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ASAP

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

Legislative Issues  Public Policy

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News

Volume 20, No. 22 June 5, 2015

HCA, Allied Groups Urge Congressional Delegation to Reject Extension of Medicare Sequestration Cuts HCA and a coalition of nearly a dozen health care provider groups this week joined forces to send a strong letter to New York’s Congressional Delegation urging their action to reject an extension of the Medicare sequestration cuts included in the Senate-passed trade package.

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“Extending Medicare sequestration reductions to pay for non-Medicare programs reinforces a dangerous

 With such a big focus on the intersection between technology, quality outcomes and payment, you will not want to miss HCA’s Technology Symposium on June 16 to See SEQUESTRATION p. 2 learn how you can plan strategically. Send us the registration form at the back of this week’s Inside ASAP ASAP or register online at http://tinyurl.com/oqqfn48 HCA, Allied Groups Act on Sequestration Cuts.................................1 HCA Meets DOH on Standard Managed Care Billing Codes..........3 Could Your LHCSA Use a Bit of Extra HCA Focus?............................3 Major Legislative Opportunities, Challenges in Session Wind Down...3 HCA Holds Executive Order 38 Webinar...........................................4 Transportation Management Services Start on Long Island.............5 Updated Managed Care Timeline Posted.........................................5 CHHA EPS Rebasing Produces Major Cuts in System.........................6 DOH Posts Personal Care & CHHA Cost Reports.............................7 ICD-10 Change Affects LHCSAs.........................................................8 Forum Held on Medicare Pay-for-Reporting......................................8 CMS Transmittal Details Corrected PPS Pricer Software....................9 CMS Issues Final Rules for Shared Savings Program.......................10 OIG’s Semiannual Report Released.................................................10 Managed Care Update on TBI, NHTD Enrollment...........................11 DOH Posts FAQs on SADC...............................................................12 DOH Affirms Policy for Loss of Records Due to Unforeseen Events......12 CMS Issues Quarterly Update of HCPCS Codes..............................13 NGS Updates....................................................................................14 Publications & Training.....................................................................14

Helping New Yorkers Feel Right At Home

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SEQUESTRATION from p. 1 precedent set last year of syphoning funds from the Medicare Trust Fund for non-Medicare purposes,” the letter states. “Such action will most certainly undermine the strength of the Trust Fund and the ability of hospitals, health systems, physicians, home care providers, nursing homes and other providers to deliver the care our communities need and deserve.” The letter can be read at http://hca-nys.org/wp-content/uploads/2015/06/ProviderSequestrationLetterJune2015.pdf. Joining HCA on the letter are: the Healthcare Association of New York State, the Greater New York Hospital Association, Suburban Hospital Alliance of New York State, Iroquois Healthcare Alliance, Rochester Regional Healthcare Alliance, LeadingAge New York, Continuing Care Leadership Coalition, Medical Society of the State of New York, and New York State Health Facilities Association. The sequestration payment cuts of 2 percent for Medicare, in effect since 2013, have worsened the financial condition of New York home health providers whose Medicare margins have been negative for 13 years in a row, compounded by the effect of federal rebasing reductions and other adverse reimbursement and regulatory actions. These actions imperil access to care and the overall sustainability of the Medicare program. HCA appreciates this collaborative effort of our allied associations and will keep the membership further informed of developments on the federal front and any advocacy needs related to this effort.

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 Laura Constable, Senior Director, Membership & Operations, lconstable@hcanys.org Lynda Schoonbeek, Director of Education, lschoonbeek@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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HCA Meets DOH on Standard Managed Care Billing Codes

Major Legislative Opportunities and Challenges in Session Wind Down

HCA met this week with the state Department of Health (DOH) and other provider associations on a requirement in this year’s state budget for standard billing codes applicable to home and communitybased services under managed care.

Major opportunities and challenges alike mark the next two, closing weeks of the State Legislative Session, scheduled to conclude June 17.

This change was long sought by HCA to simplify the claims processing for both home care agencies and managed care plans. Our meeting focused on some of the multiple codes used by plans for similar services, and DOH asked for further examples from association partners.

