TOKHTAMAN
NEW COMPLIANCE SERIES
MEDICAID ENROLLMENT
FORUMS
New ruling in Tokhtaman case largely procedural. HCA provides the latest update on saga involving 24-hour/live-in cases.
HCA has launched a new compliance roundtable series, with our first session on April 26 tackling “Survey ‘Hot Spots’ and Plans of Correction.”
HCA again reminds members of the requirement to enroll in Medicaid of face termination from managed care.
Have you signed up yet for one of our CHHA, LHCSA or HCC Forums? These are a great opportunity for focussed updates from HCA.
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Your Source for HOME CARE News, Policy and Advocacy
COMING UP ‘Stop Sepsis at Home’ Regional Training Sessions March 8, 2018: Port Washington March 9, 2018: Farmingdale Downstate CHHA Member Forum Friday, 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.
Vol. 3, Issue 9 | February 26, 2018
HCA Budget Advocacy Targets New, Critical Phase Members of the New York State Legislature return to session tomorrow after concluding a weeklong recess from session and a process of joint legislative budget hearings that included HCA testimony. With its return, the Legislature now moves into the next critical phase of budget activity. Over this next week, the Senate and Assembly will begin refining positions and language for each respective house’s budget proposals (known as “one-house” proposals). Each house will then move to “conference” their proposals; formulate one-house budget revenue, spending and policy, proposals; and present resolutions that further stake out their budget positions. These steps are scheduled to culminate by March 14, when each house takes up its one-house bills and resolutions, and joint conference committees are See BUDGET p. 5
NGS Claim Denial Reasons, Probe-and-Educate, Plus Other Finance Updates Offered at 3/22 Forum for Home Care CFOs, Execs HCA’s Senior Financial Managers Forum – one month away – offers a range of reimbursement and finance updates for home care CFOs, executives and other finance managers. This includes the opportunity to hear from New York’s Medicare Contractor, National Government Services (NGS), on some of the top claim denial reasons and audit activities, specifically the targeted probe-and-educate initiative.
INSIDE HCA Budget Advocacy Targets New, Critical Phase............................................1 NGS Claim Denials, Probe-&-Educate and More at 3/22 Finance Forum…..........1 Trial Court Dismisses Action against 2 Defendants in Tokhtaman Case…...........3 HCA Launches New Corporate Compliance Roundtable Series…......................4 Register Now for Sepsis Training Sessions on March 8 & 9 ...............................6 State Medicaid Director Helgerson to Step Down April 6..................................6 Time Ending Soon to Enroll in Medicaid or Else Face Termination…....................7 Consider Your “Spread of Hours” Impact, Changes under MW Increase…..........8 Upcoming Deadlines…...................................................................................9 Reminder: HCA Member Forums for CHHAs, LHCSAs, HCC.............................10
See FORUM p. 2 Early-Bird Rate Expiring In Two Days for OASIS Credentials, COS-C Exam…........10 2018 Wage Parity Certification Forms Posted….................................................11 CMS to Host Home Health, Hospice Open Door Forum: February 28…...............12 CMS Hospice Updates: CAHPS and Hospice Compare….........................................13 Three Final Coalition Surge Tests Held Last Week............................................…13 Home Care, Hospice, MLTC Emergency Preparedness Opportunities..................14 VBP Update....................................................................................................…15 LHCSA Applications Approved at PHHPC Meeting…............................................16 OPWDD Posts Final Draft Waiver Transition Plan…............................................16 NY eHealth Collaborative Releases Report….....................................................17 CMS Unveils New Option for Electronic Medicare Cost Report Submission…........18 Resources...................................................................................................................18
The Situation Report: the Home Care Association of New York State FORUM from p. 1 As HCA has extensively reported, the new home health targeted probeand-educate (HHTPE) program focuses on specific agencies that have been identified, through detailed data analysis, as warranting documentation review. At HCA’s Forum, on March 22, NGS’s Lauri Domingo will provide details on the overall HHTPE process, how providers can avoid being identified for HHTPE, acceptable claim error rates, and impact statistics. She’ll also provide the latest medical review and appeals data review (including the top claim denial reasons), as well as tips to avoid those denials, along with other results that affect claims. This is a unique opportunity for your finance teams to hear directly from NGS and to raise possible concerns or issues with the contractor responsible for Medicare claims administration in New York State. The Forum also falls just before the April 1 deadline for a state budget, providing you with the latest on all Medicaid reimbursement issues and budget policies affecting your agency’s finances. Plus, with CMS virtually assured to advance a Home Health Groupings Model (HHGM) or other Home Health Prospective Payment System overhaul, federal policy and technical experts will be on hand to help you navigate the impending changes and forecast for the future. We’ve got all the finance issues covered. We just need you to join us. Register today by completing the form at the back of this week’s newsletter. 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. 9 February 26, 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. 9 February 26, 2018
