March 4, 2016 Edition of ASAP

ASAP

A Weekly Publication Of HCA Home Care Association of New York State

Legislative Issues  Public Policy

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News

Volume 21, No. 9 March 4, 2016

Member Advocacy Urgently Needed on Budget Fixes amid Governor’s Non-Commitment for Wage Funding If you haven’t called your legislator yet, you must do so repeatedly throughout early next week. These calls are urgently needed. The Legislature is close to finalizing its state budget bills. Lawmakers need to hear from you in a big way, so that HCA’s budget language gets included to fix the devastating impact of the Governor’s budget and the long-standing need for home care reimbursement changes. We can’t stress enough the need for grassroots support. HCA has been hammering our requests and proposed legislative language repeatedly at all levels over the past several weeks – in meetings with key legislative committees, the Assembly and Senate Leadership and with the state Division of Budget – but our goal can only be achieved if lawmakers hear from you. Legislators need convincing, in order to counteract the Governor’s budget and his position relative to home care. Troubling comments on wage mandate A huge area of concern, of course, is the Governor’s wage mandate. The Governor has made recent comments to the media which have relied on incorrect assumptions about the financial condition of home care and its ability to cover the cost of a wage hike. Those assumptions are directly refuted by HCA’s own data and your experiences outlined in our home care financial condition report. See FIXES p. 2

Inside ASAP Member Advocacy Urgently Needed on Budget Fixes.......................1 HCA Presses for Direct FLSA Distributions to Home Care.................4 Member Hiring Announcements..........................................................4 OMIG Resumes Semiannual TPL Case Requests.................................7 Webinar Outlines Medicare Revalidation Process .............................7 Finance Summit Next Week: Register Now..........................................8 HCA ‘Essential Personnel’ Bill Reintroduced in Assembly................10 Agencies Must Post Injury and Illness Summaries.............................10 NYMMIS Trainings Available.............................................................11 Just 4 Days to Nominate Staff, Colleagues for HCA Awards............11 Emergency Prep. Staff: Plan for March 11 Webinar on TALs..............11 ICD-10 Next Steps Toolkit for Providers.............................................12 Long-Term Services, Supports Open Door Forum Scheduled..........12 Emergency Planning Guide Released................................................12 DOH Posts Regulatory Agenda.........................................................13 DOH Posts Revised Rule on Immediate Need for Personal Care......14 DSRIP Opt Out Materials Available...................................................14 Dec. Global Cap Report: Spending $52M Over Projections.............15 NGS Provides Updates on Obtaining PS&R Data............................16 QIES Systems to be Shut Down from March 16 to 21.........................16 Publications............................................................................................................17

Helping New Yorkers Feel Right At Home

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FIXES from p. 1 HCA has sought to counteract these misconceptions.

New York City-based Crain’s Health Pulse also reported on our financial data and wage impact estimates in two back-to-back articles this week. One of these articles prompted yet another noncommittal response from the Governor’s office, in this case through a spokesperson, who merely stated that “Discussions on the FY 2017 budget are ongoing.”

This week we circulated a press release, shared with HCA members in an alert on Tuesday, stressing our impact estimates of the wage mandate and our hard data on the financial condition of home care – specifically, home care’s mounting operating losses and the impossibility of supporting higher wages without commensurate funding.

This is not the response we should be hearing. Meanwhile, the Assembly has echoed the need for a wage hike in the budget. “As far as I’m concerned, it’s very important,” Assembly Speaker Carl Heastie said in press reports this week. “I don’t want to put it off to after the budget. It’s probably our biggest priority.”

We also sent a print copy of this press release to every member of the Legislature on Thursday with a cover letter about the urgent need for support of home care. You can read the release here: http:// hca-nys.org/wp-content/uploads/2016/03/ PRMinimumwagefacts.pdf.

Several media outlets also reported the Speaker’s view that “the state budget should include additional funding for some groups that depend on state assistance,” though it remains unclear how the Assembly would handle this funding, its distribution and intended recipients. “We do

Several media outlets covered our concerns, including the Binghamton Press & Sun-Bulletin, the Poughkeepsie Journal, the Rochester Democrat and Chronicle, the Journal News of the Hudson Valley and Buffalo-based WGRZ.

