DOCs & F2F
HOME CARE BILLS
SALARY HISTORY BILL
EP PROGRAM
The state’s Medical Society passes a resolution to take a strong position on seeking a streamlined F2F rule.
Community Paramedicine bill advances, as does legislation to change the Fiscal Intermediary authorization statute from the new state budget.
New York’s City Council passes legislation placing limits on the types of inquiries that employers can make about an applicant’s salary history.
New program: on June 28, HCA is hosting a comprehensive program to ready you for the new federal emergency preparedness regulations.
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Your Source for HOME CARE News, Policy and Advocacy
Vol. 2, Issue 18 | May 1, 2017
COMING UP Rediscover, Reimagine, Reinvent at HCA’s Annual Conference in Saratoga Saratoga Springs, NY May 3 to 5 Moving Beyond Personal Care to Meet the Challenge & Opportunities of Value-Based Care New York City, NY May 18, 2017 For more information on these and other programs, please visit the education and events section of HCA’s website at http://hca-nys.org/ events-education/ upcoming-events
Can’t Make the Full HCA Annual Conference This Week? No Problem! Don’t Miss Out! Register A-la-carte for the Pre-Conference, Thursday or Friday Sessions HCA’s signature Annual Conference starts on Wednesday in Saratoga. With just a few days left, there’s still time – but the window is closing – to attend by completing the online registration or completing the PDF registration form at www.hcaannualconference.com. While we recommend attending the entire conference, those who are unable to do so can pick a day rate for Wednesday, Thursday or Friday by downloading the PDF registration form, noting which day you wish to attend and faxing the form back to HCA at (518) 426-8788. Check out the full agenda on page 16, and we look forward to seeing you in Saratoga! See CONFERENCE p. 16
HCA Continues to Press Advocacy on 24-Hour/Live-in Care Issue in Wake of Court Ruling
Proposed 2018 Hospice Payment Rule Would Increase Payments by $180M
Throughout the past week, HCA has continued our strong advocacy on a labor issue that has the potential to upend the delivery of home care services in New York State, along with aspects of the budget and government. The
On April 27, the U.S. Centers for Medicare and Medicaid Services (CMS) issued a proposed rule (CMS-1675-P) updating the Medicare hospice wage index and cap amount for fiscal year (FY) 2018. See HOSPICE p. 4
See COURT p. 2 INSIDE Proposed 2018 Hospice Rule Would Increase Payments by $180M...............…1 HCA Continues Advocacy on 24-Hour/Live-in Care Issue...................................1 MLTC Tech Demo Awards Announced.....................................................................3 A Message from HCA Sponsor Sandata............................................................3 Home Care Legislation Advancing in Post-Budget Legislative Session.............4 Member Hiring Announcement......................................................................5 HCA Supports Legislation to Change FI Authorization Process..........................6 State Medical Society Engaging AMA Support for Relief of F2F Requirements.....6 DOH Schedules Health Commerce System Maintenance for May 6...................8 Make Your Emergency Preparedness Plan CoP-Ready on June 28.....................8
Worker’s Compensation Reforms Outlined.......................................................9 Legislation Passed to Limit Salary History Information.....................................9 Webinar on Financial Management Aspects of the New OASIS C2.......................9 HCA Advocates for Patient Care Transition Alerts to Home Care........................11 New Transportation Manager for NYC.............................................................12 VBP Prep/Strategy Session for LHCSAs on May 18.............................................13 Updated Advance Beneficiary Notice Posted..................................................14 CMS Releases Updated Hospice PEPPER Reports.............................................14 Health Workforce Study Released..................................................................15 NGS Updates.................................................................................................15
The Situation Report: the Home Care Association of New York State COURT from p. 1 issue has arisen in the aftermath of a State Supreme Court ruling in Tokhtaman v. Human Care, LLC, which impacts home care agencies and managed care plans that provide 24-hour “live-in” home care services. As a follow-up to our well-attended members-only conference call on the recent court decision, HCA and other Associations met via conference call to discuss a joint action plan regarding this and other related court cases. Additionally, last week we announced further education programs with the same focus. During the recent joint Association meeting, a number of issues were discussed, including:
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
Potential costs to the state Medicaid budget if live-ins must be paid for 24 hours;
Debilitating impact on home care agencies that would not be able to make potential retroactive payments and/or provide 24-hour live-in care without adequate reimbursement;
Patrick Conole Vice President, Finance & Management pconole@hcanys.org
Deleterious effect on managed care plans unless the state increased their premiums accordingly;
Andrew Koski Vice President, Program, Policy & Services akoski@hcanys.org
Whether and how the Olmstead decision (requiring care in the least restrictive setting) affects any efforts to limit care at home or in other settings; and
Alexandra Fitz Blais Director of Public Policy ablais@hcanys.org
How a ruling against the defendants would affect a state agency’s right to interpret its own regulations.
