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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. 17 April 29, 2016

HCA Conference Begins Wednesday: Some Logistical Details and a Last Call to Register! The HCA Annual Conference is next week, and we hope that you are as excited as we are about coming to Saratoga Springs to Vote Home Care! On Wednesday, May 4, HCA’s welcome and registration desk will be open from 9 a.m. to 5 p.m. If you are already registered, our staff is ready to provide you with your conference tote containing your program book, your name badge and other informational items. If you haven’t yet registered for the conference, time is running short. You can still register for the full conference or, if it’s better for your schedule, you can register for any one day through our conference website at www.hcaannualconference.com. See CONFERENCE p. 4

HCA in Post-Budget Meetings As the state Legislature prepares to return to session next week, HCA began advance discussions with key offices and staff on opportunities to continue pursuit of home care priority areas and concerns post-budget.

Inside ASAP

See BUDGET p. 2

Logistics for HCA Conference Beginning Wednesday....................…1 HCA in Post-Budget Meetings........................................................…1 HCA Meeting to Press DOH on FLSA Funding Issues.....................…1 HCC Members: Join us for May 18 Forum............................................2 HCA Memo: New FLSA Guidance on ‘Sleep Time’ Exclusions….......3 Draft Revisions to Value Based Payment Roadmap Reviewed.…........4 Learn What Value Based Payment Really Means for You on 6/17.........5 Emergency Drill for Home Care, HCA Networking Sessions..............6 OMIG Makes Minor Changes to CHHA Audit Protocols….................7 See This Home Care Marketing Video? Meet The Firm Behind it…...8 HCA Announces 2016 Award Winners….............................................9 Final Medicaid Managed Care Rule Released..............................…11 New Code of Conduct Posted.....................................................…..11 New FIDA FAQs Posted.................................................................…11 Home Health 2nd Quarter QAO Interim Reports Available..........…12 CMS’s Next Home Health & Hospice Forum: May 4….......................12 New York MMIS Training................................................................…13 Upcoming NGS Education Programs............................................…14 Guidance Issued on Unlicensed & Licensed Housing Programs......14 Information for NYC RFP Bidders....................................................14 Air Conditioners Available for Patients…........................................15 New Information Posted on FIDA-IDD…..........................................16 CMS Posts New “Return to Home” Measure for Nursing Homes….16 Publications...................................................................................…...17

HCA to Press DOH on FLSA Funding Issues in Upcoming Meeting HCA is meeting on May 9 with the state Department of Health (DOH) to press member concerns about the distribution of funding to help home care providers with their new costs under the Fair Labor Standards Act (FLSA) rule that took effect October 13, 2015. See FLSA p. 3

Helping New Yorkers Feel Right At Home

Volume 21, No. 17 April 29, 2016

ASAP – a publication of the Home Care Association of New York State BUDGET from p. 1

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HCC Members: Join us for May 18 Forum Focused on Issues of Importance to You

These issues range from further securing premium and rate-payment adequacy (especially in the allocation of new funding for budgetadopted minimum wage increases) to critical support for key areas of home care infrastructure – in support of home care’s position and functioning under the state’s health care reforms and new care/coverage models.

HCA reminds our Home Care Council (HCC) of HCA members that we are holding a May 18 HCC Member Forum in New York City focused on issues of direct importance to you.

HCA is preparing new versions of our legislative language addressing these areas for consideration in this next phase of the state legislative session, which is expected to move quickly with a mid-June end date, amid an election year and the need for legislators to return to their home districts.

The Forum will be held from 10 a.m. to 12:30 p.m. at the Hunter College Brookdale Campus in New York City (425 East 25th Street). Among other issues, the May 18 Forum will focus on:  

HCA is also keying in on otherwise wellintended legislation that is problematic for home care or home care patients. These efforts require our advocacy to reshape and/or to have these initiatives reconsidered or withdrawn. HCA will keep members closely apprised of the developments in this upcoming, next phase of the state legislative session.

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New York City Human Resources Administration (HRA) updates; Quality Incentive Vital Access Provider Pool (QIVAPP) final awards; Fair Labor Standards Act funding; The final 2016-17 State Budget, the impact of the minimum wage increase and appropriations for providers.

Please join us for this important session by completing the registration form at the back of this week’s ASAP.

For further information, please contact Al Cardillo at acardillo@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 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

Volume 21, No. 17 April 29, 2016

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

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FLSA from p. 1

HCA Memo Explains New FLSA Guidance on ‘Exclusion of Sleep Time’

HCA will query DOH on which distribution methods MLTC plans have indicated they would use to pass the funding to their home care contractors. This is important because members have received monies from some plans but they often don’t know how the amount was determined. HCA will also be seeking how much money each plan sent to its providers.

Members urged to read the guidance and share with management teams The U.S. Department of Labor has issued new guidance on “Exclusion of Sleep Time from Hours Worked by Domestic Service Employees” and a revised Fact Sheet and Frequently Asked Questions document on the treatment of sleep time.

In addition, HCA will look into DOH’s intentions for follow up with plans that have not given any funds to their home care providers yet, despite a DOH deadline of April 8 to do so.

All the materials are posted at http:// www.dol.gov/whd/homecare/ sleep_time.htm.

Furthermore, HCA will request an update on the status of the federal share for the FLSA funds, and the status of the FLSA survey. HCA and other associations worked with DOH and Mercer, the state’s actuary, to develop this survey to measure the actual costs faced by agencies.

HCA has prepared a memo explaining the guidance. You can download the memo at http://hca-nys.org/wp-content/uploads/ 2016/04/MemoFLSASleepGuidance.pdf.