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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think the state has to make up for that,” Speaker Heastie said. As far as the Senate, media reports indicate some resistance to the wage hike – but the Senate Republicans have not ruled it out. The Legislature needs to act. To convince the Senate and Assembly to support home care – not only on the wage issue but on our other priority asks – we need every employee of your agency to send a message to their legislators using HCA’s Legislative Action Center. There is no reason why every home care employee with an e-mail address and computer can’t do this. It takes five minutes of their time and could mean a world of difference. Simply have your staff visit http://p2a.co/cEX2Twq, enter their contact information and send a message immediately. We also need you, as a home care leader or executive, to call your legislators and ask them to support HCA’s budget asks. We’ve provided you with talking points, which are again published below. Dial the Senate and Assembly switchboard numbers at Senate (518-455-2800) and Assembly (518-455-4100) to be connected to your lawmaker immediately. This is urgent. Budget Talking Points When you call your legislator’s office, please ask to speak to the legislator or a member of his or her staff involved in budget or health care matters. Here are some messages to convey: •

I am a provider of home care in your district and am calling for your support during the budget process.

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Home care desperately needs investment and reimbursement fixes to stay viable.

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Two-thirds of certified home health agencies are operating in the red. Half of all home care providers are borrowing money to stay afloat.

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On top of this, the Governor’s $15 wage mandate will be catastrophic for home care without full funding. While laudable in its goal, this wage proposal alone would impose $2.19 billion in new costs on home care.

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The Home Care Association of New York State (HCA) is urging that the Legislature and Governor fully fund any minimum wage increase that may be adopted. In addition, HCA has provided specific budget language to ensure that home care’s reimbursement covers the cost of care and infrastructure needs and keeps with past pledges to cover mandates for state-imposed labor expenses and program services.

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Please encourage your legislative colleagues to support home care in this year’s budget and adopt the proposals advanced by the Home Care Association of New York State.

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HIRING

HCA Presses for Direct FLSA Distributions to Home Care This week, HCA continued our aggressive advocacy push with the state Department of Health (DOH) and the Governor’s office to ensure that state monies to help with Fair Labor Standards Act (FLSA) costs reach home care providers. HCA communicated with DOH and the Governor’s office on this vital issue, and we weighed in with the Department on its draft Frequently Asked Questions (FAQs) document regarding the funding levels and distribution process for the FLSA payments. HCA has repeatedly and adamantly asserted to the Department that guidance documents and FAQs on this matter must reflect the urgent need for full and direct payments to home care providers for the costs they’ve incurred from the FLSA rule changes. As you know, those rule changes have resulted in new and asof-yet unreimbursed cost obligations for aide overtime, recordkeeping, travel and other labor expenses since October. HCA anticipates that the Department’s soon-to-be-released FAQ document will provide needed guidance for the distribution of funds from MLTCs to their home care partners who employ and facilitate aide services. HCA will alert members once the FAQs are finalized. Given the importance of this guidance statement, HCA earlier this week

CLINICAL MANAGER, BAYADA Home Health Care RN Clinical Manager sought for our New York City Assistive Care office to visit clients, supervise staff, conduct client assessments and complete plans of care. We are looking for a flexible, enthusiastic team player who aspires to grow professionally and assume more responsibility as a leader with BAYADA. RN Clinical Managers at BAYADA Home Health Care learn to lead field staff in delivering exceptional client service and quality clinical care while ensuring adherence to policies and procedures. You’ll be responsible for internal case management and evaluation and development of field staff. You will provide clinical oversight of home health aides on a variety of non-skilled nursing cases in the boroughs of New York City. QUALIFICATIONS: Current RN license in good standing; 1-2 years recent, verifiable clinical experience (home care and experience working with the senior population a plus); demonstrated successful track record of taking on increased or diverse responsibilities; strong organizational and interpersonal skills; ambition to grow and advance beyond current position; solid communication and PC skills; prior supervisory experience preferred; knowledge of NYC, all 5 boroughs. To apply, please visit our website at www.bayada.com/careers and reference JOB ID 2015-11645. BAYADA Home Health Care is an EOE.

Job Position: Director of Patient Services (Montefiore Home Health Agency) The Director is responsible for directing, planning, coordinating and evaluating patient care services, providing supervision of professional staff, and recruiting/hiring an adequate number of professional staff to ensure quality. The Director will evaluate the performance of Patient Service Managers and support staff supervisors at stated intervals. The Director will participate in administration of the annual budget and personnel policies. The ideal candidate will manage all clinical functions. Required Qualifications: Current NYS RN License and Registration; Master’s in Nursing or Health Related Field; five years of senior and direct management experience within a CHHA. Additional Qualifications: Knowledge of clinical documentation protocols, home health regulations and standards; skill in training, working with building high performance teams; ability to develop and lead strategic plans; strong written and verbal communication skills. Please send résumé & cover letter to chenley@montefiore.org with “Director of Patient Services” and your name in the subject line. Résumés without cover letters and applicants who do not meet requirements won’t be accepted. No phone calls, please. MMC is an equal opportunity employer and will not discriminate against any employee or applicant for employment because of race, color, religion, gender, sexual orientation, or national origin.

