Home and Community-Based Services Policy Forum

2. Home and Community-Based Services Policy Forum Peter Notarstefano, Director of Home and Community-Based Services March 18, 2014

3. FEDERALUPDATE

4. Federal budget FY2014 and 2015House and Senate • $20 billion decrease from FY13 post-sequester levels • Increases funding Aging & Disability Resource Centers, Congregate and Homebound meals, Community Development Block Grants • Level funding Social Service Block Grants • New authority and $14 million in funding for the Corporation for National and Community Service

5. President’s FY 2015 budget 2015 • Introduce home health co-payments for new beneficiaries • Social Services Block grants are budgeted at $1.8 billion, which is the pre-sequester funding • Improve and extend Money Follows the Person through 2020 • Older Americans Act Supportive Services, Meal Programs, National Family Caregiver program- same as 2014 • Aging & Disability Resource Centers $5 million increase

6. Sequestration: the Congressional Piggy bank • Debt Ceiling bill- To offset the cost of restoring middle-aged military retirees’ full pension COLA- extension of the 2% Medicare sequestration on all health care providers for another year, through 2024

7. In the Senate Sustainable Growth Rate bill: • Remote Monitoring pilots for home health • Increase operational flexibility for P.A.C.E. • A number of offsets being discussed House bill did not include these amendments • March 31st, 2014 Deadline

8. OAA Reauthorization Act of 2013 S1562 Bipartisan Senate bill • OAA Reauthorization Act of 2013 HR3850 Bipartisan House bill • OAA Reauthorization Act of 2013 HR 4122 Democrat House bill • transportation services • elder abuse prevention • supplemental foods as an option in meal programs • “hold harmless”/ formula Poss. Amendment

9. HCBS Characteristics rule • Providers on the grounds of, or immediately adjacent to SNFs, Institutions for MH , ICFs for individuals with intellectual disabilities and Hospitals must fit the HCBS criteria to receive Medicaid waiver funding. What is the HCBS criteria? • States -1 year to develop transition plan • States- 5 years to be in full compliance • Residential and non-residential regs. • Separate 1115 waiver regs

11. Changes in Diagnosis Home Health • 170 ICD-9 codes removed for being too acute or no impact on home health services • Grouper refined for ICD 10 implementation on 10/1/14 • 13,000 codes to 70,000 codes

12. HH- Rebasing • Rule proposes a 3.5% rebasing cut for each of the next four years (FY14, 15, 16, and 17) • 4-year phase-in and 3.5% annual cap on payment changes Fails to account for the costs on new regulatory obligations of HHAs

13. Quality Measure Changes • Adds two new HH quality measures based on CMS claims data rather than agency reported OASIS data- Hospitalizations & ER • Home Health Compare for public reporting in 2015 • Remove 9 OASIS-based measures from CASPER reports that it believes are redundant

14. Second round HH Temporary Moratoria • Regional, temporary moratoria on enrollment of new fee-for-services Medicare, Medicaid, and CHIP providers and suppliers • Includes Ft. Lauderdale, Detroit, Dallas, Houston • Extends round one moratoria of HH agencies in Chicago and Miami • Based on OIG & DOJ findings- fraud risk & high utilization

15. Home Health • Policies and procedures • Plans for each patient in Pt. assessment • Inform state and local Emergency preparedness officials of HH patients needing evacuation • Inform new patients of the role of HHA in an emergency

16. Home Health Medicare Eligibility, Billing, Medical Reviews and Appeals • Face to Face Documentation • Additional Documentation Request • Administrative Law Judge Hearings • Recovery Audits

17. Medicare Improvement Standard • Determine if skilled services of a health care professional are needed, not whether the Medicare beneficiary will improve • Increase access -certain chronic conditions • Medicare maintenance standard • Medicare Policy Manuals have been revised

18. HH Legislation Fostering Independence Through Technology

20. Clarifying Diagnosis Coding in Hospice Claims  • Certain non-specific diagnosis or diagnosis that, under coding guidelines, are not principal diagnosis • Adult Failure To Thrive and Debility can no longer be used as primary hospice diagnosis, but CMS will delay returning claims to providers until October 1, 2014

21. Hospice Item Set • Complete the HIS at admission and discharge on all patients admitted to hospice starting July 1, 2014 • 7 National Quality Forum-endorsed (NQF) Measures

22. Hospice staff- GIP Care • Additional reporting requirements: Claims hospice patients in skilled nursing facilities or in hospitals • Visit and visit length for hospice nurses, aides, SW, PT, OT and Speech Language Pathologists

23. Hospice • Hospice inpatient already has Emergency Preparedness regs. • Community-based-must have written plan that is periodically rehearsed & Policies and Procedures • Inform state and local Emergency preparedness officials of Hospice patients needing evacuation

24. Part D Payment- Medications Hospice patients • Office of the Inspector General report • Medicare Part D paid for medications that should have been covered by Medicare Part A under the hospice benefit • More oversight from CMS

26. Fair Labor Standards Act:Domestic Service- Final Rule • Companionship services” defined • Third party employers of direct care workers are not permitted to claim either the exemption for companionship services or the exemption for live-in domestic service employees. • effective January 1, 2015

27. Adult Day Services

28. Adult Day Services - VA • Proposed Rule Allows Veterans Administration Provider Agreements • Applies to Adult Day, Home Health • Veteran Centered care • Reimbursement methodology tied to established payments ( Medicare, Medicaid)

29. FIDE SNPS- ADS • 40 Fully Integrated Dual Eligible Special Needs Plans Managed Care Organizations in 7 states Arizona California Hawaii Massachusetts Minnesota New York Wisconsin • 134,000 beneficiaries enrolled - Medicare and Medicaid • Can contract with Adult Day Services- supplemental benefit

30. Research Opportunities ADS • 2012 National Study of Long-Term Care Providers by the NCHS 65% response rate • RTI conducting update of Regulatory Review of Adult Day Services

31. Medicare ADS Act of 2013 • Introduced by Rep. Linda Sanchez • Creates a Medicare Certified Adult Day Center • Paid based on the Home Health Prospective Payment System • Revised legislation from the bill introduced in 2009

32. Increasing Access To Home and Community-Based Services

33. Balancing Incentive Program • 17 states participating • 2% enhanced FMAP • Increases Medicaid spending for HCBS

34. Money Follows the Person • 46 states including the District of Columbia • As of June 2013, a total of 35,050 older adults/ persons with disabilities transitioned to the community since MFP began in January 2008. Challenges: • Lack of Affordable housing • Shortage of Medicaid providers

35. Community First Choice • 6% enhanced FMAP on personal attendant care • California and Maryland participating • Conflict free case management • Person-centered care

36. HCBS Spousal Impoverishment Protections • Eligibility for Medicaid for HCBS will be the same as SNF eligibility • For couples, where one spouse needs Medicaid services in the community Starts 1/1/14 ? Ends 12/31/19

37. Contact Information Peter Notarstefano, Director of HCBS LeadingAge 202 508-9406 pnotarstefano@leadingage.org