April 22, 2016 Edition of ASAP

ASAP

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

Legislative Issues  Public Policy

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News

Volume 21, No. 16 April 22, 2016

Several New Innovations Unveiled at May 4-6 Annual Conference: Register Today!

HCA’s Annual Conference is less than two weeks away, and we urge you to attend this fun and informative program, on May 4 to 6, where we’ll be unveiling several unique, innovative initiatives coming soon for home care.

One of these innovations is our upcoming Quality Measurement, Risk and Compliance Tool (HQMT).

During a special “Focus Group” session, representatives from ABILITY Healthcare Solutions and HCA’s Quality Workgroup will discuss a unique partnership that is soon bringing this first-of-its-kind web-based tool for providers to use.

See INNOVATIONS p. 3

HCA Stays on Top of FLSA Fund Flows, Advocacy HCA continues to track the funding sent by MLTC plans to their contracted home care providers for Fair Labor Standards Act (FLSA) costs.

HCA has aggressively advocated that the funds be distributed as a $0.34 increase per each hour of aide services and not be limited to only compensating agencies who can document their new overtime, travel and 24-hour care expenses. We have repeatedly told state health officials that it is very difficult to document such costs because aides often work for more than one patient and their patients are typically enrolled in more than one MLTC plan.

See FLSA p. 2

Inside ASAP New Innovations at Annual Conference: Register Today!...................1 HCA Stays on Top of FLSA Fund Flows, Advocacy..............................1 No Decision by Supreme Court on FLSA Lawsuit................................3 Senators Object to Prior Authorization Proposal................................4 New Information Posted on HIPAA Patient Rights..............................4 Revised OMIG CHHA Audit Protocols Shared....................................4 Allen Health Care Partners to Decrease Hospitalizations, ER Visits........5 HCA Pre-Conference Highlight: Value-Based Payment......................5 Flu Vaccination Report Due by May 2...................................................6 Flapjacks & Liquid Gold of Knowledge at HCA Conference..............7 Reminder: Next Week’s Mandatory Emergency Drill...........................8 Uniform Billing Codes Update............................................................8 Concerned about PHI Breaches? 6/15 Bootcamp has Answers..........9 CMS Issues Proposed Rule for 2017 Medicare Hospice Benefit........10 NYC Council Considers Bill to Establish Division of Paid Care........12 Proposed Rule Issued on OPWDD Cost Reports..............................12 CMS MA Data Compares Quality Based on Race, Ethnicity..............13 CMS to Host Quality Reporting Program Webinar...........................14 Publications......................................................................................................15

Helping New Yorkers Feel Right At Home

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

Volume 21, No. 16 April 22, 2016 

FLSA from p. 1 Many members have told us that they are being sent funds but are having problems in determining the method of distribution and/or how the amount was computed. Meanwhile, some have gotten funds based on their agency’s share of the total number of aide hours provided by all network providers to that plan; others have reported that there still are many plans that have not sent any funds to their home care providers. HCA will be contacting DOH if the monies are not released from these plans.

The state has posted a list of plans that received the FLSA funds and the amounts they were given at http:/ /www.health.ny.gov/health_care/medicaid/redesign/2016/2016-03-11_flsa_add_info.htm.

HCA asks members to continue to inform us of their experiences with receiving FLSA funds from plans.

That information can be communicated to Andrew Koski at akoski@hcanys.org or (518) 810-0662.

HCA will use this information to: convey the many issues with the funds distribution; gauge the level of funding you’ve received relative to your costs; and press for follow-up steps with the Department, stressing the need for complete funding of FLSA-related costs.

FLSA Survey Meanwhile, Mercer, the state Department of Health’s Actuary, continues to revise and finalize the draft survey that will query home care providers about their actual new costs under the FLSA rule. HCA and other provider associations gave extensive input to the state to ensure that the requested information will be available without taking providers an inordinate amount of time. Once it is finalized, HCA will notify members.

