July 1, 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. 26 July 1, 2016

2017 Medicare Payment Proposal Issued: Read HCA’s Detailed Memo As announced in an alert to the membership this week, the U.S. Centers for Medicare and Medicaid Services (CMS) has released its proposed Medicare Home Health Prospective Payment System (HHPPS) rule calling for a reduction in Medicare payments by 1.0 percent, or $180 million, nationally in 2017. Also this week, HCA has prepared a detailed Public Policy Memo on the 2017 Medicare HHPPS proposed rule.

See MEDICARE p. 3

New HHPPS & Other Reimbursement Insights at Sept. 8-9 Finance Retreat The U.S. Centers for Medicare and Medicaid Services (CMS) has issued its big proposed payment rule for home health (see related p. 1 story above.) HCA invites you to learn more about it, and the broader Medicare payment landscape, during our September 8 to 9 Senior and Financial Managers Retreat at the scenic Mohonk Mountain House in New Paltz.

See RETREAT p. 4

HCA Continues Multi-faceted Campaign for Minimum Wage Funding This week, state health associations joined together by conference call for the second in a series of meetings, previously convened by HCA, to discuss the minimum wage implementation strategy.

Inside ASAP

See WAGE p. 2

2017 Medicare Payment Proposal and HCA Memo..............................1 New HHPPS, Other Payment Insights at Finance Retreat......................1 HCA Presses Campaign for Minimum Wage Funding...........................1 HCA Invites You to Sponsor Women’s Healthcare Summit...................5 HCA Reviewing Draft Guidance on Medicaid F2F.................................6 QIVAPP and FLSA Funds Approved by DOB..........................................7 Supreme Court Declines to Hear Challenge on FLSA Rule.................7 New Info Posted on Home Health Pre-Claim Review Demo................9 Member Hiring Announcement...........................................................10 Share this Resource with DSRIP, VBP Leads!........................................11 Join Us for Call on “Bring The Vote Home” Next Steps......................12 CMS Posts New OASIS Guidance Manual.........................................13 Filing Deadline Extended for Managed Care Integrity Report..........13 Community First Choice Option Update............................................14 Alert Issued on Home Health Agency and Physician Conduct............15 Governor Signs CHRC Bill Barring Delivery of FBI Info to Providers...16 Emergency Preparedness Update.......................................................17 Clarification Issued on CDPAP Personal Assistants...........................18 OMIG Compliance Certification Forms to be Posted December 1.....18 New Maximum Weekly Workers’ Compensation Benefit Rate...........19 Changes Proposed to Medicare Appeals Process.............................20 LHCSAs: Comments Sought on Draft Private Duty Audit Protocols.......21 Workgroup Releases Care Coordinator Curriculum Guidelines.......21 Information Provided on ACF Do Not Refer List.................................22 eMedNY Trainings Announced...........................................................22 NGS Updates.......................................................................................22 Publications.......................................................................23

Summer ASAP Schedule, Office Closed Monday As previously announced, we are kicking off our summer biweekly ASAP schedule. We won’t be publishing on July 8. The next edition will be on July 15, followed by July 29, August 12 and August 26. As always, we will keep you informed of breaking developments by e-mail alerts.

We will resume regular weekly publication in September and will also be announcing some other new communications features soon.

Office Closed Monday: Our offices will be closed on Monday, July 4, for the Independence Day Holiday. We will reopen July 5 for regular hours.

Helping New Yorkers Feel Right At Home

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

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funding set-aside in this year’s final budget for the minimum wage increase, in a streamlined and unimposing avenue through the plans.

WAGE from p. 1 HCA, the New York State Association of Health Care Providers (HCP), and LeadingAge NY, along with their respective government affairs representatives, continued to discuss advocacy options and strategies best suited to achieve an adequate, timely, and transparent funding implementation process.

A second meeting of the Minimum Wage Stakeholder Workgroup – organized by the state Department of Health (DOH) – is anticipated for early July. HCA looks forward to gaining additional insight into DOH’s intentions for implementation and offering further constructive feedback throughout this workgroup process. Independent of any decisions that are made, HCA will continue to insist that providers must receive direct and adequate funding to accommodate this wage increase.

HCA, along with our association partners, have asserted the critical need for home care providers to receive necessary monies to cover the new costs associated with the minimum wage increase, and for the state to deliver these funds in time for the January 1, 2017 implementation date. HCA holds the position that the money should be passed directly and entirely through to the provider, via a mechanism that presents little to no further administrative burden to home care providers or managed care plans.

As previously reported by HCA, DOH has said it is in the process of working with the U.S. Centers for Medicare and Medicaid Services (CMS) to push for the federal match of this increase. HCA is prepared to work with DOH in this advocacy, urging CMS for a similar increase to reimbursement on Medicare cases.

HCA has spent countless hours developing and refining estimates on the cost to home care agencies of the minimum wage increase and has shared this data with DOH and other provider associations.

On Tuesday’s call, the associations discussed the merits of various strategic pathways and next steps toward realizing a cohesive advocacy approach. We agreed to set up a meeting with managed care plans to discuss our joint positions and ways to collaborate so that home care providers receive the

Please contact HCA policy staff with any questions or concerns.

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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MEDICARE from p. 1

HCA will be preparing comments to CMS on the proposed rule, and we will continue our outreach to New York’s Congressional Delegation opposing CMS’s chronic cuts to home care and detailing their consequences. HCA invites your feedback on any specific components of the proposed rule as we plan next steps for comments and advocacy.

You can download the memo at http://hcanys.org/wp-content/uploads/2016/06/ HCAMemoProposed2017HHPPS.pdf.

The proposed rule establishes rates of payment for Medicare home health services and other regulatory updates in calendar year 2017. HCA’s memo outlines all of the complex payment calculations that would affect your individual agency: rate rebasing, case-mix-weight changes, CMS’s “casemix-creep” adjustment, wage index factors, outlier adjustments, and more. Please also be sure to review the appendices which include an updated table of casemix weights and wage index information.

Following the comment period, which ends on September 5, CMS will be issuing a final version of the rule in mid-to-late fall.

Medicare Focus at Finance Retreat: Sept. 8-9 HCA’s policy memo is the first in a series of information updates and education for the membership about 2017 payment issues. We encourage all home health providers to attend our Senior and Financial Managers Retreat on September 8 and 9 at the Mohonk Mountain House, which will include a session on Medicare payment items and other insights applicable to all payor lines affecting your financial operation. A brochure and online registration are available on the education page of our website at http://hca-nys.org/events-education/upcomingevents.

The memo also provides details on changes to the value-based purchasing pilot in nine states (New York is not one of them); a proposed payment change for negative pressure-wound therapy using a disposable device; a proposal to centralize claims processing; quality reporting updates; and more.

While the proposed 2017 rate changes are consistent with the disastrous rebasing reductions already in effect for the past three years, HCA advises home care finance managers to read our summary carefully and pay particularly close attention to the outlier methodology changes, which are among the more substantial updates in the proposed rule.

D.C. Policy Summit and Advocacy Day We also encourage all Medicare-certified home health members to attend a first-ever multistate Public Policy Summit and Capitol Hill Advocacy Day on July 12 to 13 in Washington. For this Summit, we’re bringing together home care representatives from all over the country through the Council of State Home Care Associations (which includes HCA), as well as Congressional leaders, Medicare contractors, CMS, and D.C. insiders for learning and advocacy. The session will address payment issues, but also burning topics like the Medicare face-to-face requirement. A registration form for this program is also on our website.

