The state Department of Health (DOH) has posted a notice to home care agencies, medical directors and other provider representatives on the Health Commerce System (HCS) regarding an investigation into the reliability of a laboratory service provider’s glucose and potassium test results that could affect HCA members.

The notice, available here, states the following:

On 5/22/2018 the New York State Department of Health (Department) issued an Order for Summary Action against a laboratory service provider, Modern Diagnostic Laboratory Inc. due to findings of an investigation by the Wadsworth Center’s Clinical Laboratory Evaluation Program. The investigation determined that glucose and potassium test results were not reliable and in some instances falsely reported.

Today (5/23/2018), the Department issued an Amended Order for Summary Action against MDL. The Amended Order enables MDL to resume providing services under existing contracts. The Amended Order requires that MDL meet certain requirements, including but not limited to, the immediate employment of an independent consultant who will be approved by the Department, and the cessation of any inappropriate testing and reporting practices.

For providers seeking to contract with an alternative laboratory, a list of other approved laboratories can be found at the following link: https://www.wadsworth.org/regulatory/clep/approved-labs.

No other information is available at this time regarding actions that providers should take for lab services affected by these findings. HCA remains in communication with the Department for further information, which we will share in an alert to the membership or in our newsletter as necessary.

 

Caring Awards

The Caring Award recognizes a staff person of an agency who has exhibited the compassion, skills and service that sets his or her contribution apart and/or whose actions on a particular day or over a period of time exemplify caring in home care.

Vicky Gentile, Home Health Aide at New York City-based Selfhelp Community Services

“Vicky Gentile embodies the caring, dedicated spirit we wish to be associated with our name,” says Selfhelp Community Services, noting Ms. Gentile’s exceptional care to patients.

As an example, Ms. Gentile began working with a complex dementia care case. None of the client’s previous aides had lasted for any length of time. But Ms. Gentile was different. Her kindness, hard work ethic, and sense of cooperation enabled her to remain for many years with this client who, because of her condition, suffers from suspicion of others and is easily agitated.

Ms. Gentile also has had to frequently interact with the client’s daughter, who suffers from schizophrenia and other mental illness, causing the daughter to behave at times in a hostile manner, even making inappropriate demands.

Here again, Ms. Gentile remained calm and within the bounds of her role. In this case, as with so many others, Ms. Gentile responds with understanding, compassion, maturity, skillful patience and wise judgment.

Amy Marshall-Uber, Home Health Aide at Eddy Licensed Home Care Agency, which is part of St. Peter’s Health Partners and serves New York’s Capital Region

Ms. Marshall-Uber has been a dedicated home health aide with the Eddy VNA for 25 years. “I can remember when Amy started … and I knew then she was going to be outstanding at providing exceptional patient care,” said Ann Marie Moran, an RN case manager who nominated Ms. Uber for the award and tells a very personal story about Ms. Uber’s work.

Ms. Marshall-Uber had recently lost her father just a few months ago to cancer, all the while remaining committed to providing care to Eddy VNA patients, many of them in end-of-life care. When Ms. Moran’s own father became ill, “I knew that Amy would be a wonderful match with my father” to work with him as his own aide. They quickly forged a near-familial bond. “Knowing how hard it was for my Dad – who was fiercely independent and wanted to maintain his dignity — this was not easy, but Amy was able to make him feel comfortable and special at each and every visit.” This included the kindness and caring she provided on his dying day — and extended to the entire family.

“Thank you and your family for allowing me to be a small part of making him comfortable in the time he had left,” Ms. Uber later wrote to Ms. Moran and her family in yet another gesture of kindness and compassion following the patient’s death. “My dad had such respect and gratitude for Amy and the work she did,” Ms. Moran says.

Julio Vega, Doctor of Physical Therapy at HCR Home Care, based in Rochester, New York

Julio Vega, a Doctor of Physical Therapy (DPT) at HCR Home Care, consistently looks for opportunities to best impact patient care at each and every visit with patients. He gives undivided attention and focus on the task at hand, and he empowers patients to believe in themselves and that they can do more.

As one woman explained of the care provided to her husband, Julio “did more with him in one visit then they did in all the time he was in rehab.” She was so impressed with his care that she requested Julio Vega to be his full time therapist. On another occasion, a physician noted that the doctor’s practice was very impressed with the results that its patient was making under Julio Vega’s care. Another patient wrote to HCR: “I met Julio Vega who totally put me and my husband at ease the minute we met him. He explained everything up-front that would be happening over the next two weeks. Julio is extremely knowledgeable in his job and very passionate about what he does and it shows in everything he does and says.  Julio shows kindness, understanding and empathy towards what may be going on in the client’s life.”

The patient added: “I feel extremely blessed that Julio and I met. I believe he helped me tremendously in my first two weeks of recovery out of the hospital.”

Josh Klein, CEO of New York City-based Royal Care

Josh Klein, CEO of Royal Care, believes in a philosophy of caring that he communicates to staff about their work with patients: “You Care For Them” – the patients – and “We Care For You.”

In this vein, Mr. Klein has taken a unique approach to caring for his staff, building a multi-million-dollar center called “Royal U,” focusing on employment services, such as employment appreciation and satisfaction, along with education focused on value-based care and quality patient outcomes.

His company’s Royal U initiative includes a facility specifically for home care workers to get spa treatments and other amenities. “Josh is one of the most caring people I’ve ever met and an even better boss,” said one nominee at Royal Care. “His love and devotion for every employee within his company is inspiring and refreshing to see.”

Triple-Aim Quality and Innovation Awards

The “Triple Aim” Quality and Innovation Award demands that home care and hospice agencies, payors, and other providers work to: improve patients’ experiences of care (including satisfaction); address the health of populations; and reduce per-capita costs in the health care system. This new HCA award recognizes a home care or hospice provider agency, Managed Long Term Care plan or team that has implemented a concrete, innovative clinical model, workforce supports, patient or staff education program, or other initiative with demonstrated outcomes in terms of client satisfaction, population health improvement, and cost reduction or avoidance.

Kim Gendron, Family Nurse Practitioner at St. Peter’s Health Partners Medical Associates/Eddy VNA Home Based Primary Care, which serves New York’s Capital Region

Kim Gendron started her career as a nurse’s aide, eventually becoming an LPN, then an RN, working as a home care nurse, and later pursuing her nurse practitioner (NP) degree. Today she is very much the driving force behind St. Peter’s Health Partners’ Home Visiting Primary Care Provider Program.

Primary care in the home consists of chronic disease management that improves the patient’s quality of life and reduces the risk of unnecessary emergency department visits or hospitalizations.

Ms. Gendron recruited other NPs to join the team and has worked hard to develop the office-based staff in the St. Peter’s program. She also brought on per-diem NPs that assist with covering on-call during weekends so patients have access to a provider 24/7.

Establishing contracts for Mobile Imaging in the home (x-ray and ultrasound), she has also worked with local laboratories to provide blood draws and introduce home infusion therapy. Her commitment to her patients and to this program is evidenced in the quality outcomes she delivers and the impact she and her team have on improving the patient’s quality of life.

Her vision is to expand this program so more patients can benefit. Without Kim Gendron, this program would not be the success it is today.

Shannon Whittington, Interdisciplinary Care Team Manager and Director of the Gender Affirmation Program at New York City-based Visiting Nurse Service of New York

Shannon Whittington, MSN BSN, is an Interdisciplinary Care Team Manager at the Visiting Nurse Service of New York (VNSNY) and the Director of VNSNY’s Gender Affirmation Program (GAP).

GAP specially trains and assigns selected home care nurses to provide post-operative skilled nursing care in the home to patients who have undergone vaginoplasty, a type of Gender Affirmation Surgery for transgender individuals transitioning from male to female. This work supports an underserved population dealing with complex physical and emotional after-care needs.

