May 13, 2016 Edition of ASAP

ASAP

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

Legislative Issues  Public Policy

News

Volume 21, No. 19 May 13, 2016

Adequate, Swift Payment for Minimum Wage Tops List of Key Home Care Legislation Being Advanced by HCA As the post-budget period of the State Legislative Session “moves to the tarmac,” HCA has been in full gear drafting and advancing vital legislation for the home care system.

Premium/Rate Support for Minimum Wage, Overtime, Worker’s Comp, Other Most critically, HCA has worked intensively with colleagues to draft and present for legislative introduction jointly supported legislation to ensure that rates paid to home care providers and to See TOPS p. 2

June 17 Program Offers All You Need to Know about Value Based Payments for Home Care By now you may be overwhelmed with the barrage of highvolume information about value-based payments (VBP).

Inside ASAP

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HCA, Partners Sponsor June 2 Webinar for Medicare Documentation, F2F As announced in an e-mail alert earlier this week, HCA and provider association colleagues (the Healthcare Association of New York State and the Medical Society of the State of New York) are co-sponsoring a free June 2 webinar, facilitated by National Government Services (NGS), outlining Medicare home health eligibility and documentation requirements.

Registration for this program is open to all HCA members at https://attendee.gotowebinar.com/ register/9076336920263410177.

See VBP p. 5

Rate Adequacy for Wages Tops List of Key HCA Legislation...............1 HCA, Partners Sponsor 6/2 Webinar on Documentation, F2F.............1 June 17 VBP Program Offers All You Need to Know..............................1 DOH Announces Series of VBP Bootcamps.........................................5 HCA Presses, DOH Agrees, to Release FLSA Distribution Methods.......7 HCA Facilitates Process to Flag Live-In/24-Hour Payment Issues.......8 Nursing Home-to-Home Transition Targeted by HCA........................8 HCA Forming Pediatric Workgroup.....................................................9 Medicare Revised CoPs Sent to OMB..................................................9 MLTC Technology Demo Announced.................................................10 Managed Care Update.......................................................................11 Personal Care & CDPAP Provider Needed for Rockland County........12 NGS Updates: Hospice Payment & Service Intensity Add-On Issues......12 CMS Revised Guidance Limits Scope of Actions for Certain Claims......13 PHHPC Committee Posts Agenda......................................................14 Health Workforce Retraining Program Funding Announced............15 ePACES Adds a New Feature on June 1..............................................16 OSHA Rule: Recording, Reporting Occupational Injuries, Illnesses......16 Publications.............................................................................................................17

Helping New Yorkers Feel Right At Home

See F2F p. 4

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

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TOPS from p. 1 managed care plans reflect the full and necessary reimbursement to meet the cost of major new labor requirements, including minimum wage increases, wage parity, overtime/FLSA expenses, workers’ compensation coverage, and others. This legislation will assure accountability, transparency and expediency of adequate rates that cover wage costs to providers. In drafting this bill, to be introduced soon, HCA has engaged the Legislature to stand firm in support of full funding for minimum wage.

HCA won hard-fought funding for minimum wage in the state budget – and we continue to press for full funding and appropriate distribution of funds for the additional new labor mandates (see related p. 7 and 8 stories). The push for this new legislation will help ensure that the necessary rates and premiums to transmit these funds are appropriately and expeditiously set and passed through to providers and managed care plans.

HCA will provide members with key information on this priority bill upon formal introduction, as well as guidance for vital grassroots member advocacy to support and urge its passage.

This legislation tops a series of bills that HCA has developed and is positioning for consideration in the session.

Quality Innovation and Improvement through Home Care – S.7810 (Hannon) HCA has been pursuing an intensive agenda to promote health care quality innovation and improvement through home care. HCA has formulated and gained introduction of legislation, S.7810 by Senator Hannon, to provide home care agencies with support for quality initiatives that include: addressing priority areas of public health through home care (such as falls prevention, sepsis early recognition and intervention, pressure ulcer prevention); specialized training; application of new technologies; implementation of quality tools like the HCA Quality Measurement, Risk and Compliance Tool

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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(HQMT) including support for electronic interface; promoting use of clinical guidelines, pathways and evidenced based care; promoting collaboratives with physicians, hospitals, nursing homes, behavioral health providers; and others.

The elevation of home care’s quality innovation potential is a potential game-changer in the current environment of value based care, shared savings and quality focus.

circumstances. Reported results and data from HCA’s health payment and practices survey last summer provided further basis for development and legislative interest. HCA will provide further details upon introduction.

