June 24, 2016 Edition of ASAP

ASAP

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

Legislative Issues  Public Policy

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News

Volume 21, No. 25 June 24, 2016

QIVAPP and FLSA Funds Awaiting Approval HCA has received a further update on the expected date that home care providers can expect to receive the federal share of add-on monies for labor-related expenses.

The update includes monies for the Quality Incentive Vital Access Provider Pool (QIVAPP) program (for April 1, 2014 to March 31, 2015) and the Fair Labor Standards Act (FLSA) changes (October 13, 2015 to March 31, 2016).

The state Department of Health (DOH) has confirmed that there are two rate packages to pay for these adjustments awaiting approval from the state Division of the Budget (DOB). DOB returned the QIVAPP See FUNDS p. 2

Comments Solicited on Home Health Pre-Claim Review Demo

Guidance on LTHHCP Authority, Roles Now Under DOH Review

The U.S. Centers for Medicare and Medicaid Services (CMS) is taking comments on its recently announced Medicare Home Health Pre-Claim Review Demonstration until July 21.

Following up recent discussions with state officials, HCA this week provided the Department of Health (DOH) with background for a planned DOH letter or directive updating the status of the LTHHCP. See LTHHCP p. 5

The announcement is in the June 21 Federal Register at https://www.gpo.gov/fdsys/pkg/FR2016-06-21/pdf/2016-14569.pdf.

Inside ASAP

See DEMO p. 3

QIVAPP, FLSA Funds Awaiting Approval.............................................1 Guidance on LTHHCP Authority, Roles Now Under DOH Review.......1 Comments Sought on Pre-Claim Review Demo...................................1 Member Hiring Announcement...........................................................3 Important HCA Events and Education Updates.............................6-7 DOH Posts 2015 CHHA Cost Report Software...................................8 Final 2016 CHHA Pediatric Rates Posted..............................................8 Update on $200M Health Care Pool..................................................9 Next Week is Last Weekly ASAP for Summer........................................9 Plans Vet Final Draft Uniform Billing Codes......................................10 Managed Care Update................................................................10 HCA Input Shapes “Workforce Center of Excellence” Initiative......11 HCA Comments on 2017 Hospice Proposed Rule............................12 Hospice Quality Reporting: Annual Payment Update......................13 Support Your Coders at July ICD-10 Training....................................13 HCA Attends Hurricane Sandy Recovery Workshop........................14 NGS Closed July 4..............................................................................14 UAS-NY Courses Updated.................................................................15 Medicare Trust Funds Report Issued.................................................15 Webinar Held on NHTD/TBI Transition Plan.......................................15 Medicare Part D Update.....................................................................16 Publications.........................................................................................16

Save the Date: HCA’s popular Senior and Financial Managers Retreat is coming on Sept. 8-9 at the Mohonk Mountain House in New Paltz. We’ll have registration and more information coming to you next week. Be sure to mark your calendars now!

Helping New Yorkers Feel Right At Home

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

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FUNDS from p. 1 rate package back to DOH and it will be resubmitted to DOB in a few days. It is not known how long it will take DOB to approve the rate packages; but once they are approved, the rates will then take about six weeks to get loaded into the system. At that time, MLTC plans would receive the funds. Then the plans will have a to-be-determined time to distribute monies to their contracted home care providers.

Assuming that DOB approves the rate packages sometime in July, home care providers will not receive QIVAPP and FLSA funds until the fall.

HCA has repeatedly voiced our objections to the method of distributions for these funds. In either case or for both (QIVAPP and FLSA), the funds have been hamstrung by restrictive eligibility requirements, untimely rate approvals, uneven distributions and unclear guidelines for providers and managed care plans alike.

HCA continues to work with the Department on improvements to the distribution methods, especially as we represent the industry in stakeholder meetings on the minimum wage hike, set to go into effect on December 31, and the need for appropriate, timely and complete funding of this added cost to the home care system.

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

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

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DEMO from p. 1 As mentioned in the June 20 ASAP, CMS changed its “prior-authorization” demonstration in five states (Illinois, Florida, Texas, Michigan and Massachusetts) to a “pre-claim review” program following vigorous objections raised by HCA, our association partners, and many Congressional Representatives.