Ms. Whittington has always been a model of a caring and dedicated visiting nurse. As a field nurse, prior to her managerial work, she consistently provided the most caring and thoughtful level of care. Now, as Director of the GAP program for the past two years, she is part of a team dedicated to helping a very vulnerable population at possibly the most important time in their lives to realize a safe and healthy gender transition. This also has meant forging a cultural shift within nurses, managers, and senior leaders regarding transgender care.

Since the start of the program in 2016, GAP has provided care to 110 patients who have undergone vaginoplasty. And the program has expanded to include competency training of all VNSNY and related entities in LGBT cultural sensitivity.

Her work as director of this program offers an outstanding example of leadership in providing compassionate, culturally sensitive care to a population that frequently faces stigma and barriers to essential health services in the community.

Physician Home Care Champion Award

This new HCA award recognizes a physician in New York State who has demonstrated a strong and model commitment to home care patients and agency partners. The awardee will have engaged in an exemplary fashion with home care providers on: care management at home (through effective care-transitions, primary care house-calls, home care-directed telehealth, and other means); specific community health interventions that directly involve collaboration with a home care agency; and/or other home care-supportive leadership roles.

Kevin Costello, MD, Albany Medical Center Internal Medicine, Albany, New York

The HCA Physician Home Care Champion Award is an excellent way to recognize a Capital Region physician who has served home care patients in their own homes, through different programs, for over fifteen years. Kevin Costello, MD is a gerontologist who began to work with VNA Home Health patients during his tenure at Albany Medical Center’s Internal Medicine Group. His responsiveness to home care community professionals, in caring for their patients, has earned him incredible respect as a physician and as an individual.

In 2007, Dr. Costello founded a new collaborative program with the Albany Medical Center hospitalist program, case management, the department of medicine and VNA Home Health (formerly the Visiting Nurse Association of Albany). The Early Facilitated Hospital Discharge Program was a visionary initiative created to improve patient transition from hospital to home. Its goal was to reduce complications of hospital-acquired illnesses, assure timely physician follow-up to prevent unnecessary re-hospitalization, and bridge the gap between hospital discharge and when the patient is able to see his or her physician to establish post-acute care.

In this work, he would visit the patient the day after discharge and collaborate with the home care nurse to assure medications, treatments and services ordered met the patient’s needs. He would provide interim orders for home care services until the patient returned to see his or her primary MD, which only occurred after he had reported the patient off to the primary care physician. He often visited several times until this transition occurred and he was available for calls from the patient – or the VNA – 24 hours a day.

Currently his “Home Based” physician practice services many patients that would otherwise not receive the regular physician follow up care needed due to their inability to get to a physician’s office. His practice maintains and improves the health of his patients and allows him to see what daily challenges patients face in their homes, from needing assistance with medication management to the need for home care services. He truly exemplifies a “Physician Home Care Champion.”

John “Jack” McIntyre, MD, Medical Director, HCR Home Care, based in Rochester, New York

Dr. Jack McIntyre has worked as HCR Home Care’s Medical Director since 2015. In that short time, he has made significant contributions to HCR and the home care industry widely. Dr. McIntyre has advanced the understanding of home care among the physician population through his work with the Medical Society. He even took it a step further and made a presentation to the Council on Medical Services which resulted in the adoption of new policies by the American Medical Society (AMA) supporting the training of home health aides and regulatory oversight of home health agencies (Resolution of 703-A-14).

Dr. McIntyre has been instrumental to HCR in achieving best-practice standards and regulatory requirements by developing and delivering education to staff, patients and his physicians. He has accompanied HCR staff on home visits. He provides an orientation class to all new staff members on how to effectively communicate with patients and peers. He has met, alongside HCR’s Leadership Team, with patient care partners to develop relationships and increase HCR’s visibility in the community. He has worked tirelessly with physicians who are signing home care orders to increase compliance, by educating them on the value of home care and how the industry is regulated. His insight into how behavioral health affects patients has brought a whole new perspective on HCR case-conferencing work. Dr. McIntyre has even completed record reviews to provide HCR with ways to improve orders and documentation. His contributions to the work at HCR and in home care broadly are truly exceptional.

The Advocacy Award

The Advocacy Award recognizes a provider agency or person (including both elected and appointed officials) who took risks to improve the home care industry, clients and workers through advocacy efforts.

William Dombi, President and CEO of the National Association for Home Care and Hospice (NAHC), based in Washington, DC

Year after year, budget after budget, in the face of countless, administrative rules, legislation, legal cases and emergencies, Bill Dombi has been the go-to person and leader of positive advocacy action for home care and hospice.

For over 30 years, Mr. Dombi has taken on the most substantive and consequential challenges to home care. He’s detangled technically thorny issues, and has formulated and fought for the best possible outcomes for the field. He provides the most expert analysis, sets the advocacy direction for these major issues, and develops proactive comprehensive annual blueprints advancing home care and hospice priorities, all the while spotting signs of trouble or opportunity within the fine print of federal language or industry developments or trends.

While this field is blessed with a relentless advocate in Bill Dombi, this blessing is doubled in the form of a person who is respected by all sides and in all quarters with the highest degree of integrity, credibility, collegiality, and knowledge.

As aptly put by NAHC’s Board of Directors Chair, “Bill Dombi has been at the center of every fight for home care and hospice in the last 30 years.” Bill Dombi is truly the leading home care and hospice advocate for our state, for every state, and for the country.

Ruth F. Wilson Award

HCA’s highest honor, the Ruth F. Wilson Award, is presented to an individual whose work has had a dramatic effect on home care, reaching beyond a single agency. The recipient will have strengthened the practice of our profession, raised the standards of quality and care for patients, or advanced the level of understanding and mutual cooperation among the home care community, legislators, federal and state agencies, health care providers and the public.  

Rebecca Fuller Gray, Director of the Division of Home and Community Based Services, New York State Department of Health (DOH), based in Albany

Becky Fuller Gray has been the cornerstone of home care and hospice in the state Department of Health for nearly 15 years, following her work as a home health nurse. Her knowledge and commitment to the principles of home care, its capabilities and contributions have stood above any other state official over this same long period. Time and again she has been the prevailing voice of judgment in state policy actions.

Ms. Fuller Gray has proactively engaged providers and HCA to advance the home care field and formulate solutions to challenges. Specific examples include her leadership and artful program role in the Department’s implementation of New York’s model home telehealth statute in 2007-08 and her workgroup efforts on standards for home health aide training and home health/MLTC regulations.

She helped shepherd the recent overhaul of requirements and payment parameters for physicians to sign home care service orders, relieving a major obstacle that had absorbed RN clinical time, strained relationships with physicians, and placed undue procedural limits on reimbursement.

In 2017, when the Medicaid face-to-face requirement threatened to mirror an already massive burden that existed under Medicare, Ms. Fuller Gray supported a streamlined approach with input from HCA and the Medical Society. Today, as home care continues to face attempts by others sectors to step into Article 36 without appropriate licensure, she delivered on a directive promoting collaboration and reinforcing Article 36 standards.

In Hurricane Sandy and in related state emergencies, Becky Fuller Gray has represented home care in the state emergency bunkers, helped navigate provider needs, advocated for emergency waivers, and provided support and recognition of the role home care personnel play in these disasters.

Becky Fuller Gray and her team are always available to engage on problems and are always working to help provide answers or craft solutions that fit real-world provider and patient needs.

The national push for extension of the home health rural add-on continues, as Congress considers extension bills and other fiscal matters amid the ongoing debate over the continuing budget resolution.

