August 7, 2017 Edition of the Situation Report by Home Care Association of New York State

CFOs, CEOs, COOs, Finance Managers and other Data-Wise HCA Members

Before reading this week's Situation Report, we want to know… • Are you concerned about CMS's new Medicare payment proposal to cut almost $1 billion from home health in 2019? • Do you need MLTC, QIVAPP, FLSA, FFS and other rate information to help forecast your Medicaid budget line? • Want expert guidance to help build better contract arrangements? Take a moment NOW to register for HCA’s Senior and

Financial Manager’s Retreat on September 7-8 in New Paltz to get your questions answered and ensure a strong footing for your 2018 budget! REGISTER HERE See Situation Report below

EP PROGRAM

SEPSIS CALL

HOSPICE RULE

WORKFORCE PROGRAM

HCA announces a full-day program on home care emergency preparedness essentials with top preparedness officials and experts.

HCA is gathering users of HCA’s sepsis screening tool to discuss your experiences, gain input and preview data-collection plan.

Learn more about the 2018 hospice payment rule which includes an aggregate increase in payments by $180 million.

DOH is now accepting applications for organizations to launch regional workforce centers statewide.

PAGE 5

PAGE 7

PAGE 8

PAGE 10

Your Source for HOME CARE News, Policy and Advocacy

Vol. 2, Issue 29 | August 7, 2017

COMING UP Senior & Financial Manager’s Retreat September 7-8 Mohonk Mountain House New Paltz

In Wake of Senate’s ‘No’ Vote on ACA Repeal, HCA & Coalition Direct Our Advocacy against Trump Administration’s Signals to Withhold ACA Subsidies

Optimizing Your Agency’s Revenue Cycle for Improved Financial Performance September 13, 2017 New York City

Since our last edition of The Situation Report went to press, on July 24, the health care debate culminated in the well-publicized defeat of a U.S. Senate bill to repeal the Affordable Care Act (ACA). Also known as the “skinny” repeal, the defeated Senate legislation was different from other efforts to overturn ACA in that it didn’t also include ACA “replacement” language. See ACA p. 6

All HCA programs and registrations are posted at http://hcanys.org/eventseducation/upcomingevents

HCA Memo Details Proposed 2018 HHPPS Payment Changes

DOH Posts Medicaid F2F Guidelines

Learn more at Sept. 7-8 Finance Conference

Applies only to CHHA FFS cases

HCA has prepared a detailed memo (see http://hca-nys.org/wp-content/uploads/2017/ 08/CMS2018ProposedRuleMemoFinal.pdf) outlining the recently posted proposed rule for the 2018 Medicare Home Health Prospective Payment System (HHPPS).

In its July Medicaid Update, the state Department of Health (DOH) posted long-anticipated guidance on implementation of the federally-required face-to-face (F2F) requirements for Medicaid home health cases, distinct

Summer Schedule HCA is publishing The Situation Report on a biweekly schedule for the summer. Our next edition will be on August 21. We will notify you by e-mail of all important breaking updates.

See PPS p. 2

INSIDE HCA & Coalition Advocate on ACA Subsidies.............................................................1 HCA Memo Details Proposed 2018 HHPPS Changes .................................................1 DOH Posts Medicaid F2F Guidelines.......................................................................1 Reservation Deadline Extended to Aug. 20 for Finance Retreat................................4 HCA Presents Full-Day Emergency Prep Program..................................................5 You’re Invited: Home Care Sepsis Initiative Call-in on Aug. 24 ...................................7

See F2F p. 3

2018 Hospice Rule Expected to Increase Payments by $180M....................8 In Memoriam: NAHC President Val Halamandaris.........................................8 DOH Announces Applications for Workforce Investment Initiative.............10 HCA Co-Sponsors Sept. 13 Webinar to Outline ICD-10 Changes....................11 April Global Cap Report: Medicaid Spending $2M Below Projections..........11 CMS Issues Quality Program Non-Compliance Letters to Some Hospices.....12 U.S. Department of Labor to publish RFI on Overtime Rule...........................13

The Situation Report: the Home Care Association of New York State

 PPS from p. 1 Under the proposed rule, the U.S. Centers for Medicare and Medicaid Services (CMS) estimates a -0.4-percent reduction in payment in 2018 (or $80 million). HCA’s memo outlines all of the complex payment calculations, including case-mix-weight changes, CMS’s “case-mix-creep” adjustment, wage index factors, outlier adjustments, and more. Importantly, the proposed rule introduces a significant, new, and complex change for 2019; CMS plans to change the unit of payment from a 60-day episode of care to a 30-day period of care, starting January 1, 2019, which is estimated to reduce Medicare home health payments nationally by $950 million. This proposal will require significant further analysis, preparation and evaluation with the membership, so please be sure to read the memo’s discussion of this proposed change. CMS’s proposed rule is subject to a comment period ending on September 25. A final version of the rule is traditionally issued in mid-to-late fall. Gain Insights at September 7-8 Finance Retreat The proposed HHPPS rule will be just one of several featured components at HCA’s upcoming Senior and Financial Manager’s Retreat on September 7 to 8. Our program will include the opportunity to get your questions answered on the intricacies of the proposed HHPPS rule, learn new updates, and discuss with HCA your concerns. All HCA member executives, CFOs and finance managers should attend, along with any other management staff who have responsibility for budgeting and finance decisions at your organization.