As HCA stated in comments this week to Modern Healthcare news, “New York Medicare-certified providers have been operating at a loss on Medicare payments for several years in a row.”

Meanwhile, “60% of New York agencies have reported having to reduce staff or cut other costs to function, and half have used a line of credit or borrowed money for operating expenses over the last two years.”

In the Modern Healthcare article, linked to our Facebook page, HCA also contended that CMS’s “reimbursement cuts haven’t fully accounted for regional variations, such as higher wages for workers and high concentrations of hospital-based certified agencies and dual-eligibles in some areas of the country.”

Please stay tuned for more information and updates, and be sure to attend our upcoming education programs on payment and regulatory matters.

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RETREAT from p. 1 This Retreat is one of our most popular programs. The information is concrete, it’s vital to your financial forecasting, and it comes to you at one of the nation’s most scenic resorts, giving you an opportunity to learn and unwind.

The Retreat features several top experts on payment issues, including Colin Roskey, Executive Vice President at The Partnership for Quality Home Healthcare. Mr. Roskey is a leading expert on Medicare home health payment, regulatory and political issues with incredible call-back of data and a wealth of insights.

The session is well timed, now that CMS just this week issued its Home Health Prospective Payment System (HHPPS) rule calling for payment reductions of $180 million nationally in 2017, including the continuation of rate rebasing, updates to the “case-mix-creep” adjustments and an array of other reimbursement actions.

HCA’s Policy staff will open the program with a full menu of federal and state reimbursement updates (on HHPPS and other issues), setting the stage for Roskey’s forecasts on day two of the Retreat, covering Medicare payment, regulatory and political conditions percolating at the federal level, including HHPPS. The Retreat gives you an opportunity to hear about the latest changes as CMS gears up for the final HHPPS rule.

We have several other exciting sessions planned, including segments on: 

Strategic positioning to assess your strengths when interacting with Delivery System Reform Incentive Payment (DSRIP) programs and other partnership models;

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Implications of employee wage, hour and overtime policy changes;

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Breaking down New York’s Value Based Payment incentives;

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New York State Medicaid policy and reimbursement updates; and

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Emerging workforce development efforts.

To learn more, download the brochure on our education and events page at http://hca-nys.org/events-education/upcoming-events.

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Invitation to Sponsor: First-ever W omen’ Women’ omen’ss Healthcare Leadership Summit HCA is offering several sponsorship opportunities for organizations that want to support — and gain exposure at — e HCA’s first-ever Women’ omen’ss Healthcar Healthcare Leadership Summit on September 28 to 29 in Saratoga. What better or more positive way is there to promote your brand than at this important leadership program for women in healthcare?

The summit will be held at the Excelsior Springs at the Courtyard Marriott, 47 Excelsior Avenue, Saratoga Springs, NY. A full brochure for this summit is coming soon soon. The program aims to empower, inspire and connect women in the field of health care to celebrate current successes, tackle the challenges and sharpen their leadership prowess.

With change comes opportunity, so in this unprecedented era of change in the health care industry, there is an opportunity to foster greater balance in gender diversity within our industry’s leadership.

The issues and necessary skills required of women leaders are comparable to that of their male counterparts; however, the context and conditions for women leaders can be uniquely challenging.

Please support this exciting new program.

Download the brochure today: http://hca-nys.org/wp-content/uploads/ 2016/06/Womens-Summit-SponsorshipBrochure.pdf 5

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HCA Reviewing Draft Guidance from DOH on Medicaid F2F Requirement HCA continues efforts for repeal of existing Medicare F2F requirement, with advocacy aimed at new Medicaid regulation as well In late January, the U.S. Centers for Medicare and Medicaid Services (CMS) issued a final rule regarding a new physician face-to-face (F2F) documentation requirement for CHHA Medicaid home health services.

The following are some key highlights of CMS’s final rule: 

It aligns the new Medicaid requirements with the current Medicare timeframes for the physician F2F encounter. For initial ordering of home health services (nursing and home health aide), the physician must document that a F2F encounter (related to the primary reason the beneficiary requires home health) has occurred no more than 90 days before or 30 days after the start of services. The encounters may occur via an approved telehealth delivery service.

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The F2F encounter may be performed by the physician or certain authorized non-physician practitioners (NPPs). The rule also maintains the role of physicians in ordering Medicaid home health services and medical supplies, equipment, and appliances.

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The final rule does not prescribe how Medicaid F2F documentation must be captured. It does state that the documentation should support the need for what was ordered, but the states will provide specific details on what they will require.

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There is no “homebound” requirement in Medicaid to receive home health services.

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It clarifies that services cannot be restricted to the home.

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The F2F requirement does not apply to personal care services.

While the final rule (CMS-2348-F) for Medicaid F2F is technically effective on July 1, 2016, CMS acknowledged – and state Department of Health (DOH) officials confirmed this week – that provider compliance and DOH enforcement with this requirement must be achieved by July 1, 2017.

The final rule is at: https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-01585.pdf.

Anticipating the impending effective date of this rule, HCA has kept in close touch with state health officials over the past several months seeking any information they could provide about their implementation plan for Medicaid F2F and advocating exemption of Medicaid F2F wherever possible (such as under managed care). We fully realize that Medicaid F2F poses a substantial new administrative burden which needs to be mitigated in every possible way.

This week, officials within the state Department of Health (DOH) Division of Home and Community Based Services have finally shared “draft” guidance with HCA related to the Medicaid F2F encounter requirements for home health services (including medical equipment). That document also includes a detailed Question and Answer (Q&A) section that we will comment on and address concerns. The Department’s Office of Health Insurance Programs (OHIP) and the Division of Long Term Care have also been asked to review and weigh in on the draft document. HCA will notify the membership as soon the Medicaid F2F guidance is finalized.

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Continued from previous page DOH plans to publish the final guidance in the July edition of the Medicaid Update at: http:// www.health.ny.gov/health_care/medicaid/program/update/2016/index.htm. Meanwhile, Department officials are encouraging CHHAs to begin updating their policy and procedures to incorporate this new requirement, while emphasizing that compliance with this requirement is not required until July 1, 2017.

HCA has long advocated with Congress for a repeal of the Medicare F2F rule, and we will now also target the Medicaid F2F requirements to ensure that they are not implemented in a duplicative and onerous way for providers. HCA also continues to work with our F2F provider workgroup, and our multi-association workgroup with the hospital and physician associations to mitigate the burdens and processes of both Medicare and Medicaid F2F. For further information, contact the HCA Policy staff.

QIVAPP and FLSA Funds Approved by DOB Will take time for monies to reach providers According to the state Department of Health (DOH), the state Division of Budget (DOB) has approved rate packages that include the federal share for the Quality Incentive Vital Access Provider Pool (QIVAPP) for April 1, 2014 to March 31, 2015 and the Fair Labor Standards Act (FLSA) changes for October 13, 2015 to March 31, 2016. The date that money will reach providers is not known.

In the past, DOH has said that it takes over a month to load the rates into the system, and, once that takes place, MLTC plans will have 30 days from receipt of payment to pass through the QIVAPP and FLSA funds to their contracted home care providers.

