ASAP
A Weekly Publication Of HCA Home Care Association of New York State
Legislative Issues Public Policy
News
Volume 20, No. 20 May 22, 2015
State Senate Introduces HCA “Veterans Home Care Pilot Program” Bill Legislation developed by HCA to establish a “Veterans Home and Community Based Care Pilot Program” has been introduced in the State Senate by Veterans Committee Chairman Senator Thomas Croci (R-Suffolk County). See VETERANS p. 3
Take 2 Minutes Now for Convenient, Fast HCA Advocacy We recently introduced you to our new online Legislative Action Center at http:// p2a.co/CrvM1NC; and now, we need you to start using it for achieving a positive state legislative outcome. See ACTION p. 2
Inside ASAP Senate Introduces HCA “Veterans Home Care” Bill............................1 Take 2 Minutes Now for Convenient, Fast HCA Advocacy...................1 Assembly Passes Advanced Aide Bill, Other Legislative Updates.....3 HCA Continues Advocacy on QIVAPP..................................................5 5/28 Conference Speaker to Show Interdisciplinary Home Care Model........6 HCA’s Technology Symposium: June 16..............................................6 Worker Wage Parity Certification Forms Due June 1............................7 CMS Conducts Its 3rd Forum on F2F Encounter Templates...............7 DOH Issues Final 2015 Non-NYC Personal Care Rates......................8 DOH Posts 2014 LTHHCP Cost Report Software................................9 New Info on Fair Hearings, Transitions under Managed Care............9 LHCSA Applications to be Submitted Through NYSE-CON.............10 DSRIP Update.....................................................................................11 HCA, DOH Partner on Falls Prevention Efforts..................................11 HCA Presents to State Medical Society.............................................12 Duke University, HCA Team up for Care Coordinator Training..........12 Developments in Emergency Preparedness......................................13 ICD-10 Testing Week: June 1-5...........................................................14 CMS Calls for Technical Experts on Preventable Readmission.........14 CMS Conference Call on HQRP, HIS Manual Updates on 6/17..........15 Guidance Issued on Surplus Payments by Third Parties.....................15 SADC Certification Webinar Available...............................................15 Update on Continuing Ed. Requirement for Social Workers............16 ADM Issued on Nursing Home Transition to Managed Care............16 Special Needs ALP Grants Announced..............................................17 PHHPC Committee Meets..................................................................18 HRA to Change Transitional Benefits for Certain Cases...................18 Publications........................................................................................18
This week, HCA bid farewell to our Education Director, Lynda Schoonbeek, who is retiring. Lynda has been a vital part of our team, developing, planning, promoting and assuring the success of hundreds of HCA education conferences and programs throughout the past 7 years. We at HCA, and the membership at large, will miss her professionalism, kindness, creativity, expertise and warm personality. HCA has also been recruiting a new Education Director and will make an announcement soon. In the meantime, from all of us at HCA, we extend our love and wellwishes to Lynda in her retirement as she fills her canvas with new experiences.
NOTE: HCA’s offices will be closed on Monday, May 25, for the Memorial Day holiday.
Helping New Yorkers Feel Right At Home
ASAP – a publication of the Home Care Association of New York State
Volume 20, No. 20 May 22, 2015
ACTION from p. 1 The Legislative Action Center is available from HCA’s website. There, we are posting online advocacy campaigns that allow you and your staff to send messages to the state Legislature and Congress in the amount of time it takes to enter your contact information. As reported in recent editions of ASAP, HCA has succeeded in gaining introductions of legislation to modernize the home care insurance law and expedite the adoption of home care-managed care regulatory realignment measures. Click the links at the end of this article and you’ll find two campaigns on our Legislative Action Center related to these issues. For each one, enter your contact information and hit “Send Email.” A pre-written advocacy message will go directly to your legislator’s inbox. This takes only a few minutes of your time and you can take action right after reading this article, on your desktop computer, smartphone or tablet. So far, more than 200 people have taken action on these campaigns. Have you? Because this process is so quick and easy, we ask that you get all of your staff to take action today!
We will be posting additional advocacy campaigns in the coming days and weeks as the state legislative session enters into crunch time for the passage of bills that will help support the work that you do. We need a high-volume response and will be sending you additional action alerts as new HCA-priority bills get introduced and advanced through the process. If you need any assistance at all, please do not hesitate to write to HCA’s Communications Director Roger Noyes at rnoyes@hcanys.org and he will be happy to help you take this critical step on behalf of New York home care. Direct Links to Advocacy Action Items ‘Support S.5076: Legislation to Modernize Home Care Insurance Coverage’ (http://p2a.co/exDaV7b) ‘Support Assembly Bill (A.0736) to Advance Home Care-Managed Care Regulatory Realignment’ (http://p2a.co/SLxGeaI)
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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VETERANS from p. 1
Assembly Passes Advanced Aide Bill and Other Home Care Legislative Updates
The program would “test the benefit, quality, costeffectiveness and increased access to services of a coordinated, interdisciplinary plan of home and community based services for veterans.” It would provide an enhanced integrated, interdisciplinary model to more fully meet the comprehensive health, psychosocial and related needs of veterans. It would be structured and implemented as a collaborative model between home care agencies, physicians and other partners with experience in veterans care. Eligible home care agency applicants would include Certified Home Health Agencies, Licensed Home Care Services Agencies and Long Term Home Health Care Programs.
The state Assembly this week unanimously passed legislation to authorize “Advanced Home Health Aides.” The bill, A.7188/Glick, passed by a margin of 109-0. As reported in last week’s ASAP, HCA supports the Advanced Home Health Aide (AHHA) designation and recently worked with other groups to send a letter urging negotiations to sort out a series of outstanding issues to make this concept workable.