Volume 2, No. 29 August 7, 2017 

The Situation Report is a weekly publication of the Home Care Association of New York State (HCA). Unless otherwise noted, all articles appearing in The Situation Report are the property of the Home Care Association of New York State. Reuse of any content within this newsletter requires permission from HCA.

Joanne Cunningham HCA President jcunningham@hcanys.org Roger L. Noyes Director of Communications, Editor of The Situation Report rnoyes@hcanys.org Al Cardillo Executive Vice President acardillo@hcanys.org Patrick Conole Vice President, Finance & Management pconole@hcanys.org Andrew Koski Vice President, Program, Policy & Services akoski@hcanys.org Alexandra Fitz Blais Director of Public Policy ablais@hcanys.org Laura Constable Senior Director, Membership & Operations lconstable@hcanys.org Celisia Street Director of Education cstreet@hcanys.org Mercedes Teague Finance Manager mteague@hcanys.org Jenny Kerbein Director of Governance & Graphic Design jkerbein@hcanys.org Billi Wilson Manager, Meetings & Events bwilson@hcanys.org

Home Care Association of New York State (HCA) 388 Broadway, 4th Floor, Albany, NY 12207 Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org

Teresa Brown Administrative Assistant tbrown@hcanys.org

The Situation Report: the Home Care Association of New York State

Volume 2, No. 29 August 7, 2017 

F2F from p. 1 from and in addition to the long-standing F2F requirement for Medicare home health. (See the guidelines at https://www.health.ny.gov/ health_care/medicaid/program/update/2017/201707.htm#f2f.) The requirement is effective July 1, 2017. HCA and the Medical Society of the State of New York (MSSNY) worked in partnership to draft guidelines – well before the July 1 effective date – for DOH to use as the basis for Medicaid F2F. Our purpose was to ensure a streamlined process for physicians and home care agencies, and the narrowest applicability of the requirements to avoid the kinds of extensive, onerous, duplicative and confusing standards set by the U.S. Centers for Medicare and Medicaid Services (CMS) in the case of F2F for Medicare home health services. Akin to the Medicare version of F2F (which requires physicians or non-physician practitioners to meet “face-to-face” with patients and certify the patient’s home health eligibility as a condition of home health services and payment), CMS required states to also apply F2F for Medicaid cases as of July 1, but it provided states with latitude for developing their own guidelines, presenting a window for HCA and MSSNY to work with state officials on a workable structure in state regulations. While HCA had pressed the state to post its Medicaid F2F guidelines at an earlier date, before July 1, we appreciate DOH’s action on the new Medicaid requirements. We also appreciate DOH’s decision to substantially adopt the components and standards that HCA and MSSNY shared with the Department over the last several months. HCA and MSSNY recommended that the state apply the widest possible exemption of the F2F requirements, including exemption of all traditional and extended models of managed care, as well as similarly integrated models like ACOs, value based payment, bundled payment and DSRIP. We further urged the state to seek a full waiver of F2F on the

basis that New York’s entire Medicaid program functions under a CMS-approved managed care waiver. While short of this level of exemption, DOH’s adopted Medicaid F2F requirements will apply only to CHHA fee-for-service (FFS) cases, not to mainstream managed care or managed long term care plan cases, significantly reducing the applicability and potential burden of Medicaid F2F, given that the majority of home care falls under managed care. HCA has confirmed with DOH that the following specific managed care vehicles are also exempt from Medicaid F2F applicability: Fully Integrated Duals Advantage (FIDA); Medicaid Advantage; Special Needs Plans (SNPs); the Program for All-Inclusive Care for the Elderly (PACE); and Health and Recovery Plans (HARP). The requirements also do not apply F2F to personal care-only cases. Importantly, the requirement only applies to the initial ordering of services and F2F need not be conducted at recertification. This one-time applicability of F2F (at start of services) also extends to dual-eligible cases. However, if the patient “is discharged and care is subsequently restarted, the F2F encounter must be completed at the start of the new episode of care,” DOH states. “If a Medicaid or dually eligible MedicareMedicaid member is receiving home health services under managed care and transitions to FFS home care services, the F2F exemption under managed care would continue for as long as the member continues receiving home care services under FFS (unless there is a discharge and restart of care under FFS).” HCA also stresses the distinction in coverage rules for Medicare and Medicaid services – notably the absence of a “home-bound” requirement for Medicaid

The Situation Report: the Home Care Association of New York State

Volume 2, No. 29 August 7, 2017 

cases. Under Medicare F2F, the physician must document the home-bound eligibility standard, but such is not the case for Medicaid F2F. “Medicaid requires that the member be certified as medically needing home health care services,” states the DOH guidance. “Medicaid requires a basic determination of medical necessity for home health services and allows medically necessary home care services to be provided in any setting where normal life activities take place.” The timeline for obtaining the F2F documentation is similar to the Medicare requirement (within 90 days before or 30 days after start of services). And the guidelines permit certain non-physician practitioners to conduct the F2F encounter (though a physician must sign-off on the certification). HCA will be providing further details and education on the new requirements as needed and as providers operationalize the standards. We encourage members to attend our September 7-8 Senior and Financial Manager’s Retreat to gain updates on all relevant state Medicaid reimbursement matters, as well as Medicare and other finance issues affecting your bottom line and operational management.