On the Web In an effort to keep ASAP shorter, HCA is posting some of our in-depth stories as web-only content, including the full version of this article. These articles are on the HCA Blog at http://hca-nys.org/blog.

Each association agreed to do so. HCA has already solicited some member feedback and invites you to provide any examples of codes used by managed care plans for paraprofessional and professional services. Please send these examples to Andrew Koski at akoski@hcanys.org by Friday, June 12.

In this wind down of the annual legislative calendar, the state Senate and Assembly will be considering significant issues that both directly and indirectly impact home and communitybased care, many with huge implications for this sector.

The group will meet again in a few weeks to discuss its findings and how to implement standard billing expeditiously. The budget provision states that it shall apply to “any coding of payment or claims for long term care on or after January 1, 2016.”

Could Your LHCSA Use a Bit of Extra HCA Focus?

The full array of possible home care-impacting bills from among the thousands introduced in the Legislature are too numerous to include in this report, and we have summarized some of the most significant legislative developments in the complete version of this article. (See link below.)

Part learning lab, part policy discussion, HCA’s Upstate LHCSA Forum, on June 24 in Utica, will offer you and your LHCSA peers an opportunity to get a little bit more of HCA focus on issues that matter most to you. HCA plans these Forums to set our sights on the specific needs of certain segments of our membership. If you are a LHCSA, then this program is for you, and we strongly urge your attendance.

Over the next two weeks, HCA will continue strenuously advocating on areas of both priority support and concern, while also working to effect the passage or the reconsideration of other bills of potential assistance or set-back to home and hospice care patients, agencies and plans ...

At the Forum, we’ll discuss state legislative developments, state regulatory changes, your LHCSA’s role in DSRIP and value based payments,

Read this complete story online at http://hca-nys.org/?p=1373 3

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and any unique local or marketplace issues affecting your program. Your participation is vital because it will feed directly into HCA’s advocacy agenda, our education planning and the flow of information to you. Best yet, the program is free of charge and you can use this opportunity to bring several members of your team for learning, discussion and strategic planning. CHHAs, LTHHCPs: Get Your LHCSA Contractors into the Loop HCA’s Forums are traditionally members-only; but for this program, we welcome our CHHA and LTHHCP members to invite any of their LHCSA contractors, including non-members, who might benefit from the discussion, which ultimately benefits your collaborative work. Simply forward this invitation to your partnering LHCSA’s main contacts and invite them to attend on June 24. Complete the registration form at the back of this week’s ASAP and tell us you are coming by e-mailing or faxing the form to HCA so we can plan for your attendance. Here are the location details: HCA’s Upstate LHCSA Forum June 24 10 a.m. to 12:30 p.m. Location: Homecare Services of Faxton St. Lukes Sogg’s Room Center for Rehabilitation and Continuing Care Services 1650 Champlin Ave. Utica, NY 13502

HCA Holds Executive Order 38 Webinar This week, HCA held a members-only webinar to provide updates on Executive Order (EO) 38. Frank Fanshawe, Counsel to HCA and Partner at Wilson, Elser, Moskowitz, Edelman & Dicker, LLP, covered the following issues: the June 29 deadline for submitting the Disclosure Report and any waivers; necessity of obtaining a Grants Gateway account; “covered provider” status; waiver procedures; definitions of administrative and program expenses and limits on administrative costs; limits on executive compensation; compensation surveys; penalties for failing to submit disclosure form and/or for not complying with EO 38 requirements; and pending court cases. Several questions were raised during the program including: any need for Nassau County providers to file a disclosure form, given the court decision affecting the applicability of EO 38 in that county; how proprietary agencies are affected by the requirement that an agency’s governing body (which must include two independent directors or voting members) must approve salaries exceeding the executive compensation limits; documents needed to substantiate the work of executives involving program services; treatment of quality assurance activities and submission of assessment forms as administrative or program services; and others. Since EO 38 was developed, HCA has provided written comments; met with Administration officials to express our concerns; joined in one lawsuit; and provided many education programs. HCA is also examining how the definition of administrative expenses can encompass more activities conducted by members, including activities 4

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related to the Delivery System Reform Incentive Payment (DSRIP) program and other changes in the delivery of health care services.

