August 7, 2015 Edition of ASAP

ASAP

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

Legislative Issues  Public Policy



News

Volume 20, No. 28 August 7, 2015

DOH Preps Full Slate of EPS Rebasing Cuts at Odds with Legislative Process HCA has raised strong objections to the state Department of Health (DOH) based on word that it is preparing a Dear Administrator Letter (DAL) which would implement a full rebasing cut under the Medicaid CHHA episodic payment system (EPS), contrary to EPS-related legislation awaiting the Governor’s signature.

DOH indicates that it is preparing the DAL for release next week.

As previously reported, the Department is required to rebase the system at least every three years, per the 2011 Medicaid Redesign Team (MRT) legislation enacting EPS. Implemented in May 2012, the first leg of rebasing See REBASING p. 3

Update on NAHC F2F Lawsuit Counsel for the National Association for Home Care & Hospice (NAHC) presented oral argument before U.S. District Court Judge Christopher Cooper on August 6, 2015, regarding NAHC’s lawsuit challenging the validity of the physician narrative requirement in the face-to-face (F2F) encounter rule.

While the U.S. Centers for Medicare and Medicaid Services (CMS) rescinded the narrative requirement from its rule after HCA, NAHC and others expressed strong concerns, and after NAHC filed its lawsuit last year, CMS has not provided nearly $200 million in retroactive payments to home health agencies that were wrongfully denied claims because of the now-rescinded narrative requirement. NAHC brought litigation on the validity of the narrative requirement so that home health agencies that provided care to patients in good faith are paid for their inappropriately disallowed claims.

See LAWSUIT p. 2

Inside ASAP DOH Preps Full Slate of EPS Rebasing Cuts....................................1 Update on NAHC F2F Lawsuit…........................................................1 Important Due Dates…....................................................................2 Education Calendar…......................................................................4 Value Based Pay Implementation Progresses…...............................5 HCA Pursues Post-Session Legislative Agenda.................................6 Developments on HCA Palliative Care Initiative….............................6 Member Hiring Announcements…....................................................7 EO 38 Lawsuit to be Heard on September 2…...................................8 Go Online for NEW ASAP Web Exclusive Articles…..........................8 Home Health Open Door Forum on August 12…...............................8 HCA Memo Summarizes FY 2016 Hospice Rule…............................9 HCA Compliance Symposium Coming on Oct. 8…..........................9 ICD-10 Less than 60 Days Away!.........................................................9 Revised Rule Issued on Immediate Personal Care Needs…...........10 DSRIP Update…...........................................................................11 Compliance Certification Forms to be Posted Dec. 1…..................11 Publications….................................................................................12

Reminder: HCA is publishing ASAP every other week for the summer. We are not publishing on August 14 but will publish again on August 21.

Helping New Yorkers Feel Right At Home

Volume 20, No. 28 August 7, 2015

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

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LAWSUIT from p. 1 According to NAHC, District Judge Cooper posed numerous well focused questions to both parties. Of particular concern for the judge was whether the challenged rule, on its face, permitted Medicare to deny a home health services claim based solely on the sufficiency of the physician narrative, regardless of what the whole patient record revealed on the patient’s homebound status and skilled care need.

There is no timetable for the court to issue its ruling in the case. If a favorable decision is rendered by the judge, CMS will be required to reopen and pay all the claims rejected in the past on the basis that the face-to-face narrative was insufficient.

Important Due Dates Cost Reports •

CHHA Cost Report: August 15

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LTHHCP Cost Report: August 15

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Personal Care Cost Report: September 15

Wage Parity

HCA continues to press for congressional relief on the face-to-face encounter requirements including a reversal of past denied claims. HCA has advocated that the F2F documentation requirement be met by a statement on the plan of care and has also been working with HCA members on a form for physicians to complete and add to their home care patient’s records as a basis for compliance with the requirement.

•

State Home Care Worker Wage Parity Certification Forms are due September 1 from LHCSAs to their contracted CHHAs, LTHHCPs and managed care plans for the period September 1 through November 30, 2015.

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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Volume 20, No. 28 August 7, 2015

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

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REBASING from p. 1 comes due this year, with projected reductions of $30 million scored in the budget process. However, DOH’s plan, shared with HCA and association peers late this week, would proceed with full rebasing cuts, doubling or even tripling the level of cuts scored in the budget.