Trial Court Dismisses Action against Two Defendants in Tokhtaman Case Case continues for remaining litigants, along with option for plaintiffs to overcome dismissals that were ruled largely on procedural grounds On February 21, a Manhattan trial court favorably ruled on a motion filed by two defendants – County Agency, Inc. and Hershel Walker – in the Tokhtaman v. Human Care case, dismissing the action against them. However, the dismissal, based on procedural grounds, does not affect the claims against a third defendant, Human Care, LLC (a home care provider). As extensively reported, HCA is closely following the Tokhtaman case due to its potential implications for the state Department of Labor’s “13-hour” rule. That rule determines whether “24-hour/live-in” aides are entitled to pay for time worked in excess of 13 hours in a given day – unpaid time which has historically been reserved for meals and sleep. The technical reason for dismissal in this most recent decision is that the plaintiffs failed to seek a default judgment against defendants within a year, as required by CPLR 3215(c). Importantly, because the dismissal was granted “without prejudice,” plaintiffs may be able to file a new complaint against these two parties. In addition, the complaint alleges that the plaintiffs were jointly employed by Human Care, LLC and County Agency, Inc., meaning that the potential liability remains the same notwithstanding the dismissal of County Agency, Inc. This is the latest development in a series of legal actions in the case. Late last year, HCA had filed an amicus brief (joining with the New York State Association of Health Care Providers and the Home Care Association of America) supporting a motion by defendants for appeal in the case to the Court of Appeals. That motion, by Human Care, LLC, was denied largely on technical grounds, and the case still rests with the trial court. Meanwhile, there are two other cases centering on this compensation issue in the Appellate Division: Andryeyva v. New York Health Care, Inc. (HCA also submitted an amicus brief in this appeal) and Moreno v. Future Care Health Services. While the “13-hour standard” continues to be challenged in the courts, the state Department of Labor (DOL) has since codified this standard in an emergency regulation intended to reinforce DOL’s own longstanding regulatory interpretation, as sought by HCA. That emergency regulation – which is still in effect after being extended to April 4 – was recently challenged at the state Industrial Board of Appeals (IBA), an independent review board. HCA joined in an amicus brief opposing that challenge, and the IBA subsequently denied the petition to revoke the rule, leaving it intact. HCA will continue to update members on forthcoming developments with Tokhtaman and other related cases, as well as the status of the emergency regulation which remains in effect at least until April 4, pending finalization of the rule or another extension of the rule on an emergency basis.
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Volume 3, No. 9 February 26, 2018
The Situation Report: the Home Care Association of New York State
Tackling Survey ‘Hot Spots’ and Plans of Correction Corporate Compliance Roundtable Discussion
HCA is launching a new series of interactive roundtables to provide home care providers an opportunity to focus on regulatory, compliance, and enforcement topics that may cause you major challenges and keep you up at night. Each roundtable will present a panel of subject matter experts on a featured topic. For our inaugural roundtable program, the issue of focus will be state surveys of LHCSAs and CHHAs, including common issues that agencies are cited for and tips and guidance for the development and implementation of effective plans of correction.
April 26, 2018 Location:
Selfhelp Community Services, Inc. 520 Eighth Avenue 5th Floor New York, NY 10018 9:30 to 10:00am Registration and continental breakfast
Learn from your fellow home care providers’ experiences and the following expert panelists: Andrea Brown, RN, President/CEO, AB Coaching and Consulting, Inc. Nancy Lisy, RN, Senior Health Care Consultant, Loeb & Troper Rosemary Vander Wyde, President, Vander Wyde Health Care Consultants We encourage you to come prepared with questions. Alternatively, you may submit your questions in advance by emailing Andrew Koski (at akoski@hcanys.org) and we will pose these questions anonymously during the program. Please note in the email subject line: Compliance Roundtable.
10:00am to 12:00Noon Program Sponsorship opportunities are available, for further information please contact Ms. Billi Wilson at 518-810-0666 or email: bwilson@hcanys.org.
This is an HCA Member’s Only Program. To become an HCA Member, please contact Laura Constable, Senior Director of Membership and Operations, at (518) 810-0660 or at lconstable@hcanys.org.
REGISTRATION – (Deadline April 20)
REGISTRATION FEE
Name: _________________________________________________
HCA Members Only
$59 ________
Title:__________________________________________________ Agency:________________________________________________
PAYMENT
Address:_______________________________________________
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City/State/Zip:___________________________________________
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*Make checks payable and mailed to:
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HCA Education and Research 388 Broadway, 4th Floor, Albany, NY 12207
Phone:______________________________ Ext._______________ Email: _________________________________________________
Credit Card #: _______________________ Exp. Date:_______ Security Code: ________ _________________________________________________________________________ Name and/or Company Name on Card
Cancellations received by April 20th are refundable less a 25% administrative fee. Cancellations must be received in writing via e-mail to info@hcanys.org. No refunds after that time or for no shows. Substitutions are permitted.
