November 20, 2015 Edition of ASAP by Home Care Association of New York State

ASAP

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

Legislative Issues  Public Policy

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News

Volume 20, No. 41 November 20, 2015

Urge Gov. Cuomo to Sign Bill Limiting Impact of CHHA Medicaid Rebasing Deadline for Governor’s signature is fast approaching! As previously reported to the membership, the Legislature unanimously passed and sent to the Governor an HCA-developed bill (S.5878/A.8171) to limit the level of CHHA Episodic Payment System (EPS) rebasing cuts. These cuts have an impact on all home care agencies serving the Medicaid population, from CHHAs to subcontracting LHCSAs. This bill, crafted in cooperation with HCA’s association partners, is on the Governor’s desk and we need him to sign it into law given that the state Department of Health has separately implemented a rebasing plan that would double or triple the size of rebasing cuts established in the state fiscal plan. See REBASING p. 3

HCA Continues Advocacy for Vital Home Care Worker Funding

Court Strikes Part of E.O. 38 Rule, but Upholds Limits Involving State Funds

HCA continues to advocate for critical funding so that home care providers and managed care plans can meet new and significant costs due to the changes in overtime, live-in and travel expenses, Workers Compensation, wage parity and other labor related expenses.

The State Supreme Court, Albany County this week struck down a portion of the state’s Executive Order (E.O.) No. 38 rule while upholding other key provisions, as explained in a memo prepared today for members by HCA Counsel Frank Fanshawe, Partner at Wilson Elser.

Inside ASAP

See COURT p. 4

See FUNDING p. 2

Urge Gov. Cuomo to Sign Bill Limiting CHHA Rebasing....................1 HCA Continues Advocacy for Home Care Worker Funding...............1 Court Strikes Part of E.O. 38 Rule........................................................1 VBP Subcommittees Finalizing Recommendations............................5 Member Hiring Announcements..........................................................5 CMS Issues Final Rule on Joint Replacement Bundle..........................6 OMIG Posts Webinar on 2015 Certification.........................................7 Health Personnel Flu Vaccination Report Training Posted.................7 HCA Hospice & Palliative Care Forum Convening December 1.........8 HCA Companionship Exemption Program Closes Out Seats...........8 Check Web Browser for Compatibility w/ HCS Security Upgrade......9 DSRIP Update.......................................................................................9 HCA Offers Home Care Perspective at PHHPC Meeting...................10 PHHPC Committee Reviews Home Care Applications.....................10 Next Steps in GoldSTAMP – Home Care Analysis Soon....................11 Applications Open for Term on HCA’s Board....................................11 HCA Home Care Sepsis Screening Tool Vetted w/ Top Experts.......12 HCA Provides Recommendations on State HIT Infrastructure..........12 HCA MLTC Forum to Address State Medical Society.......................13 Children’s Health-Homes Delayed Until September 2016................13 DOH Issues Proposed Rule on Early Intervention Services...............13 NGS Closed on Thanksgiving............................................................14 CMS Issues MedLearn Matters on CY 2016 HHPPS Final Rule...........14 Publications..........................................................................................................................14

HCA’s offices will be closed on November 26 and 27 for Thanksgiving and we will not be publishing ASAP on November 27. We reopen on Monday, November 30. Have a joyous Thanksgiving!

