BUDGET
WAGE PARITY
FI BILL
FORUMS
President Trump issues a budget proposal with Medicaid changes, a Medicare Home Health Groupings Model and other home health, hospice impacts.
Home care providers and their contractors must submit and/or obtain wage parity certifications by March 1.
Fiscal Intermediary legislation would tweak requirements for existing FIs to continue providing services.
Due to members’ requests, HCA has added a Downstate CHHA Member Forum to our lineup of Forums for CHHAs, LHCSAs and HCC Members.
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COMING UP Upstate CHHA Member Forum Feb. 23, 2018 Albany Long Island ‘Stop Sepsis at Home’ Sessions March 8, 2018 (Port Washington) March 9, 2018 (Farmingdale) Downstate CHHA Member Forum March 16, 2018 NYC Senior Financial Managers Forum March 22, 2018 Albany Register for these and other programs online at https://hcanys.org/eventseducation/ upcoming-events.
Your Source for HOME CARE News, Policy and Advocacy
Vol. 3, Issue 8 | February 16, 2018
We Need Your Voice Now and Throughout Next Week on State Budget Advocacy All HCA Member Leaders: Schedule Legislative Advocacy Visits Next Week in Local District Offices. All Staff at Your Organization: Send E-mails Using HCA’s Legislative Action Center; Please Forward Link to Action Center for a High Volume of Messages Sent By Your Entire Team! Next week, the Legislature is on break for the President’s Day holiday. This is a perfect – and necessary! – opportunity for you to schedule a visit with your Assembly and Senate representatives in their local, district offices nearby your organization. See ADVOCACY p. 3
HCA CFO & Finance Forum Offers Answers as Federal and State Budget Fiscal Impacts Converge on Home Care The President last week signed a sweeping set of Medicare payment changes to home care, including a modified rural add-on, a payment overhaul akin to the Home Health Groupings Model (HHGM), and other important changes. His proposed budget (separate from See FORUM p. 2
Editor’s Note: This is a special early (Friday) edition of HCA’s newsletter. Our offices are closed on Monday for President’s Day. Please also note we will experience an e-mail outage over the weekend and on Monday, as noted to members in an alert (http:// conta.cc/2sDDKDO) sent earlier today. This is due to a migration of our e-mail server. Please see the link above for alternate contact information.
INSIDE We Need Your Voice on State Budget Advocacy.........................................1 HCA CFO & Finance Forum Offers Answers.................................................1 Important Upcoming Deadlines................................................................4 Medicaid Enrollment Requirement Update...............................................5 President Releases Proposed Budget........................................................5 Wage Parity Certification Forms Due March 1.............................................8 Emergency Rule Issued on FIDA Enrollment...............................................8 Fiscal Intermediary Legislation Passes....................................................9
Need Updated OASIS Credentials or COS-C Exam?......................................9 NYC CHHA Session Added to Lineup of LHCSA, CHHA, HCC Forums.................10 HCA Memo Provides Hospice Reimbursement, Audit, Coding Updates.......11 CMS Announces New Option for Submission of Medicare Cost Reports........12 Health Home Supportive Housing Funding Available...................................12 Additional VBP Information Available...................................................12 National Health Expenditure Data Released...........................................13 Resources................................................................................................13
The Situation Report: the Home Care Association of New York State FORUM from p. 1 last week’s spending bill) includes cuts to Medicaid and other major impacts on the home care sector. Meanwhile, the state budget, due by April 1, proposes a similar breadth of impacts to New York’s home care providers and MLTCs on the Medicaid side. In a full day of expert updates, HCA’s Senior Financial Managers Forum, on March 22, will help you assess, budget and understand the intricacies of these big factors (plus others) in your organization’s financial planning. As reported in our February 12 newsletter, the implications of the recent federal spending bill are sprawling and profound. At our Forum:
Colin Roskey, a Washington-based health policy expert who specializes in home care, will offer a well-timed overview to help you wade through the tangle of new payment changes. Ed Buckley, CEO of Select Data, will present some cost-control measures tied to the assumptions of the HHGM model. We’ll also have NGS official Lauri Domingo discussing the Targeted Probe and Educate documentation initiative and other contractor insights that directly affect your fiscal and regulatory compliance operations.