FAX TO: (518) 426-8788
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_________________________________________________________________________ Billing Address of card (including City, State and Zip Code) _________________________________________________________________________ Authorized Signature
The Situation Report: the Home Care Association of New York State BUDGET from p. 1 convened to reconcile positions. This starts the march toward three-way negotiations with the Executive and ultimate adoption of a three-way agreed-upon budget. The formal schedule, as set forth by the Legislative Leaders, outlines these key budget steps, and can be viewed at: http://assembly.state.ny.us/Press/files/ 20180206.php. HCA Budget Meetings and Proposals During the recess, HCA conducted further budget analysis, honed diverse budget proposal concerns with the membership and state association colleagues, and assimilated this input from all sources into our budget response. HCA has now:
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Written and presented to the Legislature amendments to the Governor’s proposals that would strike or significantly modify proposals imposing harm to the plans, providers, patients and/or workers (e.g., eliminates or changes MLTC cuts, blocks the MLTC-LHCSA ten-contract limit, proposes a transparent process for examining the Executive’s contacting questions, creates safeguards for home telehealth services, and others). Written and presented amendments to further improve a number of gubernatorial budget proposals that we conceptually support but that can be improved for MLTC, home care and hospice (such as proposals to fund health transformation, health workforce, rural home care, and other issues). Drafted and submitted legislative and budget language to insert HCA’s additional budget proposals, which include: increased health workforce funding; targeted assistance to home care/hospice shortage areas and disciplines; authorizing pilots for additional ways of supporting home care/hospice worker recruitment and retention; instituting a study of the competitive health labor market and recommend plan/provider reimbursement and policy adjustments to support recruitment and
Volume 3, No. 9 February 26, 2018
retention; establish an interagency state task force to promote entry into home care and hospice practice, including actions that span from secondary school to the existing workforce in terms of promoting the value and need for home care/hospice occupations; authorizing state health workforce retraining grants to include retraining and cross-training of hospital and nursing home workers for home care; providing specific state support for home care’s role in addressing critical public health problems and solutions (such as sepsis, asthma, opioids, pressure ulcers, health disparities and other high cost/high risk areas); and more. HCA’s efforts enable us to help surgically shape the budget proposals and proactively include new substantive proposals to assist MLTC, home care and hospice in ways otherwise not addressed in the proposed budget. With the return of the Legislature and startup of this next budget phase, HCA will be holding meetings this week with key legislative offices to further discuss our budget proposals, legislative assessment of the Governor’s proposals, and actions/positions each house is likely to take. We will use the outcome of these discussions to strategically plan next, immediate advocacy needs and steps. It is critical that HCA members be ready to engage in continued grassroots advocacy with their elected officials and legislative leaders as the proposals before us are once again hugely consequential to the entire system. Please continue to reach out to your legislative representatives using the talking points already shared with members (https://hca-nys.org/statebudget-talking-points-week-of-2-19-23) and encourage your entire team to use our Legislative Action Center which allows them to send an advocacy message to their representatives with a quick push of the button. Three Legislative Action Center campaigns on the budget have been posted here: http://p2a.co/CrvM1NC.
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Providers on Long Island: Register Now for Sepsis Training Sessions on March 8 & 9 to Improve Your Patients’ Health Outcomes and Provide System Support On March 8 and 9, HCA is holding the next installments of our “Stop Sepsis at Home” initiative on Long Island: in Port Washington and Farmingdale. If you haven’t yet attended one of these sessions and your agency provides services on Long Island, please make sure that you and your clinical teams register today by selecting either the Port Washington or Farmingdale locations on our online form at https://www.surveymonkey.com/r/SepsisRegionalTrainings. These sessions are free of charge, and they provide you with both the broad perspectives as well as the detailed technical training to begin using HCA’s first-in-the-nation home care sepsis identification tool and protocols that will make your agency a leader in combatting the sepsis crisis as well as a valuable partner to hospitals, physician practices and payors. “Stop Sepsis at Home” is supported by a grant from the New York State Health Foundation, with collaboration and technical support from IPRO, the Rory Staunton Foundation for Sepsis Prevention, the Sepsis Alliance, individual clinician leaders, and others on our project steering committee. To learn more, please visit our website for this initiative at www.stopsepsisathomeny.org. IPRO Sepsis Spotlight IPRO, a major collaborator on our “Stop Sepsis at Home” initiative and on other federal sepsis projects, has featured HCA’s campaign and website in its latest Sepsis Spotlight newsletter, which we’ve posted to the “Tools and Resources” section of our website at http://stopsepsisathomeny.org/tools-and-resources/ under “Newsletters, Fact Sheets and Marketing Materials.”
