MedPAC
LHCSA, CDPAP
CoPs
SEPSIS
HCA responds to MedPAC recommendations for HHA cuts, seeking a more complete, regionspecific analysis of supporting data for payment decisions.
HCA is holding back-to-back sessions upstate for agencies interested in being a CDPAP fiscal intermediary, along with our Upstate LHCSA Forum at the same location.
HCA gains clarification on some of the new CoP requirements, as we call for a one-year delay in the effective date.
Join HCA and partners for the fourth webinar in a series to prepare you for use of the sepsis screening tool in home care.
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COMING UP
Your Source for HOME CARE News, Policy and Advocacy
Vol. 2, Issue 5 | January 30, 2017
State Advocacy Day and PAC Reception Feb. 6-7, 2017 Albany, NY Feb. 6: PAC reception at HCA’s offices Feb. 7: HCA Board Meeting and appointments with legislators
Make Your Voice Heard on Feb. 7 for HCA Advocacy Day
Free HCA Member Webinar on New Home Health CoP Changes Prepare Now for Implementation of the New Home Health Conditions of Participation (CoPs) Feb. 14, 2017 11 a.m. to 12 p.m.
If you haven’t registered yet, please let us know you are coming by completing the registration form (at http://hca-nys.org/wp-content/uploads/2016/12/2017-HCAAdvocacy-Day-Flyer.pdf) and making sure to schedule appointments with your See ADVOCACY p. 2
Registration for these and other events is at http://hca-nys.org/ events-education/ upcoming-events.
Reports and briefings coming soon HCA is calling on all member leaders to attend our State Advocacy Day on February 7 in Albany, beginning with an open session of our Board of Directors (and invited guest state officials and legislative leaders), followed by an afternoon of legislative office meetings.
HCA Takes Aim at Federal Regs, Seeks CoP Implementation Delay
Minimum Wage Survey Imminent
HCA this week prepared and circulated two new federal advocacy pieces targeting a series of problematic home care regulations while calling for a one-year delay in implementation of the sweeping new Home Health Conditions of Participation (CoPs). See REGS p. 3
The state Department of Health (DOH) is finalizing its minimum wage survey, and home care providers can expect it to be posted for their completion very soon, possibly this week. See WAGE p. 4
INSIDE Make Your Voice Heard on Feb. 7 for HCA Advocacy Day.....................................…1 Minimum Wage Survey Imminent…...................................................................1 HCA Takes Aim at Federal Regs, Seeks CoP Delay…...............................................1 Finalized Rule Places Limits on Sharing of Wage Info….........................................4 HCA President Responds on MedPAC Cut Recommendations…............................5 Join HCA for March 9 Programs Upstate on CDPAP and LHCSA Forum…..................6 HCA Obtains CMS Clarification on Medicare Home Health CoPs….........................7 Webinar on Pressure Ulcer Quality and Cost Performance: Feb. 8........................8 Register for Webinar IV on Home Care Sepsis Screening Tool: February 9…...........9 Member Hiring Announcement….......................................................................9 UAS to be Upgraded on February 1, 2017.......................................................…10
DEIP Webinar to Explain Funding Opportunity for HIT Connections............….....10 November Global Cap Report: Spending $26M Above Projections…..................11 PACE Applications Available............................................................................12 Cybersecurity Guidance Posted…...................................................................12 Additional Information on Proposed State Budget...........................................13 PHHPC Committee Acts on Home Care Applications.........................................14 FAQs Issued on NHTD/TBI Transition to Managed Care…...................................14 Advancing Care Coordination Webinar Announced….......................................15 Dual Eligibles Report Released.......................................................................16 IMPACT Act Conference Call…..........................................................................16 Comments Sought on Draft Audit Protocols for OPWDD Clinic Services…...........16 DOH Posts Information for Making Address Changes........................................16 NGS Updates….............................................................................................17
The Situation Report: the Home Care Association of New York State ADVOCACY from p. 1 legislators for the afternoon of February 7. We also urge you to attend our PAC reception the night before, on February 6. (See the registration form for details.) HCA is in the process of finalizing documents for Advocacy Day. These include: our home care and MLTC financial condition report; a summary document outlining our requests in this year’s budget; and instructions for HCA members to use as you discuss HCA’s “asks” with legislative representatives. These documents will be shared with the membership later this week. As highlighted in last week’s newsletter, the budget negotiations are a vital opportunity to address urgent home care provider and MLTC needs for payment adequacy, infrastructure investment, regulatory flexibility and workforce support. The Governor’s proposed budget presents opportunities as well as challenges in many of these areas. But the proposed budget is coupled with longstanding or previously emergent issues that require urgent action and a voice from home care provider and MLTC members, specifically regarding the minimum wage funding roll-out, service challenges in a changing health care system, the financial toll of past reimbursement policies, and other issues. February 7 is your opportunity, alongside HCA, to press for legislative proposals that address the core issues necessary for supporting the home care infrastructure. Please register for Advocacy Day today, commit to attending our evening PAC reception on February 6, and make your appointments now to meet with legislators on the afternoon of February 7. We’ll be sending you additional supporting documents and messaging very soon. Stay tuned.