Reservation Deadline Extended to Aug. 20: Register Now for Popular HCA Finance Retreat at Scenic Mohonk Mountain House HCA’s upcoming Senior and Financial Managers Retreat returns to the resplendent Mohonk Mountain House in New Paltz. The resort has extended HCA’s block of discounted rooms for attendees of the retreat. The reservation deadline is now August 20, so please be sure to make your reservations and get registered for the September 7-8 conference as soon as possible. Every segment of the retreat offers vital information to assist your leadership and finance teams with budgeting, forecasting and gaining an overall handle on reimbursement issues at all levels. HHPPS questions and concerns? It’s no doubt that prominent among your list of questions and concerns involves the recently posted proposed Medicare Home Health Prospective Payment (HHPPS) rule. (See related p. 1 story.) The new proposal includes a complete overhaul of the episodic payment system in 2019, changing from 60-day to 30-day increments, along with related case-mix changes for an estimated financial impact of $950 million nationally! But the rule more immediately proposes other modifications to the Medicare home health reimbursement methodology in 2018 that your finance teams need to digest. Our federal update with Colin Roskey (Partner at Scully, Roskey & Missmar) will cover critical aspects of the rule, as will presentations by the HCA Policy team and other speaker sessions devoted to Medicare reimbursement. Medicaid reimbursement, stats, hospice, contracting and more We’ll also have an equally comprehensive examination of Medicaid reimbursement issues with state health care finance officials, plus a “hot topics in finance” panel session; a “know your stats” workshop; updates on

The Situation Report: the Home Care Association of New York State

Volume 2, No. 29 August 7, 2017 

hospice reimbursement; and a session on “Building Contracts and Arrangements to Succeed in a Managed Care and Value Based Payment Environment.” All of this plus farm-to-table dining, a cocktail reception, and access to a range of outdoor activities await you on September 7-8 at the historic Mohonk Mountain House. Please download the brochure for more information or register online at the links below. Download the brochure: http://hca-nys.org/wp-content/uploads/2017/07/HCA-Senior-Financial-ManagersRetreat-Brochure-2017.pdf Register online: https://www.eventville.com/Catalog/EventRegistration1.asp?EventId=1012224

HCA Presents Full-Day Program on Emergency Preparedness Essentials in Home Care and Hospice on Sept. 27 Includes tabletop exercise that partly fulfills imminent CoP requirement; plus, group registration discounts offered for HCA members! HCA presents a comprehensive full-day program on September 27 in Albany, during National Preparedness Month, that will delve into all critical and timely aspects of home care and hospice emergency preparedness affecting your operation. The program features state health and emergency preparedness officials, including regional officers, planning managers and the Director of the Office of Health Emergency Preparedness, Michael J. Primeau, for insights on challenges and opportunities in home care and hospice preparedness. This is a great opportunity to share your experiences and concerns with top health emergency preparedness officials. Most urgently, with the fast-approaching November 16 effective date for the new emergency preparedness Conditions of Participation (CoPs), we’ll also have state DOH officials helping you to sort out the differences between the new federal CoP requirements and existing state regulations so that you know how much work is ahead of you in order to ramp up fully for federal compliance. DOH will also share insights on what surveyors will be examining in their audit process. In addition, we’ll have a session on Incident Command Principles and a tabletop training exercise that includes the necessary elements for qualifying as your agency’s secondary exercise requirement under the new CoPs! Best yet, we are offering a special HCA Member group rate of $99 per person if you send three or more staff to this program, so please take this opportunity for staff development across multiple areas. Download the brochure to register at: http://hca-nys.org/wp-content/uploads/2017/08/HCA-EP-EssentialsProgram-Registration.pdf.

The Situation Report: the Home Care Association of New York State

Volume 2, No. 29 August 7, 2017 

ACA from p. 1 This “replacement” language – which had already passed the U.S. House of Representatives and was previously under consideration in the Senate – had called for billions of dollars in Medicaid reductions, among other measures (i.e. tax credits for obtaining private health coverage, in place of ACA’s individual mandate) that are now off the table, at least for the time being. With the Senate adjourned until after Labor Day, the chamber’s rejection of the so-called “skinny” bill temporarily protects ACA on the Congressional front; however, the Trump Administration has repeatedly threatened ACA from another angle – namely, by withholding key subsidy payments to health insurers that would otherwise help maintain ACA’s stability. These subsidies, or “cost-sharing reduction” (CSR) payments, are intended to cover insurers so that they can provide lowdeductible plans and help reduce out-of-pocket costs for individuals who obtain insurance coverage through ACA’s health exchanges. Without these payments, insurers – already jittery about marketplace stability as a result of proposed ACA changes – say they would have to pursue significant premium increases directly affecting consumers. Throughout this year’s health care debate, HCA and a coalition of several health care provider, labor, and consumer organizations have advocated vigorously with New York’s Congressional Delegation seeking its opposition to Medicaid reductions and other damaging aspects of the ACA repealand-replace efforts in Congress. We continued our efforts this past week with a joint letter to the Delegation, on August 3, urging Congress “to avoid an imminent threat to our State’s individual health insurance market and Basic Health Plan” by seeking Congress’s help to protect the cost-sharing reduction funds. “The[se] payments help those who need it most,” our letter states, including 700,000 low-income New Yorkers earning less than 200 percent of the Federal poverty level (FPL) and approximately 65,000 New Yorkers earning between 200 percent to 250 percent of the FPL who benefit from lower cost-sharing as a result of the CSR payments. “In New York, the Department of Financial Services instructed health plans to develop 2018 premiums under the assumption that CSR subsidies would continue, and plans submitted premiums accordingly with that belief,” our letter states. “If

