ASAP
A Weekly Publication Of HCA Home Care Association of New York State
Legislative Issues Public Policy
News
Volume 20, No. 18 May 8, 2015
HCA Unveils New Website, Digital Advocacy Platform at HCA Annual Conference Welcome to HCA’s new and improved website: www.hcanys.org. At our Annual Conference this week, HCA President Joanne Cunningham unveiled HCA’s new and improved website, along with other digital tools that HCA is offering to make our organization stronger, including our partnership with Phone2Action, an online advocacy platform. During her address to the membership, Ms. Cunningham demonstrated the new website and the web-based advocacy tool, where users can send eSee WEBSITE p. 2
Inside ASAP HCA Unveils New Website, Digital Advocacy Platform.......................1 HCA Presents Awards for Caring and Leadership................................4 New Board Members Join HCA’s Governance Structure......................6 HCA Presses Priority Bills Amid Senate Leadership Uncertainty.........7 CMS Updates Manual on Physician Certification, F2F Changes...........8 HCA Continues to Advocate on QIVAPP...............................................9 Pioneer ACO Model Findings Released................................................9 Guidance Issued on BIP Funds............................................................10 Changes in Waiver Services for those in Residences............................10 ALP Deadline Extended.......................................................................11 DOH Publishes 2015 Medicaid Hospice Residence Rates..................11 Arguments Presented in Companionship Exemption Appeal...........12 NGS Creates Dedicated E-mail for Submitting Cost Reports...........12
Helping New Yorkers Feel Right At Home
ASAP – a publication of the Home Care Association of New York State
Volume 20, No. 18 May 8, 2015
WEBSITE from p. 1 mails, Facebook posts and Tweets to state and federal elected officials, all with a push of the button. Basically, HCA supplies the message, you hit “send,” making it easy for you and your staff to communicate with lawmakers on vital issues. Members at the conference got a chance to test drive the new feature, sending messages to officials thanking them for adopting HCA’s home care-hospital collaborative legislation and seeking support for a federal bill to allow certain non-physician practitioners to order/certify Medicare home health. We will be sending you alerts when new campaigns are posted to the Legislative Action Center, so please familiarize yourself with it so that you are ready for new campaigns that will demand quick action. A direct link to the Legislative Action Center is at http://p2a.co/CrvM1NC. As you browse the website and our Legislative Action Center, here are a few other things to keep in mind: •
Some website content is password-protected and is invisible if you are not logged in. This includes links to our HCA Data webpage, the ASAP newsletter, Policy Memos, Member
At HCA’s Annual Conference this week, journalist, documentary filmmaker and author T.R. Reid compared the different models of health care adopted by major industrialized nations and how they differed from the U.S. health care system. His reporting on the issue gained prominence as part of a PBS Frontline series.
ASAP is a weekly publication of the Home Care Association of New York State (HCA). Unless otherwise noted, all articles appearing in ASAP are the property of the Home Care Association of New York State. Reuse of any content within this newsletter requires permission from HCA. President: Editor:
Joanne Cunningham, jcunningham@hcanys.org Roger L. Noyes, Director of Communications, rnoyes@hcanys.org Al Cardillo, Executive Vice President, Policy & Programs, acardillo@hcanys.org Patrick Conole, Vice President, Finance & Management, pconole@hcanys.org Andrew Koski, Vice President, Program Policy and Services, akoski@hcanys.org Laura Constable, Senior Director, Membership & Operations, lconstable@hcanys.org Lynda Schoonbeek, Director of Education, lschoonbeek@hcanys.org Mercedes Teague, Finance Manager, mteague@hcanys.org Jenny Kerbein, Director of Governance and Special Projects, jkerbein@hcanys.org Billi Hoen, Manager, Meeting and Events, bhoen@hcanys.org Teresa Brown, Administrative Assistant, tbrown@hcanys.org 388 Broadway, 4th Floor, Albany, NY 12207 Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org
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ASAP – a publication of the Home Care Association of New York State
Volume 20, No. 18 May 8, 2015
Alerts and our Resource Library. We recommend that you stay logged in at all times so that you have access to the wealth of resources we offer exclusively to members. •
HCA has imported your user name and password to the new site. However, if you do not have a password or do not know it, simply click “Lost Password” at the login page or send an e-mail to HCA’s Communications Director Roger Noyes at rnoyes@hcanys.org and he will be happy to help you navigate any user issues.