The legislation was drafted by HCA following the recommendations of a roundtable session convened in mid-February by the New York State Health Foundation in conjunction with HCA to explore provider and consumer experiences, challenges and possible approaches for improving access and coordination of home and community based care for veterans.
The letter was signed by a diverse coalition of provider organizations and groups representing persons with disabilities and the aging, including HCA’s sister organizations LeadingAge New York, the New York State Association of Health Care Providers (HCP), the Hospice and Palliative Care Association of New York State and others.
Pilot programs would be selected through a request for applications process and be further guided by an advisory group.
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 legislation would seek state, federal and philanthropic funding, including federal waivers or other federal authority for integrating coverages for services through the pilot program. Also included is a special program fund in the state finance system to receive and allocate moneys to support the initiative.
The Senate has major issues with the existing legislative approach, in A.7188, which needs critical amendments to meet the Senate’s concerns as well as recommended actions by HCA and other association partners. Among the outstanding issues which need to be addressed in the final proposal are: 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 is also seeking Assembly sponsorship of this legislation and will be continuing to collaborate with Senator Croci and our organizational partners in support of the program and access to needed home care services for veterans. For further information, please contact Al Cardillo at acardillo@hcanys.org.
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Continued from p. 3 HCA 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. Other legislation on the move HCA and association partners are also working to advance legislation to ensure payment adequacy for home and community based care. One bill has been advanced by HCA and a second by HCP. HCA is awaiting word on the introduction of our 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. Meanwhile, a bill advanced by HCP and covered in last week’s ASAP, 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. This legislation was introduced last week by Senator Hannon, as S.5459, and referred to the Committee on Health. This week, an Assembly version of the bill was introduced by Assemblyman Gottfried as A.7687. It was referred to the Assembly Health Committee. Other bills advanced through the legislative process this week include: • A.7535 Gottfried – Relates to fiscal intermediary services in the consumer directed personal assistance program. This bill defines fiscal intermediary services, within the consumer directed personal assistance program, and requires licensing of fiscal intermediaries. This bill has been reported to the Assembly Health Committee. A companion bill in the Senate (S.5565/Hannon) was previously reported to the Senate Health Committee. •
A.2150 Gottfried – Authorizes an attending physician to make decisions regarding hospice on behalf of an incapable adult without a surrogate. On May 21, this bill was advanced to third reading and is on the Assembly calendar. A companion bill in the Senate (S.1153/Hannon) has been in the Senate Health Committee since January.
•
S.5535 Hannon – Delays the transition of Traumatic Brain Injury (TBI) and Nursing Home Transition and Diversion (NHTD) waiver populations into Medicaid managed care until at least April 1, 2017; provides that the commissioner shall convene a workgroup to develop recommendations on transitioning these populations and spells out membership and responsibilities of the workgroup. This bill was referred to the Senate Health Committee this week.
HCA will continue to keep the membership apprised of key state legislative developments and corresponding advocacy needs. For more information, please contact a member of HCA’s Policy staff. 4
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HCA Continues Advocacy on QIVAPP Submits Joint Association Letter to Jason Helgerson and others HCA continued to advocate for fairness in the eligibility determination process for the Quality Incentive Vital Access Provider Pool (QIVAPP) program by sending a joint letter with other associations to State Medicaid Director Jason Helgerson, with copies to the state Department of Health (DOH) Commissioner, Administration officials, and legislative officials. The letter, signed by HCA, the New York State Association of Health Care Providers (HCP) and LeadingAge NY, took issue with DOH’s most recent interpretation of provider eligibility criteria for participation in QIVAPP, as reflected in its April 29, 2015 QIVAPP Webinar Frequently Asked Questions (FAQs) document. The letter also addresses the future use of the QIVAPP program as a means to assist home care providers in meeting rising costs stemming from the Home Care Worker Wage Parity Law of 2010 and other ongoing mandates. As covered in many past editions of ASAP, DOH changed the original health benefit requirement outlined in the April 23, 2014 Dear Administrator Letter wherein an agency must provide comprehensive health insurance coverage to its employees. The change, outlined in an April 29 Frequently Asked Questions document, states: “a minimum of 30% of a provider’s total workforce must be enrolled in the health benefit” in order for the provider to qualify for QIVAPP funding. HCA has consistently pointed out that this new policy penalizes home care providers who offer comprehensive health coverage but whose workers may choose not to participate in the provider’s health benefit because they access these benefits through other means or elect to receive a higher wage rather than obtain health coverage. We have argued that these agencies are incurring similar costs as those agencies whose workers opt for health insurance because under the state wage parity law, they still have to provide cash or other benefits for aides who don’t choose the health benefit. In the letter, HCA and the other associations request that DOH retract its April 29 reinterpretation of the health benefit eligibility standard. Additionally, we ask DOH to identify a long term strategy outside of QIVAPP for investing additional funds into the home care system to support wage parity and other increased employer costs. We further call upon the Department to establish a work group of associations, providers and plans to discuss adequate reimbursement for all counties impacted by wage parity and other mandates, and advocate that home care providers must be reimbursed at an established sufficient amount and Managed Long Term Care Plan premium rates must be set at levels that are adequate to permit plans to meet or exceed this rate. The letter is at http://hca-nys.org/wp-content/uploads/2015/05/JointQIVAPletter52215.pdf. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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New Speaker to Show Interdisciplinary Home Care Model at May 28 HCA Conference Mount Sinai Hospital’s mobile acute-care program, run by Dr. Linda DeCheerie, was recently profiled in the New York Times, and this week we are very excited to announce that Dr. DeCheerie is now on the speaker roster for HCA’s upcoming conference on New Models of Care and Coverage. The program is less than one week away, on May 28, in Albany. Please register now for this information-rich, highly relevant conference. Consider the story of Martin Fernandez, 82, a patient who came to Mount Sinai with a fever and abdominal pain. The Times writes that Mr. Fernandez had the unique option of being admitted to the hospital or heading home as part of Mount Sinai’s ‘Hospital at Home’ program: “If he chose to be hospitalized at home, doctors and nurses would visit daily. He would receive lab draws and intravenous medications, even X-rays or ultrasound scans if he needed them. The costs to him would be no greater than if he were physically in the hospital. In three or four days, he would be discharged – and he would not have to go anywhere.” This interdisciplinary approach sounds a lot like the work you do in home care, doesn’t it? It is just one of several new models that you need to learn more about as DSRIP and Value Based Payment models seek to collapse the distinctions between provider silos and encourage a team approach to driving down costs and providing value. On May 28, Dr. DeCheerie will be sharing these and other insights on new models that bring together primary care, palliative care, home care and more to meet the goals of an integrated, value-based health care system where payment is determined by a prescribed set of quality metrics. Please see the updated brochure (at http://hca-nys.org/wp-content/uploads/2015/04/ NewModelsofCareMay28.pdf ) for more information about this premier conference, which will also include Dr. Marc Berg, who is the contract expert at KPMG working with the state on its development plan for Value Based Payments, along with key decision-makers from the state Department of Health and expert consultants.