the CSRs are discontinued and the State is unable to modify rates, it would disrupt the stability of the New York marketplace. That disruption, along with the loss of significant Essential Plan funding, would result in more uninsured New Yorkers, more financial instability for providers and higher costs for all.” The letter (available at http://hca-nys.org/ wp-content/uploads/2017/08/CSR-letter-toNew-York-State-Congressional-Delegation2.pdf) specifically asks Members of Congress to contact U.S. Health and Human Services Secretary Tom Price and the Trump administration to continue the CSR payments and to support legislation that would permanently fund the CSRs. Meanwhile, the U.S. Court of Appeals has ruled against the Trump Administration on one aspect of the CSR matter, by permitting State Attorneys General to defend the subsidy payments in response to a brief led by New York State Attorney General Eric Schneiderman and 15 other attorneys general. The health care debate remains a dynamic one. Following the Senate’s defeat of the ACA repeal, media attention has shined the light on a bipartisan group of lawmakers called the “Problem Solvers Caucus,” led by New York Republican Congressman Tom Reed and New Jersey Democrat Rep. Josh Gottheimer, who have been meeting over the past several weeks to consider compromise measures. It remains to be seen what lay in store for the coming weeks, as ACA opponents and supporters gear up for continued action on health care; HCA will remain steadfast in our work to maintain essential health benefits and Medicaid funds that New Yorkers rely upon for home and community based services.

The Situation Report: the Home Care Association of New York State

Volume 2, No. 29 August 7, 2017 

You’re Invited: Home Care Sepsis Initiative Call-in on Aug. 24 HCA, IPRO to host statewide call-in/check-in for all HCA users of the Adult Sepsis Screening Tool On August 24, from 10:30 to 11:30 a.m., HCA and IPRO are hosting a statewide call-in/check-in for all users of the HCA Adult Sepsis Screening Tool and intervention initiative. (See registration details below.) Please note that this call is substantially for those organizations who have a user-agreement for the Adult Sepsis Screening Tool. If you have not yet signed a user-agreement and would like to do so, please e-mail sepsistool@hcanys.org. HCA launched the Adult Sepsis Screening Tool in late March via user-agreement, and providers continue to sign-up for authorization to use the tool. Providers have also, previously, utilized the HCA tool in conjunction with a U.S. Centers for Medicare and Medicaid Services (CMS) pilot implemented by IPRO in two large regions of the state: central New York and the broader capital area region. HCA and IPRO invite and urge all users to participate in this call-in session! In this session, HCA and IPRO will report to agencies on important statewide progress and developments with this effort, including a preview of the planned data collection and sharing portion of the initiative. (A more detailed presentation will follow). The prime purpose, however, will be the opportunity for all individual agencies to pose questions and exchange experiences, comments, recommendations, ideas and a sense of their findings to date. The call also offers an opportunity to identify further areas of support that you need and that we can be helpful in providing. We will use this information in shaping further steps with the initiative, including new opportunities being developed with the state Department of Health (DOH). HCA and IPRO continue to work with key partners including the National Sepsis Alliance, Rory Staunton Foundation, DOH, the U.S. Centers for Disease Control and Prevention, CMS, the Visiting Nurse Associations of America, and others in this initiative. HCA also continues to explore state, federal and philanthropic funding support for agency, clinician and aide-level training and education. Register for the Call To participate on August 24, please register through the online form at https://www.surveymonkey.com/r/ sepsis-check-in. Using the e-mail address entered into the online form, HCA will provide you with dial-in information in advance of the call. Thank you, and we look forward to and urge all user participation.

The Situation Report: the Home Care Association of New York State

Volume 2, No. 29 August 7, 2017 

Final 2018 Hospice Payment Rule Expected to Increase Payments by $180M

In Memoriam: NAHC President Val Halamandaris

On August 1, the U.S. Centers for Medicare and Medicaid Services (CMS) published in the Federal Register a final rule (CMS-1675-F) updating the Medicare hospice wage index and cap amount for fiscal year (FY) 2018.

HCA is sad to report on the passing of NAHC president, national home care leader, and friend, Val Halamandaris.

HCA’s hospice members can download the FY 2018 final rule at: https://s3.amazonaws.com/publicinspection.federalregister.gov/2017-16294.pdf. As finalized, hospices nationally would see an estimated 1.0 percent ($180 million) increase in Medicare payments for FY 2018. In addition, the rule makes changes to the Hospice Quality Reporting Program (Hospice QRP), including new quality measures utilizing data collected in the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey.

Val has left an indelible mark on the home care field and the national advocacy effort on behalf of America’s elderly and medically needy of all ages and circumstances.

Significant highlights of the final rule are below. Routine Annual Rate Setting Changes Section 411(d) of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) amended Section 1814(i) of the Social Security Act (SSA) to set the market basket percentage increase at 1 percent for hospices in FY 2018. As such, hospices will generally see a 1.0 percent ($180 million aggregate) increase in their payments for FY 2018. The hospice payment system also includes a statutory aggregate cap. The aggregate cap limits the overall payments made to a hospice annually. As mandated by the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act), the cap amount for accounting years that end after September 30, 2016, and before October 1, 2025, must be updated by the hospice payment update percentage, rather than the Consumer Price Index

His life and efforts have benefited citizens across the country, and have led and inspired the home health and broader health community beyond measure. His efforts and message have been felt across many a Congress, Presidents’ Administrations, Cabinets and throughout government. HCA extends our deepest condolences to the Halamandaris family and to the entire NAHC Team. We express our profound appreciation for the many years of Val’s leadership, unwavering advocacy and vision. Further information and a memorial page are at: http://65.207.21.208/.

