SURVEY
CURES ACT
APPEALS BACKLOG
MLTC QUALITY
HCA reminds members to make plans for completing our home care industry survey, which is vital to our 2017 advocacy.
Sweeping Congressional CURES Act includes electronic verification requirement for home care, other provisions.
A federal judge has ordered HHS to clear its backlog of Medicare appeals following an industry lawsuit.
Learn the latest about the MLTC quality incentive performance measures and home care’s role in meeting them.
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Your Source for HOME CARE News, Policy and Advocacy
Vol. 1, Issue 14 | December 12, 2016
COMING UP Tools, Resources and Knowledge for VBP Readiness and Success Dec. 15, 2016 DoubleTree by Hilton Hotel Tarrytown 455 S. Broadway, Tarrytown, NY 10591 Northeast Home Health Leadership Summit: “Extreme Makeover, Home Care Edition” Jan. 17-19, 2017 The Colonnade Hotel Boston To register for HCA conferences and events, please visit our education page at http:/ /hca-nys.org/eventseducation/upcomingevents
HCA Presses Urgent Action to Fix Funding Mechanism for Minimum Wage With the fast approaching December 31 effective date for the state’s mandatory increase in the minimum wage (MW), many providers and health plans are reporting serious concern and disarray over implementation of state funding adjustments to meet MW costs. See URGENT p. 2
Comptroller Audit: DOH Made $16.6 Million in CHHA EPS Overpayments
HCA Takes 2017 Priority Proposals to Legislature, Executive HCA has taken our 2017 priority proposals to Albany’s Capitol Hill, working to build these urgent home and community-based initiatives into the oncoming state legislative and budget session. See PROPOSALS p. 5
INSIDE HCA Presses Urgent Action to Fix Funding Mechanism for Minimum Wage...........1 HCA Takes 2017 Priority Proposals to Legislature, Executive...............................1 Comptroller Audit: DOH Made $16.6 Million in CHHA EPS Overpayments............1 Meet the Experts in Boston for 2017 Home Health Leadership Summit..............4 State’s VBP Advisor Jason Ganns Opens HCA Conference in Tarrytown.................6 Reminder: HCA Needs Your Responses on Home Care Survey Due Jan. 6............6 Uniform Billing Codes Start on May 1..................................................................7 CURES Bill Passes House and Senate with Home Care Provisions.........................7 Medicare Appeals Backlog Must Be Cleared by 2021.........................................8
Overpayments occurred between 2012 and 2015 The state Comptroller’s Office has recently released the results of an audit which finds that the State Department of Health (DOH) “erroneously” made $16.6 million in Medicaid See AUDIT p. 3
MLTC Update..................................................................................................9 MLTC Quality Workgroup Briefed on Performance Measures..........................10 Home Care-Related Applications Approved by PHHPC..................................11 DOH Issues Winter Preparedness Guidance.................................................11 VA Extends Drug Copayment Amounts..........................................................13 Revised Revalidation Info Posted..................................................................13 NGS Updates............................................................................................13 Medicaid Section 1115 Waiver Extended......................................................14 CMS Releases 2015 Health Data..................................................................14 CMS Releases 2017 Spousal Impoverishment Levels....................................15 Resources............................................................................................15
The Situation Report: the Home Care Association of New York State URGENT from p. 1 While the state budget allocated funding to support Medicaid costs related to the MW increase, the state’s guidance and distribution formula have left many MLTC plans and home care providers in projected payment shortfall and procedural uncertainty. HCA has shared with the Governor’s office, State Division of the Budget, State Department of Health and State Legislature reports from home care providers and MLTCs of major problems attempting to implement the funding adjustments for MW. Many are reporting that the funds thus far received to meet the statutory wage mandates (both wage parity and MW) are inadequate to the need, or not materializing altogether. HCA is daily urging state administrative officials to intervene to detangle these problems and help ensure plan and provider fiscal capability to comply with the MW increase. While the increase takes effect December 31, plans and providers face the obligation of processing new contract amendments now – a point being underscored by HCA in its request to the Administration for immediate assistance. There is great variance being reported from plan to plan and provider to provider in the rate adjustment amounts. On the positive side, some plans and providers are reporting success in achieving contract amendments at the state’s anticipated average adjustment amount of $1.33/hour for MW; but this appears to be the minority result thus far as some plans are offering less or providing a lump sum, or not establishing the amount of rate adjustment