ASAP
A Weekly Publication Of HCA Home Care Association of New York State
Legislative Issues Public Policy
Assembly Intros HCA Priority Bill to Advance Home Care-Managed Care Regulatory Realignment As reported in an alert to the membership this week, Assembly Health Committee Chairman Richard Gottfried has introduced HCA-developed legislation to accelerate implementation of regulatory realignment measures for home care and managed care that have been advanced by the state’s See REGULATORY p. 4
HCA and Coalition Advocate for Workable Advanced Aide Proposal This week, HCA, along with a diverse coalition of provider organizations and groups representing persons with disabilities and the aging, sent a letter to Governor Cuomo and the State Legislative Leaders urging negotiations to sort out the outstanding issues that are preventing an advanced home health aide (AHHA) proposal from being enacted.
Inside ASAP
See AIDE p. 3
Assembly Intros HCA Regulatory Realignment Bill..............................1 In Five Minutes, You Can Advocate on HCA Priority Bills.....................1 HCA & Coalition Advocate for Workable Advanced Aide Proposal....1 Associations Advance Payment Adequacy Legislation..............................5 HCA Essential Personnel Bill Passes Assembly Unanimously..............5 DOH Posts Hotline Rates for Non-Hospital-Based CHHAs......................5 State Senate Appoints New Majority Leader........................................6 QIVAPP and Managed Care Update......................................................6 HCC HCA Member Forum on May 27...................................................7 Provider Training Seminars and Webinars Available.............................7 OMIG Sends TPL Letters.........................................................................8 DOL to Propose Overtime Exemption Changes for Salaried Workers.....9 Motions Advanced in NAHC F2F Suit..................................................10 Influenza Mask Rule No Longer in Effect for Season..........................11 LTHHCP Forum on May 19....................................................................11 OPWDD ‘Outside Services’ Resources.................................................11 Learn More about DSRIP, VBP and other Care Models on May 28.....12 PHHPC Committee Meeting Agenda Released..................................13 State Survey Hearing Requests Must be Filed Electronically..............13 New Policy Issued for Social Adult Day Care.......................................14 Member Hiring Announcement..........................................................14 Publications......................................................................................................15
News
Volume 20, No. 19 May 15, 2015
In Five Minutes, You Can Advocate on HCA Priority Bills Using our New Legislative Action Center During the past two weeks, HCA has succeeded in getting two priority HCA-developed bills introduced. A.7456 in the Assembly would speed up the Department of Health’s action on regulatory clarity and realignment to support home care and Managed Long Term Care network organizations. (See p. 1 story.) Meanwhile, last week, we reported on a landmark bill in the Senate (S.5076) to update New York’s antiquated State Insurance Law so that it better reflects the current role of home care and provides more flexible insurance coverage standards for the provision of home care. These bills are many months in the making, from initial deliberations within HCA and our Board, to bill drafting, to multiple meetings with sponsors and stakeholders and, now, introduction of the bills and assignment of bill numbers. However, there is still a lot of work to do to achieve passage of these bills – to make sure that See ACTION p. 2
Helping New Yorkers Feel Right At Home
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ACTION from p. 1 both houses of the Legislature pass the bills and that the Governor signs them. We need your help in this effort. As reported in last week’s ASAP, and presented at our Annual Conference, HCA’s website has a new Legislative Action Center. This powerful grassroots advocacy tool allows you to advocate on HCA’s priority bills with a quick push of the button. Here’s what we need you to do: 1. Visit HCA’s Legislative Action Center at http://p2a.co/CrvM1NC. You can also reach it from the home page of HCA’s website and on the state advocacy page of our site, wherever you see the Legislative Action Center logo. Continued on next page
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 Continued from p. 2
2. Click the campaigns entitled “Support Home Care Insurance Modernization (S.5076)” and “Support A.7456 and Senate Action for Home Care Regulatory Realignment.” You’ll see a banner under each campaign that says “contact your legislator.” Click this banner. 3. Enter your contact information and a prewritten advocacy message will go to your legislator as soon as you click “send.” The message is written for you; all you have to do is enter your address and other information so that the system can identify your legislator for you. This process shouldn’t take you more than a few minutes and you should urge all of your staff to take action today. HCA will be sending you a reminder about this critical action step next week. Remember, the more legislators who hear from you – their constituents – the better chance we have of getting these bills advanced through the long process ahead. Just a few minutes of your time could result in major changes supporting the work you do on behalf of patients. Write your lawmakers today.
