cms approves five-year renewal of lthhcphca-nys.org/documents/082710asap.pdf · 2 asap is a weekly...

Legislative Issues Public Policy News

A Weekly Publication Of HCAHCAHCAHCAHCAHome Care Association of New York State

Helping New YorkersFeel RightAt Home

ASAPVolume 15, No. 34, August 27, 2010

Inside Inside Inside Inside Inside ASAPASAPASAPASAPASAP See LTHHCP p. 2

CMS Approves Five-Year Renewal of LTHHCP..................................1HCA Launches New Online Advocacy Platform............................3CMS Chief Responds to HCA, NY Delegation on PECOS.............5New CAHPS Patient Exclusions to Affect NY Providers.................6Upcoming HCA Forums....................................................................6HCA Brings Provider Perspective to LTC Meeting..........................7DOH Releases RFP for Uniform Assessment Tool............................8HEAL Capital RGA Released as “Continuous Recruitment”.........10HCA Seeks Repeal of Burdensome 1099 Requirement.................11Save the Date for HCA’s Clinical and Technology Conference......12Sign Up for Executive Education Opportunities.............................13CMS to Solicit Comments on Provider Evaluation Process...........14PTs Sent Comparative Billing Reports............................................15HHS Proposes Amendments to HIPAA Regulations.....................16Get Ready for Test of Version 5010 HIPAA Transactions...............17NGS Updates............................................................................17New Rule Announced for Med Equipment Suppliers....................18Insurance Plan Starts for Those with Pre-Existing Conditions.......18Coverage Expanded for Tobacco Cessation Counseling..............19Health Resources...................................................................19Member Hiring Announcements.....................................................21

CMS Approves Five-Year Renewal of LTHHCPBig victory for LTHHCP patients, providers and NYS; HCA extends congratulations and appreciation to DOHofficials

HCA is thrilled to report to the membership that the U.S. Centers for Medicare and Medicaid Services (CMS) hasapproved the renewal of the Long Term Home Health Care Program (LTHHCP) for five years effective September1, 2010.

Full renewal and enhancement of the LTHHCP waiver has been a high Association priority, encompassing extensiveadvocacy for the past several years.

Renewal of the waiver is a tremendous victory for New York’s aged and disabled population and the long term caresystem as a whole, as well as to the state in its policy priority to cost-effectively rebalance its system from institutionalto patient-centered home and community-based services.

The approval letter is at http://www.hca-nys.org/082410LTHHCPWaiverApproval.pdf.

Prior to the August 20 letter from CMS to the state Department of Health (DOH) granting a five-year renewal ofthe waiver, CMS had approved numerous short-term extensions.

As mentioned in past HCA communications to members, CMS has approved the LTHHCP waiver with a seriesof new services and enhancements, as well as with the continuation of spousal impoverishment budgeting tocurrent and future participants in the LTHHCP.

HCA extends sincere appreciation and congratulations to the DOH officials who spearheaded the waiver renewalefforts, including Mark Kissinger and Carla Williams, Deputy Commissioner and Deputy

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ASAP is a weekly publication of the Home Care Association ofNew York State (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 & Regulatory Affairs, [email protected]

Andrew Koski, Vice President, Advocacy & Public Policy, [email protected]

Alexis Silver, Vice President for Policy & Clinical Affairs, [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, Executive Assistant, Office Manager, [email protected]

Teresa Brown, Administrative Assistant, [email protected]

President:

Editor:

194 Washington Avenue, Suite 400, Albany, NY 12210Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org

Volume 15, No. 34 August 27, 2010ASAP – a publication of the Home Care Association of New York State

LTHHCP continued from p. 1

Continued on page 5

Director, respectively, of DOH’s Office of Long Term Care, and Doreen Sharp, Director of the LTHHCP, andrecognizes the hard work of HCA’s LTHHCP Forum members and the many consumer and provider associationsfor their diligence and advocacy.

Now that CMS has issued its final approval, the array of program enhancements advocated by HCA and DOHwill be implemented into the operation of the LTHHCP. HCA has already begun discussion of next steps withthe Department, including provider and Social Services District guidance on implementation. In this regard,DOH is preparing transmittals for both districts and providers notifying and guiding them on the changes andenhancements contained in the new waiver.

With respect to the change in the minimum reassessment period for patients – from 120 to 180 days – which wassuccessfully secured by HCA, the Legislature and Executive during the Legislative session, HCA is advised thata forthcoming DOH transmittal will indicate that, on and after September 1, the new 180 day reassessmentinterval will be applied as follows: 1) to new cases, and 2) to existing cases after the end of their current 120 dayauthorization period. HCA advises that providers and districts wait for the DOH official transmittal beforetaking specific action. If specific guidance is necessary with regard to any such cases prior to the receipt of thetransmittal, providers and districts should inquire directly with the Office of Long Term Care in the stateDepartment of Health for written instruction.

HCA will be seeking follow-up meetings with DOH to discuss implementation of the program enhancementscontained in the waiver renewal, including home and community support services, community transitional services,assistive technology, community integration services and others. More information on those services is in NewYork’s application to renew the LTHHCP at http://www.nyhealth.gov/facilities/long_term_care/docs/home_health_care_program_waiver_renewal_-_2009-01-01_-_2013_12_31.pdf. As part of these discussions,

http://www.nyhealth.gov/facilities/long_term_care/docs/home_health_care_program_waiver_renewal_-_2009-01-01_-_2013_12_31.pdf

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Engaging in home care advocacy has never beeneasier. HCA, in partnership with the NationalAssociation for Home Care and Hospice (NAHC),has launched a new online advocacy system, availabledirectly through our website at:

http://www.congressweb.com/cweb2/index.cfm/siteid/NAHC-NY

Our new online Legislative Action Center mergestogether, on a single web page, an array of state andfederal legislative advocacy action items developedboth by NAHCand HCA.

When arriving atthe new page,users have achoice ofadvocating onissues under the“Home CareAssociation ofNew York State”header or underthe “Federal/National Issues”header; thislatter categoryincludes itemsgenerated by NAHC.

The following online advocacy campaigns are nowavailable through the site:

• Stop Home Health Cuts• Stop Hospice Cuts• Increase the Rural Add-on• Promote Telehomecare/Remote Monitoring• Allow NP/PAs to Order Home Health Services• Delay Physician Enrollment Requirement and

Hold Home Health Agencies Harmless

Each of these items includes links to talkingpoints, issue briefs, studies and reports,Delegation letters, and other supportingresources; but, most importantly, each item alsocontains a “Write Your Legislators” link, whichallows you to send a message directly to yourstate and federal elected officials.

How the system works

To participate in online advocacy through HCA’sLegislative Action Center, users should do thefollowing:

• Click the link to “Write Your Legislators”for each action item;

• Enter your contact information;

• Select “Review Your Message(s).” You’llnotice that, in clicking this button, a boxappears, containing an advocacy note inthe form of an e-mail message. Read themessage carefully and be sure topersonalize the text to reflect youragency’s unique experiences andcircumstances. Use this opportunity toprovide agency-specific data, share ananecdote about a patient affected by theissue, or describe the unique pressures onyour agency stemming from the issue;

• Once your message is customized andready for submission, click the “SendMessages” button and your advocacymessage will go directly to the inbox ofyour elected representatives.