HCA’s Technology Symposium: June 16 Helping you make the jump from ‘dial-up’ in an increasingly ‘broadband’ health care world Integration, connectivity and data flow are the lifeblood of our evolving health care system. To make the cut, home care providers must include technology investment as a core part of your strategic business planning. Now more than ever, you need to be mindful that the technologies which have aided you in the past may not be up to speed for the kinds of partnerships and payment models commanded by state and federal reform policies, including DSRIP and Value Based Payments. In other words, dial-up service no longer cuts it in an increasingly broadband health care world. This is why we invite you to our Technology Symposium and Vendor Showcase on June 16 in Albany which will help you navigate all the paths of opportunity and gain a better understanding of tools and trends available for satisfying today’s state and federal health initiatives. You’ll hear from policy leaders, industry experts and trend-setting peers with insight, case examples, and practical solutions for utilizing the latest home care technologies to ensure your success in meeting the clinical demands, partnership expectations, and improvement standards that will determine your success as a provider of home 6
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care services in your community. This learning opportunity is vital as HCA works at the advocacy level to promote targeted and enhanced investments in this priority area. To learn more please download the brochure at the back of this week’s ASAP, or use our online registration process to join the roster at www.hcanys.org. HCA’s Technology Symposium and Vendor Showcase June 16, 2015 Albany Marriott Wolf Road Albany, NY
Worker Wage Parity Certification Forms Due June 1 As reported in an alert to the membership earlier this week, the next round of state-required vendor Home Care Worker Wage Parity Law certification forms is due June 1 for Licensed Home Care Services Agencies (LHCSAs) and other entities that contract with Certified Home Health Agencies (CHHAs), Long Term Home Health Care Programs (LTHHCPs) and/or managed care organizations (MCOs) who serve New York City, Long Island and Westchester. CHHAs, LTHHCPs and/or MCOs that contract with LHCSAs are required to obtain a written certification on a quarterly basis from the LHCSA or other entity which attests to the LHCSA’s or other entity’s compliance with the state’s Home Care Worker Wage Parity Law for defined certification periods and on a prospective basis. The form due June 1 covers the period June 1, 2015 through August 31, 2015 and is sent to the CHHA, LTHHCP and/or MCO, not the state Department of Health (DOH). To learn more, read HCA’s alert at http://hca-nys.org/member-alerts/worker-wage-parity-certification-forms-due-june-1.
CMS Conducts Its 3rd Open Door Forum on F2F Encounter Templates On May 20, the U.S. Centers for Medicare and Medicaid Services (CMS) held the third Special Open Door Forum call for the voluntary electronic clinical template for the home health face-to-face (F2F) encounter. The CMS representatives on the call presented the latest version of both the electronic and paper templates. As with the other versions, the revised versions for both the electronic and paper templates follow the subjective, objective, assessment and plan (SOAP) model for documentation. The paper version is two pages and consists predominately of questions requiring a narrative response, while the electronic version is a combination of questions that require a narrative response and checkboxes. CMS included with this revised version a “Progress Note Guidance” page that describes the purpose of the template and the criteria for the home health certification, including the F2F encounter. The presenters reminded participants that the templates are not mandatory but can serve as a physician progress note and/or guide for documenting the F2F encounter for patients who are referred to home health care. Continued on next page
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Continued from p.7 CMS informed participants that before the templates can be released, they must first go through the Office of Management and Budget approval process, which CMS estimates will take approximately six months. A notice will first be published in the Federal Register allowing for a public comment period. The majority of the call was dedicated to a question and answer period. Many of the questions were related to process issues, specifically, when a physician’s co-signature would be required on the F2F encounter document. CMS could not provide a definitive answer to these questions since they are currently reviewing their policies on F2F co-signatures. Additional questions revolved around whether support staff and other members of the care team could assist with completing the template, whereby the physician would sign and date the document. CMS was clear that the progress note must be completed by the physician or the allowed non-physician practitioner. During the call, CMS stated that it plans to publish further guidance in the Medicare Program Integrity Manual. CMS will also continue to accept comments on the templates but requests that comments be submitted as quickly as possible. Feedback and questions on the templates can be sent to: HomeHealthTemplate@cms.hhs.gov. CMS’s paper and electronic F2F template can be downloaded at: http://www.cms.gov/Research-StatisticsD a t a - a n d - S y s t e m s / C o m p u t e r - D a t a - a n d - S y s t e m s / E l e c t r o n i c - C l i n i c a l -Te m p l a t e s / HomeHealthHHElectronicClinicalTemplate.html. For further information, contact HCA Policy staff.