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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Volume 21, No. 16 April 22, 2016

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

No Decision by Supreme Court on Companionship Exemption Lawsuit Despite earlier indications that it would do so this week, the U.S. Supreme Court has not decided whether to review a lower court’s decision on a challenge to the Fair Labor Standards Act (FLSA) final rule.

Each year, the Supreme Court agrees to review only a small percentage of cases submitted for consideration, and HCA awaits further information.

Last August, the U.S. Court of Appeals for the District of Columbia Circuit ruled that the U.S. Department of Labor (U.S. DOL) acted within its authority when it extended minimumwage and overtime protections to home care workers. The implementing federal rule went into effect in October 2015.

The National Association for Home Care and Hospice (NAHC) and other plaintiffs representing the home care industry appealed the lower court’s decision to the Supreme Court last November, a month after their request for a stay of the decision was rejected by U.S. Chief Justice John Roberts.

HCA actively opposed the thenproposed and final rule because it added new costs and complexities to the delivery of home care services without commensurate funding.

Since it was finalized in midOctober, HCA has worked to get the state to deliver funding that covers providers’ new costs in overtime, travel, 24-hour cases, and other related costs. (See separate p. 1 story on state FLSA state funding.)

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INNOVATIONS from p. 1 As you know, a home care provider’s quality and compliance tracking may be: fragmented; dispersed across multiple jurisdictions and accrediting sources; and lacking single-source automation for multiple staff involved in quality and compliance efforts. This new automated tool, developed by HCA with the technological design of ABILITY, will put all of these metrics in one place, assisting workflow and ensuring that all of the discrete metrics for quality and compliance are accounted for. The tool will also help you quantify your value proposition for contract partners and payors. You won’t want to miss this one-of-a-kind learning session during the conference.

Bring The Vote Home The theme of our 2016 conference is “Vote Home Care,” and HCA is seizing on the energy of this year’s elections season, bringing a rallying spirit to home care’s big state-level convention, HCA’s Annual Conference. In keeping with this theme, HCA President Joanne Cunningham’s address at the conference will unveil a new “Bring The Vote Home” campaign that is taking place nationally, with HCA leading the charge in New York. The purpose of the campaign is to organize home care providers and their staff to assist patients in the process of registering to vote and casting an absentee ballot from home, recognizing that many patients are homebound or have difficulty getting to the polls on Election Day. We’ve designed this program to be as easy to implement as possible.

The goal is to help patients overcome disenfranchisement while getting elected officials aware of the fact that home care patients are voting – and that candidates need to respond favorably to their needs. We already have a campaign website and video up and running (at www.bringthevotehomeny.org) if you’d like a quick preview.

Exhibitor Innovations HCA’s exhibitors will also show you their latest innovations in the exhibit hall, a great opportunity for one-stop-shopping and browsing. We have tons of other exciting general sessions, “focus groups” and “think-tank” programs in store – plus fun and festivities, including our Stars-and-Stripes Political Action Committee Party, a chance to have your picture taken with presidential candidates, our annual awards program, and more.

Please register as soon as possible. You can download the brochure at http://hca-nys.org/wp-content/uploads/2016/04/2016HCA-Annual-Conference-Detailed-Brochure.pdf or register online at https://www.eventville.com/Catalog/ EventRegistration1.asp?EventId=1011878.

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

Volume 21, No. 16 April 22, 2016 

Senators Object to Medicare Home Health Prior Authorization Proposal Concerns echo issues raised by HCA and others This week, a group of U.S. Senators sent a letter opposing the recently proposed Medicare home health prior-authorization program. The letter, to the U.S. Centers for Medicare and Medicaid Services (CMS), came from Senators representing states in the demo region affected by the initiative. New York is not one of the demo states.

As reported in the April 1 ASAP, HCA submitted comments that strongly objected to this demonstration and asked that it be rescinded. In the demonstration, CMS would perform prior authorization before processing claims for home health services in Florida, Texas, Illinois, Michigan and Massachusetts.

