ASAP
A Weekly Publication Of HCA Home Care Association of New York State
Legislative Issues Public Policy
News
Volume 20, No. 20 May 29, 2015
HCA Insurance Bill Now a 2-House Measure: Act Now in Support! Take action today using our Legislative Action Center Assembly Insurance Committee Chairman Kevin Cahill has introduced HCA’s home care insurance realignment bill (A.7706), making this legislation a two-house, bipartisan measure, following Senate Insurance Chairman James Seward’s introduction of the bill (S.5076) in late April. The legislation seeks to provide long-overdue updates to the State Insurance Law dictating coverage for home care services. (More information is on our website at http://hca-nys.org/member-alerts/insurance-chairman-introduces-hca-bill-to-modernize-coveragefor-home-care.) See INSURANCE p. 5
HCA Conference Offers Long View, Did you attend this HCA Program? Inner Workings of DSRIP & Value If you did, clip this article and share it with your team Based Payments to Support Home and management to report back on just a little bit of Care Provider Role what you learned. From Managed Long Term Care (MLTC) to Delivery System Reform Incentive Payments (DSRIP) to Value Based Payments (VBP), the state is moving fast on new care and payment models that seek to encourage integration of providers, balance payment risk, reduce costs and improve outcomes. See DSRIP p. 2
Inside ASAP HCA Insurance Bill Now a 2-House Measure.....................................1 HCA Conference Delves into New Payment Models.........................1 HCA Brings Popular Members-Only LHCSA Forum Upstate...........5 HCA Seeking Appropriate Parameters to New Health Bills............6 Member Hiring Announcement..........................................................6 HCA HCC Forum Held......................................................................7 Rule Proposed on Direct Deposit and Payroll Debit Cards.............7 IMPOR TANT IMPORT ANT: DOH Eliminates the 2% Medicaid Reductions..........8 CMS Plans Claim Review Process for Home Health F2F....................8 HCA to File Joint Amicus Brief in Andryeyeva Case...........................9 Home Health Pre-claim Review Update...........................................10 Sen. Schumer Garners Support for NP Certification Bill................11 CMS Proposes Rule to Overhaul Medicaid Managed Care, CHIP.......12 6/16 Tech. Symposium is Last Signature HCA Event Before Sept....13 Avalere: Home Health Margins Fall by Two-Thirds in 5 Years.........15 CMS to Host June 2 Forum on Quality Reporting Requirements...15 CMS Proposes Cost Report Revisions for SNF-Based Hospices...16 OIG Releases 2015 Work Plan Mid-Year Update............................16 EISEP RFP for Nassau County..........................................................18 Publications.......................................................................................................19
If you didn’t, you missed out on a lot of great information. Give this article a read, and if it’s the kind of program that would benefit you or one of your colleagues, make sure your organization does not miss the next HCA education event. Our last signature program before September is coming up on June 16: HCA’s Technology Symposium. Details are on p. 13. You can see all of HCA’s conferences and events at http://hca-nys.org/events-education/upcoming-events.
Helping New Yorkers Feel Right At Home
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ASAP – a publication of the Home Care Association of New York State
DSRIP from p. 1 Any one of these new models, in itself, requires a lot of work. This includes strategic planning, collaboration among providers, contract negotiations, and decisionmaking about the package of project options that providers will be pursuing. All three models converging in a short period of time only amplifies the work activity on your plate, and HCA’s conference on Navigating New Models of Care & Coverage this week in Albany provided an important forum to help you.
Touching on these and other fundamental questions, state policymakers and their contractors helped lay out the vision for these various moving pieces. As emphasized by State Medicaid Director Jason Helgerson, the soon-to-come VBP initiative is a mechanism for making the DSRIP/PPS structure self-sustaining and “self-funding” as the $8 billion in DSRIP project dollars approved by the federal government end in the out-years.
Broad insights One of the major questions posed by participants during Thursday’s conference was: How do these initiatives work together? If the Performing Provider Systems (PPSs) in DSRIP are the dominant network for population management, how, then, do MLTCs and other managed care vehicles operate under this tent if they are already overseeing enrollment and coordination of services? Also, what is the intent of VBPs when its aims are already inherent to the payment and clinical expectations of the PPS model? Lastly, how can providers play an integral role in these systems?
Indeed, the federal government made VBPs a condition of its approval for the DSRIP funding awarded to New York State so that the network and project development work under DSRIP have a lasting role in the health care system, Mr. Helgerson said. Mr. Helgerson also emphasized that VBPs, separate from the Medicaid Global Cap and other budget-savings measures, are not intended to cut reimbursement to providers but to “help you capture savings.” However, a provider’s success
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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depends on the experience and know-how you bring to the table and the level of risk that you pursue.
whether your agency can shoulder the expectations of each potential project design. Regarding the role of managed care, the state’s 25 PPS networks are distinct models that are also encouraged to include managed care, and the state is continuing its roll-out of managed care enrollment for the vast majority of Medicaid services, noted Greg Allen, Director of the Division of Program Development at the state Department of Health. Responding to questions, Mr. Allen stressed that PPSs are not to be seen as a replacement for managed care but as a complementary structure.
Dr. Marc Berg, who is a partner at the state’s VBP contractor, KPMG, outlined the three tiers of VBP riskload, each with a varying mix of upside and downside risk. Level 1, at one end of the spectrum, is designed as a feefor-service structure plus “upside-only shared savings” for meeting value-based metrics, while Level 3, at the higher-risk end of the spectrum, involves a prospective capitation or bundle arrangement, offering both the greatest opportunities for share-savings and assumption of the highest risk.