Priority legislation, developed by HCA and unanimously passed by the Legislature in June (see related page _ story), provides that any EPS rebasing reductions may not exceed the amount scored in the adopted 2015-16 State Fiscal Plan for this year’s state budget.

HCA has informed the Department that it would be “highly objectionable for DOH to release such a DAL that ignores the unanimous passage of this legislation and the express will of the Legislature, particularly as the Governor has not even had opportunity to act” on the bill. Our recent communication to DOH officials also argues that: •

Proceeding with such rebasing cuts poses severe conflicts with DOH positions on value based payment (VBP), the Delivery System Reform Incentive Payment initiative, and other policies predicated on home care. For example, in the VBP discussions, DOH has emphatically assured providers that it will not rebase to lower reimbursement levels should providers and health plans achieve cost reductions as a result of implementing payment and delivery reforms.

•

Congress, as part of the Affordable Care Act, specifically limits rebasing reductions under the Medicare episodic payment system, with the express purpose of avoiding a plunge in financial support for home care.

DOH’s action entirely conflicts with this national policy.

•

With state reforms heavily reliant on home care, DOH should be investing in, not cutting, home care – the only sector being cut in this fashion.

HCA urged the Department to fully reconsider and revise its intentions with regard to rebasing, especially in the wake of the system’s needs and legislation now awaiting delivery to the Governor.

HCA will inform the membership of DOH’s response. Given this latest development, especially, we will need to engage the full membership in an all-out drive to garner the Governor’s approval of the HCA-developed bill limiting EPS rebasing cuts.

For further information, please contact a member of the HCA Policy staff.

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

Volume 20, No. 28 August 7, 2015 

EDUCATION UPDATE August 18: What Non-Financial Managers Need to Know About Financial Statements (Webinar). This webinar will present the different types of financial statements geared towards non-financial managers, and how to interpret financial statements for management use.

August 26, Sept. 9, Sept. 23: Pharmacology for Therapists & Other Interested Clinicians (Webinar Series). This series will review the profile of the typical rehabilitation patient, the common adverse drug reactions observed, the impact of side effects of treatment outcomes, and the problems of polypharmacy.

Sponsored in part by:

Sept. 9: Future of Home Health Northeast Regional Symposium – “Preparing for the Future of Home and Community-Based Care” (NYC). This program is sponsored by the Alliance for Home Health Quality and Innovation along with nine state home care associations, including HCA. 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.

Sept. 17-18: 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.

Sept. 30: ICD-10-CM & OASIS Coding Back to Basics & Beyond (Nanuet) Oct. 1: Optional Coding Exam (Nanuet) Ensure success with your CHHA’s ICD-10-CM transition. On September 30, presenter Patricia Tulloch will help sharpen your clinician and coder skill sets to enhance documentation that supports ICD-10-CM diagnoses precision and verifies the consistency of the OASIS assessment. The 2015 Home Care Coding Specialist Exam (HCS-D) 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.

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

Oct. 26-27: Blueprint for OASIS Accuracy – OASIS-C1 Data Set (NYC) Oct. 28: Optional COS-C Exam (NYC) Effective up-to-the minute education targeted for field data collectors, their supervisors and those preparing for the optional Certificate for OASIS SpecialistClinical (COS-C) exam. Two-day workshop on October 26-27, followed by optional COS-C exam at same location on October 28.

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.

Save the Date for These Future Events!

Nov. 17 and 18: HCA’s Quality Symposium (Troy)

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Value Based Payment Implementation Progresses Need more information? Come to our Senior & Financial Manager’s Retreat on September 17-18 The state Department of Health (DOH) convened the full Value Based Payment (VBP) workgroup this week to discuss progress, subcommittee phases and further new developments. HCA has served as a core member of the VBP workgroup.

beneficiaries, managing population health and assuming financial risk across the entire spectrum.

On home care specifically, HCA raised alignment issues related to CMS’s separate proposed payment rule for home care which seeks to develop an adverse form of VBP for home care. CMS’s rule targets nine designated states (New York is not included in the pilot, but this list could change), and is executed with steep initial cuts to providers, pending performance.

