hca-nys - docs & f2f home care bills salary...
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COMING UP
INSIDE
Your Source for HOME CARE News, Policy and Advocacy Vol. 2, Issue 18 | May 1, 2017
Rediscover,Reimagine,Reinvent at HCA’sAnnual Conferencein SaratogaSaratogaSprings, NYMay 3 to 5
Moving BeyondPersonal Care toMeet the Challenge& Opportunities ofValue-Based CareNew York City, NYMay 18, 2017
For moreinformation on theseand other programs,please visit theeducation andevents section ofHCA’s website athttp://hca-nys.org/events-education/upcoming-events
See COURT p. 2 See HOSPICE p. 4
Proposed 2018 HospicePayment Rule WouldIncrease Payments by $180M
On April 27, the U.S. Centers forMedicare and Medicaid Services (CMS)issued a proposed rule (CMS-1675-P)updating the Medicare hospice wageindex and cap amount for fiscal year(FY) 2018.
HCA Continues to Press Advocacyon 24-Hour/Live-in Care Issue inWake of Court Ruling
Throughout the past week, HCA has continuedour strong advocacy on a labor issue that hasthe potential to upend the delivery of homecare services in New York State, along withaspects of the budget and government. The
Proposed 2018 Hospice Rule Would Increase Payments by $180M...............…1HCA Continues Advocacy on 24-Hour/Live-in Care Issue...................................1MLTC Tech Demo Awards Announced.....................................................................3A Message from HCA Sponsor Sandata............................................................3Home Care Legislation Advancing in Post-Budget Legislative Session.............4Member Hiring Announcement......................................................................5HCA Supports Legislation to Change FI Authorization Process..........................6State Medical Society Engaging AMA Support for Relief of F2F Requirements.....6DOH Schedules Health Commerce System Maintenance for May 6...................8Make Your Emergency Preparedness Plan CoP-Ready on June 28.....................8
Worker’s Compensation Reforms Outlined.......................................................9Legislation Passed to Limit Salary History Information.....................................9Webinar on Financial Management Aspects of the New OASIS C2.......................9HCA Advocates for Patient Care Transition Alerts to Home Care........................11New Transportation Manager for NYC.............................................................12VBP Prep/Strategy Session for LHCSAs on May 18.............................................13Updated Advance Beneficiary Notice Posted..................................................14CMS Releases Updated Hospice PEPPER Reports.............................................14Health Workforce Study Released..................................................................15NGS Updates.................................................................................................15
EP PROGRAM
New program: on June 28, HCAis hosting a comprehensiveprogram to ready you for thenew federal emergencypreparedness regulations.
DOCs & F2F
The state’s Medical Societypasses a resolution to takea strong position onseeking a streamlined F2Frule.
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SALARY HISTORY BILL
New York’s City Council passeslegislation placing limits on thetypes of inquiries that employerscan make about an applicant’ssalary history.
HOME CARE BILLS
Community Paramedicine billadvances, as does legislation tochange the Fiscal Intermediaryauthorization statute from thenew state budget.
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Can’t Make the Full HCA Annual Conference This Week? No Problem!Don’t Miss Out! Register A-la-carte for the Pre-Conference, Thursday or Friday Sessions
HCA’s signature Annual Conference starts on Wednesday in Saratoga. With just a few daysleft, there’s still time – but the window is closing – to attend by completing the onlineregistration or completing the PDF registration form at www.hcaannualconference.com.While we recommend attending the entire conference, those who are unable to do so canpick a day rate for Wednesday, Thursday or Friday by downloading the PDFregistration form, noting which day you wish to attend and faxing the form back toHCA at (518) 426-8788. Check out the full agenda on page 16, and we look forward toseeing you in Saratoga! See CONFERENCE p. 16
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The Situation Report is a weeklypublication of the Home CareAssociation of New York State(HCA). Unless otherwise noted, allarticles appearing in The SituationReport are the property of theHome Care Association of NewYork State. Reuse of any contentwithin this newsletter requirespermission from HCA.
Joanne CunninghamHCA President
Roger L. NoyesDirector of Communications,Editor of The Situation Report
Al CardilloExecutive V ice President
Patrick ConoleVice President,
Finance & [email protected]
Andrew KoskiVice President,
Program, Policy & [email protected]
Alexandra Fitz BlaisDirector of Public Policy
Laura Constable Senior Director,
Membership & [email protected]
Celisia StreetDirector of Education
Mercedes Teague Finance Manager
Jenny KerbeinDirector of Governance &
Special [email protected]
Billi Wilson Manager, Meetings & Events
Teresa BrownAdministrative Assistant
Volume 2, No. 18 May 1, 2017
Home Care Association of New York State (HCA)388 Broadway, 4th Floor, Albany, NY 12207
Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org
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COURT from p. 1
issue has arisen in the aftermath of a State Supreme Court ruling inTokhtaman v. Human Care, LLC, which impacts home care agenciesand managed care plans that provide 24-hour “live-in” home careservices.