Helping New Yorkers Feel Right At Home

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

Volume 20, No. 41 November 20, 2015 

FUNDING from p. 1 This week, HCA met with the Healthcare Association of New York State (HANYS), LeadingAge NY, the New York State Association of Health Care Providers (HCP) and other partner associations to discuss a coordinated response to efforts aimed at increasing the minimum wage to $15 per hour. Each association agreed to try to calculate and share an estimate of the cost impact on its industry. Meanwhile, we continued to seek feedback from the state Department of Health (DOH) on HCA’s proposal to establish a “set-aside” or “stop-loss” pool to pay health plans and providers for new overtime costs. DOH said today that it has sent the proposal to its MLTC independent actuary, Mercer, to review. The advantage of this mechanism would be its ability to reimburse the actual cost increases – instead of relying on the state’s accounting methods for many (mostly incalculable) factors and costs – as we seek to secure state/ federal approval for premium adjustments to plans, and figure out how to further downstream those payments to network providers. HCA also sought clarification from DOH on its “Dear Colleague Letter” announcing its intention to increase rates under Medicaid fee-for-service and managed care to account for these new costs. We have scheduled a meeting with DOH to clarify: 1) how the purported funds would be distributed to plans and providers; and 2) the basis of DOH’s calculated adjustment of $0.34 per hour across all aide hours, and its calculation that 10 percent of all aide hours are associated with overtime. Meanwhile, HCA continues to engage with the State Legislature on the need for adjustments to ensure adequacy of payment to managed care plans and providers, and is preparing legislative language for the upcoming session to support this goal. For more information, contact HCA Policy staff.

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

Volume 20, No. 41 November 20, 2015

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

REBASING from p. 1 The Governor’s signing of S.5878/ A.8171 would establish more reasonable limits on rebasing for CHHAs and their contracting LHCSAs. We need you and your staff to urge the Governor’s positive action on this bill. Adding to the urgency is the fact that the Governor’s deadline to pass this bill is very fast approaching, so we need you to act today as soon as possible! Your action needed now! HCA’s Legislative Action Center at http://p2a.co/PqrSggn has a special message urging the Governor to sign this bill now. We ask that you click this link to immediately write Governor Cuomo urging his approval of S.5878/ A.8171 on behalf of New York’s home care patients and agencies. All you need to do is click the campaign link (http://p2a.co/PqrSggn), fill in your contact information, and send an e-mail directly to Governor Cuomo. A pre-written message will be sent to his office with a push of the button, though you are welcome to edit the message before sending. This process should take less than a minute of your time. Any HCA members with government affairs teams or direct connections to the Governor’s office are strongly urged to use our message in your outreach to contacts in the Governor’s office on this bill. Our message is published in the sidebar (at right) for your use in contacting the Governor’s office.

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Dear Governor Cuomo: The State Legislature unanimously passed a bill (S.5878/A.8171) recently delivered to your desk that I urge you to sign into law for the sake of health system stability. This bill would ensure that state rebasing of the Medicaid rates for home health matches the 2015-16 state budget agreement. Specifically, the budget assumes a $30 million decrease in reimbursement from state rebasing of home health rates. S.5878/ A.8171 implements a safety-net to ensure that the rebasing cuts do not exceed this projected, budget-assumed, level. While any such cuts to home care are very detrimental, this projected cut level is one that the Legislature and home care providers have, since the budget enactment, relied on in their forecasting. The need for this legislation is underscored by a recent development where, contrary to the passage of this bill and the adopted budget agreement, state Department of Health (DOH) staff moved forward with a rebasing plan that would double or even triple the reductions projected in the state budget. Under these newly implemented rates, the base reimbursement for home care has plunged 35.6 percent. By comparison, when the President and Congress authorized a rebasing plan for Medicare home health rates, it limited the reductions to an aggregate 3.5 percent over a four-year period out of concern that rebasing should not produce cuts detrimental to home care services and patients. S.5878/ A.8171 would align state and federal policy in these concerns toward Medicaid rebasing. As you know, the home care system in recent years has absorbed major cuts from the Medicaid Redesign process, including a global spending cap, wage parity requirements, a transition to universal managed care enrollment and other policies that have significantly drained services and resources from the home care system to a point where further cuts cannot be sustained. This situation is especially counterproductive as state policies, hospitals, insurers and other partners are relying on home care providers as never before to meet your administration’s new health care goals for elderly and disabled New Yorkers through mechanisms like DSRIP, Value Based Payment models, managed care, integration of care and others. Many of these providers risk the extreme danger of not being able to fulfill their needed role in many of the post-Medicaid Redesign Team initiatives to provide this needed, cost-effective care. This is occurring at the same time that other sectors are receiving billions of dollars in direct waiver investment funds to lead these very delivery system reform projects. New York’s home care providers are not asking for the rebasing process to go away. We are just seeking to ensure that the implementation of rebasing is in keeping with the state budget agreement. We urge your approval of the safety-net provisions for rebasing established in S.5878/A.8171 by signing this important bill. Thank you.