State Medicaid Director Jason Helgerson and VBP Project Director Marc Berg, M.D., of KPMG, emphasized the purpose of New York’s VBP Roadmap, now approved by the federal government, in serving as a dynamic, evolving implementation framework. Progress and workplans for VBP implementation subcommittees were discussed and can be viewed along with the related workgroup meeting contents at http://hcanys.org/wp-content/uploads/2015/08/ VBPWorkgroupMeetingMaterials08032015.pdf.

DOH officials also considered whether the MLTC model, as a partial-capitation design, needs revision to fit the Medicare VBP/shared savings system. DOH suggested a roundtable to explore this issue, perhaps beginning in the fall. HCA offered to develop and contribute ideas in this area.

The subcommittee analyses and recommendations will ultimately go to the main VBP workgroup, which is the overall steering committee.

The draft Medicare Alignment proposal has been posted for public comment at https:// www.health.ny.gov/health_care/medicaid/redesign/ dsrip/vbp_reform.htm. Members are encouraged to comment to dsrip@health.ny.gov by 3 p.m. on August 31, 2015.

In a significant development, DOH presented a draft proposal to allow New York State and providers to elect to align Medicare payments and shared savings with the state’s VBP framework for Medicaid. The draft, which would be submitted to the U.S. Centers for Medicare and Medicaid Services (CMS), includes proposals to: •

Allow providers and managed care organizations to include Medicaid beneficiaries in CMS innovative payment models.

•

Permit inclusion of Medicare fee-for-service beneficiaries in the provider VBP arrangements outlined in the state’s Roadmap.

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Simultaneously work with Medicare Advantage plans on a complementary alignment.

•

Allow, specifically, the Montefiore Health System to be the first Accountable Care Organization in the country to encompass both duals and Medicaid- and Medicare-only

Need more information and insights?

HCA has crafted an education agenda in the areas of finance, corporate compliance and quality all serving to assist providers under VBP and other new models that are driving big shifts, incentives and risk in the flow of government payments.

From the finance angle, we strongly encourage providers to attend our Senior and Financial Manager’s Retreat on September 17 to 18 where Dr. Berg and other state officials will outline the developments with VBP. If you haven’t yet considered your place in VBP, you need to begin thinking about it now, and our Retreat is a great way to gain some more education on this huge new development in payment structure. See our registration form at the back of this week’s ASAP. For further information, contact Al Cardillo at acardillo@hcanys.org.

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HCA Pursues Post-Session Legislative Agenda HCA met throughout this week with legislative offices to pursue post-session legislative planning on home care initiatives.

We met with key Senate and Assembly offices on HCA initiatives supporting managed care-home care payment adequacy, modernization of insurance coverage for home care, quality innovation, clinical and health information technology funding, telehealth insurance coverage for home care, and HCA’s veterans home care pilot legislation.

We also discussed strategic action aimed at gaining Governor Cuomo’s support for our legislation to limit Medicaid reductions from the state Department of Health’s rebasing of the CHHA Medicaid episodic payment system (EPS). Under HCA-initiated legislation (S.5878 Hannon/A.8171 Gottfried) which the Legislature unanimously passed in June, any such reductions may not exceed the amount scored for rebasing in the legislatively adopted 2015-16 State Fiscal Plan.

This legislation awaits delivery to the Governor, at which point HCA will be urging home care agencies, consumers, home care workers and all concerned to urge his signature. However, in a more recent development, the state Department of Health has notified home care provider associations that it is preparing a Dear Administrator Letter (DAL) which would go ahead with cuts in excess of the budgeted projections for EPS rebasing. (Please see related p. 1 story.) This adds more urgency and a new challenge to our advocacy efforts, so please stay tuned for how you can work to communicate strong support for HCA’s bill upon its delivery to the Governor’s office.

HCA also discussed other critical issues with the Legislature, such as: home care infrastructure needs related to the state’s move toward value-based payment (see related page 5 story); legislation held aside at the end of session that would authorize hospitals, clinics and emergency medical services to provide services in the home in a manner potentially violating the state’s home care laws and regulations; implementation of standardized billing/coding for home care (enacted as part of this year’s budget); advanced home health aide authorization; and other items.

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

Developments on HCA Palliative Care Education and Training Initiative HCA thanks all of our members who responded to our Palliative Care Education and Training Survey in July!

