ASAP
A Weekly Publication Of HCA Home Care Association of New York State
Legislative Issues Public Policy
News
Volume 21, No. 23 June 10, 2016
High Risk For Home Care: Act Now to Urge Amendments on New, Problematic Advanced Aide Proposal This week HCA received draft bill language on an “Advanced Home Health Aide” (AHHA) proposal being circulated in the Legislature that is extremely problematic for home care. HCA has supported the “Advanced Home Health Aide” concept in prior years (and advanced legislation to achieve this). We have also been involved in stakeholder meetings to shape these past proposals. However, this latest version (in bill-draft form) contains many more baseline objectionable items that HCA is actively working with key legislative offices to fix. See RISK p. 2
Important: LTHHCP Options Continue Prior announcement of waiver expiration does not mean LTHHCP providers close, or op-certs expire Last week, a General Information System (GIS-16 MA/ 11) notice was issued by the state Department of Health (DOH) indicating expiration of the Medicaid home and community based services waiver for the Long Term Home Health Care Program (LTHHCP).
Inside ASAP
See LTHHCP p. 4
Act Now to Urge Amendments on Problematic Aide Proposal........1 LTHHCP Options Continue....................................................................1 HCA Co-Hosts July Federal Advocacy Day........................................1 HCA Presses Core Issues at Minimum Wage Meeting......................5 CMS Prior-Auth. Demo to Be Implemented With Modifications......7 Upcoming Education Programs.........................................................9 QIVAPP, FLSA and Other Managed Care-Home Care Updates......11 High Stakes in Final Week of Legislative Session..............................12 Save the Date: Finance Retreat & Women In Healthcare Summit......14 DOH Issues Final 2016 Non-NYC Personal Care Rates...................15 HCA Data Web Update: 2014 CHHA, LTHHCP Cost Report Data.......16 Round 3 of PPS Lead Regulatory Waiver Request Announced.........16 OMIG Releases Draft OPWDD Audit Protocols...............................17 DOH Posts NHTD/TBI Transition Plan............................................17 HCA Memos on NGS Home Care, Hospice Updates.....................17 Member Hiring Announcement........................................................18 March Global Cap Report: Spending $3M Under Projections.......19 OIG Issues Work Plan Mid-Year Update...........................................20 New Members Appointed to MedPAC............................................22 Panel Makes Recommendations on Star Ratings.............................22
HCA Co-Hosts July Home Care Federal Advocacy Day with State Association Partners On July 12 to 13, HCA will join state association partners from across the country, along with the independent Council of State Home Care Associations, to host the inaugural Council of States Federal Advocacy Day. We strongly invite you to attend. Please see the flyer posted at the back of this week’s ASAP and at http://hcanys.org/wp-content/uploads/2016/06/PublicPolicy-Summit-Brochure-July-2016.pdf. See FEDERAL p. 5
Helping New Yorkers Feel Right At Home
ASAP – a publication of the Home Care Association of New York State
Volume 21, No. 23 June 10, 2016
RISK from p. 1 Developments are fast moving and it appears that, at HCA’s urging, some of the issues that we object to may be in the process of being modified. To support our efforts, we need your immediate advocacy action today to continue to push for consideration of HCA’s amendments. To this end, today we have posted an advocacy message that you can send with a quick push of the button using our Legislative Action Center. Please click the link below, enter your contact information and send this message immediately. Have your staff do the same. It takes only a minute of your time. http://p2a.co/ylhxhlS In addition, please call and e-mail the Chairman of the Senate Higher Education Committee, Kenneth LaValle, who is incredibly influential when it comes to the fate of this bill. His office number in Albany is (518) 455-3121. His e-mail is lavalle@nysenate.gov. Senator LaValle’s committee, which has jurisdiction over this proposal, repeatedly declined to pass an “advanced home health aide” proposal in the past. This new legislation under consideration poses greater risk to the home care community and we need to convince him to either amend it or stop it. Please call and write him today using the language in our Legislative Action Center message. HCA has posted a text version of this message to our website (in Word format) so you can cut and paste it into an e-mail or use it as a guide in your phone calls. Please click http://hca-nys.org/wp-content/uploads/2016/06/ AdvocacyMessageonAHHA061016.docx. Further background In prior years, while the Assembly acted on an “Advanced Home Health Aide” proposal, the Senate has held off, largely due to disagreement and a different philosophy about the approach. This year, an AHHA
ASAP is a weekly publication of the Home Care Association of New York State (HCA). Unless otherwise noted, all articles appearing in ASAP are the property of the Home Care Association of New York State. Reuse of any content within this newsletter requires permission from HCA. President: Editor:
Joanne Cunningham, jcunningham@hcanys.org Roger L. Noyes, Director of Communications, rnoyes@hcanys.org Al Cardillo, Executive Vice President, Policy & Programs, acardillo@hcanys.org Patrick Conole, Vice President, Finance & Management, pconole@hcanys.org Andrew Koski, Vice President, Program Policy and Services, akoski@hcanys.org Alexandra Blais, Director of Public Policy, ablais@hcanys.org Laura Constable, Senior Director, Membership & Operations, lconstable@hcanys.org Celisia Street, Director of Education, cstreet@hcanys.org Mercedes Teague, Finance Manager, mteague@hcanys.org Jenny Kerbein, Director of Governance and Special Projects, jkerbein@hcanys.org Billi Hoen, Manager, Meeting and Events, bhoen@hcanys.org Teresa Brown, Administrative Assistant, tbrown@hcanys.org 388 Broadway, 4th Floor, Albany, NY 12207 Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org
2
Volume 21, No. 23 June 10, 2016
ASAP – a publication of the Home Care Association of New York State
Continued from previous page proposal has again passed the Assembly, and recent developments in the Senate are now creating an environment in which an AHHA bill may be considered in the Senate. However, the proposal that is circulating is very problematic and must be amended before it proceeds any further in the process. Yesterday, HCA convened a call with our Board of Directors to discuss this new proposal (which is still in draft form and, therefore, has not been assigned a bill number yet). The Board echoed several of HCA’s core concerns with the bill and determined that now is the time for grassroots advocacy to get the Legislature to amend the bill in ways that answer edits submitted by HCA. Here are some of the core concerns with this bill-draft:
It includes unnecessary and oppressive nurse-staffing ratios for supervision of “advanced home health aide” tasks. At HCA’s urging, we have recently learned that this issue may have been eliminated from the bill, but it could still be in play.
As designed, the bill would trigger a host of new federal regulatory requirements (“Conditions of Participation” and others), which mean more frequent and costly nurse supervision activities. These regulatory triggers, nurse-ratio requirements, and accompanying salary increases for “advanced home health aides” would collectively impose enormous new costs and administrative burdens.
The bill includes absolutely no dedicated funding mechanism to offset these new costs, nor any assurances of managed care premium coverage to fill-in the cost gap for employers. Providers will be mandated to utilize advanced aides and receive no new funding to compensate them for doing so. This is yet another unfunded mandate and places providers in an extremely vulnerable financial situation.
The bill is devoid of any liability protections for nurses, who would have the discretion (and, thus, responsibility) to determine which aides are competent to assume additional tasks.
The bill also raises major, unanswered questions as to how an aide is deemed eligible, and then properly trained, to assume these new tasks while offering no prerogative for employers to determine the suitability of employees for “advance home health aide” service.
These are among the core concerns with this bill but there are a host of other technical issues that demand our attention as the bill draft winds its way through the process. We need to get all members on record before this bill goes any further, as it is still in a formative stage and therefore ripe for amendment. The bill draft and HCA’s comments on the bill are very fluid and the bill text is extremely convoluted. Members with government-relations teams who want more information to assist in the advocacy ground effort can contact acardillo@hcanys.org or jcunningham@hcanys.org.
