A Publication of the Healthcare Association of New York Statehttp://www.hanys.org/news/http://www.hanys.org/news/http://www.hanys.org/news/images/hanys_logo_56x51.pngHANYS NewsHANYS News HANYS Comments on Draft DSRIP Evaluation Plan <p> HANYS this week <a href="http://www.hanys.org/fetch/?file=/waiver/2014-07-21_dsrip_evaluation_comments.pdf">submitted comments</a> on the New York State Department of Health's (DOH's) <a href="http://www.health.ny.gov/health_care/medicaid/redesign/docs/dsrip_2014-07-14_evaluation_plan_draft.pdf">draft Delivery System Reform Incentive Payment (DSRIP) Evaluation Plan</a>. &nbsp;The draft plan describes the methods that will be used by the Independent Evaluator to assess the extent to which DSRIP achieves the intended goals and objectives of the program.&nbsp; In its comments, HANYS thanked DOH for addressing many of the issues HANYS previously raised and provided additional comments regarding the approach and objectives of the Evaluation Plan.&nbsp; Specifically, HANYS expressed concern about:</p> <ul> <li> the likelihood of an appropriate control group being available for comparison purposes;</li> <li> recipient subgroups to be examined;</li> <li> the use of composite measures comprised of data from different sources and timeframes;</li> <li> evaluation of relative performance of Performing Provider Systems;</li> <li> the use of &ldquo;meaningful use&rdquo; criteria;</li> <li> how data will be collected; and</li> <li> timeframes for measuring changes in admissions and readmissions.</li> </ul> <p> <a href="http://www.hanys.org/waiver/index.cfm">HANYS' Medicaid waiver website</a>&nbsp;provides a wealth of information for members, including materials and recordings of previous educational sessions, links to DSRIP data, and other DSRIP materials.&nbsp; Contact: &nbsp;<a href="mailto:kciccone@hanys.org">Kathy Ciccone</a></p> http://www.hanys.org/news/index.cfm?storyid=3595 2014-07-24T14:00:00-04:00 Quality,Finance,Executive Suite,Government Affairs,regulations,emergency,financial,navigator State Submits Application for CMMI State Health Innovation Plan Grant <p> Last week, New York State <a href="http://www.hanys.org/fetch/?file=/reform/ny_sim_project_narrative_testing_grant_application.pdf">submitted an application</a> to the Center for Medicare and Medicaid Innovation (CMMI) State Innovation Models (SIM):&nbsp; Round Two Funding grant program.&nbsp; States are competing for awards of up to $100 million over four years.</p> <p> The CMMI <a href="http://innovation.cms.gov/initiatives/State-Innovations-Model-Testing-Round-Two/">SIM initiative</a> provides financial and technical support for states to test and evaluate multi-payer health system transformation models.</p> <p> The state's Round Two Funding application builds on the <a href="https://www.health.ny.gov/technology/innovation_plan_initiative/">State Health Innovation Plan (SHIP)</a> developed last year; if successful, the state would use most of the grant funding to advance the Advanced Primary Care (APC) model and practice transformation.</p> <p> HANYS supports the goals of SHIP but has strongly encouraged consideration of an alternative governance structure, recognition of the financial fragility of many hospitals, acknowledgement of hospitals' fixed costs and the unique public goods they provide, adoption of a meaningful and complete overhaul of the regulatory system, better synchronization between major reform program, and ensuring that transparency efforts are meaningful and relevant. &nbsp;Contact: <a href="mailto:vgrey@hanys.org">Val Grey</a></p> <p> &nbsp;</p> http://www.hanys.org/news/index.cfm?storyid=3597 2014-07-24T14:00:00-04:00 Government Affairs,Communications,Finance,Executive Suite,Quality,navigator,financial,regulations,emergency NYS Triple Aim: HANYS Highlights Mount St. Mary’s Collaboration to Educate Expectant and New Mothers <p> This week, HANYS is highlighting Mount St. Mary's Hospital and Health Center's collaboration to educate expectant and new mothers.&nbsp;&nbsp;&nbsp; To learn more, <a href="http://www.hanys.org/tripleaim/case-studies/?a=vs&amp;s=Mount_St_Marys_Collaborates_to_Educate_Expectant_and_New_Mothers">read the full story here</a>.&nbsp; This story is just one of the many initiatives profiled on <a href="http://www.hanys.org/tripleaim/">HANYS' NYS Triple Aim website</a> that shares how New York healthcare providers are improving population health, enhancing the quality of patient care, and reducing the cost of healthcare despite fiscal constraints. Contact: <a href="mailto:shutton@hanys.org">Shannon Hutton</a></p> http://www.hanys.org/news/index.cfm?storyid=3600 2014-07-24T14:00:00-04:00 Government Affairs,Executive Suite,Quality,emergency,regulations,navigator PCMH Advisory Services Helps Integrate Behavioral and Palliative Care in Primary Care Settings <p> HANYS Solutions' Patient-Centered Medical Home (PCMH) Advisory Services has expanded its services to include the integration of behavioral health and palliative care into primary care settings.</p> <p> New York State, through its Prevention Agenda, Hospital-Medical Home (H-MH) demonstration, State Health Innovation Plan, and Medicaid 1115 waiver, has identified integrating behavioral health and palliative care services within primary care as essential to successfully achieving health system transformation.&nbsp; Improving the coordination of care for these medically complex patients within primary care settings is key to lowering costs and improving outcomes.</p> <p> <a href="http://pcmh.hanyssolutions.com/">HANYS Solutions PCMH Advisory Services</a> has been an integral partner in transforming primary care practices throughout the state&mdash;most recently working with H-MH demonstration awardees to successfully achieve practice transformation and National Committee for Quality Assurance (NCQA) Recognition.