Embed Size (px)
Citation preview
Legislative Issues Public Policy News
A Weekly Publication Of HCAHCAHCAHCAHCAHome Care Association of New York State
Helping New YorkersFeel RightAt Home
ASAPVolume 20, No. 19 May 15, 2015
Inside Inside Inside Inside Inside ASAPASAPASAPASAPASAP
In Five Minutes, You Can Advocate
on HCA Priority Bills Using our
New Legislative Action Center
During the past two weeks, HCA has succeeded ingetting two priority HCA-developed billsintroduced. A.7456 in the Assembly would speedup the Department of Health’s action onregulatory clarity and realignment to supporthome care and Managed Long Term Care networkorganizations. (See p. 1 story.) Meanwhile, lastweek, we reported on a landmark bill in the Senate(S.5076) to update New York’s antiquated StateInsurance Law so that it better reflects the currentrole of home care and provides more flexibleinsurance coverage standards for the provision ofhome care.
These bills are many months in the making, frominitial deliberations within HCA and our Board,to bill drafting, to multiple meetings withsponsors and stakeholders and, now, introductionof the bills and assignment of bill numbers.
However, there is still a lot of work to do to
achieve passage of these bills – to make sure that
See ACTION p. 2
HCA and Coalition Advocate for
Workable Advanced Aide Proposal
This week, HCA, along with a diverse coalition ofprovider organizations and groups representingpersons with disabilities and the aging, sent a letter toGovernor Cuomo and the State Legislative Leadersurging negotiations to sort out the outstanding issuesthat are preventing an advanced home health aide(AHHA) proposal from being enacted.
See AIDE p. 3
Assembly Intros HCA Priority Bill
to Advance Home Care-ManagedCare Regulatory Realignment As reported in an alert to the membership this week,Assembly Health Committee Chairman RichardGottfried has introduced HCA-developedlegislation to accelerate implementation ofregulatory realignment measures for home care andmanaged care that have been advanced by the state’s
See REGULATORY p. 4
Assembly Intros HCA Regulatory Realignment Bill..............................1In Five Minutes, You Can Advocate on HCA Priority Bills.....................1HCA & Coalition Advocate for Workable Advanced Aide Proposal....1Associations Advance Payment Adequacy Legislation..............................5HCA Essential Personnel Bill Passes Assembly Unanimously..............5DOH Posts Hotline Rates for Non-Hospital-Based CHHAs......................5State Senate Appoints New Majority Leader........................................6QIVAPP and Managed Care Update......................................................6HCC HCA Member Forum on May 27...................................................7Provider Training Seminars and Webinars Available.............................7OMIG Sends TPL Letters.........................................................................8DOL to Propose Overtime Exemption Changes for Salaried Workers.....9Motions Advanced in NAHC F2F Suit..................................................10Influenza Mask Rule No Longer in Effect for Season..........................11LTHHCP Forum on May 19....................................................................11OPWDD ‘Outside Services’ Resources.................................................11Learn More about DSRIP, VBP and other Care Models on May 28.....12PHHPC Committee Meeting Agenda Released..................................13State Survey Hearing Requests Must be Filed Electronically..............13New Policy Issued for Social Adult Day Care.......................................14Member Hiring Announcement..........................................................14Publications......................................................................................................15
2
ASAP is a weekly publication of the Home Care Association of NewYork State (HCA). Unless otherwise noted, all articles appearing inASAP are the property of the Home Care Association of New YorkState. Reuse of any content within this newsletter requires permissionfrom HCA.
Joanne Cunningham, [email protected]
Roger L. Noyes, Director of Communications, [email protected]
Al Cardillo, Executive Vice President, Policy & Programs, [email protected]
Patrick Conole, Vice President, Finance & Management, [email protected]
Andrew Koski, Vice President, Program Policy and Services, [email protected]
Laura Constable, Senior Director, Membership & Operations, [email protected]
Lynda Schoonbeek, Director of Education, [email protected]
Mercedes Teague, Finance Manager, [email protected]
Jenny Kerbein, Director of Governance and Special Projects, [email protected]
Billi Hoen, Manager, Meeting and Events, [email protected]
Teresa Brown, Administrative Assistant, [email protected]
President:
Editor:
388 Broadway, 4th Floor, Albany, NY 12207Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org
Volume 20, No. 19 May 15, 2015ASAP – a publication of the Home Care Association of New York State
ACTION from p. 1
both houses of the Legislature pass the bills and that the Governor signs them.
We need your help in thiseffort.
As reported in last week’sASAP, and presented at ourAnnual Conference, HCA’swebsite has a newLegislative Action Center.This powerful grassrootsadvocacy tool allows you toadvocate on HCA’s prioritybills with a quick push ofthe button. Here’s what weneed you to do:
1. Visit HCA’s Legislative Action Center at http://p2a.co/CrvM1NC. You can also reach it fromthe home page of HCA’s website and on the state advocacy page of our site, wherever you see theLegislative Action Center logo.
Continued on next page
Volume 20, No. 19 May 15, 2015ASAP – a publication of the Home Care Association of New York State
3
2. Click the campaignsentitled “Support HomeCare InsuranceModernization (S.5076)”and “Support A.7456 andSenate Action for HomeCare RegulatoryRealignment.” You’ll see abanner under eachcampaign that says “contactyour legislator.” Click thisbanner.
3. Enter your contactinformation and a pre-written advocacy messagewill go to your legislator assoon as you click “send.”The message is written foryou; all you have to do isenter your address andother information so thatthe system can identifyyour legislator for you.
This process shouldn’t take youmore than a few minutes and youshould urge all of your staff totake action today. HCA will besending you a reminder about thiscritical action step next week.Remember, the more legislatorswho hear from you – theirconstituents – the better chance wehave of getting these bills advancedthrough the long process ahead.Just a few minutes of your timecould result in major changessupporting the work you do onbehalf of patients. Write yourlawmakers today.
