July 10, 2015 Edition of ASAP by Home Care Association of New York State

ASAP

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

Legislative Issues  Public Policy



News

Volume 20, No. 26 July 10, 2015

HCA Memo and Conference Call on NY Legislative Session Outcome HCA is holding a free, members-only conference call next week to brief you on the state legislative session outcome. The call will take place on July 15 from 10 to 11 a.m. To register, simply complete the online form at http://tinyurl.com/nzhhkld. The call will provide a deeper look at all of the important bills that passed, as well as those legislative initiatives that may be addressed when the Legislature reconvenes. We will also discuss next steps on HCA-priority bills that we are urging the Governor to sign, as well as initiatives to build up further support for those bills which were not passed. In conjunction with the call, HCA has also prepared a detailed memo on the legislative session outcome. Please be sure to review the memo in advance of the call. The memo is at http://hca-nys.org/wp-content/uploads/2015/07/ 2015LegSessionOutcomeMemo.pdf. It outlines all of the consequential bills which passed and those that did not pass but remain an ongoing area of support of concern, including several HCA-developed initiatives.

A Round-Up of Policy Updates from the Past 2 Weeks HCA sent you several e-mail alerts during the past two weeks since our last ASAP newsletter. All of these alerts are posted in longer form on our website at www.hcanys.org, but here are the articles in-brief, with links to more information. CMS Issues 2016 Proposed PPS Rule The U.S. Centers for Medicare and Medicaid Services on July 6 issued its proposal for the 2016 Home Health Prospective Payment System Rule. The proposed rule is in line with expectations, continuing the third year of See ROUND-UP p. 2

Inside ASAP HCA Memo, Conference Call on NY Legislative Outcome...............1 A Round-up of Policy Updates from Past 2 Weeks..............................1 Web Exclusives: ICD-10, Chronic Care, Bundling Proposal.............3 Prepare for Value Based Payments at HCA Finance Retreat..............4 Education Update..............................................................................5 Managed Care, QIVAPP Update........................................................6 Register: NYC Symposium on Future of Home Health….................6 Additional Info on DSRIP Waivers for Home Care.............................8 Hiring Announcements...............................................................8-9 Corrected Star Rating Preview Reports Issued...............................10 Guidance on Medicaid Coverage of Housing-Related Services….10 Publications......................................................................................................11

Helping New Yorkers Feel Right At Home

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

Volume 20, No. 26 July 10, 2015 

ROUND-UP from p. 1 rebasing, resulting in an overall 1.8% reduction in Medicare home health payments (or $350 million nationwide) in 2016. The proposal also begins a pilot project for value-based purchasing in nine states. (New York is not one of the states proposed at this time, but the selections could change.) To learn more, read our alert at http://hcanys.org/member-alerts/2016-home-health-pps-proposed-rule-posted. HCA Comments on Hospice Proposed Rule HCA has submitted our comments on the 2016 proposed rule for Medicare hospice payment updates, wage index changes and quality reporting. On the payment side, our comments specifically address: revisions to the routine home care rate, the service intensity add-on payment, the inpatient aggregate cap accounting year timeframe, and the wage index, which is particularly problematic and in need of revision. We also provide item-by-item comments on quality reporting elements of the proposed rule. Read more here: http://hca-nys.org/letters-and-comments/hca-comments-on-hospice-proposed-rule. Governor Announces DSRIP Funding Allocations to PPSs Governor Cuomo has announced the funding allocations for each of the state’s Performing Provider Systems (PPSs) under the Delivery System Reform Incentive Payment (DSRIP) program. A full list of the awards and more information are at: http://hca-nys.org/general-news/governor-announces-dsrip-funding-allocations-toppss. Please also see the related p. 8 story on the DSRIP regulatory waiver process. Continued on next page ASAP is a weekly publication of the Home Care Association of New York State (HCA). Unless otherwise noted, all articles appearing in ASAP are the property of the Home Care Association of New York State. Reuse of any content within this newsletter requires permission from HCA. President: Editor:

Joanne Cunningham, jcunningham@hcanys.org Roger L. Noyes, Director of Communications, rnoyes@hcanys.org Al Cardillo, Executive Vice President, Policy & Programs, acardillo@hcanys.org Patrick Conole, Vice President, Finance & Management, pconole@hcanys.org Andrew Koski, Vice President, Program Policy and Services, akoski@hcanys.org Laura Constable, Senior Director, Membership & Operations, lconstable@hcanys.org 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

Volume 20, No. 26 July 10, 2015

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

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Two Important Wage & Labor News Updates On June 30, the U.S. Department of Labor (DOL) issued a proposed rule that would raise the threshold for certain “white collar workers” to fall under the minimum wage and overtime pay protections of the Fair Labor Standards Act (FLSA). This rule is different than the “companionship exemption” change for home care, which has been a subject of HCA advocacy and legal action. HCA has been invited to participate in a Small Business Administration Office of Advocacy Roundtable on DOL’s proposed overtime regulations that is scheduled for July 22. Also, HCA and other organizations have submitted a “Notice of Motion” requesting permission to file an amicus brief in the Andryeyeva court case. In the case, a judge has ruled that home attendants must be paid for each hour of a 24-hour sleep-in shift, and count all 24 hours toward overtime, regardless of how many hours the aide was afforded for sleep and meals. This ruling is contrary to state Department of Labor opinions, which provide that third-party employers can pay 24-hour live-in aides for 13 hours of a 24-hour shift if the aide is afforded eight hours of sleep, five of which are uninterrupted, and three uninterrupted hours for meals. Learn more about both issues at http://hca-nys.org/member-alerts/two-important-wage-labor-news-updates. Important Clarification on EO No. 38 Disclosure Form Process HCA sent you an alert last week clarifying the due date for Executive Order (EO) 38 disclosures. Contrary to guidance on the EO 38 website and previous communications to members, the deadline to submit the Disclosure Form is after June 29 for home care providers who are required to submit a Medicaid cost report. A reading of the statute finds that the due date is August 15 for CHHAs and LTHHCPs and September 15 for personal care providers. For entities that have a Cost Report deadline earlier than June 29, such as MLTC plans, their deadline is the later of 180 days following the close of the covered reporting period or the date the cost report must be filed. Therefore, this deadline was June 29 for MLTC plans. For more information, please read our alert at http://hca-nys.org/member-alerts/important-clarificationon-eo-no-38-disclosure-form-process. Emergency Preparedness Information and Resource Updates HCA also provided an emergency preparedness update for the home and community services sector. It coordinates information from several recent state and regional emergency preparedness communications. Please see the update at http://hca-nys.org/general-news/emergency-preparedness-information-andresource-update.

Go Online For NEW ASAP Web Exclusives In an effort to keep ASAP concise, HCA is posting some of our stories as online exclusives to our website. We have created a new page called “General News” where you can find new stories about ICD-10 training videos; links to a series of resources for treating multiple chronic conditions; and an article about a new federal bundling initiative for patients with hip and knee replacements. Get these important updates and others by visiting the HCA website at: http://hca-nys.org/category/ general-news. 3

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

Volume 20, No. 26 July 10, 2015 

Ripped Straight from the Headlines to You at HCA’s Senior & Financial Manager’s Retreat A recent survey by KPMG finds that provider finance departments are not ready to take on value-based payments. Are you one of them? According to KPMG, only 15 percent of providers say they have “very sophisticated” capabilities to support capitation, bundled payments, and quality based payments – all areas in which home care providers need to become experts. Sixty-one percent are gathering tools and conducting analysis to get ready. Another 13 percent described their systems as “undeveloped” for managing risk and accounting for these new payment mechanisms. KPMG is an important voice on this issue because they are the state’s contractor for developing value-based payments. At HCA’s Senior & Financial Manager’s Retreat (September 17-18), we’ll have a KPMG expert who is working with New York on its value-based payment design, Dr. Marc Berg. He has earned high ratings at other HCE events. At the Retreat, he’ll provide invaluable insights to help you and your finance departments advance to a more ready position on this huge new change in payments. Meanwhile, this week we shared with you the new payment rates being proposed for the 2016 Medicare home health prospective payment system (HHPPS). It goes without saying that Bill Dombi, of the National Association for Home Care and Hospice, is a preeminent authority on HHPPS, the biggest reimbursement mechanism affecting the Medicare side of your operation. He’ll be at our Retreat, too, giving your finance teams the most important tips, calculations and considerations for budgeting your Medicare line in 2016. Please see the brochure at the back of this week’s ASAP for other conference sessions. You can register online at http://tinyurl.com/pp3aac9.

