ASAP
A Weekly Publication Of HCA Home Care Association of New York State
Legislative Issues Public Policy
News
Volume 20, No. 27 July 24, 2015
HCA Exploring Solutions to Physician F2F Documentation Members of the HCA board, staff and several HCA providers have been teaming up to develop a potential standard addendum to ease physician documentation compliance for meeting federal face-to-face (F2F) requirements for home care eligibility. The workgroup has been working on the form for physicians to complete and add to their home care patients’ records to help fulfil the F2F standards. Our discussions this week were joined by the U.S. Centers for Medicare and Medicaid Services (CMS) contractor and fiscal intermediary, National Government Services (NGS), for See SOLUTIONS p. 2
HCA Welcomes New Staff to Policy, Advocacy & Education Departments HCA is delighted to welcome two new members of our policy and education teams: Alexandra Blais, MPH (photo at left); and Celisia Street, LMSW (photo at right). Alex has joined HCA as Director of Public Policy, complementing and augmenting our existing public policy apparatus. She will pursue several new advocacy and growth initiatives, including a focus on engaging home care consumer audiences. She comes to HCA from Rensselaer Polytechnic Institute, where she was involved with health promotion and risk reduction initiatives for that population. She also has
Inside ASAP
See STAFF p. 4
HCA Explores F2F Documentation Solutions….................................1 HCA Welcomes New Staff…...............................................................1 New CMS Instructions for F2F Medical Reviewers…..........................2 Go Online for New ASAP web exclusive articles….............................4 MedPAC 2015 Data Book Available…................................................4 Take 5 Minutes to Complete HIT Survey…...........................................4 State’s VBP Roadmap Approved….....................................................5 Wage Vote for Fast-Food Industry a Signal to Other Sectors….........5 Hotel Rate Ends 7/31 for Home Health Symposium…........................6 13% ICD-10 Denial Rate?…................................................................6 Prep for Medicare & Medicaid Rebasing at Finance Retreat…...........7 Member Hiring Announcements….....................................................7 State Posts ICD-10 Codes for CHHA EPS Grouper….........................8 DSRIP Update…...................................................................................8 OMIG Releases Compliance Guidance for PPSs…..............................8 HCA Comments on Medicaid Managed Care Proposed Rule….......9 Managed Care Updates…..................................................................9 Reminder on Process for Expedited Personal Care..........................10 PHHPC Committee on Establishment Meets…................................10 HCA Innovates, Beta Tests Sepsis Prevention Tool…......................11 Publications...................................................................................................11
Reminder: HCA is publishing ASAP every other week for the summer. We are not publishing on July 31 but will publish again on August 7.
Helping New Yorkers Feel Right At Home
ASAP – a publication of the Home Care Association of New York State
SOLUTIONS from p. 1 vetting and feedback. We will also engage physician and hospital representatives to ensure that the form is CMScompliant, physician-friendly, and effective. This effort responds to the continuing, severe challenges, costs and access consequences for home care associated with CMS’s F2F implementation and enforcement. For the latest information on F2F medical review and HCA advocacy, see the related story on this page. For further information, please contact Al Cardillo at acardillo@hcanys.org.
Volume 20, No. 27 July 24, 2015
CMS Provides New F2F Medical Review Instructions F2F standards remain plagued with confusing instructions as HCA presses advocacy plan for clarity, streamlining The saga of Medicare face-to-face (F2F) continues with one transmittal (No. 602) issued on July 10 and another one (No. 603) issued this week from the U.S. Centers for Medicare and Medicaid Services (CMS) regarding the medical review process. Transmittal No. 602, which provides instructions to medical review contractors, elaborates on an already confusing set of requirements whereby home health agencies are expected to substantiate F2F compliance through the exchange of medical records with their certifying physicians. Under the current F2F construct, CMS also examines other patient information from the doctor in the physician’s medical records. As reflected in the 2015 home health prospective payment system rule, home care agencies are responsible for assuring that specific documentation elements are included in the certifying physician’s (or discharging facility’s) medical records for all Medicare home health beneficiaries, without which the home health claim is subject to denial. These required elements in the physician record include documentation of Medicare eligibility – namely, the need for skilled service and the reason for a patient’s homebound status
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 Alexandria 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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ASAP – a publication of the Home Care Association of New York State
– along with proof that the physician has seen the patient face-to-face (F2F) within the required timeframes.
summary of why the patients is in need of skilled services and is homebound,” according to a recent article posted to NAHC’s website.