The letter, which was also signed by HCA’s sisterorganizations (LeadingAge New York, the New York StateAssociation of Health Care Providers, the Hospice andPalliative Care Association of New York State and others),advocated for the creation of an AHHA proposal whichwould allow trained home health aides in certaincircumstances and under the assignment and supervision ofan RN to do select nursing tasks.
“In sixteen other states, nurses have safely assigned some ofthese tasks to aides with improved consistency of care,” theletter states. “This programmatic change is compatible withNew York’s evolving health care system and the movementto managed care and integrated models of delivery andfinance which rely on provider and caregiver flexibility.”
HCA has long been a proponent of broadening theexemption that currently exists in the Nurse Practice Actthat would allow for agencies to assign aides more flexiblywith appropriate oversight and supervision by the nurse.
The Senate has major issues with the existing legislativeapproach, A.7188, which was most recently moved fromthe Codes Committee to the Assembly floor for action. Thebill needs critical amendments to meet the Senate’s concernsas well as recommended actions by HCA and otherassociation partners. HCA is strongly advocating for theLegislature and Governor, working with HCA and itsadvocacy partners, to negotiate the outstanding issues toenable the passage of an AHHA proposal before theLegislature adjourns in late June.
The letter references several “outstanding issues” which needto be addressed in the final proposal. These include:financing for the training and cost of deploying an advancedaide in the home care setting; alignment with the managedcare system; regulatory flexibility in the use of advancedaides; and other issues.
HCA, along with most of the organizations supporting theletter, participated over the past year in a workgroupassembled by the Governor to identify and discuss issuesthat must be addressed before an AHHA proposal can besuccessfully implemented. HCA will be advocating in thefinal weeks of the legislative session to ensure a workableoutcome that provides appropriate protections forproviders, agency staff and patients.
Continued from p. 2 AIDE from p. 1
Volume 20, No. 19 May 15, 2015ASAP – a publication of the Home Care Association of New York State
4
Home and Community Based Care Work Group.The law creating the Work Group only required theGroup to report, but included no special authorityto assist in the implementation of the Work Group’srecommendations. The bill (A.7456) specifically states that theCommissioner of Health “shall consider therecommendations of the Work Group” and isauthorized to take the necessary steps to“expeditiously” implement the recommendations ofthe Work Group, including through waivers, byadopting regulatory changes on an emergency basis. The bill further authorizes the Commissioner towaive rules and regulations related to managed care-home care services “where such waivers are necessaryto eliminate duplication and to promote efficiency,coordination and clarity in the procedures for thedelivery of such services, and when the health, safetyand general welfare of patients will not be impairedas a result of such waivers,” the bill states. Advancement of this legislation is a major componentof HCA’s advocacy agenda for 2015. Ever since thestate introduced its Medicaid Redesign Team (MRT)initiative to pursue mandatory Managed Long TermCare (MLTC) and mainstream Medicaid managedcare enrollment and a broader managed careenrollment policy four years ago, HCA has soughtregulatory changes that would assist home careproviders, MLTC plans and other managed care plansin working efficiently and seamlessly in the care ofpatients and in the coordination of services. As extensively reported to the membership over thepast several months, the 2013-14 State Budget optedfor a Work Group process to examine areas ofregulatory realignment, even as the state was alreadyfast moving toward a program of mandatorymanaged care enrollment where regulatory changeand clarity were urgently needed. At that time, the Work Group was tasked withexamining state and federal requirements such as theapplicability of federal Conditions of Participation(CoPs), the alignment of functions between managedcare entities and home care providers, best practices
related to clean claims and related dispute resolution inthe intersection of managed care and home careregulatory structures, billing and operations. This year’s state budget, at the urging of HCA andassociation partners, did include legislation promptingthe state to pursue uniform billing codes for home careservices under managed care – an area that still demandsfurther implementation and operational design workpost-budget. However, even with the Work Group’srecommendations already in hand, the state has yet toact further on a long-developed matrix ofrecommendations for more comprehensive regulatoryrealignment. Two of HCA’s Board leaders have been instrumental inthose deliberations as members of the Work Group:current Board Member Joseph Twardy, President andCEO of Visiting Nurse Service of Northeastern NewYork, and recent Board Member Ann Frisch, ExecutiveDirector of HHC Health & Home Care. HCA andallied association colleagues, meanwhile, have alsopressed the Department to move forward on the WorkGroup’s recommendations. HCA thanks Assemblyman Gottfried for introducingthis vital bill that contains a strong charge forexpeditious movement of regulatory realignmentprovisions. If adopted, these provisions wouldstreamline the coordination of services betweenproviders and plans and establish clarity in theapplicability of various regulations. HCA has reached out to the Senate, where we anticipatesponsorship of a companion bill, and will inform themembership of future action.
What you can do to support this bill
Our new Legislative Action Center includes a campaignfor you to send a message to your legislator on this bill.Please share this campaign with your staff and makesure they send a message of support. The process issimple: just enter your contact information and hit “send”to circulate a pre-written message to your legislators.The system will automatically identify your lawmakerfor you, based on the contact information you provide.(See related p. 1 sidebar story.)
REGULATORY from p. 1
5
Volume 20, No. 19 May 15, 2015ASAP – a publication of the Home Care Association of New York State
HCA Essential Personnel Bill
Passes Assembly Unanimously
By a unanimous vote of 113-to-0, thestate Assembly this week passed HCA’s“essential personnel” legislation (A.5125-B).
This bill – which would allow home careand hospice staff to access patientsduring emergency curfews or restrictions– has been extensively summarized inseveral past editions of ASAP.
Sponsored by Senator Lanza andAssemblyman Cusick, both of StatenIsland, the bill also provides for homecare and hospice involvement in the localemergency planning process.
The Senate version of the bill (S.3482-B)has been referred to the Committee onVeterans, Homeland Security andMilitary Affairs.
DOH Posts Hotline Rates for
Non-Hospital-Based CHHAs
The state Department of Health’sBureau of Long Term Care RateSetting has posted the 2015 “Hotline”rate calculation sheets for non-hospital-based Certified Home Health Agencies(CHHAs) that filed a properlycertified, full-year 2013 cost report.
