asap - hca-nysasap – a publication of the home care association of new york state volume 19, no....
TRANSCRIPT
Legislative Issues Public Policy News
A Weekly Publication Of HCAHCAHCAHCAHCAHome Care Association of New York State
Helping New YorkersFeel RightAt Home
ASAPVolume 19, No. 34 September 19, 2014
Inside Inside Inside Inside Inside ASAPASAPASAPASAPASAP
Save The Dates for Upcoming Member ForumsLTHHCP Forum: Sept. 30 (Registration is in this week’s ASAP)HCC Member Meeting: Oct. 27 (More information coming soon)Downstate LHCSA Forum: Oct. 27 (More information coming soon)
Bill Allowing Non-Physician Practitioners to
Order Home Health Picks up Steam in Congress
HCA has long supported legislation to allow non-physician practitioners to order Medicare home health services.Legislation to do just that is picking up steam in Congress.
New York Senator Charles Schumer is a sponsor of S.1332/H.R. 2504, also known as the ‘Home Health CarePlanning Improvement Act’ (introduced in 2013), which would allow physician assistants, nurse practitioners,clinical nurse specialists and other professionals to order Medicare home health services.
Sign Up For LTHHCP Forum on
Sept. 30 to Discuss Your Role in DSRIP HCA reminds Long Term Home Health CarePrograms (LTHHCPs) of our LTHHCP Forum onSeptember 30 in Albany from 10:30 a.m. to 3 p.m.,a must-attend program for all LTHHCP providers.
See STEAM p. 4
See FORUM p. 2
Non-Physician Orders Bill Picks up Steam in Congress.........................1HCA Member Call Helps Providers Wade EO 38 Dynamics.................1Sign Up For LTHHCP Forum on Sept. 30.................................................1Audit & Compliance Risks: Do You Know What to Expect?...................3HCA Comments on Proposed Changes to Flu Mandate......................6HCA, Council Send Home Health Compare Reports to Providers........7FIDA and MLTC Transition Updates.......................................................8Reminder: Upcoming Statistical Report Due Dates..............................9Register for VNAA Northeast Regional Meeting in December............9New Safety Net Awardees and Other DSRIP Updates........................10Council Weighs Regulatory Changes, Project Licenses......................11Home Care Planning a Focus during Preparedness Month................13House and Senate Pass Post-Acute Care Transformation Act............14HCA Policy Council Focuses on Technology.......................................15Duke University Conducts Population Care Coordinator Program....15CMS Issues Hospice Quality Reporting Program Update..................16NGS Update........................................................................................17Publications.................................................................................17
See CALL p. 3
HCA Member Call Helps Providers
Wade EO 38 Dynamics in Light of
Court Proceedings
Last week, HCA held a call to update memberson the latest legal and policy developments withExecutive Order (EO) 38.
As extensively covered, EO 38 places limits onexecutive compensation and administration costsfor entities, including home care and other healthcare providers, which receive state funds, directlyor indirectly.
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 19, No. 34 September 19, 2014ASAP – a publication of the Home Care Association of New York State
FORUM continued from p. 1
The state Department of Health (DOH) has confirmed that one of the Department’s top leaders in healthprogram policy will present on the Delivery System Reform Incentive Payment (DSRIP) program, specificallyin the context of LTHHCP services. Depending on schedule availability, either state Medicaid DirectorJason Helgerson or Greg Allen, Director of Program Development and Management, will present – both ofwhom are intensively involved in DSRIP planning and implementation at the state level.
If your LTHHCP hasn’t yet considered the DSRIP option, or needs more information, you will not wantto miss hearing from DOH officials on this major new initiative.
HCA will also hold a roundtable discussion to report on LTHHCP issues, updates and needs. To register, please download the flyer at the back of this week’s ASAP and send it to HCA for this programwhich is just 10 days away. Location details are below.
Statewide LTHHCP Forum
September 30, 201410:30 a.m. to 3 p.m.Holiday Inn Turf205 Wolf RoadAlbany, NY 12205
Volume 19, No. 34 September 19, 2014ASAP – a publication of the Home Care Association of New York State
3
CALL continued from p. 1
During the call, Philip Rosenberg, Partner at NixonPeabody, provided the latest on three separate EO 38court cases – filed in Suffolk, Nassau and Albanycounties. The rulings and current proceedings of eachcase are different. In response to the Nassau decision,specifically, the state has posted the following “legalnotice” that was a major point of discussion on the call:
Based upon the April 8, 2014 decision in Agenciesfor Children’s Therapy Services, Inc. v. New York StateDepartment of Health, et al. (“ACTS”), coveredproviders conducting business in Nassau Countyneed not file Executive Order 38 disclosures. Forpurposes of this notice, “conducting business” meanshaving a place of business within Nassau County,providing program services or administrative servicesinvolving the use or receipt of State funds or State-authorized payments within Nassau County, orotherwise conducting business within NassauCounty in relation to which executive compensationis paid. Please note that the ACTS decision is underappeal. Those affected by the ACTS decision shouldperiodically check the EO 38 website for updatesregarding any changes to this notice.
Regardless of the state’s interpretation here – thatdisclosure is not required for agencies serving NassauCounty – Mr. Rosenberg stressed that most agencies arenot required to submit such disclosure statements untilthe end of June 2015, at which point another courtdecision is expected, with possible new implications.
Mr. Rosenberg also highlighted some recent clarificationsfrom the state’s EO 38 Frequently Asked Questionsdocument, including treatment of: dividends anddistributions; affiliated entities; and profits. He alsopointed out some areas that require further instruction,such as the treatment of the Program of All-InclusiveCare for the Elderly (PACE) and vendors.
He advised members to download the state’s worksheetsfor determining executive compensation and fordelineating which monies/costs qualify as ‘state funds’ or‘administrative expenses.’ Please seehttp://executiveorder38.ny.gov/.
HCA thanks Mr. Rosenberg for sharing his expertiseand time on the critical issues that encompass EO 38.Since EO 38 was proposed, HCA has been actively
Audit & Compliance Risks: Do You
Know What to Expect?