“Reviewers will consider home health agency documentation if it is incorporated into the patient’s medical record held by the certifying physician” and/or facility of discharge “and signed off by the certifying physician. The documentation does not need to be on a special form,” CMS states.
Adding yet another wrinkle, contractors are also instructed, in CMS’s transmittals, to look within the medical records for a certifying physician statement “which must indicate the continuing need for services and estimate how much longer the services will be required.” CMS doesn’t prescribe specifically how this is to be documented; but a certification statement by the physician should be included in the medical record explicitly providing a prognosis for the expected future length of services at certification and at each recertification.
CMS adds: “The reviewer shall consider all documentation from the home health agency that has been signed off in a timely manner and incorporated into the physician/ hospital record.” On this last statement, the National Association for Home Care and Hospice (NAHC) has already pointed out to CMS this week that transmittal No. 602 is inconsistent in its definition of “timely manner.” According to NAHC, CMS has since agreed to clarify that “timely” means “prior to or at the time of claim submission.” According to CMS, even if F2F documentation is deemed satisfactory for the second or subsequent episodes in a sequence – during the recertification process – agencies are nevertheless still liable for submitting satisfactory documentation for the initial, first-episode certification; otherwise, the second episode claim and subsequent claims in the sequence will not be covered. Because CMS requires the maintenance of sufficient documentation in the certifying physician’s medical record (without which a claim can be denied), agencies are advised to present as much information as possible to the certifying physicians for inclusion in their medical records. NAHC recommends including, at minimum, “the plan of care and pertinent sections from the comprehensive assessment, along with an admission
CMS’s transmittals can be read at http://tinyurl.com/ nvoxgcn and http://tinyurl.com/olvreeu. HCA has remained continually engaged in advocacy with partner organizations on proposed legislation and regulatory changes to ease the unnecessary burden of this confusing F2F documentation mandate. Several legislative approaches and F2F technical guidelines are now under consideration, including a bill introduced by Senators Robert Menendez (D-NJ) and Pat Roberts (R-KS) in late June. That bill, the “Home Health Documentation and Program Improvement Act of 2015,” aims to assist providers coping with the F2F mandate by creating a single form for certification purposes. It also addresses past claims denials by requiring the Medicare contractors to re-review claims denied after January 1, 2011, and it would waive the F2F mandate for all home health services provided to patients who receive home health immediately upon discharge from a hospital or skilled nursing facility. In addition, HCA is working with member organizations on a uniform F2F form that providers can use throughout New York. (See related p.1 story.) We have also been in talks with NAHC on a different and more potent approach to solving the F2F burden. It includes legislative language stating that the physician’s signature on the plan of care, along with the date of the F2F encounter, would be deemed to meet the F2F mandate. 3
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Volume 20, No. 27 July 24, 2015
STAFF from p. 1 previous experience coordinating a statewide nutrition education program and providing case management services.
Go Online For NEW ASAP Web Exclusives
Celisia is our new Director of Education. In her role, Celisia oversees the development and implementation of HCA’s educational programming, special events and other activities of the Association in collaboration with the HCA policy team. She comes to HCA from a long tenure as Communications and Professional Development Associate at the National Association of Social Workers-New York State Chapter. She also has experience in mental health and case management services.
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 this week on the following topics: • • •
HCA’s prior Director of Education, Lynda Schoonbeek, retired in the spring.
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Alex and Celisia’s contact information are in the masthead on page 2. Please join us in giving them a warm welcome to HCA!
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Take Five Minutes to Complete HIT Survey Sponsored by HCA & NYeC
eMedNY Trainings Scheduled Updates from the Medicare Contractor: NGS Medicare and Social Security Trustees Reports Issued OSHA Issues Revised TB Inspector Instructions Home Health Agencies to Receive Comparative Data Reports Medicare Care Choices Model Awards Announced
Get these important updates and others by visiting the following section of HCA’s website: http://hca-nys.org/category/general-news.
