NEW Health-Literacy Session Added to Nov. 16 & 17 Quality and Tech Conference Conference is just two weeks away COMING UP

Transcription

1 HHPPS QIVAPP BILLING CODES BOOTCAMP CMS is expected to soon issue final 2017 rates for Medicare home health. HCA will provide an initial summary, followed by more detailed analysis. Funding distributions sent to the state Division of Budget and CMS for approval. HCA advocated for legislation to streamline the billing process for home care and managed care. New codes coming soon. The next installment of HCA s Bootcamp series includes a program on becoming a fiscal intermediary under CDPAP. PAGE 3 PAGE 4 PAGE 6 PAGE 8 COMING UP HCA Quality & Technology Symposium Nov , 2016 Embassy Suites by Hilton Saratoga Springs 86 Congress St. Saratoga Springs, New York Bootcamp: Successfully Acting as a Fiscal Intermediary in the Consumer Directed Personal Assistance Program Dec. 1, 2016 Visiting Nurse Service of New York 107 East 70th Street (between Park and Lexington Ave) New York, NY :30 to 10 a.m. (Registration and continental breakfast) 10 a.m. to noon program Your Source for HOME CARE News, Policy and Advocacy Vol. 1, Issue 8 October 31, 2016 State Issues Minimum Wage Funding Guidelines for Plans and FFS Rates Long-awaited guidelines appear to provide significant discretion in managed care pass-through of funds; HCA will clarify and address further concerns during November 3 stakeholder meeting The state Department of Health (DOH) on Friday issued final guidelines for funding of the minimum wage increase through managed care rate adjustments and under the fee-for-service rate-setting and reconciliation process. The two guideline documents are combined in one link at MWGuidelines pdf. See WAGE p. 2 NEW Health-Literacy Session Added to Nov. 16 & 17 Quality and Tech Conference Conference is just two weeks away HCA has added a new segment to our Quality and Technology Conference addressing health literacy for home care patients and staff. This new session joins other clinical components that focus on population health management and outcomes in home care. See LITERACY p. 4 INSIDE State Issues Minimum Wage Funding Guidelines for Plans and FFS Rates...1 NEW Health-Literacy Session Added to Quality and Tech Conference HHPPS Final Rule Expected Later Today...3 Reminder: Tell Your Home Care Month Stories QIVAPP Funding Announcement Expected Soon...4 Required 2015 CHHA, LTHHCP, Hospice Reports Posted...5 Uniform Billing Codes to Take Effect Sometime Next Year...6 OMIG Posts Compliance Program Review Guidance...6 Upcoming Education...7 Dec. 1 Bootcamp: Acting as Fiscal Intermediary for CDPAP...8 Hospice Claims May Fail with New FY 2017 CBSA Codes...8 Community First Choice FAQs Posted...9 New FIDA FAQs Posted...10 CMS Stops Medicare Seamless Enrollment for Additional Plans...10 Funding Available Under Workplace Health and Safety RFA...10 CMS Issues Two Home Health Transmittals...11 Nov. 1 CMS Forum: Provider Impact of SSN Removal Policy...12 Resources...13

2 The Situation Report: the Home Care Association of New York State Volume 1, No. 8 October 31, 2016 WAGE from p. 1 For managed-care distributions to home care, the guidelines establish a $1.33 per-hour rate supplement to managed care plans for New York City, which is one of the first regions affected by the phased wage increases, although the supplement may differ for other managed care programs or regions, the guidelines state. Effective January 1, 2017, managed care organizations shall supplement their contracted reimbursement rates for providers which shall utilize the $1.33 of additional funds to pay the full increment of the additional statutory wage cost, as identified by DOH, for direct care workers. These additional funds paid to managed care shall be paid out entirely to providers and subsequently to workers for appropriate statutory wage obligations. In the process of vetting draft guidelines over the past several weeks, HCA repeatedly pressed for a direct distribution of the $1.33 amount for every home care provider s aide hours, as this would be the simplest and most judicious application of the rate supplements. After a series of discussions and edits to the guidelines, the version approved by the state Division of Budget, and issued on Friday, however, does not obligate plans to give every provider a $1.33/hour increase in additional reimbursement. And while the guidelines do dictate that funds must go to providers, and are not for any purpose other than appropriate statutory wage obligations, the guidelines nevertheless raise many questions, and appear to leave openings for wide discretion in the distribution process that HCA will be working vigorously to clarify or mitigate. The guidelines now trigger a process of provider contract amendments with plans. DOH recommends that these amended agreements be sent to providers by November 15. If providers do not execute the contract amendment, then plans are not responsible for paying the increase, the guidelines state. HCA has been invited to a stakeholder workgroup on November 3 to discuss the attestation process for these supplements and related issues where we will be working to clarify some of the provisions in the state s guidance and address further concerns. Continued on next page The Situation Report is a weekly publication of the Home Care Association of New York State (HCA). Unless otherwise noted, all articles appearing in The Situation Report are the property of the Home Care Association of New York State. Reuse of any content within this newsletter requires permission from HCA. Joanne Cunningham HCA President jcunningham@hcanys.org Roger L. Noyes Director of Communications, Editor of The Situation Report rnoyes@hcanys.org Al Cardillo Executive Vice President, Policy & Programs acardillo@hcanys.org Patrick Conole Vice President, Finance & Management pconole@hcanys.org Andrew Koski Vice President, Program, Policy & Services akoski@hcanys.org Alexandra Fitz Blais Director of Public Policy ablais@hcanys.org Laura Constable Senior Director, Membership & Operations lconstable@hcanys.org Celisia Street Director of Education cstreet@hcanys.org Mercedes Teague Finance Manager mteague@hcanys.org Jenny Kerbein Director of Governance & Special Projects jkerbein@hcanys.org Billi Wilson Manager, Meetings & Events bwilson@hcanys.org 2 Home Care Association of New York State (HCA) 388 Broadway, 4th Floor, Albany, NY Tele: ; Fax: ; Website Teresa Brown Administrative Assistant tbrown@hcanys.org

