ASAP
A Weekly Publication Of HCA Home Care Association of New York State
Legislative Issues Public Policy
News
Volume 21, No. 1 January 8, 2016
With New Legislative Session, State Advocacy Ramps Up for 2016 Help support our advocacy efforts by completing HCA’s online home care survey and joining us for our Feb. 2 State Advocacy Day – mark your calendars The state legislative session began this week with the usual flurry of activity at the state capitol, including announcements about legislative committee assignments and policy initiatives being eyed by legislators and the Governor for the coming year. Home care will be a focus of the discussion during HCA’s State Advocacy Day on February 2 where we are inviting our Board of Directors and other home care leadership staff to Albany for legislative visits to communicate our advocacy platform. See ADVOCACY p. 3
Renew Your HCA Membership Now to Avoid a Lapse in Your Benefits for 2016 A new year brings a new membership cycle for HCA. Now is the time to renew your membership in 2016 so that your benefits don’t lapse. Please do so as soon as possible if you have not done so already as part of HCA’s “Admission to Membership 2016” campaign.
Inside ASAP
See RENEW p. 2
With New Legislative Session, State Advocacy Ramps Up................1 Renew Your HCA Membership Today.................................................1 Reminder on Statistical Report Due Dates........................................2 Medicaid Levels for 2016....................................................................2 Mayor de Blasio Announces $15 Minimum Wage.............................4 Companionship Exemption Lawsuit Update....................................5 Home Care Rates Delayed As DOH Finalizes FLSA Add-Ons...........5 DOH to Pilot New “Offsite” Surveillance Process for LHCSAs.........6 Appellate Court Upholds E.O. No. 38 Regulations.........................7 DOH to Conduct Hospice Emergency Preparedness Survey............7 HCA Comments on CMS Discharge Planning Proposed Rule.........7 CMS Releases Star Rating Preview Reports.......................................8 CMS Technical Report Eyes Medicare Hospice Payment Reform......8 GoldSTAMP Pressure Ulcer Webinar on January 14..........................8 OPWDD to Hold Program on HCBS Waiver Renewal........................8 Guidance Issued on CFEEC Dispute Resolution Policy.....................9 Prior Authorization Required for Certain Medicare DME................9 Regulations for Personal Care Services and CDPA Changed..........10 DSRIP Update, FIDA Update............................................................11 UAS Changes.................................................................................11 CMS Releases Draft OASIS C2.........................................................12 State Medical Society Webinar on Opioid Use...............................12 NGS Education Programs...............................................................12 NYC Office of Labor Standards is Established................................13 MLTC Guidance Issued on Hospice Coverage................................13 Accountable Health Communities Funding Available....................14 More Info Posted on NHTD/TBI Transition to Managed Care........15 DOH Issues Medicaid Updates for December 2015........................15 Publications...............................................................................15
Helping New Yorkers Feel Right At Home
Volume 21, No. 1 January 8, 2016
ASAP – a publication of the Home Care Association of New York State
RENEW from p. 1
Reminder on Statistical Report Due Dates
To give you more food for thought, HCA has prepared an Annual Report and Member Value Statement recapping 2015 and eyeing all that’s in store for 2016.
January 11 is the due date for 2014 CHHA and LTHHCP Statistical Reports.
The report is called ‘Process’ & ‘Outcomes’ Measures: How HCA is Working For You. You can download the report (at http://hcanys.org/wp-content/uploads/2016/01/ 2016ValueStatement.pdf ) to learn more about the measures and activities that HCA has undertaken in the past year.
February 8 is the due date for 2014 LHCSA Statistical Reports and Hospice Cost and Utilization Reports.
How to renew To help you renew your membership easily, we’ve created a series of online forms for each agency type in our membership. You should have already seen these renewal links, but we’ve posted them all on a single page at the link below, along with our Annual Report and Member Value Statement and other information. http://hca-nys.org/general-news/admission-to-hca-2016-renewyour-membership For questions or concerns about membership, please contact HCA’s Senior Director of Membership Laura Constable at lconstable@hcanys.org or (518) 810-0660. We greatly value your membership in HCA. You help make us a strong association. Please renew today!
Medicaid Levels for 2016 The state Department of Health (DOH) has announced the Medicaid eligibility levels for 2016 and the regional rates for determining transfer of asset penalties. The guidances are at http:// www.health.ny.gov/health_care/ medicaid/publications/ pub2015gis.htm (GIS 15 MA/021; GIS 15 MA/023).
ASAP is a weekly publication of the Home Care Association of New York State (HCA). Unless otherwise noted, all articles appearing in ASAP are the property of the Home Care Association of New York State. Reuse of any content within this newsletter requires permission from HCA. President: Editor:
Joanne Cunningham, jcunningham@hcanys.org Roger L. Noyes, Director of Communications, rnoyes@hcanys.org Al Cardillo, Executive Vice President, Policy & Programs, acardillo@hcanys.org Patrick Conole, Vice President, Finance & Management, pconole@hcanys.org Andrew Koski, Vice President, Program Policy and Services, akoski@hcanys.org Alexandra Blais, Director of Public Policy, ablais@hcanys.org Laura Constable, Senior Director, Membership & Operations, lconstable@hcanys.org Celisia Street, Director of Education, cstreet@hcanys.org Mercedes Teague, Finance Manager, mteague@hcanys.org Jenny Kerbein, Director of Governance and Special Projects, jkerbein@hcanys.org Billi Hoen, Manager, Meeting and Events, bhoen@hcanys.org Teresa Brown, Administrative Assistant, tbrown@hcanys.org 388 Broadway, 4th Floor, Albany, NY 12207 Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org
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ADVOCACY from p. 1
care aides to $15 per hour, along with adjustments to state Medicaid reimbursement to providers for meeting the new labor costs. The Independent Democratic Conference (IDC) is a distinct group, separate from the other Democratic Senators, with its own policy agenda and caucus structure.
HCA is developing materials for this program and we will provide more information to the membership next week, so please save the date and stay tuned. One key advocacy document is our home care financial condition report which we will soon be drafting. The report includes findings from a survey of our membership. If you have not completed the survey, please do so today. (See details later in this article.) It is vital that every HCA provider member participates.
