DATA SEMINAR
COST REPORT E-FILE
LAWTALK
HOSPICE
Make sure your clinician managers and their teams know about our specially tailored program on June 6 to arm them with data for QAPI compliance and clinician success.
Starting July 2, agencies must use new platform (MCReF) if choosing to e-file Medicare cost report.
The latest installment of our LawTalk column from counsel at Jackson Lewis explores prohibitions on inquiries related to salary history, criminal backgrounds and other potential HR pitfalls.
HCA prepares a memo on the hospice proposed payment rule, plus the state is seeking responses from hospices on survey.
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Your Source for HOME CARE News, Policy and Advocacy
Vol. 3, Issue 19 | May 7, 2018
COMING UP HCA’s Annual Conference: 40 Years Strong! May 9-11, 2018 Saratoga Springs Webinar: Surveys Under the New Conditions of Participation May 31, 2018 11:30 a.m. to 1 p.m. Driving Decisions with Data: A Seminar for Clinical Managers June 6, 2018 Albany Register for these and other programs online at https://hcanys.org/eventseducation/ upcoming-events.
Two Days & Just a Few Slots Left to Hear from DOH Commissioner Zucker, NAHC’s Bill Dombi, NHPCO’s Edo Banach and Hot-Topic Experts in Saratoga HCA’s Annual Conference begins in two days, and there are just a few slots remaining for this banner 40th anniversary event to support you in home care, hospice and Managed Long Term Care. Don’t wait. Please register now using online registration or by sending us the form at the back of HCA’s conference brochure. Both options are on the conference website at: http:// hcaannualconference.com/register-2018/. The website highlights an exceptional slate of See EXPERTS p. 2
CMS Releases Guidance on Supplemental Benefits for MA Plans In-home non-skilled support services covered, as recommended by HCA The U.S. Centers for Medicare and Medicaid Services (CMS) has released guidance on ‘supplemental benefits’ to be offered by Medicare Advantage (MA) Managed Care plans and, as reported by HCA in earlier communications, these will include non-skilled in-home support services. See SUPPLEMENTAL p. 3
INSIDE Two Days & Just a Few Slots Left for HCA Annual Conference.................................1 CMS Releases Guidance on Supplemental Benefits for MA Plans.........................1 A Word from HCA Sponsor RBC Limited................................................................3 Member Hiring Announcements.....................................................................5,6 June 6 Data Seminar with Barbara Katz Tailored to HCA Member Requests..........6 DOH Posts 2017 CHHA, Personal Care Cost Report Software...............................7 HCA Data Webpage Now Includes 2016 CHHA Cost Report Data.........................7 HCA Participates in CMS Medicare Cost Report e-Filing Program.........................8 MLTC Forums Upstate on May 15 and Downstate on May 18.................................8 Health Workforce Retraining Funding Available................................................9 Settlement Conference Facilitation Program Expanded..................................10
HCA Memo Details FY 2019 Hospice Proposed Rule.........................................11 LawTalk: Good Hiring Practices, Potential Legal Landmines............................12 Guidance Provided on Appeals Transitional Period........................................14 DOH Posts Hospice Survey..............................................................................14 Social Determinants of Health Initiative Announced.......................................15 MBIs and the New Medicare Cards..................................................................15 HCA Participates in Emergency Preparedness Meeting.................................16 State’s Medicaid Cap Report Shows $58M Variance........................................17 Medicare Diabetes Prevention Program Expanded.......................................18 Important Upcoming Deadlines.....................................................................19 Resources....................................................................................................20
The Situation Report: the Home Care Association of New York State
EXPERTS from p. 1 learning on everything from advanced home health aides to workforce recruitment and retention, medreconciliation, care to prevent hospitalizations among sufferers of Alzheimer’s, home telehealth, and a bounty of other vital topics. For home care and hospice nationally, we have both of the top figures leading the charge from the association quarters, including National Association for Home Care and Hospice (NAHC) President Bill Dombi and National Hospice & Palliative Care Organization President Edo Banach. Our Board of Directors meeting, open to the HCA membership at the conference, will host a discussion with state Health Commissioner Dr. Howard Zucker and Office for Aging Acting Director Greg Olsen, a major draw for the HCA community and an opportunity to hear from the top officials at DOH and NYSOFA. Where else can you find chiefs of the state’s health, community support, eldercare and Medicaid programs as well as the brightest beacons from the federal association communities on home care and hospice? Please register and join us later this week in Saratoga!
Volume 3, No. 19 May 7, 2018
The Situation Report is a weekly publication of the Home Care Association of New York State (HCA). Unless otherwise noted, all articles appearing in The Situation Report are the property of the Home Care Association of New York State. Reuse of any content within this newsletter requires permission from HCA. Joanne Cunningham HCA President jcunningham@hcanys.org Roger L. Noyes Director of Communications, Editor of The Situation Report rnoyes@hcanys.org Al Cardillo Executive V ice President acardillo@hcanys.org Patrick Conole Vice President, Finance & Management pconole@hcanys.org Andrew Koski Vice President, Program, Policy & Services akoski@hcanys.org Laura Constable Senior Director, Membership & Operations lconstable@hcanys.org Celisia Street Director of Education cstreet@hcanys.org Mercedes Teague Finance Manager mteague@hcanys.org Jenny Kerbein Director of Governance & Graphic Design jkerbein@hcanys.org Billi Wilson Manager, Meetings & Events bwilson@hcanys.org Teresa Brown Administrative Assistant tbrown@hcanys.org
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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SUPPLEMENTAL from p. 1 The guidance is at https://hca-nys.org/wp-content/uploads/2018/05/HPMS-Memo-Primarily-Health-Related4-27-18.pdf. HCA supported this significant change in our comments and vigorous advocacy to CMS and Congress after an expansion of benefits was announced in a proposed call letter in early April. CMS is revising the definition of supplemental benefits. Previously, these benefits included the requirement that they be “primarily health related.” The definition is being expanded to “consider an item or service as primarily health related if it is used to diagnose, compensate for physical impairments, acts to ameliorate the functional/psychological impact of injuries or health conditions, or reduces avoidable emergency and healthcare utilization.” In order for a supplemental benefit to be approved, it must focus directly on an enrollee’s health care needs and be recommended by a licensed medical professional as part of a care plan. CMS says it expects organizations will establish reasonable safeguards to ensure enrollees are appropriately directed to care. CMS anticipates organizations will use this expanded definition to address health care needs and make adjustments to their annual supplemental benefit offerings based on the expected needs of their plan population. For example, organizations may decide to offer some items and services that may be appropriate for enrollees who have been diagnosed with needing assistance with Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). Continued on next page
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Continued from previous page The guidance includes a list of allowable supplemental benefits. In-home support services are described as: services to assist individuals with disabilities and/or medical conditions in performing ADLs and IADLs within the home to compensate for physical impairments, ameliorate the functional/ psychological impact of injuries or health conditions, or reduce avoidable emergency and healthcare utilization. Services must be provided by individuals licensed by the state to provide personal care services, or in a manner that is otherwise consistent with state requirements. In addition to in-home support services, the list also includes: adult day care services; home-based palliative care; support for caregivers of enrollees; medically-approved non-opioid pain management; home and bathroom safety devices and modifications; transportation; and others. Medicare managed care plans have the option, but are not required, to cover these supplemental benefits. CMS also notes in its guidance that the Bipartisan Budget Act of 2018 further expanded supplemental benefits for chronically ill enrollees beginning in contract year 2020, and CMS will provide guidance concerning these additional benefits prior to the contract year 2020 bid deadline. HCA has taken a very proactive national role in working with other state home care associations to support the implementation of this revised definition of supplemental benefits and will decide on next steps to work towards widespread adoption by the MA plans. In our comments to CMS on its initial proposed rule, we had advocated that the in-home support services be provided by those home care providers that meet federal or state licensure requirements, including Certified Home Health Agencies and Licensed Home Care Services Agencies. We also urged applicability to fee-forservice Medicare cases, in addition to MA plan coverage. In addition, we had urged that CMS require MA plans to proactively screen Medicare beneficiaries for their eligibility for skilled home care services as well as appropriateness and need for home health aide/personal care aide services, and we will be following up on all these recommendations. CMS has also released another guidance for the MA plans that revises the “uniformity” rules that determine which benefits must be offered to all enrollees. Under the revision, CMS has determined that the following is consistent with the uniformity requirement in the MA regulations: providing access to services (or reductions in specific cost-sharing and/or deductibles for services or items) that are tied to health status or disease state in a manner that ensures that similarly situated individuals are treated uniformly. However, CMS will not permit cost sharing reductions across all benefits for an enrollee; cost sharing reductions must be for specific benefits or services related to a specific health status or disease state. CMS will review benefit designs to make sure that the overall impact of the benefit design is non-discriminatory and that higher acuity, higher cost enrollees are not being excluded from these targeted benefits in favor of healthier populations. HCA will examine this guidance to determine its effects, if any, on the offering of in-home support and other supplemental benefits. For more information, contact the HCA Policy staff.