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AIDE from p. 1 The letter, which was also signed by HCA’s sister organizations (LeadingAge New York, the New York State Association of Health Care Providers, the Hospice and Palliative Care Association of New York State and others), advocated for the creation of an AHHA proposal which would allow trained home health aides in certain circumstances and under the assignment and supervision of an RN to do select nursing tasks. “In sixteen other states, nurses have safely assigned some of these tasks to aides with improved consistency of care,” the letter states. “This programmatic change is compatible with New York’s evolving health care system and the movement to managed care and integrated models of delivery and finance which rely on provider and caregiver flexibility.” HCA has long been a proponent of broadening the exemption that currently exists in the Nurse Practice Act that would allow for agencies to assign aides more flexibly with appropriate oversight and supervision by the nurse. The Senate has major issues with the existing legislative approach, A.7188, which was most recently moved from the Codes Committee to the Assembly floor for action. The bill needs critical amendments to meet the Senate’s concerns as well as recommended actions by HCA and other association partners. HCA is strongly advocating for the Legislature and Governor, working with HCA and its advocacy partners, to negotiate the outstanding issues to enable the passage of an AHHA proposal before the Legislature adjourns in late June. The letter references several “outstanding issues” which need to be addressed in the final proposal. These include: financing for the training and cost of deploying an advanced aide in the home care setting; alignment with the managed care system; regulatory flexibility in the use of advanced aides; and other issues. HCA, along with most of the organizations supporting the letter, participated over the past year in a workgroup assembled by the Governor to identify and discuss issues that must be addressed before an AHHA proposal can be successfully implemented. HCA will be advocating in the final weeks of the legislative session to ensure a workable outcome that provides appropriate protections for providers, agency staff and patients. 3
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REGULATORY from p. 1 Home and Community Based Care Work Group. The law creating the Work Group only required the Group to report, but included no special authority to assist in the implementation of the Work Group’s recommendations.
related to clean claims and related dispute resolution in the intersection of managed care and home care regulatory structures, billing and operations. This year’s state budget, at the urging of HCA and association partners, did include legislation prompting the state to pursue uniform billing codes for home care services under managed care – an area that still demands further implementation and operational design work post-budget. However, even with the Work Group’s recommendations already in hand, the state has yet to act further on a long-developed matrix of recommendations for more comprehensive regulatory realignment.
The bill (A.7456) specifically states that the Commissioner of Health “shall consider the recommendations of the Work Group” and is authorized to take the necessary steps to “expeditiously” implement the recommendations of the Work Group, including through waivers, by adopting regulatory changes on an emergency basis. The bill further authorizes the Commissioner to waive rules and regulations related to managed carehome care services “where such waivers are necessary to eliminate duplication and to promote efficiency, coordination and clarity in the procedures for the delivery of such services, and when the health, safety and general welfare of patients will not be impaired as a result of such waivers,” the bill states.
Two of HCA’s Board leaders have been instrumental in those deliberations as members of the Work Group: current Board Member Joseph Twardy, President and CEO of Visiting Nurse Service of Northeastern New York, and recent Board Member Ann Frisch, Executive Director of HHC Health & Home Care. HCA and allied association colleagues, meanwhile, have also pressed the Department to move forward on the Work Group’s recommendations.
Advancement of this legislation is a major component of HCA’s advocacy agenda for 2015. Ever since the state introduced its Medicaid Redesign Team (MRT) initiative to pursue mandatory Managed Long Term Care (MLTC) and mainstream Medicaid managed care enrollment and a broader managed care enrollment policy four years ago, HCA has sought regulatory changes that would assist home care providers, MLTC plans and other managed care plans in working efficiently and seamlessly in the care of patients and in the coordination of services.
HCA thanks Assemblyman Gottfried for introducing this vital bill that contains a strong charge for expeditious movement of regulatory realignment provisions. If adopted, these provisions would streamline the coordination of services between providers and plans and establish clarity in the applicability of various regulations. HCA has reached out to the Senate, where we anticipate sponsorship of a companion bill, and will inform the membership of future action.
As extensively reported to the membership over the past several months, the 2013-14 State Budget opted for a Work Group process to examine areas of regulatory realignment, even as the state was already fast moving toward a program of mandatory managed care enrollment where regulatory change and clarity were urgently needed.
What you can do to support this bill Our new Legislative Action Center includes a campaign for you to send a message to your legislator on this bill. Please share this campaign with your staff and make sure they send a message of support. The process is simple: just enter your contact information and hit “send” to circulate a pre-written message to your legislators. The system will automatically identify your lawmaker for you, based on the contact information you provide. (See related p. 1 sidebar story.)