While New York is not part of the Demonstration, CMS has stated that it may extend pre-claim review to other states depending on its experiences and findings in the test states.

Resources on the pre-claim review, including a fact sheet and Frequently Asked Questions document, are at https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/MedicareFFS-Compliance-Programs/Pre-Claim-Review-Initiatives/Overview.html.

Various pre-claim review scenarios are at https://www.gpo.gov/fdsys/pkg/FR-2016-06-10/pdf/201613755.pdf.

CMS describes pre-claim review as a process where a request for provisional affirmation of coverage is submitted for review before a final claim is submitted for payment. A pre-claim review differs from prior-authorization in two important ways: 1) the timing of the review, and 2) when services may begin.

For prior-authorization, a request must be submitted, and providers must wait for a decision, before initiating services. This was a major problem with CMS’s original proposal.

Under the revised demonstration, a 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

HIRING Job Position: Patient Service Manager-Quality Management (Montefiore Home Health Agency) BS in Nursing required. Candidate must have a New York State Registered Professional Nurse License and current Registration to practice nursing. Must have a valid NYS driver’s license with registration and insurance. Candidate is responsible for planning, supervising, coordinating, and evaluating patient care services provided by the nursing staff employed directly by MMC or through contract with the CHHA/LTHHCP. Required Qualifications:      

Current NYS RN License and Registration; BSN required, Master’s in Nursing preferred.

Minimum of three years of Home Care QI experience.

Knowledge of Home Care regulations (i.e. Joint Commission/DOH).

OASIS certified preferred. Coding certified preferred.

Knowledge of Excel/Power Point.

Education experience preferred/strong presentation skills.

Please apply directly through our website: www.montefiore.org/careers.

MMC is an equal opportunity employer and will not discriminate against any employee or applicant for employment because of race, color, religion, gender, sexual orientation or national origin.

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beneficiary, and before the final claim is submitted for payment. Pre-claim review must be requested for each episode of care.

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including the signed physician order and certification, to be required under the pre-claim review. HCA has contacted CMS to confirm this, as it would be contrary to current regulations, which allow for submission of signed orders/final claims up to one year after the start of services.

If the initial pre-claim review request is nonaffirmed due to an “error,” then a home health agency (HHA) 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 HHA during the pre-claim review process to explain what documentation is needed and why a prior submission was insufficient.

June 28 Open Door Forum CMS has scheduled an additional Open Door Forum on the pre-claim review demonstration for June 28 (2 to 3 p.m.). You can participate by calling 1-800-837-1935, conference ID# 94883951. (It is suggested that you call ten minutes prior to the start.)

If the pre-claim review request is not approved, and the claim is still submitted by the HHA, the claim will be denied in full, but the HHA and beneficiary will be able to appeal that determination.

Rationale for Demo 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.

Technical Updates from June 14 Open Door Forum CMS’s June 14 Open Door Forum on the preclaim review demonstration drew concerns, expressed by one participant, about the problem of obtaining documentation by physicians and the need for education targeted to the medical community.

HCA has argued that the physician F2F encounter requirement is responsible for the large number of documentation issues targeted by this Demonstration, due to the onerous and unworkable way it has been administered by CMS and the MACs. HCA will continue to advocate for reforms to simplify the F2F mandate so that it can be met by HHAs and ordering physicians.

HCA has actively engaged the Medical Society of the State of New York (MSSNY) on a variety of home care documentation and authorization issues. Most recently, we cosponsored a Medicare Face-to-Face (F2F) education program with MSSNY, the Healthcare Association of New York State and National Government Services (New York’s MAC) to establish more uniform understanding among all the sectors about their shared responsibilities for documentation and authorization of home care services.

Member Feedback Sought HCA submitted comments on the initial priorauthorization demonstration and is considering submitting remarks on the new pre-claim review process. We encourage members to send us any comments or concerns so we can assure that every angle is addressed in our comments. Your feedback can be e-mailed to info@hcanys.org (please copy Andrew Koski at akoski@hcanys.org).

