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Legislative Issues Public Policy News
A Weekly Publication Of HCAHCAHCAHCAHCAHome Care Association of New York State
Helping New YorkersFeel RightAt Home
ASAPVolume 21, No. 8 February 26, 2016
See SUMMIT p. 4
As HCA Presses Budget Asks, Members Must Provide
Groundswell of Advocacy – Now and Over Next Two Weeks
The Legislature is working on state budget language for the next phase of the negotiations. It’s officiallycrunch time.
HCA continues to meet with key legislative staff and committees to present our budget proposals andurge their inclusion in the Assembly and Senate bills, including several meetings we held this week.
Our priority focus is on the minimum wage proposal and the imperative for full funding of home care ifthe Governor’s (or any other such) proposal is adopted. We have provided the evidence and believe we
All Your Home Care Reimbursement, Payment & Bench-marking Needs
Answered at HCA’s March 9 Summit
HCA’s Senior Financial Managers Summit on March 9 in Albany (less than two weeks away!) will provideall the answers you need on all things home care finance.
The timing and location of this program are designed purposely for the involvement of state reimbursementofficials and others who will be on hand to give you the latest updates related to the state budget and othervital finance issues. Nowhere else will your finance teams get such breadth of information – all at one time and in one place – for
a modest fee. This program is open to HCA members only; so be sure to take
advantage of this important member benefit.
Members Must Provide Groundswell of Budget Advocacy.....1All Your Home Care Finance Needs Answered at March 9 Summit...1Member Hiring Announcement......................................................4HCA Visits Congress for Medicare, Medicaid Home Care Advocacy...5HCA Presses for Priority Release of FLSA Funding............................7QIVAPP Desk Audits Continuing Until March 17...............................8New Bootcamp Program on Leadership Essentials for LHCSAs....8‘Vote Home Care’ at HCA Annual Conference: May 4-6....................9State Outlines TALs Requirement, More Webinars on 3/11............9Award Nominations Due 3/ 8 for HCA Annual Conference ............10DOH Outlines Financial, Compliance Monitoring of Managed Care.......11Quality of Patient Care Star Ratings Panel Being Convened.........12CMS Proposed Rule to Strengthen Provider Enrollment Process...13Funding for Chronic Disease Self-Management, Falls Prevention...14CMS Publishes Medicare FFS Utilization Data Tool.......................14ONC Examples of Permitted Health Info Exchange under HIPPA...15Update on NHTD/TBI Waiver Transition Workgroup.....................15Publications................................................................................16
Inside Inside Inside Inside Inside ASAPASAPASAPASAPASAP
See GROUNDSWELL p. 2
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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. 8 February 26, 2016
GROUNDSWELL from p. 1
are achieving recognition that, across all sectors,home care would be most impacted and in needof full support for wage funding.
We have also focused heavily on the need forbasic investments in critical areas of the homecare and MLTC system. These include premiumand rate payment adequacy for providers andplans, and for investment in essentialinfrastructure and optimization of home care’srole and capacity. Our proposals call forinvestment appropriations, reimbursement fixesand program support, accompanied by demandsthat the state commit to full, timely, and directfunds for any minimum wage proposal thatwould be included in the budget, now estimatedat a $2.19 billion impact for home care (at fullimplementation of a $15-per-hour wage floor).
HCA’s proposed Article VII language alsoaddresses labor costs holistically: by requiringstate reimbursement levels to match mandatedcosts, whether it’s Wage Parity, the Fair LaborStandards Act overtime increases, a higher
minimum wage, workers compensation or other suchexpenses.
What You Need to Do
These efforts all coincide with other groups andorganizations making similar requests for investmentin health care and other sectors, as the Senate andAssembly work to print their one-house budget billsby the week of March 11. It is expected that theLegislature will aim to pass these bills during theweek of March 14. With all this activity, we need members to continue
ramping up their grassroots advocacy with the
Legislature to make sure that HCA’s budget asks areincluded in the one-house budget bills.
Earlier this week, we e-mailed and texted somemembers to take action using our Legislative ActionCenter. The response was swift, but it needs to be far
bigger! At ASAP press time, approximately 440 e-mail messages and phone calls were made to theLegislature … but you must keep them coming. Withthousands of people employed at HCA memberagencies, your connections to the Legislature must
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Volume 21, No. 8 February 26, 2016
approach this full potential for many hundredmore contacts. If you haven’t done so, please send a message toyour legislator by clicking http://p2a.co/cEX2Twq. Once there, select the envelope icon,enter your contact information and hit “send.” Allof your staff should be doing the same, since it isquick and easy, but we also need home careleaders to do more. Our Legislative Action Center has an option forcalling your legislators directly. You don’t need tolook up a phone number. You just need to open alink on your smartphone (http://p2a.co/cEX2Twq), select the phone icon, and enter yourcontact information.
You will then receive a call with pre-recordedinstructions from HCA’s CommunicationsDirector, Roger Noyes, patching you through toyour lawmaker’s office. You can also call theSenate and Assembly directly at the followswitchboard numbers: Senate (518-455-2800)and Assembly (518-455-4100).
