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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. 33 September 25, 2015

HCA Meets with Governor’s Office to Sustain EPS Funding HCA met this week with the Governor’s health cabinet asking intervention to sustain home care services funding under the state’s Medicaid Episodic Payment System (EPS). The state Department of Health (DOH) has prepared a drastic rate cut to take effect October 1 in connection with the Department’s rebasing of EPS. The rate cut would approach 30 percent and slash $70 million to $100 million in home care funding. DOH has loaded the rate reduction into the eMedNY system to take effect October 1 unless the Governor’s office intervenes. The Executive incorporated a $30 million EPS cut in its original state budget proposal. In response to strong advocacy by HCA and the home care community, the Legislature rejected this rebasing cut in its own budget counter-proposals, but the final budget reflected the $30 million hit. See EPS p. 3

Schumer Leads Rebasing Letter to CMS As featured in last week’s ASAP, HCA has been working with the National Association for Home Care and Hospice (NAHC) and New York Senator Charles Schumer to strengthen the opposition against federal rebasing cuts, among other issues. See SCHUMER p. 2

Inside ASAP HCA Meets with Gov’s Office to Sustain EPS Funding....................…1 NAHC Files FLSA Motion With U.S. Supreme Court........................…1 Schumer Leads Rebasing Letter to CMS.........................................…1 Member Hiring Announcement..........................................................3 Calling Applicants: HCA RFP for Quality Benchmarking Project...….4 HCA Submits Amicus Brief in Andryeyeva Case..............................…5 OMIG, Cybersecurity, Regulations all at Compliance Symposium.…5 Register Today for HCA Member Forums and Meet-ups...................6 HCA Adding New Muscle to PAC Campaign Chest….......................7 Registration Open for Northeast Leadership Summit...................…8 ICD-10 Deadline Tips...................................................................….8 Go Online For ASAP Web Exclusives…..............................................8 Tips and Reminders for ICD-10 Hospice Claims…..............................9 OMIG Posts Compliance Certification Webinar Materials…..........10 LTC Forum Registration Open.....................................................10 PHHPC Committee Meets................................................................11 Flu Vaccination Report Will Open November 2….............................11 DSRIP Update…..........................................................................12 Look Out for CERT Letters from NGS.......................................….....12 Guidance on Personal Care, CDPAP for Nursing Home Discharge......13 2016 Medicare Appeal Levels Announced.....................................…13 Private Duty Nursing Manual Revised..............................................13 Publications..................................................................................................14

NAHC Files FLSA Motion With U.S. Supreme Court HCA Overtime Survey Coming Soon The National Association for Home Care and Hospice (NAHC) and partners have filed their motion with the U.S. Supreme Court seeking an emergency stay in the Fair Labor Standards Act (FLSA) rule change involving the status of the ‘companionship exemption’ for home care provided by agencies. See SUPREME p. 4

Helping New Yorkers Feel Right At Home

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

Volume 20, No. 33 September 25, 2015 

SCHUMER from p. 1 Today, Senator Schumer sent a letter to the Acting Administrator of the U.S. Centers for Medicare and Medicaid Services (CMS), Andy Slavitt, leading the Senate’s efforts to prevent the potential rebasing cuts to home health services. Senator Schumer’s letter cited the significant and severe impact that these cuts would have on home care providers and patients, and urged further consideration. The letter, referring specifically to the “case-mix creep” adjustments under rebasing and the value-based payment pilot proposal, states: “This wide swing in penalties and the potentially onerous measures could prove to be too much change too quickly for these providers to comply with while still maintaining high quality patient care…To ensure that the millions of Americans who rely on home health services maintain access…we request that your Agency reconsider these two provisions in the proposed rule.” Senator Schumer’s letter was cosigned by Senators Susan M. Collins (R-ME), Debbie Stabenow (D-MI), and Pat Roberts (R-KS). This Senate letter accompanies a letter prepared by the House of Representatives which has amassed over 115 signatures. This letter comes after HCA President Joanne Cunningham visited the New York Delegation in D.C. last week to stress the urgency of Congressional action against these threats to the home care industry. HCA is very appreciative of Senator Schumer’s willingness to take a stand on behalf of the home care industry and the patients it serves. To review HCA’s position on rebasing and other aspects of the proposed 2016 Home Health Prospective Payment System Rule (HHPPS), please download our advocacy paper at http://hca-nys.org/policy-positions/ home-health-prospectivepayment-system-rule-for-cy-2016-what-it-means-for-nyproviders. As always, HCA will keep members informed and apprised of any opportunities to take action on this and any related issues throughout the fall as CMS nears a final decision on HHPPS. ASAP is a weekly publication of the Home Care Association of New York State (HCA). Unless otherwise noted, all articles appearing in ASAP are the property of the Home Care Association of New York State. Reuse of any content within this newsletter requires permission from HCA. President: Editor:

Joanne Cunningham, jcunningham@hcanys.org Roger L. Noyes, Director of Communications, rnoyes@hcanys.org Al Cardillo, Executive Vice President, Policy & Programs, acardillo@hcanys.org Patrick Conole, Vice President, Finance & Management, pconole@hcanys.org Andrew Koski, Vice President, Program Policy and Services, akoski@hcanys.org Alexandra Blais, Director of Public Policy, ablais@hcanys.org Laura Constable, Senior Director, Membership & Operations, lconstable@hcanys.org Celisia Street, Director of Education, cstreet@hcanys.org Mercedes Teague, Finance Manager, mteague@hcanys.org Jenny Kerbein, Director of Governance and Special Projects, jkerbein@hcanys.org Billi Hoen, Manager, Meeting and Events, bhoen@hcanys.org Teresa Brown, Administrative Assistant, tbrown@hcanys.org 388 Broadway, 4th Floor, Albany, NY 12207 Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org

Volume 20, No. 33 September 25, 2015

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

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EPS from p. 1 rebasing components) to appropriately capture home care costs. Additionally, along with demonstrating the current at-risk financial status of the home care system, and providing examples of the projected effect of the cut on individual agencies, HCA emphasized the highly defeatist nature of the cut to the Administration’s own major health reform policies and programs which so greatly depend upon a capable home care system, and which at this very time require further investment in home care, not cuts.

Following enactment of the budget, DOH let it be known that it intended to surpass the budget projection and maximize its removal of home care funding. In response, the Legislature unanimously passed legislation (S.5878/A.8171), crafted by HCA and partners and sponsored by Senator Kemp Hannon and Assemblyman Richard Gottfried, to require the rebasing to adhere to the budget agreement, and to effectively limit any rate cut from rebasing to not exceed the $30 million projection.

HCA anticipates further, imminent word from the Governor’s office in response to our meeting and will notify members upon learning of the Governor’s intent.

The legislation still awaits the Governor’s call for delivery to his office for signature. With a massive DOH rate cut loaded and ready to take effect October 1, we need the Governor to either sign the HCA legislation before next Wednesday or take action to suspend the DOH planned rate change pending his further consideration and/or approval of the legislation.

Meanwhile, over 160 letters/appeals have been sent by the HCA membership to the Governor’s office through the HCA Legislative Action Center urging his signature of S.5878/A.8171 to sustain critical EPS funding and to limit the cut level to the budget projection. HCA urges all members, staffs, agency board members and other supporters to continue full-out appeal for the Governor’s support. Please use this easy and simple method for communicating to the Governor at https://p2a.co/6snbQwL.

In this week’s meeting with the Governor’s health cabinet, HCA and colleagues from LeadingAge New York urged these very actions. HCA explained in detail the conflicting, contradictory, and damaging nature of the funding cut being engineered by DOH. We further explained the limitations of the EPS methodology (including deficiency of the base year/

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

VP Chief Financial Officer at Strong Home Care Group

HIRING

Leads and manages operations that drive the financial performance for Strong Home Care Group (SHCG), including Visiting Nurse Service of Rochester and Monroe County (VNS), Community Care of Rochester (CCR) – dba Signature Care, Finger Lakes Visiting Nurse Service (FLVNS) and Finger Lakes Home Care (FLHC). Proactively provides oversight and leadership to all financial activities of the combined agency that maximizes reimbursement, controls costs, and fully utilizes agency resources. Additionally provides executive management oversight for Information Technology Services and selected support operations as assigned by the CEO. “PLEASE VISIT www.vnsnet.com FOR A FULL DESCRIPTION” Qualified candidates please send résumé to: Human Resources 2180 Empire Blvd. Webster, NY 14580 Fax: 585-787-8369 Email: employment@vnsnet.com VNS values diversity and encourages minorities to apply. E.O.E.