Home Health Information and Clinical Technology Act HCA has drafted, and advanced for introduction, legislation to provide critical support for home care health information and clinical technology. The legislation would provide for program, policy and financial support for health information technology (HIT) and health information exchange (HIE) in home care, and between home care and critical health care partners. The bill would be a major step in addressing and overcoming the long overdue need for investment in home care HIT/HIE, which is of a growing need given the evolving health care system and new, integrated models of care and coverage. HCA will provide further details upon introduction of this bill.

Homecare-Primary Care Initiative – S.7763 (Hannon) HCA has developed and gained introduction of legislation (S.7763/Hannon) to create a home care-primary care initiative. This initiative, developed with guidance from HCA’s MLTC Forum, would provide reimbursement to home care agencies and managed care plans to enable home care agencies to utilize nurse practitioners, working with patients’ physicians, in home care as a means of supporting vital access to primary care to the homebound and other home care patients.

The anticipated benefits are in early recognition and prevention, as well as in prevention of avoidable emergency room transport and visits, hospitalizations, institutionalization and other adverse medical events and costs. This innovation will further support quality and care management in innumerable ways.

Additional Legislation In addition to these new bills, HCA has written and advanced legislation that remain top priorities for the Association. These include: a bill we have developed with the State Medical Society to create collaborative home care-physician programs to address disparities in health care treatment and access; legislation to establish a veterans home and community based services pilot program; legislation to provide essential personnel status for home care and hospice personnel; legislation to modernize the state insurance coverage laws for home care; legislation for home carehousing; and other.

Prompt Pay, Fair Practices HCA has drafted and advanced for introduction legislation to kick start improvements on prompt pay and fair practices laws related to claims payment, authorizations and settlements. The legislation is based on wide input from the HCA membership on problems in the payment and authorization process and was triggered by interest from legislators who expressed support for solving problems in the care authorization and payment process.

HCA will provide additional details on these and all of the above as this next phase of the session takes off. HCA will also be monitoring, tracking and working to support or urge reevaluation of other bills which may be considered in this session’s process.

The legislation is intended to serve as a foundation for solutions to further hone the existing prompt-pay/fair practices statutes and applicable enforcement to home care 3

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That letter was led by New York Congressional Representatives Tom Reed and Paul Tonko, garnering over 70 signatures from their House colleagues. HCA has likewise written legislation complementing the HCA fixes recommended by Congress, and we’ve worked with NGS, the state’s Medicare Administrative Contractor, on education and training programs, all the while attempting to get NGS’s support for a standardized template that would, in the very least, ease the documentation process.

HCA’s initial notice about this webinar, on Wednesday, contained an incorrect time slot, and we later followed up with a correction after confirming the correct time from NGS. The correct time for the webinar is 10:00 a.m. to 11:30 a.m. Please take note of this correction and make sure your team is aware of it.

As HCA has extensively reported, federal contractors are initiating “probe-and-educate” audits as well as other documentation reviews for compliance with the Medicare face-to-face (F2F) requirements. Under this requirement, home health providers must procure documentation that the patient has had a F2F encounter with the physician within certain timetables and prior to billing for Medicare home health services.

The ongoing complications with F2F – coupled with the initiation of audits and medical reviews – are all the more reason why it is so important for NGS to provide additional education on the precise requirements.

The June 2 webinar will feature two speakers from NGS. These speakers will provide information and guidance to hospitals, home health agencies, and all providers about the shared responsibilities for referring Medicare beneficiaries to home health services. The purpose of this unique, joint initiative is to ensure that all involved – hospital discharging physicians, community physicians and home care providers – are aware of the collective responsibility to facilitate the documentation standards, and it is an important way to engage non-home-care providers about the needs for timely processing of needed paperwork for home care billing. NGS speakers include:

In the audit process, Medicare’s home care medical record reviews include substantiating documentation from both the referring provider(s) and the home care agency. If such a review shows home care eligibility criteria and medical necessity are not met or supporting documentation is missing, all claims associated with that patient’s home health episode of care are at risk for denial.

Since the inception of the F2F rule, HCA has been at the forefront of efforts to seek repeal of the requirement or, barring repeal, changes to the rule that would ease the duplicative and costly documentation mandate for home care providers. We’ve repeatedly engaged New York’s Congressional Delegation, which issued an HCA-prompted letter to the U.S. Centers for Medicare and Medicaid Services (CMS) sharing our recommendations to change the rule. Those recommendations would allow for the requirement to be documented on the existing plan-of-care, as opposed to a separate, duplicative and onerous process insisted by CMS.