For members who have already used ourLegislative Action Center, HCA has sent follow-uptext messages and will continue to do so until weare assured of a strong advocacy response insupport of our budget asks.
Some talking points are in the sidebar (at right).Please familiarize yourself with the messaging andget ready to send messages and make calls nextweek.
HCA will send you further instructions as newdevelopments arise.
Monday’s Conference Call
Meanwhile, if you need more coaching orinformation, we are also holding a specialconference call on Monday, February 29, at 2 p.m.This call will include the latest HCA estimates ofthe wage impact and other developments with thebudget, including a detailed description of ourproposals. If you want the dial-in information,please e-mail Billi Hoen at [email protected].
Budget Talking Points
When you call your legislator’s office, please ask tospeak to the legislator or a member of his or her staffinvolved in budget or health care matters. Sometalking points are below.
• I am a provider of home care in your district andam calling for your support during the budgetprocess.
• Home care desperately needs investment andreimbursement fixes to stay viable and to continueto provide services to the frail-elderly and disabledresidents of your community.
• Two-thirds of certified home health agencies areoperating in the red. Half of all home careproviders are borrowing money to stay afloat.
• On top of this, the Governor’s $15 wage mandatewill be catastrophic for home care without fullfunding.
• While laudable in its goal, this wage proposalalone would impose $2.19 billion in new costs onhome care.
• The Home Care Association of New York State(HCA) is urging that the Legislature andGovernor fully fund any minimum wage increasethat may be adopted. In addition, HCA hasprovided specific budget language to ensure thathome care’s reimbursement covers the cost of careand keeps with past pledges to cover mandates forstate-imposed labor expenses and programservices.
• These proposals also support home care’sparticipation in DSRIP, Value-Based Paymentsand other models developed by the state.
• These necessary funds and investments, however,must be joined by a commitment to cover theGovernor’s $2.19 billion wage mandate if thismandate is included as part of the budget.
• Please encourage your legislative colleagues tosupport home care in this year’s budget and adoptthe proposals advanced by the Home CareAssociation of New York State.
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Volume 21, No. 8 February 26, 2016
We know there are countless finance issues creating anxiety or confusion, and this session will provideanswers, whether you are a LHCSA, CHHA, LTHHCP or MLTC.
This includes answers about the status of:
• Quality Incentive/Vital Access Provider Pool (QIVAPP) funds and the state’s attempts to fundFair Labor Standards Act costs (for overtime, travel and other expenses).
• The state budget process, including HCA’s calculations and strategy for the $2.19 billion proposedminimum wage mandate as well as our investment requests for billing, coverage and infrastructuresupport across the entire continuum of home care.
• Reimbursement and premium rates under fee-for-service, the Episodic Payment System (EPS) and MLTC.
• A new analysis of Medicare post-acute payment trends and bench-marking data for the MedicareHome Health Prospective Payment System and EPS.
• Federal reimbursement updates; DSRIP; Value Based Payments; and more. Every item on this agenda touches your agency’s financial operation and its participation in the state’s
health care system, very directly or indirectly. We strongly urge all home care providers to send theirfinance staff to this important, must-attend session. Please make sure that your CFOs and senior financeteams see this important announcement.
HCA’s Senior Financial Managers Summit
March 9, 20169 a.m. to 3:15 p.m.AlbanyDownload the registration form at http://hca-nys.org/wp-content/uploads/2016/01/2016CFOForum.pdf.
Job Position: Director of Patient Services (Montefiore Home Health Agency)
The Director is responsible for directing, planning, coordinating and evaluating patient care services, providingsupervision of professional staff, and recruiting/hiring an adequate number of professional staff to ensure quality. TheDirector will evaluate the performance of Patient Service Managers and support staff supervisors at stated intervals. TheDirector will participate in administration of the annual budget and personnel policies. The ideal candidate will manageall clinical functions.
Required Qualifications: Current NYS RN License and Registration; Master’s in Nursing or Health Related Field; five years ofsenior and direct management experience within a CHHA. Additional Qualifications: Knowledge of clinical documentationprotocols, home health regulations and standards; skill in training, working with building high performance teams;ability to develop and lead strategic plans; strong written and verbal communication skills.
Please send résumé & cover letter to [email protected] with “Director of Patient Services” and your name in the subjectline. Résumés without cover letters and applicants who do not meet requirements won’t be accepted. No phone calls, please.
MMC is an equal opportunity employer and will not discriminate against any employee or applicant for employment becauseof race, color, religion, gender, sexual orientation, or national origin.
HIRING
SUMMIT from p. 1
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HCA’s Federal Advocacy Aims to Prevent Cuts and Copays, Secure F2F Relief,
Protect Medicaid and Raise the Profile of New York’s Home Care Providers
This week, HCA President Joanne Cunningham and Director of Public Policy Alex Blais visitedWashington to participate in advocacy activities with numerous state home care associations to raise theprofile of the home care community’s concerns in New York State and the nation. The advocacy activitiesincluded the following.