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Most website posts are fed through the HCA Blog, which is on the home page. This is a great resource to make sure you haven’t missed any important updates from HCA. The blog categorizes all posts in chronological order and has a sorting feature so that you can sort the posts by category. For instance, if you are looking for a recent Member Alert that we e-mailed, simply sort by “Member Alerts.”
Our Legislative Action Center can be reached in multiple ways. Currently there is a banner on the home page linking to the Legislative Action Center. But you can also find the banner in our State and Federal Advocacy pages. Once you arrive at the Legislative Action Center, the instructions are fairly straightforward: Simply click the campaign you want to advocate on, enter your contact information and choose your method of contacting your elected representative: via Facebook, Twitter, e-mail, or all three.
Top: Healthcare Association of New York State President Dennis Whalen (center) discusses the hospital perspective on coordination with home care providers during a guest presentation to HCA’s Board of Directors at the HCA Annual Conference this week.
These are just a few of the exciting features we have in store for improving HCA’s digital resources and we were excited to use the Annual Conference as a Bottom: Conference attendees meet with vendors in the way of unveiling these new tools for the exhibit hall at HCA’s Annual Conference this week to learn membership. Going forward, we are also working about the newest products and services in home care. on a new member database which will give you a more interactive way of updating your membership information, your member profile, renewing your membership and registering for events. Please take the time to browse the new website and let us know what you think. If you have any navigation or user issues, please do not hesitate to contact Roger at rnoyes@hcanys.org. 3
ASAP – a publication of the Home Care Association of New York State
Volume 20, No. 18 May 8, 2015
HCA Presents Awards for Caring and Leadership at Annual Conference Lombardi Award presented for only the second time in HCA’s history, to recognize LTHHCP leadership during time of program transition Keeping with our Annual Conference tradition, HCA presented awards to four exceptional home care leaders this week. The Caring Award was presented to Cheryl Palmieri, RN of Lifetime Care; the Advocacy Award was presented to Kate Rolf, President and CEO of VNA Homecare; and the Ruth F. Wilson Award, our highest honor, was presented to Bridget Gallagher, Senior Vice President at Jewish Home Lifecare. Ms. Palmieri was recognized for her work with pediatric Palliative Care patients. “She has sacrificed her own needs and her family’s needs to serve these clients and their families, including spending the night with a dying child so the family was not alone during a time of unimaginable grief,” said her nomination. “Few possess the great strength, personal conviction and talent it takes to provide comfort and healing when families need it most, when a child is sick, afraid and subject to forces beyond their control.” Ms. Rolf and Ms. Gallagher, two leaders of the HCA Board, were honored for their advocacy and lasting leadership impact on the home care industry. “I speak from many personal experiences that Kate Rolf can be counted on as a proactive advocate for the home care community who embraces change rather than challenges it, so long as it serves patients and provides them the care they need to be healthy and safe,” said HCA President Joanne Cunningham in presenting the Advocacy Award. Ms. Cunningham again offered personal reflections in presenting the Ruth F. Wilson Award: “ We marvel at Bridget’s professionalism, loyalty and dedication to our members, her agency and to the home care community during such a time of tremendous flux. Bridget has served as an exemplary advocacy leader both in Albany and Washington, imparting the value of home care. She has always been
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Top: Caring Award Winner Cheryl Palmieri with HCA President Joanne Cunningham. Bottom: Advocacy Award Winner Mary Kate Rolf and Ms. Cunningham.
