June 12, 2015 ASAP by Home Care Association of New York State

ASAP Essential Personnel Bill Passes: Thank You For Your Advocacy! CHHA rebasing relief, home care insurance modernization, regulatory realignment, telehealth amendments, advanced aide measure are all among HCA focus bills As the state Legislative session reaches its finale in the middle of next week, HCA and our home care member advocates succeeded in getting the HCAdeveloped “essential personnel” bill passed in both houses: to provide home care and hospice staff with access flexibility to reach patients during declared emergencies. The bill passed the Senate this week after See SESSION p. 2

A Weekly Publication Of HCA Home Care Association of New York State

Legislative Issues  Public Policy

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News

Volume 20, No. 23 June 12, 2015

In two weeks, HCA will begin our summer ASAP schedule. We’ll be publishing our newsletter every other week and sending you e-mail alerts, as needed. During that time, we’ll be looking to revamp our communications to you. Our goal is to provide you with information in a concise format using the most appropriate delivery system, through our new website (www.hcanys.org), social media, alerts and other formats. Now is a good time to make sure you are making the most of HCA’s new website, including our HCA Blog where you can find our most pressing content. Do you have an HCA member account yet? You’ll need one if you want to access our ASAP archives, alerts, our HCA Data page and other members-only content that is invisible to non-members on the Blog. If you need an account, go to our log-in page and fill out the form for a “new account request.” (See image at right.) Once we confirm your membership, we’ll send you the log-in instructions. Just visit http://hcanys.org/login.

Inside ASAP Essential Personnel Bill Passes and Other Legislative Updates.......1 Act Now on HCA Priority Legislation................................................4 State Posts Interim CHHA EPS Rebasing Rates.................................6 Last Call to Register For HCA Tech. Symposium 4 Days Away!........7 Managed Care Update......................................................................7 HCA Memos Provide NGS Home Care & Hospice Updates............8 House Announces Plan to Remove Extended Sequester Cuts.........9 New July 21 Program on ICD-10 Codes for Managed Care...........10 2014 MLTC & PACE Data Posted to HCA Data Webpage..............10 Selfhelp LHCSA Opens New Location on Long Island...................11 DSRIP Update......................................................................12 State Releases March 2015 Global Cap Report............................12 HCA, Council Send Home Health Compare Report to Providers...13 Guidance on Provider Fingerprints, Background Checks...............13 Hospices: Register for 6/17 Call on HIS Manual Changes...........14 FIDA Announced for OPWDD Population Duals............................14 Alzheimer’s Disease Caregiver Support Initiative Announced.......15 Publications....................................................................16

Helping New Yorkers Feel Right At Home

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SESSION from p. 1 previously passing the Assembly. We thank you for using our Legislative Action Center to get this bill passed, and we will be asking you to direct your advocacy focus to the Governor’s office once this measure is delivered to his desk. The Governor’s signature is a final step in the process and will require a strong push by HCA and members given the Governor’s veto of a similar measure last year. HCA worked carefully on this year’s bill and memo language to address any possible areas of misreading that may have prompted last year’s veto. Meanwhile, other substantive home care bills related to insurance coverage, payment, home telehealth services, and advanced home health aide definitions were introduced and/or consumed major HCA focus and advocacy. This week saw positive movement on several legislative fronts, including the introduction of a bill in both houses to limit adverse cuts possible from the Certified Home Health Agency Episodic Payment System (EPS) rebasing. HCA sent you an alert on Thursday asking for your advocacy on this bill (sponsored by Senator Kemp Hannon and Assemblyman Richard Gottfried as S.5878/A.8171), and we need as many people as possible writing their legislators in support. The bill comes the same week that the state Department of Health has issued EPS interim rebasing rate reductions of 12 percent; this bill is very much a timely measure aimed at