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

Volume 20, No. 26 July 10, 2015 

EDUCATION UPDATE July 23: Developing Best Practices in Billing and Coding for Providers in Hospice and Palliative Care (Webinar). Learn the triggers for audits, the difference between billing under complexity versus time, the use of prolonged service codes, and nuances related to hospice and palliative care. Sept. 17Ǧ18: HCA’s Senior & Financial Manager’s Retreat (New Paltz). HCA will help you put your budget in square order, find the answers you need from top officials and contractors, and gain valuable insights from the state’s leading consultants who will reveal what they are telling their clients about where to look for new opportunities.

Sponsored in part by:

Sept. 30: ICDǦ10ǦCM & OASIS Coding Back to Basics & Beyond (Nanuet) Oct. 1: Optional Coding Exam (Nanuet) Ensure success with your CHHA’s ICDǦ10ǦCM transition. On September 30, presenter Patricia Tulloch will help sharpen your clinician and coder skill sets to enhance documentation that supports ICDǦ10ǦCM diagnoses precision and verifies the consistency of the OASIS assessment. The 2015 Home Care Coding Specialist Exam (HCSǦD) will be offered at this same location on October 1. Oct. 8: HCA’s Corporate Compliance Symposium (Albany). New York is making epic changes to its health care system. These changes have spawned regulatory compliance and legal questions that are equally big. HCA will help you manage some of these huge questions, and others, so you can develop the right protocols and practices at your agency. Oct. 26Ǧ27: Blueprint for OASIS Accuracy – OASISǦC1 Data Set (East Elmhurst) Oct. 28: Optional COSǦC Exam (East Elmhurst) Effective upǦtoǦthe minute education targeted for field data collectors, their supervisors and those preparing for the optional Certificate for OASIS SpecialistǦClinical (COSǦC) exam. TwoǦday workshop on October 26Ǧ27, followed by optional COSǦC exam at same location on October 28.

Brochures and registration information for each of these programs are available on the “Events and Education” page of our website at www.hcanys.org

Several Dates through June 2016: Teleconferences for Home Health and Hospice Aides (Teleconference). An investment in staff education is an investment in quality customer service and quality care. Various programs are being offered. Visit our website for full brochure. ICDǦ10 Coding Survival Kit (DVD Series). ICDǦ10 is closer than you think! This 10Ǧpart DVD series enables the learner to become familiar with the ICDǦ10 changes in an incremental fashion by focusing on 1Ǧ2 specific chapters on each DVD. Save the Date for These Future Events! Nov. 17 and 18: HCA’s Quality Symposium (Troy)

www.hcaǦnys.org 5

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

Managed Care, QIVAPP Update

Volume 20, No. 26 July 10, 2015 

HCA has pulled together several updates this week related to the Quality Incentive Vital Access Provider Pool (QIVAPP) program, Fully Integrated Duals Advantage (FIDA) program, MLTC and Conflict-Free Enrollment and Evaluation Center (CFEEC) transition, the appeals process for enrollees in partial capitation plans, and physician orders.

Online registration is now open for the Northeast Regional Future of Home Health Symposium: “Preparing for the Future of Home and Community-Based Care” taking place here in New York State on September 9. To register, visit http://tinyurl.com/pas863h.

The updates were provided at the state’s monthly Managed Care Policy and Planning meeting.

