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 21, No. 28 July 29, 2016
Inside Inside Inside Inside Inside ASAPASAPASAPASAPASAPSee SURVEY p.7
ReminderReminderReminderReminderReminder: HCA is on a biweekly summer ASAP schedule. Ournext edition will be published on August 12. We will keep youposted by e-mail about any breaking updates.
Calling All Women Health Leaders: Join HCA for a C-Suite of
Offerings at First-ever Women in Healthcare Leadership Summit
Top-tier, nationally recognized women thought-leaders, communications experts, researchers, authors andpopular-media voices will share their wisdom and skills as part of HCA’s inaugural Women in HealthcareLeadership Summit on September 28 and 29 in Saratoga Springs.
The conference offers a “C-Suite” of universal skills and insights to empower women executives in allhealthcare subsectors: business and finance; lobbying; government policymaking; strategy consulting; law;and other areas where women leaders aspire to enhance their talents, skills and leadership potential withinhealthcare.
DOH Posts Anticipated FLSA SurveyDue back August 26
Late yesterday, the state Department of Health(DOH) posted a long-anticipated survey to measurethe costs faced by home care providers due to therecent Labor Standards Act (FLSA) changes. Thesechanges include: paying overtime at time-and-a halfof the aide’s regular rate of pay instead of time-and-ahalf of minimum wage, paying aides for travel time,new costs for some 24-hour live-in cases, and others.
HCA Submits Comments on
Concerning Medicare Home Health
Pre-Claim Review Demonstration
Last week, HCA submitted comments on theMedicare Home Health Pre-Claim ReviewDemonstration being initiated by the U.S. Centersfor Medicare and Medicaid Services (CMS).Though this Demonstration does not currentlyapply to New York State, HCA was compelled to
See WOMEN p. 2
See DEMO p. 5
HCA Offers First-ever Leadership Summit for Women.....................1HCA Comments on Pre-Claim Review Demo....................................1DOH Posts Anticipated FLSA Survey..................................................1Concerned about Workers’ Compensation Costs?..........................6Additional FLSA Funding Available Soon......................................7LTHHCP: Q&A to Clarify Operation, Roles, Opportunities..............8DOH Announces DSRIP Updates........................................................9OMIG Posts New Compliance Alert...................................................9HCA Posts 2015 MLTC & PACE MMCOR Data.............................10HCA Gives Feedback on OMIG’s Private Duty Audit Protocols.....10RFA Now Open For Health Transformation Funds........................11DOH Seeks Input on FIDA.................................................................12Kaltenbach Now COO of MZL Home Care Agency..........................13Kate Rolf Appointed to National Rural Health Committee.............14CMS Provides Medicare Hospice Payment Update.........................15New Labor Task Force Targets Home Care......................................16CMS Proposes New Bundled Payment Models...............................17Additional DOH Staff Changes.........................................................19MedPAC Releases 2016 Data Book.................................................19NGS Updates.................................................................................19Publications..................................................................................20
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]
Alexandra Blais, Director of Public Policy, [email protected]
Laura Constable, Senior Director, Membership & Operations, [email protected]
Celisia Street, 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
ASAP – a publication of the Home Care Association of New York State Volume 21, No. 28 July 29, 2016
WOMEN from p. 1
To download a brochure, register, learn more about thesummit, or become a sponsor, please visit http://hca-nys.org/general-news/hcas-first-ever-women-in-healthcare-leadership-summit-sept-28-29-in-saratoga.
“New York State has some of the most prominent womenleaders in healthcare, but the reality is that women are vastlyunderrepresented in executive-level healthcare positions hereand throughout the United States,” said HCA President
Joanne Cunningham. “This summit addresses an unmet needfor skill-development, networking and self-empowerment.”
“Research strongly suggests that a higher representation ofwomen on corporate boards and on leadership teams helpsenhance an organization’s overall performance, which is criticalin a healthcare business and policy environment that rewardsoutcomes first and foremost,” Ms. Cunningham added. “Whenwomen gain the tools to achieve their personal career goals, notonly do they benefit, but so do the organizations they lead.”
Among the speakers at the September 28-29 Summit are:
Nancy Miriam Hawley, founder of the BostonWomen’s Health Book Collective, Inc., which wasresponsible for writing the best-seller Our Bodies,Ourselves, a classic text that shifted the national and
international dialogue aboutwomen’s health, sexuality andpower. She’ll offer insights aboutthe timeless and essentialingredients to leadership growth,success and collectively crackingthe glass ceiling in the healthcareindustry and beyond.
Karen Friedman, an internationalcommunications expert, formertelevision news anchor, writer,and author of the best-sellingbook Shut Up and SaySomething (Praeger Publishing).Her expertise drew the attentionof former Secretary of State (andPresidential candidate) HillaryRodham Clinton who chose Ms.Friedman to provide media andpolitical training for women inSouth and Central America.She’ll offer the same sort oftraining at the LeadershipSummit, showing women leadershow to best tap their uniqueperspectives as women to
ASAP – a publication of the Home Care Association of New York State
3
Volume 21, No. 28 July 29, 2016
HCAHCAHCAHCAHCA’’’’’s next BIG confers next BIG confers next BIG confers next BIG confers next BIG conference isence isence isence isence isour Senior and Financialour Senior and Financialour Senior and Financialour Senior and Financialour Senior and FinancialManager’Manager’Manager’Manager’Manager’s Retrs Retrs Retrs Retrs Retreat at theeat at theeat at theeat at theeat at theMohonk Mountain Resort inMohonk Mountain Resort inMohonk Mountain Resort inMohonk Mountain Resort inMohonk Mountain Resort inNew Paltz on September 8 to 9.New Paltz on September 8 to 9.New Paltz on September 8 to 9.New Paltz on September 8 to 9.New Paltz on September 8 to 9.Have you registered yet?
