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 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 NYS Triple Aim: HANYS Highlights Healthcare Providers Reducing Pressure Ulcers <p> This week, HANYS is highlighting how New York's healthcare providers are reducing pressure ulcers through a collaborative quality improvement program.&nbsp; To learn more, <a href="http://www.hanys.org/tripleaim/case-studies/?a=vs&amp;s=New_York_Healthcare_Providers_Are_Reducing_Pressure_Ulcers">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 share how New York healthcare providers are improving population health, enhancing the quality of patient care, and reducing the cost of healthcare despite fiscal constraints.&nbsp; Contact: <a href="mailto:shutton@hanys.org">Shannon Hutton</a></p> http://www.hanys.org/news/index.cfm?storyid=3588 2014-07-21T14:00:00-04:00 Government Affairs,Quality,Executive Suite,navigator State Plans Spanish Version of New York State of Health Website <p> New York State announced that it will have a Spanish version of its health insurance exchange website for the 2015 enrollment period to ease the enrollment process for individuals who speak languages other than English.&nbsp; As part of a series of changes being implemented to better assist non-English speaking consumers, the New York State of Health is also in the process of translating marketplace notices into Spanish and six other languages, including Russian and Chinese.&nbsp; Although materials in other languages are available online, previously individuals had to navigate through an English website to find the correct options.&nbsp; In addition to these translated materials currently available online, the state will also offer a translated paper version of the applications.&nbsp; Contact: <a href="mailto:jlee@hanys.org">Jennifer Lee</a></p> http://www.hanys.org/news/index.cfm?storyid=3589 2014-07-21T14:00:00-04:00 Government Affairs,Quality,Finance,financial,Executive Suite,regulations,navigator Primary Care Milestone Reached by 99% of Sites; H-MH Funding to Proceed <p> The second year of funding for the New York State Hospital-Medical Home (H-MH) Demonstration will proceed because a key performance milestone has been achieved, the Department of Health (DOH) announced during a conference call with HANYS on Thursday. The H-MH Demonstration is a healthcare quality and safety improvement program for Medicaid services in New York State. &nbsp;As part of this program, 156 of the 157 outpatient primary care sites at 62 New York State teaching hospitals became recognized as Patient-Centered Medical Homes by the National Committee on Quality Assurance (NCQA) by the July 1, 2014, deadline. &nbsp;Having achieved this milestone, 75% of the $75 million Year 2 funding will be distributed to H-MH participants in late August/early September. &nbsp;Operated by DOH and funded by the federal Centers for Medicare and Medicaid Services, H-MH provides up to $250 million to New York State teaching hospitals.</p> <p> HANYS Solutions <a href="http://www.pcpcc.org/transformation/support/hanys-solutions-pcmh-advisory-services">PCMH Advisory Services</a> helps outpatient primary care practices develop or enhance their PCMH initiatives and achieve NCQA recognition. &nbsp;For more information, 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:emcgill@hanys.org">Ed McGill</a></p> http://www.hanys.org/news/index.cfm?storyid=3568 2014-07-14T14:00:00-04:00 Government Affairs,Finance,Quality,navigator,financial,regulations HANYS Joins DOH Team to Reduce Infant Mortality <p> HANYS is participating with the New York State Department of Health (DOH) and other key stakeholders across the state on a national initiative to reduce infant mortality. The Collaborative Improvement &amp; Innovation Network (CoIIN) to Reduce Infant Mortality is a public-private partnership organized by the Maternal and Child Health Bureau of the Health Research and Services Administration, to reduce infant mortality and improve birth outcomes.&nbsp;</p> <p> DOH aims to work with key stakeholders in New York to build a state plan to reduce infant mortality focusing on:</p> <ul> <li> reduce elective delivery at&nbsp;less than 39 weeks of pregnancy;</li> <li> expand access to interconception care (between pregnancies) through Medicaid;&nbsp;</li> <li> promote smoking cessation among pregnant women;&nbsp;</li> <li> promote infant safe sleep practices; and&nbsp;</li> <li> improve perinatal regionalization (a geographically-targeted approach to ensure risk-appropriate care for mothers and infants).</li> </ul> <p> Important to the design of the state's plan will be aligning this initiative with other state priorities including the Prevention Agenda and the Medicaid waiver.</p> <p> HANYS looks forward to helping the state design its plan and begin implementation, which is anticipated to begin next summer. Contact: <a href="mailto:kciccone@hanys.org">Kathy Ciccone</a></p> http://www.hanys.org/news/index.cfm?storyid=3569 2014-07-14T14:00:00-04:00 Quality