These rates will be used for patients whoare exempt from the Episodic PaymentSystem. The rate calculations are locatedin the “Rate Publication Selection List”drop-down under the date of May 11,2015 on the Health Commerce System(HCS). A corresponding DearAdministrator Letter, dated May 11, 2015,accompanies the posting.
Associations Advance Home Care
“Payment Adequacy Legislation”
Legislation to ensure payment adequacy for home andcommunity based care has been advanced to theLegislature. One bill has been advanced by HCA and asecond by the New York State Association of HealthCare Providers (HCP). The two proposals arecomplementary and work in sync with new provisionsthat were included in the 2015 state budget resultingfrom our joint advocacy.
HCA has advanced legislation that would require theincorporation of essential costs in the determination ofpremium adequacy for managed care and ManagedLong Term Care (MLTCs) plans and rate/paymentadequacy for providers under both managed carecontracts and under the episodic payment system. Premiums and rates would be adjusted to ensureinclusion of costs that adequately support the deliveryof patient services and both managed care plan andprovider operations, including: compensation andbenefits; labor mandates; program/compliancemandates; staff recruitment, training and education;capital/technology infrastructure; quality assurance/improvement; emergency preparedness; and other. Thelegislation is currently in process for introduction.
Legislation advanced by HCP would require the stateDepartment of Health to select and contract with anindependent actuary to study and review Medicaidreimbursement methodologies for home care servicesprovided under contracts or agreements with insurersfor adequacy to “ensure the retention of a qualifiedworkforce capable of providing high quality care torecipients of such services in both wage parity and non-wage parity regions.”
This legislation, too, would include “adequacy” costs formeeting wage parity requirements, recruitment andtraining, salary FICA contributions, workerscompensation and other costs. This legislation wasintroduced yesterday by Senator Hannon as S.5459 andreferred to the Committee on Health.
HCA will continue priority advocacy for neededreimbursement by plans and providers through theseand other means, including our direct advocacy withthe Department of Health, and will continue closecollaboration with our association partners.
Volume 20, No. 19 May 15, 2015ASAP – a publication of the Home Care Association of New York State
6
State Senate Appoints New Majority Leader, as Senator Skelos Steps Down
Senator Dean Skelos has stepped down from his post as Senate Majority Leader and was replaced this weekby Senator John Flanagan, also of Long Island, in a vote by the Senate.
The change in leadership arose after the U.S. Attorney for the Southern District of New York, Preet Bharara,pressed charges against Senator Skelos, following the arrest earlier this year of former Assembly SpeakerSheldon Silver who was replaced in his leadership post with the current Speaker, Carl Heastie.
Senator Flanagan has most recently served as the Education Committee Chairman. He was first elected tothe Senate in 2002 after a 16-year tenure in the State Assembly.
The Senate Majority Leader, like the Speaker of the Assembly, has the greatest influence over the movementof legislation and negotiations with the other respective house and Governor in advancing public policy.Both houses, the Senate and Assembly, have faced leadership changes this year, consuming the process withdeliberations about the hierarchy and succession. HCA and our government affairs teams are working tonavigate these changes as we urge support for our legislative agenda. We will inform the membership of anynew developments that impact this process directly.
QIVAPP and Managed Care Update
At this week’s Managed Care Policy and Planning meeting held by the state Department of Health (DOH),HCA and other associations and providers received updates on the Quality Incentive Vital Access ProviderPool (QIVAPP) monies, enrollment into the Fully Integrated Duals Advantage (FIDA) program, thetransition to Managed Long Term Care (MLTC) plans and the Conflict-Free Evaluation and EnrollmentCenter (CFEEC).
QIVAPP
DOH reported that the data on aide hours and the attestations submitted by the MLTC plans are beingreviewed and it hopes to develop a list of draft awards in early June. Then, this list will be submitted to theU.S. Centers for Medicare and Medicaid Services (CMS) for its approval of the federal share of $35 million.Such approval can take several weeks to months.
As reported in last week’s ASAP, HCA continued to appeal DOH on its action to redefine the healthinsurance coverage requirement under QIVAPP.
This change, announced in a Frequently Asked Questions document posted two weeks ago (just before theMay 1 deadline for the plans to submit data), requires at least 30 percent of an agency’s workforce to beenrolled in the employer’s health coverage. This is sharply different from information provided by DOHprior to the rollout of QIVAPP and from the initial requirement outlined in the original April 2014 DearAdministrator Letter which states that the home care agency must provide comprehensive health insurancecoverage to its employees.
HCA had already communicated to DOH a request that it rescind this change so that those home careproviders who meet the original criteria continue to be eligible for QIVAPP. We objected to DOH’s change
7
Volume 20, No. 19 May 15, 2015ASAP – a publication of the Home Care Association of New York State
in rules under which both MLTC plans andhome care providers have been operating sincelast year and cautioned that this change isthreatening to disrupt the distribution ofQIVAPP monies.
We pointed out that this policy restricts choicefor aides by pressuring them to enroll in theemployer’s plan when they may be eligible forother coverage, including Medicaid or a familymember’s, or may want to opt for a higherwage instead of health benefits. Lastly, thisrequirement holds providers to a standard thatthey have no control over.
At this week’s Managed Care Policy andPlanning Meeting, HCA made a similarargument to the state Medicaid Director JasonHelgerson and other DOH staff. DOHrepeated its contention that QIVAPP isintended to reach home care agencies who areincurring health insurance costs due to theiraides selecting the employer’s health insurancebenefits.
HCA is in discussions with other associationsabout sending a joint letter to DOH and otherstate officials regarding our concerns over theQIVAPP award process.
FIDA
The latest FIDA enrollment data are asfollows: 5,902 individuals are enrolled inFIDA as of May 1; this includes 3,152 whowere “passively” enrolled on May 1. Another5,153 individuals were sent the “60-day notice”on May 1 and will be passively enrolled in July1 (unless they opt out).
A total of 44,512 individuals have opted outof FIDA (but still must be enrolled in a partialcap MLTC plan).