As a follow-up to our well-attended members-only conference callon the recent court decision, HCA and other Associations met viaconference call to discuss a joint action plan regarding this andother related court cases. Additionally, last week we announcedfurther education programs with the same focus.
During the recent joint Association meeting, a number of issueswere discussed, including:
Potential costs to the state Medicaid budget if live-ins mustbe paid for 24 hours;
Debilitating impact on home care agencies that would notbe able to make potential retroactive payments and/orprovide 24-hour live-in care without adequatereimbursement;
Deleterious effect on managed care plans unless the stateincreased their premiums accordingly;
Whether and how the Olmstead decision (requiring care inthe least restrictive setting) affects any efforts to limit careat home or in other settings; and
How a ruling against the defendants would affect a stateagency’s right to interpret its own regulations.
HCA has previously requested a meeting with the state Department ofHealth to discuss these court decisions, and we’ve invited the otherAssociations on the call to be part of this potential meeting.
Last week, HCA also conferenced with the Littler law firm, which is thenew counsel for the defendant in Tokhtaman. Littler is planning toappeal the decision to the New York State Supreme Court, AppellateDivision, 1st Department and, if unsuccessful, then to the Court ofAppeals. We discussed actions that HCA and the home care industrycould take, including amicus briefs, and meetings with state officials.
As announced in an Alert on April 25, HCA has added opportunitiesto discuss the provision of 24-hour live-in care at two separate
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sessions of HCA’s Annual Conference on May 3 to May 5 in Saratoga Springs, New York – later this week.
First, during HCA’s Board of Directors Meeting on May 3 at the Conference, Sean Doolan, Principal at the AlbanyLaw Firm of Hinman Straub and HCA’s Government Relations representative, will discuss the issues surroundingthe Court’s ruling, and HCA’s advocacy strategy on this important issue.
In addition, Frank Fanshawe, attorney at law at Jackson Lewis and HCA’s legal counsel, will participate in HCA’s“Town Hall Meeting” conference session on May 5, from 7:30 to 8:30 a.m., to discuss the legal ramifications,risk areas for members related to this latest ruling, and how best to position your organization during this timeof uncertainty.
HCA has also shared with members a Hinman Straub memorandum on this issue (http://hca-nys.org/wp-content/uploads/2017/04/Memo-Summary-of-Tokhtaman-case.pdf), outlining the action taken in this case by the StateSupreme Court, implications of the decision, its potential impact on providers, and plans and next steps.
A message from HCA sponsor SandataMLTC Tech Demo Awards Announced
Last week, the state Department of Health(DOH), Office of Health Insurance Programs(OHIP), Division of Long Term Care (DLTC),announced that, under a previous RFP, twoMLTC plans have been awarded contracts for atwo year technology demonstration. VisitingNurse Association of Central NY and Hamaspik,Choice Inc. have been awarded a total amountof $1,000,000 for these purposes as part of ademonstration from January 1, 2017 throughDecember 31, 2018.
DOH states that the overall goal of the MLTCTechnology Demonstration is to test whetherthe use of technology in the home andcommunity based setting is successful inkeeping patients there.
The two awardees will utilize several new andemerging technologies to enhance the longterm care of their enrollees in the community inan effort to improve safety and independence.The results will inform future policy directionfor DOH related to the use of assistivetechnologies in the home and communitybased sector.
For more information on the MLTC TechnologyDemonstration, please follow the link:http://www.leadingageny.org/?LinkServID=4C926C7D-ADB9-9D64-CB4C8EBF97D3AE0B
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CMS expects to publish the proposed rule in the Federal Register on May 3.
As proposed, hospices nationally would see an estimated 1.0 percent ($180 million) increase in Medicarepayments for FY 2018. The rule also updates the Hospice Wage Index and solicits comments regarding thesources of clinical information for certifying terminal illness. In addition, it proposes changes to theHospice Quality Reporting Program (Hospice QRP), including new quality measures utilizing data collectedin the Hospice CAHPS Survey.
CMS’s proposed rule also discusses new quality measure concepts under consideration for future years,solicits feedback on an enhanced data collection instrument, and describes plans to publicly display qualitymeasure data via the Hospice Compare website in 2017.
HCA will be reviewing the proposed rule in further detail and will provide the membership with additionalinformation in the near future.
For further information, contact Patrick Conole at (518) 810-0661 or [email protected].
Home Care Legislation Advancing in Post-Budget Legislative Session
As the State Legislature has resumed session in the wake of the budget’s adoption, bills of directimplication to home care have emerged and are already advancing.
These include legislation to authorize collaborative models of community paramedicine; to delay theimplementation of the new budget provisions for Consumer Directed Personal Assistance Program FiscalIntermediaries (see related p. 6 story); and to support health information and clinical technology forhome care (see related p. 11 story).
Community Paramedicine
Senate Health Chairman Kemp Hannon and Assembly Health Chairman Richard Gottfried haveintroduced HCA’s version of a community paramedicine program that has garnered the support ofmultiple associations as well as many in the EMS community. The legislation is S.5588 (Hannon) andA.2733-A (Gottfried).