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The Situation Report: the Home Care Association of New York State
Staff Development Supervisor
DIRECTOR of CLINICAL OPERATIONS
Driven to be the Best. At Home Care, Inc., a nationally recognized “top 500” certified home health agency located in the Leatherstocking Region of Central New York, seeks to hire a Director of Clinical Operations. This key leadership position will operate within a patient-centered and technology progressive healthcare environment. Responsibilities include generation, implementation and oversight of clinical policy to ensure high quality, safe and effective patient care. Successful candidate will have:
BSN / Master’s degree preferred
Two years of experience in a clinical leadership role, with a proven record of effective clinical and change leadership
Mineola, NY. NYU Winthrop Hospital’s Home Health Agency ranks as a top-performing US Home Health Agency. We currently seek a full time Staff Development Supervisor responsible for staff education development and professional growth; teaching orientation classes to new staff & coordinating student nursing, clinical pharmacy and medical student rotations; and teaching post orientation follow-up modules in collaboration with specialty nurses and the education coordinators. You will participate in the ongoing evaluation and development of the orientation program, perform field evaluations of new staff as necessary, convey appraisals of staff to management, and make recommendations; prepare quarterly and annual reports/statistics of each program. We require:
BSN, required; Master’s in Nursing preferred.
NYS RN License, required.
2-3 years Clinical Nursing Practice and Community Health Nursing required.
Two years certified home health care experience
Strong written and verbal communication skills
Knowledge of Joint Commission and Federal homecare regulations
2 years Nursing experience in a supervisory capacity in a HHA required.
1-2 years Trainer, Instructor or Education Coordinator in a Certified Home Health Agency preferred.
Good presentation, communication, PowerPoint & computer skills are vital.
Ability to conduct education sessions and conduct skills lab to develop competencies a must.
Financial and reimbursement understanding
For consideration, please submit your resume in confidence, to Patricia Brown, Director of Human Resources e-mail: pbrown@ahcnys.org Fax: 607-432-5836 Direct: 607-353-7413
Apply@ www.nyuwinthrop.org/careers, #18-22843, e-mail HRHomeCare@nyuwinthrop.org, or call 516.663.8000. An EOE.
AHC is an EOE
Director of Business Development for Managed Care Services Premier Home Health Care Services, Inc., is a leading multi-state community based service provider, specializing in both Care Management and Licensed Home Health Care Agency services. Premier is currently seeking a Director of Business Development for Managed Care Services. The role of the Director is to market in-state and out-of-state to Managed Medicaid Long Term Care (MLTC/MLTSS) plans, Managed Dual Eligible integrated plans, general Managed Medicaid and Medicare Advantage plans for provision of: Care Management, Utilization Review, Nursing Assessments and Chronic Disease Management and Transitional Care services. Candidates are required to have knowledge of pay-for-performance, Value Based Purchasing models for both cost and quality metrics. The position requires a minimum of a Bachelor’s Degree or Bachelor’s of Nursing degree. MA/MPH/MBA preferred. A minimum of 3 years of experience in a business development role with demonstrated revenue growth in managed care services and/or related health/ home care programs is essential. Excellent salary and benefits package available. Exciting bonus potential based on revenue growth. Interested candidates should forward résumés to: josullivan@phhc.com. EOE/M/F/D/V
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The Situation Report: the Home Care Association of New York State
6/6 Clinician Data Seminar Custom-Tailored to HCA Member Requests Barbara Katz, a popular presenter at past HCA programs, joins Sutter Center clinicians in June lineup of mustattend sessions for clinician managers As we head into HCA’s annual conference, we also want to remind members of some other great learning sessions for your clinician staff, coming up in June. If you attended our Value Based Payment conference in 2015, you’ll recall that consultant Barbara Katz, RN from BK Consulting was a star speaker, with incredible knowledge and delivery on home care clinical issues. Conference evaluations called her “impeccable” and “engaging.” HCA has since worked closely with her to create a whole new program in response to specific requests from clinician managers wanting tools to put the strength of data at their fingertips. The result is an illuminating June 6 program Driving Decisions with Data: A Seminar for Clinician Managers. Please make sure your clinical teams are aware of this program specially customized and tailored to them. This practical and interactive seminar will help clinician managers understand their role in using data to drive decisions for your agency’s CoP-required work on Quality Assurance and Performance Improvement (QAPI) processes and in daily clinical work. Managers will leave with essential tools and techniques for obtaining data, step-by-step data analysis methods and practical methods for achieving target goals. Participants will also have an opportunity to analyze clinical and business data, to develop action plans and to apply datadriven decisions to real operational work problems. Virtual Integrated Care Management (ICM): Train-the-Trainer and Certification In another newly developed program for clinicians, join faculty experts from the acclaimed Sutter Center for Integrated Care for a one-of-its-kind Virtual Integrated Care Management (ICM) Train-theTrainer program in June with WEBEX training dates on June 5, 12, 19 and 26 (all from 1 to 3 p.m.) along with a series of self-paced online learning modules. Cnical Man ICM is a person-centered, evidence-based care delivery model. It provides cross setting support, with a focus on self management, care transitions, and case management best practices for communication and coordination. This program offers the convenience of online learning without time away from the office, plus the opportunity for CEUs and special certification as an ICM specialist. Information for both programs is at the back of this week’s newsletter as well as on our education and events page at https://hcanys.org/events-education/upcoming-events.