DOH sent a letter to about 43,000 FIDA-eligible individuals who have not opted-out.This includes individuals who are FIDA
HCC HCA Member Forum on May 27
The next meeting of the Home Care Council (HCC)of HCA Member Forum is on Wednesday, May 27,at 10 a.m. in New York City.
The Forum is an opportunity for former HCCmembers who are now part of HCA to discussparticular issues they are facing, including managedcare payments; contracts with the New York CityHuman Resources Administration; companionshipexemption lawsuit; Quality Incentive Vital AccessProvider Pool (QIVAPP) program; education needsand other topics.
The registration form is at the back of this week’sASAP.
Provider Training Seminars and
Webinars Available
eMedNY has announced programs for Utica,Poughkeepsie, Hauppauge, Rensselaer andCanandaigua during this month and June. Some ofthe topics include:
• ePACES for professional, institutional,dental, durable medical equipment, privateduty nursing, physician and transportation.
• ePACES for Coordination of Benefitsbilling for professionals and clinics.
• eMedNY website review.
• Electronic Remittance/PDF RemittanceRequest Form and Electronic FundsTransfer (EFT) Application.
• New Provider/New Biller
The training schedule is athttps://www.emedny.org/training/index.aspx.
8
Volume 20, No. 19 May 15, 2015ASAP – a publication of the Home Care Association of New York State
eligible but excluded from passive enrollment.
More than 10,200 providers have registered for the core provider FIDA training module on the Lewin portal.Three new modules (behavioral health, cultural competency, and the Americans with Disabilities Act) arenow available. Another module on recovery/wellness is being finalized. Plans will send letters to theircontracted providers when all modules are available on the portal.
MLTC transition
DOH intends to transition the following counties to mandatory MLTC enrollment in May: Chemung, Essex,Hamilton, Chautauqua, Schuyler, Seneca and Yates.
CFEEC
The CFEEC is now operational in regions 1 through 6 (a list of the regions is athttp://www.health.ny.gov/health_care/medicaid/redesign/docs/2015-03-26_updated_cfeec_timeline.pdf.)
In these regions, all new individuals who require more than 120 days of community-based long term careservices must be assessed, using the Uniform Assessment (UAS-NY) tool, by the Medicaid Enrollment Broker,Maximus, to determine their eligibility for Medicaid community based long term care and eligibility forenrollment in a Medicaid MLTC plan.
Maximus’ average number of calls about the CFEEC is from 675 to 702 per day. Maximus has completed19,355 evaluations statewide.
For more information, contact Andrew Koski at (518) 810-0662 or [email protected].
TPL Letters Seek Repayment, Documentation on Cases Paid by Medicare
The state Office of the Medicaid Inspector General (OMIG) is again sending out letters to some providersseeking documentation and repayment checks for Medicare payments they received as a result of Third PartyLiability (TPL) billing.
These letters are sent out two to three times a year as the state pursues its appeals process with the federalgovernment regarding payment responsibility for dual-eligible claims.
Under this appeals process, providers have had to demand-bill certain select claims to Medicare, triggering anadjudication process for those claims previously paid by Medicaid and targeted for review. In some cases, thisprocess results in a Medicare payment to providers that must be returned to the state. OMIG’s letter includesa list of such beneficiaries and episodes.
New York’s TPL contractor is the University of Massachusetts Medical School (UMASS). The letter instructsagencies to send UMASS certain documentation for each episode/case identified in the letter. Thisdocumentation includes the final Medicare remittance advice and a copy of the case report listing the Medicarepayment amount that the agency is returning. “As an alternative, you may also submit an internal spreadsheetused by your agency to track Medicare payments returned as a result of this project,” the letter states.
Continued on next page
Volume 20, No. 19 May 15, 2015ASAP – a publication of the Home Care Association of New York State
9
The letter stresses that checks should not be sent to UMASS along with this documentation. Instead, thechecks should be made payable ‘NYS OMIG’ at a separate address identified in the letter.
Documentation and checks are due within 30 days of the letter. Agencies may contact UMASS with questionsor to dispute the findings or case selections at (866) 262-7594.
DOL to Propose Changes to Overtime Exemption for Salaried Workers
The National Association for Home Care and Hospice (NAHC) reports that the U.S. Department of Labor(DOL) submitted a proposed rule on May 5, 2015 for review by the Office of Management and Budget(OMB) that would modify the standards for the application of overtime exemptions for professional andexecutive personnel who are paid on a salary basis.
While the specifics of the proposal are not public, it is expected that the rule change would raise the minimumsalary level required for an application of the exemptions and tighten the standards for determining whetheran employee is a “professional” or “executive.”
The current minimum salary necessary to qualify for the exemptions is $455 per week. That level was set in2004. Previous to 2004, the minimum salary level was $155 or $250 per week depending on the employee’sduties. The Obama Administration had expressed concerns that individuals with wages less than $24,000 ayear were being required to work an extensive amount of hours without additional compensation. In Marchof last year, President Obama indicated that he wanted the standards to be updated and ordered DOL to beginwork on a revision of the rules.
According to NAHC, many expect that the minimum salary level will likely double. A number of Washingtonthink tanks have called for increases much higher and some Members of Congress have called for a salary levelof $69,000.
NAHC says that home care and hospice, like many other industries, make use of the salaried executive andprofessional exemptions. For instance, many companies pay professional clinical staff a base salary equivalentto the minimum exemption level and then add compensation on a per-visit basis to incentivize productivity. Ifthe salary minimum is raised significantly, home care and hospice companies will be handicapped in using thiscompensation method effectively.
The proposed rule will likely be released by OMB in a matter of weeks. At that point, the opportunity forpublic review and comment will begin. NAHC and HCA encourage members to get prepared to evaluate theimpact of the rule change on their business so that effective comments can be prepared. A helpful starting pointis for providers and associations to gain a full understanding of the number and makeup of staff currentlysubject to an exemption, along with the number of hours worked by such staff.
HCA will provide updates on any developments involving the proposed rule.