Updated Managed Care Timeline Posted

HCA advises members to review the materials posted at http://executiveorder38.ny.gov/ and to consult with their own legal staff about the ramifications of EO 38 on their operations.

The state Department of Health (DOH) has posted an updated timeline of the transition of populations and benefits into Mainstream Medicaid Managed Care plans for “Medicaid-only” recipients.

HCA will keep members informed of any new developments with EO 38. For more information, contact HCA Policy staff.

Transportation Management Services Start on Long Island

It is at http://www.health.ny.gov/ health_care/medicaid/redesign/docs/ mrt1458_timeline.xls.

LogistiCare will begin managing Medicaid transportation services on Long Island starting in July. This is the last region of the state to implement the management change.

Some important proposed dates include:

LogistiCare and the state Department of Health (DOH) will reach out to, and collaborate with, health care and transportation providers and county officials on the roll out. Within a few months of implementation, DOH will transition Medicaid Managed Care enrollees to the fee-for-service transportation management. Other regions operating under a Medicaid transportation management contract are: •

Hudson Valley Region, which covers 24 counties, managed by Medical Answering Services (MAS);

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New York City Region, covering all 5 boroughs, managed by LogistiCare Solutions;

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Finger Lakes and Northern New York Regions, covering 24 counties, managed by MAS; and

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Western New York Region, covering 7 counties, managed by MAS.

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January 2016: Nursing Home Transition and Diversion waiver recipients

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April 2016: Traumatic Brain Injury recipients

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December 2016: Assisted Living Program residents and benefits

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January 2017: Care at Home Waivers 1,2,3,4 and 6 population

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December 2017: Medicaid “spend-down” recipients

Individuals who are receiving hospice services when they apply for Medicaid will remain in Medicaid fee-for-service (FFS) and Early Intervention services will also remain in Medicaid FFS.

For questions, call the Medicaid Transportation Unit at (518) 473-2160. 5

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CHHA EPS Rebasing Produces Major Cuts in System The state Department of Health’s (DOH) rebasing of the Certified Home Health Agency (CHHA) Episodic Payment System (EPS) is carrying a potential of major cuts to the state’s home care system. CHHA Medicaid rebasing, authorized by the underlying Medicaid Redesign Team initiative passed in 2011, is being administratively carried out by DOH. While some savings from rebasing were assumed in the state fiscal plan, the full reduction potential of rebasing is more than twice the amount reflected in the approved state budget. This week, DOH invited HCA and representatives from Leading Age New York and the New York State Association of Health Care Providers (HCP) to discuss the Department’s current activity and plans for implementation of rebasing. The following are highlights from the meeting: •

DOH began the meeting by showing HCA and others the CHHA EPS claims data for 2013, in which the total statewide amount reimbursed to CHHAs from EPS (not including Low Utilization Payment Adjustments, or “LUPAs”) was $334 million, while DOH estimates the actual service costs for those episodes of care to be $214.5 million (using 2011 rates).

• DOH reported that the Division of Budget (DOB) has approved DOH’s plan to impose a statewide interim CHHA EPS payment reduction of 12 percent to the current CHHA EPS (Base Year 2009), which DOH believes will achieve an estimated annual statewide savings of approximately $30 million. DOH will be forwarding this payment reduction to the Office of Health Insurance Programs eMedNY system and CHHAs can expect to see this retrospective rate reduction (effective April 1, 2015) in their remittance advices towards the end of this month or early July. • The interim CHHA EPS payment reduction of 12 percent applies to CHHA EPS Rate 6