This past week, the Senate favorably voted the bill from the Senate Health Committee and advanced itto the Senate Calendar where it is now positioned for a full Senate vote as soon as this week. TheAssembly version is currently in the Assembly Health Committee.
The bill would create a section within the Hospital-Homecare-Physician Collaboration Program law(authored in 2015 by HCA and the Iroquois Healthcare Alliance, which is the upstate hospitalassociation) to include among the collaborative models a Hospital-Homecare-Physician-EMS model forcommunity paramedicine. Under this model, home care and partners would be permitted to design andimplement a mutual plan that would enable EMS support in addition to strict emergency response and
HOSPICE from p. 1
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transport, for purposes of supporting patients, including averting emergencies and transport, andpreventing avoidable emergency room and hospital use.
Unlike the community paramedicine legislation opposed by HCA, other provider associations and thenurses’ association two years ago, this legislation does not allow a paramedicine model that violatesother jurisdictions, including article thirty-six or practitioner licensure, and establishes upfront a designprocess intended to ensure clinical and program coordination across all relevant providers, a majoromission from the opposed proposal.
The expanse of support for this HCA-drawn solution is providing significant momentum for passage. Thedesign is in sync with the move to integrated models of care, including the Delivery System ReformIncentive Payment (DSRIP) program and Value Based Payments (VBPs). It creates opportunities for homecare agencies (and home care partners, like MLTCs, hospices and others) to develop programs thataddress high priority patient and system goals, leading to potential dramatic cost-savings. The model isnot limited to Medicare or Medicaid, and stands to be of substantial interest to commercial insurers andhealth plans, along with bundled payment models.
The legislation wasincluded previously in theSenate’s one-house budgetbill. The Senate pressedhard for adoption as partof the budget, but theproposal was tabled fromthe final budget along witha host of other itemswithout immediate budgetimpact. This was due tothe decision to limit majorfiscal items in theavailable timetable for theclosing budgetdiscussions.
HCA’s memorandum onthis bill can be viewed athttp://hca-nys.org/wp-content/uploads/2017/04/HCA-Memo-Support-S5588Hannon-A2733AGottfried-Community-Para-2017.pdf.
For further information,contact Al Cardillo [email protected].
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HCA Supports Legislation to Change Fiscal Intermediary Authorization ProcessImplemented in State Budget
HCA is supporting efforts to change a provision in this year’s final state budget regarding an authorizationprocess for fiscal intermediaries (FIs) involved in consumer directed personal assistance services, effectiveApril 1, 2017.
During the legislative process, when this concept was first proposed, HCA advocated for changes in theproposal to streamline such an authorization process for those Licensed Home Care Services Agencies(LHCSAs) who provided FI services, in recognition of the fact that they already met many of the newrequirements. We also pushed for a reasonable time period to allow existing FIs to continue to operatebefore they had to obtain the state’s authorization.
While the one-house Assembly and Senate bills both included a one-year “grace period” to allow existingFIs to obtain such authorization, the final budget did not include this language or our other suggestedrevisions.
This week, HCA issued memos in support of legislation (S.5544 Hannon/A.7216 Gottfried) that would movethe effective date of this new requirement to January 1, 2018 and provide a one-year grace period so thatentities operating as FIs prior to April 1, 2017 could continue to provide services without any interruption topatient care during the time that they sought to obtain this newly required DOH authorization.
This bill was on both the Senate and Assembly Health Committees’ respective agendas this week and wasreported out. We will inform members of the status of these bills as they are further considered in thelegislative process.
For more information, contact Andrew Koski at (518) 810-0662 or [email protected].
State Medical Society Engaging AMA Support for Relief of F2F RequirementsFace-to-Face requirements for Medicaid cases still set for July 1 enforcement
As HCA has reported since September, a special joint task force of the Medical Society of the State of NewYork (MSSNY) and HCA has been working to support and promote physician-homecare agency engagement.
Taking aim at one of the most pressing obstacles for patients, physicians and home care agencies, MSSNYhas advanced a formal resolution recommended by the task force tasking MSSNY to work with theAmerican Medical Association (AMA) to achieve relief in the federal Face-to-Face (F2F) requirements.
The resolution states:
RESOLVED, that the Medical Society of the State of New York work with the American Medical Associationto advocate to simplify the Medicare requirements for a “Face to Face” visit by a physician to a patient as aprecondition for Medicare home health coverage, including advocating for alternatives for such “Face to
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Face” visit such as by telehealth; and be it further RESOLVED, that the New York delegation present thisresolution at the 2017 AMA House of Delegates
This engagement brings in critical voices and allies to the advocacy process on F2F. HCA is extremely gratefulfor MSSNY’s support on this issue, as well as its support broadly in conducting the joint Medical Society-Home Care Association task force. The task force is chaired by MSSNY Long Term Care Committee Chair, Dr.Evelyn Dooley-Seidman. It is comprised of an expert team of MSSNY home care and long term carephysicians; representatives of HCA’s home care and MLTC members; as well as the associations’ policy andexecutive staffs.