In a separate but important federal matter, HCA has also learned that key leaders are considering a priority bill for authorization of home care services as part of an omnibus package. The bill is sponsored by Buffalo-area Congressman Chris Collins and has strong support from New York’s Congressional Delegation who we need to press Congressional leaders for final adoption of this measure.  Continue reading “Act Now on Home Health Rural Add-on, NPP Authorization of Home Care” →

For a low cost of $149/$249 (member/non-member rate), HCA is offering an unlimited number of your HR, executive and management staff to get guidance from top legal experts on the law, policies-and-procedures, and staff training to address sexual harassment in the workplace and reduce your organization’s exposure to costly legal liabilities. Join our webinar on January 30 from 10 to 11 a.m.  Continue reading “Webinar Offers Premium Legal Guidance for Home Care HR/Execs on Sexual Harassment Law, Procedures” →

Yesterday, HCA submitted comments to the state Department of Labor (DOL) and testimony for a state Senate Hearing on DOL’s proposed scheduling/call-in pay rule, which would have major implications for health care providers, especially home care. Our comments are here and our testimony is here.

As described in numrous communications, the rule would impose the following requirements on employers (with certain exceptions):

An employee must be paid an additional two hours of call-in pay if reporting for a shift that was not scheduled 14 days in advance.

An employee whose shift is canceled within 72 hours of the scheduled start time must be paid at least four hours of call-in pay. Continue reading “HCA Submits Comments and Senate Testimony on Proposed Scheduling Rule” →

End-of-the-year Congressional activity is putting home care at risk, and we need your action now to reach your Congressional Representatives in Washington. 

Continue reading “Urgent Action Alert: Take 1 Minute to Write Congress Opposing BIG End-of-year Home Health Cuts” →

Responding to a united voice of advocacy from the home care community, the U.S. Centers for Medicare and Medicaid Services (CMS) has withdrawn its Home Health Groupings Model (HHGM) from the final Calendar Year 2018 Medicare Home Health Prospective Payment System (HHPPS) rule, posted late this afternoon.

Noting the volume of technical comments on “various aspects of the proposed case-mix adjustment methodology under the HHGM,” CMS says that commenters “were most concerned about the proposed change in the unit of payment from 60 days to 30 days and such change being proposed for implementation in a non-budget neutral manner.”

HCA made this a major point in our comments on the rule, noting that “HHGM must be revised to be implemented in a true budget-neutral fashion,” we wrote. “Budget neutrality is an essential hallmark of past payment reform policies and is an important protection against system-wide fiscal destabilization.” Continue reading “In Win for Home Care, HHGM Withdrawn from 2018 HHPPS Final Rule” →

HCA’s upcoming Quality and Technology Symposium, on November 16 & 17 in Suffern, NY, is our signature conference geared for home care clinical managers, directors of patient services, quality improvement officers and strategic planners, including the executive teams at your organization who need to think big about the many quality and technology imperatives in home care.

Download the brochure

Register online

BK Health Care Consulting chief Barbara Katz got rave reviews for her segment at one of HCA’s value-based payment programs last year, and we are thrilled to tap her unique expertise again for two exceptional sessions on November 16 and 17:

• An interactive seminar on clinician time and task-management to help you “climb out of chaos” and gain a “roadmap to sanity” while juggling constant change and running an effective operation; plus

• A segment on what is perhaps the biggest hot-topic in quality of care: meeting the new Conditions of Participation (CoPs) for implementing a Quality Assurance/Quality Improvement (QAPI) program.

Continue reading “QAPI CoPs, Clinician Time Management Seminar Among 10 Hot Topics at HCA Quality & Tech Symposium” →

In preparation for federal advocacy efforts on September 12, HCA has prepared a series of advocacy documents to guide our visits with lawmakers and their staff.

We encourage you to read these for a review of HCA’s messaging. Please also share them with your Congressional contacts to encourage their action on critical home care federal priorities.

Foremost among our concerns is the ongoing threat to Medicaid, posed by Congressional attempts to repeal and replace the Affordable Care Act, as well as the new Home Health Groupings Model that the U.S. Centers for Medicare and Medicaid Services (CMS) has proposed for 2019, with cuts of up to $1 billion from the system.

HCA is also pressing for: continuation of the Medicare rural add-on; Congressional opposition to hospice rebasing; and relief from regulatory burdens like the Medicare face-to-face rule, pre-claim review, and the current limits on practitioners permitted to order and refer for home care services.

See the PDF downloads below for more information.

• “Home Care Advocacy Ask: Regulatory Relief for Home Care Providers”
• “2018 Proposed Rule: Reject Drastic New HHGM Payment System for Home Care”
• “Continue 3% Medicare Add-On for Rural Home Health”
• “CMS Should Collaborate with Industry to Evaluate Impact of Hospice Payment Reform Before Implementing Any Rebasing Initiatives”
• “Why Medicaid Works – and Why AHCA Cuts are Wrong”

 

 

Continue reading “DOH Hurricane Alert: Immediate Action for Home Care, Hospice Storm Preparedness” →

Program includes tabletop exercise that partly fulfills imminent CoP requirement; plus, group registration discounts offered for HCA members!

September 27, 2017
Albany

HCA presents a comprehensive full-day program on September 27 in Albany, during National Preparedness Month, that will delve into all critical and timely aspects of home care and hospice emergency preparedness affecting your operation.

The program features state health and emergency preparedness officials, including regional officers, planning managers and the Director of the Office of Health Emergency Preparedness, Michael J. Primeau, for insights on challenges and opportunities in home care and hospice preparedness. This is a great opportunity to share your experiences and concerns with top health emergency preparedness officials. Continue reading “Are You Prepared: Emergency Preparedness Essentials in Home Care & Hospice Settings” →

One of our signature programs, HCA’s one-day Corporate Compliance Symposium (October 19 in Albany) is packed with five carefully designed sessions bringing the expertise of legal minds, top consultants, health association leaders and public officials to address your most relevant compliance worries, concerns and needs.

From big-picture considerations to the concrete mechanics of your compliance program planning, this conference will:

• Emphasize the focus areas targeted by government auditors (i.e., OMIG and OIG) so you can assure your readiness;
• Provide takeaways and best-practice guidance based on real-world cases of HIT- and HIPAA-related breaches and enforcement actions;
• Help you overcome exposure and identify new risks introduced by your participation in new integrated models of care; and
• Examine growing segments of the home care continuum that are drawing scrutiny and new regulatory activity from state compliance agencies.

Learn more. Check out the brochure and register online at the links below.

The Senate last week issued a draft health care bill with even deeper Medicaid cuts than the already adopted House plan.

HCA, meanwhile, has continued its work in collaboration with a New York coalition of health care organizations urging members of New York’s Congressional Delegation to resist the Senate measure, along with any consensus bill that would follow in like form. Continue reading “As Senate Bill Goes Public, HCA Heads to Washington Opposing Even Deeper Medicaid Cuts” →

Today, HCA Executive Vice President Al Cardillo delivered testimony before a panel of the state Assembly and Senate on the Health and Medicaid portions of the proposed state budget. HCA’s written testimony is posted to our website here.

The hearing drew testimony from multiple sectors of health care, with stakeholders commenting on the Governor’s Executive Budget proposals and pursuing issues for the Legislature’s consideration in its own one-house budgets and/or resolutions.

Legislators also received testimony from officials at the state Department of Health, office of the State Medicaid Inspector General, Department of Financial Services and other offices representing the Executive on various components of the Health and Medicaid budget.

The Legislature addressed some important and sometimes pointed questions to state officials on issues of relevance to home care. This included: the state’s management of the Medicaid global cap and related Executive “super-powers” for rate changes; the state’s distribution of minimum wage funds to home care; the purview of the Governor’s proposed Health Care Regulation Modernization Team; and other issues. Continue reading “HCA Budget Testimony Stresses Payment, Regulatory, Workforce and Infrastructure Needs” →

The state Department of Health (DOH) has sent an urgent alert to providers that the Health Emergency Data System (HERDS) is activated in preparation for Hurricane Matthew; providers (including home care and hospice) are required to submit data within three hours.

An alert is the “highest priority emergency communication” and “warrants immediate action or attention by the recipient,” according to the DOH communication.

Hurricane Matthew made landfall in Cuba at about 8 p.m. last night. It is a Category 4 storm carrying maximum sustained winds of 130 mph and moving north at 8 mph.

To plan for this event and its potential New York impact, DOH is requiring home care, hospice and other providers to complete one or more survey forms in advance of Hurricane Matthew. Providers should check the Health Commerce System (HCS) to access these required surveys and instructions.

Continue reading “Hurricane Matthew Alert: DOH Requires HERDS Data Response in Three Hours” →

All home care providers are urged to attend an important September 30 webinar (from 10:30 a.m. to noon) launching HCA’s home care screening tool and protocol for sepsis recognition and intervention.

We reported on the webinar in Monday’s edition of The Situation Report newsletter, but HCA just wanted to draw your attention to this important program, given recent alarms by the U.S. Centers for Disease Control and Prevention (CDC) about this top cause of health care morbidity and cost. (Please see our recent press release on the tool for more information and reasons why home care adoption of sepsis intervention is a top priority.)

The September 30 webinar is being hosted by IPRO, HCA and other key organizations. It is the first of three sessions on the adoption, integration and use of this sepsis tool in patient care. Continue reading “Free Sept. 30 Webinar to Launch Home Care Sepsis Screening Tool” →

 

Women in healthcare offer tremendous skills, talents and track records; but women remain underrepresented in healthcare executive leadership roles.

HCA is proud to offer the first-ever Women in Healthcare Leadership Summit in Saratoga on September 28 and 29. This event, a first for HCA and unlike any other, includes several top-tier, nationally recognized women leaders offering skills for advancement in healthcare and all areas of professional development.

DOWNLOAD THE BROCHURE
REGISTER ONLINE
BECOME A SPONSOR

Summit Exhibitors

The following vendors will be on-site for our Women’s Mini-Expo of products and services to support you in work and in life.

• Arbonne
• Audrey’s Art Ltd.
• Pampered Chef
• Shaklee
• Thirty-One Gifts
• Yogibo, LLC
• Young Living Essential Oils
• LuLa Roe
• Massaging Insoles
• Rodan + Fields
• Stella & Dot
• Jamberry Nails
• Peyster Street Designs

Summit Sponsors

HCA extends a big thanks to the following sponsors who are supporting this program.

 

 

HCA is offering several sponsorship opportunities for organizations that want to support — and gain exposure at — HCA’s first-ever Women’s Healthcare Leadership Summit on September 28 to 29 in Saratoga. What better or more positive way is there to promote your brand than at this important leadership program for women in healthcare? Continue reading “Invitation to Sponsor: First-ever Women’s Healthcare Leadership Summit” →

As you read in Friday’s ASAP newsletter, HCA recently sent a letter to New York’s Congressional Delegation expressing firm objections to a recently announced “prior-authorization” demo for Medicare home health services.

HCA is excited to formally introduce Bring The Vote Home New York (BTVH-NY).

HCA President Joanne Cunningham previewed this new campaign at HCA’s Annual Conference earlier this month. Today we are formally launching New York’s version of this national initiative, which is helping home care patients get registered and able to vote, so their voices are heard in the political process.

Bring the Vote Home is taking place in states across the country, including New York. In essence, the campaign offers an easy process for your staff to distribute forms during home visits so their patients can register and receive an absentee ballot. HCA is sponsoring the New York part of the campaign. Continue reading “HCA Invites You to Bring The Vote Home-NY” →

Continue reading “HCA & Association Partners Sponsor June 2 Webinar on Medicare Documentation, F2F” →

The U.S. Centers for Medicare and Medicaid Services (CMS) has released a final rule that covers many aspects of Medicaid managed care.

The rule and fact sheets are at https://www.medicaid.gov/medicaid-chip-program-information/by-topics/delivery-systems/managed-care/managed-care-site.html.

The rule covers long term services and supports (LTSS); care coordination; provider screening and program integrity; subcontractual relationships; quality; beneficiary information and appeals; delivery system reform efforts; and other areas.

Last July, HCA had submitted extensive comments on the then proposed rule, which can be viewed at https://hca-nys.org/letters-and-comments/comments-on-medicaid-managed-care-proposed-rule

HCA’s comments address: the misalignment between federal and state regulations for home care; the need for actuarial soundness of rates by states to managed care plans and rates by plans to home care providers; disenrollment due to home care provider changes; transitions of care; state monitoring requirements; grievances and appeals and aid continuing; provider screening and enrollment; uniform billing; and plan contacts.

HCA will be reviewing the final rule – which, including public comments and CMS’s responses, is over 1,000 pages – to learn if the issues we raised were addressed, and to determine which provisions will affect managed care in New York.

A full summary of the provisions is provided below.  Continue reading “Final Medicaid Managed Care Rule Released  “ →

OMIG has released its 2016-17 Work Plan, detailing the areas of focus in the Medicaid program for State Fiscal Year April 1, 2016 to March 31, 2017.

According to OMIG, this year’s Work Plan continues a focus on organizing work according to categories of service. Building on the 2015-16 Work Plan, OMIG continues to utilize its Business Line Teams across a number of areas, including but not limited to the Delivery System Reform Incentive Payment Program (DSRIP), Managed Long Term Care, Transportation, Home and Community Care Services, and Managed Care.

Further, OMIG will continue to emphasize provider outreach and education, particularly focusing on providers having proactive compliance programs that will prevent or, when necessary, detect and address abusive practices.

The 2016-17 WorkPlan, and plans from previous years, are at: https://www.omig.ny.gov/index.php/information/work-plan. It outlines several areas of focus in home care, LTHHCP and CHHA rates, compliance program review and managed care.

The following are some areas of OMIG focus in the 2016-17 Work Plan follow. Agencies should use these targeted activities, along with the OMIG audit protocols and other materials on the OMIG’s website, to strengthen their ongoing compliance work. Continue reading “OMIG 2016-17 Work Plan Now Available” →

This week, President Obama released his 2017 proposed budget. While the provisions are not expected to pass as part of the budget, various provisions could become part of other Congressional actions, and HCA will remain vigilant in monitoring such legislation.

A summary of the health provisions is at http://www.hhs.gov/sites/default/files/fy2017-budget-in-brief.pdf. Additional information is at https://www.whitehouse.gov/omb. Continue reading “President Obama Releases 2017 Proposed Budget” →

Updated January 25, 2016

HCA’s State Advocacy Program is on February 1 and 2 in Albany. Below are some resources to register and learn more about what HCA is seeking as part of the state budget process and 2016 legislative session. Please check this page regularly for updates.

Registration

Download: Registration for HCA’s PAC Reception for Senate Health Committee Chairman Kemp Hannon (Feb. 1) and our State Advocacy Day (Feb. 2)

Download: Invitation to HCA’s PAC Reception for Senator Hannon

Resources

HCA Resource Guide: Advocacy Day and Home Care’s “Asks” Made Simple

HCA’s 2016-17 State Budget Testimony

HCA’s 2016 Financial Condition Report (“Risk Factors: What You Need to Know about the Financial Condition of New York’s Home Care Community”)

HCA’s “Priority Asks: Position Home Care to Meet the State’s Policy Goals”

HCA invites you, one of New York’s exceptional home care leaders, to attend our 2016 Advocacy Day for Home Care Leaders on February 1-2 in Albany.

