November 13, 2015 Edition of ASAP

ASAP

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

Legislative Issues  Public Policy

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News

Volume 20, No. 40 November 13, 2015

More Engagement with Congress for Home Care Month, Including Special Visit with Rep. Tom Reed in Ithaca HCA continues to work with members to engage elected officials in recognition of National Home Care Month in November. As we reported last week, we’ve been posting infographics from Members of Congress with quotes about the importance of home care as part of a digital campaign for National Home Care Month, and we encourage all HCA members to log on to Facebook to “like” and “share” these infographics.

Last week, we shared a quote from Rep. Lee Zeldin. Earlier this week, we posted a quote from Rep. Joseph Crowley. (Shown at right; click the image to see Rep. Crowley’s quote on our Facebook See CONGRESS p. 4

DOH Releases Guidance on Financial Support to Address New Overtime Costs Late Monday, the state Department of Health (DOH) released a Dear Colleague Letter that describes efforts the state will take to modify Medicaid reimbursement rates in order to address new overtime, travel and live-in rules that result from implementation of the Fair Labor Standards Act (FLSA) rule.

Inside ASAP

See OT p. 2

More Engagement with Congress for Home Care Month...................1 DOH Releases Guidance on Financial Support for OT Costs..............1 Education and New Guidebook on FLSA Rule.....................................3 CMS Issues Guidance on Audits for F2F, Medicare Eligibility.............5 Member Hiring Announcements...........................................................5 Just 4 Days Left to Get Ready for HCA Quality Symposium.................7 Providers Need Not Revise Doc Orders Written Before Oct. 1...........7 Managed Care Update: QIVAPP, FIDA, CFEEC....................................8 Featured Home Health Summit ‘Training Agent’: Angus Clark............9 DOH Issues Hospice Medicaid Rates for FFY 2016.............................10 Minor Changes Planned for ABNs......................................................10 Applications Open for Term on HCA’s Board of Directors.................11 DOH Posts NHTD/TBI Transition Meeting Materials........................11 CMS Approves New York’s Community First Choice Option............12 Medicare 2016 Levels..........................................................................12 Alzheimer’s Disease Caregiver Support Initiative Announced..........13 PHHPC Committee Meeting Agenda Posted....................................13 HEAP Season Opens November 16.....................................................13 UAS-NY Changes Made......................................................................14 Publications............................................................................14

Top: Rep. Joseph Crowley speaks about home care.

Bottom: Rep. Tom Reed meets with Tina Champion, a patient at VNS of Ithaca and Tomkins County, in recognition of National Home Care Month.

Helping New Yorkers Feel Right At Home

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

Volume 20, No. 40 November 13, 2015 

OT from p. 1 The Letter is at http://hca-nys.org/wp-content/uploads/2015/11/FLSAColleagueMessage.pdf.

HCA has been strenuously advocating that home care providers and managed care plans receive funding to meet these new costs, including our recommendation to DOH of a stop-loss approach to funding as a means of bridging the gap pending the federal decision period for approval of rate changes. While we will be seeking additional details and clarification on the state’s plans, DOH’s letter is a first step to address these new expenses at a time when both providers and plans are facing new costs and limited revenues.

In the letter, DOH describes its efforts to assess the additional funding needed for both fee-for-service providers and managed care plans. These DOH efforts include conducting its own surveys on overtime and costs related to “live-in 24-hour” cases and reaching out to home care associations and managed care plans.

Recently, HCA, along with LeadingAge NY and the New York State Association of Health Care Providers, surveyed our members about the cost impact of the FLSA changes and we are awaiting a meeting with DOH to share our initial findings.

As DOH expects the survey process and subsequent analysis to take three months or so to complete, DOH says it will expedite rate relief to fee-for-service home care programs and managed care plans retroactive to October 13, 2015 (the effective date of the FLSA rule).

DOH has decided to take the following actions: It will “apply the home care industry standard that 10 percent of total hours worked are associated with overtime. It will also include additional funding for the new FLSA employee travel and live-in requirement ...The total per hour adjustment is estimated to be an increase of $0.34/hour across all aide hours. The Department will monitor the effect of this additional funding and expects the increase to be passed on to the worker and/or agency as appropriate.” DOH notes that, in relation to the $0.34/hour increase, there will also be an “additional component developed as a rate

ASAP is a weekly publication of the Home Care Association of New York State (HCA). Unless otherwise noted, all articles appearing in ASAP are the property of the Home Care Association of New York State. Reuse of any content within this newsletter requires permission from HCA. President: Editor:

Joanne Cunningham, jcunningham@hcanys.org Roger L. Noyes, Director of Communications, rnoyes@hcanys.org Al Cardillo, Executive Vice President, Policy & Programs, acardillo@hcanys.org Patrick Conole, Vice President, Finance & Management, pconole@hcanys.org Andrew Koski, Vice President, Program Policy and Services, akoski@hcanys.org Alexandra Blais, Director of Public Policy, ablais@hcanys.org Laura Constable, Senior Director, Membership & Operations, lconstable@hcanys.org Celisia Street, Director of Education, cstreet@hcanys.org Mercedes Teague, Finance Manager, mteague@hcanys.org Jenny Kerbein, Director of Governance and Special Projects, jkerbein@hcanys.org Billi Hoen, Manager, Meeting and Events, bhoen@hcanys.org Teresa Brown, Administrative Assistant, tbrown@hcanys.org 388 Broadway, 4th Floor, Albany, NY 12207 Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org

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Volume 20, No. 40 November 13, 2015

ASAP – a publication of the Home Care Association of New York State adjustment under the existing fee-forservice and managed care rate-setting methodologies to reflect payment for 13 hours for live-in personal care cases.”

The DOH letter also says that the per-hour amount will be factored into adjustments for fee-for-service rates, retroactive to October 13, 2015, to be developed under the existing rate setting methodologies, with payments anticipated in January 2016.

According to DOH, both the managed care and fee-for-service payments are designed to provide funding for home care providers to meet their initial obligations under the FLSA rule.

HCA has many questions and will be seeking further information on various issues, including how DOH calculated the 10 percent and $0.34/hour amounts; how much money will be advanced to managed care plans; how the funds will be distributed to home care providers; any documentation requirements for both plans and providers; etc.

At this week’s DOH Managed Care Policy and Planning meeting, DOH indicated that each MLTC plan will receive $0.34/hour and hopes that the survey data sent by MLTC plans will help determine how to get the money to home care providers.

We will provide more information to members once we obtain additional guidance from DOH.

Education and New Guidebook on FLSA Rule New federal overtime changes for home care present huge challenges for agencies seeking to understand the intricacies of the rule for compliance, managing their payroll, and structuring their assignment of staff.

FLSA Companionship Exemption: How the Home Care Final Rule WILL Affect Your Organization Background On August 21, 2015, the U.S. Court of Appeals for the D.C. Circuitt issued a determination to uphold the United States Department of Labor’s (US DOL) xemption” Home Care Final Rule, which eliminates the federal “companionship exemption” ployed by for certain “domestic service” workers, including home care aides employed ments for agencies. The final rule also institutes new record-keeping requirements agencies employing “live-in” staff. These changes are effective Octoberr 13, 2015.

November 2015

GUIDEBOOK

DOH intends to submit managed care rate adjustments to the U.S. Centers for Medicare and Medicaid Services (CMS) for approval retroactive to October 13, 2015.

However, in order to expedite funding into the rates, DOH intends to advance stateshare-only payments to managed care plans which will be distributed as lump-sum amounts by December 2015.

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To help you, HCA has prepared a new Guidebook on the recently promulgated Fair Labor Standards Act (FLSA) rule for home health aide wages which all members should download and read at http://hca-nys.org/wp-content/ uploads/2015/11/ CompanionshipExemptionGuidebookNovember2015.pdf.

As announced in an E-alert earlier this week, HCA is holding a special Bootcamp program on “Achieving Compliance with the New Companionship Services and Live-in Overtime Compensation Rules” (December 15 in NYC).

Seating is limited and there are only a few slots left since we announced the program just this week. Members can still register by completing the PDF registration form on our website’s education page. Simply look for the session title and click the link to register for the program which is listed among our other education programs at http://hcanys.org/events-education/upcoming-events.

If the December 15 session sells out, as we expect it will, HCA is considering scheduling a repeat program for members, and we will notify you of any further educational opportunities to assist with the FLSA rule.

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CONGRESS from p. 1 page.) We thank Members of Congress who are participating in this public recognition effort.

In addition, HCA Communications Director Roger Noyes and HCA Director of Public Policy Alex Blais also attended an event this week organized by HCA member Visiting Nurse Service of Ithaca and Tomkins County to recognize home care.

This special event engaged Rep. Tom Reed, who came to the VNS offices and presented a proclamation in honor of National Home Care Month. (See photos: this page.)