DOH Issues Final 2015 Non-NYC Personal Care Rates The state Department of Health (DOH) posted to the Health Commerce System (HCS) the final 2015 “Hotline” Medicaid rates for Personal Care and/or Consumer Directed program providers. DOH has previously posted the 2015 final (or hotline) rates for Long Term Home Health Care Programs (LTHHCPs) and non-hospital-based Certified Home Health Agencies (CHHAs). The rate calculations sheets are located in the “Rate Publication Selection List” drop-down section of the HCS, dated May 14, 2015. These rates, effective January 1, 2015, reflect the application of a zero percent roll factor adjustment. The rates also reflect a 6.08 percent uniform percentage rate add-on payment to personal care providers in social service districts which do not include a city with a population of over one million persons. To be eligible for this rate addon, a personal care provider must have submitted to DOH a signed certification statement on the use of these funds. Personal Care and Consumer Directed program providers have 30 days to file an appeal with DOH but only in cases where the 2015 final rates have changed from the 2015 initial rates. If you have specific questions about your rates, contact DOH’s Kathy Omencinsky at (518) 473-4421. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
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DOH Posts 2014 LTHHCP Cost Report Software The state Department of Health (DOH) has posted the 2014 Long Term Home Health Care Program (LTHHCP) Medicaid cost report software, along with a related Dear Administrator Letter (DAL), to the Health Commerce System (HCS) at https://commerce.health.state.ny.us. To access the software, providers must enter their HCS user ID and password, select “LTHHCP Cost Report” under “my applications,” and then scroll down to access the 2014 cost report software for download. The application was revised to reflect a change in the Department’s internal process for accepting and storing cost report data that requires a separate link for users to review historical cost report information for reports submitted prior to April 29, 2015. It has no impact on the process for users to upload your 2014 cost report software and users should certify the finalized 2014 cost reports on the links identified as “after APR-28-2015.” The LTHHCP cost report and certifications must be submitted by August 15, 2015. The Department has also told HCA that all LTHHCPs are expected to file a cost report if they provided services and received Medicaid or other payor revenue in 2014, even if the LTHHCP in question has closed or is no longer operating. Specific questions on the cost report should be directed to DOH’s Russ Smith at (518) 473-4421. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
New Info on Fair Hearings under Managed Care and Population Transition The state Department of Health (DOH) has posted information on new Managed Long Term Care (MLTC) Initial Adverse Determination (IAD) notices, including a new right to request a Fair Hearing without first exhausting the plan’s internal appeal process. Materials from an April 29 webinar on IADs are at http://www.health.ny.gov/health_care/medicaid/redesign/docs/mltc_model_notice_training_april-29.pdf. MLTC are required to use IAD notices for most plan “actions,” including denials, reductions, suspensions or terminations and other situations. They are used to inform enrollees of their Fair Hearing rights. The notices are for partial capitation plans only, not Medicaid Advantage Plus or Programs for All-Inclusive Care for the Elderly (PACE). In a major change, MLTC enrollees will no longer have to utilize the plan’s internal appeal process before requesting a Fair Hearing. “Aid to Continue,” under which the enrollee’s current services must continue if an appeal is requested timely, will not be available if an individual requests an internal appeal, but will continue to be available if a Fair Hearing is requested. Also, enrollees are entitled to aid to continue without regard to the expiration of the prior service authorization. The new letters that will include these changes are expected to be available in June and will apply to all plan actions on or after July 1. Continued on next page 9
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Continued from p. 9 Also, newly posted Managed Care Policy and Planning meeting materials include the following information: •
In 2017, currently carved out Medicaid behavioral health services and children in foster care will be moved to managed care.
•
The existing home and community based services (HCBS) that are in the six 1915c children’s waivers, including Care at Home I and II, will be aligned to one array of HCBS benefits, pending federal approval, and will be moved to managed care. As a result of this transition, the 1915c waivers will be discontinued as separate programs once the transition is complete.
•
The transition of care coordination services of the six 1915c children’s waivers to health homes will also occur in 2017.
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
LHCSA Applications to be Submitted Through NYSE-CON The state Department of Health announced this week that it is transitioning from paper forms to electronic submission for health care facility and agency licensure applications. The next step in this ongoing process is the electronic submission of Licensed Home Care Services Agency (LHCSA) applications for new agencies and Change in Ownership/Controlling Persons via the New York State Electronic Certificate of Need (NYSE-CON) system. Beginning May 21, 2015 the Department will no longer accept paper applications for new LHCSAs or for changes in ownership and/or controlling persons of LHCSAs. In order to submit applications via NYSE-CON, applicants need a Health Commerce System (HCS) account. LHCSA application submissions will be similar to CON application submissions. Additional information about the NYSE-CON system, forms and schedules for the LHCSA application and Training documents can be accessed at: http://www.health.ny.gov/facilities/cons/. Technical questions related to submission of applications via NYSE-CON can be sent to: nysecon@health.ny.gov. For specific questions, e-mail the Department at: homecareliccert@health.ny.gov. For further information, contact the HCA Policy staff.
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DSRIP Update The state Department of Health (DOH) has updated its timeline for the Delivery System Reform Incentive Payment (DSRIP) program. It is at http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/timelines/docs/year_1_timeline.pdf. Some notable dates include: • • • • • •
First payment to Public Hospitals Performing Provider Systems (PPSs) – May 18 Payment made to Safety Net PPSs – May 28 PPS Partner Networks posted – Late May Domain 1 Implementation Plan due from PPSs – June 1 First Quarterly Report/Project Implementation plans due from PPSs – July 31 Second DSRIP payments to PPSs – Late January 2016
For updated information on DSRIP, join the MRT Innovation eXchange at https://www.ny-mix.org/.
