Legislative Issues Public Policy News A Weekly Publication Of HCA HCA HCA HCA HCA Home Care Association of New York State Helping New Yorkers Feel Right At Home A S AP Volume 21, No. 13 April 1, 2016 Inside Inside Inside Inside Inside ASAP ASAP ASAP ASAP ASAP HCA and Partners Oppose CMS Prior Authorization Proposal HCA this week submitted a strongly worded comment letter opposing a prior authorization demo for Medicare home health services being floated by the U.S. Centers for Medicare and Medicaid Services (CMS). We are also part of a nationwide effort, in collaboration with partner state associations throughout the country, weighing in jointly on the rule, all calling for the rule to be rescinded. HCA’s Comments Voice Strong Support for Physician Signature, Billing Flexibility Proposal Reflecting HCA Recommendations 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. 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. More Budget Details: Wage Hike Approved, Analysis Ongoing..........1 HCA and Partners Critique CMS Prior Authorization Proposal..........1 HCA Voices Strong Support for Doc Signature, Billing Flexibility ........1 Supreme Court to Decide Whether to Hear FLSA Lawsuit Case..........8 Urgency Continues on FLSA Advocacy ..................................................8 U.S. DOL Releases FLSA/Home Care Guide.........................................9 Member Hiring Announcements..........................................................10 HCA Ed Director Street Appointed to State’s Social Work Board.....11 HCA Brochure Announces Full Annual Conference Lineup................11 OIG: Hospices Inappropriately Billed Over $250M in Claims............12 ePACES To Add New Feature on June 1, 2016....................................12 MLTC Plans and Counties Advised of CDPAP Change........................14 Gold STAMP Webinar Eyes Physician Engagement on Pressure Ulcers..15 NGS Updates.......................................................................................15 Publications ............................................................................ 15 See OPPOSE p. 5 See COMMENTS p. 7 Additional Budget Details Released, Wage Hike Approved, Analysis Ongoing New wage-related bill introduced for adoption with budget; HCA fields recent state requests for wage impact data as discussions continue As reported to the membership in two alerts late yesterday and today, the Governor and Legislature have reached a deal on the budget provisions affecting home care. The Legislature passed some portions of the budget deal last night, with the remainder of the budget bills acted on today. Yesterday, we reported that the budget has an HCA-sought $200 million infrastructure pool (including at least $30 million for community-based providers) as well as some minimal home-care managed care rate language. See BUDGET p. 2
Transcript
Legislative Issues Public Policy News
A Weekly Publication Of HCAHCAHCAHCAHCAHome Care Association of New York State
HCA this week submitted a strongly wordedcomment letter opposing a prior authorizationdemo for Medicare home health services beingfloated by the U.S. Centers for Medicare andMedicaid Services (CMS).
We are also part of a nationwide effort, incollaboration with partner state associationsthroughout the country, weighing in jointly on therule, all calling for the rule to be rescinded.
HCA’s Comments Voice Strong
Support for Physician Signature,
Billing Flexibility Proposal Reflecting
HCA Recommendations
HCA this week submitted comments in strongsupport of long-sought proposed changes to thestate’s physician order and billing deadlines for homecare.
These proposed changes, initiated and drafted byHCA, have been a long time in the making, andHCA this year succeeded in getting the Departmentof Health to consider these vitally needed changes.
More Budget Details: Wage Hike Approved, Analysis Ongoing..........1
HCA and Partners Critique CMS Prior Authorization Proposal..........1
HCA Voices Strong Support for Doc Signature, Billing Flexibility........1
Supreme Court to Decide Whether to Hear FLSA Lawsuit Case..........8
Urgency Continues on FLSA Advocacy..................................................8
U.S. DOL Releases FLSA/Home Care Guide.........................................9
Member Hiring Announcements..........................................................10
HCA Ed Director Street Appointed to State’s Social Work Board.....11
HCA Brochure Announces Full Annual Conference Lineup................11
OIG: Hospices Inappropriately Billed Over $250M in Claims............12
ePACES To Add New Feature on June 1, 2016....................................12
MLTC Plans and Counties Advised of CDPAP Change........................14
Gold STAMP Webinar Eyes Physician Engagement on Pressure Ulcers..15
Additional Budget Details Released, Wage Hike Approved, Analysis OngoingNew wage-related bill introduced for adoption with budget; HCA fields recent state requests for wage impact data asdiscussions continue
As reported to the membership in two alerts late yesterday and today, the Governor and Legislature havereached a deal on the budget provisions affecting home care. The Legislature passed some portions of thebudget deal last night, with the remainder of the budget bills acted on today. Yesterday, we reported that the budget has an HCA-sought $200 million infrastructure pool (including atleast $30 million for community-based providers) as well as some minimal home-care managed care ratelanguage.