In remarks to the audience at Tuesday’s event, Reed, as reported today by the Lansing Star, said: “I have 11 older brothers and sisters. We’ve seen first-hand, treatment in a hospital and treatment at home … I can assure you that the Reed family – we like to be home. So we want to take a moment and do the right thing and recognize everything you do here for the constituents and the people of the 23rd Congressional District here in Ithaca and Tompkins County. Job well done.”

After the reception at VNS’s offices – which drew citizens of the Ithaca community, VNS staff and Board Members, and VNS’s LHCSA and hospice health organization partners – Rep. Reed joined VNS Executive Director Sue Ellen Stuart and HCA staff to visit a nearby Senior Housing center (Titus Towers) which has received a state grant to expand its nurse case manager program in partnership with VNS. Under this partnership, VNS clinicians are staffed at Titus Towers to prevent premature nursing-home admission or hospitalizations among the approximately 250 disabled and/ or elderly residents at Titus Towers.

The $500,000 grant is part of the Medicaid Redesign Team’s Supportive Housing Initiative. Rep. Reed met with Tina Champion, a resident at Titus Towers who receives services from VNS to see this unique partnership in action.

Rep. Reed has been a champion of home care, particularly in his work to press the U.S. Centers for Medicare and Medicaid Services to streamline the Medicare face-to-face requirement.

We thank him for his strong recognition of the value of home care this week and in his prior efforts on behalf of home care. We also especially thank Sue Ellen Stuart and her team from VNS for organizing and hosting this important event, and for including HCA in the opportunity to share in the celebration of National Home Care Month.

Please stay tuned for additional National Home Care Month updates throughout the next two weeks.

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

CMS Issues Guidance on Home Health ‘Probe and Educate’ Review for F2F, Medicare Eligibility CMS audit involves Medicare patient eligibility and F2F requirement The U.S. Centers for Medicare and Medicaid Services (CMS) has recently issued a Medlearn Matters (MLN) article SE1524 which provides further details on the ‘Probe and Educate’ Review audits it is conducting for home health agencies (HHAs).

SE1524 is at: https://www.cms.gov/ Outreach-and-Education/MedicareLearning-Network-MLN/ MLNMattersArticles/Downloads/ SE1524.pdf.

Earlier this year, CMS announced its plans to begin a ‘Probe and Educate’ strategy for reviewing Medicare home health claims related to patient eligibility (certification/re-certification) as outlined in the 2015 final rule for the home health prospective payment system (HHPPS). Agencies have since awaited specific instructions from CMS on the implementation process.

As previously reported, CMS says that Medicare Administrative Contractors (MACs) have begun sending Additional Documentation Requests (ADRs), as of October 1, 2015, and that the first round of claim reviews and provider education will conclude in approximately one year.

CMS will direct the MACs to select a sample of five claims for pre-payment

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HIRING Patient Relations Manager Americare, New York’s leader in home health care, seeks a high energy, dynamic, self-starter for an exciting career opportunity in its patient relations department. The Patient Relations Manager’s primary responsibility will be to develop relationships and educate MDs about home care and the benefits to their patients. The ideal candidate will have 2-3 years home care or pharmaceutical experience. An excellent compensation and benefits package is offered, including: 401K with company match, medical, dental and direct deposit.

E-mail résumé to hrrecruiter@americareny.com. www.americareny.com.

EOE Jefferson County Public Health Service Director of Patient Services is responsible for the administrative, professional and financial operations of the home health programs. Minimum qualifications include licensed and currently registered nurse with two years of experience as a Supervising Public Health Nurse; or two years of home care nursing experience plus a master’s degree in nursing, public health, business administration or another health related field. Master’s degree preferred.

Applications Accepted At: Jefferson County Department of Human Resources, 175 Arsenal Street, Watertown, NY 13601; (315)-785-3147. EOE. http://www.co.jefferson.ny.us Alpine Home Health Care Alpine Home Health Care seeks a part-time Director of Patient Services (DPS) for our Buffalo, NY location. The DPS is responsible for the administrative, professional and clinical operations of the home health care program. Minimum qualifications includes licensed Registered Nurse in the state of New York, BSN and three years experience as a professional nurse and Two years administrative/supervisory experience.

Send résumés to Avi Katz via email to akatz@alpinehhc.org.

EOE – M/F/D/V ABOUT US: Alpine Home Health Care, founded in 2008, is a Certified Home Health Agency [CHHA] proudly serving the Bronx, Kings, Queens, New York City and Rockland counties, along with expanded operations to Buffalo, NY.

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review from each HHA within their jurisdiction.

