see solutions p. 2 · the saga of medicare face-to-face (f2f) continues with one transmittal (no....
TRANSCRIPT
Legislative Issues Public Policy News
A Weekly Publication Of HCAHCAHCAHCAHCAHome Care Association of New York State
Helping New YorkersFeel RightAt Home
ASAPVolume 20, No. 27 July 24, 2015
Inside Inside Inside Inside Inside ASAPASAPASAPASAPASAP
HCA Welcomes New Staff to Policy, Advocacy & Education Departments
HCA is delighted to welcome two new members of our policyand education teams: Alexandra Blais, MPH (photo at left);and Celisia Street, LMSW (photo at right).
Alex has joined HCA as Director of Public Policy,complementing and augmenting our existing public policyapparatus. She will pursue several new advocacy and growthinitiatives, including a focus on engaging home care consumeraudiences. She comes to HCA from Rensselaer PolytechnicInstitute, where she was involved with health promotion andrisk reduction initiatives for that population. She also has
HCA Exploring Solutions to Physician F2F Documentation
Members of the HCA board, staff and several HCA providers have been teaming up to develop a potentialstandard addendum to ease physician documentation compliance for meeting federal face-to-face (F2F)requirements for home care eligibility.
The workgroup has been working on the form for physicians to complete and add to their home care patients’records to help fulfil the F2F standards. Our discussions this week were joined by the U.S. Centers for Medicareand Medicaid Services (CMS) contractor and fiscal intermediary, National Government Services (NGS), for
See STAFF p. 4
Reminder: HCA is publishing ASAP every otherweek for the summer. We are not publishing onJuly 31 but will publish again on August 7.
See SOLUTIONS p. 2
HCA Explores F2F Documentation Solutions….................................1HCA Welcomes New Staff…...............................................................1New CMS Instructions for F2F Medical Reviewers…..........................2Go Online for New ASAP web exclusive articles….............................4MedPAC 2015 Data Book Available…................................................4Take 5 Minutes to Complete HIT Survey…...........................................4State’s VBP Roadmap Approved….....................................................5Wage Vote for Fast-Food Industry a Signal to Other Sectors….........5Hotel Rate Ends 7/31 for Home Health Symposium…........................613% ICD-10 Denial Rate?…................................................................6Prep for Medicare & Medicaid Rebasing at Finance Retreat…...........7Member Hiring Announcements….....................................................7State Posts ICD-10 Codes for CHHA EPS Grouper….........................8DSRIP Update…...................................................................................8OMIG Releases Compliance Guidance for PPSs…..............................8HCA Comments on Medicaid Managed Care Proposed Rule….......9Managed Care Updates…..................................................................9Reminder on Process for Expedited Personal Care..........................10PHHPC Committee on Establishment Meets…................................10HCA Innovates, Beta Tests Sepsis Prevention Tool…......................11Publications...................................................................................................11
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ASAP is a weekly publication of the Home Care Association of NewYork State (HCA). Unless otherwise noted, all articles appearing inASAP are the property of the Home Care Association of New YorkState. Reuse of any content within this newsletter requires permissionfrom HCA.
Joanne Cunningham, [email protected]
Roger L. Noyes, Director of Communications, [email protected]
Al Cardillo, Executive Vice President, Policy & Programs, [email protected]
Patrick Conole, Vice President, Finance & Management, [email protected]
Andrew Koski, Vice President, Program Policy and Services, [email protected]
Alexandria Blais, Director of Public Policy, [email protected]
Laura Constable, Senior Director, Membership & Operations, [email protected]
Celisia Street, Director of Education, [email protected]
Mercedes Teague, Finance Manager, [email protected]
Jenny Kerbein, Director of Governance and Special Projects, [email protected]
Billi Hoen, Manager, Meeting and Events, [email protected]
Teresa Brown, Administrative Assistant, [email protected]
President:
Editor:
388 Broadway, 4th Floor, Albany, NY 12207Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org
ASAP – a publication of the Home Care Association of New York State
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vetting and feedback. We willalso engage physician andhospital representatives toensure that the form is CMS-compliant, physician-friendly,and effective.
This effort responds to thecontinuing, severe challenges,costs and access consequencesfor home care associated withCMS’s F2F implementationand enforcement. For thelatest information on F2Fmedical review and HCAadvocacy, see the related storyon this page.
For further information, pleasecontact Al Cardillo [email protected].
CMS Provides New F2F Medical Review InstructionsF2F standards remain plagued with confusing instructions as HCA pressesadvocacy plan for clarity, streamlining
The saga of Medicare face-to-face (F2F) continues with one transmittal(No. 602) issued on July 10 and another one (No. 603) issued this weekfrom the U.S. Centers for Medicare and Medicaid Services (CMS)regarding the medical review process.
Transmittal No. 602, which provides instructions to medical reviewcontractors, elaborates on an already confusing set of requirementswhereby home health agencies are expected to substantiate F2F compliancethrough the exchange of medical records with their certifying physicians.Under the current F2F construct, CMS also examines other patientinformation from the doctor in the physician’s medical records.
As reflected in the 2015 home health prospective payment system rule,home care agencies are responsible for assuring that specific documentationelements are included in the certifying physician’s (or discharging facility’s)medical records for all Medicare home health beneficiaries, without whichthe home health claim is subject to denial. These required elements in thephysician record include documentation of Medicare eligibility – namely,the need for skilled service and the reason for a patient’s homebound status
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– along with proof that the physician hasseen the patient face-to-face (F2F) within therequired timeframes.