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Lauri Domingo, R.N., Provider Outreach and Education, Home Health Clinical Consultant; and

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Shelly Bernardini R.N., B.S.N., C.P.H.M., Lead Home Health Clinical Consultant.

Online registration for this June 2 webinar is provided by NGS. Registrants are invited to e-mail their pre-webinar questions for speakers to HCA at pconole@hcanys.org before May 26. Please address these questions for the speakers so that we can compile them and forward them for answering by NGS. 4

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VBP from p. 1 You’ve read about VBP in HCA’s newsletter, observed the high-level discussions at the state-level VBP Roadmap meetings, and have probably scanned countless news articles and analyses from Washington thinktanks about this major structural change affecting home care and all providers at the state and federal levels.

VBP is BIG news, and all home care organizations need to learn as much as possible to get a handle on it: what it is, how it works and how to prepare.

On June 17, HCA is helping you cut through all this volume of information to find value in VBP constructs for your organization during a daylong education program specialized for home care.

This program is for members-only and is sure to fill up quickly, so we encourage you to register as soon as possible for this one-of-a-kind program in Nanuet, New York.

The day will include five segments exploring New York State’s VBP program for Medicaid; the federal landscape of VBP initiatives; clinical outcomes targets for VBP; insights to prepare your team for VBP; and VBP data and dashboards from leading consultants, technical experts and state government program leaders.

Please download our brochure at the link below to learn more information about the agenda, and be sure to register by completing the form on the last page of our brochure.

Cut Through the Volume: Learn What Value Based Payment Really Means for Your Organization June 17, 2016 Nanuet, NY The program brochure is at http://hca-nys.org/wp-content/uploads/2016/04/HCAVBPProgramBrochureJune172016.pdf.

DOH Announces Series of VBP Bootcamps This week the state Department of Health (DOH) announced it will be launching a new Value Based Payment (VBP) Bootcamps webpage which will provide schedules, outlines, and registration options for its VBP Bootcamp series.

The DOH VBP Bootcamps are learning sessions offered regionally to provide individuals from all health sectors with information necessary to participate in VBP arrangements and state payment reform efforts.

The first one will be held in the Capital Region beginning on June 2. There will be a live webcast available for those who cannot attend.

While these DOH sessions will help convey the state perspective on VBP, HCA’s June 17 VBP program in Nanuet (see related p. 1 story) will provide a home-care-specific angle while tying together the state’s initiatives in VBP with those occurring at the federal level as well. HCA encourages members to learn as much as possible about this major new payment architecture for home care and other services at both the state and national levels. Our June 17 program, for members only, is specifically geared for home care providers, while the state sessions are broader in scope.

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Continued from previous page The following is a list of dates for all of the upcoming state VBP Bootcamp sessions: Region 1: Capital Region, Mid-Hudson & Southern Tier Session 1: June 2 Session 2: June 15 Session 3: July 6 Region 2: Mohawk Valley, North Country & Tug Hill Seaway Session 1: June 29 Session 2: July 13 Session 3: July 27 Region 3: New York City (excluding Queens) Session 1: July 20 Session 2: August 17 Session 3: September 12 Region 4: Central, Finger Lakes & Western Session 1: August 31 Session 2: September 21 Session 3: October 6 Region 5: Long Island & Queens Session 1: September 27 Session 2: October 19 Session 3: October 26 Please visit the VBP Bootcamp website for more information at http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/vbp_bootcamp/index.htm Also, for more general information about VBP, please see DOH’s general VBP webpage: http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/vbp_reform.htm

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HCA Presses, DOH Agrees, to Release FLSA Distribution Methods HCA meeting nets critical updates on next steps This week, HCA met with numerous state Department of Health (DOH) officials to advocate for HCA members regarding the distribution of the funding intended to help home care agencies meet their new costs under the Fair Labor Standards Act (FLSA).

HCA raised several issues and concerns to DOH, including: home care providers not receiving monies from some of their contracted MLTC plans; providers not being informed of how the funds were distributed and thus unable to understand their allotments; providers receiving amounts that varied by plan from less than $.01 to over $0.50 per hour of aide services; having to document overtime, travel and other FLSA-related services by plan and the ensuing difficulties of doing so; and others.

HCA requested and DOH agreed to share the FLSA distribution methods used by each plan and, for those plans who have indicated so, the amounts they are giving to their home care providers. This will be useful in understanding how the amounts were calculated and if providers have not received what is due them.