3 The Situation Report: the Home Care Association of New York State Volume 1, No. 8 October 31, 2016 Continued from previous page In addition to the managed care implementation guidelines, the Department also issued a document outlining the fee-forservice implementation and reconciliation process for minimum wage, indicating that home care providers will be surveyed in mid- December to verify the current impact estimates of the wage increase for the April 2017 rates. A follow-up survey will be issued to all sectors in March to determine the out-year impacts of minimum wage under fee-forservice. For future rate periods, cost report data will be used to determine reimbursement rates, and a supplemental cost report will be issued in the last quarter of each calendar year to verify provider wage scale and the specific wage related fringe benefits and establish future reimbursement rates. Any necessary reconciliations (up or down) will be made in reimbursement rates for the next rate cycle. The guidelines leave several troubling openings for discretion in the distribution process, and HCA will be following up with the Department for clarification and further advocacy HHPPS Final Rule Expected Soon HCA will provide initial summary, followed by a more detailed memo The U.S. Centers for Medicare and Medicaid Services (CMS) is expected to post its final rule for the 2017 Home Health Prospective Payment System (HHPPS) later today or sometime early this week, after press time for The Situation Report. The posting will include final rates for Medicare home health services effective January 1. HCA has already shared a memo outlining the proposed rule, which was issued over the summer, and we have provided comments to CMS regarding flaws in its reimbursement methodology. Under the proposed rule, Medicare payments to home health would be reduced by 1.0 percent, or $180 million. You can read our summary of the proposed rule at uploads/2016/06/hcamemoproposed2017hhpps.pdf. Once the final rule is released, which could include changes from the proposed rule, HCA will provide you with a brief summary. We will also be analyzing the rule closely in the coming days and provide you with a detailed analysis of all the final payment calculations, including rate rebasing, case-mix-weight changes, CMS s case-mix-creep adjustment, wage index factors, outlier adjustments, and more. 3 Reminder: Tell Your Home Care Month Stories What has your agency or staff done to engage, educate, or support patients in a unique way? We want to hear your stories for our 2016 National Home Care Month theme of public service. Please send us a photograph and a paragraph or two describing how your agency or staff has engaged in public service through home care. The photo can be of your staff or patients (or both), depending on the story you choose to tell. To tell your stories, please click our online form ( and we will feature your stories in our weekly newsletter and our Facebook page throughout the month of November. The sooner you send us your stories, the better, so that we can begin promoting them at the start of November, but please send us your submissions no later than Friday, November 11. If you have any questions, please contact HCA s Communications Director Roger Noyes at rnoyes@hcanys.org.