HCA has previously requested a meeting with the state Department of Health to discuss these court decisions, and we’ve invited the other Associations on the call to be part of this potential meeting. Last week, HCA also conferenced with the Littler law firm, which is the new counsel for the defendant in Tokhtaman. Littler is planning to appeal the decision to the New York State Supreme Court, Appellate Division, 1st Department and, if unsuccessful, then to the Court of Appeals. We discussed actions that HCA and the home care industry could take, including amicus briefs, and meetings with state officials. As announced in an Alert on April 25, HCA has added opportunities to discuss the provision of 24-hour live-in care at two separate 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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Al Cardillo Executive V ice President acardillo@hcanys.org
Laura Constable Senior Director, Membership & Operations lconstable@hcanys.org Celisia Street Director of Education cstreet@hcanys.org Mercedes Teague Finance Manager mteague@hcanys.org Jenny Kerbein Director of Governance & Special Projects jkerbein@hcanys.org Billi Wilson Manager, Meetings & Events bwilson@hcanys.org Teresa Brown Administrative Assistant tbrown@hcanys.org
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sessions of HCA’s Annual Conference on May 3 to May 5 in Saratoga Springs, New York – later this week. First, during HCA’s Board of Directors Meeting on May 3 at the Conference, Sean Doolan, Principal at the Albany Law Firm of Hinman Straub and HCA’s Government Relations representative, will discuss the issues surrounding the Court’s ruling, and HCA’s advocacy strategy on this important issue. In addition, Frank Fanshawe, attorney at law at Jackson Lewis and HCA’s legal counsel, will participate in HCA’s “Town Hall Meeting” conference session on May 5, from 7:30 to 8:30 a.m., to discuss the legal ramifications, risk areas for members related to this latest ruling, and how best to position your organization during this time of uncertainty. HCA has also shared with members a Hinman Straub memorandum on this issue (http://hca-nys.org/wp-content/ uploads/2017/04/Memo-Summary-of-Tokhtaman-case.pdf), outlining the action taken in this case by the State Supreme Court, implications of the decision, its potential impact on providers, and plans and next steps.
MLTC Tech Demo Awards Announced Last week, the state Department of Health (DOH), Office of Health Insurance Programs (OHIP), Division of Long Term Care (DLTC), announced that, under a previous RFP, two MLTC plans have been awarded contracts for a two year technology demonstration. Visiting Nurse Association of Central NY and Hamaspik, Choice Inc. have been awarded a total amount of $1,000,000 for these purposes as part of a demonstration from January 1, 2017 through December 31, 2018. DOH states that the overall goal of the MLTC Technology Demonstration is to test whether the use of technology in the home and community based setting is successful in keeping patients there. The two awardees will utilize several new and emerging technologies to enhance the long term care of their enrollees in the community in an effort to improve safety and independence. The results will inform future policy direction for DOH related to the use of assistive technologies in the home and community based sector. For more information on the MLTC Technology Demonstration, please follow the link: http://www.leadingageny.org/ ?LinkServID=4C926C7D-ADB9-9D64CB4C8EBF97D3AE0B
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A message from HCA sponsor Sandata
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HOSPICE from p. 1 CMS expects to publish the proposed rule in the Federal Register on May 3. As proposed, hospices nationally would see an estimated 1.0 percent ($180 million) increase in Medicare payments for FY 2018. The rule also updates the Hospice Wage Index and solicits comments regarding the sources of clinical information for certifying terminal illness. In addition, it proposes changes to the Hospice Quality Reporting Program (Hospice QRP), including new quality measures utilizing data collected in the Hospice CAHPS Survey. CMS’s proposed rule also discusses new quality measure concepts under consideration for future years, solicits feedback on an enhanced data collection instrument, and describes plans to publicly display quality measure data via the Hospice Compare website in 2017. HCA will be reviewing the proposed rule in further detail and will provide the membership with additional information in the near future. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
Home Care Legislation Advancing in Post-Budget Legislative Session As the State Legislature has resumed session in the wake of the budget’s adoption, bills of direct implication to home care have emerged and are already advancing. These include legislation to authorize collaborative models of community paramedicine; to delay the implementation of the new budget provisions for Consumer Directed Personal Assistance Program Fiscal Intermediaries (see related p. 6 story); and to support health information and clinical technology for home care (see related p. 11 story). Community Paramedicine Senate Health Chairman Kemp Hannon and Assembly Health Chairman Richard Gottfried have introduced HCA’s version of a community paramedicine program that has garnered the support of multiple associations as well as many in the EMS community. The legislation is S.5588 (Hannon) and A.2733-A (Gottfried). This past week, the Senate favorably voted the bill from the Senate Health Committee and advanced it to the Senate Calendar where it is now positioned for a full Senate vote as soon as this week. The Assembly version is currently in the Assembly Health Committee. The bill would create a section within the Hospital-Homecare-Physician Collaboration Program law (authored in 2015 by HCA and the Iroquois Healthcare Alliance, which is the upstate hospital association) to include among the collaborative models a Hospital-Homecare-Physician-EMS model for community paramedicine. Under this model, home care and partners would be permitted to design and implement a mutual plan that would enable EMS support in addition to strict emergency response and