HCA, DOH Partner on Falls-Prevention Efforts HCA continues working through the HCA Quality Committee and with Falls Prevention Program officials in the state Department of Health (DOH) to promote and support falls-prevention programming in home care agencies throughout the state. We resubmitted home care quality innovation language to the Legislature, seeking introduction of a bill that, among other measures, would support evidence-based falls-prevention programs in home care. We also continued discussing with DOH a possible joint education, technical and program initiative for home care providers. Moreover, we submitted a letter supporting new falls-prevention funding for DOH. These initiatives well-align to the major new models of care and coverage being sought by the state and implemented in the marketplace. Falls prevention webinar DOH and the State University at Albany School of Public Health have posted a related webinar entitled “Making Fall Prevention Part of Primary Care: Implementing CDC’s STEADI Toolkit in a New York State County Health System.” It showcases a comprehensive resource designed to assist health care providers incorporate fall risk assessment and proven interventions into clinical practice. The webcast covers efforts by HCA member United Health Services to incorporate fall-risk assessments and referral into clinical practice, along with other community linkages. HCA encourages members to access the webinar at http://www.albany.edu/sph/cphce/phlchron.shtml. For further information, please contact Al Cardillo at acardillo@hcanys.org.
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Medical Society Adopts Resolution on behalf of LTHHCP
HCA Presents to State Medical Society HCA presented this week to the Long Term Care Committee of the Medical Society of the State of New York (MSSNY). The Committee had expressed particular interest in discussing the latest developments in HCA’s and MSSNY’s work on veterans home care services. (See related p. 1 story about a newly introduced bill on veterans home care services.)
The MSSNY House of Delegates has adopted a resolution in support of the Long Term Home Health Care Program (LTHHCP). It reads: RESOLVED, That that the Medical Society of the State of New York work to assure the continuity of Long Term Home Health Care Program (LTHHCP) in managed care contracts; and be it further.
HCA Executive Vice President Al Cardillo also updated the committee on the passage of HCA’s “ Hospital-Homecare-Physician Collaboration Program” legislation and other bills recently introduced.
RESOLVED, That the Medical Society of the State of New York work with the AMA to assure that the federal waiver authority which authorized the Long Term Home Health Care Program (LTHHCP) does not expire in September of 2015; and be it further
Discussion also focused on face-to-face documentation procedures; technology connectivity; the status of the Long Term Home Health Care Program and MSSNY’s resolution urging the program’s continuity (see sidebar); telehealth; and other issues related to physician involvement in home care, including consideration of medical director roles in home care (akin to hospice).
RESOLVED, That the Medical Society of the State of New York urge that the State Department of Health conduct a study to evaluate the clinical and cost-effectiveness of the Long Term Care Health Care Program (LTHHCP) as opposed to Medicaid Long Term Care to determine the efficacy of one or both models in the evolving health care system.
Duke University, HCA Team up for Population Care Coordinator Training Duke University faculty traveled to New York City last week to conduct a multi-day, on-site portion of its cutting-edge Population Care Coordinator Program (PCCP). The on-site component combines with semester-long online classes that ultimately lead to important new skill development and PCCP certification for home care clinicians.
A related MSSNY resolution related to coverage of home based, long term care and related services in new models of care reads: RESOLVED, That the MSSNY, through its Long Term Care Subcommittee to the Quality Improvement and Patient Safety Committee, work with all relevant federal and state agencies to assure that long term care services including home care services, physician home visits, telehealth and palliative care are integrated into and paid for through new initiatives underway to restructure the Health Care Delivery System such as the Delivery System Reform Incentive Payment (DSRIP) Program, Medicare Shared Savings Accountable Care Organizations and the Fully Integrated Duals Advantage (FIDA) Program.
The onsite component is ordinarily conducted at the Duke campus, but Duke faculty brought the session to New York (at the site of HCA Member Visiting Nurse Service of New York) to support the participation by a large number of nurses locally who may not otherwise have been able to avail themselves of this critical training. This certification program trains clinical staff for care in an increasingly evidenced-based, patient-focused system. HCA’s Executive Vice President, Al Cardillo, 12
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was invited to again participate with the Duke team in presenting a component of the training program. Providers interested in the Population Care Coordinator Program should contact Duke program leaders at http://pccp.nursing.duke.edu/. For further information, please contact Al Cardillo at acardillo@hcanys.org.
Developments in Emergency Preparedness HCA engages utility companies on home care emergency preparedness Since the fall, HCA has been reaching out to the New York State Public Service Commission and individual utility companies on emergency preparedness connections for home care. Last Friday, HCA and partners at the New York State Association of Health Care Providers (HCP) met onsite with officials of Orange and Rockland County-based and Con-Edison utility companies. We exchanged critical information about home care and utility emergency response efforts and are now working on specific steps to facilitate mutual awareness of the connection between utility companies and home care agencies in meeting the needs of vulnerable individuals. DOH-HCA Collaborative Initiatives HCA also met this week with state Department of Health (DOH) officials to review progress and plan next steps on collaborative emergency preparedness initiatives, including a “Transportation Assistance Levels” (TALs) initiative for home care, which was previously summarized for the membership, and other collaborative efforts. Essential Personnel Legislation HCA also met with key state Senate offices this week to discuss and urge passage of HCA’s “Essential Personnel” legislation for home care and hospice. The Assembly unanimously passed its version of this bill (A.5125-B sponsored by Assemblyman Michael Cusick) last week, and HCA is working with Senator Lanza, sponsor on the Senate side, for passage of the companion bill. Both the Senate and Assembly unanimously passed this bill last year, though the measure was vetoed by the Governor. HCA has worked with both sponsors and with the Governor’s office to address any outstanding questions and interpretative issues prompting the Governor’s veto. For further information, please contact Al Cardillo at acardillo@hcanys.org.
