ASAP
A Weekly Publication Of HCA Home Care Association of New York State
Legislative Issues Public Policy
News
Volume 20, No. 37 October 23, 2015
HCA Brings Reimbursement Issues to Legislature HCA met with key Senate and Assembly offices this week for assistance and intervention on urgent needs in home care services reimbursement. Restoration of episodic rates HCA asked for intervention to reign-back the Department of Health’s 30-percent rate cut to home care under its rebasing of the Episodic Payment System (EPS). Both houses of the Legislature confirmed that the Department’s rate cut is contrary to the understanding and fiscal projections for rebasing in the adopted 201516 State Budget. See LEGISLATURE p. 4 Errors Impact Claims that Span
Oct. 1 ICD-10 Implementation Your Advocacy Needed on FLSA Overtime Pay Issue! As reported in last week’s ASAP, HCA is seeking funding to support new federal overtime requirements that went into effect last week. The new federal requirements prohibit third-party employers from using the “companionship exemption” of the Fair Labor Standards Act (FLSA) for home care aides, resulting in higher overtime costs for aide services in New York State.
Inside ASAP
See FLSA p. 2
HCA Brings Reimbursement Issues to Legislature................................1 Your Advocacy Needed on FLSA OT Pay Issue!.....................................1 Errors Impact Claims that Span Oct. 1 ICD-10 Implementation............1 DOH Posts Consumer Directed FLSA BIP Payment Program FAQs......3 Member Hiring Announcement.............................................................3 Congress Passes PACE Expansion........................................................4 No Social Security COLA for 2016.........................................................4 Quality Symposium is HCA’s Final BIG Conference of 2015..................5 HCA Holds Rochester and Utica Meet-Ups.........................................6 Status of Medicare Part B Premiums.....................................................6 Revised Rule Issued on Payroll Debit Cards..........................................6 QIVAPP Developments..........................................................................7 Urge Governor’s Support for “Essential Personnel” Bill......................7 October Emergency Preparedness Info, Resources..............................8 Value Based Payment Committee Work Progresses.............................8 Flu Vaccination Report Opens on Nov. 2...............................................9 New ICD-10 FAQs Added....................................................................10 DOH Proposes Rule on Immediate Needs for Personal Care.............11 New G-Codes for Hospice, Home Health...........................................11 Care At Home Waiver Extension..........................................................12 New Training Modules for Hospices on Submitting Quality Data......13 Publications...........................................................................................................13
The U.S. Centers for Medicare and Medicaid Services (CMS) has announced that home health claims with episodes spanning the October 1 ICD10 implementation date are being incorrectly rejected and returned to providers. National Government Services (NGS) and other contractors are suspending these claims, including those already rejected and returned to providers. They are currently manually processing these claims upon receipt, bypassing the edit causing the problem, until a system fix is implemented. No provider action is required; HCA will update the membership as more information becomes available. For questions, please contact NGS’s Provider Contact Center at 1-866-275-3033.
Helping New Yorkers Feel Right At Home
Volume 20, No. 37 October 23, 2015
ASAP – a publication of the Home Care Association of New York State FLSA from p. 1
Action Center (at http://p2a.co/B3WW1xf ) which allows you to send a message directly to the Governor. All you have to do is visit the campaign link, enter your name and contact information, and then select “Send Email” to have a pre-written message sent directly to the Governor’s office on this urgent appeal.
HCA has been pressing the Governor’s office and key legislative committees for funding to support these new, increased cost obligations, which are not accounted for in fee-for-service or capitated Medicaid home care rates at a time when home care providers are besieged by payment cuts, most recently through rate rebasing, and are already struggling with labor costs in Wage Parity regions.
Please circulate this advocacy campaign link to your staff and ask them to complete it. We know this is a major issue for your organization, and we ask that you meet the urgency of this mandate by sending a message to the Governor as soon as possible.
HCA and members have even taken our position to the media, including a recent interview with WNYC, which has the largest public radio audience of any NPR affiliate.
DOH clarifies info required in OT survey The state Department of Health (DOH), meanwhile, has clarified the information that home care agencies should send their contracted MLTC plans as part of a DOH survey of their overtime and travel costs related to the federal rule change.
As WNYC reported, “home health agencies operate on thin margins and most actually lose money … employers now will have even greater incentive to limit overtime by using more workers to cover shorter shifts.”