“Medicaid reimbursement hasn’t increased for home care attendants for some time,” Senator Klein said in published reports on nystateofpolitics.com.“We have to be mindful if we’re going to make them pay $15 for a minimum wage, and they’re relying exclusively on Medicaid dollars.” (You can read Senator Klein’s remarks here: http://www.nystateofpolitics.com/ 2016/01/klein-home-care-attendants-should-have15-wage-too/.)
Since the start of 2016, Governor Cuomo has been issuing a series of press releases detailing pieces of his agenda for 2016 in the areas of infrastructure development, economic growth and environmental initiatives. The Governor will be presenting his broader state agenda – including for health care – as part of his combined State of the State and Budget Addresses next week, on January 13, which is a major marker point in the escalation of state legislative activities for 2016. HCA will review the address closely and respond to any parts affecting home care providers.
As this campaign for a $15 minimum wage in home care – and other industries – has gained momentum, HCA has been working proactively with other state associations to determine the cost impact of a $15 base wage as we press for funding to meet the increased costs within a capped program like Medicaid. HCA has specifically met several times with the Healthcare Association of New York State, LeadingAge New York and the New York State Association of Health Care Providers over the past several weeks to calculate the cost impact of a $15 minimum wage within each subsector and across the entire health care continuum based on a comparison with the current wage profiles in each industry. We are still working on the cost estimates, but they are staggering, with the home care impact far exceeding the impact in other sectors.
Wage and labor issues are expected to be a big focus of legislative attention following moves last year by the state’s wage board to require a minimum wage increase to $15 per hour for workers in the fast-food industry – an announcement that came with signals for extending the expanded wage requirements to other industries, specifically home care. This has been followed up with actions from the Governor to raise the minimum wage for state employees and State University of New York workers. (Also, see separate story about New York City Mayor de Blasio raising the minimum wage to $15 per hour for city government employees and employees who provide contracted work for the city at social service organizations).
HCA will keep the membership informed of our analysis when it is complete. In the meantime, your response to our financial condition survey will help us better understand the impact of wage changes. Meanwhile, HCA met with the IDC this week to discuss its proposal and assumptions for increasing Medicaid reimbursement to home care providers to meet the wage proposal. We also communicated our concerns about the intricacies of developing a legislative package that accurately and appropriately
Already this year, the Independent Democratic Conference, led by Senator Jeff Klein, is backing legislation to raise the minimum wage for personal 3
ASAP – a publication of the Home Care Association of New York State accounts for the real costs of increased wages, and ensures that dollars sufficient to cover all associated costs are factored into managed care plan premiums and home care provider rates, under both managed care and episodic/fee-for-service rates. HCA is also developing our own legislative language for consideration by the IDC and the Legislature as this proposal – or similar ones – take shape. The cost calculations being conducted by HCA and association partners across the continuum will be an important data point in this effort.
Volume 21, No. 1 January 8, 2016
Mayor de Blasio Announces $15 Minimum Wage This week, New York City Mayor Bill de Blasio announced a $15 minimum wage for all citygovernment employees and employees who provide contracted work for the city at social service organizations. The announcement is at http://www1.nyc.gov/ office-of-the-mayor/news/019-16/mayor-deblasio-guaranteed-15-minimum-wage-all-citygovernment-employees—#/0.
Important: Member Survey Due in One Week HCA reminds members that our Home Care Financial Condition online survey is due from members one week from today: on January 15.
According to the mayor’s press release, the $15 minimum wage, which will be implemented over three years, will affect about 1,000 home care workers whose agencies provide services through a contract with the city Department for the Aging.
We realize that these surveys can take time to complete, but they are the best way for us to obtain and trend current data on your experience with the fiscal and regulatory environment of home care in New York State as we begin our 2016 advocacy activities on your behalf.
HCA is examining how, if at all, such an increase would affect agencies that provide personal care services under contracts with the NYC Human Resources Administration.
If you completed the survey, thank you. If not, please do so as soon as you can. The survey has 30 questions. All answers will be used in the aggregate and no agencyspecific identifying information will be shared.
On a similar topic, Governor Cuomo continues to push for a $15 minimum wage and this week announced that the State University of New York will raise the minimum wage for more than 28,000 employees. This follows similar actions taken to increase wages for fast-food workers and state employees.
You can take the survey online at https:// w w w. s u r v e y m o n k e y. c o m / r / 2015HomeCareFinCondSurvey. We’ve also published a PDF version of the survey at the back of this week’s ASAP. You are welcome to download the PDF, complete it by hand or with text edits, and send it to HCA by fax or e-mail at rnoyes@hcanys.org or (518) 426-8788.
HCA continues to advocate that any increase in the minimum wage be accompanied by increased rates to home care providers under fee-forservice Medicaid and managed care plans and that rates should also incorporate other rising labor costs such as overtime, travel, Workers Compensation, health insurance, etc. (Please see related p. 1 story about the upcoming legislative session.)
If you have any questions about the survey, do not hesitate to contact HCA’s Communications Director Roger Noyes at rnoyes@hcanys.org. Please stay tuned in the coming week for more critical information about our advocacy agenda and activities for 2016, including logistics for our February 2 State Advocacy Day.
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org. 4
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Volume 21, No. 1 January 8, 2016
Companionship Exemption Lawsuit Update An “amicus curiae” brief has been filed by a group of states along with a second brief submitted by two national disability rights organizations urging the U.S. Supreme Court to hear the lawsuit brought by the National Association for Home Care and Hospice (NAHC) and other home care associations challenging the validity of the new federal Fair Labor Standards Act (FLSA) rules affecting the “companionship services” and “live-in domestic services” exemptions. According to NAHC, these supporting briefs are important in that the Supreme Court decides to hear cases on the basis of whether the issues presented have significant public importance. The state brief, filed by the Attorney Generals from Kansas, Arizona, Arkansas, Georgia, Michigan, Nevada, North Dakota, Oklahoma, Texas, Utah, Wisconsin, and Wyoming, explains that the new rules have great impact on Medicaid, and the states that fund that program. The brief from the disability rights groups focuses on the negative impact on persons with disabilities caused by the rules that increase care costs, but do not require increased funding support. A review of the appeal by the U.S. Supreme Court is discretionary. The Court accepts few cases each year and does so only with cases that show great public importance or a conflict in rulings from federal Courts of Appeal. NAHC is awaiting the reply brief that is expected from the U.S. Department of Labor. It is due on February 24, 2016. At that point, NAHC will have the opportunity to respond. Thereafter, the Court will decide if it is going to hear the case, a decision that is usually made within 60 days. HCA just held two in-person programs that focused on the FLSA rules and other labor law changes and how agencies can bolster their compliance and minimize facing lawsuits. We will continue to keep members updated on any new developments with the above court case and other labor issues.