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Clinical Manager, Private Care/MLTC Manhattan Partners in Care, a respected leader in home health care, is currently seeking a Clinical Manager. The Clinical manager is accountable to the Associate Clinical Director to ensure quality and safe delivery of home care services in a cost effective manner, and to coordinate provision of home care services that reflects the agency’s philosophy and ensures standards of care are maintained. To qualify you must be a New York State licensed/certified RN with three (3) years clinical background. The ideal candidate will have excellent problem solving, organizational, interpersonal, written and verbal communication skills. Previous managerial experience with at least two (2) years’ experience in LHCSA or CHHA also preferred. Please email resume to: Joyann.thompson@partnersincareny.org
The Situation Report: the Home Care Association of New York State
Volume 3, No. 19 May 7, 2018
DOH Posts 2017 CHHA, Personal Care Cost Report Software; HCA Seeks Extension The state Department of Health (DOH) recently posted the 2017 Medicaid cost report software for nonhospital based CHHAs and personal care providers. Both are on the Health Commerce System, or HCS (https:// commerce.health.state.ny.us). In each case, the cost report, operator’s certification, and accountant’s certification are due no later than July 16, 2018. For the second year in a row, this is significantly earlier than previous years’ cost reports. Accompanying the cost reports on the HCS, below each respective Dear Administrator Letter (DAL), are “Submission Guidelines” and “Electronic Certification Access Instructions” to assist in completing the reports. HCA has requested that DOH grant an extension to allow providers at least 90 days to complete both The Personal Care DAL emphasizes that to certify your cost report electronically, the CPA and agency signatory must each have an HCS account. (Questions about the HCS can be made to the DOH helpline at 1-866-5291890.) For both the operator and CPA certifications, a current “Electronic Certification Access Request Form” must be on file with the Department. If a form was submitted for the 2016 Cost Report and the same individuals are providing the certifications in 2016, a new form is not required. If one or both of the certifiers have changed, a new form must be completed (once the agency and CPA accounts are established). Specific questions regarding the personal care cost report should be directed to DOH’s Kathy Omecinsky or Richard Kappes at PersonalCare-Rates@health.ny.gov. The CHHA DAL emphasizes that the 2017 software includes a new field to provide the dates for the period covered in the cost report. Specific questions regarding the CHHA cost report software should be directed to DOH’s Russ Smith at CHHA-Rates@health.ny.gov. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
HCA Data Webpage Now Includes 2016 CHHA Cost Report Data This week, HCA posted to our HCA Data website an HCA-developed spreadsheet of the 2016 Medicaid Cost Reports for all non-hospital-based CHHAs operating in the state. HCA Data is a members-only page that provides data reports to assist home care and hospice providers and managed care plans in their: benchmarking efforts; understanding of system-wide trends; and access to reimbursement and premium rates. The page is not visible on our site unless you are logged in with an HCA member website account. Our log-in page is here: http://hca-nys.org/login. Upon login, using your member username and password, the HCA Data link will appear in the site menu at the top right. You can also enter your e-mail address to obtain your password. Or, simply e-mail HCA’s Communications Director Roger Noyes at rnoyes@hcanys.org if you do not yet have an HCA website account. HCA has recently requested the fourth quarter 2017 Medicaid Managed Care Operating Reports (MMCORs) for each MLTC and Program of All-Inclusive Care for the Elderly (PACE) plan in the state, which we expect to receive from the state Department of Health in June or July. HCA will then prepare a detailed spreadsheet summarizing key MMCOR data, including such items as: plan enrollments; per-member-per-month premium
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revenue and premium income or loss; key utilization and unit cost data; and other information. HCA Data currently has 2016 MMCOR data available to members. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
HCA Participates in CMS Medicare Cost Report e-Filing Program Last week, HCA participated in a Medicare Cost Report e-Filing program held by the U.S. Centers for Medicare and Medicaid Services (CMS). The slides are available at https://www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/201805-01-MCREF-Presentation.pdf. Beginning May 1, home care and other Medicare Part A providers can use the Medicare Cost Report e-Filing (MCReF) system to submit cost reports with fiscal years ending on or after December 31, 2017. Agencies will have the option to electronically transmit their cost report through MCReF or mail or hand deliver it to their Medicare Administrative Contractor. Starting July 2, agencies must use MCReF if they choose electronic submission of their cost report. Access to MCReF will be controlled by the CMS Enterprise Identity Management (EIDM) system. Security Officials (SOs) and Backup SOs registered in EIDM for access to the Provider Statistical and Reimbursement (PS&R) system will have access to MCReF through their existing account. Providers that are not registered in EIDM as PS&R users must register and assign an SO for their organization (see https://portal.cms.gov/wps/portal/ unauthportal/eidm/newuserregistration). CMS emphasized during the webinar that providers will not receive an extension to the cost report filing date for any system issues that prevent e-Filing. CMS has also posted a MCReF transmittal at https://www.cms.gov/Regulations-and-Guidance/Guidance/ Transmittals/2018Downloads/R2075OTN.pdf, and an MLN Matters article at https://www.cms.gov/Outreachand-Education/Medicare-Learning-Network-MLN/MLNmattersArticles/downloads/MM10611.pdf. Questions about MCRef can be sent to OFMDPAOQUESTIONS@CMS.HHS.GOV.
MLTC Forums Upstate on May 15 and Downstate on May 18 to Discuss PostBudget Priorities, Strategies HCA is holding the next installments of our Forums for MLTC organization members on May 15 upstate (in Syracuse) and May 18 downstate (New York City). Both sessions run from 10 a.m. to 1 p.m. HCA’s MLTC organization members have already received notice about the Forums, but if you are an MLTC representative and haven’t yet registered, you can do so at https://www.surveymonkey.com/r/MLTC2018. These Forums – like our LHCSA, CHHA, Hospice, HCC and CFO Forums – are an important part of your membership in HCA to meet with our team and obtain updates on vital rate, regulatory and program issues. Continued on next page
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Continued from previous page Once you have registered using the online form on the previous page, HCA will provide you with additional details about the program agendas, which will include a discussion of post-budget priority areas and strategies.