While some MLTC plans had initially asked their home care contractors for overtime data specific to that plan, DOH has now specified that the home care provider should send data to each plan that covers all of its Medicaid recipients served with all plans.
Act Now Using Legislative Action Center This week we sent you an alert on this issue. We need your help to make the case for funding with the Governor’s office. HCA has activated a new campaign on our Legislative
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ASAP is a weekly publication of the Home Care Association of New York State (HCA). Unless otherwise noted, all articles appearing in ASAP are the property of the Home Care Association of New York State. Reuse of any content within this newsletter requires permission from HCA. President: Editor:
Joanne Cunningham, jcunningham@hcanys.org Roger L. Noyes, Director of Communications, rnoyes@hcanys.org Al Cardillo, Executive Vice President, Policy & Programs, acardillo@hcanys.org Patrick Conole, Vice President, Finance & Management, pconole@hcanys.org Andrew Koski, Vice President, Program Policy and Services, akoski@hcanys.org Alexandra Blais, Director of Public Policy, ablais@hcanys.org Laura Constable, Senior Director, Membership & Operations, lconstable@hcanys.org Celisia Street, Director of Education, cstreet@hcanys.org Mercedes Teague, Finance Manager, mteague@hcanys.org Jenny Kerbein, Director of Governance and Special Projects, jkerbein@hcanys.org Billi Hoen, Manager, Meeting and Events, bhoen@hcanys.org Teresa Brown, Administrative Assistant, tbrown@hcanys.org 388 Broadway, 4th Floor, Albany, NY 12207 Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org
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ASAP – a publication of the Home Care Association of New York State Continued from p. 2 The survey, which the state sent to MLTC plans, is part of a DOH effort to estimate the new costs for providing home care due to changes in the calculation of overtime under FLSA, which also includes requirements that aides must be paid for travel time from one patient to another. The original survey (dated October 8) did not include a question about travel expenses and was amended on October 15. MLTC plans have been asked to send survey results to DOH by October 30. The survey covers the period October 1, 2014 through September 30, 2015 and requests information on: number of aides (personal care aides and home health aides) providing services; number of non-overtime and overtime hours worked by aides; number of live-in aide cases; and number of live-in aide cases where aides are not receiving five hours of uninterrupted sleep. HCA, LeadingAge NY and the New York State Association of Health Care Providers also recently surveyed members to ascertain the costs of overtime and other changes. We are in the process of collecting and developing preliminary results. For more information, please contact a member of HCA’s Policy staff.
DOH Posts Consumer Directed FLSA BIP Payment Program FAQs While HCA advocates for the state to provide funding to agencies and managed care plans to help them meet new overtime expenses and other increasing labor costs (see other p. 1 stories), the state Department of Health (DOH) has posted Questions and Answers (Q&As) on funding for Fiscal Intermediaries (FIs) that contract with local departments of social services and managed care plans for the provision of consumer directed personal assistance services (CDPAS). The Q&As are at https://www.health.ny.gov/health_care/medicaid/ redesign/2015-10-21_flsa_qa.htm. The money, part of the CDPAS Fair Labor Standards Act (FLSA) Balance Incentive Payment (BIP) Pool Program, is for FIs that provided services during the period April 1 to June 30, 2015. FIs must complete applications for funding; they are due November 2, 2015.
HIRING Director of Business Development and Marketing The VNS of Northeastern New York is a dynamic, progressive home health organization dedicated to delivering the highest quality level of care through industry best practice. VNS has an opening for: The Director of Business Development and Marketing: plans, organizes, directs, and provides the leadership to achieve the agency’s business development and marketing objectives. The position is responsible for providing leadership and direction throughout the sales and marketing function, and successfully directs the resultant business through the admissions process. The candidate develops and sustains strong relationships with agency, network, and hospital system providers to support growth and patient care objectives; and oversees the work of the Intake Coordinator and Liaisons who monitor and evaluate referral trends, market shifts and specialty service needs to assure highest levels of service delivery and to track and anticipate future program requirements and opportunities. This position develops strategic marketing plans to realize objectives of growth and promoting the exceptional care provided by the VNS; has ultimate responsibility for meeting goals and objectives of marketing plans; assures the development of action plans for Marketing and Sales positions that are effective and efficient; executes annual marketing, development and communication plans; conducts direct one-onone follow-ups; and develops and maintains relationships with managed care organizations and networks, physicians, hospitals and other real or potential referral sources and business partners. Requirements: Experience in health care marketing or related field with an entrepreneurial perspective and a proven ability to get to ‘yes’. Bachelor’s degree required. Send résumé and cover letter to: Fax: 518-382-5699; E-mail: porcellik@vnshomecare.org; or Human Resource VNS, 108 Erie Blvd. Schenectady, NY 12305.
