Nov. 14, 2016 Edition of The Situation Report

HOME CARE MONTH

CFO CALL

FIDA

What do last week’s election results mean for health care, and home care specifically?

Read the next installment of our Home Care Month stories about a nurse who helped her patient leave an unsafe home situation.

HCA has scheduled the first in a series of regular conference calls for CFOs and Finance Managers. Call No. 1: HHPPS Rule!

The state is extending the FIDA program through 2019. Learn about its plan and other managed care updates.

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ELECTION

COMING UP HCA Quality & Technology Symposium Nov. 16-17, 2016 Embassy Suites by Hilton Saratoga Springs 86 Congress St. Saratoga Springs, New York 12866 Bootcamp: Successfully Acting as a Fiscal Intermediary in the Consumer Directed Personal Assistance Program Dec. 1, 2016 Visiting Nurse Service of New York 107 East 70th Street (between Park and Lexington Ave) New York, NY 10021 9:30 to 10 a.m.

(Registration and continental breakfast) 10 a.m. to noon program

Your Source for HOME CARE News, Policy and Advocacy

Vol. 1, Issue 10 | November 14, 2016

DOH Extends Time for Minimum Wage Contract Amendments as Questions Raised on Distribution HCA was expected to meet today with the state Department of Health (DOH) and other stakeholders to discuss funding and other issues related to the minimum wage increase in New York City that is effective on December 31, 2016. However, that meeting has since been cancelled and we are awaiting a new date. In preparation for the meeting, HCA continued our outreach to home care members to learn what they are being told by their MLTC plan contractors about the status of their rates for 2017.

See WAGE p. 2

Political Landscape Uncertain for Health Care, Home Care after Shock-Wave Election Last week’s big political news, of course, was the election of Donald J. Trump as President of the United States, though it will take time to assess the ripple effect of this major shift in the political landscape for health care – and, even more so, for the very specific issues and needs of home care.

INSIDE Minimum Wage Update.....................................................................................1 Political Landscape Uncertain for Health Care, Home Care after Election.............1 This Week’s Home Care Month Story...................................................................4 Last Call for HCA Conference on Quality & Clinical Topics This Week.....................5 Nov. 22 HCA Call to Discuss 2017 HHPPS Rule.......................................................5 NGS Update on Hospice Claims Issue Re: New FY 2017 CBSA Codes........................6 FIDA Extended Through December 31, 2019, and Other Managed Care Updates...7 DSRIP Update.....................................................................................................8 Unique Dec. 15 Program on VBP Readiness Offers Tangible Insights......................9

See ELECTION p. 3

OIG Releases 2017 Work Plan...................................................................10 Important Upcoming Deadlines.................................................................11 PHHPC Establishment and Project Review Committee Agenda Posted........12 2017 Application and Revalidation Fee Announced....................................12 Next CMS Home Health, Hospice & DME Open Door Forum: November 16.....13 2017 Outpatient Therapy Cap Amounts Announced...................................13 CMS Issues RFI on Home and Community Based Services.........................13 CMS Posts New Hospice Q&A Document...................................................14 2017 Medicare Levels Announced.............................................................14 New SSI Levels Posted.............................................................................15 Resources.............................................................................................................15

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

WAGE from p. 1 At last week’s Managed Care Policy and Planning meeting, in which HCA participated in (see related p. 7 story), there was significant discussion about how much of the $1.33 supplement targeted for the minimum wage increase must be passed on to home care providers, and if plans can reduce their rates with providers prior to passing on the $1.33.

While no final decisions were made on these issues, DOH indicated support for plans being allowed to reduce their rates if the rates were currently at a certain to-be-determined level as part of their “negotiations” with home care contractors prior to passing on the $1.33. HCA argued that this is contrary to stakeholder discussions with DOH, as well as DOH’s October 28 guidelines, and we will continue to advocate strongly against this position.

Plans have said, in some cases, that they cannot send contract amendments to their home care contractors by the November 15 deadline until the above issues are resolved, so DOH told plans that it will delay the November 15 deadline for amendments and will issue additional guidance.

Meanwhile, we have heard from our home care members that many still have not been contacted by their plan contractors, while some plans have indicated that they will pass on the $1.33 per hour increase and others plan to pass through less than $1.33. Still other plans, meanwhile, have expressed an intention to reduce rates and add the minimum wage adjustment on top of the reduced rate, and HCA has already brought this issue to DOH’s attention.

HCA continues to urge both providers and MLTC plans to report on the experiences they are having with implementation of the wage adjustment. You can send such information to Andrew Koski at akoski@hcanys.org.