2016 Home Care Rates Delayed As DOH Finalizes FLSA Add-On Monies The state Department of Health (DOH) has delayed the release of initial 2016 Medicaid rates for CHHAs, LTHHCPs and Personal Care programs so that the Department can finalize a retrospective rate adjustment that will increase the amount home health and personal care aides are paid for overtime (from time-and-a-half at minimum wage to time-and-a-half of base wage) and to account for travel expenses and live-in requirements. The need for rate adjustments to cover these costs has been a major advocacy aim of HCA’s work to assure payment adequacy in home care. By early to mid-December, DOH normally issues the initial Medicaid rates for the upcoming year but has yet to do so for 2016 due to the new federal wage requirements of the Fair Labor Standards Act (FLSA), which went into effect October 13, 2015. DOH currently estimates the new FLSA regulations will result in an increase of $0.34/hour across all aide hours. The Department is in the process of adding the state Medicaid share ($0.17/hour) retroactive to October 13, 2015 (in anticipation of federal approval on the other $0.17) as part of the 2015 Medicaid rate package and then will need to implement a similar adjustment to providers’ initial 2016 Medicaid rates. Continued on next page
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Continued from previous page HCA has met several times with the Department to discuss the rate package for fee-for-service and managed long term care to ensure that payments appropriately match the new FLSA cost obligation for providers – and to ensure that payments are appropriately disbursed across the continuum from payor to network provider. Adjustments will also be made to the CHHA Episodic Payment System (EPS) reimbursement retroactive to October 1, 2015 and continuing on in 2016. DOH has told HCA that it plans to release both the retrospective rate adjustments and upcoming 2016 initial Medicaid rates towards the end of this month. HCA will notify the membership as soon as DOH issues these updated Medicaid rates and related policies for disbursement in both fee-for-service and managed long term care. Meanwhile, HCA has been asked to participate in the review of an FLSA survey that the state plans to send directly to home care providers to ascertain their new costs. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
DOH to Pilot New “Offsite” Surveillance Process for LHCSAs Starting next month, the state Department of Health (DOH) plans a pilot project to perform off-site surveillance activities of selected LHCSAs in all regions of the state. LHCSAs that are selected by the Department for the pilot will be required to participate. Under the pilot, the regional DOH surveillance staff will conduct specific audits to determine compliance with requirements in the following areas: • • • • • •
Clinical Records Personnel Records Emergency Preparedness Health Commerce System Quality Assurance Complaint Procedures
The pilot project is scheduled to begin February 1. The Department plans to notify the selected LHCSAs of the specific audit area to be conducted, along with required materials to be submitted, contact information for submitting materials, and timeframes for submission. Selected LHCSAs will receive notification via the Health Commerce System (HCS). The selected LHCSAs will be required to fax the requested materials to the appropriate regional office. It is anticipated that providers will be informed of audit findings through statement-of-deficiencies reports. HCA to Hold Statewide Call on Audit Process: January 19 HCA has scheduled a statewide call to discuss this process with members on January 19 from 2 to 3 p.m. Be on the lookout for registration information next week for this free call that will include guest presenters from DOH. 6
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ASAP – a publication of the Home Care Association of New York State
Appellate Court Upholds E.O. No. 38 Regulations HCA this week sent members an alert about recent court decisions concerning the state Department of Health’s Executive Order No. 38 regulations which limit executive compensation and allowable administrative costs for certain providers that receive state funds or state-authorized payments. The cases, in particular, concern services in Nassau County, which, under a prior court ruling, were not subject to the regulations but may now be affected. The cases also have broader implications for the mandate statewide. If you and your legal teams have not yet seen the alert, which includes an analysis from HCA General Counsel Frank Fanshawe of Wilson Elser Moskowitz Edelman and Dicker, please visit the “Member Alerts” section of our website at http://hca-nys.org/category/member-alerts to find the full story.
DOH to Conduct Hospice Emergency Preparedness Survey The state Department of Health (DOH) has told HCA that it will be issuing a hospice emergency preparedness survey next Monday, January 11. The survey is mandatory and will be due the following Friday, January 15. It will be issued via the Health Commerce System as a Health Emergency Response Data System (or HERDS) survey. The purpose is to obtain information on hospices’ emergency preparedness planning related to evacuation of hospice patients in various settings (inpatient and hospice residences). A PDF version of the survey shared with HCA has been posted to our website at http://hca-nys.org/wp-content/uploads/2016/01/HospiceEmergencysurveyfromPreviewmode.pdf.
HCA Comments on CMS Discharge Planning Proposed Rule HCA has submitted comments to the U.S. Centers for Medicare and Medicaid Services (CMS) on its proposal to modify the Medicare Conditions of Participation (CoPs) related to discharge planning requirements for hospitals, critical access hospitals and home health agencies. The proposal was first issued in October. Our comments indicate support for efforts to revise the CoPs in this area but express several technical and substantive areas of concern, including: CMS’s cost estimates (which fall short of the real impact); implications and possible conflicts with managed care practices; flaws in the publicly reported quality data that hospitals would use for assisting patients in selecting a post-acute provider; the content requirements of discharge summaries; and other issues. HCA will continue to follow this issue and update you with any related news. HCA’s comments have been posted to the “Letters and Comments” section of our website at: http://hca-nys.org/category/letters-and-comments. You can view the proposed rule at https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-27840.pdf. If you have any questions or concerns, please do not hesitate to contact Alex Blais at ablais@hcanys.org or (518) 810-0658; or Andrew Koski at akoski@hcanys.org or (518) 810-0662.
