February 19, 2013

Applications for EQUAL funds for ACFs due by Feb. 28

DOH has issued the application for EQUAL funding, which is available to Adult Care Facilities (ACFs) that serve recipients of SSI or Safety Net Benefits. EQUAL applications are due by 4 p.m. on Thursday, Feb. 28, 2013.

Funding will be distributed via the Statewide Financial System (SFS), so any organizations that do not yet have an SFS account must register as soon as possible by returning the attached SFS Application Form to Dot Persico at DOH.

Click here for more information.

Attachements:

Contact: Diane Darbyshire, ddarbyshire@leadingageny.org, 518-867-8828

Uniform Assessment System being piloted in four counties

LeadingAge New York has learned that the Uniform Assessment System (UAS-NY) will be piloted in Warren, Broome, Chautauqua and Otsego counties for the following programs: Adult Day Health Care, Assisted Living Program, Long Term Home Health Care Program, Managed Long Term Care Plans, Nursing Home Transition and Diversion Waiver, Traumatic Brain Injury Waiver, Care at Home I and II Waivers, Personal Care Services Program and the Consumer Directed Personal Assistance Program.

DOH has posted updates on the initiative on the Medicaid Redesign website. The Jan. 29, 2013 update includes the steps and activities that organizations in the pilot must take before assessments are administered using the UAS-NY, resources and technical assistance that will be available, information about training for assessors and the implementation plan and timeline. For the recorded webinar, click here. For the PowerPoint presentation, click here.

This four-county pilot is a precursor to statewide implementation for the aforementioned programs, and we encourage members participating to let us know of their experiences so we can support members and advocate appropriately. Currently, there are many unanswered questions about the UAS-NY implementation.

Contact: Kathleen Pellatt, kpellatt@equipforquality.com, 518-867-8848

Important information requests for nursing homes impacted by Hurricane Sandy

In an effort to give some cash relief to those facilities that provided or continue to provide care to evacuated residents, the Department of Health is considering a temporary suspension (between one to two pay periods) of the two-week Medicaid payment lag. This is a recommendation that grew out of the joint DOH-Association workgroup. Please click here for more details on responding to the payment lag survey. As with any advance payment, the facility would then incur a period during which there would be no Medicaid check as the lag is restored. However, by that time, DOH anticipates they will be able to release payments based on the current reconciliation process. DOH is looking for a response from the associations by the end of today.

Attachments:

On a related note, please be reminded that the separate survey for the reconciliation process mentioned above is due to DOH by Feb. 25, 2013.

Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827

LeadingAge New York Annual PAC Golf Tournament!

Join us on Mon., May 20, 2013 at Saratoga Spa Golf Course for LeadingAge New York's Annual PAC Golf Tournament! $120 for 18-hole tournament | $60 for pro-golf clinic and 9-hole golf tournament

$25 for Cocktail Reception. Sponsorships range from $200 - $5,000 and can also be customized to meet your organizations' needs!

The format of this year's golf tournament has been modified to ensure the best outcome for golfers, sponsors and the PAC. Click here for more information and to register.

FAQs on new adult home regulations

DOH has issued Frequently Asked Questions (FAQs) on the recently adopted adult home regulations. These regulations establish new requirements for documentation and recordkeeping when serving people with serious mental illness in adult homes. In addition, it creates a “transitional adult home,” with requirements to limit the percentage of seriously mentally ill people residing in adult homes of 80 beds or more. Click here for more information.

Attachment: Adult Home FAQs

Contact: Diane Darbyshire, ddarbyshire@leadingageny.org, 518-867-8828

State of the Union address focuses on Medicare

The President identified the rising cost of health care very early on in his Feb. 12, 2013 State of the Union speech as “the biggest driver of long term debt,” and singled out Medicare as an area where significant savings could be achieved.

He stated that modest changes to Medicare are necessary to help address the problem of high health care costs. While not giving specifics, the president identified three ways Medicare cost could be reduced to decrease health care spending:

Changing the reimbursement system to a value-based purchasing methodology;
Require added cost sharing on the part of wealthiest seniors; and
Implement reforms to reduce taxpayer subsidies to prescription drug companies.

The president stated that he is “prepared to enact reforms that will achieve the same amount of health care savings by the beginning of the next decade as the reforms proposed by the bipartisan Simpson-Bowles commission.” At the end of 2010, the Simpson-Bowles commission issued 18 recommendations to reform the health care system, estimating a savings of $400 billion over a ten-year period. Notably, the president did not commit to adopting those specific recommendations.

Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827

Nursing homes potentially benefit from CMS effort to eliminate obsolete regulations

CMS has issued a final rule entitled: Medicare and Medicaid Program; Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction. According to CMS, “this final rule identifies reforms in Medicare and Medicaid regulations that CMS has identified as unnecessary, obsolete or excessively burdensome on health care providers and beneficiaries. This rule increases the ability of health care professionals to devote resources to improving patient care, by eliminating or reducing requirements that impede quality patient care or that divert providing high quality patient care.”

Through this final rule, CMS is projecting savings to providers between $231 million and $676 million per year. Hospitals are likely to realize the most savings by allowing registered dieticians to order therapeutic diets. The majority of the savings from this change will result from less use of Parenteral Nutrition (PN). Critical Access Hospitals (CAHs), Rural Health Centers (RHCs) and Federally Qualified Health Centers (FQHCs) are expected to save $42 million annually from reduced travel costs from no longer requiring physicians to be onsite once every two weeks.

Long term care facilities that apply for an extension of the deadline to have sprinklers installed in their facilities may realize $22 million in savings. The majority of this amount comes from not having to install sprinkler systems in older facilities that are slated for replacement. CMS estimates that the great majority of the 15,800 nursing homes have met the sprinkler mandate, and only 125 facilities will need an extension of the deadline. Fifty out of the 125 are replacing their facility and 75 have not completed the installation in the existing facility.

Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827

What’s next with the MLTC implementation?

On the Feb. 14 MLTC implementation advisory call, DOH confirmed there still has not been any approval from CMS to stop the enrollment into the LTHHCP in the counties where mandatory enrollment has started. DOH consistently anticipates receiving approval in the future, but the LTHHCP is still a viable program that can enroll participants in all counties.

Other new announcements:

Approximately 3,000 long term CHHA cases in New York City, Nassau, Suffolk and Westchester will start to receive the initial “mandatory announcement letters” by the end of February. DOH did clarify they are unaware of how many long term CHHA cases there are because of the lag time in submitting claims.
“Mandatory announcement letters” to Private Duty Nursing (PDN) cases will not be sent until sometime in March 2013.
DOH did clarify if someone was receiving only Social Adult Day services does not meet the threshold of over 120 days of community-based long term care services for mandatory enrollment into a MLTC. DOH will be providing more guidance shortly.
Questions remain within the DOH of whether the “Continuity of Care” policy will be extended beyond March for New York City and whether the policy can be expanded to Nassau, Suffolk and Westchester.

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871

CMS reports increased Medicare benefits to seniors

According to CMS, the number of Medicare beneficiaries receiving preventive care services with little or no cost sharing, and the number of seniors benefitting from the incremental closing of the Medicare Part D “donut hole” increased in 2012. The report entitled The Affordable Care Act – A Stronger Medicare Program in 2012 cites these benefits as stemming from reforms made under the Affordable Care Act (ACA). Among these reforms are increased discounts to beneficiaries who pay for prescription medications while they are in the “donut hole” and elimination of coinsurance and the Part B deductible for recommended preventive services. In 2012, 34.1 million Medicare beneficiaries used at least one free preventive service and 3.5 million beneficiaries reached the donut hole and received a discount on their prescription medication costs averaging $706 per beneficiary.

In 2012, the ACA provided that a beneficiary would pay 86 percent of the cost of generic medication in the donut hole and the full price for brand name drugs. Each year until 2020, the ACA requires that these percentages are decreased until the beneficiary is paying 25 percent of the cost for both generic and brand name drugs. Since the ACA’s enactment, 6.1 million beneficiaries have saved $5.7 billion on prescription medications: $2.3 billion in 2011 and $2.5 billion in 2012. CMS noted that most of the savings were for drugs that treat chronic conditions, suggesting that beneficiaries who must continuously take medication are benefiting the most from the ACA’s gradual elimination of the donut hole.

Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827

Congress seeks alternative to the Medicare Part B SGR methodology

A bill introduced in the House of Representatives on Wednesday, Feb. 6, 2013 would serve as a permanent “doc fix.” The Medicare Physician Payment Innovation Act (MPPIA) (H.R. 574), co-sponsored by Allison Schwartz (Dem. Pa.) and Joe Heck (Rep. Nev.), would end the use of the Sustainable Growth Rate (SGR) to pay physicians for Medicare services.

Since 2002, Congress has had to intervene to prevent rate cuts to physicians and other providers who bill for Medicare Part B services. These cuts are driven by the SGR methodology which ties the annual adjustments to the Medicare Physician Fee Schedule to economic growth. The MMPIA seeks to take an incremental approach towards implementing an alternative to the SGR.

For more details, please click here.

Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827

Brookdale hosts free webinar on influenza preparedness for adult care facilities

The Brookdale Center for Healthy Aging, in collaboration with the City of New York Department of Health and Mental Hygiene’s Office of Emergency Preparedness and Response, will host a free webinar for adult care providers on influenza preparedness on Tuesday, Feb. 26, 2013 at noon. Brookdale’s EP Central is a forum for NYC ACF providers; however, webinars, tools and resources are accessible by all and often are relevant to the greater adult care provider community in New York State.

To join the free webinar, click here. For those wishing to join only through audio conference, long distance charges may apply: Dial-in number: (409) 777-9000, access code: 250023.

Contact: Karen Revitt, krevitt@leadingageny.org, 518-867-8385

Nursing home bed hold payment rate adjustments

DOH notified nursing home providers that the Medicaid billing system will reflect new amounts for bed hold payment claims submitted on and after Feb. 18. This implements the 2012-13 state budget provision reducing hospitalization bed reservation payments from 95 to 50 percent of a home’s Medicaid rate. DOH will also reconcile bed hold payments made since July 1, 2012 over the course of five payment cycles starting with checks dated March 4.

The DAL sets out three varieties of bed reservation days:

1. Leave of absence for temporary hospitalization (reimbursed 50 percent of Medicaid rate);

2. Leave of absence for visits to a health care professional that are expected to improve the patient’s physical condition or quality of life (95 percent of the rate); and

3. All other leaves of absence (95 percent of the rate).

The 12-month combined limit for hospitalization and health care professional leaves (numbers 1 and 2 above) is 14 days. The 12-month limit for “other” leaves of absence is 10 days (in addition to the combined 14 day limit). These changes do not apply to residents under the age of 21.

The DAL also provides new rate codes associated with each type of leave.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841

Cash receipts assessment reconciliation

DOH is processing initial 2011 and 2012 nursing home cash receipts assessment reconciliations. Rate adjustments reflecting these may be made as early as Medicaid billing cycle 1855 which has a late March check release date. Payments for the two years will be reconciled using the 2010 per-diem assessment reimbursement amount, meaning that eventually a final reconciliation based on actual 2011 and 2012 data will need to be done. DOH intends to send out more information on the process and timing shortly.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841

OMIG posts CHHA audit protocols

The Office of the Medicaid Inspector General (OMIG) has just posted the final audit protocols for Certified Home Health Agencies (CHHAs), which are effective Feb. 14, 2013. While LeadingAge NY and other associations were successful in advocating for some changes, other areas of concern remain.

The CHHA protocols cover 34 different areas, encompassing a multitude of laws, regulations and provider manual requirements. They specifically relate to services provided prior to Dec. 31, 2010, which pre-dates the inception of episodic payments, other MRT initiatives and the tropical storms/hurricanes. LeadingAge NY and other associations have been in active discussions with the OMIG since December 2012 on draft versions of the protocols. Our concerns were outlined in a joint association memo sent last month. We have had several meetings and communications with OMIG to identify specific concerns and, yet, the protocols have not been revised from a January draft version.

LeadingAge NY plans to closely monitor the ensuing audits, and bring any concerns to the OMIG's attention. OMIG officials have agreed to provide an educational forum for CHHA providers to review the protocols and answer their questions. LeadingAge NY thanks those members that provided us with feedback during this process.

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871

LeadingAge New York Annual Awards/Employee of Distinction Awards

Do you have outstanding people working or volunteering for your organization? Do you think your organization is exemplary and deserves recognition? Do you want to share your innovative thinking with others? Take action and recognize organizational and team excellence through the LeadingAge New York Annual Awards program! Click here for more information.

2013-2014 Leadership Academy

LeadingAge New York has formed a Leadership Academy specific to New York State to create an engaged group of transformational senior living leaders. We know the future of long term care, services and housing may look very different. Ignite your flame and become a transformational leader to guide your organization toward success! Click here for more information.

2013 LeadingAge New York Art Competition & Exhibit Call for Artwork ends this Friday!

LeadingAge New York is accepting entries for its 2013 Art Competition and Exhibit. All entries must be received no later than Feb. 22, 2013.

The top 70 paintings will be on display at our Housing Conference in March, Adult Day Health Care Conference in April, Annual Conference & Exposition in May and the Financial Managers and the DNS/DSW conference this fall. The exhibit will be available virtually on the LeadingAge NY website and our Facebook page. Between conferences, the Art Show will be on display in LeadingAge NY's office. As in years past, we will continue to have a Best in Show, Honorable Mention and Merit Award winners. Contact: Earl D. Gifford III, egifford@leadingageny.org, 518-867-8833