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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preventing the most severe cuts to home care since the original Medicaid Redesign Team package of 2011. (See related p. 6 story.) HCA also worked with Senator Catharine Young and Assemblywoman Addie Russell on a bill introduced this week to amend Chapter 6 of 2015 in support of home telehealth. The amendments – introduced in both houses (S.5852/A.8200) – ensure that the new article of public health law created for telehealth in Chapter 6 does not inadvertently conflict with home telehealth provisions otherwise existing elsewhere in statute for home care. It also clarifies that remote home telehealth is not to be construed as an in-home “visit,” which may result in coverage limits. And the bill incorporates telehealth coverage provisions under long term care insurance policies, similar to how the new law includes telehealth under general insurance. More information about the bill is in HCA’s Memo of Support at http://hca-nys.org/policy-positions/ hca-memo-of-support-to-amend-telehealth-provisions-for-home-care. As previously reported, HCA has also advanced bills for regulatory realignment under home caremanaged care, modernization of the home care insurance law, and a pilot program for home care services to veterans (which is now a two-house bill) and will continue to push for further action on these bills before session ends in the middle of next week. Meanwhile, Senator Kevin Parker has introduced a companion bill (S.5855) to the Assembly’s Advanced Home Health Aide legislation, which already passed the Assembly (A.7188/Glick). The bill does not have Senate Majority sponsorship, as it seeks to amend the Nurse Practice Act in ways that have been objectionable to the Senate leadership. The legislation also contains other areas of concern that HCA has been working to have addressed in any final version of this legislation which would result in this muchneeded flexibility for the delivery of home health aide services. Other bills on HCA’s “watch” and advocacy list were reported in a web-exclusive on HCA’s website last week at http://hca-nys.org/policy-positions/major-legislative-opportunities-and-challenges-in-sessionwind-down. These include bills related to fiscal intermediary services under the consumer-directed personal assistance program, community paramedicine, hospital/clinic “offsite” services, the CARE Act, and others. The fiscal intermediary, community paramedicine and “offsite” services bills were subject to extensive discussions with stakeholders and HCA has advanced amendments on each of these bills on behalf of home and community-based providers. With only a few days left in this year’s session, we need members to engage in a strong advocacy push. Please see the related p. 4 story about how you can help, and be on the lookout for special instructions next week as our advocacy priorities and focus may shift with fast-moving developments in the legislative arena. For more information, please contact a member of HCA’s Policy staff.

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Act Now on HCA Priority Legislation The state’s Legislative session ends on June 17. During the next five days, HCA is working to amend any bills of concern. We are also pushing hard on priority bills that HCA and partner associations have advanced to support home care. We need your help. The Legislature won’t be compelled to act unless they hear from you, their constituents. As you know, HCA’s Legislative Action Center is an easy-to-use online tool for reaching your legislators. Now that it is crunch time, we need all HCA members to take just a minute or two to advocate. Right now, there are several online advocacy campaigns posted to the Legislative Action Center but we want you to focus on a few of them. They are at the links below. Please click each link, enter your contact information, and send a message to your legislator with a push of the button to support HCA’s key legislative goals. Please note that we have deactivated our campaign for the home care “essential-personnel” bill since it passed both houses as of yesterday. We will refocus that campaign once the bill is delivered to the Governor for his signature. As the legislative session deadline draws nearer, we may be asking you to pick up the phone on each of these bills, or others, and it is imperative that you and your government-relations teams respond quickly to our advocacy instructions. If you need any assistance in this process, please do not hesitate to contact HCA’s Communications Director Roger Noyes. •

Legislation to Limit CHHA Rebasing. Click here to act on this bill: http://p2a.co/Ax3JJQP

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Legislation to Modernize the Home Care Insurance Law. Click here to act on this bill: http://p2a.co/exDaV7b.

ASAP – a publication of the Home Care Association of New York State

Volume 20, No. 23 June 12, 2015 

ASAP – a publication of the Home Care Association of New York State

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State Posts Interim CHHA EPS Rebasing Rates Interim rates get released the same week that HCA advances bill to hold the line on disastrous cuts The state Department of Health (DOH) has posted to the Health Commerce System (HCS) the revised interim Episodic Payment System (EPS) rates for Certified Home Health Agencies (CHHAs). This posting occurred the same week that HCA succeeded in gaining the introduction of bipartisan legislation to hold the line on EPS rebasing cuts. (Please see p. 2 for a related update.) HCA has also posted a Legislative Action Center item for you to advocate on behalf of this important bill. If you have not written your legislator yet on this measure, we ask that you do so as soon as possible. Just click http://p2a.co/Ax3JJQP, enter your contact information and hit “Send Email” to reach your lawmaker. All CHHAs who are affected by this cut should take the time to act as soon as possible on this bill. The interim CHHA EPS rates are effective April 1, 2015 through September 30, 2015 and reflect an interim percentage reduction of 12 percent to the current 2009 base year episodic payment rates. This reduction is an initial step before DOH implements a final rebasing of EPS beginning on October 1, 2015. A Dear Administrator Letter (DAL) accompanying the rates indicates that the interim percentage adjustment was needed to comply with the statute for rebasing to take effect no later than April 1, 2015, and to preserve the $30 million annual financial plan savings estimated for rebasing in the final 2015-16 state budget. Based on the latest available statewide CHHA episodic utilization, DOH believes the interim reduction of 12 percent achieves this estimated savings of approximately $30 million, but clearly CHHAs are at risk for a much more expansive rebasing impact going forward – one big reason for HCA’s legislation to limit rebasing. Along with the DAL, DOH has also posted to the HCS a schedule of rates that are effective April 1, 2015 which shows the impact of the reduction to the 109 case-mix-adjusted payment rates for each CHHA in the state when providing services to patients 18 years of age and older under EPS. DOH has forwarded the CHHA interim rate revisions to the Office of Health Insurance Programs eMedNY system for payment and these will be applied retroactively to claims with episode start dates of April 1, 2015 and later. It is important to note that these rate revisions do not include any adjustment to the rates for pediatric patients, who continue to be reimbursed on a historical fee-for-service per unit basis. For specific questions on these rates, contact DOH’s Tim Casey or Charles Toby at (518) 4734421.