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ASAP – a publication of the Home Care Association of New York State LEGISLATURE from p. 1 The legislatively understood limits to rebasing (mitigating the 30-percent rate cut) are reflected in the Hannon/Gottfried legislation (S.5878/A.8171), crafted by HCA and association colleagues. Though unanimously passed by the Legislature in June, this bill still awaits delivery to Governor Cuomo for final approval; once passed, bills typically are “called-up” by the Governor’s office for signature, and the Governor’s office has yet to call-up this bill, at the same time that the Administration has permitted the Department of Health (DOH) to go ahead with far more sweeping rebasing cuts. HCA is requesting that the Legislature deliver the bill to the Governor with the urgent appeal for his signature, honoring the integrity of the budget agreement and preventing EPS reimbursement from bottoming out. We’ve also asked the Legislature to directly request an Administrative stop to the Department’s cut, and to restore the EPS rates to the intended budget levels. You can help. On our Legislative Action Center, HCA has posted a message on this issue that we urge members to send to Governor Cuomo. The campaign is available at http://p2a.co/ 6snbQwL. Please act on this issue today! Aide overtime reimbursement HCA also discussed with the Legislature the serious cost requirements for managed care plans and home care agencies associated with the federal Fair Labor Standards Act rule change (see p. 1 story), and we appealed for legislative assistance with the necessary adjustments in both the managed care and EPS payment rates. HCA discussed approaches for payment adjustment, including both legislative and budget language. HCA is working on model language proposals. HCA also discussed the overall reimbursement adequacy needs in the managed care/home care services model and is working to update and resubmit our payment adequacy legislation to both the Senate and Assembly. We continue working with providers and the Department of Health to ascertain the costs and possible approaches for reimbursing the new mandatory overtime expenses. For further information, please contact a member of the HCA Policy staff. 4
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Congress Passes PACE Expansion The U.S. House of Representatives has passed legislation, already adopted by the Senate, to pave the way for expansion of the PACE program for younger individuals and persons with disabilities. PACE, or the Program of All-Inclusive Care for the Elderly, is a fully-capitated Medicaid and Medicare program for patients with chronic conditions. It is currently limited to recipients who are 55 or older and who are eligible for a nursing-home-level of care. The legislation (S.1362/H.R.3243) requires President Obama’s signature to become law. As the National Association for Home Care and Hospice (NAHC) notes, President Obama’s 2016 budget proposed a pilot program in selected states to expand PACE to individuals between the ages of 21 and 55. For more information, please contact a member of HCA’s Policy staff.
No SS COLA for 2016 Last week, the Social Security Administration announced that monthly Social Security and Supplemental Security Income benefits will not increase in 2016 due to no increase in the Consumer Price Index for Urban Wage Earners and Clerical Workers. This means that there will also be no change in the maximum amount of earnings subject to the Social Security tax, as well as the retirement earnings test exempt amounts. More information is at http:// www.socialsecurity.gov/news/press/ releases/#/post/10-2015-1.