HCA sent an alert this week reminding all home care members to take a few minutes to answer a very brief survey sponsored by HCA and the New York e-Collaborative (NYeC) on home care technology use.
MedPAC Data Book Available
If you haven’t completed the survey yet, please do so as soon as possible, as it will assist us in advocating on your behalf. The survey is very brief and should only take five or ten minutes to complete.
The Medicare Payment Advisory Commission (MedPAC) has released its 2015 data book on health care spending and the Medicare program. It is at http://www.medpac.gov/ documents/data-book/june-2015databook-health-care-spending-and-themedicare-program.pdf?sfvrsn=0.
The survey is at https://nyec.wufoo.com/forms/ home-care-association-of-nys-technologysurvey. The deadline is July 27 and we need as big a response as possible.
Some areas covered include: dual eligible beneficiaries, post-acute care, Medicare Advantage managed care, quality of care, and Medicare beneficiary demographics.
Please contact Elizabeth Amato (eamato@nyehealth.org) with any questions about accessing or completing the survey or Al Cardillo (acardillo@hcanys.org) at HCA with general questions about this request for information. 4
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Volume 20, No. 27 July 24, 2015
State’s VBP Roadmap Approved by CMS Subcommittees already meeting to further guide VBP implementation The U.S. Centers for Medicare and Medicaid Services (CMS) has approved New York State’s Roadmap to Value Based Payment (VBP). CMS’s July 22 approval letter states that “the roadmap provides a path forward for payment reform as part of New York’s delivery system reform efforts and serves as one of several methods to help support the financial sustainability of the state’s Medicaid program.” The approval also requires that this roadmap be updated at least annually, and recognizes that adjustments may be necessary for circumstances further identified in planning and implementation. CMS’s letter and the Roadmap are at http://hca-nys.org/wp-content/uploads/2015/07/VBPletterroadmap.pdf. Planning and implementation work has already begun through a series of subcommittees to address critical topics like: technical design, regulation, community-based organizations, social determinants of health, and targeted clinical conditions. HCA staff are serving on these subcommittees and have also served on the broader workgroup, meeting since early in the year, to provide input and recommendations. VBP is a fast-paced road being paved at the federal, state and market levels. There are huge challenges to all sectors, each for varied reasons, but the state’s plan also offers opportunities. To help guide you, HCA is providing a special session on VBP at our Senior and Financial Manager’s Retreat on September 17 and 18 at the Mohonk Mountain House in New Paltz. Please see the registration form at the back of this week’s ASAP. For further information, please contact Al Cardillo at acardillo@hcanys.org.
State Board Approves $15 Wage for Fast-Food Industry, Signaling Possible Labor Changes in Other Sectors The state’s wage board has endorsed a proposal to raise the minimum wage to $15 per hour for workers in fastfood chains that have 30 or more nationwide locations – a proposal which may signal labor changes outside of the food sector, including for home care and other health services. The proposed fast-food wage hike would occur first in the New York City region in a phased fashion, climbing from $10.50 on December 31, 2015 and rising each year until hitting $15 on December 31, 2018. The rest of the state would see a hike to $9.75 at the end of this year, culminating in a $15 wage on July 1, 2021. This proposal follows previously scheduled changes to the statewide minimum wage broadly, which are already approved to reach $9 by the end of this year for all employers in the state. The $15 wage change, endorsed by Governor Cuomo, is expected to be implemented by the state labor commissioner. It does not require legislative approval because state law allows for wage changes, through the wage board, “in a specific industry or job classification if it finds that wages are insufficient to provide for the life and health of workers within that industry or classification.” Continued on next page 5
ASAP – a publication of the Home Care Association of New York State Continued from p. 5
Online registration is now open for the Northeast Regional Future of Home Health Symposium: “Preparing for the Future of Home and CommunityBased Care” on September 9 in New York City. The hotel deadline is July 31, so please register as soon as possible by visiting http://tinyurl.com/pas863h. A flyer is also posted at the back of ASAP.