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

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Volume 1, No. 10 November 14, 2016 

The Situation Report is a weekly publication of the Home Care Association of New York State (HCA). Unless otherwise noted, all articles appearing in The Situation Report are the property of the Home Care Association of New York State. Reuse of any content within this newsletter requires permission from HCA. Joanne Cunningham HCA President jcunningham@hcanys.org Roger L. Noyes Director of Communications, Editor of The Situation Report rnoyes@hcanys.org Al Cardillo Executive V ice President, Policy & Programs acardillo@hcanys.org Patrick Conole Vice President, Finance & Management pconole@hcanys.org Andrew Koski Vice President, Program, Policy & Services akoski@hcanys.org Alexandra Fitz Blais Director of Public Policy ablais@hcanys.org Laura Constable Senior Director, Membership & Operations lconstable@hcanys.org Celisia Street Director of Education cstreet@hcanys.org Mercedes Teague Finance Manager mteague@hcanys.org Jenny Kerbein Director of Governance & Special Projects jkerbein@hcanys.org Billi Wilson Manager, Meetings & Events bwilson@hcanys.org Teresa Brown Administrative Assistant tbrown@hcanys.org

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

Volume 1, No. 10 November 14, 2016 

ELECTION from p. 1 In broad terms, the President-elect has vowed repeatedly throughout his campaign to repeal the Affordable Care Act, though it is also unknown the extent to which this would be ventured or how politically feasible. Given that the Republican-controlled House of Representatives has repeatedly voted over the past few years to fully repeal the ACA, it may be likely that a full repeal will be attempted.

Other possible, sweeping changes for health care policy include a move to block-grant the Medicaid program, which has been proposed by GOP officials in the past but may now have more legs considering that both houses of Congress and the Presidency were won by the Republican column this election cycle. Under block-grants, states would receive a lump sum of federal money for Medicaid – rather than the current open-ended entitlement controlled by states and matched by federal dollars.

This would be an enormous change to the Medicaid program, and a significant target of HCA advocacy with partners across the health care continuum. In addition, past Medicare reforms proposed by Republicans may gain new traction in 2017 and we will await specific proposals and will report on their expected impact on consumers and providers. Some of these past Medicare reforms promoted by the Republican health leaders have been: raising the Medicare age of eligibility; phasing out Medicare feefor-service; and instituting a “premium support” model that provides Medicare beneficiaries with a lump sum to be used for health care services.

As far as specific Congressional results, the GOP maintained control of majorities in each house, with a Senate majority of 51 to 48, and a House majority of 241 to 194, according to the estimates known at this time. New York’s senior U.S. Senator, Charles Schumer, won reelection, which puts him in line as a likely choice for Senate Minority Leader, an influential post for New York, in light of the fact that the Senate remains closely divided and Republicans did not exceed a filibuster-free majority. This close margin provides some latitude for parliamentary procedures that the Senate minority and its leadership may use to stall, block or apply leverage on certain measures.

As we have reported in recent weeks, Senator Schumer has expressed strong support for legislation (S.578/H.R.1342) to allow non-physician practitioners to order and refer Medicare home health services, with signs suggesting that the Senator had considered including this measure as a priority in the postelection session of Congress. That prospect is incredibly uncertain at this point, given the shock waves of last week’s election, though HCA will continue our close work with Senator Schumer’s office on priorities like: S.578/H.R.1342; reform of the Medicare face-to-face rule; reimbursement policy; and other federal issues.

Here in Albany, it appears that the state Senate remains in Republican hands, though the margin is very close, with a one-seat difference. (The Assembly has held onto its sizeable Democratic majority, as forecasted.) We have witnessed a similar balance of power in past election cycles, and it remains to be seen how the close margin in the Senate will play out in terms of the Senate’s legislative agenda and voting pattern. This depends especially on the Independent Democratic Conference (IDC), a breakaway group of Democrats that has shared power in the past with the GOP majority, and how the IDC will align its bloc across the lines of margin.

HCA will work to align our advocacy strategy responsively with the current political environment through our legislative affairs representatives and other contacts in state and federal government. We will keep you closely apprised of all significant developments in this area.

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Volume 1, No. 10 November 14, 2016 

This Week’s Home Care Month Story: Nurse Identifies and Assists Patient with Significant Home and Personal Safety Challenge Home care nurses, aides and other home care staff often perform good works that go well beyond the core of their training.

Carla Rhodes, of Rochester-based UR Medicine Home Care, was recently the primary nurse on a case with ongoing social concerns. She made all the patient visits herself, regularly updating all staff regarding the patient’s status and concerns. A team player, Ms. Rhodes enlisted the help of social work and adult protective services (APS) to deal with verbal, financial and other concerns in the patient’s home.

During a co-visit, when the patient told Rhodes she needed to leave the home because the patient didn’t feel safe, Ms. Rhodes managed to communicate options with the patient, to contact the social worker, APS, and security while remaining in the home even as the social situation worsened. “She demonstrated calmness and resourcefulness while safely communicating with the patient and others,” says her agency, UR Medicine Home Care.

Rhodes

Ms. Rhodes spent two hours in the patient’s home, and another half hour in a nearby parking lot arranging for the patient’s safe exit from the home. “The time in the parking lot showed a fellow coworker that Carla was anxious and frightened about safety concerns, but you never would have known that she was anxious while in the home,” her agency says.

“Carla routinely exceeds standards of care in her compassion, reliability and communication, but her recent performance assisting a patient dealing with safety issues was Academy Award worthy, and we are eternally grateful that she was in the home to help in a volatile situation,” says UR Home Care. “Carla is an outstanding, compassionate nurse who views every patient holistically, and who went above and beyond expectations to secure the safety of this patient.”