Have you checked out HCA’s Corporate
Compliance Symposium yet? This must-attend program for your complianceteams is less than two weeks away, on October 1.Learn more and register now at the link below.
No other program offers you and your staff a one-day crash course on all of the major home careregulatory compliance issues and updates thatdirectly affect the clinical, administrative, andfinance operations of your agency. You’ll gain insights from major players and bignames in the field ... like Medicaid InspectorGeneral James Cox, expert consultants Mary St.Pierre and Connie Raffa. Also, new this year, HCA has invitedrepresentatives from two Department of Healthregional offices – the people who are often yourfirst point of contact on state and federalregulatory issues. OMIG protocols, F2F compliance, OIG targetareas, DOH regional surveillance activities,compliance responsibilities under managed care,top claim denial reasons, ZPICs ... CERTs ...MACs. Get clarity on all of these items. Registertoday at the link below or download the form atthe back of this week’s ASAP.
https://www.eventville.com/search/groups.asp?CoordinatorGroupId=1002199.
engaged on a number of advocacy and legal fronts.We have submitted comments on numerousproposed rule versions; met with Administrationofficials; joined the Albany legal action as a plaintiff;and provided numerous education programs.
Volume 19, No. 34 September 19, 2014ASAP – a publication of the Home Care Association of New York State
4
STEAM Continued from p. 1
Many of these practitioners already perform services under Medicare and, in some instances, can order nursinghome care and prescribe medications. Not only is this bill good for access to care and the streamlining of homecare authorizations, but one study even estimates that it would accrue significant savings to the Medicaresystem – as much as $100 million over ten years.
H.R. 2504/S.1332 is a bipartisan bill (with both Republican and Democratic sponsors in each House) and itssupport has grown to 154 House cosponsors and 24 Senate cosponsors, according to the National Associationfor Home Care and Hospice (NAHC) which is working to garner further support.
HCA has made this bill a priority of our federal advocacy efforts over the past several years, along withrebasing relief, face-to-face rule changes and other advocacy goals reported in last week’s ASAP. We thankSenator Schumer for introducing this important measure and expressing his continued support.
In an update at HCA’s Senior and Financial Managers Retreat last week, Medicare home health policy expertColin Roskey, of Alston & Bird, indicated that this is one regulatory relief provision which has a stronglikelihood of moving through Congress. HCA urges members to build on this support by reaching out to yourelected representatives. One way to do so is by sending a message through the Legislative Action Center at http://www.congressweb.com/nahcadvocacy/208. All you need to do is provide your contact information andclick ‘send’ on a pre-written advocacy message. It takes just a minute of your time.
For more information, please contact the HCA Policy staff.
Volume 19, No. 34 September 19, 2014ASAP – a publication of the Home Care Association of New York State
5
EDUCATIONUPDATE
Sponsoredinpartby:
Brochuresandregistrationinformationforeachoftheseprogramsareavailableat
www.hcanys.org/events.cfm;orusetheQRcodebelow:
CreatingYourSeatattheTableforChronicDiseaseManagement(Teleconference).Thisprogramwillhelpagenciesunderstandconceptsassociatedwithcaretransitions,stateandnationaleffortsaroundcaretransitionsandhospitalpenaltiesforreadmissions.September25
HCA’sCorporateComplianceSymposium(Albany).HCA’ssignatureCorporateComplianceSymposiumbringstogethertopexpertswhowillhelpyouunderstandtheintricaciesofstateandfederalcompliancerequirementsandknowwhattoexpectwhenitcomestoaudits,appealsandotheroversightprocesses.October1
CustomerLoyalty:AProvenStrategytoBoostYourBottomLine(Webinar).Thiswebinarisdesignedtohelpyoubetterunderstandcustomerloyalty,employeeengagementandhowtoimplementaloyaltystrategy.October14
UtilizingMaintenanceTherapyinyourAgencytoElevateClinicalPrograms(TwoPartWebinarSeries).PresenterArnieCisneroswillteachthespecificsofmaintenanceprogrammingduringthiswebinarseries,andhelpyoucreateauditproofprogramsforchronicpatients.October23andNovember6
BlueprintforOASISAccuracy– TransitiontoOASISC1(EastElmhurst)AtwodayOASISWorkshoponDataCollectionRulesandGuidanceincludingeducationonOASISC1changeswithoptionalCertificateforOASISSpecialistClinical(COSC)exam.ExamcandidateswillhavetheoptionofsittingfortheOASISCortheOASISC1examversion.October27– 28Workshop;October29Exam(Waitlistonly)
SupervisionPlus™– ASupervisoryTrainingandCertificateProgram(NewYorkCity)Thisfullday,skilldevelopment,howtodoittrainingsession,presentedbyDr.RobertFazzi,isdesignedspecificallyforsupervisors,managersanddirectorsinhomecareandhospiceagencies.Learnthemosteffectivestrategiesforsupervisingandmotivatingstaff,andthenewestsupervisoryapproachesforincreasingthemorale,teamcommitmentandretentionofvaluableemployees.November3
NortheastHomeHealthLeadershipSummit (Boston,MA)Nowinit’s13th year,thisisthepremiergatheringofhomehealthagencyleadersthroughoutthenortheast.Visitwww.nehomehealthsummit.com.January20to22.
ICD10CodingSurvivalKit(DVDSeries)ICD10iscloserthanyouthink!This10partDVDseriesenablesthelearnertobecomefamiliarwiththeICD10changesinanincrementalfashionbyfocusingon12specificchaptersoneachDVD.Ongoing
SavetheDateforTheseFutureEvents!
AreYouReadyforFIDA?(Albany)December5
HomeHealthLegalUpdates (NYC)December10
HomeCareSurvivalBootcamp (NYC)RegisterforoneorallinthefourpartseriesDecember11,January8,February12,March12
HCA’sAnnualConference2015(SaratogaSprings)May6to7followedbyaLeadershipProgramonMay8
www.hcanys.org
6
Volume 19, No. 34 September 19, 2014ASAP – a publication of the Home Care Association of New York State
HCA Comments on Proposed Changes to Flu Mandate
HCA submitted comments to the state Department of Health (DOH) on its proposed rule that would makesome technical and substantive changes to the flu mask rule. (Please also see the p. 11 article on PHHPC Committeemeetings).