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Volume 21, No. 1 January 8, 2016
CMS Releases Star Rating Preview Reports
GoldSTAMP Pressure Ulcer Webinar on January 14
Home care “Quality of Patient Care Star Ratings Preview Reports” are now available in the CASPER folders.
The state is holding an upcoming webinar on pressure ulcer prevention. Background and registration for the January 14 program (11 a.m. to noon), are at: http:// www.albany.edu/sph/cphce/ goldstamp_webinar_0116.shtml.
These reports contain data that will be publicly reported on the Home Health Compare website in April 2016. January 25 is the deadline to submit a request to have the star-rating data suppressed. (Providers should follow the directions in the Preview Reports to submit a suppression request.) The January refresh of the Home Health Compare website will occur on January 28. The data will match the preview reports that were uploaded to CASPER in October. Questions can be directed to HomeHealthQualityQuestions@cms.hhs.gov.
CMS Technical Report Eyes Medicare Hospice Payment Reform Includes analysis of Medicare hospice benefit utilization The U.S. Centers for Medicare and Medicaid Services (CMS) recently released a December 2015 Technical Report completed by Abt Associates entitled “Medicare Hospice Payment Reform: Analysis of How the Medicare Hospice Benefit is Used.” The report is at https://www.cms.gov/Medicare/ Medicare-Fee-for-Service-Payment/Hospice/ Downloads/December-2015-Technical-Report.pdf. It contains details of hospice utilization and payment. This data, which CMS will consider for hospice payment reform decisions, was referenced in the preamble to CMS’s 2016 Medicare hospice payment rule. Much of the analysis is from fiscal year 2013 data. Items covered include: live discharges; drug reporting on hospice claims; a comparison of visits received under hospice services and home health services; and financial analyses. Information is compared to the same report Abt Associates completed for CMS in 2014. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org. 8
As an active member of the statewide coordinating committee for the GoldSTAMP Program to Prevent Pressure Ulcers, HCA encourages members to explore this helpful and timely webinar. Pressure ulcer prevention and control is a key program aligning well with state goals under the Delivery System Reform Incentive Payment (DSRIP) program and value-based payment initiatives. HCA has featured this clinical topic at our Quality Symposium and in initiatives of our Quality Committee. Also, the state Department of Health is currently examining pressure ulcer incidence among home care patients. It plans to review incidence results in an upcoming meeting of the statewide coordinating committee.
OPWDD to Hold Program on HCBS Waiver Renewal On January 13, the Office for People with Developmental Disabilities (OPWDD) will be hosting two programs on the draft 1915 (c) Comprehensive Home and Community-Based Services (HCBS) Waiver Renewal 2014 agreement posted to its website on December 23, 2015. To register for the webinars and to obtain information on the draft waiver agreement, visit http://www.opwdd.ny.gov/ opwdd_services_supports/ people_first_waiver/ HCBS_waiver_services.
ASAP – a publication of the Home Care Association of New York State
Volume 21, No. 1 January 8, 2016
Guidance Issued on CFEEC Dispute Resolution Policy The state Department of Health (DOH) has issued a policy on the dispute-resolution process between MLTCs and the Conflict-Free Evaluation and Enrollment Center (CFEEC) should there be a disagreement on a consumer’s eligibility for Community Based Long Term Care (CBLTC) services. The policy is at http://www.health.ny.gov/health_care/medicaid/redesign/docs/mltc_policy_15-08.pdf. When a consumer contacts the CFEEC (Maximus) for an evaluation, a nurse evaluator will complete the Uniform Assessment System (UAS) to determine the consumer’s eligibility for CBLTC. If the consumer is deemed eligible, the CFEEC will “warm transfer” the consumer to the enrollment broker for education on the MLTCs available in the consumer’s area before selecting a plan. Should the selected plan disagree with the CFEEC’s eligibility determination, a dispute-resolution form must be submitted to the CFEEC two business days following the plan assessment; the plan has up to six business days to resolve the issue directly with CFEEC staff. If no resolution is made, the CFEEC will bring the consumer’s case to the DOH Medical Professional for review and final determination. The consumer will be notified in writing that the case is under review and a determination will be made within three business days. Once a determination has been made by the DOH Medical Professional, the consumer will be notified of the decision. If the Medical Professional overturns the MLTC’s denial of enrollment, the MLTC will be required to enroll that consumer. In the event that the denial is upheld, the consumer will receive a written notice of the decision that will include fair hearing rights.
Prior Authorization Required for Certain Medicare DME Last week, The U.S. Centers for Medicare and Medicaid Services (CMS) issued a final rule establishing a prior authorization process for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) that CMS has determined are frequently subject to “unnecessary utilization.” The prior authorization process is intended to assure that all relevant coverage, coding, and clinical documentation requirements are met before the item is furnished. CMS will generate a “master list” of items that meet specific criteria, as well as a subset from the master list that will require prior authorization. Items on the master list will likely include those with an average purchase fee of $1,000 or greater, or an average rental fee schedule of $100 or greater (adjusted annually for inflation). CMS will publish the “Required Prior Authorization List” in the Federal Register with a 60-day notice. For items requiring prior authorization, the supplier must submit all relevant documentation for review before furnishing the item to the beneficiary and submitting the claim. CMS or its contractors will review the prior authorization request and provide a provisional decision. A claim submitted with provisional affirmation will be paid so long as all other requirements are met. A claim submitted with a non-affirmation decision or without a decision will be denied. Unlimited resubmissions of prior authorization requests are allowed. More information is at http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Factsheets-items/2015-12-29.html and the final rule (with the DME on the “master list”) is at https:// www.gpo.gov/fdsys/pkg/FR-2015-12-30/pdf/2015-32506.pdf.