Volume 2, No. 5 January 30, 2017
The Situation Report is a weekly publication of the Home Care Association of New York State (HCA). Unless otherwise noted, all articles appearing in The Situation Report are the property of the Home Care Association of New York State. Reuse of any content within this newsletter requires permission from HCA. Joanne Cunningham HCA President jcunningham@hcanys.org Roger L. Noyes Director of Communications, Editor of The Situation Report rnoyes@hcanys.org Al Cardillo Executive V ice President, Policy & Programs acardillo@hcanys.org Patrick Conole Vice President, Finance & Management pconole@hcanys.org Andrew Koski Vice President, Program, Policy & Services akoski@hcanys.org Alexandra Fitz 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 & Special Projects jkerbein@hcanys.org Billi Wilson Manager, Meetings & Events bwilson@hcanys.org
Home Care Association of New York State (HCA) 388 Broadway, 4th Floor, Albany, NY 12207 Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org
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Teresa Brown Administrative Assistant tbrown@hcanys.org
The Situation Report: the Home Care Association of New York State
REGS from p. 1 These documents accompanied a letter sent to the Medicare Payment Advisory Commission (MedPAC) raising “grave” concerns with MedPAC’s recommendations for home health payment cuts, another target of our federal advocacy efforts. (See p. 5 story.) The inauguration of Donald J. Trump as President, coupled with a new Congress, has signaled a shift in orientation regarding industry regulations and potential new openness for regulatory relief. For many regulations affecting home care providers, HCA and partners have succeeded in gaining bipartisan sponsorship of legislation to address mandates which do little or nothing to enhance the safety and quality of patient care or services, instead causing paperwork burdens, unnecessary and unfair delays in care, or denials of payment for necessary services already provided to patients. In a new document, entitled Home Care Advocacy Ask: Regulatory Relief for Home Care Providers, HCA targets five areas of regulation that demand change, consistent with our past advocacy efforts and support garnered from Members of New York’s Congressional Delegation. Despite past bipartisan support on many of these issues, officials at the U.S. Centers for Medicare and Medicaid Service (CMS) and other government agencies have resisted calls for change. HCA is redoubling those efforts in 2017 as new appointments and policies are made within government agencies. Our position paper takes aim at: the Medicare face-to-face rule; the pre-claim review demonstration project; unfunded federal overtime mandates; limits on practitioners authorized to order and refer home care services; and the compressed timetable for implementation of the new federal CoPs.
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For specific background details and advocacy recommendations on each of these issues/regulations, please download the report at http://hca-nys.org/wpcontent/uploads/2017/01/ HomeCareRegulationsandMandates.pdf. Digging deeper, the CoPs are also the subject of a separate document, entitled One-Year Delay Needed for Home Care Providers to Implement Biggest Changes to CoP Regulations in Nearly 30 Years. In this piece, HCA commends the intent of the CoP changes, but points out that the changes, though proposed two years ago, were swiftly finalized just this month with only six months for providers to prepare for them by a July 13, 2017 deadline. In addition, the structure of the system (emphasizing managed care and new integrated models) has moved on from that which existed when these revised CoPs were initiated years ago. (Please see related p. 7 story about some clarifications obtained by HCA on the CoPs.) CMS has yet to even issue Interpretive Guidelines to educate state surveyors on the CoP changes and enforcement actions, putting further pressure on state health department surveillance units and providers to understand, implement and enforce over fifty new CoP amendments or additions – the biggest, one-time set of changes to the CoPs since 1989. HCA is seeking a oneyear delay in implementation of the new CoPs until July of 2018. To read more about our positioning and recommendations on the CoPs, please download the document here: http://hca-nys.org/wp-content/ uploads/2017/01/OneYearDelayCoPs2017.pdf. Please also note that HCA is holding a February 14 webinar, free for HCA members, where you can learn more about the impact of the CoPs on your operation. To register, please complete and fax back the form here: http://hca-nys.org/wp-content/uploads/2017/01/ HCA-Conditions-of-Participation-Webinar-RegistrationForm.pdf. HCA is meeting with Members of Congress next week to discuss these and other issues. Please be on the lookout for further information on how you can support our federal grassroots advocacy.
The Situation Report: the Home Care Association of New York State
Volume 2, No. 5 January 30, 2017
WAGE from p. 1 Last week, the state shared its updated version of the survey, which was revised to incorporate some comments by HCA and other associations. As we suggested, the survey was streamlined and changed to incorporate 2016 not 2015 data (so that more accurate and current costs are obtained). We thank DOH for simplifying the survey, and our members who provided comments on a prior version. The intent of the survey is to help DOH determine the impact of the minimum wage increases and develop a reimbursement methodology that “will respond to the benchmarks for minimum wage salaries through the year 2021.” The survey asks agencies to report the number of hours that employed staff were paid and the percentage of wages currently spent on payroll taxes and other benefits that are paid as a percentage of wages or required to increase if wages go up, divided by region as follows: New York City; Long Island and Westchester; and the rest of the state. Cost Report requirement coming DOH has also told HCA that it will be working toward a formal cost report system to capture necessary data not obtained from the survey, and we have asked DOH to share information on this process for our engagement on the development phase of this cost report system. We will notify members once the survey is available for completion.