The proposed rule is at http://w3.health.state.ny.us/dbspace/propregs.nsf/4ac9558781006774852569bd00512fda/4584f0ce13a394aa85257d250052c5ed?OpenDocument.
HCA’s comments are at http://www.hca-nys.org/documents/Influenzaproposedrulefinalcomments.pdf.
The proposed changes include: revisions in vaccine documentation requirements; clarifications that a mask is notrequired when personnel provide services outside of the patient’s home, is not required for those providing speechtherapy services and not required for patients who communicate through lip reading; and clarification that healthcare facilities can adopt more stringent requirements than the state’s requirements.
One change would alter the current requirement that documentation must include the name and address of theindividual who ordered or administered the vaccine and the date of vaccination. This requirement would bereplaced with language stating that “documentation must include: a document, prepared by the licensed healthcarepractitioner who administered the vaccine, indicating that one dose of influenza vaccine was administered, andspecifying the vaccine formulation and the date of administration.”
Most significantly, the rule would change documentation requirements in the case of contract staff, allowing afacility or agency to accept an attestation from the contract staff ’s employer stating that specified persons havebeen vaccinated and that the employer maintains the required documentation. This provision would provide reliefto Licensed Home Care Services Agencies (LHCSAs) and Certified Home Health Agencies (CHHAs), allowingthe LHCSA to send each CHHA a list of aides and attest to their immunization status.
In our comments, HCA states that while we still have concerns with many facets of the rule, we support theproposed changes that would:
• Revise the vaccine documentation requirements.
• Clarify that a mask is not required in certain cases (outside of the patient’s home, for speech therapyservices, and for patients who communicate through lip reading).
• Allow an attestation from contract-staff employers who would maintain the documentation.
We do, however, seek further relief from the requirement that agencies document the influenza vaccination statusof all personnel and report this data to DOH. This creates an onerous burden on home care agencies where an aidemight work for more than one agency and the subcontracted LHCSA has to supply information on each aide tomultiple contracting agencies. HCA’s comments state:
We urge that this requirement be changed to eliminate duplicative and excessive reporting. Thesubcontracting agency should only have to report once on its personnel and not have to also provide this
Volume 19, No. 34 September 19, 2014ASAP – a publication of the Home Care Association of New York State
7
same information to all of its contractors. Meanwhile, the contractor should not have to submitsimilar information on these same personnel who are employed by their subcontractors. This isduplicative and a highly inefficient use of time and resources.
We point out that the mask requirement is costly for home care agencies already affected by recent andprolonged cuts, other unfunded mandates and instability from major Medicaid redesign in this state, and weurge reimbursement to cover the direct and indirect costs of this mandate.
With regard to compliance, HCA’s comments stressed again the differences between institutional and homecare settings when it comes to the constancy of on-site supervision, and we urged DOH to recognize therealistic challenges faced by home care agencies when DOH judges agency efforts to comply with thismandate.
For more information, contact Andrew Koski at (518) 810-0662 or [email protected].
HCA, Council Send Home Health Compare Reports to ProvidersSome providers received reports without current data; Healthcare First is working on a correction
HCA, in conjunction with the Council of State Home Care Associations, this week sent our Medicare-certified provider members updated Home Health Compare reports using OASIS-C data from April 2013through March 2014.
However, Healthcare First (who generates the reports) has recently indicated to HCA that a small percentageof providers experienced discrepancies in their reports involving some data that was not updated (again,only some providers and data were impacted). Healthcare First is correcting the problem and is in theprocess of notifying all providers about this issue.
While these corrections are pending, providers will not see any July data if they try to click the report link intheir e-mail between now and when the corrected reports are available. As soon as the corrections are made,Healthcare First will generate another e-mail and link.
The reports contain individual agency dashboard data, including a comparison to outcomes of providers ineach agency’s market and a snapshot of the provider’s outcomes history. Also included is the quarterlyupdate of an individual agency’s OASIS percentile data – an agency-specific report that provides the agency’soutcome percentile in the state and nationally.
The reports are issued three or four times annually. At this time, they can only be sent to one person peragency. If you would like to change who receives the reports at your agency, please e-mail HCA’s VicePresident for Finance and Management Patrick Conole at [email protected].
8
Volume 19, No. 34 September 19, 2014ASAP – a publication of the Home Care Association of New York State
FIDA and MLTC Transition Updates
This week’s meeting of the Medicaid Managed Care Advisory Review Panel (MMCARP) included updatedinformation on New York’s Fully Integrated Duals Advantage (FIDA) plan demo and the Managed Long TermCare (MLTC) transition.
FIDA update
Here’s the latest on FIDA:
• Currently, 22 MLTC plans are going through the readiness review process to become FIDAs.
• In early November, plans will be notified if they are found ready to participate. This determination isbased on many elements such as systems, staffing, network adequacy, marketing, and training.
• Plans have signed a three-way contract with the U.S. Centers for Medicare and Medicaid Services(CMS) and the state Department of Health (DOH) which is contingent on passing the readinessreview process.
• All enrollments (opt-in and passive) will be processed through the enrollment broker, NY MedicaidChoice.
• Participants may disenroll at any time during the demonstration.
• January 1, 2015 is the effective date for individuals in Region I (New York City and Nassau) to opt intothe demonstration.
• April 1, 2015 is the effective date for individuals who are passively enrolled in Region I. Passiveenrollment for Region I will take place over five months.
• April 1, 2015 is the effective date for individuals in Region II (Westchester and Suffolk) to opt into thedemonstration.
• July 1, 2015 is the effective date for individuals who are passively enrolled in Region II.