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

Volume 20, No. 41 November 20, 2015 

COURT from p. 1 The memo is available here: http://hcanys.org/wp-content/uploads/2015/11/ EO38courtdecisionmemo.pdf. In the case, LeadingAge New York et al v. Shah (in which HCA is a Plaintiff ), the court struck down the provisions that limit executive compensation paid from all funds; but it upheld the regulations limiting executive compensation and administrative expenses stemming exclusively from state funds or stateauthorized payments. As extensively reported to the membership, the E.O. No. 38 regulations set limits on the administrative expenses and executive compensation of covered providers, which include most health care providers and managed care plans that receive state funds or state-authorized payments above certain minimum thresholds. For an administrative expense cap, the regulations provide that no more than 25 percent of a covered provider’s operating expenses paid for with state funds or state authorized payments may be used for administrative expenses. This percentage is reduced to 20 percent in 2014 and to 15 percent in 2015 and thereafter. Members and their legal representatives are urged to download Mr. Fanshawe’s memo for further background on the ruling, its implications and next steps.

HCA’s Quality Symposium this week gathered experts from the home care consultant, provider, managed care, quality assurance and state Department of Health quarters to help providers meet the new imperative for quality enhancement in a changing health care landscape. Clockwise from top left are: HCA Board Member Laurie Neander, President and CEO of At Home Care; state Director of the Office of Quality and Patient Safety Patrick Roohan; Vice President of the Eddy Visiting Nurse Association Michelle Mazzacco; Vice President of People Care, Inc. James P. Rolla; Maureen Forster of Empire Blue Cross Blue Shield; and Executive Vice President and Chief of Provider Operations for VNS of New York Marki Flannery. Providers and plans shared some of their unique approaches to quality programming in contract relationships from the perspectives of health plans to the CHHA and LHCSA network provider levels, along with insights from state officials and consultants on the changing sphere of home care clinical and quality management. Laurie Neander joined HCA Executive Vice President Al Cardillo in demonstrating the evolution of HCA’s new Quality Risk Management Tool which is being prepared for provider use in 2016.

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

Value Based Payment Subcommittees Finalizing Recommendations The state Department of Health (DOH) Value Based Payment (VBP) subcommittee process is winding its way toward final recommendations. When finalized in subcommittee, the recommendations will be packaged and presented to the project’s overall steering committee for further assessing and packaging before final handoff to the state. HCA is a member of the steering committee; and HCA staff and/or HCA providers are participants on all of the various subcommittees.

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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

This week, two VBP technical design subcommittees and the Social Determinants of Health/Community Based Organizations subcommittees met. Among the many comments and recommendations offered by HCA this week were for: providers to have direct access to data from the Uniform Assessment System (UAS) for purposes of VBP, and implementation of legislative changes championed by HCA in 2011 that allow mandate relief, innovation and flexibility for providers to support workforce, quality and efficiency connected to integrated models. The slide decks to this week’s meetings can be accessed at http://hca-nys.org/wp-content/ uploads/2015/11/VBPslides112015.pdf. The home site to the VBP and VBP committee process is at http://www.health.ny.gov/ health_care/medicaid/redesign/dsrip/ vbp_reform.htm. HCA continues to strongly urge members to access, study and strategically consider the information provided for proactive pursuit of VBP participation. HCA will also continue to assist the membership in multiple ways. For further information, please contact Al Cardillo at acardillo@hcanys.org.

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 include 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.