Finalized Rule Places Limits on Sharing of Wage Info The state Department of Labor (DOL) has finalized a regulation to carry out a 2015 legislative change that directs DOL “to adopt standards for reasonable workplace and workday limitations on the time, place, and manner for inquiries, discussion of, or the disclosure of wages.” The rule is in the February 1, 2017 State Register at https://docs.dos.ny.gov/info/register/2017/feb1/pdf/rulemaking.pdf (page 9). The regulation states: An employer may, in a written policy provided to an employee either electronically, through publicly available posting, or by paper copy, place reasonable limitations on the time, place and manner that an employee may inquire about, discuss, or disclose wages. Such limitations must be justified without reference to the content of the regulated speech, narrowly tailored to serve a significant interest, and leave open ample alternative channels for the communication of information. An employer shall not impose restrictions on employees in such a way that unreasonably or effectively precludes or prevents inquiry, discussion, or disclosure of wages at the worksite and/or during work hours, directly or in practice. An employer may prohibit an employee from discussing or disclosing the wages of another employee unless the other employee provides verbal or written permission, either directly or indirectly. Employers who have such policies must maintain a copy of the policies for six years.
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Volume 2, No. 5 January 30, 2017
HCA President Responds on MedPAC Recommendations to Cut, Rebase Medicare Home Health Rates As reported in last week’s edition of The Situation Report, the Medicare Payment Advisory Commission (MedPAC) recently voted unanimously to recommend an additional five-percent Medicare payment cut in the next annual rates for home health agencies. The recommendations also call on the U.S. Centers for Medicare and Medicaid Services (CMS) to implement a two-year rebasing of the home health prospective payment system (HHPPS) beginning in 2019. MedPAC intends to incorporate these recommendations in its Report to Congress in March. On Thursday, HCA President Joanne Cunningham sent a letter to MedPAC’s Executive Director, Dr. Mark E. Miller, raising “grave concerns” about MedPAC’s recommendations and the data assumptions underlying them. The letter is at http://hca-nys.org/wp-content/uploads/2017/01/ MedPAC2017ReporttoCongress.pdf. In the letter, also cc’d to New York’s Members of Congress, Ms. Cunningham presented some New York-specific home health agency financial findings that vary substantially from MedPAC’s aggregate, national data assumptions. As noted in the letter, MedPAC bases its recommendations on a claim that free-standing home health agencies nationally had an operating margin of 15.6 percent in 2015, thus warranting payment reductions. “This national estimate alone is questionable, as it does not consider any of the 1,500-plus agencies in the U.S. that are part of a hospital or skilled nursing facility,” Ms. Cunningham said. “Nationally, facility-based agencies have an average un-weighted Medicare operating margin of -6.19 percent. In New York (where these facility-based agencies represent more than 20 percent of all Medicare certified providers), this un-weighted operating margin is -32.53 percent.” Ms. Cunningham urged MedPAC to amend its recommendations to urge “CMS to analyze regional differences in home health operating margins to properly substantiate any payment decisions under consideration,” especially considering the toll of past home health rebasing efforts which have failed to properly account for the financial impact on agencies in large regions of the country. This lack of a regional or state analysis has been a longstanding issue in MedPAC and CMS payment considerations. “MedPAC and CMS need only look at New York’s case for compelling reasons why a regional analysis is justified, especially considering that more than 5 percent of all Medicare home health patients and visits occur in New York, a significant sample size for analysis,” Ms. Cunningham added. “New York’s home care Medicare margins, as a whole, have remained negative for fourteen years in a row, with an
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The Situation Report: the Home Care Association of New York State overall un-weighted average margin of -16.36 percent in 2014 (the most recent year of data available to HCA for analysis). This is a complete inverse of the national figure cited by MedPAC.” “CMS has yet to consider any of these distinct factors in payment decisions which have major implications for providers and beneficiaries, and it should be compelled to do so,” she added. “MedPAC, an influential voice on payment matters, can help promote a more statistically sound analysis from CMS when it comes to the urgent issue of reimbursements to care for the elderly and persons with disabilities. Absent a regional analysis by CMS, the blunt instrument of across-the-board payment or rebasing cuts fails to address regional inequities, causing New York operating margins to plummet while other regions of the country have continued to report positive margins in some cases.” HCA will use this letter and other outreach to brief Members of Congress on the implications of MedPAC’s recommendations. Other federal advocacy issues With a new Congress and Trump Administration, HCA has also prepared a series of new federal advocacy documents urging a delay in the implementation of the Home Health Conditions of Participation (CoPs) and Congressional or Executive action on a series of regulations that have implications for home care operations and finances. (See related p. 1 story.)