As a result of her efforts, the patient was able to not only receive the proper care, but also be placed in a safer living situation.

During National Home Care Month in November, HCA is recognizing the work of home care providers and staff to serve the community, including exceptional work to support the social, environmental and safety needs of vulnerable patients, as demonstrated by Carla Rhodes’ heroic work. To read more of these stories, please visit our National Home Care Month website at www.nationalhomecaremonth.com.

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

Volume 1, No. 10 November 14, 2016 

Last Call for HCA’s Signature Conference on Quality & Clinical Topics This Week We know that you take quality of care, outcomes and all clinical matters very seriously. This Wednesday and Thursday is HCA’s only signature conference of the year exclusively directed at these areas of focus, which matter most to you.

If you are a clinical manager, supervisor, quality improvement professional or have responsibility for quality assurance and clinical functions at your organization, our Quality and Technology Symposium is designed expressly for you. Please don’t miss it. There is still time to register before Wednesday.

“Quality” is the first word in the conference title, but it is also the entire focus of the program. We’ve got insightful, priority clinical topics covered, such as population health, health literacy, sepsis prevention, care for targeted populations, perspectives from the state’s quality-of-care program officials, and a hands-on workshop for developing a Quality Assurance & Performance Improvement (QAPI) plan. But also, the technology components of this program are entirely framed from the quality perspective, revealing tools to help you improve outcomes and achieve higher levels of patient satisfaction.

Please don’t miss this singular opportunity to get education and perspectives geared expressly for the quality imperative in home care, which will benefit your organization as a whole in an evolving, outcomes-based health care environment. 

Download the conference brochure: http://hca-nys.org/wp-content/uploads/2016/10/HCA-Quality-andTechnology-Symposium-Brochure-2016.pdf

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Register online: https://www.eventville.com/Catalog/EventRegistration1.asp?EventId=1012037

Nov. 22 HCA Call to Discuss 2017 HHPPS Rule Call is part of a new series addressed to finance leaders As announced in an alert last week, HCA is holding the first in a series of free member conference calls with financial managers on November 22 (from 10 to 11 a.m.) to brief you and maintain a dialogue about the latest reimbursement and finance issues. Our first call will focus squarely on the recently finalized 2017 Medicare Home Health Prospective Payment System rule.

HCA has already provided you with a memo on the rule (http://hca-nys.org/wp-content/uploads/2016/11/ CMS2017FinalHHPPSRuleMemo.pdf) and we recommend that you read it in advance of the call to prepare any questions.

This new series of calls will be held quarterly or every other month. They will be led by HCA’s Vice President for Finance and Management Patrick Conole and are a byproduct of our efforts with a select workgroup of finance managers who have deliberated with HCA’s Policy team on reimbursement issues and policies.

These calls are open to all HCA members and are directed toward CFOs, Financial Managers, CEOs or COOs, and any other executive staff closely involved in finance or payment issues at your organization. Each call will

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seek to address recent or developing finance issues, but we will also open up the phone lines for a two-way exchange of ideas, questions or concerns.

To register for the first of these calls, on November 22, please complete the online form at: https:// www.surveymonkey.com/r/financecall1. HCA will then use the email address entered on the form to send you dial-in instructions in advance of the call. If you have any questions, please contact Patrick Conole at pconole@hcanys.org.

NGS Update on Hospice Claims Issue Re: New FY 2017 CBSA Codes In the October 31 edition of The Situation Report (http://hca-nys.org/wp-content/uploads/2016/10/ SitRep103116.pdf), HCA described reports from some hospice provider members that claims submitted on or after October 1, 2016 with updated Fiscal Year (FY) 2017 Core Based Statistical Area (CBSA) codes have not been paid. These claims have been returned back to the provider (RTP’d).

While this issue does not affect all hospice claims submitted with FY 2017 rates, it does impact CBSA codes that were updated for FY 2017, after transitioning from the special 50xxx codes used in FY 2016.

Some hospice providers in the New York City have been specifically affected.

HCA immediately contacted National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC) for home health and hospice, to look into the matter and resolve it as quickly as possible.

The claims in question are with a date of service on and after October 1, 2016 with a correct CBSA code (as per the FY 2017 Hospice Wage Index listing).

The claims are incorrectly returning to providers with reason code 36458, which states: “Hospice claim with a CBSA code in the 50XXX-99900 range is present on the claim and the date of service is October 1, 2016 or after. CBSAs in the 50XXX range are invalid for dates of service October 1, 2016 and after.

Standard CBSA code should be billed.”

NGS reported that it “will be updating the Medicare system to allow claims with reason code 36458 with the correct CBSA code (per the FY2017 Hospice Wage Index list) to process as of November 10, 2016. Providers may begin to resubmit these claims for processing and any subsequent claims that were held starting on November 10, 2016.”

The production alerts on the NGS website will be updated shortly and a listserv message will be sent to all hospice providers.