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Volume 20, No. 18 May 8, 2015
accessible, a great problem-solver, a future-thinker and dynamic contributor as Board Chair, all while making great strides of change within her own organization.” Special addition: Lombardi Award In addition to our Caring, Advocacy, and Ruth F. Wilson awards, HCA also renewed the Lombardi Award, which was bestowed only once in the history of HCA, as a special and singular high honor to Senator Tarky Lombardi, Jr. himself, for his unprecedented championing of home care throughout his legislative career, and for creation of New York’s Landmark Long Term Home Health Care Program (LTHHCP). Given the major transitions occurring for LTHHCP services – and the incredible work of LTHHCP leaders in assuring continuity of care for patients during the transition – HCA felt the time was ripe for renewing the Lombardi award. Senator Lombardi was at the event and had the honor of presenting the second-ever Lombardi Award to Pam Horowitz, Administrator/Director of Home Care at Parker Jewish Institute for Health Care and Rehabilitation. “In her more recent years at Parker, in the midst of very rapid change affecting her long term patients, Pam’s leadership of the LTHHCP was remarkable for her work to assure that her patients continued to receive the home care services they needed,” said Senator Lombardi during the ceremony. “Through this transition and changing home care landscape, Pam has been a dynamic leader who was able to assist the agency in transitioning seamlessly by opening up a Certified Home Health Agency, to ensure excellent care, safety, dignity and stability for patients,” stated her nomination. HCA congratulates our award winners and thanks them for their service to patients and the overall home care system in New York State.
Top: Senator Tarky Lombardi, Jr., who created the legislation for the Long Term Home Health Care Program (also known as the Lombardi Program), joins HCA President Joanne Cunningham in presenting the Lombardi Award to Pam Horowitz. Bottom: Ruth F. Wilson award winner Bridget Gallagher with Ms. Cunningham.
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ASAP – a publication of the Home Care Association of New York State
Volume 20, No. 18 May 8, 2015
New Board Members Join HCA’s Governance Structure HCA is happy to introduce seven home care leaders newly elected to our Board of Directors during this past week’s Annual Conference. The Board of Directors oversees HCA’s policy, programmatic, advocacy, fiscal and education activities in consultation with HCA’s staff.
Kaltenbach Castle
HCA relies on the expertise and talent of the board in key decision-making through the board committee structure, regular scheduled meetings and on an ad-hoc basis. During this year’s Annual Conference board meeting, HCA welcomed the following new Board Members, some of whom have served on the Board in the past: June A. Castle, CHCE, Chief Financial Officer at VNA Homecare; Walter Kaltenbach, Chief Executive Officer, Able Health Care Service; Sandy Merlino, Vice President of Hospital Market Development, Integrated Delivery Systems at Visiting Nurse Service of New York; Sylvia McTigue, Chief Administrative Officer, Elant Choice; Mary Queally, Director, LHCSA, Elder Serve-Hebrew Home of Riverdale; Michele Quirolo, President and CEO at Visiting Nurse Association of Hudson Valley; and Jane Shukitis, RN, BSN, MPA, President and CEO of Visiting Nurse Service of Rochester and Finger Lakes Visiting Nurse Service.
McTigue
Queally
Merlino
Quirolo
To learn more about our new Board Members, including biographical information, please see the Board Profiles document here: http://hca-nys.org/wp-content/uploads/2015/ 05/IncomingBoardProfiles2015.pdf. In addition, this year’s Board Officers are: Board Chair Pam Joachim, Executive Director, Montefiore Medical Center Home Health; Board Vice Chair Sue Brett, COO/Vice President, People Care; Board Secretary Laurie Neander, CEO, Bassett Healthcare Network: At Home Care, Inc.; and Board Treasurer Sue Larman, CEO of Visiting Nurse Association of Albany.
