HAH Update

May 2, 2014

Nine Bills Pass Legislature

During the 2014 state legislature HAH tracked, sponsored and had an impact on more legislation than ever. The legislation which the association supported will generate revenue, cut down on regulatory and legal burdens, increase patient access and improve the healthcare delivery system in our state.

“Our thanks go to members for their input, institutional knowledge and support,” said George Greene, President & CEO of HAH, “to the Governor and the Department of Human Services, and to legislators who work tirelessly to sift through thousands of bills each session. In particular, I would like to thank the following key legislators for supporting HAH’s positions during this legislature: Senator Josh Green, Chair of the Senate Committee on Health; Representative Della Au Bellati, Chair of the House Committee on Health; Representative Sylvia Luke, Chair of the House Committee on Finance; Senator Suzanne Chun Oakland, Chair of the Senate Committee on Human Services; Senator David Ige, Chair of the Senate Committee on Ways and Means; Representative Scott Nishimoto, Vice Chair of the House Committee on Finance; Senator Clayton Hee, Chair of the Senate Committee on Judiciary and Labor; Representative Angus McKelvey, Chair of the House Committee on Consumer Protection & Commerce; Senator Rosalyn Baker, Chair of the Senate Committee on Commerce and Consumer Protection; Representative Mele Carroll, Chair of the House Committee on Human Services; and Representative Karl Rhoads, Chair of the House Committee on Judiciary.”

The following nine bills from HAH’s legislative package passed out of the legislature this session:
Home Care Licensing (HB2094).  Extends the 2014 sunset of Act 21, Special Session Laws of Hawaii 2009, to June 20, 2019 and appropriates funds to establish a full-time equivalent permanent position in the Department of Health to facilitate the licensing of home care agencies.
Mental Health Notice of Discharge (HB1723).  Exempts hospital discharges of non-forensic psychiatric patients from section 334-60.7, Hawaii Revised Statutes, discharge requirements, allowing hospitals to discharge involuntary civil commitment patients when the treating physician determines patient is fit for discharge without seeking court approval, as previously required.  The measure will make important services available to other members of the community, and will result in significant cost savings to hospitals with psychiatric facilities.
Sustainability – Hospital (HB2293).  Extends the sunset for the hospital sustainability bill beyond the existing sunset of June 30, 2014. The legislation raises funds from private facilities to draw down $38.3 million in federal matching Medicaid funds to improve reimbursements that would maintain access to care for this population. No state funds and no taxpayer dollars will be used.
Sustainability – Nursing Facility (SB2057)Extends the sunset for the nursing facility sustainability bill beyond the existing sunset of June 30, 2014. The legislation raises funds from private facilities to draw down $9.5 million in federal matching Medicaid funds to improve reimbursements that would maintain access to care for this population. No state funds and no taxpayer dollars will be used.
Emergency Management (HB849).  Recodifies Hawaii's emergency management statutes by updating statutes established more than half a century ago, recognizing changes in the field of emergency management and reorganization of the federal emergency management infrastructure.
Telehealth (SB2469).  Modernizes the practice of medicine in Hawaii by promoting telehealth—which is used effectively and extensively throughout the country—by requiring coverage for telehealth services. The bill would (1) require reimbursement for telehealth services to be equivalent to reimbursement for the same medical services provided in person; and (2) include primary care providers, mental health providers, oral health providers, advanced practice registered nurses, psychologists, and dentists as eligible telehealth providers.
POLST – APRN (HB2052). Increases access to Provider Orders for Life-Sustaining Treatment (POLST) by updating references from "physician orders for life-sustaining treatment" to "provider orders for life-sustaining treatment" throughout chapter 327K, HRS; expanding healthcare provider signatory authority to include advanced practice registered nurses; and correcting inconsistencies over terms used to describe who may sign a POLST form on behalf of a patient.
Naturopathic Physicians (SB2577). Requires naturopathic practitioners to fulfill the same education, examination, and training requirements as physicians or osteopathic physicians licensed under chapter 453 to qualify for prescription privileges.
Advanced Practice Registered Nurses (Act 46). Replaces references to advanced practice registered nurse recognition with advanced practice registered nurse licensure to align Hawaii's law with national standards.


CMS Increases Payments to FQHCs

On April 29 the Centers for Medicare & Medicaid Services (CMS) issued a final rule that could increase Medicare payments to Federally Qualified Health Centers (FQHC) by as much as 32 percent. The new payment system will be implemented beginning on October 1, 2014. FQHCs will be transitioned to the new payment system throughout 2015.

Read more


Upcoming Education

Partnering with Physicians – The New Model: Strategies to Win Business and Improve Care Coordination

Too often agency-physician relations deteriorate into burdensome exchanges that must be endured, rather than fruitful alliances to provide optimal patient care. Understand why this happens and what you can do to promote partnerships with your referral sources.

Speaker: Michael Blackstone, MD, Founder/CEO, Suture Health, Inc.

Objectives: After attending this webinar, the home health/hospice participant will be able to:

  • Outline why physician-homecare relations deteriorate and what can be done to transform challenges into opportunities.
  • Discuss the physician psyche and how to become their “hero”.
  • Explain how to properly communicate your value and sell your services.