Mr. Allen stressed that the PPS’s role is to build the projects and pursue integration while the State Medicaid Director Jason managed care plan’s role remains Helgerson speaking at HCA’s New When asked how home care the same: to build provider Models Conference this week. agencies can accept downside networks and manage the care risk under VBP when most of the DSRIP of its covered populations. Over the long term, investment dollars are flowing through lead entities the state envisions PPS models, or smaller at the top of the PPS model (mostly the hospitals), aggregates of them, parlaying into Accountable Mr. Helgerson advised home care providers to Care Organizations (ACOs). reach out to other providers in their community to work together within a payment bundle for DSRIP, in particular, presents a key opportunity shared responsibility and risk management (both area for home care, policymakers said, as the PPS upside and downside). model will succeed in achieving its main outcomes (like ER and admissions avoidance) only if it He also emphasized that not all PPS network works with a network of home care providers, providers will receive project dollars for all many of whom are already operating under projects, and these determinations depend on the contracts with managed care plans. Nearly all fund-flow models now being developed by the speakers emphasized the integral role of home PPS lead entities. care. During her presentation, Consultant Tracy Miller, Esq., of the law firm Bond, Schoeneck and King, emphasized that providers may not receive funds simply because they are involved in a project: “You need to ask,” and tailor your expertise for the most suitable PPS projects. Thus, payment negotiations should be a major consideration in
A Deeper Look at DSRIP and Other Models On June 1, the PPS leads under DSRIP must submit their implementation plans; the first quarterly reports are due July 31; and a second round of payments for Year 1 projects are coming in January. Right now is a critical time for home 3
ASAP – a publication of the Home Care Association of New York State
care providers to ensure they have a seat at the table in this process. Ms. Miller provided a very detailed look at the way these new structures will operate, including potential opportunities for home care in the fund-flow models now under development. Again, while project dollars are only available for some PPS network providers for some projects – depending on how the fund-flow models are built – Ms. Miller emphasized some other advantages of PPS participation for home care providers, including: opportunities for sharing of evidence-based protocols, workforce training, potential IT support, performance measurement and, of course, referral relationships. She also described many of the structural and technical aspects of the PPS model and gave some examples of regulatory waivers under DSRIP, including those applicable to home care (e.g., expansion of home care and hospice geographic service areas), but stressed that the waivers are specific to distinct projects and providers. Thus, agencies should be sure to request that their organizations are explicitly recognized for receiving regulatory waivers in the project documentation. Rounding out the session, the Director of Mount Sinai Hospital’s mobile acute-care program, Dr. Linda DeCheerie, outlined her organization’s hospital-athome program as a new innovation and vision for care delivery and coverage within the evolving system. The program was presented to the conference participants as an example of innovations that are possible within, and in alignment with the goals of, virtually all of the
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new models – from DSRIP to managed care to VBPs and others. Mount Sinai’s program, in particular, was supported through funding from the federal Center for Medicare & Medicaid Innovation (CMMI). Did you miss out on this important program? If you didn’t have a chance to attend this important program, you missed out on a lot of key information, insights and considerations. HCA has one more major conference coming up before September: our Technology Symposium, on June 16 in Albany. The importance of technology in all aspects of provider and health plan operations, and indeed in all of the new models, was repeatedly stressed by participants and presenters alike throughout yesterday’s conference, and has been an advocacy priority of HCA. In fact yesterday’s conference prompted DOH to invite HCA’s submission of our technology finance ideas and proposals to the Department. Our education programs provide a two-way flow of information: providers gain critical insights but they also help support the exchange of ideas with policymakers. Please see the related p. 13 story for details and how to register for the Technology Symposium. For more information, please contact a member of the HCA Policy staff.
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INSURANCE from p. 1 Now that the bill has been introduced in both houses, we need your help to urge both the Senate and Assembly to adopt this critical measure before the end of the legislative session on June 17, just a few weeks away. HCA already asked you to message your legislators after Senator Seward introduced this important measure. Now, given the bill’s bipartisan two-house support, we need all HCA members to act now, in a big way, to get this legislation passed in both houses. This week we updated our Legislative Action Center campaign on this bill to reflect the Assembly’s sponsorship. So far, nearly 400 of you and your colleagues have sent messages to the Senate and Assembly on this measure. We need an additional 100 of you to do so now. If you have not yet done so, it is crucial for you to use the Legislative Action Center as soon as possible to voice your support for S.5076/ A.7706. Please share this article with your colleagues and make sure that you and all of your staff take this next critical advocacy step to help position S.5076/A.7706 for adoption: 1. Visit our action campaign on this bill at http://p2a.co/exDaV7b. 2. Read the background information if needed. 3. Enter your contact information in the fields and click “Send Email.” A pre-written message will go to the inboxes of your legislators. It’s simple. This process takes less than a minute of your time and it can make a huge difference by getting the whole Legislature on board and on-message with this vital bill that supports the work you do. If you have any questions about using our Legislative Action Center, or about the bill itself, please do not hesitate to contact Roger Noyes at rnoyes@hcanys.org. 5
HCA Brings Popular Members-Only LHCSA Forum Upstate At your request, HCA is bringing our popular LHCSA Forum to our upstate LHCSA members on June 24 (from 10 a.m. to 12:30 p.m.) in Utica, a central location for your travels. We have traditionally held the forum downstate, which draws an engaged audience of LHCSA members in the New York City metropolitan region to gain updates and exchange concerns directly with HCA Policy staff and invited guests, including state officials and consultants. Several upstate LHCSAs have attended the downstate Forums in the past because they value the information, and they’ve requested an upstate forum to address unique LHCSA needs in that region. Therefore, HCA will now also gather our LHCSA members upstate to discuss state legislative developments, regulatory changes, payment models like the Delivery System Reform Incentive Payment (DSRIP) program and local issues in your region. This program is free of charge, a benefit of your HCA membership, and is open to HCA members only. To join us, complete the registration form at the back of this week’s ASAP where you will find more information about the program, including location.