The Situation Report: the Home Care Association of New York State

Volume 2, No. 29 August 7, 2017 

(CPI). Therefore, the cap amount for FY 2018 will be $28,689.04 (2017 cap amount of $28,404.99 increased by 1 percent). Hospice Quality Reporting Program The rule finalizes eight measures from the CAHPS Hospice Survey data already submitted by hospices. Further, the rule finalizes the extension or exception for quality reporting purposes from 30 calendar days to 90 calendar days after the date that an extraordinary circumstance occurred. The rule describes CMS’s plans to publically display quality measure data via Hospice Compare in August 2017. Additionally, this rule outlines policies and procedures associated with the public reporting of the quality measures used in the hospice program. Hospice CAHPS Experience of Care Survey The Hospice CAHPS Survey is a component of the Hospice Quality Reporting Program. The final rule establishes requirements for the Hospice CAHPS Survey for the FY 2020, FY 2021, and FY 2022 annual payment updates. In addition, the rule adopts two global CAHPS Hospice Survey measures and six composite CAHPS Hospice Survey-based measures, which would be derived from data submitted on the survey. The rule also finalizes how these measures will be calculated based on the survey data. More information about the survey can be obtained at the survey website: www.hospicecahpssurvey.org. Public Reporting CMS will begin public reporting hospice quality reporting program (HQRP) data via a Hospice Compare site in August 2017. While HQRP includes both the Hospice Item Set (HIS) and Hospice CAHPS Survey data, this new website will initially display only HIS data. The public display of the Hospice CAHPS Survey data will be added in winter 2018. In the final rule, CMS has also finalized policies and procedures associated with the public reporting of the quality measures used in the Hospice Program, including release of the aggregate quality data file and the Provider Preview Reports. Quality Measure Concepts under Consideration for Future Years Although CMS did not add new measures based on the Hospice Item Set in this final rule, CMS discussed and received public feedback on the following two measure concepts under consideration for future years:  

Potentially avoidable hospice care transitions; and Access to levels of hospice care.

Both measure concepts would be claims-based measures. These two measure concepts are under development. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

The Situation Report: the Home Care Association of New York State

Volume 2, No. 29 August 7, 2017 

DOH Announces Applications for Workforce Investment Initiative The state Department of Health (DOH) has posted the application process for entities interested in becoming a Long Term Care Workforce Investment Organization. See https://www.health.ny.gov/health_care/medicaid/ redesign/2017/mltc_invest.htm. Up to $245 million is available, through the state’s 1115 waiver amendment, for Workforce Investment Organizations throughout the state to retrain, recruit and retain health care workers in the long-term care sector. Funds are available through March 2020. Under this program, MLTC plans (including Fully Integrated Dual Advantage plans) are to enter into contracts with the DOH-designated workforce training centers to: 

Invest in initiatives to attract, recruit and retain long term care workers in the areas they serve;



Develop plans to address reductions in health disparities by focusing on the placement of long-term care workers in medically underserved communities;



Consistently analyze the changing training and employment needs of the area that the program serves;



Provide for broad participation and input from stakeholders; and



Support the expansion of home care and respite care, enabling those in need of long-term care to remain in their homes and communities and reduce New York’s Medicaid costs associated with longterm care.

Participation is open to all eligible applicants statewide, including: not-for-profits; not-for-profit entities formed by for-profit entities for the purpose of this program; and educational institutions. Submissions are due by 3 p.m. on August 28, 2017 and announcements are expected by September 28, 2017. The broad outlines of this program proposal were introduced to members during a past Quality and Technology Conference, and HCA has been awaiting further details on the overall structure of these Workforce Investment Organizations. Home care workforce challenges have been a prime focus of HCA’s policy and advocacy work, including HCA proposals made during the state budget process seeking a comprehensive approach to recruitment, training and retention. According to DOH, the Workforce Investment Program will be broken into six regions: Central, Hudson Valley, Long Island, North East, New York City, and Western. The application seeks organizations with a range of competencies, including: an ability to reach a diverse population and enlist a large geographic region; sufficient infrastructure to conduct training; capacity to create customized curricula for long-term care workers; the employment of evaluation metrics, data collection methods and outcomes reporting. Continued on next page

The Situation Report: the Home Care Association of New York State

Volume 2, No. 29 August 7, 2017 

Continued from previous page Applicants should also demonstrate an ability to align training with the goals of DSRIP; be able to train multiple types of direct care skillsets and job titles; indicate broad knowledge of the needs of the longterm care delivery system; and be able to incorporate technology to extend the reach of training. Questions should be directed to the Office of Health Insurance Programs, Division of Long Term Care by e-mail at MLTCWorkforce@health.ny.gov.