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ASAP – a publication of the Home Care Association of New York State provided extensive recommendations and guidance to the Department on the draft FAQs, which were shared with us late last Friday, following consultation with a group of HCA provider and plan members to reflect their input and concerns. HCA’s comments include textual line edits to the draft as well as global recommendations. First, we point out that the FAQs must indicate the continuation of funds past the March 31 close of the state fiscal year. The FAQs are not currently clear about this continuation, likely because the Department has tied this document to the state’s budget schedule and fiscal year timetable (April 1 to March 31). HCA has separately advanced Article VII budget language that would require more permanent rate coverage of FLSA-related and other costs; but, given that the budget process is evolving, HCA argues that the Department must now make a more firm commitment upfront in its statements of policymaking regarding the FLSA add-ons.

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so it is clearly understood that funds are available for aggregate agency and worker costs. We also urge the Department to streamline its multi-step, multi-form FLSA attestation process which, as currently conceived, is burdensome to providers and plans, given that many providers have contracts with multiple plans. Lastly, we urge the Department to revise the attestation forms to reflect the intended purposes of the FLSA funding. HCA is continuing to press for Departmental action to improve the fund distribution process which is a top priority of our advocacy at both the Departmental level and in the state budget process. In both directions, we are pushing for immediate, direct and appropriate distribution of funds. FLSA Survey Update Meanwhile, HCA and other provider associations this week had a conference call with DOH and its actuary, Mercer, to further discuss a draft survey that is being developed to ascertain the anticipated/incurred new costs due to FLSA changes.

Secondly, the distribution process must also be “straightforward, direct and without ambiguity,” HCA said, so that providers and plans can assure a smooth dedication of funds for their intended purpose. We also insist that the distribution process, both to and under managed care, is made consistent with the Department’s past indications, and in keeping with the state’s manner of adjusting fee-for-service rates. This way, home care providers would receive the promised addition of $.34 per all aide hours, and MLTCs would be “likewise ensured funding commensurate with the paying out of this $.34 per hour.”

HCA has been very involved in the process of submitting revisions and comments to DOH and Mercer in an effort to keep provider interests and concerns prominent. We will continue to strongly advocate for a reasonable and effective survey tool that does not present a significant burden on your staff and resources.

To make sure the funds adequately cover all costs, HCA’s recommendations to DOH state the following: “It is essential that the FAQs clarify that the FLSA funding is to cover the full and aggregate costs to home care agencies associated with the FLSA,” again

While DOH has not finalized how it will disseminate the survey, we have recommended that the survey be distributed through the Health Commerce System.

The survey requests information about agency overtime, live-in cases, travel and administrative expenses, and will include a cover letter and an attestation form. HCA has worked to ensure that the questions are clear and capture all FLSA-related costs. The survey results will be used to determine necessary funding under Medicaid fee-forservice and managed care that home care providers need for FLSA compliance.

For more information, contact Alex Blais at (518) 8100658 or ablais@hcanys.org. 5

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OMIG Resumes Semiannual TPL Case Requests Using Traditional Appeals The state Office of the Medicaid Inspector General (OMIG) has resumed its semi-annual demand billing process for claims for the second half of federal fiscal year (FFY) 2015. Details are outlined in a letter that some Medicare-certified home care providers (CHHAs or LTHHCPs) should have received from OMIG and its Third Party Liability (TPL) contractor, the University of Massachusetts Medical School (UMMS). The letter identifies which cases have been selected to undergo appeals (through demand billing) for cases with dates of services that occurred in the third and fourth quarter of FFY 2015 only (April 1, 2015 through September 30, 2015). If your agency is selected for future quarterly initiatives, a separate notification letter and “Case Selection Report” will be sent at that time. HCA members interested in knowing whether they should have received a letter from OMIG can e-mail HCA at info@hcanys.org. For specific questions about the letters, contact UMMS’s Laurie Burns at (866) 626-7594.

Webinar Outlines Medicare Revalidation Process to Avoid Deactivation, Loss of Billing Privileges The U.S. Centers for Medicare and Medicaid Services (CMS) provided a webinar this week on Medicare revalidation. Under the Affordable Care Act, certified home health agencies are required to resubmit and recertify the accuracy of their enrollment information (revalidation) every five years. The webinar provided the following helpful information: •

CMS will begin Cycle 2 of its revalidation process this month. This follows Cycle 1 that included revalidation notices mailed by March 23, 2015 to those who were enrolled as of March 2011.