“Reviewers will consider home health agencydocumentation if it is incorporated into thepatient’s medical record held by the certifyingphysician” and/or facility of discharge “andsigned off by the certifying physician. Thedocumentation does not need to be on aspecial form,” CMS states.
CMS adds: “The reviewer shall consider alldocumentation from the home health agencythat has been signed off in a timely mannerand incorporated into the physician/hospital record.”
On this last statement, the NationalAssociation for Home Care and Hospice(NAHC) has already pointed out to CMSthis week that transmittal No. 602 isinconsistent in its definition of “timelymanner.” According to NAHC, CMS hassince agreed to clarify that “timely” means“prior to or at the time of claim submission.”
According to CMS, even if F2Fdocumentation is deemed satisfactory forthe second or subsequent episodes in asequence – during the recertification process– agencies are nevertheless still liable forsubmitting satisfactory documentation forthe initial, first-episode certification;otherwise, the second episode claim andsubsequent claims in the sequence will notbe covered.
Because CMS requires the maintenance ofsufficient documentation in the certifyingphysician’s medical record (without which aclaim can be denied), agencies are advised topresent as much information as possible tothe certifying physicians for inclusion in theirmedical records. NAHC recommendsincluding, at minimum, “the plan of care andpertinent sections from the comprehensiveassessment, along with an admission
summary of why the patients is in need of skilledservices and is homebound,” according to a recentarticle posted to NAHC’s website.
Adding yet another wrinkle, contractors are alsoinstructed, in CMS’s transmittals, to look within themedical records for a certifying physician statement“which must indicate the continuing need for servicesand estimate how much longer the services will berequired.” CMS doesn’t prescribe specifically how thisis to be documented; but a certification statement bythe physician should be included in the medical recordexplicitly providing a prognosis for the expected futurelength of services at certification and at eachrecertification.
CMS’s transmittals can be read at http://tinyurl.com/nvoxgcn and http://tinyurl.com/olvreeu.
HCA has remained continually engaged in advocacywith partner organizations on proposed legislation andregulatory changes to ease the unnecessary burden ofthis confusing F2F documentation mandate. Severallegislative approaches and F2F technical guidelines arenow under consideration, including a bill introducedby Senators Robert Menendez (D-NJ) and Pat Roberts(R-KS) in late June.
That bill, the “Home Health Documentation andProgram Improvement Act of 2015,” aims to assistproviders coping with the F2F mandate by creating asingle form for certification purposes. It also addressespast claims denials by requiring the Medicarecontractors to re-review claims denied after January 1,2011, and it would waive the F2F mandate for all homehealth services provided to patients who receive homehealth immediately upon discharge from a hospital orskilled nursing facility.
In addition, HCA is working with memberorganizations on a uniform F2F form that providerscan use throughout New York. (See related p.1 story.)We have also been in talks with NAHC on a differentand more potent approach to solving the F2F burden.It includes legislative language stating that thephysician’s signature on the plan of care, along withthe date of the F2F encounter, would be deemed tomeet the F2F mandate.
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previous experience coordinating a statewide nutritioneducation program and providing case managementservices.
Celisia is our new Director of Education. In her role,Celisia oversees the development and implementationof HCA’s educational programming, special events andother activities of the Association in collaboration withthe HCA policy team. She comes to HCA from a longtenure as Communications and ProfessionalDevelopment Associate at the National Association ofSocial Workers-New York State Chapter. She also hasexperience in mental health and case management services.
HCA’s prior Director of Education, LyndaSchoonbeek, retired in the spring.
Alex and Celisia’s contact information are in themasthead on page 2. Please join us in giving them awarm welcome to HCA!
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Take Five Minutes to Complete HIT
Survey Sponsored by HCA & NYeC HCA sent an alert this week reminding all homecare members to take a few minutes to answer avery brief survey sponsored by HCA and the NewYork e-Collaborative (NYeC) on home caretechnology use.
If you haven’t completed the survey yet, please do
so as soon as possible, as it will assist us inadvocating on your behalf. The survey is very briefand should only take five or ten minutes tocomplete. The survey is at https://nyec.wufoo.com/forms/home-care-association-of-nys-technology-survey. The deadline is July 27 and we need as big
a response as possible.
Please contact Elizabeth Amato([email protected]) with any questions aboutaccessing or completing the survey or Al Cardillo([email protected]) at HCA with generalquestions about this request for information.
Go Online For NEW ASAP
Web Exclusives
In an effort to keep ASAP concise, HCA isposting some of our stories as online exclusivesto our website. We have created a new pagecalled “General News” where you can find newstories this week on the following topics:
• eMedNY Trainings Scheduled
• Updates from the MedicareContractor: NGS
• Medicare and Social Security TrusteesReports Issued
• OSHA Issues Revised TB InspectorInstructions
• Home Health Agencies to ReceiveComparative Data Reports
• Medicare Care Choices Model AwardsAnnounced
Get these important updates and others byvisiting the following section of HCA’s website:http://hca-nys.org/category/general-news.
MedPAC Data Book Available
The Medicare Payment AdvisoryCommission (MedPAC) has released its2015 data book on health care spending andthe Medicare program.
It is at http://www.medpac.gov/documents/data-book/june-2015-databook-health-care-spending-and-the-medicare-program.pdf?sfvrsn=0.
Some areas covered include: dual eligiblebeneficiaries, post-acute care, MedicareAdvantage managed care, quality of care,and Medicare beneficiary demographics.