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Shukitis
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Volume 20, No. 18 May 8, 2015
HCA Presses Legislative Priorities Amid Leadership Uncertainty in the Senate While much of HCA’s overall staff focus was commanded by our Annual Conference this week, our policy and advocacy teams worked simultaneously to continue pressing our legislative priorities at the state capitol. In this week’s most prominent development affecting the legislative session and legislative leadership, state Senate legislative activity was sidelined by news that the U.S. Attorney for the Southern District of New York, Preet Bharara, pressed charges against the Senate’s Majority Leader, Dean Skelos. This follows the arrest earlier this year – also on charges from Mr. Bharara – of former Assembly Speaker Sheldon Silver who was replaced in his leadership post with the current Speaker, Carl Heastie. The Senate leadership question remains in dynamic flux, with new updates emerging regularly. While several important developments are likely to occur throughout today and into the weekend, we continue to work with relevant committee chairs and Executive officials on HCA priorities already in the pipeline, as well as measures for which we are seeking bill introduction. As announced in last week’s ASAP, the Senate’s Insurance Committee Chairman, James Seward, introduced an HCA bill to modernize the state’s insurance law for home care. HCA continued to advocate on this measure and met this week with the office of the Assembly’s Insurance Committee Chairman, Kevin Cahill, and the state’s Department of Financial Services (which now includes the office formally known as the State Insurance Department), to brief the offices on the bill and work to gather bicameral support. In another important development, the HCA-developed ‘Essential Personnel’ bill was reported from both the Codes Committee and Ways and Means Committee. It is now ready for a vote on the Assembly floor next week. This legislation, previously summarized for the membership, aims to support home care and hospice providers and staff in meeting their patient care duties during declared emergencies and to incorporate home care and hospice as part of local emergency management planning. We also expect word soon on several other bills that HCA has written and presented to various legislative committee leaders reflecting core elements of our 2015 advocacy agenda. This agenda includes the insurance modernization bill already introduced in the Senate, the home care-hospital-physician collaboration measure already adopted and signed into law as part of the state budget in April, as well as a measure to establish uniform billing codes for home care-managed care reimbursement, also adopted in the state budget. Our other broad priorities include the need for legislation to authorize regulatory flexibility and realignment under the home care-managed care model, home care technology financing, quality innovation, payment adequacy for Managed Long Term Care plans and their network home care providers, and passage of an agreeable Advanced Home Health Aide (AHHA) proposal. The Assembly Codes Committee has placed the Assembly AHHA proposal, A.7188 by Assemblywoman Glick, on next week’s committee agenda. This bill is similar to the Governor’s previous AHHA proposal – which the Legislature omitted from the final budget – but contains additional levels of regulation and mandates as part of the proposed model. HCA will continue to keep the membership apprised of these important developments during a dynamic time in the state legislative process. For more information, please contact the HCA Policy staff. 7
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CMS Updates Benefit Manual to Reflect Physician Certification, F2F Changes A new Change Request (No. 9119) from the U.S. Centers for Medicare and Medicaid Services (CMS) updates the Medicare Benefit Policy Manual to reflect physician certification requirements for home care, as previously published in the 2015 Home Health Prospective Payment System (HHPPS) Rule.
billing Medicare but stresses that agencies should not wait until the end of a 60-day episode of care to obtain a completed certification/recertification. •
Depending on the referral source, the certifying physician’s medical record and/or the acute/post-acute care facility’s medical records are to be used as the basis for certification of patient eligibility for home health. CMS does, however, permit the agency to provide the certifying physician with information from its assessment of the patient for inclusion into his or her medical record in support of home health eligibility. However, this information must be corroborated by other entries in the physician record.
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Also included in the manual update is the requirement that a physician’s “recertification statement must indicate the continuing need for services and estimate how much longer the services will be required.” The National Association for Home Care and Hospice (NAHC) notes in a recent report that this requirement has been in the regulation for many years but has never been incorporated into the Medicare manual, stating that this update is“unclear as to whether the estimated duration for services can be stated as a physician order or must it be included in the recertification.”
Many of the updates reflect information previously shared with the membership about the certification requirements generally and about the face-to-face (F2F) mandate specifically, including CMS’s elimination of the narrative component of F2F. During HCA’s Annual Conference this week, one of the clinical documentation review specialists from New York’s Medicare Administrative Contractor, National Government Services (NGS), provided participants with a deeper look at the 2015 certification and F2F changes that are now incorporated into this latest manual update. Shelly Bernardini, RN and Medicare Home Health Clinical Consultant at NGS, walked participants through the changes and reinforced some of the nuances, including a specific step – now reinforced in the manual – which requires the certifying physician to name the community physician who will followup with the patient following discharge from an acute/ post-acute care setting. CMS claims the additional documentation is needed in order for the certifying physician to meet the requirement that the patient be under the care of a physician. Several attendees at HCA’s Annual Conference noted the difficulty of obtaining this information or expecting the physician to insert this information into the documentation. HCA will be seeking further confirmation and clarification of the precise expectations related to this requirement.