This week’s focus: Stop Home Health Cuts!

Members are encouraged to send a message toCongress on any of the action items displayed on

HCA Launches New Online Advocacy PlatformLegislative Action Center allows members to send an advocacy message directly to elected officials with push of thebutton

See ADVOCACY p. 4

http://www.congressweb.com/cweb2/index.cfm/siteid/NAHC-NY

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our Legislative Action Center web page; but this week we especially ask that you help us inaugurate thenew system by engaging in our campaign to “Stop Home Health Cuts.”

As providers are well aware, the U.S. Centers for Medicare and Medicaid Services (CMS) has proposedunprecedented Medicare cuts, including a 3.79 percent reduction both in 2011 and in 2012. These cuts willreduce home health payments by about $1.5 billion nationally over this period – at a time when New YorkState home health agencies are already reporting an overall -18.73 percent Medicare operating margin,according to 2008 data.

To engage in this important advocacy campaign, HCA urges members to read the briefing documentsavailable for this issue at our Legislative Action Center and then send a message directly to Congress at thefollowing link: http://tinyurl.com/284wnmb.

Additional HCA campaigns coming soon

In addition to the “Stop Home Health Cuts” and other NAHC advocacy action campaigns alreadyavailable on the site, HCA will soon be posting to the Legislative Action Center our own advocacy actionitems and will publicize each campaign by sending links directly to the membership in the form of HCAE-alerts.

The challenges facing home care providers – at both the state and federal levels – are enormous. At the statelevel alone, officials are already talking about upwards of a $13 billion to $15 billion state deficit next year,putting home care at potential risk. And now, more state budget cuts are possible, as early as mid-September, given the state’s recent passage of an FMAP (Federal Medical Assistance Percentage)contingency plan to close the state’s funding gap through across-the-board reductions as a result of less-than-expected federal Medicaid assistance to New York State. (See recent editions of ASAP for moreinformation.)

Our advocacy as a community will be critical, to ensure that New York’s home care system is appropriatelysupported by state and federal officials. HCA’s Legislative Action Center will play an important role in thisprocess.

In the meantime, please bookmark our new Legislative Action Center web page, again athttp://www.congressweb.com/cweb2/index.cfm/siteid/NAHC-NY. (To make it easy, HCA hascreated links to the Legislative Action Center through our “State Advocacy” and “Federal Advocacy”buttons on the home page of our website at www.hcanys.org.)

And remember, the Legislative Action Center is just one of many exciting tools and methods for themembership to engage in advocacy on vital issues. Please also be sure to continue your direct, face-to-faceoutreach with members of Congress and the State Legislature, and please continue to raise awareness inany way possible (though written correspondence, media outreach, etc.) among elected officials about thevalue of home and community-based services to patients in your community.

For more information, or for assistance in using the new system, feel free to contact HCA’s CommunicationsDirector Roger Noyes at [email protected].

ADVOCACY Continued from p. 3

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From Left: HCA Executive Vice President Al Cardillo HCA Executive Vice President Al Cardillo HCA Executive Vice President Al Cardillo HCA Executive Vice President Al Cardillo HCA Executive Vice President Al Cardillo andHCA President Joanne CunninghamHCA President Joanne CunninghamHCA President Joanne CunninghamHCA President Joanne CunninghamHCA President Joanne Cunningham held a member visitwith Able Health Care ServicesAble Health Care ServicesAble Health Care ServicesAble Health Care ServicesAble Health Care Services CEO Walter KaltenbachCEO Walter KaltenbachCEO Walter KaltenbachCEO Walter KaltenbachCEO Walter Kaltenbach,AAAAAble Regional Able Regional Able Regional Able Regional Able Regional Administrdministrdministrdministrdministraaaaatttttor Nellie Ror Nellie Ror Nellie Ror Nellie Ror Nellie Rhone-Phone-Phone-Phone-Phone-Perrerrerrerrerryyyyy, andother Able staff to discuss policy and advocacy and to learn moreabout issues of interest to Able at the provider level. Able is botha Special Needs Certified Home Health Agency (CHHA) and aLicensed Home Care Services agency. Its CHHA providescomprehensive support to individuals with developmentaldisabilities throughout the five boroughs of New York City, LongIsland and Westchester counties. Able provides home careservices in cooperation with the Office of People withDevelopmental Disabilities (OPWDD, formerly OMRDD). Many ofAble’s clients are faced with a variety of conditions, such asmental retardation, autism, cerebral palsy, epilepsy and otherneurological and physical impairments. The agency’s mission is toprovide these patients with the ability to participate in themainstream of society by affording them the opportunity toremain in their home setting.

HCA Member HCA Member HCA Member HCA Member HCA Member VisitVisitVisitVisitVisitContinued from p. 2

HCA will also be exploring the opportunities affordedfor Medicaid coverage of medication dispensers forLTHHCP patients, along with HCA’s proposal thatwas enacted into law which allows for the collaborativeservice of patients under more than one waiver or casemanagement authority.

For more information, contact the HCA Policy staff.

CMS’s Dr. Berwick Responds to HCA,Congressional Outreach on PECOSHCA, Congressman Arcuri, New Jersey Home CareAssociation confer on follow-up action

HCA and the New York and New Jersey CongressionalDelegation members have received a response to ourjoint outreach on PECOS (the Provider Enrollment,Chain and Ownership System) from U.S. Centers forMedicare and Medicaid Services (CMS) AdministratorDr. Donald Berwick.

In a letter addressed to New York Congressman MichaelArcuri (D-Utica), Dr. Berwick states that:

CMS will, for the time being, not implement changesthat would automatically reject claims based on orders,certifications and referrals made by providers that didnot have their applications approved by July 6, 1010.

Providers should not see any change in the processing of submitted claims. We will continue to work withthe provider community on PECOS enrollment and will provide notice to providers prior to turning on theedits that reject claims automatically.

The full text of Dr. Berwick’s letter is accessible at http://www.hca-nys.org/CMSPECOSResponse81910.pdf.

Working with HCA and the New Jersey Home Care Association, on July 30, Congressman Arcuri andCongressman Christopher Smith of New Jersey spearheaded a letter cosigned by the members of both states’Congressional Delegation members requesting that CMS provide for a reasonable implementation of the newPECOS enrollment requirements for physicians ordering home health services. Dr. Berwick’s letter is in responseto this original Delegation letter.

HCA appreciates Dr. Berwick’s direct reply and engagement in assisting with the PECOS issue and believes thismay establish the groundwork for further clarification and assurance of protections which HCA believes are stillnecessary.

While HCA appreciates the flexibility described in Dr. Berwick’s letter, HCA believes that CMS should neverthelessexplicitly assure providers that they will not be subject to penalties or recoupments for home health services

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Upcoming HCA ForumsUpcoming HCA ForumsUpcoming HCA ForumsUpcoming HCA ForumsUpcoming HCA Forums

HCA members are reminded about two importantupcoming members-onlymembers-onlymembers-onlymembers-onlymembers-only forums: the StatewideStatewideStatewideStatewideStatewideLong TLong TLong TLong TLong Term Home Health Carerm Home Health Carerm Home Health Carerm Home Health Carerm Home Health Care Pre Pre Pre Pre Program (Logram (Logram (Logram (Logram (LTHHCP)THHCP)THHCP)THHCP)THHCP)ForumForumForumForumForum and the Downstate Licensed Home CareDownstate Licensed Home CareDownstate Licensed Home CareDownstate Licensed Home CareDownstate Licensed Home CareServices Agency (LHCSA) ForumServices Agency (LHCSA) ForumServices Agency (LHCSA) ForumServices Agency (LHCSA) ForumServices Agency (LHCSA) Forum, both in NewYork City.