ASAP – a publication of the Home Care Association of New York State SUPREME from p. 1 The motion argues “irreparable harm” from the rule. It cites affidavits from a range of organizations, disabilities groups and state associations, including HCA, noting, from our own affidavit, “the New York Medicaid program’s lack of preparedness to incorporate the increased costs from the new rule, which has created a serious risk to patient access and continuity of care, as well as home care agency operations, if the new rule is allowed to take effect.” Our affidavit also emphasized the adverse effects on workers whose access to overtime is put at risk under the new rules. The motion will be decided by U.S. Supreme Court Chief Justice Roberts who has the option of including the other judges in his decision. It is expected that the Chief Justice and/or colleagues would give the U.S. Department of Labor (which promulgated the FLSA rule change) time to respond before deciding on the emergency stay. The stay is being sought as plaintiffs pursue a final appeal on the FLSA rule in reversal of lower court decisions to date. If it takes up the case, the court will find itself facing its own precedent on this issue, from eight years ago, when it unanimously upheld the FLSA exemptions for home care in the landmark Coke case. Of course, this is a different court, and the outcome would have major ramifications for overtime pay in home care. Related survey in the works In a related effort, next week, HCA, in concert with other provider associations, will be sending members a brief survey to assess the financial and other impacts of any changes to the overtime requirements under the recent U.S. Department of Labor rule. As noted in many communications and programs for members, the major FLSA changes for New York providers are that aides would have to be paid time-and-a-half of their regular rate of pay, instead of time-and-a-half of minimum wage, and more detailed recordkeeping would be required for 24-hour live-in cases. Barring a hold by the Supreme Court, the rule affecting wages and overtime is expected to take effect on or about October 13. HCA is taking a proactive approach by surveying our members on the expected costs due to the rule and will use that data in further discussions with the state about the need to increase rates and premiums to home care providers and managed care plans for meeting these new costs due to the rule. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org. 4

Volume 20, No. 33 September 25, 2015 

Calling Interested Applicants: HCA Announces RFP for Quality Data Benchmarking Project Exciting RFP opportunity is hot off the presses HCA is issuing a Request For Proposals (RFP) for a software entity to provide HCA and HCA providers with benchmarking services for comprehensive quality data to support agencies and their services. The benchmarking will be based on data that will be collected via our Quality Committeedeveloped HCA Quality Measurement, Risk and Compliance Tool (HQMT©). The preliminary HQMT was showcased at last November’s HCA Quality Symposium, beta tested by HCA providers this spring, and readied for this RFP by the HCA Quality Committee and Board of Directors. This is a first-of-its-kind effort at either the state or national level to create such a standardized tool. Software entities interested in applying should contact HCA’s Executive Vice President Al Cardillo at acardillo@hcanys.org for information on the RFP or how to apply. HCA requests letters of interest/ intent to the RFP by no later than October 7, 2015. HCA has established a deadline for proposals of 5 p.m., Friday, November 6, 2015.

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

Volume 20, No. 33 September 25, 2015 

HCA Submits Amicus Brief in Andryeyeva Case This week, HCA, LeadingAge NY and the Home Care Association of America submitted an amicus brief at the appeals level in a case that would have major ramifications for the delivery of 24-hour sleep-in home care cases if a lower court’s decision is upheld. 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. As pointed out in the amicus brief, the lower court’s ruling conflicts with state Department of Labor opinions that agencies have depended upon. Those opinions 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 lower court’s holding will exorbitantly increase wage costs for this already struggling industry,” the brief states, “causing many of the home care agencies to close and/or reduce the availability of live-in services and/or decrease the hours of home care workers.” The brief adds: “If this decision stands, it is highly likely that many providers will no longer offer live-in services and, therefore, home care workers that benefit from live-in assignments will no longer receive such assignments.” Members can download the brief at http://hca-nys.org/wp-content/uploads/2015/09/amicusbriefandreyeyeva092415.pdf. 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 immensely; and the availability of such services for all populations would be severely limited. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.