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Join HCA for March 9 Programs Upstate on CDPAP and LHCSA Forum On March 9, HCA is holding two programs upstate for LHCSAs and for all home care agencies looking to participate as fiscal intermediaries under the Consumer Directed Personal Assistance Program (CDPAP). The March 9 sessions will be held at the Mohawk Valley Health System Sogg’s Room (1650 Champlin Avenue) in Utica. The first program is entitled Successfully Acting as a Fiscal Intermediary in the Consumer Directed Personal Assistance Program, starting at 9:30 a.m. with registration and breakfast followed by a 10 a.m. to noon program. Immediately following this event, HCA is hosting a members-only Upstate LHCSA Forum at the same location from noon to 3 p.m., beginning with lunch. A statewide Medicaid program, CDPAP empowers consumers by giving them flexibility and freedom to choose who provides their care and how it is provided. LHCSAs can participate in this growth by becoming a Fiscal Intermediary (FI). At this morning session, you will get important information about CDPAP, including: consumer eligibility requirements and obligations; the process to become an FI; advantages and disadvantages of LHCSAs serving as FIs; requirements and obligations of the FI; policies and procedures; required contracts; wage and hour issues facing FIs; potential risk areas; and best practices of a successful program. The program will be presented by Michael Weiner, a partner in the law firm of Glaser & Weiner, LLP. For more than 20 years, Mr. Weiner has been a trusted advisor to his clients, providing them with practical legal counsel and business advice. LHCSAs are encouraged to participate in this program and to stay for the noon Upstate LHCSA Forum for an exchange of valuable information, advocacy concerns and recommendations for action on: state budget developments; federal legislative issues; uniform billing codes; the minimum wage increase and state funding; CDPAP; the Delivery System Reform Incentive Payment Program (DSRIP) and value based payment; and issues in your region. Participants should register for either one or both programs. Separate registration forms are at http://hca-nys.org/eventseducation/upcoming-events.
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Volume 2, No. 5 January 30, 2017
HCA Obtains CMS Clarification on Medicare Home Health CoPs HCA has obtained clarification on some important parts of the final rule on the Medicare Home Health Conditions of Participation (CoPs). As indicated in last week’s edition of The Situation Report, the U.S. Centers for Medicare and Medicaid released the final rule on January 13. While this rule has an effective date of July 13, 2017, it includes provisions on Emergency Preparedness (section 484.102) that are also in another CMS final rule, “Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers.” That rule has a different effective date – November 15, 2017 – from the CoPs but with overlapping emergency preparedness requirements. We asked CMS to clarify which date the Emergency Preparedness requirements in the Medicare home health CoPs are effective: July 13, 2017 or November 15, 2017? CMS responded as follows: The Emergency Preparedness rule was effective in November 2016. That rule had a separate implementation date of November 2017. The final HHA (home health agency) rule does not change the effective date or the implementation date of the Emergency Preparedness rule. HHAs are expected to implement the Emergency Preparedness requirements by November 2017.
HCA also sought CMS clarification on Section 484.60 of the Medicare Home Health CoPs final rule which includes a requirement that home health agencies have to provide the patient an individualized written plan of care. We pointed out that this is contrary to what is stated in the comments and responses part of the final rule that says: “We agree that it is not appropriate to require HHAs to routinely provide each patient with a copy of his or her plan of care and we have removed this requirement from the regulation at section 484.50(c).” In response to our question on this matter, CMS stated: Section 484.60(e) requires HHAs to provide each patient with written information regarding (1) Visit schedule, including frequency of visits by HHA personnel and personnel acting on behalf of the HHA; (2) Patient medication schedule/instructions, including: medication name, dosage and frequency and which medications will be administered by HHA personnel and personnel acting on behalf of the HHA; (3) Any treatments to be administered by HHA personnel and personnel acting on behalf of the HHA, including therapy services; (4) Any other pertinent instruction related to the patient’s care and treatments that the HHA will provide, specific to the patient’s care needs; (5) Name and contact information of the HHA clinical manager. By contrast, 484.60(a) requires that the home health plan of care must include the following:
All pertinent diagnoses;
The patient’s mental, psychosocial, and cognitive status;
The types of services, supplies, and equipment required;
Continued on next page
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The Situation Report: the Home Care Association of New York State Continued from previous page
The frequency and duration of visits to be made; Prognosis; Rehabilitation potential; Functional limitations; Activities permitted; Nutritional requirements; All medications and treatments; Safety measures to protect against injury; A description of the patient’s risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors; Patient and caregiver education and training to facilitate timely discharge; Patient-specific interventions and education, measurable outcomes and goals identified by the HHA and the patient; Information related to any advanced directives; Any additional items the HHA or physician may choose to include; and All patient care orders
We do not believe that the written information described in 484.60(e) is at all equivalent to the plan of care described at 484.60(a).