On other issues raised by HCA, DOH reported that: 

It hopes to send the federal share of FLSA funding to MLTC plans by about July 9, and then plans will be required to distribute the monies to their home care contractors;

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There will not be a reconciliation process and home care providers need to contact their plans about the amounts they received;

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Plans that did not distribute the funds are subject to investigation by the Office of the Medicaid Inspector General (OMIG);

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DOH will include FLSA monies in plans’ April rates (for April 1, 2016 to March 31, 2017) which should be released in the fall. It will be up to providers and plans to negotiate distribution of the money to home care providers.

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The FLSA survey that HCA and other provider associations have worked on with DOH/ Mercer is expected to be released at the end of this month and it will be completed through the Health Commerce System or “survey monkey,” an online survey vendor;

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The results of the FLSA survey will be used to determine whether the FLSA add-ons to the April MLTC rates are accurate or need to be adjusted;

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The Fully Integrated Duals Advantage (FIDA) plans should receive their FLSA funds for the October 13, 2015 to March 31, 2016 period by the end of this month and will be expected to pass them through to their home care contractors; and

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The October rate package for mainstream Medicaid managed care plans should include FLSA monies (about $2 million).

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

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HCA Facilitates Provider Process to Flag Live-In, 24-Hour Care Payment Issues HCA has continuously raised with the state Department of Health (DOH) the issue that some MLTC plans are not paying at least 13 hours for live-in 24 hour care (sleep-in) cases, as required under DOH’s November 2014 policy.

That policy is at http://www.health.ny.gov/health_care/medicaid/redesign/mltc_policy_14-08.htm.

While DOH has agreed to follow up with these plans, members have confirmed that most of these plans are still not in compliance.

HCA raised this issue again at our meeting this week on the Fair Labor Standards Act. (See related p. 7 story.) DOH said that home care providers who face this situation should send the following data to MLTCTAC@health.ny.gov:   

Name of plan; Name of patient(s); and Time period that patient received live-in 24-hour care and the plan only paid for 12 hours.

If your agency decides to send this information, HCA reminds you to obtain the consent of the patient before releasing his or her name. HCA also asks that you send a general e-mail (without patient data) to Andrew Koski at akoski@hcanys.org to inform him that you have sent the DOH-requested information about live-in 24-hour care provided under contract with a particular MLTC plan.

Nursing Home-to-Home Transition Targeted by HCA HCA is working to map out the challenges and ways of supporting and improving the effective transition of nursing home patients to home.

Last week, HCA Executive Vice President Al Cardillo addressed this topic in a presentation to the statewide conference of the New York Medical Directors Association (MDA). HCA presented step-by-step details of the prospective discharge and transition to home care process, critical considerations for nursing home discharge planners and collaborating home care clinicians in creating a successful transition and post-discharge care plan, gaps and challenges, examples of best practices, and recommendations for potential improvements to support this process.

Health care transition is a major focal point in federal, state and health sector reform and new model initiatives. While often discussed at the broad programmatic and goal levels, the specific area of nursing home-to-home care transitions are not so frequently analyzed and dissected in details that reveal areas for needed support.

Yet, just two weeks ago, the U.S. Centers for Medicare and Medicaid Services announced new quality performance metrics for nursing homes that include successful transition to home as a key new metric.

As a follow-up to HCA’s recent work with the Medical Directors, HCA and the MDA will be working to develop a list of potentially joint recommendations to support nursing home-to-home care transitions for 8

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regulatory, policy and legislative areas. We will provide more information in the coming weeks; meanwhile HCA members are encouraged to share their challenges, best practices and recommendations with HCA on this vital area.

HCA Forming Pediatric Workgroup HCA is forming a workgroup on the care of children at home. This is a huge area of challenge and need, with growing concern particularly in the evolving system.

The workgroup will help hone an advocacy and education agenda by HCA to: 

Message what home care is currently (and further capable) of doing in the quality and costeffective care of children and their needs from prenatal and beyond, including well-child, acute and chronic medical, and long term care, including medically fragile and technology dependent children.

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Document the special needs and challenges to children, families and providers in pediatric home care, including the many aspects of pediatrics and pediatric services which both significantly differ from and are not accommodated by the traditional adult and geriatric system, or by the reforms and new models that are almost entirely oriented to non-pediatric populations.

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Determine advocacy, policy, program and education recommendations to address these needs and challenges, and to support and advance vital home care for children.

If your agency currently has a pediatric program or other pediatric expertise and you wish to serve on this workgroup, please e-mail Al Cardillo (acardillo@hcanys.org) or Alex Blais (ablais@hcanys.org).