Continued from p.8
Volume 20, No. 19 May 15, 2015ASAP – a publication of the Home Care Association of New York State
10
Motions Advanced in NAHC F2F Suit
The National Association for Home Care and Hospice (NAHC) this week reported on some newdevelopments in its legal challenge to the Medicare home health face-to-face (F2F) requirement.
NAHC has filed a Motion for Summary Judgment and supporting Memorandum of Law in the case. TheMedicare Program has until June 26 to respond. NAHC’s final brief is due July 24.
The briefs focus on whether or not the plain language of the Affordable Care Act (ACA) permits the U.S.Centers for Medicare and Medicaid Services (CMS) to require a physician narrative, specifically, in itsinterpretation for how F2F would be documented. “If the language of the law is unclear or ambiguous,NAHC must prove that the requirement is arbitrary and capricious,” NAHC states in a recent article onthe legal proceedings.
The NAHC and CMS arguments tangle over the different interpretations of statute. NAHC also arguesthat a narrative is not a reasonable foundation for determining Medicare eligibility, as it does not accountfor the totality of the patient’s medical record, which, NAHC asserts, would provide a more completeaffirmation of the patient’s Medicare eligibility.
“NAHC further supports its arguments with evidence of the confusion surrounding the standard for acompliant physician narrative, the high rate of claim denials, and the failure of CMS to provide adequateguidelines on compliance,” NAHC states in its article. “Also, NAHC explains that CMS itself abandonedthe requirement when it realized it was virtually impossible to administer it fairly.”
Even though CMS rescinded the narrative requirement in 2015, providers are still vulnerable toretrospective claims audits for services in 2014 and prior, giving NAHC cause to press forward on thecase. In a similar vein, NAHC is also seeking remedy for the thousands of claims denials that werealready determined on the basis of physician narratives.
Complicating this issue is the fact that F2F remains in effect after January 1, 2015, albeit without thespecific narrative requirement at issue in the case. This new requirement poses a whole new set of issuesthat the home care community is otherwise seeking to address.
HCA has long advocated for a legislative fix on the F2F documentation issue. We understand the burdenit places on agencies and the exorbitant amount of resources expended to comply, whether in the case ofthe narrative requirement or the current requirements.
Short of repealing this problem regulation, the home care industry has asked, at a minimum, forCongressional action compelling CMS to streamline the face-to-face certification process.
HCA will keep the membership apprised of any further developments on this issue as they emerge.
Volume 20, No. 19 May 15, 2015ASAP – a publication of the Home Care Association of New York State
11
Influenza Mask Rule No Longer in Effect for Season On Thursday, the state Department of Health (DOH) Commissionerdeclared that influenza is no longer prevalent in New York State. This means the flu-mask requirement is no longer in effect. Under thisrequirement, home care and other health care workers must be vaccinatedagainst influenza during this influenza season, or else wear a surgical orprocedure mask in areas where patients are typically present. This policywas in effect since December 11, 2014. The rescission of this policy will remain in effect until DOH again declaresinfluenza to be prevalent in the state (which usually occurs in the late fall orearly winter). The announcement is at http://tinyurl.com/or5c9fz. Information on this issue is at http://health.ny.gov/FluMaskReg. Questions can be directed to [email protected]
LTHHCP Forum on May 19 As a LTHHCP provider, you have a unique stake in payment and programreform to prepare your organization’s special skills for meeting the needsof the elderly and chronic care populations. Next week, on May 19, we are holding a special members-only LTHHCP
Forum just for you, with a focus on your role in emerging care models aswell as additional program changes that you need to know about, including:a recently issued Dear Administrator Letter on care management, stateworkgroup recommendations on regulatory streamlining, a state budgetprovision aimed at uniform billing codes for home care-managed carereimbursement, soon-to-come action on the LTHHCP waiver, qualityinnovations tools, and other issues that directly affect you.
We know that you value hearing from the state Department of Health’sLong Term Care, Division of Home and Community Based Services,Division of Managed Care and other regulatory and program officials onhow these issues affect your patients and what to expect for the future ofyour programs. For a minimal charge of $40, covering lunch and program materials, youwill get vital information and perspectives. You will also help HCA continue
OPWDD
‘Outside
Services’
Resources
Earlier this week,the Office forPeople withDevelopmentalDisabilities(OPWDD) heldtwo webex trainingsessions regardingupcoming changesto the outsideservices that can bebilled to Medicaidfor individuals wholive in certifiedresidential settings.(See last week’sASAP.)
The originalmemorandumregarding thesechanges, thePowerPointpresentation and arecording of thepresentation areavailable at http://www.opwdd.ny.gov/opwdd_services_supports/people_first_waiver/news.
Additional meetingopportunities willbe scheduled asOPWDD preparesfor the October 1,2015 changes.
Volume 20, No. 19 May 15, 2015ASAP – a publication of the Home Care Association of New York State
12
to advocate on your behalf by letting us know about local issues and needs for your specific program amid majortransitions in long term care. Please register today for this special focus program for all LTHHCP providers. Your participation is vital. Further information is below. HCA’s Statewide LTHHCP Forum
Tuesday, May 1910 a.m. to 2:30 p.m.Albany HiltonState and Lodge Streets Albany, NY 12207Register at http://tinyurl.com/nxzt6r7.
You’ve Asked for Education on DSRIP, VBP, and We’ve Got it for You on May 28 HCA members have told us that Delivery System Reform Incentive Payment (DSRIP) programs and other newmodels of care delivery are the number 1 area where more education is needed. If you agree, then be sure to join us on May 28 in Albany for one day of focus on all of the new care models that willfundamentally change how your organization will operate in the future, from your participation in DSRIP to theonset of Value Based Payments (VBP), and more. Watching the information flow from virtually every health care provider group or association, like HCA, you’llsee that DSRIP and Value Based Payments dominate the headlines, and for good reason. Providers must have astrategic action plan for these models or else miss out on vital opportunities to be a player in a fast-changinghealth care system. HCA continues to offer the home care perspective on these health system changes, and our May 28 conferencewill provide you with access to the major architects and consultants working to bring these new models onlineincluding State Medicaid Director Jason Helgerson; the state’s contractor on the design of Value Based Payments,Dr. Marc Berg; Greg Allen, the state Department of Health’s main program development leader; expert consultantslike Tracy E. Miller from Bond Schoeneck and King; and others. From them, you will gain an understanding of how these models fit together, how to re-tool your organization tooperate in these new models, and how to get your business plan ready for participation. Please see the details below. Are You Ready to Navigate New Models of Care and Coverage?