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Volume 20, No. 21 May 29, 2015
HCA Seeking Appropriate Parameters to New Health Bills HCA is pouncing on two newly introduced bills that appear to have major implications for home care and other community services, and on which there has yet to be vetting and consultation. While HCA supports the flexibility and access intentions of the legislation to respond to patient needs, both bills lack the parameters to ensure that the intended flexibility would be exercised without conflict with existing licensure, certification and standards for services provided by home and community based providers. In fact, S.5522, specifically, supersedes all of these existing standards in granting flexibility. HCA is also responding on a third bill which adds licensure requirements for fiscal intermediaries under the consumer directed personal assistance program (CDPAP). HCA is working with partner associations in reaching out to the sponsors, legislative leaders and backers of these bills to discuss the inclusion of proper parameters guiding any new such authorization. The bills are summarized below. “Outpatient/Clinic Services at Home” – Senate bill S.5522 (by Senator Hannon) and Assembly bill A.7714 (by Assemblyman Gottfried) would allow hospital outpatient departments and community clinics to provide services to chronically ill patients at home. The bill would “notwithstand” any law, rule or regulation to the contrary, meaning that it would disregard the provisions of Article 36 of the public health law, state rules and
HIRING Jewish Home Lifecare is currently hiring for the following positions: Supervisor of Rehabilitation Services, PartTime Weekend RNs, Fee for Service 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, we are looking for: •
Associate VP of Home Care who 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. The Associate VP: Plans, directs and evaluates a quality assured, clinically excellent, compliant, cost effective, and consumer satisfied CHHA 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, along with knowledge of home health regulations, accreditation and quality standards.
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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 CHHA. 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 will be hosting an Open House for the above mentioned Fee for Service openings on June 17 and June 24 from 3-7 p.m. at Jewish Home Lifecare, 104 West 29th Street, 8th Floor. Please contact Victoria Izraylevsky, Director of Human Resources at vizraylevsky@jewishhome.org for additional information. We offer competitive compensation, excellent benefits, and a positive work environment. Please send a cover letter and resume to: Victoria Izraylevsky, Director of Human Resources at vizraylevsky@jewishhome.org.
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ASAP – a publication of the Home Care Association of New York State regulations governing home care, and similarly disregard laws pertaining to other community services. This bill was reported yesterday by the Senate Health Committee to the Senate Floor Calendar; the Assembly bill is in that chamber’s Health Committee. “Community Paramedicine” – Senate bill S.5481 (by Senator Hannon) and Assembly bill A.7503 (by Assemblyman Gottfried) would authorize emergency medical services and technicians to provide for evaluating, preventing, or improving the health condition of an individual in circumstances other than the initial emergency medical care and transportation of sick or injured persons, and include services and/or coordination of services in the home, subject to the scope of practice of an emergency medical services technician under the “medical control” of a hospital. A.7503 passed the Assembly yesterday, and S.5481 was reported by the Senate Health Committee to the Senate Floor. Fiscal Intermediary Licensure – Senate bill S.5565 (by Senator Hannon) and Assembly bill A.7535 (by Assemblyman Gottfried) proposes that no entity provide, directly or through contract, fiscal intermediary services for CDPAP without a license as a fiscal intermediary issued by the Commissioner of Health. Licensing would be subject to a state review and approval process, plus an additional fee. Currently, most if not all of, the fiscal intermediaries are already state-licensed entities, particularly Licensed Home Care Services Agencies. While HCA understands and appreciates the legislation’s intentions toward accountability and integrity of fiscal intermediaries, the legislation would appear to add yet an additional cost and regulatory layer for already licensed providers participating in the program. HCA will be seeking reconsideration of the bill and its provisions with the bill sponsors.
HCA HCC Forum Held HCA convened the Home Care Council of HCA Member Forum this week in New York City. The meeting, co-chaired by Andrew Koski and HCA Consultant Joseph Campanella, provided updates on: Human Resources Administration (HRA) recent request for proposals; HRA transitional personal care benefits; state legislation; Quality Incentive Vital Access Provider Pool; companionship exemption lawsuit; payment for live-in cases; Fully Integrated Duals Advantage; Value Based Payment; and future education programs. Members also had the opportunity to share recent experiences and concerns faced by their agencies. The next Forum meeting will be on September 21.