• All FIDA-eligible duals in Region I will receive the FIDA Program Announcement Letter in December2014. All FIDA-eligible duals living in Region II will receive a letter in March 2015. This will be thefirst notification a participant receives; it marks the start of potential opt-in enrollment.
• Participants will also receive 90-day, 60-day, and 30-day passive enrollment reminder notices beforetheir scheduled date for passive enrollment.
• An independent, conflict-free entity – the Participant Ombudsman (PO) – will provide participantswith free assistance in accessing care, understanding and exercising rights and responsibilities, andappealing adverse decisions.
Continued on next page
Volume 19, No. 34 September 19, 2014ASAP – a publication of the Home Care Association of New York State
9
• FIDA plans will be required to notifyparticipants about the PO’s availabilityin enrollment materials, annual noticesof Grievance and Appeal procedures,and all written notices of denial,reduction or termination of a service.
Conflict-Free Evaluation and Enrollment Center
Last week’s ASAP included information about anew Conflict-Free Evaluation and EnrollmentCenter (CFEEC) for individuals seekingcommunity-based long term care services formore than 120 days. Under this change, NewYork’s enrollment broker, Maximus/NYMedicaid Choice, will conduct initial evaluationsusing the Uniform Assessment System (UAS)for new consumers of long term care services.Once the evaluation is completed, the consumerwill have the option of selecting a plan andreceiving enrollment assistance from Maximus.
MLTC plans will no longer be allowed to enrollnew individuals until Maximus has conductedan initial evaluation to determine eligibility.MLTC plans will have access to the Maximusassessment, but they will still be responsible forcompleting their own assessments (using theUAS) for determining the place of care.
In last week’s article, we inadvertently left outthat the transition of individuals to CFEEC inErie, Monroe and Onondaga counties will occurin March 2015.
MLTC transition
DOH indicated at this week’s MMCARPmeeting that it hopes sometime in 2015 to enrollindividuals receiving services under the NursingHome Transition and Diversion, TraumaticBrain Injury and Assisted Living Programs intoMLTC plans, dependent on approval from CMS.
For more information, contact Andrew Koski at(518) 810-0662 or [email protected].
Continued from p. 8
Registration Open for VNAA
Northeast Regional Meeting in
December
New York home care providers are invited to attendthe Visiting Nurse Associations of America(VNAA) Northeast Regional Meeting onDecember 4 to 5 in Hartford, Connecticut.
The meeting will feature informative sessions ledby VNAA senior staff and other industry expertson legislative and regulatory updates, finance andbusiness development, care transitions and bestpractices.
For further information, and to register, please visit:http://vnaa.org/calendar_day.asp?date=12/4/2014&event=146.
Reminder: Upcoming
Statistical Report Due Dates In an E-alert earlier this week, HCA remindedmembers that the 2011 Statistical Report is duetoday, September 19, for Licensed Home CareServices Agencies (LHCSAs), including LHCSAsproviding services in Assisted Living Programs(ALPs), who must submit a separate StatisticalReport for their ALP patients. We also highlighted some other reports that aredue by October 31. They include:
• The 2012 Certified Home HealthAgency/Long Term Home Health CareProgram Statistical Report
• The 2012 Hospice Cost and UtilizationReport
These reports have been activated and must besubmitted electronically via the Health CommerceSystem (HCS).
Volume 19, No. 34 September 19, 2014ASAP – a publication of the Home Care Association of New York State
10
Continued on next page
New Safety Net Awardees and Other DSRIP Updates
The following are some updates on the Delivery System Reform Incentive Payment (DSRIP) program, a majorhealth financing initiative involving $6 billion in federal dollars to fund newly created regional health networkscalled Performing Provider Systems (PPS).
Updated safety net lists DOH has posted updated lists of safety net providers based on the recent appeals process. The updated lists areat http://www.health.ny.gov/health_care/medicaid/redesign/dsrip_safety_net_definition.htm. During two appeal processes, HCA conveyed many issues and concerns to DOH, and DOH made some changesin response. HCA is part of a coalition of associations that has met with the state Medicaid Director and otherDOH officials to make recommendations for improving the safety net process. In addition, HCA assisted manymembers with the appeals application. Specifically, HCA has advocated for consideration in the appeals process of home care providers who did nothave a Medicaid provider number but served a largely Medicaid population through contracts with managed careplans and other home care entities. It seems that DOH did accept this recommendation, but HCA is seekingconfirmation. HCA stresses that a home care provider can still participate in a PPS as a Vital Access Provider (VAP) exceptionwithout safety net provider status. However, such providers are limited to receiving no more than 5 percent of aproject’s total valuation. DOH expects to soon post a form for requesting a VAP exception.
DSRIP project plan application
DOH has announced that any potential PPS must notify the Department of its intent to submit a new DSRIPProject Plan Application by October 1. Any current emerging PPS that is a DSRIP Design Grant recipient isexempt from this requirement.
The intent letter should be addressed to the State Medicaid Director at [email protected] and include the PPSname, lead entity information, lead and secondary contacts for the new emerging PPS, as well as proposedcounties of service.
The new PPS must also submit a list of network providers (the state will provide a template upon receipt of theofficial letter) and a signed attestation stating that the network providers have agreed to partner with the emergingPPS. New applicants will also be responsible for setting up the necessary Health Commerce System (HCS)accounts (a process that could potentially take over a month) to access the online network tool and Project Planapplication. Every PPS must have HCS access in order to submit its partner networks by the time the networktool closes (to perform final attribution) in mid-November.
Furthermore, if the newly emerging PPS was previously turned down for a Project Design Grant, the entity muststill submit all of the materials stated above as well as provide an explicit explanation as to how it remedied theissues stated in the initial denial. Specific guidance will be given to these applicants on a case-by-case basis.
Volume 19, No. 34 September 19, 2014ASAP – a publication of the Home Care Association of New York State
11
Continued from p. 10
More information on the DSRIP Project Plan application will be forthcoming. The current DSRIP timeline isavailable at http://www.health.ny.gov/health_care/medicaid/redesign/docs/dsrip_timeline.pdf.