Medicare Revised CoPs Sent to OMB This week, the final rule that would make revisions to the Medicare Home Health Conditions of Participation (CoPs) was sent to the Office of Management and Budget (OMB).

In October 2015, the U.S. Centers for Medicare and Medicaid Services (CMS) issued proposed changes to the Home Health CoPs that would be the first major changes since 1989.

These changes include several new requirements in the areas of quality improvement (requiring home health agencies to maintain a Quality Assessment and Performance Improvement, or QAPI, program); infection control measures; changes in the responsibilities and oversight for aide services; and extensive new changes, written policies, and notification and documentation requirements for assuring patient’s rights; among many other provisions governing the operation of virtually all home health agencies nationwide.

HCA submitted extensive comments, based on member feedback. While we expressed general support for CMS’s focus on patient-centered, data-driven, outcome-oriented process changes, we expressed concern in three areas: 1) the addition of new unfunded costs at the same time that CMS has 9

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implemented dramatic cuts; 2) the regulatory conflict between the proposed CoPs and CMS-approved waivers allowing states to enroll patients into managed care; and 3) the significant feasibility challenges and resource dislocation that these changes may cause for overstretched home care agencies.

Our comments are at http://www.hca-nys.org/documents/MedicareCoPsproposedcommentsDec2014.pdf.

HCA will keep members informed on the status of the final rule.

Managed Long Term Care Technology Demonstration Announced HCA continues efforts for home care technology funds The state Department of Health (DOH) has announced a Request for Applications (RFA) for $1 million in state funds for a 24-month MLTC Technology Demonstration. The RFA is for upstate, rural areas of New York.

The RFA is at http://www.health.ny.gov/funding/rfa/1604061136/index.htm.

Through the demonstration, MLTC plans will propose the use of various technologies to enhance community based long term care for participating MLTC plan enrollees. The primary goal is to determine if existing home and community based technologies – that are currently not covered under Medicaid – may contribute to allowing individuals to remain in the least restrictive setting as long as appropriate and to decrease unnecessary institutionalization.

The funds will be used for the purchase, lease, or rental of select emerging technologies. A limited portion of the funding may be designated for administrative costs (start up and consumer education), and collection of data required by DOH. The demonstration will provide opportunities to decrease safety risks in the home and increase enrollee independence.

Though the funds are for MLTC plans, home care providers may want to find out if the plans they contract with expect to apply for funding and, if so, how the provider can work with the plan on carrying out the demonstration.

The following must be included in the applications and can comprise partnership activities with home care: 1) develop outreach services to identify enrollees who could benefit from home and community based technologies; 2) develop a high quality system to match the most appropriate home and community based technology with each enrollee; and 3) provide consumer education and training for enrollees and caregivers on the assigned home and community based technologies.

An applicant must be a not-for-profit MLTC plan and have a minimum of six months experience in MLTC operation. DOH is seeking to fund a minimum of two Technology Demonstration projects in upstate, rural counties, with at least two MLTC plans.

Contractors will not be funded to demonstrate technology in the following counties: Kings, Queens, Bronx, New York, Richmond, Westchester, Suffolk and Nassau.

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Continued from previous page Mainstream Managed Care Organizations (MMCOs) and Fully Integrated Duals Advantage (FIDA) plans are not eligible to participate in this demonstration.

Applicants may choose to demonstrate a technology from the following four main categories: in-home monitoring; communication; telemedicine; and pill dispensing and reminding.

Approximately $1 million in state funds will be available for this demonstration, and the contract period is expected to be December 1, 2016 through November 30, 2018.

Letters of intent are optional and due May 17; questions are due May 24 and applications are due June 7.

Technology Funding for Home Care HCA has prioritized funding to meet the technology needs of home care agencies, which is particularly important as the state rolls out the Delivery System Reform Incentive Program (DSRIP) and new payment models. This week, HCA asked the Governor’s office to release grant funds to the home care community for technology purposes. HCA has also drafted a home care technology bill (the Home Health Information and Clinical Technology Act) and submitted it to the Senate for its review. (See related p. 1 story.)

HCA was instrumental in securing in this year’s final state budget a new infrastructure pool for home care and other community based providers. While our proposal called for significantly more money, the budget did include a $200 million infrastructure pool with at least $30 million dedicated to community-based providers.

As part of our core advocacy strategy, HCA will continue to press the vital importance of home care infrastructure and HIT support.

Managed Care Update This week, HCA participated in the state Department of Health’s (DOH) Managed Care Policy and Planning Meeting.

