Page 1

ASAP Dombi Headliner

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

Legislative Issues  Public Policy



Volume 20, No. 32 September 18, 2015

Schumer to Lead Senate Letter on Home Health Medicare Rebasing Senate effort joins House campaign seeking CMS reconsideration of its current rebasing methodology At the request of home care associations nationally, Congress is finalizing a series of letters addressed to the U.S. Centers for Medicare and Medicaid Services (CMS) pressing for a reconsideration of CMS’s Medicare Home Health rebasing methodology. See SCHUMER p. 4

NAHC’s Bill Dombi took the stage at HCA’s Senior and Financial Manager’s Retreat this week. Our next big conference is the HCA Corporate Compliance Symposium on October 8 where one of the headliners is New York’s new OMIG Chief Dennis Rosen. Don’t miss this next HCA signature conference. A brochure is at the back of ASAP.

Oct. 8 HCA Symposium to Focus on Major Compliance, Audit and Cybersecurity Concerns Register today! Wrapping up a successful Senior and Financial Manager’s Retreat this week, focus now turns to our next signature conference coming up: the HCA Corporate Compliance Symposium on October 8 in Albany.

Inside ASAP Schumer to Lead Senate Letter on Rebasing.....................................1 Oct. 8 HCA Compliance Symposium: Register Today!.......................1 IPRO to Audit QIVAPP Pool Eligibility.................................................3

If you thought the finance Retreat was excellent for your CFO and financial management teams, you can expect the same for your compliance officers, COOs, See COMPLIANCE p. 2

DSRIP Update......................................................................................3 Managed Care Update.......................................................................4 ‘Stay’ Requested on FLSA Court Ruling .............................................5 Court Accepts HCA Amicus Brief in Live-In Home Care Case.............5 HCA Regional Meet-Ups: Help Us Help You!.....................................6 HCA, DOH Meet on Uniform Billing Codes for Managed Care.........7 ICD-10 Update....................................................................................7 Fiscal Intermediary Services Update...................................................8 NGS Updates......................................................................................8 Home Health Survey Protocol Training Item Revised.........................9 MA Value-Based Insurance Design Model Webinar To Be Held.........9

Helping New Yorkers Feel Right At Home

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

Volume 20, No. 32 September 18, 2015 

COMPLIANCE from p. 1 executives and other staff with responsibility for regulatory compliance at your agency – a pretty big tent, given the major implications of regulatory compliance on home care. Here are some big reasons to attend on October 8: •

The state’s new Medicaid Inspector General, Dennis Rosen, will make his HCA program debut. Get to know the new OMIG chief, hear his priorities and ask questions about what to expect from the state’s primary Medicaid audit unit under his helm.

While Dennis Rosen will offer the big picture of OMIG priorities, we’ll also have OMIG’s deputy chief, Thomas Meyer, on hand to field your questions about the intricacies of OMIG’s work plan for home care and the status of audit issues in a changing health care landscape.

Rebecca Fuller Gray, Director of the Division of Home and Community Based Services at the state Department of Health, is a household name in the New

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, Roger L. Noyes, Director of Communications, Al Cardillo, Executive Vice President, Policy & Programs, Patrick Conole, Vice President, Finance & Management, Andrew Koski, Vice President, Program Policy and Services, Alexandra Blais, Director of Public Policy, Laura Constable, Senior Director, Membership & Operations, Celisia Street, Director of Education, Mercedes Teague, Finance Manager, Jenny Kerbein, Director of Governance and Special Projects, Billi Hoen, Manager, Meeting and Events, Teresa Brown, Administrative Assistant, 388 Broadway, 4th Floor, Albany, NY 12207 Tele: 518-426-8764; Fax: 518-426-8788; Website


Volume 20, No. 32 September 18, 2015

ASAP – a publication of the Home Care Association of New York State York Home Care compliance arena. Her name is on virtually all the DALs in your file drawer spelling out the state’s regulatory requirements. She’ll be at our Symposium, addressing some of the regulatory alignment issues facing you under managed care and the Delivery System Reform Incentive Payment (DSRIP) program, including many of the areas that the Home and Community Based Regulatory Workgroup has been working to sort out. •

Gerald Archibald of the Bonadio Group will help you tackle several other DSRIP issues, in his presentation “An Epic Program with Big Compliance Considerations,” as you wade through unprecedented partnership negotiations, shared governance, new levels of information sharing and competitive marketplace considerations. And, newly added to the program, HCA’s expert Counsel Frank Fanshawe of Wilson Elser will present on “eRisks and Responses,” keeping you informed of practices and responsibilities related to cybersecurity.