4 The Situation Report: the Home Care Association of New York State Volume 1, No. 8 October 31, 2016 LITERACY from p. 1 Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Health literacy affects the majority of Americans, especially underserved populations and people that are 65 years or older, which are key home care demographics. Beyond delivering direct-care services, one of home care s core strengths is its ability to educate and assess the social and environmental determinants of health, putting the patient at the center of his or her own decision-making. To do this, home care staff all need baseline health literacy skills, as well as the ability to assess and instill these basic concepts in the patient care teaching environment, so patients can best selfdetermine their care, as well as follow and understand their treatment plans. In a November 17 session at our two-day Quality and Technology Symposium, nurse clinical experts Misty Kevech, Cindy Sun, and Crystal Welch will delve into key components of health literacy including: assessment, interventions, tips, and tools to improve patient outcomes and quality of life. Participants will learn actionable ways to enhance health literacy among direct-care staff as well as patients and family caregivers. Other clinical-quality highlights In other clinical-quality highlights, the conference will also feature Noreen Nelson, PhD, Clinical Assistant Professor at NYU s Rory Meyers College of Nursing, who will discuss the role of home care in population health management, a topic that is getting some heavy focus from federal and state policymakers aiming to improve health outcomes in a value-based payment environment. Dr. Nelson, a national population health clinical expert, will show how home care providers can play a pivotal role in delivering positive population health outcomes. These are just a few of the clinical and quality components of the conference, which also features segments on technology innovations to support your organization. Please register as soon as possible, as this signature HCA conference is just two weeks away, and make sure your nurse and clinical managers, quality improvement staff, and health IT strategists participate as well. Register online: Download the brochure: Symposium-Brochure-2016.pdf QIVAPP Funding Announcement Expected Soon The state Department of Health (DOH) has informed HCA that it expects to announce very soon the amount of funding that will be received by those agencies that qualify for the Quality Incentive Vital Access Provider Pool (QIVAPP) program for This week, DOH intends to send letters requesting approval for the funding to the state Division of the Budget and the U.S. Centers for Medicare and Medicaid Services (CMS). Previously, DOH had confirmed that it will be issuing one payment to the MLTC plans for the QIVAPP. Plans will then be expected to pass on those funds to their qualified home care contractors. Continued on next page 4

5 The Situation Report: the Home Care Association of New York State Volume 1, No. 8 October 31, 2016 Continued from previous page QIVAPP was initially intended to help New York City home care agencies with the added labor costs of the state Wage Parity law, though the law additionally applies to Long Island and Westchester, areas for which HCA has also sought funding support. What s more, DOH added restrictive eligibility criteria that limited which agencies qualified during the period, drawing objections from HCA about the manner in which the distributions were determined, at odds with their purpose. For the period, DOH decided that the funding would be provided to those agencies found QIVAPP-eligible for and for additional home care agencies found eligible after submitting documentation. In early September, DOH announced that five additional agencies now qualified to receive QIVAPP for organizations that did not qualify in MLTC plans were then required to submit the number of hours of each of their eligible home care contractors, along with an attestation that the plans were paying at least $18.50 per hour for aide services. Once the QIVAPP funding allotments are announced and HCA receives specific information, we will alert our members. For more information, contact Andrew Koski at (518) or akoski@hcanys.org. Required 2015 CHHA, LTHHCP, Hospice Reports Posted The state Department of Health (DOH) has posted a Dear Administrator Letter (DAL) on the Health Commerce System stating that it is activating the 2015 annual Statistical Report for CHHAs and LTHHCPs, and the 2015 Cost and Utilization Report for Hospices on October 31, The reports will be activated and available for completion from this date through December 30, The DAL is at All CHHAs, LTHHCPs, and Hospices are required to complete and submit the 2015 reports. According to the DAL, failure to meet the specific requirements may subject the agency to an enforcement action under Section 12 of the Public Health Law. Such agencies may be liable for civil penalties for violations of Article 36 (for CHHAs and LTHHCPs) or Article 40 (for Hospices). Enforcement actions will also negatively impact DOH s ability to make an affirmative statement to the agency s character and competence. In addition, DOH will suspend certificate of need applications currently in process for agencies that are delinquent in submitting the reports. At HCA s Corporate Compliance program in October, DOH reported that 85 percent of CHHAs/LTHHCPs and 82 percent of Hospices had submitted their reports in Agencies are strongly encouraged to enter and submit data as early as possible. Agencies that wait until the last week to enter data may encounter extended system delays and wait times for support due to limited system and personnel resources. Attached to the DAL are instructions for completing and submitting the reports. Questions and requests for assistance can be sent to HCStatRpts@health.state.ny.us. 5