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Regulations for Personal Care Services and CDPA Changed The state Department of Health (DOH) has released information to MLTCs on revisions to the Personal Care Services (PCS) and Consumer Directed Personal Assistance (CDPA) regulations, effective December 23, 2015. The guidance is at http://www.health.ny.gov/health_care/medicaid/redesign/mrt_90.htm (see MLTC Policy 15.09). Provisions include changes to the definitions and eligibility requirements for continuous (“split-shift”) as well as live-in 24-hour PCS and CDPA. MLTCs must apply the revised definitions and eligibility requirements immediately when conducting PCA and CDPA assessments and reassessments. In addition, the revised regulations set forth revised criteria for notices that deny, reduce or discontinue these services. The definitions of “some assistance” and “total assistance” are repealed in their entirety. This means, in part, that a “total assistance” need with certain activities of daily living is no longer an eligibility requirement for continuous personal care services or continuous consumer directed personal assistance. “Turning and positioning” is added as a specific Level II personal care function and as a CDPA function. Certain definitions and eligibility requirements are revised as follows: •
“Continuous personal care services” means uninterrupted care, by more than one personal care aide, for more than 16 hours in a day for a patient who needs assistance with such frequency that a live-in 24-hour personal care aide would be unlikely to obtain, on a regular basis, five hours daily of uninterrupted sleep during the aide’s eight-hour period of sleep.
•
“Live-in 24-hour personal care services” means care by one personal care aide for a patient whose need for assistance is sufficiently infrequent that a live-in 24-hour personal care aide would be likely to obtain, on a regular basis, five hours daily of uninterrupted sleep during the aide’s eight-hour period of sleep.
•
“Continuous consumer directed personal assistance” means uninterrupted care, by more than one consumer-directed personal assistant, for more than 16 hours in a day for a consumer who needs assistance with such frequency that a live-in 24-hour consumer directed personal assistant would be unlikely to obtain, on a regular basis, five hours daily of uninterrupted sleep during the aide’s eight-hour period of sleep.
•
“Live-in 24-hour consumer directed personal assistance” means care by one consumer-directed personal assistant for a consumer whose need for assistance is sufficiently infrequent that a live-in 24-hour consumer directed personal assistant would be likely to obtain, on a regular basis, five hours daily of uninterrupted sleep during the aide’s eight-hour period of sleep.
The provisions also state that services shall not be authorized if assistance can be met by voluntary assistance from informal caregivers, by formal services other than the Medicaid program, or by adaptive or specialized equipment or supplies. Also, the nursing assessment is no longer required to include an evaluation of the degree of assistance required for each function or task, since the definitions of “some assistance” and “total assistance” are repealed. The regulations describe factors that nursing and social assessments must document. They also revise the Department’s regulations governing the content of notices for denials, reductions or discontinuances of PCS 10
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and CDPA. All MLTCs must ensure that their notices denying, reducing or discontinuing PCS or CDPA are consistent with these regulations. Additional information is at http://www.wnylc.com/ health/entry/7/. Questions can be directed to DOH’s Bureau of Managed Long Term Care at mltcworkgroup@health.ny.gov.
DSRIP Update The state Department of Health (DOH) has announced the following changes to the Delivery System Reform Incentive Payment (DSRIP) program website: •
DSRIP Webinars and Presentations can be found at http://www.health.ny.gov/ health_care/medicaid/redesign/ dsrip/ webinars_presentations.htm.
•
DSRIP Archives can be found at http://www.health.ny.gov/ health_care/medicaid/redesign/ dsrip/archives/index.htm.
UAS Changes The state Department of Health (DOH) has announced changes in functionality related to the Open/Close Node in all Uniform Assessment System (UAS-NY) records. Effective December 21, 2015, DOH has removed the ability to close a UAS-NY record from all users who currently have this functional capability. DOH claims it took this action because records are being inappropriately or inadvertently closed, resulting in the creation of duplicate consumer records and making it difficult for users to access and work in a record. Going forward, if an individual leaves your program/ plan: 1. Complete all items in the Discharge/Disenroll section of the Enrollment Node. This includes discharge/disenroll date and discharge/disenroll reason. 2. Remove the case file from your organization’s case list. Note that the discharge/disenroll date must be at least one day prior to the date a record is removed from your organization’s case list. 3. If you come across a record that has been inappropriately or inadvertently closed, call (don’t e-mail) the UAS-NY Project Team at (518) 408-1021, and they will reopen the record. BIP Changes In 2016, the UAS-NY will be expanded to accommodate the requirements of the Balancing Incentive Program 11
FIDA Update The state Department of Health (DOH) has posted a Frequently Asked Questions (FAQs) document about nursing home coverage and the Fully Integrated Duals Advantage (FIDA) program. The FAQs are at http:// www.health.ny.gov/health_care/ medicaid/redesign/fida/2015-1230_fida-nf_faq.htm. Some topics covered include: inapplicability of three-day prior hospital stay requirement; role of the FIDA care manager and the nursing home Interdisciplinary Team process; pharmacy billing; Medicaid nursing home eligibility; hospice coverage; and other issues. HCA members should check the state FIDA website at http:// www.health.ny.gov/health_care/ medicaid/redesign/mrt_101.htm on a regular basis.
Volume 21, No. 1 January 8, 2016
ASAP – a publication of the Home Care Association of New York State (BIP). As part of this expansion, the UAS-NY will undergo a series of related releases that will require coordinated upgrades of the UAS-NY Offline Application. The planned major releases are: •
February 1, 2016: addition of ‘No Wrong Door’ Screen; and addition of Coordinated Assessment System (CAS) for the Office for People with Developmental Disabilities.
•
June 1, 2016: addition of New York State Community Mental Health Assessment.
•
October 1, 2016: addition of the Child and Adolescent Needs and Strengths.
To support the February 1, 2016 release, the UASNY Offline Application will be available for download by January 19, 2016. Questions should be directed to (518) 408-1021 or at uasny@health.ny.gov.
State Medical Society Webinar on Opioid Use HCA members may be interested in an upcoming free-of-charge webinar series on opioid use and pain control. The series (beginning January 26), sponsored by the Medical Society of the State of New York (MSSNY) and New York State Office for Alcoholism and Substance Abuse, is entitled “Revisiting the Role of Opioid Analgesics for Simple and Complex Patients with Chronic Pain.” It will provide information on managing pain, understanding the potential for patient addiction, and determining best practices for safe prescribing. A flyer with links to registration is at http:// mssny.informz.net/MSSNY/data/images/ Opioid%20Webinar%20Flyer%20rev2.pdf.