Face-to-Face for Medicaid Cases
In a meeting this week with state Department of Health (DOH) officials, HCA confirmed the still-anticipated July 1 date for enforcement of F2F requirements for Medicaid cases, adding the Medicaidmandate alongside the existing requirements for Medicare cases.
With all new Federal regulations under scrutiny by the Trump Administration and Congress, and thusopportunity for change, we continue to press for reconsideration, repeal, or at least streamlining of F2F andall other areas of regulatory overburden. However, until and unless HCA and DOH are advised otherwise,home care and physicians face the July 1 Medicaid enforcement date.
HCA has drafted, for MSSNY and its task force’s review, a set of streamlined procedures that our associationscould co-endorse for Medicaid Face-to-Face compliance. Upon task force agreement, the procedures wouldbe relayed to DOH as a guidance document the Department would use to implement Medicaid F2F in amanner that would minimize the logistical layers and burdens, and maximize accommodation of patients andproviders. HCA discussed this plan with DOH this week, and DOH agreed to review and consider.
HCA discussions with hospitals to standardize F2F elements within EHRs
Simultaneous with our task force, and our other state and federal activities, HCA has reengaged with thestate hospital association on an initiative which we have worked on the past two years to try to create astandardized addendum to the physician/hospital record that would satisfy all of the required F2F andmedical eligibility documentation for home care. A workgroup of HCA had created this addendum andpresented it to the Fiscal Intermediary (FI), National Government Services (NGS), for affirmation. The FIindicated that audits would still probe the overall record for compliance, thus limiting the addendum as asole solution for streamlined documentation.
At its last meeting, the HCA-MSSNY task force discussed the merit of approaching the state and regionalhospital associations to discuss interest in promoting electronic health record (EHR) integration of theelements of the addendum, so that all of the requisite documentation for home care F2F and eligibility wouldbe populated within the record itself, rather than only in an addendum.
HCA has approached the state hospital association, begun preliminary discussions, and is now preparingrequested information for the hospital association’s further evaluation of our proposal.
HCA will maintain our efforts at every level to resolve this major priority need for home care.
For further information, please contact Al Cardillo ([email protected]), Patrick Conole([email protected]), or Joanne Cunningham ([email protected]).
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DOH Schedules HealthCommerce SystemMaintenance for May 6
The state Department ofHealth (DOH) will beconducting systemmaintenance on the HealthCommerce System (HCS)beginning at 3 p.m. onSaturday, May 6.
Critical applications (thosewhich can be found at https://commerce.health.state.ny.us/hcs/drapps.html) will beavailable following a shortdowntime. Other non-criticalapplications and services willbe unavailable fromapproximately 3 p.m. onSaturday, May 6, until 3 a.m.on Sunday, May 7. A reminderabout this system maintenancewill be displayed on the HCSuntil maintenance is complete.
The Commerce AccountsManagement Unit (CAMU) willbe available during themaintenance. If you haveissues accessing HCSapplications during themaintenance, please callCAMU at 1-866-529-1890.
Further question or concernsabout this maintenance can besent to the following address:[email protected].
Make Your Emergency Preparedness Plan CoP-Ready on June 28
The new federal Conditions of Participation (CoP), along with aseparate federal rule, haveestablished sweeping newemergency preparednessrequirements for 17 types ofproviders, including home careand hospice – an historical first!
This regulation goes into effecton November 16, despite a delayin other CoP provisions for homehealth, requiring providers to planadequately for natural and man-made disasters, with a specificfocus on patients and employees.
On June 28, in Suffern, NY(conveniently located for upstateand downstate agencies alike),HCA is hosting RBC President andemergency preparedness expert Barbara Citarella for acomprehensive workshop to assist agencies in: understanding thefour major components of this regulation; planning for continuity ofoperations (COOP); operationalizing policies and procedures;communication; and conducting/testing a training program relatedto your emergency plans.
An agency’s entire emergency plan must be built on a hazardvulnerability assessment platform using an all-hazards approach toensure continuity of services to patients. In addition, planning andcommunication should include a collaborative partnership with ahealth care coalition. This session will focus on the majorcomponents of COOP and its correlation to the new EmergencyPreparedness (EP) regulations.
Learn more and register by downloading the form at http://hca-nys.org/wp-content/uploads/2017/04/Make-Your-EP-Plan-CoP-Ready-June-28-2017.pdf.
Make Your Emergency Preparedness Plan CoP-Ready!June 28, 2017Crowne Plaza Hotel3 Executive BoulevardSuffern, NY 10901
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Worker’s CompensationReforms Outlined
The state Workers’ Compensation Board hasposted information on Workers’ Compensationreforms that were part of the final state budget.