The $15 level is higher than the amount currently required for home health aide wages in New York City and Long Island under the State Home Care Worker Wage Parity Law. It is also well above the $9 rate that will be required statewide under the broader minimum wage hike set to go into effect on December 31. The state Wage Parity Law levels (for the period of March 1, 2015 to February 28, 2016) are as follows:
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Hotel Rate Ends on July 31 for Symposium: Future of Home Health
This week’s actions could signal proposals for other sectors. In a press statement this week, 1199 SEIU called the wage increase “a first step” toward expanding the $15 starting rate for other workers, “especially homecare and healthcare workers.”
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Volume 20, No. 27 July 24, 2015
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.
In New York City, the minimum rate of home care aide “total compensation” is $14.09, consisting of a “base wage” of at least $10 per hour, “additional wages” of up to $1.69 per hour and “supplemental (benefit) wages” of up to $2.40 per hour.
Please call the hotel directly at 1-800-222-8733 before July 31 and ask for the HCA room block. 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
In Long Island and Westchester, the minimum rate of home care aide total compensation is $11.50, consisting of a base wage of at least $10 per hour, and supplemental (benefit) wages of up to $1.50 per hour.
13% Denial Rate? Reduce Your Exposure with ICD-10 Staff Training
The Wage Parity Law, in particular, has been a major advocacy focus for HCA and the provider community. The industry has called for payment adequacy legislation to: set MLTC, other managed care, and home care rates at a level that funds the wage parity levels; and for the state to incorporate these and other labor costs in their payments to managed care plans, with adequate payment flow to providers.
With major ICD-10 coding changes in sight, HCA is continuing our education to assist your billing and clinical staff so that the October coding transition doesn’t catch you off guard.
We have also participated in litigation to invalidate the wage parity law, arguing that the home care system is not in a financial position, under existing state reimbursement policies, to support the enhanced wage levels.
CMS predicts a 13 percent claim denial rate when ICD-10 hits in October. You will want to take every measure possible to reduce your exposure to claim denials, and that means training your staff. On September 30, HCA presents coding expert Trish Tulloch, of RBC Limited, for her hit program ICD10-CM & OASIS Coding: Back to Basics and Beyond in Nanuet, NY.
These and other wage developments will continue to be a focus of HCA’s advocacy in support of the home care community.
A registration form is at the back of this week’s ASAP. You can also register your team online immediately at http://tinyurl.com/pp3aac9. 6
ASAP – a publication of the Home Care Association of New York State
Medicare & Medicaid Rebasing Cuts all at Once? Prepare at HCA’s Finance Retreat: Sept. 17 & 18 Medicare rebasing cuts are hitting for a third year in 2016. Retroactive CHHA Medicaid rebasing has cut home care payments going back to April 1. Meanwhile, a more permanent structure of Medicaid rebasing is moving forward in October, with even bigger, unknown payment changes for CEOs, CFOs and other finance managers. Come to our Senior and Financial Manager’s Retreat in September, where you’ll gain insights from top experts and payor representatives on these and other major payment changes. Bill Dombi alone is worth the price of admission. Mr. Dombi, who is Vice President for Law at the National Association for Home Care and Hospice, will provide invaluable perspectives on the major components of Medicare rebasing. Meanwhile, on the Medicaid side, we’ll have state Department of Health officials, like Tim Casey, on hand to give you straight-from-the-source information about the state’s Medicaid rebasing proposal, which remains a big question mark for providers. HCA’s expert policy team will also provide a cliff-notes crash-course on all of the major payment developments affecting your organization. As if these topics weren’t big enough, our conference agenda will also fill in the picture for other major issues and unknowns like the future of TPL audits, value based payments, MLTC payment
Volume 20, No. 27 July 24, 2015
HIRING Director of Programs & Services and Compliance Visiting Nurses Home Care is a LHCSA servicing 18 counties in the Capital Region and an affiliate of VNA Home Health, a CHHA 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: 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 and registration to practice as a Registered Professional Nurse. Please submit résumé to HR@vnhc.com.
