHCBS regarding this portion of the drill to request flexibility if providers are otherwise prepared but have not yet completed TALs records for all patients.

The DAL reminds providers that the Health Commerce System (HCS) is the primary mechanism for communication from DOH to providers, and stresses that for purposes of this drill and all real emergencies, all communication between DOH and providers will take place via the HCS Integrated Health Alert Notification System (IHANS).

HCA reminds providers to update their HCS accounts and ensure accurate contact information for appropriate staff. We will provide additional information as we receive it, including clarification on the applicability of TALs in this drill. If you have questions, please contact Alex Blais at ablais@hcanys.org.

HCA Provides Comments, Recommendations on DOH-Planned MLTC $245M Workforce Initiative HCA has provided extensive comments to the state Department of Health (DOH) on its draft plans to channel $245 million through MLTC plans for the long term care workforce.

These workforce funds had been long earmarked under the state’s Medicaid waiver, and have been in (and out) of discussion and planning stages for several years.

HCA has weighed in at each stage of the plan’s conceptual development; but these current comments address the most detailed DOH iteration to date, following the Department’s request for HCA’s input and a meeting with DOH several weeks ago when we provided substantial verbal comment on the draft plan.

Continued on next page

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Continued from previous page The current draft concept, mapped out by the Office of Health Insurance Programs, would channel the workforce funds through MLTCs for downstream allocation to proposed “Workforce Centers of Excellence.” The funds would be for training long term care personnel (professional and aide-level) of providers participating in MLTC networks.

DOH’s draft conceives that the funding would be used for the following purposes: 

Invest in initiatives to attract, recruit and retain long term care professionals in the areas they serve;

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Develop plans to address reductions in health disparities by focusing on the placement of long term care workers in medically underserved communities;

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Train needed workers to care for currently uninsured populations who will seek care under the Affordable Care Act expansion; and

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Support the expansion of home care and respite care, enabling those in need of long term care to remain in their homes and communities and reduce New York’s Medicaid costs associated with long term care.

HCA provided detailed comments, extensive language changes and recommendations on all aspects of the draft, and included additional critical ways of supporting the home care/long term care workforce (and direct provider support and funding) not otherwise reflected in the draft.

In summary form, these comments ask that DOH: 

Incorporate the use of funds both for support of basic workforce infrastructure needs of providers directly, as well as for the DOH proposed Centers of Excellence (emphasizing that support in both areas is needed especially because the current DOH premium structure for MLTC does not adequately cover needed provider workforce infrastructure).

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Recognize additional, essential purposes critical to recruitment and retention for long term care personnel, especially aide level personnel (such as transportation, daycare, peer support, psychosocial support, etc.) which are particularly critical for this workforce. We also press for allocation factors that give priority weighting for underserved areas, needed capacity and disciplines.

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Create an advisory group of HCA and key association/stakeholder representatives to direct DOH in the formulation of guidelines, criteria, evaluation and general project “steering.”

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Provide regulatory, administrative and procedural flexibility for provider/workplace innovation that further supports staff efficiency, quality of care and job satisfaction, aligned with new state policies and reforms. (HCA noted that this could be accomplished through innovative laws written

by HCA over the past several years that have been passed and signed by the Governor and are available as a supportive resource for this program.)

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Expand the list of potential areas of new training. (HCA included specifics on additional areas.)

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Continued from previous page 

Modify language to reflect a partnership between DOH, MLTCs, providers and the so-called new “Centers of Excellence.”

DOH is currently reviewing HCA’s comments and recommendations. HCA will keep the membership apprised of the progress and status of this critical new initiative, which is especially important in the wake of the new minimum wage law, as well as continuing developments in the health care system that call for workforce capacity in underserved areas and disciplines, new skill sets, and roles aligned with the system’s needs and changes.

For further information, contact Al Cardillo at acardillo@hcanys.org.

Register Today for Comprehensive Palliative Care Conference in White Plains on June 6 to 7 The Collaborative for Palliative Care is holding a two-day conference in White Plains on June 6 to 7 called “Changing the Conversation about Serious Illness: The Future of Palliative Care,” and we encourage HCA members to attend.