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CMS is streamlining the revalidation process after receiving feedback from providers who revalidated under Cycle 1.

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CMS will be posting all currently enrolled providers with a due date for revalidation or an indication that the date is to be determined (TBD). The date of revalidation is supposed to be posted in the due date field six months prior to that date. This information will be posted at http://go.cms.gov/MedicareRevalidation.

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Those who are required to revalidate should also receive a revalidation request from their Medicare Administrative Contractor (MAC) within two to three months of their due date. It will be sent either by e-mail (to e-mail addresses reported on your prior applications) or regular 7

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Finance Summit Next Week: Register Now!

Providers who are within two months of their listed due date but have not received a notice from their MAC are advised to submit their revalidation application.

The state is in the process of finalizing a budget, and you’ll want to know the status for home care on these fast-moving developments, including HCA’s asks.

CMS advises agencies not to submit a revalidation application if there is not a listed due date on the database at http:// go.cms.gov/MedicareRevalidation (unless they have gotten such a request from their MAC).

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Those who don’t respond to a request for revalidation can face a possible deactivation of their ability to bill Medicare.

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mail (at least two of your reported addresses: correspondence, special payments and/or your primary practice address) identifying your due date.

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Deactivated providers are required to submit a complete enrollment application to reactivate and will not be able to retroactively bill for services provided while they were deactivated due to not revalidating. A helpful MLN Matters article is at https://www.cms.gov/ Outreach-and-Education/ Medicare-Learning-NetworkMLN/MLNMattersArticles/ Downloads/SE1605.pdf.

Providers are also required to revalidate their Medicaid enrollment every five years. More information on that process is at www.emedny.org/info/ ProviderEnrollment/revalidation/ index.aspx.

HCA’s Senior Financial Managers Summit is next week, and there are several reasons why your finance teams should attend this timely members-only program on March 9 in Albany.

State officials are also finalizing their process for the distribution of Fair Labor Standards Act-related funds. HCA has commented on the Department’s draft guidance on this issue as we seek direct, full and timely payment. Your finance teams will want to know the latest about this process. (See related p. 4 story.) State reimbursement officials will also provide several updates on: the budget; the Medicaid global cap; CHHA Episodic Payment System (EPS) utilization data; premium rate adjustments for MLTCs; the CHHA, LTHHCP and Personal Care fee-for-service Medicaid rates; and the 2015 Medicaid cost reports. This session is also your opportunity to ask questions of the Department about the status of Quality Incentive/Vital Access Provider Pool (QIVAPP) funding, Wage Parity and overtime adjustments to plans and home care providers. Robert Simione will provide participants with the latest aggregate benchmarking data for Medicare and Medicaid to help you make sense of how the various federal and state fiscal policy levers are affecting your bottom-line and operational practices related to your peers. Audrey El-Gamil, from Dobson, DaVanzo & Associates, will provide highlights of an important study she conducted to identify the clinically appropriate and cost-effective placement of Medicare patients following discharge from the acute care hospital, and will offer suggestions on how home care can be utilized most effectively in the future. As always, HCA’s Policy staff will tie these issues together (and more) with insights on all of the major state and federal payment matters affecting all home care providers. Download the registration form at http://hca-nys.org/wpcontent/uploads/2016/01/2016CFOForum.pdf.

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HCA ‘Essential Personnel’ Bill Reintroduced in Assembly, Joining Senate Companion Measure The HCA-developed home care and hospice “essential personnel” bill (A.9381) has been reintroduced in the Assembly, following the reintroduction of companion legislation in the Senate. This legislation has been extensively reported to the membership. It would allow “essential personnel” status for home care and hospice personnel needing to reach patients in an emergency when curfews or restricted zones are otherwise in effect. It would also incorporate home care and hospice input in local emergency planning decisions. Assemblyman Michael Cusick reintroduced the bill in the Assembly late last week. Its Senate sponsor is Andrew Lanza (S.6692). Both officials represent Staten Island, an area that was hard hit by Hurricane Sandy. The Staten Island Advance has covered the issue and the work of the two bill sponsors to get this measure enacted. While Governor Cuomo has vetoed similar measures in the past, those actions are based on what appear to be a misread of the bill, prompting a redraft (to clarify any issues causing initial concerns) as well as outreach from sponsors and HCA to explain the intent of this important legislation. The “essential personnel” designation is important, but so, too, is the incorporation of home care in local emergency response planning. HCA is working to support this aim broadly, scheduling a series of upcoming meetings that will bring together home care agencies and local emergency managers for a series of roundtable discussions – starting in western New York counties – to raise mutual awareness and discuss needs in responding to vulnerable populations during an emergency. Please also see our related p. 11 story on the upcoming March 11 webinars related to the Transportation Assistance Level initiative that will soon be required for home care and hospice. This initiative lays out a process for meeting the transportation needs of vulnerable populations in preparation for a forecasted emergency. Stay tuned for more emergency preparedness updates coming soon.