During the Open Door Forum, CMS seemed to indicate that it expects the full documentation,

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LTHHCP from p. 1

The document would be provided to LTHHCP providers, managed care plans, hospitals, Performing Provider Systems, physicians, local social services districts and other key stakeholders. It would clarify the continuing authority and array of roles for LTHHCPs in New York’s evolving health care system. It is intended to provide assistance and guidance to LTHHCPs and all system stakeholders on the LTHHCP, considering the advent of LTHHCP-recipient enrollment into managed care and DOH’s recent General Information System (GIS) communication regarding the LTHHCP waiver.

The HCA background language offered collaboratively to DOH aims to affirm (and put to rest any question as to) the ongoing operational authority of LTHHCP providers, as well as to outline roles and opportunities for LTHHCP providers and partners under the reformed policies of the state. It will provide much-needed clarification for LTHHCPs, system partners and sources of referral.

As reported in ASAP and a recent e-mail alert, HCA has posted a six-question survey on the LTHHCP to assist in this collaborative effort with DOH. The survey is at https://www.surveymonkey.com/r/BQDX3N8. If you are an LTHHCP provider – even if all of your patients have since enrolled in managed care – your participation in the survey is needed!

Please take a moment to complete the survey today. Thank you to all LTHHCP providers who have already responded, and stay tuned for further progress reports.

For further information, please contact Al Cardillo at acardillo@hcanys.org.

Have You Committed to Bring The Vote Home?

Learn more, and commit to participate, by clicking the “Join Us” tag at http:// www.bringthevotehomeny.org/.

We’ll continue to follow up with you soon to further urge your participation.

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SAVE THE DATE for These  Make Sure You REGISTER for This 

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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/events-education/ upcoming-events.

Skin & Wound Care Management Live Training Courses HCA members receive a discounted rate ($300

off 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:  

July 11-15, 2016 at Uniondale, NY October 24-28, 2016 at Elmhurst, NY

The Art of ICD-10-CM Coding for Home Health July 13 and 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 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.

Also available free to HCA Members through the Wound Care Education Institute is an array of on-demand webinars using the code “HCANYS”.

Visit our website for brochures and details.

Addressing Factors that Increase Workers’ Compensation Costs and Developing Ways that Home Care Providers Can Reduce Their Expenses

Blueprint for OASIS Accuracy

130 East 59th Street New York, NY 10022 9 to 9:30 a.m. registration and continental breakfast; 9:30 a.m. to noon program

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.

September 28, 2016

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 risk-management 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 represents some of the region’s largest and most highly respected businesses to negotiate commercial insurance and risk-management program terms, conditions and pricing.

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DOH Posts 2015 CHHA Cost Report Software The state Department of Health (DOH) recently posted the 2015 Medicaid cost report software for non-hospital based CHHAs. The posting is on the Health Commerce System at https://commerce.health.state.ny.us.

This week’s CHHA post follows a posting last month of the 2015 LTHHCP report.

The CHHA cost report, operator’s certification and accountant’s certification are due no later than September 15, 2016.

An accompanying Dear Administrator Letter (DAL) emphasizes that the inclusion of non-CHHA data in the cost report (in particular, LTHHCP costs) is inconsistent with the declaration made in the operator’s certification that the included costs are “incurred to provide patient care service in the CHHA and that the costs shown as attributable to the CHHA are not a duplication of costs reported for use in the calculation of reimbursement rates for other programs.” Thus, CHHAs should not include LTHHCP costs or other nonCHHA costs in the report.

Please note the following change: 

General Information Page 1 – Providers must enter the Begin Date and End Date of the period covered by the report (lines 015 and 016). If your agency’s Medicaid operating certificate was in effect on or before January 1, 2015, and remained in effect through December 31, 2015, please enter beginning and ending dates of January 1, 2015 and December 31, 2015, respectively. If your agency’s operating certificate was effective after January 1, 2015, please enter the effective date as the Begin Date. If the operating certificate was discontinued during 2015, due to closure or sale of the agency, please enter the last date it was in effect as the End Date.

For questions, contact the helpline at 1-866-529-1890. Specific questions regarding the CHHA cost report should be directed to DOH’s Charles Toby or Tim Casey at (518) 473-4421.