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Last Call to Register For HCA Technology Symposium Just 4 Days Away! You need to be thinking now about the future of your technology portfolio. HCA’s Technology Symposium next week (on June 16 in Albany) is designed to help. There are just a few days left to register for this final signature HCA conference of the summer. Please complete your registration today so that you don’t miss out. A registration form is published at the back of this week’s ASAP. Online registration is available at http://tinyurl.com/oqqfn48. DSRIP. MLTC integration. ACO partnerships. These are the clinical and payment models of the future; technology is vital to their success – and your success within them. Just listen to people like Greg Allen, one of the state’s top program implementation officials in health care. At last month’s HCA New Models conference, he told attendees that members of a DSRIP stakeholder group explicitly voiced concerns to him that the DSRIP Performing Provider Systems “can’t meet our performance targets without ‘wiring in’ community-based providers.” That means you and your peers! Anyone who attended that conference saw the benefit of being in the room to provide input to state officials on this area of need. This same opportunity awaits you at HCA’s Technology Conference, with a deeper focus on technology needs and development areas. We know you want to be a strong player in these new care models. We know you have a voice that officials need to hear when it comes to home care IT investment. Our conference will provide you with this opportunity to learn and to advocate. You’ll also gain some concrete case examples from your home care peers, meet with health technology vendors, learn ways you can use Regional Health Information Organizations (RHIOs) and other networks to plug into the health care grid now, and hear about HCA’s home care IT advocacy agenda.

Managed Care Update The following managed care update is based on information provided at a state Department of Health (DOH) Managed Care Policy and Planning meeting this week. QIVAPP The state hopes to finalize the amounts that each Managed Long Term Care (MLTC) plan will be getting (which must then be passed on to their qualified home care providers) under the Quality Incentive Vital Access Provider Pool (QIVAPP) program by the end of June. Then it will go to the U.S. Centers for Medicare and Medicaid Services (CMS) for approval which, according to past DOH communications, could take months. DOH also said there is money in this year’s state budget to continue QIVAPP. DOH indicated that it wants to first make sure the program is “solid” (by examining attestations, etc.) before continuing it. MLTC transition CMS has approved New York’s request to expand mandatory MLTC enrollment into Chautauqua, Chemung, Essex, Hamilton, Schuyler, Seneca and Yates counties. Continued on next page 7

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Continued from p. 7 The “front door” will close services under Medicaid fee-forservice on June 19 to individuals dually eligible for Medicare and Medicaid who need community-based long term care. As of June 22, those recipients will have to utilize New York Medicaid Choice for an assessment to determine their eligibility to receive such services in an MLTC plan.

HCA Memos Provide NGS Home Care & Hospice Updates

DOH is awaiting approval from CMS to mandate MLTC enrollment in Jefferson, Allegany, Lewis, St. Lawrence, Franklin, and Clinton counties; such approval is expected soon. These are the last counties in the state that have yet to transition.

Late this week, National Government Services (NGS), New York’s Medicare Administrative Contractor, held two advisory meetings: one for hospice and one for home care.

DOH indicated that it has extended the deadline from July 1 to August 15, 2015 by which plans must submit how they will move from fee-for-service provider payments to alternative payment methodologies. This is required under the Special Terms and Conditions of the state’s contract with CMS. CFEEC DOH has posted an updated timeline for implementation of the Conflict-Free Evaluation and Enrollment Center (CFEEC) at http://www.health.ny.gov/health_care/medicaid/ redesign/2015-06-05_updated_cfeec_timeline.htm. CFEEC will occur in early June in Chautauqua, Chemung, Essex, Hamilton, Schuyler, Seneca and Yates counties. Pending approval from CMS, it will start in late June in Allegany, St. Lawrence, Franklin, Clinton, Jefferson and Lewis counties. Once it is implemented in these counties, CFEEC will be in every county. The intent of CFEEC is to provide independent and conflictfree evaluation, education, and enrollment services for new applicants in need of community based long term care services. The CFEEC specifically evaluates an individual’s eligibility for Medicaid community based long term care and enrollment in an MLTC plan. Maximus, New York’s Enrollment Broker (also called New York Medicaid Choice), has so far conducted 23,331 assessments under the CFEEC. FIDA DOH reported that 4,407 individuals are enrolled in a Fully Integrated Duals Advantage (FIDA) plan as of June 2 in the 8