New York Congressional Delegation Meetings
HCA Public Policy Director Alex Blais and HCA’sWashington-based contract lobbyist, Brett
Heimov of En-vision Strategies, met with the NYDelegation Offices ofRepresentatives Peter King (R-2), Nita Lowey (D-17), JoeCrowley (D-14) and ChrisCollins (R-27) to press forstrong opposition againstMedicare home healthcopayments for Medicarebeneficiaries.
The New York Congressional Delegation hastraditionally been strong supporters of HCA andsteadfastly opposed to home health beneficiarycopayments. In addition, HCA discussed theprecarious financial condition of New York’s homecare community, presenting the findings of HCA’s2016 financial condition report, which indicatesthat two-thirds of New York’s agencies areoperating in the red, with reimbursement notmeeting the costs of providing care to patients.
In addition, HCA discussed the continuedproblems with the Medicare face-to-faceregulation, providing information about theenormous difficulty and financial burden ofcompliance.
National Meeting on Bring the Vote Home
HCA staff also participated in a national meetingof numerous state home care associations that areparticipating in an initiative which we are soonintroducing more formally to the HCAMembership called Bring the Vote Home New York(BTVH).
HCA discussed this initiative with HCA membersduring our regional Meet-ups this past fall andreceived strong encouragement from the membershipregarding their participation. BTVH was firstpromoted by a national home health advocacy
organization called the Partnershipfor Quality Home Health Care. Itis now being launched by numerousstate associations along with HCA.It aims to assist home care agencycaregivers in facilitating theparticipation of their patients andfamilies in the elections process byregistering to vote and voting byabsentee ballot.
HCA will be conducting a full launch of the BTVH-NY program, which HCA has tailored to meet theneeds of New York’s home care community. Expect tolearn more about this initiative in the spring and atthe HCA Annual Membership Conference on May4-6, 2016. We have already launched a website forthis campaign with a video that you can show yourstaff at http://www.bringthevotehomeny.org/.
National Meeting of the Partnership for MedicaidHome Based Care
HCA also was asked to participate in a nationalboard meeting of the Partnership for MedicaidHome Based Care, a group of organizations andnationally-based agencies that have come together toadvocate for a coordinated national strategy toimprove the Medicaid home based care programs,educate lawmakers about the importance ofMedicaid, and develop education programs andstrategies to enhance home-based Medicaidprograms.
For more information about our federal advocacyefforts, please contact Alex Blais at [email protected].
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HCA Presses for Priority Release of FLSA Funding on All Home Care Aide
Hours
This week, HCA continued our vigorous efforts to get the state Department of Health (DOH) to releaseappropriate and timely funding to home care providers for new costs under the Fair Labor Standards Act(FLSA). These funds are for the period of October 1, 2015 through March 31, 2016. These efforts havecommanded significant, dedicated policy staff time aimed at ensuring a workable process that meetsproviders’ cost obligations.
To push the issue further, HCA scheduled a recent meeting with DOH and other associations where wecalled for a pass-through of funds from managed care plans to their contracted home care providers basedon all home care aide hours.
This approach, we argued, would be similar to the way that DOH distributed the funds under Medicaidfee-for-service home care. It would also align with DOH’s written instructions and conversations about thefund distribution.
We stressed that this call for funding of all home care aide hours would ensure an uncomplicated andworkable process for both plans and providers. It would also address the inherent difficulty providers havefaced when it comes to documenting their FLSA costs per plan while recognizing the multitude of newexpenses (travel, overtime, recordkeeping, recruitment of new aides, staff training, and payroll changes,etc.) incurred by home care agencies.
For payments after March 31, DOH could construct a distribution process based on the results of a surveythat DOH is developing with the associations, as long as this survey appropriately captures the costsincurred by home care providers. This week, HCA forwarded comments to DOH on the most recent draftversion of the survey after obtaining feedback from members.
HCA has already sent about twenty questions to DOH about the FLSA funding for inclusion in DOH’ssoon-to-be released Questions and Answers (Q&As) document. Just today, we received a draft of theQ&As and will be providing immediate input to DOH.
HCA has told the Department that its guidance (in the Q&A or elsewhere) must clearly explain thedistribution process – from the state to managed care plans and then to CHHAs and LHCSAs. It alsomust cover the attestation process, allowable uses of funds by providers, and other issues.
HCA will be reviewing the draft Q&As closely to ensure that it is not only consistent with past promisesand assurances regarding the distribution of funds but also to further press language recommendationsthat ensure providers are paid timely, proportionately, without undue burdensome documentationrequirements, and commensurate with all of their FLSA-related costs.
HCA will keep members informed on any new developments on the funding distribution.
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QIVAPP Desk Audits Continuing Until March 17
Today is the deadline for home care providers who were contacted by IPRO, the state’s contractor, to senddocumentation regarding their eligibility for the Quality Incentive Vital Access Provider Pool (QIVAPP)program.
The requested information included documentation that 30 percent of the total workforce is enrolled in thehome care agency’s health benefits plan. When this criteria was first announced, HCA objected stronglybecause there are sound reasons why aides may have declined health benefits, including having health coveragefrom a spouse or Medicaid or making a decision to opt for a higher wage rate (without health insurance).
According to a state Department of Health (DOH) letter, IPRO’s desk audits should be completed by March17.
