Category: General News

Slide Presentation: Legislative Forum on Home and Community Care Services

On January 8, HCA, the Hospice and Palliative Care Association of New York State and the New York State Association of Health Care Providers held a forum for state legislators and their staff offering background on home and community care services – in particular, home care, hospice/palliative care and MLTC – that may aid in:

  • Assisting constituents, families and communities with their health care needs.

Continue reading “Slide Presentation: Legislative Forum on Home and Community Care Services”

Home Care 101 for Legislators, Staff on January 8

The Home Care Association of New York State, the Hospice and Palliative Care Association of New York State, and the New York State Association of Health Care Providers are jointly holding a January 8 Home and Community Care Services Open Forum for State Legislators and their staff at the Legislative Office Building in Albany. Details are in the flyer here. Continue reading “Home Care 101 for Legislators, Staff on January 8”

Saluting Veterans in Home Care and Hospice

For Veterans Day, the Home Care Association of New York State (HCA) joins its home care, hospice and managed long term care provider members throughout New York State in recognizing exceptional individuals who have made the ultimate sacrifice through military service.

Our observance of veterans also coincides with National Home Care and Hospice Month in November.

HCA honors the wishes of patients, including our nation’s veterans, to live independently, with dignity, and with the medical,
social or assistive services to help them fulfill those wishes in the community setting.

If you are a veteran – or if your veteran constituents need care – HCA is proud to be a resource for services at (518) 426‐8764.

Join HCA, IPRO, HANYS and Partners for Major Cross-Sector Sepsis Summit on Oct. 3 in Albany

HCA, IPRO, HANYS, the Rory Staunton Foundation for Sepsis Prevention, Sepsis Alliance and partner organizations invite you to register for a first-of-its-kind All-Sector Sepsis Summit on October 3 in Albany.

Click the event page here for online registration and to download the brochure for the full agenda, which includes top state health officials, physician experts, representatives of the various health sectors, public policy and education partners, and quality and clinical experts.

Continue reading “Join HCA, IPRO, HANYS and Partners for Major Cross-Sector Sepsis Summit on Oct. 3 in Albany”

Your Action Needed NOW on HCA Bills to Support Home Care, Hospice and MLTC

This year’s state legislative session is expected to wind down very quickly in terms of the timeline and level of legislative activity, especially given statewide elections in the fall which will likely drive an early beginning to the summer campaign season.

As reported in several recent editions of The Situation Report newsletter, HCA has written a slate of proactive bills to support the home care, hospice and MLTC membership. HCA’s measures are designed to position the home and community based system favorably given the current political environment in which the Legislature and Governor are expected to concentrate on only a select range of issues for action.

Today, we need your grassroots help in writing to the legislative sponsors, bolstering their support for our initiatives while helping to raise the visibility of issues that affect home care, hospice and MLTC organizations.

What We Need You to Do Now

HCA has created a new landing page on our Legislative Action Center with seven messages of support for HCA’s bills that all members must send to the legislative sponsors as soon as possible.

Please act on all seven of these messages, each of which takes less than a minute of your time to send by entering your contact information and pressing a button on each action item. Your action will significantly augment our chances of success.

So, click the link to our Legislative Action Center, where you’ll see boxes for each action item. Click “add your voice” on each action item, read the short summary, enter your contact information, and send the messages today. Please do this for all seven messages.

With our Legislative Action Center, we’ve worked to make this process quick and easy for you, so your participation is imperative. Please also use the messages as a basis for making phone calls to the legislative sponsors as well. The more ways that they hear from you, the better our chances of success.


In Letter to CMS, HCA Opposes Thresholds Exempting States from Having to Submit Monitoring Plans of Medicaid Access

HCA has submitted comments to the U.S. Centers for Medicare and Medicaid Services (CMS) urging CMS to maintain its existing requirement for states, like New York, to submit an access monitoring review plan that holds states accountable on Medicaid access to care.

Under a rule known as the “equal access provision,” states are required to set Medicaid fee-for-service (FFS) rates to ensure access to services for Medicaid beneficiaries at a comparable level to non-Medicaid FFS-insured individuals. To hold states accountable for keeping competitive rates, CMS in 2015 began requiring states to submit an access monitoring review plan (or AMRP) every three years when rate changes occur (among other factors) to fee-for-service entities like Certified Home Health Agencies (CHHAs) and other FFS providers. Continue reading “In Letter to CMS, HCA Opposes Thresholds Exempting States from Having to Submit Monitoring Plans of Medicaid Access”

DOH Issues Notice on Investigation into Reliability of Glucose, Potassium Results by Lab Provider

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:

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.