At that time, the Work Group was tasked with examining state and federal requirements such as the applicability of federal Conditions of Participation (CoPs), the alignment of functions between managed care entities and home care providers, best practices 4
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Associations Advance Home Care “Payment Adequacy Legislation”
HCA Essential Personnel Bill Passes Assembly Unanimously
Legislation to ensure payment adequacy for home and community based care has been advanced to the Legislature. One bill has been advanced by HCA and a second by the New York State Association of Health Care Providers (HCP). The two proposals are complementary and work in sync with new provisions that were included in the 2015 state budget resulting from our joint advocacy.
By a unanimous vote of 113-to-0, the state Assembly this week passed HCA’s “essential personnel” legislation (A.5125B). This bill – which would allow home care and hospice staff to access patients during emergency curfews or restrictions – has been extensively summarized in several past editions of ASAP.
HCA has advanced legislation that would require the incorporation of essential costs in the determination of premium adequacy for managed care and Managed Long Term Care (MLTCs) plans and rate/payment adequacy for providers under both managed care contracts and under the episodic payment system. Premiums and rates would be adjusted to ensure inclusion of costs that adequately support the delivery of patient services and both managed care plan and provider operations, including: compensation and benefits; labor mandates; program/compliance mandates; staff recruitment, training and education; capital/technology infrastructure; quality assurance/ improvement; emergency preparedness; and other. The legislation is currently in process for introduction.
Sponsored by Senator Lanza and Assemblyman Cusick, both of Staten Island, the bill also provides for home care and hospice involvement in the local emergency planning process. The Senate version of the bill (S.3482-B) has been referred to the Committee on Veterans, Homeland Security and Military Affairs.
DOH Posts Hotline Rates for Non-Hospital-Based CHHAs
Legislation advanced by HCP would require the state Department of Health to select and contract with an independent actuary to study and review Medicaid reimbursement methodologies for home care services provided under contracts or agreements with insurers for adequacy to “ensure the retention of a qualified workforce capable of providing high quality care to recipients of such services in both wage parity and nonwage parity regions.”
The state Department of Health’s Bureau of Long Term Care Rate Setting has posted the 2015 “Hotline” rate calculation sheets for non-hospitalbased Certified Home Health Agencies (CHHAs) that filed a properly certified, full-year 2013 cost report.
This legislation, too, would include “adequacy” costs for meeting wage parity requirements, recruitment and training, salary FICA contributions, workers compensation and other costs. This legislation was introduced yesterday by Senator Hannon as S.5459 and referred to the Committee on Health.
These rates will be used for patients who are exempt from the Episodic Payment System. The rate calculations are located in the “Rate Publication Selection List” drop-down under the date of May 11, 2015 on the Health Commerce System (HCS). A corresponding Dear Administrator Letter, dated May 11, 2015, accompanies the posting.
HCA will continue priority advocacy for needed reimbursement by plans and providers through these and other means, including our direct advocacy with the Department of Health, and will continue close collaboration with our association partners. 5
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State Senate Appoints New Majority Leader, as Senator Skelos Steps Down Senator Dean Skelos has stepped down from his post as Senate Majority Leader and was replaced this week by Senator John Flanagan, also of Long Island, in a vote by the Senate. The change in leadership arose after the U.S. Attorney for the Southern District of New York, Preet Bharara, pressed charges against Senator Skelos, following the arrest earlier this year of former Assembly Speaker Sheldon Silver who was replaced in his leadership post with the current Speaker, Carl Heastie. Senator Flanagan has most recently served as the Education Committee Chairman. He was first elected to the Senate in 2002 after a 16-year tenure in the State Assembly. The Senate Majority Leader, like the Speaker of the Assembly, has the greatest influence over the movement of legislation and negotiations with the other respective house and Governor in advancing public policy. Both houses, the Senate and Assembly, have faced leadership changes this year, consuming the process with deliberations about the hierarchy and succession. HCA and our government affairs teams are working to navigate these changes as we urge support for our legislative agenda. We will inform the membership of any new developments that impact this process directly.
QIVAPP and Managed Care Update At this week’s Managed Care Policy and Planning meeting held by the state Department of Health (DOH), HCA and other associations and providers received updates on the Quality Incentive Vital Access Provider Pool (QIVAPP) monies, enrollment into the Fully Integrated Duals Advantage (FIDA) program, the transition to Managed Long Term Care (MLTC) plans and the Conflict-Free Evaluation and Enrollment Center (CFEEC). QIVAPP DOH reported that the data on aide hours and the attestations submitted by the MLTC plans are being reviewed and it hopes to develop a list of draft awards in early June. Then, this list will be submitted to the U.S. Centers for Medicare and Medicaid Services (CMS) for its approval of the federal share of $35 million. Such approval can take several weeks to months. As reported in last week’s ASAP, HCA continued to appeal DOH on its action to redefine the health insurance coverage requirement under QIVAPP. This change, announced in a Frequently Asked Questions document posted two weeks ago (just before the May 1 deadline for the plans to submit data), requires at least 30 percent of an agency’s workforce to be enrolled in the employer’s health coverage. 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. HCA had already communicated to DOH a request 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 6
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HCC HCA Member Forum on May 27 The next meeting of the Home Care Council (HCC) of HCA Member Forum is on Wednesday, May 27, at 10 a.m. in New York City.