State Medicaid Director Helgerson to Step Down April 6 In a message to the health care community, associations and other stakeholders on the Medicaid Redesign Team (MRT) listserv, state Medicaid Director Jason Helgerson announced that he was resigning from his position effective April 6. The announcement on Friday confirmed media reports throughout the past week about Mr. Helgerson’s decision to leave state government after the state budget process is expected to be finalized in early April. Mr. Helgerson reiterated that, even with his departure, several major Medicaid initiatives would remain in the works, such as the continued implementation of MRT initiatives, as well as specific model changes such as the Delivery System Reform Incentive Payment (DSRIP) program and value based payments (VBP). “Delivery systems across our state are changing and health outcomes are measurably improved,” he said in his message. “Organizations are working together as never before and as a result the system is really starting to work like a seamless, patient-centered delivery system focused on results.” Mr. Helgerson joined Governor Cuomo’s administration in 2011 from the state of Wisconsin where he had led Medicaid redesign efforts. His legacy in New York includes the MRT changes which have had a profound
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impact on the delivery of home and community-based services, as well as program model and federal waiver changes to remake the health care system through DSRIP, VBP and other efforts. As of press time for The Situation Report, no replacement for Mr. Helgerson had been announced. HCA appreciates the work Mr. Helgerson did with HCA, his inclusion of HCA in his top health reform committees, as well as the input and outreach he repeatedly invited.
Time Ending Soon to Enroll in Medicaid or Face Termination from Managed Care HCA seeks further guidance for Fiscal Intermediaries undergoing separate authorization process HCA reminds members that all home care agencies that provide services to managed care enrollees must enroll in Medicaid and obtain a Medicaid provider number. If providers don’t take such action, they face termination as a managed care provider sometime over the summer. Plans have been notifying those home care and other providers that do not have a Medicaid provider number, but plans were instructed not to initiate terminations at this time. Though the original deadline to enroll as a Medicaid provider was December 2017, the state Department of Health (DOH) has advised HCA that it is still accepting applications. Plans have been told by DOH to send out provider contract amendments about the enrollment requirement, check lists of those providers who have a Medicaid provider number and those who have pending applications, and to identify and reach out to those who have not submitted an enrollment application. 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. DOH has also told us that if a Licensed Home Care Services Agency (LHCSA) enrolls in Medicaid as a Managed Care “non-billing” provider, it will have to obtain another Medicaid provider number if it wants to enroll as a personal care agency that provides services to a local department of social services. The requirement to enroll in Medicaid also applies to fiscal intermediaries (FIs) under the consumer directed personal assistance program. FIs should use the form for personal care agency and CDPAP program providers. HCA has alerted DOH that FIs who recently submitted Authorization applications to meet new FI requirements were told to not apply for Medicaid provider numbers until such authorizations had been approved. This will, thus, delay those FIs from also meeting the enrollment requirement. HCA will advise members once DOH provides further guidance. All applications, along with the required documents, must be mailed not e-mailed. A list of providers that have enrolled in Medicaid and webinar materials are at the links below:
https://www.emedny.org/info/ProviderEnrollment/ManagedCareNetwork/ MMC_Providers_Presentation_-_1-25-2018.pdf https://www.emedny.org/info/ProviderEnrollment/ManagedCareNetwork/index.aspx
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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With Minimum Wage Increase, Agencies Should Consider “Spread of Hours” Impact and Obligations Due to the recent increases in the minimum wage, HCA reminds members that home care agencies may be required to pay for an additional hour of services on certain cases under the state Department of Labor (DOL) regulations regarding “spread of hours” and “split shifts.” The regulations are Title 12 NYCRR Section 142-2.4 at https://www.labor.ny.gov/formsdocs/wp/cr142.pdf. They require employers to pay an additional hour at minimum wage to employees in cases when the “spread of hours” exceeds ten hours or the employee works more than one shift in a day separated by more than a meal period (a “split shift”). Given the December 31, 2017 increase in the minimum wage, agencies are strongly advised to review the spread of hours/split shift regulation at this time. “Spread of Hours” is defined as the interval between the beginning and end of an employee’s workday. The spread of hours for any day includes “working time plus time off for meals plus intervals of off-duty” (Title 12 NYCRR Section 142-2.18). “Split Shift” is defined as a schedule of daily hours in which the working hours required or permitted are not consecutive. A meal period of one hour or less is not considered an interruption of consecutive hours (Title 12 NYCRR Section 142-2.17). For example, an employee working more than ten hours in a day including a lunch break, or an employee who had two shifts where there is a break longer than a meal period (even if the number of hours between the start of the first shift and the end of the last shift did not exceed ten), would be entitled to an additional hour of pay at minimum wage, even though the additional hour was not “worked.” This “bonus pay” is known as the “Spread of Hours” or “Split Shift” requirement. State DOL regulations do not require the extra hour to be paid if the employee’s usual hourly rate is enough above minimum wage that the employee was paid at least the minimum wage for all hours worked plus one premium hour (at the minimum wage) for each day in which there was either a spread of hours exceeding ten hours or a split shift. For many employers who formerly paid their employees above the current minimum wage requirement, this “spread of hours/split shift” requirement did not affect their aides’ pay. This was because those employees’ regular pay rate resulted in a total wage that was higher than the amount required under the regulation. Now that the minimum wage has been rising since December 31, 2016, many employers are paying wages that are equal to or just above the new minimum wage amount and their employees may be entitled to an extra hour of pay under the spread of hours/split shift regulation. HCA has argued and will continue to advocate that Medicaid rates paid to managed care plans include payment for the spread of hours and other labor-related expenses so that they can pay their home care contractors for these costs. This report is a partial reprint of an article in our January 23, 2017 edition of The Situation Report that was written by Roni E. Glaser, Esq., Partner at Glaser & Weiner, LLP.