OMIG, Cybersecurity, New Model Regs All Await at Compliance Symposium Your compliance team cuts across several staff roles at your agency. They are a line of defense against payment risk, assuring quality of care. Make sure they are the strongest line of defense possible at HCA’s Corporate Compliance Symposium on October 8 in Albany, just two weeks away. Your compliance teams will get answers about the future of OMIG audits, especially in a changing health care environment. In fact, OMIG’s new chief, Dennis Rosen, will be making his first appearance before the HCA membership. We want to make this session a two-way learning opportunity: you and your staff will hear Mr. Rosen’s vision for the OMIG work plan, but you’ll also have a chance to acquaint him with your unique audit and compliance 5

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

Volume 20, No. 33 September 25, 2015 

concerns. The deputy inspector general, Thomas Meyer, will also discuss ongoing OMIG activities for home care. In a new, cutting-edge session, HCA’s expert Counsel Frank Fanshawe of Wilson Elser will present on “eRisks and Responses,” keeping you up to speed on practices and responsibilities related to cybersecurity. Rebecca Fuller Gray, one of the Department of Health’s lead officials in the home care compliance arena, will address some of the many regulatory issues facing you in the changing health care system. We’ll also have experts like Gerald Archibald, of the Bonadio Group, who will help you tackle several other DSRIP issues, in his presentation “An Epic Program with Big Compliance Considerations.” Register online at http://tinyurl.com/qbbpjsh, or complete the PDF registration form at the back of this week’s ASAP.

Register Today for HCA Member Forums and Meet-ups HCA is continuing our series of Member Forums for specific segments of the HCA membership. These forums provide a custom-tailored focus on issues affecting LHCSAs, LTHHCPs and MLTCs. We’ve designed these forums recognizing that each subset of our membership has a unique scope of technical issues and advocacy needs. To register, download the form at the back of ASAP and pick a forum meeting (or more than one) that you would like to attend based on the program area that represents your agency or health plan type. For MLTCs, our MLTC Forum is coming first, on October 30; our LTHHCP Forum is on November 1; and our Downstate LHCSA Forum is on November 23. Member Meet-Ups The HCA Member Forums are distinct from a series of regional Meet-Ups that HCA has also announced. While the Forums are entity specific, the regional Meet-Ups will approach your needs from a different angle, offering a pipeline for members of all types in each region to engage the HCA team with an eye toward strategy development and advocacy related to your market needs and geographic area. Specific attention will be paid to your experiences with DSRIP regional health networks and other local payment issues, as well as home care service concerns otherwise specific to your region. To register for an HCA Meet-Up, please see the flyer at the back of this week’s ASAP where you can find registration information. We recommend that you come to both program types: our entity-specific Forums and our regional-specific MeetUps. Registration information for both event types is also posted to our Education and Events page at http://hcanys.org/events-education/upcoming-events.

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

Volume 20, No. 33 September 25, 2015 

HCA Adding New Muscle to PAC Campaign Chest HCA’s PAC Council, comprised of HCA Board Members, providers and vendors met for the first time in April to discuss the growth and sustainability of HCA’s Political Action Committee (PAC). Since then, HCA has ramped up our PAC efforts, with more to come. We’ve: • • • •

Created a PAC mission statement Distributed the first Annual PAC Report (in May) Enhanced our PAC webpage Created an online donation form, using Paypal, which allows you to donate easily by transferring Paypal credits from your Paypal account, if you have one, or use a credit card to contribute.

In a major new initiative, we’ll be identifying PAC Ambassadors, and, through them, hosting a PAC “Morning Perk” program where Ambassadors can host their district legislators to engage, educate and possibly support them financially with a PAC donation at events in your region. Also, soon we’ll be launching the first-ever comprehensive HCA PAC campaign which will include various communications, including direct appeals to members through ASAP, phone calls, advertising and meetings. We’re also going to begin recognizing our big donors at HCA’s Annual Conference in exciting and fun ways. You can donate to HCA PAC today by visiting our newly enhanced PAC webpage at http://hca-nys.org/advocacypac/pac. Our Paypal button is ready to accept your contributions. You can also download our PAC report on the site to learn more about the history of HCA PAC, our collections and disbursements to date, and read instructions for contributing by check. HCA wants to recognize the excellent work of our PAC Council members including: Rae Szymanski of VNA of Hudson Valley; Kenneth Kilroy of Progressive Home Health Services, Inc.; Bernhard Schiel of Bestcare, Inc.; Elizabeth Zicari of HCR Homecare; Anne Calvo of Winthrop University Hospital Home Health Agency; Eric Johansmeyer, of Any-Time Homecare, Inc.; and Paul Essner of TSG Financial. Please stay tuned as HCA adds new muscle to our PAC campaign in support of elected officials and their efforts on behalf of home care. 7