Health Workforce Retraining Funding Available The state Department of Health (DOH), in consultation with the state Department of Labor, is soliciting applications from organizations proposing to train or retrain health industry workers to obtain new positions, meet the new job requirements of existing positions, or otherwise meet the requirements of the changing public health and health care market and the diversity of the populations seeking health care services. The Request for Applications (RFA) is at https://www.health.ny.gov/funding/rfa/17842/index.htm. Questions are due by May 15, 2018; a Questions and Answers document will be posted about May 25; and the application is due June 22. Please note this is a separate and distinct program from the Workforce Investment Organization initiative through Managed Long Term Care. Up to $18,320,000 (total) is available to support this RFA for a two-year period. Regional funding is available based on the amount available in a region and will be awarded on a competitive basis within a region. The contract will run for two years, from January 1, 2019 to December 31, 2020. In particular, this program is intended to address workforce needs including, but not limited to, the following:
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The growth of home and community-based long-term care and the need for long term care workers caring for individuals wishing to remain in their homes and communities;
Skills needed to ensure safe and effective care transition from one setting to another, to reduce avoidable hospital readmissions and emergency care usage;
The need for new skills required for existing public health and health care workers to maintain current employment including meeting new job or certification/licensing requirements;
Additional skills needed to prepare individuals for new job opportunities that are created due to changes in the market, including new employment for laid off workers or workers at risk of being laid off;
Occupational shortages, both current and anticipated in the near future;
Changes in skills required to support models of integrated care management and interdisciplinary team-based care;
Changes in skills required to support emerging technologies, including telehealth; and
The need for data production and analytic skills that are required to support performance measurement, quality improvement, better population health management and high quality, cost effective health care service delivery. Continued on next page
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Continued from previous page Eligibility Requirements Organizations eligible to apply for funding include: certified home health agencies, licensed home care services agencies, long term home health care programs, hospices; health worker unions; hospitals; long term care facilities; health care facilities trade associations; and others. Applicants must be legally existing organizations located in New York State capable of entering into a Master Grant Contract with DOH. They must be pre-qualified in the Grants Gateway, if not exempt, on the date applications are due. Applicants must have a minimum of two years of training experience with the target population and meet other requirements. HCA post-budget advocacy on workforce issues HCA has developed legislation to address workforce issues faced by home care and hospice providers and will be seeking legislative introductions. These include: a health worker retraining/cross-training program; a recruitment, training and retention rate add-on targeting shortage areas and disciplines and pilots for personnel support; a labor study and recommendations for securing home care and hospice recruitment and retention; and a state task force to promote occupations in home care and hospice.
Settlement Conference Facilitation Program Expanded The U.S. Department of Health and Human Services (HHS) has announced the expansion of the Settlement Conference Facilitation (SCF) program to reach additional providers and suppliers. SCF is an alternative dispute resolution process at the Office of Medicare Hearings and Appeals (OMHA) that gives certain providers and suppliers an opportunity to resolve their eligible Part A and Part B appeals. All Medicare Part A and Part B providers and suppliers who are waiting appeal reviews at the Administrative Law Judge (ALJ) level or Medicare Appeals Council level could potentially be eligible to participate in the SCF. This appeals option is completely separate and distinct from the Third-Party Liability (TPL) settlement between the state Office of the Medicaid Inspector General (OMIG) and the U.S. Centers for Medicare and Medicaid Services. (The most recent update on this settlement is in the March 5, 2018 edition of The Situation Report at https://hca-nys.org/wp-content/uploads/2018/03/SitRep030518.pdf.) SCF appellant eligibility criteria includes the following:
The appellant must be a Medicare provider or supplier that has been assigned a National Provider Identifier (NPI);
The appellant cannot have filed for bankruptcy and/or expect to file for bankruptcy in the future;
The provider or supplier must not have or have had False Claims Act litigation or investigations pending against them, or other program integrity concerns, including pending civil, criminal, or administrative investigations. Continued on next page
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Continued from previous page Beyond the appellant’s eligibility, certain requirements apply to the appeals themselves. Some of the SCF appeals eligibility criteria include the following:
The appeals must involve request(s) for ALJ hearing or Council review filed on or before November 3, 2017, and these must consist of 500 or more appeals pending at OMHA and the Council combined; or they can include any number of appeals pending at OMHA and the Council that each have more than $9,000 in billed charges;
The request(s) for ALJ hearing and/or Council review must arise from a Medicare Part A or Part B Qualified Independent Contractor (QIC) reconsideration decision;
Appeals must not be scheduled for an ALJ hearing or an ALJ hearing must not have been conducted;
The amount of each individual claim must be $100,000 or less (for the purposes of an extrapolated statistical sample, the overpayment amount extrapolated from the universe of claims must be $100,000 or less);
Appeals must not be beneficiary-initiated appeals of QIC reconsiderations or any appeals arising from Medicare Part C, Medicare Part D, or appeals of Social Security Administration decisions regarding entitlement, Part B late enrollment penalties, and Part B and Part D income related monthly adjustment amounts (IRMAAs).
OMHA will conduct an open door call on May 22, 2018 to provide information to appellants interested in resolving their appeals through this process. Registration is at https://blh.ier.intercall.com/catalog. More information on the SCF program is at https://www.hhs.gov/about/agencies/omha/about/specialinitiatives/settlement-conference-facilitation/index.html. Providers not eligible for the SCF might be eligible for the Low Volume Appeals (LVA) Initiative which has been extended until June 8, 2018. The LVA allows providers with fewer than 500 claims and billed amounts of $9,000 or less per appeal to settle for a partial payment of 62 percent of the net Medicare approved amount. HCA has provided a lot of information on LVA, and more recently in the April 9 edition of The Situation Report at https://hca-nys.org/wp-content/uploads/2018/04/SitRep040918.pdf. CMS’s website on LVA is at https:// www.cms.gov/Medicare/Appeals-and-Grievances/OrgMedFFSAppeals/Appeals-Settlement-Initiatives/LowVolume-Appeals-Initiative.html.
HCA Memo Details FY 2019 Hospice Proposed Rule Reminder: hospice association leader Edo Banach to present at HCA annual conference on Thursday The U.S. Centers for Medicare and Medicaid Services (CMS) has released its proposed rule to update the fiscal year (FY) 2019 Medicare payment rates and wage index for hospices serving Medicare beneficiaries. HCA has prepared a memo on the proposed rule, available at https://hca-nys.org/wp-content/uploads/2018/05/ 050418CMSProposedRuleFY2019Hospice.pdf. Continued on next page
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Continued from previous page CMS estimates that hospices nationally will see an estimated 1.8 percent ($340 million) increase in their payments for FY 2019 over 2018. CMS is proposing updates to the hospice payment rates and the hospice aggregate cap. It also proposes to allow physician assistants (PAs) to be considered the Attending Physician, as well as changes to the Hospice Quality Reporting Program (HQRP), including: a new factor for HQRP measure removal; new data review and correction timeframes for data submitted using the Hospice Item Set (HIS); changes to the quality measures displayed on Hospice Compare in FY 2019; updates to the public display of HIS measures; and an extension of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey participation requirements, exemption criteria, and public reporting policies for future years. For further details, please download the memo. NHPCO President Edo Banach on Thursday HCA reminds all members that National Hospice and Palliative Care Organization President Edo Banach will be presenting at HCA’s Annual Conference on Thursday in Saratoga Springs. This is a great opportunity for hospices and organizations wishing to expand their palliative care offerings to hear about current and future trends in the hospice and palliative care arenas. More information and registration are on our conference website at www.hcaannualconference.com.
LawTalk: Good Hiring Practices, Potential Legal Landmines By Vincent E. Polsinelli and Christopher J. Stevens, Jackson Lewis When it comes to hiring the right people, employers often want as much information as they can obtain about applicants to maximize the odds of finding the right fit. This is especially so in the home care context, where many employees will be going into customers’ homes. Despite this pressure, employers must always be mindful of the legal landscape overlaying the hiring process. Staying abreast of all applicable laws is critical, and there are more potential landmines now than ever before. Indeed, there are a growing number of laws – including local laws enacted by various municipalities – that limit the type of information an employer can seek from a job applicant. The following will provide a brief summary and some examples. Be careful when requesting salary information Nationally, there is a growing trend of laws limiting employers from obtaining information about an applicant’s salary history. New York State has been no exception. Albany, Buffalo, New York City, Rochester, and (most recently) Westchester County have all adopted local laws prohibiting employers (to various extents) from asking about an applicant’s salary history. The New York City law went into effect on October 31, 2017, prohibiting employers in New York City from inquiring about, relying upon, and verifying a job applicant’s salary history during all stages of the employment process. (HCA reported on this law in the November 6 edition of The Situation Report.) In summary, with some limited exceptions, employers cannot: ask applicants questions about or solicit information about applicants’ current or prior earnings or benefits; ask applicants’ current or former
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employers or their employees about applicants’ current or prior earnings or benefits; search public records to learn about applicants’ current or prior earnings or benefits; or rely on information about applicants’ current or prior earnings or benefits to set their compensation. As another example, Albany County recently enacted an ordinance that prohibits employers from screening applicants based on their past or current wages or requiring that an applicant’s prior wages satisfy minimum or maximum criteria. That ordinance also makes it unlawful to request that an applicant disclose salary history as a condition of consideration for employment, and to request salary information from an applicant’s prior employer(s). There are indications that this trend could expand statewide. Governor Cuomo recently unveiled proposed legislation that would ban employers across New York State from asking about a prospective employee’s salary history. Employers, of course, will want to keep a careful eye on the progression of that legislation. (HCA reported on the state legislation in the April 16 edition of this newsletter.) “Ban the Box” continues to expand “Ban the box” laws – laws that limit an employer’s ability to ask about an applicant’s criminal record – have become similarly widespread. New York City has been at the forefront of this effort, having enacted the “Fair Chance Act” (FCA) back in 2015. The FCA, like other ban-the-box laws, generally prohibits employers from making inquiries about an applicant’s arrest or conviction record until after a conditional offer of employment is made. In addition to the FCA, the New York City Commission on Human Rights recently finalized regulations that impose additional restrictions on employers. As just a few examples, the regulations make it a violation to use a standard boilerplate job application that requests or refers to criminal history, even if it contains a disclaimer stating that requests about an applicant’s arrest or conviction record do not apply to applicants in New York City. They also make it a violation of New York City Law to ask an applicant about even a pending criminal case before extending a conditional offer of employment. Buffalo, Syracuse and Rochester have each passed similar laws – though their scope is much more limited than New York City’s FCA and its associated regulations. Private employers in the health care industry certainly need to be aware of these laws, which govern their employment applications and pre-offer discussions with prospective employees. None of the laws discussed above, however, will alter the post-offer process in which home care employers are required by regulation to request background checks on new hires through the Criminal History Record Check statute. In summary, the hiring process contains more potential liability landmines for employers now than it ever has before. This will become increasingly true as the trends discussed above continue to spread and additional municipalities adopt their own versions of similar laws. Statewide change is also on the horizon. It is critical for employers to stay up-to-date on the developing law in this area in order to avoid potential liability. Each month, attorneys at Jackson Lewis (the firm that represents HCA as its counsel) will provide a brief, informational article on a legal topic relevant to HCA’s members. Please note that HCA LawTalk articles are for general, informational purposes, are not legal “advice,” and do not create an attorney-client relationship. Because each case is unique, the information provided should be considered to be general in nature, and should never be considered a substitution for legal counsel. Readers should not take, or refrain from taking, any action based on information in this article without first seeking legal advice from competent counsel.
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Guidance Provided on Appeals Transitional Period The state Department of Health (DOH) has provided additional guidance for a transitional period of implementing changes in the service authorization, appeals and grievance procedures required under a federal Medicaid rule. The transitional period will run from the first day the changes are effective – May 1, 2018 – to August 31, 2018. As mentioned in numerous Situation Report stories, one of the biggest changes is that, starting with plan service determinations made on May 1, enrollees wishing to dispute a plan’s adverse determination regarding their services must exhaust the plan’s internal appeal process before requesting a state Fair Hearing. In the April 30 guidance, DOH says it expects plans and their management contractor to issue notices that are compliant with model notices supplied by DOH for service authorization request, adverse benefit, appeal and grievance determinations made on and after May 1. However, where the plan or its management contractor issues an adverse benefit or appeal determination notice that reflects the pre-May 1, 2018 appeal process, the state will honor the notice the enrollee receives and the enrollee may request a Fair Hearing without first asking for an internal plan appeal. Managed care plans are required to confirm their readiness to implement these changes as of May 1 by submitting a “2018 Plan Readiness Attestation” to DOH by May 14. Some elements of the attestation include: all appropriate staff have been trained in the new requirements; member notices of the changes were sent to all plan enrollees; and staff have been prepared to assist enrollees in completing forms and taking other steps related to grievances and appeals. The attestation is at https://hca-nys.org/wp-content/uploads/2018/05/2018-Mega-Rule-Attestation.docx. During the May 1 to August 31, 2018 transitional period, all plans must submit a biweekly log of Plan Appeals received every other Friday, utilizing a DOH template. The first biweekly report is due May 18 and covers appeals requested from May 1 to May 11. The appeal changes, along with FAQs, webinar materials, model notices and other guidance, are at https:// www.health.ny.gov/health_care/managed_care/plans/appeals/index.htm.
DOH Posts Hospice Survey The state Department of Health (DOH) has posted a survey for hospices to complete. The survey is at https://www.surveymonkey.com/r/HospiceUtilization. It is due May 16. The survey seeks to research hospice utilization in New York State, with the goal of assisting DOH to identify recommendations and strategies to increase hospice utilization. DOH notes that state hospice utilization and lengths of stays are low compared to national averages. Nationwide, 46.6 percent of Medicare beneficiaries who died in 2015 received hospice services, while only 30.3
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percent of New York State Medicare beneficiaries who died in 2015 received hospice services. In 2016, Medicare hospice beneficiaries spent a national average of 70 days in hospice, compared to only 49 days in New York State. In 2016, New York ranked 49th for the average number of days Medicare hospice beneficiaries spent in hospice among all 50 states. Any questions, comments, or concerns on this survey can be sent to mark.kissinger@health.ny.gov or ALTCteam@health.ny.gov.
Social Determinants of Health Initiative Announced The state Department of Health (DOH) is launching a new initiative to identify innovative ideas to effectively address the Social Determinants of Health (SDH) for Medicaid members across New York State. The intent of this “Call for SDH Innovations” is to solicit input from interested parties across the state and around the country. Innovations will be reviewed by a team of health care experts identified by DOH. Top innovations will receive special recognition but all innovations, with the consent of the submitting organization, will be shared publicly by DOH. The Call for Social Determinants of Health Innovation application is at: https://www.surveymonkey.com/r/ SDH_Innovations. Later this fall, DOH will host a Social Determinants of Health Innovation Summit that will allow the applicants with the best solutions to pitch their product or idea to a panel of expert judges and audience members. It will be a chance for top health care professionals and investors to hear about innovations aimed at better health in Medicaid. At the summit, winners of each category will be honored with a ‘2018 SDH Health Innovation Award’. While there is no state funding for this initiative, it is a chance for innovative companies and organizations to receive exposure to health care decision-makers including, but not limited to, providers, Managed Care Organizations, and DSRIP Performing Provider Systems. Innovations are due by June 15, 2018 at 5 p.m. Questions can be sent to SDH@health.ny.gov.
MBIs and the New Medicare Cards As part of a campaign to issue Medicare cards with new numbers known as Medicare Beneficiary Identifiers (MBIs), the U.S. Centers for Medicare and Medicaid Services (CMS) has tips for obtaining your agency patient’s MBI (https://www.cms.gov/Medicare/New-Medicare-Card/Understanding-the-MBI.pdf). These include:
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Asking your Medicare patients. Medicare is mailing the new Medicare cards in phases by geographic location (https://www.cms.gov/Medicare/New-Medicare-Card/NMC-Mailing-Strategy.pdf) to people with Medicare. Ask your Medicare patients for their new Medicare card when they receive
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care. If they have received a new card but don’t have it with them at the time of service, remind them they can use MyMedicare.gov to get their new Medicare number.
Use the Medicare Administrative Contractors’ secure MBI look-up tool. Learn about (https:// www.cms.gov/Medicare/New-Medicare-Card/Providers/New-Medicare-Card-Provider-Letter.pdf) and sign up (https://www.cms.gov/Medicare/New-Medicare-Card/Providers/MACs-Provider-Portalsby-State.pdf) for the Portal to use the tool when it is available no later than June 2018. You can look up MBIs for your Medicare patients who don’t have their new cards when they come for care.
Check the remittance advice (https://www.cms.gov/Medicare/New-Medicare-Card/Providers/ Providers-and-office-managers.html#C4). Starting in October 2018 through the end of the transition period, Medicare will return the MBI on every remittance advice when you submit claims with valid and active Health Insurance Claim Numbers (HICNs).
Medicare resource links on the new cards are at https://www.cms.gov/Medicare/New-Medicare-Card/ Providers/Providers-and-office-managers.html.
HCA Participates in Emergency Preparedness Meeting Last week, HCA participated in the Capital District Emergency Preparedness Coalition (HEPC) North Country Sub Regional Planning meeting. HEPCs are coalitions of providers, local and state emergency management and local public health preparedness officials that work together to plan for and coordinate emergency preparedness across the continuum, including individual sector preparedness and challenges, collaboration across sectors, exercise planning and hotwashes, trainings, hazard and vulnerability assessments, and other areas of concern. The May 2 HEPC meeting included discussions on: medical response to the Las Vegas Mass Shooting incident and lessons learned; Point of Dispensing (POD) exercise held on April 3; potential role of HEPCs in “Mass Gathering” events; and regional training events. POD exercises involve responding to a simulated biological, chemical or radiological public health emergency. They include dispensing strategies, sites and modalities, as well as other strategies to achieve goals appropriate to the targeted population. In two of the counties represented at the May 2 meeting, the local public health departments were able to utilize nurses from their associated home care departments to assist with the POD exercise. At the meeting, HCA stressed the importance of involving additional home care and hospice providers in all exercises and planning activities. HCA has been encouraging all home care agencies, hospices and managed long term care plans to send staff to the HEPC meetings and to participate in HEPC activities. It will enable you to develop and build upon your own internal emergency preparedness planning and meet state and federal requirements. Continued on next page
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The Situation Report: the Home Care Association of New York State
Continued from previous page Those interested should contact Andrew Koski at akoski@hcanys.org. A list of upcoming HEPC meetings follows. HEPC Capital District Region – Capital District Sub Regional Lower Hudson Valley Long Island Western New York Sub Regional Central New York Bronx Emergency Preparedness Coalition Finger Lakes Sub Regional Emergency Preparedness Coalition of Manhattan
MEETING DATE May 11 June 6 June 7 June 14 June 14 June 14 June 18 August 15
HCA also encourages home care and hospice providers to participate in trainings related to preparedness. DOH’s Office of Health Emergency Preparedness (OHEP) publishes an electronic newsletter (the Aware Prepare Update) featuring upcoming trainings related to preparedness. The May edition is at https:// www.urmc.rochester.edu/MediaLibraries/URMCMedia/flrtc/2018_May_AP.pdf. Also coming soon is a resource toolkit for providers – compiled over the past year by HCA in collaboration with the New York State Association of Health Care Providers (HCP), and a provider workgroup – that will assist providers in supporting the emergency preparedness tasks of patients and families. Under a grant from the state Department of Health Office of Emergency Preparedness, HCA and HCP work with all home care and hospice providers to support their roles in emergency preparedness in the entire state. HCA and HCP have jointly conducted local EP information and collaboration sessions for home care, hospice, local public health preparedness officials and county emergency managers. The sessions are comprised of small local groups that have already covered 55 counties in the state. Many of these sessions are yielding new levels of local engagement and planning. Our next sessions are planned for Nassau and Suffolk counties in early fall. For more information on HCA’s emergency preparedness activities, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org; or Al Cardillo at (518) 810-0663 or acardillo@hcanys.org.
Medicaid Cap Report: $58M Variance from Projections In April through February The state’s latest Medicaid Global Cap Spending Report (for the past fiscal year through February 2018) finds that overall spending was $58 million above the global cap projections, across all sectors, a difference of $19.003 billion in actual spending versus $18.945 billion in estimated spending for the period. The state fiscal year (SFY) begins on April 1 and ends on March 31. Nearly all of the provider and plan categories were above the cap projections. “Other Long Term Care” (which includes home care) was $35 million above projections. DOH notes that there were 3,887 more
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personal care recipients during this period, driving the costs. Managed Long Term Care was $86 million over projections due to there being 700 more recipients than anticipated during the report period. In other report highlights:
The Accounts Receivable (A/R) ending balance for SFY 2017 was $204 million. The state is expected to recoup $135 million by the end of SFY 2018, resulting in a projected A/R balance of $69 million by March 2018. Through the end of February, retroactive rates owed to the state were $158 million. This reflects net recoveries of $46 million since March 2017.
Total Medicaid enrollment reached 6,156,115 at the end of February 2018. This reflects a net increase of 40,462 enrollees since March 2017.
The report contains multiple other data, including tables or summaries of: Vital Access Provider program award amounts; Inventory of Medicaid Rate Packages, Regional Medicaid spending and enrollment estimates; and more. The full report is at: https://www.health.ny.gov/health_care/medicaid/regulations/global_cap/monthly/ sfy_2017-2018/docs/feb_2018_report.pdf. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
Medicare Diabetes Prevention Program Expanded At the end of April, the U.S. Centers for Medicare and Medicaid Services (CMS) announced that it had expanded the Medicare Diabetes Prevention Program (MDPP) to include home in this national performancebased payment model that addresses type 2 diabetes prevention in eligible Medicare beneficiaries who have an indication of pre-diabetes. Community-based organizations can now enroll as Medicare suppliers of health behavior change services. The MDPP model was launched in 2012 as a small, voluntary model tested at 17 sites across the country in partnership with the YMCA-USA, U.S. Centers for Disease Control and Prevention (CDC), and other public and private partners. Now, CMS is expanding this set of services nationwide based on promising results. In the initial model test, 45 percent of beneficiaries met the 5 percent weight loss target, which translates to a clinically meaningful reduction in the risk of developing type 2 diabetes. Through the MDPP, trained community health workers and other health professionals empower beneficiaries at high risk of developing type 2 diabetes to take ownership of their health through curriculum-driven coaching and proven behavior change strategies for weight control. As a new preventive service for qualifying Medicare beneficiaries, MDPP services are available without a referral or co-payment. Eligible organizations can begin the screening and enrollment process to become an MDPP Supplier by using the Provider Enrollment Chain and Ownership System (PECOS) or submitting the paper CMS-20134 Form. For information on the steps to enrollment, please refer to the https://tinyurl.com/y77j3y4q. More information on MDPP is at https://innovation.cms.gov/initiatives/medicare-diabetes-prevention-program.
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Volume 3, No. 19 May 7, 2018
The Situation Report: the Home Care Association of New York State
Upcoming Deadlines Requirement/Change Home Care, Fiscal Intermediaries and other providers who contract with Managed Care Organizations must be enrolled in Medicaid
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Effective/Due Date Still being accepted, but providers are advised to submit now
More Information https://www.emedny.org/info/ProviderEnrollment/Manage dCareNetwork/index.aspx
Transition Period for Using Health Insurance Claim Number (HICN) or new Medicare Beneficiary Identifier (MBI)
April 1, 2018 to December 31, 2019
https://www.cms.gov/Medicare/NewͲMedicareͲ Card/index.html
Implementation of Universal Billing Codes for Home and CommunityͲBased Long Term Care Services under Managed Care
April 1, 2018
https://www.health.ny.gov/facilities/long_term_care/reimb ursement/letters/dal_2017Ͳ12Ͳ07_billing_codes.htm
Submission of Expression of Interest for the Medicare Low Volume Appeals Initiative
Due April 12 to June 8
https://www.cms.gov/Medicare/AppealsͲandͲ Grievances/OrgMedFFSAppeals/AppealsͲSettlementͲ Initiatives/LowͲVolumeͲAppealsͲInitiative.html
Changes in appeals system for Medicaid managed care enrollees
May 1, 2018
https://www.health.ny.gov/health_care/managed_care/pla ns/appeals/index.htm
Changes to NYC Paid Sick Leave Law Become Effective
May 5, 2018
http://www1.nyc.gov/site/dca/about/paidͲsickͲleaveͲ law.page
2018 Medicaid Managed Care Plan Readiness Attestation Forum
Due May 14, 2018
https://hcaͲnys.org/wpͲcontent/uploads/2018/05/2018Ͳ MegaͲRuleͲAttestation.docx
NYS Hospice Survey
Due May 16, 2018
https://www.surveymonkey.com/r/HospiceUtilization
NYS Health Foundation ‘Patients as Partners’ RFP
Due May 16, 2018 for online inquiry form
https://nyshealthfoundation.org/rfp/patientsͲasͲ partners/?utm_source=Patients+as+Partners+RFP+Release+ April+2018&utm_campaign=Patients+as+Partners+RFP+Rel ease&utm_medium=email
Long Term Care Planning Council Survey
Due June 18, 2018
https://www.surveymonkey.com/r/HM9DM97
Health Workforce Retraining Program RFA
Due June 22, 2018
https://www.health.ny.gov/funding/rfa/17842/index.htm
Hearing on state Department of Labor’s proposed rule to exclude meals and sleep time for all employees
July 11, 2018
www.labor.ny.gov
Certified Home Health Agency 2017 Cost Report
Due July 16, 2018
https://commerce.health.state.ny.us/public/hcs_login.html
Personal Care Provider 2017 Cost Report
Due July 16, 2018
https://commerce.health.state.ny.us/public/hcs_login.html
The Situation Report: the Home Care Association of New York State
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Resources
“2017 Profile of Older Americans,” by the Administration for Community Living https://www.acl.gov/sites/default/files/Aging%20and%20Disability%20in%20America/ 2017OlderAmericansProfile.pdf.
“Enhancements to Processing of Hospice Routine Home Care Payments,” MLN Matters article by the U.S. Centers for Medicare and Medicaid Services https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNMattersArticles/downloads/MM10573.pdf
“Electronic Visit Verification: Implications for States, Providers, and Medicaid Participants,” by the National Association of States United for Aging and Disabilities https://tinyurl.com/y7s7ravl
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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Virtual Integrated Care Management (ICM) Train-the-Trainer and Certification Gain CEUs and ICM Specialist Trainer Certificate
Live Webex Training Series Dates * June 5, 2018: 1:00PM – 3:00PM June 12, 2018: 1:00PM – 3:00PM June 19, 2018: 1:00PM – 3:00PM June 26, 2018: 1:00PM – 3:00PM *Attendance is required of all four live trainings plus all self-paced online modules for trainer certification.
Train the Trainer Specialist Exam/Certificate Upon successful completion of all live and self‐paced sessions, as well as a web‐based examination, participants will receive an Integrated Care Management Specialist Trainer Certificate. As an authorized trainer, you will gain access to training materials including PDFs of all slide decks and activities used in each class, plus four stoplight tools on Heart failure, COPD, diabetes and depression. You’ll also be able to provide in‐ service trainings to colleagues or new hires at your agency. Participants will receive 12 CEUs for nursing and therapy in states that accept California‐awarded CEUs. This course is endorsed by the National Association for Homecare and Hospice (NAHC).
To thrive in a value‐based payment environment, health care providers must equip their clinicians with the tools and competencies necessary to engage patients, reduce unnecessary utilization, and promote high‐level patient satisfaction. Integrated Care Management (ICM) is a person‐centered, evidence‐based care delivery model that fulfills these goals. It provides cross‐setting support, with a focus on self‐management, care transitions, and case management best practices for communication and coordination. An effective ICM program helps clinicians to clearly articulate the value of these competencies to patients, families and other stakeholders. These and other characteristics make it a valuable asset in achieving new standards under the recently expanded home health Conditions of Participation (CoPs). Join faculty experts from the acclaimed Sutter Center for Integrated Care for a one‐of‐ its kind Virtual ICM Train‐the‐Trainer program in June. This series includes four 2‐ hour live webinar sessions as well as four self‐paced online training modules designed to solidify competencies for successfully implementing an ICM program with evidence‐based guidelines targeting four chronic conditions: heart failure, diabetes, COPD, and depression. Participants will learn how to develop: • Continuous, integrated care processes across all aspects of home health services; • Patient‐centered, interdisciplinary approaches that recognize the contributions of various skilled professionals; and • An evidence and outcome‐based approach to patient care that can be understood by the patient and caregivers and incorporates the shared decision‐making model. ICM is founded on the most effective practices, interventions and tools in the most recent literature. Its goal is to take the “best of the best” and maximize patient support where the patient faces daily challenges – the home.