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State’s VBP Roadmap Approved by CMSSubcommittees already meeting to further guide VBP implementation
The U.S. Centers for Medicare and Medicaid Services (CMS) has approved New York State’s Roadmap to ValueBased Payment (VBP).
CMS’s July 22 approval letter states that “the roadmap provides a path forward for payment reform as part ofNew York’s delivery system reform efforts and serves as one of several methods to help support the financialsustainability of the state’s Medicaid program.”
The approval also requires that this roadmap be updated at least annually, and recognizes that adjustments maybe necessary for circumstances further identified in planning and implementation.
CMS’s letter and the Roadmap are at http://hca-nys.org/wp-content/uploads/2015/07/VBPletterroadmap.pdf.
Planning and implementation work has already begun through a series of subcommittees to address criticaltopics like: technical design, regulation, community-based organizations, social determinants of health, andtargeted clinical conditions. HCA staff are serving on these subcommittees and have also served on the broaderworkgroup, meeting since early in the year, to provide input and recommendations.
VBP is a fast-paced road being paved at the federal, state and market levels. There are huge challenges to allsectors, each for varied reasons, but the state’s plan also offers opportunities. To help guide you, HCA isproviding a special session on VBP at our Senior and Financial Manager’s Retreat on September 17 and 18 atthe Mohonk Mountain House in New Paltz. Please see the registration form at the back of this week’s ASAP.
For further information, please contact Al Cardillo at [email protected].
State Board Approves $15 Wage for Fast-Food Industry, Signaling Possible Labor
Changes in Other Sectors
The state’s wage board has endorsed a proposal to raise the minimum wage to $15 per hour for workers in fast-food chains that have 30 or more nationwide locations – a proposal which may signal labor changes outside ofthe food sector, including for home care and other health services.
The proposed fast-food wage hike would occur first in the New York City region in a phased fashion, climbingfrom $10.50 on December 31, 2015 and rising each year until hitting $15 on December 31, 2018. The rest of thestate would see a hike to $9.75 at the end of this year, culminating in a $15 wage on July 1, 2021.
This proposal follows previously scheduled changes to the statewide minimum wage broadly, which are alreadyapproved to reach $9 by the end of this year for all employers in the state.
The $15 wage change, endorsed by Governor Cuomo, is expected to be implemented by the state laborcommissioner. It does not require legislative approval because state law allows for wage changes, through thewage board, “in a specific industry or job classification if it finds that wages are insufficient to provide for the lifeand health of workers within that industry or classification.”
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Volume 20, No. 27 July 24, 2015ASAP – a publication of the Home Care Association of New York State
Hotel Rate Ends on July 31 for
Symposium: Future of Home Health
Online registration is now open for the NortheastRegional Future of Home Health Symposium:“Preparing for the Future of Home and Community-Based Care” on September 9 in New York City. Thehotel deadline is July 31, so please register as soon aspossible by visiting http://tinyurl.com/pas863h. Aflyer is also posted at the back of ASAP.
The symposium will feature panelists and speakerson alternative models of care delivery, achieving the‘Triple Aim’, shifting care into the home andcommunity, and research and policy priorities.Thought-leaders from across the care continuum willspeak to the challenges and opportunities facinghome health care now and in the future.
Please call the hotel directly at 1-800-222-8733before July 31 and ask for the HCA room block.
Future of Home Health SymposiumSeptember 99 a.m. to 4:30 p.m.DoubleTree by Hilton Hotel Metropolitan569 Lexington Avenue, New York, NY 10022www.metropolitannewyorkcity.doubletree.com
This week’s actions could signal proposals forother sectors. In a press statement this week, 1199SEIU called the wage increase “a first step” towardexpanding the $15 starting rate for other workers,“especially homecare and healthcare workers.”
The $15 level is higher than the amount currentlyrequired for home health aide wages in New YorkCity and Long Island under the State Home CareWorker Wage Parity Law. It is also well above the$9 rate that will be required statewide under thebroader minimum wage hike set to go into effect onDecember 31. The state Wage Parity Law levels (forthe period of March 1, 2015 to February 28, 2016)are as follows:
• In New York City, the minimum rate ofhome care aide “total compensation” is$14.09, consisting of a “base wage” of atleast $10 per hour, “additional wages” ofup to $1.69 per hour and “supplemental(benefit) wages” of up to $2.40 per hour.
• In Long Island and Westchester, theminimum rate of home care aide totalcompensation is $11.50, consisting of abase wage of at least $10 per hour, andsupplemental (benefit) wages of up to$1.50 per hour.
The Wage Parity Law, in particular, has been amajor advocacy focus for HCA and the providercommunity. The industry has called for paymentadequacy legislation to: set MLTC, other managedcare, and home care rates at a level that funds thewage parity levels; and for the state to incorporatethese and other labor costs in their payments tomanaged care plans, with adequate payment flowto providers.
We have also participated in litigation to invalidatethe wage parity law, arguing that the home caresystem is not in a financial position, under existingstate reimbursement policies, to support theenhanced wage levels.
These and other wage developments will continueto be a focus of HCA’s advocacy in support of thehome care community.
13% Denial Rate? Reduce Your
Exposure with ICD-10 Staff Training
With major ICD-10 coding changes in sight, HCA iscontinuing our education to assist your billing andclinical staff so that the October coding transitiondoesn’t catch you off guard. CMS predicts a 13 percent claim denial rate whenICD-10 hits in October. You will want to take everymeasure possible to reduce your exposure to claimdenials, and that means training your staff. OnSeptember 30, HCA presents coding expert TrishTulloch, of RBC Limited, for her hit program ICD-10-CM & OASIS Coding: Back to Basics andBeyond in Nanuet, NY. A registration form is at the back of this week’s ASAP.You can also register your team online immediately athttp://tinyurl.com/pp3aac9.