HCA member Visiting Nurse Association of Hudson Valley is part of the consortium supporting this important conference, with major organizational and planning work by Cornelia Schimert RN, BSN, Director of Community Relations at the VNA, who is home care’s representative on the State Palliative Care Council.

This program seeks to promote a better understanding of what palliative care is; to explore model approaches in different settings; to share best inter- and multi-disciplinary clinical and policy practices; and to foster professional reflection and sharing.

Conference offerings include: prominent keynote speakers; a roundtable discussion with palliative care experts; three intensive workshops and over 25 conference sessions; as well as networking opportunities.

Attendees include physicians, nurses and nurse practitioners, social workers, clergy, lawyers, care and case managers, administrators, ethicists, educators, psychologists, therapists, complementary care practitioners and interested individuals and members of the community.

Palliative Care is at a critical juncture within the transformative process reshaping our health care system.

There is growing consensus about the value and importance of palliative care services for any serious illness, yet there is lack of access to palliative care resources in many settings, and a need for greater communication about palliative care concerns. This conference strives to bring together presenters and participants with the aim of advancing a common understanding, and a level of expertise in palliative care, throughout the health care continuum and in community settings.

The conference will be held at the Westchester County Center, 198 Central Avenue, White Plains, NY 10606.

You can register online at http://www.palliativecareconference.org.

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Volume 21, No. 15 April 15, 2016 

HCA Data Webpage Now Includes 2013 Medicare Home Health Agency Utilization, Payment Data This week, HCA staff posted to our HCA Data website an HCA-developed summary spreadsheet of 2013 Medicare Provider Utilization and Payment Data for each Medicare certified home health agency (HHA) in the state. The data comes from the U.S. Centers for Medicare and Medicaid Services (CMS).

CMS’s new website can be found at: https://www.cms.gov/Research-Statistics-Data-and-Systems/ Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/HHA.html.

CMS’s public use file (PUF) website includes individual HHA utilization and payment data organized by CMS’s Certification Number (6-digit provider identification number). HCA has organized our spreadsheet to include some of the following data: total episodes, non-Low Utilization Payment Adjustment (LUPA) episodes, total LUPAs, total charge amount, total Medicare payment amount, charge vs. payment margin percentage and outlier percentage. HCA’s spreadsheet also includes a second sheet that describes how each of the columns was determined or calculated.

Important: HCA Data is a members-only page that provides data reports to assist home care and hospice providers and managed care plans in their benchmarking efforts, understanding of system-wide trends, and access to reimbursement and premium rates. The page is not visible on our site unless you are logged in with an HCA member website account.

Our log-in page is here: http://hca-nys.org/. Upon login, the HCA Data link will appear in the site menu at the top right. You can also enter your e-mail address to obtain your password. Or, simply e-mail HCA’s Communications Director Roger Noyes at rnoyes@hcanys.org if you do not yet have an HCA website account.

HCA has recently submitted a freedom of information law (FOIL) request for the 2014 Medicaid Cost Reports for all non-hospital based CHHAs and all LTHHCPs in the state. Upon receipt of this data, HCA will prepare a spreadsheet summarizing key CHHA & LTHHCP data, including such items as: total operating revenue by payor, total operating expenses, operating margins, unit costs, patient utilization data by payor source, and more.

HCA Data also currently has 2014 Medicaid Managed Care Operating Reports (MMCOR) data available to members and hopes to have 2015 data available sometime in June.

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

Office of Civil Rights has Begun Phase 2 HIPAA Audits The U.S. Department of Health and Human Services (HHS) Office of Civil Rights (OCR) has begun Phase 2 of its Health Insurance Portability and Accountability Act (HIPAA) Audit Program.

Phase 2 audits are currently under way and begin with verification of an entity’s address and contact information. An e-mail is being sent to covered entities and business associates requesting that contact information be provided to OCR. OCR will then transmit a pre-audit questionnaire to gather data about

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the size, type, and operations of potential auditees; this data will be used with other information to create potential audit subject pools.

OCR will review the policies and procedures used by covered entities and their business associates to meet selected standards and implementation specifications of the Privacy, Security, and Breach Notification Rules. OCR anticipates that the audits will primarily be desk audits, although some on-site audits will be conducted.