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transport, for purposes of supporting patients, including averting emergencies and transport, and preventing avoidable emergency room and hospital use. Unlike the community paramedicine legislation opposed by HCA, other provider associations and the nurses’ association two years ago, this legislation does not allow a paramedicine model that violates other jurisdictions, including article thirty-six or practitioner licensure, and establishes upfront a design process intended to ensure clinical and program coordination across all relevant providers, a major omission from the opposed proposal. The expanse of support for this HCA-drawn solution is providing significant momentum for passage. The design is in sync with the move to integrated models of care, including the Delivery System Reform Incentive Payment (DSRIP) program and Value Based Payments (VBPs). It creates opportunities for home care agencies (and home care partners, like MLTCs, hospices and others) to develop programs that address high priority patient and system goals, leading to potential dramatic cost-savings. The model is not limited to Medicare or Medicaid, and stands to be of substantial interest to commercial insurers and health plans, along with bundled payment models. The legislation was included previously in the Senate’s one-house budget bill. The Senate pressed hard for adoption as part of the budget, but the proposal was tabled from the final budget along with a host of other items without immediate budget impact. This was due to the decision to limit major fiscal items in the available timetable for the closing budget discussions. HCA’s memorandum on this bill can be viewed at http://hca-nys.org/wpcontent/uploads/2017/04/ HCA-Memo-SupportS5588HannonA2733AGottfriedCommunity-Para-2017.pdf. For further information, contact Al Cardillo at acardillo@hcanys.org.
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HCA Supports Legislation to Change Fiscal Intermediary Authorization Process Implemented in State Budget HCA is supporting efforts to change a provision in this year’s final state budget regarding an authorization process for fiscal intermediaries (FIs) involved in consumer directed personal assistance services, effective April 1, 2017. During the legislative process, when this concept was first proposed, HCA advocated for changes in the proposal to streamline such an authorization process for those Licensed Home Care Services Agencies (LHCSAs) who provided FI services, in recognition of the fact that they already met many of the new requirements. We also pushed for a reasonable time period to allow existing FIs to continue to operate before they had to obtain the state’s authorization. While the one-house Assembly and Senate bills both included a one-year “grace period” to allow existing FIs to obtain such authorization, the final budget did not include this language or our other suggested revisions. This week, HCA issued memos in support of legislation (S.5544 Hannon/A.7216 Gottfried) that would move the effective date of this new requirement to January 1, 2018 and provide a one-year grace period so that entities operating as FIs prior to April 1, 2017 could continue to provide services without any interruption to patient care during the time that they sought to obtain this newly required DOH authorization. This bill was on both the Senate and Assembly Health Committees’ respective agendas this week and was reported out. We will inform members of the status of these bills as they are further considered in the legislative process. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
State Medical Society Engaging AMA Support for Relief of F2F Requirements Face-to-Face requirements for Medicaid cases still set for July 1 enforcement As HCA has reported since September, a special joint task force of the Medical Society of the State of New York (MSSNY) and HCA has been working to support and promote physician-homecare agency engagement. Taking aim at one of the most pressing obstacles for patients, physicians and home care agencies, MSSNY has advanced a formal resolution recommended by the task force tasking MSSNY to work with the American Medical Association (AMA) to achieve relief in the federal Face-to-Face (F2F) requirements. The resolution states: RESOLVED, that the Medical Society of the State of New York work with the American Medical Association to advocate to simplify the Medicare requirements for a “Face to Face” visit by a physician to a patient as a precondition for Medicare home health coverage, including advocating for alternatives for such “Face to
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Face” visit such as by telehealth; and be it further RESOLVED, that the New York delegation present this resolution at the 2017 AMA House of Delegates This engagement brings in critical voices and allies to the advocacy process on F2F. HCA is extremely grateful for MSSNY’s support on this issue, as well as its support broadly in conducting the joint Medical SocietyHome Care Association task force. The task force is chaired by MSSNY Long Term Care Committee Chair, Dr. Evelyn Dooley-Seidman. It is comprised of an expert team of MSSNY home care and long term care physicians; representatives of HCA’s home care and MLTC members; as well as the associations’ policy and executive staffs. Face-to-Face for Medicaid Cases In a meeting this week with state Department of Health (DOH) officials, HCA confirmed the stillanticipated July 1 date for enforcement of F2F requirements for Medicaid cases, adding the Medicaid mandate alongside the existing requirements for Medicare cases. With all new Federal regulations under scrutiny by the Trump Administration and Congress, and thus opportunity for change, we continue to press for reconsideration, repeal, or at least