Our March 22 program falls just over a week before the April 1 state budget deadline. As now proposed, the budget includes LHCSA contract limits; MLTC eligibility changes, cuts and carve-outs; direct-care workforce monies; infrastructure pools; and a range of other items on the table. HCA Policy and Finance experts will be joined by Department of Health Finance and Rate officials to discuss the latest on these items as well as the mechanics and updates on: the Medicaid Global Cap; CHHA EPS rebasing; premium rate adjustments to MLTC; QIVAPP funding; Wage Parity and overtime adjustments to plans and home care providers; home care fee-forservice Medicaid rates; the Medicaid cost reports; and other Medicaid reimbursement issues. All home agencies should be sure to have at least one executive, finance officer, CFO or other official with finance responsibility in attendance for this well-timed immersion in all of the necessary fiscal updates. Register now at https://hca-nys.org/wp-content/uploads/2018/01/HCASenior-Financial-Mgr-Forum-Registration-Form.pdf. 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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Volume 3, No. 8 February 16, 2018
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 Vice President acardillo@hcanys.org Patrick Conole Vice President, Finance & Management pconole@hcanys.org Andrew Koski Vice President, Program, Policy & Services akoski@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 & Graphic Design jkerbein@hcanys.org Billi Wilson Manager, Meetings & Events bwilson@hcanys.org Teresa Brown Administrative Assistant tbrown@hcanys.org
The Situation Report: the Home Care Association of New York State
Volume 3, No. 8 February 16, 2018
ADVOCACY from p. 1 Legislators, away from their duties in Albany, will be more readily available in their local offices doing constituent work next week – including meeting with you about HCA’s budget and legislative asks and concerns. Please schedule these appointments as soon as possible for anytime next week. When meeting with the legislator or staff, speak simply about your agency, the areas it serves, its number of patients and staff, and other demographic information. The conversation should then turn to our budget requests, which HCA has formulated in a series of talking points that reflect our 2018 Budget and Legislative Asks document previously shared with the membership (https://hca-nys.org/wp-content/uploads/2018/ 02/2018BudgetandLegislativeAsks.pdf).
HCA President Joanne Cunningham testified on Monday before a joint hearing of the Senate and Assembly on the Medicaid and health care proposals of the budget. Her testimony is at https://hca-nys.org/testimony/hca-testifiesat-health-state-budget-hearing-on-behalf-of-home-carehospice-and-mltc.
As background, you are encouraged to print and present HCA’s Asks document to Legislators or their staff, as well as our financial condition report, which HCA recently updated to reflect some methodological changes in the statistics. Both documents are linked to the State Advocacy section of HCA’s website at https://hcanys.org/advocacy-pac/state. For further background, you may also want to read HCA’s budget testimony (see the link in the photo caption above), delivered earlier this week before a joint legislative hearing on the health and Medicaid budget. HCA’s Legislative Action Center: 3 messages, 3 minutes of your time, all staff must send! HCA has posted three new messages to our Legislative Action Center, a vehicle for you and your staff to email legislators with a pre-written advocacy message. This effort takes just a few minutes of your time, which means it should be done by as many of your staff as possible – and, in addition to your personalized meetings or phone calls with the Legislature. All three messages are listed below with links to send all three. While HCA has conveyed a series of legislative proposals and budget requests to the Legislature and Governor, the following issues are among the ones in active play as part of negotiations. Please forward these links to your staff, Board of Directors and other key contacts with instructions for them to click the links and send messages, assuring a high volume of e-mails on these critical issues and asks:
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Message 1: Reject LHCSA contract limits and other managed care-home care actions, cuts (click here to act: http://p2a.co/g8HD8K7)
Message 2: Support proportionate home care infrastructure investment and cost-savings initiatives (click here to act: http://p2a.co/9NhQZwK)
Message 3: Maintain Home Care Standards for Home Telehealth and other In-Home Services (click here to act: http://p2a.co/kIG4ki2)
Volume 3, No. 8 February 16, 2018
The Situation Report: the Home Care Association of New York State
Important Upcoming Deadlines Requirement/Change
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Effective/Due Date
More Information
Home Care and other providers who contract with Managed Care Organizations must be enrolled in Medicaid
January 1, 2018 but still being accepted
https://www.emedny.org/info/ProviderEnrollment/Ma nagedCareNetwork/index.aspx
Posting of OSHA Form 300A
February 1 to April 30
https://www.osha.gov/recordkeeping/RKforms.html