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

Volume 20, No. 41 November 20, 2015 

CMS Issues Final Rule on Joint Replacement Bundle Hospitals in Buffalo and NYC Metro required to participate, with incentives to work with home care The U.S. Centers for Medicare and Medicaid Services (CMS) issued a final rule to implement the Comprehensive Care for Joint Replacement model. It provides a bundled payment to hospitals for hip and knee replacements, with opportunities for home care and other post-acute providers to participate. Under this model, set to start on April 1, 2016, the hospital in which the hip or knee replacement and/or other major leg procedure takes place will be accountable for the costs and quality of related care from the time of the surgery through 90 days after hospital discharge — what is called an “episode” of care. This model is being tested in 67 geographic areas throughout the country, including Buffalo, New York City, Long Island and the northern metropolitan area; nearly all hospitals in those geographic areas are required to participate. For locations, visit https://data.cms.gov/dataset/Comprehensive-Care-for-Joint-ReplacementModel-Met/qek8-9bd4. Depending on the hospital’s quality and cost performance during the episode, the hospital will either earn a financial reward or, beginning with the second performance year, be required to repay Medicare for a portion of the spending above an established target. According to CMS, this payment structure gives hospitals an incentive to work with physicians, home health agencies, skilled nursing facilities, and other providers to make sure beneficiaries receive the coordinated care they need with the goal of reducing avoidable hospitalizations and complications. Hospitals in the model will be provided access to additional tools – such as spending and utilization data and sharing of best practices – to improve the effectiveness of care coordination. The model also gives providers additional flexibilities that are not otherwise available under Medicare so they can better manage the care of patients, including patients who are at home. For more information, including the proposed and final rule, please visit https://innovation.cms.gov/initiatives/cjr. The full text of the rule is also available in PDF format at https://s3.amazonaws.com/publicinspection.federalregister.gov/2015-29438.pdf. The permanent online location of the final rule will be available November 24, 2015. Webinars The U.S. Centers for Medicare and Medicaid Innovation (CMS Innovation Center) will host a webinar on Monday, November 30 from 2 to 3 p.m. to detail the model. Registration is at http://tinyurl.com/ook42zt, and we encourage home care providers to participate to learn more about how they can work with hospitals to achieve success under the model, especially in the geographic regions where hospitals will be required to participate.

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

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OMIG Posts Webinar on 2015 Certification This week, the state Office of the Medicaid Inspector General (OMIG) posted Webinar No. 35: OMIG’s Certification Process: Mandatory Compliance Programs & Deficit Reduction Act of 2005. The webinar is at http://www.omig.ny.gov/resources/webinars. It provides background on the state and federal annual certification requirements, including information and completion guidance regarding the two 2015 certification forms which will be posted on OMIG’s website on December 1, 2015. Webinar No. 25 will be removed from OMIG’s website on December 1, 2015, at which time the 2014 certification forms will no longer be accessible. Under the federal Deficit Reduction Act (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 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. Certification is required for every Federal Employer Identification Number (FEIN) under which a provider orders, claims or receives Medicaid payments, or submits claims on behalf of another for Medicaid services. 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. Providers with questions are encouraged to contact OMIG’s Bureau of Compliance at compliance@omig.ny.gov.

Health Personnel Flu Vaccination Report Training Posted The state Department of Health (DOH) has posted Healthcare Personnel Influenza Vaccination Report training. The November 3 training is at https://meetny.webex.com/meetny/lsr.php?RCID=6011787276e0447eafdb4134b583cd38. As mentioned in previous editions of ASAP, DOH opened the Healthcare Personnel Influenza Vaccination Report on November 2 on the Health Commerce System. The Dear Administrator Letter and Frequently Asked Questions on the report are at https://apps.health.ny.gov/pub/ctrldocs/alrtview/postings/ Notification_19310.pdf. Continued on next page

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

Volume 20, No. 41 November 20, 2015 

Continued from previous page Similar to last year, the process involves a single, longitudinal report for which agencies should enter data in November, or as soon as data is available, and then resubmit data as often as necessary as new personnel join the agency and/or as they submit documentation of vaccination. This year’s report covers personnel employed by or affiliated with a facility or agency from October 1, 2015 through March 31, 2016. At this time, DOH has not yet declared influenza prevalent, and, thus, home care and other health care providers are not required to meet the state’s flu-mask requirement under which certain personnel not vaccinated against influenza for the current influenza season must wear a surgical or procedure mask while in areas where patients or residents are typically present. Last year, the influenza season ran from December 11, 2014 to May 14, 2015.