HCA also asked when CMS would issue Interpretive Guidelines for the states, and we are awaiting a response on these important instructions for state surveyor enforcement. HCA’s comprehensive memo on the final rule is at http://hca-nys.org/wpcontent/uploads/2017/01/MedicareHomeHealthCoP011817.pdf. Given the complexity of these new CoPs, the delay in Interpretive Guidelines and the costs for implementation, HCA is urging CMS to postpone the implementation for an additional year. (See related p. 1 story for a position paper on the CoP implementation date and other federal advocacy efforts regarding regulations.) CoPs Webinar HCA is offering a webinar, free of charge, on February 14 from 11 a.m. to 12 p.m. for HCA members ($79 for non-members) that will provide you with a deeper understanding and implementation plan for the newly finalized Home Health CoPs. To register, please complete and fax back the form here: http://hca-nys.org/wp-content/uploads/2017/01/HCAConditions-of-Participation-Webinar-Registration-Form.pdf.
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Volume 2, No. 5 January 30, 2017
Webinar on Pressure Ulcer Quality and Cost Performance: Feb. 8 HCA Executive Vice President Al Cardillo, LMSW is among the featured speakers for an important February 8 (11 a.m. to noon) statewide webinar on pressure ulcer quality and cost performance. Registration is at http://tinyurl.com/jltokfn. This educational webinar will examine the Gold STAMP Program (see http:// www.albany.edu/sph/cphce/ goldstamp.shtml) and highlight resources available to home care and other providers through this program. Pressure ulcers can cause pain, increase the risk for infection, and may slow recovery from another illness or surgical procedure. Home care’s role in pressureulcer identification and treatment is vital, especially with the advent of new models, like the Delivery System Reform Incentive Payment (DSRIP) program, which provide opportunities for home care providers to tackle clinical issues and meet outcomes measures. Other speaker include: Nancy Leveille, RN, MS, Sr. Director of Center for Wound Healing Research of the New York State Health Facilities Association; and Laura E. Edsberg, Ph.D., Director of Center for Wound Healing Research and Associate Professor in the Natural Sciences Department at Daemen College.
The Situation Report: the Home Care Association of New York State
Volume 2, No. 5 January 30, 2017
Register for Webinar IV on Home Care Sepsis Screening Tool: February 9 HCA, partners from IPRO and others are gearing up for the fourth in a series of webinars to guide home care agencies on use of the home care sepsis screening and intervention tool. The next webinar is on February 9, from 10:30 a.m. to noon. Please note that agencies are required to access all of the webinars in this series to obtain a user agreement (to be issued soon after the final webinar) for employing this tool in the future. Archived recordings of the first two webinars in the series (held September 30 and October 20) are posted at http:// atlanticquality.org/initiatives/sepsis-initiative/educational-eventswebinars/. Providers can bookmark this page for a future posting of the final two webinars in the series. As emphasized in this series, sepsis is the number one all-cause of Medicare thirty-day hospital readmissions in New York State, and second only to schizophrenia in its impact on New York Medicaid. Home care providers, using this first-of-its-kind screening tool, can play a powerful role in identifying and acting on this public health crisis. The January 19 webinar focused on the integration of the tool into electronic health records (EHRs). The upcoming February 9 webinar (for clinical leaders, educators and administration) will be a train-the-trainer session and introduction to the screening tool protocol. Registration information is below. Sepsis Webinar IV: Thursday, February 9 10:30 a.m. to noon Train-the-Trainer and Introduction of Screening Tool Protocol To join the online event, visit http:// tinyurl.com/zdgtdn7, click “Register” and complete the online form. If assistance is required, contact QNet WebEx Support at qnet_webex_support@hcqis.org or 571-598-1988. Questions on the home care sepsis initiative can be directed to HCA at acardillo@hcanys.org or to IPRO at Sara.Butterfield@areaI.hcqis.org or Eve.Bankert@areaI.hcqis.org.
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Volume 2, No. 5 January 30, 2017
UAS to be Upgraded on February 1, 2017 The UAS-NY online application is scheduled to be upgraded to version 1.2.75 on Wednesday, February 1, 2017. The application, including the UAS-NY Training Environment, will be unavailable beginning at 5:30 p.m. on February 1. The upgrade will be completed by no later than Thursday, February 2, 2017 at 8 a.m. There is no required upgrade of the Offline Client associated with this online release. Once the online upgrade to 1.2.75 is complete, the current version of the Offline Client, 1.2.59, will work with the new online version. Any questions can be directed to the UAS-NY Support Desk at 518-408-1021 or uasny@health.ny.gov.