The program begins at 6 p.m. on the evening of February 1 with a special fundraising reception hosted by HCA’s Political Action Committee (PAC) for Senate Health Committee Chairman Kemp Hannon who will address attendees, followed by our main Advocacy Day program on February 2 beginning at 9:30 a.m.

Continue reading “Join HCA for our Home Care Leaders State Advocacy Day on February 1-2” →

HCA participated in a meeting yesterday with the state Department of Health (DOH) officials to review DOH-revised survey instruments for home care agencies and hospices for completion and tracking during public emergencies.

Specific parts of a multipart survey process are designed by DOH to be put into motion in emergencies depending on the nature, extent and details of the emergency.

The sections of the survey include basic agency and patient information, agency surge capacity resources and/or assistance needs, evacuation and repatriation information, and others.

The Department also reviewed a survey intended for completion by hospice providers to determine the status and extent of emergency preparedness planning.

The Department also plans to issue in the next several months a Dear Administrator letter reminding, clarifying and stipulating for providers the required contact persons and roles for indication on the Health Commerce System (HCS). HCA reminds providers to check their agency’s contacts currently listed/required for the HCS to be sure that all such individuals and related information is accurate and up to date.

HCA’s home care agencies and hospices can review the draft surveys at the links below and provide HCA with any further comments on the survey, which we, in turn, will add to our feedback to the Department.

• Home Care Emergency Evacuation Survey
• Home Care Emergency Repatriation Survey
• Home Care Emergency Survey: Agency Form
• Home Care Emergency Survey Capacity Form
• Home Care Abbreviated Emergency Response Provider Survey
• Hospice Emergency Planning Survey

DOH plans an HCS emergency preparedness drill this spring using the revised survey tools. HCA requested and DOH agreed to conduct a webinar, likely to be held in February, providing a walk-through of the surveys and an opportunity for exchange with the home care sector.

For further information, please contact Al Cardillo at acardillo@hcanys.org.

During a state Department of Health (DOH) Managed Care Policy and Planning meeting this week, DOH provided key updates on changes it is implementing in the Fully Integrated Duals Advantage (FIDA) Program which home care provider contractors and plans should take note of. The changes are as follows:

• Passive enrollment is suspended until further notice, except in limited circumstances (such as plan drops out of FIDA).

• DOH will be monitoring the effect of these changes prior to expanding enrollment into region 2 (Suffolk and Westchester) and does not expect it to start until after mid-2016.

• The coverage continuity period for out-of-network providers remains 90 days or until a Person Centered Service Plan (PCSP) is developed and implemented, whichever is later.

UAS

• Plans may use the existing MLTC schedule for completion of a participant’s Uniform Assessment (UAS) if the Participant is transferring from a sister MLTC/PACE/MAP plan; i.e., each FIDA enrollee transferring from a sister plan need not complete a new assessment until six months from the date of their last MLTC assessment.

• The FIDA plan must contact the participant and review any available medical record and claims history from the pre-enrollment period to determine changes in health status, health event, or needs that would trigger an updated UAS.

• If an updated UAS is required, it will be conducted within six months of the last UAS, and development of PCSP implemented within 90 days following the enrollment effective date.

• All other participants have a PCSP deadline of 90 days from the enrollment effective date.

Assurance and Participant Satisfaction

DOH/CMS and the Contract Management Team (CMT) will evaluate the FIDA Plan’s IDT delivery and operations. Specifically, the CMT will assess a Plan’s IDT performance against the following existing measures:

• In the last six months, did anyone from the participant’s health plan, doctor’s office, or clinic help coordinate care among these doctors or other health providers?

• How satisfied is the participant with the help in coordinating care in the last year?

• What is the percentage of participants discharged from a hospital who were readmitted within 30 days, either for the same condition as their recent hospital stay or for a different reason?

• What is the percentage of patients 65 years or older discharged from any inpatient facility and seen within 60 days following discharge by the physician providing on-going care, who had a reconciliation of the discharge medications with the current medication list in the medical record documented?

• What is the total percentage of all participants who saw their primary care doctor during the year?

• What is the percentage of participants in FIDA who reside in a nursing facility (NF), wish to return to the community, and were referred to preadmission screening teams or the Money Follows the Person Program?

• What is the number of nursing home-certifiable participants who lived outside the NF during the current measurement year as a proportion to those during the previous year?

• Follow-up required after hospitalization for mental illness.

 Medicare Rates

• CMS has committed to an upward adjustment related to the Medicare Part A and B rates for all of 2016 and 2017.

• The 2016 rates are not yet final but will be retroactive to January 1, 2016.

• CMS will send rate letters to plans explaining the adjustment.

• CMS is conducting additional analysis of the Part D bids.

• CMS is open to reconsidering the assumptions used in determining the adjustment for calendar year 2016 based on revised projections of enrollment and recent experience in the demonstration.

Quality Withhold

• The quality withhold (QW) is effective upon execution of the Three-way Contract Amendments.

• The 2015 and 2016 quality withhold (QW) payments will be tied to participation through December 31, 2016. This will essentially add a new criterion to the QW calculation that excludes an organization from receiving QW amounts if the organization does not participate at least through 2016. (QW amounts are 1 percent of rate in 2015 and 2 percent in 2016).

• For any plans that do not continue through December 31, 2016, quality withhold amounts from 2015 and 2016 will be pooled and added to amounts earned by FIDA plans participating on January 1, 2017 (based on 2016 performance).

IDT Reforms

• The participant has a right to choose the make-up of its Interdisciplinary Team (IDT) and its members. The IDT can consist of just a care manager and participant, or broader, with a variety of members (from the original IDT list).

• IDT members may meet at different times. The care manager may separately meet with different IDT members in developing the PCSP.

• Provider participation in an IDT is adjustable, depending on member availability, items being discussed in a given meeting, or the needs, wishes, and goals of the participant.

• Primary care providers may sign off on a completed PCSP without attending IDT meetings.

• Plans have authorization over any medically necessary services included in the PCSP that are outside of the scope of practice of IDT members.

• IDT training will be encouraged, but not

• Plans develop their own procedures for communication among IDT members.

• Plans retain responsibility for effective and efficient information sharing among providers (including non-IDT participants), including any PCSP revisions.

• DOH/CMS and the Contract Management Team (CMT) will evaluate the FIDA plan’s IDT delivery and operations.

• FIDA plans must meet Medicare-Medicaid Plan Model of Care (MOC) elements and consistently update MOCs to reflect changes to the IDT policy.

• The CMT will assess a Plan’s IDT performance against specific data collected and percentages calculated.

Reporting

• Completion of the bi-weekly and monthly dashboards is no longer required.

• DOH/CMS will streamline several reporting measures (e.g., NY1.1, NY1.2, and NY2.1) based on the new IDT policy (to be released). Changes to these measures would be applicable beginning with the 4^th quarter of 2015 (October – December) reporting period.

Marketing

Plans now have authorization to do the following:

• Market multiple lines of business under the Medicare Marketing Guidelines.

• Provide a written or verbal comparison (either DOH/CMS prepared or plan-prepared) among their MLTC (Partial, PACE, MAP) and FIDA programs.

• Conduct outbound FIDA marketing calls to individuals enrolled in any other Medicaid or Medicare product line with the plan or company.

• Organize in-person appointments if they are solicited by the individual.

• Conduct promotional activities and make nominal gifts at the Medicare Marketing Guidelines levels ($15).

• Send, with a prior approval from DOH/CMS, FIDA educational materials (e.g., letters, newsletters, etc.) to participants who have opted out.