Codes 4810 to 4920, and will not include any adjustment to the rates for pediatric patients, whose services will continue to be reimbursed on a historical fee-for-service per-unit basis. The reduction will also not apply to any CHHA EPS LUPAs as well as any excess outlier payment. • DOH is in the process of completing its full rebasing initiative using CHHA EPS claims data and OASIS assessment data from 2013 as the new base year. DOH’s full rebasing initiative is scheduled to go into effect on a prospective basis beginning October 1, 2015. • DOH staff stated that the Department’s senior management still needs to sign off on the completed full CHHA EPS rebasing initiative and then it will be sent to DOB for its approval. Once DOB gives approval, DOH will issue a Dear Administrator Letter (DAL) that includes detailed instructions for CHHAs and their software vendors to use in updating the CHHA’s EPS billing software. DOH hopes to have this information available to CHHAs this summer. • DOH’s full rebasing initiative includes a significant reduction to the CHHA EPS base rate, lowering it from the current $5,633 to the new base rate of $3,629. DOH’s rebasing efforts will require CHHAs to make changes to their Medicaid grouper software, outlier thresholds and LUPA payment units while incorporating the 108 new case-mix indices. • DOH stated that its full rebasing initiative, when implemented, will result in an estimated statewide 28 percent reduction to the current CHHA EPS, which, if See REBASING p. 15

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DOH Posts 2014 Personal Care & CHHA Cost Reports The state Department of Health (DOH) recently posted the 2014 cost reports for personal care and Certified Home Health Agency (CHHA) providers on the Health Commerce System (HCS). Personal care The personal care cost report software will be used to determine the 2016 rates. Please note the following cost report instruction: •

Part II Statistics – only directly billed Medicaid hours through a local district contract should be reported in the “Medicaid” column. All hours billed to a third party, including those billed to managed long term care plans for Medicaid patients, should be reported in the “Other” column.

The cost report must be electronically filed by September 15, 2015. The operator’s certificate and accountant’s opinion is also due September 15, 2015. Late cost reports/certifications could result in a two percent rate reduction. New personal care providers who opened in 2014 (and, therefore, do not have actual 2014 costs and statistics for the entire year) must still report their budgeted costs and estimated statistics. To certify your cost report electronically, the CPA and agency signatory must each have an HCS account. For both the operator and CPA certifications, a current “Electronic Certification Access Request Form” must be on file with the Department. If a form was submitted for the 2013 Cost Report and the same individuals are providing the certifications in 2014, a new form is not required. If one or both of the certifiers have changed, a new form must be completed (once the agency and CPA accounts are established). For questions, providers can contact the helpline at 1-866-529-1890. Specific questions regarding the personal care cost report should be directed to DOH’s Kathy Omecinsky at (518) 473-4421. CHHA cost report DOH’s posting of the 2014 non-hospital-based CHHA cost report software this week follows a posting two weeks ago of the 2013 Long Term Home Health Care Program report. The CHHA cost report, operator’s certification and accountant’s certification are due August 15, 2015. An accompanying Dear Administrator Letter (DAL) emphasizes that the inclusion of non-CHHA data in the cost report (in particular, LTHHCP costs) is inconsistent with the declaration made in the operator’s certification that the included costs are “incurred to provide patient care service in the CHHA and that the costs shown as attributable to the CHHA are not a duplication of costs reported for use in the calculation of reimbursement rates for other programs.” Thus, CHHAs should not include LTHHCP costs or other non-CHHA costs in the report. Please note the following change: •

General Information Page 1 – Providers must enter the Begin Date and End Date of the period covered by the report (lines 015 and 016). If your agency’s Medicaid operating certificate was in effect on or 7

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before January 1, 2014, and remained in effect through December 31, 2014, please enter beginning and ending dates of January 1, 2014 and December 31, 2014, respectively. If your agency’s operating certificate was effective after January 1, 2014, please enter the effective date as the Begin Date. If the operating certificate was discontinued during 2014, due to closure or sale of the agency, please enter the last date it was in effect as the End Date. For questions, contact the helpline at 1-866-529-1890. Specific questions regarding the CHHA cost report should be directed to DOH’s Charles Toby or Tim Casey at (518) 473-4421. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

ICD-10 Change Affects LHCSAs Preparation necessary While much of the education on ICD-10 diagnosis codes has focused on Certified Home Health Agencies (CHHAs), HCA advises Licensed Home Care Services Agencies (LHCSAs) to also examine the impact of this change on their operations. LHCSAs should reach out to their contracted managed care plans to ensure that they are given the new diagnosis codes; otherwise, the LHCSAs face non-payment of claims if they continue to use ICD-9 codes for services starting October 1, 2015. LHCSAs should also determine if they will be receiving new authorizations, as well as the corresponding ICD-10 diagnosis codes, for services that continue past September 30 or if the home care providers are expected to use their existing authorization and obtain the new ICD-10 diagnosis code from the plan. HCA is contacting some managed care plans to determine how they are adapting to this change and plans to hold a program on July 21 with health plans on their activities and what actions their contracted home care providers need to take to ensure payment past September 30. Information geared to CHHAs on the ICD-10 transition is at https://www.emedny.org/icd/index.aspx and http://www.cms.gov/Medicare/coding/ICD10/index.html. For additional information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.