HCA’s 2018 Award Recipients

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.

Continue reading “HCA’s 2018 Award Recipients”

WNY HCA Members Write to Rep. Collins on NPP Authorization Bill

HCA members serving Buffalo, Rochester and surrounding counties sent a letter this week to Western New York Congressman Chris Collins bolstering his support for legislation (H.R. 1825) to allow non-physician-practitioners (NPPs) to order and refer for home health services.

Rep. Collins is sponsor of this priority bill and has indicated his support to move it forward this Congressional session. The bill has widespread bipartisan co-sponsorship, including from 11 members of the New York House Delegation. Please see the list of House cosponsors here. If Representatives serving your patients are not on this list, please contact their offices to urge their co-sponsorship of H.R. 1825 so that we can keep up momentum on this priority bill. If you need any assistance, please contact HCA’s Communications Director Roger Noyes at Continue reading “WNY HCA Members Write to Rep. Collins on NPP Authorization Bill”

Register Now for HCA’s 40th Annual Conference “40 Years Strong” on May 9-11

Conference40 Years Strong, HCA’s Annual Conference

Date: May 9-11, 2018

VenueSaratoga Hilton, Saratoga Springs



Registration is now open for HCA’s milestone Annual Conference celebrating our 40th year as an association with the theme 40 Years Strong.

Please help make this the best celebration yet, by registering today using the form at the back of our brochure here.

For this banner conference, we’ll be joined by special guest Bill Dombi, President of the National Association for Home Care and Hospice, as well as other expert presenters offering insights on all facets of home care operations.

These sessions, networking opportunities and more will help your organization plan for the future by: tackling emerging issues, enhancing your team’s performance, confronting public health and population health challenges, and optimizing your success with some of the biggest challenges happening to home care in decades.

HCA’s 2018 Budget and Legislative Action Proposals

HCA has issued our 2018 Budget and Legislative Action Proposals. These include the following broad areas:

  • Reject Budget Cuts and Harmful Program Actions to MLTCs and Home Care
  • Support Budget Proposals to Reimburse Minimum Wage & Health Care Infrastructure
  • Develop Appropriate, Actuarially Sound and Timely Payment for MLTCs and Providers Address Workforce Needs in Home Care and Hospice
  • Maintain NY Licensure Standards for Home Care — and Act Against Scofflaws
  • Utilize Home Care’s Expertise to Yield Savings in Community and Public Health

Home Care, Hospice and Managed Long Term Care Financial and Program Trends 2018

HCA has prepared a 2018 report on the finance and program trends within the home care, hospice and MLTC sectors. This report is based on a statistical analysis of state-required financial documents, a survey of HCA’s membership, and other data sets. It provides aggregate data on financial margins, accounts-receivable balances, direct-care staffing vacancies and turnover rates, and other important findings within New York’s home care, hospice and MLTC sector.


Act Now on Home Health Rural Add-on, NPP Authorization of Home Care

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”

Webinar Offers Premium Legal Guidance for Home Care HR/Execs on Sexual Harassment Law, Procedures

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”

HCA Submits Comments and Senate Testimony on Proposed Scheduling Rule

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”

Urgent Action Alert: Take 1 Minute to Write Congress Opposing BIG End-of-year Home Health Cuts

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. 

Amid the flurry of activity is extender legislation that reportedly includes some version of the Home Health Groupings Model (HHGM) or other cuts that may be as high as $3 billion to $6 billion nationally over ten years, according to our partners at the National Association for Home Care and Hospice (NAHC).

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

In Win for Home Care, HHGM Withdrawn from 2018 HHPPS Final Rule

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”

Gov. Cuomo Signs Lanza-Cusick Bill Supporting Home Care & Hospice Role in Reaching Vulnerable Patients during Emergencies

ALBANY — The Home Care Association of New York State (HCA) commends New York Governor Andrew Cuomo for signing a bill, S.5016-A/A.6549-A, which assures home care and hospice provider input into local emergency planning, including essential-personnel access for home care and hospice staff to reach vulnerable patients when disasters strike.