The Statewide LStatewide LStatewide LStatewide LStatewide LTHHCP ForumTHHCP ForumTHHCP ForumTHHCP ForumTHHCP Forum will occur onSeptember 30September 30September 30September 30September 30 and the Downstate LHCSA ForumDownstate LHCSA ForumDownstate LHCSA ForumDownstate LHCSA ForumDownstate LHCSA Forumwill take place on October 1October 1October 1October 1October 1.

These Forums are offered free of chargefree of chargefree of chargefree of chargefree of charge to HCAmembers and will provide important updates onissues related to reimbursement and other financematters, the state and federal regulatoryenvironment, policy opportunities, and operationalissues relevant to these provider organizations.

LLLLLTHHCP prTHHCP prTHHCP prTHHCP prTHHCP providersovidersovidersovidersoviders, please mark your calendars forSeptember 30September 30September 30September 30September 30. Downstate LHCSA membersDownstate LHCSA membersDownstate LHCSA membersDownstate LHCSA membersDownstate LHCSA members: savethe date for October 1October 1October 1October 1October 1. More information,including registration, will be available shortly.

provided in good faith to Medicare recipients on the basis of their physicians’ PECOS status, which providerscannot control, under the unreasonable terms of the July 6 PECOS enrollment deadline imposed by CMS.

Following our receipt of the letter, HCA today conferred with Congressman Arcuri’s office and the New JerseyHome Care Association to discuss next steps. HCA will be working with these parties to draft a reply to Dr.Berwick seeking the additional and necessary clarifications and assurances. In addition, HCA will be working toprepare legislation for introduction by Congressmen Arcuri and Smith to address the PECOS issue if the sought-after clarification is not provided.

PECOS has been extensively covered by HCA over the past several months. Members are referred to prior issuesof ASAP for further background.

HCA greatly appreciates the continuing diligence and commitment of New York Congressman Arcuri to the supportof home health providers on PECOS and other important issues of concern to the home care community.

For more information, please contact a member of the HCA Policy staff.

New CAHPS Patient Exclusions to Affect NY Providers

The U.S. Centers for Medicare and Medicaid Services (CMS) recently announced that home care agencies locatedin states with regulations or laws that govern the release of confidential and private health information for specificpatient populations should exclude these patients from their CAHPS-eligible patient population.

Additionally, Medicare-certified home healthagencies administering the Home HealthCAHPS survey (which stands for ConsumerAssessment of Healthcare Providers andSystems) are responsible for making sure thatthe agency complies with all applicable state lawsrestricting the release of information for certainpatient populations.

New York does have additional protectionsrelated to the disclosure of Protected HealthInformation (PHI) in cases of HIV, behavioral/mental health disorders, drug and alcoholinformation and genetic testing; therefore,patients with those diagnoses or who have hadgenetic testing should be excluded from theHome Health CAHPS survey.

In enacting this new policy, CMS will revise thelist of patients who are not eligible to participatein the CAHPS survey to include patients forwhom release of health information is restrictedby state laws or regulations. The revised list willbe included in the Home Health CAHPS

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Protocols and Guidelines Manual, Version 3.0, which will be released in September 2010.

Considering that many of our provider members are affected by this new exclusion policy, HCA has soughtclarification from the Home Health CAHPS Survey Team on a number of issues, and we have consequentlydetermined that:

• Home health agencies will not be required to seek additional consent/specific authorizations – as requiredby New York State law in order to include PHI-applicable patients as part of the Home Health CAHPSsurvey – since these patients are now exempt;

• The deadline for agency exemption status has been extended past the original June 16 deadline, whichmeans agencies that are newly eligible for exempt status may still apply. Medicare-certified home healthagencies that served 59 or fewer patients who meet survey eligibility should complete the exemption requestform at https://homehealthcahps.org. Agencies should not include among the count of eligible patientsany of the patients protected by state privacy regulations or laws.

Since many HCA members had already included or planned to include the newly excluded patients in their surveypopulation, HCA has requested guidance from the Home Health CAHPS Survey Team, as well as from CMS,regarding the appropriate action for these providers to take in response to the policy change. Additionally, HCAhas requested guidance on whether the specifically protected populations must be excluded, or whether they couldbe included as long as all the additional requirements of state privacy protections are met. HCA will share anyinformation with providers as soon as we are notified of CMS’s decisions on these issues.

For more information, please contact Lexi Silver at [email protected] or (518) 810-0658.

HCA Brings Provider Perspective to Long Term Care Meeting

HCA this week participated in a discussion on The Future of Long-Term Care, hosted by AARP, which included afocus on the home care provider perspective in the area of long term care policy.

The meeting brought together a large and diverse group of stakeholders, including provider associations, consumeradvocates, organizations serving people with disabilities and/or older persons, and officials from the stateDepartment of Health (DOH) and the state Office for the Aging (NYSOFA).

The purpose of the meeting was to review recent state and federal legislative changes that impact long-term care,activities occurring on the local level (specifically Albany County) in the area of long-term care, AARP’s involvementin advocating for long-term care reform, and ways to improve the system.

HCA pointed out that more than half of our members face negative financial margins, due to Medicaid andMedicare cutbacks and unfunded mandates – a condition that has left the long term care system fragile, hamperingits capacity to meet the growing need for services. HCA also sought clarification on federal health reform provisions(under the Patient Protection and Affordable Care Act, or PPACA) that cover home and community-basedservices in order to determine their impact on New York’s existing programs. HCA is concerned that some of thenew federal initiatives in the area of long term care could actually undercut the innovations already made in NewYork State to provide these vital services to individuals most in need.

Mark Kissinger, Deputy Commissioner of DOH’s Office of Long Term Care, reviewed the final state budgetactions that affected long term care services, including the elimination of the Medicaid trend factor for home

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Story continued on page 10

care and personal care providers, hospitals and nursing homes, as well as the Department’s support forinitiatives to:

• Create a County Long Term Care Financing demonstration, supporting up to five counties that operatenursing homes to invest in other non-institutional long term care services.

• Develop a Long Term Care Financing demonstration to test the approach of combining private financialcontributions and Medicaid coverage for 5,000 individuals.

• Expand the existing Nursing Home Rightsizing demonstration, by increasing from 2,500 to 5,000 thenumber of beds able to be decertified and then converted to approved alternative models such as the LongTerm Home Health Care Program, Managed Long Term Care, adult day health care, assisted living, orothers.

Mr. Kissinger said that New York is reviewing the new demonstrations/programs under PPACA to determine if itwants to participate in them.

NYSOFA Director Mike Burgess and other staff discussed the agency’s initiatives, including: consumer directionin the Nursing Home Diversion project and Expanded In-Home Services for the Elderly Program; chronic diseaseself-management programs; the patient navigator program to help coordinate care for individuals discharged fromhospitals; and the New York Connects point-of-entry system.