This program is sponsored by the Alliance for Home Health Quality and Innovation along with nine state home care associations, including HCA, who are inviting their memberships to attend this regional conference, akin to the Northeast Home Health Leadership Summit held every January. HCA members have a unique opportunity to attend this daylong program in HCA’s home state.

QIVAPP The state Department of Health (DOH) is in the final stage of determining the next round of QIVAPP funds to MLTCs (which then have to be passed through to their eligible home care network providers). DOH hopes to release distribution sheets sometime next week and then will request federal approval for the $35 million federal share. Federal approval can take a few months.

The symposium will feature panelists and speakers on alternative models of care delivery, achieving the ‘Triple Aim’, shifting care into the home and community, and research and policy priorities. Thought-leaders from across the care continuum will speak to the challenges and opportunities facing home health care now and in the future. The Alliance will also host a cocktail reception the evening prior for speakers and attendees.

HCA will alert members once the awardees are announced. IPRO will be reviewing the documentation to determine if any agencies who received funding should not have, and any agencies that were passedover for funding but should have received it.

Further details and hotel information are below. Please call the hotel directly at 1-800-222-8733 before July 31 and ask for the HCA room block. HCA will share a brochure and flyer information next week. In the meantime, please register online at http://tinyurl.com/pas863h.

DOH will hold internal discussions on the distribution of additional money for QIVAPP that was in the final 2015 state budget. HCA and other associations will be meeting DOH in August as a follow up to a joint association letter we sent on QIVAPP.

Northeast Regional Future of Home Health Symposium September 9 9 a.m. to 4:30 p.m. DoubleTree by Hilton Hotel Metropolitan 569 Lexington Avenue, New York, NY 10022 www.metropolitannewyorkcity.doubletree.com

FIDA As of July 1, there are 6,368 individuals enrolled in FIDA while 51,328 have opted out (and remain in partial capitation MLTC plans). This includes 2,599 individuals who were “passively enrolled.” 4,211 individuals are expected to be passively 6

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

Volume 20, No. 26 July 10, 2015 

enrolled on August 1 and 1,721 on September 1. There may be future “waves” of passive enrollment, possibly in October. The state intends to release a white paper on FIDA in about September and will be seeking feedback. The paper will outline suggested changes in the program. MLTC Transition

CFEEC 27,882 evaluations have been completed by Maximus under the CFEEC. The CFEEC is now in operation throughout the entire state.

Physician Orders DOH reminds MLTC plans that they are required to share any physician orders they have obtained with their contracted home care providers. Many LHCSAs have reported to DOH certain cases where plans which secure physician orders don’t make them available.

The effect of this change is that:

Aid-continuing is no longer available if the enrollee asks only for an internal appeal of a plan’s proposed reduction or discontinuance of services and does not also timely request a state fair hearing;

•

Enrollees must request a state fair hearing within 10 days of the date of the MLTC “Action Taken” notice to obtain aidcontinuing;

The 60-day deadline to request a state fair hearing begins on the date of the MLTC “Action Taken” notice.

In addition, MLTC plans were required to use new model Initial Adverse Determination notices starting July. More information is at http://tinyurl.com/ps3c45k and http:// tinyurl.com/ojkw8fb.

DOH has posted guidance on fair hearings. When an MLTC partial capitation plan makes a decision, on or after July 1, 2015, to deny, reduce or discontinue enrollees’ services, enrollees may immediately request a state fair hearing from the New York State Office of Temporary and Disability Assistance (“OTDA”), according to DOH’s guidance to stakeholders.

•

The guidance is posted at http://tinyurl.com/ ojtg36x.

Appeals

Enrollees are no longer required to exhaust their plan’s internal appeals processes before obtaining a state fair hearing;

Enrollees do not need to specifically request aid-continuing to obtain it, but they may tell OTDA that they specifically decline it; and

Furthermore, the guidance (MLTC Policy 15.03) states that this policy change applies only to enrollees in MLTC partial capitation plans. Enrollees in other MLTC products, such as Medicaid Advantage Plus (MAP) and the Program for All-Inclusive Care for the Elderly (PACE), must continue to exhaust their plan’s internal appeals processes before obtaining a state fair hearing.