streamlining of F2F and all other areas of regulatory overburden. However, until and unless HCA and DOH are advised otherwise, home care and physicians face the July 1 Medicaid enforcement date. HCA has drafted, for MSSNY and its task force’s review, a set of streamlined procedures that our associations could co-endorse for Medicaid Face-to-Face compliance. Upon task force agreement, the procedures would be relayed to DOH as a guidance document the Department would use to implement Medicaid F2F in a manner that would minimize the logistical layers and burdens, and maximize accommodation of patients and providers. HCA discussed this plan with DOH this week, and DOH agreed to review and consider. HCA discussions with hospitals to standardize F2F elements within EHRs Simultaneous with our task force, and our other state and federal activities, HCA has reengaged with the state hospital association on an initiative which we have worked on the past two years to try to create a standardized addendum to the physician/hospital record that would satisfy all of the required F2F and medical eligibility documentation for home care. A workgroup of HCA had created this addendum and presented it to the Fiscal Intermediary (FI), National Government Services (NGS), for affirmation. The FI indicated that audits would still probe the overall record for compliance, thus limiting the addendum as a sole solution for streamlined documentation. At its last meeting, the HCA-MSSNY task force discussed the merit of approaching the state and regional hospital associations to discuss interest in promoting electronic health record (EHR) integration of the elements of the addendum, so that all of the requisite documentation for home care F2F and eligibility would be populated within the record itself, rather than only in an addendum. HCA has approached the state hospital association, begun preliminary discussions, and is now preparing requested information for the hospital association’s further evaluation of our proposal. HCA will maintain our efforts at every level to resolve this major priority need for home care. For further information, please contact Al Cardillo (acardillo@hcanys.org), Patrick Conole (pconole@hcanys.org), or Joanne Cunningham (jcunningham@hcanys.org).
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The Situation Report: the Home Care Association of New York State
DOH Schedules Health Commerce System Maintenance for May 6 The state Department of Health (DOH) will be conducting system maintenance on the Health Commerce System (HCS) beginning at 3 p.m. on Saturday, May 6. Critical applications (those which can be found at https:// commerce.health.state.ny.us/ hcs/drapps.html) will be available following a short downtime. Other non-critical applications and services will be unavailable from approximately 3 p.m. on Saturday, May 6, until 3 a.m. on Sunday, May 7. A reminder about this system maintenance will be displayed on the HCS until maintenance is complete. The Commerce Accounts Management Unit (CAMU) will be available during the maintenance. If you have issues accessing HCS applications during the maintenance, please call CAMU at 1-866-529-1890. Further question or concerns about this maintenance can be sent to the following address: hcsoutreach@health.ny.gov.
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Make Your Emergency Preparedness Plan CoPReady on June 28 The new federal Conditions of Participation (CoP), along with a separate federal rule, have established sweeping new emergency preparedness requirements for 17 types of providers, including home care and hospice – an historical first! This regulation goes into effect on November 16, despite a delay in other CoP provisions for home health, requiring providers to plan adequately for natural and manmade disasters, with a specific focus on patients and employees. On June 28, in Suffern, NY (conveniently located for upstate and downstate agencies alike), HCA is hosting RBC President and emergency preparedness expert Barbara Citarella for a comprehensive workshop to assist agencies in: understanding the four major components of this regulation; planning for continuity of operations (COOP); operationalizing policies and procedures; communication; and conducting/testing a training program related to your emergency plans. An agency’s entire emergency plan must be built on a hazard vulnerability assessment platform using an all-hazards approach to ensure continuity of services to patients. In addition, planning and communication should include a collaborative partnership with a health care coalition. This session will focus on the major components of COOP and its correlation to the new Emergency Preparedness (EP) regulations. Learn more and register by downloading the form at http://hcanys.org/wp-content/uploads/2017/04/Make-Your-EP-Plan-CoP-ReadyJune-28-2017.pdf. Make Your Emergency Preparedness Plan CoP-Ready! June 28, 2017 Crowne Plaza Hotel 3 Executive Boulevard Suffern, NY 10901
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The Situation Report: the Home Care Association of New York State
Worker’s Compensation Reforms Outlined The state Workers’ Compensation Board has posted information on Workers’ Compensation reforms that were part of the final state budget. These included: capping classification of Maximum Medical Improvement at 2.5 years by creating a credit to employers for temporary payments beyond the threshold; the guaranteed development of new Impairment Guidelines, to be adopted by January 1, 2018, which will adhere to modern medical evidence and modern medical outcomes; and the issuance of a pharmaceutical formulary by the Workers’ Compensation Board by December 31, 2017. The Board has posted a summary of the reforms (http://www.wcb.ny.gov/content/main/ SubjectNos/sn046_936.jsp); information on the extreme hardship redetermination procedure (http://www.wcb.ny.gov/content/main/ SubjectNos/sn046_938.jsp); and material on urgent hearings where the claimant is not being paid (http://www.wcb.ny.gov/content/main/ SubjectNos/sn046_937.jsp).