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Volume 20, No. 37 October 23, 2015
Quality Symposium is HCA’s Final BIG Conference of 2015 HCA has reshuffled the deck a bit on our upcoming Quality Symposium (November 17-18 in Troy, near Albany), adding an important new session on the “Quality-Compliance Connection,” featuring an official from the state Office of the Medicaid Inspector General (OMIG). Members who attended our Compliance conference earlier this month will remember the value of hearing directly from OMIG staff on audit and regulatory questions; we decided to extend this important discussion to the domain of quality-care innovation. Speaking from this angle, Assistant Medicaid Inspector General for Compliance, Matthew Babcock, will explain how home care providers can structure their quality programs in a way that assures compliance. Risk tool One novel method for meeting the compliance-quality link is HCA’s Quality Risk Tool, now in the RFP stages of development. The tool has already garnered initial praise from OMIG and state quality management officials. Now you will have a chance to see how it fits your imagination for quality control, as HCA and members demo the latest version of this exciting new offering (expected to go on line in 2016). Highlighting the tool, HCA Board Member Laurie Neander of At Home Care and HCA Executive Vice President Al Cardillo will offer your quality-improvement teams with can’t-miss information on this new, firstof-its-kind platform for measuring risk in clinical, financial and operational quality oversight. HCA members have been working with us exhaustively on this tool. It promises to be a concrete, systematized and efficient platform to help you meet the quality imperative for home care. You can’t afford to miss out on a broader understanding of the tool so you can plan for its use in 2016, which is reason enough to attend our Quality Symposium. CMS Star Ratings and quality in contract relationships Are CMS Star Ratings beleaguering you? Sara Butterfield of IPRO will help you work to understand the scoring system and improve your scores. Plus, Day 2 of the conference is focused almost exclusively on the issue of home care quality in contractual relationships, whether you are a LHCSA contracting with a CHHA or MLTC plan, or if you are a CHHA or LTHHCP operating under the umbrella of a broader plan network. Marki Flannery, of VNS of NY, and Maureen Forster of Empire Blue Cross Blue Shield Plus will provide a vital perspective on quality initiatives in the provider-plan relationship, as will James P. Rolla, of People Care, and Michelle Mazzacco, of the Eddy Visiting Nurse Association, who will outline quality care innovations in the LHCSA realm specifically. We’ll also have Tracey Langlais, of CDPHP, explaining quality benchmarks that managed care plans are looking for in home care; Rebecca Fuller Gray of the Department of Health (DOH) explaining quality surveillance from the state’s perspective; developers and users of a new wound-care app to help you curb the challenges and costs related to wound care (Healogram Co-Founder Nathan Ie and Lorraine Poliey, RN, Wound Care Manager at Montefiore Home Care); and a general state update on quality and payment innovation from DOH’s Pat Roohan. We’ve thought of every angle, enlisted top minds in the quality of care arena, and all we need is you to register today for this final big HCA conference of 2015! Check out our brochure and online registration links at the top of our Education and Events page at http://hca-nys.org/events-education/upcoming-events.
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HCA Holds Rochester and Utica MeetUps, Sessions to Come Downstate in November HCA was on the road this week! Several senior members of the HCA team travelled to Rochester and Utica on Thursday for the first two in a series of five HCA Regional Meet-Ups. As a new twist on the traditional member meetings, HCA’s Meet-Ups bring together home care providers to discuss the experiences, concerns, and ideas in a regional context. This fall series is focusing on the regional Delivery System Reform Incentive Payment (DSRIP) networks, Value Based Payment, and home care’s positioning related to those and other pressing issues. HCA’s goal is to listen to members and, in turn, utilize their feedback to develop tools, strategy, and advocacy efforts to support the industry as it moves forward in this changing climate. It also presents an excellent opportunity for providers to hear from one another about experiences in other networks. DSRIP and VBP are two newer initiatives with large implications on home care agencies both immediately and in years to come. HCA is a voice for members in Albany and Washington, but the association can help you at home, too. These Regional Meet-Ups offer a chance for you to shape HCA’s agenda and work plan heading into 2016. In both Rochester and Utica, staff met with representatives from several agencies and had lively discussions about DSRIP engagement, home care’s stake in various project areas, concerns over flow of DSRIP dollars, and projections about the lasting impact of these projects and partnerships. Members presented the issues that are creating the most distress, and brainstormed about what HCA could do on their behalves. HCA staff is looking forward to the next Meet-Ups in Long Island, New York City and Westchester in early November: Patchogue (November 5), New York City (November 5) and Westchester (November 6). If you haven’t registered for this free event yet, do it now using the form at the back of ASAP. Come prepared to discuss DSRIP, payment models, new areas and models for home care, and anything else that is really keeping you up at night. 6
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Status of Medicare Part B Premiums The U.S. Department of Health and Human Services has not yet announced Medicare premium changes for 2016. Should there be an increase in the Medicare Part B premium, the law contains a “hold-harmless” provision that protects approximately 70 percent of Social Security beneficiaries from paying a higher Part B premium, in order to avoid reducing their net Social Security benefit (when there is no or a minimal Social Security cost-ofliving adjustment as mentioned in story on page three). Those not protected include higher income beneficiaries subject to an income-adjusted Part B premium and beneficiaries newly entitled to Part B in 2016. In addition, beneficiaries who have their Medicare Part B premiums paid by state medical assistance programs will see no change in their Social Security benefit. The state, however, will be required to pay any Medicare Part B premium increase for this group of beneficiaries.