Thursday, May 28, 2015Empire State Plaza Meeting Room 2-4Albany, NY
Continued on next page
Volume 20, No. 19 May 15, 2015ASAP – a publication of the Home Care Association of New York State
13
Who should attend? Home health provider and health plan CEOs, CFOs, COOs and those who need a better understanding ofemerging care models to position successfully in a new service and payment delivery environment. How to register?
Download the brochure and registration form at http://tinyurl.com/papvh4u.Register online at http://tinyurl.com/phafn2z.
PHHPC Committee Meeting Agenda Released
This week, the state Department of Health (DOH) posted the agenda for the Public Health and HealthPlanning Council (PHHPC) Establishment and Project Review Committee meeting on May 21.
The agenda and supporting documents are athttp://www.health.ny.gov/facilities/public_health_and_health_planning_council/meetings/2015-05-21.
The agenda includes applications for 40 new Licensed Home Care Services Agencies (LHCSAs), including28 in New York City, Long Island and/or Westchester and 12 outside of these areas; and 3 applications forchanges in ownership in existing LHCSAs. One of the applicants for a new LHCSA is a rural county healthdepartment that intends to close its Certified Home Health Agency (CHHA).
There are no applications for new CHHAs or expansion or transfers of ownership of existing CHHAs.
State Survey Hearing Requests Must be Filed Electronically
The U.S. Centers for Medicare and Medicaid Services (CMS) has issued a survey and certification letterstating that providers who disagree with actions imposed on their agencies/facilities and want to request ahearing with an Administrative Law Judge must submit their request electronically to the DepartmentalAppeals Board (DAB) using the DAB E-File at https://dab.efile.hhs.gov.
This policy is effective, and retroactive to, October 1, 2014.
The CMS letter is at http://tinyurl.com/of33kol.
In order to utilize the electronic filing system, petitioners must first become a registered user. The letterincludes detailed instructions on how to register and use the DAB’s Electronic Filing System.
Written requests for hearings delivered by postal delivery are no longer accepted as of October 1, 2014,unless the petitioner does not have access to the Internet or a computer. In those circumstances, petitionersmay call the Civil Remedies Division and provide an explanation as to why they cannot file electronically or
Continued from p. 12
Volume 20, No. 19 May 15, 2015ASAP – a publication of the Home Care Association of New York State
14
a request for a waiver from e-filing can be submitted along with a written request. Confirmation of a waiverfrom e-filing will be received in writing.
The CMS letter includes an attachment that provides sample language that can be used in the Appeal Rightsnotice which details a petitioner’s options for filing a hearing request.
Although the letter was issued April 24, 2015, the effective date for the directive is retroactive to October 1,2014.
New Policy Issued for Social Adult Day Care
The state Department of Health (DOH) has posted a new policy relating to Social Adult Day Care (SADC)and Managed Long Term Care (MLTC) plans.
The policy is athttp://www.health.ny.gov/health_care/medicaid/redesign/mltc_policy_15.01_social_adult_day_care.htm.
According to the guidance, SADC programs that are currently contracting with an MLTC plan or want tocontract with MLTC plans must undergo a new certification process that was established by DOH, in
HIRINGJewish Home Lifecare is currently hiring for the following positions:
Director of Quality and Performance Improvement, Associate Director of Rehabilitation Services, Part-Time Weekend RNs,Fee for Service Nutritionists, Fee for Service positions in OT, PT, SLP, and LMSW for our CHHA. We are also currentlyrecruiting for an RN Instructor and Fee for Service RNs for our LHCSA.
In addition to the above mentioned positions, we are looking for:
An Associate Vice President of Home Care provides the leadership, management and vision necessary to ensure that theCHHA has the proper operational controls, administrative and reporting procedures, organizational structure and peoplesystems in place to effectively grow the organization and to ensure financial strength and operating efficiency. Plans,directs and evaluates a quality assured, clinically excellent, compliant, cost effective, and consumer satisfied CHHA.Develops and holds accountable an effective CHHA leadership level that manages clinical service, fiscal management,business development, and human resource operations. Facilitates CHHA operations through appropriatedepartmentalization and delegation of duties per the approved organizational structure. Participates in the identification,development and assures the implementation of new and/or revised Home Health programs in order to maintain andenhance current and future state market share. License and current registration as a Registered Professional Nurse,Bachelor’s Degree in Nursing required. Knowledge of home health regulations, accreditation and quality standards.
The Director of Clinical Excellence for QAPI (Quality Assurance Performance Improvement) is responsible for directing thedevelopment, implementation, and evaluation of the Quality Assurance Performance Improvement program for theorganization’s Certified Home Health Agency (CHHA). This involves collaboration with the administrative and clinicalleadership in order to effectuate a successful and regulatory compliant program. The Director of Clinical Excellence forQAPI fosters a culture that promotes a commitment to continually improving quality of care for clients and thatempowers staff to build quality improvement processes into daily work activities. License and current registration as aRegistered Professional Nurse, Bachelor’s Degree in Nursing required. Minimum three years home care experience;knowledge of home health regulations, accreditation and quality standards.
We offer competitive compensation, excellent benefits, and a positive work environment. For further consideration,please send a cover letter and resume to: Victoria Izraylevsky, Director of Human Resources, [email protected].
Volume 20, No. 19 May 15, 2015ASAP – a publication of the Home Care Association of New York State
15
conjunction with the Office of the Medicaid Inspector General (OMIG) and the New York State Office for theAging (NYSOFA).