For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

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Volume 1, No. 10 November 14, 2016 

FIDA Extended Through December 31, 2019, and Other Managed Care Updates This week, the state Department of Health (DOH) announced a final decision with the U.S. Centers for Medicare and Medicaid Services (CMS) to extend the FIDA Demonstration through December 31, 2019.

FIDA, or Fully Integrated Duals Advantage, was originally approved to run from January 1, 2015 through December 31, 2017. Last year, CMS offered states an opportunity to extend their demonstrations through December 2019. Having previously submitted a non-binding letter of intent to do so, DOH has now formally accepted the opportunity from CMS and has officially committed to the two-year extension.

“Although we are approaching the end of the second demonstration year, we are still early on in terms of understanding the impact of FIDA, particularly following the updates made last winter,” says DOH in its Dear Colleague letter. “The two-year extension will allow DOH and CMS to maximize our experience with fully integrated care and assess the demonstration’s impact on quality and cost while engaging stakeholders in planning for the future.”

DOH adds: “We appreciate the engagement of stakeholders in developing and implementing FIDA, and we remain committed to improving care for dual eligibles in New York State as we move ahead. Pending final review of the Medicare provider networks, we anticipate rolling out FIDA to Region 2 (Suffolk and Westchester) in 2017. More information about this will be forthcoming in the weeks ahead.”

FIDA Plan Withdrawals At about the same time that DOH announced it was extending the timeframe for FIDA, three FIDA plans have decided to close as of January 1, 2017, affecting about 280 individuals. The program has been marked by low enrollment, as shown in figures reported by DOH (see later in this article).

Those plans exiting FIDA are: AlphaCare; WellCare; and CenterLight.

Enrollees should receive a “60-day” and a “30-day” notice that explains the change and their options.

Individuals who do not actively choose another FIDA or partial cap MLTC plan will be auto-enrolled into one of the other 14 FIDA plans.

There are currently seventeen FIDA plans; enrollment was 5,077 as of October. A list of plans is at https:// www.health.ny.gov/health_care/medicaid/redesign/fida/2016-07-06_fida_trends.htm.

CMS guidance for FIDA plans that are not renewing their contracts is at http://www.wnylc.com/health/download/616/.

Other managed care updates The following additional managed care updates were reported at DOH’s November 10 Managed Care Policy and Planning meeting: 

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MLTC enrollment (as of October) includes: 182,301 for all MLTC plans; 164,781 for partial capitated plans; 6,318 in Medicaid Advantage plans; 5,749 in Programs of All-Inclusive Care for the Elderly

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(PACE); 5,077 in FIDA plans; and 376 in FIDA for individuals with intellectual and developmental disabilities (FIDA-IDD). 

The Conflict-Free Evaluation and Enrollment Center continues to receive a large number of calls per day (1,074) and has conducted a total of 113,016 evaluations determining that 97 percent are eligible for MLTC enrollment.

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The next meeting of the Nursing Home Transition Diversion/Traumatic Brain Injury waivers workgroup on the transition to managed care will be on November 16; for more information, contact waivertransition@health.ny.gov.

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In 2017, DOH will launch a stakeholder process for planning the future of integrated care in New York after FIDA ends; the process will include evaluating how and whether to consolidate or maintain existing integrated products.

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As part of a large FIDA advertising campaign, letters have been sent to over 6,000 providers encouraging them to take another look at FIDA and letters have started to be sent to former opt-out and new eligibles (since December 2014) to educate them about the program.

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New York is adding Community First Choice Option (CFCO) services to the Medicaid Managed Care (MMC) and MLTC benefit packages effective April 1, 2017; a 60-day announcement with the April 2017 effective date was issued to plans.

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A supplement to the member handbook and template member letter on CFCO has been finalized; strategies and a timeline for issuance are being formulated.

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A guidance document for plans is in the final clearance process to provide details on the carve-in of CFCO services, including: social transportation; vehicle and environmental modification; and moving assistance.

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An implementation webinar scheduled for January 5, 2017 will provide information on how to operationalize CFCO services and supports.

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New notice requirements, applicable to managed care plans, include a non-discrimination statement and taglines that inform the consumer that assistance is available in languages other than English.

For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.

DSRIP Update The current timelines for the Mid-Point Assessment under the Delivery System Reform Incentive Payment (DSRIP) program have been revised.

It was initially anticipated that the Independent Assessor’s (IA) initial recommendations for (Performing Provider System (PPS) review would be completed on November 10 and released to the public on November 17.

Continued on next page

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Continued from previous page In developing the initial recommendations, the IA has requested additional time to review and analyze the significant amount of data available to them as part of this process. Given the importance of the Mid-Point Assessment to the overall DSRIP program, the state Department of Health (DOH) has agreed to modify the schedule for the Mid-Point Assessment as outlined in the table below.