CMS Low Volume Appeals Settlement for CHHAs with NPIs ending in an even number
Expression of Interest must be submitted from February 5 to March 9
https://www.cms.gov/Medicare/AppealsͲandͲ Grievances/OrgMedFFSAppeals/AppealsͲSettlementͲ Initiatives/LowͲVolumeͲAppealsͲInitiative.html
Wage Parity certification forms due from CHHAs, LTHHCPs and managed care organizations to DOH; from LHCSAs to their contracted CHHAs, LTHHCPs and managed care organizations; and from Fiscal Intermediaries to their contracted managed care plans
March 1, 2018
https://www.health.ny.gov/health_care/medicaid/rede sign/mrt_61.htm (wait for posting of 2018 forms)
Submission of Conflict of Interest (COI) Compliance Implementation Plan forms by NHTD/TBI providers to their Regional Resource Development Centers
March 1, 2018
https://hcaͲnys.org/wpͲ content/uploads/2018/01/ConflictͲofͲInterestͲ ComplianceͲImplementationͲPlanͲ1.docx; https://hcaͲ nys.org/wpͲcontent/uploads/2018/01/COIͲComplianceͲ ImplemenationͲPlanͲPowerͲPoint.pdf
Medicare Bundled Payments for Care Improvement Advanced model
Applications due March 12, 2018
https://innovation.cms.gov/initiatives/bpciͲadvanced
CMS Low Volume Appeals Settlement for CHHAs with NPIs ending in an odd number
Expression of Interest must be submitted from March 12 to April 11
https://www.cms.gov/Medicare/AppealsͲandͲ Grievances/OrgMedFFSAppeals/AppealsͲSettlementͲ Initiatives/LowͲVolumeͲAppealsͲInitiative.html
Health Care Facility Transformation Program
Applications due March 14, 2018
https://grantsgateway.ny.gov/intelligrants_NYSGG/mo dule/nysgg/goportal.aspx?NavItem1=4&ngoID=500097 9
Criminal history record check requirements apply to hospice
April 1, 2018
https://www.health.ny.gov/facilities/home_care/advan ced_home_health_aides/docs/ahha_legislation.pdf
Submission of COI Compliance Implementation Plan forms by Regional Resource Development Centers to state Department of Health
April 1, 2018
https://hcaͲnys.org/wpͲ content/uploads/2018/01/ConflictͲofͲInterestͲ ComplianceͲImplementationͲPlan.docx; https://hcaͲ nys.org/wpͲcontent/uploads/2018/01/COIͲComplianceͲ ImplemenationͲPlanͲPowerͲPoint.pdf
Start of Transition Period for Using Health Insurance Claim Number (HICN) or Medicare Beneficiary Identifier (MBI)
April 1, 2018
https://www.cms.gov/Medicare/NewͲMedicareͲ Card/index.html
Implementation of Universal Billing Codes for Home and CommunityͲBased Long Term Care Services under Managed Care
April 1, 2018
https://www.health.ny.gov/facilities/long_term_care/r eimbursement/letters/dal_2017Ͳ12Ͳ 07_billing_codes.htm
Community First Choice Option Services Available to Medicaid Managed Care Enrollees
April 1, 2018
https://www.health.ny.gov/health_care/medicaid/rede sign/community_first_choice_option.htm
Healthcare Personnel Influenza Vaccination Report
May 1, 2018 for personnel employed from October 1, 2017 to March 31, 2018
immunize@health.ny.gov or (518) 473Ͳ4437
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Medicaid Enrollment Requirement Update The state Department of Health (DOH) has advised HCA that managed care plans will be sending contract amendments to their network providers about the requirement to enroll in Medicaid. If the provider fails to enroll in Medicaid, the plan will initiate termination of that provider by July 1, 2018. DOH advises plans that they should not be initiating terminations relating to failure to enroll in Medicaid now. Plans have been told to send out these provider contract amendments, check enrollment and pending enrollment data to track compliance, and to identify and reach out to providers who have not complied. More information, including a list of providers that have enrolled in Medicaid and webinar materials, is at https://www.emedny.org/info/ProviderEnrollment/ManagedCareNetwork/MMC_Providers_Presentation_-_125-2018.pdf and https://www.emedny.org/info/ProviderEnrollment/ManagedCareNetwork/index.aspx. Home care providers that only bill managed care plans and don’t have a Medicaid provider number should download the enrollment form for home health agencies at https://www.emedny.org/info/ ProviderEnrollment/index.aspx and check off “Managed Care Only (Non Billing)” under section 2. HCA has informed members about this new Medicaid enrollment requirement many times. While this action was required in federal legislation (“21st Century Cures Act”) by January 1, 2018, DOH is still accepting Medicaid enrollment applications and encourages home care and other health care entities to submit Medicaid applications immediately if providing – or intending to provide – services to managed care enrollees. Currently, there are 10,000 new applications from all types of providers pending DOH’s decision, including those awaiting additional information from the provider. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
President Releases Proposed Budget On February 12, President Trump released his proposed budget for 2019. It is at https://www.hhs.gov/about/budget/index.html. According to media coverage, the budget is not likely to be enacted, especially since Congress recently passed legislation (see last week’s edition of The Situation Report) that lays out federal spending for 2018 and 2019; still, the proposed budget provides insight into what policies President Trump’s administration would like to implement. The Administration’s materials state that the Medicare proposals would save $494 billion over ten years. They include the following:
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Implement a “unified post-acute care” payment system that includes home health agencies, skilled nursing facilities, inpatient rehabilitation facilities and long-term care hospitals. Payment will be
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based on episodes of care and patient characteristics rather than the site of services. The first year of implementation (2024) would be budget neutral relative to estimated payments. The Medicare Payment Advisory Commission (MedPAC) had met in November to recommend a unified payment system and it is not known if the President’s proposal matches MedPAC’s, which was intended to “correct known biases” of the current payment systems and “redistribute payments within each setting.” MedPAC’s proposed redistribution would, in effect, increase payments for medically complex patients and decrease payments for rehabilitation care that is “unrelated” to a patient’s condition. See the November 20 edition of The Situation Report for details at https://hca-nys.org/wp-content/uploads/2017/11/ SitRep112017.pdf.
Provide a lower annual Medicare payment update in 2019 to 2023 for home health agencies, skilled nursing facilities, inpatient rehabilitation facilities and long-term care hospitals.
Establishment of the home health groupings model (HHGM) payment system to take effect Jan. 1, 2020, which the administration calculates would lead to $16.7 billion in savings over a 10-year period. A new payment framework, similar to HHGM, was in fact included in the spending bill that was signed into law on February 9. The new payment model in last week’s spending bill has a 2020 start date and is mandated to be budget-neutral.
Eliminate the requirement of a face-to-face provider visit for durable medical equipment. (HCA will be examining this proposal to determine if it can be expanded to include the exemptions of face-to-face requirement for home health services.)
Make a number of changes to the Medicare appeals system, including: establishing a postadjudication user fee for all unfavorable Medicare appeals at the Office of Medicare Hearings and Appeals and the next level; increasing the minimum “amount in controversy” required for the administrative law judge level; allowing the Office of Medicare Hearings and Appeals to issue decisions without holding a hearing if there is no material fact in dispute; limiting the right to appeal a redetermination of a claim that was denied because no documentation was submitted to support the services billed; and others.
Institute Medicare program integrity actions that strengthen the federal and state ability to fight fraud, waste and abuse and to reduce improper Medicare payments. These include: imposing penalties on providers who fail to update their records; allowing state Medicaid Fraud Control Units to receive federal matching funds for the investigation or prosecution of abuse and neglect in non-institutional settings; requiring states to implement claims edits to automatically deny “unusual” personal care services payments, such as payments for duplicative services, for services provided by personal care service attendants who did not meet state qualification requirements, and for services rendered to individuals no longer eligible for Medicaid; allowing revocation and denial of provider enrollment based on affiliation with a sanctioned entity; requiring states to assign unique identifiers to personal care service attendants that will be listed on claims along with dates that attendants performed services in question; and more. Continued on next page
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Continued from previous page
Allow beneficiary assignment to Accountable Care Organizations on a broader set of primary care providers that would include nurse practitioners, physician assistants, and clinical nurse specialists.
Conduct a demonstration to test the effectiveness of covering comprehensive substance abuse treatment in Medicare.
Medicaid The President’s Medicaid proposals assume a savings of $1.438.9 billion over ten years, according to reports. Some of the proposals include:
Repealing and replacing Obamacare with block grants for Medicaid and the marketplace. Block-grants have long been a part of the Congressional Republican platform for health care as way of capping funds.
Allowing states the option to grandfather the managed care authorities in waivers and demonstration programs under their state plans as long as there are no substantive changes to the waiver or demonstration program and they have been renewed at least once.
Removing states’ authority to substitute a higher home equity limit than the statutory minimum.
Providing states the option to apply asset tests to populations determined eligible by the Modified Adjusted Gross Income (MAGI) standard.
Allowing for federal/state coordinated review of dual eligible special needs plan marketing materials.
Streamlining the appeals communication requirements imposed on private and non-profit health plans that integrate payment and services for Medicare-Medicaid enrollees.