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Medicare & Medicaid
Rebasing Cuts all at Once?
Prepare at HCA’s Finance
Retreat: Sept. 17 & 18 Medicare rebasing cuts are hitting for athird year in 2016. Retroactive CHHAMedicaid rebasing has cut home carepayments going back to April 1.Meanwhile, a more permanent structureof Medicaid rebasing is moving forwardin October, with even bigger, unknownpayment changes for CEOs, CFOs andother finance managers. Come to our Senior and FinancialManager’s Retreat in September, whereyou’ll gain insights from top experts andpayor representatives on these and othermajor payment changes. Bill Dombi alone is worth the price of
admission. Mr. Dombi, who is VicePresident for Law at the NationalAssociation for Home Care andHospice, will provide invaluableperspectives on the major componentsof Medicare rebasing. Meanwhile, onthe Medicaid side, we’ ll have stateDepartment of Health officials, likeTim Casey, on hand to give youstraight-from-the-source informationabout the state’s Medicaid rebasingproposal, which remains a big questionmark for providers. HCA’s expert policy team will alsoprovide a cliff-notes crash-course on allof the major payment developmentsaffecting your organization. As if these topics weren’t big enough,our conference agenda will also fill inthe picture for other major issues andunknowns like the future of TPL audits,value based payments, MLTC payment
Director of Programs & Services and Compliance
Visiting Nurses Home Care is a LHCSA servicing 18 countiesin the Capital Region and an affiliate of VNA Home Health,a CHHA certified in 11 counties.
We have a full time position open for a Director ofPrograms & Services and Compliance. This individual willbe responsible for the delivery of quality care for allagency programs and services as well as planning,implementing and monitoring the agency corporatecompliance program. This position reports directly to theCEO and is based in the Menands office.
Requirements: a B.S.N. in Nursing or Registered Nursewith a Bachelor’s Degree in a related field; Master’sDegree in Nursing or related field preferred; Minimum ofthree to five years supervisory/management experience ina health care setting, preferably in home care orcommunity-based services; Must possess a current NYSdriver’s license and current license and registration topractice as a Registered Professional Nurse.
Please submit résumé to [email protected].
Regional Program Director-Albany Area
VNA Homecare is hiring an Albany-area Regional ProgramDirector who is responsible for the regional delivery andsupervision of care management services provided forenrollees within the MLTC in the Capital Region, inaccordance with agency policy and procedures, and underthe direction of the Senior Director of Care Management.The Regional Program Director provides leadership anddirection to the regional team ensuring that high quality,culturally sensitive and cost-effective services andbenefits are provided.
Requirements: Bachelor’s degree from an approvedschool, acceptable to New York State Department ofHealth; Master’s degree in health related field preferred;Two years’ experience as home care nurse in a healthagency; Current NYS driver’s license and automobileinsurance; Knowledge and/or experience in long termpatient care and chronic disease management.
For this and other openings at VNA Homecare, visit
http://tinyurl.com/q46v6yn to apply.
HIRING
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updates, regulatory issues like Medicare face-
to-face, and much more. Please register now online at http://tinyurl.com/pp3aac9 or download thebrochure at the back of ASAP.
State Posts ICD-10 Codes
Applicable to 2009 Base Year
CHHA EPS GrouperDOH continues to post information associatedwith CHHA EPS rebasing initiative
The state Department of Health (DOH) hasposted a list of ICD-10 diagnosis codes thatare applicable to the 2009 base year CHHAEpisodic Payment System (EPS) Medicaidgrouper. See: http://www.health.ny.gov/facilities/long_term_care/reimbursement/chha.
DOH notes that applicable diagnoses maychange if the CHHA EPS Grouper is revisedto reflect data from a more recent base year.
Last month, DOH posted the revised interimEPS rates for CHHAs, beginningretrospectively for episodes ending on or afterApril 1, 2015 through September 30, 2015.
The interim rates reduce the current 2009base year episodic payment rates by 12percent. This reduction is an initial stepbefore DOH implements a final rebasing ofEPS beginning on October 1, 2015. DOHhas stated that this interim percentageadjustment was needed to comply with thestatutory deadline for rebasing to take effect– by April 1, 2015 – and to preserve the $30million annual financial plan savingsestimated for rebasing in the final 2015-16state budget.
In addition to the 12 percent reduction,CHHAs are at risk for a much moreexpansive rebasing impact beginning onOctober 1, which is why HCA introduced
DSRIP Update
The state Department of Health (DOH) has postedPerforming Provider System (PPS) Network lists for theDelivery System Reform Incentive Payment (DSRIP)program.
The lists and additional information are at http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/pps_network_partners.htm.
The network list is a combination of the providers andentities that are partnering with PPSs for both valuationand/or performance. HCA members should check toconfirm that they are listed with the PPSs you’ve beenworking with.
Using these network lists, DOH has attributed Medicaidmembers to partnering PPS providers, and, on a quarterlybasis, DOH will assess PPS performance in DSRIPprojects. This will occur through the ongoingmeasurement of a PPS’s achievement of metrics andoutcomes.