This program is being held in Albany to facilitate participation from state officials you need to hear from. Some big players in the state’s compliance field will be there for you, and all you need to do is register today. Please download the PDF brochure at the back of this week’s ASAP or register online at All of HCA’s education registration forms and links are on the Education and Events page of our website at Please be sure to register for our Compliance Symposium today.


IPRO to Audit QIVAPP Eligibility The state Department of Health (DOH) has reported that IPRO will be sending an e-mail to about 200 providers as part of an audit for Quality Incentive Vital Access Provider Pool (QIVAPP) eligibility during the second round of funding. Specifically, IPRO will e-mail New York City providers who have been identified as eligible for the second installment of the QIVAPP monies to request documentation that these home care providers do, in fact, meet the eligibility criteria. DOH hopes to finalize its draft list of QIVAPP awardees by the end of September. Then it intends to send a request to the U.S. Centers for Medicare and Medicaid Services (CMS) by the end of the month. Prior to the completion of IPRO’s audit process, DOH plans to pursue MLTC rate increases for the QIVAPP “adjustment,” which could take a few months pending CMS review. DOH will then make any necessary changes to the QIVAPP awardee amounts based on IPRO’s audit findings, likely after a decision is made by CMS.

DSRIP Update The state Department of Health (DOH) has posted the DSRIP 1115 Quarterly Report that covers the first quarter of DSRIP year one from April 1, 2015 to June 30, 2015. The report is at health_care/medicaid/redesign/dsrip/docs/ first_quarterly_report_2015.pdf. It covers Performing Provider System (PPS) valuation awards; regulatory waivers; value based payments; Certificates of Public Advantage; Performance Fund payments: information technology; and capital grants. DOH has also posted the Value Based Payment Subcommittees’ materials at https:// dsrip/vbp_reform.htm. HCA is participating in a number of subcommittees along with members. 3

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

Volume 20, No. 32 September 18, 2015 

SCHUMER from p. 1 In meetings with the offices of New York Senators Charles Schumer and Kirsten Gillibrand this week, HCA President Joanne Cunningham specifically reinforced the New York home care community’s call for Congressional action on rebasing, along with other urgent issues, like the need to fix CMS’s burdensome Medicare face-to-face rule. In response to advocacy by the National Association for Home Care and Hospice (NAHC) and HCA, Senator Schumer agreed to lead a letter in the Senate on rebasing, with cosignatures by Senators Deborah Stabenow, Susan Collins and Pat Roberts who will circulate the draft for further sign-on among Senate colleagues before sending it to CMS.

Managed Care Update Members should take note of new dates posted on the updated “Managed Care Benefit and Population Expansion” chart: •

January 1, 2016 – Office for Persons with Developmental Disabilities (OPWDD) Phase 1 voluntary enrollment into OPWDD-FIDA (Fully Integrated Duals Advantage) for dual eligibles in New York City, Long Island, Westchester and Rockland.

December 1, 2016 – enrollment of Assisted Living Program (ALP) residents (duals and nonduals) into managed care and ALP benefit added to managed care.

January 1, 2017 – enrollment of Nursing Home Transition and Diversion (NHTD) and certain Care at Home consumers into managed care.

April 1, 2017 – enrollment of Traumatic Brain Injury consumers into managed care (moved from January 1, 2017).

December 1, 2017 – enrollment of Medicaid spend-down population into managed care.

The Schumer-led effort joins a House-initiated letter – also addressed to CMS – being finalized by Reps. Greg Walden, Tom Price, Earl Blumenauer and James P. McGovern. The House letter, which has 117 signatures, specifically requests that CMS “reconsider its proposed case mix cut until it evaluates the specific causes of case mix changes from 2012 to 2014,” among other recommendations related to CMS’s proposed 2016 Home Health Prospective Payment System Rule. HCA and our government affairs representative, Brett Heimov at Envision Strategy, have appealed for support from New York’s House Delegation on the letter. As of ASAP press time, the following New York Representatives had signed-on: Yvette D. Clarke (D-NY-9); Richard Hanna (R-NY-22); Brian Higgins (D-NY-26); John Katko (R-NY-24); Peter T. King (RNY-2) and Kathleen Rice (D-NY-4). HCA appreciates the support of these Congressional Representatives and Senator Schumer’s office for their understanding of the grave risk posed by CMS’s rebasing cuts. To read HCA’s major arguments against rebasing and other aspects of the proposed 2016 Home Health Prospective Payment System Rule, please download our advocacy paper at As CMS looks to finalize its rule later in the fall, HCA will keep the members informed of key advocacy developments and action items. 4

You can read the chart at http:// medicaid/redesign/docs/ mrt1458_timeline.pdf.

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

Volume 20, No. 32 September 18, 2015 

Home Care Plaintiffs Request‘Stay’ on Court Ruling to Eliminate FLSA Exemption The National Association for Home Care and Hospice (NAHC) and other plaintiffs filed briefs this week with the U.S. Court of Appeals requesting a stay of the court’s recent decision to uphold the U.S. Department of Labor (U.S. DOL) rule that eliminates the ‘companionship exemption’ for home care agencies, among other changes to the Fair Labor Standards Act (FLSA). If a stay is not granted, then the plaintiffs say they will request that the U.S. Supreme Court issue a stay and hear the case. Without a stay by either court, the ruling may go into effect on or about October 13. Meanwhile, the U.S. DOL argued in its brief that the Court of Appeals ruling should take effect sooner than October 13. As indicated in previous communications to members, the most direct effects of the U.S. DOL rule are that aides will have to be paid at time-and-a-half of their regular rate of pay rather than time-and-a-half of minimum wage. The rule would also result in more stringent recordkeeping for live-in/sleep-in cases. HCA will keep members informed of any new developments.

Court Accepts HCA Amicus Brief in Live-In Home Care Case HCA to hold program on labor implications The state Supreme Court Appellate Division (Second Judicial Department) has accepted a motion by HCA and other associations to file an amicus brief in a case that has major implications for home care providers and consumers. In the case, Andryeyeva v. New York Health Care, Inc., the judge decided that home attendants working on 24hour/sleep-in cases must be paid for each hour of the 24-hour shift, also ruling that sleep (eight hours) and meal periods (of up to three hours) cannot be deducted unless the attendant resides in the home of the person who is receiving care. This ruling conflicts with state Department of Labor opinions that agencies have depended upon. Those rulings provide that third-party employers of 24-hour care attendants may pay their employees for 13 hours of a 24-hour shift, if the attendant gets 8 hours of sleep, five of which are uninterrupted, and three uninterrupted hours for meals. The issues raised by this lawsuit are very significant and have surfaced in a number of other recent judicial proceedings. If this decision is upheld, the cost of 24-hour sleep-in services would be prohibitive; agencies and managed care plans would not be able to afford such care for Medicaid recipients; the cost for private pay patients who need such care would increase tremendously; and the availability of such services for all populations would be severely limited. HCA expects to file the amicus sometime later this month. We will notify members once we have done so, and we will soon be finalizing an education program on this topic. Please stay tuned for the program date where we’ll discuss the issues raised in this case and similar ones, and how agencies can prepare now in the event that the judge’s decision is upheld. For more information, contact Andrew Koski at (518) 810-0662 or 5

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


Volume 20, No. 32 September 18, 2015 

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

Volume 20, No. 32 September 18, 2015 

HCA Meets with DOH on Uniform Billing Codes for Managed Care This week, HCA and other associations met with the state Department of Health (DOH) and managed care plan representatives to discuss the establishment of standard billing codes for home and community-based services under managed care. This change was long sought by HCA to simplify the claims processing for both home care agencies and managed care plans and was included in this year’s state budget as a direct result of HCA advocacy and legislative development. HCA had already solicited member feedback on the codes used by plans, and all the associations had compiled a comprehensive list of codes for home care services. At the meeting, plan representatives raised issues with the accuracy and utility of codes we developed, and also contended that it was not possible to meet the January 1, 2016 effective date for uniform billing codes, due to: the complexity of code development; the need for contract amendments; and systems’ reprogramming. Both home care and plan representatives agreed to establish a workgroup to drill further into the codes and to address issues raised by both. We also agreed to focus on home care services and later address waiver services. DOH will be sending an e-mail to the MLTC plans about the standard billing code requirement, and to ask the plans to identify the codes they use for home care services and to select plan representatives to participate in a review of the codes. HCA will keep members updated on this issue. For more information, contact the HCA Policy staff.

ICD-10 Update As the October 1 due date for ICD-10 approaches, the state Department of Health (DOH) has announced two education sessions geared to Uniform Assessment System (UAS) users. The sessions focus on: transitioning from ICD-9 to ICD-10; editing ICD codes in an assessment; carrying forward existing ICD codes; and offline ICD code processing requirements. Dates and registration information follows: For the September 21 session (10 a.m.), register at For the September 23 session (1 p.m.), register at HCA has updated its chart of MLTC plans and their activities related to the ICD-10 transition. The chart is at Lastly, the U.S. Centers for Medicare and Medicaid Services (CMS) has posted a new ICD-10 resource, “Claims Submission Alternatives for Providers Who Have Difficulties Submitting ICD-10 Claims.” It


Volume 20, No. 32 September 18, 2015

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


i s at http s:// MLNMattersArticles/Downloads/SE1522.pdf.

Fiscal Intermediary Services Update The state Department of Health (DOH) has provided clarification to HCA on its recently issued policy guidance regarding requirements for entities that want to provide fiscal intermediary (FI) services for individuals enrolled in MLTC plans who are receiving consumer directed personal assistance services. The current guidance is at It includes the following language about organizations interested in becoming an FI for an MLTC plan: The organization must apply for a discrete Medicaid provider ID number that is solely associated with its FI by completing the New York State Medicaid Enrollment Form available at the following link: info/ProviderEnrollment/personal_care/index.aspx. This was interpreted by home care providers, plans and the Associations to mean that entities were required to apply for another Medicaid provider number for their FI services even if they already had one for other lines of home care business. HCA had informed DOH that this was a burdensome and unnecessary requirement for providers that already had Medicaid provider numbers and were providing personal care/FI services. DOH has now clarified that such entities don’t have to obtain another Medicaid provider number. Entities that want to provide FI services and don’t already have a Medicaid provider number still must obtain one. All providers still must meet the other requirements outlined in the guidance. Home care providers contacted by their MLTC contractors about their discrete Medicaid provider number should provide their already existing provider number to the plans. DOH will be issuing some type of clarification on this issue and HCA will notify members when that happens. For more information, contact Andrew Koski at (518) 810-0662 or

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

NGS to Conduct EDI Maintenance on September 30 – On September 30, the Electronic Data Interchange (EDI) Gateway will be shut down for maintenance at 5 p.m. for approximately six hours


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

Volume 20, No. 32 September 18, 2015 

in preparation for ICD-10. Once reactivated, all claims with dates of service October 1, 2015 and later must be submitted with ICD-10 diagnosis and procedure codes. •

Certifying Home Health Care Webinar – On Monday, September 21, from 12:30 to 2 p.m., NGS will host a webinar on patient/beneficiary eligibility, face-to-face encounters and certification requirements. Visit NGS’s website to register at

For further information, contact Patrick Conole at (518) 810-0661 or

Home Health Survey Protocol Training Item Revised The U.S. Centers for Medicare and Medicaid Services (CMS) has issued a letter to State Survey Agency Directors on the revision of a home health agency (HHA) survey protocol training item. It is at SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-15-52.pdf. When surveyors determine that expected outcomes have not been met for the various standards/tags within a Condition, the HHA Survey Protocol provides HHA-specific guidelines for when surveyors may consider citing the actual Condition at issue. Previous trainings advised surveyors that the phrase “consider citing the Condition” in the protocol implied the surveyor “should” cite a Condition-level deficiency. CMS has now revised its training to indicate that surveyors may consider citing the Condition when indicated by the regulation, but the phrase should not be taken as a prescriptive element of the guidance over surveyor judgment.

MA Value-Based Insurance Design Model Webinar To Be Held The Center for Medicare and Medicaid Innovation in the U.S. Centers for Medicare and Medicaid Services (CMS) is hosting a September 24 webinar at 3:30 p.m. to discuss the recently-announced Medicare Advantage Value-Based Insurance Design Model (MA-VBID). Attendees will receive an overview of the model as well as an opportunity for questions and answers about the model. Registration is at As described in the September 4 ASAP, MA-VBID will test the hypothesis that higher quality and cost savings would result from giving Medicare Advantage (MA) plans flexibility to offer targeted extra supplemental benefits or reduced cost sharing to enrollees who have specified chronic conditions. The MA-VBID model will begin January 1, 2017 and run for five years. CMS will test the model in 7 states: Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania, and Tennessee. More information is at




Meet and hear From OMIG’s New Chief, Dennis Rosen! CONNECT

Epic Health Care Changes = Big Regulatory QUESTIONS negotiations


NEW AUDIT Challenges

Gain an understanding of the complicated structures

Register today at



Hilton Albany 40 Lodge Street 8:30am – 4:30pm


October 8




Corporate Compliance Symposium

October 8 Hilton Albany 40 Lodge Street 8:30am – 4:30pm

October EIGHT


Corporate Compliance Symposium

October 8 Hilton Albany 40 Lodge Street 8:30am – 4:30pm

OMIG Priorities


Leadership CHANGE

Complex Systems

Regulatory Alignment

Corporate Compliance Symposium

October 8 Hilton Albany 40 Lodge Street 8:30am – 4:30pm

Providers negotiations




Hotel Information

$159 Sept. 7 Corporate Compliance Symposium REGISTRATION

 

SPECIAL NEEDS In accordance with the Americans with Disabilities Act, or special dietary needs, please let us know how we can accommodate you: _______________________________________________________________

September 18, 2015 Edition of ASAP  
September 18, 2015 Edition of ASAP  

ASAP is HCA's weekly publication of home care policy, legislative and regulatory news.