6 The Situation Report: the Home Care Association of New York State Volume 1, No. 8 October 31, 2016 Uniform Billing Codes to Take Effect Sometime Next Year The state Department of Health (DOH) has shared with HCA and other associations a Dear Administrator Letter (DAL) that will soon be sent to managed care plans and providers to inform them that uniform billing codes will be required for Medicaid-covered home and community-based long term care services. The date of this requirement has not been finalized yet. In addition, the DAL states that managed care plans are required to pay claims electronically via electronic funds transfer. HCA and the other associations provided feedback to DOH on the draft DAL and it will be finalized soon. The DAL includes a list of the uniform billing codes for personal care aide, home health aide, consumer directed personal assistant, nursing, therapies, telehealth, medication dispensers, and adult day health care services. These uniform billing requirements, along with the electronic funds transfer mandate, were sought by HCA to help home care agencies and their managed care contractors by simplifying billing procedures and facilitating timely payments for agencies. These provisions for uniform billing implementation were then included in the final state budget. HCA has worked with the other associations and plan representatives for over a year (along with some select HCA members) to develop the uniform codes. Once the DAL and associated billing codes are finalized, HCA will share them with our members. OMIG Posts Compliance Program Review Guidance 6 The New York State Office of the Medicaid Inspector General (OMIG) has posted a Compliance Program Review Guidance, which details what OMIG looks for when assessing compliance programs required under state law. The 33-page Guidance addresses all requirements under each of the eight elements as well as the seven prime risk areas, which include billing, payment, medical necessity and quality of care, governance, mandatory reporting, credentialing, and other risk areas. This Guidance replaces any prior guidance offered by OMIG. The eight elements of a compliance plan include: written policies and procedures; designation of an employee vested with the responsibility for the day-to-day operation of the compliance program; training and education on compliance issues; establishment of communication lines to the responsible compliance position; disciplinary policies to encourage participation in the compliance program; having a system for routine identification of compliance risk areas and another system for responding to compliance issues; and a policy of non-intimidation and non-retaliation. The Compliance Program Review Guidance is available at: Questions can be directed to OMIG s Bureau of Compliance at (518) or compliance@omig.ny.gov (include CPR Guidance in the subject line).

7 The Situation Report: the Home Care Association of New York State Volume 1, No. 8 October 31, 2016 Upcoming Education HCA has a full roster of in-person and webinar-based educational offerings on a host of topics geared for all levels, from agency leaders and clinical managers to home health aides. Visit our website for registration options. Webinars for Home Health and Hospice Aides: HCA is sponsoring a series of webinars to provide training for home health and hospice aides. These programs are being offered on various dates through June Here are some upcoming installments of the series: 7 Nov. 10: The Aide s Role in Patient Centered Care Dec. 8: The Aide s Role in Understanding Mental Health Disorders November 10: The Most Important Conversation We re Not Having Advance Care Planning (Webinar). This webinar will give direct-care staff at all levels the tools they need to be better equipped to initiate, support and sustain conversations about endof-life care preferences with patients and families as well as physicians, health care providers and community members. November 16 & 17, 2016: HCA Quality & Technology Symposium (Saratoga, NY). This signature conference is geared for your clinical leaders, nurse managers, health information technology strategic planners, and executives seeking to know the latest trends and hot topics in quality and technology. November 30, 2016: OASIS-C2, Are You Ready for the Changes? (Webinar). OASIS continues to be the single most important document in home health impacting reimbursement, quality outcomes, survey findings, and public ratings of home health agencies. CMS has released the final OASIS-C2 form and Guidance Manual, required for assessments beginning January 1, This webinar will help your home health clinicians, supervisors and quality coordinators stay up-to-date with these critical changes. December 1, 2016: Successfully Acting as a Fiscal Intermediary in the Consumer Directed Personal Assistance Program (NYC). Demand for the Consumer Directed Personal Assistance Program (CDPAP) is growing rapidly. CDPAP empowers consumers by giving them flexibility and freedom to choose who provides their care and how it is provided. LHCSAs can participate in this growth by becoming a Fiscal Intermediary (FI). At this session, you will get important information about CDPAP, including: consumer eligibility requirements and obligations; the process to become an FI; advantages and disadvantages of LHCSAs serving as FIs; requirements and obligations of the FI; policies and procedures; required contracts; employer and wage and hour issues facing FIs; potential risk areas; and best practices of a successful program. This program is for existing FIs and those LHCSAs who are considering becoming FIs under CDPAP. Save The Dates December 15, 2016: Value Based Payment Conference (Tarrytown, NY) January 17 to 19, 2017: Northeast Home Health Leadership Summit: Extreme Makeover, Home Care Edition (Boston) May 3-5, 2017: HCA s Annual Membership Conference (Saratoga Springs, NY)