See BUDGET p. 2
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ASAP – a publication of the Home Care Association of New York State Volume 21, No. 13 April 1, 2016
BUDGET from p. 1 Today, more information was disclosed aboutthe minimum wage outcome, though thedetails remain incredibly opaque and there arereports of some possible funding. (Onefunding chart from the Legislature points to apossible home care allocation of $211 millionstate-share over two years). HCA remainsguarded when it comes to these fundingreports until there is official confirmationsurrounding the dollar level, mechanism andtiming for distribution. HCA will be meetingwith the State Medicaid Director and officialsat the Departments of Budget and Health tolearn more details about this provision andother elements affecting home care onTuesday. Throughout the past several months, HCAand partners engaged in an all-out advocacypush on the wage issue, crunching the impactdata, meeting with all key staff of theLegislature and Executive, sending advocacymessages and press releases, garnering mediacoverage, and using the force of our coalition
partnerships to call for the rejection of this wage hike ifit is not fully funded.
The final outcome and impact of the wage hike is stillbeing assessed. While HCA and partners called forfull funding or rejection of the wage hike, theaggressive advocacy led the Legislature to partiallymitigate the impact of the Governor’s wage hike in thefinal budget through a modest phase-in and at leastsome apparent funding in the final budget.
What we know about the wage deal
Under the deal, New York City’s minimum wage willincrease to $15 per hour in three years (four years foremployers with 10 or fewer employees) and in LongIsland and Westchester over six years.
For upstate, the minimum wage will go up to $12.50over the next five years and would be indexed to $15thereafter based on a Division of Budget index to bedetermined. (See charts on page 3).
Additionally, the Senate this morning adopted separatelegislation that was originally part of the Assembly’sone-house budget bill, requiring the minimum wage to
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Continued from previous page Minimum Wage Effective Dates
be enacted on top of worker parity benefits. Thisaction reflects direct support for a top priority of thestate’s health care workers union, further devastatinghome care providers already deeply affected by theworker parity requirements. This legislation isexpected to be approved by the Assembly shortly.HCA is strongly opposed to this component of theAssembly budget bill because it again increasesmandatory compensation without commensuratefunding for home care providers. Some follow-up wage discussions and newinformation
In the aftermath of this outcome, HCA has beenengaged throughout the day with state officials whohave requested additional home care wage impactdata for possible wage funding provisions.
In addition, the State Operations budget doesinclude adjustments to the Medicaid Global Cap,increasing it to $18.778 billion from the Governor’s$18.54 billion proposal, but it is not clear whetherthis cap adjustment is to account for the wageproposal, and to what degree, if any.
HCA has also identified budget language in the “aid tolocalities” bill referring to unspecified amounts that:
“shall support direct salary costs andrelated fringe benefits within themedical assistance programassociated with any minimum wageincrease that takes effect during thetimeframe of these appropriations,pursuant to section 652 of the laborlaw. Each eligible organization inreceipt of funding made available bythese appropriations may be requiredto submit written certification, insuch form and at such time thecommissioner may prescribe,attesting to the total amount of fundsused by the eligible organization, howsuch funding will be or was used forpurposes eligible under theseappropriations.”
It is not clear whether there are actually new Medicaidfunds for these purposes, or whether this languagetargets existing Medicaid funds. Details, follow-upmeasures, and the intricacies of the various bills will beanalyzed over the next several hours and HCA willobtain necessary clarifications.
Investment Pool Includes at Least $30M forCommunity-based Providers
The health provisions also reveal versions of HCA-developed priorities in some areas for home care whichhave been adopted in the final health care budget bills,including an appropriation of up to $200 million forhealth care infrastructure funding, a minimum of $30
4
million being earmarked for community-basedproviders, including home care.
HCA had aggressively worked with a coalitionof community providers for inclusion of suchdedicated funding. A core part of HCA’sadvocacy message this year was the need forspecific appropriations to support the capitalneeds of home care providers at a time whenproviders must ramp up for new deliverymodels like the Delivery System ReformIncentive Payment Program, Value BasedPayments, and others.
These appropriations are a step in the rightdirection after years of underfunding for homeand community-based capital needs, althoughwe had requested and provided a compellingcase for much more substantial funding.Without support from the Governor, theLegislature’s ability to further supplementthese funds for home care was limited. Scaled-Back Home Care-Managed Care RateAdequacy Language
HCA this year also authored home care-managed care rate adequacy language, which wassubstantially included in the Assembly’s initialbudget language several weeks ago butdramatically scaled back by the Administration inthis final agreement. The final rate adequacylanguage was diminished by the push-back of theGovernor’s negotiators resulting, essentially, in astate provision mirroring federal standards. Theresulting language merely adds that actuariallysound rates for MLTC “shall comply with allapplicable laws and regulations, state and federal,including regulations as to the actuarialsoundness for Medicaid managed care.”