The meetings provided key updates on reimbursement and payment issues, upcoming education programs, medical review data and comprehensive error rate testing (CERT) findings, utilization and benchmarking data and more. HCA has prepared two Public Policy Memos on each of the meetings with detailed updates. The Hospice memo is available at: http://hca-nys.org/wp-content/ uploads/2015/06/ 061215NGSHospiceMtgSummary.pdf. The Home Health memo is available at: http://hca-nys.org/ wp-content/uploads/2015/06/ 061215NGSHomeHMemo.pdf. HCA members are urged to read the memos carefully for critical updates relevant to your organization. All HCA memos are posted online at http://hcanys.org/category/policy-memos.

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New York City Metropolitan area; 47,702 people have opted to not join (and remain in their “partially capped” MLTC plan). Starting July 1, DOH says that 3,908 individuals will be passively enrolled into a FIDA plan; this target population was sent a 60-day notice on April 27 and a 30-day notice on May 26. As of August 1, another 5,584 individuals will be passively enrolled into FIDA; this group was sent a 60-day letter on May 26 and a 30-day notice on June 24. Other FIDA updates include: •

An outreach letter and Frequently Asked Questions document were sent to Medicaid and Medicare providers.

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An outreach letter was sent to about 43,000 individuals who are eligible for FIDA but have not yet opted out or been passively enrolled.

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On June 18 in New York City, CMS and DOH will convene a roundtable for plans and providers on FIDA. For more information and to reserve space, contact CMS at Melissa.Seeley@cms.hhs.gov (by June 15).

LTC summit DOH announced that it will hold a policy summit for plans, providers and consumers in the fall to examine certain Medicaid long term care policy issues such as the FIDA program and how the MLTC program may be “tweaked” to focus on the goals of the Delivery System Reform Incentive Payment (DSRIP) program. At a participant’s suggestion, the summit will also cover value based payments. HCA intends to be an engaged part of this summit and will let the membership know about opportunities to convey your feedback, recommendations and concerns into the process once a date is set. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.

House Plans to Replace Sequester Cuts in Trade Bill with Alternative Payment Offset HCA and allied state associations led provider letter targeting the cuts last week A series of complicated maneuvers are underway as of ASAP press time to address the extension of sequestration cuts included in a trade bill known as the Trade Adjustment Assistance (TAA) program. The publication Inside Health Policy reported earlier this week that the U.S. House leadership proposed to replace the extended Medicare sequestration cuts in a series of maneuvers that involves splitting the TAA program into three separate bills. The extended sequestration cuts have been a target of HCA advocacy with allied associations. As reported on page 1 of last week’s ASAP, we spearheaded efforts by nearly a dozen provider groups to send a joint letter to Congress on the issue. Continued on next page 9

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Continued from p. 9 “Extending Medicare sequestration reductions to pay for non-Medicare programs reinforces a dangerous precedent set last year of syphoning funds from the Medicare Trust Fund for non-Medicare purposes,” the letter states. In lieu of the extended sequestration payment cuts, in 2024, House Ways and Means Chair Rep. Paul Ryan had advanced an alternatives offset that would increase penalties on taxpayers who fail to file correct 1099 forms. HCA will report to the membership on any final outcome that occurs after ASAP press time.

New July 21 Program on ICD-10 Diagnosis Codes for Managed Care Do you know what new diagnosis codes will be required for managed care claims starting October 1 due to the transition from ICD-9 to ICD-10? How can you obtain such codes and ensure that your claims for services under managed care are not denied after September 30? What actions are Mainstream Medicaid Managed Care and Managed Long Term Care plans requiring of their network home care providers to ensure a smooth transition? Answers to all of these questions, and more, will be provided at a newly announced program on July 21 in New York City that is for Licensed Home Care Services Agencies and Certified Home Health Agencies. Learn more by downloading the registration form for this timely program. The form is at the back of this week’s ASAP. DOH survey Meanwhile, the state Department of Health (DOH) would like to learn about providers’ readiness for the upcoming ICD-10 implementation and asks that you complete a brief, anonymous survey. The survey is at https://www.surveymonkey.com/s/eMedNYICD10ReadinessSurvey. It will help DOH to design and target its communication and implementation efforts as October 1, 2015 approaches.