Based on the results of these initial reviews, the MACs will conduct provider-specific educational outreach. The MACs will deny each non-compliant claim and outline the reasons for denial in a letter to the HHA, which will be sent at the conclusion of the probe review. CMS also instructs the MACs to offer individualized telephone calls/education to all providers who have errors in their claim sample. MACs will discuss the reasons for denials, provide pertinent education and reference materials, and answer questions.

In addition to these educational outreach efforts, for those providers that are identified as having moderate or major concerns, the MACs will repeat the ‘Probe and Educate’ process for dates of services occurring after education has been provided. The MLN matters article includes a table that outlines the actions the MAC will follow depending on results of the ‘Probe and Educate’ review. The following table outlines MAC actions following HHA probe reviews.

No or Minor Concerns

Moderate / Major Concerns

5 Claim Sample

0 1*

2 5*

For each provider with no or minor concerns, For each provider with major to moderate CMS will direct the MACs to: concerns CMS will direct the MACs to:

Action

1. Deny non compliant claims; and,

2. Send detailed review results letters explaining each denial.

3. Send letters that: (1) Offer the provider 1:1 phone call to discuss claim denials if any; and (2) Indicates that no more reviews will be

conducted.

4. Await further instruction from CMS.

1. Deny non compliant claims; and,

2. Send detailed review results letters explaining each denial.

3. Send letters that: (1) Offer the provider 1:1 phone call to discuss; (2) Indicates the review contractor will repeat Probe & Educate process with an additional 5 claim sample; and

4. Repeat Probe & Educate of 5 claims with dates of after the implementation education.

*Note: If the CHHA fails to submit 5 claims, the provider will be considered of moderate concern (unless 4 claims were reviewed and the MAC approved all four).

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

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

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Just 4 Days Left to Get Ready for the “Elements of Home Care Quality” at HCA Quality Symposium What: HCA’s Quality Symposium, our final signature conference of the year!

When: November 17-18, Just 4 Days Away.

Where: Troy, NY, near Albany Who: HCA’s quality committee and policy staff; Department of Health qualityprogramming officials; OMIG qualitycompliance officials; expert field-level providers sharing best-practices; MLTC representatives sharing quality-of-care imperatives under managed care; IPRO officials discussing CMS star ratings; developers/practitioners employing a new app for use in wound care ... and YOU! How: Register at the links below •

PDF brochure: http://hca-nys.org/ wp-content/uploads/2015/10/ HCA-2015-Quality-SymposiumBrochure.pdf

•

Online registration: https:// www.eventville.com/Catalog/ EventRegistration1.asp?EventId=1011709

Providers Not Required to Revise Physician Orders Written Before Oct. 1 The U.S. Centers for Medicare and Medicaid Services (CMS) has recently posted a new frequently asked question (FAQ) and answer in response to inquiries from the provider community about the requirements regarding physician orders written before the October 1 ICD-10 compliance date.

In FAQ 12625 (at https://questions.cms.gov/faq.php?id=5005&faqId=12625), CMS explains that it is not requiring the ordering provider to translate ICD-9 diagnosis codes to ICD-10 on orders written before October 1 for lab, radiology, or any other services.

Specifically CMS states: •

Orders written before October 1 should have ICD-9 codes.

Continued on next page

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Continued from previous page •

For orders written before October 1 for services that will continue to be delivered and billed after October 1, providers can opt to use the General Equivalence Mappings (GEMs) to translate the ICD-9 codes on the original order to ICD-10. Providers are not required to update codes to ICD-10 for orders written before October 1.

•

Orders written on or after October 1 must use ICD-10.

For more guidance on claims processing and billing, please visit the CMS ICD-10 FAQ website at: https://www.cms.gov/Medicare/Coding/ICD10/Frequently-Asked-Questions.html.

For further information, please contact HCA Policy staff.

Managed Care Update: QIVAPP, FIDA, CFEEC The following update is based on a meeting of the state Department of Health (DOH) Managed Care Policy and Planning group and other information received by HCA. QIVAPP IPRO, the entity selected by DOH to audit agencies on their eligibility for the Quality Incentive Vital Access Provider Pool (QIVAPP) program, has sent out letters to home care providers who have been selected to receive QIVAPP funding.

The letter asks the home care agency to document that it meets the qualifying criteria, including that it: receives a base hourly rate of $18.50 from MLTC plans; offers a specialty training program that exceeds the DOH requirements; has a currently active quality assurance program; and provides comprehensive health coverage.

Letters obtained by HCA request that all documentation be provided by November 20. HCA members who have already received QIVAPP funds or expect to receive them for the first time should ensure that they send the data to IPRO by the deadline in their letters.