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

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Registration Open for Northeast Home Health Leadership Summit The popular Northeast Home Health Leadership Summit is coming to Boston again on January 19 to 21. The summit website is ready for you to register online today at http://nehomehealthsummit.com/. There, we’ve posted a fun video to get you jazzed for the conference, playing on the conference theme “Mission Possible.” This highly acclaimed Summit brings together home care leaders from throughout New York and New England, and you won’t want to miss being among this peer group. Check out the video and register today at http://nehomehealthsummit.com/.

ICD-10 Deadline Approaches CMS releases new FAQs As the October 1 deadline approaches for ICD-10, the U.S. Centers for Medicare and Medicaid Services (CMS) posted revised and new Frequently Asked Questions (FAQs) about the transition from ICD-9 codes. The FAQs are at https://www.cms.gov/Medicare/Coding/ICD10/ Clarifying-Questions-and-Answers-Related-to-the-July-6-2015-CMSAMA-Joint-Announcement.pdf. One of the new questions clarifies that ICD-10 coding flexibility for services paid under the Medicare fee-for-service Part B physician fee schedule won’t be expanded to other providers. CMS’s justification is that “many physicians are in small practices that need additional flexibility to gain experience with the ICD-10 coding set. Claims billed under the Part B physician fee schedule are paid using CPT codes and not ICD-10 codes.” HCA advises members to continue working with billing vendors to ensure readiness. eMedNY has lots of resources at https://www.emedny.org/icd/ index.aspx; CMS has information at https://www.cms.gov/Medicare/ Coding/ICD10/Latest_News.html. In addition, HCA has prepared a chart outlining the activities being taken by some MLTC plans to transition from ICD-9 to ICD-10 diagnosis codes. The chart is available at http://hca-nys.org/wp-content/uploads/2015/09/ ICD10chartforMLTCtransition.pdf. A conversion tool to convert ICD-9 to ICD-10 diagnosis codes is at https:/ /www.aapc.com/icd-10/codes/. Continued on next page

Go Online For ASAP Web Exclusives In an effort to keep ASAP concise, HCA is posting some of our stories as online exclusives to our website. We have created a new page called “General News” where you can find news on the latest Medicaid Global Spending Cap Report, a new Federal Health IT Strategic Planning Report, NHTD and TBI Waiver workgroup materials related to the MLTC transition of these waiver services in January, and a SOFA Survey on an Office of Community Living. Get these important updates by visiting the HCA website at: http://hca-nys.org/ category/general-news.

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Continued from p. 8 UAS The transition affects completion of evaluations under the Uniform Assessment System (UAS). Online assessments with a reference date of October 1 or later must use the ICD-10 code. Offline users won’t have access to the ICD-10 database until a later time. A recording of this week’s UAS-NY Savvy Sessions on the ICD-10 transition will be posted at http://www.health.ny.gov/health_care/medicaid/redesign/uniform_assessment_system/index.htm. ePACES Changes Coming With The Implementation of ICD-10 eMedNY will require the use of ICD-10 diagnosis codes for dates of service October 1, 2015 and after; and, beginning on October 1, ePACES users will begin to see a pop-up when entering the ePACES application to alert them of the following change: •

On the Diagnosis Tab, the Diagnosis Version (ICD-9 or ICD-10) is currently defaulted to ICD-9. Beginning next Thursday, if the submitted claim has a date of service October 1, 2015 or after, users will need to select the ICD-10 version.

Also on October 8, 2015 the Diagnosis Version will default to ICD-10. Therefore if users are submitting a transaction with a date of service prior to October 1, 2015, they will need to change the version from ICD-10 to ICD-9. Questions may be directed to the eMedNY Call Center at (800) 343-9000.