CMS Releases Draft OASIS C2
NGS Education Programs
The U.S. Centers for Medicare and Medicaid Services (CMS) has recently issued a draft of OASIS C2 in order to comply with requirements for standardized, cross-setting measures for postacute care under the Improving Medicare PostAcute Care Transformation (IMPACT) Act of 2014.
National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), has recently posted the following educational webinars. •
Ordering and Certifying Medicare Home Health Services: Monday, January 11, from 3 to 4 p.m., and Friday, January 22, from noon to 1 p.m. (Registration is at: https:// attendee.gotowebinar.com/register/ 4612808991184945410)
•
NGS Hospice Billing: Tuesday, January 19, from 2 to 3 p.m. (Registration is at: https://attendee.gotowebinar.com/ register/8325907037047626753)
The complete draft and background information can be found at: https://www.cms.gov/Medicare/ Quality-Initiatives-Patient-AssessmentInstruments/HomeHealthQualityInits/OASISData-Sets.html. IMPACT requires CMS to develop standardized assessment data and quality measures across postacute care (PAC) settings including home care, nursing homes, inpatient rehabilitation facilities and long term care hospitals.
For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
It also specifies domains and timeframes for each provider type to submit the cross-setting measures. The quality measure domains include: functional 12
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status, cognitive function, and changes in functional and cognitive function; skin integrity and changes in skin integrity; medication reconciliation; incidence of major falls; and communicating the existence of and providing for the transfer of health information and care preferences. Resource use and other measures – such as total Medicare spending per beneficiary, discharge to community, and potentially preventable hospital readmission rates – are also part of the required quality measures. OASIS C2 is scheduled for implementation on January 1, 2017. At that time, home health agencies must begin reporting measures related to changes in skin integrity, medication reconciliation and resource use. In addition to some nominal formatting changes, the following are key components of the OASIS C2: •
The version includes three new standardized items (M1028, M1060, GG0170c), along with modifications to standardize with other post-acute settings of care (M1311, M1313, M2001, M2003, and M2005).
•
The look-back period and item number were changed in five items (M1500, M1510, M2015, M2300 and M2400).
For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
NYC Office of Labor Standards is Established On November 30, New York City Mayor Bill de Blasio signed legislation (743-A) to create a new Office of Labor Standards. The bill language is at http://tinyurl.com/zz85767. The office has responsibility for: worker education on safety and protections, facilitating the exchange and dissemination of information on safety and protection, providing educational materials and programs to assist employers with labor law compliance, collecting and analyzing data on the city’s workforce and workplaces to identify gaps and prioritize areas for the improvement of working conditions and practices, and other functions. In addition, the Office Director is authorized to receive complaints, conduct investigations in response to complaints, hold public and private hearings, serve subpoenas, receive evidence, mediate disputes, and to receive, administer, pay and distribute monies collected in and as a result of actions brought for violations. The legislation allows the Office to take over administration of the Earned Sick Time Act (“Paid Sick Time”) and Transit Benefit law, but the mayor is given the option to designate another agency or office for these tasks.
MLTC Guidance Issued on Hospice Coverage The state Department of Health (DOH) has issued a policy guidance and Frequently Asked Questions (FAQs) that provide information on coverage of and billing for hospice services provided to MLTC enrollees who are residents in either a skilled nursing facility (SNF) or a hospice residence. The guidance is at http://www.health.ny.gov/health_care/medicaid/redesign/mltc_policy_13-18b.htm; the FAQs are at http://www.health.ny.gov/health_care/medicaid/redesign/2015-12-31_hospice_mltc_faq.htm. Continued on next page
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Volume 21, No. 1 January 8, 2016
Continued from previous page MLTC enrollees who require hospice services and meet hospice eligibility requirements may elect the benefit without disenrolling from their MLTC plan. Individuals already enrolled in hospice remain excluded from enrolling into MLTC plans. For MLTC enrollees (partial capitation MLTC and Medicaid Advantage Plus), hospice services (with the exception of daily room and board charges) are not included in the plan benefit and are billable directly to Medicare and Medicaid as appropriate. MLTC enrollees who are residents of an SNF and subsequently elect hospice services while in the facility will remain enrolled in the MLTC plan. The MLTC plan is responsible for the room and board portion of the facility stay and will reimburse the facility in accordance with the provider contract. The facility will receive additional reimbursement as indicated directly from the applicable hospice provider. MLTC enrollees who elect to receive hospice services in a hospice residence licensed under Article 40 will also remain enrolled in the MLTC plan. There are currently 11 such licensed hospice residences in New York State. The per diem room and board component of the hospice residence shall be covered by an MLTC plan and authorized as a respite service under the definition of social and environmental supports. MLTC plans are advised to coordinate with hospices to provide the necessary care to enrollees and support their enrollee’s needs. MLTC enrollees in receipt of hospice services are not prohibited from transferring to another MLTC plan. Lastly, Program of All-Inclusive Care for the Elderly (PACE) enrollees who elect enrollment in the hospice benefit are considered to be voluntarily disenrolled from PACE.
Accountable Health Communities Funding Available This week, the U.S. Department of Health and Human Services announced funding of up to $157 million to test whether screening beneficiaries for health-related social needs and associated referrals to communitybased services will improve quality and affordability in Medicare and Medicaid. The five-year program, called the Accountable Health Communities (AHC) Model, will support up to 44 bridge organizations, through cooperative agreements. The model will test three scalable approaches to addressing health-related social needs and linking clinical and community services: community referral, community service navigation, and community service alignment. Applicants must submit a non-binding letter of intent by February 8 to http://innovationgov.force.com/ahc; applications are due March 31. Webinars on the AHC Model application process will be held on: • •
Thursday, January 21, 2016 from 2 to 3:30 p.m. Register at http://tinyurl.com/jpudvql. Wednesday, January 27, 2016 from 3 to 4:30 p.m. Register at http://tinyurl.com/z8nf27s. Continued on next page 14
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Continued from previous page Questions about the model and applications can be submitted to AccountableHealthCommunities@cms.hhs.gov or call the help desk at 1-844-711-2664. More information is at https://innovation.cms.gov/initiatives/ahcm/.