3
ASAP – a publication of the Home Care Association of New York State
Volume 21, No. 23 June 10, 2016
LTHHCP from p. 1 The announced expiration was based on information available to DOH that no Medicaid patients continued to be in the LTHHCP (whereas as recent as last Friday, agencies were reporting to HCA that their LTHHCPs continued to serve patients), thus triggering cessation of the waiver authority. Meanwhile, HCA has been in steady discussions with DOH since last fall discussing and exploring LTHHCP continuity options, with promising and progressing scenarios. HCA and DOH had an extensive meeting this morning to further layout a roadmap for these options, for clarification of LTHHCP status, and guidance to LTHHCP providers and partners on next steps. Last week’s DOH GIS announcement has been misinterpreted by some counties and LTHHCPs to mean expiration of the “LTHHCP.” This is not the case, and providers should not interpret the GIS as an expiration of: operating LTHHCP certificates; LTHHCP provider authorization, or LTHHCP capability to admit and serve patients. Next Steps Based on today’s meeting, the following steps are in motion: 1. Preparation of a communication from DOH to LTHHCPs and significant stakeholders that will indicate the continuing authority of LTHHCP providers within the overall evolved Medicaid system, and outline further options/ roles for LTHHCP continuity within that context. 2. Drafting of a “Frequently Asked Questions” document to clarify both general and procedural items related to LTHHCP. This includes, for example, affirmation of LTHHCP status as “safety-net” providers for participation under the Delivery System Reform Incentive Payment (DSRIP) program; continuing provision of LTHHCP care 4
management under contract for MLTC enrollees; and elements to meet basic survey/operational conditions. These clarifications are intended to assist both LTHHCPs and partners, especially managed care plans, hospitals, physician practices, local districts and other potential sources of collaboration and/or referral. 3. Clarification of direct billing status for LTHHCPs. 4. A survey of all LTHHCPs to identify patients current being served by LTHHCPs directly and under contract with managed care. 5. Additional information/outreach to assist with provider and other needed stakeholder understanding of LTHHCP status and capability. HCA and DOH asks that all LTHHCPs please complete the quick survey discussed in item four (above) at https:// www.surveymonkey.com/r/BQDX3N8, the results of which HCA will share with DOH and will be used to help further assist with next steps. HCA will keep LTHHCPs closely apprised of our progress and, in the meantime, urges LTHHCP sponsors to contact HCA if you have any questions, recommendations or need to confirm LTHHCP options that currently exist. HCA appreciates the collaboration of DOH Directors of Home and Community Based Services and Long Term Care, Rebecca Fuller Gray and Mark Kissinger, in this effort. For further information, please contact Al Cardillo at acardillo@hcanys.org.
ASAP – a publication of the Home Care Association of New York State
Volume 21, No. 23 June 10, 2016
FEDERAL from p. 1 This two-day program will feature a first day of policy and legislative discussion led by policymakers from the U.S. Centers for Medicare and Medicaid Services (CMS), Capitol Hill and the D.C. advocacy community on the pressing regulatory and legislative issues impacting the nation’s home care provider community. The second day will begin with a Capitol Hill breakfast and include advocacy visits facilitated by attendees’ respective state home care associations. HCA will be scheduling visits with pivotal New York health care leaders serving on the health committees of jurisdiction as well as Members of Congress representing your Congressional Districts. Portions of the program will also feature opportunities for networking and to hear from D.C. insiders. This opportunity is available to all HCA members and is a tremendous way to establish and nurture a relationship with your agency’s Congressional Representatives. HCA’s federal lobbyist, Brett Heimov, Managing Director, Envision Strategy in Washington, D.C., will facilitate HCA’s meetings with the New York Congressional Delegation. “July is an optimal time for New Yorkers to pay a visit to their D.C. Congressional Representatives,” Mr. Heimov says. “It is vitally important that providers make sure their New York Delegation understands the challenges experienced by New York’s home care community.” The program will focus on discussions of: federal home care compliance issues; the federal face-to-face regulation; the “Probe and Educate” audits launched by CMS; discussions about federal Medicaid policy changes; Congressional areas of interest impacting home care; and much more. For further information, contact HCA President Joanne Cunningham at jcunningham@hcanys.org. Otherwise, please download the flyer and join us for this important program.
HCA Presses Core Issues at DOH Minimum Wage Workgroup Meeting This week, HCA policy staff and our state legislative firm, Hinman Straub, attended the first in a series of stakeholder meetings conducted by the state Department of Health (DOH), bringing together organizations whose members are affected by the recently enacted minimum wage increases (which go into effect, on a phased basis, beginning December 31). This initial meeting served as a stage-setting for an implementation strategy on Medicaid funding to home care and other health care entities to help meet the increased minimum wage levels. During this meeting, and since the increase was finalized in the budget, HCA advocated that monies be paid in a timely and straightforward manner to plans and providers, without the problems encountered under previous state efforts to provide labor-related and other retroactive funding to home care providers. HCA has also worked with other associations to develop cost estimates of a minimum wage increase and has shared this data with DOH. (Please also see p. 12 story about our legislative initiatives on minimum wage.) The state has categorized stakeholders into four groups for this process: health care associations (home care, nursing homes and hospitals); health plan associations; mental health groups; and a fourth “catchall” category. The state intends to hold three additional meetings over the summer, at which HCA will be proactive in representing members’ interests. Any and all developments and outcomes will be reported to the 5
ASAP – a publication of the Home Care Association of New York State
Volume 21, No. 23 June 10, 2016
membership. While the early meetings are planned to be held by discrete stakeholder groups, DOH plans to bring all of the groups together toward the end of the summer to finalize the design. Below are some more process details:
DOH insists that the final process and rates will be decided and submitted to the U.S. Centers for Medicare and Medicaid Services (CMS) and stakeholders no later than October. The group agreed to proceed with a goal of mid-September to ensure that money is available for services provided under Medicaid fee-for-service and managed care in advance of the first wage increase scheduled for December 31, 2016.
DOH provided a list of the Medicaid program and service rates impacted by the funding for the minimum wage increase. That document is available at http://hca-nys.org/wp-content/uploads/ 2016/06/MinimumWageStakeholdersWorkgroupMedicaidRatesImpacted.pdf.
DOH is currently discussing several policy issues internally and plans to have stakeholder discussions about them, in subsequent meetings, including: how rates will be adjusted for contracted staff; how the rate adjustments can reflect staff working in different regions subject to different minimum wage levels; how DOH can assure that funds added to the rates are actually used for the minimum wage adjustment; and whether there are steps that the state/stakeholders can take to ensure that Medicare rates will also be adjusted for minimum wage increases.
DOH is using the following assumptions: existing cost report (and other) data will be used for the calculations, though surveys may be required for data not available; wage compression will not be included; this adjustment will be incorporated into current rate methodologies; and this particular adjustment will only cover Medicaid and will not include other payors. However, in response to concerns consistently raised by HCA and others, DOH also indicated its plans to hold discussions with CMS and the Obama Administration to try and obtain additional monies for future Medicare reimbursement.
HCA and others at the meeting asked several questions and presented concerns to DOH regarding the implementation process. Of particular note were the following points:
In response to HCA’s inquiry, DOH indicated that this year’s final state budget included $58 million in state appropriations for the cost of the minimum wage increase effective December 31, 2016 for home care, nursing homes and hospital providers. DOH will be providing a breakdown of the money in the budget, both cash and appropriations, by sector, and the current methodology for determining the cost to the system due to the minimum wage increase. HCA will provide that information to members once we receive it, and we will work with DOH to ensure that its methodology and estimates are compatible with ours.