Those SADC entities with existing MLTC contracts will have 30 days to complete the Certification. ACertification must be completed for each SADC site.
Completion of the Certification will attest to an SADC’s compliance with Title 9 NYCRR section 6654.20, asrequired under Article VII, section C of the Managed Long Term Care model contract.
Under this new policy, it is the responsibility of the MLTC plan to ensure that SADCs under contract havecompleted the Certification. Further, an MLTC plan may not enter into a new contract with an SADC untilCertification has been successfully completed. Plans must request a copy of the confirmation notice generatedupon the SADC’s successful completion of the electronic Certification, and maintain this for their records.
DOH advises plans to consider the individual needs of each enrollee during the assessment process and toclearly identify the need for SADC as a service in the plan of care. MLTC plans should not enroll a recipient inSADC unless the recipient has a functional or clinical need for community based long term care services(CBLTCS) defined specifically as personal care services in the home, home health care, private duty nursing,consumer directed personal assistance services, and adult day health care. SADC can contribute to the totalcare plan but cannot represent the primary service provided to the enrollee.
In order to complete the Certification, an SADC will need to:
• Provide the SADC owner and program director’s information, including Social Security number;• Answer a series of questions attesting to compliance;• List any MLTC plans the SADC contracts with; and• Certify that the information provided is true.
Certification will need to be completed on an annual basis.
Publications
• “Medicaid: A Small Share of Enrollees Consistently Accounted for a Large Share of Expenditures,” bythe Government Accountability Officehttp://www.gao.gov/assets/670/669916.pdf
• “Managed Long Term Care,” by the New York Legal Assistance Grouphttp://www.wnylc.com/health/entry/114/
• “A Profile of Older Americans: 2014,” by the Administration on Aginghttp://www.aoa.acl.gov/Aging_Statistics/Profile/2014/docs/2014-Profile.pdf
• “Updates on Hospice Election Form, Revocation, and Attending Physician,” by the U.S. Centers forMedicare and Medicaid Serviceshttp://tinyurl.com/o5cqrzu
For more information, contact Andrew Koski at (518) 810-0662 or [email protected].
Please join the staff of HCA and member colleagues from the Association and the home care community for the next Home Care Council of HCA MEMBER Forum. Participation in HCA Member Forums gives you an opportunity to interact with HCA staff and Members, and exchange valuable information with your member colleagues. As part of this process, we especially want to take the opportunity to hear your feedback, continue to learn how best to serve you and let you know about a number of offerings that are in store for both the Association and the Home Care Council Forum.
Some of the vital issues to be covered include: • HRA Contract and other updates • Quality Incentive/Vital Access
Provider Pool (QIVAPP) monies • Companionship Exemption lawsuit • Managed Care Payment and other
issues • Fully Integrated Duals Advantage
(FIDA) program • Education programs – changing
personnel needs and other topics
FAX TO: (518) 426-8788 For more information, contact Andrew Koski at (518) 810-0662 or at [email protected]
Home Care Council of HCA Member Forum
Wednesday, May 27, 2015 10:00am to 1:00pm
Hunter College Brookdale Campus 425 East 25th Street
(between 1st and FDR Drive) The Osborn Room (Mezzanine Level)
New York, New York 10010
A continental breakfast will be served.
Please plan to join us for this important free-of-charge members-only session by simply completing this registration form.
Registration Name:______________________________________________ Title: _________________________________________ Organization:_______________________________________________________________________________________ City State Zip:_______________________________________________________________________________________ Email:_______________________________________________ Phone:________________________________________ (Required for registration.)
Forum Notice HCC MEMBER
Cancellation Policy: Cancellations received by May 12 will receive a full refund, less 25% of total due as an administrative fee. Cancellations received on May 13 or later will forfeit theirregistration fee, along with those who register and do not attend. Substitutions are permitted. Please contact Teresa Brown at (518) 426-8764 or [email protected] to cancel.
STATEWIDELTHHCP FORUM
Tuesday, May 19th
10:00am-2:30pm
LocationAlbany Hilton
State and Lodge StreetsAlbany, NY 12207
Preliminary Agenda Items Include:
• Mandatory MLTC Enrollment, FIDA, DSRIP, Value Based Payments and Other Critical Developments and Implications for LTHHCP
• Status, Developments and Reports of LTHHCPs locally, regionally and statewide
• Discussion with State Long Term Care, Division of Home and Community Based Services, Division of Managed Care and Division of Health Care Financing Officials re LTHHCP program, operation and policy issues.
• More
RegistrationOnce complete, please fax to (518) 426-8788. You must provide us with an email address in order to receive your confirmation.
_________________________________Name
_________________________________Title
_________________________________Agency
_________________________________Phone
_________________________________ Email (Required)
This is an HCA Members-Only session.There is a $40 fee per person for thissession to cover the costs of meetingmaterial and lunch.
The Forum provides LTHHCP representatives, statepolicymakers, other invited guest speakers and HCAstaff the opportunity to discuss the salient issuesaffecting the LTHHCP at the local, state and federallevels, as well as the program’s priority advocacyneeds.
Statewide implementation of mandatory managed care enrollment is continuing, FIDA is ramping up, DSRIP is being implemented, and simultaneously the state and federal governments are moving the health care payment system to “Value Based Payment.” Meanwhile, a new DAL on care management has just been issued, the state regulatory reform workgroup is considering recommendations for additional regulatory streamlining, the state budget includes a new uniform coding/billing system for home care‐managed care, action on the LTHHCP waiver is due this September, a series of new home care quality innovations is being explored, and many other developments are in full swing.
Attend this important Forum opportunity to discuss these and critical LTHHCP program and operational issues, opportunities, and needs amid these changes and developments.
Payment of $40 per person
_______ VISA _________ MC _______ AM EX
Credit Card No._____________________________________________________________
Expiration Date:________________________ Sec. Code:___________________________
Card Billing Address:_________________________________________________________
__________________________________________________________________________
Name on Card:______________________________________________________________
Signature:__________________________________________________________________
Or, make checks payable to: HCA and mail to 388 Broadway, 4th Floor, Albany, NY 12207
_________________________________Name
_________________________________Title
_________________________________Agency
_________________________________Phone
_________________________________ Email (Required)
Are You Ready to Navigate New Models of Care and Coverage?