Making non-emergency medical transportation an optional Medicaid-covered service.
Instituting a number of Medicaid program integrity proposals.
Continuing Medicaid disproportionate share hospital allotment reductions.
Reforming Graduate Medical Education payments.
HCA will work with our partners at the National Association for Home Care and Hospice and ElevatingHOME and our federal legislative affairs firm to advocate against any proposals that would adversely affect home care under Medicare and Medicaid. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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Wage Parity Certification Forms Due March 1 2018 forms to be posted soon The next round of state-required Home Care Worker Wage Parity Law certification forms are due March 1, for CHHAs, LTHHCPs, and Managed Care Organizations (MCOs) who provide or arrange for aide services in New York City, Long Island and Westchester. The Wage Parity law, and related certification requirement, does not apply to areas outside of New York City, Long Island and Westchester. CHHAs, LTHHCPs and MCOs must certify prospectively to DOH, on an annual basis, their compliance with the Wage Parity Law. These certification forms are due for the March 1, 2018 to February 28, 2019 period; the forms are sent to HCWorkerParity@health.ny.gov. Meanwhile, CHHAs, LTHHCPs and MCOs that contract with LHCSAs and/or fiscal intermediaries (FIs) are required to obtain a written certification on a quarterly basis from the LHCSA or FI which attests to the LHCSA’s or FI’s compliance with the state’s Home Care Worker Wage Parity Law for defined certification periods and on a prospective basis. This form, also due March 1, 2018, covers the period March 1, 2018 to May 31, 2018, and is sent to the CHHA, LTHHCP or MCO, not to DOH. DOH has not but intends to soon post 2018 certification forms; agencies should wait until they are posted and not use the 2017 posted forms. HCA advises members to indicate which period of time is covered by the certification form; for instance, CHHAs/LTHHCPs and MCOs should write March 1, 2018 to February 28, 2019 and LHCSAs/FIs should write March 1, 2018 to May 31, 2018. The wage parity levels for New York City, Long Island and Westchester are at https://www.health.ny.gov/health_care/medicaid/redesign/mrt_61.htm. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
Emergency Rule Issued on FIDA Enrollment The Office for People With Developmental Disabilities (OPWDD) has issued an emergency rule that allows individuals to be enrolled into the Medicare Prescription Drug plans and Fully Integrated Duals Advantage plans for Individuals with Intellectual and Developmental Disabilities (FIDA-IDD), through certain parties, in situations where there is no other person to make that election for them. The rule is at https://opwdd.ny.gov/regulations_guidance/opwdd_regulations/enrollment and https:// docs.dos.ny.gov/info/register/2018/feb14/toc.html (page 11). The rule also specifies who can enroll beneficiaries or individuals in a Medicare Part D prescription drug plan or in a Medicare Advantage plan with prescription drug coverage and who can pursue grievances, complaints, exceptions and appeals in such plans. Continued on next page
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Continued from previous page Furthermore, the rule states that if a person lacks the ability to choose a FIDA-IDD plan or act in the FIDA-IDD review process, a guardian lawfully empowered to enroll a person in a FIDA-IDD plan may enroll the person in a FIDA-IDD Plan or appoint another party to enroll the person.
Fiscal Intermediary Legislation Passes The State Legislature has passed legislation (S.7326/Hannon; A.9035/Gottfried) that would change the date for the requirement that fiscal intermediaries (FIs) in the Consumer Directed Personal Assistance Program be authorized by the state Department of Health (DOH). The legislation now awaits the Governor’s approval. As communicated to members throughout the past year, the adopted 2017-18 state budget established a new requirement that FIs be state-authorized by DOH and an Authorization application was released last November. This provision took effect April 1, 2017. As a follow up to this new requirement, legislation was passed that set January 1, 2018 as the date by which the authorization requirement would begin for an FI established after April 1, 2017 (i.e. new FIs) and FIs seeking to be formed after April 1 must wait for this authorization before being permitted to operate. It also allowed existing FIs (operating prior to January 1, 2018) to continue to operate until January 1, 2019. That legislation was signed by the Governor but he indicated that he had concerns with the bill and intended to secure “an agreement with the Legislature to pass legislation in the upcoming session to address these concerns.” S.7326/A.9035 is intended to address the Governor’s concerns and is expected to be signed by the Governor. It would allow existing FIs to operate until January 31, 2018 and continue to operate after that only upon obtaining DOH authorization. It is our understanding that DOH intends to interpret this provision to mean that only those existing fiscal intermediaries that have submitted applications for authorization prior to January 31, 2018 may continue to operate as an FI while the application is pending. New fiscal intermediaries will be required to obtain prior-authorization from DOH before acting as an FI. HCA will notify members when the Governor takes any action on the legislation.