These included: capping classification ofMaximum Medical Improvement at 2.5 years bycreating a credit to employers for temporarypayments beyond the threshold; the guaranteeddevelopment of new Impairment Guidelines, tobe adopted by January 1, 2018, which will adhereto modern medical evidence and modern medicaloutcomes; and the issuance of a pharmaceuticalformulary by the Workers’ Compensation Boardby December 31, 2017.
The Board has posted a summary of the reforms(http://www.wcb.ny.gov/content/main/SubjectNos/sn046_936.jsp); information on theextreme hardship redetermination procedure(http://www.wcb.ny.gov/content/main/SubjectNos/sn046_938.jsp); and material onurgent hearings where the claimant is not beingpaid (http://www.wcb.ny.gov/content/main/SubjectNos/sn046_937.jsp).
Legislation Passed to LimitSalary History Information
The New York City Council has approvedlegislation prohibiting employers from inquiringabout, relying upon, and verifying a jobapplicant’s salary history.
The legislation, Int. 1253-A, is at http://legistar.council.nyc.gov/View.ashx?M=F&ID=5083445&GUID=1CDC0DBF-2D3E-4458-9657-8F560D3C1847.
Mayor Bill de Blasio is expected to sign the billsoon; it will be effective 180 days after it issigned. Int. 1253-A prohibits employers frominquiring about a prospective employee’s salaryhistory during all stages of the employment
New Webinar on FinancialManagement Aspects of the NewOASIS C2Webinar is open to all, but is free of charge tomembers who attended HCA’s Senior FinancialManagers Forum in April
On May 11, HCA is offering a unique webinaropportunity for all members, but it’s free of chargefor those who attended or paid for our AprilSenior Financial Managers Forum. The webinar, onFinancial Management Aspects of the New OASISC2, was originally scheduled as part of the AprilForum; but flight delays prevented our speakerfrom presenting.
This is why HCA has invited Melinda Gaboury – afavorite national speaker and the cofounder andChief Executive Officer of Healthcare ProviderSolutions, Inc. (HPS) – to present the session as awebinar on May 11, free for those who attendedthe Senior Financial Managers Forum, as well asfor a small fee open to all other registrants.
All health care finance managers know theimportant connection between clinician activitiesand budgeting. Now that the OASIS C2 is in effect,this parallel understanding of clinician assessmentprocedures and their cost impact will help drivetop-to-bottom improvements in the function andefficiency of your organization.
During this webinar, Ms. Gaboury will review howto calculate the HHRG, corresponding HIPPS codeand determine case-mix weight, all of which arefundamental to a home care agency’s operation-wide understanding of the clinician’s role in patientcare and financial outcomes. The webinar will alsoestablish processes that agencies need tostrengthen regarding OASIS-C2 completion andreview, as well as the specific OASIS-C2 M itemsthat have a direct impact on patient outcomes andcosts.
Learn more and register at http://hca-nys.org/wp-content/uploads/2017/04/Financial-Mgmt-Aspects-of-New-OASIS-C2-Webinar.pdf.Continued on next page
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process. It would prohibit an employer, employment agency, employee, or agent from:
1. Inquiring about the salary history of a job applicant; and/or
2. Relying on the salary history of a job applicant when determining the salary, benefits or othercompensation for the applicant during the hiring process, including the negotiation of a contract.
The legislation defines “to inquire” as communications with the applicant, a current or prior employer, oran agent of a current or former employer on salary history. It also refers to conducting “a search ofpublicly available records or reports for the purpose of obtaining an applicant’s salary history.”
“Salary history” includes the applicant’s current or prior wage, benefits, or other compensation. It does notinclude any objective measure of the applicant’s productivity, such as revenue, sales, or other productionreports.
There are some exceptions that employers should be aware of:
1. If applicants voluntarily and without prompting disclose their salary history to the prospectiveemployer, an employer is permitted to consider salary history in determining a prospectiveemployee’s salary, benefits, and other compensation, and may verify a job applicant’s salaryhistory.
2. An employer, without inquiring about salary history, also is permitted to discuss salary, benefits,and other compensation expectations with the applicant, as well as any unvested equity ordeferred compensation the applicant would forfeit or have cancelled by resigning his or her currentemployment.
3. The legislation does not apply to current employees applying for an internal promotion or transfer.
4. It does not apply to New York City employers acting pursuant to any federal, state or local lawauthorizing the disclosure or verification of salary history or requiring knowledge of salary historyto determine an employee’s compensation.
Should an employer’s attempt to verify an applicant’s non-salary-related information or conduct abackground check result in disclosure of the applicant’s salary history, the employer is prohibited fromrelying on the salary information during the hiring process and contract negotiation stages when settingthe salary, benefits, or other compensation of the applicant.
Home care providers should review their employment practices to ensure that they conform to thislegislation if and once it becomes effective. HCA will notify members when it is signed.
This article is based on information provided by Jackson Lewis, the firm that employs HCA’s counsel.
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HCA Advocates for Proposed New Rules to Provide Patient Care Transition Alertsto Home CareHCA Home Care Technology Act legislation, other proposals and efforts gaining ground
HCA and our Technology Committee have been working closely with the leaders of the New York e-HealthCollaborative (NYeC) to garner support for home care’s capacity in health information technology (HIT) andhealth information exchange (HIE).
HCA’s committee also continues to directly develop proposals for HIT/HIE and clinical technology. These aremajor priorities for home care and its capabilities within managed care, DSRIP, VBP, ACOs and virtually allnew, integrated and evidenced-based models of care and payment.
HCA’s representatives have served on the state HIT Infrastructure Committee and have worked diligentlyfrom all angles to try to ensure that home care – long overlooked for federal and state HIT investments – isgiven due consideration throughout state policy and financing. Selfhelp Vice President, Russell Lusak, anHCA representative on both HCA’s and the state’s technology committees, is a recipient of this year’s HCAAdvocacy Award for his continuous and effective advocacy for HIT and HIE support for home care.
This past Thursday, HCA submitted comments and recommendations on a proposed State Health InformationNetwork-New York (“SHIN-NY”) rule change. HCA requested that the rule include home care among theprovider types enabled to receive “Patient Care Alerts” upon significant changes in status (e.g., ahospitalization, or transport to the emergency room). Providers would receive alerts by participating in theirregional health information organization (RHIO), or another qualified entity (QE) similarly authorized as aregional health information network under the SHIN-NY.
HCA continues to work with state and regional leaders to map out streamlined participation in RHIOs andQEs for home care and hospice. In the coming weeks, HCA’s committee will be pursuing steps we havediscussed with state leaders, as the timetable of RHIO and SHIN-NY activity opens up for theseopportunities.
In addition, HCA also commented on and supported approval of the proposed SHIN-NY rule change related topatient consent to participation in health information sharing with relevant providers via the SHIN-NY. Theproposed change simplifies and streamlines the consent process for both patients and providers. Complicated and duplicative consent processes can significantly obstruct access to timely and criticalinformation for patient care. It also adds to mounting provider administrative burdens and costs, as well aspatient frustration with the number of forms to complete.
HCA Home Care Technology Act: A.5046-A
In a related matter, HCA legislation called the “Home Health Information and Clinical Technology Act,”introduced earlier this session by Assembly Health Committee Chairman Richard Gottfried, is currently in theAssembly Ways and Means Committee.
The bill has now been amended with a technical date change that would help position it for possible post-budget consideration.
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This bill would provide a host of state policy and finance mechanisms to support health information andclinical technology for certified home health agencies, licensed home care services agencies, long termhome health care program providers, and managed long term care plans. Its features range from capitalgrants, to rate and premium adjustments, to quality incentive payments, to workforce training funds fortechnology, to funding from the Health Care Reform Act.
In addition, HCA was successful in working with partners to gain a minimum $75 million set-aside in the newbudget for a Health Care Facility Transformation Program, which would be available for home care and othercommunity health providers, and should be able to be tapped for HIT-HIE infrastructure.
New York State needs a comprehensive plan for the support of home care technology capacity, includingexpansion to connect critical allied community based support services (covering social determinants ofhealth) into the information network.
HCA Technology Survey
To effectively profile and advocate home care’s HIT-HIE need, HCA needs your engagement! HCA recentlysent an alert requesting provider participation in a vital HIT-HIE survey. The information from this survey isneeded to support the above efforts, and more, including demonstrating the need for investment to stateofficials. The survey is at https://www.surveymonkey.com/r/79MHQ9J. HCA appreciates the responses wehave received thus far. If you are a CHHA, LHCSA or LTHHCP and have not yet completed this survey, pleasecomplete and return it ASAP. The survey only takes a few minutes and its value is significant to ouradvocacy effort.
For further information, please contact Al Cardillo at [email protected] or Alex Fitz Blais [email protected].
New Transportation Manager for NYC
The state Department of Health has announced a contract award to Medical Answering Services, LLC (MAS)as the new Medicaid transportation manager for the New York City (NYC) region, which includes: Manhattan,Brooklyn, Bronx, Staten Island, and Queens, effective April 23, 2017.
In NYC, MAS will be responsible for administering, prior approving, and coordinating non-emergency medicaltransportation for Medicaid fee-for-service and mainstream managed care enrollees at the most medicallyappropriate, cost effective mode of transport. Dual eligible (Medicare and Medicaid) consumers enrolled ineither a Managed Long Term Care plan (Partial Cap, PACE, Medicaid Advantage Plus) or a MedicaidAdvantage Plan) will continue to receive their non-emergency medical transportation services through theirplans.
MAS is currently the Medicaid transportation manager for the Hudson Valley, Finger Lakes, Northern New Yorkand Western New York regions and has been providing services to over 2 million Medicaid enrollees in 55counties.