FIDA DOH has received many comments from stakeholders on the future of MLTC and Fully Integrated Duals Advantage (FIDA) plans and is discussing potential FIDA changes with the U.S. Centers for Medicare and Medicaid Services (CMS).

As of November 2, approximately 7,540 individuals are enrolled in FIDA. DOH has posted a FIDA Plan benefits comparison chart at http://www.health.ny.gov/health_care/medicaid/redesign/fida/docs/ plan_benefits_english.pdf.

The seven-page chart compares the benefits under FIDA, MLTC partially capped plans, the Program of AllInclusive Care for the Elderly (PACE) and Medicaid Advantage Plus (MAP).

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Continued from previous page DOH reported at this week’s Managed Care Policy and Planning meeting that New York has requested permission from CMS to use state funds to adjust managed care premiums when CMS does not act upon plan rate increase requests in 45 days.

Conflict-Free Evaluation and Enrollment Center The Conflict-Free Evaluation and Enrollment Center (CFEEC) receives about 701 calls per day. The assessments are done by 144 nurses. So far, 43,812 evaluations have been conducted, of which 97 percent have found that the individual is eligible for enrollment into an MLTC. The CFEEC conducts assessments for individuals seeking Community-Based Long Term Care (CBLTC) services for more than 120 days. It evaluates a consumer’s eligibility for one of the four MLTC products: partially capitated plans; PACE; MAP; and FIDA. More information on the CFEEC is at http://www.health.ny.gov/health_care/medicaid/redesign/mrt_90.htm.

Featured Home Health Leadership Summit ‘Training Agent’: Angus Clark Grammy-nominated musician Angus Clark of SongDivision will lead the final mission at the 2016 Northeast Home Health Leadership Summit on January 19-21 in Boston. He’ll show you how to create a culture of innovation through his interactive session demonstrating how to cultivate group cohesiveness and productivity in your agency to innovate and succeed.

Here’s what other leaders say about their experience with SongDivision: “We just finished a fabulous day singing and writing our own song with SongDivision. It was phenomenal; we’ll carry this with us for a long time.”

“I’ve been a CEO for over 25 years and we’ve never had a session where we got this kind of energy and excitement in the room.”

“SongDivision rocked our world. They sent us out from our event in very high spirits!”

For full mission details, speaker information, a brochure of other sessions or to sign up and join the home health leadership go-team, visit www.nehomehealthsummit.com.

Members of HCA and other sponsoring state associations receive a discounted rate. PLUS, take advantage of the early bird discounts if registered by Dec. 18!

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DOH Issues Hospice Medicaid Rates for FFY 2016 The state Department of Health’s Office of Health Insurance Programs this week issued a Dear Administrator Letter (DAL) to announce the publication of Medicaid Hospice rates and both the Worker Recruitment and Retention (WRR) and Recruitment, Training and Retention (RTR) add-ons for the October 1, 2015 through September 30, 2016 rate period.

The updated Medicaid hospice rates were attached to the DAL but will also be posted soon to: http:// www.health.ny.gov/facilities/long_term_care/reimbursement/hospice/. DOH has forwarded these rates to the Division of Program Operation and Systems for payment, and hospices should notice these payment changes in the next two to three weeks.

For hospices that have filed a Certification for RTR with DOH, the published rates include a 3 percent add-on payment authorized by Section 4013 of the Public Health Law (PHL) and a payment of $9.92 per day as the allocable portion of the payments authorized by Section 3614.9 of the PHL. These funds are solely for the purposes of improving recruitment, training and retention of non-supervisory personnel with direct patient care responsibility and hospices are prohibited from using such funds for any other purposes.

The DAL also notes that, in accordance with the federal Medicare hospice rule, there will be a change to the Medicare Routine Home Care (RHC) rates effective with the January 1, 2016 rate period and consistent with the state Medicaid regulations, applicable to the Medicaid hospice rates beginning on January 1, 2016. That rule changes the payment methodology for RHC to implement two rates that will result in a higher base payment for the first 60 days of hospice care and a reduced base payment for days of hospice service thereafter.

It also establishes a service intensity add-on (SIA) payment to the RHC rates for services provided by a registered nurse or social worker during the last seven days of a beneficiary’s life.

For specific questions concerning these rates, hospices should contact DOH’s Russ Smith at (518) 473-4421.

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

Minor Changes Planned for Advance Beneficiary Notice of Noncoverage The U.S. Centers for Medicare and Medicaid Services (CMS) has proposed to make minor revisions to the Advance Beneficiary Notice of Noncoverage (ABN) form.