Rule Proposed on Direct Deposit and Payroll Debit Cards The state Department of Labor (DOL) has proposed a rule that provides guidance on the permissible methods of paying wages, including payment by check, direct deposit and payroll debit cards. The proposed rule is at http://docs.dos.ny.gov/info/ register/2015/may27/pdf/rulemaking.pdf. The proposal covers: written information on payroll debit cards and other options for receiving wages that must be provided to employees; whether fees can be charged for payroll debit cards; locations where employees can withdraw wages at no charge within reasonable proximity to home or work; and other issues. Employers cannot make participation in the payroll debit card program a condition of hire or continued employment. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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DOH Eliminates the 2% Across-the-Board Medicaid Payment Reductions However, DOH still seeking CMS approval for retrospective repayment of the 2 percent reduction from April 1, 2014 to March 31, 2015 The state Department of Health issued a notice this week advising impacted providers that, effective May 8, 2015, the 2 percent across-the-board Medicaid payment reduction will be eliminated for claims with service dates on or after April 1, 2015. This change will be reflected in checks issued in Cycle 1969 (checks dated May 18, 2015 with a release date of June 3, 2015). The 2 percent cut has switched on and off over the past few years due to negotiations with the federal government. Members will recall that the final 2014-15 state budget also discontinued the cut after March 31, 2014, including the alternative cuts made in lieu of the 2 percent cut (such as the additional 0.7 percent Gross Receipts Tax, or “GRT,” on LTHHCP payments). However, in May of 2014, the Department reinstated the 2 percent reduction pending approval from the U.S. Centers for Medicare and Medicaid Services (CMS) to eliminate it. Thus, while the cut is being eliminated for dates of service after April 1, 2015, retroactive repayment of the 2 percent reduction taken over the period April 1, 2014 through March 31, 2015 is still pending federal approval CMS. DOH’s notice is at https://www.emedny.org/Notice/2_Percent_ATB_Provider_Notice.pdf. Specific questions on this notice can be e-mailed to DOH at 2percentacrosstheboard@health.ny.gov and DOH asks that inquiries use the title of its notice (“2% Across-the-Board Medicaid Payment Reductions”) as the subject line in the e-mail. HCA has made elimination of the 2 percent cut a key part of our state budget advocacy including our work with DOH to navigate the federal authorization process to gain retroactive repayment. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
CMS Plans Claim Review Process for Home Health F2F Strategy appears to reflect recommendations of home care community by initiating a ‘Probe and Educate’ process The U.S. Centers for Medicare and Medicaid Services (CMS) has recently issued its plan for review of the home health physician face-to-face (F2F) encounter documentation requirements. As part of its strategy, CMS plans to initiate a “Probe and Educate Review” process beginning October 1, 2015. These reviews will impact claims with a “from” date beginning August 1, 2015. CMS’s strategy is what many in the home care industry – including HCA and our colleagues at the National Association for Home Care and Hospice (NAHC) – recommended to CMS as part of its 2015 Calendar Year home health prospective payment system (PPS) final rule, which included revisions to the F2F documentation requirements beginning January 1, 2015. HCA, NAHC, and others recommended a period of review and for the Medicare Administrative Contractors (MACs) to provide significant education prior to Medicare simply issuing Medicare claim denials. Although 8
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CMS never before stated that it would implement such a plan, this week’s announcement seems to be following our recommendations. We will continue to press CMS to ensure adequate education is provided prior to denying claims. The following additional information on the “Probe and Educate Review” process was posted to CMS’s website at http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFSCompliance-Programs/Medical-Review/Home_Health_Medical_Review_Update.html. Details on ‘probe and educate’ reviews CMS will conduct pre-payment reviews of home health claims for episodes beginning on or after August 1, 2015 as part of its ‘Probe and Educate’ strategy. It is not yet known how far past August 1 these reviews will go. The purpose of this process is to ensure that home health agencies understand the new patient certification requirements. Because home health episodes have a 60-day certification, CMS anticipates the first documentation requests will be sent on or about October 1, 2015. CMS plans to provide additional details and information on this process in the near future and HCA will keep you apprised of new developments. We have reached out to National Government Services (NGS), New York’s home health MAC, and NGS has indicated it will be providing related education (conference calls/webinars) on the following dates: June 16, July 1, July 20, August 3, August 24, September 7, and September 21. Registration for these sessions is required through NGS’s website (www.ngsmedicare.com). For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
HCA to File Joint Amicus Brief in Andryeyeva Case HCA will be filing an amicus brief with other entities in a case being appealed that has major implications for the provision of home care services. In the case, Andryeyeva v. New York Health Care, Inc., the judge decided that 24-hour/sleep-in home care attendants must be paid for each hour of the 24-hour shift, and sleep (eight hours) and meal periods (up to three hours) cannot be deducted unless the attendant resides in the home of the person who is receiving care. This ruling is contrary to state Department of Labor opinions, which provide that third-party employers of 24hour care attendants may pay their employees for 13 hours of a 24-hour shift, if the attendant is afforded eight hours of sleep, five of which are uninterrupted, and three uninterrupted hours for meals. If this decision is upheld, the cost of 24-hour sleep-in services would be prohibitive; agencies and managed care plans would not be able to afford such care for Medicaid recipients, the cost for private pay patients who need such care would increase tremendously, and the availability of such services for all populations would be severely limited. HCA will keep members updated on the status of this case. The amicus brief will be submitted sometime in June or July. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org. 9