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The Situation Report: the Home Care Association of New York State
Volume 3, No. 9 February 26, 2018 ď Žď€
Important Upcoming Deadlines Requirement/Change
Effective/ Due Date
Home Care and other providers who contract with Managed Care Organizations must be enrolled in Medicaid
Still being accepted, but providers are advised https://www.emedny.org/info/ProviderEnrollment/ManagedCareNetwork/index.aspx to submit now
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/Appeals and Grievances/OrgMedFFSAppeals/Appeals Settlement Initiatives/Low Volume Appeals Initiative.html
More Information
Wage Parity certification forms due from CHHAs, LTHHCPs and managed care organizations to DOH; from LHCSAs to their contracted CHHAs, LTHHCPs and March 1, 2018 managed care organizations; and from Fiscal Intermediaries to their contracted managed care plans
https://www.health.ny.gov/health_care/medicaid/redesign/mrt_61.htm
Submission of Conflict of Interest (COI) Compliance Implementation Plan forms by NHTD/TBI providers to their Regional Resource Development Centers
March 1, 2018
https://hca nys.org/wp content/uploads/2018/01/Conflict of Interest Compliance Implementation Plan 1.docx; https://hca nys.org/wp content/uploads/2018/01/COI Compliance Implemenation Plan Power Point.pdf
Medicare Bundled Payments for Care Improvement Advanced model
Applications due March https://innovation.cms.gov/initiatives/bpci advanced 12, 2018
Expression of Interest CMS Low Volume Appeals Settlement for CHHAs with must be submitted https://www.cms.gov/Medicare/Appeals and Grievances/OrgMedFFSAppeals/Appeals Settlement NPIs ending in an odd number from March 12 to April Initiatives/Low Volume Appeals Initiative.html 11 Health Care Facility Transformation Program Criminal history record check requirements apply to hospice Submission of COI Compliance Implementation Plan forms by Regional Resource Development Centers to state Department of Health Start of Transition Period for Using Health Insurance Claim Number (HICN) or Medicare Beneficiary Identifier (MBI) Implementation of Universal Billing Codes for Home and Community Based Long Term Care Services under Managed Care Community First Choice Option Services Available to Medicaid Managed Care Enrollees Healthcare Personnel Influenza Vaccination Report
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Applications due March https://grantsgateway.ny.gov/intelligrants_NYSGG/module/nysgg/goportal.aspx?NavItem1=4&ngoID 14, 2018 =5000979 April 1, 2018 April 1, 2018
https://www.health.ny.gov/facilities/home_care/advanced_home_health_aides/docs/ahha_legislati on.pdf https://hca nys.org/wp content/uploads/2018/01/Conflict of Interest Compliance Implementation Plan.docx; https://hca nys.org/wp content/uploads/2018/01/COI Compliance Implemenation Plan Power Point.pdf
April 1, 2018
https://www.cms.gov/Medicare/New Medicare Card/index.html
April 1, 2018
https://www.health.ny.gov/facilities/long_term_care/reimbursement/letters/dal_2017 12 07_billing_codes.htm
April 1, 2018
https://www.health.ny.gov/health_care/medicaid/redesign/community_first_choice_option.htm
May 1, 2018 for personnel employed from October 1, 2017 to March 31, 2018
immunize@health.ny.gov or (518) 473 4437
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Volume 3, No. 9 February 26, 2018
Reminder: HCA Member Forums for CHHAs, LHCSAs, HCC HCA has several member Forums coming up for CHHAs, LHCSAs and HCC members to exchange information with you about the state budget and federal landscape, regulatory issues, reimbursement and rate issues, program models or requirements, and other specific issue areas vital to your organization type. Each of these Forums is listed on our website (at https://hca-nys.org/events-education/upcomingevents), along with registration forms and notices about other educational programs and events. These programs give you 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 team’s participation. 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
Early-Bird Rate Expiring In Two Days for OASIS Credentials, COS-C 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? Hurry now to register for our next Blueprint For OASIS Accuracy program in East Syracuse (April 9 and 10) before the early-bird discount rate expires this Wednesday, February 28. Your agency’s reimbursement, its Home Health Compare ratings, and its overall profile of clinical findings and outcomes all hinge on OASIS accuracy. Blueprint For OASIS Accuracy 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 Specialist-Clinical) 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
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April 9-10, 2018 Workshop (8 a.m. to 4 p.m.) April 11, 2018 COS-C Exam (optional)
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Continued from previous page
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.