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.
The Forum is an opportunity for former HCC members who are now part of HCA to discuss particular issues they are facing, including managed care payments; contracts with the New York City Human Resources Administration; companionship exemption lawsuit; Quality Incentive Vital Access Provider Pool (QIVAPP) program; education needs and other topics.
At this week’s Managed Care Policy and Planning Meeting, HCA made a similar argument to the state Medicaid Director Jason Helgerson and other DOH staff. DOH repeated its contention that QIVAPP is intended to reach home care agencies who are incurring health insurance costs due to their aides selecting the employer’s health insurance benefits.
The registration form is at the back of this week’s ASAP.
Provider Training Seminars and Webinars Available eMedNY has announced programs for Utica, Poughkeepsie, Hauppauge, Rensselaer and Canandaigua during this month and June. Some of the topics include:
HCA is in discussions with other associations about sending a joint letter to DOH and other state officials regarding our concerns over the QIVAPP award process.
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ePACES for professional, institutional, dental, durable medical equipment, private duty nursing, physician and transportation.
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ePACES for Coordination of Benefits billing for professionals and clinics.
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eMedNY website review.
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Electronic Remittance/PDF Remittance Request Form and Electronic Funds Transfer (EFT) Application.
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New Provider/New Biller
FIDA The latest FIDA enrollment data are as follows: 5,902 individuals are enrolled in FIDA as of May 1; this includes 3,152 who were “passively” enrolled on May 1. Another 5,153 individuals were sent the “60-day notice” on May 1 and will be passively enrolled in July 1 (unless they opt out). A total of 44,512 individuals have opted out of FIDA (but still must be enrolled in a partial cap MLTC plan).
The training schedule is at https://www.emedny.org/training/index.aspx.
DOH sent a letter to about 43,000 FIDAeligible individuals who have not opted-out. This includes individuals who are FIDA 7
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eligible but excluded from passive enrollment. More than 10,200 providers have registered for the core provider FIDA training module on the Lewin portal. Three new modules (behavioral health, cultural competency, and the Americans with Disabilities Act) are now available. Another module on recovery/wellness is being finalized. Plans will send letters to their contracted providers when all modules are available on the portal. MLTC transition DOH intends to transition the following counties to mandatory MLTC enrollment in May: Chemung, Essex, Hamilton, Chautauqua, Schuyler, Seneca and Yates. CFEEC The CFEEC is now operational in regions 1 through 6 (a list of the regions is at http://www.health.ny.gov/health_care/medicaid/redesign/docs/2015-03-26_updated_cfeec_timeline.pdf.) In these regions, all new individuals who require more than 120 days of community-based long term care services must be assessed, using the Uniform Assessment (UAS-NY) tool, by the Medicaid Enrollment Broker, Maximus, to determine their eligibility for Medicaid community based long term care and eligibility for enrollment in a Medicaid MLTC plan. Maximus’ average number of calls about the CFEEC is from 675 to 702 per day. Maximus has completed 19,355 evaluations statewide. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
TPL Letters Seek Repayment, Documentation on Cases Paid by Medicare The state Office of the Medicaid Inspector General (OMIG) is again sending out letters to some providers seeking documentation and repayment checks for Medicare payments they received as a result of Third Party Liability (TPL) billing. These letters are sent out two to three times a year as the state pursues its appeals process with the federal government regarding payment responsibility for dual-eligible claims. Under this appeals process, providers have had to demand-bill certain select claims to Medicare, triggering an adjudication process for those claims previously paid by Medicaid and targeted for review. In some cases, this process results in a Medicare payment to providers that must be returned to the state. OMIG’s letter includes a list of such beneficiaries and episodes. New York’s TPL contractor is the University of Massachusetts Medical School (UMASS). The letter instructs agencies to send UMASS certain documentation for each episode/case identified in the letter. This documentation includes the final Medicare remittance advice and a copy of the case report listing the Medicare payment amount that the agency is returning. “As an alternative, you may also submit an internal spreadsheet used by your agency to track Medicare payments returned as a result of this project,” the letter states. Continued on next page 8
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Continued from p.8 The letter stresses that checks should not be sent to UMASS along with this documentation. Instead, the checks should be made payable ‘NYS OMIG’ at a separate address identified in the letter. Documentation and checks are due within 30 days of the letter. Agencies may contact UMASS with questions or to dispute the findings or case selections at (866) 262-7594.