HCA has repeatedly pressed the state to give the funds to the plans expeditiously, and for the plans to pass that money on as a $0.34 increase on each hour of aide services. HCA has also stressed the difficulty of the state’s documentation requirements for new overtime, travel and 24-hour care expenses. The straight, across-the-board process outlined by HCA would be simpler for both the plans and home care providers, we contend.

HCA advises members to consult with their counsel about how the guidance affects your practices for excluding sleep time from an employee’s hours, and, if necessary, make any changes to your compliance enforcement and any written agreements with aides who work on 24-hour live-in cases. This information is very important as it affects FLSA funding and soon-to-be implemented minimum wage increases.

HCA has also communicated numerous times to DOH the difficulty of identifying overtime and travel expenses for each plan (versus in the aggregate) as aides often serve patients who are enrolled in different plans.

The guidance distinguishes between “live-in employees,” and shifts of 24 hours or more under the Fair Labor Standards Act (FLSA). We further note that use of the term “24-hour live-in” services in New York State is distinct from the definition of “live-in employees” under the FLSA and members should be aware of these distinctions, outlined in the memo.

HCA has been tracking the distribution of the funds and urges members to let us know which plans have distributed money, which plans have not, the distribution method, and any other issues you have encountered. This information can be reported to Andrew Koski at (518) 810-0662 or akoski@hcanys.org; or Alex Blais at (518) 810-0658 or ablais@hcanys.org.

For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org. 3

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

Volume 21, No. 17 April 29, 2016 

CONFERENCE from p. 1 Just so you can plan ahead, here is what’s on the agenda for Wednesday: 

10 a.m. to noon: Pre-Conference Session on Opportunities for Home Care Providers under ValueBased Payment.

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1:30 p.m. to 4:30 p.m.: HCA’s Annual Corporation and Board of Directors Meetings (all members are invited to attend).

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3 to 6 p.m.: Exhibit Gallery opens with 31 vendors. Our vendors are listed on the Annual Conference website at www.hcaannualconference.com.

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4:30 to 6 p.m.: Welcome Reception, followed by dinner of your own choosing in Saratoga.

A complete outline of the full program is available at www.hcaannualconference.com and includes a listing of our generous sponsors, exhibitors, networking opportunities and valuable learning opportunities. Handouts In an effort to go green and save on conference costs, we ask that you download any speaker handouts that are of interest to you prior to attending the conference. (Please note that not all speakers are providing handout materials). A link to the handouts is at http://hcaannualconference.com/hca-conferencehandouts/. This page is password protected. You should have already received the password if you registered. But if not, you can contact HCA’s Education Director Celisia Street at cstreet@hcanys.org. Additional reminders Bring your business cards to exchange with your peers and for the exhibit gallery where many vendors are giving away fabulous prizes. Dress for the conference is business casual. Questions about the Annual Conference? Contact us at (518) 426-8764 or info@hcanys.org.

Draft Revisions to Value Based Payment Roadmap Reviewed with Committee Public Comment Period Continues Yesterday, state officials from the Department of Health (DOH) and project team directors from KPMG reviewed with the state Value Based Payment workgroup their draft (but intended) revisions/update to the state’s Roadmap to Value Based Payment (VBP). The redline draft of the Roadmap update and the slide deck explaining the status and next steps can be viewed at http://hca-nys.org/wp-content/uploads/2016/04/VBPWrkgrp428RoadmapChanges.pdf. DOH aims to compile remaining public comment and to submit the update to the Roadmap in May. HCA members wishing to comment should take advantage of this opportunity, submitting comments to dsrip@health.ny.gov. The DOH VBP website shows an April 18 due date for comments, but yesterday DOH indicated that public comments were still being received. HCA is an active member of the main DOH VBP workgroup and the innumerable subcommittees established under the project. At yesterday’s meeting, HCA raised a number of key points surrounding both 4

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

Volume 21, No. 17 April 29, 2016 

the update and VBP design overall. In a discussion involving value assessment of “price points” in a bundle (e.g., the price of a particular service versus the total cost of care), HCA raised the importance of accommodation for minimum wage increases, Fair Labor Standards Act adjustments and other external mandates, as these will eventually affect calculations of fiscal performance versus base year targets under VBP (and thus also “shared savings” or bonus payment potential for home care, MLTC and other sectors). DOH acknowledged the HCA-raised issue and indicated that it would plan to revise the base year/performance targets, or to otherwise adjust the numbers to reflect the new cost of such mandates.

Learn What Value Based Payment Really Means for Your Organization at June 17 HCA Program

HCA also responded to the latest draft DOH recommendation pertaining to terms for financially challenged providers’ participation in (or exclusion from) VBP arrangements. HCA encouraged a positive, supportive foundation for participation by challenged providers, whereas DOH’s current scheme affords a very narrow band of opportunity combined with punitive-like provisions for such participation.

The Obama and Cuomo Administrations are both moving quickly on these initiatives, including: a federal VBP pilot program in nine states; the paving of New York’s VBP Roadmap as a circuit extension of its Delivery System Reform Incentive Payment (DSRIP) program (see related p. 4 story); continued emphasis on Accountable Care Organizations and bundled payment arrangements; and the Comprehensive Care for Joint Replacement Model (CJR), which began in parts of the state and nation on April 1.

HCA is holding a special must-attend, membersonly program on value based payments on June 17 in Nanuet. (A registration form is published at the back of this week’s ASAP.) Both the state and federal governments are pushing ambitious agendas to promote “value” over “volume” in our health care system – and the stakes are high for home care. As one news article proclaimed, the trip toward Value Based Payment (VBP) systems will, indeed, be a “bumpy ride.”