Legislation Passed to Limit Salary History Information The New York City Council has approved legislation prohibiting employers from inquiring about, relying upon, and verifying a job applicant’s salary history. The legislation, Int. 1253-A, is at http:// legistar.council.nyc.gov/ View.ashx?M=F&ID=5083445&GUID=1CDC0DBF2D3E-4458-9657-8F560D3C1847. Mayor Bill de Blasio is expected to sign the bill soon; it will be effective 180 days after it is signed. Int. 1253-A prohibits employers from inquiring about a prospective employee’s salary history during all stages of the employment Continued on next page
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New Webinar on Financial Management Aspects of the New OASIS C2 Webinar is open to all, but is free of charge to members who attended HCA’s Senior Financial Managers Forum in April On May 11, HCA is offering a unique webinar opportunity for all members, but it’s free of charge for those who attended or paid for our April Senior Financial Managers Forum. The webinar, on Financial Management Aspects of the New OASIS C2, was originally scheduled as part of the April Forum; but flight delays prevented our speaker from presenting. This is why HCA has invited Melinda Gaboury – a favorite national speaker and the cofounder and Chief Executive Officer of Healthcare Provider Solutions, Inc. (HPS) – to present the session as a webinar on May 11, free for those who attended the Senior Financial Managers Forum, as well as for a small fee open to all other registrants. All health care finance managers know the important connection between clinician activities and budgeting. Now that the OASIS C2 is in effect, this parallel understanding of clinician assessment procedures and their cost impact will help drive top-to-bottom improvements in the function and efficiency of your organization. During this webinar, Ms. Gaboury will review how to calculate the HHRG, corresponding HIPPS code and determine case-mix weight, all of which are fundamental to a home care agency’s operationwide understanding of the clinician’s role in patient care and financial outcomes. The webinar will also establish processes that agencies need to strengthen regarding OASIS-C2 completion and review, as well as the specific OASIS-C2 M items that have a direct impact on patient outcomes and costs. Learn more and register at http://hca-nys.org/wpcontent/uploads/2017/04/Financial-Mgmt-Aspectsof-New-OASIS-C2-Webinar.pdf.
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Continued from previous page process. It would prohibit an employer, employment agency, employee, or agent from: 1. Inquiring about the salary history of a job applicant; and/or 2. Relying on the salary history of a job applicant when determining the salary, benefits or other compensation for the applicant during the hiring process, including the negotiation of a contract. The legislation defines “to inquire” as communications with the applicant, a current or prior employer, or an agent of a current or former employer on salary history. It also refers to conducting “a search of publicly available records or reports for the purpose of obtaining an applicant’s salary history.” “Salary history” includes the applicant’s current or prior wage, benefits, or other compensation. It does not include any objective measure of the applicant’s productivity, such as revenue, sales, or other production reports. There are some exceptions that employers should be aware of: 1. If applicants voluntarily and without prompting disclose their salary history to the prospective employer, an employer is permitted to consider salary history in determining a prospective employee’s salary, benefits, and other compensation, and may verify a job applicant’s salary history. 2. An employer, without inquiring about salary history, also is permitted to discuss salary, benefits, and other compensation expectations with the applicant, as well as any unvested equity or deferred compensation the applicant would forfeit or have cancelled by resigning his or her current employment. 3. The legislation does not apply to current employees applying for an internal promotion or transfer. 4. It does not apply to New York City employers acting pursuant to any federal, state or local law authorizing the disclosure or verification of salary history or requiring knowledge of salary history to determine an employee’s compensation. Should an employer’s attempt to verify an applicant’s non-salary-related information or conduct a background check result in disclosure of the applicant’s salary history, the employer is prohibited from relying on the salary information during the hiring process and contract negotiation stages when setting the salary, benefits, or other compensation of the applicant. Home care providers should review their employment practices to ensure that they conform to this legislation if and once it becomes effective. HCA will notify members when it is signed. This article is based on information provided by Jackson Lewis, the firm that employs HCA’s counsel.