HCA has been assisting members with their responses to the multiple requests by IPRO for documentation.HCA has also been pressing the state to complete the desk audit process timely so that agencies can obtaintheir long-overdue QIVAPP monies.
For more information, contact Andrew Koski at (518) 810-0662 or [email protected].
New Bootcamp Program on Leadership Essentials for LHCSAsSeparate policy-focused LHCSA Forum also coming up on March 29 As part of HCA’s education for LHCSA members, we are excited to announce a new April 12 (9:30 a.m. to 12:30p.m.) program on Leadership Essentials for LHCSAs in the Changing Health Care Environment in New YorkCity. This program is part of our popular home care Bootcamp series, so please register soon to get a seat. As members know, the U.S. Centers for Medicare and Medicaid Services (CMS) has initiated Medicare valuebased reimbursement, and New York State is committed to value based payments for Medicaid. LHCSAshave a rich history of providing vital care, but fast-changing regulations and standards create new challengesin this landscape. This three-hour program, presented by Trish Tulloch of RBC Limited, is designed to identify, detail and refinethe knowledge and skill set required for the clinical leadership of LHCSAs and to show how your peers areadapting practices to meet this challenge. The program is targeted to agency clinical leadership, including Directors of Patient Services; Supervisors;Quality Managers; and Educators that support clinical staff providing care. To learn more, download the registration form at http://hca-nys.org/wp-content/uploads/2016/02/April12SurvivalBootcampLeadershipforLHCSAs.pdf and make sure your LHCSA staff are aware of thisimportant opportunity for clinical leadership education. Forum for Downstate LHCSA leaders
Please also note that HCA is holding our Downstate LHCSA Forum on March 29 in New York City, whichis more policy focused and includes a range of HCA updates for our downstate LHCSA members on: fiscal
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issues such as the budget, the Governor’s minimum wage proposal, Fair Labor Standards Act (FLSA) andQuality Inventive/Vital Access Provider Pool (QIVAPP) adjustments, regulatory updates, and programdevelopments. Registration for this Forum is at http://hca-nys.org/wp-content/uploads/2016/02/HCADownstateLHCSAForumMarch292016Registration.pdf.
Save The Date to ‘Vote Home Care’ at HCA Annual Conference: May 4-6
HCA’s 2016 Annual Conference is coming up soon in scenic Saratoga Springs.
It’s an energetic election year, so we’ve decided to use that theme for our Annual Conference, as we all ”Vote
Home Care!”
Earlier this week, HCA sent you the first ballot opportunity: a chance to elect your staff or a colleague toreceive one of our Annual Awards, which will be presented at the Conference. Learn more athttp://hca-nys.org/wp-content/uploads/2016/02/Award-Nomination-Form-2016.pdf.
We have a lot of fun, informative events and sessions planned, so be on the lookout for conference registrationinformation soon on our conference website at www.hcaannualconference.com.
We are also updating the sponsor and exhibitor information at this link, but there’s still time to support ourconference and education programming throughout the year as a sponsor or exhibitor.
If you are interested in these great opportunities at the HCA Annual Conference or other events, pleasedownload our Marketing Prospectus on the conference website or contact Billi Hoen at [email protected].
We look forward to seeing you on May 4-6 in Saratoga! Stay tuned for more information soon.
State Outlines Transportation Assistance Level Requirement, With Two More
Sessions on March 11
On Thursday, the state held its first WebEx guidance sessions for home care agencies and hospices onimplementation of the Transportation Assistance Levels (TALs) initiative in home care. If you missed theprogram, the state is holding two other sessions on March 11 at 10:30 a.m. and 2 p.m. TALs aim to assist with evacuation transport needs for vulnerable individuals preparatory to an emergency.TALs, already in effect for other sectors, are coming soon for home care. Documentation and reportingof TALs must be communicated to the state Department of Health (DOH) during an emergency eventby means of the HERDS Home Care Emergency Response Survey on the Health Commerce System(HCS). Information for the March 11 sessions is in the flyer at http://hca-nys.org/wp-content/uploads/2016/02/61e8afb2-9a73-45ef-8305-87f722e915cb.pdf.
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During the February 25 session this past week, DOHreviewed the final TAL 1, 2 and 3 designations. Homecare and hospice providers will be required to implementTALs likely beginning in June 2016.
A forthcoming Dear Administrator Letter (DAL) willprovide the final implementation date, at which timeCHHAs, LHCSAs, LTHHCPs and hospices mustmaintain a current TAL status for each patient on roster.TALs should be reassessed with any changes in patientstatus. The Department emphasized that TALs are for useonly in planned evacuations not for events such as a fire.
The HERDS Home Care Emergency Response Surveywill be deployed in emergencies of large scope 96 hoursbefore the anticipated event. The survey contains fourcomponents:
• Agency Form: this needs to be completed once atthe onset of the emergency.
• Capacity Form: this is completed at the onset andone or more times daily throughout the event.
• Evacuation Form: this form denotes if the patientis the sole responsibility of the reporting agency orif the patient is the shared responsibility withanother provider for the purposes of avoidingduplicate patient data.
• Repatriation Form: indicates when a patient isreturned to temporary or permanent housing.
There will be a mandatory emergency response drill inspring 2016. Details will be provided in an upcomingDAL. Providers can find a HERDS Quick ReferenceCard and other related guidance documents on the HCS.
HCA encourages all home care staff involved inemergency preparedness or planning activities toparticipate in one of the March 11 sessions, especiallythose staff normally responsible for emergencypreparedness reporting activities like those describedabove for the new TALs initiative.
Continued from previous page
Award Nominations Due
March 8 for HCA Annual
Conference Ceremony
HCA’s Annual Conference is comingup on May 4 to 6. As part of thisprogram, HCA presents our annualawards to staff of HCA’s home caremembers, and we’re ready to receive
your nominations. We are offering three award categories,similar to past years: our Ruth F.Wilson Award, our Caring Award andour Advocacy Award. The categoriesand criteria are spelled out in thenomination form at http://hca-nys.org/wp-content/uploads/2016/02/Award-Nomination-Form-2016.pdf. You can use this form to sendus your nominations by March 8. Youcan also enter your nominations usingan online survey form, also by March 8,at https://www.surveymonkey.com/r/2016HCAAwards. This is a great way to recognize yourstaff, with the possibility of mediacoverage through HCA’scommunications department. Theawards ceremony is a featured event ofour annual conference: one of the mosttouching reflections on the great workyour staff does each day to care forpatients, to advocate on behalf of homecare, and to lead New York’s home caresystem at the provider level.
Please nominate one of your staff or acolleague today and be ready to join thecelebration at our Annual Conference.
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DOH Outlines Financial, Compliance Monitoring Processes for Managed Care
At this week’s meeting of the Medicaid Managed Care Advisory Review Panel (MMCARP), the stateDepartment of Health (DOH) provided information on the challenged financial condition of some MLTCsand other managed care plans. It also summarized the state’s financial and compliance monitoring processesfor such plans.
DOH reported that:
• Two MLTC plans were financially insolvent as of September 30, 2015. The plans were issuedstatements of deficiency (SODs) and placed on monthly financial reporting.
• One MLTC plan was financially impaired and was issued an SOD. The plan’s parent organizationmade a capital infusion to cure the impairment.
• Four plans had net worth deficiencies.
• Two plans were identified for closer monitoring due to a deteriorating net worth.
• Five plans reported a quick ratio below $1.00 (explained on next page) and were flagged for potentialliquidity issues.
DOH said that it is working with these plans to address their financial concerns and ensure that sufficientresources exist to pay providers.
These findings, along with HCA’s recent financial condition report, demonstrate the importance of rate andpayment adequacy for MLTCs as well as home care providers, a major component of our budget advocacyasks. As our own report shows, 63 percent of MLTC plans had negative premium incomes in 2014 (up from57 percent in 2013 and 42 percent in 2012).
In response to a request by one MMCARP member, DOH said that it could not provide the name of anyplans that are facing financial difficulties. In the past, HCA has advocated that the state create somemechanism to address unpaid claims from home care providers for services provided to managed care plansthat become insolvent.
Legislation (S.6667, Valesky/A.9311, Gottfried) has been proposed to establish a Health InsuranceGuaranty Fund to protect consumers and providers from the financial failure of a health insurer. HCAbelieves that this would cover the insolvency of a managed care plan and is reviewing the legislation.
How the Financial and Compliance Monitoring Processes Work
DOH further explained the financial and compliance monitoring process at the panel meeting.
According to DOH, all MLTC plan cost reports are reviewed both quarterly and annually for solvency andcompliance with statutory reserve requirements for minimum net worth requirements and contingent reserverequirements.
Plans that are deemed financially impaired or insolvent are issued an SOD and required to: 1) develop a planof corrective action to cure the impairment or insolvency and submit it to DOH for review and approval; and
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2) submit monthly financial statements to enable the Department to monitor plan financial performancefor at least one year post restoration.
Additional metrics are reviewed to determine potential financial distress. This includes calculating eachplan’s “Quick Ratio” – measured in terms of the value of the plan’s assets to cover its liabilities – to ascertainits liquidity and ability to meet current liabilities.
DOH also computes a plan’s “net worth,” the plan’s net worth in excess of minimum net worthrequirements, to determine the potential for the plan’s distress. DOH flags any plan whose percent ofexcess net worth over the minimum net worth required is 10 percent or less.
In addition, DOH assesses a plan’s access to additional capital if needed. DOH looks at each plan’scorporate affiliation (system-based, provider-sponsored or independent) to determine potential capitalresources.
Compliance monitoring of Medicaid Managed Care Plans
DOH also issues SODs for violations of statutes and/or regulations and statements of findings (SOFs)for plan non-compliance with Medicaid contract provisions.
SODs or SOFs are identified in routine surveys; ad hoc state surveys; comprehensive operational reviews;routine/ongoing monitoring activities; or other reviews. Plans are required to submit plans of correction(POCs) that describe: the activities the plan will take to resolve the deficiency/finding and ensure futurecompliance; time frames for implementing the POC activities; and the plans’ staff responsible forimplementing the POC as well as monitoring of ongoing compliance.