OMIG Compliance Guidance for PPSs
The state Office of the Medicaid Inspector General(OMIG) has posted DSRIP Compliance Guidance2015-02: Frequently Asked Questions by PerformingProvider System (PPS) Leads Relative to CompliancePrograms.
This joint publication by OMIG and the Department ofHealth (DOH) provides responses to DSRIP-relatedcompliance questions.
It covers OMIG expectations for PPS Lead Entitiesrelative to: their partners’ use of DSRIP funds,obligations to provide compliance training andeducation, responsibility to check for excluded orsanctioned parties, and obligation to refundoverpayments. It also provides information on the roleof the Independent Assessor.
The publication is at https://www.omig.ny.gov/images/stories/compliance_alerts/20150715_dsrip_faqs.pdf.
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state legislation, passed by both houses, to limit the Department’s rebasing initiative. We are awaiting deliveryof the bill to the Governor’s office and will alert you to any advocacy needs at that time.
DOH has also posted a schedule of rates, effective April 1, 2015, which show the impact of reductions to the109 case-mix-adjusted payment rates for CHHA EPS. These rate revisions do not include any adjustment tothe rates for pediatric patients, whose services continue to be reimbursed on an historical fee-for-service per unitbasis.
For specific questions on these rates, contact DOH’s Tim Casey or Charles Toby at (518) 473-4421 or e-mailDOH at [email protected]. We note that Mr. Casey will be presenting at HCA’s Senior and FinancialManager’s Retreat on September 17 and 18 where he’ll provide the latest updates on the expectations for theCHHA rebasing process in October. Please register now by downloading the brochure at the back of thisweek’s ASAP.
For further information, contact Patrick Conole at (518) 810-0661 or [email protected].
HCA Comments on Medicaid Managed Care Proposed Rule
This week, HCA submitted comments to the U.S. Centers for Medicare and Medicaid Services (CMS) on aproposed rule that would provide the most significant update to Medicaid managed care rules in more than adecade. Please see the “Letters and Comments” page of HCA’s website to download the letter at http://hca-nys.org/category/letters-and-comments.
The rule covers the delivery of managed long term services and supports (LTSS); quality improvement; programand fiscal integrity; state delivery system reforms; rates to plans; beneficiary experience; and other areas. HCA’scomments address: the misalignment between federal and state regulations for home care; the need for actuarialsoundness of rates by states to managed care plans and rates by plans to home care providers; disenrollment dueto home care provider changes; transitions of care; state monitoring requirements; grievances and appeals andaid continuing; provider screening and enrollment; uniform billing; and plan contacts.
For more information, contact the HCA Policy staff.
Managed Care Updates
The state Department of Health (DOH) has posted marketing guidance for the Fully Integrated Duals Advantage(FIDA) program and information on the transition of behavioral health services to managed care. It is athttps://www.health.ny.gov/health_care/medicaid/redesign/docs/cy_2015_ny_market_guide.pdf.
Some areas covered include requirements related to: non-English speaking populations; written materials attime of enrollment; the enrollment process; identification cards; promotional activities; telephone contact;customer call centers; and marketing of other plan products.
Behavioral health
DOH has posted an entire Medicaid Update issue on the transition of behavioral health to managed care. It is athttp://www.health.ny.gov/health_care/medicaid/program/update/2015/jul15_mu_speced.pdf. It includesinformation on the implementation timeline; role of health homes; provider technical assistance; payment and networkcontracting requirements; quality assurance; and other issues. More information is at http://tinyurl.com/qz8srh5.
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Reminder on Process for Immediate Personal Care Needs
The state Department of Health (DOH) has issued a notice to remind local departments of social services ofDOH regulations that provide for an expedited authorization process for Medicaid personal care services. Thisprocess applies in cases when services are needed to protect health or safety of a recipient but the nursing assessmentcannot be completed in five business days.
The notice is at http://www.health.ny.gov/health_care/medicaid/publications/docs/gis/15ma011.pdf.
According to DOH, the expedited authorization process may be most appropriate for recipients:
• Whose enrollment in an MLTC plan, through no fault of the recipient, might not occur with reasonablepromptness (i.e. by the 20th of the month); and
• Who reside at home in the community, or are seeking to return to the community, have no informalcaregivers who are able and willing to provide assistance with needed personal care services tasks, are notalready receiving home care services from a home care services agency, and who have no third partyinsurance or Medicare to pay for needed assistance.
In February of this year, DOH had published a revised rule for the procedures by which Medicaid applicants mayestablish presumptive eligibility for “immediate personal care services.” That rule is at http://tinyurl.com’q85ylur.
Questions regarding this information can be sent to [email protected].
PHHPC Committee on Establishment Meets
The Public Health and Health Planning Council (PHHPC) Committee on Establishment and Project Reviewmet on July 23.
The agenda included the following items related to home care:
• One application was a change in ownership by a CHHA that serves the general population in Greene,Orange, Ulster and Westchester as well as the developmentally disabled population in Dutchess, Putnam,and Sullivan.
• Under another application, the same entity proposes a change in ownership of its CHHA and LTHHCPthat serves western New York.
• Applications by 29 entities (8 outside of the New York City metropolitan area) to establish a LHCSA; and
• Applications by 10 LHCSAs for a change in ownership (including 3 outside of the New York Citymetropolitan area).
All the applications were recommended for approval and sent to the full PHHPC for its consideration onAugust 6.
The July 23 meeting materials are at http://www.health.ny.gov/facilities/public_health_and_health_planning_council/meetings/2015-07-23/.