As reported in the June 26 ASAP, mandatory MLTC enrollment is now in effect in the entire state after the transition occurred on July 3 in Allegany, Clinton, Franklin, Jefferson, Lewis and St. Lawrence counties.

•

Under DOH regulations, LHCSAs are responsible for obtaining physician orders; if their patient is in a managed care plan, this requirement can be met by obtaining the order from the plan, as long as it meets the requirements outlined in state regulations. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.

Volume 20, No. 26 July 10, 2015

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

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Additional Info on DSRIP Waivers for Home Care The state Department of Health (DOH) has provided additional information on waivers under the Delivery System Reform Incentive Payment (DSRIP) Program and posted an updated timeline. In September 2014, DOH, the Office of Mental Health, the Office of Alcoholism and Substance Abuse Services and the Office for People with Developmental Disabilities issued guidance to Performing Provider Systems (PPSs) interested in seeking regulatory waivers in connection with DSRIP and the Capital Restructuring Financing Program. See http://tinyurl.com/ow7p9lb. PPSs received responses to their initial waiver requests in February. The first round of waiver requests and the associated responses are available at http://tinyurl.com/pvh6wms. Some of the waiver requests include allowing: other medical professionals to sign physician orders (such as physician assistants and nurse practitioners) for CHHAs and/or LHCSAs; CHHA and/or LHCSA expansion into additional counties; establishment of new CHHAs; additional clinicians to supervise home health aides and to provide supervision other than on-site; waiver of hospice need and geographic limitations; exceptions to the 90-day Medicaid billing limit due to late signed physician orders; use of the Uniform

HIRING Hospice and Palliative Care Association of NYS (HPCANYS) Seeks New President & CEO HPCANYS is a not-for-profit organization, located in Albany, NY, representing hospice and palliative care programs, allied organizations and individuals that are interested in the development and growth of quality, comprehensive endof-life services. The President and CEO provides leadership and manages and directs all functional areas of the Association as prescribed by the Board of Directors. The responsibilities and duties of the successful candidate will include, but are not limited to:

• • •

•

Provide leadership, vision, strategic thinking in the development of and strategic execution of the annual strategic blueprint. Lead, develop and manage all aspects of a member organization within the annual budget. Develop and maintain relationships with strategic partners including healthcare, business, media and community stakeholders; and governmental groups within the state and national arena. Coordinate all political action and advocacy activities with the appropriate leadership. Seek external program funding including grants and non-dues revenue. Manage all aspects of the Association’s communication strategies including website, quarterly newsletter, weekly e-news and other related strategies as needed. Excellent verbal and written communication skills.

Education/Experience: • Bachelor’s degree required; strong preference for Master’s or other advanced degree (e.g., MPA, MBA, MPH or JD) preferred. • Some meaningful experience in each of the following areas: health care, public policy and notfor-profit or trade association management. • At least five years’ intensive senior-level experience in at least one of: health care, public policy or notfor-profit or trade association management. • Ability and willingness to travel and ability to apply information technology. Candidates meeting the above qualifications should submit the following for a complete submission: cover letter; current résumé (1-2 pages in length preferred), which includes previous work experience and salary history; recommendation letters (optional, but desired). Please submit to iferrandino@hpcanys.org by close of business, Friday, July 31, 2015. For additional information call 518-446-1483.