Forum Held on New Medicare Pay-for-Reporting Requirement This week, the U.S. Centers for Medicare and Medicaid Services (CMS) held an Open Door Forum on the new Medicare Pay-for-Reporting Requirement that was part of the 2015 Home Health Prospective Payment System (PPS) final rule. Slides and additional information are at https://www.cms.gov/Medicare/Quality-Initiatives-PatientAssessment-Instruments/HomeHealthQualityInits/Home-Health-Quality-Reporting-Requirements.html. While home health agencies have been required to submit Outcome and Assessment Information Set (OASIS) quality data for their patients, the quantity of OASIS assessments had never been established. Under the 2015 8

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PPS rule, however, CMS imposed a 70 percent compliance standard score for OASIS submissions for 2017, which will increase to 80 percent in 2018 and to 90 percent in 2019 and subsequent years. The first 12-month reporting period for the new Quality Assessments Only (QAO) measure runs from July 1, 2015 to June 30, 2016 and will affect an agency’s annual payment update for 2017. Agencies that don’t meet the requirement will have their payment update reduced by two percentage points. Each agency will be expected to submit a minimum set of two “matching” assessments for each patient admitted to their agency. This would ideally consist of a Start of Care (SOC) or Resumption of Care (ROC) assessment and a matching End of Care (EOC) assessment. However, there are several scenarios that could meet this “matching assessment requirement.” CMS’s materials list seven examples and CMS will use a formula to determine compliance for payment. (Please see the slides for details.) Your agency’s 2013-14 Historical Performance Report will be available in late June 2015 (in your CASPER folders). It will show how the QAO metric is calculated and the percentage of quality assessments submitted during the 2013-14 performance period. This report is for informational purposes only and will not affect the annual performance computation for 2014-15 or for 2015-16. Questions can be directed to hhapureconsiderations@cms.hhs.gov.

CMS Transmittal Details Corrected PPS Pricer Software The U.S. Centers for Medicare and Medicaid Services (CMS) recently released Transmittal 3268 (http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3268CP.pdf ) which instructs the Medicare claims processing contractor on several changes planned for the home health Pricer software. The new software updates will allow processing of bill type 032Q or 033Q, as required by Change Request 8581 (http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3219CP.pdf ), related to automatic claim re-openings. It also corrects errors affecting the payments on 2015 claims. The Pricer software currently contains the following two payment errors: •

It uses a table with incorrect case-mix weights for all Health Insurance Prospective Payment System (HIPPS) codes beginning with 4. The weights for all codes beginning with 4 are using the weight for the corresponding code that begins with 2 (e.g., a claim submitted with HIPPS code 4AFKS is being paid using the weight for 2AFKS).

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There is an error with HIPPS codes beginning with 1 or 2 that are submitted with 20 or more therapy visits and must be re-coded to a HIPPS code beginning with 5. If the clinical severity value encoded in the treatment authorization code was a D, the claim is re-coded into a higher case-mix group in error.

Transmittal 3268 corrects the weight table and the re-coding logic. It also instructs the Medicare Administrative Contractors (MACs) to adjust claims to correct payments. The implementation date for the changes is October 5, 2015. The contractors must complete all the adjustments within 60 days after the implementation date. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org. 9

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CMS Issues Final Rules for Medicare Shared Savings Program This week, the U.S. Centers for Medicare and Medicaid Services (CMS) released a final rule updating the Medicare Shared Savings Program to “encourage the delivery of high-quality care for Medicare beneficiaries and build on the early successes of the program and of the Pioneer Accountable Care Organization (ACO) Model.” The final rule: •

Creates a new Track 3, based on some of the successful features of the Pioneer ACO Model, which includes higher rates of shared savings, the prospective assignment of beneficiaries, and the opportunity to use new care coordination tools;

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Streamlines the data sharing between CMS and ACOs;

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Establishes a waiver of the 3-day-stay Skilled Nursing Facility (SNF) rule for beneficiaries that are prospectively assigned to ACOs under Track 3; and

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Refines the policies for resetting ACO benchmarks to help ensure that the program continues to provide strong incentives for ACOs to improve patient care and generate cost savings, and announces CMS’s intent to propose further improvements to the benchmarking methodology later this year.