When: May 7, 8:00 - 9:30 am
Where: Webinar
Price: Members $149| Non-Members $298
Details: Flyer

The Aide’s Role in Maintaining Professional Boundaries Teleconference

The relationship formed between aide and patient is different from non-professional, casual, social and personal relationships. While it is essential that the patients needs be foremost, establishing healthy boundaries or limits with our patients is essential to developing a healthy working relationship. This teleconference will address how to maintain those boundaries, managing boundary crossings, and examples of acceptable and non-acceptable behaviors.

When: May 8, 9:00 – 10:00 am
Who’s invited: Home Health and Hospice Aides
Price: Members $95 | Non-Members $190
Details: See flyer

Click here to see a list of upcoming healthcare education offered through HAH.

ICD-10 Pushed to Oct 1, 2015

It’s official. The new ICD-10 compliance date is October 1, 2015. A rule released by CMS this week also requires HIPAA-covered entities to continue to use ICD-9-CM through Sept. 30, 2015.

Organizations locally and nationally are still grappling with how to dial back the clock on ICD-10 implementation. CMS itself is seeking feedback on this.

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Castle Urgent Care Opens in Kaneohe

On April 23 Castle Urgent Care opened at the Castle Professional Center in Kaneohe. The urgent care center is open from 8 am to 10 pm daily. Castle is also expanding business hours for its satellite laboratory, pharmacy, and X‑ray facility, all located at Castle Professional Center.

You are invited to an open house at Castle Professional Center on Wednesday, May 7, from 11 a.m. to 2 p.m. to get a glimpse of what the facility will look like by the end of 2015. Enjoy entertainment and light refreshments.

Contact information and FAQs


CMS Proposed Changes for Medicare SNFs

Yesterday, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule outlining proposed Fiscal Year 2015 Medicare payment rates for skilled nursing facilities (SNFs). 
Overall, the proposed rule is positive for our skilled nursing facilities. This represents AHCA's continued dialogue with CMS and success in educating the agency about SNF issues.
Here are some of the highlights in proposed payment and policy changes:
Medicare rate: Across-the-board 2% net increase for all SNFs.
RUGs: No change in therapy-related RUG categories. AHCA has been in close communications with CMS about ultra-high therapy rates and were successful in keeping it out of the proposed rule.  
Value-based purchasing: None included.
Wage index: It is not yet known how the wage index adjustment may affect local skilled nursing providers. The changes in the wage index are not accurate across areas (it is estimated that 63% will have no change, 15% will see an increase, and 22% a reduction), and AHCA is putting together an online calculator by next week for member facilities to see how they might be impacted.

COT OMRA: AHCA is seeking clarity on how proposed revisions to the Change of Therapy (COT) Other Medicare Required Assessment (OMRA) policy may affect members.

CMPs: CMPs were not included in the proposed rule. AHCA had asked for CMS approval of use of these Civil Monetary Penalty funds and more transparency of how they are used.

CMS Fact Sheet


CMS Proposes Updates for Hospice

On May 2, 2014, CMS issued a proposed rule that would update fiscal year 2015 Medicare payment rates and the wage index for hospices serving Medicare beneficiaries. As proposed, hospices would see an estimated 1.3 percent ($230 million) increase in their payments for FY 2015. Of significance, the proposal does not include any payment reform changes at this time (including no tiered payment model, no rebasing and no site of service adjustment for patients in nursing facilities).
A few highlights: this proposed rule would implement the sixth year of the seven-year BNAF phase-out, reducing the BNAF by 15 percent, for a total reduction of 85 percent since FY 2010.

Hospice providers are required to begin using a Hospice Experience of Care Survey for informal caregivers of hospice patients surveyed in 2015. CMS plans to launch a website for the hospice survey in the summer of 2014.


Part D Prior Authorization

The National Association for Home Care & Hospice (NAHC) and its affiliated Hospice Association of America (HAA) are working with CMA and other stakeholders to address the considerable problems associated with CMS’ Part D/ prior authorization policies.

The Center for Medicare Advocacy (CMA) challenges as “illogical” and “immoral” the CMS decision to mandate prior authorization under Part D for drugs prescribed for hospice patients. CMA equates the policies contained in the March 10 guidance, which takes effect May 1, to “burden shifting to the dying patient” under which the patient’s drug submission must first be rejected by the drug plan and the patient must actively pursue a coverage determination from the plan in order to secure coverage. CMA is a national nonprofit, nonpartisan organization that provides education, advocacy and legal assistance to help older people and people with disabilities obtain fair access to Medicare and necessary health care.

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Community Calendar

AHA Annual Membership Meeting
May 4-7, 2014
Washington DC
Register and Information

American Association for Homecare Washington Legislative Conference
May 7-8, 2014
Washington DC
Register Online

Suicide Prevention Training
May 8, 8:00 am - 12:00 pm
Queen Liliuokalani Children's Center - Honolulu

Healthcare Professionals' Training: Micronesian Cultural Awareness
May 9, 12:00 - 1:30 pm

Diabetes Management Innovations Conference
May 13-14, 2014
Hyatt Regency McCormick, Chicago, IL

Best Practices for Care Transitions: Engaging Emergency Departments and Urgent Care Centers Webinar
May 14, 9:00 - 10:00 am

ISHIB Annual Meeting – Medical and Social Determinants of Cardiometabolic Health
May 15-16, 2014
New York Hilton Midtown
More Information

ATA 2014 Annual Meeting and Exposition
May 17-20, 2014
Baltimore, Maryland
More Information

ACHA Congressional Briefing
May 20-21
Hyatt Regency Washington on Capitol Hill
More Information

For more healthcare-related events and education, see our Community Calendar online.
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