Need Updated OASIS Credentials or COS-C Exam for OASIS Mastery? HCA members: save on early-bird rate expiring in just two weeks for Syracuse workshop and exam Are you or your staff in need of contact-hours and OASIS training? Do you or your staff need to renew your COS-C exam certificate? OASIS data collection is the measurement of your patients’ clinical needs, intensity and outcomes. And, like any measurement, the practice of OASIS assessment is only as good as the eye “reading the scale” and the hand entering its values. Continued on next page
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Continued from previous page Your agency’s reimbursement, its Home Health Compare ratings, and its overall profile of clinical findings and outcomes all hinge on OASIS accuracy. HCA’s upcoming Blueprint For OASIS Accuracy program in East Syracuse includes a two-day workshop on April 9 and 10, led by experts at OASIS Answers, along with an optional COS-C (Certificate for OASIS SpecialistClinical) certification exam at the same location on April 11, at the same location. Be sure to invite your clinical teams to register for this important training and invest in OASIS mastery for the benefit of your organization.
Workshop Details
April 9-10, 2018 Workshop (8 a.m. to 4 p.m.) April 11, 2018 COS-C Exam (optional)
Workshop Registration Fees HCA Member Fee (by 2/28): $549* HCA Member Fee (after 2/28): $599* Prospective Member Fee: $849* *Workshop fee includes instructors for two days, two lunches and handout materials. Exam fee is additional.
Location Hilton Garden Inn 6004 Fair Lakes Road East Syracuse, NY 13057 HCA has reserved a limited block of rooms at the rate of $109 per night. Please call (315) 431-4800 before March 9 and ask for the Home Care Association of NYS Block Group Code: SMERF.
Registration Register using the brochure (at https://hca-nys.org/wp-content/uploads/2018/01/Blueprint-for-OASIS-Flyer-Syracuse-April2018.pdf) or online at https://www.eventville.com/catalog/eventregistration1.asp?eventid=1012335.
NYC CHHA Session Added to Lineup of HCA Member Forums for CHHAs, LHCSAs, HCC This past week, HCA sent alerts highlighting several upcoming provider entity Forums we are holding for CHHA, LHCSA and HCC members. This lineup also includes a Senior Financial Manager’s Forum specifically for executives, CFOs and finance officers at all member agencies. Each of these Forums is listed on our website (at https://hca-nys.org/events-education/upcoming-events), along with registration forms and notices about other educational programs and events. Our CHHA Forum in Albany is fast approaching on February 23. While this Forum was originally designed as a statewide Forum for all CHHAs, several members have requested a downstate version to better facilitate
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attendance from our downstate CHHA members. Therefore, we have scheduled a second session of the CHHA Forum on March 16 in New York City. We have a lot of Forums and other programs in store for the membership to give you member value and important updates directly relevant to your organization type and role. Dates for each Forum are again listed below just so you can see them all in one place and plan for your teams’ participation. Upstate CHHA Member Forum (Albany): Friday, February 23, 2018 Downstate CHHA Member Forum (NYC): Friday, March 16, 2018 Senior Financial Managers Forum (Troy): March 22, 2018 Downstate LHCSA/HCC Forum (NYC): March 27, 2018 Upstate LHCSA Forum (Utica): April 16, 2018 HCC Forum (NYC): April 18, 2018
HCA Memo Provides Hospice Reimbursement, Audit, Coding Updates from NGS Reminder: Hospices must calculate and submit their cap report by Wednesday, February 28, one month earlier than was previously the case National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), conducted a Hospice Advisory Meeting this week for the state associations in Jurisdiction 6 (J6) and particular hospice representatives in the U.S. Centers for Medicare and Medicaid Services (CMS) J6 region. HCA participated in the meeting and received important updates, posed questions and advocated on behalf of our hospice membership. We have prepared a detailed memorandum on the meeting, summarizing key updates and/or presentations by NGS staff as well as information acquired by HCA on issues of particular importance to New York State. Members can download our memo at https://hca-nys.org/wp-content/uploads/2018/02/ 021718NGSHospiceMtgSummary.pdf. Items in the memo include: NGS website and NGSConnex updates; audit and reimbursement issues; Targeted Probe and Educate/Medical Review; Comprehensive Error Rate Testing (CERT) results; upcoming education; Hospice Notice of Election; and updates on the appropriate use of Occurrence Code (OC) 27. Of more immediate importance, we remind hospices that they must calculate and submit their cap report by Wednesday, February 28, one month earlier than was previously the case, due to the shift in the cap year to the federal fiscal year. More details are in the memo as well as on NGS’s website at https://tinyurl.com/ ycyjqmlz.