The announcement is at http://www.gpo.gov/fdsys/pkg/FR-2015-11-09/pdf/2015-28449.pdf.

The ABN is given to individuals prior to providing home health care (and/or other items or services) usually paid for by Medicare but that may not be paid for in a particular case because the care does not meet Medicare requirements for coverage.

According to CMS, minimal formatting changes have been made to the ABN, including the addition of language informing beneficiaries of their rights under Section 504 of the Rehabilitation Act of 1973 by alerting the beneficiary of CMS’s nondiscrimination practices and the availability of alternative forms of the ABN if needed.

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Continued from previous page Additionally, minor language and grammatical changes have been made to the form’s instructions to improve provider/supplier comprehension and decrease the probability of errors in completing the ABN. In the October 30 ASAP, HCA alerted members that nonsubstantive changes were also made to the Home Health Change of Care Notice (HHCCN).

The HHCCN is used to notify Medicare home health beneficiaries of changes to their plans of care. Home health agencies must provide the HHCCN whenever they plan to reduce or terminate a beneficiary’s home health services due to a physician-ordered change in the plan of care or a lack of orders to continue the care or limitation of the agency in providing the specific service (i.e. staffing shortages or safety concerns in a beneficiary’s home).

DOH Posts NHTD/TBI Transition Subcommittee Meeting Materials

Applications Open for 2016-18 Term on HCA’s Board of Directors The HCA Nominating and Governance Committee, chaired this year by Joseph Twardy, President and CEO of VNS of Northeastern New York, will consider candidates for HCA’s Board of Directors who have demonstrated leadership potential; a strong interest in public policy and advocacy; and commitment to promoting and implementing a vision and strategic policy direction for the home care industry and the Association.

The subcommittees were set up by the larger Workgroup that was established as part of an agreement to delay the transition of the Nursing Home Transition Diversion (NHTD) and Traumatic Brain Injury (TBI) waiver programs to managed care (until January 1, 2017).

HCA’s Board of Directors is comprised of members from regions throughout the state of New York who represent a variety of provider members including LHCSAs, CHHAs, MLTCs, LTHHCPs and Hospices. Candidates are asked to complete and submit the PDF application at the back of this week’s ASAP or visit https:// www.surveymonkey.com/r/ 2016BoardNomination to submit their application online.

The subcommittees whose minutes were posted include October 6 meetings of: Services and Workforce; Outreach and Education; UAS-NY; and Finance and Rates; and the October 23 meeting of the Services and Workforce Subcommittee.

The deadline for submission is December 15. All candidates for consideration must be affiliated with an HCA member organization.

Of note, the October 23 meeting reviewed NHTD/TBI waiver services and discussed whether or not to recommend adding them to MLTC and/or mainstream Medicaid managed care plans.

If you have questions regarding the application or nomination process, please contact Jenny Kerbein, Director of Governance, at jkerbein@hcanys.org, or at (518) 810-0659.

The state Department of Health (DOH) has posted materials from the NHTD/TBI Transition Workgroup Subcommittee meetings that were held in October.

The materials are at http://www.health.ny.gov/health_care/ medicaid/redesign/mrt_90.htm.

The next full Workgroup meeting will be on November 30 from 1 to 3 p.m. in Albany.

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CMS Approves New York’s Community First Choice Option New York has received approval from the U.S. Centers for Medicare and Medicaid Services (CMS) of a state plan amendment to establish the Community First Choice Option (CFCO). CFCO is a new state plan option under the Affordable Care Act for states to provide home and community-based attendant services and receive a six percent increase in the federal medical assistance percentage (FMAP).

CMS’s approval is at http://www.health.ny.gov/health_care/medicaid/redesign/ community_first_choice_option.htm.

Under CFCO, individuals determined to need an institutional level of services would be eligible for: assistance with activities of daily living; instrumental activities of daily living; and health-related tasks through hands-on assistance, supervision and/or cueing. States are required to use a person-centered plan that is based on an assessment of functional need.

New York will deliver services under an Agency Model and an Agency with Choice Model. Under the Agency Model, services are provided by direct care workers employed by an agency, while the Agency with Choice Model is similar to consumer-directed personal assistance services in that consumers will select, manage, and train their workers and can choose a relative other than a parent or spouse.

Some of the services that will be covered are: home and community-based attendant services and supports (including personal care, supervision and cueing); environmental modifications; assistive devices; congregate and/or home delivered meals; electronic back-up systems; and transition assistance for going from an institution back to the community.

DOH plans to provide webinars on this new program.