HCA has, and continues to raise many concerns about how these funds were administered and distributed, including restrictive eligibility criteria, unclear guidance for providers and plans, and long delays in the monies reaching home care agencies.

DOH is in the process of finalizing the QIVAPP guidelines for the period from April 1, 2015 to March 31, 2016.

HCA has made a number of suggestions for this round that include more flexibility in health benefit requirements and an opportunity for those agencies denied funding in 2014-15 to apply for the 2015-16 period. HCA will alert members once DOH issues any QIVAPP instructions for 2015-16.

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

Supreme Court Declines to Hear Challenge on FLSA Rule Get the latest on wage, hour & overtime policy changes at Sept. 8-9 Finance Retreat The U.S. Supreme Court on Monday declined taking up a challenge to the U.S. Department of Labor (DOL) rule on the Fair Labor Standards Act (FLSA) changes for home care.

As previously reported, DOL finalized a rule in mid-October rewriting the “companionship exemption” of the FLSA, and eliminating exemptions applicable to agencies that provide home care.

The rule change affects minimum wage and overtime for home care workers nationally. However, because New York State has a state minimum wage law and overtime requirements, the DOL rule change primarily 7

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affects overtime calculations in New York. As a result, New York home care providers must pay aides at timeand-a-half of their regular rate of pay — not time-and-a-half of minimum wage — for purposes of overtime.

Following an extensive comment period on the proposed rule change that drew strong objections from the home care industry as well as some major consumer-advocacy groups, DOL decided to move forward with the proposal, prompting the National Association for Home Care and Hospice (NAHC) and co-plaintiffs to file a lawsuit. The case eventually reached the U.S. Court of Appeals for the District of Columbia Circuit, which ruled in favor of DOL, the last stop before the U.S. Supreme Court.

The Court of Appeals stated that DOL acted within its authority in eliminating minimum-wage and overtime exemptions for agency-based home care workers (even though DOL completely reversed course from its prior position to the Supreme Court in the 2007 Coke case decision), setting a path for the rule change to go into effect. This prompted a request from plaintiffs that the U.S. Supreme Court issue a stay on the rule change as the nation’s highest court weighed its decision about whether to take up the home care community’s appeal.

The U.S. Supreme Court denied a stay of the rule change in October, triggering the rule change to go into effect on October 13, 2015. In this week’s latest development, the U.S. Supreme Court has now denied taking up the case altogether, closing the current effort to settle the matter through litigation. (Each year, the Supreme Court agrees to review only a small percentage of cases submitted for consideration.)

HCA has actively opposed this rule change since the outset because it adds new costs and complexities to the delivery of home care services without commensurate funding. While HCA supports appropriate wages and benefits for home care workers, requisite funding must be supplied to pay for those costs.

Before the rule was implemented, we testified at public meetings, provided written comments on various draft versions of the rule, and offered several education programs for members to help them prepare for the FLSA changes. HCA has also worked with the state Department of Health to develop a survey to measure home care providers’ actual costs due to the changes.

In addition, since the rule was finalized in mid-October, HCA has worked to get the state to deliver funding that covers providers’ new costs in overtime, travel, 24-hour cases, and other related costs. However, this funding has been unevenly distributed, inadequate and untimely, prompting continual HCA advocacy with state officials to ensure a smoother distribution method and to get the funds approved as soon as possible.

HCA has also been strongly advocating for state funding to help home care agencies with the recently increased state minimum wage and argued that the monies must completely go to agencies in a way that avoids the pitfalls and complexities of the FLSA funding.

HCA continues to press for appropriate distribution of the FLSA funds, along with distribution of other payment add-ons for the separate Wage Parity Law. This separate add-on for Wage Parity is called the Quality Incentive Vital Access Provider Pool, or QIVAPP, and both payment packages (FLSA and QIVAPP) are reportedly in the works.

DOH confirmed with HCA that there are two rate packages to pay for these adjustments recently approved by the state Division of the Budget (DOB). (See related p. 7 story.)

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Continued from previous page In addition to our advocacy for funding of FLSA and other labor costs (including legislation aimed at payment adequacy for labor and other unfunded costs), HCA has developed several education programs to assist providers in complying with the rule.

Our just-announced Senior and Financial Managers Retreat on September 8 and 9 in New Paltz includes a segment on “Implications of Employee Wage, Hour & Overtime Policy Changes,” led by labor law attorneys from Hodgson Russ, LLP. It is just one part of a comprehensive program on home care finance issues that we encourage providers to attend. A brochure and online registration are linked below.

HCA will follow up with any updates as we consider next steps in response to the ruling.

Brochure: http://hca-nys.org/wp-content/uploads/2016/06/SrFinanceRetreatBrochure2016.pdf Online Registration: https://www.eventville.com/catalog/eventregistration1.asp?eventid=1011953

New Info Posted on Home Health Pre-Claim Review Demo HCA raises concerns on CMS forum call, CMS responds The U.S. Centers for Medicare and Medicaid Services (CMS) has posted updated and new information on its Medicare Home Health Pre-Claim Review Demonstration. As covered in the past two editions of ASAP, the Demonstration applies to five states identified by CMS as “high-risk”– Illinois, Florida, Texas, Michigan and Massachusetts (not New York), but HCA is closely monitoring this issue because CMS has indicated that it may extend the Demonstration to other states.

Under this Demonstration, the home health agency (HHA) must submit a request for pre-claim review to the Medicare Administrative Contractor (MAC) for each episode of care. The HHA will have to submit documentation from the medical record that supports medical necessity, and demonstrates that the Medicare home health coverage requirements are met (including the face-to-face/F2F encounter). HCA submitted a query about whether signed physician orders must be sent as part of the pre-claim review; as a result, CMS has added instructions confirming that the plan of care must include the physician’s signature and date.

On a CMS Open Door Forum this week, HCA raised concerns about the requirement to have signed physician orders – as opposed to verbal orders – for initiating the pre-claim review process. The pressures of an extensive pre-claim review process will place even greater demands on providers to expeditiously secure physician documentation. While the pre-claim review proposal does not change the deadline for securing signed physician orders – these still must be submitted within one year of the service date, or prior to billing, whichever is sooner – the practical reality is that agencies will have to secure signed orders earlier in the process and this will put enormous pressure on home care agencies who otherwise already struggle to obtained timely, signed orders. This concern was supported by numerous participants in the Open Door Forum, and CMS said that it would reexamine this requirement. Along these lines, HCA has recommended that CMS allow verbal physician orders for purposes of pre-claim review, allowing the signed order to be obtained later in the process, prior to billing of the final claim.

The pre-claim review request may be submitted at any time before the final claim is submitted, and the review process must occur before the final claim is submitted for payment. The FAQs were revised, and HCA confirmed at this week’s Open Door Forum, that there is no longer a requirement that pre-claim 9

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review occurs within 30 days of the start of services, but a pre-claim request can be submitted at any time before the final claim is submitted.

The MAC will send the HHA a decision affirming or non-affirming the pre-claim review request within targeted timeframes of 10 business days of the first request and 20 business days of resubmitted requests.

CMS clarifies in the related documents that if a provider submits a claim for payment without a preclaim review request being submitted, the home health claim will still undergo a pre-payment review (and if determined to be payable, the payment will be reduced by 25 percent).