OCR maintains that the audits are primarily a compliance improvement activity by determining what types of technical assistance should be developed and what types of corrective action are necessary.

Additional information on the HIPAA audits can be found at http://www.hhs.gov/hipaa/forprofessionals/compliance-enforcement/audit/phase2announcement/index.html.

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

FIDA FAQs Posted The state Department of Health (DOH) has posted two Frequently Asked Questions (FAQ) documents on the Fully Integrated Duals Advantage (FIDA) program.

They are at http://www.health.ny.gov/health_care/medicaid/redesign/fida/docs/2016-0405_harp_faq.pdf and http://www.health.ny.gov/health_care/medicaid/redesign/fida/docs/2015-1222_fida_reforms_faq.pdf.

One set of FAQs cover Health and Recovery Plan (HARP), health homes and hospice services; the other covers changes due to reforms announced last year.

New York State Health Foundation Conference Sponsorship Opportunity The New York State Health Foundation announced this week that it is sponsoring conference participation in support of healthy communities. This sponsorship opportunity is being launched as part of efforts to create healthy communities that encourage New Yorkers to eat well, get active, and access programs that support healthy choices.

Community-based organizations, health departments, and other low-resource organizations can apply for this funding through a Request for Proposals (RFP) process, and those who are awarded money will be able to use those funds to attend and present at conferences and meetings across the state and country related to this topic area.

The RFP can be viewed here: http://nyshealthfoundation.org/uploads/rfps/building-healthycommunities-scholarships-rfp.pdf.

Applications are being accepted between now and June 30, 2017.

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CMS Provides Hospice Quality Reporting Updates HQRP Webinar on May 10 The U.S. Centers for Medicare and Medicaid Services (CMS) will be hosting a Hospice Quality Reporting Program (HQRP) webinar on May 10 from 2 to 3:30 p.m.

The main focus of the webinar will be navigation of the CASPER system, with special attention to data submission requirements for HQRP, how to access Final Validation Reports (FVRs), and how to use information in the FVRs to determine whether data has successfully been transmitted to CMS or will need to be corrected. More information and a link to register will be provided as soon as it is made available from CMS. If you have questions or need additional information, please email the PAC Training mailbox at PACTraining@econometrica.com CAHPS Hospice Survey Quarter 4 2015 Data Submission Deadline of May 11 May 11, 2016 is the deadline for survey vendors to submit data on the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey Quarter 4 2015 (patient deaths in October, November and December 2015). Survey vendors are responsible for successfully submitting files by 11:59 p.m. Eastern Time on May 11, 2016.

Following the submission of survey data to the CAHPS Hospice Survey Data Warehouse, an automated e-mail will be sent to CAHPS Hospice Survey vendors advising if the uploaded file did not meet the established naming standards. If the uploaded file fails to meet the established naming standard, the file will not be processed. A correct file will need to be resubmitted prior to the deadline.

A series of edit checks will be applied to successfully submitted files. Survey vendors and hospices will receive an e-mail indicating that CAHPS Hospice Survey Data Submission Reports (containing results from the edits checks) are available for viewing in their respective folders in the CAHPS Hospice Survey Data Warehouse. Reports will be posted by 5 p.m. Eastern Time on the next business day after submission by the survey vendor.

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

Upcoming NGS Education Programs National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), has recently posted the following educational webinars. 

Provider Enrollment Revalidation: April 20, from 10 to 11 a.m. (Registration is at: https:// attendee.gotowebinar.com/register/4144375258521146113) Continued on next page

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Continued from previous page 

Home Health Face-to-Face Encounter and the Plan of Care: April 26, from 12 to 12:30 p.m. (Registration is at: https://attendee.gotowebinar.com/register/7268983894566246145)

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Home Health Billing Scenarios: Common Billing Errors: April 28, from 10 to 11:30 a.m. (Registration is at: https://attendee.gotowebinar.com/register/8784221968938319620)

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Ordering and Certifying Medicare Home Health Services: April 28, from 3 to 4 p.m.

(Registration is at: https://attendee.gotowebinar.com/rt/48586692185987844)

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

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