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CMS Announces New Option for Submission of Medicare Cost Reports The U.S. Centers for Medicare and Medicaid Services (CMS) has announced that, beginning in March, providers will have the option to submit Medicare cost reports through a new national web portal. The Medicare Cost Report e-Filing system will be available for cost reporting periods ending on or after December 31, 2017. CMS will offer training during March and April. HCA will notify the membership when CMS announces those training dates.
Health Home Supportive Housing Funding Available The state Department of Health (DOH) has released the Health Home Supportive Housing Program (HHSHP) Request for Applications (RFA). The RFA is at https://www.health.ny.gov/funding/rfa/17643/index.htm. DOH is seeking applications from community-based organizations to provide rental subsidies and nonmedical services to homeless Medicaid members who are enrolled or enrolling in New York State’s Health Home Program. HHSHP is a prior-funded program that is in effect from October 1, 2014 to September 30, 2018. This program will serve participants that are currently enrolled in the program and single individuals who are enrolled/enrolling in a Health Home and may include a certain number of families with minors under the age of 18 years old. The total anticipated amount available for this procurement is up to $500,000 annually, for up to approximately 16 awards. The contracts will run from October 1, 2018 to September 30, 2023.
Additional VBP Information Available The state Department of Health (DOH) has released 2018 Value Based Payment (VBP) Arrangement Fact Sheets for the Total Care for the General Population (TCGP), Integrated Primary Care (IPC), Health and Recovery Plan (HARP) Subpopulation, HIV/AIDs Subpopulation and Maternity Care Arrangements. The Measurement Year 2018 Fact Sheets provide an overview of the New York State Medicaid VBP Arrangements, including a high-level description of:
Types of care included in the arrangement Method used to define the attributed population for the arrangement Calculation of associated costs under the arrangement, and Quality measures recommended for use in the arrangement.
The documents can be found on the VBP Resource Library (https://www.health.ny.gov/health_care/ medicaid/redesign/dsrip/vbp_library/index.htm) under the VBP Arrangement Fact Sheets tab; Measurement Year 2018 Fact Sheets. Questions can be sent to DOH at vbp@health.ny.gov.
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The Situation Report: the Home Care Association of New York State
Volume 3, No. 8 February 16, 2018
National Health Expenditure Data Released This week, the U.S. Centers for Medicare and Medicaid Services (CMS) Office of the Actuary released the projected national health expenditures for 2017-2026. An article on this report is at https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.1655. The Office of the Actuary’s report will appear at: http://www.cms.gov/Research-Statistics-Data-andSystems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsProjected.html. Some highlights include:
National health expenditure growth is expected to average 5.5 percent annually over 2017-2026, more rapid than has been experienced from 2008-16 (4.2 percent).
Medicare is projected to experience the most rapid annual growth at 7.4 percent over the 20172026 period, largely driven by enrollment growth and faster growth in utilization from recent nearhistorically low rates.
Medicare spending growth is projected to have accelerated to 5.0 percent in 2017 from 3.6 percent in 2016. The acceleration results from faster projected growth in spending per beneficiary, as well as faster enrollment growth.
Medicaid is projected to average 5.8 percent annual growth over 2017-2026, which is slower than the average observed for 2014-2016 of 8.3 percent, when the major impacts from the Affordable Care Act’s expansion took place.
Medicaid spending growth is expected to accelerate to 6.9 percent in 2018 from 2.9 percent in 2017, primarily due to faster projected growth in Medicaid’s net cost of health insurance.
Resources
“Information for all Providers General Billing” (updated February 7, 2018), by eMedNY https://www.emedny.org/ProviderManuals/AllProviders/PDFS/Information_for_All_ProvidersGeneral_Billing.pdf
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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Senior Financial Managers Forum
March 22, 2018
Senior Financial Managers Forum March 22, 2018
HCA’s Senior Financial Managers Forum is our popular daylong conference that covers every major finance and reimbursement issue confronting home care providers and MLTC plans on the state and federal levels. Traditionally, HCA’s Forum has been reserved for HCA members only, but this year we are opening registration to all home care providers and MLTCs, with a premium registration rate for HCA members. As in past years, HCA Policy staff will be joined by state Department of Health reimbursement officials, consultants, federal policy experts, and, new this year, a representative from New York’s Medicare Administrative Contractor, National Government Services. Please join us on March 22 to hear from these experts and get all of your finance questions and information needs covered.