until the plan receives state funding. HCA has stressed to the Administration that, in setting payment rates, the state is responsible under public health law section 4403-f to “consider costs borne by the managed care program in setting rates to ensure actuarially sound and adequate rates of payment to ensure quality of care shall comply with all applicable laws and regulations, state and federal.” This language was added to state law in this year’s budget by the Legislature in response to HCA’s rate adequacy language, and specifically is intended to encompass costs borne for MW, the Fair Labor Standards Act overtime changes, state wage laws, as well as all other applicable laws. Another issue relates to the continuing uncertainty of the provision of MLTC and provider MW support in the areas outside of New York City and for upstate regions, despite continuous 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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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
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The Situation Report: the Home Care Association of New York State queries by HCA. State funding for the MW increase is thus far in motion only for New York City. In addition, the funding has not been allocated to account for consumer directed personal assistance services. HCA continues to urge clarification of the timetable and allocation of increased MW funds for home care workers, agencies and MLTCs serving other areas of the state. HCA asks providers and plans to continue to update us on your experiences, positive or negative, with regard to MW implementation. HCA will be seeking further assistance and discussions with the Administration today and continuously until this situation is addressed. Home care agencies with questions about how their contracted plans developed the passthrough amounts should contact the plans for clarification. Meanwhile, HCA also reminds providers and plans that the Department of Health’s guidance for MW funding issued on October 28 states: “If a dispute arises over whether the contracted increase for wages between the provider and the MCO is consistent with these Guidelines, providers or MCOs may seek the Department’s guidance.” Principal contacts for MW payment at DOH are John Ulberg, Director of Health Care Finance, and Daniel Carmody, Director of MLTC Reimbursement. The November 22 DOH guidance documents are at http://hca-nys.org/wp-content/uploads/2016/ 11/Supplemental-MLTC-MW-Guidance-forExhibit-11.22.16.pdf and http://hca-nys.org/wpcontent/uploads/2016/11/Minimum-WageFunding-Availabe-in-Aggregate-by-MLTCPlan_11.22.16.pdf. These should be read in tandem with previous DOH-issued guidance on October 28. See http://hca-nys.org/wp-content/ uploads/2016/10/MWGuidelines102816.pdf. For further information or to share updates, please contact Andrew Koski at akoski@hcanys.org.
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AUDIT from p. 1 payments to 95 CHHAs over a 3 and one-half-year period. The report faults the Department’s mistaken payments for more days of care than what was actually provided. In 2012, as part of its Medicaid redesign program, DOH implemented the Episodic Payment System (EPS) to reimburse CHHAs for health care services provided to Medicaid recipients in their homes. The payment system is based on 60-day episodes of care. CHHAs can be paid for a full episode or may receive pro-rated payments based on the number of days of care on the claim. For the period May 1, 2012 through December 31, 2015, the Comptroller’s auditors identified about $16.6 million in mistaken Medicaid payments to 95 CHHAs. However, the Comptroller’s report shows that approximately 93 percent ($15.4 million) of these went to just 20 CHHAs. While the report does not identify any of the 95 CHHAs impacted, HCA has asked DOH for that information in addition to the timetable for the recovery of the funds and further details on the process itself. The Comptroller found several areas of overpayment:
$8.2 million to CHHAs for recipients who were transferred into MLTC plans during a 60-day episode of care. Under the EPS methodology, CHHAs should have received pro-rated payments for the partial episodes of care.
$7.1 million to CHHAs for multiple episodes for the same recipient within 60 days of the recipient’s original episode start date. $1.3 million to CHHAs for full 60-day payments for recipients who subsequently obtained services from a different CHHA within an episode of care. The Comptroller additionally determined that DOH has not established eMedNY system controls to prevent the improper payments they identified. The issues found by auditors were raised by DOH employees
The Situation Report: the Home Care Association of New York State during the construction of the EPS. However, insufficient resources and the EPS billing configuration prevented the development of effective eMedNY system controls to prevent the overpayments, according to DOH officials. The Comptroller’s report recommended that DOH:
Review the $16.6 million in mistaken payments made to CHHAs and recover overpayments, as appropriate, and ensure prompt attention is paid to the largest dollar amounts of overpayments; and
Develop and implement mechanisms to identify and recover overpayments when CHHAs do not bill according to DOH guidelines.