Original

Revised

IA Recommendations released for PPS review

11/10/2016

11/28/2016

IA Recommendations released for Public Comment

11/17/2016

11/29/2016

PPS response and public comment period ends

12/10/2016

12/21/2016

MidͲPoint Assessment revised recommendations released for 2nd public comment period

12/23/2016

1/2/2017

MidͲPoint Assessment 2nd public comment period ends

1/23/2016

1/23/2017

PAOP convenes to review MidͲPoint Assessment recommendations (includes 1 day of public comment)

1/31/2017

1/31/2017

The revised timeline still allows for two public comment periods on the Mid-Point Assessment recommendations and for the Project Approval and Oversight Panel (PAOP) to convene as scheduled on January 31, 2017.

For questions regarding the Mid-Point Assessment, contact dsrip@health.ny.gov.

Unique Dec. 15 Program on VBP Readiness Offers Tangible Insights for Home Care As you know, Medicare and Medicaid policymakers are moving aggressively and deliberately toward valuebased payment (VBP) systems. To succeed and gain rewards under VBP, you must understand your data, prepare your staff, know your value-proposition and position your agency wisely to mitigate risk and avoid cost liability. You will gain all of these insights and more on December 15 during our newly announced conference on VBP Readiness and Success.

Download the brochure now at http://hca-nys.org/wp-content/uploads/2016/11/VBP-Readiness-and-SuccessBrochure-Dec-15-2016.pdf.

This program will delve into: VBP operational readiness for home care; VBP workforce investment opportunities for home care; VBP insights from managed care payors; VBP-focused data assessment; as well as other tools and inside knowledge to help you position your organization for VBP. Continued on next page

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Continued from previous page

Medicare Hospice

Please register today for this one-day, in-depth learning opportunity coming to you on December 15 in Tarrytown.

Medicare requires that a registered nurse make an onsite visit to the patient’s home at least once every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient’s need. OIG will determine whether RNs made required on-site visits to the homes of Medicare beneficiaries who were in hospice care.

You can’t afford to miss learning more about this priority topic that is the predominant focus of New York health care policymaking and payment.

Download the brochure: http://hca-nys.org/wpcontent/uploads/2016/11/VBP-Readiness-andSuccess-Brochure-Dec-15-2016.pdf Register online: https://www.eventville.com/ Catalog/EventRegistration1.asp?EventId=1012048

OIG Releases 2017 Work Plan The U.S. Office of Inspector General (OIG) has released its 2017 Work Plan at https:// oig.hhs.gov/reports-and-publications/archives/ workplan/2017/ HHS%20OIG%20Work%20Plan%202017.pdf.

The Work Plan summarizes new and ongoing reviews and activities that OIG plans to pursue, including audits, evaluations, and certain legal and investigative initiatives. This edition also forecasts areas of anticipated OIG planning and new work areas.

In fiscal year (FY) 2017 and beyond, OIG will expand its focus on delivery system reform, alternate payment models, coordinated care programs, and value-based purchasing.

Future planning efforts for FY 2017 and beyond will also include: additional oversight of hospice care, including review of hospice medical records and billing documentation to determine whether Medicare payments for hospice services were made in accordance with Medicare requirements.

Medicare Home Health Under its Work Plan, OIG will determine: whether home health agencies are accurately providing patient information to state agencies for recertification surveys, as well as compliance with various aspects of the home health prospective payment system (HHPPS), including documentation required for claims paid by Medicare.

Medicaid Home Health Services and Other Community-Based Care OIG activities for Medicaid home health include: 

A planned data brief on fraud in Medicaid personal care services and recommendations for improving program oversight.

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Examination of Medicaid payments by states for adult day care services to determine whether providers complied with federal and state requirements.

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Determining the extent to which selected states made use of Medicaid waivers and if costs associated with the waivers are efficient, economical, and do not inflate federal costs.

OIG will also analyze the U.S. Centers for Medicare and Medicaid Services’ (CMS) oversight of state Medicaid waivers.

Medicaid Managed Care For Medicaid managed care, OIG will:

The following (next column) is a summary of the focus areas within hospice, home health and Medicaid managed care.

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Determine whether the federal share of recoveries are returned to the federal

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

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payments made to MCOs are within the limits set forth in federal regulation.

government in the case of Medicaid managed care payments that states receive through profit-limiting methodologies. 

Volume 1, No. 10 November 14, 2016

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Examine states’ reimbursements to determine whether managed care organizations (MCOs) are appropriately and correctly reimbursed for services provided and to ensure that the data used to set rates are reliable and include only costs for services covered under the state plan.

Determine whether Medicaid MCOs identified and addressed incidents of potential fraud and also describe how states oversee MCOs’ efforts to identify and address fraud and abuse.

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Review states’ reimbursements made to MLTC plans to determine whether those reimbursements complied with certain federal and state requirements.

As HCA has stressed during recent meetings of our Compliance Symposium and in other venues, the OIG Work Plan is an important roadmap for home care providers and plans to conduct internal assessments of their compliance with payment and regulatory issues.

Providers and plans are urged to flag these specific target areas as part of their ongoing compliance assessment activities, as the OIG Work Plan identifies those areas of greatest risk or audit focus.