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HCA Advocates for Proposed New Rules to Provide Patient Care Transition Alerts to Home Care HCA Home Care Technology Act legislation, other proposals and efforts gaining ground HCA and our Technology Committee have been working closely with the leaders of the New York e-Health Collaborative (NYeC) to garner support for home care’s capacity in health information technology (HIT) and health information exchange (HIE). HCA’s committee also continues to directly develop proposals for HIT/HIE and clinical technology. These are major priorities for home care and its capabilities within managed care, DSRIP, VBP, ACOs and virtually all new, integrated and evidenced-based models of care and payment. HCA’s representatives have served on the state HIT Infrastructure Committee and have worked diligently from all angles to try to ensure that home care – long overlooked for federal and state HIT investments – is given due consideration throughout state policy and financing. Selfhelp Vice President, Russell Lusak, an HCA representative on both HCA’s and the state’s technology committees, is a recipient of this year’s HCA Advocacy Award for his continuous and effective advocacy for HIT and HIE support for home care. This past Thursday, HCA submitted comments and recommendations on a proposed State Health Information Network-New York (“SHIN-NY”) rule change. HCA requested that the rule include home care among the provider types enabled to receive “Patient Care Alerts” upon significant changes in status (e.g., a hospitalization, or transport to the emergency room). Providers would receive alerts by participating in their regional health information organization (RHIO), or another qualified entity (QE) similarly authorized as a regional health information network under the SHIN-NY. HCA continues to work with state and regional leaders to map out streamlined participation in RHIOs and QEs for home care and hospice. In the coming weeks, HCA’s committee will be pursuing steps we have discussed with state leaders, as the timetable of RHIO and SHIN-NY activity opens up for these opportunities. In addition, HCA also commented on and supported approval of the proposed SHIN-NY rule change related to patient consent to participation in health information sharing with relevant providers via the SHIN-NY. The proposed change simplifies and streamlines the consent process for both patients and providers. Complicated and duplicative consent processes can significantly obstruct access to timely and critical information for patient care. It also adds to mounting provider administrative burdens and costs, as well as patient frustration with the number of forms to complete. HCA Home Care Technology Act: A.5046-A In a related matter, HCA legislation called the “Home Health Information and Clinical Technology Act,” introduced earlier this session by Assembly Health Committee Chairman Richard Gottfried, is currently in the Assembly Ways and Means Committee. The bill has now been amended with a technical date change that would help position it for possible postbudget consideration. Continued on next page
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Continued from previous page This bill would provide a host of state policy and finance mechanisms to support health information and clinical technology for certified home health agencies, licensed home care services agencies, long term home health care program providers, and managed long term care plans. Its features range from capital grants, to rate and premium adjustments, to quality incentive payments, to workforce training funds for technology, to funding from the Health Care Reform Act. In addition, HCA was successful in working with partners to gain a minimum $75 million set-aside in the new budget for a Health Care Facility Transformation Program, which would be available for home care and other community health providers, and should be able to be tapped for HIT-HIE infrastructure. New York State needs a comprehensive plan for the support of home care technology capacity, including expansion to connect critical allied community based support services (covering social determinants of health) into the information network. HCA Technology Survey To effectively profile and advocate home care’s HIT-HIE need, HCA needs your engagement! HCA recently sent an alert requesting provider participation in a vital HIT-HIE survey. The information from this survey is needed to support the above efforts, and more, including demonstrating the need for investment to state officials. The survey is at https://www.surveymonkey.com/r/79MHQ9J. HCA appreciates the responses we have received thus far. If you are a CHHA, LHCSA or LTHHCP and have not yet completed this survey, please complete and return it ASAP. The survey only takes a few minutes and its value is significant to our advocacy effort. For further information, please contact Al Cardillo at acardillo@hcanys.org or Alex Fitz Blais at ablais@hcanys.org.
New Transportation Manager for NYC The state Department of Health has announced a contract award to Medical Answering Services, LLC (MAS) as the new Medicaid transportation manager for the New York City (NYC) region, which includes: Manhattan, Brooklyn, Bronx, Staten Island, and Queens, effective April 23, 2017. In NYC, MAS will be responsible for administering, prior approving, and coordinating non-emergency medical transportation for Medicaid fee-for-service and mainstream managed care enrollees at the most medically appropriate, cost effective mode of transport. Dual eligible (Medicare and Medicaid) consumers enrolled in either a Managed Long Term Care plan (Partial Cap, PACE, Medicaid Advantage Plus) or a Medicaid Advantage Plan) will continue to receive their non-emergency medical transportation services through their plans. MAS is currently the Medicaid transportation manager for the Hudson Valley, Finger Lakes, Northern New York and Western New York regions and has been providing services to over 2 million Medicaid enrollees in 55 counties. Continued on next page
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Volume 2, No. 18 May 1, 2017
Continued from previous page Enrollees who are unable to utilize mass transit must ask their medical practitioner to request their transportation from MAS for their first trip. Subsequent trip requests will require medical practitioners to complete and sign a medical justification form (2015 form). Upon receipt of the 2015 form from the medical practitioner, the information will be reviewed and the request for prior authorization for non-emergency transportation will be approved or denied based upon state Medicaid program criteria. The 2015 form and associated documentation will be uploaded and retained in the MAS system for future reference. MAS will seek a new medical justification form for an enrollee anytime a change in their health status necessitates a change to their mode of transport. If a medical practitioner has previously requested transportation for an enrollee and has already completed the 2015 form, and the medical needs of the enrollee have not changed, the enrollee may book the ride directly with MAS. MAS can be contacted at 1-844-666-6270; its website is www.medanswering.com. More information is in a NYC Human Resources Administration April 26 Medicaid Alert at http://a069marc.nyc.gov/marc/default.aspx (registration required).