Though New York was not part of the demonstration, HCA fears that such a prior-authorization process could be expanded to other states, and we took the opportunity to voice our strong concerns that the proposal “would create altogether unnecessary obstacles in access to care, increase system-wide costs, and jeopardize the quality of care that patients receive.”Our comments are at http://hca-nys.org/wp-content/ uploads/2016/04/Medicare-Home-Health-Prior-Authorization-Comments-Final.pdf.

The letter from the U.S. Senators makes similar arguments as HCA’s: If finalized, this proposal could delay the delivery of care and place already vulnerable patients at risk. Patients who would otherwise receive care at home may need to seek care in more costly settings or return to hospitals. Beyond ensuring that these patients receive timely care, we should also consider that many patients prefer to remain in the comforts of their home.

HCA will keep members informed of the status of this demonstration.

New Information Posted on HIPAA Patient Rights The U.S. Department of Health and Human Services (HHS) has posted updated Frequently Asked Questions about patient rights under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

The document is at http:// www.hhs.gov/hipaa/for-professionals/ privacy/guidance/access/ index.html#newlyreleasedfaqs.

It covers a patient’s access right, by clarifying what types and amounts of charges are permissible when providers copy protected health information (PHI) for a recipient, and how access to records can be provided.

Revised OMIG CHHA Audit Protocols Shared Late today, the Office of the Medicaid Inspector General (OMIG) shared with HCA its revised audit protocols for CHHAs. According to the OMIG, the changes from the prior version are primarily corrections to regulatory citations. HCA will be reviewing the protocols very carefully to determine if there are any other changes since the previous version and, if so, will provide feedback to OMIG and inform members.

HCA has already contacted OMIG requesting that the new, more flexible provisions for signed M.D. orders be reflected in the protocols and OMIG has agreed.

The revised protocols can be viewed at http://hca-nys.org/wpcontent/uploads/2016/04/CHHAProtocol042216.pdf.

They should soon be posted on the OMIG’s website at https:/ /www.omig.ny.gov/audit/audit-protocols.

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

Volume 21, No. 16 April 22, 2016 

Allen Health Care Partners to Decrease Hospitalizations and ER Visits

By Marie Andreacchio, Allen Health Care Services, a Platinum-Level HCA Sponsor Allen Health Care Services (AHCS) is a licensed home care organization that has been training and providing Home Health Aide (HHA) services for over 30 years. In line with our mission, we are focused on meeting the demands of the changing health care delivery system by exploring strategies to meet mutual goals of our provider partners, which are to decrease preventable admissions, reduce unnecessary emergency room visits and increase customer satisfaction.

In the latter half of 2014 we implemented our Personal Aide Care Technology TM (PACT) program. Our PACT program teaches aides to observe for patient condition changes (early onset) and provides them with the tools to report those changes. Patient condition changes are reported to the AHCS nurse using a clinical designated phone number or the secured web browser on the aide’s smart phone; this allows our clinical team to respond promptly. Clinical interventions may include patient/caregiver education, facilitating an MD appointment or notifying the health plan’s designated case manager.

Allen Aides have reported over 400 patient alerts saving plans hundreds of thousands of dollars and have successfully addressed a multitude of health issues. Our PACT programs also foster patient satisfaction, a key indicator utilized by our managed care partners. When surveyed, 97 percent of patients reported satisfaction with the program. Forty-six percent indicated they would have called 911 if it were not for the PACT Program.

The PACT program positions AHCS as a valuable partner in a health care delivery system that will increasingly be evaluated and reimbursed based on quality outcomes.

To learn more about Allen Health Care Services, visit http://www.allenhealth.com/why-allen/.

HCA Pre-Conference Highlight: Opportunities for Home Care Providers under Value-Based Payment A priority area of federal and state health care policy is instituting payment and policy changes that emphasize value over volume and the provision of quality, patient-centered care.

State policymakers have indicated that 80 to 90 percent of Medicaid payments will flow through a value-based payment (VBP) construct by the end of 2019.