DOL to Propose Changes to Overtime Exemption for Salaried Workers The National Association for Home Care and Hospice (NAHC) reports that the U.S. Department of Labor (DOL) submitted a proposed rule on May 5, 2015 for review by the Office of Management and Budget (OMB) that would modify the standards for the application of overtime exemptions for professional and executive personnel who are paid on a salary basis. While the specifics of the proposal are not public, it is expected that the rule change would raise the minimum salary level required for an application of the exemptions and tighten the standards for determining whether an employee is a “professional” or “executive.” The current minimum salary necessary to qualify for the exemptions is $455 per week. That level was set in 2004. Previous to 2004, the minimum salary level was $155 or $250 per week depending on the employee’s duties. The Obama Administration had expressed concerns that individuals with wages less than $24,000 a year were being required to work an extensive amount of hours without additional compensation. In March of last year, President Obama indicated that he wanted the standards to be updated and ordered DOL to begin work on a revision of the rules. According to NAHC, many expect that the minimum salary level will likely double. A number of Washington think tanks have called for increases much higher and some Members of Congress have called for a salary level of $69,000. NAHC says that home care and hospice, like many other industries, make use of the salaried executive and professional exemptions. For instance, many companies pay professional clinical staff a base salary equivalent to the minimum exemption level and then add compensation on a per-visit basis to incentivize productivity. If the salary minimum is raised significantly, home care and hospice companies will be handicapped in using this compensation method effectively. The proposed rule will likely be released by OMB in a matter of weeks. At that point, the opportunity for public review and comment will begin. NAHC and HCA encourage members to get prepared to evaluate the impact of the rule change on their business so that effective comments can be prepared. A helpful starting point is for providers and associations to gain a full understanding of the number and makeup of staff currently subject to an exemption, along with the number of hours worked by such staff. HCA will provide updates on any developments involving the proposed rule.
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Motions Advanced in NAHC F2F Suit The National Association for Home Care and Hospice (NAHC) this week reported on some new developments in its legal challenge to the Medicare home health face-to-face (F2F) requirement. NAHC has filed a Motion for Summary Judgment and supporting Memorandum of Law in the case. The Medicare Program has until June 26 to respond. NAHC’s final brief is due July 24. The briefs focus on whether or not the plain language of the Affordable Care Act (ACA) permits the U.S. Centers for Medicare and Medicaid Services (CMS) to require a physician narrative, specifically, in its interpretation for how F2F would be documented. “If the language of the law is unclear or ambiguous, NAHC must prove that the requirement is arbitrary and capricious,” NAHC states in a recent article on the legal proceedings. The NAHC and CMS arguments tangle over the different interpretations of statute. NAHC also argues that a narrative is not a reasonable foundation for determining Medicare eligibility, as it does not account for the totality of the patient’s medical record, which, NAHC asserts, would provide a more complete affirmation of the patient’s Medicare eligibility. “NAHC further supports its arguments with evidence of the confusion surrounding the standard for a compliant physician narrative, the high rate of claim denials, and the failure of CMS to provide adequate guidelines on compliance,” NAHC states in its article. “Also, NAHC explains that CMS itself abandoned the requirement when it realized it was virtually impossible to administer it fairly.” Even though CMS rescinded the narrative requirement in 2015, providers are still vulnerable to retrospective claims audits for services in 2014 and prior, giving NAHC cause to press forward on the case. In a similar vein, NAHC is also seeking remedy for the thousands of claims denials that were already determined on the basis of physician narratives. Complicating this issue is the fact that F2F remains in effect after January 1, 2015, albeit without the specific narrative requirement at issue in the case. This new requirement poses a whole new set of issues that the home care community is otherwise seeking to address. HCA has long advocated for a legislative fix on the F2F documentation issue. We understand the burden it places on agencies and the exorbitant amount of resources expended to comply, whether in the case of the narrative requirement or the current requirements. Short of repealing this problem regulation, the home care industry has asked, at a minimum, for Congressional action compelling CMS to streamline the face-to-face certification process. HCA will keep the membership apprised of any further developments on this issue as they emerge.