• Plans may submit enrollment requests to Maximus (consistent with MLTC procedure). Maximus will process the enrollment and send letters, which include Independent Consumer Advocacy Network Independent Consumer Advocacy Network Independent Consumer Advocacy Network Independent Consumer Advocacy Network (ICAN) contact information, to the individuals that: 1) confirms the Participant’s enrollment in FIDA; 2) informs the Participant that choice counseling is available through Maximus; and 3) informs the participant of the option to switch or disenroll from a FIDA Plan at any time.

• Plans may remain on the phone when prospective participants call Maximus.

• Plans do not have to include both the plan phone number and enrollment broker number in their marketing materials.

ADA Attestation Form

• No provider should be terminated from a FIDA plan network for not answering in the affirmative to elements on the form.

• The form is to help FIDA participants identify which providers offer specified accessibility features.

• Completion or non-completion of the form, or responding in the affirmative to elements included therein does not alter existing obligations to comply with the Americans with Disabilities Act (ADA).

• FIDA plans must maintain a complete and accurate provider directory, including information collected by the form. FIDA plans have discretion on how to address provider refusals to complete the form.

Next Steps

• DOH will release the full set of FIDA Reforms, including an updated IDT policy.

• Reforms are effective immediately unless otherwise stated.

• Plans should make sure that they participate in the Friday FIDA plan conference calls.

This post provides an October 2015 emergency preparedness update for the home and community services sector. It coordinates information from several recent state and regional emergency preparedness communications. (You can download this update in memo format as a PDF here.)

HCA is a collaborative partner to the New York State Department of Health for statewide emergency preparedness efforts. HCA thanks the Office of Health Emergency Preparedness (OHEP), the Office of Primary Care and Health Systems Management (OPHSM), the regional Health Emergency Preparedness Coalitions (HEPCs) and the Regional EP Training Centers (RTCs) for this ongoing partnership, support and resource.

Continue reading “Emergency Preparedness Information and Resource Update: October 2015” →

The state Department of Health (DOH) has yet again issued its monthly Medicaid Global Cap report. This latest report, for July, covers the period ending July 31 and beginning at the start of the fiscal year: on April 1.

It finds that overall spending for this period was $4 million below Medicaid Global Cap projections, across all sectors, a difference of $5.984 billion in actual spending versus $5.988 billion in estimated spending for the four-month period.  Continue reading “July Medicaid Global Cap Report: Spending $4M Under Projections” →

The Office of the National Coordinator for Health Information Technology (ONC) has released the updated Federal Health IT Strategic Plan 2015-2020 at http://www.healthit.gov/policy-researchers-implementers/health-it-strategic-planning. Continue reading “Final Federal Health IT Strategic Plan 2015-2020 Released” →

The state Department of Health (DOH) has posted a summary of the Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) Transition Workgroup meeting held on August 24 and Frequently Asked Questions (FAQs) related to the Workgroup.

The materials are available at http://www.health.ny.gov/health_care/medicaid/redesign/mrt_90.htm.  Continue reading “NHTD & TBI Transition Workgroup Materials Posted” →

The New York State Office for the Aging (SOFA) is conducting a survey related to state legislation that authorizes it to study the feasibility of creating an Office of Community Living “with the goal of providing improvements in service delivery and improved program outcomes that would result from the expansion of community living integration services for older adults and persons of all ages with disabilities.”

A primary component of this effort is data and information collection through working with stakeholders. SOFA has developed a stakeholders group and is holding public forums throughout the state.

SOFA is conducting a survey of consumers and providers about the possibility of creating a new state Office of Community Living. The provider survey is at https://bostonu.qualtrics.com/jfe/form/SV_b28zoikIEQnU2BD.

More information on this effort is at http://www.aging.ny.gov/CommunityLiving/index.cfm.

The state Department of Health is expanding the NYSE-CON application to allow pre-opening inspections for Certificate of Need (CON)-approved projects, utilizing the “Regional Office” tab in NYSE-CON.

The Regional Office tab, available since May 2015, is accessible when CON projects have been approved and contingencies have been satisfied.

The tab now enables applicants to create project phases, attach documentation for DOH review prior to the pre-opening inspection, and receive communications from DOH staff regarding the preopening inspection.

Additional information can be found at http://www.health.ny.gov/facilities/cons/nysecon/.

Questions can be directed to nysecon@health.ny.gov.

The U.S. Centers for Medicare and Medicaid Services (CMS) has posted a transmittal that provides detailed information on its Medicare Care Choices Model (MCCM).

The transmittal is at https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R121DEMO.pdf.

Under MCCM, Medicare and dual eligible beneficiaries with advanced cancers, chronic obstructive pulmonary disease, congestive heart failure, or HIV/AIDS who meet hospice eligibility requirements under the Medicare hospice benefit will be eligible to receive palliative care services from certain hospice providers while concurrently receiving services from curative care providers. Continue reading “Transmittal Issued on Medicare Care Choices Model” →

This week, the U.S. Centers for Medicare and Medicaid Services (CMS) Office of Minority Health unveiled the first CMS plan to address health equity in Medicare. Its plan focuses on six priority areas and aims to reduce health disparities in four years.

The Equity Plan focuses on Medicare populations that experience disproportionately high burdens of disease, lower quality of care, and barriers accessing care. These include racial and ethnic minorities, sexual and gender minorities, people with disabilities, and those living in rural areas.

The six priority areas include expanded collection and analysis of standardized data; integration of equity solutions across CMS programs; developing approaches to reduce disparities; health care workforce; improving communications and language access for those with limited proficiency; and increasing the physical accessibility of health care facilities.

To learn more, visit: https://www.cms.gov/About-CMS/Agency-Information/omh/index.html.

Medicare has contracted with a Supplemental Medical Review/Specialty Contractor (SMRC) that is evaluating medical records and related documents to determine whether claims were billed in compliance with coverage, coding, payment, and billing practices.

However, some providers may not be getting the medical records because the provider address is incorrect or because they do not know about the SMRC.

New York’s Medicare Administrative Contractor, National Government Services (NGS), urges all providers to update their addresses in the National Plan and Provider Enumeration System (NPPES). The SMRC uses this source to mail additional development requests (ADRs) for medical records; an incorrect address can result in records being returned and, as a result, claims being denied.

NGSConnex and IVR Systems Not Available this Weekend

NGS also reports that, due to scheduled maintenance, NGSConnex and the Interactive Voice Response System (IVR) systems will not be available this weekend.

For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

Home care and personal care spending slightly above projections

The state Department of Health (DOH) has issued its June 2015 Medicaid Global Spending Cap Report.

It shows overall spending to be $11 million less than projected for the current fiscal year through June. (The current state fiscal year began on April 1, 2015 and ends March 31, 2016.) Continue reading “DOH Releases June 2015 Global Cap Report” →

eMedNY has notified providers of rate changes for certain services under the Nursing Home Transition and Diversion (NHTD) waiver program. Also, the state Department of Health (DOH) has announced a stakeholder group for the transition of the NHTD and Traumatic Brain Injury (TBI) programs to managed care.

The following rate changes were implemented July 13 and are effective retroactive to April 1, 2015: Continue reading “Some NHTD Rates Change: New TBI Rates Coming Soon” →

The state Office of the Medicaid Inspector General (OMIG) has posted revised (July 3, 2015) audit protocols for the Traumatic Brain Injury (TBI) program.

They are available at https://www.omig.ny.gov/images/stories/audit_protocols/tbi_protocol_7_3_2015.pdf.

The protocols cover: missing/incomplete service plan; missing documentation of service; billed more hours than authorized or documented; incorrect rate code billed; services performed by unqualified staff; staff training not completed; failure to meet health requirements; and other issues.

HCA members providing TBI services are strongly advised to review the revised audit protocols for compliance purposes.