The pre-claim review demonstration replaces a previously announced home health “prior-authorization” demonstration, which was strenuously opposed by HCA, our association partners and many Congressional Representatives. HCA previously submitted comments on the prior-authorization program and intends to submit comments on the revised pre-claim review demonstration.

Several informational materials have been posted, including: a revised Frequently Asked Questions (FAQs) document; a new Operational Guide; and a new Demonstration Overview. They are available at https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFSCompliance-Programs/Pre-Claim-Review-Initiatives/Overview.html.

We have already reached out to a number of our members for their feedback on the proposed demonstration. Any member not contacted by us who is interested in providing comments can send an email to Andrew Koski at akoski@hcanys.org.

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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Share this Resource with DSRIP, VBP Leads So They Know Your Value!

HCA reminds members of a new resource document for communicating your value-proposition to DSRIP and Value-Based Payment Partners.

Have you seen it yet?

The piece is called Don’t Reinvent the Wheel: Home Care is Already Your Hub for Community-based DSRIP and Value Based Services.

Several members have told us that Delivery System Reform Incentive Payment (DSRIP) Performing Provider Systems (PPSs) and their committees may not understand home care’s role in the system and the infrastructure you already provide.

In some cases, these committees and potential Value Based Payment (VBP) partners appear to be considering options for duplicating home care services from within other settings – even interfering with the jurisdictional requirements of Article 36 (an area of concern that HCA is working to address in other venues).

As a special member benefit, we invite you to contact HCA’s Communications Director Roger Noyes (at rnoyes@hcanys.org) if you’d like HCA to put your logo on this important piece that we urge you to share in your outreach efforts!

Learn more on our website at http://hca-nys.org/publications/share-this-resource-with-dsrip-vbp-leads-so-they-know-your-value.

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Join Us for Call on “Bring The Vote Home” Next Steps HCA is holding a series of three conference calls with members to discuss next steps in our Bring The Vote Home-New York (BTVH-NY) campaign. You only need to join one of the calls. (HCA scheduled three dates to give you the most options for joining.)

We invite all members to join the calls to learn more about this very important effort. The call is purely informational, and there is no obligation to commit to the campaign, but we do want to discuss some logistics with you.

The call dates and times are below:   

Thursday (7/7) at 11 a.m.

Friday (7/8) at 1 p.m.

Wednesday (7/13) at 2 p.m.

We hope you can commit time to join one of these calls, or have one of your staff participate so they can learn more about next steps for BTVH-NY. To join one of these calls, please complete the online form at https:// www.surveymonkey.com/r/YRCLQX8 and we will send you dial-in instructions in advance.

What is BTVH-NY? Bring The Vote Home is a national initiative designed to help seniors and people with disabilities vote. For those who may have difficulty traveling to the polls, we can help them register to vote or cast an absentee ballot.

Learn more at www.bringthevotehomeny.org.

Why is BTVH-NY important?

BTVH-NY is a great way to help your patients by giving them a voice.

Many of your patients are unable to vote in-person because they are homebound or have a life-limiting illness.

Home care providers are uniquely equipped to help by bringing ballot information directly to patients.

Elected officials will take notice. If a lot of home care providers participate, HCA can make a big splash about this campaign in the media, and this will put elected officials on notice that constituents are registering to vote and seeking to get their interests heard as home care patients. This is especially important in a big election year like this one!

Please join us for one of these informational calls. If you have any questions, please contact Alex Blais at ablais@hcanys.org.

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CMS Posts New OASIS Guidance Manual This week, the U.S. Centers for Medicare and Medicaid Services (CMS) posted the OASIS-C2 Guidance Manual to its website. CMS previously posted a draft version in late December 2015. OASIS-C2 is scheduled to be implemented on January 1, 2017. It replaces the OASIS-C1 that was created to conform with ICD-10 coding.

One significant addition is the inclusion of several items in response to the Improving Medicare Post-Acute Care Transformation (IMPACT) Act. Passed in 2014, the law requires standardized data to be submitted by various post-acute providers, including home health agencies (HHAs), skilled nursing facilities (SNF) and inpatient rehabilitation facilities (IRFs). The goal of IMPACT is to get an apples-to-apples comparison of outcomes and costs across various settings, with the ultimate goal of adjusting Medicare reimbursements accordingly.

Appendix G of the new manual summarizes the changes from OASIS-C1/ICD-10 to OASIS-C2, including new items/IMPACT Act items. They include, but are not limited, to: 

M1028: Active Diagnoses, Comorbidities and Co-existing Conditions



M1313: Worsening in Pressure Ulcer Stats since SOC/ROC



M2001: Drug Regimen Review – Did a complete drug regimen review identify potential clinically significant medication issues?

Another item of note includes new instructions on how agencies can adopt pressure ulcer guidelines from the National Pressure Ulcer Advisory Panel (NPUAP). Agencies may adopt NPUAP guidelines but definitions on staging may not align with OASIS scoring instructions. If so, the manual states that agencies are instructed to rely on the OASIS instructions.

The manual is available at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/HomeHealthQualityInits/Downloads/OASIS-C2-Guidance-Manual-6-17-16.pdf.

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

Filing Deadline Extended for Managed Care Program Integrity Report The state Office of the Medicaid Inspector General (OMIG) has extended the timeframe to file the 2016 Annual Program Integrity Report for managed care plans. That timeframe is between January 1 and January 31, 2017.

The state’s Model Contract requires Managed Care Organizations (MCOs) to conduct an annual assessment of their conformity with all contractor regulatory and contractual Medicaid program integrity obligations.

Once the assessment has been completed, plans must submit an annual report to OMIG. OMIG expects the assessment will address MCO activities and operations for the complete calendar year. For example, the 2016 Annual Program Integrity Report should respond to the MCO’s conformity with program 13

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integrity obligations between January 1, 2016 and December 31, 2016. Previously, OMIG set a deadline of December 31, 2016 for the annual report, the last day of the year, but this did not provide plans with sufficient time to prepare a report factoring the entire 12-month reporting period. OMIG has extended the 2016 Annual Program report to January 31, 2017 so that plans have an additional month to account for the entire reporting year.

DOH and OMIG have determined that the program integrity areas to be assessed are planning, prevention, detection, and investigation/recovery activities related to the prevention or detection of Medicaid fraud, waste and abuse.

The MCO Annual Program Integrity Report form is at https://www.omig.ny.gov/images/stories/mcocomprehensive-provider-report/MCO_Annual_Program_Integrity_Report_20151021.docx.

The Reporting Instructions may be accessed at https://omig.ny.gov/images/stories/mco-comprehensiveprovider-report/MCO_Annual_Program_Integrity_Report-Reporting_Instructions.pdf.

Community First Choice Option Update This week, the state Department of Health (DOH) provided an update on the Community First Choice Option (CFCO).

As previously reported, CFCO provides enhanced federal Medicaid funding to expand and enhance personal attendant services and supports into the Medicaid State Plan for eligible individuals who need help with everyday activities due to a physical, developmental or behavioral disability. The focus is on person-centered, individually directed services that help recipients to maximize their independence and participation in community settings. The service delivery model options under CFCO include the traditional agency model and an “agency with choice” model, similar to consumer directed services.