HCA Hospice & Palliative Care Forum Convening December 1 The HCA Hospice and Palliative Care Provider Forum will convene for a robust agenda of topics and presenters on December 1 in Albany. This upcoming agenda includes: presentations and discussion on palliative care education and training developments opportunities; new innovations in palliative care and hospice programing, including new proposal development; state and federal policy issues and advocacy needs; implementation of the new HCA-authored law on RN and MSW education and training in palliative care; and more. In addition to HCA-member palliative care home care agency and hospice providers, invited participants and presenters include the Center to Advance Palliative Care, state Palliative Care Education and Training Council, the state Department of Health, legislative health committees, health plans, executives from the state boards for nursing and social work, and more. This forum of HCA meets in committee-like format, taking up critical issues related to the field, and making recommendations for HCA program, policy, legislative, budget and education initiatives to support these critical services. Just this week, the state’s Value Based Payment (VBP) project committee highlighted palliative care and hospice care in connection with criteria for shared savings under prospective VBP 8

HCA Companionship Exemption Program Closes Out Seats New one scheduled for January 6 HCA’s upcoming education program, Achieving Compliance with the New Companionship Services and Live-In Overtime Compensation Rules, has been closed to new registrants, but HCA has just scheduled another similar program on January 6. The January 6 program (see form at the back of this week’s ASAP) will include a presentation by the Littler Mendelson Law Firm on developing compliance strategies in light of the U.S. Department of Labor’s new rules that narrow the companionship and live-in domestic worker exemptions from federal minimum wage and/or overtime obligations for home care agencies. They will also discuss recent court cases that challenge the application of the “13-hour payment” practice for New York’s “live-in 24 hour care” cases and other agency practices. In addition, participants will receive tips on how to restructure their staffing, care delivery, and time-tracking policies and procedures to reduce labor costs and ensure compliance. Members can download a registration form for the newly added January 6 program at the back of this week’s ASAP.

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

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contracts, underscoring the growing recognition and opportunities for enhanced support of the field.

DSRIP Update

Seating is limited for the December 1 meeting. If you would like to participate, please register as soon as possible with Billi Hoen at bhoen@hcanys.org.

The Delivery System Reform Incentive Payment (DSRIP) program website has been updated to include the presentations delivered by 12 Performing Provider Systems (PPSs) to the Project Approval and Oversight Panel (PAOP) on November 9 and 10. (The presentations are here: http://www.health.ny.gov/ health_care/medicaid/ redesign/dsrip/2015-11-910_paop_meetings.htm.)

For further information, please contact Billi Hoen at bhoen@hcanys.org; Alexandra Blais at ablais@hcanys.org; or Al Cardillo at acardillo@hcanys.org.

Check Web Browser for Compatibility with HCS Security Upgrade Other enhancements added To comply with state encryption standards (http://its.ny.gov/document/ encryption-standard), the state Department of Health (DOH) has upgraded the encryption method for HCS data. Your browsers will need to be compatible with TLS 1.1 encryption in order to access the HCS. Follow the instructions below or visit the following link to test your browser’s compatibility: https://www.ssllabs.com/ssltest/viewMyClient.html •

Internet Explorer users should open their browsers and: press “Alt T” and select “Internet Options”; select the “Advanced” tab; scroll down to the “Security” section; locate and check “Use TLS 1.0, TLS 1.1 and TLS 1.2”; press “OK”.

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Google Chrome users should open their browsers and: press “Alt F” and select“Settings”; scroll down and select“Show advanced settings”; scroll down to the Network section and click on “Change proxy settings…”; select the “Advanced” tab; scroll down to the “Security” section; locate and check “Use TLS 1.0, TLS 1.1 and TLS 1.2”; press “OK”.

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Safari users: Version 7 or greater is automatically TLS 1.0, TLS 1.1 and 1.2 enabled.