The U.S. Centers for Medicare and Medicaid Services (CMS) is also promoting the use of VBP in Medicare, with 30 percent of traditional Medicare payments now in alternative payment models; this figure will climb to 50 percent by 2018.

Home care providers need to be armed with information, data and a vision to effectively participate in VBP and other new payment models.

Mechanic

At HCA’s upcoming Annual Conference, Robert E. Mechanic (a Senior Fellow at Brandeis University’s Heller School of Social Policy and Management, as well as Executive 5

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Volume 21, No. 16 April 22, 2016 

Director of the Health Industry Forum) will review the landscape of these new models under Medicare, with a focus on Accountable Care Organizations and bundled payments. He will discuss how integrated service delivery systems can utilize home care as a cost-effective, patient-centered alternative to facility-based care and to reduce unnecessary hospital admissions, readmissions and emergency visits.

You’ll also learn how the nation’s most innovative health systems are using home care effectively in value-based payment models, along with some challenges that must be overcome to integrate home care effectively.

Panelists for this session include: Lauren Huber, MA, BSN, RN COS-C, CCM, Director of Quality Management, Regulatory Compliance and Education, Montefiore Home Care; Michelle Mazzacco, Vice President/Director, Eddy Community Services Division, St. Peter’s Health Partners; Mark Murphy, Senior Vice President, System Development and Ambulatory Care Administration, St. Joseph’s Health.

Mr. Mechanic’s research focuses on health care payment systems and the adaptation of organizations to new payment models. Prior to Brandeis, Mr. Mechanic was a Senior Vice President with the Massachusetts Hospital Association and Vice President with the Lewin Group. His work has been published in The New England Journal of Medicine, JAMA and Health Affairs. He is a trustee of Atrius Health, a 750-physician multispecialty group practice.

You can download the conference brochure at http://hca-nys.org/wp-content/uploads/2016/04/2016-HCAAnnual-Conference-Detailed-Brochure.pdf or register online at https://www.eventville.com/Catalog/ EventRegistration1.asp?EventId=1011878.

Flu Vaccination Report Due by May 2 Influenza still prevalent and mask rule in effect Home care and other provider agencies have one week left to complete and submit the Healthcare Personnel Vaccination Report.

This year’s report covers personnel employed by or affiliated with a facility or agency from October 1, 2015 through March 31, 2016. Please note: if personnel work in or are affiliated with more than one agency, then these individuals must be counted in the total number of personnel for each agency where that individual works.

The vaccination report may be accessed on the Health Commerce System under the Health Electronic Response Data System (HERDS) at https://commerce.health.state.ny.us.

Questions about the Healthcare Personnel Influenza Vaccination Report should be directed to DOH’s Bureau of Immunization at either (518) 473-4437 or immunize@health.ny.gov.

Step-by-step instructions for completing the report, and a Frequently Asked Questions document, are at www.health.ny.gov/flumaskreg. Technical questions about the report or on the use of HERDS should be directed to the Health Emergency Preparedness Program at (518) 408-5163 or hseppny@health.ny.gov.

Influenza has been declared prevalent since February 11 which triggers the requirement that home care and other health care workers who are not vaccinated against influenza must wear surgical or procedure masks in areas where patients are typically present. This mask requirement will remain in effect until the DOH Commissioner declares that influenza is no longer prevalent in the state.

HCA will notify members once influenza has been declared no longer prevalent.

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

Volume 21, No. 16 April 22, 2016 

Flapjacks, a Dollop of Butter Butter,, and the Sweet Liquid Gold of Knowledge at HCA ence in T wo W eeks!

Two Weeks!

HCA’’s Annual Confer Conference Imagine your plate stacked high with warm, fluffy, golden-brown pancakes. Now add a creamy pat of butter, which represents time spent with friends and colleagues, and the sweet liquid gold of illuminating answers from HCA’s policy team poured on top.