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Volume 20, No. 26 July 10, 2015 

Assessment System instead of the Outcome and Assessment Information Set (OASIS); hospices to bill for palliative care; hospice residences in Article 28 facilities; Article 28 providers to serve patients at home; Federally Qualified Health Centers to provide certain services off-site. Further information is available at http://tinyurl.com/ojz65cd. HCA is seeking information on when DOH intends to make determinations on the home care/hospice-related waiver requests. The state agencies are now inviting PPS leads to submit additional waiver requests, the deadline for which is September 15, 2015. An e-mail with instructions has been sent to the PPS leads. Responses to these requests will be sent to the PPS leads by November 1, 2015, and posted on the DSRIP website. HCA members who are part of PPSs and are seeking waivers – such as to allow service area expansion or take other actions that require a waiver – should contact their PPSs about submitting such waivers for DOH approval. Timeline The DSRIP Year 1 Timeline has been updated to reflect recent changes to several key DSRIP deliverables. The timeline is now available at http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/timelines/ year_1_timeline.htm. Some notable upcoming dates are: PPS Partner Networks posted (mid-July); PPS First Quarterly Report and Project Implementation Plans due from PPSs ( July 31); opt-out letters mailed to Medicaid beneficiaries (midAugust to September); and additional regulatory waiver requests due (September 15) Any questions on the timeline may be directed to DSRIP@health.ny.gov.

HIRING Director of Programs & Services and Compliance Visiting Nurses Home Care is a Licensed Home Care Agency servicing 18 counties in the Capital Region and an affiliate of VNA Home Health, a Certified Home Health Agency certified in 11 counties. We have a full time position open for a Director of Programs & Services and Compliance. This individual will be responsible for the delivery of quality care for all Agency Programs and Services as well as planning, implementing and monitoring the Agency Corporate Compliance Program. This position reports directly to the CEO and is based in the Menands office. Requirements include a B.S.N. in Nursing or Registered Nurse with a Bachelor’s Degree in a related field. Master’s Degree in Nursing or related field preferred. Minimum of three to five years Supervisory/ Management experience in a health care setting, preferably in Home Care or Community-based Services. Must possess a current NYS Driver’s License and Current License & Registration to practice as a Registered Professional Nurse. Please submit Resume to HR@vnhc.com

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

Volume 20, No. 26 July 10, 2015 

Corrected Star Rating Preview Reports Issued The U.S. Centers for Medicare and Medicaid Services (CMS) advises home health agencies that it discovered errors in Provider Review Reports that were distributed to providers’ CASPER folders on June 30 related to the Quality of Patient Care Star Ratings program. Providers who have already downloaded and circulated these reports are urged to discard all copies. They can be recognized by the file name that ends: “Star2_prvw_for_Oct2015.” Replacement reports are scheduled to be distributed to providers’ CASPER shared folders by Friday, July 10. They will be available there for 120 days, or until November 6, 2015. Users can recognize the revised reports by the file name that ends: “Star2REV_prvw_for_Oct2015.” The revised version also includes the word “REVISED” in the initial title, and in the heading on the “scorecard” page. The second round of Quality of Patient Care Star Ratings is scheduled to be published on the Home Health Compare website on October 8, 2015. Providers can request CMS review of their star ratings if they can document errors or omissions in the data submitted to CMS which have impacted their final star rating. To submit a request, see the instructions on page 3 of the preview report. Given the need to revise the preview reports, the deadline for submitting these requests is being extended to July 24, 2015. Any questions about these reports can be directed to HomeHealthQualityQuestions@cms.hhs.gov. Additional information about the home health Quality of Patient Care Star Ratings, including the process and outcome quality measures, is available at: https://www.cms.gov/Medicare/Quality-Initiatives-PatientAssessment-Instruments/HomeHealthQualityInits/HHQIHomeHealthStarRatings.html.

CMS Issues Guidance on Medicaid Coverage of Housing-Related Services Last week, the U.S. Centers for Medicare and Medicaid Services (CMS) issued an Informational Bulletin to clarify the circumstances under which Medicaid reimburses for certain housing-related activities. The Bulletin is at http://tinyurl.com/ox5ksyj (click federal policy guidance at top of page). While CMS does not provide federal financial participation (FFP) for room and board in home and communitybased services, it can assist states with coverage of certain housing-related activities and services. These include: •

Individual Housing Transition services – services that support an individual’s ability to prepare for and transition to housing.