The F2F requirement remains a continued target of HCA’s advocacy and education programming, including the detailed workshop presented at HCA’s Annual Conference this week where participants had an opportunity to hear more about the requirements, share concerns and inform HCA’s action plan on this issue. HCA will continue to keep you informed of these efforts as we seek to mitigate this burdensome mandate.
Some other items of note: •
CMS’s manual update maintains its policy that the physician certification must be completed prior to the home health agency
Change request 9119 is at http://hca-nys.org/wpcontent/uploads/2015/05/R208BP.pdf. 8
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Volume 20, No. 18 May 8, 2015
HCA Continues to Advocate on QIVAPP As the May 1 deadline passed for Managed Long Term Care (MLTC) plans to send attestation forms and information on aide services to the state, HCA continued to appeal the state Department of Health (DOH) on its action to redefine the health insurance coverage requirement under the Quality Incentive Vital Access Provider Pool (QIVAPP) program. This change, announced in a Frequently Asked Questions document posted last week (just before May 1), requires at least 30 percent of an agency’s workforce to be enrolled in the employer’s health coverage for the agency. This is sharply different from information provided by DOH prior to the rollout of QIVAPP and from the initial requirement outlined in the original April 2014 Dear Administrator Letter which states that the home care agency must provide comprehensive health insurance coverage to its employees. In a communication to DOH, HCA asked that it rescind this change so that those home care providers who meet the original criteria continue to be eligible for QIVAPP. We objected to DOH’s change in rules that both MLTC plans and home care providers have been operating under since last year and cautioned that this change is threatening to disrupt the distribution of QIVAPP monies. We pointed out that this policy restricts choice for aides by pressuring them to enroll in the employer’s plan when they may be eligible for other coverage, including Medicaid or a family member’s, or may want to opt for a higher wage instead of health benefits. Lastly, this requirement holds providers to a standard that they have no control over. HCA has initiated communications with other provider associations about taking some joint action and will keep members informed. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
Pioneer ACO Model Findings Released This week, the U.S. Department of Health and Human Services released an evaluation report showing that the Pioneer Accountable Care Organization (ACO) created as a pilot project by the Affordable Care Act generated substantial savings to Medicare in just two years. Additionally, the Office of the Actuary in the U.S. Centers for Medicare and Medicaid 9
Have You Registered? Get all of the Details at the back of this week’s ASAP
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Services (CMS) has certified that this patient care model is the first to meet the stringent criteria for expansion to a larger population of Medicare beneficiaries. The report is at http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/ActuarialStudies/ Downloads/Pioneer-Certification-2015-04-10.pdf. The Pioneer ACO Model was found to generate over $384 million in savings to Medicare over its first two years. To date, actuarial analyses show that ACOs in the Pioneer ACO Model and the Medicare Shared Savings Program have generated over $417 million in total program savings for Medicare. Additional information about the Pioneer ACO Model and its actuarial certification can be found at http://innovation.cms.gov/initiatives/Pioneer-ACO-Model/.
Guidance Issued on BIP Funds The state Department of Health (DOH) has posted a notice indicating that the U.S. Centers for Medicare and Medicaid Services (CMS) will consider a state’s specific request to extend the timeframe for the investment of Balancing Incentive Program (BIP) funds from September 30, 2015 through September 30, 2017. The notice is at http://www.health.ny.gov/health_care/medicaid/redesign/guidance.htm. Extensions should be focused on existing activities which require additional time to complete. States interested in an extension have to submit certain information to CMS by July 1, 2015. As covered in numerous past editions of ASAP, under BIP, states receive enhanced federal Medicaid funding to provide increased non-institutional LTSS to Medicaid recipients. New York was expected to receive almost $600 million. As part of BIP, states must implement three structural changes in Long Term Care Services and Supports (LTSS) including: 1) “conflict-free” case management; 2) a no-wrong-door single-entry-point system; and 3) a core standardized assessment instrument. Additional information on BIP, including a list of fund awardees, is at http://www.health.ny.gov/health_care/medicaid/redesign/balancing_incentive_program.htm.