Now that’ eakfast worth waking up for! that’ss a br breakfast This political season, presidential candidates are hitting the circuit of community pancake breakfasts to make their pitches and to hear from would-be constituents. HCA is bringing the same spirit to our elections-themed Annual Conference on May 4-6 4-6. There, you’ll have a chance to savor a few flapjacks and gain some stick-to-your-ribs knowledge about all of the latest happenings in the home care industry, as we “Vote Home Care!”

At our Town Hall and Pancake Br Breakfast eakfast, eakfast HCA will open the floor for discussion where you’ll get to ask the HCA Policy Team your pressing questions on advocacy, regulations, home care program developments, trends, reimbursement, and more.

This year’s conference will be both fun and informative. Informative Informative, with sessions on value-based payment, home care marketing, health information technology, and other vital issues. And fun, as you get a photo opportunity with the 2016 presidential candidates; fact-check your trivia smarts at our Stars-and-Stripes PAC Reception; poll your future with a psychic reading; and enjoy a cocktail with exhibitors.

Don’t delay. Send us your registration now for this signature conference, which is happening in just two weeks weeks! Registration links are below.

You can download the brochure at http://hca-nys.org/wp-content/uploads/2016/04/2016HCA-Annual-Conference-Detailed-Brochure.pdf or register online at https:// www.eventville.com/Catalog/EventRegistration1.asp?EventId=1011878.

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

Volume 21, No. 16 April 22, 2016 

A Reminder – and More Information – about Next Week’s Mandatory Emergency Drill for Home Care As reported in last week’s ASAP and a follow-up e-mail alert this week, the state Department of Health (DOH) released a Dear Administrator Letter (DAL) from the Division of Home and Community Based Services (DHCBS) 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 occurs.

Initially, the DAL stated that successful completion of the drill would involve collection of Transportation Assistance Levels (TALs) of patients. DOH has since revised this guidance, and TALs will no longer be required for this drill. Instead, TALs are still expected to be in place for the June 1 deadline for TALs implementation previously prescribed by DOH. 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 real emergencies, all communication between DOH and providers will take place via the HCS Integrated Health Alert Notification System (IHANS).

Earlier this week, DOH distributed further information regarding the drill, including the Emergency Scenario to use during the drill. All of those materials can be viewed at https://apps.health.ny.gov/pub/ ctrldocs/alrtview/postings/Notification_20314.pdf.

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. If you have questions, please contact Alex Blais at ablais@hcanys.org.

Uniform Billing Codes Update This week, HCA and other provider associations met to finalize recommended billing codes. The purpose of this effort is to implement a provision of the 2014-15 state budget that requires uniform billing codes for home and community-based services under Medicaid managed care.

The Associations hope to finalize their recommendations and send them to the state Department of Health (DOH) by next week. Earlier, the state had indicated an intention to send these revised codes to managed care plans for their final comments.

The uniform billing requirement was sought by HCA to help home care agencies and their managed care contractors by simplifying billing procedures and facilitating timely payments for agencies as a result.

Continued on next page

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Volume 21, No. 16 April 22, 2016

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

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Continued from previous page The Associations have been meeting for about a year to develop uniform codes, and HCA sought feedback from our members in the early development stages. Managed care plans have also provided input on various billing code versions and these final recommendations were based on extensive managed care plan feedback.

HCA will notify members once the codes have been finalized and DOH establishes an implementation schedule.

For more information, contact the HCA Policy staff.

Concerned about PHI Data Breaches, the Costs, and Other Implications?

HCA’s 6/15 Bootcamp has Answers With thousands of direct-care staff working remotely throughout the state, and handling sensitive patient information, home care’s risk of a data breach should be on the minds of all agency leaders.

Indeed, the complexities of HIPAA and HITECH regulations, including cyber security, are some of the most critical compliance issues facing home care and other health care providers.

In an environment where data breaches occur with increasing frequency, federal regulators have also amplified their auditing and investigations of provider compliance with HIPAA/HITECH. Recent violations have resulted in substantial financial penalties levied against providers.