For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

Final 2016 CHHA Pediatric Rates Posted The state Department of Health (DOH) this week posted the 2016 final fee-for-service (FFS) “Hotline” Medicaid rates for non-hospital-based CHHAs that filed a properly certified, full-year 2014 cost report.

These agency-specific rates should be used for patients who are exempt from the CHHA Episodic Payment System (EPS), such as pediatric patients. They are located in the “Rate Publication Selection List” drop-down under the date of June 20, 2016 on the Health Commerce System (HCS). DOH has also posted a corresponding Dear Administrator Letter (DAL).

These rates, effective January 1, 2016, reflect a zero percent roll factor adjustment. They also include a 4.7 percent uniform percentage rate add-on payment for the Recruitment, Training & Retention (RT&R) funding (Section 3614.9) to qualifying providers for the period of January 1, 2016 through December 31, 2016 as well the 3 percent rate add-on for the RT&R funding (Section 3614.8) to qualifying providers (CHHAs who

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submitted a signed attestation) for the same time period. According to DOH, the statewide administrative and general (A&G) cap for CHHAs in 2016 is 26.16 percent.

CHHAs have 30 days (from the receipt of the DAL) to file an appeal with DOH’s Bureau of Managed Long Term Care. However, the appeals process only applies in cases where the 2016 final rates have changed from the 2016 initial rates.

As reported on p. 8 of this week’s ASAP, the state has also posted the 2015 non-hospital-based CHHA cost report software on the HCS. The 2015 cost report is due by September 15, 2016.

For specific questions about your rates, contact DOH’s Charles Toby or Tim Casey at (518) 473-4421.

For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

Update on $200M Health Care Transformation & Infrastructure Pool HCA partnered with the Community Health Care Association in working throughout the state budget process to allocate major new infrastructure funds to the community health care sector. As previously described, these efforts resulted in the final budget providing for a $200 million health care “transformation and infrastructure funding pool,” with at least a $30 million floor in investment funds reserved for community health providers.

This program is currently being implemented by the state Department of Health (DOH) and the state Dormitory Authority (DA).

The statute for this program requires that DOH and DA provide the Legislature with their agreement for “purposes of awarding, distributing and administering the funds” allocated under this program, no less than 30 days prior to the release of the planned Request for Applications (RFA) for the funding. The agreement, appending the RFA, was submitted to the Legislature approximately two weeks ago, giving until roughly mid-July for the Legislature’s reaction prior to implementation.

Following legislative review, the RFA will be readied for public release.

Because of strict state procurement restrictions, the RFA is not being shared in advance with the public for review or input. However, HCA 9

Next Week is Last Weekly ASAP for Summer HCA to begin news clip updates HCA reminds members that we will be publishing our ASAP newsletter every other week during July and August. Next week is our final weekly ASAP until September but you can be assured we’ll send you alerts and other updates by e-mail as needed.

As we alternate weeks for ASAP, HCA will also begin sending you a new communications feature: a home care news clips update that will share a series of links about home care and other health-related news from traditional media, blogs, and other sources, flagging certain articles of interest. You can expect to start seeing these clips in early July.

For any questions about HCA’s communications, please contact HCA Communications Director Roger Noyes at rnoyes@hcanys.org.

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will be monitoring its status closely and providing home care agencies with notice of its availability immediately upon its posting/release.

HCA urges all members to explore the opportunities under this funding when released. Securing this funding was a major, and urgently needed, resource gain for home care this session, and an important success of the HCA advocacy team.

For further information, please contact Al Cardillo at acardillo@hcanys.org.

Plans Vet Final Draft Uniform Billing Codes for Home Care-Managed Care The implementation of uniform billing codes for home and community-based services under Medicaid managed care continues to proceed. Most recently, the state Department of Health (DOH) has sent sample codes to the plans for their final feedback.

As reported in many previous editions of ASAP, HCA and other provider associations have been working for over a year on developing uniform billing codes, as required by a provision of the 2014-15 state budget. After much work, the associations agreed on codes for personal care, home health, consumer-directed services, telehealth, medication dispensers, and adult day health care services.