Thursday, May 28, 2015Empire State Plaza – Albany NY
Meeting Room 2-4
9:00am
Welcome and HCA Update Joanne Cunningham, President
9:15am to 10:30am
The State’s Roadmap on New Models of CareNew York State continues to rapidly reform its Medicaid program and work collaboratively with the federal government on introducing and facilitating the adoption of new models of care, coverage, service delivery and financing. Hear from New York’s health care and Medicaid reform leader about the state’s vision in the adoption of new models of care delivery, as New York State’s Medicaid program evolves with a focus on care delivery through Managed Long Term Care plans, Fully‐Integrated Duals Advantage plans, Delivery System Reform Incentive Payments (DSRIP) and others. This session will help you understand the state’s continued priorities, areas of focus, and expectations for how you can fully participate in these and emerging models.
Jason Helgerson, State Medicaid Director, Deputy Commissioner, New York State Department of Health
10:30am to 11:30am
Value Based Payment – Positioning for Home Health ProvidersState and federal reforms are prompting massive and far‐reaching changes that affect how health care and home care services are delivered. These reforms are also driving change in the financing of and payment for care. Understanding how new payment models work, how they are constructed and how the payment incentives function is critical as you plan for a successful future. With the advent of Value Based Payment Models, successful providers are compelled to learn ways of positioning themselves competitively. Hear from the State of New York’s lead contractor about how VBP models work, how outcomes are measured and how this model aims to improve value and outcomes while reducing the costs of care.
Marc Berg, MD, Ph.D., Partner, Global Center of Excellence for Health, KPMG
11:45am to 12:45pm
DSRIP Lessons Learned and Next StepsOne of the most recent innovations in delivery system reform came in the form of a waiver with the federal government that set in motion the plan for a larger focus on outcomes, payment and service delivery integration. This initiative, the Delivery System Reform Incentive Payment (DSRIP) program, aims to promote collaboration among health care and community care providers, transform health care service and reduce re‐hospitalizations while offering incentives and rewards for high quality outcomes. Hear from the state’s DSRIP implementer about how DSRIP is transforming payment and services for patients and the lessons learned in the rollout and adoption of this innovative initiative.
Greg Allen, Director of the Division of Program Development and Management within the New York State Office of Health Insurance Programs (OHIP).
AGENDA
Who should attend
Home health provider and health plan CEOs, CFOs, COOs and those who need a better understanding of emerging care models to position successfully in a new service and payment delivery environment.
With the enactment of far‐reaching health care reforms at the federal and state levels, changes to the health care delivery and payment systems are evolving quickly. To jump‐start these initiatives, policymakers are incentivizing the creation of new models that focus on the seamless integration of health care delivery, providing value, high quality care and targeted outcomes.
It is critical for the home care community to understand how these new models work, how they are financed, and how they are constructed. In addition, the provider community needs to be prepared to position themselves competitively and effectively in these new models.
This workshop is designed to be informative, thought‐provoking and relevant as you position your organization in this environment of change and in this environment of health care service delivery and payment reform evolution. Don’t miss this opportunity!
AGENDA
12:45pm to 1:30pm
Lunch and the Opportunity to Share Ideas with Your Peers
1:30pm to 2:30pm
Re‐Tooling Your Operation to Achieve Success in New Models of Care and Service DeliveryDSRIP implementation poses unprecedented challenges and opportunities for performing providers systems (PPSs) and the providers who participate in them. This session will focus on assisting participating providers to anticipate, understand, and tackle DSRIP developments in the first year, including fund flow models and potential funding opportunities emerging from PPSs, project participation, regulatory waivers, and PPS compliance and HIPAA requirements.
Tracy E. Miller, Bond Schoeneck and KingMs. Miller practices health care and not‐for‐profit corporate law, focusing on corporate, regulatory and compliance matters for health care providers, health systems, managed care plans and charitable organizations.
2:30pm to 3:30pm
Strengthening Your Business Model in an Era of New ModelsSuccessful health care organizations in a new environment of evolving service, coverage, payment and delivery system reforms must challenge themselves to make necessary changes to their business models in order to adapt and successfully partner. The future success of home health as critical partners in new models will depend on the ability to become more efficient, streamline functions, and provide a high level of care with excellent outcomes at a competitive cost. In this final session, learn what others across the nation are doing to strengthen their business models and boost their offerings of support to their partners.
Presenter TBA
REGISTRATION FORM – Fax to (518) 426‐8788 or Mail to the address below.Please register by May 22 to guarantee your seat, lunch and handout materials.
Name: _____________________________________________________________________________________________
Title:_______________________________________________________________________________________________
Agency:_____________________________________________________________________________________________
Address:____________________________________________________________________________________________
City/State/Zip:______________________________________________________________________________________
Phone:______________________________________ Ext.________________
Fax: __________________________________________________________
Email: ___________________________________________________
PAYMENTPlease 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 one week prior to program)
Please print clearly.
Credit Card #: ____________________________________ Exp. Date:__________ Security Code: ____________
_____________________________________________________________________________________________________Name and/or Company Name on Card
_____________________________________________________________________________________________________Billing Address of card (including City, State and Zip Code)
_____________________________________________________________________________________________________Authorized Signature
Cancellations received by May 18 are refundable less a 25% administrative fee. Cancellations must be received in writing via e‐mail to [email protected]. No refunds after that time or for no shows. Substitutions are permitted. Questions? Call HCA at (518) 426‐8764.
REGISTRATION FEE
HCA Members $229 per person ________
Non‐Members $329 per person ________
Are you Ready to Navigate New Models of Care and Coverage?Thursday, May 28, 2015Empire State Plaza, Meeting Rooms 2-4, Albany NY
FAX TO: (518) 426‐8788