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ICD-10 Testing Week: June 1-5 National Government Services (NGS), New York’s Medicare Administrative Contractor, reports that providers and billing partners will be able to send test claims for the ICD-10 Acknowledgement Testing Week with Electronic Data Interchange (EDI) from June 1 to 5, 2015. Registration will not be required for the Acknowledgement Testing Week. Test claims with ICD-10 diagnosis codes must be submitted with current dates of service, since testing does not support future dated claims. Test claims will receive the TRN, 999 and 277CA acknowledgements as appropriate, to confirm if the claim would be accepted or rejected in the system. Testing will not confirm claim payment or produce a remittance advice. All test files must have the “T” in the ISA15 field for Test files. The EDI Help Desk is available weekdays from 8 a.m. to 5 p.m. If you have questions during testing week, call (877) 273-4334. NGS Closed for Memorial Day NGS’s offices will be closed on Monday, May 25, 2015. Electronic claim files transmitted after 5 p.m. on Friday, May 22, 2015 will have a claim receipt date of Tuesday, May 26, 2015. EDI front-end acknowledgement transactions will be created as expected, as EDI claim files are received. The Fiscal Intermediary Standard System Direct Data Entry (FISS DDE) Provider Online System will be available on Monday, May 25, 2015 during regular hours but there will be no support available to respond to any issues. Providers will be able to access NGSConnex and use the interactive voice response (IVR) system. The IVR phone number for New York State is (866) 275-3033. NGS’s offices will reopen with normal business hours on Tuesday, May 26, 2015. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
CMS Calls for Technical Experts on Preventable Readmission Measures The U.S. Centers for Medicare and Medicaid Services (CMS) has contracted with RTI International and Abt Associates to develop measures for potentially preventable readmissions, in alignment with the Improving Post-Acute Care Transformation Act of 2014 (known as the IMPACT Act). As part of this process, CMS has asked its contractors to convene groups of post-acute stakeholders and experts, including Home Health Agencies, Skilled Nursing Facilities, Inpatient Rehabilitation Facilities and Long-Term Care Hospitals. For consideration, please e-mail materials to nchong@rti.org by June 1, 2015. Additional details about this project are at https://www.cms.gov/Medicare/Quality-Initiatives-PatientAssessment-Instruments/MMS/TechnicalExpertPanels.html. For further information, contact the HCA Policy staff. 14
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CMS Conference Call on HQRP and Updates to HIS Manual: June 17 The U.S. Centers for Medicare and Medicaid Services (CMS) has opened registration for a national provider call on June 17 from 1:30 to 3 p.m. on the Hospice Quality Reporting Program and updates to the Hospice Item Set (HIS) Manual. During the call, CMS will discuss the new HIS Manual (V1.02) with a focus on updates that were made to the HIS Manual from V1.01 to V1.02. CMS recommends that Hospice Providers review V1.02 on the HIS website (at http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospiceQuality-Reporting/Hospice-Item-Set-HIS.html) prior to the call. Registration is at http://www.eventsvc.com/blhtechnologies. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
Guidance Issued on Surplus Payments by Third Parties The New York City Human Resources Administration has released an Alert on surplus payments by third parties. The Alert is at http://www.nyc.gov/marc (registration required). The Alert advises organizations assisting consumers that Medicaid coverage under the Surplus Pre-Payment Program (Pay-In) can only be authorized when payment is made using a recipient’s own net available excess income. Payment must be made by the recipient or a legally responsible third party (guardian, power of attorney, etc.) using the recipient’s own funds. Legally responsible third parties can either submit legal documentation as proof of status or a completed MAP 3107a attestation form. Others who submit a payment on behalf of a recipient must also complete MAP 3107a, affirming that the recipient’s funds were provided to him or her to be used for the payment. These include but are not limited to: adult children, siblings, neighbors, friends, etc. If proper documentation is not submitted to support the submission of payment by a third party, the payment will be returned, which may impact the recipient’s Medicaid coverage.
SADC Certification Webinar Available The state Department of Health (DOH) has post a pre-recorded webinar regarding Social Adult Day Care (SADC) Certification. The webinar presentation and materials are at https://www.health.ny.gov/health_care/medicaid/redesign/mrt_90.htm (see MLTC Policy 15.01). Under a new policy issued on May 8, SADC programs that are currently contracting with a Managed Long Term Care (MLTC) plan or want to contract with MLTC plans must undergo a new Certification process that
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was established by DOH, in conjunction with the Office of the Medicaid Inspector General (OMIG) and the New York State Office for the Aging (NYSOFA). Certification must be completed for each existing SADC site by June 30, 2015. New sites may certify at any time during the year. The Certification must be completed electronically at www.omig.ny.gov/sadc-certification. Through this process, the SADC must print and retain a copy of a confirmation document as proof of completion. Certifications must be completed on an annual basis, twelve months from a prior Certification. MLTC plans must ensure that SADCs under contract have completed the Certification and 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. Questions pertaining to this webinar should be sent to SADCCertification@OMIG.ny.gov.
Update on Continuing Education Requirement for Social Workers As of January 1, 2015, all Licensed Master Social Workers (LMSWs) and Licensed Clinical Social Workers (LCSW) must complete 36 hours of continuing education in each three-year registration period. Only 12 of these hours can be completed through self-study courses that are structured study, offered by a State Education Department (SED) approved provider based on audio, audio-visual, written, online and other media. Self-study courses do not include live instruction. However, to assist licensees, who will register between January 1, 2015 and January 1, 2016, the state chapter of the National Association of Social Workers reports that SED will allow them to complete 100 percent of their required continuing education through self-study activities that are taken from a provider conditionally approved or approved by the Department. This exception only applies to licensees that register between January 1, 2015 and January 1, 2016. More information is at https://naswnys.org/continuing-education-events-important-ce-notice/important-ce-notice/.