This program delves into all of themajor home care finance issuesyou need to learn about, including:rate updates; big-picture items,like new models of care; themechanics of such issues asemployee wage, hour andovertime policies as well as homecare reimbursement changes; andnew areas of exploration.Download the brochure andregister today on our educationpage at http://hca-nys.org/events-education/upcoming-events.
communicate with maximum impact acrossdiverse audiences.
Bethany Gilboard, CEO of InnovativeHealth Alliance of New York and Alliancefor Better Healthcare, LLC, a successfulveteran of health care industry strategy andone of the state’s most prominent womenhealthcare leaders, who will share her uniqueperspective on tackling tough professionaland personal challenges and dilemmas.
Vicky Hines, a home care leader andprevious HCA Board Chair, who has risenthrough the ranks to become Chief OperatingOfficer of the University of Rochester MedicalFaculty Group. As a leading policy voice inhealthcare, Ms. Hines will offer tips forprofessional development that can lead to thebest career choices.
Dr. Jacqueline Hornor Plumez, authorof The Bitch in Your Head: How to FinallySquash Your Inner Critic, who will presenttools and techniques to combat negative thinking –a perspective that has led to her appearances onThe Today Show and Good Morning America, aswell as articles in Ladies’ Home Journal and TheNew York Times Magazine.
Rachel Soares of the Catalyst Research Centerfor Equity in Business Leadership, who directsresearch to identify the global gender leadershipgap, investigate myths that restrain women’sadvancement into corporate leadership, andexplore how diversity, leadership andperformance intersect. Her session will acquaintattendees with the principles of “sponsorship,”offering concrete strategies to get sponsored andbe a sponsor.
The program will also include a women’s mini-expo ofvendors, networking receptions, and a chance forwomen to obtain a free executive headshot for their C.V.or professional networking platforms.
Please join us for this first-of-a-kind conference tocultivate your c-suite spirit!
4
ASAP – a publication of the Home Care Association of New York State Volume 21, No. 28 July 29, 2016
5
ASAP – a publication of the Home Care Association of New York State Volume 21, No. 28 July 29, 2016
provide feedback, as this Demonstration may be applied to New York or nationally in the future and itpresents very significant concerns.
The Medicare Home Health Pre-Claim Review Demonstration was initially a Prior AuthorizationDemonstration, but was changed after strenuous objections by HCA, other provider associations and over100 members of Congress. HCA also previously submitted comments on the initial Prior Authorizationprogram. The Demonstration is being initiated in five states identified by CMS as “high risk”:Massachusetts, Illinois, Florida, Texas, and Michigan. Under the Pre-claim Review Demonstration, homehealth agencies (HHAs) in these states must submit:
A request for pre-claim review to the Medicare Administrative Contractor (MAC) for each episodeof care;
Documentation from the medical record that supports medical necessity and demonstrates that theMedicare home health coverage requirements are met (including the face-to-face/F2F encounter);
A request for pre-claim review at any time before the final claim is submitted.
The review process must occur before the final claim is submitted for payment. The MAC is expected tosend the HHA a decision affirming or non-affirming the pre-claim review request within targetedtimeframes of 10 business days of the first request and 20 business days of resubmitted requests.
During one of the CMS Open Door Forums held on this program, HCA raised concerns about therequirement that HHAs must obtain signed physician orders – as opposed to verbal orders – for initiatingthe pre-claim review process. This was supported by other Open Door participants. While CMS said itwould reexamine this requirement, the policy has not changed.
In our comments, HCA explains that the current documentation requirements will lead to long delays inHHAs initiating the process and obtaining a determination on its pre-claim review request. Thisdocumentation includes signed physician orders, F2F encounter evidence and other articles which all mustbe submitted as part of the pre-claim review process. We describe the numerous problems encountered byHHAs in obtaining signed orders and documentation to meet the F2F rule.
“CMS should conclude from [its Probe and Educate] reviews and other home care claims experience thatthere is a major issue with the requirements for documenting home health eligibility, as opposed to anindication of fraud and abuse in home health,” we state in our comments. “Also, there seems to be littleconsistency among the MAC staff and we fear that this will carry over into the pre-claim reviewdemonstration.”
HCA adds: “The expectations put on doctors regarding their written records to show that their patients areeligible for Medicare-covered home health are unreasonable, unrealistic and overwhelming. Until CMSsimplifies the documentation requirements, we expect that the pre-claim review demonstration will result inmany ‘non-affirmed’ requests.”
Furthermore, requiring that all this documentation be submitted with the request for a pre-claim review“will delay agencies in requesting a pre-claim review decision and leave the agency in limbo as to whether
DEMO from p. 1
ASAP – a publication of the Home Care Association of New York State Volume 21, No. 28 July 29, 2016
6
their final claim will be approved. Secondly, requiringagencies to utilize this process for every 60-day episode ofcare will create an unreimbursed and tremendous paperworkburden on agencies. We expect that HHA staff will have tospend countless hours in obtaining and submittingdocuments multiple times to the MACs as the HHAs aretold that their pre-claim review was not affirmed and they aretold to send additional evidence.” In addition, our commentspoint out that CMS already has many existing tools andauditing entities at its disposal to address Medicare integrityissues, including but not limited to:
Recovery Audit Contractors (RACs) Zone Program Integrity Contractors (ZPICs) State-level surveillance agents (targeting Conditions
of Participation adherence) Third-party liability payment auditors Office of the Inspector General MACs’ “Probe and Educate” reviews
HCA also stressed that the pre-claim review process willincrease costs to Medicare, home health providers, MACsand worsen an already massive backlog of appeals. Wemention that HHAs are already “subject to devastatingrebasing reductions and other reimbursement cuts thatalready underpay these existing cost obligations, not tomention the new cost obligations of a pre-claim reviewprocess, which has a direct impact on the initiation ofservices,” and we urge CMS to rescind this proposedDemonstration and solicit feedback from the providercommunity on more appropriate ways to address Medicareintegrity issues.
Given that documentation is the key area of allegednoncompliance, we request that CMS instead opt foreducation, clear guidelines and compliance standards, andprovider support in place of the pre-claim review proposal.