HCA is reviewing PPACA’s provisions to determine what opportunities and obstacles lie ahead for home careproviders in the area of long term care – and in other facets of health delivery – and will be developing an action planthat includes meetings with state and federal officials, continued educational programs, and advocacy with ourmembers.

For more information, please contact Andrew Koski at (518) 810-0662 or [email protected].

DOH Releases RFP for Uniform Assessment Tool

The state Department of Health (DOH) has released a request for proposal (RFP) for a vendor to implement auniform assessment tool (UAT) for Medicaid programs that will be used to identify the need for long term careservices.

According to the RFP, the goals of the UAT for the Medicaid program are to provide:

• Assessment of functional needs through empirically tested and validated means;

• An electronic system and uniformity of data across programs;

• Access to programs and services with minimum duplication and maximum consistency;

and

• A basis for allocation of resources, standardization of care delivery, and quality outcomes.

The tool will be used for the following programs:

• Assisted Living Program (ALP)

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Upcoming HCA Programs and EventsUpcoming HCA Programs and EventsUpcoming HCA Programs and EventsUpcoming HCA Programs and EventsUpcoming HCA Programs and Events

Registration for these and other events is at www.hca-nys.org/events.cfm

Registration available at http://wwwRegistration available at http://wwwRegistration available at http://wwwRegistration available at http://wwwRegistration available at http://www.hca-nys.or.hca-nys.or.hca-nys.or.hca-nys.or.hca-nys.org/events.cfmg/events.cfmg/events.cfmg/events.cfmg/events.cfm

Blueprint for OASIS AccuracyBlueprint for OASIS AccuracyBlueprint for OASIS AccuracyBlueprint for OASIS AccuracyBlueprint for OASIS AccuracySeptember 20-21, 2010 September 20-21, 2010 September 20-21, 2010 September 20-21, 2010 September 20-21, 2010 (workshop); September 22, 2010 September 22, 2010 September 22, 2010 September 22, 2010 September 22, 2010 (COS-C exam) — Syracuse

Spend two intense and fun days learning all there is to know to collect the OASIS-C accurately, plus an opportunity on a third dayto take the COS-C exam — all at one location. In this session, participants will learn to understand the specifics of the new OASISitems, changed items and process measures as well as changes to data collection rules and conventions. This program also providesthe opportunity to demonstrate mastery of learned concepts through participation in application scenarios.

The Federal Health Reform LawThe Federal Health Reform LawThe Federal Health Reform LawThe Federal Health Reform LawThe Federal Health Reform LawUnderstanding the New Law to Position Home Care for SuccessUnderstanding the New Law to Position Home Care for SuccessUnderstanding the New Law to Position Home Care for SuccessUnderstanding the New Law to Position Home Care for SuccessUnderstanding the New Law to Position Home Care for SuccessOctober 15, 2010 October 15, 2010 October 15, 2010 October 15, 2010 October 15, 2010 — New YNew YNew YNew YNew York Cityork Cityork Cityork Cityork City.....

With the enactment of the federal health care reform law, the home care community has huge challenges as well as opportunitiesahead. This program will help home health leaders understand provisions of the new law that will impact their agencies directlyas well as providers across the continuum of care. Don’t miss this opportunity to hear from an all-star cast of strategically chosenpresenters who will discuss how the health reform law affects particular dimensions of the health delivery system while providinginsights into the opportunities that lie ahead for home care agencies.

Integrated Chronic Care ManagementIntegrated Chronic Care ManagementIntegrated Chronic Care ManagementIntegrated Chronic Care ManagementIntegrated Chronic Care ManagementOctober 26 and 27 — AlbanyOctober 26 and 27 — AlbanyOctober 26 and 27 — AlbanyOctober 26 and 27 — AlbanyOctober 26 and 27 — Albany

The Home Based Chronic Care Model developed by Baptist Health Home Health Network has caught the attention of providersnationwide for its innovative approach to chronic disease management and is fully endorsed by the National Association for HomeCare and Hospice (NAHC). Join HCA for a two-day session exploring this award-winning model. On day one, October 26, theExecutive Training program will be held to support leaders who want to develop a core business strategy for patient centered, highquality, chronic care management and position themselves for success across the health care system of the future. On day two,October 27, the Train the Trainer program will prepare home care clinicians for the future of integrated chronic care deliverythrough classroom instruction and web-based training resulting in the Integrated Chronic Care Specialist designation. Seating islimited, so register now through HCA’s website.

Home Care Executive Certificate Program (HCECP)Home Care Executive Certificate Program (HCECP)Home Care Executive Certificate Program (HCECP)Home Care Executive Certificate Program (HCECP)Home Care Executive Certificate Program (HCECP)November 3-5, 2010 — New YNovember 3-5, 2010 — New YNovember 3-5, 2010 — New YNovember 3-5, 2010 — New YNovember 3-5, 2010 — New York Cityork Cityork Cityork Cityork City

Home health agency leaders looking to strategically position their organization for growth and success may be interested in TheHome Care Executive Certificate Program (HCECP) offered by the California Association for Health Care Services at Home(CAHSAH). The HCECP is a three module curriculum that covers strategic positioning, financial management and legal considerations.The program will be offered on November 3 to 5 at the Affinia Manhattan Hotel in New York City through the support of HCAEducation and Research. It is designed for administrators and senior managers with three or more years of home care administrativeexperience or upper level management.

ICD-9-CM & OASIS Coding — Back to Basics and BeyondICD-9-CM & OASIS Coding — Back to Basics and BeyondICD-9-CM & OASIS Coding — Back to Basics and BeyondICD-9-CM & OASIS Coding — Back to Basics and BeyondICD-9-CM & OASIS Coding — Back to Basics and BeyondNovember 17, 2010 — TNovember 17, 2010 — TNovember 17, 2010 — TNovember 17, 2010 — TNovember 17, 2010 — Trrrrroyoyoyoyoy

OASIS C experts agree that ongoing and specialized home health training to accurately assign diagnosis codes remains critical toreflect the complexity of home care patients and ensure accurate reimbursement. This workshop includes a comprehensiveoverview of ICD-9-CM coding with specific application to the home health industry and the revised OASIS-C. Coding mandates,exceptions and best practices will be reviewed. This workshop will provide the fundamentals necessary to achieve nationalcredential status. The Home Care Coding Specialist Exam (HCS-D) will be offered on November 18, at this same location.

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• Personal Care Services Program (PCSP) and Consumer Directed Personal Assistance Program (CDPAP)

• Adult Day Health Care (ADHC)

• Long Term Home Health Care Program (LTHHCP)

• Nursing Home Transition and Diversion (NHTD)

• Traumatic Brain Injury (TBI) Waiver

• Care at Home Waiver (I/II)

• Managed Long Term Care (MLTC) and Program for All Inclusive Care for the Elderly (PACE)

DOH has already chosen a UAT developed by interRAI which the vendor will be utilizing.

The vendor is responsible for:

• System reliability and quality;

• System documentation;

• Development of training materials and software training program;

• Support for live pilot activities; and

• Other work.

In past discussions with DOH, we have been told that the tool won’t be used to steer individuals into a particularprogram but will be used to identify their capabilities and needs. Also, initially the UAT will not be used forpediatric cases or clients served by the Office of Mental Health or the Office for People with DevelopmentalDisabilities.

This year’s final state budget included a provision for DOH to conduct a study using resident data collected froma UAT to evaluate and adjust Medicaid rates for ALPs, and also a $4.8 million appropriation for the UAT.