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Volume 2, No. 18 May 1, 2017
VBP Prep/Strategy Session for LHCSAs on May 18
Andrea Brown, President and CEO of AB Coaching and Consulting, is back on May 18 in New York City,presenting for a LHCSA-focused program to help your organization seize opportunities and meet thechallenges of value-based care. The program, Moving Beyond Personal Care to Meet the Challenges andOpportunities of Value-Based Care, is part of HCA’s popular bootcamp series.
To gain visibility and leverage in the new payment and care-delivery paradigms, LHCSAs, with AndreaBrown’s help, should consider fine-tuning their operations to make them congruent with the structures ofreimbursement models governing managed long term care. On May 18, she’ll:
Review managed care plan metrics and their rating system to identify specific metrics that LHCSAoperations can positively impact as part of the LHCSA value-proposition pitch to plan managers;
Help delineate the various roles, standards of service, and documentation in the coordination ofLHCSA and MLTC plan operations; and
Review clinical operations and other changes that clinical staff can make in the delivery of care,paraprofessional staff supervision, and paraprofessional education to enhance operationalefficiency, ensure compliance with regulations, and enhance quality.
More information and a registration form are in the flyer at http://hca-nys.org/wp-content/uploads/2017/03/HCA-Bootcamp-Moving-Beyond-Personal-Care-May-18-2017.pdf.
Enrollees who are unable to utilize mass transit must ask their medical practitioner to request theirtransportation from MAS for their first trip. Subsequent trip requests will require medical practitionersto complete and sign a medical justification form (2015 form).
Upon receipt of the 2015 form from the medical practitioner, the information will be reviewed and therequest for prior authorization for non-emergency transportation will be approved or denied based uponstate Medicaid program criteria. The 2015 form and associated documentation will be uploaded andretained in the MAS system for future reference. MAS will seek a new medical justification form for anenrollee anytime a change in their health status necessitates a change to their mode of transport.
If a medical practitioner has previously requested transportation for an enrollee and has already completedthe 2015 form, and the medical needs of the enrollee have not changed, the enrollee may book the ridedirectly with MAS.
MAS can be contacted at 1-844-666-6270; its website is www.medanswering.com.
More information is in a NYC Human Resources Administration April 26 Medicaid Alert at http://a069-marc.nyc.gov/marc/default.aspx (registration required).
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Volume 2, No. 18 May 1, 2017
Updated Advance Beneficiary Notice PostedMust be used by June 21
In March 2017, the Office of Management and Budget approved the Advance Beneficiary Notice of Noncoverage(ABN) Form CMS-R-131 for another 3 years.
There are no changes to the form, except the new expiration date of March 2020, and a non-substantive changeto include language informing beneficiaries of their rights to CMS nondiscrimination practices and how torequest the ABN in an alternative format if needed.
Starting June 21, 2017, you must use the most recent version of the CMS-R-131 to deliver a valid ABN; however,you may begin using the new form immediately. The ABN is a notice given to beneficiaries in fee-for-service Medicare to convey that Medicare is not likely toprovide coverage in a specific case. It must be delivered to affected beneficiaries or their representative beforeproviding the items or services that are the subject of the notice. For more information, including the new formand instructions, go to https://www.cms.gov/MEDICARE/medicare-general-information/bni/abn.html.
Questions regarding the ABN can be e-mailed to [email protected] (please copy Andrew Koski [email protected]).
CMS Releases Updated Hospice PEPPER Reports
The U.S. Centers for Medicare and Medicaid Services (CMS) recently released, via the TMF Health QualityInstitute, the fourth quarter fiscal year (FY) 2016 Hospice Program for Evaluating Payment Patterns ElectronicReport (PEPPER), summarizing statistics for FYs 2014, 2015, and 2016 (through September 2016). PEPPERprovides provider-specific Medicare data statistics for discharges/services vulnerable to improper payments.PEPPER can support a provider’s compliance efforts by identifying where it is an outlier for these risk areas. Thisdata can help identify both potential overpayments as well as potential underpayments.
Since its release, 32 percent of Medicare-certified hospice providers have downloaded the updated PEPPER. Ifan HCA hospice member has not yet downloaded its PEPPER, it is available for download through the PEPPERResources Portal. To obtain your hospice’s PEPPER, the Chief Executive Officer, President, Administrator orCompliance Officer of your hospice should:
Review the Secure PEPPER Access Guide at: https://www.pepperresources.org/Portals/0/Documents/PEPPER/HOSPICE/HospicePEPPERUsersGuide_Edition6.pdf
Review the instructions and obtain the information required to authenticate access. Note: A newvalidation code will be required. A patient control number (UB04 form locator 03a) or medical recordnumber (UB04 form locator 03b) from a paid claim for a traditional Medicare FFS beneficiary with a claim“from” or “through” date in July 1-September 30, 2016 will be required.
Visit the PEPPER Resources Portal at: https://securefile.tmf.org/
Complete all the fields and download your PEPPER
For further information, contact Patrick Conole at (518) 810-0661 or at [email protected].
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Volume 2, No. 18 May 1, 2017
Health Workforce Study Released
The Center for Health Workforce Studies has released its annual report, “The Health Care Workforce inNew York, 2015-2016, Trends in the Supply and Demand for Health Workers.”