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Verify that payments made under a risksharing mechanism and incentive

For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

Important Upcoming Deadlines

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Requirement

Effective/ Due Date

Increase in “white collar” exemption thresholds to $47,476 per year ($913 per week)

Dec. 1, 2016

https://www.dol.gov/WHD/overtime/final2016/

Home Care Worker Wage Parity certification forms, covering December 1, 2016 to February 28, 2017, for LHCSAs and other entities that contract with Managed Care Organizations (MCOs), CHHAs and/or LTHHCPs serving New York City, Long Island and Westchester

Dec. 1, 2016

http://www.health.ny.gov/health_care/medicaid/redesign/mrt_61.htm

2015 CHHA/LTHHCP Statistical Report

Dec. 30, 2016

https://commerce.health.state.ny.us/public/hcs_login.html

2015 Hospice Cost and Utilization Report

Dec. 30, 2016

https://commerce.health.state.ny.us/public/hcs_login.html

State and federal compliance program certification forms

Dec. 31, 2016

https://www.omig.ny.gov/compliance/certification

Minimum Wage Increases to: $11 for New York City; $10 for Long Island and Westchester; and $9.70 for rest of the state

Dec. 31, 2016

http://www.labor.ny.gov/legal/laws/pdf/minimum wage/19a amended rule.pdf

Healthcare Personnel Influenza Vaccination Report for personnel employed from October 1, 2016 to March 31, 2017

May 1, 2017

http://hca nys.org/wp content/uploads/2016/10/ctrlaccamstmpNotification_21226.pdf

More Information

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Volume 1, No. 10 November 14, 2016 

PHHPC Establishment and Project Review Committee Agenda Posted The state Department of Health (DOH) has posted the agenda for the November 17 Public Health and Health Planning Council (PHHPC) Establishment and Project Review Committee.

The agenda, along with supporting documents, is at http://www.health.ny.gov/facilities/ public_health_and_health_planning_council/meetings/2016-11-17/.

The agenda includes applications by: 

One CHHA to acquire and merge another CHHA.



One hospice to open a 12-bed hospice inpatient unit (in Nassau) and another hospice to convert two dedicated inpatient-only beds to two residence beds, resulting in a final hospice residence bed count of ten (in Rockland).

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Three entities to establish LHCSAs associated with Assisted Living Programs (ALPs), to serve: Monroe; Northeast counties (12); and Western counties (nine).

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Eleven LHCSAs for changes of ownership.

The November 17 meeting will be held in New York City; it will also be webcast at http://www.health.ny.gov/events/webcasts/.

For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.

2017 Application and Revalidation Fee Announced The U.S. Centers for Medicare and Medicaid Services (CMS) has announced the application fee for home care agency enrollment, revalidation or establishment of a new practice location in Medicaid or Medicare. The fee will be $560 in 2017, up from $554 in 2016.

Providers are required to pay two separate fees for revalidation in Medicare and Medicaid. However, if they are revalidating for both programs in the same year, then they only have to pay one fee. Providers can also apply for a “hardship” waiver for the fee.

Information on Medicare revalidation is at https://www.cms.gov/Medicare/Provider-Enrollment-andCertification/MedicareProviderSupEnroll/Revalidations.html.

Medicaid revalidation information is at https://www.emedny.org/info/ProviderEnrollment/revalidation/ index.aspx.

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

Volume 1, No. 10 November 14, 2016 

Next CMS Home Health, Hospice & DME Open Door Forum: November 16 The U.S. Centers for Medicare and Medicaid Services (CMS) will host its next Home Health, Hospice and Durable Medical Equipment (DME) Open Door Forum on Wednesday, November 16 from 2 to 3 p.m.

It will cover the Home Health Prospective Payment System (HHPPS) final rule; home health and hospice PEPPER (Program for Evaluating Payment Patterns Electronic Report); Round 1 of the 2017 contract suppliers for Medicare’s durable medical equipment Competitive Bidding Program; the Hospice Quality Reporting Program; announcements related to home health and hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS); and Change Request (CR) 9585.

The call in number and passcode for the call is: 1-800-837-1935; conference ID: 44695683.

CMS recommends calling in at least 15 minutes prior to the start time.

2017 Outpatient Therapy Cap Amounts Announced The U.S. Centers for Medicare and Medicaid Services (CMS) has announced the Medicare Part B outpatient therapy cap amounts for 2017.

The caps, which do not apply to patients receiving therapy as part of a home health episode of care, are: $1,980 for physical therapy and speech-language pathology combined; and $1,980 for occupational therapy. There is an “exception” process whereby the cap limit can be exceeded for “reasonable and necessary services.”

More information is at https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/ R3644CP.pdf, and http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-LN/ MLNMattersArticles/Downloads/MM9865.pdf.

CMS Issues RFI on Home and Community Based Services The U.S. Centers for Medicare and Medicaid Services (CMS) has issued a request for information (RFI) for feedback on additional reforms and policy options to accelerate the provision of Medicaid home and communitybased services (HCBS).

Specifically, CMS seeks input on how best to ensure high quality HCBS that: promote the health and well-being of beneficiaries; reduce fraud, waste and abuse, and protect beneficiaries from harm; and address workforce challenges, such as wages, training and retention.