Live Webex Sessions Content: • Overview of chronic care and patient engagement best practices, including Wagner’s Care Model, health care policy research findings, and the Integrated Care Model • Motivational interviewing and health coaching • Interventions for patients with low health literacy and patient education best practices • Overview of the Transitions of Care best practices • Pivotal role of the integrated care manager in the future health care environment • Tips and takeaways for hardwiring ICM best practices
Self‐Paced Online Modules Content: Evidence‐based guidelines and patient behaviors needed for optimal condition management of the following: • Heart Failure • Diabetes • COPD • Depression
Virtual Integrated Care Management (ICM) Train-the-Trainer and Certification Gain CEUs and ICM Specialist Trainer Certificate
ICM Faculty Beth Hennessey, RN, BSN, MSN Beth has over 40 years of healthcare experience in a variety of settings including acute care, case management, medical practice management, home care, higher education, and now as the Executive Director of the Sutter Center for Integrated Care. Beth’s passion is the development, implementation, and evaluation of innovative approaches for true person‐ centered care delivery. Beth has published widely in refereed journals on best practices in patient centered care, “what matters most”, chronic care management, transitions of care, patient engagement, health literate care, and successfully positioning providers across the continuum to meet the quadruple aim of healthcare reform. Beth has served on multiple state and national workgroups some of which include: National Association of Home Care and Hospice Board, VNAA Policy Board, Alliance for Home Health Quality and Innovation Transitions of Care workgroup, CMS Expert Panel on Patient Engagement Measures, Arkansas Home Care Association Board, and CMMI Comprehensive Primary Care Initiative AR Core Workgroup. Paula Suter, RN, BSN, MA Paula is the Clinical Manager of Integrated Care Management (ICM) at the Sutter Center for Integrated Care. Drawing from her clinical and academic experience, she designs, implements, and evaluates person‐centered health care delivery programs to meet the needs of patients and populations. Paula is passionate about advancing excellence in home and community care, establishing this sector as a value added partner for healthcare reform. She has more than 30 years of health care clinical and leadership experience in a variety of settings including home care, acute care, intensive care, cardiac rehab, education, and research. Prior to joining Sutter, Paula co‐developed the Home‐Based Chronic Care Model™ which received national awards for excellence from the National Association of Homecare and Hospice and Modern Healthcare. She currently sits on the executive committee for a national health care quality initiative, is a member of the VNAA Best Practice workgroup, and has served as a reviewer for a leading homecare journal. In 2012, Paula was selected as one of 73 participants in the Centers for Medicare and Medicaid (CMMI) Innovation Advisors Program. Drawing from the advanced skill set acquired through successful completion of this program, she offers training and support to providers nationwide.
REGISTRATION Name: _______________________________________________ Title/Profession:_______________________________________ Agency:______________________________________________ Address:_____________________________________________ City/State/Zip:________________________________________ Phone:____________________________ Ext._______________ Email: _______________________________________________
REGISTRATION FEES (per person NOT per connection) □ $499 HCA Member □ $649 Non‐Member (Within New York State) Out of New York State Providers
□ $499 I am a member of my state home care association (please specify) _____________________________________
□ $649 I am not a member of my state home care association
PAYMENT ____MasterCard
CANCELLATIONS
must be received in writing via e‐mail to info@hcanys.org. Cancellations received by May 22 are refundable less a 25% administrative fee. No refunds will be given once course materials and log‐in information have been provided. No refunds will be provided for no shows. Substitutions (for the entire program only) are permitted. DO NOT FORWARD YOUR ACCESS LINK: you must notify us in advance of the substitution to ensure your agency is not charged for an additional registration.
FAX TO: (518) 426‐8788
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*Make checks payable and mailed to: HCA Education and Research 388 Broadway, 4th Floor, Albany, NY 12207 _______________________________________ _____________ _____________ Card Number Expiration Date Security Code _____________________________________________________________________ Name and/or Company Name on Card _____________________________________________________________________ Billing Address of card (including City, State and Zip Code) _____________________________________________________________________ Authorized Signature
Driving Decisions with Data A Seminar for Clinical Managers
June 6, 2018 – Albany Marriott Hotel – Albany, NY
Driving Decisions with Data A Seminar for Clinical Managers
Meet the Presenter Barbara Katz, RN, MSN President, BK Health Care Consulting
Barbara is an experienced clinician, manager, trainer and health care consultant. She is a graduate of the Yale School of Nursing, She has a Certificate in Training and Development from Fairfield University and a Coaching Certification from the American Talent Development Association. Barbara was the 2013 winner of the Connecticut Association for HealthCare at Home’s Judith A. Hriceniak Award for Excellence in Nursing Leadership. Barbara has been a hospital nurse, an APRN, a training manager, a director of quality improvement and a clinical manager for a group of medical practices. She has also been a marketing director for a home health care agency and has managed operations for a private duty home care agency. She has designed and taught seminars on process improvement, data analysis, management, motivational interviewing and team-building. Barbara frequently speaks on topics including the practical use of data to improve outcomes, motivational interviewing, health literacy, collaboration and care transitions and adapting to the new world of health care.
Driving Decisions with Data A Seminar for Clinical Managers June 6, 2018 Albany Marriott 189 Wolf Road, Albany, NY 12205 Registration & Continental Breakfast: 8:30AM Program: 9 – 4:30PM
Home health care agencies will survive and thrive in the new value based health care world if their clinical managers use data to improve population health outcomes, lower costs, reduce waste in work and improve the patient and clinician experience. The new Medicare Conditions of Participation for home health care also require agencies to adopt a data driven approach to Quality Assurance/Quality Improvement (QAPI). This practical and interactive seminar will help managers understand their role in using data to drive decisions for both the agency QAPI process and in daily clinical work. Managers will leave with essential tools and techniques for obtaining data, step by step data analysis methods and practical methods for achieving target goals. Participants will have an opportunity to analyze clinical and business data, to develop action plans and to apply data-driven decisions to real operational work problems. By the end of this program, participants will be able to: Explain why data-driven decisions are vital in the new world of health care Describe the role of data in meeting the Medicare Conditions of Participation for QAPI List key home health care measures Describe four key steps to making data-driven management decisions Utilize basic data analysis techniques to turn data into actionable information Use data to solve operational problems and to achieve agency QAPI goals
Driving Decisions with Data – A Seminar for Clinical Managers June 6, 2018 – Albany Marriott Hotel – Albany, NY HOTEL INFORMATION Albany Marriott 189 Wolf Road, Albany, NY 12205 HCA has reserved a limited block of rooms at the Marriott – Wolf Road, Albany, NY for the night of Tuesday, June 5 at a discounted rate of $139 per night. To receive this special rate, please call 1‐800‐228‐9290 prior to May 16, and ask for the Home Care Association of NYS group rate.
REGISTRANT INFORMATION – Please register by May 22 Name: __________________________________________________________________________ Title:____________________________________________________________________________ Agency:_________________________________________________________________________ Address:_________________________________________________________________________ City/State/Zip:____________________________________________________________________ Phone:________________________________ Ext._________ Fax: _________________________ Email: ___________________________________________________________________________ (Required)
HCA REGISTRATION FEE* ____ HCA Member Fee
$239
____ Non‐Member Fee
$389
*Fee includes continental breakfast and lunch.
PAYMENT – Please check method of payment: ________MasterCard _______VISA ______American Express ______Check* *Make checks payable to: HCA Education and Research and mail to 388 Broadway, 4th Floor, Albany, NY 12207. Checks must be received by May 30. ______________________________________________________________________________ Card Number _______________________________________ __________________________________ Expiration Date Security Code ______________________________________________________________________________ Mailing Address of Card Holder ______________________________________________________________________________ City, State, Zip ______________________________________________________________________________ Name on Card ______________________________________________________________________________ Authorized Signature
FAX to 518-426-8788
HCA Cancellation Policy HCA registration cancellations received by May 23 are refundable less a 25% administrative fee. No refunds will be issued after this date. Cancellations must be received in writing at info@hcanys.org. Substitutions are permitted.
Special Needs In accordance with the Americans with Disabilities Act, or special dietary needs, please let us know how we can accommodate you: ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________