Revised Rule Issued on Payroll Debit Cards The state Department of Labor has issued a revised proposed rule that provides guidance on the permissible methods of paying wages, including payment by check, direct deposit and payroll debit cards. The proposed rule is at http://docs.dos.ny.gov/ info/register/2015/october28/toc.html (page six). The rule covers written notices and consent, allowable fees, and various methods of payments. It was changed from a prior version after receiving many comments from employees, employee advocates, employers, business advocates, and financial institutions.
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Volume 20, No. 37 October 23, 2015
QIVAPP Developments This week, HCA and other associations met with the state Department of Health (DOH) to clarify recently released information on which MLTC plans and their contracted home care providers will be eligible for the second “submission” of Quality Incentive Vital Access Provider Pool (QIVAPP) funding. DOH provided the following information: •
It has not requested approval yet from the U.S. Centers for Medicare and Medicaid Services for the federal share ($35 million) of QIVAPP, but expects to do so very soon.
•
IPRO is conducting desk and/or on-site audits of every home care provider who has been approved to receive funding under the second submission.
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MLTC plans will be responsible for recouping any QIVAPP monies that DOH has determined must be returned by home care providers.
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If home care providers don’t agree with their expected amount of QIVAPP under the second submission, they should contact their MLTC plans.
•
The $70 million in QIVAPP covers the period from April 1, 2014 to March 31, 2015.
As mentioned in last week’s ASAP, DOH has released to the Associations a preliminary list of MLTC plans and their contracted providers who are eligible for QIVAPP under the second submission for the federal share ($35 million). Due to an increase in the number of providers and hours submitted (compared with the first submission), some providers will be asked to return some funds. The list of plans and providers is not final and will be revised based on awards being held for validation and IPRO’s audits. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
Urge Governor’s Support for “Essential Personnel” Bill The HCA-developed “Essential Personnel” bill has been delivered to Governor Cuomo, who has until October 26 (Monday) to sign it into law. To drum up support, HCA has posted another campaign to our Legislative Action Center where you can voice support for the Governor’s positive action on this bill at http:// p2a.co/0YDl60I. “Emergency preparedness has been a key tenet of your Administration’s efforts to help New Yorkers,” states the HCA advocacy message to Governor Cuomo. “In this spirit, the home care and hospice community seeks your support for nurses, therapists and other staff as they assist vulnerable patients at home when major disasters strike.” “Legislation delivered to your desk in mid-October offers a remedy. A.5125-B/S.3482-B (Lanza/Cusick), a bipartisan bill which unanimously passed both houses of the Legislature, would extend ‘essential-personnel’ 7
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status to home care and hospice staff providing vital medical and relief services when emergency curfews or travel orders otherwise restrict their access to patients at home.” As you know, during recent events like Superstorms Sandy and Irene, as well as the blizzards of last November in Buffalo, nurses and other caregivers found their professional work and practice area severely compromised by: a lack of priority status for fuel, transportation issues, and travel restrictions that jeopardized critical relief services, as reported by NPR, the New York Times, ABC Nightly News and other national media. Fixing this problem, A.5125-B/S.3482-B would ensure input and inclusion of home care and hospice in local emergency management planning efforts. Please take action on this campaign today at the link on page 7. All you need to do is enter your contact information to send this pre-written message to the Governor’s office with a quick push of the button, and we urge you to circulate this link to your staff so they can do the same.
October Emergency Preparedness Info, Resources Under the deliverables of a state Department of Health and Federal Emergency Management Agency project, HCA has been sending you periodic emergency preparedness updates, including one circulated to members earlier this week. Our latest update is posted to the HCA website at http://hca-nys.org/general-news/emergency-preparedness-information-and-resource-update-october-2015. It offers key policy updates that you and your emergency preparedness teams are encouraged to review. It also details some of the collaborative emergency preparedness activities for home care being conducted by provider organizations like HCA, the Department of Health and regional emergency preparedness coalitions. HCA thanks the state Department of Health/Office of Health Emergency Preparedness (OHEP), the regional Health Emergency Preparedness Coalitions (HEPCs) and the Regional Training Centers (RTCs) for the helpful information contained in this update.