2018 Wage Parity Certification Forms Posted CHHAs, LHCSAs, FIs, MCOs, LTHHCPs must comply The state Department of Health has posted the 2018 Home Care Worker Wage Parity forms that 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. The 2018 forms for CHHAs, LTHHCPs, LHCSAs and MCOs are at https://www.health.ny.gov/health_care/ medicaid/redesign/2016/2016-02-17_wage_parity_alert.htm, while the form for Fiscal Intermediaries (Consumer Directed Personal Assistance Services) is at https://www.health.ny.gov/health_care/medicaid/ redesign/2017/mrt61_cdpas_attestation.htm. 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. Continued on next page
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Continued from previous page 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. 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 on the forms. 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.
CMS to Host Home Health, Hospice Open Door Forum: February 28 The U.S. Centers for Medicare and Medicaid Services (CMS) is hosting its next Home Health and Hospice Open Door Forum on Wednesday, February 28, 2018 from 2 to 3 p.m. To participate, use the dial-in number and conference code below:
Dial-In: 1-800-837-1935 Conference ID: 31630800
Agenda items, summarized below, will be followed by a question-and-answer session. Home Health Agenda Items
Claims Adjustments for 2018 Home Health Rural Add-on Payments;
Posting of Materials from Abt Associates’ Home Health Technical Expert Panel Meeting held on February 1, 2018 (link: https://www.cms.gov/center/provider-Type/home-Health-Agency-HHACenter.html);
Changes to the on-demand CASPER reports;
Changes to the calculation algorithm for “Timely Initiation of Care” to align with the new Conditions of Participation; and
Update on the home health Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey (https://homehealthcahps.org).
Hospice Agenda Items
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Update on electronic submission of hospice Notices of Election (NOE); Hospice Upcoming Training and Education Events; Hospice Item Set (HIS) modifications after preview reports; and Hospice CAHPS survey
The Situation Report: the Home Care Association of New York State
Volume 3, No. 9 February 26, 2018
CMS Hospice Updates: CAHPS and Hospice Compare The U.S. Centers for Medicare and Medicaid Services (CMS) issued the following Medicare hospice updates this week. Public Reporting of CAHPS Hospice Survey Results CMS announced the initial publication of results from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey on Hospice Compare (https://www.medicare.gov/hospicecompare/), a consumer tool for comparing hospice organizations. Survey results are published for all Medicare-certified hospices that had at least 30 completed surveys during the eight quarters from Quarter 2, 2015 to Quarter 1, 2017 (April 1, 2015 through March 31, 2017). In addition to the survey results, the Hospice Compare site provides a variety of other data, including the Hospice Item Set (HIS). Hospice Compare Quarterly Refresh Available The February 2017 quarterly Hospice Compare refresh is now available, based on patient stays discharged for Quarter 2, 2016 through Quarter 1, 2017. The updated data can be found on the Hospice Compare website at: https://www.medicare.gov/ hospicecompare/. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
Three Final Coalition Surge Tests Held Last Week Last week, the state held the last three Coalition Surge Tests and Interoperable Communication Drills (CST/ IOC) for this month (as extensively reported in past editions of The Situation Report). They included drills in the following regions: Finger Lakes (February 20), Western New York (February 21) and Lower Hudson Valley (February 22). These were in addition to drills held in the Capital District on January 23, 2018, Central New York on January 25, 2018, and Long Island on February 8, 2018. The Finger Lakes drill/exercise involved the simulated evacuation of three hospitals due to severe winter weather that caused utility outages; Western New York’s exercise involved evacuation of healthcare facilities due to weather-related outages; and the Lower Hudson Valley drill was an evacuation of three hospitals due to an attack on the hospitals’ power plants. As relayed to members multiple times, the goals of the CST/IOC drills are to test: functional surge capacity and identify gaps in surge planning by providers; the ability of providers to perform the tasks with existing onsite staff without excessive guidance; whether the evacuating facility knows who to contact in an evacuation scenario, and its ability to reach partners on a moment’s notice; and to develop, strengthen and demonstrate information sharing among public health and medical preparedness and response partners. Continued on next page
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The Situation Report: the Home Care Association of New York State
Volume 3, No. 9 February 26, 2018
Continued from previous page On the day of the drill, home care and other providers who are listed correctly in certain Health Commerce System (HCS) roles were supposed to receive an Integrated Health Alerting and Notification System (IHANS) notification informing them of the simulated disaster and the need to complete a survey using the Health Electronic Response Data System (HERDS) on the HCS. As part of the drill, they were asked if they could take any patients that were hospitalized and had to be evacuated. HCA will be meeting with state Department of Health (DOH) officials to discuss any issues we identified, including a lack of IHANS notification for members who should have been contacted, a lack of IHANS information sent to HCA, the need for assistance in completing an After Action Report (AAR), and others. The HCS roles you need, in order to receive IHANS notifications, include the following: Administrator; HPN Coordinator; Emergency Response Coordinator; Director of Home Care Patient Services (for home care agencies); and Director of Patient Services (for hospices). If you have one of these roles in the HCS, your emergency contact information is correct (go to “Communication Directory Person Update” tool and check Emergency Contact), and you did not receive IHANS notification, please contact Andrew Koski at akoski@hcanys.org. An AAR is at https://hcanys.org/wp-content/uploads/2018/01/AARIP_Template-modified-9-29-7.docx. HCA will inform members of any future drills or exercises for home care and/or hospice participation. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