Frequently Asked Questions (FAQs)
The DSRIP FAQ document has been updated and now includes the following new or updated information:
• A section titled “Project 2.d.i”• DSRIP Project Advisory Committees (PACs)• Vital Access Provider (VAP) Exception• Attribution and Valuation• Role of managed care plans
Please see http://www.health.ny.gov/health_care/medicaid/redesign/docs/dsrip_faq.pdf.
Medicaid analytics and export-import functionality
As previously reported, the Medicaid Analytics Performance Portal webpage is athttp://www.health.ny.gov/health_care/medicaid/redesign/dsrip_medicaid_analytics_performance_portal.htm.
Also, starting September 17, PPS users will be able to export their provider data to a CSV file. Likewise, PPSusers will be able to import a CSV file containing provider data. DOH will provide guidance regarding the useof this new functionality.
Webinars
Slides and an audio recording from a September 10 webinar about the role of health homes in DSRIP areavailable at: http://www.health.ny.gov/health_care/medicaid/redesign/dsrip_webinars_presentations.htm.Q&As from the webinar will be transcribed and posted at a later date.
Questions related to health homes should be submitted to: https://apps.health.ny.gov/pubdoh/health_care/medicaid/program/medicaid_health_homes/emailHealthHome.action. All other questions can be directed [email protected].
Council Weighs Changes to Flu Mask Mandate, DSRIP Regulatory Flexibility,
Project Licenses
This week, various committees of the Public Health and Health Planning Council (PHHPC) met to discuss oract on several system changes.
The Committee on Establishment and Project Review approved and forwarded the following applications to thefull PHHPC for consideration at its October 2 meeting:
1. A change in ‘controlling person’ by one Certified Home Health Agency.
Continued on next page
Volume 19, No. 34 September 19, 2014ASAP – a publication of the Home Care Association of New York State
12
2. Sixteen entities to establish Licensed HomeCare Services Agencies (LHCSAs); nineexisting LHCSAs for a change in ownership;three existing LHCSAs for a change inmembership; and one existing LHCSA for atransfer of membership interests.
During the LHCSA agenda item, Vicky Hines, COOat the University of Rochester Medical Faculty Group,raised concerns about the approval of hundreds of newLHCSAs this year and the lack of any informationabout their activities. In response, DOH agreed toprovide some data at the next committee meeting.
The committee’s materials are at http://w w w . h e a l t h . n y . g o v / f a c i l i t i e s /public_health_and_health_planning_council/meetings/2014-09-18/.
Flu mask rule discussed
The Committee on Codes, Regulations and Legislationreviewed the proposed adoption of changes to the flumask rule (see related p. 6 article on HCA’s commentsto the proposed changes). DOH reported that it hasreceived comments from a few organizations thatsupported the proposed changes – those comments citethe decreased administrative burden – and DOH saidit intends to finalize the rule as is.
DSRIP regulatory flexibility eyed
The Delivery System Reform Incentive Payment(DSRIP) Regulatory Flexibility Guidance document waspresented at this week’s meeting of PHHPC’s HealthPlanning Committee. It is available at http://w w w . h e a l t h . n y . g o v / f a c i l i t i e s /public_health_and_health_planning_council/meetings/2014-09-17/docs/flexibility_request.pdf.
This DSRIP-related regulatory flexibility was includedin the final 2014-15 state budget. It allows waiver ofregulatory requirements under DSRIP to “avoidduplication of requirements and to allow the efficientimplementation of the proposed project” and a capitalrestructuring financing program. The DSRIP
Continued from p. 11
regulatory provisions stem fromrecommendations and proposals by HCA and thehospital community regarding the need forregulatory flexibility in assuring an effective andefficient functioning of collaborative models.
The guidance document developed by DOH:identifies regulatory areas and specific regulationsfor which the state will or will not entertain waiverrequests. It also identifies agency policies that willbe waived and notes that, in some cases, waiversmay not be available due to federal rules or statestatute.
The document will be revised on an ongoing basisas Performing Provider Systems (PPS) getunderway and as the process of projectdevelopment yields greater specificity with respectto areas where regulatory waivers may be beneficialand appropriate.
Waiver requests will be included in the DSRIPProject Plan application and will requireinformation about: the regulation for which awaiver is being requested; the components of theProject Plan affected by the regulation; the reasonthe waiver is needed; and an explanation as to whythe waiver would not negatively impact patientsafety.
The following sections of the guidance documentdiscuss some of the areas that DOH will consider:
• Waivers of 10 NYCRR Part 760 to permitCertified Home Health Agencies(CHHAs) to extend their geographicservice areas within a PPS.
• Requests to extend the service areas ofLHCSAs within a PPS can be madeunder existing regulatory authority anddon’t require waivers.
• Requests for waivers of needmethodologies set forth in 10 NYCRRPart 790 (hospice). In addition, inconjunction with a PHHPC
Volume 19, No. 34 September 19, 2014ASAP – a publication of the Home Care Association of New York State
13
recommendation, DOH is already in the process of reviewing the hospice need methodology to determinewhether amendments to the regulations are necessary.
• Requests for waivers of 10 NYCRR Section 401.2(b), which provides that an operator may use anoperating certificate only for the designated site of operation. This would allow individuals with chronicillnesses to be visited at home by practitioners employed by general hospital outpatient departments anddiagnostic and treatment clinics.
• A PPS is likely to request regulatory waivers in order to facilitate its ability to carry out DSRIP projectsinvolving telemedicine and/or telehealth. (HCA will be looking into whether this can include hometelehealth.)
• Allowing physician assistants (PAs) to issue and sign home care orders for LHCSAs cannot beaccomplished through a waiver and DOH plans to pursue regulatory changes. Federal regulations donot allow nurse practitioners or physician assistants to sign medical orders for CHHAs and Long TermHome Health Care Programs (LTHHCPs). Please the related p. 1 story about Congressional efforts toprovide more latitude in the signing of orders.
• DOH cannot authorize Advanced Home Health Aides pursuant to its authority under PHL Section2807(20)(e) and (21)(e) without statutory changes. However, the recommendations of the AdvancedHome Health Aide Workgroup will be used in development of a future legislative proposal. (See lastweek’s ASAP for updates on this workgroup and the advanced aide proposal.)
HCA will be reviewing these recommended changes and providing feedback to DOH.
For more information, contact HCA Policy staff.
Home Care Emergency Preparedness a Focus during Preparedness Month
September is Emergency Preparedness Month. Home care providers are encouraged to focus on their emergencypreparedness programs, activities and patient outreach and education efforts.
Over the past week, HCA participated in three regional Health Emergency Preparedness Coalition (HEPC)meetings to gather information and provide the home care perspective. The HEPCs include state and regionalofficials, and regional health provider representatives who engage on local emergency preparedness assessment,planning, training and response activities.
HCA also met with state Department of Health (DOH) Office of Health Emergency Preparedness (OHEP)officials and association partners to plan joint activities and initiatives in emergency preparedness under abroader Federal Emergency Management Agency (FEMA) initiative. Focus areas include emergency preparednessexercises and drill planning, implementation of transportation assistance levels (see below) and more.
TALs Implementation
DOH will be implementing its Transportation Assistance Levels (TALs) initiative for home care this fall. Aspreviously reported, a recent DOH Dear Administrator Letter announced the implementation of TALs in facilitysettings. DOH this week indicated that the DAL for home care is currently in process and planned for release
Volume 19, No. 34 September 19, 2014ASAP – a publication of the Home Care Association of New York State
14
before the end of the year, along with education webinars and other programs on this initiative. HCA and partnerassociations will assist in staffing the webinars and will be providing updates as they occur.
September 24 ICS program
HCA also reminds providers of an Incident Command System training offering by the Long Island regionalcenter on September 24 at Good Samaritan Hospital on Long Island. Check the September 5 edition of ASAP foradditional details and a link to registration.
For further information, please contact Al Cardillo [email protected].
House and Senate Pass Post-Acute Care Transformation Act
Mandates Hospice surveys at least once every three years
The U.S. House and Senate have passed legislation called the “Improving Medicare Post-Acute CareTransformation Act.”
This legislation would require post-acute providers to submit standardized data on services; it would also requirethe U.S. Department of Health and Human Services (HHS) to develop new post-acute payment models.
Post-acute providers subject to these provisions include home health agencies, skilled nursing facilities, inpatientrehabilitation facilities and long-term care hospitals.
Home care providers would be required to report standardized patient assessment data by January 2019 (anearlier timetable applies for other settings). The standardized patient assessment data shall include functionalstatus, cognitive function, special services, medical condition, impairments, prior functioning levels, and any othercategories determined by the HHS Secretary. By January 1, 2017, for home health, HHS would specify additionalquality measures that post-acute providers are required to submit, addressing, at a minimum, the following qualitydomains: 1) functional status and changes in function; 2) skin integrity and changes in skin integrity; 3) medicationreconciliation; 4) incidence of major falls; and 5) patient preference regarding treatment and discharge options.
The bill, which now goes to the President for his consideration, would also mandate Hospice surveys at least onceevery three years. It would also correct a legislative drafting error preventing the implementation of AffordableCare Act (ACA) provisions related to Hospice medical reviews, allowing the U.S. Centers for Medicare andMedicaid Services to implement ACA provisions authorizing medical review of hospice providers with a highproportion of long-stay patients.
These hospice provisions were first proposed by New York Rep. Tom Reed and Senator Mike Thompson ofCalifornia under H.R. 5393. Rep. Reed has been a strong advocate for home care and hospice quality, havingworked closely with HCA on legislation – and corresponding CMS outreach – to streamline the Medicare physicianhome health face-to-face requirement, as extensively reported in past editions of ASAP.
Providers can see a more detailed summary of this legislation athttp://waysandmeans.house.gov/UploadedFiles/PAC_Section_by_Section_FINAL.pdf.
For more information, please contact a member of HCA’s Policy staff.
Volume 19, No. 34 September 19, 2014ASAP – a publication of the Home Care Association of New York State
15
HCA Policy Council Focuses on Technology
The HCA Policy Council met this week, focusing on home care technology issues and proposals.
The Council reviewed and prepared comments on several state health information databases and related regulatoryissues that are currently before the new State Health Information Technology workgroup.
This workgroup, which first met on September 11, is charged with providing recommendations on the state’shealth information infrastructure by December 1, timed for the 2015 state budget and legislative session. (Theworkgroup slides are at http://www.hca-nys.org/documents/HITWorkgroup91114Slides.pdf.)
HCA will work to ensure that the Council’s comments and recommendations – in particular the need to supportand invest in home care technology – are considered by the workgroup, which newly includes home carerepresentation under legislation advanced by HCA. HCA Board and Council members Russell Lusak, SeniorVice President of Selfhelp Community Services, and Kate Rolf, President and CEO of VNA Homecare Options,as well as HCA member Mary Ann Christopher, President and CEO of the VNS of New York, are on theworkgroup.
Other issues discussed by the Council were:
• Opportunities for hospital-home care electronic patient information exchange under “meaningful use”technology requirements for federal hospital funding.
• Chicago-based Rush University Medical Institute’s Virtual Integrated Practice model (a Rush projectdirector participated in the Council meeting).
• HCA’s plans to take up a technology development package with the state Department of Health’stechnology office in the coming weeks. HCA encourages and invites member ideas for this developingpackage.
For further information, contact Al Cardillo [email protected].
Duke University Conducts Population Care Coordinator Program
HCA presented as part of a Duke University “Population Care Coordinator Certification Program” (PCCP)last Thursday in New York City.
The program, ordinarily conducted on site at Duke, was hosted at the Visiting Nurse Service of New York. Itconsists of a multiple week online curriculum, coupled with an onsite component targeted to clinicians, particularlynurses and social workers.
The PCCP focuses on a combination of population health/intervention and patient outcome studies to inform,better integrate, and customize provider and practitioner evidence-based approaches to treatment and care.