Value Based Payment Committee Work Progresses The state Department of Health (DOH) Value Based Payment (VBP) core committee, as well as a technical design subcommittee, met this week for updates. HCA is a participant in both. The Technical Design Committee discussed such items as: “total care for total population” bundles; costs associated with bundles for an array of clinical conditions; contracting combinations; patient attribution; and other issues. One big focus was VBP arrangements between managed care/MLTC plans and advance primary care (APC) providers for various types of bundles, including chronic-care bundles. HCA probed the possibilities and options for VBP arrangements where ACPs are directly partnering with home care providers – say, in the case of managing congestive heart failure patients. DOH and KPMG (the state’s VBP contractor) reinforced the state’s intent for flexibility in such options, including whether the partnered home care provider is inside or outside the managed care plan’s direct contract network. Continued on next page
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Continued from p. 8 For MLTCs, the VBP intends to attribute patients to the plan’s home care or nursing home providers, as applicable. While MLTCs could pursue alternative attribution, the state proposed attribution to home care or nursing home providers as a standing approach, subject to an MLTC alternative. HCA emphasized the need for regulatory streamlining and compatibility, a point seconded by DOH, to the extent that such streamlining would be within the purview of state policymaking or accommodated by federal request. The committee also discussed criteria for hospital shared savings derived from VBP models, and whether such criteria and savings apportionment should be set as a standard, or issued as guidance but not a requirement, or a mix of both. Some criteria could include: health information and technology; efficiency; innovation and care design; and quality and engagement. The core VBP workgroup also met to review the progress and draft work of all of the committees to date. Core materials from both meetings are available at the following links: •
http://hca-nys.org/wp-content/uploads/2015/10/ ConsolidatedVBPSubcommitteeRecommendations10162015final.pdf • http://hca-nys.org/wp-content/uploads/2015/10/NYSVBPTechnical-DesignISCMeeting4PresentationFINAL.pdf •· http://hca-nys.org/wp-content/uploads/2015/10/ VBPWorkgroupPresentationSCsrecommendations10162015combinedfinal.pdf
Your attention to all of these developments is critical, and we urge you to submit comments, questions and input to HCA on an ongoing basis. HCA members should be proactively planning for VBP, and we will continue assisting members through resources and information. VBP connections will also be discussed at HCA’s November 17-18 Quality Symposium in Troy, near Albany. (See related page 5 coverage.) For further information, please contact Al Cardillo at acardillo@hcanys.org.
Flu Vaccination Report Opens on Nov. 2 The state Department of Health (DOH) has posted a Dear Administrator Letter (DAL), along with Frequently Asked Questions (FAQs), announcing that the Healthcare Personnel Influenza Vaccination Report will open on November 2, 2015 and must be electronically submitted by May 1, 2016. The DAL and FAQs are at https://apps.health.ny.gov/pub/ctrldocs/alrtview/postings/Notification_19310.pdf. The vaccination report is very similar to last year’s. It is a single, longitudinal report for which agencies should enter data in November, or as soon as data is available, and then resubmit data as often as necessary as new personnel join the agency and/or as they submit documentation of vaccination. This year’s report covers personnel employed by or affiliated with a facility or agency from October 1, 2015 through March 31, 2016. The vaccination report may be accessed on the Health Commerce System (HCS) under the Health Electronic Response Data System (HERDS) at https://commerce.health.state.ny.us/. An updated, pre9
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recorded webinar training session for the vaccination report will be available at www.health.ny.gov/ FluMaskReg under the heading “Training.” DOH advises that those completing the report should first view the webinar and review all instructions and FAQs. You will need to be assigned the role “HERDS Data Reporter” within the HCS in order to access the report. Note that if personnel work in or are affiliated with more than one agency, then these individuals must be counted in the total number of personnel for each agency where that individual works. Questions about the report should be directed to the DOH Bureau of Immunization at either (518) 4734437 or immunize@health.ny.gov. Technical questions about the vaccination report or on the use of HERDS should be directed to the Health Emergency Preparedness Program at (518) 408-5163 or hseppny@health.ny.gov. At this time, DOH has not yet declared influenza prevalent, and, thus, home care and other health care providers are not required to meet the state’s flu-mask requirement under which certain personnel not vaccinated against influenza for the current influenza season must wear a surgical or procedure mask while in areas where patients or residents are typically present. Last year, the influenza season ran from December 11, 2014 to May 14, 2015.