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HCA Innovates, Beta Tests Sepsis Prevention Tool
A workgroup of the HCA Quality Committee has been working throughout the spring and early summer toinnovate a sepsis early recognition tool and protocol for use in home care.
This week the workgroup launched a beta test of the tool and protocol. This test will run through early August.Following the beta, participating providers will report, analyze and discuss findings with HCA. We hope tofinalize and eventually present the tool to home care agencies for adoption as a basic part of their practice.
Sepsis morbidity and mortality rates are devastating in both human and fiscal terms. Data from the National SepsisAlliance reports that: a new case of sepsis occurs in the U.S. every 20 seconds; sepsis is the leading cause of death inhospitals; and mortality increases 8 percent every hour that treatment is delayed. IPRO data shows sepsis to be thenumber one cause of all Medicare fee-for-service hospital 30-day readmissions in New York State in 2013.
All indications are that this initiative would break new ground in potential sepsis intervention, in New YorkState and nationally, and would be an invaluable protocol to bring to the table in partnership discussions underthe Delivery System Reform Incentive Payment (DSRIP) program and other models. Meanwhile, HCA issimultaneously exploring funding support with the state hospital association (HANYS) for a joint hospital-home care sepsis initiative. We are also presenting proposals to the Legislature.
For further information, please contact Al Cardillo at [email protected].
Publications
• “Long-Term Services and Supports for Older Americans: Risks and Financing,” by the Health andHuman Services Office of the Assistant Secretary for Planning and Evaluation Office of Disability,Aging and Long-Term Care Policyhttp://aspe.hhs.gov/daltcp/reports/2015/ElderLTCrb.pdf
• “Data Note: Medicare Advantage Enrollment, by Firm, 2015,” by the Kaiser Family Foundationhttp://files.kff.org/attachment/data-note-data-note-medicare-advantage-enrollment-by-firm-2015
• “CMS Bundled Payments for Care Improvement (BPCI) Initiative Models 2-4: Year 1 Evaluation &Monitoring Annual Report,” by the Lewin Grouphttp://innovation.cms.gov/Files/reports/BPCI-EvalRpt1.pdf
• “Addressing Performance Measure Gaps in Home and Community-Based Services to SupportCommunity Living: Interim Report, July 15, 2015,” by the National Quality Forumhttp://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=79920
• “Physician Documentation Requirements for Certification of Home Health Care,” by NationalGovernment Serviceshttp://www.ngsmedicare.com/ngs/wcm/connect/aa29ab35-52a1-4298-9fc4-da87f9a9e9d5/Physician_Documentation_Requirements_Certification_Home_Health_Care_Letter.pdf?MOD=AJPERES
For more information, contact Andrew Koski at (518) 810-0662 or [email protected].
Blueprint for OASIS Accuracy –
OASIS-C1 Data Set
www.hca-nys.org
Two day OASIS C-1 Data Collection Rules and Guidance workshop, with an optional Certificate for OASIS Specialist-Clinical (COS-C) exam. Effective up-to-the-minute education targeted for field data collectors, their supervisors and those preparing for the COS-C exam. Experience the comprehensive and nationally acclaimed two-day Blueprint for OASIS Accuracy workshop and learn to confidently teach, audit and collect OASIS C-1 items accurately. Through guided, expert instruction, and participation in problem-solving discussions and application scenarios, achieve mastery of the OASIS items, conventions, and the latest data collection rules. Rather than provide opinions, assumptions, or unfounded interpretations, the “Blueprint” presenters will model reliance on CMS guidance documents and provide and demonstrate strategies for how to find defendable answers to your OASIS questions. Facilitators: Linda Krulish Annette Lee Linda Krulish, PT, MHS, COS-C Linda is a physical therapist in home care since 1988. She is a nationally recognized expert on OASIS and home health quality improvement. She is the President and Founder of OASIS Answers. Annette Lee, RN, MS, HCS-D, COS-C Annette is a registered nurse practicing since 1990, with the majority of her nursing experience in home health. She is a Senior Associate with OASIS Answers, Inc. COS-C Exam The Certificate for OASIS Specialist – Clinical (COS-C) Exam is a voluntary Certificate examination for those interested in demonstrating and establishing their expertise and commitment to OASIS data accuracy. Administered the day following the Blueprint for OASIS Accuracy training, the scope of the COS-C exam is similar to the Blueprint workshop agenda, covering CMS guidelines related to OASIS time points, regulations, patient populations, and OASIS-C1 item specific scoring. Candidates who successfully pass the examination are awarded the COS-C designation. Please note the exam fee is in addition to the two-day Blueprint workshop fee. Register for the exam online at www.oasisanswers.com or complete the attached form and send to OASIS Answers, Inc.
October 26 and 27 Workshop
8:00am to 4:00pm
October 28 COS-C Exam
9:00am to 11:30am Individuals may register for the
workshop, the exam or both.
Workshop/Exam Location Visiting Nurse Service of NY
1250 Broadway, 7th Floor Meeting Rooms 7A/B/C
New York, NY 10001
Hotel Accommodations Courtyard Marriott Times Square West
307 West 37th Street (at 8th Ave) New York, NY 10018
HCA has reserved a limited block of rooms at the rate of $289 per night.
Please call (212) 912-0009
before September 18 and ask for the group code: HCA Blueprint
Fax to (518) 426-8788
REGISTRANT INFORMATION Registration deadline is October 5 Name: ___________________________________________________________________ Title:______________________________________________________________ Agency:____________________________________________________________ Address:___________________________________________________________ City/State/Zip:______________________________________________________ Phone:_________________________ Ext._________ Fax: __________________ Email: _____________________________________________________________ (Required)
PAYMENT Please check method of payment: (Checks must be received by workshop date).