HCA is holding a June 15 workshop in New York City, part of our popular home care Bootcamp series, to review what constitutes Protected Health Information (PHI) and the regulations related to the sharing of PHI. Most importantly, you will learn about the critical aspects of cybersecurity compliance, common areas for HIPAA violations, compliance with the HIPAA Privacy, Security and Breach Notification Rules and what’s required (from a compliance perspective) when the inevitable data breach occurs, such as a stolen laptop or lost thumb drive that contains protected health information.

This session is being led by Frank Fanshawe, HCA’s counsel and Partner at the Health Care Law practice in Wilson Elser’s Albany office. He has practiced health care law for 25 years, including significant real-world legal and executive-level experience with a nationally recognized health insurer in the northeastern United States, where he was responsible for HIPAA/HITECH compliance. Don’t miss this high-value program with insights from a top expert in HIPAA compliance. Register today. A PDF registration form is linked below, along with further details.

HIPAA eRisks and Responses for Home Care Agencies June 15, 2016 130 East 59th Street (near Lexington Ave.) 7th Floor New York, NY 10022 9:30 a.m. to noon Register at: http://hca-nys.org/wp-content/uploads/2016/03/June-15-Survival-Bootcamp-HIPAAeRisks-Registration-Form.pdf

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

Volume 21, No. 16 April 22, 2016 

CMS Issues Proposed Rule for FY 2017 Medicare Hospice Benefit The U.S. Centers for Medicare and Medicaid Services (CMS) issued a proposed rule this week (CMS-1652-P) that would update the fiscal year (FY) 2017 Medicare payment rates and the wage index for hospices serving Medicare beneficiaries.

The proposed rule (https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-09631.pdf ) updates the hospice wage index, payment rates, and cap amount for FY 2017.

In addition, the rule proposes to changes the hospice quality reporting program, including proposing new quality measures. The proposed rule also solicits feedback on an enhanced data collection instrument and describes plans to publicly display quality measures and other hospice data beginning in the middle of 2017.

Finally, this rule updates hospice monitoring data analysis and provides discussion about ongoing monitoring efforts.

The following are highlights of CMS’s proposed rule.

Payment Update As proposed, hospices would see a 2.0 percent ($330 million) increase in their payments for FY 2017. The proposed 2.0 percent hospice payment update percentage for FY 2017 is based on an estimated 2.8 percent inpatient hospital market basket update, reduced by a 0.5-percentage point productivity adjustment and by a 0.3-percentage point adjustment set by the Affordable Care Act (ACA).

As discussed in the FY 2016 Hospice Wage Index and Payment Rate Update final rule, CMS implemented changes required by the Improving Medicare Post-Acute Care Transformation Act of 2014. Specifically, for accounting years that end after September 30, 2016 and before October 1, 2025, the hospice cap is updated by the hospice payment update percentage rather than using the consumer price index for urban consumers (CPI– U). As required by section 1814 of the Act, the hospice cap amount for the 2017 cap year will be $28,377.17, which is equal to the 2016 cap amount ($27,820.75) updated by the FY 2017 hospice payment update of 2.0 percent.

As a reminder, in the FY 2016 Hospice Wage Index and Payment Rate Update final rule, CMS finalized the alignment of the cap accounting year with the federal fiscal year beginning in 2017. Therefore, the 2017 cap year will start on October 1, 2016 and end on September 30, 2017. Table 26 in the FY 2016 Hospice Wage Index and Payment Rate Update final rule outlines the timeframes for counting beneficiaries and payments during the 2017 transition year.

This rule also updates data analysis regarding hospice trends including diagnosis reporting, pre-hospice spending, non-hospice spending, and live discharges. Ongoing and future monitoring efforts are also discussed and monitoring will occur at the aggregate and provider-levels.

Hospice CAHPS Experience of Care Survey The Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey is a component of the Hospice Quality Reporting Program (HQRP) required under ACA. The proposed rule provides a description of the Hospice CAHPS survey, including the model of survey implementation, the survey 10

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respondents, eligibility criteria for the sample, and the languages in which the survey is offered, among other details.