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Influenza Mask Rule No Longer in Effect for Season On Thursday, the state Department of Health (DOH) Commissioner declared that influenza is no longer prevalent in New York State. This means the flu-mask requirement is no longer in effect. Under this requirement, home care and other health care workers must be vaccinated against influenza during this influenza season, or else wear a surgical or procedure mask in areas where patients are typically present. This policy was in effect since December 11, 2014. The rescission of this policy will remain in effect until DOH again declares influenza to be prevalent in the state (which usually occurs in the late fall or early winter). The announcement is at http://tinyurl.com/or5c9fz. Information on this issue is at http://health.ny.gov/FluMaskReg. Questions can be directed to FluMaskReg@health.ny.gov
LTHHCP Forum on May 19 As a LTHHCP provider, you have a unique stake in payment and program reform to prepare your organization’s special skills for meeting the needs of the elderly and chronic care populations. Next week, on May 19, we are holding a special members-only LTHHCP Forum just for you, with a focus on your role in emerging care models as well as additional program changes that you need to know about, including: a recently issued Dear Administrator Letter on care management, state workgroup recommendations on regulatory streamlining, a state budget provision aimed at uniform billing codes for home care-managed care reimbursement, soon-to-come action on the LTHHCP waiver, quality innovations tools, and other issues that directly affect you. We know that you value hearing from the state Department of Health’s Long Term Care, Division of Home and Community Based Services, Division of Managed Care and other regulatory and program officials on how these issues affect your patients and what to expect for the future of your programs. For a minimal charge of $40, covering lunch and program materials, you will get vital information and perspectives. You will also help HCA continue
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OPWDD ‘Outside Services’ Resources Earlier this week, the Office for People with Developmental Disabilities (OPWDD) held two webex training sessions regarding upcoming changes to the outside services that can be billed to Medicaid for individuals who live in certified residential settings. (See last week’s ASAP.) The original memorandum regarding these changes, the PowerPoint presentation and a recording of the presentation are available at http:// www.opwdd.ny.gov/ opwdd_services_supports/ people_first_waiver/ news. Additional meeting opportunities will be scheduled as OPWDD prepares for the October 1, 2015 changes.
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to advocate on your behalf by letting us know about local issues and needs for your specific program amid major transitions in long term care. Please register today for this special focus program for all LTHHCP providers. Your participation is vital. Further information is below. HCA’s Statewide LTHHCP Forum Tuesday, May 19 10 a.m. to 2:30 p.m. Albany Hilton State and Lodge Streets Albany, NY 12207 Register at http://tinyurl.com/nxzt6r7.
You’ve Asked for Education on DSRIP, VBP, and We’ve Got it for You on May 28 HCA members have told us that Delivery System Reform Incentive Payment (DSRIP) programs and other new models of care delivery are the number 1 area where more education is needed. If you agree, then be sure to join us on May 28 in Albany for one day of focus on all of the new care models that will fundamentally change how your organization will operate in the future, from your participation in DSRIP to the onset of Value Based Payments (VBP), and more. Watching the information flow from virtually every health care provider group or association, like HCA, you’ll see that DSRIP and Value Based Payments dominate the headlines, and for good reason. Providers must have a strategic action plan for these models or else miss out on vital opportunities to be a player in a fast-changing health care system. HCA continues to offer the home care perspective on these health system changes, and our May 28 conference will provide you with access to the major architects and consultants working to bring these new models online including State Medicaid Director Jason Helgerson; the state’s contractor on the design of Value Based Payments, Dr. Marc Berg; Greg Allen, the state Department of Health’s main program development leader; expert consultants like Tracy E. Miller from Bond Schoeneck and King; and others. From them, you will gain an understanding of how these models fit together, how to re-tool your organization to operate in these new models, and how to get your business plan ready for participation. Please see the details below. Are You Ready to Navigate New Models of Care and Coverage? Thursday, May 28, 2015 Empire State Plaza Meeting Room 2-4 Albany, NY
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Continued from p. 12 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. How to register? Download the brochure and registration form at http://tinyurl.com/papvh4u. Register online at http://tinyurl.com/phafn2z.
PHHPC Committee Meeting Agenda Released This week, the state Department of Health (DOH) posted the agenda for the Public Health and Health Planning Council (PHHPC) Establishment and Project Review Committee meeting on May 21. The agenda and supporting documents are at http://www.health.ny.gov/facilities/public_health_and_health_planning_council/meetings/2015-05-21. The agenda includes applications for 40 new Licensed Home Care Services Agencies (LHCSAs), including 28 in New York City, Long Island and/or Westchester and 12 outside of these areas; and 3 applications for changes in ownership in existing LHCSAs. One of the applicants for a new LHCSA is a rural county health department that intends to close its Certified Home Health Agency (CHHA). There are no applications for new CHHAs or expansion or transfers of ownership of existing CHHAs.