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waiver programs but are now part of state plan services, include: Assistive Technology; Community Habilitation; Community Transitional Services; Durable Medical Equipment/Medical Supplies; Environmental Modification; Home Delivered/Congregate Meals; Home Health Care; Homemaker/ Housekeeper; Personal Care/Consumer Directed Personal Assistance Program; Personal Emergency Response; Vehicle Modification; Transportation; Supervision and Cueing; voluntary training course for individuals on how to managed their home care workers; transition expenses to help an individual move from an institutional setting to a community-based setting; and others.

In response to HCA’s inquiry, DOH indicated that, contrary to earlier indications, CFCO will be implemented under fee-for-service and managed care at the same time. In the coming months, the scope of benefits for managed care organizations will be amended to include the above services and their rates will be adjusted.

State plan services under CFCO are available to individuals who are: 

Eligible for medical assistance under the State Plan;



Have an institutional level of care as determined by the functional assessment used by that population (Uniform Assessment System); and



Living in their own home or a family member’s home (not a congregate setting).

DOH emphasized in the program that CFCO will not reduce or change the existing services that managed care enrollees receive, but may provide additional services. Assessments and authorizations will be conducted by the managed care plan for its enrollees and local departments of social services for individuals in Medicaid fee-for-service.

During a lengthy question and answer part of the webinar, DOH stated that it will conduct outreach to providers and consumers on the new benefits under CFCO, and that it has requested guidance from the U.S. Centers for Medicare and Medicaid Services on how CFCO will interact with the current Nursing Home Transition and Diversion and Traumatic Brain Injury waiver programs.

The materials from the update are available at http://www.albany.edu/sph/cphce/ltc_webinar_03292016_handouts.pdf.

More information on CFCO is at http://www.health.ny.gov/health_care/medicaid/redesign/community_first_choice_option.htm.

Alert Issued on Home Health Agency and Physician Conduct Home health data brief also posted The federal Office of Inspector General (OIG) has issued an alert on improper arrangements and conduct involving home health agencies (HHAs) and physicians.

The alert notifies HHAs that the federal government is stepping up its enforcement in home health fraud, waste and abuse. In the past year, the government has obtained criminal convictions and reached civil settlements with several HHAs, individual physicians, and heads of home-visiting physician companies that 15

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defrauded Medicare by making or accepting payments for patient referrals, falsely certifying patients as homebound, and billing for medically unnecessary or unrendered services.

The alert advises HHAs and physicians: HHAs and physicians that wish to enter into compensation arrangements for services provided must ensure that those arrangements and the payments under them are fair market value and commercially reasonable in the absence of Federal health care program referrals. Although many compensation arrangements are legitimate, a compensation arrangement may violate the Federal anti-kickback statute if even one purpose of the arrangement is to compensate a physician for his or her past or future referrals of Federal health care program business. Payments made (or received) to induce (or in return for) referrals, or for arranging for referrals, potentially raise a number of concerns, including corruption of medical judgment, patient steering, overutilization, increased costs to Federal health care programs, and unfair competition.

Data Brief OIG also released a data brief that examines Medicare claims data for 2014 to 2015 to identify HHAs, supervising physicians, and geographic areas whose Medicare claims have characteristics similar to those observed by OIG in cases of home health fraud.

This data brief assesses the national prevalence and distribution of selected characteristics commonly found in OIG-investigated cases of home health fraud and identifies the five distinct characteristics common to them: 

High percentage of episodes for which the beneficiary had no recent visits with the supervising physician;



High percentage of episodes that were not preceded by a hospital or nursing home stay;

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High percentage of episodes with a primary diagnosis of diabetes or hypertension;

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High percentage of beneficiaries with claims from multiple HHAs; and Continued on next page

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Governor Signs Bill Prohibiting Delivery of FBI Info to Providers as Part of CHRC Bill intended to put CHRC in compliance with federal law Governor Cuomo yesterday signed a bill into law excluding FBI information from the reports made available to home care and nursing home providers for background checks.

The bill (S.7298 /Hannon and A.10382/Hyndman) is intended to bring the state’s Public Health Law into conformance with federal law and regulations with regard to the secondary dissemination of FBI criminal history record information to private entities.

Applicants for employment in home care and other settings will still be subject to New York State and national FBI fingerprint based criminal history record checks (CHRC). However, the current statutory language authorizing dissemination of FBI criminal history record check information violates federal law and is eliminated under this bill.

HCA will be further reviewing the bill for any implications to home care provider practices.

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Continued from previous page 

High percentage of beneficiaries with multiple home health readmissions in a short period of time.

HCA advises members to read the entire alert and data brief and share these documents with their counsel and compliance staff to ensure that they are in compliance with the relevant laws and rules.

The alert is available at http://oig.hhs.gov/compliance/alerts/guidance/HHA_%20Alert2016.pdf.

More information is in the brief at http://oig.hhs.gov/oei/reports/oei-05-16-00031.pdf.

Emergency Preparedness Update Central and Western New York emergency preparedness exercises under development Officials of the state Department of Health’s (DOH) western and central New York regional offices have begun the planning process for fall emergency preparedness exercises.

The October to November exercise, dubbed “WRECKIT,” will simulate emergency preparedness and response for a severe weather event – a mock ice storm – that will impact an 18-county area of western New York. Roles in the emergency will be played by local emergency managers, road maintenance, home care, hospitals, and an array of additional key partners.

HCA participated in this week’s kickoff discussions and offered ideas for home care and hospice. In the weeks to come, HCA will be providing further detail and guidance to agencies in preparation for this fall exercise. Agency participation will be voluntary, but all will be encouraged to participate.

Meanwhile, HCA invites all home care, hospice and MLTC plan providers throughout the state to submit suggestions for emergency preparedness drills you believe would benefit home care and your broader health communities. HCA will channel these ideas into the state and regional health emergency preparedness coalition process.

Guidance to providers when a patient refuses evacuation Providers have requested HCA’s help in obtaining state guidance for situations when emergency evacuations are advised or ordered but patients refuse to relocate. In these situations, providers are asking for direction on required regulatory and ethical practices for protection of staff and patients.

HCA has referred and discussed this dilemma with the state Office of Health Emergency Preparedness and the Office of Primary Care and Health Systems Management. The Department has completed its internal review and will be preparing written guidance for us. HCA will make the response available to providers.

Questions on TALs Implementation The DOH Transportation Assistance Levels (TALs) initiative for home care (covered extensively by HCA’s communications and education programing) became effective June 1. TALs is a categorization of patient transport needs and associated transport resources for planned evacuation in emergencies.

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Continued from previous page In March and April, DOH officials conducted webinars to describe TALs, explain responsibilities for implementation and field provider questions. DOH also issued DHCBS 16-02 to provide further guidance on the TALs and home care responsibilities.

Now that it is a month from the June 1 implementation, HCA invites provider questions, comments or experiences that you feel would be helpful to be brought to DOH, and likewise to share with colleagues.

Please go to the HCA survey monkey link here: https://www.surveymonkey.com/r/8T97Q7H to convey your TALs comments to us.

For further information, please contact Alex Blais at ablais@hcanys.org or Al Cardillo at acardillo@hcanys.org.

Clarification Issued on CDPAP Personal Assistants As part of the June 2016 Medicaid Update, the state Department of Health has issued a clarification on previously announced communications about recent changes regarding who can work as a Consumer Directed Personal Assistance Program (CDPAP) personal assistant.