HCA Executive Vice President Al Cardillo served on the program faculty. He examined current trends anddeveloping models in the health care system and PCCP’s very effective alignment to them.
Continued on next page
Volume 19, No. 34 September 19, 2014ASAP – a publication of the Home Care Association of New York State
16
The program appears extremely well synchronized to state and health system trends in care management,service integration, managed care, the Delivery System Reform Incentive Payment (DSRIP) program, andemphases on population health and evidence based care.
For more information on the PCCP, visit http://pccp.nursing.duke.edu/.
For further information, please contact Al Cardillo at [email protected].
CMS Issues Hospice Quality Reporting Program Update
The U.S. Centers for Medicare and Medicaid Services (CMS) earlier this year asked hospices to submit dataon two quality measures that impact the 2015 payment year. The two measures include a structural measureand the National Quality Forum (NQF) no. 0209 pain measure.
The data was collected in calendar year 2013. Approximately 3,500 hospices nationally submitted andattested to the data for both measures. In a recent analysis of this data, entitled Hospice Quality ReportingProgram Fiscal Year 2015 Reporting Cycle Data Analysis, CMS reports that:
• Nearly 100 percent of hospices answered “yes” to the only structural measure question: “Does yourQAPI program contain three or more patient-care-related quality indicators?” (This is consistentwith the prior year’s response.)
• NQF no. 0209 measures the percentage of patients who report being uncomfortable because ofpain at the initial assessment and who report that pain was brought to a comfortable level within 48hours. However, NQF no. 0209 has been removed from the Hospice Quality Reporting Program(HQRP) for fiscal year (FY) 2016 and subsequent years because an analysis of the FY 2014 reportingcycle data revealed that the measure does not easily correspond with the clinical processes for painmanagement, resulting in variances in what hospices collect, aggregate, and report. CMS also raisedquestions and concerns with the high rate of patients excluded (due to ineligibility) and the high rateof patients reporting they are not uncomfortable due to pain at the initial assessment.
• As with FY 2014, the majority of errors (2,270) for FY 2015 were due to providers having “missing”patient-level data that cannot be accounted for. Forty-one hospices (1.1 percent) had one or more errorsthat resulted in exclusion of their data from the NQF No. 0209 analysis, a slight decrease compared toFY 2014.
For additional details, see: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/Downloads/Fiscal-Year-2015-Reporting-Cycle-Data-Analysis.pdf.
For further information, contact Patrick Conole at (518) 810-0661 or [email protected].
Continued from p. 15
Volume 19, No. 34 September 19, 2014ASAP – a publication of the Home Care Association of New York State
17
NGS Update
National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), has recentlyposted the following information to its website.
• End-to-End ICD-10 Volunteer Testing Form – Providers interested in volunteering to test their end-to-end ICD-10-CM transactions should complete and submit the following online form:http://www.surveymonkey.com/s.aspx?sm=dabdcO5aI8Nn0c7zyFJtHQ%3d%3d#q1.
To help prepare for the ICD-10 transition on October 1, 2015, the U.S. Centers for Medicare andMedicaid Services (CMS) is soliciting volunteers for a first round of limited end-to-end testing withthe MACs on January 26 through January 30, 2015. Fifty participants for each MAC will be selectedfrom the volunteers and notified of their selection by October 24, 2014. Those selected will be providedspecific details about the testing process.
• New EDI Help Desk Closure Times – The NGS Electronic Data Interchange (EDI) Help Desk isopen Monday through Friday from 8 a.m. to 5 p.m. Beginning September 25, the EDI Help Desk willclose each Thursday for training from 2 to 4 p.m.
• J6: CR8877 and the New Requirements for Hospice – On September 25, from 4 to 5 p.m., NGS willconduct an open door forum on Change Request (CR) 8877 which implements new requirements forall hospice providers, including timely filing of the Notice of Election (NOE) and discharges. Registerat https://www1.gotomeeting.com/register/274361528.
• PECOS FAQs – CMS has recently released an updated fact sheet on the Provider Enrollment, Chainand Ownership System (PECOS). It includes information on enrollment applications, applicationfees, revalidations, and much more. It can be downloaded at: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Internet-Based-PECOS-FAQs-Fact-Sheet-ICN909015.pdf.
For further information, contact Patrick Conole at (518) 810-0661 or [email protected].
Publications
• “Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life(2014),” by the Institute of Medicinehttp://books.nap.edu/openbook.php?record_id=18748
• “An Examination of New York State’s Integrated Primary and Mental Health Care Services for Adultswith Serious Mental Illness,” by the NYS Health Foundationhttp://nyshealthfoundation.org/uploads/resources/integrated-primary-care-mental-health-services-rand-sept-2014.pdf
For more information, contact Andrew Koski at (518) 810-0662 or [email protected].
Cancellation Policy: Cancellations received bySeptember 27 will receive a full refund, less 25% oftotal due as an administrative fee. Cancellationsreceived on September 27 or later will forfeit theirregistration fee, along with those who register anddo not attend. Substitutions are permitted. Pleasecontact Teresa Brown at (518) 426-8764 [email protected] to cancel.
STATEWIDELTHHCP FORUM
Tuesday, September 3010:30am-3:00pm
Location
Holiday Inn – Turf205 Wolf Road
Albany, NY 12205
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 this session to cover the costs of meeting material and lunch.
The Forum provides LTHHCP representatives, state policymakers, other invited guest speakers and HCA staff the opportunity to discuss the salient issues affecting the LTHHCP at the local, state and federal levels, as well as the program’s priority advocacy needs.
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)
The agenda is planned in a roundtable-type format, with LTHHCP participants invited to report on issues, updates and needs, followed by discussion with State Department of Health home care and managed long term care officials, discussion on DSRIP participation and opportunities, and policy, program and strategic discussion with HCA.
Corporate Compliance Symposium
Albany Hilton, State & Lodge Streets, Albany, NY
New boundaries in the expansion of Managed care, the dizzying intersection of federal and state home care program requirements, and ever‐aggressive government audit regimens all require providers and plans to double down on their internal compliance strategies. This is especially important in today’s increasingly dynamic regulatory landscape where the rules, expectations and tactics are constantly changing.