8 The Situation Report: the Home Care Association of New York State Volume 1, No. 8 October 31, New Dec. 1 Bootcamp: Acting as a Fiscal Intermediary for CDPAP Demand for the Consumer Directed Personal Assistance Program (CDPAP) is growing rapidly. CDPAP is a Medicaid program that provides consumers with flexibility and freedom to choose who provides their care and how it is provided. LHCSAs can participate in this growth by becoming a Fiscal Intermediary. On December 1, HCA is holding a Bootcamp program for organizations interested in acting as a Fiscal Intermediary. At this session, you will get important information about CDPAP, including: consumer eligibility requirements and obligations; the process to become a Fiscal Intermediary; advantages and disadvantages of LHCSAs serving as Fiscal Intermediaries; requirements and obligations of the Fiscal Intermediary; policies and procedures; required contracts; employer and wage and hour issues facing Fiscal Intermediaries; potential risk areas; and best practices of a successful program. The program is geared towards existing Fiscal Intermediaries and those LHCSAs who are considering becoming Fiscal Intermediaries under CDPAP. Presenter Michael Weiner is a partner in the law firm of Glaser & Weiner, LLP. For more than 20 years, Mr. Weiner has been a trusted advisor to home care and other clients, providing them with practical legal counsel and business advice. He routinely counsels clients on health care regulatory, compliance and transactional matters, as well as general corporate matters involving purchases and sales of businesses, contract analysis, bank financing, shareholder disputes and intellectual property. Details for this program are below. Successfully Acting as a Fiscal Intermediary in the Consumer Directed Personal Assistance Program December 1, 2016 New York City Download the registration form: HCABootcampFiscalIntermediaryCDPAPDec12016.pdf Hospice Claims May Fail with New FY 2017 CBSA Codes HCA has heard from some hospice provider members that claims submitted on or after October 1, 2016 with updated Fiscal Year (FY) 2017 Core Based Statistical Area (CBSA) codes have not been paid and have been returned back to the provider (RTP d). While this issue does not affect all hospice claims submitted with FY 2017 rates, it does impact CBSA codes that were updated for FY 2017, after transitioning from the special 50xxx codes used in FY Specifically, some hospice providers in the New York City have been affected. HCA has contacted National Government Services (NGS), New York s Medicare Administrative Contractor (MAC) for home health and hospice, to look into the matter and resolve it as quickly as possible. HCA will update the members as additional information becomes available. For further information, contact Patrick Conole at (518) or pconole@hcanys.org.

9 The Situation Report: the Home Care Association of New York State Volume 1, No. 8 October 31, 2016 Community First Choice FAQs Posted The state Department of Health (DOH) has posted Frequently Asked Questions (FAQs) on the Community First Choice Option (CFCO) that arose from a June 27 program. The FAQs, along with the slides from the June 27 webinar, are at health_care/medicaid/redesign/community_first_choice_option.htm. The FAQs cover: a new implementation date (April 1, 2017 for both Medicaid managed care and feefor-service); eligibility criteria; elements of the person-centered service plan; assessment and authorization of services; role of the Conflict Free Evaluation and Enrollment Center; comparisons of the traditional agency and agency with choice models; and more. One question (no. 31) in the FAQs identifies an issue that has been of concern to providers and plans: the requirement that a consumer cannot receive service coordination and another service (such as personal care) from the same agency. HCA will be following up with DOH on this issue. DOH has also sent information on the implementation of CFCO to MLTC plans. As reported to members in past communications, CFCO provides increased federal Medicaid funding to expand and enhance personal attendant services and supports into the Medicaid State Plan for eligible individuals who need help with everyday activities due to a physical, developmental or behavioral disability. The focus is on person-centered, individually directed services that help recipients to maximize their independence and participation in community settings. The CFCO services, some of which were only available in waiver programs but are now part of state plan services, include: Assistive Technology; Community Habilitation; Community Transitional Services; Durable Medical Equipment/Medical Supplies; Environmental Modification; Home Delivered/ Congregate Meals; Home Health Care; Homemaker/Housekeeper; Personal Care/Consumer Directed Personal Assistance Program; Personal Emergency Response System; Vehicle Modification; Transportation; Supervision and Cueing; voluntary training course for individuals on how to manage their home care workers; transition expenses to help an individual move from an institutional setting to a community-based setting; and others. HCA members can provide CFCO services under managed care as a service provider or as a fiscal intermediary for consumer directed services. (Please see p. 8 story about a special HCA workshop on how to provide these fiscal intermediary services.) More information on CFCO is at community_first_choice_option.htm. 9

10 The Situation Report: the Home Care Association of New York State Volume 1, No. 8 October 31, 2016 New FIDA FAQs Posted The state Department of Health (DOH) has posted new Frequently Asked Questions (FAQs) related to the Fully Integrated Duals Advantage (FIDA) plans. The FAQs, along with other helpful materials, are at redesign/fida/mrt101/faq/index.htm. They cover: appeals by non-participating providers; changes in drug and other coverage; and participation in Participant Advisory Committee (PAC) meetings. CMS Stops Medicare Seamless Enrollment for Additional Plans The U.S. Centers for Medicare and Medicaid Services (CMS) has temporarily stopped accepting new proposals from Medicare managed care plans to utilize its seamless enrollment process. CMS states that it is taking this action so that it can review its policies for the optional seamless enrollment mechanism in light of recent inquiries regarding the mechanism, its use by Medicare Advantage (MA) managed care organizations and the beneficiary protections currently in place. Under this procedure, MA organizations may develop processes to provide seamless enrollment in an MA plan for newly MA-eligible individuals who are currently enrolled in other health plans offered by the MA organization (such as commercial or Medicaid plans) at the time of their conversion to Medicare. CMS also intends to issue a memorandum clarifying current policy and requirements for MA organizations currently approved to offer seamless conversion enrollment. According to CMS data, the only MA plan in New York State that has been approved for seamless enrollment is Affinity Health Services Holdings, Inc. CMS s announcement on suspending new seamless enrollment proposals, along with other materials, is at Funding Available Under Workplace Health and Safety RFA The state Department of Labor (DOL) has funding available under a Workplace Health and Safety request for applications (RFA). The RFA, along with questions and answers, is at The purpose of the Workplace Health and Safety (WHS) RFA is to secure the services of eligible communitybased organizations, direct service providers, occupational health and safety clinics, and other not-for 10