DOH has given the managed care plans a final opportunity to review the draft codes and provide “critical feedback that would prevent plans from implementing these codes.” The deadline for such responses is June 30.

The uniform billing requirement – along with a requirement that plans pay electronic claims from providers via electronic funds transfer – was sought by HCA to help home care agencies and their managed care contractors by simplifying billing procedures and facilitating timely payments for agencies.

HCA will keep members apprised of any further new developments.

For more information, contact the HCA Policy staff.

Managed Care Update This week’s Medicaid Managed Care Advisory Review Panel meeting, held by the state Department of Health (DOH), provided updates on the Fully Integrated Duals Advantage (FIDA) program, as follows: 

Four FIDA Frequently Asked Questions (FAQs) were posted at https://www.health.ny.gov/ health_care/medicaid/redesign/mrt_101.htm. These relate to: 1) the Integrated Appeal and Grievance Process; 2) HARP-like benefits, Health Homes, and Hospice; 3) FIDA Reforms; and 4) FIDA Open Questions.

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DOH and the U.S. Centers for Medicare and Medicaid Services (CMS) revised the 2017 priorauthorization requirements for FIDA plans. Effective January 1, 2017, it will be left to each

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plan’s discretion whether to require plan or Interdisciplinary Team (IDT) prior-authorization for many FIDA-covered services. 

FIDA letters will be sent to potential FIDA providers, in addition to consumers who meet any of the following three categories: 1) joined managed long term care after December 2015; 2) opted out of FIDA and live in zip codes where the more active, interested FIDA plans have the most enrollment; and 3) opted out and live in zip codes with the highest Medicare advantage enrollment.

DSRIP Timeline Updated The Delivery System Reform Incentive Payment (DSRIP) program Year 2 Timeline has been updated to reflect recent changes to key DSRIP deliverables.

The updates include the opening of a Medicaid Analytics Performance Portal (MAPP) in August for performing provider systems (PPSs) to add providers to their performance networks as well as the announcement to PPS Leads informing them of the opportunity to submit additional Regulatory Waiver Request applications by August 1.

PPSs must submit their Primary Care Project Narrative by August 31. The timeline also includes several deliverables related to Mid-Point Assessment recommendation public comment periods and Project Approval & Oversight Panel review.

The DSRIP Year 2 Timeline is available at: http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/timelines/index.htm.

Questions about the Timelines can be directed to DSRIP@health.ny.gov.

HCA Input Helping to Shape DOH “Workforce Center of Excellence” Initiative HCA input is making its way into the $245 million “Workforce Center of Excellence” (WCE) initiative planned by the state Department of Health.

The initiative, which has been extensively described in prior editions of ASAP, is to be funded with the state’s federal Medicaid waiver. Funds would flow through premium adjustments to MLTC plans – and from plans to the eventual DOH-designated WCEs. This week, HCA provided another in a series of comments and recommendations on the Department’s draft WCE plan.

To date, HCA input has already been reflected in elements throughout the draft plan, including: scope and types of education and training programing that could be covered for providers; the ability of providers or provider networks to conduct WCE training; assurance of provider input on regional workforce capacity, training and education needs; and provider input on WCE implementation and evaluation.

This week, HCA offered or reasserted several recommendations for: funding options/flexibility (through a “state pooled funding” approach); language changes to appropriately reflect the provider’s role as the 11

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employer and deliverer of service; a direct provider consortium role serving as WCE; additional options for funding; use of “shelf-ready” models of education, training and special skill development; and regulatory flexibility.

HCA also continues to assert the parallel need for adequate funding to (and through) managed care and fee-for-service to cover basic and in-service home care aide and professional training.

HCA will keep the membership closely apprised of the progress and timetable for launch.

For further information, please contact Al Cardillo at acardillo@hcanys.org.

HCA Comments on 2017 Hospice Proposed Rule This week, HCA submitted extensive written comments on the 2017 proposed rule for Medicare hospice payment updates, wage index changes and quality reporting recently posted by the U.S. Centers for Medicare and Medicaid Services (CMS).

HCA’s comments have been posted to the “Letters and Comments” Section of our website at http://hca-nys.org/category/letters-and-comments. See top item.