Regional Program Director-Albany Area VNA Homecare is hiring an Albany-area Regional Program Director who is responsible for the regional delivery and supervision of care management services provided for enrollees within the MLTC in the Capital Region, in accordance with agency policy and procedures, and under the direction of the Senior Director of Care Management. The Regional Program Director provides leadership and direction to the regional team ensuring that high quality, culturally sensitive and cost-effective services and benefits are provided. Requirements: Bachelor’s degree from an approved school, acceptable to New York State Department of Health; Master’s degree in health related field preferred; Two years’ experience as home care nurse in a health agency; Current NYS driver’s license and automobile insurance; Knowledge and/or experience in long term patient care and chronic disease management. For this and other openings at VNA Homecare, visit http://tinyurl.com/q46v6yn to apply.
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ASAP – a publication of the Home Care Association of New York State updates, regulatory issues like Medicare faceto-face, and much more.
DSRIP Update
Please register now online at http:// tinyurl.com/pp3aac9 or download the brochure at the back of ASAP.
The state Department of Health (DOH) has posted Performing Provider System (PPS) Network lists for the Delivery System Reform Incentive Payment (DSRIP) program.
State Posts ICD-10 Codes Applicable to 2009 Base Year CHHA EPS Grouper
The lists and additional information are at http:// www.health.ny.gov/health_care/medicaid/redesign/ dsrip/pps_network_partners.htm.
DOH continues to post information associated with CHHA EPS rebasing initiative The state Department of Health (DOH) has posted a list of ICD-10 diagnosis codes that are applicable to the 2009 base year CHHA Episodic Payment System (EPS) Medicaid grouper. See: http://www.health.ny.gov/ facilities/long_term_care/reimbursement/ chha. DOH notes that applicable diagnoses may change if the CHHA EPS Grouper is revised to reflect data from a more recent base year. Last month, DOH posted the revised interim EPS rates for CHHAs, beginning retrospectively for episodes ending on or after April 1, 2015 through September 30, 2015. The interim rates reduce the current 2009 base year episodic payment rates by 12 percent. This reduction is an initial step before DOH implements a final rebasing of EPS beginning on October 1, 2015. DOH has stated that this interim percentage adjustment was needed to comply with the statutory deadline for rebasing to take effect – by April 1, 2015 – and to preserve the $30 million annual financial plan savings estimated for rebasing in the final 2015-16 state budget. In addition to the 12 percent reduction, CHHAs are at risk for a much more expansive rebasing impact beginning on October 1, which is why HCA introduced
The network list is a combination of the providers and entities that are partnering with PPSs for both valuation and/or performance. HCA members should check to confirm that they are listed with the PPSs you’ve been working with. Using these network lists, DOH has attributed Medicaid members to partnering PPS providers, and, on a quarterly basis, DOH will assess PPS performance in DSRIP projects. This will occur through the ongoing measurement of a PPS’s achievement of metrics and outcomes.
OMIG Compliance Guidance for PPSs The state Office of the Medicaid Inspector General (OMIG) has posted DSRIP Compliance Guidance 2015-02: Frequently Asked Questions by Performing Provider System (PPS) Leads Relative to Compliance Programs. This joint publication by OMIG and the Department of Health (DOH) provides responses to DSRIP-related compliance questions. It covers OMIG expectations for PPS Lead Entities relative to: their partners’ use of DSRIP funds, obligations to provide compliance training and education, responsibility to check for excluded or sanctioned parties, and obligation to refund overpayments. It also provides information on the role of the Independent Assessor. The publication is at https://www.omig.ny.gov/images/ stories/compliance_alerts/20150715_dsrip_faqs.pdf.