Attention Providers: Important DEIP Webinar to Explain Funding Opportunity for HIT Connections! The New York eHealth Collaborative (NYeC) is hosting two webinars on the Data Exchange Incentive Program, a funding opportunity for providers and organizations to connect to the SHIN-NY. The webinars are being held on February 2 (10 to 11 a.m.) and February 7 (1 to 2 p.m.). NYeC is a participant in HCA’s Technology Committee and has been an active partner and supporter of HCA technology developments in home care. Incentive funding of $10,000 per organization is available (in accordance with eligibility and program requirements). This program is open to Article 28 nursing homes, Article 36 home care agencies and programs, Article 40 hospice facilitates, Behavioral Health providers and others. (A flyer can be downloaded at http://hca-nys.org/wp-content/uploads/2017/01/DEIP-Webinar-Announcement.pdf.) The state Department of Health (DOH), with support from the U.S. Centers for Medicare and Medicaid Services (CMS), has established the Data Exchange Incentive Program (DEIP) to increase HIE adoption across the state. Building Electronic Health Record (EHR) interfaces to New York State Qualified Entities (QEs) will increase the quantity and quality of data in the Statewide Health Information Network for New York (SHIN-NY) and build value for providers and patients at the point of care. This program is designed to help defray the cost for an organization when connecting to their local QE. Organizations participating in DEIP are incentivized to contribute a pre-defined set of data elements to their local QE. Limited funding is available and this program is operated on a first-come, first-served basis. The webinar will cover:
DEIP program basics Eligibility requirements Data contribution requirements Program milestones Payment milestones QE contacts How to get started Continued on next page
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Continued from previous page Registration links are below: Session 1: February 2 (10 to 11 a.m.): https://attendee.gotowebinar.com/register/ 2271865181655566593 Session 2: February 7 (1 to 2 p.m.): https://attendee.gotowebinar.com/register/321339250563676417 Questions can be e-mailed to deip@nyehealth.org.
November Global Cap Report: Spending $26M Above Projections The state Department of Health (DOH) has issued its monthly Medicaid Global Cap report. This latest report, for November, covers the period of April 1, 2016 to November 30, 2016. The full report is at: https://www.health.ny.gov/health_care/medicaid/regulations/global_cap/monthly/ sfy_2016-2017/docs/nov_2016_report.pdf. It finds that overall spending for this period was $26 million above Medicaid Global Cap projections, across all sectors, a difference of $13.741 billion in actual spending versus $13.715 billion in estimated spending for the eight-month period. Specifically, DOH mentions the following two significant pressures on the Global Cap:
Managed Long Term Care was $18 million above projections due to higher-than-expected enrollment. Through October, there were 4,433 more recipients (2.4 percent higher) than anticipated; and
“Other Long Term Care” spending was $34 million above estimates (a category that includes home care). This is a result of higher-than-expected utilization through November. There were 2,909 more individuals receiving personal care services than anticipated. The Department shows actual spending of $431 million versus projected spending of $397 million.
It should be noted, however, that DOH confirmed in a 2016 meeting with HCA and other association representatives that the Medicaid Global Cap projections will not include any additional Medicaid spending due to the phase-in of the $15-per hour statewide minimum wage, as these expenses will be kept outside the cap. In other report highlights:
Total Medicaid Managed Care (MMC) spending was $19 million over projections, a difference of $9.895 billion (actual spending) versus $9.876 billion (estimated spending).
Total Medicaid enrollment reached 6,113,035 enrollees at the end of November 2016. This reflects a net decrease of 54,255 enrollees, or 0.9 percent, since March 2016. Continued on next page
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Continued from previous page HCA is surveying these global cap reports carefully in an information gathering effort, combined with other data analysis, to ensure accurate reflections of home care finances, with an eye toward any indication of rate or payment decisions stemming from the state’s analysis of home care’s performance. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
PACE Applications Available The U.S. Centers for Medicare and Medicare Services (CMS) has released the PACE application and key dates for the 2017 Programs of All-Inclusive Care for the Elderly (PACE) application cycle. Beginning in 2017, all PACE applications, both initial and service area expansion (SAE) applications, will be submitted via the Health Plan Management System (HPMS). A copy of the 2017 PACE application is posted at https://www.cms.gov/Medicare/Health-Plans/PACE/Overview.html. Initial applicants must complete the Notice of Intent to Apply (NOIA) to ensure timely access to CMS systems, including HPMS. CMS uses the NOIA information to generate a pending contract number, which the applicant needs in order to request access to HPMS. The NOIA data collection form for organizations interested in applying under the PACE program is Attachment A in a CMS memo (http://hca-nys.org/wpcontent/uploads/2017/01/PACE-Application-Guidance_011717.pdf). CMS will only accept the NOIA data collection form electronically through the PACE portal at: https://dmao.lmi.org. All initial applications and any SAE application that includes the addition of a new PACE center require a State Readiness Review (SRR) of the new center. The SRR must be submitted with either the initial submission of the application or submitted in response to the subsequent request for additional information. If the required SRR is not submitted, the application will be denied. Applicants must also submit a Medicare Part D application in HPMS simultaneously with the initial PACE application.
Cybersecurity Guidance Posted The U.S. Department of Homeland Security has posted a guidance on cybersecurity issues for health care providers. The document, titled “Healthcare and Public Health Sector Cyberdependencies,” is at http://hca-nys.org/wp-content/uploads/2017/01/Cyberdependency_Homeland-Security_012417.pdf. The document discusses processes supported by information communication technology; cybersecurity incidents affecting medical data, business management systems and building and access control systems; and recommendations for agencies to address cybersecurity risks. Last week’s edition of The Situation Report informed members that the U.S. Centers for Medicare and Medicaid Services (CMS) has posted guidance to State Survey Agency Directors on recommendations to providers regarding cybersecurity. That guidance, including additional resources, is at https://www.cms.gov/Medicare/ProviderEnrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-17-17.pdf.