HCA offered comments and suggestions for state support of health practitioner/direct care workforce training and education in VBP, as well as for support of collaborative models of home care and primary care in VBP. DOH and/or KMPG expressed interested in follow up to both.

These and other VBP policy constructs will challenge home care providers, but they also provide opportunities in an increasingly integrated health care environment. Providers must learn about how VBP is structured, which quality and outcome measures actually matter most under VBP, and how to position themselves for VBP by making clinical and operational changes.

HCA’s VBP input and advocacy will continue full steam. HCA urges providers to continue their internal strategic analysis and positioning, and their engagement with managed care plans, hospitals, physicians, behavioral health, nursing homes and other partners for VBP.

This must-attend program will provide an important table-setting for a series of drill-down workshops that HCA is launching to help agencies get ready for a VBP state and federal policy environment.

Please also plan on participating in HCA’s upcoming June 17 symposium on VBP, which will be held at DoubleTree Hotel and Conference Center in Nanuet. See the sidebar article.

Complete the registration form at the back of this week’s ASAP or download it from our Education and Events page at http://hca-nys.org/eventseducation/upcoming-events.

For further information, please contact Al Cardillo at acardillo@hcanys.org. 5

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

Volume 21, No. 17 April 29, 2016 

NYS Emergency Response Drill for Home Care HCA completes first round of local emergency preparedness networking meetings As reported in the past two editions of ASAP, this week the state Department of Health (DOH) Division of Home and Community Based Services (DHCBS) conducted an emergency response drill that began on April 25 and ends today, April 29. Participation in this drill was required of all CHHAs, LTHHCPs, and LHCSAs. Lack of participation will result in citation and potential further penalization. This drill simulated a weather emergency scenario unfolding over the course of several days, impacting all areas of the state in some way. The drill was designed 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. It also served to remind providers that the Health Commerce System (HCS) is the primary mechanism for communication from the DOH to providers. For purposes of this drill and real emergencies, all communication between DOH and providers did, and will continue to, take place via the HCS Integrated Health Alert Notification System (IHANS). HCA hopes that this drill was a success for all members. If you have questions, concerns, or feedback to provide, please contact Alex Blais at ablais@hcanys.org. Emergency Preparedness Networking Meetings HCA completed its first round of local emergency management networking meetings, concluding with a fivecounty session in Elmira on Wednesday. In three sessions, begun this month in Western New York, the networking meetings brought together home care providers, hospices, local health departments and county emergency managers covering 17 counties in all. HCA will be working with the New York State Association of Health Care Providers (HCP), the state Department of Health, the state Emergency Managers Association, Department of Homeland Security and others on next steps to build on the foundation of these local networking sessions. HCA thanks all those who participated in these robust meetings. It is anticipated that the next region targeted for these sessions will be the broader capital/northeastern region of the state, to commence in the upcoming July 2016 to June 2017 state emergency preparedness planning year. More information, including dates and locations, will follow. (Sessions are also planned to ultimately cover all counties and regions of the state.) For further information, please contact Al Cardillo at acardillo@hcanys.org or Alex Blais at ablais@hcanys.org.

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

Volume 21, No. 17 April 29, 2016 

OMIG Makes Minor Changes to CHHA Audit Protocols HCA has reviewed the revised state Office of Medicaid Inspector General (OMIG) audit protocols for CHHA services provided prior to April 1, 2012, which the OMIG shared with us late last Friday. We have found some changes from the September 2, 2014 protocols that are for service dates prior to December 31, 2010. First, the OMIG added the following new provisions in the introduction: Audit protocols are used as a guide in the course of an audit to evaluate a provider’s compliance with Medicaid requirements and to determine the propriety of Medicaid expended funds. In this effort, OMIG will review and consider any relevant contemporaneous documentation maintained and available in the provider’s records to substantiate a claim.

In past comments on draft audit protocols, HCA had suggested language to clarify that OMIG would review any documentation to substantiate that the agency tried to comply with an audit protocol, and we welcome this new language. OMIG has also added the following new provision in the introduction to advise agencies that even if an agency complies with the audit protocols, OMIG can still recover Medicaid funds: “Furthermore, audit protocols do not limit or diminish OMIG’s authority to recover improperly expended Medicaid funds and OMIG may amend audit protocols as necessary to address identified issues of non-compliance.” In addition, under protocol 26, “Patient Excess Income (‘Spend down’) Not Applied Prior to Billing Medicaid,” OMIG has added the following new language: The spend-down amount should be applied beginning with the first service rendered in the month and each service thereafter until the spend-down is exhausted. Each sampled claim subject to spend-down application billed to Medicaid before the spend-down is met will be disallowed.

The rest of the changes are mostly revisions to the regulatory references or minor rewording of the protocols. HCA advises home care providers (CHHAs and LHCSAs) to review all of the protocols and make any necessary revisions to their compliance efforts. The new CHHA audit protocols (dated April 22, 2016) can be reviewed at https://www.omig.ny.gov/images/stories/audit_protocols/chha_protocol_4_27_16.pdf. As noted in last week’s ASAP, HCA notified OMIG that it needs to revise these protocols to reflect the new provisions for signed physician orders, and OMIG has agreed to add guidance for its auditors to reflect this change. To learn more about the recently approved physician order changes, which provide more flexibility and align the timetables with the Medicare requirements, see last week’s ASAP.