Legislation, effective in April 2016, permitted parents of adult children (21 or older) to be hired and work as their adult children’s CDPAP personal assistant. Parents of children who are younger than 21 can still not be hired as that minor child’s personal assistant (neither can spouses, nor “designated representatives”). The clarification addresses questions about whether adult relatives who reside with a consumer can be that consumer’s personal assistant. The guidance states that the April change was intended to expand, not narrow, the pool of CDPAP aides. The clarification provided reads as follows: Living in the same home with the consumer does not disqualify a family member from being selected and hired as a personal assistant. Whether the consumer is self-directing or not is irrelevant.

Provisions for the CDPAP have always allowed otherwise eligible family members to provide care while living in the same residence with the consumer. This remains unchanged in light of the April 1, 2016 change to the law.

The full text of the provided clarification is available at http://www.health.ny.gov/health_care/medicaid/program/update/2016/jun16_mu.pdf (page 12).

Questions can be directed to the state Department of Health Division of Long Term Care at (518) 474-5888.

OMIG Compliance Certification Forms to be Posted December 1 In this month’s Medicaid Update, the Office of the Medicaid Inspector General (OMIG) announced that it intends to post the State Social Services Compliance Certification form for 2016 on December 1, 2016.

OMIG will hold a webinar in November 2016 to review this new form.

Home care and other health care providers must complete the State Social Services Compliance Certification to certify that a compliance program is in place and meets the state’s requirements, including eight elements outlined at https://www.omig.ny.gov/images/stories/provider_compliance/ssl_faqs.pdf.

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Continued from previous page In addition, the Deficit Reduction Act of 2005 applies to health care entities receiving or making $5 million or more in Medicaid payments during a federal fiscal year. The law requires that they establish written policies and procedures informing their employees, contractors and agents about federal and state false claim acts and whistleblower protections. Further, they must certify that they are in compliance with this federal law.

More information on the DRA certification can be found at https://www.omig.ny.gov/images/stories/provider_compliance/dra_faqs.pdf.

While both certification forms are due by the end of December, OMIG has recommended in past years that they be filed in mid-December to avoid any delays.

As part of the state Department of Health Medicaid enrollment revalidation process, now underway, required providers will be asked to submit evidence that they met the December state certification obligation.

Certifying in December and retaining a copy of the Certification Confirmation and/or confirmation e-mails will help Medicaid-required providers to complete the revalidation process.

Additional information on the federal and state certification processes is available at https://www.omig.ny.gov/compliance/compliance-library.

The announcement can be viewed here: http://www.health.ny.gov/health_care/medicaid/program/update/2016/jun16_mu.pdf (page 5).

Questions can be directed to OMIG’s Bureau of Compliance at (518) 408-0401 or compliance@omig.ny.gov.

New Maximum Weekly Workers’ Compensation Benefit Rate HCA to hold workers’ compensation program in September Effective July 1, 2016, workers’ compensation claims with dates of accident or dates of disablement during the period from July 1, 2016 through June 30, 2017 will be subject to a maximum weekly benefit rate of $864.32.

This is based upon the requirement that the maximum weekly benefit rate for workers’ compensation claimants be set at two-thirds of the New York State average weekly wage for the previous calendar year. The state Department of Labor has reported to the Superintendent of the Department of Financial Services that the New York State average weekly wage for 2015 was $1,296.48 (two thirds of which is $864.32).

The official announcement is posted here: http://www.wcb.ny.gov/content/main/SubjectNos/sn046_864.jsp.

HCA workers’ compensation program HCA will be holding a program on September 29 in New York City to address the rising cost of workers’ compensation. It will cover fixed and variable costs affecting workers’ compensation insurance for home care

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agencies, and address strategies related to the variable costs that agencies can use to significantly improve their bottom lines.

The presentation will also address the higher prices that employers often pay when they aren’t aware of what motivates the insurance companies and their agents. The goal is to help employers understand what the insurance underwriters are doing, why they’re doing it, and how they’re doing it, so that employers can leverage that information as an advantage.

The registration form is at http://tinyurl.com/zwjq8qz.

Changes Proposed to Medicare Appeals Process This week, the U.S. Department of Health and Human Services (HHS) proposed some changes to the Medicare Appeals Process – in part to address a backlog of over 800,000 appeals awaiting adjudication at the administrative law judge (ALJ) level.

Some of these proposed changes include: 

Designate select Medicare Appeals Council decisions (final decisions of the Secretary) as precedential to provide more consistency in decisions at all levels of appeal, reducing the resources required to render decisions, and possibly reducing appeal rates by providing clarity to appellants and adjudicators.



Expand the Office of Medicare Hearings and Appeals’ (OMHA) available adjudicator pool by allowing attorney adjudicators to: decide appeals for which a decision can be issued without a hearing; review Qualified Independent Contractor (QIC) dismissals; issue remands to the U.S. Centers for Medicare & Medicaid Services (CMS) contractors; and dismiss requests for hearing when an appellant withdraws the request. This change would allow ALJs to focus their efforts on conducting hearings and adjudicating the merits of more complex cases.



Revise the amount in controversy (AIC) calculation ($1,500 in 2016) for certain claim appeals to generally use the Medicare allowable amount (rather than the billed amount) for most Part B claims. This change would more closely align the AIC, which is the threshold amount required for an ALJ hearing, with the actual amount in dispute in an appeal.



Simplify proceedings when CMS or CMS contractors are involved by limiting the number of entities (CMS or contractors) that can be a participant or party at the hearing (although additional entities may continue to submit position papers and/or written testimony).



Clarify areas of the regulations that currently confuse appellants or OMHA staff and may result in unnecessary appeals to the Medicare Appeals Council.



Create process efficiencies by eliminating unnecessary steps (e.g., by allowing ALJs to vacate their own dismissals rather than requiring appellants to appeal a dismissal to the Medicare Appeals Council); streamlining certain procedures (e.g., by using telephone hearings for appellants who are

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not unrepresented beneficiaries, unless the ALJ finds good cause for an appearance by other means); and requiring appellants to provide more information on what they are appealing and who will be attending a hearing. 

Address areas for improvement previously identified by stakeholders to increase the quality of the process and responsiveness to customers, such as establishing an adjudication time frame for cases remanded from the Medicare Appeals Council, revising remand rules to better ensure cases keep moving forward in the process, simplifying the escalation process, and providing more specific rules on what constitutes good cause for new evidence to be admitted at the ALJ level of appeal.

Additional information is available here: http://www.hhs.gov/dab/medicare-appeals-nprm-fact-sheet-june2016.pdf.

LHCSAs: Comments Sought on Draft Private Duty Nursing Audit Protocols The state Office of Medicaid Inspector General (OMIG) has shared draft audit protocols for private duty nursing (PDN) services provided by LHCSAs. They cover, among other items: documentation of services; assessments; plans of care; annual performance evaluation; health tests; and assessments.

OMIG has recently posted audit protocols for independent providers of PDN services. They, along with other audit protocols, are available at https://www.omig.ny.gov/audit/audit-protocols.

In the past, HCA has submitted comments on OMIG draft protocols for other services and is seeking feedback from those members who provide PDN. LHCSA members who want to review and comment on the draft protocols should contact Andrew Koski at akoski@hcanys.org.

State Workgroup Releases Guidelines for Core Curriculum of Care Coordination Workers The state Department of Health’s (DOH) Workforce Workgroup under the State Health Innovation Plan (SHIP) and State Innovation Models (SIM) released a document this week called “Revised Guidelines for Core Curriculum to Train Care Coordination Workers” which was produced by a workgroup subcommittee.