DOH officials agreed with the audit recommendations and indicated actions will be taken to address them. Their full response is included in the Comptroller’s report. In comments to Bloomberg BNA this week, HCA noted: “It appears that the Comptroller’s audit substantially identifies errors in the state’s claims-processing system for EPS. The state has indicated it will be putting extra back-end edits in the claims-processing system to curtail any future issues. As far as past reimbursements called into question, we are seeking further information on the anticipated recovery process for these overpayment amounts, which represent less than two percent of all expenditures under EPS since its inception. Nevertheless, these overpayments have been identified at a time of enormous financial pressure on CHHAs, due to the rate rebasing process, unfunded mandates, and other costs.” HCA will update the membership as more information from DOH becomes available or when DOH shares with us the list of 95 CHHAs that were overpaid and by what amount. The Comptroller’s audit report can be downloaded at: http://www.osc.state.ny.us/audits/allaudits/093017/ 16s4.pdf. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
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Meet the Experts in Boston for 2017 Home Health Leadership Summit Join your peers for the one-and-only conference that brings together home care executives from throughout the Northeast: The 2017 Northeast Home Health Leadership Summit in Boston. This year’s theme is “Extreme Makeover: Home Care Edition.” We’ve already begun introducing you to some of the “makeover experts” in store for you and your colleagues. Please be sure to take advantage of this unique opportunity for learning, insights and networking with peers from throughout the region. The early-bird registration deadline expires on December 16. This conference is carefully designed by a collaborative of nine state home care associations in New England, New York and New Jersey, so you can be assured that the lineup is packed with top experts, consultants, policymakers and inspiring leaders to support your operation, your pursuit of new care models, your understanding of political and policy trends ... and YOU as a home care professional. Members of the collaborative associations, including HCA, get a discount for attending. Everything you need to know (registration, hotel information, sponsors, speakers and agenda) is at www.nehomehealthsummit.com.
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PROPOSALS from p. 1 On the heels of meetings with the Governor’s office and the state Division of Budget, HCA conducted similar in-depth meetings with the state Department of Health and the Assembly Health and Assembly Leadership offices this past week, covering critical areas of home care need while presenting legislative and budget proposals we have formulated to address those needs. HCA will be continuing similar meetings with state Senate leaders early this week, and submitting our legislative and budget bill language for state officials to consider for introduction. HCA’s proposals have been developed with extensive input from the HCA Board, Policy Council and other key committees and members. They address fundamental areas such as:
Ensuring sound premium and payment levels for providers and health plans for essential operating and patient service costs. This is particularly urgent with current and next phase increases in wage/labor costs, and expenses necessitated by state reforms.
Positioning and facilitating home care’s participation in new alternate service delivery and payment models including the Delivery System Reform Incentive Payment (DSRIP) program, Value Based Payments (VBP), patient centered medical homes/advanced primary care practices, Accountable Care Organizations (ACOs), bundled payments, etc., through: program flexibility and home care policy support; enforcing compliance by other sectors related to article 36 and 40 requirements (in other words, prohibiting unlicensed crossover into home care and hospice); and leveraging home care in addressing public health priority problems and savings opportunities through sepsis prevention, early identification and treatment, falls prevention, asthma mitigation, health disparities, and other interventions.
Establishing and implementing a comprehensive plan for ensuring a home care workforce and infrastructure sufficient to meet growing needs, with special focus on underserved areas and populations.
Providing a dedicated mechanism for home care working capital.
Supporting clinical and health information technology, and health care quality initiatives and innovation, in home care. (Both the Senate and Assembly have already introduced this HCA legislation.) These are critical for home care participation in Medicaid Redesign Team (MRT) reforms and will advance innovations for improved performance, quality and cost-savings in the broader health care system.
HCA also has proposals to address additional, critical areas involving hospice and palliative care, emergency preparedness, commercial coverage for home care, primary care in home care, pediatrics and other areas. HCA will be working all angles to advance these essential advocacy needs, as well as those prompted by gubernatorial or legislative actions, with the fast-approaching legislative and budget session. To assist these advocacy efforts, we ask that all home care agencies complete HCA’s 2016-17 Home Care Industry Survey recently shared with the membership. (Please see related p. 6 story.) For further information, please contact Al Cardillo at acardillo@hcanys.org.