Tips and Reminders for ICD-10 Hospice Claims The U.S. Centers for Medicare and Medicaid Services (CMS) and National Government Services (NGS) are providing the following quick tips and reminders for hospice providers about the October 1 implementation of ICD-10, which is quickly approaching. ICD-9 and ICD-10 codes are not permitted on the same Medicare claim(s). Since hospice claims do not cross months, all hospice claims for dates of service (DOS) prior to October 1, 2015 must be billed with ICD-9-CM codes and all claims for DOS on or after October 1, 2015 must be billed with ICD-10-CM codes. Hospices should refer to the following guidance for additional information: •

SE1325: https://www.cms.gov/Outreach-and-education/Medicare-Learning-Network-MLN/ MLNMattersArticles/Downloads/SE1325.pdf

•

SE1408: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNMattersArticles/downloads/SE1408.pdf

When submitting a Notice of Elections (NOE) for admissions that occur on or after October 1, hospices are required to use the ICD-10 codes. Continued on next page

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The following reason codes may occur when an improper ICD-9 or ICD-10 code appears on the claim: •

Reason code 19508: An invalid ICD-9 or ICD-10 diagnosis code is submitted on the claim. Hospices should review the submitted ICD-9 or ICD-10 diagnosis code, make corrections and resubmit.

•

Reason code 19511: An ICD-9 diagnosis code is present in any diagnosis fields except the admitting diagnosis field (as it is a protected field) and the “from” date of service on or after the ICD-10 date. Only a valid ICD-10 code can appear on the claim on or after October 1, 2015. Hospices should correct the diagnosis code and resubmit the claim.

•

Reason code 19512: An ICD-10 diagnosis is present in any diagnosis fields except the admitting diagnosis field (as it is a protected field) and the “from” date of service is prior to the ICD-10 PARM date. Prior to October 1, only ICD-9 codes may be present on the claim. Hospices should correct the diagnosis code and resubmit the claim.

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

OMIG Posts Compliance Certification Webinar Materials The Office of the Medicaid Inspector General (OMIG) has posted materials for its webinar, OMIG’s Compliance Certification Process for Mandatory Compliance Programs: Enrolling Provider or Revalidating Provider. Please see https://omig.ny.gov/resources/webinars. Medicaid providers are mandated to certify that they have a compliance program meeting certain requirements upon applying for enrollment in Medicaid and during December of every year. Certification is required for every Federal Employer Identification Number (FEIN) under which a provider orders, claims or receives Medicaid payments, or submits claims on behalf of another for Medicaid services. Information on the certification process is at https://omig.ny.gov/compliance/certification. OMIG will post two certification forms in the fall to meet state and federal requirements. These must be submitted in December. Questions can be sent to compliance@omig.ny.gov and calls can be directed to OMIG’s Bureau of Compliance at (518) 408-0401.

LTC Forum Registration Open White Paper released Registration is now open for the state Department of Health (DOH) Long Term Care Forum on September 29 at the New York Academy of Medicine (NYAM) from 10 a.m. to 1 p.m. in Manhattan. It will discuss the future of MLTC and the Fully Integrated Duals Advantage (FIDA) program. Registration is now available at https://attendee.gotowebinar.com/register/6859294863089283586. To participate via phone, you must register through the above link. You will receive a confirmation e-mail and call-in number to enable you to participate by phone. To attend in-person, e-mail DOH at FIDA@health.ny.gov 10

ASAP – a publication of the Home Care Association of New York State with the subject line “Long Term Care Forum.” Space is limited to the first 200 people who respond. Interest does not guarantee in-person attendance.

Volume 20, No. 33 September 25, 2015 

Flu Vaccination Report Will Open Nov. 2

White Paper Meanwhile, DOH has released a draft white paper that proposes enhancements to partially capitated MLTC plans. These enhancements would: “allow for the creation of community partnerships to better align the program with DSRIP goals, including value based payments, integrating behavioral health services into the model, and enhancing care transitions. In the absence of mandatory fully integrated care (Medicare and Medicaid), we believe this enhanced model will allow MLTC participants enrolled in a partially capitated program to receive services in a way that promotes integration between Medicare and Medicaid providers, thereby enhancing care for participants.” DOH proposes to offer the MLTC Plus (MLTC Plus) initiative, which will expand benefit packages for selected MLTC partial capitation plans and enhance provider coordination through targeted incentive payments and new care management protocols. The MLTC Plus is seen as a complement and enhancement to the state’s Delivery System Reform Incentive Payment program (DSRIP), and the state Office of Health Insurance Programs will work closely with plans and providers to develop and discover the most effective protocols and incentives. The White Paper is at http://hca-nys.org/wp-content/uploads/2015/09/ LTC-forum.pdf. HCA will be reviewing the paper and providing feedback.