Our comments can be viewed in their entirety in the “Lettersand Comments” section of our website: http://hca-nys.org/category/letters-and-comments.
CMS has posted several informational materials on pre-claim review, including a revised Frequently Asked Questionsdocument, an Operational Guide, and an overview. They areat https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Pre-Claim-Review-Initiatives/Overview.html.
Is Your Agency Interested in
Reducing Workers’
Compensation Costs?
Please reserve your seat today at thenext session in our Home CareSurvival Bootcamp Education Series:Addressing Factors that IncreaseWorkers’ Compensation Costs andDeveloping Ways that Home CareProviders Can Reduce Their Expenses.
This session will be held on September28 from 9:30 a.m. to noon in New YorkCity.
The financial burden of Workers’Compensation has been increasing forhome care providers due to numerousfactors. Agencies face the potential foradditional increases due to the recentlyenacted $15 minimum wage and ashrinking Workers’ Compensationinsurance market. By developing acohesive Workers’ Compensation risk-management strategy, home careagencies can play an active role inreducing their costs. Learn from aninsurance industry expert with the firmMarshall & Sterling, Inc. about pricingissues and the need to understand howinsurance companies and their agentsdecide these issues. When it comes to Workers’Compensation, in particular, the goal isto help employers understand what theinsurance underwriters are doing, whythey’re doing it, and how they’re doingit, so that your agency can leverage thatinformation to positively impact yourbottom line.
To register, please download thebrochure at http://hca-nys.org/wp-content/uploads/2016/06/Sept-28-Survival-Bootcamp-Work-Comp-Costs-and-Expense-Reduction.pdf.
ASAP – a publication of the Home Care Association of New York State Volume 21, No. 28 July 29, 2016
7
The DOH survey was developed and modified with inputfrom HCA and the other provider associations in order tohelp the state to ascertain the actual costs faced by agenciesunder the FLSA changes. As stated in the survey, DOH“intends to utilize this information to form the basis for thedetermination of appropriate program change adjustments tofee schedules and/or capitation rates.” The informationrequested in the survey is in reference to the time periods of2014, and between October 2015 and March 2016. Itrequests responses, by region, about the:
Number of hours of aide services provided Number of overtime hours Average hourly rate paid to aides Number of Medicaid home care clients Number of 24-hour live-in cases Travel expenses Other costs
Throughout the process of survey development, HCAadvocated for a brief survey that captured only importantFLSA-related information and minimized sections related totravel expenses. A quick review of the survey shows that it isvery detailed and will take more time to complete thananticipated.
DOH has provided some funding to help home careproviders with the FLSA changes under Medicaid fee-for-service and managed care. However, those funds for managedcare patients only cover the period of October 13, 2015 toMarch 31, 2016, and DOH has said that any new fundingwill be up to negotiation between providers and health plans.(See sidebar story on this page.)
The survey is due August 26 and must be submitted online. Itcan be accessed at http://www.health.ny.gov/health_care/medicaid/redesign/fair_labor_standards_act.htm (underFLSA Updates). HCA and the other provider associationshave identified a number of concerns with the survey roll-out. These include: a short timeframe to send questions(August 5); giving the associations as the first place to contact;and DOH’s decision not to hold a webinar to help agencies withthe survey (as we jointly suggested). We intend to further raisethese issues with DOH.
All questions about the survey must be sent by August 5 [email protected]. DOH intends to post a FrequentlyAsked Questions document by August 12.
Additional FLSA Funding
Available Soon
The state Department of Health(DOH) has announced that thefederal-share of funding to assisthome care providers in complyingwith the final Fair Labor StandardsAct (FLSA) rule change, for theperiod of October 13, 2015 toMarch 31, 2016, will be paid to theMLTC plans via checks dated August
10. Plans will then have 30 days topass the funds to their home carecontractors. DOH previously advised HCA thata federal-share of $22.8 million (thesame amount given to the plansearlier as the state-share of the FLSAmonies) will be available in thisAugust 10 payment, and that plansare expected to pass-through thefederal monies to their home careproviders in the same amounts asthey did with the state-share.
These funds are intended to helphome care providers with new costsfaced under the FLSA final rule,including paying overtime at time-and-a half of the aide’s regular rate ofpay instead of time-and-a half ofminimum wage; travel expenses;costs of 24-hour sleep-in cases; andothers. HCA has repeatedly raised concernsto DOH about the distribution ofthese funds, including: thedocumentation required ofproviders; differences in methodsused to determine the amounts thathome care providers should receive;the varied amounts that providershave received from plans; the lack ofany mechanism to appeal the
SURVEY from p. 1
ASAP – a publication of the Home Care Association of New York State Volume 21, No. 28 July 29, 2016
8
amounts; and the untimely flow of funds.
Despite vigorous HCA objection, DOH has indicated that it will not be providing additional funds tomeet the FLSA requirements after March 31, 2016 and any new funding will be up to negotiation betweenproviders and health plans.(Please see related p. 7 story about additional FLSA funding.) HCA continues to work with DOH and other provider associations to assure that the problematicdistribution of FLSA funding is not repeated in monies appropriated to assist home care providers withthe upcoming minimum wage increases. We will also continue to press our agenda for payment adequacyof all labor and mandate costs, as reflected in legislation that HCA advanced earlier this year, which we arepriming for consideration in state budget negotiations or other legislative vehicles.
LTHHCP: Q&A to Clarify Operation, Roles, Opportunities
A draft questions-and-answers (Q&A) document for the LTHHCP is in progress and reportedly under“active review” at the state Department of Health (DOH).
This new Q&A is intended to assist LTHHCPs, MLTCs, local social services districts, performingprovider systems (PPSs) and other stakeholders with guidance on LTHHCP status, operation and roles inthe restructured Medicaid and health system.
The Q&A would clarify the standing of LTHHCPs, their operating authority and service roles under stateand federal statutes, and certain procedures in the new service delivery structure.