Medicare 2016 Levels The U.S. Centers for Medicare and Medicaid Services (CMS) has released the Medicare levels for 2016.

premium amounts is in a Kaiser Family Foundation report at http://files.kff.org/attachment/issuebrief-whats-in-store-for-medicares-part-bpremiums-and-deductible-in-2016-and-why.

The notice is at https://www.cms.gov/ Newsroom/MediaReleaseDatabase/Pressreleases/2015-Press-releases-items/2015-1110.html.

The annual Part B deductible will increase from $147 to $166.

Medicare Part A

Medicare Part B The Medicare Part A amounts are below.

The Medicare Part B premium will remain at $104.90 per month for most beneficiaries. It will be $121.80 per month for those who apply for Part B in 2016 and beneficiaries who pay an additional income-related premium. More information on the recently passed federal legislation that addressed the Medicare Part B

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•

Hospital deductible for the first 60 days: $1,288 (up from $1,260 in 2015);

•

Hospital daily copayment for days 61 to 90: $322 (up from $315);

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Continued from previous page •

Hospital daily copayment for days 91 to 150: $644 (up from $630);

•

Skilled nursing facility daily copayment for days 21 to 100: $161 (up from $157.50);

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Part A premium for those who are not automatically eligible and have less than 30 quarters of coverage: $411 per month (up from $407); and

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Part A premium for those not automatically eligible and have from 30 to 40 quarters of coverage: $226 per month (up from $224).

PHHPC Establishment and Project Review Committee Meeting Agenda Posted This week, the state Department of Health (DOH) posted the agenda of the November 19 meeting of the Public Health and Health Planning Council (PHHPC) Committee on Establishment and Project Review.

The agenda and supporting documents are at http://www.health.ny.gov/facilities/ public_health_and_health_planning_council/ meetings/2015-11-19/.

Alzheimer’s Disease Caregiver Support Initiative Announced

The agenda includes applications by 25 entities to establish new LHCSAs, including four upstate and two associated with Assisted Living Programs (ALPs). There are six applications for LHCSA changes of ownership. There are no applications related to CHHAs.

The state Department of Health (DOH) has announced a request for applications (RFA) for an Alzheimer’s Disease Caregiver Support Initiative for Underserved Communities.

HEAP Season Opens November 16

The announcement is at http://www.health.ny.gov/ funding/rfa/1509221136/index.htm.

New York’s Home Energy Assistance Program (HEAP) will be open for applications on November 16.

This initiative will provide support to a target population of caregivers for those with Alzheimer’s disease and other dementias, either or both of whom are members of underserved communities.

The program helps individuals with their heating costs if they meet certain eligibility criteria. The maximum gross monthly income for this season is $2,244 for individuals and $2,935 for couples.

It is anticipated that $1.5 million per year will be available to fund up to fifteen entities across the state over a five-year period to provide a wide range of caregiver support and respite services. Each successful applicant will be awarded up to $100,000 per year through a five-year contract with DOH.

The benefit amount varies from $21 to more than $500, while the emergency benefit varies from $140 to $575.

Eligible applicants must be community not-forprofit organizations, government agencies, or established partnerships of two or more of these types of organizations.

Questions about HEAP should be directed to the individual’s local department of social services or the state hotline at 800-342-3009.

Questions are due November 25; answers will be posted December 7; and applications are due January 12, 2016.

More information is at http://otda.ny.gov/ programs/heap/program.asp#regular.

13

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

Volume 20, No. 40 November 13, 2015 

UAS-NY Changes Made This week, the state Department of Health (DOH) announced that in order to comply with the requirements of New York State Information Technology Encryption Standard (NYS-S14-007, section 4.1), the Health Commerce System (HCS) will be upgraded to allow only Transport Layer Security (TLS) 1.1 or later encryption for data in transit.

This change to HCS will be implemented starting November 18, 2015.

It has two implications for the UAS-NY and its users: • All users must ensure that their browsers are configured to enable TLS1.1 or later.

• All users must upgrade their installation of the UAS-NY Offline Application from version 7.16 to version 7.26.

A new version of the UAS-NY Offline Application (v7.26) is available that will permit communication with HCS after the change. All current installations of the Offline Application must be upgraded to this new version prior to November 18, 2015. The new version can be deployed at any time prior to this date.

After the HCS upgrade on November 18, 2015, only the UAS-NY Offline Application version 7.26 will be able to communicate with the HCS and synchronize data to the online UAS-NY application. Older versions of the UAS-NY Offline Application will no longer work.

Agencies are advised to refer to the References and Resources section of the UAS-NY Training Environment, course 8500 Online and Offline Application, Section No. 5 “Accessing the Offline Application Download” for download and installation instructions.