According to the Visiting Nurse Associations of America, the proposed regulation included certain potential program changes of interest to home-based care providers, including a waiver of the homebound status requirement for beneficiaries in certain ACOs. That change, however, was not incorporated into the final rule. Over 400 ACOs are participating in the Medicare Shared Savings Program, serving about 7 million beneficiaries. More information is at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ sharedsavingsprogram/index.html and http://www.cms.gov/Newsroom/MediaReleaseDatabase/Factsheets/2015-Fact-sheets-items/2015-06-04.html.

OIG’s Semiannual Report Released The U.S. Office of the Inspector General (OIG) has released its semiannual report for the 6-month period that ended March 31, 2015. The report is at http://oig.hhs.gov/reports-and-publications/archives/semiannual/2015/sar-spring15.pdf. It summarizes: OIG’s reports issued during this period; recently completed actions and settlements in home health, personal care, hospice, quality of care, electronic health records, etc.; and program exclusions, suspensions and debarments. Some of the topics covered in the reports include: provision of hospice care in Assisted Living Facilities; federal Medicaid reimbursement for Office for People With Developmental Disabilities (OPWDD) waiver program services; provision of continuous 24-hour personal care services; New York’s Medicaid expenditures for durable medical equipment; and CMS oversight of Medicare contractor performance. 10

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Managed Care Update on TBI, NHTD Enrollment The Alliance of TBI and NHTD Waiver Providers held a conference this week which provided updates on the transition to managed care for individuals receiving services under the Traumatic Brain Injury (TBI) and Nursing Home Transition and Diversion (NHTD) waiver programs. The following information is based on a presentation by the state Department of Health (DOH). •

•

About 5,000 TBI and NHTD individuals will be affected by the transition to Mainstream Medicaid Managed Care (MMMC) for “Medicaid-only” recipients and to managed long term care (MLTC) for those dually eligible for Medicare and Medicaid. The current timetable, subject to federal approval, is that voluntary managed care enrollment for NTHD will start in January 2016 followed by mandatory enrollment in March 2016, while voluntary enrollment for TBI will start in April 2016 and mandatory enrollment in June 2016. During voluntary enrollment, individuals are encouraged to select a managed care plan; if they don’t do so within the allotted time period, they are then autoenrolled. For both populations, DOH will send an initial notification letter, 60-day and then 30-day notices. The state currently intends to transition the entire TBI/NHTD populations at the same time and not by region or county.

•

DOH intends to post a transition plan for public comment in mid-June.

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Like current practice, the Conflict-Free Evaluation and Enrollment Center (CFEEC) will have to do an assessment for individuals new to receiving long term care services. Individuals who are currently receiving TBI or NHTD services won’t have to

undergo a CFEEC assessment but will undergo an assessment by the plan. •

Most of the current waiver services for TBI and NHTD will be part of the managed care benefit package, except for service coordination, community transitional services and home care visits by physicians. DOH stated that service coordination won’t be a covered benefit because the managed care plans are responsible for care management (which is similar to service coordination). At this week’s conference, there was much discussion about the effect of the plans not covering service coordination.

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DOH encouraged current providers of service coordination to reach out to managed care plans if they want to provide care management (and other waiver services) for their patients who transition to managed care.

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As with other populations that transitioned to managed care, plans will have to continue the current services received by TBI and NHTD patients for 90 days at the current provider rate. After 90 days, the managed care plan can change the services (based on an assessment), at which point use of the existing service provider and payment amounts are open to contract negotiation.

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Any housing subsidies received by current TBI and NHTD recipients will continue when they enroll into a managed care plan, but such subsidies will not be available to new applicants because it is not a waiver service.