This guidance would help respond to questions (and much misunderstanding and confusion) in the wake ofongoing state reforms, especially several new LTHHCP developments such as: 1) the recent finalization ofthe Department’s statewide enrollment of LTHHCP Medicaid and dual eligible Medicaid-Medicarerecipients into managed care; and 2) the final extension/expiration of the specific 1915(c) federal waiver fornon-state plan Medicaid services offered by the LTHHCP (per GIS 16 MA/11).
Much confusion has surrounded the LTHHCP’s provider standing and capability ever since the MedicaidRedesign Team (MRT) implemented broad system reforms in 2011 and 2012, in particular mandatorymanaged care enrollment and the consolidation of waivers and programs under the state’s comprehensive1115 federal waiver. Many LTHHCP providers have continued providing services both directly and undervarious contractual arrangements around the state. However, with patients transitioned to managed careand little guidance on the LTHHCP’s status under these reforms, providers have faced declining patientcensuses, along with the perception of a potentially dwindling program service roles and future opportunityarea.
The anticipated Q&A would aim to clarify and affirm to LTHHCPs and all stakeholders the LTHHCP’sstanding and capability. It could also potentially reveal new opportunity areas and help clear up themisunderstanding about LTHHCP’s utility and operation.
Even in the wake of MRT reforms, LTHHCPs have been virtually all designated by DOH as “safety-net”providers for the Delivery System Reform Incentive Payment (DSRIP) program. LTHHCPs, as dualMedicare and Medicaid certified providers, can well position themselves under Value Based Payments.
ASAP – a publication of the Home Care Association of New York State Volume 21, No. 28 July 29, 2016
9
Thus, the Q&As would inform critical LTHHCP decisionsabout strategic partnerships, future resources and structures.
HCA has been reaching out to DOH to expedite the Q&As andprovide other support for LTHHCPs. Upon finalization, HCAwill ask DOH to convene a webinar – or join one sponsored byHCA – to review the Q&As and identify any additionalquestions or needed guidance.
DOH Announces DSRIP Updates
This week, the state Department of Health (DOH) announcedsome updates regarding the Delivery System Reform IncentivePayment (DSRIP) Program. These are summarized below.
Round 3 regulatory waiver requests due August 1
Once again, Performing Provider System (PPS) leads have beeninvited by the state Department of Health (DOH), Office ofMental Health (OMH), Office of Alcoholism and SubstanceAbuse Services (OASAS), and the Office for People WithDevelopmental Disabilities (OPWDD) to submit additionalRegulatory Waiver requests to DOH by August 1, 2016.
Responses to these requests will be sent to the PPS leads byOctober 1, 2016 and posted on the DSRIP website.
In September 2014, these government agencies issued guidanceon the submission of these requests. That guidance is availablehere: https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/regulatory_flexibility_guidance.htm.
Further information, including past waiver requests, theregulatory waiver request template, as well as deadlines andresponse dates can be viewed here: https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/reg_flex_guide_res_prog_stat_waiver_resp_approvals.htm.
Integrated services webinar
The Integrated Services webinar, held on July 14, 2016, has beenposted to the DSRIP website in the “Integrated Services” sectionof the “Webinar and Presentations” webpage at https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/webinars_presentations.htm.
Continued on next page
OMIG Posts New
Compliance Alert
The state Office of theMedicaid InspectorGeneral (OMIG) hasposted a new ComplianceAlert (2016-01), whichprovides notice of theAugust 1, 2016 increase inthe Civil MonetaryPenalties by theU.S. Department ofJustice. The Alert can be viewedat: http://on.ny.gov/2a5MqIZ.
Under the DeficitReduction Act (DRA) of2005, the penalties applyto Medicaid providersthat receive or makeannual payments underthe state Medicaid plan ofat least $5 million.
Further informationabout the DRArequirements may befound in OMIG’sCompliance Library athttps://www.omig.ny.gov/compliance/compliance-library.
Effective August 1, 2016,the False Claims Act civilpenalty increases to arange of $10,781 to$21,563 per claim and theAdministrative Remediescivil penalty will change to$10,781 per claim.
ASAP – a publication of the Home Care Association of New York State Volume 21, No. 28 July 29, 2016
10
Updated DSRIP FAQs
Revised FAQs have been posted to the DSRIP website at: https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/dsrip_faq/index.htm.
Question no. 2 in the PPS section of the DSRIP Frequently AskedQuestions (FAQ) was revised to mitigate confusion caused by theoriginal answer. The item is revised as follows:
Q: Can a provider still join a PPS at this point in time? If yes, can youstill participate in the financial incentive payment? (Revised July2016)
A: At this time, the PPS provider networks are closed. However, annuallyPPS networks will reopen for the addition of new partners for performancepurposes only. We recommend reaching out to the PPS in your regionregarding participation. A list of PPS contact information can be found onthe DSRIP website at: http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/providers_professionals.htm.
The answer was revised to eliminate the following sentence, which hadcaused confusion: “At DSRIP midpoint, providers may be added forvaluation.” Please refer to the revised wording for informational purposes.
Any questions may be directed to [email protected].
Members-Only HCA Data Webpage Now Includes
2015 MLTC & PACE MMCOR Data
This week, we posted to our members-only “HCA Data” webpage anHCA-developed spreadsheet of the 2015 fourth quarter MedicaidManaged Care Operating Reports (MMCORs) for each MLTC andProgram of All-Inclusive Care for the Elderly (PACE) plan in thestate.
Important: HCA Data is a members-only page that provides datareports to assist home care and hospice providers and managed careplans in their benchmarking efforts, understanding of system-widetrends, and access to reimbursement and premium rates. The page isnot visible on our site unless you are logged in with an HCA memberwebsite account.
Our log-in page is here: http://hca-nys.org/login. Upon login, theHCA Data link will appear in the site menu at the top right. You can
Continued from previous page HCA Provides
Feedback on OMIG
Audit Protocols for
Private Duty
Nursing
This week, HCA submittedcomments to the stateOffice of the MedicaidInspector General (OMIG)on its draft audit protocolsfor private duty nursingservices provided byLHCSAs. In ourcomments, we requestOMIG to revise threeprotocols which areincorrect or requireclarification. These include:
1. Timeframe forobtaining signedphysician orders;
2. PPD skin testrequirement; and
3. Criminal historychecks for nurses.
HCA has providedfeedback to OMIG onnumerous audit protocolsand appreciates that it hasreached out to us on privateduty nursing protocols.