Home Health and Hospice Agencies Must Post Injury and Illness Summaries The Occupational Safety and Health Administration (OSHA) reminds employers of their obligation to post a copy of OSHA’s Form 300A, which summarizes job-related injuries and illnesses logged during 2015. It must be displayed in a common area where notices to employees are usually posted each year between February 1 and April 30. For more information on recordkeeping requirements and which type of agencies are affected, visit OSHA’s Recordkeeping Rule website (https://www.osha.gov/recordkeeping2014/records.html). Agencies with more than ten employees who meet the following definition for home health care are required to post form 300A: Establishments primarily engaged in providing skilled nursing services in the home, along with a range of the following: personal care services; homemaker and companion services; physical therapy; medical social services; medications; medical equipment and supplies; counseling; 24-hour home

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care; occupation and vocational therapy; dietary and nutritional services; speech therapy; audiology; and high-tech care, such as intravenous therapy.

Hospice organizations (with more than ten employees) are also required to post form 300A. In addition, under OSHA’s recordkeeping regulation, certain covered employers are required to prepare and maintain records of serious occupational injuries and illnesses using the OSHA 300 Log.

NYMMIS Trainings Available Training is now available for all providers in both instructor-led and webinar formats on New York’s Medicaid Management Information System (MMIS). Current courses include: Introduction to NYMMIS: Features and Functionality and Introduction to Provider Enrollment. NYMMIS is also producing several computer-based trainings in upcoming months via the Learning Management System. Visit the interim NYMMIS website at www.interimNYMMIS.com for more information.

Just Four Days Left to Nominate Staff, Colleagues for HCA Annual Awards Nominations due March 8 HCA’s Annual Conference is coming up on May 4 to 6. As part of this program, HCA presents our annual awards to staff of HCA’s home care members, and we want as many nominations as possible! We are offering three award categories, similar to past years: our Ruth F. Wilson Award, our Caring Award and our Advocacy Award. The categories and criteria are spelled out in the nomination form at http://hcanys.org/wp-content/uploads/2016/02/Award-Nomination-Form-2016.pdf. You can use this form to send us your nominations by March 8, just four days away. This is a great way to recognize your staff, with the possibility of media coverage through HCA’s communications department. Please nominate one of your staff or a colleague today and be ready to join the celebration at our Annual Conference.

Home Care Emergency Preparedness Staff: Plan for March 11 Webinar on Required TALs Initiative If you missed last week’s program, the state is holding two other sessions on March 11 (10:30 a.m. and 2 p.m.) to outline implementation of the Transportation Assistance Levels (TALs) initiative in home care and hospice. Please mark your calendars and be ready to participate. TALs aim to assist with evacuation transport needs for vulnerable individuals preparatory to an emergency. The TALs requirement, already in effect for other sectors, is coming soon for home care. Documentation and reporting of TALs must be communicated to the state Department of Health (DOH) during an emergency event by means of the HERDS Home Care Emergency Response Survey on the Health Commerce System (HCS). Continued on next page 11

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Continued from previous page Information for the March 11 sessions is in the flyer at http:// hca-nys.org/wp-content/uploads/2016/02/61e8afb2-9a7345ef-8305-87f722e915cb.pdf. See last week’s ASAP for a summary of prior webinars on this issue and be prepared to attend one of the March 11 sessions.

ICD-10 Next Steps Toolkit for Providers The U.S. Centers for Medicare and Medicaid Services (CMS) has released the Next Steps Toolkit to help providers track and improve ICD-10 progress. The Toolkit is at https://www.cms.gov/Medicare/Coding/ ICD10/Downloads/ICD10NextStepsToolkit20160226.pdf. It includes information and resources on how to: •

Assess ICD-10 progress using key performance indicators to identify potential productivity or cash flow issues.

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Address opportunities for improvement.

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Maintain progress and keep up-to-date on ICD-10.

Additional information on ICD-10 is at https:// www.cms.gov/Medicare/Coding/ICD10/ index.html?redirect=/ICD10.