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The regional resource development centers (RRDCs) are funded through June 2016, but DOH indicated that at some point there will be no need for them.

Participants at the conference expressed many concerns about enrolling this population into managed care due to their 11

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multiple needs. Concerns were also raised about the extent to which plans will authorize waiver services, and how providers can continue to provide such services. For additional information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.

DOH Posts FAQs on SADC The state Department of Health (DOH) has posted Frequently Asked Questions (FAQs) about a certification process for Social Adult Day Care (SADC) programs. The FAQs are at http://www.health.ny.gov/health_care/medicaid/redesign/docs/sadc_certification_faq_201505-29.pdf. The FAQs cover: annual site inspections; incorrect certifications; self-evaluation form; certificate of occupancy; and other topics. They clarify that the certification does not apply to Adult Day Health Care programs. Under a new policy, issued on May 8, SADC programs that are currently contracting with a Managed Long Term Care (MLTC) plan or want to do so must undergo a new certification process. Certification must be completed for each existing site by June 30, 2015. New sites may certify at any time. The certification must be completed electronically at www.omig.ny.gov/sadc-certification. A printed copy of the confirmation document must be kept as proof of completion. Certifications must be completed on an annual basis, twelve months from a prior certification. Additional information is at http://www.health.ny.gov/health_care/medicaid/redesign/mrt_90.htm. See MLTC Policy 15.01(a).

DOH Outlines Policy for Loss of Records Due to Unforeseen Events New DOH guidance supersedes the December 2012 Medicaid Update article In its May 2015 Medicaid Update (http://www.health.ny.gov/health_care/medicaid/program/update/2015/ may15_mu.pdf ), the state Department of Health (DOH) cites federal law and state regulations requiring all Medicaid providers to maintain records necessary to fully disclose the extent of services, care, and supplies provided to Medicaid enrollees. Under Title 18 of the New York Codes Rules and Regulations at Section 504.3, providers, by enrolling, agree to: prepare and maintain contemporaneous records demonstrating their right to receive payment under the Medicaid program; and to keep, for a period of six years from the date the care/services/supplies are furnished, all records necessary to disclose the nature and extent of services and all information regarding claims for payment submitted by, or on behalf of, the provider and to furnish such records and information, upon request. Other record-keeping requirements are in the Provider Policy Manuals at https://www.emedny.org/ ProviderManuals/index.aspx Providers whose records are unexpectedly damaged, lost, or destroyed are required to notify, immediately upon discovery of the loss, the Self-Disclosure Unit of the state Office of the Medicaid Inspector General/ OMIG. (They should also inform their counsel.) This notification must include: specific details of the event 12

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causing the loss, destruction or damage to records; the type of records; the date(s) of service; documents/ photographs substantiating damaged records; and any efforts made to remediate/mitigate the damaged records. Other evidence of loss (e.g., police reports) must accompany the self-reporting notification. Providers must also notify any other state or local regulatory agency such as their DOH Regional Office. Lastly, in the event of an audit for the time period, OMIG will evaluate, on a case-by-case basis, whether there are mitigating circumstances for missing or damaged documents. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

CMS Issues Quarterly Update of HCPCS Codes The U.S. Centers for Medicare and Medicaid Services (CMS) recently issued Transmittal 3269 (http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3269CP.pdf ) which provides the quarterly update to the list of Healthcare Common Procedure Coding System (HCPCS) codes used by Medicare systems to enforce consolidated billing of home health services. CMS also updates the home health consolidated billing code lists annually, to reflect the annual changes to the HCPCS code set itself. Additional updates may occur as frequently as quarterly. The new coding identified in each update describes the same services that were used to determine the applicable Home Health Prospective Payment System (HHPPS) payment rates. No additional services will be added by these updates. This recurring update notification provides quarterly home health consolidated billing updates effective October 1, 2015. The following HCPCS code is added to the home health consolidated billing non-routine supply code list in this update: •

A7048 – Vacuum drainage collection unit and tubing kit, including all supplies needed for collection unit change, for use with implanted catheter. This code replaces HCPCS code A7043, which is deleted from the code list.