HCA also applauds the bill’s legislative sponsors, Assemblyman Michael Cusick and Senator Andrew Lanza, for their tireless efforts to develop and frame this legislation for unanimous passage in both houses of the Legislature and for support from the Governor. Both legislators saw first-hand the enormous need for coordinated response in their Staten Island districts when Superstorm Sandy devastated the region. 

For further background on the bill, please read HCA’s Memorandum of support here

“From Superstorm Sandy, Hurricane Irene, and countless major snow emergencies across New York, we’ve seen home care and hospice providers ready to serve as a vital resource to assist local emergency managers in reaching vulnerable patients who may be alone or without power at home,” said HCA President Joanne Cunningham. “These efforts could be substantially enhanced with a greater voice for home care and hospice in the emergency management planning process, including for addressing ‘essential personnel’ status, as this bill does. Home care and hospice providers applaud Assemblyman Cusick and Senator Lanza for their staunch support of this important bill, and for working vigorously with the Governor’s office to get it signed into law.”

Continue reading “Gov. Cuomo Signs Lanza-Cusick Bill Supporting Home Care & Hospice Role in Reaching Vulnerable Patients during Emergencies”

QAPI CoPs, Clinician Time Management Seminar Among 10 Hot Topics at HCA Quality & Tech Symposium

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”

Sept. 2017 Federal Documents on HHGM, Rural Add-on, Hospice, Medicaid and Regulatory Issues

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.



DOH Hurricane Alert: Immediate Action for Home Care, Hospice Storm Preparedness

The state Department of Health (DOH) late yesterday sent a brief alert to LHCSAs, CHHAs and Hospices (see here) on “immediate action” to be taken for Hurricanes Irma and Jose preparedness efforts.

These actions include required updates and corrections to your agency’s contacts in the Health Commerce System (HCS), as well as provider readiness to use the HCS to assist in possible DOH survey efforts.

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

Are You Prepared: Emergency Preparedness Essentials in Home Care & Hospice Settings

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

September 27, 2017

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”

HCA’s Oct. 19 Compliance Symposium Addresses Your Top Worries, Concerns, Needs

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.

As Senate Bill Goes Public, HCA Heads to Washington Opposing Even Deeper Medicaid Cuts

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”

HCA-Prompted Letter from Rep. John Faso Helps Achieve CoP Delay

As Home Health Care News reports, “Lawmakers, too, were pushing for a delay to give agencies more time to comply with the significant changes. The Home Care Association (HCA) of New York worked with New York Congressman John Faso to urge CMS to delay the effective date as recently as March 27, when Rep. Faso sent a letter to CMS Administrator Seema Verma.”

“Home care providers understand the rationales and goals of the CoP changes, and they report vigorous and hurried efforts to get their staff trained and ready,” the letter reads. “Moving back implementation by six months will allow for all parties involved to be better prepared to operate and ultimately provide quality care to home care beneficiaries.”

Rep. Faso’s letter can be read here.

HCA, Member Providers Testify at NY Assembly Hearing on Home Care Workforce Issues

ALBANY — Today the state Assembly held a public hearing on home care workforce issues.

This hearing follows an earlier one, held last week (on February 22) in New York City. HCA sent the following statement in response to the February 22 hearing:

Today’s HCA testimony in Albany was presented by HCA Executive Vice President Al Cardillo. The testimony can be downloaded from our website at:

“The public health system has been reconfigured to require and rely on ready access to timely, capable and person-centered home care,” Mr. Cardillo said. “Current governmental policies and reforms are rapidly and substantially deepening this reliance.” Continue reading “HCA, Member Providers Testify at NY Assembly Hearing on Home Care Workforce Issues”

HCA Statement: State Assembly Hearing on Home Care Workforce Issues

Media urged to attend a second Assembly hearing on Monday in Albany (details are below)

HCA greatly appreciates the state Assembly’s focus on home care workforce issues during a hearing today in New York City and another hearing scheduled on Monday in Albany.

Home care workforce recruitment, retention and staffing shortages have long been a concern for providers, consumers, and aging and disabled New Yorkers.

Home care is a demanding occupation that requires a unique set of skills and aptitudes. A comprehensive set of solutions is therefore needed to support this vital workforce, along with adequate reimbursement from the state for labor and non-labor service costs at a time when home care providers and Managed Long Term Care plans alike are experiencing operating losses statewide.