The RFP is at http://www.health.state.ny.us/funding/rfp/1005130955/1005130955.pdf.

Written questions on the RFP are due October 8; RFPs are due November 3; vendor selection is estimated tooccur by December 22; and the anticipated contract start date is March 2011.

HCA will be further reviewing the RFP and seeking additional information about the implementation of the UATand will keep members informed of new developments.

For more information, contact Andrew Koski at (518) 810-0662 or [email protected].

HEAL-NY Capital Grant RGA Released as “Continuous Recruitment”

The state Department of Health’s (DOH) Health Care Efficiency and Affordability Law for New Yorkers (HEAL-NY) Capital Grant Program will provide grants for capital projects to address conditions as cited in PublicHealth Law (PHL) Section 2818 (2), including initiatives to support facilities in financial distress and to addressunmet health care needs in New York State, as determined by the Commissioner of Health.

Continued from p. 8

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Eligible applicants include general hospitals, nursing homes, diagnostic and treatment centers licensedpursuant to PHL Article 28; mental health outpatient clinics licensed pursuant to the Mental HygieneLaw, Article 31; or federally qualified health centers, Certified Home Health Agencies, AssistedLiving Programs and Residences, adult homes, enriched housing programs, and independent livingcenters.

The Commissioner of Health and the Director of the Dormitory Authority shall determine eligible awardeesbased on an applicant’s ability to meet the following criteria:

• Having a loss from operations for each of the three consecutive preceding years, as evidenced by auditedfinancial statements; and

• Holding a negative fund balance or negative equity position in each of the three preceding years, asevidenced by audited financial statements; and

• Having “a current ratio of less than 1:1 for each of three consecutive preceding years” (HCA is seekingclarification as to whether this criterion refers to a “loss ratio” involving expenses and revenue or if thisitem refers to some other ratio); or

• Fulfilling an unmet health care need for the community, as determined by the Department of Health,through: consideration of the volume of Medicaid and medically indigent patients served; the servicevolume and case mix, including but not limited to maternity, pediatrics, trauma, behavioral andneurobehavioral, ventilator, and emergency room volume; and, the significance of the institution inensuring health care service access as measured by market share within the region.

The application is available at http://www.health.state.ny.us/funding/rfa/1008011008/index.htm.

For further information, contact:

Robert G. SchmidtDirector, HEAL NY Implementation TeamNew York State Department of HealthDivision of Health Facility PlanningCorning Tower, Room 1119Albany, NY 12237Phone: 518-474-5665E-mail: [email protected]

HCA Seeks Repeal of Administratively Burdensome 1099 Tax RequirementOpposition to new 1099 reporting requirement is mounting among association community

HCA is fighting a provision of the recently passed federal health care law that would require all employers(including home health agencies, trade associations like HCA, etc.) to file a 1099 form with the Internal RevenueService (IRS) for transactions with a vendor that amount to more than $600 a year, be it a single transaction orcumulative transactions, beginning on January 1, 2012.


Continued from p. 10

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Current 1099 tax reporting requirements are used to document income for individual workers other than wagesand salaries. Typically, independent contractors or freelancers receive these forms each year from their clients orfrom companies that employ them. (HCA currently issues the forms for speakers who charge over $600 or whoearn over $600 a year from services provided to HCA.) Under the new requirement, employers or agencies wouldhave to potentially issue or file 1099 reports for such items as office supplies, meeting registrations, office cleanings,outside consultants, hotel stays, or any payment to a business.

The administrative cost and time spent in fulfilling this new requirement would be enormously burdensome –especially for smaller agencies or employers – in light of an already administratively taxed home care system in NewYork State, which is currently beset with Third Party Liability (TPL) billing requirements, an onslaught ofgovernment audit activities, a regressive Medicaid Administrative and General (A&G) cost cap that reduces anagency’s margins for fulfilling such obligations, and other oppressive regulatory mandates.

Several efforts are underway in Congress to repeal or revise this provision, including a campaign by the AmericanSociety of Association Executives (ASAE) and other business groups. Currently, the U.S. Senate is revising theSmall Business Jobs Act tax relief and lending bill with several amendments, ranging from repeal of this provisionto raising the reporting threshold from $600 to $5,000. The Senate expects to begin voting on this bill on September14. HCA, in partnership with the larger trade association community, will be reaching out to Congress in supportof efforts to repeal this burdensome requirement.

HCA members can learn more about this proposed requirement, and how it may impact your agency, by visitinghttp://capwiz.com/asae/utr/1/CRDNNALZSM/GXYLNAPYIT/5625673226.

For further information, contact Patrick Conole at (518) 810-0661 or at [email protected].

Save the Date for HCA’s Signature Clinical and Technology Conference

On November 3 and 4, HCA will host our annual Clinical and Technology Conference, one of HCA’s signatureevents, geared for individuals who supervise front line staff and for individuals in operations management.

At this year’s conference, attendees will learn about: innovations that peers are tapping into to provide enhancedquality of care, ways to uncover partnering opportunities across the health care continuum, how to provide “guestexcellence” now that Home Health CAHPS (Consumer Assessment of Healthcare Providers and Systems) isbefore us, tips on strengthening your leadership skills … and that is just on the first day of this two-day conference.

On day two, attendees will hear about health information exchange initiatives – which include home care –spearheaded by the state Department of Health and the Health Information Exchange of New York (HIXNY).Day two also includes valuable information on innovative technologies for improving health outcomes in caseswhere patients suffer from low vision, as well as medication management recommendations for patients onanticoagulant regimens.

As a bonus, HCA is pleased to have Patricia Tulloch, Senior Consultant with RBC Limited, conduct a specialsession on OASIS-C Hot Topics, from 2:30 to 4 p.m., at the end of the two-day conference. This session, included inthe two-day registration fee, can also be purchased separately.

The complete conference brochure, including information on the registration fees, will be available in earlySeptember.



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HCA is pleased to have several sponsors supporting this education effort. They include the American Medical AlertCorp., HHC Health and Home Care, Montefiore Hospital Home Health Agency, Philips Lifeline, Verizon Wireless,and the VNA of Hudson Valley. With their support, HCA is able to keep the registration fee the same as it has beenfor the last two years. The two-day registration fee also includes group meals, such as the HCA awards dinner,where we will recognize a dedicated home health aide along with the Home Telehealth Champion of the Year incelebration of November’s National Home Care Month. Nomination forms for these recognition programs will besent to HCA members in September.

The Clinical and Technology Conference is a great opportunity to network with peers as well as have the time toinvestigate new products and services offered by the 18 vendors who will be on hand.

Please save the dates of November 3 and 4 for HCA’s Clinical and Technology Conference, at a new location, TheCentury House in Latham (near Albany), and look for registration materials in your e-mail inbox – coming soon.

For further information, contact Lynda Schoonbeek at [email protected].

Sign Up for Executive Education Opportunities Available through HCA

Home health agency executives and managers have an opportunity to get ahead of the curve by broadening theirknowledge and tapping into potential success under federal health care reform, enhancing the operation of theiragency, and honing their leadership skills by taking part in four dynamic education programs being offered throughHCA Education and Research in the coming months.

Federal Health ReformOctober 15 – New York City

This one-day educational program is designed to support home care leaders in their understanding of the federalhealth reform law and to help them gear up their agencies for the opportunities and challenges that lie ahead. Learnhow this new law will impact businesses, long term care, technology and others across the health care continuum.Learn, too, how to strategically position your agency for success in the future.

Integrated Chronic Care ManagementOctober 26 and 27 – Albany

The Home Based Chronic Care Model developed by Baptist Health Home Health Network has caught the attentionof providers nationwide for its innovative approach to chronic disease management. The program is fully endorsedby the National Association for Home Care and Hospice (NAHC).

In this two-part program, attendees will have the opportunity to hear from developers of the Home Based ChronicCare Model. Session one, the Executive Training program, on October 26, will support leaders who want toimplement a core business strategy for patient-centered, high quality, chronic care management and positionthemselves for success across the health care system of the future.

On October 27, participants will be able to take part in a Train the Trainer session on chronic care management –a “how-to” program geared for nurse managers and supervisors.



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Both of these programs are being marketed to members of sister home care associations across the nation, so weencourage you to sign up as soon as possible, as seating will be limited.

Home Care Executive Certificate ProgramNovember 3-5 – New York City

Home health agency leaders looking to strategically position their organization for growth and success will beinterested in The Home Care Executive Certificate Program (HCECP) offered by the California Association forHealth Care Services at Home (CAHSAH). The HCECP is a three-module curriculum that covers strategicpositioning, financial management, and legal issues. It is designed for administrators and senior managers withthree or more years of home care administrative experience or upper-level management.

Northeast Home Health Leadership SummitJanuary 19 and 20 – Boston

The 2011 Northeast Home Health Leadership Summit is appropriately themed the Art of Leadership, providingattendees with the tools and techniques for future success. This premier event is attended by more than 200 homehealth agency executives from throughout New England, New York and New Jersey, with a focus, this year, onenhancing your leadership skills. The full agenda and registration information can be found on the Summit’swebsite at www.nehomehealthsummit.com.

Register for all HCA programs online, now!

Online registration is available for all of these HCA programs at www.eventville.com/hcanys, with the exceptionof the Home Care Executive Certificate Program. Further information on this program and online registration isavailable at http://www.cahsah.org/educational_events/HCECP.asp.

Brochures for these programs, along with a listing of all HCA education opportunities, can be found atwww.hcanys.org/events.cfm and through HCA’s new educational newsletter, The Educator. HCA members cansign up for a free subscription to The Educator at http://www.surveymonkey.com/s/Educatorsubscription, andnon-members can purchase individual subscriptions for only $25 annually by completing the subscription form athttp://www.hca-nys.org/EducatorSubscriptionForm.pdf. The first issue of The Educator will debut the weekof September 8.

For further information, contact Lynda Schoonbeek at [email protected].

CMS to Solicit Comments on Evaluation of Provider Performance

The U.S. Centers for Medicare and Medicaid Services (CMS) will hold a “listening session” on September 20 tosolicit input on which types of organizations may be interested in receiving data to evaluate the performance ofproviders as required by a provision of the federal health reform law (known formally as the Patient Protectionand Affordable Care Act, or PPACA) and other related issues. Organizations will also have an opportunity tosubmit written comments on this provision.

This session will also solicit input on: the criteria such organizations will have to meet for participation; proceduresfor CMS to approve interested organizations for participation; provider communities and geographic areas thatmight be served by these entities; data elements required, and the sources and types of other data that these


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organizations might match to Medicare claims; and challenges in calculating performance measures from thedata, as well as issues related to the identification, selection, and reporting of the performance measures.

Section 10332 of PPACA requires the U.S. Department of Health and Human Services (HHS) to make dataavailable – by January 1, 2012 – to qualified entities for the evaluation of the performance of providers of servicesand suppliers. A qualified entity is a public or private entity that meets qualifications established by the HHSSecretary and that proposes to use claims data to evaluate the performance of providers of services and supplierson measures of quality, efficiency, effectiveness, and resource use.

Persons interested in attending the meeting or participating by teleconference must register by completing theonline registration at http://www.cms.gov. Registration is required, as the number of call-in lines will be limited.The call-in number will be provided upon confirmation of registration.

Written comments about the implementation of this PPACA provision must be received by September 27,2010.

More information is at http://edocket.access.gpo.gov/2010/pdf/2010-21369.pdf.

PTs are Sent Comparative Billing Reports

During the week of August 9, the U.S. Centers for Medicare and Medicaid Services (CMS) mailed its first-evercomparative billing reports (CBRs) to 5,000 independent physical therapists.

The initial reports apply to outpatient physical therapy services provided by independent physical therapists andare based on 2009 Medicare claims data.

Physical therapists were chosen due to an identified vulnerability in their billing procedures centered on use of theKX modifier. The KX modifier is required to indicate that: a service was medically necessary and justified bymedical records, the physical therapy financial limitation cap was met, and a patient’s condition requires furthertreatment.

The next groups that may be targeted are hospices, chiropractors, and ambulance providers.

CMS has issued similar reports in the past, including the Program for Evaluating Payment Patterns ElectronicReport (PEPPER) sent to inpatient hospitals, and Resource-Based Relative Value Scale (RBRVS) feedbackreports sent to physicians, but this is the first time CMS has issued CBRs.

Information on the CBR program, including a frequently asked questions document, is at:http://www.safeguard-servicesllc.com/cbr/default.asp.

Documentation requirements for outpatient physical (and occupational) therapy are at:http://www.ngsmedicare.com/content.aspx?CatID=1&DOCID=22840.

For more information, contact Andrew Koski at (518) 810-0662 or [email protected].

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HHS Proposes Amendments to HIPAA Regulations

Recently, the Office for Civil Rights (OCR) issued a proposed rule setting forth modifications to the Privacy,Security and Enforcement rules issued under the Health Insurance Portability and Accountability Act of 1996(HIPAA). The proposed rule implements the changes to HIPAA that are contained in the Health InformationTechnology for Economic and Clinical Health Act (the HITECH Act).

The proposed rule would: expand individuals’ rights to access their information and restrict certain disclosuresof protected health information (PHI) to health plans; expand certain privacy requirements to business associatesof covered entities, such as patient safety organizations, which provide outcomes analysis and other data supportto health care entities; establish new limitations on the use and disclosure of PHI for marketing and fundraisingpurposes; and prohibit the sale of PHI without patient authorization.

Other key items within the proposed rule include:

• Revising the definition of business associate to include patient safety organizations, health informationorganizations, E-prescription gateways, persons who facilitate data transmission, vendors of personalhealth information, and subcontractors of a covered entity;

• Amending the definition of PHI to provide that the privacy and security rules do not protect individuallyidentifiable health information of persons who have been deceased for more than 50 years;

• Defining electronic media to reflect the current National Institute of Standards and Technology definition,including intranets and voice technology digitally produced from information systems and transmittedby phones;

• Amending the definition of workforce to clarify that the term includes employees, volunteers, traineesand other persons whose conduct in the performance of work for a business associate is under the directcontrol of the business associate;

• Holding a business associate contractually liable not only for improper uses and disclosures of PHI butalso for compliance with all other requirements of the Privacy Rule that pertain to the performance of thebusiness associate’s contract;

• Requiring material changes to the notice of privacy practices, including a statement that describes theuses and disclosures of PHI that require an individual’s authorization; and

• Providing that the noncompliance penalties could be imposed on covered entities and business associatesfor the acts of their agents, including workforce members and subcontractors acting within the scope ofthe agency.

OCR proposes a 180-day period beyond the effective date of the final rule by which covered entities and businessassociates are expected to be in compliance with the proposed rule, unless otherwise specified. In addition, theproposed rule includes a one-year transition period for compliance with the business associate contract changes.The one-year period is in addition to the 180-day compliance period. Thus, covered entities and business associateshave one year past the compliance date to renew or modify existing contracts to meet the new requirements.

For further information, please contact the HCA Policy staff.

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Get Ready for Test of Version 5010 HIPAA Transactions

Beginning January 2011, the Medicare Fee-for-Service program will be ready to test Version 5010 HIPAA (theHealth Insurance Portability and Accountability Act) transaction standards with external partners. Other industrysegments should be ready to follow suit.

Version 5010 compliance will become mandatory by January 1, 2012. Health care providers, health plans,clearinghouses and vendors should be finished with their internal testing of the Version 5010 electronic health caretransaction by December 31, 2010, which is the first recommended deadline for internal testing standards, and beready to start testing with their external partners beginning in January 2011, which is only four months away.

The latest news, along with additional information on Version 5010 and ICD-10, can be found atwww.cms.gov/icd10.

For further information, please contact Patrick Conole at (518) 810-0661 or at [email protected].

NGS Updates

National Government Services (NGS), New York’s principal regional home health intermediary, has posted thefollowing updates on its website at http://www.ngsmedicare.com.

• Claim Adjustment Reason Code, Remittance Advice Remark Code, and Medicare Remit Easy PrintUpdate – Recently, the U.S. Centers for Medicare and Medicaid Services (CMS) issued Change Request7089 (http://www.cms.gov/Transmittals/downloads/R2019CP.pdf ), which provides the latest updateof remittance advice remark codes (RARCs) and claim adjustment reason codes (CARCs), effectiveOctober 1, 2010 for Medicare. These are the changes that have been added since CR 6901. Providersshould be sure billing staff are aware of these changes.

• Medicare Secondary Payer (MSP) Teleconference – On August 31, from 1 to 2:30 p.m., NGS willprovide an MSP Conditional Billing teleconference. This session will provide instructions on how tocomplete the appropriate form locators (FLs) on the UB-04 (CMS-1450) claim form for submittingconditional claims to Medicare. Conditional claims are claims submitted to Medicare to request paymentin situations in which the primary payer has not made payment for a valid reason or in accident-relatedsituations in which the primary payer has not made payment promptly. Examples will also be reviewedduring the teleconference.

Registration for this free event is at www.NGSMedicare.com. To complete your registration, select Home Healthand Hospice as your business type, select your region (state), then select “Go.” From the Home Health and Hospiceportal page, select the Events Calendar subnavigation under the Education and Support category (on dark bluenavigation bar).

• NGS Will Be Closed in Observance of Labor Day – In observance of Labor Day, all NGS offices will beclosed on Monday, September 6, 2010. This includes the Provider Contact Center (PCC) and TelephoneReopenings Unit (TRU). The interactive voice response (IVR) system will remain open. The PCCs andTRU will reopen on Tuesday, September 7, 2010 at 8 a.m. for normal business hours.

For further information, contact HCA’s Patrick Conole at (518) 810-0661 or at [email protected].


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New Rule Announced for Medical Equipment Suppliers

This week, the U.S. Centers for Medicare and Medicaid Services (CMS) announced a new rule for suppliers ofdurable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) that adds several new standardsand strengthens existing standards which suppliers must meet before being able to furnish equipment and suppliesto Medicare beneficiaries.

All suppliers for these items, including those medical equipment items prescribed by the beneficiary’s physician– from simple canes and walkers to complex power wheelchairs, oxygen supplies and equipment, and hospitalbeds – now must meet these new standards.

This final rule will:

• Require DMEPOS suppliers to obtain oxygen from a state-licensed oxygen supplier (applies only instates that require oxygen licensure).

• Require DMEPOS suppliers to remain open to the public for at least 30 hours a week, with exceptionsfor physicians or licensed non-physician practitioners furnishing services to their own patient(s) as partof their professional service, and DMEPOS suppliers working with custom made orthotics andprosthetics.

• Ensure that DMEPOS suppliers continue to maintain ordering and referring documentation fromphysicians or non-physician practitioners.

• Prohibit DMEPOS suppliers from sharing a practice location with certain other Medicare providersand suppliers subject to certain exceptions.

The final rule also clarifies and expands the existing enrollment requirements that DMEPOS suppliers mustmeet to establish and maintain billing privileges in the Medicare program.

The final rule is at http://edocket.access.gpo.gov/2010/pdf/2010-21354.pdf.

More information is at https://www.cms.gov/apps/media/press_releases.asp (see August 26 press release).

For more information, contact a member of HCA’s Policy staff.

Insurance Plan Starts for Those with Pre-Existing Conditions

Last week, the NY Bridge Plan, an insurance policy offered by New York to people with pre-existing healthconditions, started accepting applications. It will provide coverage starting October 1, 2010.

The NY Bridge Plan will provide immediate coverage to individuals for medical expenses, including those expensesrelated to a pre-existing condition. It will cost $362 per month in upstate New York counties and $421 per monthin downstate counties. Physician services are subject a $20 co-payment and there are no deductibles.

The program was created under the federal health reform law (the Patient Protection and Affordable Care Act,or PPACA) and will end in 2014 when individuals will be able to purchase insurance through state healthinsurance exchanges, also provided for under the new law.

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To be eligible, individuals must:

• Be a legal U.S. resident.• Be a resident of New York State.• Have one or more pre-existing medical conditions.• Not have had health care coverage for the last six months.

The NY Bridge Plan covers a broad range of services, including primary and specialty care, inpatient and outpatienthospital care, and prescription drugs, as well as assistance from professional nurses and caseworkers to helpmembers manage chronic conditions and maintain overall health. The NY Bridge Plan is an Exclusive ProviderOption (EPO), which means that participants must use doctors and health care providers who are in the network,except in cases of emergency or when care is not available through a participating provider.

Group Health Incorporated (GHI) has been selected to serve as the designated non-profit contractor to operatethe Plan.

Enrollment is on a first-come, first-served basis. Once the program is full, a waiting list will be established. Foradditional information, call 1-877-444-9622, or visit www.nybridgeplan.com.

Coverage Expanded for Tobacco Cessation Counseling

The U.S. Department of Health and Human Services has announced new expanded Medicare coverage of evidence-based tobacco cessation counseling.

Previously, Medicare had covered tobacco counseling only for individuals diagnosed with a recognized tobacco-related disease or showed signs or symptoms of such a disease. Under the new coverage, any smoker covered byMedicare will be able to receive tobacco cessation counseling from a qualified physician or other Medicare-recognizedpractitioner who can work with them to help them stop using tobacco.

The new benefit will cover two individual tobacco cessation counseling attempts per year. Each attempt may includeup to four sessions, with a total annual benefit thus covering up to eight sessions per Medicare patient who usestobacco.

In addition, all Medicare beneficiaries will continue to have access to smoking-cessation prescription medicationthrough the Medicare Prescription Drug Program (Part D).

More information is at http://www.cms.gov/apps/media/press_releases.asp (see August 25 press release).

Health Resources

Publications

• “Advancing Home and Community-Based Services: Transforming Policies, Programs, and Service Deliveryin Long-Term Care,” by the National Academy on an Aging Societyhttp://www.hcbs.org/files/193/9616/PP&AR.pdf



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• “Room for Interpretation: Causes of Variation in County Medicaid Asset Transfer Rates, Opportunitiesfor Administrative Cost Reduction,” by the NYS Health Foundationhttp://www.rockinst.org/pdf/health_care/2010-08-Room_for_Interpretation.pdf

• “What Disability and Long-Term Care Risks Do Retirees Face?” by the Robert Wood Johnson Foundationand the Center for Home Care Policy and Research at the Visiting Nurse Service of New York (VNSNY)http://www.rwjf.org/reports/grr/044889.htm

• “Consumer Assessment of Health Providers and Systems (CAHPS) Update for Home Health Agencies,”by the U.S. Centers for Medicare and Medicaid Services (CMS)http://www.cms.gov/MLNMattersArticles/downloads/SE1025.pdf

• “Medicare Policy Regarding Pressure Reducing Support Surfaces,” by CMShttp://www.cms.gov/MLNMattersArticles/downloads/SE1014.pdf

• “New York Consumer Guide to Health Insurers,” by the New York State Insurance Departmenthttp://ins.state.ny.us/consumer/health/cg_health_2010.pdf

• “Step-by-step guide to enrolling in the NYSARC Pooled SNT for Medicaid spend-down (updated August),”by the Evelyn Frank Legal Resources Program of Selfhelp Community Serviceshttp://wnylc.com/health/entry/44/

• “Medicaid Reimbursement of Home Care and other Medical Expenses,” by the Evelyn Frank LegalResources Program of Selfhelp Community Serviceshttp://wnylc.com/health/entry/18/

Education

National Government Services (NGS) is holding the following sessions:

• “How to Avoid the Top Home Health Claim Submission Errors,” September 16, 2010, at 1 p.m.• “How to Avoid the Top Hospice Claim Submission Errors,” September 14, 2010, at 1 p.m.• “Home Health Billing Basics,” September 23, 2010, at 1 p.m.

To register, visit: www.NGSMedicare.com; choose Home Health and Hospice and your state (Region) and select “Go.” Select theCalendar of Events option under the Education and Support category (on dark blue navigation bar).

• “Hoarding Behavior Among Older Adults,” October 12, 1:30 to 3 p.m., by the Geriatric Mental HealthAlliance

http://www.mhaofnyc.org/advocacy/geriatric-mental-health-alliance-of-new-york/upcoming-events.aspx


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Patient Service Manager –Patient Service Manager –Patient Service Manager –Patient Service Manager –Patient Service Manager –Quality Management/EducationQuality Management/EducationQuality Management/EducationQuality Management/EducationQuality Management/Education

Make the most of your career with Montefiore Home Care.Accredited by the Joint Commission, this Center ofExcellence serves residents in the Bronx and WestchesterCounty during all stages of life in the comfort of their ownhomes. Through a deep commitment to high-quality service,we have become one of the most respected homehealthcare programs in the country. Currently, we are lookingfor a Patient Service Manager of Quality Management/Patient Service Manager of Quality Management/Patient Service Manager of Quality Management/Patient Service Manager of Quality Management/Patient Service Manager of Quality Management/Education Education Education Education Education to help us build on this continued success.

In this position, the selected candidate will serve as a qualityimprovement and educational resource for our staff.Responsibilities include: developing and implementingquality improvement activities, including staff education, tomaintain high-quality care; monitoring occurrences;reporting on complaints and concerns; and overseeingclinical documentation reviews and audits.

Qualified applicants will have a BSN (Master’s degree inNursing or Nursing Education is preferred); 2 years’experience as a community health nurse for a CertifiedHome Health Agency or Long Term Home Health CareProgram; and 1 year of patient service managementexperience (ideally in quality management/education). Anequivalent combination of education and experience will beconsidered. Current NYS RN licensure is also required.Preferred applicants will have 1 year of supervisoryexperience.

In return, we offer a competitive salary and a comprehensivebenefits package. To find out more, please send yourresume with current salary information, indicating position ofinterest, to: Tisa Hall, Montefiore Medical Center, HumanResources, One Fordham Plaza, Suite 1100, Bronx, NY10458, fax 718-562-4180, or email to: [email protected] equal opportunity employer.

Hiring Announcements

Occupational Therapists (2 Positions)Occupational Therapists (2 Positions)Occupational Therapists (2 Positions)Occupational Therapists (2 Positions)Occupational Therapists (2 Positions)

Position DescriptionPosition DescriptionPosition DescriptionPosition DescriptionPosition Description

• Provides occupational therapy services in accordance with the physician’s plan of care.

• Assists the physician in assessing the patient’s functional level by applying appropriate tests andmeasurements, and advises the physician in the development and revision of the plan of care.

• Evaluates the patient’s abilities and disabilities pertaining to sensory, fine motor function,developmental delays and functional status.

• Treats patients through the use of therapeutic activities to relieve pain, develop and restorefunction, attain and maintain maximum performance, and utilize adaptive equipment within thefunctional limitations of the patient and in accordance with the plan of care.

• Observes, documents and reportsthe patient’s responses totreatment and any change in thepatient’s condition to the physician,and/or the coordinator of care.

• Evaluates need for adaptiveequipment and orders and/orfabricates adaptive/assistivedevices and equipment and trainsthe patient in the safe and effectiveuse of the equipment.

• Instructs and advises patients,family members and other homehealth personnel in: the phases ofphysical therapy in which they mayassist the patient; the safe use ofassistive devices; and thecompletion of the home exerciseprogram.

• Demonstrates and teachesalternate techniques to perform theactivities of daily living, transfers,and mobility and positioning.

• Regularly reviews the rehabilitationneeds of patients; initiates, notifiesthe coordinator of care and/or thephysician of the need for revisionsof the patient’s plan of care.Ensures that the plan of careaddresses all problems identifiedduring the evaluation ordemonstrates rationale for notdoing so.


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• Initiates diagnostic, preventative and rehabilitative procedures as appropriate to the patient’scare and safety. Makes referrals to other disciplines as indicated by the needs of the patients ordocuments rationale for not doing so.

• Observes signs and symptoms and reports to the physician and/or other appropriate healthprofessionals as often as needed or as dictated by the changes in the patient’s condition.

• Assists with the coordination of the plan of care and maintains continuity of patient carethrough interdisciplinary coordination with the other health professionals by attending patientcare conferences.

• Teaches, supervises and counsels the patient and designated caregiver regarding home careprocedures as appropriate to the patient’s condition.

• Develops, prepares and maintains individualized patient care documentation with accuracy,timeliness and in accordance with the Corporation’s policies.

Qualification RequirementsQualification RequirementsQualification RequirementsQualification RequirementsQualification Requirements

1. New York State license and current registration to practice as an Occupational Therapist;and

2. One year of post license experience as an Occupational Therapist.

Interested candidates should apply online by visiting: employment.nychhc.org/homecareemployment.nychhc.org/homecareemployment.nychhc.org/homecareemployment.nychhc.org/homecareemployment.nychhc.org/homecare

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