VBP Prep/Strategy Session for LHCSAs on May 18 Andrea Brown, President and CEO of AB Coaching and Consulting, is back on May 18 in New York City, presenting for a LHCSA-focused program to help your organization seize opportunities and meet the challenges of value-based care. The program, Moving Beyond Personal Care to Meet the Challenges and Opportunities of Value-Based Care, is part of HCA’s popular bootcamp series. To gain visibility and leverage in the new payment and care-delivery paradigms, LHCSAs, with Andrea Brown’s help, should consider fine-tuning their operations to make them congruent with the structures of reimbursement models governing managed long term care. On May 18, she’ll:
Review managed care plan metrics and their rating system to identify specific metrics that LHCSA operations can positively impact as part of the LHCSA value-proposition pitch to plan managers;
Help delineate the various roles, standards of service, and documentation in the coordination of LHCSA and MLTC plan operations; and
Review clinical operations and other changes that clinical staff can make in the delivery of care, paraprofessional staff supervision, and paraprofessional education to enhance operational efficiency, ensure compliance with regulations, and enhance quality.
More information and a registration form are in the flyer at http://hca-nys.org/wp-content/uploads/2017/ 03/HCA-Bootcamp-Moving-Beyond-Personal-Care-May-18-2017.pdf.
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The Situation Report: the Home Care Association of New York State
Volume 2, No. 18 May 1, 2017
Updated Advance Beneficiary Notice Posted Must be used by June 21 In March 2017, the Office of Management and Budget approved the Advance Beneficiary Notice of Noncoverage (ABN) Form CMS-R-131 for another 3 years. There are no changes to the form, except the new expiration date of March 2020, and a non-substantive change to include language informing beneficiaries of their rights to CMS nondiscrimination practices and how to request the ABN in an alternative format if needed. Starting June 21, 2017, you must use the most recent version of the CMS-R-131 to deliver a valid ABN; however, you may begin using the new form immediately. The ABN is a notice given to beneficiaries in fee-for-service Medicare to convey that Medicare is not likely to provide coverage in a specific case. It must be delivered to affected beneficiaries or their representative before providing the items or services that are the subject of the notice. For more information, including the new form and instructions, go to https://www.cms.gov/MEDICARE/medicare-general-information/bni/abn.html. Questions regarding the ABN can be e-mailed to BNImailbox@cms.hhs.gov (please copy Andrew Koski at akoski@hcanys.org).
CMS Releases Updated Hospice PEPPER Reports The U.S. Centers for Medicare and Medicaid Services (CMS) recently released, via the TMF Health Quality Institute, the fourth quarter fiscal year (FY) 2016 Hospice Program for Evaluating Payment Patterns Electronic Report (PEPPER), summarizing statistics for FYs 2014, 2015, and 2016 (through September 2016). PEPPER provides provider-specific Medicare data statistics for discharges/services vulnerable to improper payments. PEPPER can support a provider’s compliance efforts by identifying where it is an outlier for these risk areas. This data can help identify both potential overpayments as well as potential underpayments. Since its release, 32 percent of Medicare-certified hospice providers have downloaded the updated PEPPER. If an HCA hospice member has not yet downloaded its PEPPER, it is available for download through the PEPPER Resources Portal. To obtain your hospice’s PEPPER, the Chief Executive Officer, President, Administrator or Compliance Officer of your hospice should:
Review the Secure PEPPER Access Guide at: https://www.pepperresources.org/Portals/0/Documents/ PEPPER/HOSPICE/HospicePEPPERUsersGuide_Edition6.pdf
Review the instructions and obtain the information required to authenticate access. Note: A new validation code will be required. A patient control number (UB04 form locator 03a) or medical record number (UB04 form locator 03b) from a paid claim for a traditional Medicare FFS beneficiary with a claim “from” or “through” date in July 1-September 30, 2016 will be required.
Visit the PEPPER Resources Portal at: https://securefile.tmf.org/
Complete all the fields and download your PEPPER
For further information, contact Patrick Conole at (518) 810-0661 or at pconole@hcanys.org.
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The Situation Report: the Home Care Association of New York State
Volume 2, No. 18 May 1, 2017
Health Workforce Study Released The Center for Health Workforce Studies has released its annual report, “The Health Care Workforce in New York, 2015-2016, Trends in the Supply and Demand for Health Workers.” It is at http://albany.us7.list-manage.com/track/ click?u=b7960dfcf756f94605561779d&id=65762d372f&e=eb78a43c1d. This report summarizes data and information about New York’s health workforce, including (by region) for home care:
Number of health care jobs; Average hourly wages; Employment projections; and Recruitment and retention difficulties.