Auxiliary Wage-related Issues Remain Murky
HCA is still determining all of the variouspieces of the wage component, itscorrespondence with the global cap, and anyfurther measures related to it. We arecontinuing to comb through and analyze the
budget bills, field requests from state officials on wageimpact data and gain additional information. We alsohope to learn more in our meeting with state officials onApril 5 that will review the health and minimum wageprovisions.
HCA is also in the process of planning and executingfollow-up steps to the budget process to better securesupport for home care, so please stay tuned for moreinformation and follow-up activity. Other items In other items, the Legislature successfully rejected theGovernor’s proposal to restrict MLTC eligibility to anursing-facility-level-of-care, as well as the Governor’sproposed carve-out of transportation services fromMLTC. HCA advocated rejection of both.
Also rejected in the final bill was the Governor’s proposedelimination of spousal refusal and a reduction in thecommunity spouse resource allowance. The final billdelays, until January 1, 2018, the transition of theTraumatic Brain Injury and Nursing Home Transitionand Diversion waiver programs into managed care andmandates that these benefits, when offered undermanaged care, be substantially comparable to the servicesparticipants received as of January 1, 2015.
The budget agreement includes a paid family leaveprogram. When fully phased- in, employees will beeligible for 12 weeks of paid family leave when caring foran infant, a family member with a serious healthcondition or to relieve family pressures when someone iscalled to active military service. Benefits will be phased-inbeginning in 2018 at 50 percent of an employee’s averageweekly wage, capped to 50 percent of the statewide averageweekly wage, and fully implemented in 2021 at 67 percent oftheir average weekly wage, capped to 67 percent of thestatewide average weekly wage. This program will be fundedentirely through a payroll deduction on employees with nodirect costs to business, though HCA has to confirm whatadministrative costs will be incurred by employers.Employees are eligible to participate after having worked fortheir employer for six months.
HCA will provide additional information as we learn ofmaterial developments in our continued analysis.
ASAP – a publication of the Home Care Association of New York State Volume 21, No. 13 April 1, 2016
As part of the proposed demonstration, CMS would perform prior authorization before processing claimsfor home health services in five identified demo states: Florida, Texas, Illinois, Michigan and Massachusetts,though it is possible that this pilot could be extended to New York and other states as well.
More information on the proposed demo is at https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing-Items/CMS-10599.html?DLPage=4&DLEntries=10&DLSort=1&DLSortDir=descending.
As HCA explains in our comment letter, “this proposal would create altogether unnecessary obstacles inaccess to care, increase system-wide costs, and jeopardize the quality of care that patients receive.”
We also take aim at the justifications and inherent contradictions of this proposed rule compared to otherfederal regulations and initiatives.
HCA’s letter can be read at http://hca-nys.org/wp-content/uploads/2016/04/Medicare-Home-Health-Prior-Authorization-Comments-Final.pdf.
Our core arguments against the rule are summarized below:
• Access to care threatened. Mandatory prior-authorization programs can negatively impactbeneficiary access to care by imposing significant delays in receiving needed services. Such delays canresult in patients being kept in hospitals unnecessarily or discharged home without the services andsupports they need, risking unnecessary and costly rehospitalizations. It can also impede the timelydelivery of vital home health services to individuals living at home who did not have a prior inpatientstay but who – in the professional judgment of physicians and care planners – are deemed to needhome care to remain safe and healthy in their community setting.
• Prior authorization will not address integrity issues. According to Comprehensive Error Rate Testingreports, the vast majority of claims errors in home care (90 percent) are for insufficient documentation,predominantly in the face-to-face (F2F) narrative requirement. F2F disallowances are technical andbureaucratic in nature, rather than resulting from evidence that services were not needed or provided.
• Under prior authorization, all agencies are scrutinized and subject to service delays, when CMS
should target entities or regions that pose greatest risk. This initiative unfairly and arbitrarilyscrutinizes and delays service authorizations for all home care agencies in the demo states, even thosewho have a long-established record of compliance with existing rules and regulations. As it is, CMShas a range of existing audit entities able to conduct this work, including Recovery Audit Contractors(RACs), Zone Program Integrity Contractors (ZPICs), state-level surveillance agents (targetingConditions of Participation adherence), third-party liability payment auditors, the Office of the InspectorGeneral, the Medicare Administrative Contractors’ ’ “Probe-and-Educate” audits, and others. CMS’s timeand resources would be better allocated targeting those specific home health agencies, regions, orutilization bands suggesting fraudulent activity, rather than punishing all agencies.