____MasterCard ____VISA ____ American Express _____ Check*
*Make checks payable to: HCA Education and Research
and mail to: 388 Broadway, 4th Floor, Albany, NY 12207
______________________________________________________________________ Card Number Security Code Expiration Date
______________________________________________________________________ Name on Card
______________________________________________________________________ Card Billing Address (Street/Suite/Room Number)
______________________________________________________________________ City, State, Zip
______________________________________________________________________ Authorized Signature
Register Online for the workshop only at
www.eventville.com/hcanys
WORKSHOP ONLY REGISTRATION FEE
Member Fee:: $519
Non-Member Fee: $655
Workshop fee includes
instructors for two days, two
light breakfasts and handout
materials. Exam fee is
additional.
Blueprint for OASIS Accuracy – 2-Day Workshop – October 26 and 27, 2015
Cancellation Policy: Refunds will be issued for those that cancel the workshop by October 5, less a 25% administrative fee. Cancelling after this date or for no shows will forfeit the registration fee. Substitutions are permitted for the workshop. Cancellations must be received in writing via e-mail at [email protected]
Walk-in registrations will not be accommodated.
Exam Registration Fee $250 – For those participating in the
workshop
Renewal Exam Fee $200 – For those participating in the
workshop
Taking the Exam Only – add $50
To register for the COS-C Exam use the attached form or go to:
www.oasisanswers.com Registrations for the exam must be received two
weeks prior to the exam date.
Preparing for the Future of Home and Community-Based Care
Building off the IOM Future of Home Health Care Workshop, the symposium will feature panelists and speakers
on alternative models of care delivery, achieving the Triple Aim, shifting care into the home and community,
and research and policy priorities. Thought leaders from across the care continuum will speak about the
challenges and opportunities facing home health care now and in the future.
Wednesday, September 9th9:00 am – 4:30 pm ET with a
Cocktail Reception to be held on September 8th
DoubleTree by Hilton Hotel Metropolitan569 Lexington Ave, New York City
Association & Alliance Members: $259 Non-members: $359
M O R E I N FO R M AT I O N : www.ahhqi.org/home-health/future-project-symposium
T H A N K YOU TO OU R PA RT N E R I N G O RG A N I Z AT I O N S
Future of Home HealthNORTHEAST REGIONAL SYMPOSIUM
AHHQI.ORG
HCA’s Senior & Financial Manager’s Retreat September 17 & 18, 2015 Mohonk Mountain House, New Paltz, NY
“CHHA Medicaid EPS rebasing cuts are here, and more cuts are coming. TPL and F2F are weighing on our bottom line. We’ve hardly got our head around DSRIP – and now the state is moving to value-based payments. Meanwhile, our accounts receivable is through the roof, and it feels like we’ve exhausted all potential growth opportunities.”
Are these the kinds of thoughts keeping you up at night? Come to
HCA’s Senior and Financial Manager’s Retreat
September 17 and 18
to get away – and to get a better grasp of
today’s home care payment and regulatory environment.
We’ll help you put your budget in square order, find the answers you need from top officials and contractors, and gain valuable insights from the state’s leading consultants who will reveal what they are telling their clients about where to look for new opportunities. HCA is offering this program in
critical domains: The Big Picture,
Reimbursement Mechanics and Updates (Medicaid and Medicare), Strategic Planning for New Growth Areas, and A Medicare Focus. Details are fleshed out later in this brochure.
Also, did we mention that this is all taking place at one of the nation’s top-ranked resorts, conveniently located in the Catskills? If you’ve been to this retreat before – at the scenic Mohonk Mountain Resort in New Paltz – you know it’s the right place to get informed and inspired. With your hotel and conference registration, we have you covered: expert presenters, all meals at Mohonk’s world-class dining facilities, an evening reception to network, access to the resort’s trails and picturesque grounds, and months-worth of insights in two days. You just need to reserve your spot.
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Please register by August 15 to get your seat at the table. And while you are at it, why not make it a ‘table for two’? Bring your CEO, chief finance officer or finance directors for shared learning and strategic planning.
Growth Big Picture Mechanics Medicare Focus
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Domain I: The Big Picture
Let HCA’s policy and executive team set the stage for you. We’ll give you the latest info from Albany and Washington. We’ll tell you what we are doing to shape the payment and regulatory environment in a way that mitigates risk and opens new opportunities. Best yet, we’ll answer your questions on any reimbursement, payment or regulatory issues needing clarification.
• HCA’s Policy & Executive Team – Sept. 17
Big Picture
Mechanics
• DOH Reimbursement Updates (Tim Casey and Dan Carmody) – Sept. 17
• New Developments in TPL (OMIG & UMASS) – Sept. 17 The timing of this conference couldn’t be better: DOH will be finalizing its CHHA rebasing rates in October, just a few weeks after the Retreat. You’ll get the most up-to-date preview of the state’s intentions for resetting the CHHA reimbursement system – not to mention countless other Medicaid reimbursement, MLTC, FIDA and managed care updates that all home care programs need to know about. We don’t need to tell you that TPL billing and audits have been a major unreimbursed assignment for home care agencies across the state. Things may be changing. For instance, what does the future hold, now that much of the state’s dually eligible population has moved into managed care? TPL occupies a big space in your administrative budget; you’ll want to know what’s coming next from OMIG and its TPL contractors.