New ICD-10 FAQs Added The U.S. Centers for Medicare and Medicaid Services (CMS) has added new frequently asked questions (FAQs) to the web page under the Coding, National Coverage Determinations and Local Coverage Determinations sections at https://www.cms.gov/Medicare/Coding/ICD10/Frequently-AskedQuestions.html. The following FAQs were added: Coding •
“From the Centers for Disease Control and Prevention: Interpretation of Excludes1 notes in ICD10-CM when the conditions are unrelated to one another.” (Posted October 16, 2015)
•
“What qualifier do I use for ICD-10 diagnosis codes on electronic claims?” (Posted October 16, 2015)
National Coverage Determinations (NCDs) •
“How were the ICD-9 codes translated to ICD-10 for NCDs and LCDs? Have the coverage policies changed because of ICD-10?” (Posted October 19, 2015)
Local Coverage Determinations (LCDs) •
“Have the Medicare Administrative Contractors (MACs) altered their LCDs implementing ICD10-CM?” (Posted October 19, 2015) Continued on next page
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Continued from p. 10 •
“How were the ICD-9 codes translated to ICD-10 for NCDs and LCDs? Have the coverage policies changed because of ICD-10?” (Posted October 19, 2015)
DOH Proposes Rule To Meet Immediate Needs for Personal Care The state Department of Health has issued a proposed rule to implement a 2015 state law that addresses individuals who have “immediate needs” for personal care services (PCS) or consumer directed personal assistance (CDPA). The proposed rule is at http://docs.dos.ny.gov/info/register/2015/october28/toc.html (page three). The regulations would require social services districts to perform expedited Medicaid eligibility determinations for Medicaid applicants who the districts determine have an immediate need for PCS or CDPA. Medicaid applicants with an immediate need include those who are not currently authorized for any type of Medicaid coverage as well as those who are currently authorized for Medicaid but for communitybased coverage without coverage for long term care services. Under the proposal, these individuals must present a physician’s order documenting the need for assistance with certain personal care services functions and attest to the district that they have no informal caregivers, are not receiving PCS from an agency, have no adaptive or specialized equipment or supplies to meet their needs, and have no third party insurance or Medicare benefits available to pay for the needed assistance. Districts would also have to perform expedited PCS or CDPA assessments for Medicaid recipients who the districts determine have an immediate need for either service, and authorize PCS or CDPA for Medicaid recipients who are eligible for such services. These procedures would apply to Medicaid recipients seeking personal care services that are exempt or excluded from enrollment in managed care as well as Medicaid recipients who are not exempt or excluded from enrollment but who have not yet been enrolled.
New G-Codes Differentiate RN & LPN Visits for Hospice, Home Health Different codes will facilitate hospice payment reforms The U.S. Centers for Medicare and Medicaid Services (CMS) recently issued Change Request No. 9369, which provides additional G-Codes differentiating Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) in the home health and hospice settings. Change Request No. 9369 can be downloaded at: https://www.cms.gov/Regulations-and-Guidance/ Guidance/Transmittals/Downloads/R3378CP.pdf. These two new codes, G0299 for RNs and G0300 for LPNs, were necessary so that, beginning with hospice services provided on or after January 1, 2016, CMS can appropriately pay hospices for RN visits during the last seven days of life in the Routine Home Care (RHC) setting when those visits are eligible for the ServiceIntensity Add-on (SIA). These two G-codes will be effective for hospice dates of services on and after January 1, 2016, and for home health episodes of care ending on or after January 1, 2016; the existing code 11
Volume 20, No. 37 October 23, 2015
ASAP – a publication of the Home Care Association of New York State
“G0154 – Direct skilled nursing services of a licensed nurse (LPN or RN) in the home health or hospice setting” will be retired. CR No. 9369 also modifies the hospice chapter of the Medicare Claims Processing Manual to require use of the two new G-codes (with retirement of G-0154) and to correct the existing example for the two-tiered RHC payment system, as the example (issued as part of CR No. 9201) was incorrect relative to the day counts. (It did not take into consideration that 2016 is a leap year.) The home health chapter of the Medicare Claims Processing Manual has also been modified to reflect the changes. Use of the new G-codes will be required for both home health and hospice under Medicare and may be applicable to Medicaid and other payor claims where reporting of nursing visits is required. The state Department of Health (DOH) told HCA this week that hospice providers can expect an early December retrospective Dear Administrator Letter (DAL) regarding the October 1, 2015 hospice payment rates; it will include a paragraph on how DOH plans to implement the latest G-codes. DOH and Xerox are working on the design and development of the new Medicaid system, called NYMMIS. We will be following up with DOH to learn if it is able to change the billing processes in time for the scheduled January 1, 2016 implementation of the new G-Codes and SIA. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