HCA will be holding itsannual CorporateCompliance program onOctober 6 in Albany; moreinformation on thissignature program willfollow soon.
Volume 21, No. 28 July 29, 2016ASAP – a publication of the Home Care Association of New York State
11
also enter your e-mail address to obtain your password. Or, simply e-mail HCA’s Communications DirectorRoger Noyes at [email protected] if you do not yet have an HCA website account.
HCA’s 2015 MMCOR spreadsheet summarizes key MMCOR data, including such items as:
Plan enrollments Per-member-per-month premium revenue and premium income or loss Unit costs Personal care and home health aide utilization and other information
Last month, HCA posted the 2014 Medicaid Cost Reports for all non-hospital based CHHAs andLTHHCPs in the state to this page as well.
HCA Data is just one of many resources for members and is only visible if you log-in to our website. Pleaseuse HCA’s website to find information and updates. Once logged-in, you will see a blog feed on our homepage offering virtually every important member resource or update, including recent e-mail alerts, policymemos, archives of our ASAP newsletter and more.
For further information, contact Patrick Conole at (518) 810-0661 or [email protected].
Grant RFA Now Open For State Health Transformation FundsIncludes HCA-sought dedicated pool for home and community based providers; learn more at August 8 applicantwebinar The state Department of Health (DOH) has released a Request for Applications (RFA) under the StatewideHealth Care Facility Transformation Program, which includes HCA-sought dedicated funding for home andcommunity-based providers. The RFA can be accessed on DOH’s website (http://www.health.ny.gov/funding/rfa/1607010255/index.htm) or through the Grants Gateway website here (https://grantsgateway.ny.gov/intelligrants_NYSGG/module/nysgg/goportal.aspx?NavItem1=4&ngoID=5000607). Applications mustbe submitted in the Grants Gateway by 4 p.m. on Friday, September 16, 2016. HCA and community health provider representatives worked in partnership to push for this transformationfunding during budget negotiations, convincing the Legislature and Governor to dedicate a portion of thesefunds for home and community-based providers specifically. At our urging, the final initiative includes a minimum of $30 million dedicated for the home and community-based sector as part of the entire $195 million pool otherwise available for all sectors. While the $30 million minimum is dedicated to home and community-based providers, specifically, theseentities are also eligible for funding in the remainder of the pool as well. The goal of this program is to provide grants that primarily support capital projects (but it may include non-capital expenses such as debt restructuring) “for the purpose of strengthening and protecting continued accessto health care services in communities throughout New York State and associated with a merger,
ASAP – a publication of the Home Care Association of New York State Volume 21, No. 28 July 29, 2016
12
consolidation or significant corporate restructuring activity that is part of an overall transformation planintended to create a financially sustainable system of care.”
Non-capital projects, in addition to debt restructuring, that may be eligible for funding include generaloperating expenses directly connected to the eligible project for which funding is sought as well as non-capitalexpenses in cases where the RFA does not explicitly mention them as excluded. Those excluded are generaloperating expenses applicable to day-to-day operations and unconnected to the eligible project for whichfunding is being sought.
The overall pool is open to health care providers fulfilling a health care need for acute inpatient, outpatient,primary, home care or residential health care services in a community. Home and community-basedproviders, eligible for at least $30 million of this total amount, are defined as diagnostic and treatmentcenters, mental health and alcohol and substance abuse treatment clinics, primary care providers and home
care providers.
A letter of intent is due August 19, though DOH indicates this is optional. DOH has also announced anApplicant Webinar on Monday, August 8 at 1 p.m. Participants must register in advance at https://meetny.webex.com/meetny/onstage/g.php?MTID=e31794d9a38496235b755383458cb4e0c.
Potential applicants may continue to submit questions related to the RFA [email protected] until Wednesday, August 10. Responses to all questionswill be posted to the DOH website on or about August 17, and made available to all webinar participants.
DOH Seeks Input on FIDA
On July 22, the state Department of Health (DOH) provided an update on the Fully Integrated DualsAdvantage (FIDA) program and sought input on the future of FIDA. The webinar provided updated FIDAstatistics, discussed recent reforms, and outlined an upcoming advertising campaign and outreach mailings.
Some of the prominent data includes:
FIDA enrollment totals 5,370 including 1,620 in Brooklyn; 1,153 in the Bronx; 1,118 in Queens;982 in Manhattan; 345 in Nassau; and 152 in Staten Island. This is much less than the stateoriginally estimated and the state has been looking for ways to encourage enrollment. As acomparison, over 150,000 individuals statewide are enrolled in MLTC partial capitation plans.
The five largest plans are VNSNY, HealthFirst, GuildNet, Fidelis and Elderplan.
The largest number of those who have opted out of FIDA reside in Brooklyn (48 percent), Queens(20 percent), Manhattan (16 percent), Bronx (10 percent), Nassau (4 percent) and Staten Island (2percent).
Zip codes with the highest opt outs tend to have a large number of FIDA eligibles who speakRussian, Chinese and Spanish and a large number of FIDA eligibles who are currently enrolled in aMedicare Advantage managed care plan.
The number of monthly disenrollments has decreased from 747 in January to 184 in June.
Continued on next page
ASAP – a publication of the Home Care Association of New York State Volume 21, No. 28 July 29, 2016
13
65 appeals have been filed since June 2015, including almost half (30) related to personal careservices.
Some of the recent reforms include: fewer assessments for enrollees transferring from an existing MLTC orFIDA plan, more flexibility in the Interdisciplinary Team (IDT) process, less rigid marketing rules, amongothers.