One concern addressed in our comments relates to CMS’s Medicare Choice Model (MCCM), where Medicare beneficiaries and dually eligible beneficiaries are able to receive hospice-like support services from certain hospice providers while concurrently receiving services provided by their curative care providers.

All three New York hospices participating in the current MCCM demonstration are HCA members; however, we have heard concerns about access for beneficiaries who cannot meet the 14 individual requirements before enrolling in the demonstration. Plus, CMS is only paying hospices $400 per-beneficiary per-month for palliative services. HCA urges CMS to loosen some of the requirements and increase the monthly capitation so providers can meet their costs while participating in this model.

On the payment side, our comments specifically address several items in the proposed rule, including revisions to the service intensity add-on (SIA) payment, so that other disciplines such as Licensed Practical Nurses (LPNs) can be included in the SIA, and issues with the wage index, which is particularly problematic and in need of revision.

We provided item-by-item comments on quality reporting elements of the proposed rule, such as the Hospice Quality Reporting Program (HQRP) data submission process and future quality measures; the impact of Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey results on 2017 payments (an unfunded mandate in need of reimbursement support); and the issues associated with live discharge rates and double billing of Medicare Part D Medication Costs incurred on behalf of hospice beneficiaries.

For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

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Hospice Quality Reporting: Annual Payment Update The U.S. Centers for Medicare and Medicaid Services (CMS) is mailing notifications to hospices that are not in compliance with Hospice Quality Reporting requirements. According to CMS, all notifications will be mailed by June 29.

Since Calendar Year (CY) 2015 and after, CMS considers both Hospice Item Set (HIS) and Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data from January 1 through December 31 to determine the Annual Payment Update (APU) compliance threshold.

Hospices that receive a notice of non-compliance have an opportunity to submit a request for reconsideration on quality data submissions affecting their FY 2017 APU. CMS has provided reconsideration instructions in the notification letter and its Reconsideration Requests website at: https:// www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-QualityReporting/Reconsideration-Requests.html.

For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

Support Your Coders: July ICD-10 Training for Reimbursement, Regulatory Compliance Is your coding team fluent with ICD-10?

They need to be confident, so that you can be confident, too, about the big picture concerns for your agency; ICD-10 substantially impacts your reimbursement and regulatory compliance.

Summer is a great time to devote some hours for your staff to brush up on their skills for coding accuracy.

On July 13 and 14, HCA is sponsoring the popular workshop The Art of ICD-10-CM Coding for Home Health in Nanuet (Rockland County), accessible for agencies downstate and upstate alike.

Be sure your staff is registered.

This program is especially well timed, as thousands of new diagnosis codes across all disciplines and settings are about to hit the system in October, just one year after ICD-10 was implemented.

ICD-10 was a big enough change requiring continuing education. Now is an excellent time for your team to brush up on last year’s changes just as another set of new codes is queued for the fall. Best yet, your team is eligible for contact hours for attending!

This two-day program is led by Sparkle Sparks, a Senior Associate Consultant with OASIS Answers, Inc., an AHIMA-approved ICD-10-CM coding instructor, and a seasoned expert in the area of diagnosis coding.

Your team will develop basic ICD-10-CM coding skills and foster good habits crucial to coding success, coding accuracy and regulatory compliance.

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Continued from previous page Please make sure that your coding staff, at all levels, take advantage of this opportunity to drill-down into their coding practices, which will have a concrete impact on your organization when your team returns from this focused training. See the brochure and online registration links below.

Brochure: http://hca-nys.org/wp-content/uploads/2016/01/ArtofICD-10CodingJuly2016-Flyer.pdf Register online: https://www.eventville.com/Catalog/EventRegistration1.asp?EventId=1011834

HCA Attends Hurricane Sandy Recovery Workshop This week, HCA attended an event hosted by multiple government stakeholders on “Hurricane Sandy Recovery: Best Practices and Lessons Learned from Home and Community-Based Service Providers.”

The event was hosted by the National Association of County and City Health Officials (NACCHO) in partnership with the Office of the Assistant Secretary of Preparedness and Response (ASPR) of the U.S. Department of Health and Human Services (HHS).