Senior Financial Managers Forum
AGENDA
March 22, 2018
8:00am – 8:30am
12:00pm – 1:00pm
HCA Registration & Continental Breakfast
Lunch
8:30am – 9:30am
1:00pm – 2:15pm
HCA Update
What’s in Store for Home Care in 2018 on the Federal Regulatory and Reimbursement Front?
HCA staff will provide a state legislative update, focusing on the Governor’s proposed 2018‐19 Executive Budget and its impact on home care and Medicaid managed long term care, along with an update on our advocacy efforts in Albany and in Washington. HCA staff will highlight our annual financial condition report as well as discuss the latest on minimum wage funding, 24-hour live in cases, Value Based Payments, the Quality Incentive Vital Access Provider Pool (QIVAPP) and the 2018 Medicare Home Health Prospective Payment System (HHPPS). 9:30am – 10:30am
Department of Health Update John Ulberg, Jr., Medicaid Chief Financial Officer, Division of Finance and Rate Setting, Office of Health Insurance Programs, NYS Department of Health (Invited) Mr. Ulberg and/or staff from his Division will provide updates on the following: provisions in the 2018‐19 Executive State Budget that impact home care, personal care and Medicaid Managed Long Term Care (MLTC) plans; the Medicaid Global Cap; CHHA Episodic Payment System (EPS) re-basing; premium rate adjustments to MLTC; QIVAPP funding; Wage Parity and Overtime adjustments to plans and home care providers; the CHHA, LTHHCP and Personal Care fee‐for‐service Medicaid rates; the Medicaid cost reports; and other Medicaid reimbursement issues. 10:30-10:45am
Break
10:45am – 12:00pm
Targeted Probe and Educate Lauri Domingo, Home Health Clinical Consultant, Jurisdictions 6 and K, Provider Outreach & Education, National Government Services (NGS) Ms. Domingo will provide an update on the new Medicare Home Health Targeted Probe and Educate (HHTPE) – an audit program which focuses on specific agencies that NGS has identified as at-risk for documentation noncompliance (including for face-to-face documentation). Ms. Domingo will also review: the latest medical review and appeals data (including the top claim denial reasons) and tips to avoid those denials; the latest Comprehensive Error Rate Testing (CERT) results and findings; NGS HHPPS utilization data specifically for New York State; and updates on important upcoming NGS educational webinars that may be of interest to HCA participants.
Colin Roskey, Principal, Lincoln Policy Group; Partner, Scully Roskey & Missmar (Invited) Washington, D.C.-based federal home health policy expert Colin Roskey is one of the most knowledgeable voices on Medicare home health and hospice regulatory and reimbursement issues. During his session, Mr. Roskey will provide an overview of the national health care landscape, as well as provide insight into upcoming methodology changes to the Medicare HHPPS, including the prospect that Congress or the federal government will revive the Home Health Groupings Model (HHGM). Mr. Roskey will also present on other regulatory and legislative items percolating at the federal level, including opportunities to revise the current face-to-face regulations and the status of legislation/bills that would be helpful to our industry. 2:15pm – 3:30pm
Payment Reform: Aligning Services, Costs, Risks, and Outcomes with Reimbursement Ed Buckley, Chief Executive Officer, Select Data Above all else, CMS wants Medicare home care payment reform that includes a new Home Health Groupings Model (HHGM). Reform means change and change can mean opportunity, but it can also mean risk. Since this reform, if enacted, will affect agencies uniquely, it is imperative that agencies think about implementing a new classification system to control costs and manage care. These classifications will require robust models to distinguish between patients in need of services for recovering from acute conditions and those in need of chronic care management. In this session, Ed Buckley of Select Data will provide insights on how to succeed under HHGM by delineating the care delivery priorities of your patients, better classifying their needs, and developing new costcontrol measures and models. 3:30pm – 3:45pm
HCA Closing Remarks & Adjourn
Senior Financial Managers Forum March 22, 2018
Registration
Registration Fee and Payment â–Ą â–Ą
HCA has reserved a limited block of rooms at the Hilton Garden Inn in Troy, NY for the night of Wednesday, March 21 at a discounted rate of $119 per night. To receive this special rate, please call (888) 224-9761 prior to February 21, and ask for the group code HCAC.
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