The proposed rule also outlines participation requirements for the FY 2019 and FY 2020 annual payment updates. For the FY 2019 Annual Payment Update (APU), hospices must collect survey data on an ongoing basis from January through December of calendar year (CY) 2017. For the FY 2020 APU, hospices must collect survey data on an ongoing basis from January through December of CY 2018. Lastly, the proposed rule includes survey data submission deadlines for the FY 2018, FY 2019, and FY 2020 APU periods.

Public display of the survey results will not occur until CMS has collected at least four quarters of data.

CMS anticipates that public display of the data will occur during CY 2017. Additional information on the Hospice CAHPS survey can be found at www.hospicecahpssurvey.org.

New Hospice Quality Measures CMS is proposing two new quality measures for FY 2017. The first, “Hospice Visits When Death is Imminent,” is a measure that will assess hospice staff visits to patients and caregivers in the last week of life.

The second, “Hospice and Palliative Care Composite Process Measure,” will assess the percentage of hospice patients who received care processes consistent with guidelines. This measure will be based on select measures from the seven that are currently being submitted under the HQRP (Pain Screening, Pain Assessment, Dyspnea Treatment, Patients Treated with an Opioid who are given a Bowel Regimen, and Treatment Preferences & Beliefs/Values Addressed if desired by patient).

Enhanced Data Collection CMS is considering enhancing the current Hospice Item Set (HIS) data collection instrument to be more in line with other Post-Acute Care settings. This revised data collection instrument would be a comprehensive patient assessment instrument, rather than the current chart abstraction tool. By integrating a core standard data set into a comprehensive assessment system, hospices can use such a data set as the foundation for valid and reliable information for patient assessment, care planning, and service delivery. This will enable greater accuracy in quality reporting; decrease provider burden; help surveyors ensure hospices are meeting Conditions of Participation (CoPs) and providing high quality patient care; and, in the future, enable payment determinations.

Public Reporting CMS expects to begin public reporting via a Compare Site in CY 2017. In addition, CMS expects to post hospice demographic data on a public use file at https://data.medicare.gov in late spring/early summer 2016.

Comment Period CMS’s proposed rule will be open for public comment until 5 p.m. on June 20, 2016. HCA plans to submit comments on behalf of the membership. Members are encouraged to share with HCA their concerns by emailing Patrick Conole at pconole@hcanys.org.

Providers interested in submitting their own comments can do so either electronically, by regular mail, express or overnight mail, hand, or courier and should refer to File Code CMS-1652-P. Electronic 11

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comments on the proposed rule can be sent to http://www.regulations.gov. (Follow the instructions under the “More Search Options” tab.) Providers preferring to submit comments by regular mail should send them to: CMS, Department of Health and Human Services, Attention: CMS-1652-P, P.O. Box 8010, Baltimore, MD 21244-8010.

Additional information on CMS’s proposed rule, including access to the proposed FY 2017 Hospice Wage Index, can be found at http://www.cms.gov/Center/Provider-Type/Hospice-Center.html.

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

NYC Council Considers Bill to Establish Division of Paid Care The New York City Council is considering a bill (Introduction Number 1084) to establish a Division of Paid Care within the city Office of Labor Standards.

A bill summary and text are at http://legistar.council.nyc.gov/ LegislationDetail.aspx?ID=2576392&GUID=632A3331-9DC6-4348-ADB6AD9FFF5F03A7&Options=ID%7cText%7c&Search=int.+1084.

The Division would work on issues related to home care and child care workers.

The responsibilities of the Division, led by a coordinator, would include conducting public outreach campaigns and informational clinics to inform paid care workers of their rights and obligations under local, state and federal laws related to labor standards, benefits and education or training programs; collecting and publishing information useful for paid care workers; coordinating with other city agencies; and developing related policies and programs.

The Division also would house an advocate who would assist paid care workers by developing an intake and referral system to address workplace grievances and who would investigate systemic legal violations related to licensed and unlicensed home care agencies.

