Underscores adverse impact of proposed cuts, eligibility changes, structural limits and urges support for process improvements, home care licensure standards, workforce and infrastructure
ALBANY — HCA President Joanne Cunningham testified today before a joint legislative panel on the Medicaid and health areas of the state budget. Her testimony, on behalf of HCA’s home care, hospice and Managed Long Term Care providers and plans, is available at https://hca-nys.org/wp-content/uploads/2018/02/201819HCAStateBudgetTestimonyUpdatedFeb132018.pdf.
Of primary concern in this Executive Budget are the proposed cuts and program changes that impact MLTCs and home care, Ms. Cunningham said.
“Virtually the entire long term care Medicaid and Medicare patient population in New York State has been moved under the care of MLTCs and their providers. The Administration has removed most other options,” Ms. Cunningham said. Continue reading “HCA Testifies at Health State Budget Hearing on Behalf of Home Care, Hospice and MLTC “
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.
HCA has sent comments to the U.S. Centers for Medicare and Medicaid Services (CMS) urging it to halt a new proposal that would fundamentally overhaul the Medicare home health reimbursement system to the tune of $1 billion in cuts, beginning January 2019, as part of the proposed 2018 Home Health Prospective Payment System Rule. (Our comments are available here.)
This payment system, (called the Home Health Groupings Model, or “HHGM”) is the most drastic reimbursement change affecting the home care sector in decades. Because it is not budget-neutral (which should be a fundamental requirement when modifying any payment system), CMS needs to rescind this policy change and put into place a stakeholder-involved process to make rational and methodical policy changes that will not have dire consequences on America’s home care agencies. Continue reading “HCA Comments on 2018 HHPPS, with Focus on HHGM Payment Cuts”
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 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”
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”
HCA submitted extensive comments this week on the U.S. Centers for Medicare and Medicaid Services proposed rule for the 2017 Home Health Prospective Payment System (HHPPS). You can download the comments here.
The comments address such areas as the continued methodology flaws in CMS’s rebasing of Medicare home health rates, including the incorporation of a “case-mix-creep” adjustment that appears to adjust the rebasing cuts to a level beyond that authorized by Congress. We also seek CMS action to address the lack of a comprehensive impact analysis for rebasing and the failure of rebasing to incorporate all usual and necessary indirect and direct costs in CMS’s analysis. Continue reading “HCA Submits Comments on HHPPS Rule for Medicare Home Health”
While the U.S. Centers for Medicare and Medicaid Services (CMS) has revised the Medicare Prior Authorization of Home Health Services Demonstration to now become a Pre-Claim Review Demonstration, HCA believes the revised Demonstration would still create unnecessary obstacles to care, increase system wide costs, and jeopardize the quality of care that patients receive. Download our July 20, 2016 comments to CMS on the 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 https://hca-nys.org/wp-content/uploads/2016/04/DOHsProposal_90DayPhysicianOrderFlexibilit-March28.pdf.
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 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”
On January 25, 2016, HCA published a two-page document outlining our “asks” of the Legislature for the 2016-17 State Budget and legislative session. The requests, in a document called “Priority Asks: Position Home Care to Meet the State’s Policy Goals,” include the need for reimbursement support and programmatic changes to support home care in a changing state health care policy environment.
On January 25, 2016, HCA published a financial condition report of New York’s home care community. The report, called “Risk Factors: What You Need to Know about the Financial Condition of New York’s Home Care Community,” is based on an analysis of state cost report and statistical data, accompanied by a survey of New York’s home care providers.
On January 25, 2016, HCA delivered testimony on the proposed State Budget before a joint legislative health committee. HCA’s testimony is available here.
HCA has submitted comments to the U.S. Centers for Medicare and Medicaid Services (CMS) on its proposal to modify the Medicare Conditions of Participation (CoPs) related to discharge planning requirements for hospitals, critical access hospitals and home health agencies. The proposal was first issued in October.
While HCA supports efforts to revise the CoPs in this area, we commented on several technical and substantive areas of concern, including: CMS’s cost estimates (which fall short of the real impact); implications and possible conflicts with managed care practices; flaws in the publicly reported quality data that hospitals would use for assisting patients in selecting a post-acute provider; the content requirements of discharge summaries; and other issues.
You can download the comments here.
HCA has submitted comments to the U.S. Centers for Medicare and Medicaid Services (CMS) on a proposed rule that would provide the most significant update to Medicaid managed care rules in more than a decade. The rule covers the delivery of managed long term services and supports (LTSS); quality improvement; program and fiscal integrity; state delivery system reforms; rates to plans; beneficiary experience; and other areas.
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 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.
The Home Care Association of New York State (HCA) strongly supports legislation, S.5852/A.8200, amending chapter 6 of 2015 in further support of telehealth services in New York.
New York’s home telehealth program and providers have been national leaders in applying this innovative technology to the care and medical management of patients, demonstrating improved patient outcomes, avoidance of preventable hospital and emergency room use, cost-savings to the system, and other critical health and system benefits.