ADM Issued on Transition of Nursing Home Benefit to Managed Care The state Department of Health (DOH) has issued an Administrative Directive (ADM) on the transition of the nursing home benefit into Medicaid managed care, including mainstream Medicaid managed care (MMMC) and Managed Long Term Care (MLTC) plans, for adults 21 and older. The ADM is at http://www.health.ny.gov/health_care/medicaid/publications/docs/adm/15adm01.pdf. Previously, long term nursing facility services were covered through the fee for service (FFS) Medicaid program or by MLTC plans. For consumers enrolled in an MMMC plan, the plan covers nursing home admissions for rehabilitation services only. Unlike consumers enrolled in MLTC plans, MMMC enrollees permanently placed
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in nursing homes were an excluded population, and were disenrolled from the plan when the admission was determined to be permanent. Beginning February 1, 2015 in New York City, the long term nursing home benefit transitioned into Medicaid managed care. Nassau, Suffolk and Westchester counties transitioned in this benefit on April 1, 2015, with the rest of the state to follow on July 1, 2015. This is for non-dually eligible individuals in receipt of Medicaid, and does not affect the short term or rehabilitation nursing home benefit currently covered by MMMC plans. Also on February 1, 2015, dually eligible individuals in receipt of long term nursing facility services are no longer excluded from enrollment in MLTC. These consumers moved from excluded to a mandatory population. Under this policy, consumers entering a nursing home for long term placement are required to remain in or enroll in a managed care plan, either MMMC or MLTC, if otherwise eligible, and to access this benefit through the managed care plan’s network providers. Enrollees selecting a nursing home outside the MMMC or MLTC plan service area or outside the plan network are required to transfer to a plan that contracts with the selected nursing home, or obtain approval from the plan to enter the out-of-network nursing home. Consumers who are new to managed care or new to Medicaid will be educated regarding enrollment in a plan that contracts with the nursing home of choice, and will be enrolled in a plan once eligibility is established. Consumers may not remain in or disenroll to fee for service Medicaid if otherwise eligible for MMMC or MLTC. Additional information on the transition of the nursing home benefit into MMMC plans is at http://www.health.ny.gov/health_care/medicaid/redesign/mrt_1458.htm.
Special Needs ALP Grants Announced The state Department of Health (DOH) has announced funding for Special Needs-Assisted Living Programs (SN-ALPs) under a Training and Services program and Capital Improvement Project. Up to $2 million in funding is available over a two-year period with a maximum of $400,000 per awardee for special needs populations who are high-cost Medicaid members, while up to $3 million in funding over a one-year period with a maximum of $600,000 per awardee is available for capital improvement projects. ALPs eligible to apply include DOH licensed Adult Homes or Enriched Housing Programs that at the time of application have ALP beds or an award for ALP beds. The RFA is at http://grantsgateway.ny.gov. Applications must be submitted online by July 8, 2015.
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PHHPC Committee Meets
Volume 20, No. 20 May 22, 2015
Publications
The Public Health and Health Planning Council (PHHPC) Committee on Establishment and Project Review met and approved applications. See http:// www.health.ny.gov/facilities/public_health_and_health_planning_council/ meetings/2015-05-21/ for an agenda and supporting documentation.
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The committee approved applications for 40 new Licensed Home Care Services Agencies (LHCSAs) and three applications for changes in ownership in existing LHCSAs. There were no Certified Home Health Agency (CHHA) applications. The state Department of Health announced at the meeting that LHCSA applications for new agencies and changes in ownership must now be done through the New York State Electronic Certificate of Need system (see separate p. 10 story).
http:// leavittpartners.com/wpcontent/uploads/2015/ 05/Impact-ofAccountableCare_Employers05.2015.pdf •
The next full PHHPC meeting is June 11 and can be viewed as a webcast at https://www.health.ny.gov/events/webcasts/.
HRA Changes Transitional Benefits for Certain Cases
Now, plans are to transition newly Medicare-eligible members into their own Managed Long Term Care (MLTC) plan (if they have one) or direct the member to contact the state’s enrollment broker. If the dual-eligible beneficiary does not choose an MLTC plan prior to disenrollment, he or she will be without coverage and must contact the Conflict Free Evaluation and Enrollment Center (CFEEC) to re-enroll with an MLTC plan. HRA will continue to provide Transitional Benefits for MMMC or MLTC members who only need Personal Care Level 1 (Housekeeping Services) and therefore are no longer eligible for managed care services.
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“Origins and Future of Accountable Care Organizations,” by Leavitt Partners http:// leavittpartners.com/wpcontent/uploads/2015/ 05/Impact-ofAccountableCare_Origins05.2015.pdf
The New York City Human Resources Administration (HRA) will no longer accept referrals for Transitional Benefits for individuals receiving personal care benefits through a Mainstream Medicaid Managed Care (MMMC) plan who become dually eligible for Medicare (and Medicaid) and/or are disenrolled from the plan. Previously, the state allowed HRA to provide transitional personal care benefits to Medicaid recipients who were receiving personal care services from an MMMC plan immediately prior to plan disenrollment and who met certain requirements.
“Employer Perspectives on Accountable Care,” by Leavitt Partners
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“Federal Strategy Needed to Help Ensure Efficient and Effective Delivery of Home and Community-Based Services and Supports,” by the Government Accountability Office http://www.gao.gov/ assets/680/ 670306.pdf
For more information, contact Andrew Koski at (518) 8100662 or akoski@hcanys.org.