Long-Term Services and Supports Open Door Forum Scheduled The U.S. Centers for Medicare and Medicaid Services has announced the next “Long-Term Services and Supports” Open Door Forum. CMS’s Open Door Forums are intended for all stakeholders who interact with CMS or work with consumers who rely on services that CMS provides. The Forum will be on Tuesday, April 26, 2016 from 2 to 3 p.m. Agenda and call-in information will be posted soon. To 12

Emergency Planning Guide Released The U.S. Centers for Disease Control and Prevention (CDC) has released an emergency planning guide that is specific to home health and hospice providers. It is at http://www.cdc.gov/phpr/ healthcare/planning2.htm. The Long-Term, Home Health, and Hospice Care Planning Guide for Public Health Emergencies was developed to help improve the planning efforts of these health care entities and their coordination and integration within the community. The Planning Guide focuses on six topic areas: situational awareness, continuity of operations, facility or agency operations, crisis standards of care, staffing, and fatality management. HCA has provided the membership with New York Statespecific home care emergency planning guides and templates. We will be updating these resources soon in conjunction with a series of meetings we are scheduling, starting in the western New York region, to connect home care providers with local emergency management units for purposes of coordination and mutual understanding of emergency response needs related to home care. Please be on the look-out for more information soon.

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receive the agenda and other announcements via e-mail, sign up at: https://subscriptions.cms.hhs.gov/accounts/USCMS/subscriber/new?topic_id=USCMS_497. More information is at: https://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/ODF_Disability.html.

DOH Posts Regulatory Agenda The state Department of Health (DOH) has posted regulatory actions under consideration for submission as a Notice of Proposed Rulemaking for January through June 2016. The agenda is at http://docs.dos.ny.gov/info/register/2016/march3/pdf/regulatoryagenda.pdf. Some areas considered for DOH proposed rulemaking include: •

CHHA Determinations of Public Need – Update the need methodology used to estimate the need for CHHAs.

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Determination of Public Need for Hospices – Update the need methodology used to estimate the need for hospice care and services.

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Personal Emergency Response Services (PERS) – Allow for annual authorizations and delete the requirement that authorization of PERS be contingent upon a reduction/elimination of personal care aide/home health aide hours.

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Community First Choice Option (CFCO) – Possibly amend the regulations to reference CFCO and the service it covers. CFCO is primarily an enhanced personal attendant program that will provide additional federal matching funds.

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Assisted Living Program (ALP) Billing for Assessments – Provide for reimbursement of the cost of preadmission assessments conducted directly by ALPs.

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Early Intervention Program – Authorize the DOH Commissioner to establish a fixed payment methodology for service coordination services.

These proposals indicate DOH’s intended areas of rulemaking and may be supplemented with additional regulatory proposals. HCA will not only comment on any significant regulatory changes for home care but will also continue to advance priority proposals through DOH regulatory channels as through the legislative process, including our Article VII language, now under consideration, to optimize home care’s role in the current health care system.

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DOH Posts Revised Rule to Meet Immediate Need for Personal Care The state Department of Health (DOH) has posted a revised rule to implement legislation that addresses individuals’ immediate need for Personal Care Services (PCS) and Consumer Directed Personal Assistance (CDPA). The rule is at http://docs.dos.ny.gov/info/register/2016/march3/pdf/rulemaking.pdf (page 18). Under this regulation, social service districts would be required to perform expedited Medicaid eligibility determinations for Medicaid applicants who have an immediate need for PCS or CDPA. This includes applicants who are not currently authorized for any type of Medicaid coverage as well as those who are currently authorized for Medicaid but only for community-based Medicaid coverage without long-term care services. The social services district would be required to determine whether the applicant has submitted a “complete” Medicaid application as soon as possible after receipt of the application, physician’s order, and signed attestation of immediate need, but no later than four calendar days after receipt of such documentation. Eligibility for Medicaid also must be determined as soon as possible after receipt of a complete Medicaid application stating an immediate need for PCS or CDPA, and no later than seven calendar days. The regulations also provide for expedited PCS or CDPA assessments of Medicaid recipients with immediate needs for these services in cases where the recipient is also eligible for Medicaid coverage of community-based long-term care services.

DSRIP Opt Out Materials Available The state Department of Health (DOH) has posted some resources about the “Opt-Out” process for Medicaid recipients who don’t want to share their data with Performing Provider Systems (PPSs) under the Delivery System Reform Incentive Payment (DSRIP) program. Starting the week of February 22 and continuing through mid-March, DOH has been mailing about five million Opt-Out letters to Medicaid recipients (phase two). This follows up a previous phase one mailing that was sent to about 700,000 Medicaid recipients in late October 2015. An Opt-Out webinar conducted by DOH in October 2015, as well as updated FAQs, are at: http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/docs/2015-12-02_opt-out_webinar.pdf http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/opt-out_process_faqs.htm More information is at www.health.ny.gov/health_care/medicaid/redesign/dsrip/consumers.htm. Medicaid members should be directed to call the Medicaid call center at 1-855-329-8850 (toll-free) for questions they may have on the Opt-Out process.