Information on the New York State Information Technology Encryption Standard is at http://its.ny.gov/document/encryption-standard.

Publications •

“Redesigning Children’s Behavioral Health Services in New York’s Medicaid Program,” by the United Hospital Fund https://www.uhfnyc.org/assets/1432

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

14

2016

HCA

Board

Nomination application

The Home Care Association of New York State (HCA) is actively seeking nominations for its Governing Board.

HCA’s Mission Statement The Mission of HCA is to promote and enhance the quality, accessibility and availability of home and community based care by empowering our members to meet the needs of the individuals and communities they serve.

Responsibilities of HCA Board of Directors The Board’s principal task is to promote and implement a vision and strategic policy direction for the home care industry and the Association.

Duties of the HCA Board of Directors •

Participating in scheduled Board meetings, assigned ad-hoc workgroups and Association events.

•

Providing strategic policy guidance on issues that support cost-effective, efficient, high quality home and community-based care services; and promote home and community-based care as a core integral service that crosses home care settings.

•

Representing the broad interests of the entire membership.

About HCA’s Board of Directors The HCA Board is composed of 25 Directors who represent a variety of provider member organizations including CHHAs, MLTCs, LTHHCPs, Hospices, and LHCSAs. In addition, non-provider members (such as allied organizations or individuals knowledgeable in home care, etc.) may also be elected to the Board of Directors. All HCA Board Members are expected to serve the mission and goals of HCA. HCA seeks a Board that represents racial, ethnic, gender and geographical diversity.

Meetings, Terms of Office, and Committees HCA Board of Directors’ meetings are held five times per year; however, the Chairperson may convene the Board throughout the year by conference call. A Board Member’s appointment is for a two-year term and the bylaws allow for up to four consecutive two-year appointment terms. Board Members may be invited to participate in Board Committees which include the Executive, Nominating and Governance, and Finance and Investment Committees. In addition to the regularly scheduled meetings, Board Members are asked to attend HCA signature events which include the HCA Annual Membership Meeting, held in May, and HCA’s Advocacy Day, usually held in late January or early February.

Candidate Criteria The Nominating and Governance Committee of HCA’s Board is seeking nominations for Board candidates who have exhibited accomplishments in one or more of the following areas: • • •

Demonstrated commitment to HCA Leadership role in an HCA member organization in good standing Participation in HCA signature events including the HCA Annual Membership Conference and Advocacy Day

Characteristics of Candidates

How to Submit: Please return • Your completed application (on the back of this form) • Your current bio/C.V. • A letter of support from your Board Chair or CEO to: Jenny Kerbein, Director of Governance HCA, 388 Broadway, 4th Floor, Albany, NY 12207 or at: jkerbein@hcanys.org, or by fax to (518) 426-8788 by December 15, 2015.

In addition, the following personal characteristics are sought in Board candidates: • • • • • • •

Demonstrated leadership potential Commitment to HCA’s Engagement and Attendance policy which requires Board Members to routinely participate in scheduled meetings and signature events Commitment to HCA’s mission, values, and strategic plan Consensus builder Strong interest in public policy discussions and advocacy Active participant and contributor in meetings and discussions Authority to vote on items before the Board

Please submit your nomination materials no later than

December 15.

Nomination Process and Timeline Candidates should complete the nomination application on the back of this form

by December 15, 2015. Candidates’ applications will be reviewed by the HCA Nominating and Governance Committee. Those candidates selected for consideration will be contacted and vetted for approval by the HCA Board of Directors and the HCA Membership at the Annual Meeting in May.

All nominees must be employed by an HCA member in good-standing.

Print and complete form for submission, or submit your application quickly and easily online at:

www.surveymonkey.com/r/2016BoardNomination Name of Nominee:____________________________________________________________________________ Title:_______________________________________________________________________________________ Organization:________________________________________________________________________________ Address:____________________________________________________________________________________ City:_______________________________________________________ State:__________ Zip: ____________ Telephone:____________________________________________ Fax: ________________________________ email:______________________________________________________________________________________ Relevant Experience (attach resume): ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Areas of expertise/contributions you feel you can make: ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Why are you interested becoming a member of HCA’s Board of Directors? ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Have you attended HCA’s Annual Meeting in the past? YES ________ Have you attended HCA’s Advocacy Day in the past? YES ________

NO _________ NO _________

Submit completed application along with your bio/C.V. and letter of support by December 15, to Jenny Kerbein at jkerbein@hcanys.org or via FAX at (518) 426-8788.