• The byproducts of prior authorization contradict CMS’s goals and innovations. The bottleneckcreated by prior-authorization contradicts the very goals, procedures and technical designs of CMS’s
OPPOSE from p. 1
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own innovations, be it value-based payment, bundling initiatives, Accountable CareOrganizations or other specific new pilots by delaying timely care transitions.
• This demonstration process redirects care-planning decisions from the patient’s care team to
the Medicare contractors. These government contractors are not directly liable for the timelyinitiation of care at the clinical level and they are not intimately involved in urgent clinicaldecisions where time is of the essence, especially during discharge from hospitals on weekendsand evening hours and in other critical circumstances.
• This demo will escalate costs throughout the system. By denying an expeditious discharge orreferral to cost-effective home care settings, this proposal will substantially escalate the cost ofservices while patients await approval for services in the home, where post-acute care is mostcost-effective. This demonstration will also significantly raise administrative costs for agenciestasked with new paperwork requirements.
• The demo will also result in many additional requests for administrative appeals from
beneficiaries, further increasing an already massive backlog of appeals at a time when it takesabout five months for entering new appeals cases into the Administrative Law Judge docket andwhen the average processing time for an appeal in fiscal year 2015 was about 550 days.
• Prior authorization runs counter
to and contradicts quality
measures and regulatory
requirements for timely initiation
of services, undermining patients’satisfaction with care as measuredby CMS “Star Ratings” andrequired by CMS’s own Conditionsof Participation (CoPs).
Given that documentation is the key area ofalleged noncompliance being targeted bythis initiative, HCA calls on CMS to optfor education, clear guidelines andcompliance standards, and providersupport in place of this prior-authorizationproposal, which will have many adverseand unintended consequences including thejeopardizing of access to care, the increaseof system and operational costs, and anegative impact on quality of care.
HCA will keep the membership apprised ofthis issue and our advocacy argumentswhich we are sharing with New York’sCongressional Delegation to apply pressureagainst this misguided policy proposal.
Stay tuned for additional details to come.
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ASAP – a publication of the Home Care Association of New York State Volume 21, No. 13 April 1, 2016
The proposal would align the state’s deadlines with the broader timetables allowed under Medicare. Theproposed changes were further recommended and advanced by the Home and Community-Base CareWorkgroup. 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 theproposed rule was posted, “We appreciate the state’s support for a sensible timeline that has worked underMedicare. This proposal ensures that providers and physicians can focus on the initiation or modification of thecare itself.”
The proposal has been extensively reported to the membership. What follows is a summary of the currentrequirements and what the new proposal does.
Current requirements
Providers currently must obtain signed physician orders within 30 days of the start of home care. Meanwhile,state regulations require a provider to obtain these orders prior to billing, and the state’s billing system itself doesnot allow for claims to be submitted after 90 days of the service date.
“This leaves providers with a double-jeopardy situation,” says HCA Vice President of Finance & ManagementPatrick Conole in this week’s formal comments: “First, a 30-day window for [physicians] to provide theirsignatures … and second, a total 90-day deadline from the service date to have the physician signature and,following, the preparation submission of the claim for billing.”
No exception code currently exists to allow for home care billing after the 90-day window in cases where the physiciansignature is obtained late, even with the due-diligence of the home care provider to get the signatures timely.
What the proposed rule does
This proposed rule aligns with Medicare, requiring the signature prior to billing; Medicare allows a one-yearwindow to bill. The rule will be joined by a separate, anticipated guidance for a new exception code allowing homecare agencies to bill after 90 days when the physician signature is not obtained in that time.
Further recommendations
HCA expressed strong support, and also made three additional recommendations. The first calls on theDepartment to accelerate its issuance of the separate guidance allowing for a billing exception code whensignatures are not received in the 90-day billing timeline, allowing for flexibility on the billing end that iscommensurate with the flexibility allowed on the physician signature end of the equation.
Secondly, we also request that the Department work with the Office of the Medicaid Inspector General toincorporate the rule change in its documentation for compliance assumptions, audit standards and procedures.Thirdly, we reiterate our call for home care health information technology support to allow for better recordexchange between home care and physicians for orders and other coordination.
HCA’s comments are at http://hca-nys.org/wp-content/uploads/2016/04/DOHsProposal_90DayPhysicianOrderFlexibilit-March28.pdf.
We will immediately inform the membership of any next steps on finalization of this rule and accompanyingguidance on the billing exception codes.
ASAP – a publication of the Home Care Association of New York State Volume 21, No. 13 April 1, 2016
Supreme Court to Decide Whether to Hear FLSA Lawsuit Case
The U.S. Supreme Court is expected to decide today during a conference session whether to review a lowercourt’s decision on a challenge to the Fair Labor Standards Act (FLSA) final rule. New York’s home careproviders have already incurred significant unreimbursed costs associated with the rule’s implementation –an issue for which HCA continues to vigorously advocate.