HCA collaborated on the survey that was sent to home care agencies. The goals of this report are to assist policymakers and other stakeholders to target health workforce education and job training resources to address the most pressing health care workforce needs; to guide health workforce policies, including decisions about the capacity of health professions education programs; and to inform current and prospective students about health care employment prospects and opportunities. HCA advanced a series of workforce proposals in the state budget and will be seeking legislative and administrative support in this next phase of the legislative session.
NGS Updates National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), has recently posted the following information to its website.
E-mail Verification Requirement in NGSConnex – Beginning May 1, all NGSConnex users will be required to complete a one-time verification to validate the e-mail address associated with their NGSConnex user profile upon logging in with the user ID and password. NGS requires the e-mail address to be a unique e-mail address for the NGSConnex user. It is imperative that NGSConnex users prepare now before Multi-Factor Authentication (MFA) becomes mandatory for all NGSConnex users. In preparation, NGS is asking users to verify the email address associated with one’s user profile, as this is how users will receive one’s daily MFA security code, which will be necessary to successfully access information in NGSConnex.
2017 MAC Satisfaction Indicator (MSI) Now Available – The Medicare Administrative Contractor (MAC) Satisfaction Indicator (MSI) takes 10 minutes and allows providers to share opinions of NGS’s services directly with the U.S. Centers for Medicare and Medicaid Services (CMS). Providers can access the survey at: https://cfigroup.qualtrics.com/jfe/form/ SV_3WeVjGWpc5NQXOJ?MAC_BRNC=5&MAC=J6%20%E2%80%93%20NGS
For further information, contact HCA’s Patrick Conole at (518) 810-0661 or at pconole@hcanys.org.
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The Situation Report: the Home Care Association of New York State CONFERENCE from p. 1
Wednesday, May 3, 2017 HCA Member Provider Pre-Conference Rate: $219 Pre-Conference Achieving Value through Palliative Care, with Dr. Todd R. Coté, MD, HMDC, FAAFP, FAAHPM, Program Director, University of Kentucky Fellowship in Hospice and Palliative Medicine Assistant Professor, University of Kentucky, College of Medicine Chief Medical Officer, Bluegrass Care Navigators Medical Marijuana in NY, with Dr. Bernie Lee, Associate Chief Medical Officer, Metropolitan Jewish Hospice and Palliative Care HCA Annual Corporation and Board of Directors Meetings (for HCA Members Only) HCA’s Imagination Celebration Welcome Reception
Thursday, May 4, 2017 HCA Member Provider Thursday ONLY Rate: $329 What’s Keeping Your Colleagues in Other States Up At Night? Panelists: Pat Kelleher, Executive Director, Home Care Alliance of Massachusetts; Bobby Lolley, RN, Executive Director, Home Care Association of Florida; Timothy Rogers, President & CEO, Association for Home & Hospice Care of North Carolina Opening Keynote: Pulitzer Prize Winning Author Kathryn Schulz on “How Mistakes Drive Innovation” Essential Elements Workshops (concurrent)
Know Your Data to Maximize Value Based Payments
Optimizing Revenue Cycle Management in Today’s Payment Environment
Clever & Nimble: Innovations in Recruitment and Retention
2017 HCA Home Care Awards Luncheon
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Volume 2, No. 18 May 1, 2017
Thursday, May 4, 2017 (continued) Think Tank Sessions (concurrent)
Plan-Provider Partnerships for 5-Star Quality
Lessons in Leadership & Advocacy from a Global Nursing Leader
Strategies for Advancing the Home Care Advocacy Agenda
Keynote Speaker: Dr. Paul Marciano, Employee Engagement and Retention Expert presents Carrots and Sticks Don’t Work: Building a Culture of Employee Engagement with the Principles of RESPECT HCA PAC Party (separate donation required)
Friday, May 5, 2017 HCA Member Provider Friday ONLY Rate: $229 HCA Town Hall Meeting This is your opportunity to Ask HCA your burning questions during this open-format Q&A session. Plus, special guest speaker Frank Fanshawe of Jackson Lewis will discuss the legal ramifications and risk areas for members related to recent litigation and court decisions on 24-hour “live-in” cases. General Session: Karen Butterton, Chief Operating Officer, Barnes Healthcare Services presents Discover Your Niche in a Value-Based Healthcare Marketplace: Positioning Your Agency for Success. Closing Keynote Speaker: Paul Angone, Author, Organizational Consultant and Millenial Expert on Understanding the Millenial Mindset: The Secrets to Engaging, Retaining and Leading Millenials.