Domain II: Reimbursement Mechanics and Insights (Medicaid & Medicare)
Growth
• Value Based Purchasing (Mark Berg, KPMG) – Sept. 18
• Panel Discussion on Plan, Physician Practice, Hospital/HomeCare – Sept. 17
• New Business Lines in Evolving Market Places (industry experts) – Sept. 17
We know you need more answers about all of the new payment models on the horizon, as well as growth opportunities that cut across payor lines. If you thought DSRIP was a big change, by now you know it’s merely a temporary bridge to a more permanent structure called value-based payments. The state’s value-based payment program offers a blend of upside and downside risk, at various tiers, and Dr. Mark Berg will get you thinking now about which options to pursue – and how to acclimate your operation for success. HCA also knows there are several other value and growth areas that may seem hidden to you – and we have top experts to present these insights, including a panel who will discuss innovative arrangements with plans, physicians and hospitals. Meanwhile, home care providers value the advice of consultants as you explore growth opportunities, so we’ll also have top experts here to help you explore new business lines to diversify your portfolio as well.
Domain III: Strategic Planning – Inside and Outside the Government Payor Box
Conference Sessions September 17 (9:15am to 4:45pm) September 18 (8:30am to noon)
We know you need more answers…
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• Maximizing Your Medicare Revenues Through Improving Operations and Benchmarking (Michael Freytag, Black Tree Healthcare Consulting) – Sept. 17
• Federal Update on F2F, Regulatory Issues and Reimbursement (Bill Dombi, NAHC) – Sept. 18 You’ve been benchmarked! It’s how Medicare and Medicaid rates are set; it’s even how auditors decide who to target for review. But you can also use benchmarking to your advantage. You just need the data, and a little insight. While HCA has substantially built up our capabilities in this area, through our HCA Data page and other resources, a lot of this data gathering and analysis has also been done for you by expert consultants and benchmarking analysts. Enter Black Tree Healthcare Consultants, who will show you the most important Medicare comparative data to set your compass right. NAHC’s Bill Dombi is one of the sharpest and most knowledgeable voices on Medicare home health – bar none. We are delighted that he is available to present some very practical insights on evolving guidance related to the face-to-face requirement, Medicare rebasing and other major payment issues affecting the Medicare side of your operation.
Domain IV: A Focus on Medicare
Growth Mechanics Big Picture Medicare Focus
Medicare Focus
Conference Sessions September 17 (9:15am to 4:45pm) September 18 (8:30am to noon)
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Mohonk Mountain House Rates and Other Information Your combined hotel and registration rate includes your room, all meals, breaks, valet parking and
meeting amenities. A single room rate is $305 per person, per day; double rates are $229 per person, per day. Local taxes
and a 12% gratuity are additional. All Mohonk reservations should be made by August 15 to receive the HCA conference rate and be guaranteed a room. After this date, higher rates will apply based on availability.
Call 800-772-6646 and ask for the HCA rate.
Not Staying Overnight at Mohonk? Since this is a remote resort in the mountains, and Mohonk wants to also be prepared for those not
staying overnight, a “per-day rate” of $120 is charged. This day rate includes lunch, breaks,
meeting amenities, and self-parking. Day guests must register with HCA as well in order to access the property. Please include the fee(s) with your HCA registration (next page).
Thanks to our Sponsors and Exhibitors!
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The registration fee of $299 for HCA members includes two days of expert speakers and handout materials, plus
breaks, a reception and lunch on the final day that is not included with your room package. Potential members are
also welcome at the rate of $399 per person. Mohonk Resort rooms/meals are additional – see page 4.
REGISTRANT INFORMATION – Please register by August 15. Name: __________________________________________________________________________ Title:____________________________________________________________________________ Agency:_________________________________________________________________________ Address:_________________________________________________________________________ City/State/Zip:____________________________________________________________________ Phone:________________________________ Ext._________ Fax: _________________________ Email: ___________________________________________________________________________ (Required)
PAYMENT – Please check method of payment:
________MasterCard _______VISA ______American Express ______Check*
*Make checks payable to: HCA Education and Research and mail to 388 Broadway, 4th Floor, Albany, NY 12207. Checks must be received by September 8.
______________________________________________________________________________ Card Number _______________________________________ _______________________________________ Expiration Date Security Code
______________________________________________________________________________ Mailing Address of Card Holder
______________________________________________________________________________ City, State, Zip
______________________________________________________________________________ Name on Card
______________________________________________________________________________ Authorized Signature
HCA REGISTRATION FEE
____ Member Fee $299
____ Non-Member Fee $399
MOHONK RESORT FEES Check one of the following. See resort information and pricing on page 4 for details.
____ I will make my overnight room reservation directly with Mohonk. $0
____ I require a Mohonk “day only” pass at $120 per day. $_________
Total: $___________
FAX this form to 518-426-8788 or register online at www.eventville.com/hcanys
HCA Cancellation Policy HCA registration cancellations received by August 28 are refundable less a 25% administrative fee. No refunds will be issued after this date. Cancellations must be received in writing at [email protected]. Substitutions are permitted. Please note Mohonk’s cancellation policy when making your reservation.
Senior Financial Managers Retreat September 17 & 18, 2015 Mohonk Mountain House
Special Needs In accordance with the Americans with Disabilities Act, or special dietary needs, please let us know how we can accommodate you: ______________________________________________________________________________________________________ ____________________________________________________________________