2014 MLTC & PACE Data Posted to HCA Data Webpage HCA has updated our HCA Data webpage (http://hca-nys.org/hca-data) to now include spreadsheets with highlights of the 2014 Medicaid Managed Care Operating Reports (MMCORs) for all Managed Long Term Care (MLTC) plans as well as Program of All-Inclusive Care for the Elderly (PACE) programs in the state. HCA Data is a members-only webpage. It provides data reports to assist home care and hospice providers and managed care plans in their benchmarking efforts. To see this page, which is otherwise hidden from our site menu, you must have an HCA member password. (If you do not know your password, please send a message to rnoyes@hcanys.org and we can send you one.) This latest data update supplements a similar set of managed 10

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care data spreadsheets that HCA has prepared for 2013 and 2012. It also adds to an analogous set of HCAprepared data spreadsheets summarizing all Certified Home Health Agency (CHHA) and Long Term Home Health Care Program (LTHHCP) Medicaid cost reports for 2013, 2012 and 2011. The MMCOR data spreadsheets, in particular, include such items as: plan enrollments; per-member-permonth premium revenue and premium income; medical expense ratios; percent of premium revenue spent on home care and personal care; unit costs; and other important information. HCA’s data reports were analyzed and prepared by HCA’s Vice President for Finance and Management Patrick Conole, who can be reached at (518) 810-0661 or pconole@hcanys.org.

Selfhelp Community Services LHCSA Opens New Location on Long Island Selfhelp Community Services held a ribbon cutting ceremony at its new Westbury location on June 2 for its Licensed Home Care Services Agency (at 498 Union Avenue) which will serve Nassau County. More than 50 elected officials, other guests, home health aides and clients were on hand to celebrate at the open house and to preview the new state-of-the-art training facility. The opening of the new office was facilitated by the Selfhelp/Kimmel partnership and collaboration that began in 2013. Mrs. Johanna Friedl, a Holocaust survivor and home care client of Selfhelp, spoke emotionally about how much the care, companionship and activities arranged by Selfhelp have meant to her. “All I have to do is call. And I really appreciate the coffee house gatherings sponsored by Selfhelp,” explained Mrs. Friedl. A cake was also cut in celebration of Mrs. Friedl’s 91st birthday this week. Selfhelp has a special division, Nazi Victim Services Program, which is the largest provider of services to Holocaust survivors in North America. Decade-of-Service awards were presented to Selfhelp’s distinguished home health aides as well. Top Photo: Holocaust survivor, Mrs. Johanna Friedl, who turned 91 on June 9, speaks at Selfhelp’s LHCSA opening in Nassau County about how much home care means to her. Bottom Photo: Nancy Kelly Sullivan, Managing Director of Selfhelp Community Services’ Long Island Licensed Home Care Agency; Viviana Russell, Town of North Hempstead Councilwoman; Howard Kimmel, founder of Kimmel Housing Development Foundation; Stuart C. Kaplan, Selfhelp CEO; Nancy Barreno, Nassau County Legislative Aide; [far right]: Legislator Siela A. Bynoe.

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DSRIP Update The state Department of Health (DOH) provided an update on the state’s Delivery System Reform Incentive Payment (DSRIP) program at this week’s Managed Care Policy and Planning meeting. Performing Provider Systems (PPSs) had to submit their implementation plans by June 1. These will be posted once DOH finishes reviewing the plans and the PPSs have sent any additional requested information. DOH will be sending letters to individuals who have been attributed to a PPS, offering them an opportunity to opt out of having their personal information shared with providers in the PPS. If they opt out, they can still receive services under DSRIP. DOH plans to hold a stakeholder meeting to discuss this “opt-out” process. DOH reported that it is considering providing DSRIP funds to managed care plans to pay them for their costs under DSRIP. One possibility would be to provide the plans with enhanced administrative payments. The state is also considering flowing Vital Access Provider (VAP) payments to plans, and using value based payments to address future requests for financial assistance from providers. HCA has advocated that DOH recognize the costs incurred by home care providers under DSRIP and provide them with capital and technology support. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.

State Releases March 2015 Global Cap Report State Fiscal Year 2014-15 ends $8 million below $16.962 billion target The state Department of Health (DOH) has issued its March 2015 Medicaid Global Spending Cap report, which covers the end of the 2014-15 fiscal year global cap target period. (The state’s fiscal year begins on April 1 and ends on March 31.) The March report shows overall spending to be $8 million less than projected for the 2014-15 fiscal year, ending March 31. The actual spending amount for this twelve-month period (April 1, 2014 through March 31, 2015) was $16.954 billion versus an estimated cap for the entire 2014-15 fiscal year of $16.962 billion. DOH notes that this is the fourth consecutive fiscal year that Medicaid has remained below the cap target simultaneous with the expansion of health coverage to the Medicaid population. Medicaid enrollment increased by 516,000 recipients during this time period. The report is at http://tinyurl.com/oyn924v. For reporting purposes, home care and personal care services are lumped into the category labelled “Other Long Term Care.” According to the report, that category was $70 million above projections for fiscal year 2014-15 – a difference between projected spending of $620 million and actual spending of $690 million. The report states that the $70 million in spending over projection was due to a slower than anticipated shift in Managed Long Term Care (MLTC) as well as a delay in achieving the additional federal financial participation 12