Changes in Waiver Services for those in Residences The Office for People with Developmental Disabilities (OPWDD) has announced changes, effective October 1, 2015, to the separately-billed Medicaid supports and services that people residing in Individual Residential Alternatives (IRAs), Community Residences (CRs) and Family Care can access. Today, people living in Supportive Residences and Family Care Homes can receive additional home and community based services (HCBS) waiver habilitation services on weekday evenings and weekends and these services can be billed to the person’s Medicaid card. Beginning on October 1, 2015, these types of services may continue, but will become the responsibility of the residential provider and cannot be separately
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billed to Medicaid. There are also more limited changes to services available to people living in Supervised IRAs or CRs. OPWDD has sent a memo to residential providers and is starting to work with residential providers to make arrangements for the continuation of existing and needed services. Part of this process will include adjustments to residential rates to incorporate needed funding. In advance of the October 1 implementation, OPWDD has indicated that it will work with residential agencies to ensure that these changes are made in a way that does not diminish the quality of services for people who live in certified residences. OPWDD will be holding a WebEx on Monday, May 11 at 2:30 p.m. to discuss these changes. You can register at https://meetny.webex.com/meetny/onstage/g.php?d=647639281&t=a. If you have any questions that must be addressed prior to the May 11 program, please e-mail peoplefirstwaiver@opwdd.ny.gov.
ALP Deadline Extended The state Department of Health (DOH) has extended the application due date for the Assisted Living Program 3400 Initiative. The new application due date is June 22, 2015. DOH has also extended the date for posting responses to questions. That date is now May 22, 2015. Under this initiative, DOH is requesting applications to award up to 3,400 ALP beds. This will allow entities new to the delivery of adult home services, current adult homes new to the delivery of ALP services, and current providers of ALP services to apply for ALP beds across New York State for the remainder of the original 6,000 beds. More information is at https://www.health.ny.gov/facilities/assisted_living/program_application/.
DOH Publishes 2015 Medicaid Hospice Residence Rates The state Department of Health (DOH) Bureau of Managed Long Term Care and Fee-For-Service has issued the Medicaid Hospice Residence base rates that include the Recruitment, Training and Retention (RT&R) add-ons for the period January 1, 2015 through December 31, 2015. The rates are accompanied by a DOH Dear Administrator Letter (DAL). The formula on which these rates are based was promulgated in accordance with Section 4014 of the Public Health Law (PHL) and Subpart 86-6 of Title 10 of the Commissioner’s Administrative Rules and Regulations. DOH will also be posting the 2015 Medicaid Hospice Residence Base Rates at: http://www.health.ny.gov/ facilities/long_term_care/reimbursement/hospice/. The base rates represent 94 percent of the weighted average calendar year Medicaid rate of the nursing facilities located in the Wage Equalization Factor (WEF) region of your hospice residence. For hospices that have RTR certifications on file with the Department, the published rates also include a payment of $9.92 per day as authorized by Section 3614.9 of the PHL. Specific question on these rates should be directed to DOH’s Russ Smith at (518) 473-4421. For further information, contact HCA’s Patrick Conole at (518) 810-0661 or pconole@hcanys.org. 11
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NAHC, DOL Present Oral Arguments to Court of Appeals in Companionship Exemption Case The National Association for Home Care and Hospice (NAHC) reported this week that it presented oral arguments before the U.S. Court of Appeals related to its legal action targeting the U.S. Department of Labor’s changes to the “companionship exemption” for home care. The case reached this level because the federal government is appealing a U.S. District Court ruling that sided with NAHC and invalidated the rules that were scheduled to take effect on January 1, 2015. It is expected that the Court of Appeals will issue a ruling in the next two months. The Court goes to recess in July. NAHC indicates that it is “committed to take all steps available to prevent the challenged rules from taking effect, including an appeal to the Supreme Court if needed.” HCA supports wage and overtime policies which provide for home care workforce stability, retention and quality. Regrettably, recent federal rules, such as the U.S. Centers for Medicare and Medicaid Services’ unprecedented rebasing cuts, are at direct odds with such goals. In New York State, DOL’s rule would change the way providers have to calculate and pay overtime for most aide services. Currently, New York’s rules require providers to calculate and pay overtime based on time-and-ahalf of minimum wage, not time-and-a-half of the worker’s actual wage (as the DOL rule would require). Additionally, DOL’s rule would: circumvent established legal precedents and Congressional intent with respect to the companionship definitions; result in a disincentive for overtime; disrupt continuity-of-care for patients; and fail to provide reimbursement support for the new labor expenses brought on by the rule.