The court is expected to announce on April 4 whether it will accept or reject the home care industry’s petitionthat challenged the rule. However, each year, the Supreme Court agrees to review only a small percentage of thecases submitted for consideration.
Last August, the U.S. Court of Appeals for the District Columbia Circuit ruled that the U.S. Department ofLabor (U.S. DOL) acted within its authority when it extended minimum-wage and overtime protections tohome care workers.
The implementing federal rule went into effect in October 2015.
The National Association for Home Care and Hospice (NAHC) and other plaintiffs representing the homecare industry appealed the lower court’s decision to the Supreme Court last November, a month after theirrequest for a stay of the decision was rejected by U.S. Chief Justice John Roberts.
In February, attorneys representing the federal government submitted a brief arguing that the Supreme Courtshould not take up the case.
As covered in past editions of ASAP and communications to members, HCA has taken a strong standagainst the then-proposed U.S. DOL rule, testifying at public meetings, providing written comments onvarious draft versions of the rule and offering many education programs for members so that they couldprepare for the FLSA changes.
Meanwhile, HCA has continues to work with colleagues in an effort to make the state’s approach providefunding to compensate home care agencies for their new FLSA-related costs. (See related story below fordetails.)
Urgency Continues on FLSA AdvocacyDOH Posts FLSA Plan Payments
While today is the deadline for home care agencies to submit the Fair Labor Standards Act (FLSA)attestations to the state Department of Health (DOH), HCA is giving increased urgency to our advocacyrequest that the attestations be revised in a way reflecting use of the FLSA funds for all FLSA-related costs.
HCA and members have taken issue with the current attestation form that pledges the agency to pass thefunding “through to the home care worker, in its entirety.”
This week, HCA reached out again to Jason Helgerson, the state Medicaid Director, and other DOHofficials to advocate for changes to the attestation and the funding distribution process.
Continued on next page
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HCA also continued to seek support from the managed care sector for our proposal that FLSA funding bepassed through to home care providers based on $0.34 per each hour for all aide services provided fromOctober 13, 2015 to March 31, 2016.
This proposal must be instituted in a timely manner, as MLTC plans are requesting documentation onovertime and travel from their home care contractors, despite our advocacy that other FLSA-related costsalso be considered, including: changes in recordkeeping, payroll and employer/employee agreementdocuments; aide initial training and annual in-services; 24-hour live-in cases where the aides work more than13 hours; and other expenses.
HCA will alert our members of any new developments as we press for a more workable DOH approach.
Meanwhile, HCA advises members to submit the attestations to DOH and suggests that they include theabove FLSA-related expenses when replying to documentation requests from their MLTC partners.
FLSA Payment List
In response to HCA’s request during our March 18 meeting with Mr. Helgerson, DOH yesterday posted thelist of MLTC plans and the amounts of FLSA funding that they recently received. The list is at http://www.health.ny.gov/health_care/medicaid/redesign/2016/2016-03-11_flsa_add_info.htm.
FLSA Survey
Meanwhile, HCA will be meeting with DOH next week to finalize our comments on its draft FLSA surveythat Mercer, DOH’s actuary, has been developing to measure the actual costs faced by agencies due to theFLSA changes. Once finalized, agencies will be asked to complete it and the results will be used to informDOH about any need for continued funding.
Supreme Court Consideration
In a related development, the Supreme Court is considering whether to take up a case filed in the court tochallenge the FLSA changes. (See related p. 7 story.)
For more information, contact Andrew Koski at (518) 810-0662 or [email protected].
U.S. DOL Releases FLSA/Home Care Guide
The U.S. Department of Labor (U.S. DOL) has issued a guide called Paying Minimum Wage and Overtime toHome Care Workers: A Guide for Consumers and their Families to the Fair Labor Standards Act.
The guide is at http://www.dol.gov/whd/homecare/homecare_guide.htm.
According to U.S. DOL, the guide explains who needs to follow the Fair Labor Standards Act (FLSA) rulesand how to follow them. The guide provides examples of situations involving hiring a home care workerdirectly, using a home care agency, and arranging care through a self-directed program. It discusses paidproviders who are family members of the consumer and who are live-in workers.
Other helpful resources from U.S. DOL are at http://www.dol.gov/whd/homecare/.
ASAP – a publication of the Home Care Association of New York State Volume 21, No. 13 April 1, 2016
Job Position: Director of Performance Improvement and StaffDevelopment (Winthrop University Hospital Home HealthAgency)
Winthrop seeks a Director of Performance Improvement and StaffDevelopment for the CHHA, which services Nassau, Suffolk and Queens.
The PI Director is responsible for the quality assessment/assuranceprogram, compliance with DOH regulations and The Joint Commissionstandards, as well as overseeing the educational programs of theagency.