DOH will conduct a four-month multifaceted advertising campaign and outreach mailings. Mailings willtarget: 1) Medicare providers who have provided services to FIDA eligibles between January and July 2016(about 9,000); 2) consumers who have opted out of FIDA and are still FIDA eligible; and 3) consumerswho have joined MLTC since December 2014 and never opted out of the FIDA program.
DOH discussed the future of FIDA and is seeking comments on whether to extend the program intoSuffolk and Westchester in 2017 or 2018 and whether to request federal approval for a two-year extensionof FIDA for the period from January 1, 2018 to December 31, 2019.
The July 22 handouts are at https://www.health.ny.gov/health_care/medicaid/redesign/2016/docs/2016-07-22_stakeholder_update.pdf.
Home Care Leader Walter Kaltenbach Appointed COO of MZL Home Care
Agency Walter Kaltenbach – a longtime executive in home careand member of HCA – was recently appointed ChiefOperating Officer of Brooklyn-based MZL Home CareAgency, which joined as an HCA provider member earlierthis year. Mr. Kaltenbach has over 20 years of leadership experiencein home health care services, including at Premier HealthCare, People Care, and Able Health Care, where he servedas CEO for sixteen years before coming to MZL. He hasbeen a dedicated political advocate at both the state andfederal levels, lending his voice particularly on behalf ofspecial-needs individuals through programs served underthe Office for People With Developmental Disabilities(OPWDD) system. Mr. Kaltenbach has a record of successfully negotiatingand acquiring strong referral source contracts with managed care organizations, implementingcompanywide performance improvement plans, mentoring senior executive staff, and increasingrevenue. He has been an active and engaged member of HCA’s Policy Council for several years, providinginsight and expertise on emerging issues facing home care policy, and was appointed to the HCA Board ofDirectors in 2015. MZL Home Care Agency is part of the Gefen Senior Care group, providing home and community basedservices since 1998. MZL is the LHCSA component of this group, delivering home care services under
Continued from previous page
Kaltenbach
ASAP – a publication of the Home Care Association of New York State Volume 21, No. 28 July 29, 2016
14
contract to CHHAs, hospices and MLTCs in the five boroughs of New York City, Long Islandand Westchester Rockland, Dutchess and Putnam counties, while operating offices in Brooklyn, Queens andLong Island. MZL provides a wide variety of home care services including home health aides, personal careaides, housekeeping, and chore services. MZL also provides skilled care services such as assessments,including through the Uniform Assessment System (UAS-NY).
HCA congratulates Mr. Kaltenbach on the recent appointment, appreciates MZL for joining HCA asmembers, and looks forward to Mr. Kaltenbach’s ongoing leadership voice in the HCA community and Boardas we continue to tap his insights on advocacy, policy, program development, reimbursement, and regulatoryand operational issues.
Recent Board Member Kate Rolf Appointed to National Advisory Committee on
Rural Health and Human Services
HCA Member Kate Rolf, President and Chief Executive Officer ofSyracuse-based VNA Homecare, has been appointed to a four-yearterm on the National Advisory Committee on Rural Health andHuman Services (NACRHHS) of the Health Resources and ServicesAdministration. NACRHHS is comprised of 21 nationally recognizedrural health experts who advise the Secretary of the U.S. Department ofHealth and Human Services on ways to address health care issuesacross rural America.
“I am excited to have this opportunity to contribute to suchan important body,” Ms. Rolf said. “The potential to influence federalpolicy as it relates to rural America is an honor, especially giventhat approximately 1.5 million New Yorkers live in areas designated asrural by the United States Department of Agriculture.”
Ms. Rolf brings a wide range of health policy expertise to thecommittee. She has more than 20 years of leadership experience and is anactive member of several community organizations. She has served onthe HCA Board of Directors, where Ms. Rolf recently completed herterm as Board Treasurer, and received HCA’s 2015 prestigious Advocacy Award. Ms. Rolf currently serveson the Board of Directors for the Visiting Nurse Associations of America (VNAA) and LeadingAge NewYork, where she chairs the Home and Community Based Service Cabinet.
HCA has long focused on the needs of home care providers in rural areas. On the reimbursement front, we’vesuccessfully advocated for the continuation of the rural add-on for Medicare home health services. We havealso worked closely with the New York State Legislative Commission on Rural Resources to press a series oflegislative initiatives that support the rural delivery of home care, but those measures are applicable to allhome care service regions. Our initiatives include home care access to discretionary grant funding andregulatory flexibility.
HCA applauds the Health Resources and Services Administration for appointing Ms. Rolf to theNACRHHS, where she will be a strong New York home care voice on behalf of rural health delivery issues.
Rolf
ASAP – a publication of the Home Care Association of New York State Volume 21, No. 28 July 29, 2016
15
CMS Provides Medicare Hospice Payment Update
The U.S. Centers for Medicare and Medicaid Services (CMS) has identified three issues that are affectingpayments for the two-tier routine home care (RHC) payment and the service intensity add-on (SIA) payment.The following is a summary of each issue and the timeframe for when those issues might be corrected.
Two-Tier RHC Payments
Issue: The two-tier payment rate is not being applied appropriately to claims submitted on or after January 1,2016.
In some instances, the Medicare system is incorrectly paying at a low rate, instead of the high rate, causing anunderpayment to providers.
In other instances the Medicare system is incorrectly paying the RHC at a high rate, when the low rate isappropriate. The Medicare system is checking a single prior benefit period and not all benefit periods that arenot separated by 60 days. This inappropriate payment is causing an overpayment to providers. C
MS will be providing instructions to the Medicare Administrative Contractors (MACs) in the January 2017release to correct the Medicare system issue. Providers currently do not need to take action and should notreport any overpayments on their credit balance reports.