11 The Situation Report: the Home Care Association of New York State Volume 1, No. 8 October 31, 2016 profit organizations that can assist the state DOL to provide education and training about occupational health and safety hazards, including prevention of assault and discrimination. The RFA will support some of the following efforts to provide training, education, and assistance for workers, advocates, and businesses: Prevention measures against workplace accidents, injuries, illnesses, harassment, and other physical and psychological workplace health and safety concerns; Occupational safety and health best practices intended to protect and enhance workplace safety; Workers rights to seek medical attention and monetary compensation for injuries suffered at the workplace (i.e. through Workers Compensation Board claims); and Business compliance with occupational safety and health regulations and best practices in partnership with DOL s on-site consultation program. While applications are accepted until January 17, 2017, agencies are advised to apply earlier as the application process will close once all the allotted funds ($5 million) have been awarded. In the absence of future state budget appropriations, all activities supported by the contract must be completed and awarded funds must be fully expended by March 31, After November 4, 2016, all submissions must be through the Grants Gateway system at grantsreform.ny.gov/. Applicants may be single entities as well as consortiums of entities, applying through a lead applicant. Single award amounts will not exceed $200,000. Learn more about the possible projects for this request by reviewing the RFA and FAQs. CMS Issues Two Home Health Transmittals The U.S. Centers for Medicare and Medicaid Services (CMS) issued two new Transmittals for Medicare Administrative Contractors (MACs) regarding payment under the Medicare home health prospective payment system (PPS). The following is summary of each Transmittal: Transmittal 3629: Denial of Home Health Payments When Required Patient Assessment Is Not Received by CMS ( Downloads/R3629CP.pdf) Submission of an Outcome and Assessment Information Set (OASIS) for all home health episodes of care is a condition of payment. If the OASIS is not found during medical review of a claim, the claim is denied. Original Medicare systems validate the Health Insurance Prospective Payment System (HIPPS) code submitted on a home health claim against the HIPPS code calculated when the OASIS assessment is received in the Quality Improvement Evaluation System (QIES). If the codes do not match, the HIPPS code calculated from the OASIS assessment is used for payment. Currently, the Medicare system takes no action on claims when the OASIS is not found. Going forward, 11

12 The Situation Report: the Home Care Association of New York State Volume 1, No. 8 October 31, 2016 Continued from previous page Medicare systems will deny the home health claim if the OASIS assessment is not found in the QIES system upon receipt of a final claim for a home health episode and the receipt date of the claim is more than 30 days after the assessment completion date. Transmittal 3630: Correcting Editing for Condition Code 54 and Updating Remittance Advice Messages on Home Health Claims ( Transmittals/Downloads/R3630CP.pdf) A previous CMS Transmittal Change Request (9474) updated the original Medicare systems to accept and process condition code 54 in cases when a home health claim contained no skilled visits in a billing period and a policy exception is documented at the home health agency. A system edit requires condition code 54 to be present when such claims are submitted for payment with no skilled visits. This edit is functioning properly with regard to visits submitted as non-covered by the home health agency. However, shortly after CR No was implemented, MACs reported that the edit is also impacting claims that were submitted with covered skilled visits but those visits were non-covered during medical review. This Transmittal corrects the problem. For further information, contact Patrick Conole at (518) or pconole@hcanys.org. Nov. 1 CMS Forum: Provider Impact of Policy Removing SSN from Medicare Beneficiary Cards The U.S. Centers for Medicare and Medicaid Services (CMS) will hold an Open Door Forum on Tuesday, November 1 from 2 to 3 p.m. to discuss how the Social Security Number Removal Initiative (SSNRI) will impact health care providers. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires CMS to remove Social Security Numbers (SSNs) from all Medicare cards by April A new randomly generated Medicare Beneficiary Identifier (MBI) will replace the SSN-based Health Insurance Claim Number (HICN) on the new cards for transactions like billing, eligibility status, and claim status. To participate: Dial and reference conference ID: ; Dial-in at least 15 minutes before call start time; and For TTY services, dial A podcast will be available at ODF-Podcast-Transcripts.html. CMS plans to hold additional ODFs on this issue. You can learn more about this initiative at