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ASAP – a publication of the Home Care Association of New York State

Volume 21, No. 9 March 4, 2016 

December Global Cap Report: Spending $52M Over Projections The state Department of Health (DOH) has issued its monthly Medicaid Global Cap report. This latest report, for December, covers the period of April 1 to December 31, 2015. It finds that overall spending for this period was $52 million above Medicaid Global Cap projections, across all sectors, a difference of $13.881 billion in actual spending versus $13.829 billion in estimated spending for the nine-month period. According to the report, the state has done a mid-year (six-month) update to the current Global Medicaid Spending Cap estimates based on experiences through September 2015. Specifically, DOH mentions the following two significant pressures on the Global Cap which have now been incorporated: •

Significant enrollment growth in the MLTC program. Year-to-date growth (through September) was 11,000 individuals, primarily in New York City (68 percent). The original estimates only assumed an annual growth of 10,000 and have been revised to reflect projected growth of 16,375 recipients; and

•

A recent court ruling on the Fair Labor Standards Act (FLSA) requiring overtime to be paid at time and one half of wage, travel time is compensable hours, and changes to live-in rules for home care.

The category that includes home care (“Other Long Term Care”) was completely even with projections. The Department shows actual spending of $515 million versus projected spending of $515 million, which is a significant improvement from the September 2015 report which showed Other Long term Care services as being $34 million over estimated spending as a result of more recipients billed than anticipated in personal care. Medicaid Managed Care (MMC) was $11 million over projections, a difference of $9.768 billion (actual spending) versus $9.757 billion (estimated spending), which is also significantly better than the September report when MMC spending was $81 million over estimates. Medicaid total enrollment reached 6,366,170 enrollees at the end of December 2015. This reflects an increase of 190,103 enrollees, or 3.1 percent, since March 2015. The full report is at http://www.health.ny.gov/health_care/medicaid/regulations/global_cap/monthly/ sfy_2015-2016/docs/december_2015_report.pdf. HCA is analyzing these reports carefully in an information gathering effort, combined with other data analysis, related to home care’s performance under the Global Cap. The Medicaid Global Cap for the current fiscal year (April 1, 2015 to March 31, 2016) is $17.7 billion for all sectors. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org. 15

ASAP – a publication of the Home Care Association of New York State

Volume 21, No. 9 March 4, 2016 

NGS Provides Updates on Obtaining PS&R Data Continuing Access to PS&R Depends on Annual Recertification of Your EIDM Account National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), recently released information indicating that providers must annually recertify their accounts in the Enterprise Identity Management (EIDM) system in order to maintain access to their Provider Statistical and Reimbursement (PS&R) data. NGS began sending messages about the need to recertify in mid-February. These notices have not been sent to end users. Provider Security Officials must respond timely to the recertification request or lose access to the PS&R. Providers should alert appropriate staff to the EIDM recertification requirement. The following message comes directly from NGS’s website: With the transition from IACS to EIDM for the management of PS&R user accounts complete, EIDM is preparing to re-enforce the requirement for annual certification of accounts. EIDM will be sending Security Officials regular e-mails indicating which of their users are due for certification, when that certification is due, and instructions on how to perform the certification. For all existing users, their certification due date has been set to March 15, and thereafter all existing and new accounts must be recertified by the Security Official on a no-less-than annual basis. If Security Officials do not perform the required certification of their users’ access, those users will lose access to PS&R and will have to make a new access request to regain entry. Idle user accounts which are not re-certified by Security Officials may be removed from the system altogether.

NGS also notes the following: •

End users will not receive a notification from EIDM regarding the need for their account to be recertified – only the Security Officials will receive these e-mails.

•

All certification activities in EIDM are performed by the Security Official; there are no system steps for end users to take.

•

The e-mail will be from donotreply@cms.gov, and should have arrived on or around February 15, 2016.