The following HCPCS codes are added to the consolidated billing therapy code list: •

97607 – Negative pressure wound therapy (e.g., vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters.

•

97608 – Negative pressure wound therapy (e.g., vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters.

These codes replace HCPCS codes G0456 and G0457 which are deleted from the home health consolidated billing therapy code list. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org. 13

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

Volume 20, No. 22 June 5, 2015 

NGS Updates National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), has recently posted the following information to its website. •

How to Prevent Revalidation Processing Delays – One way to prevent a very common delay in your revalidation is for providers to ensure that they meet the name matching requirements before submitting an application. For details, visit the “Prevent Revalidation Processing Delays” section of NGS’s website at www.ngsmedicare.com.

•

MAC Satisfaction Survey – NGS will be sending e-mail updates with a satisfaction survey link, available beginning June 15. The survey takes 10 minutes to complete and allows you to share experiences with the services NGS provides.

•

Enterprise Identity Management Transition for Provider Statistical and Reimbursement Reports (PS&R) – Beginning June 13, the existing system for controlling access to the PS&R application hosted by the U.S. Centers for Medicare and Medicaid Services (CMS) will be replaced by Enterprise Identity Management (EIDM). At that time, individuals will be unable to create new “Individuals Authorized Access to CMS Computer Systems” (IACS) accounts for accessing PS&R. Changes to existing IACS accounts will be allowed but none of these changes will be carried over to the new EIDM accounts. Also, access to PS&R will continue to be available using existing IACS accounts.

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

Publications •

“Medicaid: Additional Actions Needed to Help Improve Provider and Beneficiary Fraud Controls,” by the Government Accountability Office http://www.gao.gov/assets/680/670208.pdf

•

“Medicare Administrative Contractors: CMS Should Consider Whether Alternative Approaches Could Enhance Contractor Performance,” by the Government Accountability Office http://www.gao.gov/assets/670/669945.pdf

•

“FIDA Demo Starts in NYC and Nassau County but delayed in Suffolk & Westchester – Updated Enrollment Numbers,” by the New York Legal Assistance Group http://www.wnylc.com/health/news/33/

Training •

“Home Health Change of Care Notice (HHCCN) and Advance Beneficiary Notice of Noncoverage (ABN) Web-Based Training,” by the U.S. Centers for Medicare and Medicaid Services http://tinyurl.com/q5yzanb

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

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

Volume 20, No. 22 June 5, 2015 

REBASING ontinued from p. 6 accurate, would result in approximately $70 million fewer dollars in the CHHA EPS. DOH did note, however, that the actual individual percent reduction will vary amongst CHHAs depending on the patients they serve and case-mix indices used. HCA stressed the overall impact of a potential 30 percent reduction in the payment system on already fragile agencies, including subcontracting Licensed Home Care Services Agencies who would also be affected by the cut. HCA noted the conflict between the reduction and the state’s current new models and priority policies, virtually all of which center on home care. HCA also stressed that while the state budget included over $2 billion in new capital funds for hospitals, essentially no new investment has been provided for home care. HCA is working to formulate a multi-tiered advocacy strategy to mitigate the proposal, including a possible legislative remedy, and will keep members closely apprised of these efforts.

UPSTATE LHCSA FORUM Please join your LHCSA colleagues, HCA staff and Board Members for this exchange of valuable information, advocacy concerns and recommendations for action. Some of the vital issues to be covered include: • State legislative developments • DOH regulatory changes • DSRIP and value based payment • Issues in your region

June 24, 2015 10:00am – 12:30pm Location:

Homecare Services of Faxton St. Lukes Sogg’s Room Center for Rehabilitation and Continuing Care Services 1650 Champlin Ave. Utica, NY 13502

Registration ____________________________________________________ Name ____________________________________________________ Title ____________________________________________________ Agency

This forum is for HCA Members Only. If you are not currently a member of HCA, but would like to become one, please contact Laura Constable, Director of Membership at (518) 426-8764.

____________________________________________________ Address ____________________________________________________ City/State/Zip ____________________________________________________ Phone/Ext. ____________________________________________________ Email (Required) Second Registrant from same organization:

There is no fee for this program.

____________________________________________________ Name ____________________________________________________ Title