Minimum qualifications include: BSN, NYS RN license, two yearsprofessional nursing experience, two years supervisory experience ina CHHA or related home health program; working knowledge ofPerformance Improvement/ Quality Assurance, The Joint Commissionstandards and DOH regulations. Master’s degree preferred.
Job Position: Director of Patient Services (Montefiore HomeHealth Agency)
The Director is responsible for directing, planning, coordinating andevaluating patient care services, providing supervision ofprofessional staff, and recruiting/hiring an adequate number ofprofessional staff to ensure quality. The Director will evaluate theperformance of Patient Service Managers and support staffsupervisors at stated intervals. The Director will participate inadministration of the annual budget and personnel policies. The idealcandidate will manage all clinical functions.
Required Qualifications: Current NYS RN License and Registration;Master’s in Nursing or Health Related Field; five years of senior anddirect management experience within a CHHA.
Additional Qualifications: Knowledge of clinical documentationprotocols, home health regulations and standards; skill in training,working with building high performance teams; ability to develop andlead strategic plans; strong written and verbal communication skills.
Please send résumé & cover letter to [email protected] with“Director of Patient Services” and your name in the subject line. Résuméswithout cover letters and applicants who do not meet requirements won’tbe accepted. No phone calls, please.
MMC is an equal opportunity employer and will not discriminate againstany employee or applicant for employment because of race, color,religion, gender, sexual orientation, or national origin.
HIRING
Job Position: Director of Finance(Montefiore Home HealthAgency) Position Summary: The Director ofFinance is responsible for thefinancial and reimbursementfunctions of the Montefiore HomeHealth Agency, managing accountsreceivable/payable, billing, thirdparty payers, cost reports, annualbudget, grants and special funds. TheDirector will work closely with theExecutive Director and AgencyManagement to: set financialoperation and effectively managefinancial resources; ensure efficientwork flow process and effectivebilling compliance with all regulatoryand accrediting bodies; and providefinancial analysis and recommendplan of action. The Director isresponsible to uphold compliancewith agency policies and procedures,standards and regulatoryrequirements.
Required Qualifications: Bachelor ofScience in Accounting required (MBAand or CPA preferred); minimum oftwo years’ experience in home healthfinancing/accounting or three years’hospital finance plus two years’administrative managementexperience, preferably in a healthcare setting.
Additional Qualifications:Demonstrated skill in training andworking with building highperformance teams; high levels ofanalytical ability; leadership andcreativity in management/development of staff; ability todevelop and lead the strategic plans;strong written and verbalcommunication skills.
Please send résumés and coverletters to: www.montefiore.org/careers. Résumés without coverletters and applicants who do notmeet the requirements will not beaccepted. No phone calls, please.
Volume 21, No. 13 April 1, 2016ASAP – a publication of the Home Care Association of New York State
HCA Education Director Celisia Street Appointed to State’s Social Work Board
HCA Director of Education Celisia Street, a Licensed Master SocialWorker (LMSW), has been appointed by the New York State Board ofRegents to serve on the State Education Department Social Work Board.
The Board of Regents appoints a State Board for each licensed professionto advise and assist the Board of Regents and the State EducationDepartment on matters of professional regulation.
Professional board members must be New York State-licensedprofessionals who are residents of the state. Members of the board adviseon licensing requirements, licensing examinations and practice issues, andprovide community outreach, as well as participate in licensuredisciplinary and/or restoration and moral character proceedings.
A board or committee member is appointed for a five-year term.
HCA congratulates Ms. Street on the prestigious appointment andrecognition of her professional accomplishments in the field of socialwork.
HCA Brochure Announces Full Annual Conference LineupRegister today for May 4-6 program in Saratoga
HCA’s Annual Conference brochure is hot off the presses and ready for you to “Vote Home Care,” the fun,informative theme of this year’s conference.
The brochure is available at http://hca-nys.org/wp-content/uploads/2016/04/2016-HCA-Annual-Conference-Detailed-Brochure.pdf. Give it a glance and pull out the registration form at the back to reserve yourspot as delegate! You can also register online at https://www.eventville.com/Catalog/EventRegistration1.asp?EventId=1011878. Other conference details are on the conference website at http://hcaannualconference.com/.
Our “A” list of speakers includes some big names in the public sphere, with acclaimed book titles to their namesand credits from the Huffington Post, the Washington Post and the New England Journal of Medicine, recentappearances on CNN and MSNBC, accolades from academic quarters, and prior speaking invites to companieslike Google and Siemens.