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State’s Value Based Payment Advisor Jason Ganns Present Opening Segment at Thursday VBP Conference in Tarrytown HCA’s final big conference of the year, on Value Based Payments (VBP), is on Thursday in Tarrytown. Opening the program is VBP design expert Jason Ganns of KPMG. It’s not too late to register. A link to online registration is here: https://www.eventville.com/Catalog/EventRegistration1.asp?EventId=1012048. KPMG is the firm helping the Department of Health (DOH) to design New York’s Value Based Payment initiative, which will become the overarching structure for Medicaid payment redesign in New York State. As such, KPMG’s insights are critical for your future operation in the Medicaid marketplace, as VBP constructs and project negotiations take hold. Our opening session with Jason Ganns will help your organization get ready 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. Mr. Ganns has presented at HCA programs in the past, with high marks for his knowledge and insights about the state’s VBP Roadmap. He is leading just one of several segments during our December 15 program which will also help you prepare your data, your workforce, and your contractual relationships with payors as you pursue VBP. Seats are still available for this one-day, highly concentrated focus program on VBP that you cannot afford to miss. Register today.
Reminder: HCA Needs Your Responses on Home Care Industry Survey Due Jan. 6 HCA reminds members to plan time for answering our 2016-17 State of the Home Care Industry survey, which was issued last week. The survey is vital for our advocacy efforts in 2017. As in past years, the results of this survey will be paired with a data analysis, culminating in a written report showing home care’s major financial and regulatory stresses. The due date for completion of surveys is January 6. The survey can be completed online at the following link: https://www.surveymonkey.com/r/HCAfinancesurvey We recommend that you print out a PDF version of the survey first, complete it on paper, and then enter your information in the online link, just in case you experience website connectivity issues while entering your answers or need multiple staff to participate in answering questions. The PDF is at http://hca-nys.org/wpcontent/uploads/2016/11/FinancialConditionSurvey2017.pdf. We can’t stress enough how important your input is for our advocacy in 2017. Please be assured that all agency-identifying information will be kept strictly confidential and reported only in the aggregate. If you have any questions or difficulties completing the survey, please contact HCA’s Communications Director Roger Noyes at rnoyes@hcanys.org or (518) 810-0665.
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Uniform Billing Codes Start on May 1 The state Department of Health (DOH) has announced that uniform billing codes for Medicaid-covered home and community-based long term care services will be required starting on May 1, 2017. This change, included in the 2015-16 state budget, was long sought by HCA to help home care agencies and their managed care contractors by simplifying billing procedures and facilitating timely payments. HCA and other provider associations had worked hard to develop uniform codes for over a year to meet the statutory deadline of January 2016, but additional time was needed to obtain support from all parties. The codes will cover personal care, home health aide services, consumer directed personal assistant services, nursing, therapies, telehealth, medication dispensers, and adult day health services. The legislative provision also requires managed care plans to pay claims electronically via electronic funds transfer. DOH intends to finalize and post a “Dear Administrator Letter” shortly with the codes and instructions. HCA will alert members when that is released. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
CURES Bill Passes House and Senate with Home Care Provisions Electronic visit verification, telehealth and home infusion benefit among home care and personal care provisions Congress has passed a sweeping $6.3 billion health care measure, called the CURES act, which includes some home care provisions, among additional measures that also address mental health, combatting opioid use, funding for biomedical research, and reforms to the drug and medical device approval process under the Food and Drug Administration (FDA). The home care-related measures include an electronic visit verification process for personal care and home health, telehealth provisions, a new Medicare coverage benefit for home infusion therapy, and other items. Specifically, the bill would implement a Medicaid Electronic Visit Verification (EVV) program, starting in 2019 for personal care and in 2023 for home health aide services. States would have latitude in developing EVV according to some baseline standards, but it appears that the legislation does not compel states to reimburse agencies for EVV. States that do not implement an EVV program, or otherwise secure a waiver, will be subject to financial penalties. The legislation requires states to “consult with agencies and entities that provide personal care services, home health care services … to ensure that such a system is: minimally burdensome; takes into account existing best practices and electronic visit verification systems in use in the state; and is conducted in accordance with the requirements of HIPAA privacy and security law.” EVV would verify the type of service performed; the individual receiving the service; the date of the service; the location of service delivery; the individual providing the service; and the time the service begins and ends. New York State already has a verification requirement for certain providers of home care services who exceed $15 million in Medicaid reimbursements (fee-for-service and managed care). These agencies must use a stateapproved Verification Organization (VO) vendor which verifies the home health care within a claim or encounter
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collected from Electronic Visit Verification (EVV) prior to submission of the claim or encounter to the Department of Health (DOH) or to a managed care provider. HCA will be examining this component carefully to assess its overlap with existing state law and to ensure that an expanded EVV program is amended or implemented in a way that does not hinder access to care, timely payment to providers, undue cost burdens for implementation and questions about applicability under managed care. HCA has already reached out to the Office of Medicaid Inspector General (OMIG) to discuss the effects of this provision on the state’s VO requirement. OMIG has advised us that it is waiting for any proposed implementing regulations or instructions before assessing the provision’s impact. The CURES legislation also:
Requires a report on Medicare populations whose health would be improved by telehealth, along with an evaluation of existing telehealth projects, service recommendations for telehealth, and any barriers to telehealth development.