State Survey Hearing Requests Must be Filed Electronically The U.S. Centers for Medicare and Medicaid Services (CMS) has issued a survey and certification letter stating that providers who disagree with actions imposed on their agencies/facilities and want to request a hearing with an Administrative Law Judge must submit their request electronically to the Departmental Appeals Board (DAB) using the DAB E-File at https://dab.efile.hhs.gov. This policy is effective, and retroactive to, October 1, 2014. The CMS letter is at http://tinyurl.com/of33kol. In order to utilize the electronic filing system, petitioners must first become a registered user. The letter includes detailed instructions on how to register and use the DAB’s Electronic Filing System. Written requests for hearings delivered by postal delivery are no longer accepted as of October 1, 2014, unless the petitioner does not have access to the Internet or a computer. In those circumstances, petitioners may call the Civil Remedies Division and provide an explanation as to why they cannot file electronically or
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a request for a waiver from e-filing can be submitted along with a written request. Confirmation of a waiver from e-filing will be received in writing. The CMS letter includes an attachment that provides sample language that can be used in the Appeal Rights notice which details a petitioner’s options for filing a hearing request. Although the letter was issued April 24, 2015, the effective date for the directive is retroactive to October 1, 2014.
New Policy Issued for Social Adult Day Care The state Department of Health (DOH) has posted a new policy relating to Social Adult Day Care (SADC) and Managed Long Term Care (MLTC) plans. The policy is at http://www.health.ny.gov/health_care/medicaid/redesign/mltc_policy_15.01_social_adult_day_care.htm. According to the guidance, SADC programs that are currently contracting with an MLTC plan or want to contract with MLTC plans must undergo a new certification process that was established by DOH, in
Jewish Home Lifecare is currently hiring for the following positions:
HIRING
Director of Quality and Performance Improvement, Associate Director of Rehabilitation Services, Part-Time Weekend RNs, Fee for Service Nutritionists, Fee for Service positions in OT, PT, SLP, and LMSW for our CHHA. We are also currently recruiting for an RN Instructor and Fee for Service RNs for our LHCSA. In addition to the above mentioned positions, we are looking for: An Associate Vice President of Home Care provides the leadership, management and vision necessary to ensure that the CHHA has the proper operational controls, administrative and reporting procedures, organizational structure and people systems in place to effectively grow the organization and to ensure financial strength and operating efficiency. Plans, directs and evaluates a quality assured, clinically excellent, compliant, cost effective, and consumer satisfied CHHA. Develops and holds accountable an effective CHHA leadership level that manages clinical service, fiscal management, business development, and human resource operations. Facilitates CHHA operations through appropriate departmentalization and delegation of duties per the approved organizational structure. Participates in the identification, development and assures the implementation of new and/or revised Home Health programs in order to maintain and enhance current and future state market share. License and current registration as a Registered Professional Nurse, Bachelor’s Degree in Nursing required. Knowledge of home health regulations, accreditation and quality standards. The Director of Clinical Excellence for QAPI (Quality Assurance Performance Improvement) is responsible for directing the development, implementation, and evaluation of the Quality Assurance Performance Improvement program for the organization’s Certified Home Health Agency (CHHA). This involves collaboration with the administrative and clinical leadership in order to effectuate a successful and regulatory compliant program. The Director of Clinical Excellence for QAPI fosters a culture that promotes a commitment to continually improving quality of care for clients and that empowers staff to build quality improvement processes into daily work activities. License and current registration as a Registered Professional Nurse, Bachelor’s Degree in Nursing required. Minimum three years home care experience; knowledge of home health regulations, accreditation and quality standards. We offer competitive compensation, excellent benefits, and a positive work environment. For further consideration, please send a cover letter and resume to: Victoria Izraylevsky, Director of Human Resources, at vizraylevsky@jewishhome.org.
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conjunction with the Office of the Medicaid Inspector General (OMIG) and the New York State Office for the Aging (NYSOFA). Those SADC entities with existing MLTC contracts will have 30 days to complete the Certification. A Certification must be completed for each SADC site. Completion of the Certification will attest to an SADC’s compliance with Title 9 NYCRR section 6654.20, as required under Article VII, section C of the Managed Long Term Care model contract. Under this new policy, it is the responsibility of the MLTC plan to ensure that SADCs under contract have completed the Certification. Further, an MLTC plan may not enter into a new contract with an SADC until Certification has been successfully completed. Plans must request a copy of the confirmation notice generated upon the SADC’s successful completion of the electronic Certification, and maintain this for their records. DOH advises plans to consider the individual needs of each enrollee during the assessment process and to clearly identify the need for SADC as a service in the plan of care. MLTC plans should not enroll a recipient in SADC unless the recipient has a functional or clinical need for community based long term care services (CBLTCS) defined specifically as personal care services in the home, home health care, private duty nursing, consumer directed personal assistance services, and adult day health care. SADC can contribute to the total care plan but cannot represent the primary service provided to the enrollee. In order to complete the Certification, an SADC will need to: • • • •
Provide the SADC owner and program director’s information, including Social Security number; Answer a series of questions attesting to compliance; List any MLTC plans the SADC contracts with; and Certify that the information provided is true.