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state legislation, passed by both houses, to limit the Department’s rebasing initiative. We are awaiting delivery of the bill to the Governor’s office and will alert you to any advocacy needs at that time. DOH has also posted a schedule of rates, effective April 1, 2015, which show the impact of reductions to the 109 case-mix-adjusted payment rates for CHHA EPS. These rate revisions do not include any adjustment to the rates for pediatric patients, whose services continue to be reimbursed on an historical fee-for-service per unit basis. For specific questions on these rates, contact DOH’s Tim Casey or Charles Toby at (518) 473-4421 or e-mail DOH at bltcr-ch@health.ny.gov. We note that Mr. Casey will be presenting at HCA’s Senior and Financial Manager’s Retreat on September 17 and 18 where he’ll provide the latest updates on the expectations for the CHHA rebasing process in October. Please register now by downloading the brochure at the back of this week’s ASAP. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
HCA Comments on Medicaid Managed Care Proposed Rule This week, HCA submitted comments to the U.S. Centers for Medicare and Medicaid Services (CMS) on a proposed rule that would provide the most significant update to Medicaid managed care rules in more than a decade. Please see the “Letters and Comments” page of HCA’s website to download the letter at http://hcanys.org/category/letters-and-comments. The rule covers the delivery of managed long term services and supports (LTSS); quality improvement; program and fiscal integrity; state delivery system reforms; rates to plans; beneficiary experience; and other areas. HCA’s comments address: the misalignment between federal and state regulations for home care; the need for actuarial soundness of rates by states to managed care plans and rates by plans to home care providers; disenrollment due to home care provider changes; transitions of care; state monitoring requirements; grievances and appeals and aid continuing; provider screening and enrollment; uniform billing; and plan contacts. For more information, contact the HCA Policy staff.
Managed Care Updates The state Department of Health (DOH) has posted marketing guidance for the Fully Integrated Duals Advantage (FIDA) program and information on the transition of behavioral health services to managed care. It is at https://www.health.ny.gov/health_care/medicaid/redesign/docs/cy_2015_ny_market_guide.pdf. Some areas covered include requirements related to: non-English speaking populations; written materials at time of enrollment; the enrollment process; identification cards; promotional activities; telephone contact; customer call centers; and marketing of other plan products. Behavioral health DOH has posted an entire Medicaid Update issue on the transition of behavioral health to managed care. It is at http://www.health.ny.gov/health_care/medicaid/program/update/2015/jul15_mu_speced.pdf. It includes information on the implementation timeline; role of health homes; provider technical assistance; payment and network contracting requirements; quality assurance; and other issues. More information is at http://tinyurl.com/qz8srh5. 9
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Reminder on Process for Immediate Personal Care Needs The state Department of Health (DOH) has issued a notice to remind local departments of social services of DOH regulations that provide for an expedited authorization process for Medicaid personal care services. This process applies in cases when services are needed to protect health or safety of a recipient but the nursing assessment cannot be completed in five business days. The notice is at http://www.health.ny.gov/health_care/medicaid/publications/docs/gis/15ma011.pdf. According to DOH, the expedited authorization process may be most appropriate for recipients: •
Whose enrollment in an MLTC plan, through no fault of the recipient, might not occur with reasonable promptness (i.e. by the 20th of the month); and
•
Who reside at home in the community, or are seeking to return to the community, have no informal caregivers who are able and willing to provide assistance with needed personal care services tasks, are not already receiving home care services from a home care services agency, and who have no third party insurance or Medicare to pay for needed assistance.
In February of this year, DOH had published a revised rule for the procedures by which Medicaid applicants may establish presumptive eligibility for “immediate personal care services.” That rule is at http://tinyurl.com’q85ylur. Questions regarding this information can be sent to services@health.ny.gov.
PHHPC Committee on Establishment Meets The Public Health and Health Planning Council (PHHPC) Committee on Establishment and Project Review met on July 23. The agenda included the following items related to home care: •
One application was a change in ownership by a CHHA that serves the general population in Greene, Orange, Ulster and Westchester as well as the developmentally disabled population in Dutchess, Putnam, and Sullivan.
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Under another application, the same entity proposes a change in ownership of its CHHA and LTHHCP that serves western New York.
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Applications by 29 entities (8 outside of the New York City metropolitan area) to establish a LHCSA; and
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Applications by 10 LHCSAs for a change in ownership (including 3 outside of the New York City metropolitan area).