To troubleshoot any problems with these updates, contact DOH at hcsoutreach@health.ny.gov. Added feature: My Notifications HCS users should also notice a new envelope icon on the HCS menu bar for “push notifications.” A counter badge will show the number of new notifications for review, allowing you to manage the notifications. For further information, contact the HCA Policy staff. 9

The state Department of Health (DOH) has announced that the “Information by PPS” section of its website is now live at: http:// www.health.ny.gov/ health_care/medicaid/ redesign/dsrip/ providers_professionals.htm. It contains links to the PPS Contact List, PPS Network Partners as well as a link to a newly created webpage for “DSRIP Performing Provider Systems (PPS).” DOH informed HCA that it has reopened the process for network providers to apply for PPS participation. HCA members who are not part of a PPS can contact a PPS about being in its network. Any questions may be directed to dsrip@health.ny.gov.

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

Volume 20, No. 41 November 20, 2015 

HCA Offers Home Care Perspective at PHHPC Meeting on SNF Bed Capacity This week, HCA participated in a meeting of the Public Health and Health Planning Council (PHHPC) Health Planning Committee that was held to discuss the need methodology for nursing home beds. The committee faces a deadline to make recommendations by the end of the first quarter of 2016, as the policy must be revised by December 31, 2016. While the meeting did not specifically address home and community-based services, HCA, represented by Vice President for Program Policy and Services Andrew Koski, took the opportunity to inform the committee about the condition of this sector, as any discussion about nursing home beds must include the availability of home care. Mr. Koski summarized the changes that home care agencies have faced, including the shift of their patients to managed care; payment and authorization issues with plans; duplicative and costly requirements providers must undertake to fulfill plan requirements and state regulatory mandates; wage and other labor pressures due to wage parity, Workers Compensation, overtime and travel expenses; need to adjust home care business practices to address major system changes such as the Delivery System Reform Incentive Payment program and Value Based Payments; significant technology challenges hindering provider collaboration with other providers; worker shortages for aides and professionals; and others. The committee members were receptive to HCA’s concerns and also heard from a variety of associations representing nursing homes and other long term care settings who reviewed the state of their industries, but did not offer recommendations at this time. The committee will have additional meetings and HCA will keep members informed of developments.

PHHPC Committee Reviews Home Care Applications This week, the Public Health and Health Planning Council (PHHPC) Committee on Establishment and Project Review met. The committee voted to approve and to send to the full council applications by 25 entities to establish new LHCSAs and six applications for LHCSA changes of ownership. There were no applications related to CHHAs. At the committee meeting, the state Department of Health (DOH) mentioned that the PHHPC Health Planning Committee met this week (see related story on this page) and will be discussing LHCSAs as part of its discussion on the long term care system. The agenda and supporting documents for the meeting are at http://www.health.ny.gov/facilities/public_health_and_health_planning_council/meetings/2015-11-19/.

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

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Next Steps in Promoting GoldSTAMP – Home Care Analysis on Horizon The coordinating committee for the state’s GoldSTAMP Program to Reduce Pressure Ulcers met to review plans for ramped up promotion of the program across all collaborating sectors – hospitals, home care, nursing homes and physicians. HCA is an active member of the state coordinating committee and has been working to promote home care provider collaboration and adoption of GoldSTAMP evidence-based practices in pressure ulcer prevention and management. State Department of Health (DOH) officials have issued a multi-provider letter encouraging GoldSTAMP practices and goals at http://hca-nys.org/wp-content/uploads/ 2015/11/DALNH1508.pdf. These goals sync with the movement toward new models of care and payment, including the Delivery System Reform Incentive Payment (DSRIP) program, Value Based Payments (VBP) and other integrated care models, creating a positive opportunity for providers to bring their GoldSTAMP program to the table. DOH has commissioned a team of project analysts to compile data examining and comparing pressure ulcer prevalence in each sector and for at-risk subpopulations. Data was presented at the committees’ recent meetings profiling hospitals and nursing homes, especially focusing on apparent wide variation in pressure ulcer prevalence; the next meeting is expected to include a focus on home care. HCA has offered to meet with and to vet advance data runs in order to provide feedback to the state’s analysts. GoldSTAMP participation and promotion is one of the focal areas of HCA’s Quality Committee. Our Quality Symposium this week presented a wound care “app” that highlighting the effectiveness of technology in pressure ulcer management. (See photos on p. 4.) HCA urges providers to visit the GoldSTAMP homepage (at http://www.albany.edu/sph/cphce/goldstamp.shtml) for further background and resources. For further information, please contact Al Cardillo at acardillo@hcanys.org. 11