PHHPC Committee Meets This week, the Public Health and Health Planning Council (PHHPC) Establishment and Project Review Committee met on the following home care and hospice applications: 1. One hospice to decertify eight residence beds, cease operating any hospice residence beds at any location, and close its offsite location which housed some of its hospice inpatient beds. 2. One CHHA to add an individual as an Independent Trustee. 3. 34 entities to establish new LHCSAs, five of which will cover upstate counties. 4. 11 existing LHCSAs, including two upstate, for a change in ownership. The hospice and CHHA applications were approved and forwarded to the full PHHPC for its consideration at the October 8 meeting. Due to time constraints, the LHCSA applications were not acted upon. They may be considered by the full PHHPC at its next meeting. The agenda and supporting documents are at http:/ /www.health.ny.gov/facilities/public_health_and_health_planning_council/ meetings/2015-09-24/docs/agenda.pdf. 11

The state Department of Health (DOH) says it plans to reopen last year’s Healthcare Personnel Influenza Vaccination Report beginning November 2, 2015 and closing it on May 1, 2016. The reporting period will be from October 1, 2015 to March 31, 2016. DOH has not declared that influenza is prevalent. This declaration would start the requirement that agencies must document whether their aides and other designated personnel have been vaccinated against influenza for the current season, and the requirement that agencies implement the flu mask requirement for those who have not been vaccinated and work in areas where patients or residents may be present. HCA will inform members when DOH declares that influenza is prevalent. Last year, the influenza season ran from December 11, 2014 to May 14, 2015. Information on the upcoming influenza season will be posted at http:// tinyurl.com/o7berz4.

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DSRIP Update Some updates to the Delivery System Reform Incentive Payment (DSRIP) program include: •

By September 30, the Independent Assessor will make final determinations on the Implementation Plans submitted by Performing Provider Systems (PPSs).

•

PPSs are scheduled to submit their second Quarterly Report in October 2015 and to receive their second DSRIP payment in January 2016.

•

Upstate PPSs will present implementation progress reports to the Project Approval and Oversight Panel (PAOP) in November 2015.

•

New York City PPSs will present implementation progress reports to the PAOP in January 2016.

The first annual DSRIP Learning Symposium was held September 17 to 18 with 400 representatives from across the 25 PPSs. According to DOH, it was designed to: •

Develop partnerships across PPSs and mechanisms to share emerging best practices and evidence-based approaches to successfully complete project deliverables.

•

Highlight promising efforts across the state (and nationally) to transform current care delivery practices and improve care transitions.

•

Promote further dialogue between PPSs and DOH about current key issues impacting PPS capacity to achieve DSRIP goals.

PPSs led sessions focused on DSRIP topics including: patient and provider engagement; county agency collaboration; behavioral health and clinical integration; expanding primary care capacity; and the evolving role of managed care organizations

Look Out for CERT Letters from NGS Once a month, National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), sends a Comprehensive Error Rate Testing (CERT) letter to each provider that received a CERT error. These letters are sent monthly until the CERT error is either overturned on appeal or the CERT contractor receives sufficient information to remove the error (if the appeals timeframe was missed). The CERT letter is printed on green paper to make it easily identifiable. Please be aware that the CERT letter is to the master address on file in the provider’s Fiscal Intermediary Standard System (FISS) record. Providers should ensure that their mailroom staff are aware of these green CERT letters so that the letter can be sent to the appropriate department in a timely manner. October 2015 Dark Days for the Common Working File (CWF) In other NGS news, Friday, October 2 and Saturday, October 3 will be “dark” days for CWF Hosts with no online services available. There will be no access to the Health Insurance Master Record (HIMR) inquiry or Business Document Service (BDS) transactions. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org. 12