Home Care, Hospice, MLTC Emergency Preparedness Opportunities Regional Health Emergency Preparedness Coalitions (HEPCs) bring together emergency preparedness partners to plan, coordinate, explore and train in critical areas of preparedness and response. These meetings are held in regions and subregions of the state throughout the July-June HEPC calendar year. Meetings are attended by providers and key emergency preparedness partners across the continuum, and are coordinated by point-persons from state and regional offices of the state Department of Health. Meetings also typically include representatives of the Regional Emergency Preparedness Training Centers, who both report on important training sessions and exercise debriefs and upcoming opportunities, as well as invite input on training needs across and within the health sectors. HCA works closely with each HEPC and participates in all aspects of HEPC planning and the regional/ subregional HEPC meetings and forums. HCA encourages all home care agencies, hospices and MLTCs to send your agency representatives to the HEPC meetings and to participate in HEPC information gathering on regional hazards, vulnerabilities and needs. Your participation is invaluable in ensuring that your emergency preparedness experiences and perspectives are visible and considered. It also enhances your awareness of the issues and needs across sectors, as effective health emergency preparedness depends on coordination of all regional partners. Participation will also assist you as providers and MLTCs in your own internal emergency preparedness planning and meeting state and federal requirements. Continued on next page
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The Situation Report: the Home Care Association of New York State
Volume 3, No. 9 February 26, 2018
Continued from previous page The statewide HEPC homepage (https://www.urmc.rochester.edu/emergency-preparedness.aspx) offers links to each regional HEPC and to state and regional calendars of meetings, trainings and other forms. In addition, the state’s Aware Prepare update for March (https://hca-nys.org/wp-content/uploads/2018/02/ 2018_March_AP.pdf) provides extremely helpful information on emergency preparedness activities, opportunities and issues. Debrief on Capital Area HEPC In the past two weeks, HCA participated in two Capital District HEPC meetings – one in Rensselaer and the other in Saranac Lake. The Rensselaer meeting of the Capital District Sub Regional Planning group received briefings on a “Flu on Call” simulation and other programs of the Upstate Poison Control Center; lessons to be learned from the Las Vegas shootings based on a visit to three affected hospitals in Las Vegas; mapping tools available on the Health Commerce System (HCS); a Hotwash/After Action Review of the Coalition Surge Test (CST) in the Capital District; and an upcoming Point of Dispensing (POD) survey. The Saranac Lake meeting covered: cybersecurity; “Flu on Call”; mapping tools; and an in-depth evaluation of the Capital District CST. (See related p. 14 story.) All participants in both meetings, including HCA, were given time to update the group on their emergency preparedness activities. With the debriefs on the CST sessions and other emergency preparedness exercises being conducted by the state, HCA takes this opportunity yet again to remind and urge all providers to check and update your HCS contacts, including your 24-hour contacts for emergency preparedness! Please take a moment and do this now. HCA works with the New York State Association of Health Care Providers, under a grant from the state Department of Health (DOH) Office of Health Emergency Preparedness, to support the emergency preparedness system in the state. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
VBP Update The state Department of Health (DOH) has released the Value Based Payment (VBP) quality measure sets for Medicaid Advantage Plus (MAP), Fully Integrated Duals Advantage (FIDA), and Programs of All-Inclusive Care for the Elderly (PACE) for measurement year 2018. These documents contain the quality measures recommended for use in VBP. The quality measure sets can be found in the VBP Quality Measures folder of the VBP Resource Library here: https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/vbp_library/index.htm. All questions can be sent to DOH at MLTCVBP@health.ny.gov.
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The Situation Report: the Home Care Association of New York State
Volume 3, No. 9 February 26, 2018
LHCSA Applications Approved at PHHPC Meeting On February 8, the Public Health and Health Planning Council (PHHPC) approved a number of Licensed Home Care Services Agency (LHCSA) applications. These included:
Seventeen applications to establish new LHCSAs; Six applications by existing LHCSAs for changes in ownership; and One application by an entity to become a LHCSA affiliated with an Assisted Living Program.
The agenda and supporting documents are at https://www.health.ny.gov/facilities/ public_health_and_health_planning_council/meetings/2018-02-08/.
OPWDD Posts Final Draft Waiver Transition Plan The Office for People With Developmental Disabilities (OPWDD) has posted the Final Draft Waiver Transition Plan which is required for the move to New York State’s 1115 Waiver, and for the development of Care Coordination Organizations which will provide Health Home Care Management services. The Final Draft Waiver Transition Plan reflects changes based on public feedback, including:
The renaming of the Care Management opt-out option to “Basic HCBS Plan Support”;
An extended timeframe for completion of the initial Life Plan to align with each individual’s person centered review schedule;
Modification to the Health Home Checklist to include a signature line for the individual, family member or guardian;
Clarification on the impact on children enrolled in the OPWDD Care At Home (CAH) Waiver; and
Additional details surrounding Phase II & III implementation plans.