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

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Volume 20, No. 41 November 20, 2015 

HCA Home Care Sepsis Screening Tool Vetted with Top Experts As HCA has previously reported, a Sepsis Workgroup of the HCA Quality Committee has innovated and betatested a home care screening tool and protocol for early recognition and entry into treatment of potential sepsis cases. HCA’s initiative is a first-of-its-kind nationally. This week, the project moved forward to vetting of the screen and protocol with top sepsis physicians and the National Sepsis Alliance. Their recommendations have been incorporated and the tool is being recirculated for second review. HCA has also reached out to the Medical Society of the State of New York to offer similar vetting with their physician committees on quality and long term care. Stay tuned for next steps, including statewide unveiling of the screen, provider education and training, collaborative connections with hospital and physician partners, and efforts to attract financial support for adoption throughout the field. The HCA initiative is now also a component of the IPRO-awarded federal project for community-based sepsis recognition and treatment. It has likewise drawn recognition from the U.S. Centers for Disease Control and Prevention, along with inquiries from other states seeking potential adoption of the HCA model. HCA acknowledges our provider workgroup and its leaders on this critical public health innovation in home care. For further information, please contact Al Cardillo at acardillo@hcanys.org.

HCA Provides Recommendations on State HIT Infrastructure HCA representatives provided key recommendations this week for inclusion in the upcoming Final Report of the State Health Information Technology (HIT) Infrastructure Workgroup. Among other areas, the recommendations included the critical importance of home care’s participation in health information exchange, and the need for investment in home care’s HIT infrastructure and its capacity for exchange within integrated, regional and statewide systems. The recommendations emphasized the need for home care’s inclusion and for state/federal investment for home care HIT. The recommendations further focused on the need for data access, including access across currently disparate databases, and on data elements (such as social determinants of health) currently not readily obtainable. The workgroup was created in the 2014 state budget to examine and make recommendations on the state’s health information technology infrastructure, including development of regional and statewide health information systems, the creation of an “all-payor” database, and issues and goals essential for the appropriate and necessary exchange of health information within the delivery system. HCA authored the addition of legislative language to include home care in these initiatives. HCA and member home care representatives on the workgroup included Russell Lusak, Senior Vice President, Selfhelp Community Services, and HCA Board Member; Mary Kate Rolf, CEO of VNA Homecare Options and immediate-past HCA Board Member; and Mary Ann Christopher, former CEO of the VNS of New York. HCA extends appreciation to these members for their expertise and efforts. For further information, contact Al Cardillo at acardillo@hcanys.org.

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

Volume 20, No. 41 November 20, 2015 

HCA MLTC Forum to Address State Medical Society A critical focus at HCA’s recent MLTC Forum meeting was the need for enhanced plan-provider engagement with physicians. In follow-up, HCA reached out to the State Medical Society (MSSNY) to seek interest in discussing such collaboration. MSSNY has invited HCA and our Forum members to discuss perspectives and recommendations at the next MSSNY Long Term Care Committee meeting in January. HCA looks forward to actionable steps and a positive report to the members following our meeting with MSSNY. For further information, please contact Al Cardillo at acardillo@hcanys.org.

Children’s Health-Homes Delayed Until September 2016 The state Department of Health (DOH) is delaying implementation of Health Homes for Children from January 1, 2016 to September 2016. The announcement is at http://hca-nys.org/wp-content/uploads/2015/11/implementation_schedule_mapp.pdf. The delay was made based upon an assessment and review of the progress made by Health Homes contingently designated to serve children. It was determined that additional time is needed to address contingencies and meet other readiness and Health-Home administrative requirements. The conversion for Adult Health-Home providers to new rate structures and billing procedures is also delayed until September 2016.