HCA received 86 responses to the survey and compiled a preliminary summary for discussion at our July 14 Hospice and Palliative Care Forum meeting.

The survey’s aim was to assist the State Palliative Care Education and Training Council in implementation of HCA’s 2014 state legislation, unanimously passed and signed by the Governor, to examine palliative care education and training needs for nurses and social workers in clinical and university settings. The ultimate goal of the legislation is to increase proficiency and clinical participation in palliative care.

Participating in HCA’s Hospice and Palliative Care Forum discussion were HCA providers and health plans, representatives of the State Council, the state Department of Health, the state Boards of Social and Nursing, university educators, consultants, legislative sponsor staff and others.

HCA will be further analyzing and providing the membership with details on the survey results.

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

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

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HIRING HVHC Supervisor-Team Lead Health Quest was formed through an affiliation of three local hospitals: Northern Dutchess Hospital (Rhinebeck, NY), Putnam Hospital Center (Carmel, NY) and Vassar Brothers Medical Center (Poughkeepsie, NY). Health Quest also includes affiliated healthcare providers Health Quest Medical Practice and The Heart Center. We also count among our partners long-term care facilities, a freestanding radiation oncology center, urgent care centers, a multi-specialty medical practice and a home care service.

This position (HVHC Supervisor-Team Lead) assists the Director of Patient Services with the supervision of home health services to patients in their place of residence in accordance with physician orders and strives to provide the highest quality of care. Skilled nursing and other therapeutic services are under the supervision of the Nursing Supervisor. The Nursing Supervisor is available at all times during operating hours (or appoints a similarly qualified alternate) and participates in all activities relevant to professional services furnished, including the development of qualifications and assignment of personnel.

QUALIFICATIONS: RN with a Bachelor of Science in Nursing or a Baccalaureate degree in human services and two years’ experience in home care or an RN with four years’ experience in home care and at least six hours of education/training in public health and management.

For inquiries, please contact Lisa Haimson at (845) 279-5711 ext. 3016 or ehaimson@health-quest.org.

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

EO 38 Lawsuit to be Heard on September 2 HCA is a plaintiff in a lawsuit against Executive Order (EO) 38 that will be heard by the State Supreme Court, Albany County in September.

The suit, LeadingAge New York, Inc. v. Shah, was filed in September 2013. A hearing in the case was delayed due to the retirement of Justice Ceresia who had been assigned to the case. The case has now been transferred to Acting State Supreme Court Justice Denise Hartman.

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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 this week on the following topics: • • •

Plaintiffs in the suit include HCA, LeadingAge New York, the New York State Health Facilities Association, Southern New York Association, Greater NewYork Health Care Facilities Association, the Empire State Association of Assisted Living and several individual provider entities.

Late in 2013, Justice Ceresia blocked the state Department of Health’s (DOH) request to dismiss the case for lack of merit.

HCA has provided extensive coverage and held numerous conference calls and education programs for members on EO 38, an Order that places limits on executive compensation and administrative expenses.

As a reminder, we have also reported on DOH’s clarification that “covered providers” must submit their Disclosure form by the date that the provider’s 2014 Medicaid cost report is due.

(Previous state communications had been inconsistent in this regard.) 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, the deadline was June 29.

In addition, providers that serve patients in Nassau County should note that they need not file EO No. 38 disclosures. This is due to an April 8, 2014 decision in Agencies for Children’s Therapy Services, Inc. v. New York State Department of Health, et al. (“ACTS”).

• • • •

PHHPC Meets On Home Care Applications Livanta Updates Standards for PT Related to Discharge Appeal Reviews Annual Review of Managed Care Exemption and Exclusion Codes Required UAS Upgrade Issued Updates from the Medicare Contractor: NGS Revised TBI Audit Protocols Posted Some NHTD Rates Change: New TBI Rates Coming Soon

Get these important updates and others by visiting the following section of HCA’s website: http://hca-nys.org/category/general-news.

CMS Open Door Forum on Aug. 12 The next U.S. Centers for Medicare and Medicaid Services (CMS) home health and hospice Open Door Forum is on Wednesday, August 12, 2015 from 2 to 3 p.m. The agenda includes: Home Health and Hospice Payment Policy; Quality Reporting; HHCAHPS/ Hospice; Claims Processing; Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program; Overview of Coordinated Care for Joint Replacement Proposed Rule; and Quality Improvement Organizations (QIOs) – New Regulation and Chapter 5 Manual Revisions.