National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), has recently posted the following information to its website.

• Impact of Sequestration on Hospice Aggregate Cap – NGS has drafted a notice that includes an example informing hospice providers of how sequestration will be handled within the aggregate cap determinations starting with the 2013 cap calculation and beyond. NGS will calculate the aggregate cap determinations by adding the sequestration and net reimbursement amounts together found on the Provider Statistical and Reimbursement (PS&R) report to determine the pre-sequester reimbursement amount. The pre-sequester reimbursement amount will be compared to the allowable Medicare payment amount which will determine the hospice’s pre-sequester payment in excess of the cap amount. If there is a pre-sequester payment in excess of the cap, that amount will be reduced by 2 percent. This amount cannot be greater than the sequestration amount found on the PS&R report. Therefore, these two amounts will be compared and the lesser of the two will be applied to the calculation.

Continue reading “Updates From the Medicare Contractor: NGS” →

On July 28, the Uniform Assessment System (UAS-NY) online application was upgraded from version 7.18 to version 7.23.

Upon login to the UAS-NY, users are presented with a list of all required and recommended training courses that are completed and not completed. Users will now have the option to “Show All Courses” or “Hide Completed Courses.”

Version 7.23 will limit the timeframe for creating an assessment. Users may only initiate an assessment if the Assessment Reference Date is no more than 30 days prior to the current date. For example, if the current date is July 24, 2015, a new assessment may be initiated if the Assessment Reference Date is between June 24, 2015 and July 24, 2015.

The state Department of Health (DOH) has posted a General Information System (GIS) message to advise local departments of social services (LDSS) that an annual review of managed care exemption (91) and exclusion (90) Restrictive/Exception (R/E) entered codes should take place.

With most Medicaid populations transitioning into mandatory managed care, DOH stresses the importance of placing an end date on 90/91 R/E codes to avoid impeding managed care enrollment.

The GIS is at http://www.health.ny.gov/health_care/medicaid/publications/pub2015gis.htm (see GIS 15 MA/012).

Livanta has been operating as the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) since August 1, 2014. It is responsible for reviewing all Medicare discharge appeals and quality of care concerns for beneficiaries in many states, including New York.

Livanta has created a bulletin which offers several important reminders regarding standards of practice for physical therapy (PT) and discharge appeals.

Livanta has asked us to share this latest bulletin with our provider membership and we recommend that you forward this information to the appropriate staff in your agencies. It is at https://hca-nys.org/wp-content/uploads/2015/08/PTDischargePlanningReminderFinal.pdf.

For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

The Public Health and Health Planning Council (PHHPC) met on August 6 where it approved all of the following items:

• One application for 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 LTHHCP that 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 City metropolitan area).

The meeting materials are at https://www.health.ny.gov/facilities/public_health_and_health_planning_council/meetings/2015-08-06/.

This week, the U.S. Centers for Medicare and Medicaid Services (CMS) announced the participants in the Medicare Care Choices Model.

The Choices Model provides Medicare beneficiaries who qualify for coverage under the Medicare hospice benefit and dually eligible beneficiaries who qualify for the Medicaid hospice benefit the option to elect to receive supportive care services typically provided by hospice, while continuing to receive curative services. Continue reading “Medicare Care Choices Model Awards Announced” →

The National Association for Home Care and Hospice (NAHC) reports that the federal Occupation Safety and Health Administration (OSHA) has issued Instructions for  general enforcement policies and procedures to be followed when conducting inspections and issuing citations related to occupational exposure to tuberculosis (TB). Continue reading “OSHA Issues Revised TB Inspector Instructions  “ →

The U.S. Centers for Medicare and Medicaid Services (CMS) has made available, beginning July 20, provider-specific comparative data reports for Home Health Agencies.

The Program for Evaluating Payment Patterns Electronic Report (PEPPER) summarizes claims data statistics for areas that may be at risk for improper Medicare payments. PEPPER is a free report comparing an agency’s Medicare billing practices with other agencies in the nation, Medicare Administrative Contractor (MAC) jurisdiction, and state. Agencies can use the data to support internal auditing and monitoring activities. Claims statistics include:

• Average case mix
• Average number of episodes
• Episodes with 5 or 6 visits
• Non- Low Utilization Payment. Adjustment (LUPA) payments
• High therapy utilization episodes
• Outlier payments

Continue reading “Home Health Agencies to Receive Comparative Data Reports” →

This week, the Medicare and Social Security Trustees released their annual reports on the long-term financial status of the Medicare and Social Security Trust Funds.

The Medicare Trustees predict that the trust fund that finances Medicare’s hospital insurance coverage will remain solvent until 2030, unchanged from last year. Continue reading “Medicare and Social Security Trustees Reports Issued  “ →

National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), has recently posted the following information to its website.

ICD-10 Acknowledgement Testing to Resume July 27

NGS will resume ICD-10 acknowledgement testing beginning Monday, July 27, 2015 and continue through the implementation of ICD-10 this fall. Registration is not required for acknowledgement testing. Continue reading “Updates from the Medicare Contractor: NGS” →

eMedNY has posted its July through September Training schedule.

Training seminars on a variety of Medicaid billing topics are being held at the following locations during July, August and September:

• Canandaigua
• Canton
• Cortland
• NYC
• Hauppauge
• Poughkeepsie
• Rensselaer

Continue reading “eMedNY Trainings Scheduled  “ →

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services’ Innovation Center (CMS Innovation Center) has announced a proposal, through the notice and comment rulemaking process of a new model for Medicare beneficiaries who undergo hip and knee replacements.

This model, called the Comprehensive Care for Joint Replacement (CCJR) Model, would test bundled payment and quality measurement for hip and knee replacements to encourage hospitals, physicians, and post-acute care providers (including home health agencies) to work together to improve quality and coordination of care throughout an entire episode of care, from the initial hospitalization through recovery.

With publication of a proposed rule, CMS is seeking input and comments from the public, including beneficiaries, health care providers, and other stakeholders.

Under this proposed model, the hospital in which the hip or knee replacement takes place would be accountable for the costs and quality of care from the time of the surgery through 90 days after — what’s called an “episode” of care.

Depending on the hospital’s quality and cost performance during the episode, the hospital would either earn a financial reward or be required to repay Medicare for a portion of the costs. According to CMS, this payment would give hospitals an incentive to work with physicians, home health agencies, and nursing facilities to make sure beneficiaries receive the coordinated care they need with the goal of reducing avoidable hospitalizations and complications.

Hospitals would have additional tools — such as spending and utilization data and sharing of best practices — to improve the effectiveness of care coordination.

This model would be in 75 geographic areas throughout the country and most hospitals in those regions would be required participate.

The proposal is available at  https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-17190.pdf and can be viewed at http://federalregister.gov/a/2015-17190 starting July 14, 2015.

The deadline to submit comments is September 8, 2015.

For more information, visit http://innovation.cms.gov/initiatives/ccjr/.

The U.S. Department of Health and Human Services (HHS) has announced new training material to help provide care for people living with multiple chronic conditions.

The resources support goal three of the HHS Strategic Framework on Multiple Chronic Conditions (http://www.hhs.gov/ash/initiatives/mcc/mcc_framework.pdf), released in 2010, which is to provide better tools and information to health care, public health and social services workers who deliver care to people living with multiple chronic conditions. Continue reading “New Training Resources on Chronic Conditions” →

The U.S. Centers for Medicare and Medicaid Services (CMS) has developed a series of videos to help ease your transition to ICD-10. The October 1, 2015 implementation date is fast approaching and these videos will provide an overview of ICD-10, implementation guidance and coding examples.