DOH Issues Proposed Rule on Early Intervention Services This week, the state Department of Health (DOH) issued a proposed rule on the Early Intervention (EI) program that would “conform existing program regulations to federal regulations and state statute.” The proposed rule is at http://w3.health.state.ny.us/dbspace/propregs.nsf/ 4ac9558781006774852569bd00512fda/f859a8ba127688da85257eff006c267f?OpenDocument. It is intended to conform state regulations with: federal regulations covering state complaint procedures and other areas, and, where applicable, with relevant amendments to the Public Health Law. In addition, according to DOH, the proposed rule allows for per-month, per-week, and/or service-event billing for service coordination, and this will result in efficiencies (as service coordinators would no longer be required to track billable service coordination activities).

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

Volume 20, No. 41 November 20, 2015 

NGS Closed on Thanksgiving National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC) will be closed November 26 to 27. This includes the Electronic Data Interchange (EDI) Help Desk, Provider Contact Center, Provider Enrollment Line, and Telephone Reopening Unit. Electronic claim files transmitted after 5 p.m. on Wednesday, November 25 will have a claim receipt date of Monday, November 30, 2015. EDI front-end acknowledgement transactions will be created as expected as EDI claim files are received. The Direct Data Entry (DDE) Provider Online System will be available on November 26 and 27, during regular hours. Providers will be able to access NGSConnex and use the Interactive Voice Response (IVR) system at 1-866-275-3033. NGS will reopen on Monday, November 30, 2015 for normal business hours.

CMS Issues MedLearn Matters on CY 2016 HHPPS Final Rule The U.S. Centers for Medicare and Medicaid Services (CMS) has posted a new MedLearn Matters article on the home health Prospective Payment System (PPS) final rule for 2016. It provides a detailed summary of the rule and can be accessed at: https://www.cms.gov/Outreach-andEducation/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9406.pdf. HCA has also provided the membership a detailed memorandum on CMS’s 2016 PPS final rule, which can be downloaded at: http://hca-nys.org/wp-content/uploads/2015/11/CMS2016FinalRuleMemoFinal.pdf. For further information, contact HCA’s Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

Publications •

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

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“A Family Caregiver’s Guide to Electronic Organizers, Monitors, Sensors, and Apps,” by the United Hospital Fund h t t p : / / w w w. n e x t s t e p i n c a r e . o r g / u p l o a d s / F i l e / G u i d e s / Te c h n o l o g y / Electronic_Organizers_Monitors_Sensors_Apps.pdf

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“Setting the Stage for Payment Reform: Updating New York’s Regulations on Risk Transfers Between Health Plans and Providers,” by the United Hospital Fund https://www.uhfnyc.org/assets/1435

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

Achieving Compliance with the New Companionship Services and Live-in Overtime Compensation Rules January 6, 2016 - AGENDA 9:00am Registration 9:30 to 9:45am HCA Welcome

Wednesday, January 6 9:00am to 11:45am

Location: Conference Center 130 East 59th Street (near Lexington Ave.) 7th Floor New York, NY 10022

Fee: $79 for HCA Members; $139 for Non-Members

9:45 to 11:45am Littler Mendelson Law Firm Join Angelo Spinola and Lisa Griffith for a discussion of compliance strategies in light of the U.S. Department of Labor’s new rules that narrow the companionship and live-in domestic worker exemptions from federal minimum wage and/or overtime obligations for home care agencies. In addition to discussing the outcome and next steps related to their law firm’s challenge to these new rules, Angelo and Lisa will also discuss recent court cases that challenge the application of the “13 hour payment” practice for New York’s “live-in 24 hour care” cases and other agency practices. Further important topics to be covered include the essentials of an effective compliance program for New York employers, including best practices for compensating extended-shift and live-in employees. Get detailed tips on how to restructure your staffing, care delivery, and time-tracking policies and procedures to reduce labor costs and ensure compliance. Angelo Spinola, Shareholder, Littler Mendelson P.C. Lisa M. Griffith, Shareholder, Littler Mendelson P.C.

REGISTRATION – (Deadline December 24th)

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