</p> <p> PCMH Advisory Services works collaboratively with clients to assess their needs and create a fully customized plan to achieve real practice transformation.</p> <p> To learn more, contact Nicole Harmon, Director, PCMH Advisory Services, at <a href="mailto:nharmon@hanys.org">nharmon@hanys.org</a> or at (716) 201-1170.&nbsp; Contact: <a href="mailto:taugust@hanys.org">Terry August</a></p> http://www.hanys.org/news/index.cfm?storyid=3601 2014-07-24T14:00:00-04:00 Government Affairs,navigator,Quality RAC Activity is Criticized on Capitol Hill <p> The Medicare program's audit procedures received criticism during congressional committee hearings held last week.&nbsp; During a roundtable discussion with health care stakeholders, members of the Senate Special Committee on Aging scrutinized the Obama Administration for failing to reduce improper payments, despite increasing audits. &nbsp;A bipartisan <a href="http://www.aging.senate.gov/imo/media/doc/Improving%20Audits%20-%20Improper%20Payments%20Report%20-%20FINAL.pdf" target="_blank">report</a> released by the Aging Committee recommended significant changes to the Medicare Recovery Audit Contractor (RAC) program, including altering the manner in which RACs are compensated. &nbsp;Under the current payment structure, RACs are paid on a contingency fee basis, providing incentives for RACs to improperly deny claims.&nbsp;</p> <p> While RAC representatives claimed the program is working, the committee report found that less than one-fourth of appealed recoveries were upheld. &nbsp;The American Hospital Association's Senior Vice President and General Counsel Melinda Hatton argued, &ldquo;redundant government auditors, unmanageable medical record requests, abundant inappropriate payment denials, and now an Administrative Law Judge work stoppage are wasting hospital resources and contributing to growing health care costs.&rdquo;&nbsp; A full replay of the hearing is available on the <a href="http://www.aging.senate.gov/hearings/improving-audits-how-we-can-strengthen-the-medicare-program-for-future-generations" target="_blank">Special Committee on Aging website</a>.</p> <p> Meanwhile, the House Committee on Oversight and Government Reform held a hearing on Medicare appeals reform at which Nancy Griswold, Chief Administrative Law Judge in the Office of Medicare Hearings and Appeals (OMHA), updated the committee on efforts to address the backlog of appeals.&nbsp;</p> <p> Due to the increase in claim appeals last year, OMHA imposed a two-year moratorium on new hospital requests for an Administrative Law Judge hearing.&nbsp; Last month, OMHA announced two pilot programs that would offer providers new options to expedite their cases. &nbsp;While the pilots are limited in their capacity to ameliorate the appeal process, the creation of the programs suggests the Administration recognizes the merit of the arguments being made by HANYS and other groups about the flawed RAC appeals process.</p> <p> For details on the OMHA pilot programs, members may access <a href="http://www.hanys.org/communications/elerts/?elertid=6204" target="_blank">HANYS' July 8 Member Update</a> on this topic.&nbsp; Additional information on the hearing is available on the House <a href="http://oversight.house.gov/hearing/medicare-mismanagement-part-ii-exploring-medicare-appeals-reform/" target="_blank">Oversight and Government Reform website</a>. Contact: <a href="mailto:eoveson@hanys.org">Elyse Oveson</a></p> http://www.hanys.org/news/index.cfm?storyid=3585 2014-07-21T14:00:00-04:00 Government Affairs,Finance,Executive Suite,navigator,financial State Unveils Proposed SHIN-NY Regulation <p> The New York State Public Health and Health Planning Council (PHHPC) released an <a href="https://www.health.ny.gov/facilities/public_health_and_health_planning_council/meetings/2014-07-24/docs/codes_committee_agenda.pdf">agenda</a> for its committee meetings that will feature a discussion on the Department of Health's (DOH) proposed regulation to formally establish the structure of the Statewide Health Information Network for New York (SHIN-NY).&nbsp; PHHPC's Codes Committee will hear a presentation on the proposed regulation by DOH on Thursday, July 24.&nbsp;</p> <p> PHHPC provided the <a href="https://www.health.ny.gov/facilities/public_health_and_health_planning_council/meetings/2014-07-24/docs/exhibits.pdf">full text of the regulation</a> as part of its meeting materials.&nbsp; Please note the regulation begins on page 377 of the materials.&nbsp; The regulation cannot be implemented until it is published in the State Register with a comment period and then finalized.&nbsp;</p> <p> This proposed rule would be the first health information technology (HIT) regulation to be released by the state.&nbsp; It includes not only the policy on the structure of SHIN-NY but also the roles and requirements for Regional Health Information Organizations (RHIOs) and others seeking to become HIT Qualified Entities (QEs)--entities officially authorized to serve as health information exchange organizations under SHIN-NY--as well as significant privacy and security policies.&nbsp;</p> <p> Hospitals, nursing homes, clinics, and private practices have the option to connect to regional information hubs (RHIOs/QEs).&nbsp; <a href="http://nyehealth.org/what-we-do/statewide-network/">SHIN-NY</a> is designed to connect these regional hubs to create a private and secure network spanning the entire State of New York.&nbsp; Contact: <a href="mailto:svanmete@hanys.org">Susan Van Meter</a></p> http://www.hanys.org/news/index.cfm?storyid=3587 2014-07-21T14:00:00-04:00 technology,Government Affairs,regulations