Some of the highlights include: 

There are 165,612 individuals enrolled MLTC plans. This includes: 148, 786 enrolled in partial capitated MLTC plans (April 1); 5,728 in Medicaid Advantage Plus plans (April 1); 5,547 in Programs of All-Inclusive Care for the Elderly (April 1); 5,490 in Fully Integrated Duals Advantage/FIDA (May 1); and 61 in FIDA for Individuals with Intellectual and Developmental Disabilities (May 1).

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DOH is moving forward with the operationalization of the Community First Choice Option (CFCO) program, which was approved on October 23, 2015, with a retroactive effective date of July 1, 2015. CFCO incorporates enhanced personal attendant services and supports into the

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Medicaid State Plan for eligible individuals who need help with everyday activities due to a physical, developmental or behavioral disability. 

An Administrative Directive Memorandum (ADM) was drafted to outline the scope and procedures of CFCO services. It has been shared with other state agencies and local departments of social services (LDSS) and will be revised based on their comments.

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Individuals who are eligible for CFCO will still have to enroll into an MLTC plan, but the program will be administered by the LDSS.

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DOH is having internal discussions on bringing CFCO benefits into MLTC plans.

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A letter to health plans was issued to provide guidance regarding the transition of non-dual Medicaid Managed Care (MMC) members interested in voluntarily enrolling into an MLTC plan. This letter is posted at http://www.health.ny.gov/health_care/medicaid/redesign/mrt90/2016-0509_mltc_mmc_letter.htm.

Personal Care and CDPAP Provider Needed for Rockland County The Rockland County Department of Social Services (DSS) is accepting new applications from public, notfor-profit, or proprietary agencies wishing to provide Personal Care and/or Consumer Directed Personal Assistance Program (CDPAP) services to Medicaid recipients in Rockland County. The personal care services would be for the period July 1, 2016 to December 31, 2020. CDPAP services would be for the period of August 1, 2016 to December 31, 2020.

An applicant may be an individual, a LHCSA, a CHHA, or any other entity that is legally qualified under New York State law to enter into a contractual relationship with a social services district to provide Personal Care and/or CDPAP. Proposals are due June 6 at 3 p.m. and are for four years. Those wishing to apply should send a request for application by e-mail as soon as possible to: Vanessa.Torres@dfa.state.ny.us or Colleen.Biavati@dfa.state.ny.us

NGS Provides Updates on Hospice Two Tier Payment and Service Intensity Add-On Payment New York’s Medicare Administrative Contractor (MAC), National Government Services (NGS), has recently posted an update on some unforeseen Medicare hospice claims processing issues that incorrectly allowed an overpayment of certain claims.

On January 1, 2016, the U.S. Centers for Medicare and Medicaid Services (CMS) transitioned to a two-tier routine home care (RHC) rate and added a service intensity add-on (SIA) payment which replaced the single RHC rate.

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Continued from previous page Below is a list of reported issues along with the latest update and/or outcome:

Reports, since it will be taken back when the issue is corrected and the claims are adjusted.

SIA Payment Issues

Two-Tier Payment Issue

Issue 1:

Issue 1:

In February, CMS reported that the Medicare claims processing system was allowing payment to all levels of care (revenue codes 0652, 0655 and 0656). This claims processing error was only occurring when both RHC and another level of service were reported on the same claim. This incorrect processing was issuing overpayments on some claims.

A reported issue is under review by CMS involving cases where there is more than one prior period of hospice service not separated by 60 days and the system is issuing an incorrect “RHC high” payment rate.

Outcome:

Outcome: A fix was installed in the system on February 22 to prevent the Medicare system from issuing an SIA payment on a level of service other than a RHC level of care. CMS instructed MACs to adjust all affected claims. The adjustments have been completed.

Issue 2: When the patient dies within the first seven days of a month, the Medicare system is designed to trigger an automatic adjustment of the prior month’s claim if that claim is eligible for the SIA payment. This adjustment will apply the SIA amounts to the previous claim that could not be identified in the initial processing. In limited circumstances, these adjustments are not occurring on the prior month’s claim as designed.

If CMS confirms that this is a system issue, it will announce any resolution in a future Medlearn Matters article and during an upcoming Home Health and Hospice Open Door Forum.

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

CMS Issues Revised Guidance Limiting Scope of Actions for Certain Claims The U.S. Centers for Medicare and Medicaid Services (CMS) this week updated Medlearn Matters (MLN) article SE 1521 regarding limits on the scope of review by Medicare Administrative Contractors (MACs) and Qualified Independent Contractors (QICs) for redeterminations and reconsiderations of certain Medicare claims received on or after April 18, 2016.