HCA’s Technology Symposium and Vendor Showcase
June 16, 2015 – Albany Marriott – Wolf Road, Albany, NY Online registration available at www.eventville.com/hcanys
HCA’s Technology Symposium Helping you make the jump from ‘dial‐up’ in an increasingly ‘broadband’ health care world Integration, connectivity and data flow are the lifeblood of our evolving health care system. To make the cut as a partner with hospitals, physicians, and payors, home care providers must include technology investment as a core part of your strategic business planning. HCA recognizes the central role of data exchange and patient care tools for all aspects of your operation: from managing care‐transitions to the analytics that offer you tangible results about home care’s value‐ proposition for DSRIP networks and other collaborative models. Meanwhile, as the state and federal governments pursue value‐based payments, technology is certain to play a leading role in the pivot towards “value over volume.” Now more than ever, you need to be mindful that the technologies which have aided you in the past may not be up to speed for these and other kinds of partnerships and payment models. In other words, dial‐up service no longer cuts it in an increasingly broadband health care world. This is why HCA is offering a one‐day Technology Symposium to help you navigate all the paths of opportunity and to gain a better understanding of tools and trends available for satisfying today’s state and federal health initiatives. You’ll hear from policy leaders, industry experts and trend‐setting peers with insight, case examples and practical solutions for utilizing the latest home care technologies to ensure your success in meeting the clinical demands, partnership expectations, and improvement standards that will determine your success as a provider of home care services in your community. This learning opportunity is vital as HCA works at the advocacy level to promote targeted and enhanced investments in this priority area.
AGENDA – Tuesday, June 16 8:15am
Registration and Vendor Showcase Pick up your valuable handout materials, a cup of coffee and then explore the products and services showcased by vendors who will be exhibiting throughout the day. 8:45am HCA Welcome 9:00am
New York’s Technology Investments and Priorities Hear from two state policymakers about the direction New York State is taking in support of technologies aimed at enhanced quality of care and greater opportunities for your organization. Learn how technology is a key ingredient to the success of new payment models like DSRIP, Value Based Payments, Managed Long Term Care, Fully Integrated Duals Advantage and other efforts where you need to be thinking strategically about your use of technology. Patrick Roohan, Director, Office of Quality and Patient Safety, NYS Department of Health Lynda Karig Hohmann, MD, PhD, MBA, Medical Director, IPRO, Division of Program Development and Management, Office of Health Insurance Programs, NYS Department of Health 10:45am
How the SHIN‐NY Can Support Your On‐Demand Health IT Connectivity. The Statewide Health Information Network of New York (also known as SHIN‐NY) allows health care stakeholders to securely access a patient’s electronic health records wherever and whenever needed. Learn how home care can connect to this network, improving patient care and achieving greater efficiencies. Elizabeth Amato, Director of Statewide Services, New York eHealth Collaborative
AGENDA – continued 11:30am
Regional Health Information Organizations: Expanding the Network New York State is leading the nation in adoption of Regional Health Information Organizations (RHIOs). This session will reveal the benefits and practical application of RHIOs and how home health providers can play a greater role in collaboration with these organizations to better manage population health and control costs. Mark McKinney, Chief Executive Officer, Hixny 12:30pm
Networking Lunch
Lunch Sponsor
Take advantage of lunchtime networking opportunities to share with your colleagues what you have done to improve efficiencies, reduce costs and enhance care within your agency through the use of technologies. Be sure also to take time to visit with the ten vendors who will be on hand at the conference to support your application of home health technology. 1:15pm
Potential Opportunities for Home Health in the Technology Arena While the state is making important strides on policies and regional health information structures to support your health IT connectivity, many of the novel product partnerships and innovations are happening at the grassroots R&D level from providers – like you – in the field. In this session, you will hear some concrete case examples from your home health provider peers who are using various technology products in an innovative way to improve patient satisfaction, care outcomes and cost efficiencies. 2:15pm
Nanotechnology – The Technology of Tomorrow Nanoscience is the chemistry of building new materials on such a minute scale that they are invisible to the naked eye. This area of innovation is destined to become the next industrial revolution that will undoubtedly leave a huge impression on the health technologies of the future, especially as health IT and related service products become a growing part of the provider and consumer experience. The nanoscience field has already begun to break exciting new ground on cancer cures, replacing worn out genes and medicinal robotics. Learn why you should pay attention to this exploding science and how it may affect the future of your clinical interactions with home care patients. Susan Brenner, MD, MPH, Assistant Vice President for NanoHealth Initiatives, Assistant Professor of Nanobioscience, SUNY Polytechnic Institute, Colleges of Nanoscience & Engineering.
3:15pm
Vendor Showcase Ten vendors who provide technological products and services in the areas of IT, operational efficiencies, and analytical software will be on hand to show how these products can support population health and clinical applications. This is a great opportunity to visit with these suppliers all in one day at one location. 4:00pm Adjourn
Registration Registration Deadline is June 10.
HCA’s Technology Symposium
_______________________________________________ Name
and Vendor Showcase
_______________________________________________ Title
June 16, 2015 Albany Marriott Wolf Road, Albany, NY Register online at: www.eventville.com/hcanys or FAX this form to (518) 426‐8788.
_______________________________________________ Agency _______________________________________________ Address _______________________________________________ City/State/Zip _______________________________________________ _______________________________________________ Email (Required)
Payment $219 HCA Member $299 Non‐Member
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_____ VISA ______ MC _____ AM EX Credit Card No.__________________________________ Expiration Date:_____________ Sec. Code:___________ Card Billing Address:______________________________ ________________________________________________ Name on Card:___________________________________ Signature:_______________________________________ Or, make checks payable to: HCA Education and Research and mail to 388 Broadway, 4th Floor, Albany, NY 12207 Checks must be received by June 12.
Vendors On‐Site:
Special Accommodations: In accordance with the Americans with Disabilities Act or special meal needs, please let us know how we can accommodate you: _____________________________________________________ _____________________________________________________
Cancellation Policy:
Cancellations received by June 5 will receive a full refund, less 25% of total due as an administrative fee. Cancellations received on June 6 or later will forfeit their registration fee, as will those who register and do not attend. Substitutions are permitted.
FAX TO: (518) 426‐8788