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for services provided through the Community First Choice Option, which the state continues to work with the federal government to approve. As noted in previous ASAP articles on the Medicaid Global Cap, HCA has expressed concerns to DOH about the impact of retroactive payments on the global cap. HCA has discussed this issue with the Department and will be carefully assessing the reconciliation of funds relative to the cap. For further information, contact HCA’s Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

HCA, Council Send Home Health Compare Report to Providers HCA, in conjunction with the Council of State Home Care Associations, this week sent our Medicare-certified provider members updated Home Health Compare reports using the provider’s OASIS-C data from October 2013 through September 2014. The reports contain individual agency dashboard data provided by Healthcare First, a contributing vendor for HCA and the Council. This includes a comparison to outcomes of providers in each agency’s market and a snapshot of the provider’s outcomes history. Also included is the quarterly update of an individual agency’s OASIS percentile data: an agency-specific report that provides the agency’s outcome percentile in the state and nationally. At this time, the reports, which are issued three or four times annually, can only be sent to one person per agency. If you would like to change who receives the reports at your agency, please e-mail HCA’s Vice President for Finance and Management Patrick Conole at pconole@hcanys.org.

Guidance Released on Medicaid Provider Fingerprints and Background Checks On June 1, the U.S. Centers for Medicare and Medicaid Services (CMS) issued a “Dear State Medicaid Director” letter on fingerprints and background checks required for certain Medicaid providers. The letter is at http://www.medicaid.gov/federal-policy-guidance/federal-policy-guidance.html. (Click on Federal Policy Guidance.) State Medicaid agencies are required to screen all applications, including initial applications, applications for a new practice location, and applications for re-enrollment or revalidation, based on a categorical risk level of “limited,” “moderate,” or “high.” State Medicaid agencies must establish categorical risk levels for providers and provider categories who pose an increased financial risk of fraud, waste or abuse to the Medicaid program. When the agency determines that a provider’s categorical risk level is “high,” or if a provider is designated as a“high” risk by Medicare (Medicare considers newly-enrolling home health agencies to be “high” categorical risk), the agency must perform certain “limited” and “moderate” screening requirements; require the submission of a set of fingerprints; and conduct a criminal background check. The requirement to submit fingerprints applies to both the “high” risk provider and any person with a 5 percent or more direct or indirect ownership interest in the provider. A state is not required to conduct a fingerprint-based criminal background check on a “high” risk provider if that provider is considered a “high” risk provider by Medicare and the provider has been enrolled by Medicare. In 13

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other words, states may rely on a provider’s Medicare enrollment even if Medicare has not conducted a background check. For those providers subject to the background checks, a state Medicaid agency must terminate or deny enrollment if the provider – or any person with a 5 percent or greater ownership interest – fails to submit the fingerprints within 30 days of request or in the required form or manner requested. Termination or denial of enrollment would also apply to those who have been convicted of a criminal offense related to that person’s involvement with the Medicare, Medicaid or CHIP programs in the last 10 years. States have 60 days from the date of CMS’s letter to begin implementation of the requirement, which must be completed within a year. HCA has reached out to DOH and was told that since state Medicaid requires Medicare enrollment for new home health agencies, Medicaid can rely on the Medicare fingerprint and background check. DOH will provide additional guidance, if necessary, on its enrollment web page and through the enrollment process. For more information, contact the HCA Policy staff.

Hospices: Register for 6/17 Call on HIS Manual Changes The U.S. Centers for Medicare and Medicaid Services (CMS) is holding a national provider call for hospices on Wednesday, June 17, from 1:30 to 3 p.m. covering updates made to the Hospice Item Set (HIS) Manual V1.02 from the V1.01. You can register at: http://www.cms.gov/Outreach-and-Education/Outreach/NPC/National-ProviderCalls-and-Events.html. Upon registration, providers will be given the opportunity to submit questions in advance of the call. The call will be recorded and transcribed. Participants should review V1.02 of the HIS Manual prior to the call. It is available at http://www.cms.gov/ Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/Hospice-ItemSet-HIS.html. V1.02 provides clarifications of HIS item definitions and expectations for use. For further information, contact HCA’s Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

FIDA Announced for OPWDD Population Duals This week, the state Department of Health (DOH) and the Office for People With Developmental Disabilities (OPWDD) announced implementation of the Medicare-Medicaid Financial Alignment Initiative (Demonstration) for individuals with intellectual and developmental disabilities (IDD) who are eligible for both Medicare and Medicaid. Known as Fully Integrated Duals Advantage (FIDA-IDD), the new