NACCHO organized the event. It convened home and community based service (HCBS) representatives, local health department representatives, and other stakeholders to hear from federal and local officials as well as discuss challenges and lessons learned from the experience before, during and after Hurricane Sandy.

There was also a focus on best practices for the future.

Many of the themes that emerged during the day mirrored feedback from HCA members about their experiences during and around the time of Hurricane Sandy. HCA will continue to advocate for home care providers in the emergency preparedness realm, and work to ensure that many of the challenges encountered as a result of Hurricane Sandy continue to be examined and addressed in advance of future disasters.

A big component of this strategy is HCA-developed “essential-personnel” legislation (S.6692/A.9381B) passed by the Legislature in the just-recently completed session. The bill, extensively summarized for the membership, would address access restrictions during emergencies, like the access issues encountered by providers during Hurricane Sandy. It would also address the need for home care input in local emergency management planning. HCA will be seeking assistance from the membership in advocacy addressed at the Governor for his signature of this bill. The bill was amended this year, mindful of concerns raised by his administration in its veto of similar past measures.

NGS Closed July 4 National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), will be closed on Monday, July 4, 2016, for Independence Day. This includes the following departments: Electronic Data Interchange (EDI) Help Desk; Provider Contact Center; Provider Enrollment Line; and the Telephone Reopening Unit. Electronic claim files transmitted after 5 p.m. on Friday, July 1, will have a claim receipt date of Tuesday, July 5, 2016. EDI front-end acknowledgement transactions will be created as expected as EDI claim files are received. The Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE) Provider Online System will be available

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

Volume 21, No. 25 June 24, 2016 

on Friday, during regular hours. While DDE will be available, there will be no support available to respond to any issues.

Providers will be able to access NGSConnex and use NGS’s Interactive Voice Response (IVR) system at 1-866-275-3033. NGS’s offices will reopen on Tuesday, July 5 for normal business hours.

For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

UAS-NY Courses Updated The state Department of Health (DOH) advises users of the Uniform Assessment System (UAS-NY) that two courses have recently been updated.

These include: Course 1011 (“Supervisory Roles in the UAS-NY”) and Course 2300 (“UAS-NY Offline Client”). Both courses contain new content and DOH recommends that these courses be revisited.

For more information, contact The UAS-NY Project Team at (518) 408-1021 or uasny@health.ny.gov.

Medicare Trust Funds Report Issued This week, the U.S. Centers for Medicare and Medicaid Services (CMS) announced that the Medicare Trustees project – the trust fund that pays for Medicare Part A hospital insurance benefits – will be funded until 2028.

In 2028, the Medicare Part A trust fund revenues are projected to cover 87 percent of program costs. This is two years earlier than last year’s report which found that the fund would remain solvent until 2030.

The Trustees’ report says Medicare will be insolvent two years earlier than predicted in the last two Medicare trustees’ reports due to lower estimated payroll taxes and a slower decline in inpatient stays.

The Trustees found that the Supplementary Medical Insurance (SMI) trust fund, which funds Medicare Parts B and D, is adequately financed over the next 10 years and beyond because premium income and general revenue income for Parts B and D are reset each year to cover expected costs and ensure a reserve for Part B contingencies.

More information is at http://tinyurl.com/hn3k3lc.

Webinar Held on NHTD/TBI Transition Plan This week, the state Department of Health (DOH) held a webinar on the transition of the Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) waiver programs to managed care.

The webinar handouts, along with the draft plan and other materials, are posted at http:// www.health.ny.gov/health_care/medicaid/redesign/mrt90/tbi-nhtd_waiver_trans_ingo.htm.

The June 10 ASAP includes a detailed description of the transition plan.

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Volume 21, No. 25 June 24, 2016

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



Medicare Part D Update The U.S. Centers for Medicare and Medicaid Services (CMS) has announced the cost sharing amounts under the Medicare Part D drug benefit.

For 2017, they are: 

Annual deductible of $400 (up from $360 in 2016);



Initial coverage limit of $3,700 (up from $3,310); and



Drug copayments, after “catastrophic” coverage is reached, of $3.30 for generic drugs (up from $2.95) and $8.25 for brand name drugs (up from $7.40).