To participate: Dial 1-800-837-1935 and enter Conference ID: 6833152. An audio recording of this call can be obtained by dialing 1-855-859-2056 and entering the Conference ID (6833152) beginning 2 hours after the call has ended. The recording expires after 2 business days.

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HCA Memo Summarizes FY 2016 Hospice Rule HCA has prepared a memo summarizing the final rule for fiscal year (FY) 2016 Medicare payment rates and the wage index for hospices serving Medicare beneficiaries. The memo is at http://hca-nys.org/wp-content/uploads/ 2015/08/CMSFinalRuleFY2016HospiceFinal.pdf.

The U.S. Centers for Medicare and Medicaid Services (CMS) estimates that hospices nationally will see a 1.1 percent ($160 million) increase in their payments for FY 2016 over FY 2015. Other elements of the rule, including quality reporting requirements, are outlined in the memo. Please make sure that the hospice officials at your organization receive this memo.

HCA Compliance Symposium Coming on Oct. 8 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’s Corporate Compliance Symposium, on October 8 in Albany, will help your compliance teams manage some of these huge questions, and others, so that you can develop the right protocols and practices at your agency.

Make sure your corporate compliance officials and management teams register today.

You can register online or download the PDF registration brochure. Links to both are posted on our education page at http://hca-nys.org/events-education/upcoming-events.

Please register today.

ICD-10 Less than 60 Days Away!

Beginning October 1, 2015 – just two months away –Medicaid will only accept and process claims using ICD-10 diagnosis and procedure codes. eMedNY has offered the following update for the handling of claims: •

Claims for dates of service on and after October 1, 2015 require ICD-10 codes.

•

eMedNY will not publish an ICD-9 to ICD-10 crosswalk. Please consult and share eMedNY resources (at https://www.emedny.org/icd/) so that staff are trained and ready for the transition. ICD-10 Questions and Answers are at https://www.emedny.org/icd/FAQs.aspx.

•

ICD-9 and ICD-10 coding are not allowed within the same claim.

•

Claims submitted with ICD-9 codes for dates of services on and after October 1 will be rejected by preadjudication edits.

•

For electronic claims, providers should test their readiness by using eMedNY’s Provider Test Environment with the detailed instructions on www.emedny.org.

•

eMedNY does not provide a method to test paper claims. ePACES features an ICD Version radio button which you will be required to select after October 1 for paper claims. This field currently defaults to ICD-

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9 as shown in the ePACES Claim Quick Reference Guides at: https://www.emedny.org/selfhelp/ ePACES/ClaimQuickRefDocs.aspx •

Be sure to communicate with Vendors, Clearing Houses and Service Bureaus on steps you will need to complete to be ready on October 1 and coordinate testing in eMedNY’s Provider Test Environment.

Questions or concerns can be directed to eMedNY’s Call Center at 1-800-343-9000.

HCA Ramps Up ICD-10 Transition Education Efforts HCA this week sent managed care plans a short survey in follow up to a highly-attended education program on ICD-10 coding under managed care.

The survey seeks to identify the ICD-10 preparation efforts, expectations, and policies of managed care plans so that HCA can develop a chart that compares these plan activities. This effort was identified by members as an immediate need at our July 21 ICD-10 transition program. Once the chart has been developed, HCA will make it available to members.

HCA is also holding a program entitled ICD-10-CM and OASIS Coding: Back to Basics and Beyond on September 30 in Nanuet.

This program includes a comprehensive overview of ICD-10-CM coding with specific application to CHHAs. Code mandates, exceptions and best practices will be reviewed. Presenters will also address code inconsistencies and common diagnosis pitfalls as well as tips to reinforce OASIS documentation to substantiate ICD-10-CM codes.

More information is at http://hca-nys.org/events-education/upcoming-events.

Revised Rule Issued on Meeting Immediate Needs for Personal Care Services The state Department of Health (DOH) has issued a revised rule that would establish a process for meeting the immediate personal care needs of Medicaid recipients.