HCA Co-Sponsors Sept. 13 Webinar to Outline ICD-10 Changes Effective in October eMedny today sent a notice reminding providers that there are approximately 3,392 new ICD-10 codes coming in October 2017 for the 2018 fiscal year. Further information and resources are at https:// www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html. The changes include 360 new codes, 142 code deletions and 226 code title revisions. Chapters where many of the major ICD-10 code changes occur include “Diseases of the Circulatory System” (Chapter 9); “Diseases of skin & subcutaneous tissue” (Chapter 12); “Injury, Poisoning and Certain Other Consequences of External Causes” (Chapter 19). New codes changes will affect case mix categories: Blindness & Low Vision; Neuro 1; Neuro 2; Diabetes; Ortho 2 and Skin 2. On September 13, HCA is hosting a webinar, in conjunction with the Home Care Association of New Hampshire, to identify the coding changes that affect home health and hospice, with a review of changes to case-mix diagnoses, updates and changes to the Coding Guidelines, and case examples to illustrate the new coding changes. Make sure your coding team learns all the intricacies of these changes. Download the flyer and register here: http://hca-nys.org/wp-content/uploads/2017/08/Coding-Update-for-FY2018-WebinarSept_13_2017.pdf.

April Global Cap Report: Medicaid Spending $2M Below Projections The state Department of Health (DOH) has issued its latest monthly Medicaid Global Cap report. The full report is at: https://www.health.ny.gov/health_care/medicaid/regulations/global_cap/monthly/ sfy_2016-2017/docs/apr_2017_report.pdf. Pursuant to legislation, the Medicaid Global Spending Cap has increased from $18.6 billion in fiscal year (FY) 2017 to $19.5 billion in FY 2018, an increase of 5.2 percent. This April 2017 report marks the first report for the new fiscal year. Continued on next page

The Situation Report: the Home Care Association of New York State

Volume 2, No. 29 August 7, 2017 

Continued from previous page It finds that overall spending for this period was $9 million above Medicaid Global Cap projections, across all sectors, a difference of $1.781 billion in actual spending versus $1.772 billion in estimated spending for the period. Specifically, DOH mentions the following two significant pressures on the Global Cap: 

Medicaid spending in major Medicaid Managed Care categories was $3 million over projections.



Medicaid spending in major fee-for-service categories was over projections with nursing home spending $8 million above estimates. This is a result of slightly higher than expected utilization.

As with all other provider or managed care categories, the category “other long term care” (which includes home care, but also other long term care sectors) exceeded its monthly cap, by $3 million, but DOH did not provide any additional explanation for this variance. In other report highlights: 

Total Medicaid Managed Care spending was $2 million over projections, a difference of $1.215 billion (actual spending) versus $1.213 billion (estimated spending).



Total Medicaid enrollment reached 6,119,299 enrollees at the end of April 2017. This reflects a net decrease of 36 enrollees since March 2017.

These reports, particularly the semi-annual and annual reports, are important given the superpowers, recently augmented in the 2017-18 state budget, allowing executive actions to cut rates in the event that spending exceeds the cap. As Washington continues to debate a health care overhaul, with billions of dollars in Medicaid funding and expansion dollars at stake, HCA will advocate for a funding mechanism that sustains vital services, and accurately accounts for reasonable cost factors, such as enrollment changes and wages and related labor costs, in a flexible interpretation of provider performance relative to the cap. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

Hospice Quality Reporting Program: CMS Issues Non-Compliance Letters to Some Hospice Providers The U.S. Centers for Medicare and Medicaid Services (CMS) has recently provided notifications to hospice facilities that were determined to be non-compliant with Hospice Quality Reporting Program (HQRP) requirements for calendar year (CY) 2016, which will affect their fiscal year (FY) 2018 Annual Payment Update (APU). Non-compliance letters were dated and sent both by U.S. mail and via the QIES-Certification and Survey Provider Enhanced Reporting (CASPER) system on July 18, 2017. The CASPER letter also identifies why the provider is non-compliant. Please check your CASPER folder to determine if your hospice received this letter. Continued on next page

Senior and Financial Managerâ€™s Retreat

September 7-8, 2017 Mohonk Mountain House New Paltz, NY

Thanks to our Sponsors!

Thanks to our Exhibitors!

Interested in participating as an exhibitor or sponsor at this event? Contact Billi Wilson at 518-810-0666 or via email at bwilson@hcanys.org 2

September 7-8, 2017 – Mohonk Mountain House, New Paltz, NY

Senior and Financial Manager’s Retreat

Getting Awayfrom it all!

Mohonk Mountain House Rates and Other Information Your combined hotel and event registration rate includes your room, all meals, breaks, valet parking and meeting amenities. A single room rate is $339 per person, per day; double rates are $241 per person, per day; plus local taxes and a 12% administrative fee.

Things to do at the Mohonk Mountain House Activities listed below are at no charge (except where noted) for overnight guests: • Visit the Barn Museum • Take a Row Boat, Paddle Boat, Canoe or Kayak out on the Lake • Play Croquet • Tour the award-winning Gardens & Maze • Explore the Greenhouse • Discover 85 Miles of Hiking (hike to skytop is recommended) • Challenge Colleagues to a game of Horseshoes • Lawn Bowling • Platform Tennis • Rock Scrambles • Shuffleboard • Basketball and Volleyball • 18-hole putting green

All Mohonk reservations should be made by August 5 to receive the HCA conference rate and be guaranteed a room. After this date, higher rates will apply based on availability. To make your room reservation, please call:

800-772-6646 and ask for the HCA rate.

The following are activities available for a fee and advanced reservations are recommended. The Spa at Mohonk Mountain House – Named number one resort spa in the United States by Condé Nast Traveler Magazine!

Not Staying Overnight at Mohonk? Since this is a remote resort in the mountains, and Mohonk wants to also be prepared for those not staying overnight, a “per-day rate” of $105 is charged. This day rate includes lunch, breaks, meeting amenities, and selfparking. Day guests must register with HCA as well in order to access the property. Please include the fee(s) with your HCA registration (page 7).