The guidelines are intended to serve as a suggested starting point or basis for programs developed to train individuals working in care coordination roles across various disciplines.

The document is available for review here: https://www.health.ny.gov/technology/ innovation_plan_initiative/docs/core_curriculum_train_ccw.pdf.

HCA encourages interested members to read through the guidelines, and invites you to provide comments, questions, or feedback to Alex Blais at ablais@hcanys.org.

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Information Provided on ACF Do Not Refer List The state Department of Health (DOH) has posted a Dear Chief Executive Officer letter to inform hospitals and other entities of the updated “Adult Care Facility (ACF) Do Not Refer List” so that hospitals don’t refer patients to facilities on this list. Home care providers who serve patients in adult care settings should be aware of this list.

ACFs are long-term residential facilities licensed by DOH and encompass adult homes, enriched housing programs, assisted living programs and assisted living residences. The “Do Not Refer List” includes the following three reasons that ACFs are prohibited from hospital referral: 

Referral Suspension: DOH has initiated action against the operating certificate.



Closed Facilities: These facilities are closed or are closing.



Uncertified Facility: These facilities are neither licensed nor certified by DOH or other state agencies or departments. These facilities are also referred to as “Questionable Operations.”

Questions about the “Do Not Refer” List can be referred to the Division of Hospitals and Diagnostic and Treatment Centers at (518) 402-1004 or hospinfo@health.ny.gov.

The list is available at http://www.health.ny.gov/facilities/adult_care/docs/acf_do_not_refer_list.pdf.

eMedNY Trainings Announced The eMedNY Training Schedule for July through September is now available at https://www.emedny.org/training/index.aspx.

Some of the topics offered include:    

ePACES for Dental, DME, Home Health, Institutional, Nursing Home, Physician, Private Duty Nursing, Professional, Transportation eMedNY Website Review New Provider/New Biller Medicaid Eligibility Verification Systems (MEVS)

In-person seminars with eMedNY Regional Representatives will be held at: Batavia, Binghamton, Canandaigua, Hauppauge, New York City, Plattsburgh, Poughkeepsie, and Rensselaer.

NGS Updates National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), posted the following update to its website. 

Electronic Signature Coming to EDI Enrollment Forms – On August 1, 2016, Electronic Data Interchange (EDI) will implement electronic signatures for online EDI enrollment forms. All 22

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EDI enrollment forms are completed and submitted online through the EDI website. With electronic signatures, EDI customers will no longer need to print, sign and fax the forms. An instruction guide for the electronic signature process will soon be available on the EDI website. 

Issue Related to Returned Claims with Reason Code W7A01 Resolved – NGS resolved an issue this week related to returned claims with reason code W7A01. Some provider claims were being incorrectly returned with the reason code W7A01 that indicates an error in the first diagnosis code which was incorrectly appearing as all zeroes. Providers will need to go into Claims Correction and correct the diagnosis code for any claims in returned-to-provider (RTP) status for reason code W7A01 with zeroes in the Diagnosis Code field.



New Version of PC Print: July 5, 2016 – A new 5.13 version of PC Print will be available for download on NGS’s website on July 5. This version includes a fix to the ‘Mark for Print’ function in the All Claims and Single Claims Reports. The fix will allow providers utilizing the software to print the 1000th or higher claim marked for printing in the All Claims and Single Claims reports.

The new version also includes updates to the Claim Adjustment Reason Code (CARC) and Remittance Advice Remark Code (RARC) lists.

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

Publications 

“2017 ICD-10-CM and ICD-10-PCS Files,” by the U.S. Centers for Medicare and Medicaid Services https://www.cms.gov/Medicare/Coding/ICD10/2017-ICD-10-CM-and-GEMs.html

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

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Senior and Financial Manager’s Retreat

Thanks to our

Sponsors and Exhibitors!

Senior and Financial Manager’s Retreat

The Home Care Association of New York State (HCA) is pleased to present one of its signature events: the 2016 Senior Financial Manager’s Retreat. This thoughtprovoking and dynamic program offers the home care community an opportunity to hear from state and national home care policy and finance experts about how to meet the fiscal and operational challenges in today’s evolving home care marketplace, as well as insights into new service-delivery and payment models that can dramatically affect an organization’s bottom line.

New models of service delivery and value based payment arrangements are front and center in our health care system. Meanwhile, new mandates impose costs to providers in uniquely challenging ways. To succeed, New York State’s home care provider community needs information, innovative ideas, and the desire to be creative in meeting the demands of an evolving patient-centered system. This Retreat will cover the big-picture items, like new models of care; the mechanics of issues like employee wage, hour and overtime policies as well as home care reimbursement changes; and new areas of exploration.

Join HCA and your fiscal and finance colleagues from across New York State for this annual educational event and retreat that offers dynamic and insightful sessions, the opportunity to network and learn from your peers, and engaging discussion to help the industry solve its most pressing problems and challenges. Don’t miss it.

Senior and Financial Manager’s Retreat PRELIMINARY AGENDA Thursday, September 8 – The Mountain Lake Conference House 8:30AM

Registration Opens 9:00–10:00AM

HCA Overview of Policy Priorities that Impact Your Bottom Line HCA’s Policy and Executive Team

Throughout the year, HCA’s policy team of experts develop, analyze and advocate for policy positions and solutions that positively impact financial positioning of New York’s home care community. This session will discuss the top-tier federal and state policy initiatives affecting providers, setting the stage for an engaging and informative dialogue throughout the Retreat on your most pressing financial problems, your questions, and your biggest organizational challenges.

10:00–11:15AM

Strategic Positioning for Home Health Providers Gerald J. Archibald, CPA, Partner, The Bonadio Group (Invited) Transformational changes are occurring in our health care delivery system. At the state level, there is a monumental Medicaid Managed Care Reform Initiative being implemented by the Department of Health (DOH) under the umbrella of the Delivery System Reform Incentive Program (DSRIP). This session will help home care providers assess their strategic positioning and identify their strengths when interacting and negotiating with the Performing Provider Systems (PPS) under DSRIP, as well as managed care plans.

11:15AM–12:45PM

Implications of Employee Wage, Hour & Overtime Policy Changes Peter Godfrey, John Godwin, and Emina Poricanin, Hodgson Russ LLP Changes affecting worker wages and benefits in recent years have caused unprecedented challenges to employers in the home care industry. This session will examine and describe details of the most pressing policy and legal changes in this area, including: court decisions impacting live-in workers; the elimination of the companionship exemption and resulting struggles with compensation rules; the implications of wage and hour class-action litigation; and a recently implemented overtime rule affecting overtime-exempt employees.

The session will close with practical tips to mitigate exposure to wage and hour liability while staying in compliance with federal and state compensation laws and regulations.

12:45–1:45PM

Network with Your Peers over Lunch in the Main Dining Room

Preliminary Agenda Continued…

Thursday, September 8 – continued 1:45–3:15PM

Breaking Down New York’s Value-Based Payment (VBP) Incentives Jason Ganns, Director, Public Sector HHS Advisory, KPMG New York State’s health policy vision involves significant changes that will have dramatic and sweeping effects on reimbursement structures to spur on the move toward Value Based Payment. In this session, participants will hear from the director of value based payment support from KPMG, which is the state Department of Health’s lead consultant for public health systems reform. Jason Ganns will break down the nuts and bolts of the state’s value based payment incentives to provide home care agencies with in-depth guidance on financial strategies for deciding how much risk to accept when negotiating VBP type contracts.