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Volume 20, No. 23 June 12, 2015 

program focuses on individuals who receive long-term care and IDD service needs. The FIDA-IDD expands on the original FIDA Demonstration (implemented in January 2015). According to OPWDD, the FIDA-IDD program will “offer more opportunities for individuals to direct their own services, be involved in care planning, and live independently in the community.” “Individuals’ existing Medicare and Medicaid benefits would be provided through an integrated benefit design that would also include a dedicated interdisciplinary team to address each individual’s medical, behavioral, longterm supports and services, and social needs,” OPWDD states. Participants are expected to have access to an adequate network of medical and supportive services, including OPWDD services such as habilitation. New York and the U.S. Centers for Medicare and Medicaid Services (CMS) expect to contract with Partners Health Plan (PHP) to coordinate the delivery of covered services for individuals who are eligible and who elect to enroll voluntarily. Up to 10,000 Medicare-Medicaid IDD enrollees in the downstate region (New York City, Long Island, Rockland, and Westchester Counties) will be targeted for this new program which is expected to start no sooner than January 1, 2016. In the next several months, the state and PHP will work through finalization of key protections and design elements. The Memorandum of Understanding (MOU) and three-way contract for the New York-CMS original FIDA partnership will serve as the basis for the MOU and three-way contract for the FIDA-IDD program. More information is at http://www.opwdd.ny.gov/news_and_publications/fida-idd-announcement.

Alzheimer’s Disease Caregiver Support Initiative Announced The state Department of Health (DOH) has announced funding under an Alzheimer’s Disease Caregiver Support Initiative. The announcement is at https://grantsgateway.ny.gov/IntelliGrants_NYSGG/module/nysgg/ goportal.aspx?NavItem1=3. The goal of this initiative is to expand the safety net for caregivers of individuals with Alzheimer’s disease and other dementias by recognizing and addressing the need for day-to-day supports and stress reduction. Applicants are required to ensure the following core services: Care Consultation; Family Consultation; Support Groups; Education and Training Programs; and Respite. A total amount of $15 million per year will be disbursed among either one statewide or ten regional entities over a five year period. Each successful applicant will be awarded up to $1.5 million per region per year or $15 million per year for a statewide initiative through a five year contract with DOH. A Letter of Interest is not required, but it is strongly encouraged and is due June 19. Questions are due June 23, 2015 and answers will be posted on or about June 30, 2015. Applications are due August 4.

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Volume 20, No. 23 June 12, 2015 

Publications •

“Caregiving in the United States 2015,” AARP www.aarp.org/ppi/info-2015/caregiving-in-the-united-states-2015.html

•

“Medicaid Balancing Incentive Program: A Survey of Participating States,” by the Kaiser Family Foundation http://files.kff.org/attachment/report-medicaid-balancing-incentive-program-a-survey-ofparticipating-states

•

“Appeals & Grievances in Managed Long Term Care – Consumer Rights: July 1, 2015 Changes,” by the New York Legal Assistance Group http://www.wnylc.com/health/entry/184/

•

“Information and Resources for Submitting Correct ICD-10 Codes to Medicare,” by the U.S. Centers for Medicare and Medicaid Services http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNMattersArticles/Downloads/SE1518.pdf

For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.

HCA’s Technology Symposium and Vendor Showcase

June 16, 2015 – Albany Marriott – Wolf Road, Albany, NY Online registration available at www.eventville.com/hcanys

HCA’s Technology Symposium Helping you make the jump from ‘dial‐up’ in an increasingly ‘broadband’ health care world Integration, connectivity and data flow are the lifeblood of our evolving health care system. To make the cut as a partner with hospitals, physicians, and payors, home care providers must include technology investment as a core part of your strategic business planning. HCA recognizes the central role of data exchange and patient care tools for all aspects of your operation: from managing care‐transitions to the analytics that offer you tangible results about home care’s value‐ proposition for DSRIP networks and other collaborative models. Meanwhile, as the state and federal governments pursue value‐based payments, technology is certain to play a leading role in the pivot towards “value over volume.” Now more than ever, you need to be mindful that the technologies which have aided you in the past may not be up to speed for these and other kinds of partnerships and payment models. In other words, dial‐up service no longer cuts it in an increasingly broadband health care world. This is why HCA is offering a one‐day Technology Symposium to help you navigate all the paths of opportunity and to gain a better understanding of tools and trends available for satisfying today’s state and federal health initiatives. You’ll hear from policy leaders, industry experts and trend‐setting peers with insight, case examples and practical solutions for utilizing the latest home care technologies to ensure your success in meeting the clinical demands, partnership expectations, and improvement standards that will determine your success as a provider of home care services in your community. This learning opportunity is vital as HCA works at the advocacy level to promote targeted and enhanced investments in this priority area.