HCA registered participants receive a 15% discount on spa services and spa retail purchases on Wednesday, September 6 & Thursday, September 7. Make sure to mention that you are with HCA when making your reservation to receive this discount. For Spa information and reservations call 877-781-1590. Golfing: Reservations for Tee Times are required and may be reserved up to 30 days in advance. Call the Pro Shop at 845-256-2154. Horse Back Riding: Contact the Stables at 845-256-2784

Plus: Receive 10% off purchases in the Gift Shop!

Senior and Financial Manager’s Retreat AGENDA Thursday, September 7 The Mountain Lake Conference House 8:30AM Registration Opens 9:00 – 10:00AM Hot Topics in Home Care Finance Roundtable Discussion Panelists: Keith Boroch, Assistant Vice President of Post Acute Consulting, McBee Associates Paul Essner, CFP, CLU, ChFC, Partner, TSG Financial David Birnbaum, Executive Vice President, NY Business Unit, Sandata Technologies Moderated by Patrick Conole, Vice President, Finance & Management, HCA HCA is changing the batting order for this year’s Retreat and opening up with a session that includes three industry experts providing their insights on current and emerging industry trends, challenges and tips for avoiding costly pitfalls and achieving financial success. During this session participants will hear how the 21st Century Cures Act will affect home care providers; narratives of successful partnerships amongst acute and post-acute providers such as home care and hospice; and how congressional actions on ACA will impact the business of running a home health agency. 10:00 – 11:00AM NYS DOH Home Health & Hospice Reimbursement Update Daniel Carmody, Director, Bureau of Managed Long Term Care Rate Setting Michael Ogborn, Deputy Director, Division of Finance and Rate Setting Office of Health Insurance Programs, New York State Department of Health (Invited) Hear from leading reimbursement experts at New York State’s Health Department about various reimbursement policy priorities, including updates to the rates that affect MLTC plans as well as home care providers. Participants will also hear the latest about the state’s plans for upcoming rate adjustments to account for mandatory minimum wage increases throughout the state, FLSA and associated QIVAPP rate adjustments as well as next steps in the move to Value Based Payments. Lastly, participants will learn about possible revisions to the Medicaid Managed Care Operating Reports (MMCORs) and a new provider reconciliation report that coincides with ongoing and future minimum wage rate adjustments. 11:00 – 11:15AM Break

11:15AM – 12:30PM Breakout Sessions

Federal Issues Update on Hospice and Palliative Care

Know Your ‘Stats’ Workshop Conference House

East Dining Room (Main Building)

Michael Freytag, Managing Director, BlackTree Healthcare Consulting

Katie Wehri, CHPC, Director of Operations Consulting, Healthcare Provider Solutions

In this session, participants will learn how to view their agency data by accessing CMS and other useful sites. The speaker will also discuss the importance of using this data to create benchmarks that, when tracked, can drastically improve financial and clinical outcomes. This session will also focus on common obstacles encountered while determining these benchmarks, and we will spend time focusing on how to overcome these obstacles by discussing the role technology plays in your current operations.

Hear from one of the nation’s most valued federal hospice and palliative care experts about the provisions and details of the federal hospice payment rule, with a particular focus on federal hospice compliance, regulatory and reimbursement changes and proposals as well as new opportunity areas in the Medicare program for hospice programs.

September 7 – 8, 2017 – Mohonk Mountain House, New Paltz, NY

AGENDA Thursday, September 7 – continued The Mountain Lake Conference House 12:30–1:45PM Network with Your Peers over Lunch in the Main Dining Room 1:45 – 3:00PM Building Contracts and Arrangements to Succeed in a Managed Care and VBP Environment Nancy Sever, Principal, Hinman Straub Meghan McNamara Principal, Hinman Straub This session will offer technical essentials and program assistance to home care providers and plans for contractual arrangements that will enable home care and plans to effectively partner in the mandated environment of managed care and VBP. 3:00 – 5:00PM It’s Time to Relax and Recharge! In an environment of constant change and stresses, home care leaders need time to recharge in order to maximize performance and focus. This is why we’ve carved-out time for attendees to participate in leisure activities of their choice at our conference location, which is one of the most beautiful mountain retreat settings in the Northeast! Use this time to visit the exceptional Mohonk Mountain House Spa, hike the beautiful grounds, kayak on the pristine lake, check out the renowned golf course, or just relax on one of the many porches and outdoor venues offering a scenic view. 5:00–6:15PM Networking Reception – The Porch HCA is hosting a cocktail reception on the beautiful porch of the Mohonk Mountain House. Join us for a cocktail, and chat with staff and colleagues. 6:30PM Dinner – Main Dining Room Enjoy one of the most sumptuous dinners in the Hudson Valley! The Mohonk Dining Room is famous for its array of delicious menu offerings using local “farm-to-table” ingredients that will satisfy every palate. PLEASE NOTE: Dinner service at The Mohonk is by reservation only. HCA’s group dinner reservation is for 6:30 p.m.; all participants must arrive at the dining room at that time.