POCs must be submitted within 15 days of an SOD/SOF. POCs submitted for a deficiency and/orfinding are reviewed by the state staff responsible for issuing the SOD/SOF. Staff may consult with otherstaff/subject matter experts prior to determining if the POC is acceptable or unacceptable.
When a POC is deemed unacceptable, a written determination and reasons are transmitted to the managedcare plan; the plan must revise and resubmit the POC until an acceptable POC is received by theDepartment: within ten days for a first revision, five days for a second revision and immediately for anysubsequent revisions.
When a POC is deemed acceptable, written notice is provided to the managed care plan.
Quality of Patient Care Star Ratings Panel Being Convened
Abt Associates, under a contract with the U.S. Centers for Medicare and Medicaid Services (CMS), isseeking individuals to join a panel of stakeholders and experts for input on the Quality of Patient CareStar Ratings that appear on the Home Health Compare website.
A technical expert panel is being convened to review the first year of data on the performance of the Qualityof Patient Care Star Ratings, and to gather feedback on potential refinements to the rating system,
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including usability of the system for patients and advocates. The panel nomination period opens on February24, 2016 and closes on March 18, 2016.
Technical Expert Panel Time Commitment
The time commitment for the panel is expected to include: 1) an in-person meeting lasting approximately twodays on May 2 to 3, 2016 in the Baltimore area; 2) time to review materials prior to the meeting; and 3) up totwo post-meeting teleconferences. Travel expenses will be reimbursed by Abt Associates.
For more information, visit https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/TechnicalExpertPanels.html#29.
If you wish to nominate yourself or other individuals for the panel, please e-mail materials [email protected] by the closing date March 18, 2016.
CMS Issues Proposed Rule to Strengthen Provider Enrollment Process
The U.S. Centers for Medicare and Medicaid Services (CMS) this week issued a proposed rule with newprovider enrollment provisions of the Affordable Care Act (ACA). According to CMS, this rule seeks toassure that entities and individuals who pose risks to the Medicare program and beneficiaries are kept out of orremoved from Medicare for extended periods.
CMS’s proposed rule, entitled “Program Integrity Provider Enrollment Process (CMS-6058-P),” can becurrently viewed at: https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-04312.pdf. It willbe posted to the Federal Register on March 1 at: http://federalregister.gov/a/2016-04312.
CMS believes that these program integrity enhancements, if finalized, would allow removal or preventedenrollment of health care providers and suppliers that attempt to circumvent Medicare’s enrollmentrequirements through name and identity changes as well as through elaborate, inter-provider relationships.
The proposed provisions also intend to address other program integrity issues and vulnerabilities, such ascases where providers and suppliers avoid paying their Medicare debts by reenrolling as a different entity.
Some major provisions of the proposed rule include:
• Disclosure of Affiliations. This would require health care providers and suppliers to report affiliationswith entities and individuals that: 1) currently have uncollected debt to Medicare or Medicaid; 2) havebeen or are subject to a payment suspension under a federal health care program or subject to an Officeof Inspector General (OIG) exclusion; or 3) have had their Medicare or Medicaid enrollment denied orrevoked. CMS could deny or revoke Medicare or Medicaid enrollment if CMS determines that theaffiliation poses an undue risk of fraud, waste, or abuse.
• Different Name, Numerical Identifier, or Business Identity. CMS could deny or revoke Medicareenrollment if a provider or supplier is currently revoked under a different name, numerical identifier, orbusiness identity.
• Abusive Ordering/Certifying. This provision would allow CMS to revoke a physician or eligibleprofessional’s Medicare enrollment if he or she has a pattern or practice of ordering, certifying,
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referring, or prescribing Medicare Part A or B services, items, or drugs that are abusive, represent athreat to the health and safety of Medicare beneficiaries, or otherwise fail to meet Medicarerequirements.
• Increasing Medicare Program Re-enrollment Penalties. CMS would raise the existing maximum re-enrollment penalty from three to ten years and add three more years to the provider or supplier’s re-enrollment penalty if the provider attempts to re-enroll in Medicare under a different name, numericalidentifier, or business identity. It would also impose a maximum 20-year reenrollment penalty if theprovider or supplier is being revoked from Medicare for the second time.
HCA will be reviewing the proposed rule further.
For further information, contact Patrick Conole at (518) 810-0661 or [email protected].
Funding Available for Chronic Disease Self-Management and Falls Prevention
The Administration on Aging’s Office of Nutrition and Health Promotion recently published two newFunding Opportunity Announcements (FOAs) – one for Chronic Disease Self-Management Educationprograms and the other for Falls Prevention programs.
The goals of these programs are to:
• Significantly increase participation of older adults and adults with disabilities in these evidence-basedprograms; and
• Implement innovative funding arrangements (e.g., contracts with integrated health care systems) tosupport these programs beyond the grant period, while embedding the programs into an integrated,sustainable, evidence-based prevention program network.
The deadline for each FOA is April 6, 2016. Please see the links below for more information:
• Falls Prevention: http://www.grants.gov/view-opportunity.html?oppId=281349
• Chronic Disease Self-Management Education: http://www.grants.gov/view-opportunity.html?oppId=281361
CMS Publishes Medicare FFS Provider & Supplier Utilization Data Tool
The U.S. Centers for Medicare and Medicaid Services (CMS) has recently published a Provider and SupplierServices and Utilization Data Tool that includes interactive maps and a dataset showing national, state, andcounty-level provider and supplier services and utilization data for selected health service areas, includinghome health.
CMS’s data tool provides information on the number of Medicare home health providers servicing ageographic region, with regions at the state and county level clearly indicated, and the number of Medicarebeneficiaries using those services. The data can also be used to reveal the degree to which use of these services is
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related to the number of providers and suppliers servicing a geographic region. Provider and supplier servicesand utilization data by geographic regions can be compared using CMS’s interactive maps.
The tool uses paid Medicare claims data from the CMS Integrated Data Repository (IDR). The IDR containsMedicare and Medicaid claims, beneficiary data, provider data, and plan data. Claims data are analyzed for a12-month reference period, and results are updated quarterly to reflect a more recent 12-month referenceperiod.
The tool is available at https://data.cms.gov/moratoria-data. All information presented graphically in thedata maps is available for download. Future updates may include comparable information on additionalhealth service areas.
Additional information on CMS’s Data tool can be found at: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2016-Press-releases-items/2016-02-22.html
For further information, contact Patrick Conole at (518) 810-0661 or [email protected].
ONC Releases Practical Examples of Permitted Health Information Exchange
under HIPPA
The Office of the National Coordinator for Health Information Technology (ONC) recently released twofact sheets summarizing permitted electronic health information exchange for treatment and health careoperations.
ONC’s fact sheets can be accessed at:
• Permitted Uses and Disclosures: Exchange for Treatment(https://www.healthit.gov/sites/default/files/exchange_treatment.pdf )
• Permitted Uses and Disclosures: Exchange for Health Care Operations(https://www.healthit.gov/sites/default/files/exchange_health_care_ops.pdf )
ONC also released a brief, which provides practical examples of exchange for treatment and health careoperations under the Health Insurance Portability and Accountability Act (HIPAA). ONC’s brief is at:https://www.healthit.gov/buzz-blog/privacy-and-security-of-ehrs/real-hipaa-care-coordination-care-planning-case-management-examples/
For further information, contact Patrick Conole at (518) 810-0661 or [email protected].
Update on NHTD/TBI Waiver Transition Workgroup
The Nursing Home Transition and Diversion (NHTD)/Traumatic Brain Injury (TBI) TransitionWorkgroup continues to meet weekly to discuss pressing issues in the transition to managed care (planned forJanuary through April 2017).
Last week, the state Department of Health posted a Questions and Answers (Q&As) document that covers:role of Regional Resource Development Centers; continuity of care protections; housing support under the
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waivers now and under managed care; status of individuals who don’t meet the nursing home level of careon the Uniform Assessment System (UAS) tool; provider qualifications; and rates.
The Q&A and other materials about the planned transition are athttp://www.health.ny.gov/health_care/medicaid/redesign/mrt90/index.htm.
This week’s meeting of the Transition Workgroup discussed proposed provider qualifications for servicecoordination; community integration counseling; independent living skills training; positive behavioralinterventions and supports; and structured day program.
The state hopes to release for public comment a Waiver Transition Plan on April 1.
Publications
• “Comprehensive Care for Joint Replacement Model (CJR) Provider Education,” by the U.S.Centers for Medicare and Medicaid Serviceshttps://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9533.pdf
• “Provider Enrollment Revalidation – Cycle 2,” by the U.S. Centers for Medicare and MedicaidServiceshttps://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1605.pdf
• “Payment and Delivery System Reform in Medicare: A Primer on Medical Homes, AccountableCare Organizations, and Bundled Payments,” by the Kaiser Family Foundationhttps://kaiserfamilyfoundation.files.wordpress.com/2016/02/8837-payment-and-delivery-system-reform-in-medicare1.pdf
For more information, contact Andrew Koski at (518) 810-0662 or [email protected].
SENIOR FINANCIAL MANAGERS SUMMIT
March 9, 2016 9:00am – 3:15pm
Albany Hilton Albany, New York
(Formerly CFO Forum)
Learn About 2016-2017 State Budget HCA Financial Condition Report Results Updates on Home Care Rates and Managed Care Premiums Minimum Wage Funding And much more!
SENIOR FINANCIAL MANAGERS SUMMIT March 9, 2016 9:00am – 3:15pm Albany Hilton Albany, New York
Join us!
HCA’s Senior Financial Managers Summit (formerly CFO Forum) is a must‐attend program for home care financial managers, CFOs and other executive staff to hear from HCA policy staff, finance and reimbursement managers from the state Department of Health (DOH) and industry consultants on home care fiscal issues. Kicking off the Forum, HCA staff will highlight key areas in the Governor’s proposed 2016-17 Executive Budget as well as many finance‐related advocacy areas where we are working on your behalf – from the federal and state budget fronts to our work on the many rate packages and payment model implementation efforts occurring internally at the DOH and state Executive levels. DOH reimbursement officials will provide yet further details on all of these issues from the state’s perspective. Robert Simione will provide participants with the latest aggregate benchmarking data for Medicare and Medicaid to help you make sense of how the various federal and state fiscal policy levers are affecting your bottom-line and operational practices related to your peers. Lastly, Ms. Audrey El-Gamil, from Dobson, DaVanzo & Associates, LLC. will provide highlights of an important study she conducted to identify the clinically appropriate and cost-effective placement of Medicare patients following discharge from the acute care hospital, and will offer suggestions on how home care can be utilized most effectively in the future. She has conducted extensive research on Medicare post-acute care payment policy and is a highly sought out expert. Please do not miss out on this robust program which delves into several important areas relevant to your agency’s fiscal health.
March 9, 2016 9:00am – 9:30am HCA Registration & Continental Breakfast 9:30am – 10:30am HCA Update HCA staff will provide a state legislative update, which will focus on the Governor’s proposed 2016‐17 Executive Budget and its impact on home care, along with an update on our advocacy efforts in Albany and in Washington. HCA staff will highlight our annual financial condition report as well as discuss the latest on Minimum Wage funding, DSRIP, Value Based Purchasing, QIVAPP and the 2016 Medicare Prospective Payment System (PPS). 10:30am – 11:30am Department of Health Update Tim Casey, Bureau of Long Term Care Reimbursement Daniel Carmody, Bureau of Managed Care Reimbursement Mr. Casey and Mr. Carmody will provide updates on the following: provisions in the 2016‐17 Executive State Budget that impact home care, personal care and Medicaid managed long term care plans; the Medicaid Global Cap; CHHA Episodic Payment System (EPS) utilization data; premium rate adjustments to Managed Long Term Care (MLTC); QIVAPP funding, Wage Parity and Overtime adjustments to plans and home care providers; the CHHA, LTHHCP and Personal Care fee‐for‐service Medicaid rates; the 2015 Medicaid cost reports and other Medicaid reimbursement issues. 11:30pm – 12:30pm Medicare PPS and CHHA Medicaid EPS Benchmarking Data Robert Simione, CPA, Vice President, Simione Financial Monitor During this session, Mr. Simione will share the latest aggregate benchmarking data for the Medicare Home Health Prospective Payment System (PPS), Medicaid EPS and managed care using comparisons from clients of Simione’s Financial Monitor here in New York versus national averages. This data is especially useful in the context of federal rebasing under the Medicare home health PPS and the state Department of Health’s rebasing efforts for CHHA EPS. Some benchmarking highlights will include: the volume of outliers, LUPAs, PEPs and full episodes; Medicare net and gross margin data; as well as average case-mix weights and visits per discipline. 12:30pm – 1:15pm – Lunch 1:30pm – 2:45pm Medicare Post-Acute Care Payment Prognosis Audrey El-Gamil, Senior Manager, Dobson, DaVanzo & Associates, LLC Ms. El-Gamil has significant experience in health policy analysis and health services research with the majority of her recent research on Medicare post-acute care payment policy. For the home health industry, Ms. El-Gamil was the project manager of a data-driven study that aimed to identify the clinically appropriate and cost-effective placement of Medicare patients following discharge from the acute care hospital. During the session , Ms. El-Gamil will provide highlights of this study which examined how the Medicare home health benefit is currently serving Medicare beneficiaries but also investigated how Medicare's use of home health could better meet beneficiary needs and improve the quality and efficiency of care. 2:45pm – 3:15 HCA Closing Remarks & Adjourn
AGENDA
SENIOR FINANCIAL MANAGERS SUMMIT March 9, 2016
9:00am – 3:15pm Albany Hilton
Albany, New York
FAX TO: (518) 426-8788
Registration __________________________________________________________________ Name
__________________________________________________________________ Title
__________________________________________________________________ Agency
__________________________________________________________________ Address
__________________________________________________________________ City/State/Zip
_______________________ _________________________________________ Phone/Ext. Email (Required)
Payment of $99 per person
_______ VISA _________ MC _______ AM EX
Credit Card No.____________________________________
Expiration Date:_____________ Sec. Code:_____________
Card Billing Address:_______________________________
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Name on Card:____________________________________
Signature:________________________________________
Or, make checks payable to: HCA and mail to 388 Broadway, 4th Floor, Albany, NY 12207
Cancellation Policy: Cancellations received by February 29th will receive a full refund, less 25% of total due as an administrative fee. Cancellations received on March 1st or later will forfeit their registration fee, as well as those who register and do not attend. Substitutions are permitted.
SENIOR FINANCIAL MANAGERS SUMMIT March 9, 2016
9:00am – 3:15pm Albany Hilton
Albany, New York
388 Broadway Fourth Floor
Albany, New York 12207 PH (518) 426-8764
WEB www.hca-nys.org
This is an HCA Members Only Program.
Become an HCA Member If you are not currently an HCA Member, but wish to become one so you can take advantage of
this and other educational programming, please contact
Laura Constable at (518) 810-0660 or at [email protected].