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The Situation Report: the Home Care Association of New York State
Volume 2, No. 5 January 30, 2017
Additional Information on Proposed State Budget HCA participated in the state Department of Health (DOH) 2017-18 Executive Health Budget briefing on Friday, January 27, 2017 and obtained additional information on the proposed Health Care Facility Transformation Program. As reported in last week’s edition of The Situation Report, the Governor has proposed to continue last year’s Health Care Facility Transformation Program at a level of $500 million, with a $30 million portion dedicated to home and community-based providers, including home care agencies. Last year, HCA, along with a coalition of community providers, was instrumental in obtaining a specific set-aside for community care. On Friday’s briefing, DOH said that the $500 million includes $300 million for bondable purposes such as construction or equipment and $200 million for non-bondable purposes, including debt retirement, startup costs and non-bondable equipment. Furthermore, priority will be given to projects not funded under the previous Statewide Health Care Facility Transformation Program. Monies under this program are available “in support of capital projects, debt retirement, working capital or other noncapital projects that facilitate health care transformation activities including, but not limited to, merger, consolidation, acquisition or other activities intended to create financially sustainable systems of care or preserve or expand essential health care services.” As we did last year, HCA will be working to shape the criteria for access of these funds by home care and other community-based providers and advocating for a greater share dedicated to such providers. DOH will soon hold a similar program on the Medicaid health proposals and HCA will participate and inform our members of any new or updated state budget information.
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The Situation Report: the Home Care Association of New York State
Volume 2, No. 5 January 30, 2017
PHHPC Committee Acts on Home Care Applications On January 26, the Public Health and Health Planning Council (PHHPC) Committee on Establishment and Project Review held a meeting to review home care and other health care applications. The agenda, and supporting documents, are at https://health.ny.gov/facilities/public_health_and_health_planning_council/meetings/2017-01-26/docs/ exhibits.pdf. The Committee approved the following applications:
Three entities to establish a new Licensed Home Care Services Agency (LHCSA) affiliated with an Assisted Living Program.
Three LHCSAs for changes of ownership.
These applications will be reviewed by the full PHHP at its February 9 meeting.
FAQs Issued on NHTD/TBI Transition to Managed Care Waiver Transition Workgroup meeting held The state Department of Health (DOH) has posted a Frequently Asked Questions (FAQs) document on the transition of the Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) waiver programs to managed care. The FAQs are at https://www.health.ny.gov/health_care/medicaid/redesign/mrt90/nhtd-tbi/response_faq.htm. The FAQs cover: “conflict-free” service coordination; staff qualifications; impact of Community First Choice Option (CFCO); future of housing subsidy; oversight, supervision and social transportation services; network capacity; role of enrollment broker and regional resource development centers (RRDCs); transition plan to managed care; and other issues. NHTD/TBI waiver participants will receive an announcement letter on or about December 1, 2017 indicating that voluntary enrollment of existing waiver participants into a managed care product will be effective statewide January 1, 2018 and that the NHTD/TBI waiver programs will no longer be available effective April 1, 2018. If current waiver participants want to continue receiving long term care services, they must enroll in managed long term care (MLTC) or mainstream Medicaid managed care (MMC) plans, depending on their program eligibility. Waiver participants will have the opportunity to voluntarily enroll into managed care effective January 1, 2018. Individuals required to mandatorily enroll in a managed care plan who do not voluntarily enroll by March 1, 2018, will be auto assigned for services, effective April 1, 2018. Participants will be sent a 60-day notice on January 1, 2018, a 30-day notice on February 1, 2018 and, if applicable, an auto assignment letter on March 1, 2018. Continued on next page
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The Situation Report: the Home Care Association of New York State
Volume 2, No. 5 January 30, 2017
Continued from previous page DOH is proposing to establish a two-year period for participants and service providers under which managed care plans will be required to contract with current waiver service providers for a minimum of two years:
If the service provider is serving five or more current waiver participants;
If the service provider continues to serve participants/members unless a health/safety concern exists; and
As long as the service provider assures that there are appropriately licensed personnel to provide and/ or supervise services.