Initiates a home infusion therapy benefit beginning in 2021. The benefit would include a beneficiary copayment, require a plan of care from physicians or other qualified practitioners, and payment rates would be made consistent with the fee structure for such therapy services as provided in a physician’s office. Questions remain as to the coordination of this benefit with the standard home health services coverage. As recently reported in Home Health Care News, “Under the new definition, it’s possible that a patient could lose access to home health aide services currently being provided in conjunction with home infusion,” since the new therapy benefit is not included as part of the home health benefit, but separate from it.
A final provision in the bill concerns newly enrolled providers in areas subject to a temporary provider billing moratoria, which does not affect New York State. The provision applies the moratoria to the service location, not the business location of the provider. The purpose of this provision is to ensure that agencies are subject to moratoria in certain regions of the country even if their business address or provider location resides outside of the moratoria area. In 2013, the U.S. Centers for Medicare and Medicaid Services (CMS) established moratoria in the Chicago, Illinois and Miami, Florida areas. This was later extended to include agencies in the metropolitan areas of Fort Lauderdale, Florida; Detroit, Michigan; Houston, Texas; and Dallas, Texas. The program is intended to target regions of the country with payment and service integrity risk. HCA will be further analyzing this legislation and will report to the membership on any additional provisions or advocacy steps for home care.
Judge: Medicare Appeals Backlog Must Be Cleared by 2021 A federal judge has recently ordered the U.S. Department of Health and Human Services (HHS) to eliminate its backlog of Medicare appeals claims by 2021. The order comes after a report revealing a large backlog of Medicare claims appeals cases, with many stemming from CHHAs. CHHAs and other Medicare health care providers that receive fee-for-service claims denials can appeal those decisions. Over the past few years, the number of appeals filed by CHHAs and other health care
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providers has dramatically increased. In 2015, 123 million Medicare fee-for-service claims were denied, of which 3 percent were appealed. The high number of appeals claims and long wait-time for processing prompted a number of national associations to file suit, including the American Hospital Association as well as the National Association for Home Care and Hospice (NAHC). HHS had already planned to pursue some action on the backlog through new administrative actions, legislative reforms and new resources. Even so, the backlog is nevertheless expected to continue through 2021, barring any further reforms or changes. Now, with the judge’s ruling, HHS must eliminate significant portions of backlogged appeals claims before the end of 2020. A timetable has been set for a 30 percent backlog reduction by December 31, 2017; 60 percent reduction by December 31, 2018; 90 percent reduction by December 31, 2019; and elimination of the backlog by December 31, 2020. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
MLTC Update HCA attended this week’s Managed Care Policy and Planning meeting held by the state Department of Health (DOH) where the following new information was provided: •
DOH is currently drafting a stakeholder process for post-FIDA (Fully Integrated Duals Advantage) planning, which will be launched in early 2017, to evaluate how and whether to consolidate or maintain existing integrated products.
•
Pending final review of the Medicare provider networks, DOH anticipates starting voluntary enrollment for FIDA into Region 2 (Suffolk and Westchester Counties) in early 2017.
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Effective November 29, 2016, non-participating providers may appeal on their own behalf using the FIDA integrated appeals process; guidance has been issued to specify the details of the policy and how plans must implement it; also included were template notices that plans must use in non-participating provider appeals.