Between 2010 and 2014, home care employment rose 43% in New York City. As of 2015, home health aides in New York City number 117,760, along with 71,390 personal care aides and 70,990 registered nurses in home care. Nevertheless, shortages and high turnover rates persist, causing enormous administrative cost and resource pressures for training and orientation in home care, not to mention disruption in the continuity of care. Continue reading “HCA Statement: State Assembly Hearing on Home Care Workforce Issues”

HCA Budget Testimony Stresses Payment, Regulatory, Workforce and Infrastructure Needs

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.Coachatestifyin

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”

HCA Issues Home Care-Managed Care Financial Findings, State Budget Proposals

ALBANY — The Home Care Association of New York State (HCA) has issued its annual financial condition report on New York’s home care and managed care systems, along with a set of vital proposals for consideration in the 2017-18 state budget. These budget proposals cover the areas of home care and managed care Medicaid payment, regulations, workforce issues, and infrastructure investment.

The financial condition report is available here and the state advocacy agenda is here. They will be featured in HCA testimony on Thursday, February 16, before a joint legislative hearing on the health and Medicaid portions of the proposed budget. Continue reading “HCA Issues Home Care-Managed Care Financial Findings, State Budget Proposals”

HCA Takes Aim at Federal Regs, Seeks CoP Implementation Delay

HCA this week prepared and circulated two new federal advocacy pieces targeting a series of problematic home care regulations while calling for a one-year delay in implementation of the sweeping new Home Health Conditions of Participation (CoPs).

In a new document, entitled Home Care Advocacy Ask: Regulatory Relief for Home Care Providers, HCA targets five areas of regulation that demand change, consistent with our past advocacy efforts and support garnered from Members of New York’s Congressional Delegation. Continue reading “HCA Takes Aim at Federal Regs, Seeks CoP Implementation Delay”

HCA President Responds on MedPAC Recommendations to Cut, Rebase Medicare Home Health Rates

The Medicare Payment Advisory Commission (MedPAC) recently voted unanimously to recommend an additional five-percent Medicare payment cut in the next annual rates for home health agencies. The recommendations also call on the U.S. Centers for Medicare and Medicaid Services (CMS) to implement a two-year rebasing of the home health prospective payment system (HHPPS) beginning in 2019.

MedPAC intends to incorporate these recommendations in its Report to Congress in March.

Yesterday, HCA President Joanne Cunningham sent a letter (see here) to MedPAC’s Executive Director, Dr. Mark E. Miller, raising “grave concerns” about MedPAC’s recommendations and the data assumptions underlying them. In the letter, also cc’d to New York’s Members of Congress, she presented some New York-specific home health agency financial findings that vary substantially from MedPAC’s aggregate national data assumptions. Continue reading “HCA President Responds on MedPAC Recommendations to Cut, Rebase Medicare Home Health Rates”

Hurricane Matthew Alert: DOH Requires HERDS Data Response in Three Hours

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”

Free Sept. 30 Webinar to Launch Home Care Sepsis Screening Tool

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”

NY, PA Home Care Associations and State Colleagues Gather in D.C. Targeting Medicare Home Health Cuts, Onerous Mandates

Gathering is part of the first-ever state home care association-led Public Policy Summit and Capitol Hill Advocacy Day on July 12-13

For immediate release: July 12, 2016


HCA Communications Director Roger Noyes: (518) 275-6961 (cell); (518) 810-0665 (office)

PHA Chief Operating Officer Jennifer Haggerty: (570) 510-5731 (cell); (717) 975-9448, ext. 22 (office) 

WASHINGTON, D.C. – State home care associations from around the nation, including New York and Pennsylvania, are converging on Washington, D.C. this week (July 12 and 13) for the first-ever Public Policy Summit and Capitol Hill Advocacy Day.

The program is sponsored by the Council of State Home Care Associations. It includes policy discussions, presentations from federal bureaus on regulatory and payment issues, insights from D.C. political insiders, and advocacy visits with lawmakers.

The home care associations representing New York State and Pennsylvania are among the leading participants. Executives from the associations have outlined a robust federal advocacy agenda for the Council, its member associations, and individual home care agencies attending.