SIA Payment
Issue: In certain situations, the Medicare system is not applying the end-of-life (EOL) SIA payment to theprevious month’s claim, when a patient dies within the first few days of a month. The Medicare system isdesigned to trigger an automatic adjustment of the prior month’s claim if the prior month’s claim is eligible forthe SIA payment. This adjustment will apply the EOL SIA amounts to the previous claim that could not beidentified in the initial processing. These adjustments are not occurring on the prior month’s claim in thefollowing situations:
When the incoming claim does not contain a qualifying RHC service;
When the provider adjusts the original claim to add qualifying (or additional) RN and/or MSWvisits; and
When the provider adjusts the IUR (32G) claim that originally applied the SIA payment, and theadjustment claim removes all EOL SIA payments.
CMS plans to issue instructions to the MACs in the January 2017 release to correct the Medicare system issue.Providers currently do not need to take action and should not submit an adjustment claim for the previousmonth, nor does the provider need to submit an appeal. This is a Medicare system issue; CMS will updateproviders on claims adjustments when additional information becomes available.
For further information, contact Patrick Conole at (518) 810-0661 or [email protected].
ASAP – a publication of the Home Care Association of New York State Volume 21, No. 28 July 29, 2016
16
Task Force on Employee Exploitation and Misclassification Established; Home
Care Targeted
Last week, Governor Cuomo signed Executive Order No. 159 to establish a Permanent Task Force onEmployee Exploitation and Misclassification. The new task force represents a merger of the ExploitedWorker Task Force, the Nail Salon Industry Enforcement Task Force and the Joint Enforcement Task Forceon Employee Misclassification.
According to the Governor’s press release (http://www.governor.ny.gov/news/governor-cuomo-announces-employers-repay-nearly-4-million-back-wages-and-damages-more-7500), the new executiveorder will expand its focus to examine a variety of ways in which workers are exploited such as unpaidwages, unpaid overtime, health and safety violations, and other instances of worker exploitation. The effortspans 15 target industries, including home health care.
According to the Governor’s press release, the new Task Force will “bring together unemployment insuranceinvestigators, wage investigators and workers compensation investigators with the investigators andpersonnel of task force agencies to comprehensively scrutinize employers engaged in the undergroundeconomy.”
The Governor also announced that the Task Force to Combat Worker Exploitation has directed 1,547businesses to pay nearly $4 million in back wages and damages to more than 7,500 workers since itsinception in July 2015. This is included in the Task Force’s 2016 report at https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/EWTFReport_Final.pdf.
This Task Force conducted more than 120 investigations in industries that included home health care.According to the report, the Task Force (and presumably the new Permanent Task Force on EmployeeExploitation and Misclassification) will explore enhancing enforcement of wage standards in the homehealth care industry and take actions in other areas. Efforts may include amending contracts to requireevidence of compliance with wage parity laws, engaging employers to communicate consequences of non-compliance, auditing employers, and enhancing penalties.
The report notes that the Task Force held hearings across the state and at two of these sessions home healthcare workers spoke of issues such as the failure to receive minimum wage and overtime, required off-the-clock work, and meal period violations. Additionally, they cited shift issues, including unpredictable andlong work hours coupled with lack of meal breaks.
The labor laws and regulations that affect home care workers are complex, varied and confusing. Home careagencies are surveyed and audited by a multitude of entities and may face the added scrutiny of theGovernor’s newly announced Task Force. Home care providers are advised to consult with trainedprofessionals in labor law and ensure that they are in compliance with the relevant rules.
The executive order is available at http://www.governor.ny.gov/news/no-159-establishing-permanent-joint-task-force-fight-worker-exploitation-and-employee.
ASAP – a publication of the Home Care Association of New York StateVolume 21, No. 28 July 29, 2016
17
CMS Proposes New Bundled Payment ModelsNew Opportunity for Home HealthProviders
The U.S. Centers for Medicare andMedicaid Services (CMS) has proposed newbundled payment models for hospitals thatwork with home care and other post-acutecare providers.
These bundles include: new models forcardiac care; an extension of the existingmodel for hip replacements to include otherhip surgeries; and a new model to increasecardiac rehabilitation utilization.
Under the proposed episode paymentmodels, the hospital in which a patient isadmitted for care would be accountable forthe cost and quality of care provided toMedicare fee-for-service beneficiaries duringthe inpatient stay and for 90 days afterdischarge. Participating hospitals would bepaid a fixed target price for each careepisode, and those that deliver higher-quality care would get a higher target price.
At the end of a model performance year,actual spending for the episode (totalexpenditures for related services underMedicare Parts A and B) would becompared to the target price that reflectsepisode quality for the responsible hospital.Hospitals that work with physicians andother providers to deliver the needed carefor less than the quality-adjusted targetprice, while meeting or exceeding qualitystandards, would be paid the savingsachieved. Hospitals with costs exceeding thequality-adjusted target price would berequired to repay Medicare.
Phased Implementation
Recognizing that hospitals will need time toadapt to the new models and establish
processes to coordinate care, CMS has proposed anumber of measures to ease the transition, includinggradually phasing-in risk. The program is scheduled torun for five years, from 2017 to 2021.
Downside risk (possible repayments to Medicare)would be phased in:
July 2017 – March 2018 (performance year 1and quarter 1 of performance year 2): Norepayment;
April 2018 – December 2018 (quarters 2through 4 of performance year 2): Capped at 5percent;
2019 (performance year 3): Capped at 10percent; and
2020 – 2021 (performance years 4 and 5):Capped at 20 percent.
Gains (payments from Medicare to hospitals) wouldbe phased in:
July 2017 – December 2018 (performanceyears 1 and 2): Capped at 5 percent;
2019 (performance year 3): Capped at 10percent; and
2020 – 2021 (performance years 4 and 5):Capped at 20 percent.
The first performance period would run from July 1,2017 to December 31, 2017. The second through fifthperformance periods would align with calendar years2018 through 2021.
Targeted Areas
For the new cardiac bundles, participants would behospitals in 98 randomly-selected metropolitanstatistical areas (MSAs). Hospitals outside of thesegeographic areas would not participate in the model.There is no application process.