A comprehensive summary of the 1115 Transition Plan Response to Public Comment document that includes the State’s response is available at https://www.health.ny.gov/health_care/medicaid/program/ medicaid_health_homes/idd/draft_idd_1115_waiver.htm. This document will be submitted to the U.S. Centers for Medicare and Medicaid Services for review and final approval. While the Transition Plan includes activities planned for the move to managed care over a five-year period, the full implementation of managed care will depend on the experiences of people served during the earlier phases of this transition period. The Transition Plan will be updated and shared as OPWDD moves forward.
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The Situation Report: the Home Care Association of New York State
Volume 3, No. 9 February 26, 2018
NY eHealth Collaborative Releases Report The NY eHealth Collaborative (NYeC) has released a report, “Pulling Information in Response to a Push: Usage of Query-Based Health Information Exchange in Response to an Event Alert.” The report is at http://wallaby.telicon.com/NY/library/2018/20180213ZZ.PDF. In query-based information exchange, end users find patient information from community-wide, longitudinal patient records. These records are maintained by the state’s Qualified Entities (QEs) in accordance with strict privacy and security rules. Because end users request the information when needed, this approach is referred to as a query. Additionally, many end users access these records through a web portal. Some highlights that are of importance to home care providers include:
Long term care and home health providers received the largest number of alerts from many QEs in New York. Alert services notify a health care provider of certain clinical events, such as when a patient has been admitted to or discharged from a hospital or emergency department.
More alerts are sent for individuals between the ages of 45-64 and those that are 65 or older.
Long term care, home health and other providers that received a larger number of alerts tended to have fewer queries in response to the alerts from most QEs.
NYeC is the state-designated entity that leads and coordinates the Statewide Health Information Network for New York (SHIN-NY), which is comprised of 8 regional health information organizations (RHIOs), also known as QEs, and supports the exchange of health information. NYeC offers a Data Exchange Incentive Program (DEIP), which is intended to increase health information exchange adoption across the state by helping to defray the cost for an organization when connecting to local QEs. DEIP participants are incentivized to contribute a predefined set of data elements to their local QE. Limited funding is available and this program is operated on a first-come, first-served basis, with incentive funding of up to $13,000 per organization. It is open to Article 28 nursing homes, Article 36 home care agencies and programs, Article 40 hospice facilitates, Behavioral Health providers and others. More information is at https://www.nyehealth.org/services/hie-adoption/. HCA has advocated in the past and continues to push for funding to address health information technology needs of home care and hospice providers. We are advocating for at least one quarter of funds ($106.25 million) under the Health Care Facility Transformation Program to go to home care, hospice and other community health care providers, and that additional flexibility be provided to ensure funds can address the most urgent system priorities.
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The Situation Report: the Home Care Association of New York State
Volume 3, No. 9 February 26, 2018
CMS Unveils New Option for Electronic Medicare Cost Report Submission In its Fiscal Year (FY) 2018 hospital final rule, the U.S. Centers for Medicare and Medicaid Services (CMS) finalized its proposal to allow all Medicare providers to utilize an electronic signature on the Medicare cost report, in lieu of an original signature and to submit electronically the cost report certification and settlement summary document. In an effort to increase the timeframe for permitting this increased flexibility, CMS made the changes effective for cost reporting periods ending on or after December 31, 2017. CMS has recently also announced the availability of a new option under which provider cost reports (which would include electronic signatures and the cost report certification and settlement summary document) may be submitted electronically. The new Medicare Cost Report e-Filing System (MCReF) is not yet publicly available but it is expected to be made available through the Enterprise Identity Management (EIDM) system in the near future. It is our understanding that CMS intends to offer provider education about the new process associated with these changes beginning in March or April. HCA will update the membership as additional information becomes available. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
Resources
“Report to the President 2017 on America’s Direct Support Workforce Crisis: Effects on People with Intellectual Disabilities, Families, Communities and the U.S. Economy,” by the President’s Committee for People with Intellectual Disabilities http://nasuad.org/sites/nasuad/files/2017%20PCPID%20Full%20Report_0.PDF
“Medicaid Demonstrations: Evaluations Yielded Limited Results, Underscoring Need for Changes to Federal Policies and Procedures,” by the U.S. General Accountability Office https://www.gao.gov/assets/690/689506.pdf
“Quality in Home and Community-Based Services to Support Community Living: Addressing Gaps in Performance Measurement,” by the National Quality Forum http://www.qualityforum.org/Publications/2016/09/Quality_in_Home_and_CommunityBased_Services_to_Support_Community_Living__Addressing_Gaps_in_Performance_Measurement.aspx
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
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