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

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

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

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

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

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

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

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

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

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

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

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

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

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

Updated January 25, 2016

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

Registration

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

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

Resources

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

HCA’s 2016-17 State Budget Testimony

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

UAS

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

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

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

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

Assurance and Participant Satisfaction

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

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

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

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

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

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

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

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

• Follow-up required after hospitalization for mental illness.

 Medicare Rates

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

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

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

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

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

Quality Withhold

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

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

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

IDT Reforms

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

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

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

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

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

• IDT training will be encouraged, but not

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

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

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

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

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

Reporting

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

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

Marketing

Plans now have authorization to do the following:

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

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

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

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

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

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

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

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

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

ADA Attestation Form

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

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

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

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

Next Steps

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

• Reforms are effective immediately unless otherwise stated.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

NGSConnex and IVR Systems Not Available this Weekend

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

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

Home care and personal care spending slightly above projections

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

• One application for a change in ownership by a CHHA that serves the general population in Greene, Orange, Ulster and Westchester as well as the developmentally disabled population in Dutchess, Putnam, and Sullivan.

• Under another application, the same entity proposes a change in ownership of its CHHA and LTHHCP that serves western New York.

• Applications by 29 entities (8 outside of the New York City metropolitan area) to establish a LHCSA; and

• Applications by 10 LHCSAs for a change in ownership (including 3 outside of the New York City metropolitan area).

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

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

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

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

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

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

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

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

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

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

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

ICD-10 Acknowledgement Testing to Resume July 27

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

eMedNY has posted its July through September Training schedule.

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

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

Continue reading “eMedNY Trainings Scheduled  “ →

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

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

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

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

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

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

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

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

The deadline to submit comments is September 8, 2015.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

TAKE ACTION TODAY

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

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

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

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

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

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

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

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

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

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

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

Please see the details below.

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

Who should attend?

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

How to register?

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