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

Volume 20, No. 33 September 25, 2015 

Guidance Issued on Personal Care, CDPAP for Nursing Home Discharges The state Department of Health (DOH) has instructed local Departments of Social Services (LDSSs) on the need to assess and provide personal care or Consumer Directed Personal Assistance Program (CDPAP) services to Medicaid recipients currently residing in nursing homes and electing the option to seek transition to the community with the support of the Nursing Home Transition and Diversion (NHTD) or Traumatic Brain Injury (TBI) waiver programs (in lieu of managed care enrollment). The notice is at http://www.health.ny.gov/health_care/medicaid/publications/docs/gis/15ma017.pdf. DOH advises the LDSSs that the provision of personal care or CDPAP combined with NHTD or TBI waiver services are often necessary for the individual’s safe discharge from the nursing facility, and these services must be in place upon discharge. Effective immediately, the waiver Regional Resource Development Center (RRDC) staff will notify the local district that a person is seeking waiver services, along with the proposed discharge/waiver eligibility date. Following this notification, and upon receipt of a physician order, LDSS staff should conduct both a nursing and social assessment following existing regulatory procedures. Additionally, district staff should work with the RRDC staff and the Medicaid recipient’s waiver Service Coordinator to integrate the assessment into the overall service plan pending approval by the RRDC. Districts are also advised that the same protocol will apply to MLTC enrollees residing in nursing facilities who wish to disenroll from the MLTC plan and, upon discharge, receive NHTD or TBI waiver services currently not available in the MLTC. Questions can be sent to services@health.ny.gov.

Private Duty Nursing Manual Revised eMedNY has posted a revised manual on prior approval guidelines for private duty nursing. The manual is at https://www.emedny.org/ProviderManuals/NursingServices/PDFS/ Private_Duty_Nursing_PA_Guidelines.pdf.

2016 Medicare Appeal Levels Announced The U.S. Centers for Medicare and Medicaid Services (CMS) has announced the 2016 threshold amounts for administrative law judge (ALJ) hearings and judicial reviews. The “amount in controversy” threshold for requesting an ALJ hearing remains at $150, the same as in 2015, but the threshold for judicial review is increasing to $1,500 from $1,460 in 2015.

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

Volume 20, No. 33 September 25, 2015 

Publications •

“Value-Based Payments Require Valuing What Matters to Patients,” Health Affairs (September 17, 2015) http://tinyurl.com/qbkx2b3

•

“Know Your Rights: Managed Long Term Care and FID Fact Sheets, Live and Recorded Webinars,” by the New York Legal Assistance Group http://www.wnylc.com/health/entry/202/

•

“Spousal Impoverishment Protections for Married Couples where One Spouse is in a Managed Long Term Care Plan – Pooled Trusts Allowed as an Option,” by the NY Legal Assistance Group http://www.wnylc.com/health/entry/165/

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“Getting Started with Hospice Item Set (HIS) Reporting: Checklist and Quick Tips, September 2015,” by the U.S. Centers for Medicare and Medicaid Services http://tinyurl.com/q6fzqgu

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

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Epic Health Care Changes = Big Regulatory QUESTIONS negotiations

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October 8 Hilton Albany 40 Lodge Street 8:30am â€“ 4:30pm

OMIG Priorities

Transition

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

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HCA is continuing our series of Member Forums for specific segments of the HCA membership. These Forums provide a custom-tailored focus on issues affecting LHCSAs, LTHHCPs, MLTCs, and HCA’s Home Care Council (HCC) of New York City members.

Registration

Once complete, please fax to (518) 426-8788. You must provide us with an email address in order to receive your confirmation. ______________________________________________________ Name

We've designed these forums recognizing that each subset of our membership has a unique scope of issue and advocacy needs that demand attention.

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Please register today to attend one of these important sessions.

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MLTC forum October 30

11am – 2pm HealthPlus/Amerigroup 9 Pine Street 14th Floor (AKA 14 Wall Street) New York, NY 10005

LTHHCP forum November 13

10:30am – 2:30pm Hilton Albany 40 Lodge Street Albany, New York 12207

Downstate LHCSA forum November 23

10am – 2pm Selfhelp Family Home Care Boardroom 530 Eighth Avenue 5th Floor New York, NY 10018

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Lunch will be provided at each of the Forums. Please let us know if you have any dietary restrictions so that we can try to accommodate you. Cancellation Policy: Cancellations received one week prior to the forum will receive a full refund, less 25% of total due as an administrative fee. Cancellations received within one week of the forum will forfeit their registration fee, along with those who register and do not attend. Substitutions are permitted. Please contact Teresa Brown at (518) 426-8764 or tbrown@hcanys.org to cancel.

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