LeadingAge New York Intelligence May 15, 2012
Only a few more days to weigh in on duals proposal The Department of Health (DOH) conducted public education to explain the revisions to the demonstration proposal for dual eligibles that the state is submitting to the Centers for Medicare and Medicaid Services (CMS). A significant change is the managed fee-for-service option, which builds upon the health home initiative. This aspect of the proposal would be implemented statewide this July, enrolling dual eligbles with a mental health diagnosis, HIV/AIDS, or other chronic conditions. Little was changed to other aspects of the proposal, termed the Fully Integrated Dual Eligible Advantage (FIDA) plan, however new technology requirements were included. LeadingAge New York raised questions about what funding might be available for managed long term care plans and providers they contract with for implementation, and DOH indicated that there may be a small amount of HEAL dollars available for this purpose. Another change of note is that Home and Community Support Services (HCSS) will be included in the capitated benefit package. The nursing home population will not be included in either approach. May 17 is the deadline for comments. Please provide us with a copy of your comments so they can be included in our analysis. Click here for more information. Contact: Diane Darbyshire, ddarbyshire@leadingageny.org, 518-867-8828 This week is National Nursing Home week Celebrating the Journey is the theme for National Nursing Home Week® 2012. Throughout the week, skilled nursing care centers nationwide will plan events to honor the lives — and milestones — of the people they care for and the staff who serve them. Celebrating the Journey reminds us that every life should be honored, every life’s story needs to be told and that every day we have the chance to begin writing a new chapter. Whether the day is filled with comedy or drama, nursing home residents and caregivers are co-authors and leading characters in each other’s life story. Today is about living life to the fullest, irrespective of age, infirmity or disability. There is no fixed formula to follow or guide the process, just the quiet routines of daily caregiving, meals, activities and, let’s hope, visits from family and friends. They bring the joy that comes from the heart of a loved one. Click here for ideas and other resources on celebrating this special week. Another opportunity for the Long Term Home Health Care Program (LTHHCP) A Dear Administrator Letter (DAL) was posted on May 10 regarding a Long Term Home Health Care Program (LTHHCP) becoming a general purpose Certified Home Health Agency (CHHA). According to the DAL this is another opportunity for a LTHHCP to become a CHHA even if they did not submit a response to the CHHA Request for Application (RFA). Please note the deadlines: Information regarding the submission of a CON application can be found on the Department’s website at: http://www.health.ny.gov/facilities/cons/. LTHHCPs will be required to pay a $2,000 CON application fee. Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871 LeadingAge New York participates in Section 202 reform discussions On April 25 LeadingAge New York joined LeadingAge staff and members, along with other affordable senior housing stakeholders, in the Washington D.C. HUD Headquarters to discuss the future of the Section 202 program. HUD convened the meeting to hear from Section 202 developers and operators on how the program could be changed to address the reduction of funding from Congress for the program. HUD’s “guiding principals” for Section 202 reform include to: (a) “Create and sustain more elderly affordable units at a lower initial cost” including awarding only a portion of new Section 202 projects with project-based Section 8 assistance; (b) “Streamline and modernize the program to reduce processing and increase success” including increasing reliance on state housing agencies and reducing HUD regulatory oversight; and (c) “Ensure that new Section 202 housing serves as a platform for frail and at-risk elderly as well as those aging-in-place” including encouraging state housing agencies to collaborate with health agencies to target Section 202 funding to the elderly population most in need of assistance. On May 7 LeadingAge New York convened a senior housing financing forum with operators, developers, and financers of senior housing to make recommendations to HUD for the Section 202 program. Contact: Ken Harris, kharris@nyahsa.org, 518-449-2707, ext. 139 DOH issues RFA for regional contractors for Money Follows the Person Demonstration The DOH Office of Health Insurance Programs, Division of Long Term Care has issued a Request for Applications (RFA) to select nine regional contractors for the Money Follows the Person (MFP) Demonstration entitled: Identification of and Outreach to Nursing Home Resident Project. The purpose of the project is to assure that nursing home residents are provided with objective information about home- and community-based services in order to make informed choices about their preferences for long term care. For more details, please refer to the RFA by clicking here. MFP is a federal program that provides an enhanced Federal Medical Assistance Percentage payment to assist in the transitioning of nursing home residents to the community. In general, New York state’s Money Follows the Person Demonstration seeks to enable ongoing systems change that will assure individuals have access to community-based services when they are in need of long term care supports. Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827 LeadingAge New York comments on quality pool measures LeadingAge New York has provided extensive written comments to DOH on their proposal for the $50 million annual quality pool included as part of Medicaid statewide pricing. As previously reported, DOH is awaiting approval from the federal government to implement statewide pricing effective January 1, 2012. DOH’s proposal would base quality pool payments on: (1) quality measures (QMs); (2) satisfaction; (3) compliance; and (4) avoidable hospitalizations, with QMs making up 60 percent of each facility’s overall score. Our comments addressed each of these areas, emphasizing the need for credible, risk adjusted measures and payments to not only top performers, but also to facilities making the biggest improvements. In 2012, facilities will be asked to submit data that would be used to allocate $50 million in quality incentive payments in 2013. Facilities that fail to submit the requested data this year would be penalized. Contact: Dan Heim, dheim@leadingageny.org, 518-867-8866 LeadingAge New York discusses vital access providers with DOH Earlier this week, LeadingAge New York met with DOH to discuss potential criteria and a process for providing temporary Medicaid rate adjustments to nursing homes that are deemed “vital access providers” and may be adversely affected by closure, merger, acquisition, consolidation and restructuring of neighboring providers or their own facility. The final 2012-13 state budget includes up to $86.4 million in funding for vital access nursing homes, hospitals, certified home health agencies (CHHAs) and clinics. HEAL NY Phase 21 included a component for these temporary rate adjustments (award announcements have not been made, but are expected very soon). DOH reportedly received 46 requests for temporary adjustments to Medicaid rates, of which 32 came from hospitals and clinics, 11 from nursing homes and 3 from CHHAs. The timing of these adjustments is undetermined, since they are under development and require federal approvals. DOH envisions an application process for these temporary rate adjustments outside of HEAL NY. Applicants will need to demonstrate that the funding will improve quality, access, cost effectiveness or the delivery system, and to present a written plan with benchmarks and goals. Further discussions with DOH are planned. Contact: Dan Heim, dheim@leadingageny.org, 518-867-8866 LeadingAge New York seeks input on EPA proposal The Environmental Protection Agency (EPA) has published a proposed rule establishing Federal emissions requirements and standards of performance for hospital/medical/infectious waste incinerators constructed on or before December 1, 2008. The rule seemingly would also apply to nursing facilities under the category of “other health care facilities.” LeadingAge New York is looking to determine whether this rule would affect our members and, if so, the nature and extent of the effect. If you are a member that has on-site medical/infectious waste incinerators or has expertise in environmental regulations, we would welcome your input on the proposed rule. Contact: Elliott Frost, efrost@leadingageny.org, 518-867-8832 OMIG releases work plan The Office of the Medicaid Inspector General (OMIG) has just issued its 2012-13 work plan. The 21-page document is intended to guide OMIG’s work through March 31, 2013 and to enhance transparency and communication between OMIG and policymakers, providers, taxpayers and other state agencies. In 2011, OMIG began implementing business line teams (BLTs) to focus on specific areas of Medicaid service delivery. These BLTs consist of personnel with experience within the various parts of OMIG including audit, investigations, legal, clinical and technical. By using this approach, OMIG hopes to enhance efficiency, conduct more thorough reviews and reduce time to completion. In 2012-13, OMIG will use the BLTs to focus on finding those providers who commit fraud and abuse. Among the areas of focus in long term care in the work plan are: (1) reviews of eligibility, rates and claims documentation for home care; (2) improper use of atypical antipsychotics in nursing homes; (3) nursing home base years, rate appeals, dropped services, bed holds and PRI assessments; (4) duplicate billing and quality of care in assisted living programs; and (5) use of recruitment and retention adjustments to managed long term care plans. Contact: Dan Heim (dheim@leadingageny.org), 518-867-8866 CMS awards only one innovation in NY New York had only one Health Care Innovation winner in the first batch of awards announced by the Centers for Medicare and Medicaid Innovation Center. According to CMS, University Emergency Medical Services, a practice plan affiliated with the Department of Emergency Medicine at the University at Buffalo, is receiving an award to deploy community health workers in emergency departments to identify high-risk patients and link them to primary care, social and health services, education, and health coaching. The award totals $2,570,749, and it is estimated that the program will yield a savings of $6.1 million over three years though reduced utilization of the ER, reduced hospital admissions and overall better health. The next batch of Health Care Innovation Awards will be announced in early June 2012. The awards are designed to support projects in communities to deliver better health, improved care and lower costs to people enrolled in government funded health insurance plans. Funding for these projects is for three years. Click here for more information. Contact: Diane Darbyshire, ddarbyshire@leadingageny.org, 518-867-8828 CMS announces cost savings through the ACA A recent CMS announcement, The Affordable Care Act: Lowering Medicare Costs by Improving Care, outlines over $200 billion in Medicare program savings through 2016, as calculated by the Congressional Budget Office. In addition to lowering the overall cost of the program, the announcement also discusses nearly $60 billion in savings for beneficiaries. For providers, it is important to keep in mind that the $200 billion savings comes in part from negative productivity and efficiency adjustments that will reduce any Medicare market basket increase. Proposed rules for skilled nursing facilities and home health agency rates for future payment periods, that will specify the productivity and efficiency adjustments for both, are due out this summer. The remainder of the program savings comes from initiatives that focus on reducing hospitalizations, fraud and abuse prevention, more preventive care, new models of care, and reducing bonus payments to Medicare Advantage plans. Most of the savings for beneficiaries derive from enhanced preventive services and closing the “donut hole” in Medicare Part D. For complete details, please click on the link above. Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827 Harris appointed CASP Advisory Group chair; Summer Institute in Arizona The Certified Aging Services Professional (CASP), formally known as the Retirement Housing Professional, national certification program provides core competencies and education to deliver housing, supportive, and community services responsive to the needs of older people. At the recent LeadingAge PEAK conference, Ken Harris, LeadingAge New York’s senior policy analyst, was elected chair of the twenty-member CASP Advisory Group, which provides advice and direction to the CASP certification program. The CASP program continues to grow with the changing needs of providing quality aging services in the least restrictive settings. Last year the CASP program recruited highly qualified national leaders in the field of senior living and aging services to write three new, state-of-the-art training manuals developed from their extensive body of knowledge for the use of CASP certification. In addition, CASP is teaming up with LeadingAge Arizona to offer the 2012 CASP Summer Institute that will take place from May 29 – June 1, 2012 in Scottsdale, Arizona. It’s not too late to sign up! Click here for information on the CASP Summer Institute. Certified Home Health Agency (CHHA) update On May 8, the Home Health Manual Policy Guidelines was updated on the eMedNY system. Please note page 6 indicates that effective May 1, for patients 18 and older, all CHHAs must use one of the episodic rate codes when billing Medicaid for conducting a home assessment. Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871 Update on the home health face-to-face encounter (F2F) On May 7, CMS released a MLN Matters® Special Edition Article which outlines the physician’s guide to Medicare Home Health Certification and includes an update on the face-to-face encounter. This is a follow-up to last week’s Intelligence article on May 8, when we posted CMS’s release of an update on the home health face-to-face encounter with over 10 pages of questions and answers (Q&As). Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871 Medicare to phase in HIPPS code verification process CMS has issued instructions to its Medicare Administrative Contractors (MACs) to begin the process of verifying Health Insurance Prospective Payment System (HIPPS) codes on Medicare claims against assessment clinical data, including both SNF and home health agency claims. Currently, claims processing is handled through the Fiscal Intermediary Shared System (FISS), while assessment data is processed through the Quality Improvement Evaluation System (QIES). While the clinical assessment forms the basis for the HIPPS code, which in turn determines the prospective payment rate paid to providers, there is currently no interface between the FISS and the QIES. Beginning with inpatient rehabilitation facilities, MACs will begin suspending claims in order to verify FISS claims data against the QIES assessment data. The claims will then be released for payment once the match is confirmed. A similar process will be phased in for SNF and home health agencies starting October 2012. While this is an internal process for the MAC that requires no additional processing on the part of the providers, it is important that you are aware of the change and the importance of ensuring a correlation between clinical data submitted to the QIES and claims data submitted to the FISS. For more details, please click here. Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827 CMS expands guidance on new therapy caps exceptions process LeadingAge New York has been keeping members up-to-date on the recent changes in the therapy caps exceptions process. CMS has recently issued updated guidance on the therapy caps exceptions process in Medlearn Matters Article # MM7785. The therapy cap amounts for 2012 are: Use of the KX modifier is still required on claims that exceed the cap. This article, however, goes into greater detail on the expansion of the caps to therapy services furnished in an outpatient hospital between October 1, 2012, and December 31, 2012 and the manual medical review requirement for services in excess of $3,700. Please note that although PT and SLP are combined for determining the cap, all three disciplines are treated separately for purposes of the $3,700 trigger and the medical review is discipline specific. Please click here for more details. Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827 Nursing home cost reports due August 17 The DOH letter providing instructions for downloading the 2011 RHCF-4 cost report software and submitting the completed report and certifications is available here. The due date has been extended to August 17, 2012, with no further extensions granted. Operator and independent accountant certifications are due at the same time and must be done electronically. The letter includes the Electronic Certification Access Request form to be used to establish access to the certification system for those not yet having access. Paper copies of financial statements of related companies reported in Part III of the report must be submitted by August 17 as well. Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841 CMS Home Health, Hospice & DME Open Door Forum The next Open Door Forum is scheduled for Wednesday, May 23, 2012 at 2 p.m. Eastern Time (ET). Please dial in at least 15 minutes prior to call start time. Open Door Forum participation instructions: This call is a conference call only. To participate by phone: Dial: 1-800-837-1935 and reference conference ID#: 52259092. Persons participating by phone are not required to RSVP. TTY Communications Relay Services are available for the hearing impaired. For TTY services, dial 7-1-1 or 1-800-855-2880. A relay communications assistant will help. Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871 DataPoint: Nursing home employee retention rates Based on 2010 reporting, New York nursing homes retain 80 percent of their nursing employees. Median retention rates for RNs and aides in New York City were above 90 percent with no region reporting a median below 70 percent. Central New York reported the lowest median rate for nursing staff at 73.6 percent. Contract staff are excluded from the calculation. More figures and an explanation on how they were calculated are available here. Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841