Certification will need to be completed on an annual basis.
Publications •
“Medicaid: A Small Share of Enrollees Consistently Accounted for a Large Share of Expenditures,” by the Government Accountability Office http://www.gao.gov/assets/670/669916.pdf
•
“Managed Long Term Care,” by the New York Legal Assistance Group http://www.wnylc.com/health/entry/114/
•
“A Profile of Older Americans: 2014,” by the Administration on Aging http://www.aoa.acl.gov/Aging_Statistics/Profile/2014/docs/2014-Profile.pdf
•
“Updates on Hospice Election Form, Revocation, and Attending Physician,” by the U.S. Centers for Medicare and Medicaid Services http://tinyurl.com/o5cqrzu
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org. 15
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 member colleagues. As part of this process, we especially want to take the opportunity to hear your feedback, continue to learn how best to serve you and let you know about a number of offerings that are in store for both the Association and the Home Care Council Forum.
Home Care Council of HCA Member Forum Wednesday, May 27, 2015 10:00am to 1:00pm Hunter College Brookdale Campus 425 East 25th Street (between 1st and FDR Drive) The Osborn Room (Mezzanine Level) New York, New York 10010 A continental breakfast will be served.
Some of the vital issues to be covered include: • HRA Contract and other updates • Quality Incentive/Vital Access Provider Pool (QIVAPP) monies • Companionship Exemption lawsuit • Managed Care Payment and other issues • Fully Integrated Duals Advantage (FIDA) program • Education programs – changing personnel needs and other topics Please plan to join us for this important free-of-charge members-only session by simply completing this registration form.
Registration Name:______________________________________________ Title: _________________________________________ Organization:_______________________________________________________________________________________ City State Zip:_______________________________________________________________________________________ Email:_______________________________________________ Phone:________________________________________ (Required for registration.)
FAX TO: (518) 426-8788 For more information, contact Andrew Koski at (518) 810-0662 or at akoski@hcanys.org
STATEWIDE LTHHCP FORUM 19th
Tuesday, May 10:00am-2:30pm Location
Albany Hilton State and Lodge Streets Albany, NY 12207
This is an HCA Members-Only session. There is a $40 fee per person for this session to cover the costs of meeting material and lunch. The Forum provides LTHHCP representatives, state policymakers, other invited guest speakers and HCA staff the opportunity to discuss the salient issues affecting the LTHHCP at the local, state and federal levels, as well as the program’s priority advocacy needs.
Preliminary Agenda Items Include: • Mandatory MLTC Enrollment, FIDA, DSRIP, Value Based Payments and Other Critical Developments and Implications for LTHHCP • Status, Developments and Reports of LTHHCPs locally, regionally and statewide
Statewide implementation of mandatory managed care enrollment is continuing, FIDA is ramping up, DSRIP is being implemented, and simultaneously the state and federal governments are moving the health care payment system to “Value Based Payment.” Meanwhile, a new DAL on care management has just been issued, the state regulatory reform workgroup is considering recommendations for additional regulatory streamlining, the state budget includes a new uniform coding/billing system for home care‐ managed care, action on the LTHHCP waiver is due this September, a series of new home care quality innovations is being explored, and many other developments are in full swing. Attend this important Forum opportunity to discuss these and critical LTHHCP program and operational issues, opportunities, and needs amid these changes and developments.
Registration
Once complete, please fax to (518) 426-8788. You must provide us with an email address in order to receive your confirmation. _________________________________ Name
_________________________________ Name
_________________________________ Title
_________________________________ Title
_________________________________ Agency
_________________________________ Agency
_________________________________ Phone
_________________________________ Phone
_________________________________ Email (Required)
_________________________________ Email (Required)
Payment of $40 per person _______ VISA
• Discussion with State Long Term Care, Division of Home and Community Based Services, Division of Managed Care and Division of Health Care Financing Officials re LTHHCP program, operation and policy issues. • More
_________ MC
_______ AM EX
Credit Card No._____________________________________________________________ Expiration Date:________________________ Sec. Code:___________________________ Card Billing Address:_________________________________________________________ __________________________________________________________________________ Name on Card:______________________________________________________________ Signature:__________________________________________________________________ Or, make checks payable to: HCA and mail to 388 Broadway, 4th Floor, Albany, NY 12207
Cancellation Policy: Cancellations received by May 12 will receive a full refund, less 25% of total due as an administrative fee. Cancellations received on May 13 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.
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