13 The Situation Report: the Home Care Association of New York State Volume 1, No. 8 October 31, 2016 Resources Implementation of New Influenza Virus Vaccine Code (revised October 21), by the U.S. Centers for Medicare and Medicaid Services MLNMattersArticles/Downloads/MM9793.pdf For more information, contact Andrew Koski at (518) or akoski@hcanys.org. 13

14 HCA Quality & Technology Symposium November 16-17, 2016 Embassy Suites by Hilton Saratoga Springs 86 Congress St Saratoga Springs, New York, 12866

15 HCA Quality & Technology Symposium Quality and Technology Solutions for Value-Driven Home Care November 16-17, 2016 Embassy Suites by Hilton Saratoga Springs 86 Congress St, Saratoga Springs, New York, The path of success in a value-based payment environment begins at the intersection of quality and technology. HCA s Quality & Technology Symposium brings you to this intersection by demonstrating ways that emerging technologies build bridges of connectivity, increase accuracy and efficiencies in care and operations, and drive quality and value in home care. To thrive in an environment of integrated payments and services, home care providers must also prioritize their demonstration of quality, for the sake of accountability, to enter new marketplaces, and to offer concrete value-propositions for system partners. This conference will present some of the unique technological and programmatic approaches being innovated by providers and policymakers for driving positive clinical outcomes,and focusing your clinical intervention strategies on core areas of need. As a special bonus, we re also holding a post-conference session on Data-Driven QAPI, offering personalized, hands-on, and customized guidance to help you interpret your quality data plus, you ll be eligible for CEUs! Don t miss this exceptional opportunity to get your agency ready to meet the imperatives of quality enhancement and technological integration! 1

16 Agenda Wednesday, November 16 8:30AM Registration and Light Breakfast 9:00AM HCA Welcome 9:00 10:30AM State Perspectives on Quality Performance Measures & Payment Innovation Patrick Roohan, Director, Office of Quality and Safety, New York State Department of Health Raina Josberger, Bureau of Quality Management & Improvement, New York State Department of Health (Invited) New York State Health Department officials will share insights about the state s priorities and planning to improve quality in the home care environment through performance measures, policy advancement, innovations in payment models and other initiatives. 10:30AM 10:45AM Break 10:45 Noon EHR Network Integration in Home Care Christina Galanis, President and CEO, HealthLinkNY Elizabeth Amato, Director of Statewide Services, NY ehealth Collaborative Hear from two of the state s most influential health information technology experts about technology policies that are influencing and shaping the landscape for the state s home care provider community. 12:00 12:45PM Lunch 12:45 1:45PM Technology Innovation Spotlight (TBA) 1:45-3:15PM New Developments in Sepsis Identification and Detection in the Home Care Setting Sara Butterfield, RN, BSN, CPHQ, CCM, Director, Health Care Quality Improvement Program, IPRO Amy Bowerman, RN, Director of Quality Improvement/Privacy Officer at Mohawk Valley Health Systems-Home Care Services and Director of Patient Services, Senior Network Health Sepsis is the number-one driver of hospital readmissions in New York. More than 1.6 million people are diagnosed with sepsis nationally, and it is the highest cost factor for hospitalizations in the U.S., at approximately $20 billion per year. There are few other concrete areas of intervention that can have a more pronounced effect on outcomes, and home care is especially equipped to help, given that the vast majority of sepsis cases occur in the community setting. HCA s Adult Sepsis Screening Tool for Home Care is a cutting-edge clinical resource that is garnering national attention for its ability to support the early detection and intervention of sepsis in the home care setting. This session will provide an overview of the tool s components, design, development and strategies for adoption and implementation. 3:00 3:30PM Extended Break and Vendor Networking 3:30 4:30PM Role of Home Care in Population Health Management Noreen Nelson, PhD, Clinical Assistant Professor, NYU Rory Meyers College of Nursing Population health management is getting some heavy focus from federal and state policymakers aiming to improve health outcomes in a value-based payment environment. Learn from a national population health clinical expert how home care providers can play a pivotal role in delivering positive population health outcomes. 4:30PM Wrap Up and Adjourn 2