The City Council held a hearing on the bill last week; HCA will be following the status of the bill and will keep members updated.

Proposed Rule Issued on OPWDD Cost Reports The state Office for People with Developmental Disabilities (OPWDD) has issued a proposed rule that would make changes to the requirements for submission of cost reports and impose penalties for late submissions.

The proposed rule is at http://docs.dos.ny.gov/info/register/2016/april27/pdf/rulemaking.pdf (page six) and http://www.opwdd.ny.gov/regulations_guidance/opwdd_regulations/CostReportSubmission-andPenaltyChanges.

Continued on next page

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

Volume 21, No. 16 April 22, 2016 

Continued from previous page The amendments require providers to submit their cost reports in the form and format prescribed by OPWDD on or before prescribed dates and extend the due date to incorporate the 30-day extension period in the current regulations and eliminate the requirements associated with making requests for an extension.

In addition, new penalties are added to providers of home and community-based waiver services for failure to submit timely cost reports. If the cost reports are not submitted by a specific date, the existing twopercent penalty will be replaced by a 50-percent penalty.

If a provider is unable to meet its fiscal obligations with such a penalty, OPWDD would be allowed to request that the provider voluntarily surrender its operating certificate and/or revoke the operating certificate.

Also, the regulations include a provision whereby a provider could avoid penalties if it demonstrates to OPWDD’s satisfaction that it cannot meet a cost report deadline due to “extraordinary and/or unforeseeable circumstances beyond its control.”

CMS Releases Medicare Advantage Quality Data for Racial and Ethnic minorities The U.S. Centers for Medicare and Medicaid Services (CMS) Office of Minority Health released data this week detailing the quality of care received by people with Medicare Advantage by racial or ethnic group. This is the first time that CMS has released Medicare Advantage data stratified by race and ethnicity.

The data are based on an analysis of two sources of information. The first is part of the Healthcare Effectiveness Data and Information Set (HEDIS). HEDIS collects information from medical records and administrative data on how well the needs of Medicare beneficiaries are met for a variety of medical issues, including diabetes, cardiovascular disease, and chronic lung disease. The second part is the Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey, which is conducted annually by CMS. CAHPS focuses on the health care experiences of Medicare beneficiaries across the nation.

The database presents HEDIS and CAHPS scores for different racial and ethnic groups at the level of individual Medicare contracts and is intended to be used to improve quality and accountability. The information provided by this database is not used to evaluate care through the star ratings program nor is it used for payment purposes.

Analysis of the quality of care delivered to beneficiaries showed that Asians and Pacific Islanders typically received care that is similar to or better than the care received by Whites, whereas African Americans and Hispanics typically received care that is similar to or worse than the care received by Whites. African Americans and Hispanics also reported their health care experiences as being similar to or worse than the experiences reported by Whites. This data help to highlight the racial and ethnic disparities that occur within health care.

The data and summary report can be viewed at https://www.cms.gov/About-CMS/Agency-Information/ OMH/OMH-DPAG-StatisticsAndData.html.

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

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

Volume 21, No. 16 April 22, 2016 

CMS to Host Quality Reporting Program Webinar The U.S. Centers for Medicare and Medicaid Services (CMS) will be hosting a webinar on Tuesday, May 10 from 2 to 3:30 p.m. for hospice providers, focusing on CMS data submission requirements for the Hospice Quality Reporting Program (HQRP), including how to: 

Access Final Validation Reports (FVRs).



Use information in the FVRs to determine whether data is successfully transmitted or needs to be corrected.

HCA members can register for the webinar at: https://secure.confertel.net/tsRegister.asp?course=6962803.

If you have questions or need additional information, e-mail PACTraining@econometricainc.com.

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

Publications 

“Performance of New York’s Accountable Care Organizations in Year 2 of the Medicare Shared Savings Program,” by the United Hospital Fund http://www.uhfnyc.org/assets/1464

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

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