One important part of our program has politics in its very name – our Political Action Committee fundraiser –which we hope you plan on attending, along with some great “think-tank” and “focus group” sessions on home careand hospice topics, general sessions with an eye-opening focus for New York’s home care citizen activists, anexciting pre-conference session on value-based payments, our annual awards ceremony, networking opportunitieswith vendors and peers, and, of course, lots of fun!
Please be sure to make your hotel reservations soon. The discount deadline is two days away, on April 3. See thebrochure for further information.
ASAP – a publication of the Home Care Association of New York State Volume 21, No. 13 April 1, 2016
OIG Report on Hospice Billing
The U.S. Office of the Inspector General (OIG)this week released its anticipated report on hospiceuse of General Inpatient Care (GIP).
OIG based its study on data from a medical recordreview of a stratified random sample of all Medicarehospice GIP stays in 2012. OIG analyzed theresults of the medical record review to estimate thepercentage of GIP stays that, it asserted, were billedinappropriately.
The OIG report is at http://oig.hhs.gov/oei/reports/oei-02-10-00491.asp.
OIG’s study also reviewed prescription drugscovered under Part D and made determinationsabout appropriateness of coverage, and examinedquality of care and care planning provided byhospices.
The report asserted that for-profit hospices weremore likely than other hospices to have inappropriatebilling.
The following are the OIG’s recommendationsfrom the report, directed to the U.S. Centers forMedicare and Medicaid Services (CMS) andendorsed for action by CMS:
• Increase oversight of hospice GIP claimsand review Part D payments for drugs forhospice beneficiaries;
• Ensure that a physician is involved in thedecision to use GIP;
• Conduct prepayment reviews for lengthyGIP stays;
• Increase surveyor efforts to ensure thathospices meet care planning requirements;
• Establish additional enforcement remediesfor poor hospice performance; and
ePACES To Add New Feature on
June 1, 2016
eMedNY is installing a new feature that willimpact ePACES users when signing on to theePACES application.
This new feature, commonly called CAPTCHA,is a program that can distinguish whether theuser attempting to sign-on is a human or acomputer, and is intended to make user datamore secure and to improve systemperformance.
Effective June 1, 2016 when users attempt tosign-on to ePACES from the www.emedny.orgwebsite, they will be asked to verify that they area person and not a computer by selecting specificimages. Once users have successfully verified thecorrect images, they will be allowed to sign intothe ePACES account. If the incorrect images areselected, the user will be asked to verify anotherset of images before being allowed access toePACES.
To familiarize yourself with the new verificationfunction, please go to https://www.google.com/recaptcha/api2/demo.
According to the state Department of Health(DOH), this feature is being added to helpsecure your data, and to prevent unauthorizedcomputer-automated access to ePACES thatcould adversely impact ePACES performance.
Important note: All users will need to haveinstalled Internet Explorer (IE) version 10 orgreater or any alternative browsers includingGoogle Chrome, Mozilla Firefox, or AppleSafari. IE versions 9 and below will NOT be
supported. Please be sure to coordinate withyour IT department to upgrade your internetbrowser, if necessary, before the effective dateshown above.
Questions about ePACES can be directed to theeMedNY Call Center at 800-343-9000.
ASAP – a publication of the Home Care Association of New York State Volume 21, No. 13 April 1, 2016
• Follow up on inappropriate GIP stays, inappropriate Part D payments, and hospices that haveevidence of poor-quality care.
For further information, please contact Patrick Conole at (518) 810-0661 or [email protected].
MLTC Plans and Counties Advised of CDPAP Change
The state has posted guidance for MLTC plans and local departments of social services (LDSS) on statelegislative changes, effective April 1, 2016, that modify who can work as a Consumer Directed PersonalAssistance Program (CDPAP) personal assistant for an eligible participant.
These changes permit parents of adult children to be hired and work as CDPAP personal assistants.
The MLTC guidance is athttp://www.health.ny.gov/health_care/medicaid/redesign/mrt90/mltc_policy/docs/16-02.pdf.
The LDSS instructions are athttp://www.health.ny.gov/health_care/medicaid/publications/docs/gis/16ma006.pdf.
The new law bars persons from being hired as CDPAP assistants if they are legally responsible for theeligible individual’s care and support. Conversely, adults who are not legally responsible for the eligibleindividual’s care and support may be a CDPAP assistant for that eligible individual.
In particular, this means that a parent of an adult child (21 years of age or older) may serve as that adultchild’s CDPAP assistant. Parents of children who are younger than 21 cannot be hired as that minor child’sCDPAP assistant. Consistent with current regulations, spouses and “designated representatives” also cannotbe hired as CDPAP assistants.