Copayments are lower for individuals who receive Extra Help (low-income assistance) or who are on Medicaid.

Publications 

“You Get What You Pay for: Measuring Quality in Value-Based Payment for Children’s Health Care,” by the United Hospital Fund http://nyshealthfoundation.org/uploads/resources/value-based-payment-in_childrenshealth-care-june-2016.pdf



“Alert: Improper Arrangements and Conduct Involving Home Health Agencies and Physicians,” by the federal Office of Inspector General http://oig.hhs.gov/compliance/alerts/guidance/HHA_%20Alert2016.pdf

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

16

Platinum Sponsor Gold Sponsors

July 12 – 13, 2016 Marriott Marquis Washington, DC

Public Policy Summit Washington, DC

Day 1 Tuesday, July 12, 2016 Shaw/LeDroit Park Room 7:30am– 8:30am

Registration and Continental Breakfast 8:30am – 9:45am

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.

9:45am –10:00am – Break 10:00am – 10:45am

Insights from CMS Speaker: Pierre L. Yong, MD, MPH, MS, Acting Director of Quality Measurement and Value-Based Incentives Group (QMVIG) in the Center for Clinical Standards and Quality at the Centers for Medicare & Medicaid Services (CMS) Dr. Yong oversees development and operations for a variety of CMS quality reporting and value-based purchasing programs. Previously, he was the Director of the Division of Quality Measurement in QMVIG, and the Director of Health Care Quality and Outcomes in the Office of the Assistant Secretary of Planning Evaluation at the U.S. Department of Health and Human Services, where he oversaw projects on value based purchasing, quality, comparative effectiveness research, and data infrastructure for patient-centered outcomes research. Pierre also previously worked at the Institute of Medicine, where he focused on a portfolio of projects related to value and costs in health care.

10:45am – 11:45am

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 – 1:45pm

Lunch Speaker: Yvette Fontenot, Partner, Avenue Solutions Prior to joining Avenue Solutions, Yvette served as the Deputy Director of the Office of Health Reform at the Department of Health and Human Services. The office is charged with developing policy and coordinating and clearing all matters related to the Affordable Care Act and providing outreach to Congress and other stakeholders with interests in health care reform. Prior to joining HHS, Yvette was a Senior Policy Director in the White House Office of Health Reform. At the White House, Yvette was responsible for coordinating the Administration’s work on implementation of the Affordable Care Act. She also briefed and advised senior White House officials about aspects of the legislation and implementation efforts. Before working at the White House, Yvette was Professional Staff with the Senate Finance Committee. Yvette had principle responsibility for provisions of the Affordable Care Act such as individual and employer responsibility requirements, tax credits for the purchase of health coverage, health insurance exchanges, health insurance rating reform, and consumer protection proposals.

Public Policy Summit Washington, DC

Day 1 Tuesday, July 12, 2016 – continued 1:45pm –2:45pm

6:15pm – 7:00pm

Perspective of the MACs

Cocktail Reception – Marriott Marquis

Panelists: Sandy Decker, Senior Provider Education Consultant, CGS Lauri Domingo, RN, Home Care Clinical Consultant, NGS Harry Feliciano, MD, MPH, Senior Medical Director, Palmetto Charles Canaan, Senior Provider Education Consultant, Palmetto Four of the nation’s MAC contractors will discuss the lessons learned and results of the “Probe and Educate” audits currently underway, as well as prior authorization and the face to face regulation.

7:00pm – 9:00pm 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.

2:45pm– 3:45pm

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.

3:45pm – 4:45pm

Panel Discussion: Preparing for Regulatory, Legislative, and Legal Issues Facing Home Health Care Providers Speakers: Nancy Taylor, Shareholder at Greenberg Traurig, LLP Colin Roskey, Executive Vice President of Partnership for Quality Home Healthcare Regulations and legislation affecting Home Health Care delivery are constantly evolving. This panel discussion will provide insight from two experienced healthcare attorneys on issues relating to current fraud efforts, faceto-face requirements, Medicaid changes and other issues.

4:45pm – 5:15pm

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.

Day 2 Wednesday, July 13, 2016 8:30am – 10:00am

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.

10:00am – 4:00pm

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