For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

QIES Systems to be Shut Down from March 16 to 21 The U.S. Centers for Medicare and Medicaid Services (CMS) is reminding providers that all Quality Improvement and Evaluation Systems (QIES) will be down from Wednesday, March 16 after 8 p.m. through Monday, March 21, 2016 at 11:59 p.m. This downtime will affect all QIES connectivity and systems. Continued on next page

16

ASAP – a publication of the Home Care Association of New York State

Volume 21, No. 9 March 4, 2016 

Continued from previous page This means the national database, Certification and Survey Provider Enhanced Reporting (CASPER) reports, and quick reference will be unavailable during this time. In addition, the following submission systems will not be available: •

Home Health Outcome and Assessment Information Set (OASIS);

•

Hospice Item Set (HIS);

•

Inpatient Rehabilitation Facility (IRF)-Patient Assessment Instrument (PAI);

•

Long-term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set; and

•

Minimum Data Set (MDS) and Payroll-Based Journal.

This downtime will affect all QIES users. It is critical that affected providers make the necessary contingency plans to accommodate for this downtime and ensure data is submitted in a timely manner. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

Publications •

“Long-Term Care Providers and Services Users in the United States: Data From the National Study of Long-Term Care Providers, 2013–2014,” by U.S. Department of Health and Human Services Centers for Disease Control and Prevention National Center for Health Statistics http://www.nasuad.org/sites/nasuad/files/LTC%20Report.pdf

•

“Comprehensive Care for Joint Replacement Model (CJR) Provider Education (Transmittal 140),” by the U.S. Centers for Medicare and Medicaid Services https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/ R140DEMO.pdf

•

“Coverage of Maternal, Infant, and Early Childhood Home Visiting Services,” by the U.S. Centers for Medicare and Medicaid Services https://www.medicaid.gov/federal-policy-guidance/downloads/CIB-03-02-16.pdf

For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.

17

2016

HCA AWARD NOMINATIONS It’s Time to

VOTE!

CARING

ADVOCACY

RUTH F. WILSON

Deadline for submission is March 8, 2016

2016 HCA AWARD NOMINATIONS

March 8 Deadline for submission

HCA is encouraging members to submit nominations for the 2016 HCA Awards. In addition to the Ruth F. Wilson Award, our highest honor, HCA will also present awards in other categories during our Annual Meeting and Awards Breakfast on May 5, 2016 In submitting nominations, members should give consideration to an individual, group of people or an organization that has made an impact on the home care industry, and the patients and clients we serve. This year we are soliciting nominations in the following categories:

Ruth F. Wilson Award HCA’s highest honor, the Ruth F. Wilson Award, is bestowed upon an individual who has demonstrated exceptional dedication and made a significant contribution to home care over a period of time. With this award, HCA recognizes someone whose work has had a dramatic effect on home care, reaching beyond a single agency. The recipient will have strengthened the practice of our profession, raised the standards of quality and care for patients, or advanced the level of understanding and mutual cooperation among the home care community, legislators, federal and state agencies, health care providers and the public. This prestigious award recognizes an individual who has made our services stronger and more visible and who has never wavered from his or her support of home care.

Caring Award This award recognizes a professional and/or a paraprofessional staff person of a member agency or a family member who has exhibited the compassion, skills and service that sets their contribution apart, or whose actions on a particular day, or over a period of time, exemplify outstanding compassion.

Advocacy Award This award recognizes a provider agency or person (including both elected and appointed officials) who took risks or “stuck their neck out� to improve the home care industry, clients and workers through their advocacy efforts.

Please complete the attached nomination form and submit it by March 8th to Jenny Kerbein at jkerbein@hcanys.org or Fax it to (518) 426-8788.

2016 HCA AWARD NOMINATIONS Nominee - Contact Information

Nominator - Contact Information

___________________________________________________ Name of Nominee

___________________________________________________ Name of Nominator

___________________________________________________ Title of Organization

___________________________________________________ Title of Organization

___________________________________________________ Address

___________________________________________________ Address

___________________________________________________ City, State, Zip

___________________________________________________ City, State, Zip

___________________________________________________ Telephone Email

___________________________________________________ Telephone Email

Please complete the information below detailing specific contributions the nominee has made to home care and the reason for your nomination. Please include as much detail as possible and indicate specific challenges faced or particular achievements reached. What has made this candidate’s contribution unique? Please use additional sheets if necessary and also include a bio or resume if applicable.

□ Ruth F. Wilson Award

□ Advocacy Award

□ Caring Award

Please describe contributions the nominee has made to Home Care related to the award category selected above: (please use additional sheet if needed) _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Please describe specific challenges faced or particular achievements reached in relation to the award category selected: (Please use additional sheet if needed) ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________

Along with your submission, please consider sending us a digital photograph of your nominated person or group. If selected as a winner, the photograph will be included in the Awards Program.

Fax by March 8, 2016 to: 518-426-8788

388 Broadway Fourth Floor Albany, New York 12207

Submit by March 8th

To: