August 21, 2015 Edition of ASAP

ASAP

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

Legislative Issues  Public Policy



News

Volume 20, No. 29 August 21, 2015

CMS Posts, Seeks Comments on Proposed F2F Clinical Template Proposed template offers little relief from F2F burden, as home care provider legislative, regulatory and legal advocacy continues The U.S. Centers for Medicare and Medicaid Services (CMS) has posted a proposed clinical template for physicians to complete in order to satisfy the documentation of the Medicare home health face-to-face (F2F) requirement. (See http://tinyurl.com/nntdvxq.)

Comments on CMS’s proposed template are due October 13 as part of the Office of Management and Budget approval process.

Important Alerts Since Our Last ASAP: Did You See Them?

The template, if approved, would be voluntary. Using a series of blanks and checkboxes, the form attempts to guide the certifying physician through the required elements of the F2F mandate.

Since our last edition of ASAP on August 7, HCA sent you a series of important e-mail alerts on everything from CHHA Medicaid rebasing to the coming deadline for wage parity certifications and a new state policy document on fiscal intermediary services.

However, as with previous iterations of the template presented during calls and other venues, this latest version, though voluntary, does not offer adequate ease of use, and it merely presents the same administrative burden, complexity and confusion for physicians and home care providers that otherwise attend the F2F requirement.

The alerts went straight to your inbox, but this article offers a quick summary, with links to the full alerts for more information.

By the way, all HCA alerts are posted to our website at http://hca-nys.org/category/member-alerts, but See ALERTS p. 3

See TEMPLATE p. 2

Inside ASAP CMS Posts, Seeks Comments on F2F Clinical Template.......................1 Important Alerts Since Our Last ASAP..................................................1

Reminder: HCA is publishing ASAP every other week for the summer. We are not publishing on Aug. 28 but will publish again on Sept. 4, resuming our weekly publication schedule.

Companionship Exemption Lawsuit Decision Issued........................3 Member Hiring Announcement.............................................................4 HCA Presses QIVAPP Concerns, Recommendations............................4 Hotel Deadline Extended for Financial Manager’s Retreat..................5 HCA to Hold Free Sept. 1 Call on Major Policy Developments............6 State Gives Progress News on QIVAPP, FIDA & MLTC..........................6 RFA Re-Opened for Capital Restructuring, and Other DSRIP News.....7 DOH Releases April 2015 Global Cap Report......................................9 Fed DOL Issues Guidelines on Independent Contractors..................10 PCA Protocols Posted with Revised Date...........................................10 Resources for Partnerships with Health Care Sector..........................11 CDPAP for Rockland County................................................................11 NGS Updates................................................................................11 Publications....................................................................12

Helping New Yorkers Feel Right At Home

Volume 20, No. 29 August 21, 2015

ASAP – a publication of the Home Care Association of New York State TEMPLATE from p. 1



earlier decision to eliminate the narrative component of F2F – was advanced, in part, to respond to the home care community’s concerns. And yet, neither response from CMS comes near to approaching the degree of streamlining that is needed. In a more substantive attempt at streamlining the process, HCA has pushed for legislation and/or policy changes that would allow for satisfaction of F2F through a simple addendum to the plan of care, or 485 documentation.

In a recent article on its website, the National Association for Home Care and Hospice (NAHC) remarks that“although CMS eliminated the narrative from the F2F encounter regulation” – which had previously required physicians to craft a detailed narrative of the need and eligibility for home health services – “the template format essentially adds [the narrative] back into the process for physicians certifying home health patients.” This is due to the fact that the checkboxes on the template “relate primarily to the physician’s physical assessment of the patient” and do not provide a streamlined avenue for documenting skilled service need and homebound status, a core feature of the F2F requirement.

At the regional level, HCA is in talks with the Medicare Administrative Contractor for our district, National Government Services, on our own version of a concise physician template that would ease the burden on home care providers and physicians while satisfying the underlying requirements of F2F. We are also engaged with partners at NAHC and the Visiting Nurse Associations of America (VNAA) on legislative relief proposals, previously reported to the membership; and NAHC has specifically pursued legal action, still pending in the courts, to prod additional reforms and reconciliation of past claim denials.

NAHC also points out that language on the template appears to require acute/post-acute physicians to “identify the community physician who will be taking care of the patient” post-discharge, regardless of whether the acute/post-acute physician discharging the patient will serve as the certifying physician for F2F purposes, which may not be the case.

HCA will continue to keep you informed of these critical developments in the process.

Relief from the F2F mandate has been an ongoing focus point of HCA state and national advocacy.

The proposed clinical template – along with CMS’s

For more information, please contact a member of the HCA Policy staff.

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 Alexandria 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

2

Volume 20, No. 29 August 21, 2015

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



ALERTS from p. 1 you must be logged in to see them. If you need a website password, please email HCA’s Communications Director Roger Noyes at rnoyes@hcanys.org to get one.

Companionship Exemption Lawsuit Decision Issued

DOH Releases Dear Administrator Letter on CHHA EPS Rebasing The state Department of Health (DOH) on August 12 posted to its website a Dear Administrator Letter (DAL) that summarizes key components of a full rebasing cut under the Medicaid CHHA Episodic Payment System (EPS), contrary to EPS-related legislation awaiting the Governor’s signature and despite strong objections from HCA and other association colleagues.

Learn more about this important new development at http://hca-nys.org/ member-alerts/doh-releases-dear-administrator-letter-on-chha-epsrebasing. This issue will also be the subject of a conference call HCA is holding on September 1. (See related p. 6 story for information.)

State Releases Fiscal Intermediary Policy DOH has posted a policy that clarifies the requirements for entities that want to provide fiscal intermediary (FI) services for consumers enrolled in managed care plans who choose to receive consumer directed personal assistance services (CDPAS).

HCA has been in frequent contact with DOH about its emerging FI policy since the Department released draft guidelines in March and has heard from many members who wanted to know how they could provide FI services.

Read the full alert at http://hca-nys.org/member-alerts/state-releases-fiscalintermediary-policy.

Wage Parity Forms Due September 1 The next round of state-required vendor Wage Parity certification forms is due September 1 for LHCSAs and other entities that contract with Managed Care Organizations (MCOs), CHHAs and/or LTHHCPs serving New York City, Long Island and Westchester.

MCOs, CHHAs and/or LTHHCPs that contract with LHCSAs are required to obtain a written certification on a quarterly basis from the LHCSA or other entity which attests to its Wage Parity compliance for defined certification periods and on a prospective basis. The form due September 1, 2015 covers the period September 1, 2015 through November 30, 2015 and is sent to the MCO, CHHA and/or LTHHCP, not the state Department of Health (DOH). Learn more at http://hca-nys.org/memberalerts/quarterly-wage-parity-certifications-due-sept-1.

For more information, contact Roger Noyes at rnoyes@hcanys.org.

3

In a long awaited ruling, the U.S. Court of Appeals today upheld the U.S. Department of Labor’s final rule that would, in effect, eliminate the current Fair Labor Standards Act (FLSA) “companionship exemption” for home care agencies.

The Associated Press reports that the plaintiffs in the case are studying the decision and considering all options, including an appeal to the Supreme Court.

As discussed in numerous communications and programs with members, if this decision stands, the most direct effect on New York home care agencies is that they will have to pay overtime at time-and-a-half of the aide’s regular pay rate instead of time-and-a-half of the minimum wage, and institute much more detailed recordkeeping for sleep-in cases.

HCA will provide more information next week on the implications of this decision.

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

Volume 20, No. 29 August 21, 2015 

HCA Presses QIVAPP Concerns, Recommendations for Home Care This week, HCA and other provider associations met with the state Department of Health (DOH) to discuss concerns and recommendations related to the Quality Incentive Vital Access Provider Pool (QIVAPP) program.

The meeting followed a joint association letter we sent DOH in May which took issue with DOH’s “new” requirement that “a minimum of 30 percent of an agency’s total workforce must be enrolled in the health benefit” to qualify for QIVAPP. In that letter, the associations also urged DOH to establish a workgroup of associations, providers and plans to discuss adequate reimbursement rates for all agencies impacted by wage parity and other mandates, and we recommended that MLTC rates be set at levels that are adequate to permit plans to provide such reimbursement.

At the meeting, the associations raised issues with the: complexity of the QIVAPP program for providers and plans; differing guidances that were issued on QIVAPP; need for continued financial assistance for home care providers but with different eligibility criteria; and desire for a workgroup to examine home care reimbursement. We also asked about the status of the current reconciliation process for the federal QIVAPP monies.

DOH insisted that its goals are to protect the integrity of the program and ensure that all allotments are sound; such efforts are ongoing and part of a final reconciliation with the $35 million federal share of QIVAPP funds. DOH is

HIRING Hospice and Palliative Care Association of NYS (HPCANYS) Seeks New President & CEO HPCANYS is a not-for-profit organization, located in Albany, NY, representing hospice and palliative care programs, allied organizations and individuals that are interested in the development and growth of quality, comprehensive endof-life services. The President and CEO provides leadership and manages and directs all functional areas of the Association as prescribed by the Board of Directors. The responsibilities and duties of the successful candidate will include, but are not limited to:

• • •

• • •

•

Education/Experience: • Bachelor’s degree required; strong preference for Master’s or other advanced degree (e.g., MPA, MBA, MPH or JD) preferred.

• Some meaningful experience in each of the following areas: health care, public policy and notfor-profit or trade association management.

• At least five years’ intensive senior-level experience in at least one of: health care, public policy or notfor-profit or trade association management.

• Ability and willingness to travel and ability to apply information technology.

Provide leadership, vision, strategic thinking in the development of and strategic execution of the annual strategic blueprint.

Lead, develop and manage all aspects of a member organization within the annual budget.

Develop and maintain relationships with strategic partners including healthcare, business, media and community stakeholders; and governmental groups within the state and national arena.

Coordinate all political action and advocacy activities with the appropriate leadership.

Seek external program funding including grants and non-dues revenue.

Manage all aspects of the Association’s communication strategies including website, quarterly newsletter, weekly e-news and other related strategies as needed.

Excellent verbal and written communication skills.

Candidates meeting the above qualifications should submit the following for a complete submission: cover letter; current résumé (1-2 pages in length preferred), which includes previous work experience and salary history; recommendation letters (optional, but desired).

Please submit to iferrandino@hpcanys.org by close of business, Friday, July 31, 2015. For additional information call 518-446-1483.

4

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

Volume 20, No. 29 August 21, 2015 

making a final selection of home care providers eligible for the $35 million federal share and hopes to make a decision by the end of August; then it will submit the revised managed care plan rates to the U.S. Centers for Medicare and Medicaid Services (CMS) for approval. CMS action is expected to take about three months, and afterwards DOH will decide on QIVAPP funding for 2015-16. ($70 million was included in this year’s budget.)

The associations advocated for additional QIVAPP or other home care funding streams for New York City and to include funding for Long Island and Westchester providers. We also argued that home care providers in rural and other parts of the state needed similar financial support.

DOH did not agree to the establishment of a workgroup, but did agree to meet monthly with the associations to discuss any issues. We will be developing an agenda for the first meeting in late September and welcome suggested topics.

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

Hotel Deadline Extended 1 More Week for Senior & Financial Manager’s Retreat If you’ve attended the HCA Senior & Financial Manager’s Retreat before, you know what a blockbuster conference it is!

For those who have not yet registered for this year’s Retreat (on September 17-18), we have some good news ... The hotel reservation deadline for rooms at the HCA rate has been extended, but you must act soon!

To make your hotel reservation, call 1-800-772-6646 and ask for the HCA rate by August 28.

Please also register for the conference as soon as possible. With the recent posting of CHHA Medicaid episodic payment system rebasing cuts, you’ll want to learn what to expect in the coming months, along with steps HCA is taking to address the rebasing impact.

We’ll also have Bill Dombi of the National Association for Home Care and Hospice (NAHC) discussing Medicare home health rebasing and other elements of the upcoming 2016 home health prospective payment system rule, plus other speakers addressing value-based payments, fee-for-service and managed care rate setting, TPL, physician orders, F2F ... the list of payment issues is big, and HCA has the experts on hand to help you get a handle on them.

Online registration and a brochure are available at the links below: • •

https://www.eventville.com/hcanys http://hca-nys.org/wp-content/uploads/2015/06/SrFinManRetreat.pdf

5

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

Volume 20, No. 29 August 21, 2015 

HCA to Hold Free Sept. 1 Call on Major Policy Developments EPS, MD Orders, VBP, QIVAPP all included in the updates On September 1, at 11 a.m., HCA is holding a free members-only conference call to brief you on several major policy developments affecting all home care providers. The agenda includes: •

Updates on the newly released rebasing reductions for the CHHA Medicaid Episodic Payment System (EPS).

•

A big, new and still-in-progress development, promoted by HCA advocacy, which will offer flexibility in the physician order process for home care.

•

Updates on Value Based Payments (VBP) and funding under the Quality Incentive /Vital Access Provider Pool (QIVAPP).

To register for the call, please complete the online form at http://tinyurl.com/oo4khwo and the dial-in information will be sent to you in advance of September 1.

This call will focus on the newest information, and is a prelude to our robust Senior & Financial Manager’s Retreat on September 17 and 18 in New Paltz.

If these agenda items and related payment issues concern you, then you’ll want to gain the most information possible by participating in both programs: our September 1 conference call and Financial Manager’s Retreat on September 17 and 18. For registration, please see the links at the related p. 5 story.

State Gives Progress News on QIVAPP, FIDA & MLTC At last week’s state Department of Health (DOH) Managed Care Policy and Planning meeting, DOH staff said that they hope to complete reconciliation for the Quality Incentive Vital Access Provider Pool (QIVAPP) and announce the second round of funding awards by the end of August. (See related p. 4 story.) Federal approval would then be required before the monies can be distributed.

FIDA Enrollments, Timeline DOH also reported at the meeting that enrollment in the Fully Integrated Duals Advantage (FIDA) program, as of August 1, reached 7,676, including 2,701 individuals who were passively enrolled on August 1. As of that date, 54,287 individuals chose to “opt out” of FIDA. (They still must enroll into an MLTC plan.)

Future passive enrollment expectations include 1,379 on September 1 and 7,500 on October 1.

FIDA plans must submit their annual marketing plan by August 31. The due date for Value Based Contracting proposals was changed to January 1, 2016.

The Medicare Rights Center has created a toolkit for health care providers to assist them in understanding FIDA. The toolkit is at http://www.medicarerights.org/FIDA-Provider-Toolkit/Provider-ToolkitIntroduction.pdf?nrd=1.

Continued on next page

6

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

Volume 20, No. 29 August 21, 2015 

Continued from p. 6 Additional information on FIDA is at http://www.wnylc.com/health/news/33/.

MLTC Enrollments and Appeals Guidance The total number of individuals enrolled in all types of MLTC plans is 146,154 (for July), including 128,165 in partially capitated plans.

The Conflict-Free Evaluation and Enrollment Center (CFEEC) is operational throughout the state and receives from 626 to 648 calls per day. DOH said it is looking into the low call numbers in counties that recently transitioned to mandatory MLTC enrollment.

DOH has also posted new guidance related to MLTC partial capitation appeal notices. The change is due to the elimination of the requirement that enrollees must exhaust their plan’s internal appeal process before requesting a fair hearing.

The guidance is at http://www.health.ny.gov/health_care/medicaid/redesign/docs/mltc_policy_15-04.pdf.

RFA Re-Opened for Capital Restructuring Dollars, and Other DSRIP News Home care and other providers are eligible for funding via a request for applications (RFA) under a newly reopened Capital Restructuring Financing Program (CRFP) related to the Delivery System Reform Incentive Payment (DSRIP) program.

According to the state Department of Health (DOH), the CRFP application process is reopened until September 1, given the high rate of disqualifications for technical and process-related requirements. Eligible entities can submit (for the first time) or resubmit their existing proposals.

The RFA is at http://www.health.ny.gov/funding/rfa/1504100252/index.htm.

CRFP grants will be awarded to capital projects that further the objectives of DSRIP. These include: improving population health, reducing service costs, increasing access, reducing avoidable hospital use, ensuring that delivery system transformation continues beyond the waiver period (through leveraging managed care payment reform), and preserving essential safety net providers.

Eligible projects include those that: • • • • • • • •

Support development of primary care service capacity; Effectuate asset acquisitions; Support consolidation of service lines among providers; Make improvements to infrastructure; Support closures, mergers, and/or restructurings; Develop telehealth infrastructure; Coordinate co-located ambulatory care services including primary care, specialty care, surgery, urgent care, and diagnostic imaging; Integrate delivery systems that strengthen and protect essential health care services; and Continued on next page

7

Volume 20, No. 29 August 21, 2015

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



Continued from p. 7 •

Other transformational capital projects which further DSRIP goals.

Applicants may be home care or other health care providers, but the preferred eligibility criteria include those projects that can commit matching funds, demonstrate transformational change from fee-for-service to valuebased payments and a demonstration of financial need.

If participating in DSRIP, the Performing Provider System (PPS) lead entity must submit the application, but applications will also be accepted from organizations not participating in DSRIP. Implementation Plans In other DSRIP news, all of the PPSs submitted their implementation plans by the August 7 deadline. These plans will be reviewed by the Independent Assessor and various state agencies. The assessor will summarize the reviews and submit them back to the PPSs for their action. DOH hopes to finalize the plans by October 7 and post them by October 14.

DOH has also updated the DSRIP Year 1 timeline generally. This new timeline extends the date for submission, review and approval of the PPS First Quarterly Reports and Project Implementation Plans. It also reflects the July 22 federal approval of the Value Based Payment Roadmap, while noting that the draft Medicare Alignment Paper is available for public comment through August 31.

In other important dates: additional regulatory waiver requests are due September 15, and the DSRIP notice and opt-out letters will be mailed to Medicaid recipients in September and October.

The timeline is at http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/timelines/ year_1_timeline.htm. Any questions related to the timeline may be directed to DSRIP@health.ny.gov.

Value Based Payment HCA and its members have been participating in many subcommittees related to Value Based Payments (VBP), including a subgroup on Social Determinants of Health and Community Based Organizations.

The subcommittee is examining such issues as economic stability, education, neighborhood and environment factors, the social and community context of health and others. Methods of analysis may include the measuring of recommended social outcomes; ways to measure a provider’s performance related to impact on social determinants of health; ways of prioritizing which social determinants to address; and how the state can incentivize providers to invest VBP savings into social determinants of health.

HCA is well represented on this group by Board Members Laurie Neander, CEO at Bassett Healthcare Network: At Home Care, Inc.; and Russell Lusak, Senior Vice President at Selfhelp Community Services.

Quality Incentive Pool At last week’s Managed Care Policy and Planning meeting, DOH also announced the establishment of a new Quality Pool for distressed hospitals to help them transition to VBP arrangements.

Payments from the Value-Based Payment Quality Incentive Program (VBPQIP) will be made to the DSRIP PPS in which the eligible hospital participates and will flow from the managed care plans to the PPSs. 8

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

Volume 20, No. 29 August 21, 2015 

DOH Releases April 2015 Global Cap Report The state Department of Health (DOH) has issued its April 2015 Medicaid Global Spending Cap Report, which covers April 1 to April 30, 2015. (The state’s fiscal year begins on April 1 and ends on March 31.)

The 2015-16 final state budget extended the Medicaid Global Spending Cap through March 2017, increasing the cap from $17 billion in state fiscal year 2015 to $17.7 billion (including the Basic Health Program) in state fiscal year 2016, an increase of 4.6 percent.

The CPI used to trend Medicaid services was 3.6 percent (the ten-year average of the Medical Care Consumer Price Index); however, several adjustments were made to the Global Cap target outside of the trend, the most significant of which was the inclusion of OHIP State Operations cost.

The April report shows overall spending to be $23 million less than projected for the 2015-16 fiscal year, ending April 30.

The actual spending amount for this one-month period (April 1, 2015 through April 30, 2015) was $1.649 billion versus an estimated cap of $1.672 billion. The report is at https://www.health.ny.gov/health_care/ medicaid/regulations/global_cap/monthly/sfy_2015-2016/docs/april_2015_report.pdf.

For reporting purposes, home care and personal care services continued to be lumped into the category labelled “Other Long Term Care.” According to the report, that category was $6 million above projections for the first month of state fiscal year 2015-16 – a difference between projected spending of $60 million and actual spending of $66 million.

The report states that the $6 million in spending over projection was a result of more recipients billed than anticipated in personal care (5.5 percent more).

The Accounts Receivable (A/R) ending balance for FY 2015 was $280 million. The state is expected to recoup $170 million by the end of fiscal year 2016, resulting in a projected A/R balance of $110 million by March 2016.

Through the end of April, retroactive rates owed to the state were $240 million. This reflects a decrease of $40 million since March 2015.

Medicaid total enrollment reached 6,197,958 at the end of April 2015. This reflects an increase of 23,993 enrollees, or 0.4 percent, since March 2015.

As noted in previous ASAP articles, HCA has expressed concerns to DOH about the impact of retroactive payments on the global cap. HCA has discussed this issue with the Department and will be carefully assessing the reconciliation of funds relative to the cap.

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

9

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

Volume 20, No. 29 August 21, 2015 

Fed DOL Issues Guidelines on Independent Contractors In mid-July, the U.S. Department of Labor (DOL) issued guidelines entitled “The Application of the Fair Labor Standards Act’s ‘Suffer or Permit’ Standard in the Identification of Employees Who Are Misclassified as Independent Contractors.”

The guidance is at http://www.dol.gov/whd/workers/misclassification/AI-2015_1.pdf.

As its long title suggests, the guidance was issued as part of a project to reduce the improper classifications of employees as “independent contractors” in all types of workplaces. It also seeks to address misclassifications related to the impact on workers under the Fair Labor Standards Act (FLSA) for minimum wage and overtime.

The guidance sets out the following factors for consideration under the FLSA test: • • • • • •

Is the work an integral part of the employer’s business?

Does the worker’s managerial skill affect the worker’s opportunity for profit or loss?

How does the worker’s relative investment compare to the employer’s investment?

Does the work performed require special skill and initiative?

Is the relationship between the worker and the employer permanent or indefinite?

What is the nature and degree of the employer’s control?

This issue was recently in the news when, on July 30, the U.S. District Court for the Northern District of Florida released an order finding that a home care registry, operating under Florida’s registry licensure, improperly classified a Certified Nursing Assistant (CNA) worker as an independent contractor.

The National Association for Home Care and Hospice (NAHC) advises home care providers utilizing independent contractors to rely on legal counsel when determining proper worker classifications. NAHC emphasizes that the federal and state labor departments are taking a special interest in home care on a variety of FLSA issues, including worker misclassification.

These government entities have enforcement authority to prosecute cases on their own and have been joined by private attorneys that specialize in these types of cases and often prosecute them on behalf of a large class of workers against a single employer.

More information on independent contractors is at http://www.dol.gov/whd/workers/misclassification/.

PCA Protocols Posted with Revised Date HCA recently noticed that the state Office of the Medicaid Inspector General (OMIG) has posted Personal Care Aides (PCA) Protocols with a revised date of May 15, 2015.

HCA checked with OMIG officials who said that the May 15 protocols don’t include any major differences from previously posted PCA protocols (effective May 2, 2014 for services provided prior to July 31, 2011). In addition, the May protocols apply to services provided prior to May 15, 2015.

HCA conducted a cursory review of the new protocols and found that the background/introduction section has changed, but the protocols are the same. One addition that HCA had sought is language that the OMIG will 10

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

Volume 20, No. 29 August 21, 2015 

“review and consider any relevant contemporaneous documentation maintained and available in the provider’s records to substantiate a claim.”

Resources for Partnerships with Health Care Sector A new offering of free resources is now available for community-based organizations (CBOs) seeking to contract with health care organizations. This suite includes case studies, a sustainability toolkit and a free online learning series.

“Building Business Acumen of Community-Based Organizations,” developed by The SCAN Foundation in collaboration with the Health Foundation, is available at http://www.thescanfoundation.org/linkage-labinitiative.

The series includes four modules: • • • •

How to Make a Business Case How to Price Long Term Services and Support Marketing Strategy and Competitive Analysis Project Planning and Management

Consumer Directed Personal Assistance Program (CDPAP) for Rockland County The Rockland County Department of Social Services (DSS) is accepting applications from public, not-for-profit, or proprietary agencies wishing to provide Consumer Directed Personal Assistance Program (CDPAP) services to Medicaid recipients in the county for the period August 1, 2015 to July 31, 2016.

An applicant may be an individual, a LHCSA, a CHHA or any other entity that is legally qualified under state law to enter into a contractual relationship with a social services district to provide CDPAP. Multiple vendors may be approved.

Completed applications are due by 3 p.m. on or before September 8, 2015.

Applications are on the County’s Regional Bid Notification System at the Empire State Purchasing group at www.empirestatebidsystem.com. If you have any questions about this process, call BidNet at 1-800-835-4603, or Susan Emanuel, Planning and Evaluation Specialist at the County DSS: (845) 364-3217.

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

•

NGS Closed on September 7 for Labor Day. This includes the Electronic Data Interchange (EDI) Help Desk, Provider Contact Center, Provider Enrollment Line, and Telephone Reopening Unit. Electronic claim files transmitted after 5 p.m. on Friday, September 4 will have a claim receipt date of Tuesday, September 8. EDI front-end acknowledgement transactions will be created as expected, as EDI claim files are received. The FISS/DDE Provider Online System will be operational on September 7 during regular

11

Volume 20, No. 29 August 21, 2015

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



hours, though no support will be available. Providers will be able to access NGS Connex and use the Interactive Voice Response (IVR) system at: 1-866-275-3033.

•

CERT Requires Valid Legible Signatures within Medical Records. The Comprehensive Error Rate Testing (CERT) program auditors will assign an error if the medical records you submit have missing or illegible signatures. CMS mandates the presence of signatures for medical review purposes. Signature requirements are applicable to all Medical claims and medical records submitted for medical review purposes. If a signature is not legible, you will need to submit a signature key or attestation statement.

Additional information on this issue is at https://www.cms.gov/Outreach-and-Education/MedicareLearning-Network-MLN/MLNMattersArticles/downloads/mm6698.pdf.

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

Publications •

“Medicare’s Hospital-Acquired Condition Reduction Program,” by Health Affairs http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_142.pdf

•· “Applying for Medicaid Personal Care Services Outside NYC,” by the New York Legal Assistance Group http://www.wnylc.com/health/entry/39/ For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.

12