All services in place at the time of the transition to managed care will continue for the first six months of the transition. After six months, the plan will reassess the member for specific service needs. Any individual seeking CFCO services at this time must be assessed to confirm the member meets the eligibility criteria for CFCO services. The proposed transition plan includes a two-year rate guarantee through April 1, 2020 for providers based on the approved rate at the time of the transition. Additional information on the transition is at https://www.health.ny.gov/health_care/medicaid/redesign/ mrt90/tbi-nhtd_waiver_trans_ingo.htm. Waiver Transition Workgroup This week, the Waiver Transition Workgroup met to continue discussions on unresolved issues related to the managed care transition. In response to concerns about the need for training, DOH suggested that training be targeted to: participants and families; waiver service providers; and plans. Meeting participants added Maximus (the Enrollment Broker) and UAS Assessors for training. State Medicaid Director Jason Helgerson reported on the uncertainty of the status of Medicaid and that communication with CMS has been put on hold pending changes in the federal Administration. He also mentioned that the state has over a hundred State Plan Amendments awaiting CMS approval that could be at risk. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org
Advancing Care Coordination Webinar Announced The U.S. Center for Medicare and Medicaid Innovation (CMS Innovation Center) will host a February 9 webinar to discuss various aspects of the final rule for the: Advancing Care Coordination through Episode Payment Models (EPMs); Cardiac Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model. Registration for the webinar (from noon to 1 p.m.) is at https://innovation.cms.gov/resources/epm-intro.html. The final rule was displayed at the Federal Register on December 20, 2016 and is effective February 18, 2017. For additional information about Episode Payment Models, including the final rule, visit https://innovation.cms.gov/initiatives/epm/index.html.
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The Situation Report: the Home Care Association of New York State
Volume 2, No. 5 January 30, 2017 ď Žď€
Dual Eligibles Report Released The Medicare Payment Advisory Commission (MedPAC) and the Medicaid and CHIP Payment and Access Commission (MACPAC) have released a data book entitled Beneficiaries Dually Eligible for Medicare and Medicaid. It is at http://www.medpac.gov/docs/default-source/publications/ jan17_medpac_macpac_dualsdatabook.pdf?sfvrsn=0. The report includes data on: dual-eligibles; Medicare and Medicaid spending; demographic characteristics; managed care enrollment; service usage; and other information.
IMPACT Act Conference Call The U.S. Centers for Medicare and Medicaid Services (CMS) will hold a call on the IMPACT Act to discuss goals, requirements, progress to date, and key milestones for 2017. A question and answer session will follow the presentation. The call is on February 23 at 1:30 p.m. Registration is at https://blh.ier.intercall.com/. The Improving Medicare Post-Acute Care Transformation of 2014 (IMPACT Act) requires the reporting of standardized patient assessment data by Post-Acute Care (PAC) providers, including home health agencies, skilled nursing facilities, inpatient rehabilitation facilities, and long-term care hospitals.
Comments Sought on Draft Audit Protocols for OPWDD Clinic Services HCA is seeking feedback on draft audit protocols developed by the Office of Medicaid Inspector General on OPWDD (Office for People with Developmental Disabilities) Article 16 clinic services. The draft protocols cover: missing parts of the treatment plan, elements of clinic service documentation, or written order; improper/duplicate billing; billing for unauthorized services; incorrect rate code; and others. Those interested in reviewing the draft protocols should immediately contact Andrew Koski at (518) 8100662 or akoski@hcanys.org, as feedback is due soon.
DOH Posts Information for Making Address Changes The state Department of Health (DOH) has posted instructions to local departments of social services (LDSS) about efforts by the state and Medicaid Managed Care Plans (MMCPs) to obtain more accurate residential and/or mailing address information for Medicaid recipients. The instructions are at https://www.health.ny.gov/health_care/medicaid/publications/pub2017gis.htm (see 2017 General Information System Messages). Continued on next page
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The Situation Report: the Home Care Association of New York State
Volume 2, No. 5 January 30, 2017
Continued from previous page DOH has provided plans with guidance that allows them to send a form letter to current enrollees, requesting that they verify or update their residential and mailing addresses. This letter may be sent to enrollees the plan has identified as having an incorrect or undeliverable address on file. The letter asks the MMCP enrollee to verify or make changes to the address information provided, and sign and date the letter. The enrollee is instructed to mail the updated information to the appropriate LDSS, using the postage paid, pre-addressed envelope provided by the plan. Upon receipt of the signed letter, the LDSS must accept this as a request by the Medicaid recipient to update the Medicaid case in WMS if the address information is different from that listed on the case record. The LDSS should retain the letter in the case record as proof of residence.
NGS Updates National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), has recently posted the following information to its website.
NGS to Conduct J6 Ask-the-Contractor Home Health Teleconference – On Thursday, February 23, from 2-3:30 p.m., NGS will be hosting an Ask-the-Contractor Teleconference (ACT) for Jurisdiction 6 home health providers to ask questions and share information with NGS. Questions may be sent in advance, but no later than February 17, to j6.provider.training@wellpoint.com. NGS requests that providers do not include protected health information (PHI) in your e-mails. The subject line should read: “J6 Home Health ACT Question.” Pre-registration is not required for this teleconference. The following is the dial-in number and conference code for the teleconference:
Dial-in number: (888) 589-5413 Conference Code: 60610143
NGS Releases New YouTube Video on Home Health Eligibility and Documenting the Need for Skilled Services – NGS has released a new YouTube video entitled, Home Health Eligibility: Documenting the Need for Skilled Services. This video covers important information on documenting the need for skilled services for the Medicare beneficiary. It can be downloaded at: https:// www.youtube.com/watch?v=ZEU3qLvf-PM.
For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
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