More Information Posted on NHTD/TBI Transition to Managed Care The state Department of Health (DOH) has posted additional information related to the transition of the Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) programs to managed care. The materials include minutes from the Services and Workforce Subcommittee and Uniform Assessment System (UAS) Subcommittee meetings; an article abstract related to TBI patients; an evaluation of state assessment tools; a crosswalk of NHTD/TBI Waiver Services and Community First Choice Option (CFCO) Services They are posted at http://www.health.ny.gov/health_care/medicaid/redesign/mrt_90.htm. The state’s intention is to enroll current NHTD and TBI participants into managed care plans on March 1, 2017.
DOH Issues Medicaid Updates for December 2015 The state Department of Health’s “Medicaid Update” for December 2015 contains a few articles which may be of interest to members, including a notice about webinar trainings for the new Medicaid Management Information System and information about mandatory electronic prescribing, which goes into effect March 27. You can download the Update at: http://www.health.ny.gov/health_care/medicaid/program/update/2015/dec_15_mu.pdf. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
Publications •
White House Conference on Aging Final Report http://www.whitehouseconferenceonaging.gov/2015-WHCOA-Final-Report.pdf
•
“Advance Care Planning as an Optional Element of an Annual Wellness Visit,” CMS Transmittal (December 22, 2015) https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/ R3428CP.pdf
•
“Developing Capitation Rates for Medicaid Managed Long-Term Services and Supports Programs: State Considerations,” by the Center for Health Care Strategies http://www.chcs.org/media/MLTSS-Rate-Setting_Final2.pdf
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org. 15
2015 State Home Care Financial Condition Survey SECTION 1: Demographic Information 1. List your contact information Your Organization Your Name Your Title Your Email Your Phone Number
2. Please check only one answer for your home care provider type, and please be sure to complete a separate survey for each type if you have multiple types of agencies. CHHA LHCSA LTHHCP
3. My agency is ____ (Please only check one answer) Voluntary Proprietary Public
2015 State Home Care Financial Condition Survey SECTION 2: Financial Data Questions 4 and 5 should be completed by CHHAs and LTHHCPs. Question 6 should be completed by LHCSAs. Your answers can be taken directly from your 2014 Medicaid Cost Reports or your 2013 Statistical Reports. Your Finance Director/Chief Financial Officer can assist you. To help, we have created a reference chart, available HERE. This document references the exact schedules on your cost reports and statistical reports for the information sought in questions 5 and 6. Again, all agencyspecific information provided to us will be kept confidential and will only be used in the aggregate. REMEMBER ... For numerical entries, do not use dollar signs ($), commas (,), decimal points (.), percent signs (%) or other characters, just the raw number. Please round up or down if your answer involves a decimal point. 4. If your agency filed a 2014 cost report, are you completing the cost report section of this survey for your LTHHCP or your CHHA? If you are a LHCSA, please skip to question 6. CHHA (my 2014 cost report) LTHHCP (my 2014 cost report)
5. Provide the following data from your 2014 Cost Report (for CHHAs or LTHHCPs). If you are a LHCSA, please skip to question 6. No. of Full Time Employees (FTEs) Medicare Feeforservice Revenues Medicaid Feeforservice Revenues All Other Payor Revenues, including Managed Care Total Patient Service Revenue All Other NonPayor Revenues Total Revenue Total Operating Expenses
2015 State Home Care Financial Condition Survey 6. For LHCSAs, please complete the following data from your 2013 LHCSA Statistical Report. If you are not a LHCSA, skip to the next question. Total Cases Unduplicated Patient Count Number of Full Time Staffing (as of Oct. 1) Total Contract Revenue Total Direct Revenue Total Costs
2015 State Home Care Financial Condition Survey SECTION 3: Payment and Program Information This section asks for your responses about the impact of billing, regulatory and payment issues. 7. Please estimate what % of your Medicaid managed care claims are paid within the "prompt" pay law timeframe for "clean" claims needing no edits (30 days for electronic claims, 45 for paper). Please just enter a raw number: no percentage sign. ___%
8. What is the average number of days that your revenues (from all payors) remain in Accounts Receivable? Please provide your best estimate. Days
9. What percent of your revenue in Accounts Receivable results in “bad debt” or not getting paid? 0 – 10% 11 – 20% 21 – 30% Over 30%
2015 State Home Care Financial Condition Survey 10. Assuming that your costs have increased in the last year, please rate the impact of each cost factor below on your increased costs. For any that have the "largest impact," please tell us more about about the specific cost impact in the text box below. No Impact Wage and Overtime Costs Benefits Costs Fuel Costs Unfunded Mandates (e.g. Flu vaccination requirements, TPL) Capital Costs Technology investment Other Administrative Costs Billing/Administrative Expenses Associated with Managed Care Basic or advanced staff training Emergency Preparedness and response Staff time and partnership development work on MLTC/DSRIP activities Tell us more about your largest cost impacts
Minimal Impact
Medium Impact
Large Impact Largest Impact
2015 State Home Care Financial Condition Survey 11. If your estimated Medicaid revenues have decreased between 2014 and 2015, please rate the impact of the following factors for this change in your Medicaid revenues. No Impact Caseload change due to managed care transition Effect of payment cuts/reimbursement changes (e.g., CHHA EPS rebasing, GRT) Inadequate managed care rates Delay in managed care payments Drop in Medicaid volume due to fewer referrals Staffing cuts
Minimal Impact
Medium Impact
Large Impact
Largest Impact
2015 State Home Care Financial Condition Survey No Impact
Minimal
Medium
Large
Largest
Impact
Impact
Impact
Impact
Other (please specify)
12. On October 1, the state implemented CHHA episodic payment system rebasing cuts. Please provide the average % reduction in your Medicaid revenue due to this initiative? (Remember: be sure to only enter the raw number: no percentage sign.) Avg. Percentage reduction (%)
2015 State Home Care Financial Condition Survey 13. If you have Medicaid managed care contracts (MCO and MLTC), please estimate the aggregate % differences between your Medicaid feeforservice (FFS) rates and your negotiated managed care rates for the following service disciplines. (You may leave any of the boxes blank if the statement doesn't apply.) Our aggregate managed care nursing service rate is LESS than FFS by (__%) Our aggregate managed care nursing service rate is MORE than FFS by (+__%) Our aggregate managed care home health aide/personal care service rate is LESS than FFS by (__%) Our aggregate managed care home health aide/personal care service rate is MORE than FFS by (+__%)
14. How have your overall contracted Medicaid managed care (MCO and MLTC) rates changed between 2014 and 2015? Enter zero if your rates have not changed. (Also, be sure to only enter the raw number: no percentage sign.) Increased by ____% Decreased by ____%
15. At any time over the past two years (2014 and 2015), have you had to use a line of credit or borrow money (including gappayment financing from parent organization) to pay for operating expenses? Yes No
16. Please rank from 15 the (actual or potential) impact of the following state regulatory requirements/initiatives (1=highest impact and 5=lowest impact).