HCA applauds Senator Young and Assemblywoman Russell for sponsoring and championing the passage of chapter 6, which effective January 1, 2016, provides for telehealth coverage under insurance policies and Health Maintenance Organization (HMO) contracts in the state. HCA further commends the sponsorship of the S.5852 amendments which are critical to ensuring that provisions set forth related to home care under chapter 6 function as intended for patients and for the goals of the new law.
The amendments – introduced in both houses (S.5852/A.8200) – ensure that the new article of public health law created for telehealth in Chapter 6 does not inadvertently conflict with home telehealth provisions otherwise existing elsewhere in statute for home care.
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”
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 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”
For Immediate Release: April 20, 2015
Roger Noyes (HCA) (518) 810-0665
Stacy Connors (IHA) (518) 348-7443
ALBANY, NY – To promote health care system integration, State Senator Kemp Hannon (R-Nassau) has advanced an important new program in this year’s state budget that supports home health care providers, hospitals and physicians as they work together on collaborative models.
The Home Care Association of New York State (HCA) and the Iroquois Healthcare Alliance (IHA) – which represent home care providers statewide and hospitals and health systems in the upstate region, respectively – applaud the Senator for his sponsorship of this vital initiative and look forward to continuing to work with the Senator on program implementation post-budget.
This initiative was previously introduced as standalone legislation (S.1110) and later adopted as a new program in the state budget, complementing related state health care policies. It specifically creates and devotes a statute within the Public Health Law to support “Hospital-Home Care-Physician Collaboration” programs. Such collaboratives could also include long term care facilities, behavioral health, supportive housing and other interdisciplinary providers.
“Collaboration among health care providers is essential to good care,” said Senator Kemp Hannon (R-Nassau). “For patients who require care at home, collaboration must include the home health care providers as this program does.” Continue reading “Home Care and Hospital Associations Applaud Senator Hannon’s ‘Hospital-Home Care-Physician Collaboration Program’ in State Budget”
Congress should permanently extend the 3 percent Medicare rural add-on for home health services delivered in rural areas so that access to skilled home and community based care is not threatened. Congress should also closely monitor the adequacy of the Medicare home health prospective payment system (PPS) payment so that agencies can continue to provide care to Medicare Home Care Association of beneficiaries in rural areas.
HCA Executive Vice President Al Cardillo delivers testimony before a joint legislative budget panel on the 2015-16 Executive State Budget.
“Home care is vital to new, priority state policies, and to the evolving health care delivery and payment models”
HCA writes a letter to the Cuomo Administration with comments on a new state budget proposal which seeks to move all health care payments from fee-for-service models to value-based models.
The U.S. Centers for Medicare and Medicaid Services (CMS) has proposed the first new changes to the Medicare home health Conditions of Participation (CoPs) in years. The CoPs haven’t been changed since 1989, and this new set of changes includes sweeping new requirements related to patients rights, quality reporting and other areas affecting the operation of most home care agencies.
HCA’s annual financial condition report is a signature publication in our state advocacy efforts. The report combines a rigorous analysis of Medicaid cost reports — which are a financial reporting instrument that home care agencies are required to submit to the state — with a survey of HCA’s members seeking their responses on financial, policy and programmatic trends in home care.
Driving Health Care Improvement and Savings through Home Care is HCA’s 2015 State Budget policy statement where we highlight key areas of needed financial, regulatory and programmatic support for the home care system. These policies fall into several main areas:
- The need for state officials to move promptly on home care-managed care regulatory relief and realignment measures already in the cue as part of the state’s Home Care Regulatory Workgroup process;
Continue reading “HCA’s Legislative Advocacy Agenda: Driving Health Care Improvement and Savings through Home Care “
HCA comments on the proposed 2015 home health prospective payment system rule which establishes the Medicare home health payment and regulatory policy for 2015. The proposed rule extends the cuts previously enacted under the federal “rebasing” regimen and makes some changes to the Medicare home health physician face-to-face rule documentation requirements.
HCA requests an extended comment period that would provide more time for the industry to vet CMS’s proposed rule revising the Medicare and Medicaid Conditions of Participation (CoP) for home health agencies. The current December 8, 2014 comment deadline does not offer adequate time to obtain crucial feedback from the home health agency members in the field, who have been operating under the existing home health CoPs since 1989.
HCA and LeadingAge New York write to the state’s Medicaid Director regarding Safety Net concerns in the Delivery Reform Incentive Payment (DSRIP) program, as well as some recommendations regarding the attribution methodology whereby patients are assigned to DSRIP networks.
HCA writes to the Governor in support of A.6530-B (Cusick)/S.4719-B (Lanza), which passed both houses of the Legislature. The legislation will help ensure vital access to care for home health and hospice patients during emergencies, as well as support the overall operation of the health system in responding to disasters.
HCA President Joanne Cunningham delivers testimony before a joint legislative budget panel on the 2014-15 Executive State Budget. HCA’s priorities are as follows:
- Regulatory streamlining and alignment are needed to support the efficiency, quality, orderly structure and payment of home care services under managed care.
- Services, including mandated home care wage laws (under the Wage Parity Law) and service delivery regulations, must be appropriately funded and reimbursed.
- Budget language is needed to support innovative hospital-home care models for patient services, system improvement and community health.
- “Essential Personnel” status is vital for supporting home care and hospice personnel during emergency response.