AGENDA – Tuesday, June 16 8:15am

Registration and Vendor Showcase Pick up your valuable handout materials, a cup of coffee and then explore the products and services showcased by vendors who will be exhibiting throughout the day. 8:45am HCA Welcome 9:00am

New York’s Technology Investments and Priorities Hear from two state policymakers about the direction New York State is taking in support of technologies aimed at enhanced quality of care and greater opportunities for your organization. Learn how technology is a key ingredient to the success of new payment models like DSRIP, Value Based Payments, Managed Long Term Care, Fully Integrated Duals Advantage and other efforts where you need to be thinking strategically about your use of technology. Patrick Roohan, Director, Office of Quality and Patient Safety, NYS Department of Health Lynda Karig Hohmann, MD, PhD, MBA, Medical Director, IPRO, Division of Program Development and Management, Office of Health Insurance Programs, NYS Department of Health 10:45am

How the SHIN‐NY Can Support Your On‐Demand Health IT Connectivity. The Statewide Health Information Network of New York (also known as SHIN‐NY) allows health care stakeholders to securely access a patient’s electronic health records wherever and whenever needed. Learn how home care can connect to this network, improving patient care and achieving greater efficiencies. Elizabeth Amato, Director of Statewide Services, New York eHealth Collaborative

AGENDA – continued 11:30am

Regional Health Information Organizations: Expanding the Network New York State is leading the nation in adoption of Regional Health Information Organizations (RHIOs). This session will reveal the benefits and practical application of RHIOs and how home health providers can play a greater role in collaboration with these organizations to better manage population health and control costs. Mark McKinney, Chief Executive Officer, Hixny 12:30pm

Networking Lunch

Lunch Sponsor

Take advantage of lunchtime networking opportunities to share with your colleagues what you have done to improve efficiencies, reduce costs and enhance care within your agency through the use of technologies. Be sure also to take time to visit with the ten vendors who will be on hand at the conference to support your application of home health technology. 1:15pm

Potential Opportunities for Home Health in the Technology Arena While the state is making important strides on policies and regional health information structures to support your health IT connectivity, many of the novel product partnerships and innovations are happening at the grassroots R&D level from providers – like you – in the field. In this session, you will hear some concrete case examples from your home health provider peers who are using various technology products in an innovative way to improve patient satisfaction, care outcomes and cost efficiencies. 2:15pm

Nanotechnology – The Technology of Tomorrow Nanoscience is the chemistry of building new materials on such a minute scale that they are invisible to the naked eye. This area of innovation is destined to become the next industrial revolution that will undoubtedly leave a huge impression on the health technologies of the future, especially as health IT and related service products become a growing part of the provider and consumer experience. The nanoscience field has already begun to break exciting new ground on cancer cures, replacing worn out genes and medicinal robotics. Learn why you should pay attention to this exploding science and how it may affect the future of your clinical interactions with home care patients. Susan Brenner, MD, MPH, Assistant Vice President for NanoHealth Initiatives, Assistant Professor of Nanobioscience, SUNY Polytechnic Institute, Colleges of Nanoscience & Engineering.

3:15pm

Vendor Showcase Ten vendors who provide technological products and services in the areas of IT, operational efficiencies, and analytical software will be on hand to show how these products can support population health and clinical applications. This is a great opportunity to visit with these suppliers all in one day at one location. 4:00pm Adjourn

Registration Registration Deadline is June 10.

HCA’s Technology Symposium

_______________________________________________ Name

and Vendor Showcase

_______________________________________________ Title

June 16, 2015 Albany Marriott Wolf Road, Albany, NY Register online at: www.eventville.com/hcanys or FAX this form to (518) 426‐8788.

_______________________________________________ Agency _______________________________________________ Address _______________________________________________ City/State/Zip _______________________________________________ _______________________________________________ Email (Required)

Payment $219 HCA Member $299 Non‐Member

________ ________

_____ VISA ______ MC _____ AM EX Credit Card No.__________________________________ Expiration Date:_____________ Sec. Code:___________ Card Billing Address:______________________________ ________________________________________________ Name on Card:___________________________________ Signature:_______________________________________ Or, make checks payable to: HCA Education and Research and mail to 388 Broadway, 4th Floor, Albany, NY 12207 Checks must be received by June 12.

Vendors On‐Site:

Special Accommodations: In accordance with the Americans with Disabilities Act or special meal needs, please let us know how we can accommodate you: _____________________________________________________ _____________________________________________________

Cancellation Policy:

Cancellations received by June 5 will receive a full refund, less 25% of total due as an administrative fee. Cancellations received on June 6 or later will forfeit their registration fee, as will those who register and do not attend. Substitutions are permitted.

FAX TO: (518) 426‐8788

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.

____________________________________________________ Name ____________________________________________________ Title