Elimination of the "companionship exemption" for home care
Executive compensation/administrative limits
Medicaid ordering, prescribing, referring and attending (OPRA) edit
DSRIP
State Wage Parity requirements in New York City, Long Island, Westchester
2015 State Home Care Financial Condition Survey 17. Which of the following actions does your agency plan to take in response to fiscal pressures, a changing health care environment and new models like DSRIP? (Please check all that apply.) Merge with another agency Collaborate as part of a Health Home, IPA, ACO, DSRIP/PPS or other health system Technology upgrades (EHR, etc.) Workforce retraining Reduce staff and other expenses to become more efficient Use LTHHCP in contracting capacity Phaseout LTHHCP Purchase a CHHA Increase use of CHHA Decrease use of CHHA Apply to open a LHCSA Increase use of LHCSA Decrease use of LHCSA Discontinue telehealth program Close our organization Other (please specify)
2015 State Home Care Financial Condition Survey 18. In your contracts with MLTCs/MCOs, how would you rate the overall impact of the following issues or experiences? (Please check all that apply.) No Impact Inadequate rates Lack of timely authorizations/reauthorizations Lack of timely payment (or increase in accounts receivable) Inconsistent billing codes A lack of state policy clarity about the regulatory requirements (e.g. responsibilities for physician orders, plans of care, supervision) I do not have a CHHA and the MLTC/MCO only wants to contract with a CHHA I do not have a LHCSA and the MLTC/MCO only wants to contract with a LHCSA The MLTCs/MCOs feel they already have a sufficient number of contracts The MLTCs/MCOs plan to cancel our contract
Minimal Impact
Medium Impact
Large Impact
Largest Impact
2015 State Home Care Financial Condition Survey No Impact
Minimal
Medium
Large
Largest
Impact
Impact
Impact
Impact
Other (please specify)
19. What % of your Medicaid receipts are FeeForService versus Medicaid Managed Care (MLTC/MCOs)? Feeforservice % is ____ Managed Care % is ____
20. What % of your Medicare receipts are FeeForService versus Medicare Managed Care? Feeforservice % is ____ Managed Care % is ____
21. If you are contracting with an MLTC or MCO, please provide the percentage of your Medicaid revenue derived from each of the following service/contract arrangements. (Simply enter a zero for any services that you do not provide.) Care management services to plan enrollees account for ___% of our Medicaid revenue from plans. Professional services (nursing, therapy) to plan enrollees account for ___% of our Medicaid revenue from plans. Aide services to plan enrollees account for ____% of our Medicaid revenue from plans. Assessment services account for ____% of our Medicaid revenue from plans. Other services account for ____% of our Medicaid revenue from plans.
22. Does your agency contract with MLTCs/MCOs for telehealth services? Yes No
2015 State Home Care Financial Condition Survey 23. If you answered "yes" to the previous question, is your payment for telehealth services adequate under managed care? (Please explain.)
24. If you are involved in a DSRIP Performing Provider System (PPS), what payment arrangement are you involved in or expect directly from the PPS? Feeforservice Capitated payments Bundled payments/ValueBased Payments Specific project area funding Unsure Other (please specify)
25. Has your agency yet received payment directly from a DSRIP PPS? Yes No
2015 State Home Care Financial Condition Survey 26. If you answered "yes" to the previous question, how much payment has your agency received from the PPS and for what purpose(s)? (Please explain in the box below.)
27. If you are involved in a DSRIP PPS, please rate the following experiences. Strongly Disagree
Disagree
Don't Know
Agree
Strongly Agree
N/A
Payment will adequately cover costs and makes participation in DSRIP worthwhile My organization expects increased referral activity from the PPS PPS committees understand the role of home care in meeting DSRIP goals DSRIP participation offers opportunity for growth in home care industry I don't know how my agency will participate in DSRIP
28. By what percentage do you expect your costs will increase due to recent changes (implemented on Oct. 13, 2015) in the federal "companionship exemption" requirements? (Remember, enter only the raw number and no percentage sign.) Percentage Increase (%)
2015 State Home Care Financial Condition Survey 29. Has your agency calculated the potential impact of the proposed minimum wage increase to $15 per hour? If yes, what were your findings and how did you arrive at this calculation?
30. Please rank from 110 which of the following are needed to support you in this current fiscal, regulatory and program environment for home care (1=highest importance and 10=lowest importance).
Policies that ensure adequate reimbursement
Uniform billing codes for managed care payments
Greater state clarity on the role and regulatory responsibilities for agencies
Regulatory relief
Capital and technology funding support
Staff recruitment or retraining funds
Agency/market data and cost analysis
Marketing materials and documentation showing the home care value proposition
Technical assistance through education programming on new models
Assistance in receiving timely authorization/payments
2015 State Home Care Financial Condition Survey THANK YOU Thank you for completing this important survey. If you have any additional comments, please note them in the text box below. 31. Comments