•

Individual Housing and Tenancy Sustaining Services – services that support the individual in being a successful tenant in his or her housing arrangement. Continued on next page

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Continued from p. 10 •

State-level Housing Related Collaborative Activities – services that support collaborative efforts across public agencies and the private sector that assist a state in identifying and securing housing for individuals with disabilities, older adults needing long term care services and supports, and homeless individuals.

•

The Bulletin lists those housing-related services that can be provided under waiver programs, Community First Choice and Money Follows the Person.

Publications •

“How Managed Long-Term Services and Supports is Providing Coordination,” AARP Public Policy Institute h t t p : / / w w w. a a r p . o r g / p p i / i n f o - 2 0 1 5 / m a n a g e d - l o n g - t e r m - s e r v i c e s - c a r e coordination.html?cmp=CRCORNAT_MAY12_015

•

“Medicare Advantage 2015 Spotlight: Enrollment Market Update,” by Kaiser Family Foundation http://files.kff.org/attachment/issue-brief-medicare-advantage-2015-spotlight-enrollment-marketupdate

•

“Not all States Reported Medicaid Managed Care Encounter Data as Required,” by the Office of Inspector General http://oig.hhs.gov/oei/reports/oei-07-13-00120.pdf

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

HCA’s Senior & Financial Manager’s Retreat September 17 & 18, 2015 Mohonk Mountain House, New Paltz, NY

HCA’s Senior & Financial Managers Retreat

“CHHA Medicaid EPS rebasing cuts are here, and more cuts are coming. TPL and F2F are weighing on our bottom line. We’ve hardly got our head around DSRIP – and now the state is moving to value‐based payments. Meanwhile, our accounts receivable is through the roof, and it feels like we’ve exhausted all potential growth opportunities.”

Are these the kinds of thoughts keeping you up at night? Come to

HCA’s Senior and Financial Manager’s Retreat

September 17 and 18

to get away – and to get a better grasp of today’s home care payment and regulatory environment.

We’ll help you put your budget in square order, find the answers you need from top officials and contractors, and gain valuable insights from the state’s leading consultants who will reveal what they are telling their clients about where to look for new opportunities. HCA is offering this program in

critical domains: The Big Picture, Reimbursement Mechanics and Updates (Medicaid and Medicare), Strategic Planning for New Growth Areas, and A Medicare Focus. Details are fleshed out later in this brochure.

Big Picture

Mechanics

Growth

Medicare Focus

Also, did we mention that this is all taking place at one of the nation’s top‐ranked resorts, conveniently located in the Catskills? If you’ve been to this retreat before – at the scenic Mohonk Mountain Resort in New Paltz – you know it’s the right place to get informed and inspired. With your hotel and conference registration, we have you covered: expert presenters, all meals at Mohonk’s world‐class dining facilities, an evening reception to network, access to the resort’s trails and picturesque grounds, and months‐worth of insights in two days. You just need to reserve your spot.

Please register by August 15 to get your seat at the table. And while you are at it, why not make it a ‘table for two’? Bring your CEO, chief finance officer or finance directors for shared learning and strategic planning.

HCA’s Senior & Financial Managers Retreat Conference Sessions September 17 (9:15am to 4:45pm) September 18 (8:30am to noon) Big Picture

Growth

Domain I: The Big Picture • HCA’s Policy & Executive Team – Sept. 17 Let HCA’s policy and executive team set the stage for you. We’ll give you the latest info from Albany and Washington. We’ll tell you what we are doing to shape the payment and regulatory environment in a way that mitigates risk and opens new opportunities. Best yet, we’ll answer your questions on any reimbursement, payment or regulatory issues needing clarification.

Mechanics

Domain II:

Reimbursement Mechanics and Insights (Medicaid & Medicare) • DOH Reimbursement Updates (Tim Casey and Dan Carmody) – Sept. 17 • New Developments in TPL (OMIG & UMASS) – Sept. 17 The timing of this conference couldn’t be better: DOH will be finalizing its CHHA rebasing rates in October, just a few weeks after the Retreat. You’ll get the most up‐to‐ date preview of the state’s intentions for resetting the CHHA reimbursement system – not to mention countless other Medicaid reimbursement, MLTC, FIDA and managed care updates that all home care programs need to know about. We don’t need to tell you that TPL billing and audits have been a major unreimbursed assignment for home care agencies across the state. Things may be changing. For instance, what does the future hold, now that much of the state’s dually eligible population has moved into managed care? TPL occupies a big space in your administrative budget; you’ll want to know what’s coming next from OMIG and its TPL contractors.