It is at http://docs.dos.ny.gov/info/register/2015/august5/pdf/rulemaking.pdf (page 16).

The revisions stem from an Order issued by State Supreme Court Justice Joan Madden on July 13.

The rule provides for presumptive eligibility for immediate temporary personal care services for Medicaid recipients. This applies when: the social services district determines that the physician’s order documents that the recipient needs assistance in the home with certain personal care functions, has a stable medical condition, and can be cared for safely at home; the physician’s order recommends the number of hours of immediate temporary personal care services; and the recipient is in receipt of Protective Services for Adults (PSA) or has been referred to PSA and the district’s PSA staff have determined that a PSA investigation and assessment are necessary.

As expeditiously as possible, but no later than three business days after receipt of the physician’s order, social services districts would be required to determine whether Medicaid recipients are presumptively eligible for immediate temporary personal care services and notify the recipients of the determination. Social service districts would be required to arrange for the provision of services as expeditiously as possible. They would also be 10

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required to determine whether Medicaid recipients are also eligible for continued personal care services, pursuant to the regular personal care services assessment process.

DSRIP Update The state Department of Health (DOH) has released information on data security and information sharing and Medicare’s alignment with the state’s reform efforts.

In July, DOH posted a Data Security and Information Sharing webinar and “Frequently Asked Questions (FAQs) for Data Sharing and Security within DSRIP.” The webinar can be accessed at https://www.youtube.com/watch?v=bm9Jy0_JXL0&feature=youtu.be. The slides are at https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/data_security/docs/ data_security_info_webinar_7-7-15.pdf. The FAQs are at https://www.health.ny.gov/health_care/medicaid/ redesign/dsrip/data_security/dsi_faq_7-15-15.htm.

They cover: data security; controls for assessing and sharing data; claims data; and the opt-out process and long term data sharing.

Compliance Certification Forms to be Posted Dec. 1 The state Office of the Medicaid Inspector General (OMIG) says it will post the Deficit Reduction Act (DRA) Certification Form and the New York State Social Services Law Compliance Program Certification Form on December 1, 2015.

The announcement comes from the July Medicaid Update at http://www.health.ny.gov/health_care/medicaid/program/update/2015/jul15_mu.pdf.

OMIG will also hold a webinar in November to explain each certification form.

Under the DRA, health care entities receiving or making $5 million or more in Medicaid payments during a federal fiscal year must certify that they are in compliance with this federal law which requires that they establish written policies and procedures informing their employees, contractors and agents about federal and state false claim acts and whistleblower protections.

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

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

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

The state Department of Health (DOH) is revalidating Medicaid provider enrollment and, as part of this process, providers will be asked to submit evidence that they met the December state certification obligation, 11

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

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

Publications •

“Signature Requirements,” (Transmittal 604) by the U.S. Centers for Medicare and Medicaid Services https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R604PI.pdf

•

“Medicare’s Hospital-Acquired Condition Reduction Program,” Health Affairs (August 6, 2015) http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_142.pdf

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

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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

4

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: _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________ _________________

LEARN

ALBANY

Meet and hear From OMIG’s New Chief, Dennis Rosen!

CONNECT

Epic Health Care Changes = Big Regulatory QUESTIONS negotiations

&

NEW AUDIT Challenges

Gain an understanding of the complicated structures

Register today at www.eventville.com/hcanys

Right

The

Hilton Albany 40 Lodge Street 8:30am – 4:30pm

Question?

October 8

PROTOCOLS Right

The

TIME

Corporate Compliance Symposium

October 8 Hilton Albany 40 Lodge Street 8:30am – 4:30pm

October EIGHT

?

Corporate Compliance Symposium

October 8 Hilton Albany 40 Lodge Street 8:30am – 4:30pm

OMIG Priorities

Transition

Leadership CHANGE

Complex Systems

Regulatory Alignment

Corporate Compliance Symposium

October 8 Hilton Albany 40 Lodge Street 8:30am – 4:30pm

Providers negotiations

partnerships

Legal

Compliance

Managed Care Plans

Hotel Information

$159 Sept. 7 Corporate Compliance Symposium REGISTRATION

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SPECIAL NEEDS In accordance with the Americans with Disabilities Act, or special dietary needs, please let us know how we can accommodate you: _______________________________________________________________

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