NGS Creates Dedicated Mailbox to Submit Cost Reports Electronically National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), has created a dedicated mailbox for home health and hospice providers to submit their Medicare cost report information electronically. Medicare cost reports must be submitted by providers to their respective MACs within five months of the cost reporting fiscal year end. Electronic cost report copies can be e-mailed to J6HHA-HospiceMedicareCR@anthem.com. NGS’s mailbox will not allow any files with the extension of .exe. If your print image file has the extension .exe, double click on it, and it will self-extract into a transmittable file and will have the proper encryption codes attached to it. If you have any questions, please e-mail J6HHA-HospiceMedicareCR@anthem.com or call NGS’s Beverly Rader-Eggert at (414) 459-5484. Currently, it is still necessary for providers to mail in their signed certification page with encryptions and the signed 339 questionnaire. A provider’s cost report will still not be deemed as received until NGS has received the signed signatures in the mail. Continued on next page
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Continued from p.12 Providers that have less than $200,000 of Medicare reimbursement may qualify for filing less than a full report. For more information, please go to the cost report section of NGS’s website at www.ngsmedicare.com. Low or no cost report submissions cannot have a balance. To claim bad debts, vaccines or other cost reimbursed items, providers will need to complete the full cost report and acquire vendor approved software. Providers are advised not to send any protected health information (PHI) to this new e-mail address. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
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Are You Ready to Navigate New Models of Care and Coverage?
Thursday, May 28, 2015 Empire State Plaza – Albany NY Meeting Room 2-4
AGENDA 9:00am
Who should attend Home health provider and health plan CEOs, CFOs, COOs and those who need a better understanding of emerging care models to position successfully in a new service and payment delivery environment. With the enactment of far‐ reaching health care reforms at the federal and state levels, changes to the health care delivery and payment systems are evolving quickly. To jump‐ start these initiatives, policymakers are incentivizing the creation of new models that focus on the seamless integration of health care delivery, providing value, high quality care and targeted outcomes. It is critical for the home care community to understand how these new models work, how they are financed, and how they are constructed. In addition, the provider community needs to be prepared to position themselves competitively and effectively in these new models. This workshop is designed to be informative, thought‐ provoking and relevant as you position your organization in this environment of change and in this environment of health care service delivery and payment reform evolution. Don’t miss this opportunity!