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

Volume 21, No. 17 April 29, 2016 

Remember This Hugely Successful Home Care Marketing Video? The Firm That Made It Is At Next Week’s HCA Annual Conference! Home care members in the New York City region may remember a hugely successful marketing campaign launched by the Visiting Nurse Service of New York called “Now What?” The campaign was incredibly effective for several reasons. It gave very relatable scenarios for why home care is needed, and it made a compelling pitch. The campaign was crisp, well-produced, and showed how home care can relieve some of the anxieties and stresses of families facing the need for eldercare services. We bet you would love to explore a similar marketing pitch to keep your intake department busy! Come to HCA’s Annual Conference next week (May 4-6 in Saratoga) and you’ll get a chance to meet the marketing mind behind this masterful campaign during a session on “Marketing Home Care” with Matt Seiden of Seiden Advertising. This session, from a top-tier New York City marketing firm, is worth the registration fee alone! Using examples of his agency’s own work, Matt Seiden will show how to: create messaging that is relevant and motivating to your audience; best focus on a brand message; prioritize your target audiences; and best integrate your communications through digital and social media. Matt Seiden’s namesake agency has consistently raised the bar for excellence in health care advertising. Seiden’s “Now What?” campaign for the Visiting Nurse Service of New York was named Integrated Campaign of the Year at the Global Healthcare Awards; and New York-Presbyterian’s recent Immunotherapy film was a Creativity Top 20 and has received more than a million views online. This is just one of several exceptional segments at our May 4-6 conference. Please register as soon as possible so we can plan for your attendance. Time is running out!

Volume 21, No. 17 April 29, 2016

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

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HCA Announces 2016 Award Winners: Come Celebrate Them at Next Week’s Annual Conference HCA is proud to announce our 2016 Annual Award winners, which include four Caring Award winners; our Advocacy Award winner; and our Ruth F. Wilson Award winner. These awards will be presented during a special luncheon at next week’s HCA Annual Conference and HCA hopes to have a big showing of support from the membership for this year’s winners: Patti Gregg, Jeffrey Duarte, Angela Pinzon, Linda Fraser, Orael Keenan and Laurie Neander. These award winners are your colleagues, as well as some truly exceptional individuals who define the great work of home care. Please join us in recognizing them at our Annual Conference next week. You can register by downloading the brochure or using the online registration link on our conference website at www.hcaannualconference.com. Below is just a snapshot of the stories you will hear during our Awards Luncheon on May 5 in Saratoga. Award Winner Profiles In Brief Three of our award winners are distinguished for their work helping long-term care and end-of-life care patients. Patti Gregg (Caring Award; Home Health Aide, VNS of Rochester and Monroe County-Finger Lakes VNS) services a diverse population of hospice, CHHA, and long term care patients in a very rural area of upstate New York, traveling several miles between cases over icy, snow-covered roads that often are unplowed by the time she is due to be at a patient’s home. She is quick to realize changes in a patient’s condition or needs, promptly notifying the case manager for follow-up. Angela Pinzon (Caring Award; Home Health Aide, Americare, Inc.) worked with the same patient for two years. When the patient turned 97, Angela bought a cake and they called her son to sing Happy Birthday together. One night, Angela heard the patient humming a melody that they always sung together, and Angela knew that the patient was leaving her. She held the patient’s hand, and they hummed the song together until the patient fell asleep. That night the patient died in her sleep and Angela called the son to inform him. Angela was asked to share her story with her peers and, in doing so, has helped numerous aides learn how to deal with dying or treatment of end-stage patients. Linda Fraser, RN, BSN, CHPN (Caring Award; Palliative Care Nurse, Visiting Nurse Association of Hudson Valley) is known not only for her excellent patient care skills but also for using humor and storytelling to help her patients cope with the challenges of advanced illness. Continued on next page 9

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Linda has been instrumental in developing VNA’s multidisciplinary care process for palliative care. One patient, Adam, was wheelchair-bound with Multiple Sclerosis and only had use of one arm. Linda worked to coordinate care among his medical and support team. She worked to ensure that his pain was managed, but she also cooked his favorite meal from his home country for him on Thanksgiving. Despite his illness, Adam knew he was cared for and loved. Jeffrey Duarte (Caring Award; Operations Manager, United Odd Fellows-Rebekah LTHHCP and CHHA) is a rising star in home care. At only 23 years old, he has worked his way up in just two years to become the Manager of Operations for the LTHHCP and CHHA. As a tribute to his kindness, Jeffrey makes many monthly trips to the post office, purchasing money orders for homebound clients so they can pay their rent on time. Of course, he never calls attention to these routine errands of altruism. He knows every client on census by name and has quietly built a rapport with them in ways that make the nurses’, social workers’ and rehab therapists’ jobs much easier. Orael Keenan (Advocacy Award; Director of Regulatory Compliance, Hospice Care Network) has worked for over 25 years in service to patients and the home care community. During her former time as a Nurse Manager on an orthopedic floor, her colleagues recall her dedication, competence and her true compassion for her patients. These feelings are also shared by her colleagues in the home care industry where she’s not only endured the struggles of managing an operation in a highly challenged home care environment but she’s also found great success. As a past HCA Board Member, she’s demonstrated her knowledge and endless passion for home care in her frequent meetings with Legislators and Department of Health officials. Orael has fought long and hard to keep her previous organization, the VNA of Long Island, afloat during a time of massive regulatory change and reform. During a fragile transition, she was able to safeguard the care of her clients and oversee the appropriate transition of all services. Laurie Neander (Ruth F. Wilson Award; President and CEO, Bassett Healthcare Network: At Home Care) is one of the state’s and nation’s most innovative and talented contributors to improving the vital practice of home care. She has brought decades of experience as a clinician and as one of the state’s most exceptional leaders in promoting the value and experience of home care. Laurie provides dynamic leadership and access to exceptional home care services to a patient population in five predominantly rural counties in upstate New York. More broadly, she contributed to the successful passage of HCA’s Medicaid telehealth reimbursement legislation and many other telehealth initiatives. Perhaps one of her most pivotal and important contributions was her creative leadership in conceiving and working with HCA to formulate, design, and test the HCA Quality Measurement, Risk and Compliance Tool (HQMT).