ASAP – a publication of the Home Care Association of New York State Volume 21, No. 28 July 29, 2016
18
Because some of the new hip surgery models, specifically hip/femur fracture surgeries, build upon theexisting Comprehensive Care for Joint Replacement (CJR) model, CMS proposes to test these bundledpayments in the same 67 MSAs that were selected for that model. These include the New York regions ofBuffalo, New York City, Long Island and the northern metropolitan area.
Collaboration with Other Providers
According to CMS, one of the major goals of bundled payments is to encourage coordination among allproviders involved in a patient’s care, including hospitals, physicians, home health providers and skillednursing facilities.
Therefore, as in the CJR model, CMS is proposing to allow hospital participants to enter into financialarrangements with these other providers as well as with Medicare Shared Savings Program AccountableCare Organizations (ACOs).
Those arrangements would allow hospital participants to share reconciliation payments, internal costsavings, and responsibility for repayment to Medicare with other providers and entities that choose toenter into these arrangements, subject to the limitations outlined in the proposed rule. Thus, these newbundled payment models offer opportunities for home health agencies to collaborate with other providersto provide home care services.
Cardiac Rehabilitation Incentive Payments
One announced cardiac model will test the effects of payments that encourage the use of cardiacrehabilitation services. The cardiac rehabilitation incentive payment model will examine the impact ofproviding an incentive payment to hospitals where beneficiaries are hospitalized for a heart attack orbypass surgery, which would be based on beneficiary utilization of cardiac rehabilitation and intensivecardiac rehabilitation services in the 90-day care period following hospital discharge.
Hospitals may use this incentive payment to coordinate cardiac rehabilitation and support beneficiaryadherence to the cardiac rehabilitation treatment plan to improve cardiovascular fitness. These paymentswill be available to hospital participants in 45 geographic areas that were not selected for the cardiac carebundled payment models, as well as 45 geographic areas that were selected for the cardiac care bundledpayment models.
The proposed rule can be viewed at https://innovation.cms.gov/Files/x/advancing-care-coordination-nprm.pdf. For more information on the Cardiac Bundled Payment Models, go to https://innovation.cms.gov/initiatives/epm/.
Information on the Cardiac Rehabilitation Incentive Payment Model is available at: https://innovation.cms.gov/initiatives/cardiac-rehabilitation/.
For more information on the CJR Model, visit: https://innovation.cms.gov/initiatives/cjr.
ASAP – a publication of the Home Care Association of New York State Volume 21, No. 28 July 29, 2016
19
Additional DOH Staff Changes
The state Department of Health (DOH) has announced the appointment of Margaret Willard as the DeputyDirector of the Division of Home and Community Based Services, Office of Primary Care and HealthSystems Management. Ms. Willard will be working with Rebecca Fuller Gray, Director of the Division ofHome and Community Based Services.
Ms. Willard brings extensive experience with her to this new role gained through her many years of workingin the area of long term care service delivery. Most recently, as the Bureau Director in the Division of LongTerm Care in the Office of Health Insurance Programs, she has played an integral role in implementing thetransition of community based services into MLTC models.
HCA has worked closely with Ms. Willard over many years and looks forward to continuing this closerelationship in her new position.
A series of earlier DOH staff changes were outlined in the July 15 ASAP, including the appointment ofAndrew Segal, former Director of External Affairs and Government Relations at Visiting Nurse Service ofNew York, as Director of Long Term Care in the Office of Health Insurance Programs, and the appointmentof Mark Kissinger as Special Assistant to the Commissioner for Long Term Care.
MedPAC Releases 2016 Data Book
The Medicare Payment Advisory Commission (MedPAC) has released its 2016 data book on health carespending and the Medicare program.
The report is available at http://medpac.gov/documents/data-book/june-2016-data-book-health-care-spending-and-the-medicare-program.pdf?sfvrsn=0. Some topics include: Medicare beneficiary demographics; dual eligible beneficiaries; quality of care; post-acute care; Medicare managed care; and other services.
NGS Updates
National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), posted thefollowing update to its website.
Using NGSConnex to Submit Documents in Response to an Additional Documentation Request –
NGS will soon allow Part A providers to submit documents in response to an additionaldocumentation request (ADR) in its self-service portal, NGSConnex. NGS will make this featureavailable beginning on July 30. Being able to electronically submit documentation for an ADR allowsproviders to respond directly through NGSConnex with no need to mail or fax one’s response tocomplete the process.
Continued on next page
ASAP – a publication of the Home Care Association of New York State Volume 21, No. 28 July 29, 2016
20
Continued from previous page
NGS Provider Enrollment Revalidation Sessions – During the month of August, NGS will behosting five “Let’s Chat about Provider Enrollment Revalidation” sessions. They will focus onprovider enrollment revalidation information, validating one’s Medicare enrollment information viaInternet-based PECOS, or completing the appropriate CMS-855 paper application. NGS staff willalso review how to use the CMS Medicare Revalidation List search tool on the CMS website. Thesessions will be held on August 3, 9, 18, 24, 30. Registration is at https://www.NGSMedicare.com.Select the Education tab, then “Webinars and Teleconference & Events.”
For further information, contact Patrick Conole at (518) 810-0661 or [email protected].
Publications
“Medicaid Coverage of Social Interventions: A Road Map for States,” by Manatt Health for the NYSHealth Foundationhttp://nyshealthfoundation.org/uploads/resources/medicaid-coverage-of-social-interventions-issue-brief-july-2016.pdf
“Mis-Managed Care: Fair Hearing Decisions on Medicaid Home Care Reductionsby Managed Long Term Care Plans, June – December 2015,” by Medicaid Matters New Yorkhttp://medicaidmattersny.org/cms/wp-content/uploads/2016/07/Managed-Long-Term-Care-Fair-Hearing-Monitoring-Project-2016-07-14-Final.pdf
“Report to Congress: Fraud Prevention System Third Implementation Year,” by the U.S. Centers forMedicare and Medicaid Serviceshttp://hca-nys.org/wp-content/uploads/2016/07/Fraud-Prevention-System-Third-Implementation-Year1.pdf
For more information, contact Andrew Koski at (518) 810-0662 or [email protected].