Care At Home Waiver Extension The state Department of Health (DOH) has issued instructions to advise local departments of social services (LDSS) staff about a 90-day temporary federal extension to continue operating the current Care At Home (CAH) I/II program, a 1915(c) home and community based Medicaid waiver. The extension allows the Care at Home Waiver to continue operating through November 20, 2015 at cost and utilization levels approved for the fifth year of the waiver program with federal financial participation. CMS is granting the temporary extension in order to provide additional time for the state to fully respond to CMS’s formal request. LDSS staff are advised to continue to accept and process applications for enrollment in CAH I/II using the currently approved eligibility criteria. All current requirements in the CAH I/II waiver remain in effect until CMS approval is obtained for the waiver renewal. In the pending CAH I/II waiver application, the Universal Assessment Tool (UAS-NY) will replace the currently used Pediatric Patient Review Instrument (PPRI) to evaluate level of care (skilled facility or hospital level of care) for CAH I/II eligibility and service need purposes. While awaiting CMS approval of the waiver renewal, the PPRI continues to be the required level of care assessment tool. Questions regarding CAH I & II operations can be directed to Linda Milano, CAH Coordinator, at (518) 473-6020 or cah@health.ny.gov. 12
ASAP – a publication of the Home Care Association of New York State
Volume 20, No. 37 October 23, 2015
New Training Modules for Hospices on Submitting Quality Data The U.S. Centers for Medicare and Medicaid Services (CMS) is offering four new training modules on submitting Hospice Item Set (HIS) admission and discharge records to CMS. Each module provides tips on submission instructions, top-ten errors, how to access and review the hospice final validation reports, available CASPER reports and suggested uses, as well as where to locate technical documentation and support. The four modules are listed below and can be accessed at https://www.cms.gov/Medicare/QualityInitiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/HIS-TechnicalInformation.html. •
“Hospice Tech Training HIS Data Submission” – outlines tips for successful HIS data submission, including CMSNet User ID and QIES User ID registration and tips for submitting HIS data.
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“Hospice Tech Training HIS Final Validation Report (FVR) and Top Ten Submission Errors” – outlines important information about accessing and reviewing the hospice final validation report and provides a summary of the 10 most frequent errors for quarters 1 and 2 of 2015.
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“Hospice Tech Training CASPER Reports for Providers” – outlines the three new hospice reports, as well as other CASPER reports and suggested uses of those reports.
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“Hospice Tech Training User Guides Location and Technical Help Desk Support” – contains important information for locating technical documentation, as well as contact information for the QTSO help desk at: 1 (888) 477-7876.
The submission of HIS records must be verified by the hospice. Some hospices nationally have reported that they submitted the HIS records but the submissions were not received by CMS, resulting in a 2-percent reduction in the annual payment update. Information about a hospice’s submissions is available in CASPER and it is the hospice’s responsibility to verify that the submissions have been accepted by CMS. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
Publications •
“The Health Care Workforce in New York, 2014, Trends in the Supply and Demand for Health Workers,” by the Center for Health Workforce Studies http://chws.albany.edu/archive/uploads/2015/10/Tracking_Report_2015.pdf
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“Recovery Auditing in Medicare for Fiscal Year 2014,” by the U.S. Centers for Medicare and Medicaid Services https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/MedicareFFS-Compliance-Programs/Recovery-Audit-Program/Downloads/RAC-RTC-FY2014.pdf Continued on next page
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ASAP – a publication of the Home Care Association of New York State
Volume 20, No. 37 October 23, 2015
Continued from p. 13 •
“Medicare Care Choices Model (MCCM) Per Beneficiary per Month Payment (PBPM) Implementation (Transmittal),” by the U.S. Centers for Medicare and Medicaid Services https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/ R125DEMO.pdf
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“Meeting the Mental Health Needs of Older Adults: Building a Partnership Between Aging Service Providers and Managed Care,” by the Geriatric Mental Health Alliance of New York http://files.ctctcdn.com/dd3bfe37001/aab700c0-85b5-42c3-b083-44836b9773bc.pdf
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“Medicare Advantage and Traditional Medicare: Is the Balance Tipping?,” by the Kaiser Family Foundation http://files.kff.org/attachment/issue-brief-medicare-advantage-and-traditional-medicare-is-thebalance-tipping
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“Medicaid Enrollment & Spending Growth: FY 2015 & 2016,” by the Kaiser Family Foundation http://files.kff.org/attachment/issue-brief-medicaid-enrollment-spending-growth-fy-2015-2016
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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