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

Final Medicaid Managed Care Rule Released The U.S. Centers for Medicare and Medicaid Services (CMS) has released a final rule that covers many aspects of Medicaid managed care. The rule, and fact sheets, are at https:// www.medicaid.gov/medicaid-chip-programinformation/by-topics/delivery-systems/ managed-care/managed-care-site.html. The rule covers long term services and supports (LTSS); care coordination; provider screening and program integrity; subcontractual relationships; quality; beneficiary information and appeals; delivery system reform efforts; and other areas. Last July, HCA had submitted extensive comments on the then-proposed rule, which can be viewed at http://hca-nys.org/letters-andcomments/comments-on-medicaid-managedcare-proposed-rule. HCA’s comments address: the misalignment between federal and state regulations for home care; the need for actuarial soundness of rates by states to managed care plans and rates from plans to home care providers; disenrollment due to home care provider changes; transitions of care; state monitoring requirements; grievances and appeals and aid continuing; provider screening and enrollment; uniform billing; and plan contacts. HCA will be reviewing the final rule – which, including public comments and CMS’s responses, is over 1,000 pages – to learn if the issues we raised were addressed, and to determine which provisions will affect managed care in New York. For a full summary of the provisions, please review a longer version of this article posted in the “General News” section of our website at http://hca-nys.org/category/general-news.

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New Code of Conduct Posted A newly-executed Code of Conduct has been provided by the state Justice Center for the Protection of People with Special Needs ( Justice Center). The Code of Conduct applies to all “custodians,” as defined in 18 NYCRR § 487.2(c)(6) and § 488.2(d)(6), who have or will have regular and direct contact with service recipients who reside in facilities under the conjoined jurisdiction of the state Department of Health (DOH) and the Justice Center. Such custodians must be provided with a copy of the Code of Conduct at the time of their initial employment, and at least annually thereafter, and are required to acknowledge that they have read and understand the Code of Conduct. The new form has been posted on the Health Commerce System at https:// commerce.health.state.ny.us/public/hcs_login.html (under Newsroom Highlights).

New FIDA FAQs Posted The state Department of Health (DOH) has posted new Frequently Asked Questions (FAQs) for the Fully Integrated Duals Advantage (FIDA) program. The FAQs are at http://www.health.ny.gov/ health_care/medicaid/redesign/fida/docs/201604_open_questions_faq.pdf. They cover: plan compliance with the Money Follows the Person program; passive enrollment in region 2 (Suffolk and Westchester); disenrollment for refusal to obtain an assessment; compensation of employed agents; and other issues. Additional FAQS and guidance documents are at http://www.health.ny.gov/health_care/medicaid/ redesign/mrt_101.htm.

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Home Health 2nd Quarter QAO Interim Reports Available The U.S. Centers for Medicare and Medicaid Services (CMS) announced this week that the second quarter Quality Assessment Only (QAO) Interim Reports are available in agencies’ Certification and Survey Provider Enhanced Reporting (CASPER) folder. These reports are informational only and are intended to help agencies monitor their compliance with the annual pay-for-reporting requirements. CMS encourages agencies to closely monitor these interim reports and investigate any discrepancies or concerns prior to receipt of the Annual QAO Metric Report. The annual report will reflect agencies’ actual compliance rate for the period of July 1, 2015, through June 30, 2016, and will be used to determine the individual agency market basket update for CY 2017; home health agencies must score at least 70 percent on the annual QAO metric or be subject to a 2 percentage point reduction. Additional information on CMS’s QAO Interim Reports can be found at: 

The Home Health Quality Initiatives website, which provides information on pay-for-reporting requirements and the calculation of the QAO metric (https://www.cms.gov/Medicare/QualityInitiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Home-Health-QualityReporting-Requirements.html).

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CASPER Reporting Provider User Guide (https://www.qtso.com/download/Guides/hha/ cspr_sec2_hha_prvdr.pdf ).

For specific question about accessing individual agency reports, contact the QTSO Help Desk at 800-339-9313 or help@qtso.com. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

CMS’s Next Home Health & Hospice Open Door Forum: May 4 The U.S. Centers for Medicare and Medicaid Services (CMS) will host its next Home Health and Hospice Open Door Forum (ODF) on Wednesday, May 4 from 2 to 3 p.m. The call-in number and passcode are below (CMS recommends calling at least 15 minutes prior to the call):  

Dial In No.: 1-800-837-1935 Conference ID: 39979021

Agenda items for the call include the following: 

A summary of the fiscal year (FY) 2017 Hospice Proposed Rule including an update on the Hospice Quality Reporting Program (HQRP) Continued on next page

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Continued from previous page 

Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) Update

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Medicaid home health face-to-face final rule (CMS 2348-F) –provisions and implementation requirements

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Medicare Home Health Value Based Purchasing

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Home health CAHPS survey update

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Home Health and IMPACT Act upcoming stakeholder engagement opportunities

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OASIS C2 Paperwork Reduction Act (PRA) update

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Open question and answer exchange

For further information, contact the HCA Policy staff.