Domain III:

Strategic Planning – Inside and Outside the Government Payor Box • Value Based Purchasing (Marc Berg, KPMG) – Sept. 18 • Panel Discussion on Plan, Physician Practice, Hospital/HomeCare – Sept. 17 • New Business Lines in Evolving Market Places (industry experts) – Sept. 17 We know you need more answers about all of the new payment models on the horizon, as well as growth opportunities that cut across payor lines. If you thought DSRIP was a big change, by now you know it’s merely a temporary bridge to a more permanent structure called value‐based payments. The state’s value‐based payment program offers a blend of upside and downside risk, at various tiers, and Dr. Mark Berg will get you thinking now about which options to pursue – and how to acclimate your operation for success. HCA also knows there are several other value and growth areas that may seem hidden to you – and we have top experts to present these insights, including a panel who will discuss innovative arrangements with plans, physicians and hospitals. Meanwhile, home care providers value the advice of consultants as you explore growth opportunities, so we’ll also have top experts here to help you explore new business lines to diversify your portfolio as well.

We know you need more answers…

HCA’s Senior & Financial Managers Retreat Conference Sessions September 17 (9:15am to 4:45pm) September 18 (8:30am to noon)

Medicare Focus

Domain IV: A Focus on Medicare • Maximizing Your Medicare Revenues Through Improving Operations and Benchmarking (Michael Freytag, Black Tree Healthcare Consulting) – Sept. 17 • Federal Update on F2F, Regulatory Issues and Reimbursement (Bill Dombi, NAHC) – Sept. 18 You’ve been benchmarked! It’s how Medicare and Medicaid rates are set; it’s even how auditors decide who to target for review. But you can also use benchmarking to your advantage. You just need the data, and a little insight. While HCA has substantially built up our capabilities in this area, through our HCA Data page and other resources, a lot of this data gathering and analysis has also been done for you by expert consultants and benchmarking analysts. Enter Black Tree Healthcare Consultants, who will show you the most important Medicare comparative data to set your compass right. NAHC’s Bill Dombi is one of the sharpest and most knowledgeable voices on Medicare home health – bar none. We are delighted that he is available to present some very practical insights on evolving guidance related to the face‐to‐face requirement, Medicare rebasing and other major payment issues affecting the Medicare side of your operation.

Big Picture

Mechanics

Growth

Medicare Focus

HCA’s Senior & Financial Managers Retreat

Thanks to our Sponsors and Exhibitors! 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

$305 per person, per day; double rates are $229 per person, per day. Local taxes and a 12% gratuity are additional. All Mohonk reservations should be made by August 15 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 $120 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 Financial Managers Retreat September 17 & 18, 2015 Mohonk Mountain House 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 4.

REGISTRANT INFORMATION – Please register by August 15. Name: __________________________________________________________________________ Title:____________________________________________________________________________ Agency:_________________________________________________________________________ Address:_________________________________________________________________________ City/State/Zip:____________________________________________________________________ Phone:________________________________ Ext._________ Fax: _________________________ Email: ___________________________________________________________________________ (Required)

HCA REGISTRATION FEE ____ Member Fee

 $299

____ Non‐Member Fee

 $399

MOHONK RESORT FEES Check one of the following. See resort information and pricing on page 4 for details.

____ I will make my overnight room reservation directly with Mohonk.

 $0

____ I require a Mohonk “day only” pass at $120 per day.

 $_________

PAYMENT – Please check method of payment:

Total:

$___________

________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 September 8. ______________________________________________________________________________ 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

HCA Cancellation Policy HCA registration cancellations received by August 28 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.

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