All the applications were recommended for approval and sent to the full PHHPC for its consideration on August 6. The July 23 meeting materials are at http://www.health.ny.gov/facilities/public_health_and_health_planning_council/ meetings/2015-07-23/. 10
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HCA Innovates, Beta Tests Sepsis Prevention Tool A workgroup of the HCA Quality Committee has been working throughout the spring and early summer to innovate a sepsis early recognition tool and protocol for use in home care. This week the workgroup launched a beta test of the tool and protocol. This test will run through early August. Following the beta, participating providers will report, analyze and discuss findings with HCA. We hope to finalize and eventually present the tool to home care agencies for adoption as a basic part of their practice. Sepsis morbidity and mortality rates are devastating in both human and fiscal terms. Data from the National Sepsis Alliance reports that: a new case of sepsis occurs in the U.S. every 20 seconds; sepsis is the leading cause of death in hospitals; and mortality increases 8 percent every hour that treatment is delayed. IPRO data shows sepsis to be the number one cause of all Medicare fee-for-service hospital 30-day readmissions in New York State in 2013. All indications are that this initiative would break new ground in potential sepsis intervention, in New York State and nationally, and would be an invaluable protocol to bring to the table in partnership discussions under the Delivery System Reform Incentive Payment (DSRIP) program and other models. Meanwhile, HCA is simultaneously exploring funding support with the state hospital association (HANYS) for a joint hospitalhome care sepsis initiative. We are also presenting proposals to the Legislature. For further information, please contact Al Cardillo at acardillo@hcanys.org.
Publications •
“Long-Term Services and Supports for Older Americans: Risks and Financing,” by the Health and Human Services Office of the Assistant Secretary for Planning and Evaluation Office of Disability, Aging and Long-Term Care Policy http://aspe.hhs.gov/daltcp/reports/2015/ElderLTCrb.pdf
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“Data Note: Medicare Advantage Enrollment, by Firm, 2015,” by the Kaiser Family Foundation http://files.kff.org/attachment/data-note-data-note-medicare-advantage-enrollment-by-firm-2015
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“CMS Bundled Payments for Care Improvement (BPCI) Initiative Models 2-4: Year 1 Evaluation & Monitoring Annual Report,” by the Lewin Group http://innovation.cms.gov/Files/reports/BPCI-EvalRpt1.pdf
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“Addressing Performance Measure Gaps in Home and Community-Based Services to Support Community Living: Interim Report, July 15, 2015,” by the National Quality Forum http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=79920
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“Physician Documentation Requirements for Certification of Home Health Care,” by National Government Services http://www.ngsmedicare.com/ngs/wcm/connect/aa29ab35-52a1-4298-9fc4-da87f9a9e9d5/ Physician_Documentation_Requirements_Certification_Home_Health_Care_Letter.pdf?MOD=AJPERES
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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Blueprint for OASIS Accuracy – OASIS-C1 Data Set Two day OASIS C-1 Data Collection Rules and Guidance workshop, with an optional Certificate for OASIS Specialist-Clinical (COS-C) exam.
Effective up-to-the-minute education targeted for field data collectors, their supervisors and those preparing for the COS-C exam.
October 26 and 27 Workshop 8:00am to 4:00pm
October 28
Experience the comprehensive and nationally acclaimed two-day Blueprint for OASIS Accuracy workshop and learn to confidently teach, audit and collect OASIS C-1 items accurately. Through guided, expert instruction, and participation in problem-solving discussions and application scenarios, achieve mastery of the OASIS items, conventions, and the latest data collection rules. Rather than provide opinions, assumptions, or unfounded interpretations, the “Blueprint” presenters will model reliance on CMS guidance documents and provide and demonstrate strategies for how to find defendable answers to your OASIS questions.
COS-C Exam 9:00am to 11:30am Individuals may register for the workshop, the exam or both.