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The December 7 FIDA Webinar will be posted on the DOH website. The program was conducted by federal officials and featured Fidelis Care FIDA Medical Director Dr. Jermel Hawkins, as well as Dr. Mohammad Sheikhai and Dr. Shen-Han Lin of Nassau University Medical Center.
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A guidance document with details on the carve-in of Community First Choice Option (CFCO) services was sent out to plans on December 7, 2016. New York State has extended the effective date (now July 1, 2017) for adding CFCO services to the Medicaid MLTC benefit packages . DOH intends to convene a workgroup with trade associations and plan representatives on January 5, 2017 to discuss implementation and operational issues. In response to plan requests, DOH said it will develop CFCO codes; it will also issue rates for CFCO services under Medicaid fee-for-service and expects that plans will use them as a guide.
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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MLTC Quality Workgroup Briefed on Performance Measures The MLTC Quality Workgroup (HCA is a participant) was briefed this past week by state Department of Health (DOH) officials on the performance metrics that DOH will use for MLTCs in awarding incentive payments. A total of $150 million has been allocated for the 2016 payment incentives to MLTCs, Programs of All-Inclusive Care for the Elderly (PACE) plans and Medicaid Advantage Plans. The briefing included a review of the 2016 MLTC quality incentive methodology, the proposed 2017 methodology and contemplation of further measure exploration, with opportunities throughout for workgroup member questions, input and recommendations in connection with the metrics and related subject matter. The 2016 methodology is similar to 2015, and the proposed 2017 methodology will be as well. The methodology examines and distributes incentive payments weighted according to the MLTC performance on four key domains: 1. 2. 3. 4.
Quality (10 measures, 50 points), Satisfaction (6 measures, 30 points), Compliance (5 measures 10 points) and Efficiency (1 measure – potentially avoidable hospitalizations –10 points).
HCA notes that the potentially avoidable hospitalization measures in this methodology focus on areas that also synchronize with both the Delivery System Reform Incentive Payment (DSRIP) program and value based payment reform targets. HCA has been stressing that these are prime opportunity areas for home care leadership in contributing to positive outcomes by addressing sepsis prevention, heart failure, respiratory infection, urinary tract infection, anemia, and electrolyte imbalance. While the methodology is targeted to MLTCs, it is inherently and inextricably also linked to the affiliated providers which deliver the care and the results. HCA has previously recommended a reflection of providers’ contribution to those results (and a shared contribution in bonus payment), and continues to do so. Meanwhile, HCA encourages providers and MLTCs to utilize both overall and plan-specific performance information in working together to maximize quality and performance rewards. HCA will be providing further information, insights and recommendations based on this briefing, and based on this program generally, as we continue to work to promote quality and effective provider-plan partnering. A copy of the briefing slide deck and related materials can be viewed at http://hca-nys.org/wp-content/uploads/2016/12/MLTCQualWorkgroupMaterials122016.pdf. HCA member MLTCs should plan to participate in HCA’s MLTC Forum conference call on December 19. MLTC representatives should contact Billi Wilson at bwilson@hcanys.org to register for this call. For further information, please contact Al Cardillo at acardillo@hcanys.org.
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Home Care-Related Applications Approved by PHHPC This week, the Public Health and Health Planning Council (PHHPC) met and approved applications related to one CHHA, two hospices and several LHCSAs. These included applications by: •
One CHHA to acquire and merge with 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).
•
Eleven LHCSAs for changes of ownership.
The materials of the meeting are at http://www.health.ny.gov/facilities/ public_health_and_health_planning_council/meetings/2016-12-08/. In October, DOH indicated that it is currently not scheduling new LHCSA establishment applications for the PHHPC agenda. The only LHCSA applications currently being scheduled on agendas are those requesting approval for a change of ownership of an existing agency, LHCSAs to be affiliated with ALPs and those submitted by governmental agencies (counties). For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
DOH Issues Winter Preparedness Guidance Following a recent Dear Administrator Letter (December 1) urging providers to revisit their emergency preparedness procedures (see p. 4 of last week’s Situation Report), the state Department of Health (DOH) has issued another, similar notice in anticipation of the winter weather season. The new notice is available at http://hca-nys.org/wp-content/uploads/2016/12/ ctrlaccamstmpNotification21434.pdf. This more recent winter-storm-related notice overlaps somewhat with the December 1 DAL, but more specifically compiles general winter-storm preparedness guidance in the event of heavy snow, icing, strong winds, road closures, loss of power and other impacts related to winter storms. The Guidance was circulated as areas of western and central New York were bracing for major lake-effect snowstorms. The guidance includes general requirements and recommendations for all settings (including for home care and hospice) related to: preparation of emergency plans and staff-wide understanding of procedures for
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evacuation and other response needs; staff coverage; and supplies. It also provides guidance specific to home care and hospice. General Guidance for All Settings For all settings, DOH says that, in the event of a forecasted storm: •
Facility fuel supply should be checked and necessary action taken to ensure that it is adequate to cover operations for the period leading up to the storm and for at least 72 hours following the storm.
•
During and following the storm, facilities needing assistance due to prolonged power outages should make requests for assistance through their local Emergency Operations Center (EOC).
•
All facilities should ensure they have enough general supplies to last a period of at least 72 hours after the storm begins without expectation of delivery from suppliers. Now is the time to ensure supplies are on hand, ordered, and/or being delivered.
•
During emergencies, facilities located in the 5 boroughs of NYC should contact New York City Emergency Management if they are in need of services of supplies. Facilities in need of assistance on Long Island and Westchester (or other parts of New York State) should contact their County EOC or County Office of Emergency Management if the EOC is not activated. It is important to note that facilities should rely on these resources as a backup and not the primary source should they need supplies pre-storm.
Home Care and Hospice For home care and hospice specifically, providers are advised to review patient care needs and “consider adjustment of visits to ensure that Level 1 patients are visited prior to the start of a forecasted storm, and that these, and all patients. are reminded of how to call for assistance if they lose their power or have a medical emergency.” The notice adds:
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•
Plans for adjusting staff schedules/prioritizing patient visits in the days immediately following the storm should be made, particularly if travel is still impeded, with a focus on reassigning staff based on proximity to patients to limit travel and reduce staff exposure to hazardous conditions.
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Agencies should also ensure that staff and their patients have enough supplies to cover a period of at least 72 hours following the start of the storm.
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Agencies should be ready to contact staffing services if a large proportion of their regular staff are unable to travel and perform any of their normal visits for a period of time following the storm.
•
Agencies should also be ready to communicate with their patients during and immediately following the storm to perform checks on their safety and condition of their health. The agency’s emergency
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response plan should include protocols for managing situations where patients refuse to evacuate a hazardous situation. HCA will keep the membership informed of any further guidance specific to your region, including forecasted events that would require attention to your emergency response plans.
VA Extends Drug Copayment Amounts and Sets Up Tiered Structure The U.S. Department of Veterans Affairs (VA) has announced that will extend the current prescription drug copayment amounts until February 27, 2017. Under current rules, the drug copayment amount for veterans in priority groups 2 through 6 of the VA’s health care system is $8, while the copayment amount for veterans in priority groups 7 and 8 is $9. In addition, there is an annual cap of $960 on the total amount of drug copayments for veterans in categories 2 through 6. These levels are being extended to February 27, 2017 at which time a tiered medication copayment structure will start. At that time, the following medication copayments will be applicable: $5 for a 30-day or less supply of a Tier 1 medication; $8 for a 30-day or less supply of Tier 2 medication; and $11 for a 30-day or less supply of a Tier 3 medication. More information on the extension is at https://www.gpo.gov/fdsys/pkg/FR-2016-12-07/pdf/2016-29337.pdf and https://www.va.gov/HEALTHBENEFITS/access/prescriptions.asp. The February 27, 2017 changes are at https:// www.gpo.gov/fdsys/pkg/FR-2016-12-12/pdf/2016-29515.pdf.
Revised Revalidation Info Posted eMedNy has posted revised information on revalidation for Medicaid providers. The Affordable Care Act requires revalidation of all Medicaid and Medicare providers every five years. This involves the submission of information on the provider’s ownership, managing employees, agents, persons with a control interest, as well as current business addresses, specialties, etc. In 2017, the fee for revalidation will be $560. The material about this revised revalidation can be found at https://www.emedny.org/info/ProviderEnrollment/ revalidation/Revalidation_of_Medicaid_Providers.pptx. Information on overall 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.
NGS Updates National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), has recently posted the following information to its website. •
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NGS Announces New Medical Policy Center – NGS has recently announced its new Medical Policy Center which includes enhanced search capabilities that can be found within NGS’s website at:
The Situation Report: the Home Care Association of New York State
Volume 1, No. 14 December 12, 2016
www.ngsmedicare.com. NGS has consolidated the Medical Policy Center to include both the Local Coverage Determinations (LCDs) and Policy Articles/Supplemental Instructions on one page for users’ convenience. The following 3-minute video explains the new Medical Policy Center: https:// www.youtube.com/watch?v=VZ9XYgv2WbE. •
NGS to Conduct EDI Maintenance on December 30 – On December 30, 2016 the Electronic Data Interchange (EDI) gateway will be brought down at 5 p.m. for approximately six hours in order to make EDI system updates in preparation for the January 2017 quarterly release implementation. During the outage timeframe, trading partners will be unable to connect to the EDI Gateway to exchange transactions with EDI. For questions, please contact the Jurisdiction 6 EDI Help Desk at: 1-877-273-4334.
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Change Request 9854 for the 2017 Update for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule can be downloaded at: https://www.cms.gov/Outreach-andEducation/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9854.pdf.
For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
Medicaid Section 1115 Waiver Extended On December 7, 2016, the U.S. Centers for Medicare and Medicaid Services (CMS) approved New York’s request to extend its Medicaid Redesign Team (MRT) Demonstration Section 1115 waiver through March 31, 2021. The 1115 waiver has been renamed the MRT Demonstration (formerly the Partnership Plan) to reflect MRT efforts that have improved and expanded the waiver’s purpose. The state Department of Health (DOH) notes that this approval comes as a result of significant efforts by both New York and CMS’s teams, with stakeholder input. The waiver renewal letter and Standard Terms and Conditions (STCs) have been posted to the MRT website at http://www.health.ny.gov/health_care/medicaid/redesign/medicaid_waiver_1115.htm (under the heading “Latest News.”)
CMS Releases 2015 Health Data The U.S. Centers for Medicare and Medicaid Services (CMS) has released data on national health expenditures in 2015. The data is in a Health Affairs article at http://content.healthaffairs.org/content/early/2016/11/22/ hlthaff.2016.1330.full.pdf+html. Some highlights include: •
Medicare spending grew 4.5 percent in 2015, slightly lower than in 2014 (4.8 percent); Continued on next page
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Continued from previous page •
Medicare hospital and prescription drug spending growth slowed while spending growth for nursing homes and home health accelerated;
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Medicare spending for home health grew 2.6 percent in 2015, up from 1.7 percent in 2014, and spending for nursing home care grew 5.6 percent in 2015, up from 2.5 percent in 2014; and
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Medicaid spending grew 9.7 percent in 2015, following growth of 11.6 percent in 2014.
The full report is at https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-andReports/NationalHealthExpendData/NationalHealthAccountsHistorical.html.
CMS Releases 2017 Spousal Impoverishment Levels The U.S. Centers for Medicare and Medicaid Services (CMS) has posted the 2017 spousal impoverishment standards. They are at https://www.medicaid.gov/medicaid/eligibility/spousal-impoverishment/index.html. For 2017: •
The maximum monthly maintenance needs allowance is $3,022.50 (up from $2,980.50 in 2016).
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The maximum community spouse resource allowance is the greater of $74,820 or the amount of the spousal share up to $120,900 ($119,220 in 2016).
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The amount of equity interest an individual can have in a home and still be eligible for Medicaid coverage is $840,000 (up from $828,000).
Resources •
“Exceptions For Late Hospice Notices of Election Delayed by Medicare Systems,” by the U.S. Centers for Medicare and Medicaid Services http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNMattersArticles/Downloads/SE1633.pdf
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“Growing Older: Providing Integrated Care For An Aging Population,” by SAMHSA-HRSA Center for Integrated Health Solutions http://files.constantcontact.com/dd3bfe37001/9f659afc-e397-4688-890f-dd86374579b6.pdf
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“Update to Editing of Therapy Services to Reflect Coding Changes,” by the U.S. Centers for Medicare and Medicaid Services http://tinyurl.com/zugvbwt
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org
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