3:15–5:15PM

It’s Time to Relax and Recharge!

In an environment of constant change and stresses, home care leaders need time to recharge in order to maximize performance and focus. New at this year’s Retreat, we’ve carved-out time for attendees to participate in leisure activities of their choice at our conference location, which is one of the most beautiful mountain retreat settings in the Northeast! Use this time to visit the exceptional Mohonk Mountain House Spa, hike the beautiful grounds, kayak on the pristine lake, check out the renowned golf course, or just relax on one of the many porches and outdoor venues offering a scenic view.

5:15–6:30PM

HCA PAC Reception [$50 Minimum Donation] – The Porch HCA’s Political Action Committee is hosting a cocktail reception on the beautiful porch of the Mohonk Mountain House. Join us for a few cocktails, chat with staff and colleagues, and support HCA’s PAC, an important advocacy tool for helping to elect lawmakers who care about strengthening New York’s home care community.

6:30–8:00PM Dinner – Main Dining Room

Enjoy one of the most sumptuous dinners in the Hudson Valley!

The Mohonk Dining Room is famous for its array of delicious menu offerings using local “farm-to-table” ingredients that will satisfy every palate. Look for the section of the dining room that is reserved for HCA!

Preliminary Agenda Continued…

Friday, September 9 – The Mountain Lake Conference House 7:30–8:30AM

HCA’s CFO Workgroup Breakfast (invitation only) 7:30–8:30AM Breakfast – Main Dining Room 8:30–9:45AM

Federal Update on Regulatory and Reimbursement Issues Colin Roskey, Executive Vice President, The Partnership for Quality Home Healthcare Washington, D.C.-based federal home health policy expert Colin Roskey will help you stay ahead of the curve with his federal home care industry forecast based on the payment, regulatory and political conditions percolating at the federal level. Get prepared for what’s coming down the federal policy pipeline.

9:45–11:00AM

New York State Medicaid Policy and Reimbursement Update John Ulberg, Director, Division of Healthcare Financing (Invited) Hear from a prominent fiscal and reimbursement expert at New York State’s Health Department about changes to reimbursement policy priorities, as well as updates to the rates that affect home care providers and MLTC plans.

Participants will hear the latest about the state’s plans for implementation of the minimum wage hike and associated QIVAPP and FLSA adjustments and the shift to Value Based Payment.

11:00–11:15AM

Break 11:15AM–12:30PM

Emerging Workforce Development Efforts to Keep Pace with New York’s Evolving Health Care Delivery System Jean Moore, DrPH, Center for Health Workforce Studies, School of Public Health, University at Albany, SUNY (Invited) A skilled and vibrant workforce is essential for your successful transition to a new payment and service delivery model that rewards value, quality and efficiency. Learn about the latest state workforce trends and development efforts to build a health care workforce that will achieve the goals set forth by the Triple Aim, DSRIP and VBP. 12:30PM

Adjourn and Lunch-To-Go A box lunch will be provided for you to enjoy at the resort or as you head for home.

Senior and Financial Manager’s Retreat

Getting Awayfrom it all!

Things to do at the Mohonk Mountain House Activities listed below are at no charge except where noted • Visit the Barn Museum • Take a Row Boat, Paddle Boat, Canoe or Kayak out on the Lake • Play Croquet • Tour the award-winning Gardens & Maze • Explore the Greenhouse • Discover 85 Miles of Hiking (hike to skytop is recommended) • Challenge Colleagues to a game of Horseshoes • Lawn Bowling • Platform Tennis • Rock Scrambles • Shuffleboard • Basketball and Volleyball • 18-hole putting green The following are activities available for a fee and advanced reservations are recommended.

The Spa at Mohonk Mountain House- Named number one resort spa in the United States by Condé Nast Traveler Magazine!

HCA registered participants receive a 15% discount on spa services on Wednesday, September 7 & Thursday, September 8th. Make sure to mention that you are with HCA when making your reservation to receive this discount. For Spa information and reservations call 877-781-1590.

Golfing: Reservations for Tee Times are required and may be reserved up to 30 days in advance. Call the Pro Shop at 845-256-2154.

Horse Back Riding: Contact the Stables at 845-256-2784

Mohonk Mountain House Rates and Other Information Your combined hotel and registration rate includes your room, all meals, breaks, valet parking and meeting amenities. A single room rate is $329 per

person, per day; double rates are $234 per person, per day. Local taxes and a 12% gratuity are additional.

All Mohonk reservations should be made by August 7 to receive the HCA conference rate and be guaranteed a room. After this date, higher rates will apply based on availability.

Call 800-772-6646 and ask for the HCA rate.

Not Staying Overnight at Mohonk?

Since this is a remote resort in the mountains, and Mohonk wants to also be prepared for those not staying overnight, a “per-day rate” of $105 is charged. This day rate includes lunch, breaks, meeting amenities, and self-parking. Day guests must register with HCA as well in order to access the property. Please include the fee(s) with your HCA registration (next page).

Senior and Financial Manager’s Retreat

September 8-9, 2016 – Mohonk Mountain House – New Paltz, NY The registration fee of $299 for HCA members includes two days of expert speakers and handout materials, plus breaks, a reception and lunch on the final day that is not included with your room package. Potential members are also welcome at the rate of $399 per person. Mohonk Resort rooms/meals are additional – see page 6.

REGISTRANT INFORMATION – Please register by August 25 Name: __________________________________________________________________________ Title:____________________________________________________________________________ Agency:_________________________________________________________________________ Address:_________________________________________________________________________ City/State/Zip:____________________________________________________________________ Phone:________________________________ Ext._________ Fax: _________________________ Email: ___________________________________________________________________________ (Required)

HCA REGISTRATION FEE ____ Member Fee

 $299

____ Non-Member Fee

 $399

____ HCA PAC Reception (I will attend and provide my personal donation at the event.)

HCA Cancellation Policy HCA registration cancellations received by August 25 are refundable less a 25% administrative fee.

No refunds will be issued after this date.

Cancellations must be received in writing at info@hcanys.org.

Substitutions are permitted. Please note Mohonk’s cancellation policy when making your reservation.

MOHONK “DAY ONLY” RESORT FEES ____ I will not require overnight accommodations, but will require a Mohonk “Per-Day Only” pass at $105 per day.

 $_________

Total: $_______ PAYMENT – Please check method of payment: ________MasterCard

_______VISA

______American Express

______Check*

*Make checks payable to: HCA Education and Research and mail to 388 Broadway, 4th Floor, Albany, NY 12207. Checks must be received by August 29.

______________________________________________________________________________ Card Number _______________________________________ Expiration Date

_______________________________________ Security Code

______________________________________________________________________________ Mailing Address of Card Holder ______________________________________________________________________________ City, State, Zip ______________________________________________________________________________ Name on Card

______________________________________________________________________________ Authorized Signature

FAX this form to 518-426-8788 or register online at www.eventville.com/hcanys

Special Needs In accordance with the Americans with Disabilities Act, or special dietary needs, please let us know how we can accommodate you: __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________