Outcome: NGS has received information that the issue is expected to be corrected in the July quarterly release.

After July 5, hospices can adjust their claims to ensure correct payment.

Special Note: Providers should not report system issue overpayments on their Quarterly Credit Balance 13

CMS had recently provided direction to MACs and QICs regarding the applicable scope of review for redeterminations and reconsiderations for certain claims. Generally, MACs and QICs have discretion while conducting appeals to develop new issues and review all aspects of coverage and payment related to a claim or line item. As a result, in some cases where the original denial reason is cured, this expanded review of

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

additional evidence or issues results in an unfavorable appeal decision for a different reason.

For redeterminations and reconsiderations of claims denied following a complex prepayment review, a complex post-payment review, or an automated post-payment review by a contractor, CMS has instructed MACs and QICs to limit their review to the reason(s) the claim or line item at issue was initially denied.

Prepayment reviews occur prior to Medicare payment, when a contractor conducts a review of the claim and/ or supporting documentation to make an initial determination. Post-payment review or audit refers to claims that were initially paid by Medicare and subsequently reopened and reviewed by a Zone Program Integrity Contractor (ZPIC), Recovery Auditor, MAC, or Comprehensive Error Rate Testing (CERT) contractor, and revised to deny coverage, change coding, or reduce payment. Complex reviews require a manual review of the supporting medical records to determine whether there is an improper payment. Automated reviews use claims data analysis to identify improper payments.

If an appeal involves a claim or line item denied on an automated pre-payment basis, MACs and QICs may continue to develop new issues and evidence at their discretion and may issue unfavorable decisions for reasons other than those specified in the initial determination.

Further information on this clarification can be found within MLN article SE 1521 at: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNMattersArticles/Downloads/SE1521.pdf.

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

PHHPC Committee Posts Agenda The agenda for the May 19 meeting of the Public Health and Health Planning Council (PHHPC) Committee on Establishment and Project Review was released this week.

It is at http://www.health.ny.gov/facilities/public_health_and_health_planning_council/meetings/201605-19/.

The agenda includes applications by seven LHCSAs for changes of ownership, but no new LHCSA applications.

The LHCSAs requesting changes of ownership serve Madison; Onondaga; Saratoga; Erie; New York City and Nassau; Queens, Long Island, Westchester, Putnam, Rockland, Orange and Ulster; and Staten Island.

We have heard and are seeking verification that the state Department of Health is concentrating its resources on going through the backlog of LHCSA licenses that are at the pre-opening survey stage and not scheduling new applications on the PHHPC agenda for new LHCSAs that are not at this stage.

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Volume 21, No. 19 May 13, 2016 

Health Workforce Retraining Program Funding Announced The state Department of Health (DOH) has announced funding under the Health Workforce Retraining Program, also known as the Health Workforce Retraining Initiative (HWRI).

The funding announcement is at https:// www.health.ny.gov/funding/rfa/1604261137/ index.htm.

This program supports the training and retraining of health industry workers with the skills necessary to obtain new positions, meet the new job requirements of existing positions, or otherwise meet the requirements of the changing public health and health care market and the diversity of the populations seeking health care services.

One of the areas identified for support includes development of home and community based long term care and the need for long term care workers caring for individuals wishing to remain in their homes and communities.

Up to $24.2 million is available over two years for projects to train health industry workers for positions with documented shortages of workers, and improve job security for health care workers who need new jobs and/or new skills due to changes in the health care system.

The initiative will reimburse home care agencies, hospitals, nursing homes, unions, trade organizations, educational institutions and other organizations for costs they incur while implementing a training program.

Trainees must be working in or laid-off from any organization that provides health care. To be eligible for training, trainees may do any clinical or nonclinical work for the health care provider that employs them. Physicians are excluded from training in this program.

Training must be designed to improve health workers’ job skills and lead to more secure or better paid 15

positions. Applicants must identify the need for training in at least one of the following areas: occupations with documented shortages; workers who have experienced or are likely to experience job loss; expanding educational capacity in shortage occupations; new job certification or licensing requirements; and emerging technologies. Consult the RFA for additional training objectives.

Applicants must also document: need for training; capability of the applicant to implement the project; collaboration among partners in the application; a strong training strategy; a clear and achievable work plan; and cost effective training outcomes.

Costs may include assessment of potential trainees, instruction, tuition, curriculum development, training supplies, training equipment, support services to trainees during training (such as mentoring, counseling, and transportation to training), and staff replacement during training.