New York Medicaid Management Information System (NYMMIS) Training The state Department of Health (DOH) announced this week in its April edition of Medicaid Update (http:// www.health.ny.gov/health_care/medicaid/program/update/2016/april_16mu.pdf ) that training for NYMMIS is now available in instructor-led and webinar formats via the interim NYMMIS website at www.interimNYMMIS.com. The course offerings include: 

Introduction to NYMMIS: Features and Functionality; and

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Introduction to Provider Enrollment

Registration for the training sessions and access to the course schedules can be done by visiting NYMMIS interim website. NYMMIS Computer-Based Trainings will also be accessible in May 2016 via the new Learning Management System (LMS). The LMS is an online training repository for videos and supporting materials that providers can access directly from their own computer with internet access. Registration for LMS will be available in May 2016; instructions will be available on the MYMMIS interim website at www.interimNYMMIS.com. 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

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

Ordering & Certifying Medicare Home Health Services: May 2, from noon to 1 p.m. (Registration is at: https://attendee.gotowebinar.com/rt/ 48586692185987844).

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Provider Enrollment: Getting Connected to PECOS: May 3, from 10 to 11 a.m. (Registration is at: https://attendee.gotowebinar.com/register/ 6991004265632210179).

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Home Health Documentation & the Additional Development Request: May 10, from noon to 12:30 p.m. (Registration is at: https:// attendee.gotowebinar.com/register/ 7045328935825498113).

For further information, contact Patrick Conole at (518) 8100661 or pconole@hcanys.org.

Guidance Issued on Unlicensed and Licensed Housing Programs The state Department of Health has issued a “Dear Colleague Letter” that outlines differences between the unlicensed and licensed options for long-term care residential and community-based programs. The letter is at http://hca-nys.org/wp-content/uploads/2016/04/ DALHousingOptions042516.pdf. The letter compares Independent Senior Housing, Adult Care Facilities and Assisted Living Residences, Enhanced Assisted Living Residences and Special Needs Assisted Living Residences on the following services: 24-hour supervision; social activities; health-related services; skilled nursing; case management; medication management; personal care assistance; meal preparation; housekeeping; and others. The letter is helpful for those who are seeking community options for consumers. The letter notes that, with some limited exceptions, any independent housing setting that provides, arranges for, or 14

Volume 21, No. 17 April 29, 2016 

Information for NYC RFP Bidders Starting July 1, 2016, e-mail will be the default means of communication for New York City agencies’ Invitations for Bids (IFBs), Requests for Proposals (RFPs), and their notices of availability. Notifications by paper mail, fax, hand delivery, or otherwise, will only be available upon request to the contracting agency. Agencies will use the Ordering Email Addresses that have been provided by vendors in the Payee Information Portal (PIP) (https:// a127-pip.nyc.gov/webapp/ PRDPCW/SelfService) for all future solicitations or notifications. Your “Ordering Email Address” will be used by the City for notification and solicitation purposes. To ensure that the City has your up-to-date email address, it is advised that you log into PIP and review this information before July 1. Resource guides are available at https://a127-pip.nyc.gov/webapp/ PRDPCW/SelfService/. If you have any difficulty creating or updating your account in PIP, please reach out to your agency contact. If you need further assistance, please contact the Mayor’s Office of Contract Services (MOCS) at MOCSOutreach@Cityhall.nyc.gov.

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

Volume 21, No. 17 April 29, 2016 

coordinates one or more of the following services is subject to Adult Care Facility and/or Assisted Living Residence licensure by the Department: 24-hour supervision/oversight; health-related services; case management/service coordination beyond information and referral; medication management; assistance with personal care; assistance with finances; and creation, implementation and/or oversight of an individualized service plan. Furthermore, DOH states that it is authorized to inspect any independent senior housing facility that reasonably appears to be providing, arranging for or coordinating such services to determine whether the facility needs to obtain a license. Any facility that fails to apply for and obtain a license when required by law is subject to a civil penalty of up to $1,000 per day and a Department order requiring closure of the facility. A few years ago, HCA worked on legislation that would clarify both the right of individuals residing in independent senior housing and the authority of home care agencies under their licensure to make arrangements for the provision of home care services the same for any other individuals living in their own homes or apartments in the community. It also made clear that these individuals may receive – and that the independent senior housing is not prohibited from offering – the usual room, board, laundry, housekeeping, information and referral, security or other basic services associated with housing that are not otherwise under the domain of licensure or regulatory requirement. HCA will be looking into the necessity of similar legislation at this time.

Air Conditioners Available for Patients The Cooling Assistance component of the Home Energy Assistance Program (HEAP) provides for the purchase and installation of air conditioners or a fan to eligible households. The HEAP Cooling Assistance component opens May 2, 2016 and will operate through August 31, 2016, or until funding allocated to this component is exhausted. Only one air conditioner or fan, not to exceed $800 with installation, will be provided per dwelling. A household may be eligible for a Cooling Assistance component benefit if the individuals are U.S. citizens or qualified aliens, and include an individual with a documented medical condition that is exacerbated by heat. They also must meet conditions for income; not have a working air conditioner (or the air conditioner is five years old or older); and did not receive a HEAP-funded air conditioner within the past ten years. More information (including details about the qualification requirements) is at https://otda.ny.gov/programs/heap/program.asp#cooling. Questions regarding the HEAP program should be directed to the local department of social services office or the Office of Temporary and Disability Assistance Hotline at 1-800-342-3009.

Volume 21, No. 17 April 29, 2016

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

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New Information Posted on FIDA-IDD The Office for People With Developmental Disabilities (OPWDD) has posted resources on the new Fully Integrated Duals Advantage for Individuals with Intellectual and Developmental Disabilities (FIDA-IDD) program. The resources are at http://www.opwdd.ny.gov/opwdd_services_supports/people_first_waiver/ care_management/FIDA_IDD. Partners Health Plan is the single IDD plan and has started 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 care (physician, hospitalization, drugs), Medicaid (care management, long term care, behavioral health), OPWDD waiver services if already enrolled in 1915(c) waivered services, transportation, and dental. Enrollment is voluntary and there will be no phased implementation and no passive enrollment. The FIDAIDD demonstration period is from April 2016 to December 2020. Some of the posted documents include Frequently Asked Questions, a Memorandum of Understanding between the U.S. Centers for Medicare and Medicaid Services and New York, a PowerPoint presentation, and fact sheet. According to an article in Crain’s New York Business, about 140 individuals have enrolled in FIDA-IDD. HCA is inquiring about the requirements for a home care provider to participate, including any licensure by OPWDD.

CMS Posts New “Return to Home” Quality Measure for Nursing Homes This week the U.S. Centers for Medicare and Medicaid Services (CMS) announced several new quality measures that will be posted for nursing homes, including the “percentage of short stay patients successfully discharged to community.” The addition of this measure spotlights the growing emphasis on the system-wide care-shift from institutions to home and community health care, and within that, the significance of effective care transitions to both quality and sustainability. While, to date, the care transition process from hospitals to community has received the bulk of attention, this latest CMS action brings into focus this other, critical area. The nursing home-to-home care transition highlights a further set of challenges in the system facing patients/families, facilities, agencies and clinicians to make the process and outcome successful. It further elevates the need for and compels new approaches to nursing home-home care collaboration in the evolving system. (More to come from HCA on this subject.) Further information on this new quality measure can be viewed on the CMS website at https://www.cms.gov/ Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-04-27.html, or e-mail Al Cardillo at acardillo@hcanys.org. 16

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

Volume 21, No. 17 April 29, 2016 

Publications 

“Medicare Managed Care Benefits and Beneficiary Protections (Chapter 4 of CMS Manual)” https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/ R121MCM.pdf

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“Enhanced Enrollment Screening of Medicare Providers: Early Implementation Results,” by the Office of Inspector General http://oig.hhs.gov/oei/reports/oei-03-13-00050.pdf

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

HCC MEMBER Forum Notice Please join the staff of HCA and member colleagues from the Association and the home care community for the next Home Care Council of HCA MEMBER Forum. Participation in HCA Member Forums gives you an opportunity to interact with HCA staff and members, and exchange valuable information with your colleagues.

Home Care Council of HCA Member Forum Wednesday, May 18, 2016 10:00am to 12:30pm Hunter College Brookdale Campus 425 East 25th Street (between 1st Ave. and FDR Drive) The Osborn Room (Mezzanine Level) New York, New York 10010

Some of the vital issues to be covered include: • HRA Update; • Quality Incentive Vital Access Provider Pool (QIVAPP) final awards; • Fair Labor Standards Act (FLSA) funding mechanism. • Final State Budget 2016-17; • Minimum wage increase; • Other policy changes.

A continental breakfast will be served.

Payment of $25 per person

Registration

Please check method of payment:

Name: ________________________________________________________

*Make checks payable to: HCA and mail to 388 Broadway, 4th Floor, Albany, NY 12207. Checks must be received by May 11.

Title: _________________________________________________________

____MasterCard ____VISA ____Am Exp

____Check*

Organization:___________________________________________________

______________________________________________________ Card Number

_______________________________________________________________ Mailing Address

_________________________________ Expiration Date

City/State/Zip:__________________________________________________

_________________ Security Code

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Email:_________________________________________________________ Phone:_________________________________________________________ (Required for registration) Cancellation Policy Cancellations received by May 11 will receive a full refund less 25% of total due as an administrative fee. Cancellations received on January22 or later will forfeit their registration fee along with those who register and do not attend. Substitutions are permitted. Please contact Teresa Brown at (518) 426-8764 or tbrown@hcanys.org to cancel.

______________________________________________________ City, State, Zip ______________________________________________________ Name on Card ______________________________________________________ Authorized Signature

FAX TO: (518) 426-8788 For more information, contact Andrew Koski at (518) 810-0662 or at akoski@hcanys.org

Cut Through the Volume: Learn What Value Based Payment Really Means for Your Organization

June 17, 2016 This is an HCA Members Only Program

DoubleTree by Hilton Hotel Nanuet 425 State Route 59 Nanuet, NY 10954

Cut Through the Volume: Learn What Value Based Payment Really Means for Your Organization

“This is the first time in the history of the Medicare program that HHS has set explicit goals for alternative payment models and value-based payments.” -Press release (January 26, 2015) from the U.S. Department of Health and Human Services (HHS).

Both the state and federal governments are pushing ambitious agendas to promote “value” over “volume” in our health care system – and the stakes are high for home care. As one news article proclaimed, the trip toward Value Based Payment (VBP) systems will, indeed, be a “bumpy ride.” Ironically, the discussion about achieving “value over volume” has been overwhelming in its abundance and sheer volume of information: a cascade of technical design information from the state’s Roadmap planning process … pages of analysis from Washington think-tanks … and the clamor of top government officials giving word to this agenda at every turn.

The Obama and Cuomo Administrations are both moving quickly on these initiatives, including: a federal VBP pilot program in nine states; the paving of New York’s VBP Roadmap as a circuit extension of its Delivery System Reform Incentive Payment (DSRIP) program; continued emphasis on Accountable Care Organizations and bundled payment arrangements; and the Comprehensive Care for Joint Replacement Model (CJR), which began in parts of the state and nation on April 1.

These and other VBP policy constructs will challenge home care providers; but they also provide opportunities in an increasingly integrated health care environment. Providers must learn about how VBP is structured, which quality and outcome measures actually matter most under VBP, and how to position themselves for VBP by making clinical and operational changes. This must-attend program will provide an important table-setting for a series of drill-down workshops that HCA is launching to help agencies get ready for a VBP state and federal policy environment.

“The problem with the majority of how health care is paid for today is that the more you do, the more you get paid, whether or not the patient got better … Really very little of our total payment in health care is actually tied to performance, and we need to change that … there is going to be consolidation, there’s going to have to be closure of certain services, and those services are going to have to be replaced with other services that better meet the needs of the community.” -State Medicaid Director Jason Helgerson, quoted in “The ‘Bumpy Ride’ to ValueBased Health Care,” City and State Magazine (May 27, 2015)

June 17, 2016 - DoubleTree by Hilton Hotel Nanuet - 425 State Route 59 - Nanuet, NY 10954

Cut Through the Volume: Learn What Value Based Payment Really Means for Your Organization

AGENDA June 17, 2016 8:30 am Registration and Breakfast

12:45 – 1:30 pm Networking Lunch 1:30 – 2:45 pm Developing Your Home Health Team for Success with Value Based Purchasing Kim Skehan, RN, MSN, Senior Manager Mark Tsiames, Principal Simione Healthcare Consultants

9:00 am Welcome – HCA 9:15 – 10:15 am New York State’s VBP Health Care Policy Priority New York State is moving quickly toward a VBP environment for the entire state Medicaid Program. Hear from one of the principal state policymakers overseeing the state’s vision about how to move Medicaid into a payment structure that: rewards and incentivizes quality; is patientcentered; and focuses on outcomes for patients. 10:15 – 11:30 am The Federal VBP Landscape, Priority VBP Initiatives and How Home Care Can Best Participate Allen Dobson, PhD, Co-Founder, Dobson and Davanzo The U.S. Centers for Medicare and Medicaid Services (CMS) has begun to roll out several payment policy initiatives that focus on VBP. These initiatives inspire innovation in payment through the creation of Accountable Care Organizations, bundling demonstrations and other creative payment changes. This session will provide an overview of VBP initiatives at the federal level. It will also focus on one specific payment innovation – the Comprehensive Care for Joint Replacement (CJR) model, which is currently functioning in many areas of the nation. The post-acute role of home care makes providers especially well positioned to deliver on the CJR initiative, as its target outcomes and goals get broadened to other regions. 11:30 – 12:45 pm VBP Focus on Clinical Outcomes and Targets Arnie Cisneros, President, Home Health Management

Strategic

Arnie Cisneros is one of home health’s most innovative strategists, and he has unique knowledge about the experience of providers participating in the federal government’s nine-state VBP demonstration. Cisneros is an expert who can speak to clinical issues as well as the broader strokes of health care policy, providing insights on how to retool your clinical assessment protocols and other internal clinical decision-making practices to maximize opportunities in a VBP environment.

Does your team have a clear understanding of what VBP means, and its potential impact on your clinical and financial operations? All employees, no matter what their roles, have the capacity to advance your agency’s capabilities for measuring and improving performance in an environment that rewards value over volume. In this session, you’ll learn key components to develop staff for a successful VBP model, including steps to enhance your QAPI program, OASIS review and CAHPS survey activities in ways that promote better outcomes and support your bottom line. Learn how to make your team ready, willing and able to take this important step. 3:00 – 4:15 pm VBP Data and Dashboards Diane Link RN, MHA BlackTree Healthcare Consulting Data is critical to an agency’s success in a home care VBP environment. This presentation will reveal which data is the most important, how to create benchmarks that work most effectively, how to utilize data to track your most problematic agency inefficiencies, how to prioritize improvement based on data, and how to develop dashboards to track trends and promote decision-making. 4:15 pm

Closing Comments

June 17, 2016

Cut Through the Volume:

DoubleTree by Hilton Hotel Nanuet 425 State Route 59 Nanuet, NY 10954

Learn What Value Based Payment Really Means for Your Organization REGISTRANT INFORMATION – Please register by June 3.

Hotel Information

Name: __________________________________________________________________________ Title:____________________________________________________________________________ Agency:_________________________________________________________________________ Address:_________________________________________________________________________ City/State/Zip:____________________________________________________________________ Phone:________________________________ Ext._________ Fax: _________________________ Email: ___________________________________________________________________________ (Required)

DoubleTree by Hilton Hotel Nanuet 425 State Route 59 Nanuet, NY 10954 (845) 623-6000

There are a limited number of rooms available for the evening of June 16th at a group rate of $125. Please call the hotel by May 16, 2016 to reserve your room, be sure to mention our group code: HC2.

Additional Registrants Name:____________________________________

Title:__________________________________

Name:____________________________________

Title:__________________________________

HCA REGISTRATION FEE HCA Members Only

$219 per person

$________

Additional Members from same organization $170 per person x ____ = $________ Total:

$________

PAYMENT – Please check method of payment: ________MasterCard

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*Make checks payable to: HCA Education and Research and mail to 388 Broadway, 4th Floor, Albany, NY 12207. Checks must be received by June 17. ______________________________________________________________________________ Card Number _______________________________________ Expiration Date

_______________________________________ Security Code

______________________________________________________________________________ Mailing Address of Card Holder ______________________________________________________________________________ City, State, Zip ______________________________________________________________________________ Name on Card ______________________________________________________________________________ Authorized Signature

FAX completed form to HCA at (518) 426-8788

HCA Cancellation Policy HCA registration cancellations received by June 3 are refundable less a 25% administrative fee. No refunds will be issued after this date. Cancellations must be received in writing at info@hcanys.org. Substitutions are permitted. Please note DoubleTree’s cancellation policy when making your reservation.

Special Needs In accordance with the Americans with Disabilities Act, or special dietary needs, please let us know how we can accommodate you:

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For more information on this or other HCA Educational Programs – call (518) 426-8764.