To give you a strong foothold in this fluid environment, HCA’s signature Corporate Compliance Symposium is bringing together top experts who will help you understand the intricacies of state and federal compliance requirements and know what to expect when it comes to audits, appeals and other oversight processes.
An effective compliance strategy is tied directly with the quality management and fiscal predictability of your organization. Make sure that your compliance and executive leadership teams get the latest information for a successful compliance strategy at HCA’s Corporate Compliance Symposium.
October 1, 2014
Prepare your compliance ‘watch’ areas using the latest information from government auditors and industry compliance experts
October 1
9:00am to 9:30amWelcome and HCA Compliance Update
9:30am to 10:30amUpdate from New York State’s Medicaid Inspector GeneralJames Cox, NYS Medicaid Inspector General
New York’s Medicaid audit chief will discuss the state’s audit activities and compliance expectations specifically in the managed care context, where managed care plans and home care providers work jointly to serve the Medicaid population. Mr. Cox will share his office’s interpretations, strategy and expectations for the future.
10:45am to NoonCompliance, Audit & Guidance for the New Home Care‐Managed Care Program StructureTom Meyer, First Deputy Medicaid Inspector General, New York State Office of the Medicaid Inspector General
This session will present the latest information on state guidance, protocols and developments related to audit, compliance and verification initiatives of the State Office of Medicaid Inspector General. Thomas Meyer, who leads the OMIG audit division, will address these issues for home care “proper” as well as for the new managed care‐home care program structure. Importantly, this session will include invaluable opportunity for conference participants and OMIG to dialogue on experiences, concerns, questions and insights related to the audit/compliance process overall, as well as in the context of the many co‐occurring, significant system and payment changes.
Noon to 12:45pmLunch
12:45pm to 1:45pmFederal Audits: The Contractors, Targets and DenialsMary St. Pierre, BSN, MGA, Home Health Consultant
The roles, responsibilities and methodologies of federal Medicare claims auditors can be overwhelming. Federal auditors contracted by the U.S. Centers for Medicare and Medicaid Services (CMS) include MACs, ZPICs (formerly PSCs), SMRCs, CERTs, and RACs. Each is charged with specific tasks. This program will provide an overview of the focus andmethodologies of the various CMS contractors and their primary targets in conducting home health audits. The program will also offer an overview of the major reasons for claim denials and guidance on how to avoid them.
Program Agenda
October 1
1:45pm to 3:00pmPerspectives from Regional DOH SurveillanceRussell J. Grogan, RN, Program Manager, Home and Community Based Services – Central NY Region DOH, Office of Health Systems Management
Rita Cedar, RN, Program Manager, Home and Community Based Services – Capital District Region DOH, Office of Health Systems Management
Regional DOH Office program representatives are primary points of provider contact on licensure/certification, regulatory, surveillance and compliance issues. Their roles, perspectives and involvement with the local home care system, and ultimately the local continuum, are a vital part of the regulatory and guidance process. Hear from and engage with DOH regional office representatives on perspectives and further guidance opportunities – especially critical in this time of evolving policy and system change.
3:00pm to 4:00pmFederal and NYS Targeted Risk Areas for Home Health Agencies and Compliance StrategiesConnie A. Raffa, JD, LLM, Partner, Arent Fox LLP
Each year, federal and state auditors revise their audit focus areas, providing a set of parameters which organizations should be especially attuned to in their risk management efforts. The Office of the Inspector General (OIG) is constantly changing this roadmap, adding to or updating the risk areas identified. This session will lead you through the intricacies of the 31 risk areas currently identified in OIG’s work plan as well as OIG Advisory Opinions and other resources that should all be included in your compliance “watch list” as you build and enhance your internal controls. Attendees will also learn about the status of emerging regulatory issues such as the face‐to‐face and therapy rules, problem marketing practices and OMIG audit protocols. Learn how to identify the problems, devise solutions and prevent problems from happening again in this vital roadmap for your organization.
4:00pm Adjournment
Program Agenda
Thanks to our Sponsors:
Please visit our Exhibitor:
Corporate Compliance SymposiumOctober 1, 2014REGISTRATION FORM
The registration fee of $219 for HCA members includes expert speakers and handout materials, plus food and beverage as noted. Potential members are also welcome at the rate of $299 per person.
REGISTRANT INFORMATION – Please register by September 26.
Name: _____________________________________________________________________________
Title:_______________________________________________________________________________
Agency:____________________________________________________________________________
Address:____________________________________________________________________________
City/State/Zip:_______________________________________________________________________
Phone:________________________________ Ext._________ Fax: ____________________________
Email: ______________________________________________________________________________(Required)
PAYMENT ‐ Please check method of payment:
________ Check* _________MasterCard ________VISA _______ American Express
*Make checks payable to: HCA Education and Research and mail to 388 Broadway, 4th Floor, Albany, NY 12207. Checks must be received by September 26.
__________________________________________________________________________________Card Number
_______________________________________ ______________________________________Expiration Date Security Code
__________________________________________________________________________________Mailing Address of Card Holder
__________________________________________________________________________________City, State, Zip
__________________________________________________________________________________Name on Card
__________________________________________________________________________________Authorized Signature
HCA REGISTRATION FEE
____ Member Fee $219
____ Non‐Member Fee $299
HCA Cancellation Policy
HCA registration cancellations received by September 19 are refundable less a 25% administrative fee. No refunds will be issued after this date.
Cancellations must be received in writing via e‐mail to: [email protected]. Substitutions are permitted.
Special NeedsIn accordance with the Americans with Disabilities Act, or special dietary needs, please let us know how we can accommodate you:______________________________________________________________________________________________________________________________________________________________________
Register on‐line at www.eventville.com/hcanys
FAX THIS FORM TO: 518‐426‐8788
LOCATIONAlbany Hilton
State & Lodge Streets Albany, NY
(518) 462-6611