Under workforce challenges, CMS solicits comments on how to strengthen the HCBS home care workforce, including possible requirements, standards or procedures for rate and wage support. Specifically, CMS seeks information for ideas to ensure that rates paid to home care providers are sufficient to attract enough providers to meet service needs, and to ensure that wages supported by those rates are sufficient to attract enough qualified home care workers.

The RFI is at https://www.gpo.gov/fdsys/pkg/FR-2016-11-09/pdf/2016-27040.pdf.

Comments are due January 9, 2017.

13

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

Volume 1, No. 10 November 14, 2016 

CMS Posts New Hospice Q&A Document A new Question and Answer (Q&A) document is now available in the “Downloads” section of the Hospice Item Set (HIS) website at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ Hospice-Quality-Reporting/Hospice-Item-Set-HIS.html.

It reflects frequently-asked HIS-related questions that were received by the Quality Help Desk during the third quarter of 2016. It also contains quarterly updates and events from the third quarter as well as an “HIS coding tip of the quarter.”

For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

2017 Medicare Levels Announced The U.S. Centers for Medicare and Medicaid Services (CMS) has announced the 2017 Medicare premiums, deductibles and copayment amounts.

They are at https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2016-Press-releasesitems/2016-11-10-2.html.

Medicare Part B The Medicare Part B monthly premium will be $109 (up from $104.90 in 2016) for most beneficiaries. It will be $134 (up from $121.80) for those who apply for Part B in 2017 and beneficiaries who pay an additional incomerelated premium (about 30 percent of the Medicare population).

The annual Part B deductible will be $183 (up from $166).

Medicare Part A The Medicare Part A amounts are:

14



Hospital deductible for the first 60 days: $1,316 (up from $1,288);



Hospital daily copayment for days 61 to 90: $329 (up from $322);



Hospital daily copayment for “lifetime-reserve” days 91 to 150: $658 (up from $644);



Skilled nursing facility daily copayment for days 21 to 100: $164.50 (up from $161);



Part A premium for those who are not automatically eligible and have less than 30 quarters of coverage: $413 per month (up from $411); and



Part A premium for those who are not automatically eligible and have from 30 to 40 quarters of coverage: $227 per month (up from $226).

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

Volume 1, No. 10 November 14, 2016 

New SSI Levels Posted The state Office of Temporary and Disability Assistance (OTDA) has posted the Supplemental Security Income (SSI) levels for 2017.

They reflect a federal cost-of-living adjustment of 0.3 percent, and are in a chart at http://otda.ny.gov/programs/ssp/2017-Maximum-Monthly-Benefit-Amounts.pdf.

The new levels are: 

Living alone: $822 (single); $1,207 (couples)



Living with others: $758 (single); $1,149 (couples)



Living in the Household of Another: $513 (single); $781.33 (couples)



Congregate Care Level 3 (adult homes and enriched housing programs): $1,429 (single); $2,858 (couple).

Resources 

“Data Breach Response: A Guide for Business,” by the Federal Trade Commission https://www.ftc.gov/system/files/documents/plain-language/pdf-0154_data-breach-responseguide-for-business.pdf



“PECOS for Physicians and Non-Physician Practitioners Fact Sheet — Revised,” by the U.S. Centers for Medicare and Medicaid Services https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/ MLN-Publications-Items/ CMS1243414.html?DLPage=1&DLEntries=10&DLFilter=physicians%20and%20non&DLSort=0&DLSortDir=ascending

For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.

15

HCA Presents

Tools, Resources and Knowledge for

VBP Readiness and Success

Thursday, December 15, 2016 DoubleTree by Hilton Hotel Tarrytown 455 S. Broadway, Tarrytown, NY 10591

Tools, Resources and Knowledge for

VBP Readiness and Success Medicare and Medicaid policymakers are moving aggressively and deliberately toward Value Based Payment (VBP) systems. These systems will induce health care providers to assume a greater level of risk – as well as potential reward – in their relationships with payors and other providers. Home care is no exception!

To succeed and gain rewards under value-based payments, you must understand your data, prepare your staff, know your value-proposition, and position your agency wisely to mitigate risk and avoid cost liability. This December 15 conference, entitled “Tools, Resources and Knowledge for VBP Readiness and Success,” will provide you with all of these necessary methods and insights.

HCA, through a series of education programs in 2015 and 2016, has already provided home care agencies with a glimpse of how VBP is designed, how it is intended to work, and how agencies can position themselves for success in VBP provider arrangements. As a next step, on December 15, HCA has assembled some of the most knowledgeable policymakers to provide tangible tools, resources and inside knowledge to promote your organizational readiness for VBP. Don’t miss this program – the first of its kind – which will provide tailored guidance to agencies seeking positive partnerships and contracts in a VBP environment.

This event is appropriate for provider agencies at any point in the VBP process, whether your organization is just beginning to discuss VBP, or if you’ve already entered into value based arrangements with others.

