Category: General News

Medicare Care Choices Model Awards Announced

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”

Home Health Agencies to Receive Comparative Data Reports

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”

Updates from the Medicare Contractor: NGS

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”

Feds Propose Hip and Knee Replacement Initiative using Bundled-Payment Model  

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/.

New Training Resources on Chronic Conditions

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”

HCA Comments on Hospice Proposed Rule

HCA has submitted our comments on the 2016 proposed rule for Medicare hospice payment updates, wage index changes and quality reporting recently posted by the U.S. Centers for Medicare and Medicaid Services (CMS). Our comments can be read here.

On the payment side, our comments specifically address several items in the proposed rule, including: revisions to the routine home care rate, the service intensity add-on payment, the inpatient aggregate cap accounting year timeframe, and the wage index which is particularly problematic and in need of revision.

We also provide item-by-item comments on quality reporting elements of the proposed rule, such as the Hospice Quality Reporting Program (HQRP) data submission process and future quality measures; the impact of Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey results on 2017 payments (an unfunded mandate in need of reimbursement support); and the reporting of diagnoses on hospice claims.

 

Emergency Preparedness Information and Resource Update

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 Announces DSRIP Funding Allocations to PPSs

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”

Supreme Court Rules on Subsidy Question for ACA Enrollees

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.

CMS Home Health Open Door Forum: July 8

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.

Medicare Contractor Updates from NGS

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.

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

DSRIP Update  

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  “

HCA Palliative Care Initiative Being Implemented Continuum-wide

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.

Act Now on HCA Priority Legislation

The state’s Legislative session ends on June 17. During this crunch time, HCA is working to amend any bills of concern. We are also pushing hard on priority bills that HCA and partner associations have advanced to support home care.

We need your help. The Legislature won’t be compelled to act unless they hear from you, their constituents.

As you know, HCA’s Legislative Action Center is an easy-to-use online tool for reaching your legislators. Now that it is crunch time, we need all HCA members to take just a minute or two to advocate for home care.

Continue reading “Act Now on HCA Priority Legislation”

HCA Gains Intro of Bill to Limit EPS Rebasing

Legislative intro occurs as DOH posts interim EPS rates, retroactive to April 1  

As the state legislative session enters its final days, HCA, working with association partners, has succeeded in advancing bipartisan legislation (S.5878 Hannon/A.8171 Gottfried) that would limit the impact of CHHA Medicaid rebasing for the Episodic Payment System (EPS).

The introduction of this legislation occurred at the same time that the Department separately posted the interim EPS rebasing rates to the Health Commerce System (HCS). Continue reading “HCA Gains Intro of Bill to Limit EPS Rebasing”

Major Legislative Opportunities and Challenges in Session Wind Down

Major opportunities and challenges alike mark the next two, closing weeks of the State Legislative Session, scheduled to conclude June 17.

In this wind down of the annual legislative calendar, the state Senate and Assembly will be considering significant issues that both directly and indirectly impact home and community-based care, many with huge implications for this sector.

Continue reading “Major Legislative Opportunities and Challenges in Session Wind Down”

June 16 Technology Symposium is Last Signature HCA Conference Before September

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

HCA’s final major conference of the spring/summer is on June 16, just three weeks away, when we present our signature Technology Symposium and Vendor Showcase in Albany.

You will not want to miss this final chance for gaining new insights to support the strategic thinking you’ll need to do throughout the critical summer planning months as you head into the fall budgeting season. (Our next big conference will be our September Financial Managers Retreat.)

 

Like many of your peers, you may be struggling a bit with your current technology portfolio to make it plug-in-ready for DSRIP participation and other integrated models. Indeed, according to HCA’s most recent survey of the industry, providers reported the need for IT support to align with health policy directives such as: “becoming interoperable with local providers”; “interoperability to advance initiatives such as bundling and DSRIP”; “community portals to hospitals, managed care plans and patients”; “expand and upgrade the use and availability of mobile devices for all field staff.”

HCA’s Technology Symposium brings a specialized focus on all of these areas of need identified by you and your peers.

As you head into the summer months and gear up for your fall budget planning, this conference is an excellent opportunity to learn about the technology investments you’ll need to think about as you prepare for the future. At the conference, HCA will have ten technology vendors on hand to give you new ideas for product applications.

You’ll also hear from a group of home care agencies who will tell you about the grassroots R&D work they have done to implement various technologies to improve patient satisfaction, care outcomes and cost efficiencies in ways you may not have considered.

State Health Department technology experts will also be on hand to make the connection between technology systems and new payment models like DSRIP, Value Based Payments, Managed Long Term Care, FIDA and Health Homes, including investments and priorities in these areas. You will not want to miss this discussion and critical exchange as HCA simultaneously works to advance legislation that will promote targeted and enhanced investments for home care. Your participation on June 16 will not only provide you with ideas but will help buttress this HCA advocacy priority by giving policymakers a concrete understanding of the very real areas of need for technology investment as part of their program and planning agenda.

You’ll also hear from representatives of Regional Health Information Organizations (RHIOs) and the New York eHealth Collaborative on ways you can better integrate your systems with the larger networks of electronic health records and collaborative partnerships.

Summer is almost here. Take advantage of this last opportunity before September to network with peers, vendors and learn from experts in the field through HCA’s signature education programming.

How to Register? 

DOWNLOAD THE BROCHURE AND FAX BACK TO HCA

REGISTER ONLINE USING CREDIT CARD

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

HCA Insurance Bill Now a 2-House Measure: Act Now in Support! 

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 & Associations Press for Fairness on QIVAPP Monies

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”

Time is Running Out: Register Now for HCA’s May 28 Conference on DSRIP, VBP and other New Models

Just nine days left to register online or through our brochure!

Like most providers, your team is surely rolling up its collective sleeves for strategic planning discussions on DSRIP and other new models, like Value Based Payments, which are very near on the horizon.

These programs are not merely tinkering with the edges of our health care system; they represent fundamental changes.

Now, and in the months ahead, your proactive and reactive work activities require an entirely new business plan, operational systems restructuring, different contract models, workforce and clinical practice reorientation, and, above all, a whole new outlook on the way you partner with other organizations.

These changes are happening swiftly. No doubt you could use a lot more answers on all of these development areas.

On May 28, just nine days away, HCA is holding a one-of-a-kind conference to help you prepare for change, asking of you the question: Are You Ready to Navigate New Models of Care and Coverage?  Continue reading “Time is Running Out: Register Now for HCA’s May 28 Conference on DSRIP, VBP and other New Models”

You’ve Asked for More Education on DSRIP, Value-based Payments, and We’ve Got it for You on May 28

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?