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Home Health Pre-claim Review Update The Office of the Medicaid Inspector General (OMIG) has posted updated information on the pre-claim review of home health claims. OMIG has identified the participating providers that are required to have their services verified by a verification organization (VO) and will notify them by a certified letter. The notice states that the VO requirement only applies to providers who receive OMIG’s notification; however, additional guidance states that “the ultimate responsibility in determining if a provider meets, or continues to meet, the requirements set forth in the statute lies with the Medicaid provider.” Providers who have any questions regarding their status under this requirement should contact OMIG at (518) 402-1470. If a participating provider does not already have a VO, it will be required to contract with one within forty-five days of the date on the notification letter. Once a VO has been selected, it is the VO’s responsibility to develop a custom implementation schedule in a reasonable timeframe not to exceed six months from the date on the notification letter. In accordance with Chapter 59 of the Laws of 2011, as amended in 2014, certain providers of home health services that exceed $15 million in Medicaid fee-for-service and/or Medicaid managed care reimbursements are required to utilize a VO to perform a pre-claim review. These providers include Certified Home Health Agencies, Long Term Home Health Care Programs and personal care providers. The VO must verify the home health services within a claim or encounter collected from electronic visit verification (EVV) prior to submission of the claim or encounter to the Department of Health (DOH) or to a managed care provider. Providers requiring a VO must select their VO from the OMIG and DOH joint list of approved VOs, which can be found at http://omig.ny.gov under the Resources tab (follow the Verification Organizations link). The VO you select does not have to be the same vendor you utilize for your EVV services. Additional information and resources related to the law can be found at http://omig.ny.gov under the Resources tab. Follow the Home Health Requirements and/or Questions and Answers (Q&As) links. When OMIG sought to implement a 2014 change that included managed care payments as part of the $15 million threshold, HCA had submitted comments on how this would adversely affect home care providers and managed care plans. The Q&As (at http://omig.ny.gov/images/stories/HomeHealth/homehealthvorequirementsquestionsandanswers5-21-15.pdf ) address eight issues raised by HCA and additional topics.
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Senator Schumer Invites Congressional Support for Bill Allowing NP Certification of Home Health Use HCA’s Legislative Action Center to urge broader support for S.578 New York Senator Charles Schumer is one of two Senators working to bolster support in the Senate for a bill that would allow Nurse Practitioners (NPs) and other advance-practice professionals to certify Medicare home health services. Senator Schumer has joined Senator Susan Collins of Maine on a letter to their colleagues encouraging them to sign on to S.578, also known as the “Home Health Care Planning Improvement Act,” which was introduced earlier this year. “We are writing to urge you to join us as cosponsors of the Home Health Care Planning Improvement Act of 2015 (S.578) to ensure that our senior and disabled citizens have timely access to home health services under the Medicare Program,” the Senators write. NPs, Physician Assistants (PAs), Clinical Nurse Specialists (CNSs) and other advance-practice health professionals are playing an increasing role in the delivery of health care but are not currently allowed to order/ certify home health services or document the required Medicare face-to-face encounter with patients. These health professionals work closely with physicians to ensure that patients receive necessary care for many Medicare-covered services. They are increasingly providing services to Medicare beneficiaries in rural and underserved areas. In particular, they serve a vital need in communities where physician shortages exist, as they are sometimes more available than physicians to expedite the required paperwork to ensure that care to beneficiaries will be initiated and continued. Flexibility for home health certification has been a longstanding HCA advocacy priority at the federal level, including our outreach to Senator Schumer’s office, along with our engagement of other New York Congressional Delegation offices. You can help this effort. HCA has posted a campaign on our Legislative Action Center that allows constituents to send a message to Congress urging the New York Congressional Delegation to cosponsor the “Home Health Care Planning Improvement Act” and press for full Congressional action on this bipartisan measure. Given the new momentum on S.578 and sponsorship of the bill by Senator Schumer, we urge all HCA members to take action using this easy online tool to urge wider support in Congress. The process takes less than a minute to complete. Simply visit the “Support the ‘Home Health Care Planning Improvement Act’ (S.578/ H.R.1342)” campaign in our Legislative Action Center at http://p2a.co/z6HUax7, enter your contact information, and click “Send Email” to write your member of Congress immediately, including Senators Schumer and Gillibrand. For more information, please contact a member of HCA’s Policy staff.
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CMS Proposes Rule to Overhaul Medicaid Managed Care, CHIP Consumer protections, improved quality care standards and rules to promote the move to value-based payment are among highlights of massive proposal The U.S. Centers for Medicare and Medicaid Services (CMS) issued a proposed rule this week which would, according to CMS, modernize the Medicaid and Children’s Health Insurance Program (CHIP) managed care regulations by revising the programs’ rules and strengthening the delivery of quality care for beneficiaries. The 653-page proposed rule (at https://s3.amazonaws.com/public-inspection.federalregister.gov/201512965.pdf ) is the first significant update to Medicaid and CHIP managed care regulations in more than a decade. CMS believes the proposed rule would improve beneficiary communications and access, provide new program integrity tools, support state efforts to deliver higher quality care in a cost-effective way, and better align Medicaid and CHIP managed care rules and practices with other sources of health insurance coverage. The proposed rule also seeks to bring Medicaid managed care in line with the goals for value-based reimbursement outlined earlier this year by U.S. Health and Human Services Secretary Sylvia Burwell, who has stated that 50 percent of Medicare payments must transition to these models by the end of 2018 Since CMS last issued managed care regulations in 2002 and 2003, New York and other states have expanded managed care to several new populations including seniors and persons with disabilities. CMS indicates that the growth of managed care in the marketplace and Medicare Advantage further highlights the importance of policy alignment when appropriate across programs in order to ease the transition for consumers whose circumstances change during the year. The following key provisions are included in CMS’s proposed rule: •
Delivery of Managed Long Term Services and Supports (MLTSS) – Encourages payment methodologies that reflect the goals of MLTSS programs to improve the health of populations, support the beneficiary’s experience of care, support community integration of enrollees and control costs. It would create a structure for engaging stakeholders regularly in the ongoing monitoring and oversight of the MLTSS program, and set standards to evaluate the adequacy of network providers, the qualifications and credentialing of providers, and the accessibility of providers to meet the needs of MLTSS enrollees.
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Quality Improvement – Sets forth a quality framework focused on transparency, alignment with other systems of care, and consumer and stakeholder engagement. It would require a quality strategy for a state’s entire Medicaid program and also establish a Medicaid managed care quality star rating system that would include performance information on all health plans.
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Program and Fiscal Integrity – Includes provisions that would strengthen the fiscal and programmatic integrity of Medicaid managed care programs and rate setting by clarifying actuarial soundness requirements; also seeks to bring Medicaid managed care in line with CMS’s goals for value-based payment.
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State Delivery System Reform – Supports states’ efforts to encourage delivery system reform initiatives within managed care programs that strive to improve health care outcomes and beneficiary experience while controlling costs; will establish minimum reimbursement standards or fee schedules for providers 12
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that deliver a particular covered service to support timely access to care, and continue to use incentive payments to managed care plans that meet quality and performance targets. •
Beneficiary Experience – Includes provisions to improve consumer experience in the areas of enrollment, communications from the state and managed care plans, care coordination, and the availability and accessibility of covered services; would set standards for care coordination, assessments and treatment plans.
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Alignment with Medicare Advantage and Private Coverage Plans – By aligning standards, where appropriate, the proposed rule would improve operational efficiencies for states and health plans, which, in turn, will improve the experience of care for individuals who transition between health care coverage options.
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Recognition of Technology Advancements – Includes a number of proposals seeking to recognize the advance of technology since 2002.
Additional information is at http://cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Factsheets-items/2015-05-26.html HCA will continue to review CMS’s proposed rule and will provide ongoing information to the membership as it becomes available. The lengthy rule will require a more rigorous examination to determine the impact on New York’s home and community based system and any advocacy needs related to the massive proposed changes. For further information, contact the HCA Policy staff.
6/16 Tech. Symposium is Last Signature HCA Conference Before September Gear up for summer planning with vital info, networking, case examples HCA’s final major conference of the spring/summer is on June 16, less than three weeks away, when we present our signature Technology Symposium and Vendor Showcase in Albany. You will not want to miss this final chance for gaining new insights to support the strategic thinking you’ll need to do throughout the critical summer planning months as you head into the fall budgeting season. (Our next big conference will be HCA’s September Financial Managers Retreat.) Like many of your peers, you may be struggling a bit with your current technology portfolio to make it plugin-ready for Delivery System Reform Incentive Payment (DSRIP) participation and other integrated models. Indeed, according to HCA’s most recent survey of the industry, providers reported the need for IT support to align with health policy directives such as: “becoming interoperable with local providers”; “interoperability to advance initiatives such as bundling and DSRIP”; “community portals to hospitals, managed care plans and patients”; “expand and upgrade the use and availability of mobile devices for all field staff.” HCA’s Technology Symposium brings a specialized focus on all of these areas of need identified by you and your peers. Continued on next page
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Continued from p. 13 As you head into the summer months and gear up for your fall budget planning, this conference is an excellent opportunity to learn about the technology investments you’ll need to think about as you prepare for the future. At the conference, HCA will have ten technology vendors on hand to give you new ideas for product applications. You’ll also hear from a group of home care agencies who will tell you about the grassroots R&D work they have done to implement various technologies to improve patient satisfaction, care outcomes and cost efficiencies in ways you may not have considered. State Health Department technology experts will also be on hand to make the connection between technology systems and new payment models like DSRIP, Value Based Payments, Managed Long Term Care, Fully Integrated Duals Advantage and Health Homes, including investments and priorities in these areas. You will not want to miss this discussion and critical exchange as HCA simultaneously works to advance legislation that will promote targeted and enhanced investments for home care. Your participation on June 16 will not only provide you with ideas but will help buttress this HCA advocacy priority by giving policymakers a concrete understanding of the very real areas of need for technology investment as part of their program and planning agenda. Indeed, technology was a big focus of our New Models conference yesterday (see related p. 1 story) and the conversation seeded some important ideas with the Department for consideration of home care technology investment to support the state’s major system restructuring initiatives. You’ll also hear from representatives of Regional Health Information Organizations (RHIOs) and the New York eHealth Collaborative on ways you can better integrate your systems with the larger networks of electronic health records and collaborative partnerships. Greg Allen, Director of the Division of Program Development at the state Department of Health, emphasized during HCA’s New Models conference yesterday the need for all home care providers to consider the opportunities under RHIOs if they want to successfully integrate with provider partners in DSRIP projects – another important incentive for you to learn more about how you can plug in to the grid. Summer is almost here. Take advantage of this last opportunity before September to network with peers, vendors and learn from experts in the field through HCA’s signature education programming. How to Register? •
Download the brochure at http://hca-nys.org/wp-content/uploads/2015/01/ HCATechnologySymposiumBrochure2015.pdf and fax it back to HCA.
•
Register online using a credit card at https://www.eventville.com/Catalog/EventRegistration1.asp?EventId=1011573.
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Avalere Analysis: Home Health Margins Fall by Two-Thirds in Past 5 Years A new analysis by Avalere Health reports nationwide home care fiscal conclusions that we already know to be the case for New York providers – that reimbursement cuts continue to erode at the operating margins of agencies, and will continue to do so as the federal Medicare rebasing process takes hold. The report (at http://homehealth4america.org/media-center/attach/299-3.pdf ) gives data on publicly traded home health companies, whose margins averaged 2.4 percent in 2014, falling by over two-thirds in the past five years. While this overall national trend of shrinking margins is similar for New York, the net outcome is strikingly worse in our state, according to HCA’s most recent cost report analyses and federal data for New York. On the Medicare side, New York’s home care Medicare margins have remained negative for thirteen years in a row, with an unweighted average margin of -16.4 percent in 2013, according to the most recent New York data available to HCA. Meanwhile, HCA’s most recent financial cost report analysis for New York finds that approximately 70 percent of Medicare-certified agencies in New York (Certified Home Health Agencies and Long Term Home Health Care Programs) had negative operating margins in 2012 and 2013 for all payors. Both the New York data and Avalere’s national findings – where, nationally, agencies overwhelmingly have more positive margins than New York – refute the Medicare Payment Advisory Commission (MedPAC) calculations of a 12.6 percent margin nationally. MedPAC has consistently overstated the national home care margin, upon which it bases its recommendations for reimbursement actions, including recommendations for severe cuts in recent years. Avalere’s findings add yet another counterpoint to MedPAC’s data. Under the rebasing process, home health agencies are receiving annual cuts of 3.5 percent between 2014 and 2017 which have already taken a huge toll on the financial viability of providers. Relief from rebasing is a top goal of HCA’s federal advocacy efforts. To read our most recent publications on the financial health of home care agencies, and our position paper on rebasing, please see the following two links in the Publications page of our website: •
http://hca-nys.org/policy-positions/ny-home-care-hit-with-growing-medicare-operating-lossesunder-cms-rebasing-cuts-threatening-access-to-care
•
http://hca-nys.org/policy-positions/hcas-financial-condition-report-home-care-financial-andprogram-support-vital-for-success-of-new-care-delivery-models
For more information, please contact the HCA Policy staff.
CMS to Host June 2 Forum on Quality Reporting Requirements The U.S. Centers for Medicare and Medicaid Services (CMS) will host a forum call on Tuesday, June 2 from 1:30 to 2:30 p.m. on the new “Pay-for-Reporting Performance Requirement” described in the Calendar Year (CY) 2015 home health Final Rule. Continued on next page 15
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Continued from p. 15 The first 12-month reporting period for the new Quality Assessments Only (QAO) measure begins July 1, 2015; compliance will potentially affect the Annual Payment Update (APU) for CY 2017. During this call, CMS will follow up on the information presented in its November 12, 2014 call, and will also include a review of the content and format of the new QAO Historical Performance Reports that will be distributed to home health agencies for information purposes only by the end of June. A link to the materials for this forum call, including a slide deck, a summary of the QAO methodology, and a sample QAO Historical Performance Report, will be posted on the Home Health Quality Reporting Program website at http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ HomeHealthQualityInits/Home-Health-Quality-Reporting-Requirements.html. To participate, call 1-800-837-1935 and enter conference ID no. 6140706. A transcript and audio recording of the call will be posted at http://www.cms.gov/OpenDoorForums/05_ODF_SpecialODF.asp. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
CMS Proposes Cost Report Revisions for SNF-Based Hospices The U.S. Centers for Medicare and Medicaid Services (CMS) recently posted to its website the proposed revisions to the skilled nursing facility (SNF)-based hospice Medicare cost report. The proposed revisions can be found at: http://tinyurl.com/qymxrms. As part of efforts to secure more detailed data from hospice programs to support payment reform, CMS has been revising cost reporting requirements for hospices. The first set of revisions, which were applicable to freestanding hospices, significantly expanded reporting requirements and became effective with cost reporting years beginning on or after October 1, 2014. CMS is proposing that these changes for SNF-based hospices would be applicable to cost reporting years beginning on or after October 1, 2015. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
OIG Releases 2015 Work Plan Mid-Year Update The federal Office of Inspector General (OIG) has released its fiscal year 2015 Work Plan Mid-Year Update. It is posted at http://oig.hhs.gov/reports-and-publications/archives/workplan/2015/WP-Update-2015.pdf and describes OIG audits, evaluations, and certain legal and investigative initiatives that are ongoing. The report also forecasts areas for which OIG anticipates planning and/or beginning work in the upcoming fiscal year and later. OIG reports that it plans to augment its portfolio of work on care quality and access in Medicare and Medicaid and continue to examine the appropriateness of Medicare and Medicaid payments, with possible additional work on the efficiency and effectiveness of payment policies and practices in managed care and other settings. Continued on next page
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Continued from p. 16 HCA has reviewed the document and highlighted some key areas that you should be aware of. This is not an exhaustive list, but just some highlights. (We also encourage those who are interested to examine the “State Program Integrity Activities” and “Compliance and Contractor Functions and Performance” sections not summarized below but available in the Work Plan link.)
Medicare and Medicaid Services (CMS) and its contractors have implemented enhanced screening procedures for Medicare providers and will also collect data on and report the number of initial enrollments and enrollment revalidations approved and denied by CMS before and after the implementation of the enhanced screening procedures. Delivery System Reform
Medicare Home Health •
Review compliance with various aspects of the home health prospective payment system (PPS), including the documentation required in support of the claims paid by Medicare.
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Determine the extent to which home health agencies employed individuals with criminal convictions and will also examine the criminal convictions of selected employees with potentially disqualifying convictions.
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Conduct a risk assessment of the Pioneer Accountable Care Organization (ACO) Model, which is a group of providers and suppliers of services (e.g., hospitals and physicians and others involved in patient care) working together to coordinate care for the Medicare fee-for-service beneficiaries they serve.
•
Review the extent that providers participating in ACOs in the Medicare Shared Savings Program use electronic health records (EHRs) to exchange health information to achieve their care coordination goals; will also assess providers’ use of EHRs to identify best practices and possible challenges in their progression toward interoperability (to the extent that information systems can exchange data and have the ability to interpret those shared data).
Hospice •
Assess the appropriateness of hospices’ general inpatient care claims and the content of election statements for hospice beneficiaries who receive general inpatient care. It will also review hospice medical records to address concerns that this level of hospice care is being misused.
Medicare Advantage (MA) Managed Care •
Medicare Equipment and Supplies •
Determine the effects of the competitive bidding program on Medicare beneficiaries’ access to certain types of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS.
Medicaid Home Health Services and Other CommunityBased Care •
Review Medicaid payments by states for adult day care services to determine whether providers complied with federal and state requirements.
•
Review health-screening records of Medicaid home health agency health care workers to
Provider Eligibility •
Review the medical record documentation to ensure that it supports the diagnoses MA organizations submitted to CMS for use in CMS’s risk-score calculations and determine whether the diagnoses submitted complied with federal requirements.
Determine the extent to which, and the way in which, the U.S. Centers for 17
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determine whether they were screened in accordance with federal and state requirements. •
Review expenditures the states claimed under the Balancing Incentive Program (BIP) to ensure that they were for eligible Medicaid long-term services and support (LTSS) and determine whether the states used the additional enhanced federal match in accordance with the statute.
Medicaid Managed Care •
Review states’ managed care plan reimbursements to determine whether managed care organizations (MCOs) are appropriately and correctly reimbursed for services provided; will ensure that the data used to set rates are reliable and include only costs for services covered under the state plan as required by, or costs of services authorized by, CMS.
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Identify Medicaid managed care payments made on behalf of deceased beneficiaries.
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Determine whether Medicaid MCOs identified and addressed potential fraud and abuse incidents and will also describe how states oversee MCOs’ efforts to identify and address fraud and abuse.
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Review the extent to which states monitor Medicaid MCOs’ grievances and appeals systems for compliance with federal requirements.
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Review State Medicaid agencies’ oversight policies, procedures, and activities to determine the extent to which states monitor Medicaid MCOs’ marketing practices and compliance with federal and state contractual marketing requirements.
EISEP RFP for Nassau County Nassau County’s Office for the Aging is accepting applications from agencies wishing to provide Housekeeper/ Chore and Homemaker/Personal Care Services funded under the Expanded in Home Services to the Elderly Program (EISEP). The starting date for this project will be January 1, 2016. Reimbursement is based on current Medicaid rates and the volume of services supplied by the agency. Applications are due July 31 and licensed agencies with offices in Nassau are invited to apply. For an application package, call (516) 227-8919 or e-mail Donna.Reed@hhsnassaucountyny.us. Questions can be address to Donna Reed, Director of Long Term Care Services, at (516) 227-8962. All project applicants are invited to attend a meeting on Friday June 5 at 10 a.m. in Library Room D037L at the Nassau County Department of Human Services, Office for the Aging, 60 Charles Lindbergh Blvd., Uniondale, NY 11553-3691. Anyone planning to attend must call (516) 227-8919 in advance.
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Publications •
“Home Health Agencies Conducted Background Checks of Varying Types,” by the Office of Inspector General http://oig.hhs.gov/oei/reports/oei-07-14-00130.pdf
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“Medicare: Results from the First Two Years of the Pioneer Accountable Care Organization Model,” by the Government Accountability Organization http://www.gao.gov/assets/670/669782.pdf
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“Medicare Parts A & B Appeals Process,” by the U.S. Centers for Medicare and Medicaid Services http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNProducts/Downloads/MedicareAppealsProcess.pdf
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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UPSTATE LHCSA FORUM Please join your LHCSA colleagues, HCA staff and Board Members for this exchange of valuable information, advocacy concerns and recommendations for action. Some of the vital issues to be covered include: • State legislative developments • DOH regulatory changes • DSRIP and value based payment • Issues in your region
June 24, 2015 10:00am – 12:30pm Location:
Homecare Services of Faxton St. Lukes Sogg’s Room Center for Rehabilitation and Continuing Care Services 1650 Champlin Ave. Utica, NY 13502
Registration ____________________________________________________ Name ____________________________________________________ Title ____________________________________________________ Agency
This forum is for HCA Members Only. If you are not currently a member of HCA, but would like to become one, please contact Laura Constable, Director of Membership at (518) 426-8764.
____________________________________________________ Address ____________________________________________________ City/State/Zip ____________________________________________________ Phone/Ext. ____________________________________________________ Email (Required) Second Registrant from same organization:
There is no fee for this program.
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Please FAX this completed form to: (518) 426-8788