Welcome and HCA Update Joanne Cunningham, President 9:15am to 10:30am
The State’s Roadmap on New Models of Care New York State continues to rapidly reform its Medicaid program and work collaboratively with the federal government on introducing and facilitating the adoption of new models of care, coverage, service delivery and financing. Hear from New York’s health care and Medicaid reform leader about the state’s vision in the adoption of new models of care delivery, as New York State’s Medicaid program evolves with a focus on care delivery through Managed Long Term Care plans, Fully‐Integrated Duals Advantage plans, Delivery System Reform Incentive Payments (DSRIP) and others. This session will help you understand the state’s continued priorities, areas of focus, and expectations for how you can fully participate in these and emerging models. Jason Helgerson, State Medicaid Director, Deputy Commissioner, New York State Department of Health 10:30am to 11:30am
Value Based Payment – Positioning for Home Health Providers State and federal reforms are prompting massive and far‐reaching changes that affect how health care and home care services are delivered. These reforms are also driving change in the financing of and payment for care. Understanding how new payment models work, how they are constructed and how the payment incentives function is critical as you plan for a successful future. With the advent of Value Based Payment Models, successful providers are compelled to learn ways of positioning themselves competitively. Hear from the State of New York’s lead contractor about how VBP models work, how outcomes are measured and how this model aims to improve value and outcomes while reducing the costs of care. Marc Berg, MD, Ph.D., Partner, Global Center of Excellence for Health, KPMG 11:45am to 12:45pm
DSRIP Lessons Learned and Next Steps One of the most recent innovations in delivery system reform came in the form of a waiver with the federal government that set in motion the plan for a larger focus on outcomes, payment and service delivery integration. This initiative, the Delivery System Reform Incentive Payment (DSRIP) program, aims to promote collaboration among health care and community care providers, transform health care service and reduce re‐hospitalizations while offering incentives and rewards for high quality outcomes. Hear from the state’s DSRIP implementer about how DSRIP is transforming payment and services for patients and the lessons learned in the rollout and adoption of this innovative initiative. Greg Allen, Director of the Division of Program Development and Management within the New York State Office of Health Insurance Programs (OHIP).
AGENDA 12:45pm to 1:30pm
Lunch and the Opportunity to Share Ideas with Your Peers 1:30pm to 2:30pm
Re‐Tooling Your Operation to Achieve Success in New Models of Care and Service Delivery DSRIP implementation poses unprecedented challenges and opportunities for performing providers systems (PPSs) and the providers who participate in them. This session will focus on assisting participating providers to anticipate, understand, and tackle DSRIP developments in the first year, including fund flow models and potential funding opportunities emerging from PPSs, project participation, regulatory waivers, and PPS compliance and HIPAA requirements. Tracy E. Miller, Bond Schoeneck and King Ms. Miller practices health care and not‐for‐profit corporate law, focusing on corporate, regulatory and compliance matters for health care providers, health systems, managed care plans and charitable organizations. 2:30pm to 3:30pm
Strengthening Your Business Model in an Era of New Models Successful health care organizations in a new environment of evolving service, coverage, payment and delivery system reforms must challenge themselves to make necessary changes to their business models in order to adapt and successfully partner. The future success of home health as critical partners in new models will depend on the ability to become more efficient, streamline functions, and provide a high level of care with excellent outcomes at a competitive cost. In this final session, learn what others across the nation are doing to strengthen their business models and boost their offerings of support to their partners. Presenter TBA
Are you Ready to Navigate New Models of Care and Coverage? Thursday, May 28, 2015 Empire State Plaza, Meeting Rooms 2-4, Albany NY REGISTRATION FORM – Fax to (518) 426‐8788 or Mail to the address below. Please register by May 22 to guarantee your seat, lunch and handout materials. Name: _____________________________________________________________________________________________ Title:_______________________________________________________________________________________________ Agency:_____________________________________________________________________________________________ Address:____________________________________________________________________________________________ City/State/Zip:______________________________________________________________________________________ Phone:______________________________________ Ext.________________ Fax: __________________________________________________________ Email: ___________________________________________________
REGISTRATION FEE HCA Members
$229 per person ________
Non‐Members
$329 per person ________
PAYMENT Please check method of payment:
____MasterCard ____VISA ____ American Express ________ Check* *Make checks payable to HCA Education and Research and mail to:
388 Broadway, 4th Floor, Albany, NY 12207 (checks must be received one week prior to program)
Please print clearly.
Credit Card #: ____________________________________ Exp. Date:__________ Security Code: ____________ _____________________________________________________________________________________________________ Name and/or Company Name on Card _____________________________________________________________________________________________________ Billing Address of card (including City, State and Zip Code) _____________________________________________________________________________________________________ Authorized Signature
Cancellations received by May 18 are refundable less a 25% administrative fee. Cancellations must be received in writing via e‐mail to info@hcanys.org. No refunds after that time or for no shows. Substitutions are permitted. Questions? Call HCA at (518) 426‐8764.
FAX TO: (518) 426‐8788