“July is a perfect time for state home care associations and their members to get the attention of lawmakers and federal officials on core payment and regulatory issues,” said Vicki Hoak, Chief Executive Officer of the Pennsylvania Homecare Association (PHA) and chair of the Council of State Home Care Associations, which collectively includes 37 constituent state associations representing home health care providers in their regions. “This first-ever summit brings hundreds of provider representatives to Washington, along with the leadership of their state home care associations, for a collective voice and problem-solving.” Continue reading “NY, PA Home Care Associations and State Colleagues Gather in D.C. Targeting Medicare Home Health Cuts, Onerous Mandates”

Briefing Papers: Federal Home Health Policy Summit and Capitol Hill Advocacy Day

The Council of State Home Care Associations is headed to Washington on July 12 and 13 for the first-ever Home Health Policy Summit and Capitol Hill Advocacy Day. The following are a series of briefing papers (in PDF format) about core issues for home care reimbursement, regulatory relief and program needs.

Invitation to Sponsor: First-ever Women’s Healthcare Leadership Summit

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”

Share this Resource with DSRIP, VBP Leads so They Know Your Value!

HCA has prepared a special resource document that we hope all members find useful in communicating your value-proposition to DSRIP and Value-Based Payment Partners.

We wanted to make sure you saw this piece and find benefit in using it. We also invite you to put your own logo on this piece so that it is branded with your organization’s imprint. (See instructions below.)

The piece is called Don’t Reinvent the Wheel: Home Care is Already Your Hub for Community-based DSRIP and Value Based Dont Reinvent Image 2Services.

Why did HCA create this piece? For several reasons. One, we have heard from many members that Delivery System Reform Incentive Payment (DSRIP) Performing Provider Systems (PPSs) and their committees may not understand home care’s role in the system and the infrastructure you already provide.

What’s more, in some cases, these committees and potential Value Based Payment (VBP) partners appear to be considering options for duplicating home care services from within other settings – in ways that may even interfere with the jurisdictional requirements of Article 36 (an area of concern that HCA is working to address in other venues).

We encourage you to share this document at PPS committee meetings and VBP stakeholder or partnership interactions so that the committees: know more about what home care does; learn some data on home care’s success in meeting PPS and VBP outcomes goals; and understand the regulatory structure that governs home care.

When sharing this document, we also encourage you to present agency-specific data and narratives to support your organization’s successes in achieving the broader points about home care’s value-proposition.

The document can be downloaded in two PDF formats. One format is a four-page document that can be printed and stapled in standard paper size. The other format is designed for 11-by-17-inch printing, front and back, so that it can be produced as a bi-fold. (HCA is happy to assist if you have difficulty printing this piece or need HCA to mail you copies.) Links are below:

Want to co-brand?

Also, HCA is happy to work with you to include your logo on this piece so that it is a co-branded document with your organization’s imprint alongside HCA’s logo.

Please contact HCA’s Communications Director Roger Noyes if you are interested in co-branding with HCA. Just send an e-mail to and we’ll work with you to make this document as effective as possible for your purposes by inserting your logo along with HCA’s.

Use HCA’s Online Legislative Action Center to Voice Opposition on CMS Prior-Authorization Proposal

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.

We are asking Congress to weigh in with the U.S. Centers for Medicare and Medicaid Services (CMS) to rescind this disastrous rule, but we need your help to echo our concerns with your Congressional representatives.

Today, HCA has posted a message to our Legislative Action Center allowing you, your staff, your board, and others to write Congress in opposition to CMS’s proposal. This message stresses: access-to-care impacts of the rule; the unprecedented overreach of presumptive pre-payment audits at the outset of care; the steering of authority from provider-level care-transitions teams to third-party bureaucrats contracted for prior-authorization; and the fact that existing audit problems (like denials for obscure documentation rules) would be extended to the prepayment phases of initiating care.

Please send this message today. It takes about a minute of time and we need hundreds of providers to write Congress to ensure that our voices are heard. All you need to do is visit the campaign link at, enter your contact information and click “Send Email.” Please urge your staff to do the same.

HCA Invites You to Bring The Vote Home-NY

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”

HCA & Association Partners Sponsor June 2 Webinar on Medicare Documentation, F2F

HCA and provider association colleagues (the Health Care Association of New York State and the Medical Society of the State of New York) are co-sponsoring a free June 2 webinar, facilitated by National Government Services (NGS), outlining Medicare home health eligibility and documentation requirements.

The webinar runs from 10:30 a.m. to noon and you can register here.