It is at http://albany.us7.list-manage.com/track/click?u=b7960dfcf756f94605561779d&id=65762d372f&e=eb78a43c1d.
This report summarizes data and information about New York’s health workforce, including (by region) forhome care:
Number of health care jobs; Average hourly wages; Employment projections; and Recruitment and retention difficulties.
HCA collaborated on the survey that was sent to home care agencies. The goals of this report are to assistpolicymakers and other stakeholders to target health workforce education and job training resources toaddress the most pressing health care workforce needs; to guide health workforce policies, includingdecisions about the capacity of health professions education programs; and to inform current andprospective students about health care employment prospects and opportunities.
HCA advanced a series of workforce proposals in the state budget and will be seeking legislative andadministrative support in this next phase of the legislative session.
NGS Updates
National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), has recentlyposted the following information to its website.
E-mail Verification Requirement in NGSConnex – Beginning May 1, all NGSConnex users will berequired to complete a one-time verification to validate the e-mail address associated with theirNGSConnex user profile upon logging in with the user ID and password. NGS requires the e-mailaddress to be a unique e-mail address for the NGSConnex user.
It is imperative that NGSConnex users prepare now before Multi-Factor Authentication (MFA)becomes mandatory for all NGSConnex users. In preparation, NGS is asking users to verify the e-mail address associated with one’s user profile, as this is how users will receive one’s daily MFAsecurity code, which will be necessary to successfully access information in NGSConnex.
2017 MAC Satisfaction Indicator (MSI) Now Available – The Medicare Administrative Contractor(MAC) Satisfaction Indicator (MSI) takes 10 minutes and allows providers to share opinions ofNGS’s services directly with the U.S. Centers for Medicare and Medicaid Services (CMS). Providerscan access the survey at: https://cfigroup.qualtrics.com/jfe/form/SV_3WeVjGWpc5NQXOJ?MAC_BRNC=5&MAC=J6%20%E2%80%93%20NGS
For further information, contact HCA’s Patrick Conole at (518) 810-0661 or at [email protected].
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Volume 2, No. 18 May 1, 2017
Wednesday, May 3, 2017HCA Member Provider Pre-Conference Rate: $219 Pre-Conference
Achieving Value through Palliative Care, with Dr. ToddR. Coté, MD, HMDC, FAAFP, FAAHPM, ProgramDirector, University of Kentucky Fellowship in Hospiceand Palliative Medicine Assistant Professor, Universityof Kentucky, College of Medicine Chief MedicalOfficer, Bluegrass Care Navigators
Medical Marijuana in NY, with Dr. Bernie Lee,Associate Chief Medical Officer, Metropolitan JewishHospice and Palliative Care
HCA Annual Corporation and Board of DirectorsMeetings (for HCA Members Only)
HCA’s Imagination Celebration Welcome Reception
Thursday, May 4, 2017HCA Member Provider Thursday ONLY Rate: $329
What’s Keeping Your Colleagues in Other States Up At Night?Panelists: Pat Kelleher, Executive Director, Home CareAlliance of Massachusetts; Bobby Lolley, RN, ExecutiveDirector, Home Care Association of Florida; Timothy Rogers,President & CEO, Association for Home & Hospice Care ofNorth Carolina Opening Keynote: Pulitzer Prize Winning Author KathrynSchulz on “How Mistakes Drive Innovation” Essential Elements Workshops (concurrent)
Know Your Data to Maximize Value Based Payments
Optimizing Revenue Cycle Management in Today’sPayment Environment
Clever & Nimble: Innovations in Recruitment andRetention
2017 HCA Home Care Awards Luncheon
Thursday, May 4, 2017(continued)
Think Tank Sessions (concurrent)
Plan-Provider Partnerships for 5-StarQuality
Lessons in Leadership & Advocacyfrom a Global Nursing Leader
Strategies for Advancing the HomeCare Advocacy Agenda
Keynote Speaker: Dr. Paul Marciano,Employee Engagement and RetentionExpert presents Carrots and Sticks Don’tWork: Building a Culture of EmployeeEngagement with the Principles of RESPECT HCA PAC Party (separate donationrequired)
Friday, May 5, 2017HCA Member Provider Friday ONLY Rate:$229 HCA Town Hall MeetingThis is your opportunity to Ask HCA yourburning questions during this open-formatQ&A session. Plus, special guest speakerFrank Fanshawe of Jackson Lewis willdiscuss the legal ramifications and riskareas for members related to recentlitigation and court decisions on 24-hour“live-in” cases. General Session: Karen Butterton, ChiefOperating Officer, Barnes HealthcareServices presents Discover Your Niche in aValue-Based Healthcare Marketplace:Positioning Your Agency for Success. Closing Keynote Speaker: Paul Angone,Author, Organizational Consultant andMillenial Expert on Understanding theMillenial Mindset: The Secrets to Engaging,Retaining and Leading Millenials.
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