Under the regulations (Title 18, section 505.28), “designated representative” means:
an adult to whom a self-directing consumer has delegated authority to instruct, supervise anddirect the consumer directed personal assistant and to perform the consumer’s responsibilitiesspecified in subdivision (g) of this section and who is willing and able to perform theseresponsibilities. With respect to a non-self-directing consumer, a “designated representative” meansthe consumer’s parent, legal guardian or, subject to the social services district’s approval, aresponsible adult surrogate who is willing and able to perform such responsibilities on theconsumer’s behalf. The designated representative may not be the consumer directed personalassistant or a fiscal intermediary employee, representative or affiliated person.
According to the above guidances, any other adult relative of the CDPAP-eligible individual may serve as theindividual’s CDPAP assistant. In all cases, the CDPAP authorization is based on the eligible individual’sassessed needs. This applies regardless of whether the CDPAP assistant is a parent or other adult relative ofthe individual or not related to the individual.
ASAP – a publication of the Home Care Association of New York State Volume 21, No. 13 April 1, 2016
Under current regulations [18 NYCRR 505.28(b)(3)], if the parent lives with the consumer/child, theparent must reside “with the consumer because the amount of care the consumer requires makes suchrelative’s presence necessary.”
This legislative change was also highlighted in the March Medicaid Update athttp://www.health.ny.gov/health_care/medicaid/program/update/2016/mar16_mu.pdf.
Gold STAMP Webinar Highlights Physician Engagement on Pressure
UlcersArchived webinar coming soon for follow-up viewing
Yesterday, HCA participated in the Gold STAMP Webinar entitled “Physician Engagement in PressureUlcer Prevention and Treatment” hosted by the University At Albany School of Public Health’s GoldSTAMP Program Committee, of which HCA is an active member.
The Gold STAMP Program to Reduce Pressure Ulcers is an evidenced-based, best-practices modelwith the goal of preventing pressure ulcers. The program operates through collaboratives comprised ofhome care agencies, hospitals and nursing homes, further working with physicians, toward preventionand reduction of pressure ulcers.
Additionally, representatives of these sectors work in combination with the state Department of Healthand the State University at Albany School of Public Health in a statewide coordinating committee toguide the collaboratives and the statewide program goals. The state project team provides educationand resources via the GoldSTAMP website (www.goldstamp.org), such as sessions like this webinar, toindividuals at all levels of the care continuum.
Thursday’s webinar featured Dr. Jennifer Reckrey of Icahn Medical School at Mount Sinai. Speaking tothe target audience of administrators and direct care staff across settings, including home care, shestressed the importance of true collaboration and communication in the prevention and management ofpressure ulcers as well as making valuable suggestions regarding the inclusion and engagement ofphysicians in pressure ulcer prevention and treatment.
The webinar was recorded and will be made available at the GoldSTAMP website. Providers withinitiatives in pressure ulcer prevention and reduction can offer important contributions to many of thecurrent health care reform models. HCA encourages providers to review and consider the resourcesand opportunities available through the GoldSTAMP program, particularly the homepage toolkit.
For further information about the GoldSTAMP program, please contact the state project team via theGoldSTAMP homepage, or HCA’s Al Cardillo ([email protected]) or Alex Blais([email protected]). The archived webinar should be available soon.
ASAP – a publication of the Home Care Association of New York State Volume 21, No. 13 April 1, 2016
NGS Updates
New York’s Medicare Administrative Contractor (MAC), National Government Services (NGS), hasposted the following news to its website.
• Modifications to HCPCS Code Set – The scheduled release of modifications to the HealthcareCommon Procedure Coding System (HCPCS) code set are available on the HCPCS QuarterlyUpdate website at: https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/HCPCS-Quarterly-Update.html. The changes are effective April 1, 2016.
• NGS Announces New Version of PC Print: April 2016 – This week, NGS made available on itswebsite a new version of PC Print 5.1.2. HCA members can download the latest version of PCPrint, by going to the EDI Software section, located within the Claims & Appeals tab on NGS’swebsite.
For further information, contact Patrick Conole at (518) 810-0661 or [email protected].
Publications
• “Predicting 30- to 120-Day Readmission Risk among Medicare Fee-for-Service Patients UsingNonmedical Workers and Mobile Technology,” Perspectives in Health Information Managementhttp://perspectives.ahima.org/predicting-30-to-120-day-readmission-risk-among-medicare-fee-for-service-patients-using-nonmedical-workers-and-mobile-technology/#.VvViGfldV1C
• “Report to the President: Independence, Technology, and Connection in Older Age,” by President’sCouncil of Advisors on Science and Technologyhttps://www.whitehouse.gov/sites/default/files/microsites/ostp/PCAST/pcast_independence_tech__aging_report_final_0.pdf
• “Medicaid Consumer Directed Personal Assistance Program (CDPAP) in New York State,” by theNY Legal Assistance Grouphttp://www.wnylc.com/health/entry/40/
For more information, contact Andrew Koski at (518) 810-0662 or [email protected].