17 Tentative Agenda Thursday, November 17 8:00AM Registration and Light Breakfast 8:30-9:30AM An Up Close Look at a Home Care Led Bundled Payment Program Amy Weiss, Vice President, Solution Development, Visiting Nurse Service of New York Whether its value-based payments, your current MLTC contract arrangements, or a range of federal program initiatives, bundled payment models are a core feature of many new clinical models to share risk, target interventions for specific populations, and reduce costs. Visiting Nurse Service of New York, the largest not-forprofit home and community based health care organization in the U.S., is actively participating in CMS s Bundled Payments for Care Improvement (BPCI) program as a risk-bearing episode initiator. In this session, VNSNY will share insights on the following topics related to its work on BPCI: Redesigning care to meet the needs of the target population Innovating through technology and data management Challenges and lessons learned Future opportunities for home care agencies in the bundled payments space 9:30-10:45AM The Value Proposition for Physician-Home Care Partnerships Cyndi Nassivera-Reynolds, VP, Transformation & Clinical Quality, Hudson Headwaters Health Network The home care-physician partnership has long been a staple of quality, care transitions and oversight. Physician buy-in and understanding of home care s role are vital for authorization of services, but also, increasingly, for unique new partnerships in care delivery. Hear from one of the state s most innovative providers about groundbreaking partnerships being forged between physicians and home care that are improving care delivery, providing high quality outcomes, and saving dollars. 10:45AM Break 11:00 Noon Enhancing Health Literacy for Improved Outcomes in Home Care Misty Kevech, RN, BS Ed, MS, COS-C, CCP, CPTM Cindy Sun, MSN, RN, COS-C Crystal Welch, MSN, RN Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Health literacy affects the majority of Americans, especially underserved populations and people that are 65 years or older, which are key home care demographics. Beyond delivering direct-care services, one of home care s core strengths is its ability to educate and assess the social and environmental determinants of health, putting the patient at the center of his or her own decision-making. To do this, home care staff all need baseline health literacy skills and the ability to assess and instill these basic concepts in the patient care teaching environment, so patients can best selfdetermine their care, as well as follow and understand their treatment plans. This session will delve into key components of health literacy including: assessment, interventions, tips, and tools to improve patient outcomes and quality of life. Participants will learn actionable ways to enhance health literacy among direct-care staff as well as patients and family caregivers by: Identifying three red flags that indicate health literacy issues. Explaining how to check written patient materials for readability levels. Describing one method to assess patient's understanding of patient education/instructions. Noon Wrap Up and Adjourn Be sure to check out the Post- Conference HHQI Workshop Bonus Session! 3

18 Post- Conference HHQI Workshop Bonus Session! Thursday, November 17 1:00 5:00PM Building & Sustaining Data-Driven QAPI Misty Kevech, RN, BS Ed, MS, COS-C, CCP, CPTM Cindy Sun, MSN, RN, COS-C Crystal Welch, MSN, RN During this interactive workshop, RN Project Coordinators from the Home Health Quality Improvement (HHQI) National Campaign team will provide personalized, hands-on guidance on data interpretation and the next steps toward developing and sustaining a strong Quality Assurance & Performance Improvement (QAPI) plan. Bring Your HHQI Data Reports for Personalized Assistance HHQI uses OASIS data to generate custom data reports on high-priority topics such as Acute Care Hospitalizations (ACH) for all CMS-reporting home health agencies. You are encouraged to bring these reports with you to this session for personalized guidance on interpretation as well as suggested next steps. To access your agency s custom reports, register or login to the HHQI Data Access System. Sample reports will be provided for those who do not bring their agency s custom reports. Learning Objectives: Interpret your agency's HHQI ACH Data Reports and identify gaps in patient care Distinguish a minimum of three free evidence-based tools/resources to address gaps in patient care List three additional support resources to assist with development and sustainment of a Quality Assurance and Performance Improvement (QAPI) plan * 3.75 Nursing CEs for this activity will be provided. Data-Driven QAPI 4

19 Thanks to our Program Sponsors! 5

20 HCA Quality & Technology Symposium REGISTRATION FORM Registration Deadline is November 7. November 16-17, 2016 Embassy Suites by Hilton Saratoga Springs 86 Congress St Saratoga Springs, New York, Name: Title: Agency: Address: City/State/Zip: Phone: Ext. (Required) Register Online at Hotel Information A small block of rooms has been secured at the Embassy Suites, 86 Congress Street, Saratoga Springs, NY for the evenings of November 15 and November 16 at a discounted rate of $149. To make your overnight accommodations, call the hotel directly at before October 21 and ask for the Home Care Association of New York State rate. FEE SCHEDULE FOR FULL SYMPOSIUM Rates are Per Person (Nov 16 & 17) HCA Member Early Bird Rate $269 $0 Yes, I will attend (Free (Register by 10/21) the post-conference session HCA Member Rate $299 $0 Yes, I will attend (Free) (Register after 10/21) the post-conference session Prospective Member Rate $399 $0 Yes, I will attend (Free) the post-conference session PAYMENT Please check method of payment: (Checks must be received by date of program). MC VISA AM EXP Check* *Make checks payable to : HCA Education and Research and mail to: 388 Broadway, 4 th Floor, Albany, NY Credit Card # Exp. Date: Security Code: Name and/or Company Name on Card Billing Address of card (including City, State and Zip Code) Authorized Signature Cancellations received in writing via to info@hcanys.org by November 7, are refundable less a 25% administrative fee. No refunds are permitted after this date or for no shows. Substitutions are permitted. 6 Please fax to: (518)

21 388 Broadway Fourth Floor Albany, NY 12207