Senior and Financial Manager’s Retreat AGENDA Friday, September 8 The Mountain Lake Conference House 7:30–8:30AM HCA’s Data Workgroup Breakfast (invitation only) 7:30–8:30AM Breakfast – Main Dining Room 8:30–9:30AM HCA Overview of Policy Priorities that Impact Your Bottom Line HCA’s Policy and Executive Team Learn what your association is doing to support the financial stability of New York’s home care provider community. This session will discuss the top-tier federal and state policy initiatives affecting providers, reinforcing the engaging and informative dialogue throughout the Retreat on your most pressing financial problems, your questions, and your biggest organizational challenges. 9:30–10:45AM Federal Update on Regulatory and Reimbursement Issues Colin Roskey, Principal, Lincoln Policy Group and Partner at Scully, Roskey & Missmar 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. We are delighted that he is available to provide an overview of the national healthcare landscape as well as provide highlights of key components of the proposed CY 2018 home health prospective payment system (PPS) and FY 2018 Hospice final rule. Mr. Roskey will also present on other regulatory items percolating at the federal level including opportunities to revise the current face-to-face regulations and the upcoming home health Conditions of Participation. 10:45–11:00M

Break

11:00AM–12:15PM Building Better MLTC-Provider Relationships Panelists TBA Panel Moderator: Al Cardillo, Executive Vice President, HCA Effective partnership is vital to the success of MLTC and home care contractual relationships. During this session, participants will hear from two MLTC-home care contractual partnerships (one upstate and the other downstate) that have worked well and benefited both entities. Participants will hear firsthand from panelists on how the plan-provider partnerships can be successful, along with an opportunity to ask questions and have an open discussion with the moderator and panelists. 12:15PM Adjourn and Lunch-To-Go A box lunch will be provided for you to enjoy at the resort or as you head for home.

Senior and Financial Manager’s Retreat September 7-8, 2017 Mohonk Mountain House New Paltz, NY The registration fee includes two days of expert speakers and handout materials, plus breaks, a reception and lunch on the final day that is not included with your overnight room package. Mohonk Resort rooms/meals are additional – see page 3 for details.

HCA Cancellation

REGISTRANT INFORMATION – Please register by August 25

Policy

Name: ______________________________________________________________________________________ Title:_________________________________________________________________________________________ Agency:_____________________________________________________________________________________ Address:_____________________________________________________________________________________ City/State/Zip:_______________________________________________________________________________ Phone:________________________________ Ext._________ Fax: ____________________________________ Email: _______________________________________________________________________________________ (Required)

HCA REGISTRATION FEE ____ Member Provider

 $299

____ Associate Member/Vendor

 $399

____ Non-Member Provider

 $399

____ Non-Member Vendor

 $599

HCA registration cancellations received by August 24 are refundable less a 25% administrative fee. No refunds will be issued after this date. Cancellations must be received in writing at info@hcanys.org. Substitutions are permitted. Please note Mohonk’s cancellation policy when making your reservation.

MOHONK “DAY ONLY” RESORT FEE ____ I will not require overnight accommodations, but will require a Mohonk “Per-Day Only” pass at $105 per day.

Total: $_________ PAYMENT – Please check method of payment: ________MasterCard

_______VISA

______American Express

______Check*

*Make checks payable to: HCA Education and Research and mail to 388 Broadway, 4th Floor, Albany, NY 12207. Checks must be received by August 31. ____________________________________________________________________________________________ Card Number ____________________________________________________________________________________________ Expiration Date Security Code ____________________________________________________________________________________________ Mailing Address of Card Holder ____________________________________________________________________________________________ City, State, Zip ____________________________________________________________________________________________ Name on Card ____________________________________________________________________________________________ Authorized Signature

FAX this form to 518-426-8788 or register online at www.eventville.com/hcanys 7

Special Needs In accordance with the Americans with Disabilities Act, or special dietary needs, please let us know how we can accommodate you: ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________

388 Broadway Fourth Floor Albany, New York 12207

Senior and Financial Managerâ€™s Retreat

September 7-8, 2017 Mohonk Mountain House New Paltz, NY

TO:

The Situation Report: the Home Care Association of New York State

Volume 2, No. 29 August 7, 2017 

Continued from previous page Any hospice determined to be non-compliant with the HQRP requirements may be subject to a two percentage point reduction in their APU. For example, CY 2016 data affects FY 2018 payment. Every hospice that is non-compliant with their HQRP requirements receives notification on July 18, 2017 so it is clear that the 30-day period starts on July 18, 2017 and ends on August 17, 2017 for sending in reconsideration requests to CMS. Hospices that receive a letter of non-compliance may submit a request for reconsideration to CMS via email no later than August 17, 2017. Failure to submit a request for reconsideration by the deadline means you accept that your hospice is non-compliant with HQRP requirements. If you receive a notice of non-compliance and would like to request a reconsideration, see the instructions in your notification letter and on the Hospice Reconsideration Requests webpage at: https://www.cms.gov/ Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/ReconsiderationRequests.html. For further information, contact HCA’s Patrick Conole at (518) 810-0661 or at pconole@hcanys.org.

U.S. Department of Labor to publish RFI on Overtime Rule The U.S. Department of Labor (DOL) recently announced that it will publish a Request for Information (RFI): “Defining and Delimiting the Exemptions for Executive, Administrative, Professional, Outside Sales and Computer Employees.” The RFI offers the public the opportunity to provide information that will aid the Department in formulating a proposal to revise these regulations. The RFI solicits feedback on questions related to the salary level test, the duties test, inclusion of nondiscretionary bonuses and incentive payments to satisfy a portion of the salary level, the salary test for highly compensated employees, and automatic updating of the salary level tests. The 60-day comment period for all issues raised in the RFI ends on September 25, 2017. The public may submit comments according to the instructions listed in the RFI as published in the Federal Register.