Contract requirements may be fulfilled by subcontracting. Collaborations among participating organizations are encouraged.

It is expected that 125 to 150 individual project awards will be funded and that 15,000-35,000 workers will be trained with these funds. The contract terms are from November 1, 2016 to October 31, 2018 Grant applications will be processed through the New York State Grants Gateway at the Grants Gateway website.

All not-for-profit vendors subject to prequalification are required to prequalify prior to grant application and execution of contracts.

Applications are due June 27 by 4 p.m.

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ePACES Adds a New Feature on June 1 eMedNY is installing a new feature that will impact all ePACES users “in an effort to make user data more secure and to improve system performance.”

This new feature, commonly called CAPTCHA, is a program that can distinguish whether the user attempting to sign-on is a human or a computer.

Effective June 1, 2016: 

All users must use Internet Explorer (IE) version 10 or greater or alternative browsers including Google Chrome, Mozilla Firefox, or Apple Safari to access ePACES. ePACES access will be denied if you use IE versions 9 and below. Please coordinate with your IT department to upgrade your internet browser, if necessary, before the effective date.

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Users will be asked to verify that he/she is a person and not a computer by selecting specific images. After successfully verifying the correct images, he/she will be allowed to sign into the ePACES account. If incorrect images are selected, the user will be asked to verify another set of images correctly before being allowed access to ePACES.

To familiarize yourself with CAPTCHA, go to https://www.google.com/recaptcha/api2/demo.

Questions about ePACES can be directed to the eMedNY Call Center at 800-343-9000.

OSHA Releases Final Rule on Recording and Reporting Occupational Injuries and Illnesses This week, the U.S. Department of Labor (U.S. DOL) Occupational Safety and Health Administration (OSHA) issued a final rule to revise its Recording and Reporting Occupational Injuries and Illnesses regulation.

The rule is at https://www.gpo.gov/fdsys/pkg/FR-2016-05-12/pdf/2016-10443.pdf. U.S. DOL guidance materials are at http://www.osha.gov/recordkeeping/finalrule/index.html.

The final rule requires employers in certain industries to electronically submit to OSHA injury and illness data that employers are already required to keep under existing OSHA regulations. The frequency and content of these establishment-specific submissions is set out in the final rule and is dependent on the size and industry of the employer.

HCA has clarified with U.S. DOL that electronic submission does not apply to home health and inhome hospice services provided by agencies with between 20 and 249 employees. OSHA intends to post the data from these submissions on a publicly accessible website, but does not intend to post any information that could be used to identify individual employees.

The final rule provisions, applicable to all employers, also update requirements on how employers inform employees to report work-related injuries and illnesses to their employer. The final rule requires 16

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employers to inform employees of their right to report work-related injuries and illnesses free from retaliation; clarifies the existing implicit requirement that an employer’s procedure for reporting workrelated injuries and illnesses must be reasonable and not deter or discourage employees from reporting; and incorporates the existing statutory prohibition on retaliating against employees for reporting work-related injuries or illnesses.

In addition, the final rule amends OSHA’s existing recordkeeping regulation to clarify the rights of employees and their representatives to access the injury and illness records.

HCA will be analyzing the rule to further discern its effect on home care agencies and will inform members once we learn more.

Publications 

“Capitation and the Evolving Roles of Providers and Payers in New York,” by the United Hospital Fund http://www.uhfnyc.org/assets/1469

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“Medicaid Program Integrity: Improved Guidance Needed to Better Support Efforts to Screen Managed Care Providers,” by the Government Accountability Office http://www.gao.gov/assets/680/676768.pdf

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“Medicare Advantage: Fundamental Improvements Needed in CMS’s Effort to Recover Substantial Amounts of Improper Payments,” by the Government Accountability Office http://www.gao.gov/assets/680/676441.pdf

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“U.S. Department of Health and Human Services Met Many Requirements of the Improper Payments Information Act of 2002 but Did Not Fully Comply for Fiscal Year 2015,” by the Office of Inspector General http://oig.hhs.gov/oas/reports/region1/171652000.pdf

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“Medicare Advantage 2016 Spotlight: Enrollment Market Update,” by the Kaiser Family Foundation http://files.kff.org/attachment/Issue-Brief-Medicare-Advantage-2016-Spotlight-EnrollmentMarket-Update

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“Comparison of Long Term Care Costs in United States,” Genworth Financial https://www.genworth.com/about-us/industry-expertise/cost-of-care.html

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

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