DOH seems to intend, at present, to put an agreed-upon amount of money into the managed care plan rates, then allow plans and providers to “negotiate” in order to determine how much money a particular agency will receive from each plan. HCA expressed strong concerns with this methodology and pointed to problems for both provider and managed care plans in the distributions for the Fair Labor Standards Act and state Wage Parity Law (Quality Incentive Vital Access Provider Pool/QIVAPP). One of our central goals will be to ensure that any money provided to cover the minimum wage increase will be passed in full to providers. This sentiment was echoed throughout the group, and we will continue to 6
ASAP – a publication of the Home Care Association of New York State
Volume 21, No. 23 June 10, 2016
insist on this throughout these discussions. HCA remains adamant that the failures of Wage Parity, QIVAPP, and FLSA not follow under minimum wage.
DOH confirmed that Medicaid funding for the minimum wage increase will be outside of the Medicaid Global Cap. DOH agreed that there needs to be a clear mechanism in place to prevent this from being included in the Medicaid Cap going forward.
The next Workgroup meeting is expected to be held in early July and will begin to delve into topics such as: home care-specific issues with MLTC plans and pass-through mechanisms; wage equivalency factor impacts; what type of data exists for cost analysis versus what data is still needed; and a strategy to pursue the federal match from CMS. To read the full minimum wage statute from the 2016 budget, visit http://hca-nys.org/wp-content/uploads/2016/06/MinimumWageStatute.pdf. Please contact the HCA Policy staff with any questions.
CMS Prior-Authorization Demo to Be Implemented With Some Modifications Demo appears to now include pre-claim component, which requires further HCA analysis to determine impact Following numerous objections raised by HCA, our association partners, and over 100 members of Congress, the U.S. Centers for Medicare and Medicaid Services (CMS) has announced what appears to be a modified version of its previously proposed “prior-authorization” demo for home health services. Now, CMS is implementing a “pre-claim review” component for services in the demo states (Illinois, Florida, Texas, Michigan and Massachusetts). Although CMS indicates that these changes are in response to stakeholder comments, HCA cautions that it remains unclear, without further detailed analysis, as to whether the new version of this proposal is an improvement over the original proposal. HCA is reviewing the particulars to discern the pre-claim review process, its effect on patient care, and how the delivery of services by providers would differ, if at all, from CMS’s “prior-authorization” demonstration. Over the past several weeks, HCA submitted comments urging CMS to rescind its original prior authorization demonstration. We worked with New York’s Congressional representatives to sign on to the Congressional letter in opposition to the demonstration. We also have worked with the New York Delegation on a separate letter to CMS and engaged members on grassroots advocacy using our Phone2Action Legislative Action Center where members sent over 500 messages to Congress opposing this program. Clearly these concerns were registered loudly, but it remains to be seen how our core issues are addressed in the final plan. A fact sheet and Frequently Asked Questions document is at https://www.cms.gov/Research-StatisticsData-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Pre-Claim-ReviewInitiatives/Overview.html. Various pre-claim review scenarios are described at https://www.gpo.gov/fdsys/ pkg/FR-2016-06-10/pdf/2016-13755.pdf. Further details According to CMS, pre-claim review is a process through which a request for provisional affirmation of coverage is submitted for review before a final claim is submitted for payment. A pre-claim review is different 7
ASAP – a publication of the Home Care Association of New York State than a prior authorization due to the timing of the review and when services may begin. For prior authorization, a request must be submitted prior to services beginning and providers should wait until they have a decision before they begin providing services. This was a major problem with CMS’s original proposal. With a pre-claim review, services will have already begun and the request is submitted after all of the initial assessments and intake procedures are completed. The pre-claim review occurs after services start but prior to the final claim being submitted. Under the demonstration, the pre-claim review request should be submitted after a Request for Anticipated Payment (RAP) is submitted, within 30 days of the first treatment provided to the beneficiary, and before the final claim is submitted for payment. Pre-claim review must be requested for each episode of care. If the initial pre-claim review request is nonaffirmed due to an “error,” then a home health agency may resubmit the request with additional documentation as many times as necessary. According to CMS, the Medicare Administrative Contractor (MAC) will work closely with the home health agency during the pre-claim review process to explain what documentation is needed and why a prior submission was insufficient. If the pre-claim review request is not approved, and the claim is still submitted by the home health agency, the claim will be denied in full, but the agency and beneficiary will be able to appeal that determination. If a provider submits a claim for payment without a pre-claim review request being submitted, the home health claim will undergo pre-payment review. If the claim is determined to be payable, it will be paid with
Volume 21, No. 23 June 10, 2016
a 25 percent reduction of the full claim amount. The 25 percent payment reduction is non-transferrable to the beneficiary. CMS states that the MAC will make every effort to issue a decision on a pre-claim review request within 10 business days for an initial request and 20 business days for a resubmitted request following a nonaffirmative decision. The demonstration will begin no earlier than August 1, 2016 in Illinois, no earlier than October 1, 2016 in Florida, and no earlier than December 1, 2016 in Texas. The demonstration will begin in Michigan and Massachusetts no earlier than January 1, 2017. Start dates for Florida, Texas, Michigan, and Massachusetts will be determined in the coming months. Though New York is not part of the demonstration at this time, HCA is concerned that CMS may expand it to other states or nationwide in the future. The pre-claim review demonstration for home health services will be discussed in an upcoming Special Open Door Forum call on June 14, from 2 to 3 p.m. More information is at http://www.cms.gov/ OpenDoorForums/. (See “Special Open Door Forums.” CMS indicates that this demonstration is in response to previous government reports that show “evidence of fraud and abuse in Medicare’s home health benefit” and a 59 percent improper payment rate for home health claims that is attributed largely to insufficient documentation. Furthermore, the demonstration states were targeted as they have been identified as “high-risk states” under the temporary moratoria on home health provider enrollment authorized under the Affordable Care Act. HCA has argued that the physician face-to-face (F2F) encounter requirement is responsible for the large number of documentation issues targeted by this demo, due to the onerous and unworkable way the requirement has been administered by CMS/MACs. HCA has worked strenuously and will continue to advocate for reforming and simplifying the F2F mandate so that it can be met by home health agencies and ordering physicians. 8
Volume 21, No. 23 June 10, 2016
ASAP – a publication of the Home Care Association of New York State
Upcoming HCA Education Programs: Register from our Website Today To register for these upcoming sessions, please visit the education page of our website and click the brochure or online registration option for each program. Visit: http://hca-nys.org/eventseducation/upcoming-events. Skin & Wound Care Management Live Training Courses
required (from a compliance perspective) when the inevitable data breach occurs.
HCA members receive a discounted rate ($300 off
Learn What Value Based Payment Really Means at June 17 HCA Program
standard rate) for day trainings offered by The Wound Care Education Institute. The courses are designed for LPN/LVNs, RNs, NPs, PAs and OTs and offer the opportunity to take a certification exam. Use the discount code “HCANYS” for these sessions:
June 17, 2016 Nanuet, NY
HCA is holding a special must-attend program on value based payments (VBP) on June 17 in Nanuet. The Obama and Cuomo Administrations are both moving quickly on VBP initiatives, including: a federal VBP pilot program in nine states; the paving of New York’s VBP Roadmap as a circuit extension of its Delivery System Reform Incentive Payment (DSRIP) program; continued emphasis on Accountable Care Organizations and bundled payment arrangements; and the Comprehensive Care for Joint Replacement (CJR) Model, which began in parts of the state and nation on April 1.
July 11-15, 2016 at Uniondale, NY October 24-28, 2016 at Elmhurst, NY
Also available free to HCA Members through the Wound Care Education Institute is an array of ondemand webinars using the code “HCANYS”. Visit our website for brochures and details.
Bootcamp: HIPAA eRisks and Responses for Home Care Agencies June 15, 2016 130 East 59th Street (near Lexington Ave.) 7th Floor New York, NY 10022 9:30 a.m. to noon
These and other VBP policy constructs will challenge home care providers; but they also provide opportunities in an increasingly integrated health care environment. Providers must learn about how VBP is structured, which quality and outcome measures actually matter most under VBP, and how to position themselves for VBP by making clinical and operational changes.
The complexities of the HIPAA and HITECH regulatory framework, including cyber security, are some of the most critical compliance issues facing home care and other health care providers. In an environment where data breaches occur with increasing frequency, federal regulators have amplified their auditing and investigations of provider compliance with the HIPAA/HITECH. Recent violations have resulted in substantial financial penalties levied against providers.
Home Health Quality Initiatives Update June 23, 2016 3 to 4:30 p.m. Webinar
This workshop will review what constitutes Protected Health Information (PHI) and the regulations related to the sharing of PHI. Most importantly, you will learn about the critical aspects of cybersecurity compliance, common areas for HIPAA violations, compliance with the HIPAA Privacy, Security and Breach Notification Rules and what’s
The U.S. Centers for Medicare and Medicaid Services’ (CMS) quality initiatives for home health have picked up the pace over the last year. Quality of Patient Care and Patient Continued on next page
9
ASAP – a publication of the Home Care Association of New York State
Survey 5-Star Ratings are available on the Medicare Home Health Compare website; agencies must now meet an OASIS quality reporting threshold; and a pay-for-performance demonstration project has begun in nine states. New Conditions of Participation that require a Quality Assessment and Performance Improvement program are on the horizon. The OASIS data collection continues to evolve and OASIS-C2 is scheduled to be implemented in 2017 with a new cross-setting item. Presenter Heather Jones, MPH, CHES, COS-C, is the Associate Vice President for Quality Initiatives and State Relations for AHHC/SCHCA. In this webinar, she will provide an update on the CMS initiatives and specify resources that are available to support agencies’ quality improvement efforts.
Blueprint for OASIS Accuracy June 22 and 23, 2016 Workshop (8 a.m. to 4 p.m.) June 24 COS-C Exam (9 to 11:30 a.m.) Workshop/Exam Location: Holiday Inn Express Hotel & Suites, 860 Holt Road Webster, NY 14580 Individuals may register for the workshop, the exam or both. This two-day OASIS-C1 workshop on Data Collection Rules and Guidance is followed by an optional Certificate for OASIS Specialist-Clinical (COS-C) exam, both held at the same location. You can register for the workshop, the exam, or both! Gain effective, up-to-the-minute education targeted for field data collectors, their supervisors and those preparing for the COS-C exam. Experience the comprehensive and nationally acclaimed two-day Blueprint for OASIS Accuracy workshop and learn to confidently teach, audit and collect OASIS-C1 items accurately.
The Art of ICD-10-CM Coding for Home Health July 13 & 14, 2016 8 a.m. to 4 p.m. Nanuet, NY This two-day diagnostic coding workshop is structured to develop basic ICD-10-CM coding skills and foster good habits crucial to coding success. This
10
Volume 21, No. 23 June 10, 2016
critical foundational knowledge, along with application through workshop exercises and coding scenarios, will lead to coding accuracy and regulatory compliance. The program is appropriate for all levels of coders.
Addressing Factors that Increase Workers’ Compensation Costs and Developing Ways that Home Care Providers Can Reduce Their Expenses September 28, 2016 130 East 59th Street (near Lexington Ave.), 7th Floor New York, NY 10022 9 to 9:30 a.m. registration and continental breakfast 9:30 a.m. to noon program This program will address fixed and variable costs affecting Workers’ Compensation insurance for home care agencies, and ways in which those agencies can affect the variable costs to significantly improve their bottom lines. The financial burden of Workers’ Compensation has been increasing for home care providers due to numerous factors. Agencies face the potential for additional increases due to the recently enacted $15 minimum wage and a shrinking Workers’ Compensation insurance market. This program will help agencies develop a cohesive Workers’ Compensation riskmanagement strategy and play an active role in reducing their costs. Presenter John Malone is a Commercial Insurance Broker with the firm Marshall & Sterling, Inc. He has worked in the insurance industry for more than 25 years and now represents some of the region’s largest and most highly respected businesses to negotiate commercial insurance and riskmanagement program terms, conditions and pricing.
ASAP – a publication of the Home Care Association of New York State
Volume 21, No. 23 June 10, 2016
QIVAPP, FLSA Distributions and Other Managed Care-Home Care Updates HCA this week confirmed with the state Department of Health (DOH) that two MLTC rate packages are awaiting approval at the state Division of Budget for federal-share monies under the Quality Incentive Vital Access Provider Pool (QIVAPP) and the Fair Labor Standards Act (FLSA) adjustments. QIVAPP is for the period April 1, 2014 to March 31, 2015 and the FLSA is for October 13, 2015 to March 31, 2016. Once approved, the rate changes will be loaded on to the system and plans should receive the monies around the end of July. They will then be expected to pass the monies through to their eligible home care contractors. QIVAPP and FLSA were among the items discussed at DOH’s Managed Care Policy and Planning meeting, which included other managed care enrollment, program and regulatory updates, such as:
Total MLTC enrollment as of June 1 is 168,409. This includes 5,759 in Medicaid Advantage Plus (MAP); 5,542 in Program of All-Inclusive Care for the Elderly (PACE); 5,377 in Fully Integrated Duals Advantage (FIDA); and 206 in FIDA for Individuals with Intellectual and Developmental Disabilities.
The Conflict-Free Evaluation and Enrollment Center has conducted 81,943 evaluations as of June 1, of which 98 percent were approved as eligible for enrollment into an MLTC plan.
The state has updated its Money Follows the Person website with a guidance for managed care organizations at http://www.health.ny.gov/health_care/medicaid/redesign/ nys_money_follows_person_demonstration.htm.
DOH has posted a Nursing Home Transition Diversion (NHTD)/Traumatic Brain Injury (TBI) transition plan to managed care at http://www.health.ny.gov/health_care/medicaid/ redesign/mrt90/tbi-nhtd_waiver_trans_ingo.htm and is seeking feedback by August 24 (see separate p. 17 story).
DOH and the U.S. Centers for Medicare and Medicaid Services (CMS) have revised the prior authorization requirements, as of January 1, 2017, so that FIDA plans have discretion as to what services require prior authorization.
Effective immediately (but to be revisited around January 1, 2017), FIDA plans can follow CMS’s Medicare Marketing Guidelines to permit commission-based or per-enrollment compensation for plan-licensed Medicare representatives. FIDA plans are allowed to market their products alongside competing MAP and Medicare Advantage products.
DOH is moving forward with the the Community First Choice Option (CFCO), which was approved on October 23, 2015, with a retroactive effective date of July 1, 2015. CFCO incorporates enhanced personal attendant services and supports into the Medicaid State Plan for
11
ASAP – a publication of the Home Care Association of New York State
Volume 21, No. 23 June 10, 2016
eligible individuals who need help with everyday activities due to a physical, developmental or behavioral disability.
An Administrative Directive Memorandum (ADM) has been drafted to outline the scope and procedures of CFCO services. It was shared with certain stakeholders and is undergoing editing before being finalized.
High Stakes in Final Week of Legislative Session The state Legislature today enters the final week of the scheduled 2016 Legislative Session, with high stake issues for home care and virtually every other issue area. Significant issues are on the table amid the race and flurry of new bill introductions, bill amendments, hurried negotiations, and lengthy calendars of votes to be taken up by state legislators before the scheduled June 16 conclusion to the session. This “end-of-session” atmosphere carries both opportunity and high risk, as legislators and constituencies far and wide seek to squeeze into these final days priority concerns, newly identified issues, or “must-do” items prior to session’s end. In this context, HCA and our government-relations team members at Hinman-Straub have worked continuously and at all key points to advance critical home care needs and concerns. We are also vigilant to catch and protect against adversities arising from any number of possible fronts. HCA communications will keep you up to date on these developments, including any need for grassroots advocacy. The following summarizes some of the key issue areas on the table as the legislative calendar concludes. Minimum Wage Accountability/Responsiveness – Introduced in Senate Senate Health Committee Chairman Kemp Hannon has formally introduced legislation developed by HCA and association colleagues to provide accountability and responsiveness for providers and managed care
Have You Committed to Bring The Vote Home? HCA announced this exciting new initiative in our May 26 ASAP and will continue to reach out to gain your participation. Learn more, and commit to participate, by clicking the “Join Us” tag at http://www.bringthevotehomeny.org/. We’ll be following up with you soon to further urge your participation.
12
Volume 21, No. 23 June 10, 2016
ASAP – a publication of the Home Care Association of New York State plans in the implementation of the minimum wage increase enacted in the state budget, as well as for Medicaid funding provided to cover other labor compensation requirements, both state and federal.
the AHHA bills introduced by the Governor and Legislature have been seriously problematic in their approaches to implementation and lack of protections. HCA will continue to press for effective, efficient and protective provisions for home care agencies, nurses, aides, patients and managed care plans.
The specific elements of this bill have been reviewed in the past two editions of ASAP and in other HCA communications.
Offsite Services In response to our meetings with his office, Assembly Health Committee Chairman, Assemblyman Richard Gottfried, plans to reinforce the bill’s criteria as part of home care minimum wage stakeholder meetings that are now underway with the Cuomo Administration. (See related p. 5 story.) HCA is participating and advocating in these meetings.
HCA worked extensively with the Healthcare Association of New York State (HANYS) to arrive at reasonable amendments to state legislation that would authorize hospitals and clinics to conduct certain services “offsite” in patients’ homes. The amendments would limit those services to primary care, and expressly exclude services that are defined as home care services, home care agency services and the professional services (e.g., nursing, physical therapy, etc.) that home care agencies provide.
Ensuring full, accountable and expeditious funding for minimum wage and all labor mandates has been an HCA priority. We will continue to press from all directions on this effort.
HCA has worked with HANYS, the Iroquois Healthcare Alliance (i.e., the upstate regional hospital association), and the State Medical Society to increase physician and primary care engagement for home care patients, including house-calls, which would be facilitated by this legislation. HCA has also written (and Senator Hannon and Assemblyman Gottfried have introduced) legislation for homecare-primary care initiatives.
Advanced Home Health Aide (AHHA) Legislation: Negotiations Picking Up As detailed in the page one story, AHHA legislation, which ground to a halt the past several years, was picked up by a key lawmaker aiming to bring this year’s negotiations to agreement. Senate Higher Education Committee Chairman, Senator Kenneth LaValle, and his committee staff have been meeting with the Assembly and Executive in an attempt to find common ground on provisions for authorization of advanced home health aides, AHHA-level tasks, qualifications, training, supervisory regulations and other components.
This now-amended “offsite” legislation prevents the unsanctioned crossover of unlicensed, uncertified entities into the Article 36 home care domain that is already a high-level concern of HCA, home care, hospice and state Department of Health officials.
HCA has provided extensive comment to Senator LaValle and staff, and shared the same with Senate Health Committee Chairman, Senator Hannon. (See our page 1 article for an outline of core concerns.)
Essential Personnel HCA and association colleagues met this week with the offices of Assemblyman Michael Cusick, Senator Andrew Lanza, and the Department of Homeland Security to discuss provisions of the “Essential Personnel” emergency response bill for home care and hospice personnel, originated by
HCA has been the leading entity working for aide and nurse flexibility for years. While noble in goal, 13
ASAP – a publication of the Home Care Association of New York State
Volume 21, No. 23 June 10, 2016
HCA several sessions ago and twice unanimously passed by the Legislature but vetoed by Governor Cuomo. The meeting aimed to confirm the responsiveness of the current bill language, but also to identify what language might be further nuanced in the bill that would address resistance from the Governor’s office. One major focus was on ways to support smaller counties in the bill’s requirement to amend their local emergency plans to accommodate “essential personnel” access to home care and hospice patients. HCA will be sending guidance to agencies to fully engage in a major grassroots effort on this legislation. HCA Initiatives in Quality, Primary Care, Managed Care, Public Health In addition to the above, HCA has successfully gained introduction of legislation supporting home care efforts in quality, primary care, managed care and public health. These legislative proposals (described in prior recent editions of ASAP) are live for passage in the remaining week of session. One additional, new bill co-written by HCA and the State Medical Society, would create “Homecare-Physician Collaboratives” for addressing health care disparities, a top public health problem and a focal point of all the major health care reform goals and models. Given the very large number of “must-do” actions by the Legislature in this remaining period, these bills will likely serve as critical table setters for the coming budget, administrative and legislative action. HCA will provide a detailed summary of these initiatives, which are derived from committee and forum venues, including our Quality Committee, MLTC Forum, LHCSA Forum, Policy Council, Board of Directors, regional member meetings and others.
Save the Date: Senior Financial Managers Retreat and First-Ever ‘Women In Healthcare Leadership Summit’! Please save the date for these exceptional upcoming HCA conferences with more information coming soon, including brochures and registration options. Mark your calendars now.
Senior Financial Managers Retreat September 8-9, 2016 Mohonk Mountain House New Paltz, NY In today’s health care market, financial managers and executives are faced with the challenge of meeting the demands of day-to-day management. But they also must engage in strategic planning efforts to keep pace with a rapidly changing and segmented reimbursement environment in order to maintain the overall fiscal health and secure future viability. During the 2016 Senior Financial 14
ASAP – a publication of the Home Care Association of New York State
Volume 21, No. 23 June 10, 2016
Managers’ Retreat, financial leaders in home care will hear the perspectives and expert analysis of HCA’s Policy Team as well as targeted insights from subject-matter experts who will provide a comprehensive update of the home care financial landscape.
Women in Healthcare Leadership Summit September 28-29, 2016 Excelsior Springs at the Courtyard Marriott 47 Excelsior Avenue Saratoga Springs, NY 12866 Women dominate the overall health care workforce, yet they are significantly underrepresented in leadership roles – this despite published research reports in Forbes, Fortune and The Wall Street Journal that indicate having women in executive roles leads to greater profitability. With change comes opportunity; so, in this unprecedented era of change in the health care industry, there is an opportunity to foster greater balance in gender diversity within our industry’s leadership. The issues and necessary skills required of women leaders are comparable to that of their male counterparts; however the context and conditions within which women lead can be uniquely challenging. This summit aims to empower, inspire and connect women in the field of health care to celebrate current successes, tackle the challenges and sharpen their leadership prowess.
DOH Issues Final 2016 Non-NYC Personal Care Rates The state Department of Health (DOH) posted to the Health Commerce System (HCS) the final 2016 “hotline” Medicaid rates for Personal Care and/or Consumer Directed program providers. DOH has previously posted the 2016 final (or hotline) rates for LTHHCPs. HCA expects DOH to post the 2016 final fee-fee-service (FFS) rates for non-hospital-based CHHAs soon. The rate calculations sheets are located in the “Rate Publication Selection List” drop-down section of the HCS, dated June 6, 2016. These rates, effective January 1, 2016, reflect the application of a zero percent roll factor adjustment. The rates also reflect a 8.7 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 add-on, a personal care provider must have submitted to DOH a signed certification statement on the use of these funds. The 2016 recruitment and retention add-on of 8.7 percent also includes adjustments to reimburse 15
Volume 21, No. 23 June 10, 2016
ASAP – a publication of the Home Care Association of New York State
non-New York City (NYC) personal care providers for the uniform additional hourly Fair Labor Standards Act (FLSA) add-on amount as determined in the recently published FLSA adjustment rates effective October 13, 2015. Personal Care and Consumer Directed program providers have 30 days to file an appeal with DOH but only in cases where the 2016 final rates have changed from the 2016 initial rates. For 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.
HCA Data Webpage Now Includes 2014 CHHA & LTHHCP Cost Report Data This week, HCA staff posted to our HCA Data website an HCA-developed spreadsheet of the 2014 Medicaid Cost Reports for all non-hospital based CHHAs and LTHHCPs in the state. Important: HCA Data is a members-only page that provides data reports to assist home care and hospice providers and managed care plans in their benchmarking efforts, understanding of system-wide trends, and access to reimbursement and premium rates. The page is not visible on our site unless you are logged in with an HCA member website account. Our log-in page is here: http://hca-nys.org/login. Upon login, the HCA Data link will appear in the site menu at the top right. You can also enter your e-mail address to obtain your password. Or, simply e-mail HCA’s Communications Director Roger Noyes at rnoyes@hcanys.org if you do not yet have an HCA website account. HCA has also just received from the state Department of Health (DOH) our freedom of information law (FOIL) request for the fourth quarter 2015 Medicaid Managed Care Operating Reports (MMCORs) from each MLTC and Program of All-Inclusive Care for the Elderly (PACE) plan in the state. HCA will prepare a spreadsheet summarizing key MMCOR data, including such items as: plan enrollments; per-member-permonth premium revenue and premium income; unit costs; and other information. HCA Data currently has 2014 MMCOR data available to members and hopes to have 2015 MMCOR data available sometime in the coming weeks. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
Agencies Announce Round 3 of PPS Lead Regulatory Waiver Requests This week, the state Department of Health (DOH), the Office of Mental Health (OMH), the Office of Alcoholism and Substance Abuse Services (OASAS), and the Office for People With Developmental Disabilities (OPWDD) announced that they are inviting Performing Provider System (PPS) leads, once again, to submit any new applications for regulatory waiver requests by August 1, 2016. All PPS leads should have received an e-mail with instructions. DOH will provide responses to the PPS leads by October 1, and responses will also be posted on the Delivery System Reform Incentive Payment (DSRIP) website. Continued on next page 16
ASAP – a publication of the Home Care Association of New York State
No. 23 June 10, 2016
Continued from previous page HCA encourages agencies to work with their PPS leads on the development of requests for regulatory waivers under DSRIP that may better facilitate successful participation in the program.
HCA Provides Memo on NGS Home Care, Hospice Updates
For more information on past waiver requests and responses, see https://www.health.ny.gov/health_care/medicaid/redesign/ dsrip/reg_flex_guide_res_prog_stat_waiver_resp_approvals.htm.
New York’s Medicare Administrative Contractor, National Government Services (NGS), held two advisory meetings this week with updates to the home care and hospice provider communities.
Please contact the HCA Policy staff with any questions.
OMIG Releases Draft OPWDD Audit Protocols The state Office of the Medicaid Inspector General (OMIG) has sought HCA feedback on draft audit protocols for Day Habilitation and Residential Habilitation Services funded by the Office for People With Developmental Disabilities (OPWDD). The day habilitation document has 23 protocols, including: missing recipient record; no service documentation; missing day habilitation plan; missing the individualized service plan; and more. The Individualized Residential Alternative (IRA) residential habilitation document includes 19 protocols. Some are general ones, similar to the day habilitation protocols, and many focus on IRA residential habilitation services. To obtain a copy of the draft protocols so you can submit comments, please contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
DOH Posts NHTD/TBI Transition Plan The state Department of Health (DOH) has posted a draft plan for transitioning the Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) programs to managed care. The proposed plan is at http:// www.health.ny.gov/health_care/medicaid/redesign/mrt90/tbinhtd_waiver_trans_ingo.htm. DOH is seeking comments by August 24 and intends to obtain approval of this transition plan from the U.S. 17
HCA Vice President Patrick Conole participated in both of these meetings, collecting information and providing feedback to NGS. Memos summarizing both meetings are posted at the links below. Home health memo: http:// tinyurl.com/jjbkwo6. Hospice memo: http:// tinyurl.com/jxed6lq. The memos provide critical information on Medicare payment and regulatory issues. The home care memo has some specific insights about the “probe-andeducate” audit process for face-toface documentation requirements as well as Comprehensive Error Rate Testing (CERT) data findings that assist providers in responding to these reviews and ensuring compliance. The hospice memo similarly reviews CERT findings, medical review and appeals data, hospice audit and reimbursement issues, and more.
ASAP – a publication of the Home Care Association of New York State
Volume 21, No. 23 June 10, 2016
Centers for Medicare and Medicaid Services (CMS) by September 1, 2017. The timeframe has been amended to conform to a transition delay included in this year’s final state budget, holding off the transition until January 1, 2018. Some highlights of the proposed transition plan include:
The Regional Resource Development Centers (RRDCs) will continue to have a role in managed care, including assessing the need for certain “enhanced” benefits and will serve as a resource to ensure that the managed care plans and providers have received appropriate training and education related to services and special needs populations.
Upon approval by CMS, effective October 1, 2017, all pending waiver applicants will be contacted by the RRDCs and advised of the opportunity to voluntarily enroll into MLTC or mainstream managed care services directly instead of seeking waiver services. Additionally, DOH will cease enrollment of any new waiver service providers and will no longer approve expansion of existing waiver service providers effective October 1, 2017.
NHTD/TBI waiver participants will receive an announcement letter on or about December 1, 2017 indicating that voluntary enrollment of existing waiver participants into a managed care product will be effective statewide January 1, 2018 and that the NHTD/TBI waiver programs will no longer be available effective April 1, 2018. If the current waiver participants want to continue receiving long term care services, they must enroll in an MLTC or mainstream managed care plan (MMC), depending on their program eligibility. Waiver participants will have the opportunity to voluntarily enroll into managed care effective January 1, 2018. Individuals will be auto assigned for services, effective April 1, 2018, if they are required to mandatorily enroll in a managed care product but do not do so voluntarily by March 1, 2018. Existing participants of the NHTD/TBI waiver programs effective January 1, 2018 will be deemed eligible for community 18
Hiring Financial Operations Manager The Financial Operations Manager position is mid-level leadership role responsible for overseeing the financial operations responsibilities for Consumer Directed Choices in Albany, NY. This position reports to the CFO, and will have three direct reports. This position is responsible for the overall management, accuracy, and efficiency of accounting operations; annual audits; financial statement reporting and analysis; cash management and forecasting; trend analysis; Medicaid billing, receivables and cost reporting; reimbursement rate analysis; budgeting; and maintaining internal financial and accounting controls for a Not for Profit organization grossing in excess of $25.0 MM. This individual works closely with the CFO to ensure the highest standards of performance are achieved Required Qualifications: BA/BS Accounting or Finance; minimum of 6 years’ experience in A/R, A/P, and general accounting functions coupled with a minimum of 3 years’ experience in a managerial/supervisory role. The successful candidate will be well versed in Generally Accepted Accounting Principles (GAAP) and have expert knowledge of QuickBooks and Microsoft Excel for analysis and complex modeling, as well as the ability to learn new financial applications and systems. The ideal individual will possess the requisite skills and experience, preferably from a Consumer Directed Personal Assistance or Home Health related Medicaid billing environment. Additional Qualifications: Must possess strong written and verbal communications skills; be team focused and foster a collaborative approach to problem solving. Please send résumés and cover letters including salary requirements to: HR@CDChoices.org. (Résumés without cover letters will not be considered). No Phone Calls, Please! Our website is www.CDChoices.org.
ASAP – a publication of the Home Care Association of New York State
Volume 21, No. 23 June 10, 2016
Continued from previous page based long term care (CBLTC) services and will not be required to go to the Conflict-Free Evaluation and Enrollment Center (CFEEC) prior to enrollment into MLTC.
Any waiver participant transitioning to MLTC will be deemed eligible for CBLTC for two years as long as the member actively participates in services identified in the plan of care. The member must receive at least one service monthly in order to maintain CBLTC eligibility.
Current NHTD/TBI waiver participants (effective January 1, 2018) are ensured continuity of care: all services in place at the time of transition will continue for the first six months of the transition period into MLTC/MMC. After six months of service transition, the plan will reassess the member for specific service needs.
DOH is proposing to establish a two-year continuity-of-care period for participants and service providers under which managed care organizations will be required to contract with current waiver service providers for a minimum of two years.
The transition plan includes a two-year rate guarantee through April 1, 2020 for providers based on the approved rate at the time of the transition.
DOH will seek to amend the definition of CBLTC to include service coordination as a CBLTC service.
MMC members have an initial 90-day grace period in which to dis-enroll for any reason and enroll in another MMC plan. This is followed by a nine-month “lock-in period” following the effective date of enrollment, in which the member may disenroll with cause and enroll in another MMC plan.
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
March Global Cap Report: Spending $3M Under Projections The state Department of Health (DOH) has issued its monthly Medicaid Global Cap report. This latest report, for March, covers the entire 2015-16 state fiscal year (SFY) period of April 1, 2015 through March 31, 2016. It finds that overall spending for the 2015-16 SFY was $3 million below the $17.7 billion Medicaid Global Cap projection, across all sectors. According to DOH, this is the fifth consecutive year that the Medicaid health care community has remained below the Global Cap target. However, DOH stated that the Medicaid Global Spending Cap was updated through September 2015 to account for the following two significant pressures on the Cap during 2015-16:
Significant enrollment growth in the MLTC program. Year-to-date growth (through September) was 11,000 individuals, primarily in New York City (68 percent). The original estimates only assumed an annual growth of 10,000 and have been revised to reflect projected growth of 16,375 recipients; and
A recent court ruling on the Fair Labor Standards Act (FLSA) requiring overtime paid at time and one-half of wage, with travel time as compensable hours, and changes to live-in rules for home care. While FLSA costs are, indeed, adding pressure, DOH confirmed this week during a meeting 19
ASAP – a publication of the Home Care Association of New York State
Volume 21, No. 23 June Volume 21, No. 23 June
with HCA and other long term care association representatives that the Medicaid Global Cap projections will not include any additional Medicaid spending due to the phase in of the $15-perhour statewide minimum wage, as these expenses will be kept outside the cap. According to the March Global Cap report, the category that includes home care (“Other Long Term Care”) was $23 million over projected spending. The Department shows actual spending of $676 million versus projected spending of $653 million for the SFY 2015-16. Medicaid Managed Care (MMC) was $66 million over projections, a difference of $12.466 billion (actual spending) versus $12.400 billion (estimated spending), which is slightly better than the September 2015 report, when MMC spending was $81 million over estimates. Total Medicaid enrollment reached 6,195,976 enrollees at the end of March 2016. This reflects an increase of 19,909 enrollees, or 0.3 percent, since March 2015. The Accounts Receivable (A/R) ending balance for FY 2016 was $193 million resulting in a reduction of $87 million to the FY 2015 beginning balance of $280 million. DOH is engaged in an initiative to eliminate all currently outstanding retroactive rates Medicaid liabilities owed to the state, no later than March 31, 2017. The full report is at: http://www.health.ny.gov/health_care/medicaid/regulations/global_cap/monthly/ sfy_2015-2016/docs/march_2016_report.pdf. The Medicaid Global Cap for the current fiscal year (April 1, 2016 to March 31, 2017) is $18.8 billion for all sectors. HCA is surveying these global cap reports carefully in an information gathering effort, combined with other data analysis, to ensure accurate reflections of home care finances, with an eye toward any indication of rate or payment decisions stemming from the state’s analysis of home care’s performance. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
OIG Issues Work Plan Mid-Year Update The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) has issued its Fiscal Year Work Plan Mid-Year Update for 2016. It summarizes new and ongoing reviews and activities that OIG plans to pursue during the current fiscal year and beyond. It describes OIG audits and evaluations that are underway or planned, and certain ongoing legal and investigative initiatives. It also notes items that have been completed, postponed, or canceled and includes new items that have been started or planned since October 2015. The Work Plan is posted at http://oig.hhs.gov/reports-and-publications/archives/workplan/2016/ WorkPlan_April%202016_Final.pdf. Continued on next page
20
ASAP – a publication of the Home Care Association of New York State
10, 2016
Continued from previous page Home health agencies should familiarize themselves with the issues (below) outlined in the report and review their compliance plans for each relevant topic. Medicare Medicare Home Health Fraud Indicators: will describe the extent that potential indicators associated with home health fraud are present in home health billing for 2014 and 2015. OIG will analyze Medicare claims data to identify the prevalence of potential indicators of home health fraud. Home Health Prospective Payment System Requirements (revised report): will review compliance with various aspects of the home health prospective payment system, including the documentation required in support of the claims paid by Medicare, and will determine whether home health claims were paid in accordance with federal requirements. Physician Home Visits – Reasonableness of Services: will determine whether Medicare payments to physicians for evaluation and management home visits were reasonable and made in accordance with Medicare requirements. Physical Therapists – High Use of Outpatient Physical Therapy Services: will review outpatient physical therapy services provided by independent therapists to determine whether they were in compliance with Medicare reimbursement regulations. CMS Oversight of Provider Ownership Information: will determine the extent to which the U.S. Centers for Medicare and Medicaid Services (CMS) collects required ownership information for provider entities enrolled in Medicare, and will describe the extent to which it verified the collected information. OIG will also determine whether CMS checked exclusions databases for enrolling and enrolled providers, as required. It will compare the ownership information that selected providers gave to CMS/states to enroll in Medicare/ Medicaid with the ownership information that the same providers gave to OIG. Medicaid Oversight and Effectiveness of Medicaid Waivers: will determine the extent to which selected states made use of Medicaid waivers and if costs associated with the waivers are efficient, economic, and do not inflate federal costs. OIG will also look at oversight of state Medicaid waivers. Adult Day Health Care Services: will review Medicaid payments by states for adult day health care services to determine whether providers complied with federal and state requirements. State Oversight of Provider Ownership Information: will determine the extent to which states collect required ownership information for provider entities enrolled in Medicaid, and will describe the extent to which they verify the collected information. OIG will also determine whether states checked exclusions databases for enrolling and enrolled providers. States’ Experiences with Enhanced Provider Screening: will review whether states are conducting enhanced screenings that assess risk for fraud, waste, and abuse for moderate- and high-risk enrolling and revalidating Medicaid providers and suppliers. Continued on next page 21
ASAP – a publication of the Home Care Association of New York State
Volume 21, No. 23 June 10, 2016
Continued from previous page Managed Care Managed Care Reimbursements: will review states’ reimbursements made to MLTC and Medicaid managed care plans to determine compliance with certain federal and state requirements. Medicaid Managed Care Entities’ Identification of Fraud and Abuse: Will determine whether Medicaid managed care organizations identified and addressed incidents of potential fraud and abuse.
New Members Appointed to MedPAC On June 2, the U.S. Government Accountability Office (GAO) announced the appointment of five new members to the Medicare Payment Advisory Commission (MedPAC), as well as the reappointment of one current member. The newly appointed members are Amy Bricker, RPh, Vice President, Supply Chain Strategy, Express Scripts, Inc., St. Louis, Missouri; Brian DeBusk, PhD, CEO, DeRoyal Industries, Powell, Tenn.; Paul Ginsburg, PhD, Leonard Schaeffer Chair in Health Policy Studies, Brookings Institution, Washington, D.C., and Professor of Health Policy, University of Southern California; Bruce Pyenson, FSA, MAAA, Principal and Consulting Actuary, Milliman, Inc. in New York, N.Y.; and Pat Wang, JD, CEO, Healthfirst, New York, N.Y. Their terms will expire in April 2019. The reappointed member, whose term will also expire in April 2019, is Jon Christianson, PhD, Professor of Health Policy and Management at the University of Minnesota’s School of Public Health in Minneapolis, Minn. He will continue to serve as Vice Chair. Congress established MedPAC in 1997 to analyze access to care, cost and quality of care, and other key issues affecting Medicare. MedPAC advises Congress on payments to health plans participating in the Medicare Advantage program and providers in Medicare’s traditional fee-for-service programs. The Comptroller General is responsible for naming new commission members. Some of MedPAC’s recommendations have been adopted by Congress, including reductions in Medicare home health reimbursement. HCA has strenuously objected to these as well as other proposals to institute a patient copayment for home health services. We plan to reach out to those MedPAC members from New York to discuss issues affecting our members.
Panel Makes Recommendations on CMS Patient Care Star Ratings The U.S. Centers for Medicare and Medicaid Services (CMS) announced this week that a summary of the Home Health Quality of Patient Care (QoPC) Star Ratings Technical Expert Panel (TEP) is available on the Home Health Star Ratings website at https://www.cms.gov/Medicare/Quality-Initiatives-PatientAssessment-Instruments/HomeHealthQualityInits/HHQIHomeHealthStarRatings.html. The meeting summary can be found in the “Downloads” section. Continued on next page
22
ASAP – a publication of the Home Care Association of New York State
Volume 21, No. 23 June 10, 2016
Continued from previous page Abt Associates convened the TEP to review the first year of data on the performance of these ratings as well as discuss and make recommendations for revising the Home Health QoPC. Among their recommendations, the TEP proposed revamping the way the Quality of Patient Care star ratings are calculated, reconsidering which data sources are included in the rating methodology and clarifying the ratings’ meaning for consumers. Specifically, the TEP expressed concern that the current methodology for calculating the star ratings may not be properly taking into consideration the diversity of home health patients, including patients whose end goal is to remain stable, not to improve. The TEP also raised concerns about consumers’ general understanding of the Quality of Patient Care star ratings, noting that while the ratings are a tool meant to help patients and their families pick a home health agency, consumers may confuse the ratings with the Patient Survey star ratings, and they may not realize the Quality of Patient Care star ratings are essentially rated on a curve, so there aren’t 4- or 5-star agencies in every market. For further information, contact the HCA Policy staff.
23
July 12 – 13, 2016
Platinum Sponsor
Gold Sponsor
Marriott Marquis Washington, DC
Public Policy Summit Washington, DC
Day 1 Tuesday, July 12, 2016 Shaw/LeDroit Park Room 7:30 – 8:30 a.m. Registration and Continental Breakfast 8:30 – 9:30 a.m. Caring for Individuals with Chronic Conditions Speaker: Laurence Wilson, Director, Chronic Care Policy Group, CMS Payment reform for post-acute care services is among the top issues facing the home health community. CMS Chronic Care Policy Group (CCPG) is responsible for developing and evaluating Medicare payment policies across the spectrum of post-acute care settings, including home health and hospice programs. As the Director of the CCPG, Laurence Wilson stands at the center of this rapidly evolving area of health care. This will be an informative session on recent developments in post-acute care reform and the future of care for individuals with chronic health conditions.
9:30 –10:30 a.m. Preventing Fraud and Abuse in Home Health Care Speaker: Mark Majestic, Director, Investigations and Audits Group, CMS (invited) 10:30 – 10:45 a.m. Break
10:45 – 11:45 a.m. Improving Care and Support of America’s Seniors and Adults with Disabilities Speaker: Michael Nardone, Director, Disabled and Elderly Health Programs, CMS DEHPG leads the Center’s work on Medicaid coverage and care coordination for the elderly and individuals with disabilities. This includes initiatives to promote community-based care options and to enhance the availability of long-term services and supports. DEHPG also manages the Medicaid prescription drug benefit and manufacturer rebates, and oversees benefits and managed care delivery system issues across the Medicaid program, including development of the new alternative benefit plans (ABPs) associated with the Affordable Care Act. 12:00 – 1:30 p.m. Lunch Speaker: Chris Jennings, President, Jennings Policy Strategies (invited) Enjoy lunch while listening to the insights and comments of one of Washington’s most connected health care policy insiders about the top federal health care policy challenges of 2016 and the outlook for 2017. 1:45 –2:45 p.m. Focus on Medicare’s Face-to-Face Rule Speakers: Representatives from CGS, NGS and Palmetto Three of the nation’s MAC contractors will discuss the lessons learned and results of the “Probe and Educate” audits currently underway. 2:45 – 3:45 p.m. Medicaid Policy Developments – Priorities of State Medicaid Directors Speaker: Matt Salo, Executive Director, National Association of Medicaid Directors The nation’s Medicaid directors are the engineers of health care policy and Medicaid changes at the state level, initiating significant changes to access to health care as well as modifications that prompted the creation of new models of care delivery and payment reform.
Public Policy Summit Washington, DC
Day 1 Tuesday, July 12, 2016 – continued 3:45 – 4:45 p.m. Home Health Care Reform Speaker: TBA, Representative from CMS
4:45 – 5:15 p.m. The Intersection of Policy and Politics Speaker: The Honorable Billy Tauzin One of Washington’s most colorful, entertaining and influential former lawmakers is Louisiana Congressman Billy Tauzin, who continues to make significant and long lasting impacts on Capitol Hill, helping to shape and affect health care policy. 6:15 – 7:00 p.m. Cocktail Reception – Marriott Marquis 7:00 – 9:00 p.m. Dinner – Marriott Marquis Speaker: Vicki Kennedy, Esq., Greenberg Traurig The spouse of the late Senator Edward Kennedy (D-MA) shares stories about Senator Kennedy’s monumental impact on Washington, DC, his mark on the shaping of decades of far-reaching federal policy in health and social services and the importance of caregiving and quality end-of-life care.
Day 2 Wednesday, July 13, 2016 8:30 – 10:00 a.m. Congressional Breakfast Briefing – Perspectives of Key Staff U.S. Capitol Visitors Center Speakers: Kim Brandt, Chief Healthcare Investigative Counsel, Committee on Finance, United States Senate Wendell Primus, Senior Policy Advisor, Office of the House Minority Leader Danielle Steele, Senior Health Policy Advisor, Representative Michael C. Burgess, M.D. (R-TX) This session offers perspectives of several of the most influential staff serving on Capitol Hill on the remainder of the 114th Congress, as well as how the November Elections are likely to affect the policy environment on Capitol Hill. 10:00 a.m. – 4:00 p.m. Meetings with Your State’s Members of Congress and Staff (Scheduled by your State Association)
Public Policy Summit July 12 – 13, 2016 Washington, DC
REGISTRATION
Hotel Information
Register online at:
www.thehomecarecouncil.org/index.php?pID=28 Or, FAX this completed form to the Council of State Home Care Associations at:
(717) 975-9456 Or mail check to: Council of State Home Care Associations 600 N. 12th Street, Suite 200 Lemoyne, PA 17043
_____________________________________________________________ Name _____________________________________________________________ Professional Designations _____________________________________________________________ Title _____________________________________________________________ Agency Name ______________________________________________________________ Agency Address ______________________________________________________________ City State Zip _______________________________ ______________________________ Email Phone If registering for more than one person, please list names and emails: Name(s) Email(s) __________________________ ___________________________________ __________________________ ___________________________________ __________________________ ___________________________________
PAYMENT INFORMATION
$195 per person x ________ = $_______ # People
Total
Marriott Marquis 901 Massachusetts Avenue, NW Washington, DC 20001 A discounted group rate of $229 is available through June 20. Call (202) 824-9200 to reserve your room at the discounted rate or reserve online at: https://aws.passkey.com/g/58264721