The following videos are currently available for viewing: Continue reading “CMS Posts ICD-10 Videos and Other Updates  “ →

This post provides an emergency preparedness update for the home and community services sector. It coordinates information from several recent state and regional emergency preparedness communications. (You can download this update in memo format as a PDF here.)

HCA thanks the New York State Department of Health/Office of Health Emergency Preparedness (OHEP), the regional Health Emergency Preparedness Coalitions (HEPCs) and the Regional Training Centers (RTCs) for this helpful information. Continue reading “Emergency Preparedness Information and Resource Update” →

Governor Cuomo today announced the awarding of specific funding allocations for each of the state’s performing provider systems (PPSs) under the Delivery System Reform Incentive Payment (DSRIP) program.

By establishing collaborative networks, the PPS projects are tasked with achieving a 25 percent reduction in avoidable hospital use over five years. Continue reading “Governor Announces DSRIP Funding Allocations to PPSs” →

The U.S. Supreme Court has ruled in favor of the Obama Administration regarding the permissibility of federal subsidies to enrollees in certain states when they obtain coverage under the Affordable Care Act (ACA).

The case revolved around a reading of ACA and the following question: Can enrollees receive the subsidies in those specific states that declined to set up their own exchanges? In such cases, enrollees have had to use the federal exchange.

By a 6-3 vote, the justices said that ACA does allow the subsidies to be provided in the 34 states that opted out of setting up their own insurance exchanges.

New York is not one of those states – it has its own exchange – and is, therefore, not affected by the ruling. Its exchange continues to operate as it has.

The U.S. Centers for Medicare and Medicaid Services (CMS) will hold a Home Health, Hospice and Durable Medical Equipment (DME) Open Door Forum on July 8, from 3:30 to 4:30 p.m. The agenda will include: home health and hospice proposed rule updates, home health CAHPS survey news, home health star rating material review, various hospice updates, home health claims processing announcement and the publication of the Office of Management and Budget (OMB) approved OASIC C1/ICD-10 data set.

The call-in number is 1-800-837-1935 and conference ID is 21624265. CMS recommends calling in at least 15 minutes ahead of time. A recording will be available two hours after the call by dialing 1-855-859-2056 and entering Conference ID 21624265.

For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), has recently posted the following information to its website.

• Reminder: NGS Requests Provider Participation in 2015 MAC Satisfaction Indicator Survey – NGS is asking all Jurisdiction 6 providers to participate in the 2015 Medicare Administrative Contractor (MAC) Satisfaction Indicator (MSI) survey. The survey takes less than 10 minute to complete and will ask you to share your experience with the services NGS provides. The survey is at https://cfigroup.qualtrics.com/SE/?SID=SV_3UBxriB8PrHOZEN&MAC_BRNC=5

• Correction of E-mail Address on Hospice Notification – The initial notification letters were sent on June 8 to hospice agencies that were subject to the two percentage point payment update reduction for Fiscal Year 2016 (due to not submitting quality data). The letters contained an incorrect e-mail address for CMS. The correct address is HospiceQRPReconsiderations@cms.hhs.gov.

• 2015 Home Health PPS Mainframe Pricer Software Available – The 2015 Home Health (HH) Prospective Payment System (PPS) Mainframe Pricer software was revised and is now available at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PCPricer/HH.html

For further information, contact HCA’s Patrick Conole at (518) 810-0661 or at pconole@hcanys.org

On June 1, the Performing Provider Systems (PPSs) submitted Domain 1 Implementation Plans to the state Department of Health (DOH) for the Delivery System Reform Incentive Payment (DSRIP) program.  DOH, other agencies, and the DSRIP Independent Assessor (IA) are currently reviewing these plans.  In early June, DOH shared baseline data, additional attribution information, detailed webinars, and guidance with the PPSs.

Project Implementation Plans are due from the PPSs by July 31. Continue reading “DSRIP Update  “ →

The HCA Palliative Care and Hospice Forum developed and succeeded last year in legislative passage of a new palliative care access initiative. The initiative aims at increased palliative care access through expanded opportunities for palliative care education, training and clinical practice participation by nurses and social workers. The HCA-developed legislation specifically charges the State Palliative Care Council with examining curricula in schools of nursing and social work, as well as opportunities in clinical practice settings, relative to palliative care.  A report will follow, with recommendations for program support to major state health and education officials.

The State Council is asking HCA and state associations representing virtually every sector of the system to briefly survey providers to help portray the level of palliative care education, training and clinical participation occurring in the field.  A parallel inquiry is being conducted with the respective professional nursing and social work schools.

HCA will be issuing a brief survey — five to ten minutes — for all home care providers to complete. It will be used as the basis to inform the recommendations for support of palliative care in home care.

This HCA initiative stands to be one of the most significant steps in potential palliative care support and development in years, and coincides perfectly with the state’s focus on delivery reform and value based payment.

Gear up for summer planning with vital info, networking, case examples

Continue reading “June 16 Technology Symposium is Last Signature HCA Conference Before September” →

TAKE ACTION TODAY

Assembly Insurance Committee Chairman Kevin Cahill has introduced HCA’s home care insurance realignment bill (A.7706), making this legislation a two-house, bipartisan measure, following Senate Insurance Chairman James Seward’s introduction of the bill (S.5076) in late April.

The legislation seeks to provide long-overdue updates to the State Insurance Law dictating coverage for home care services. (More information is on our website here.)

Continue reading “HCA Insurance Bill Now a 2-House Measure: Act Now in Support! “ →

HCA continued to advocate for fairness in the eligibility determination process for the Quality Incentive Vital Access Provider Pool (QIVAPP) program by sending a joint letter with other associations to State Medicaid Director Jason Helgerson, with copies to the state Department of Health (DOH) Commissioner, Administration officials, and legislative officials.

The letter, signed by HCA, the New York State Association of Health Care Providers (HCP) and LeadingAge NY, took issue with DOH’s most recent interpretation of provider eligibility criteria for participation in QIVAPP,  as reflected in its April 29, 2015 QIVAPP Webinar Frequently Asked Questions (FAQs) document. The letter also addresses the future use of the QIVAPP program as a means to assist home care providers in meeting rising costs stemming from the Home Care Worker Wage Parity Law of 2010 and other ongoing mandates.

Continue reading “HCA & Associations Press for Fairness on QIVAPP Monies” →

HCA members have told us that DSRIP and other new models of care delivery are the number 1 area where more education is needed.

If you agree, then be sure to join us on May 28 in Albany for one day of focus on all of the new care models that will fundamentally change how your organization will operate in the future, from your participation in DSRIP to the onset of Value Based Payments, and more.

Watching the information flow from virtually every health care provider group or association, like HCA, you’ll see that DSRIP and Value Based Payments dominate the headlines, and for good reason. Providers must have a strategic action plan for these models or else miss out on vital opportunities to be a player in a fast-changing health care system.

HCA continues to offer the home care perspective on these health system changes, and our May 28 conference will provide you with access to the major architects and consultants working to bring these new models online including State Medicaid Director Jason Helgerson; the state’s contractor on the design of Value Based Payments, Dr. Marc Berg; Greg Allen, the state Department of Health’s main program development leader; expert consultants like Tracy E. Miller from Bond Schoeneck and King; and others.

From them, you will gain an understanding of how these models fit together, how to re-tool your organization to operate in these new models, and how to get your business plan ready for participation.

Please see the details below.

Are You Ready to Navigate New Models of Care and Coverage?
Thursday, May 28, 2015
Empire State Plaza
Meeting Room 2-4
Albany, NY

Who should attend?

Home health provider and health plan CEOs, CFOs, COOs and those who need a better understanding of emerging care models to position successfully in a new service and payment delivery environment.

How to register?

• Download the brochure and registration form here.
• Register online here.