Facilitators: Linda Krulish
Annette Lee
Workshop/Exam Location Visiting Nurse Service of NY 1250 Broadway, 7th Floor Meeting Rooms 7A/B/C New York, NY 10001
Hotel Accommodations Courtyard Marriott Times Square West 307 West 37th Street (at 8th Ave) New York, NY 10018 HCA has reserved a limited block of rooms at the rate of $289 per night. Please call (212) 912-0009 before September 18 and ask for the group code: HCA Blueprint
Linda Krulish, PT, MHS, COS-C Linda is a physical therapist in home care since 1988. She is a nationally recognized expert on OASIS and home health quality improvement. She is the President and Founder of OASIS Answers. Annette Lee, RN, MS, HCS-D, COS-C Annette is a registered nurse practicing since 1990, with the majority of her nursing experience in home health. She is a Senior Associate with OASIS Answers, Inc.
COS-C Exam The Certificate for OASIS Specialist – Clinical (COS-C) Exam is a voluntary Certificate examination for those interested in demonstrating and establishing their expertise and commitment to OASIS data accuracy. Administered the day following the Blueprint for OASIS Accuracy training, the scope of the COS-C exam is similar to the Blueprint workshop agenda, covering CMS guidelines related to OASIS time points, regulations, patient populations, and OASIS-C1 item specific scoring. Candidates who successfully pass the examination are awarded the COS-C designation. Please note the exam fee is in addition to the two-day Blueprint workshop fee. Register for the exam online at www.oasisanswers.com or complete the attached form and send to OASIS Answers, Inc.
www.hca-nys.org
Blueprint for OASIS Accuracy –
2-Day Workshop – October 26 and 27, 2015 REGISTRANT INFORMATION Registration deadline is October 5 Name: ___________________________________________________________________
Register Online for the workshop only at www.eventville.com/hcanys
Title:______________________________________________________________ Agency:____________________________________________________________ Address:___________________________________________________________ City/State/Zip:______________________________________________________ Phone:_________________________ Ext._________ Fax: __________________ Email: _____________________________________________________________ (Required)
Walk-in registrations will not be accommodated. Cancellation Policy: Refunds will be issued for those that cancel the workshop by October 5, less a 25% administrative fee. Cancelling after this date or for no shows will forfeit the registration fee. Substitutions are permitted for the workshop. Cancellations must be received in writing via e-mail at info@hcanys.org
WORKSHOP ONLY REGISTRATION FEE Member Fee:: Non-Member Fee:
$519 $655
Workshop fee includes instructors for two days, two light breakfasts and handout materials. Exam fee is additional.
To register for the COS-C Exam use the attached form or go to: www.oasisanswers.com Registrations for the exam must be received two weeks prior to the exam date.
PAYMENT Please check method of payment: (Checks must be received by workshop date). ____MasterCard ____VISA ____ American Express
_____ Check*
*Make checks payable to: HCA Education and Research and mail to: 388 Broadway, 4th Floor, Albany, NY 12207 ______________________________________________________________________ Card Number Security Code Expiration Date ______________________________________________________________________ Name on Card
______________________________________________________________________ Card Billing Address (Street/Suite/Room Number) ______________________________________________________________________ City, State, Zip ______________________________________________________________________ Authorized Signature
Fax to (518) 426-8788
Exam Registration Fee $250 – For those participating in the workshop Renewal Exam Fee $200 – For those participating in the workshop Taking the Exam Only – add $50
Future of Home Health NORTHEAST REGIONAL SYMPOSIUM
Preparing for the Future of Home and Community-Based Care Building off the IOM Future of Home Health Care Workshop, 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 about the challenges and opportunities facing home health care now and in the future.
Wednesday, September 9th
9:00 am – 4:30 pm ET with a Cocktail Reception to be held on September 8th DoubleTree by Hilton Hotel Metropolitan 569 Lexington Ave, New York City
Association & Alliance Members: $259
Non-members: $359
M O R E I N FO R M AT I O N : www.ahhqi.org/home-health/future-project-symposium
T H A N K YO U TO O U R PA RT N E R I N G O RG A N I Z AT I O N S
AHHQI.ORG
HCA’s Senior & Financial Manager’s Retreat September 17 & 18, 2015 Mohonk Mountain House, New Paltz, NY
1 “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
4
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.
2 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-todate 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 (Mark 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…
3 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
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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: ________MasterCard
_______VISA
Total:
$___________
______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: _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________