Since the inception of the Medicare home health face-to-face rule, HCA has been at the forefront of efforts to seek a repeal of the requirement or, barring repeal, changes to the rule that would ease the duplicative and costly documentation mandate for home care providers

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

Final Medicaid Managed Care Rule Released  

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

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

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 2016-17 Work Plan Now Available

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: 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”

HCA’s Comments Voice Strong Support for Physician Signature, Billing Flexibility Proposal

HCA this week submitted comments in strong support of long-sought proposed changes to the state’s physician order and billing deadlines for home care. Our comments are at

These proposed changes, initiated and drafted by HCA, have been a long time in the making, and HCA this year succeeded in getting the Department of Health to consider these vitally needed changes. The proposal would align the state’s deadlines with the broader timetables allowed under Medicare. The proposed changes were further recommended and advanced by the Home and Community-Base Care Workgroup. They would apply to CHHAs, LHCSAs and LTHHCPs.

As HCA President Joanne Cunningham said in a statement to Crain’s Health Pulse in February, when the proposed rule was posted, “We appreciate the state’s support for a sensible timeline that has worked under Medicare. This proposal ensures that providers and physicians can focus on the initiation or modification of the care itself.” Continue reading “HCA’s Comments Voice Strong Support for Physician Signature, Billing Flexibility Proposal”

HCA Opposes CMS Prior Authorization Proposal

HCA this week submitted a strongly worded comment letter opposing a prior authorization demo for Medicare home health services being floated by the U.S. Centers for Medicare and Medicaid Services (CMS).

We are also part of a nationwide effort, in collaboration with partner state associations throughout the country, weighing in jointly on the rule, all calling for the rule to be rescinded. Continue reading “HCA Opposes CMS Prior Authorization Proposal”

President Obama Releases 2017 Proposed Budget

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 Additional information is at Continue reading “President Obama Releases 2017 Proposed Budget”

2016 Budget and Session Advocacy Resource Documents

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.


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


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”

Join HCA for our Home Care Leaders State Advocacy Day on February 1-2

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”

Admission to HCA 2016: Renew Your Membership

HCA presents Your Admission to HCA 2016, a simple process for renewing your membership. Simply:

Watch a short video!

  • Complete an online form.
  • Provide your contact information and select your dues category (corresponding to your agency’s current annual revenue).
  • Based on your responses to this online form, we will either mail you an invoice or contact you about alternative payment methods (i.e. credit card).

Find your membership category and complete the online form at the links below.

  • Non-government-sponsored CHHA, LTHHCP, LHCSA members: RENEW NOW
  • County or government-sponsored home care agency members: RENEW NOW
  • Associate members: RENEW NOW
  • Vendor members: RENEW NOW

Learn More2016 Value Statement (2)_Page_1

If you are not yet a member of HCA — or want to learn more about HCA’s accomplishments in 2015 — please download our member value statement and annual report called Outcomes’ & ‘Process’ Measures: How HCA is Working for You.

Questions about HCA Membership can be directed to:

Laura Constable
Senior Director of Membership
(518) 810-0660

DOH Planning Revisions, Testing of Emergency Preparedness Surveys

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.

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

DOH Announces Several Changes to FIDA Requirements, Procedures

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.


  • 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.


  • 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 4th quarter of 2015 (October – December) reporting period.


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.

Emergency Preparedness Information and Resource Update: October 2015

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”

July Medicaid Global Cap Report: Spending $4M Under Projections

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”

SOFA Conducts Survey on Office of Community Living

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

More information on this effort is at

Certificate of Need Application Update  

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

Questions can be directed to

Transmittal Issued on Medicare Care Choices Model

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

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”

CMS Releases Plan to Address Health Equity in Medicare

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:

NGS: Avoid Claim Denials by Updating Provider Info for SMRC Reviews

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

Some NHTD Rates Change: New TBI Rates Coming Soon

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”

Revised TBI Audit Protocols Posted

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

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.

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.

  • 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”

UAS Upgrade Issued

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.

Annual Review of Managed Care Exemption and Exclusion Codes Required

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 (see GIS 15 MA/012).

Livanta Updates Standards for PT Related to Discharge Appeal Reviews

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

For further information, contact Patrick Conole at (518) 810-0661 or

PHHPC Meets on Home Care Applications

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

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 and can be viewed at starting July 14, 2015.

The deadline to submit comments is September 8, 2015.

For more information, visit

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 (, 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

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
  • 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

For further information, contact HCA’s Patrick Conole at (518) 810-0661 or at

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? 



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! 


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?