Thursday, December 15, 2016 DoubleTree by Hilton Hotel Tarrytown 455 S. Broadway, Tarrytown, NY 10591

AGENDA 8:00 – 8:45AM Registration and Breakfast 8:45 – 9:00AM HCA Welcome 9:00 – 10:15AM Agency Operational Readiness for Value Based Payment Relationships (TBA) Knowledge of VBP policy directives and the State’s vision is essential to preparing to participate in VBP. What’s even more important is to assess your own agency’s readiness and strengths and weaknesses. Learn about tools and resources that will enable you to assess your organization’s readiness to: participate in VBP arrangements; determine your gaps in readiness; identify critical next steps; and better understand how to position your organization effectively for VBP success.

10:15 – 10:30AM Break

10:30 – 11:30AM Workforce Investment – the State MLTC Workforce Initiative Kalin Scott, Director, Medicaid Redesign Team Project Management Office, NYS Department of Health The New York State Department of Health (DOH) is poised to grant $250 million in new funding for workforce training aimed at ensuring that home care workers, in a new managed care environment, are adequately trained to meet the needs of a frail, elderly and disabled population. DOH officials are still determining how the funds will be made available, as well as the types of training programs that will likely be offered and the launch process for this program.

However, there is already tremendous work being done in the design of these new workforce funds, and home care agencies can benefit from getting an early tip on what’s to come.

Hear from the state’s point person on the outline of this workforce training program, including how home care agencies can access the funding, as this initiative could be key to preparing your workforce for the VBP transition and ensuring that your agency has a workforce ready to move with you as policies and payment models shift.

Tools, Resources and Knowledge for VBP Readiness and Success 11:30AM – 12:30PM VBP Insights for Home Care from the Payor’s Perspective Joseph Twardy, Assistant Vice President, Care Management, Fidelis Care Robert Hinckley, SVP, Strategy and Communications, and Chief Strategy Officer, CDPHP Health Plan David Ackman, MD, MPH, Medical Director, Provider Engagement, Empire Blue Cross Blue Shield Health Plus (Invited) Your success in a VBP environment hinges on strong partnerships with managed care plans, which are already a driving force for payment, service-authorization, caremanagement and shared-risk arrangements in home care, and increasingly so under VBP. Hear from a panel of payor representatives who will discuss: what drives decision-making in their contracting relationships; the most important value-driven elements in a home care relationship; and what data home care agencies need to bring to the table in their contracting discussions with plans.

12:30 – 1:15PM Lunch 1:15 – 4:15PM Data Workshop: Using Agency Data to Drive Decisionmaking Barbara Katz, RN, MSN Internal data assessment is one of the most powerful and proactive steps a home care agency can take on the eve of Value Based Payment implementation in the Medicaid and Medicare marketplaces. This session will provide a deep dive into your clinical data through an established and proven four-step process (Ask, Assemble, Analyze, Act) using powerful tools, including: benchmarking, percentages and rates, graphs and charts, check-sheets, stratification and trending. Don’t know what all of that means? That’s okay! This interactive workshop will teach you the techniques for using data to improve outcomes, lower costs and improve patient satisfaction – all critical to success in a VBP environment.

4:15PM Closing Remarks and Adjourn

Tools, Resources and Knowledge for

VBP Readiness and Success Thursday, December 15, 2016 DoubleTree by Hilton Hotel Tarrytown 455 S. Broadway, Tarrytown, NY 10591

Hotel Information

REGISTRANT INFORMATION – Please register by December 8.

Name: __________________________________________________________________________ Title:____________________________________________________________________________

A small block of rooms has been secured at the DoubleTree by Hilton Hotel Tarrytown, 455 S. Broadway, Tarrytown, NY 10591 for the evening of December 14 at a discounted rate of $159.

Agency:_________________________________________________________________________ Address:_________________________________________________________________________ City/State/Zip:____________________________________________________________________ Phone:________________________________ Ext._________ Fax: _________________________ Email: ___________________________________________________________________________ (Required)

Attendees may make reservations using the Group Code HC1 by either logging in to www.tarrytown.doubletree.com or calling the hotel direct

914-524-6418. before November 15.

HCA REGISTRATION FEE □ HCA Members

$219 per person

$________

HCA Cancellation Policy

□ Prospective Member

$319 per person

$________

HCA registration cancellations received by December 1 are refundable less a 25% administrative fee. No refunds will be issued after this date.

PAYMENT – Please check method of payment: ________MasterCard

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*Make checks payable to: HCA Education and Research and mail to 388 Broadway, 4th Floor, Albany, NY 12207. Checks must be received by December 15. ______________________________________________________________________________ Card Number _____________________________________ _______________________________________ Expiration Date Security Code ______________________________________________________________________________ Mailing Address of Card Holder ______________________________________________________________________________ City, State, Zip ______________________________________________________________________________ Name on Card ______________________________________________________________________________ Authorized Signature

Cancellations must be received in writing at info@hcanys.org.

Substitutions are permitted.

Please note DoubleTree’s cancellation policy when making your reservation.

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

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FAX completed form to HCA at (518) 426-8788 - or - Register online at: https://www.eventville.com/hcanys