ASAP
A Weekly Publication Of HCA Home Care Association of New York State
Legislative Issues Public Policy
News
Volume 20, No. 42 December 4, 2015
Your Admission to HCA Membership 2016! Earlier this week, HCA e-mailed home care member provider main contacts about our membership renewal campaign called “Your Admission to HCA Membership 2016.” The announcement includes an expedited process for renewing your membership in 2016 using an online form (available here: https://www.surveymonkey.com/r/ 2016HCAMembership). See MEMBERSHIP p. 2
Supreme Court Appeal Filed on Overtime Lawsuit The National Association for Home Care and Hospice (NAHC) and its co-plaintiffs have taken their case to the U.S. Supreme Court challenging the validity of U.S. Department of Labor (U.S. DOL) rules affecting overtime compensation for certain home care employees. A Petition for Writ of Certiorari to the Supreme Court was filed on November 19, challenging the U.S. DOL rules that significantly changed the “companionship services” and “live-in Your Admission to HCA Membership 2016!........................................1 domestic services” exemptions to the Fair Labor Supreme Court Appeal Filed on Overtime Lawsuit............................1 Jan. 6 Program to Offer Tips on FLSA Overtime Rule..........................3 Standards Act (FLSA) provisions on minimum CMS Cancels Dec. 16 Home Health, Hospice Forum…......................3 wages and overtime compensation. Supreme Court HCA Continues Pursuit of Legislative Support on Cost Needs..........4
Inside ASAP
Update on Managed Care Uniform Billing Codes..............................4 Member Hiring Announcements…......................................................5 Statistical Report Reminder….............................................................5 HCA Concludes National Home Care Month Campaign...................6 DSRIP Update…...................................................................................7 Governor Signs Bill Related to CDPAS…............................................8 OMIG Report Highlights Managed Care Activities….........................8 2015 OMIG Compliance Forms Posted…...........................................9 2016 Medicare Outpatient Therapy Cap Levels Announced..............9 HCA Palliative Care and Hospice Forum Breaking New Ground….10 2016 Medicaid Spousal Impoverishment Levels Released...............11 Revised ABN Posted for Public Comment….....................................11 OIG Releases Semi-Annual Report....................................................12 Medicaid Management Information System Update........................13 NYC Commuter Benefits Law Takes Effect January 1.......................13 CMS Provider Enrollment Application Fee for 2016........................13 HCS Changes.....................................................................................13 NGS Connex Website Maintenance Scheduled this Weekend…......14 Update on NHTD and TBI Transition to Managed Care...................15 Guidance Issued on UAS and Nursing Home Transition to Home....16 Sept. Medicaid Cap Report: Spending $51M Over Projections.......16 Publications......................................................................................................17
See COURT p. 3
Helping New Yorkers Feel Right At Home
Volume 20, No. 42 December 4, 2015
ASAP – a publication of the Home Care Association of New York State
MEMBERSHIP from p. 1 Please note that this process is for HCA’s provider members, since separate levels apply for non-provider members. Also, a separate process applies for HCC of HCA members who have a different dues structure. (Look for details on the process for non-provider and HCC renewals soon.) For HCA provider members, all you need to do is: complete the online form with basic information, let us know your dues level for 2016, and choose the best way to process your membership. Please make sure that only one person from your agency completes the form which was previously sent to the lead HCA contact at your organization. We value you as a member of HCA. Your participation gives strength to New York’s home care community, and your membership entitles you and your staff to all of the great benefits that HCA offers, including access to our expert policy team for guidance and technical assistance, member communications (like this newsletter), member forums and policy updates to help you plan for the future, discounted rates at our education programs, tools and resources like our new HCA website, and more. We also have a lot coming on the horizon in 2016, with new staff who are available to assist you and bring new
energy to our membership offerings, a new quality tracking tool that we will be unveiling in 2016 for the membership, a new focus on consumer resources to help individuals and families find the services that you provide, and, of course, our continued commitment to policy development and advocacy to assist you from the financial, regulatory and program-development angles. To learn more about our renewal campaign, please click the “Admission to HCA” image above for a video message from HCA President Joanne Cunningham. If you have any questions about membership or want to renew with a quick e-mail or call, please contact HCA’s Senior Director of Membership Laura Constable at lconstable@hcanys.org or (518) 810-0660.
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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COURT from p. 1 review of the appeal is discretionary. Each year, the court agrees to review only a small percentage of the cases submitted for consideration. NAHC believes that this case has an increased chance of being accepted for review because the Supreme Court has previously recognized the merits of acting on this matter when it chose to review a similar case in 2005 and 2007. In Long Island Care at Home v. Coke, the Supreme Court upheld the regulatory determination of the U.S. DOL that the “companionship services” exemption applies to employees of third-party employers, upholding the standards sought by NAHC and co-plaintiffs, and supported in legal documents presented into the court record by HCA and others. The full petition is at https:// www.hightail.com/download/ ZWJYRE9seWF1YlBxYk1UQw. The appeal process includes an opportunity for U.S. DOL to file an opposition to the petition. That opposition is expected by December 24 or 30 days later if a delay is requested and granted. NAHC and its coplaintiffs will then have the opportunity to file a response to the opposition. In addition, it is expected that “amicus curiae” briefs will be filed by outside parties that support one side or the other in the case. A number of advocacy groups for persons with disabilities have already indicated that they will file a brief in support of the NAHC petition. The petition phase of the case will likely take 75 to 90 days. At that point, the court will issue a decision either accepting the case for review or rejecting it. If accepted, a scheduling of argument on the merits is likely for March or April 2016 with a decision in late June, before the court closes the term.
Jan. 6 Program to Offer Compliance & Operational Tips for Meeting FLSA Overtime Rule As the new federal overtime rules remain an issue in the courts (see related p. 1 story), HCA is continuing to provide member education on the implications of the U.S. Department of Labor rules which have gone into effect for home care providers, affecting your overtime calculations for home health employees. As announced in our previous edition of ASAP, we’ve added a new Bootcamp program on January 6 in New York City to help providers develop a compliance strategy for the new rules and to provide tips on how to restructure your staffing, care delivery, and time-tracking policies and procedures to reduce labor costs. A registration form for the January 6 program is at the back of ASAP. It is also posted to our education and events page at http://hca-nys.org/events-education/ upcoming-events. This repeat program was added after all the seats filled up for our December program on this issue, so we encourage you to register as soon as possible for the new January 6 date before it reaches capacity.
CMS Cancels Dec. 16 Home Health, Hospice Open Door Forum The U.S. Centers for Medicare and Medicaid Services (CMS) this week announced the cancellation of the Home Health, Hospice and Durable Medical Equipment (DME) Open Door Forum scheduled for Wednesday, December 16. HCA will update the membership when CMS announces the next forum which HCA expects to occur in January or early February.
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HCA Continues Pursuit of Legislative Support on Urgent Cost Needs HCA pursued continued support this week on urgent reimbursement needs in home care and managed care, bringing our requests and proposals to the Assembly Committees on Health and Ways and Means. This week’s meetings follow similar discussions last week between HCA and the Senate Health, Finance, and Majority Leader’s offices. These discussions principally covered: needed restoration of the state Department of Health’s (DOH) rate cuts to the CHHA Medicaid Episodic Payment System (EPS) for home care; new costs to home care agencies and MLTC plans resulting from changes in the federal Fair Labor Standards Act (FSLA) rules and other new labor developments; and additional areas for critical payment adjustment for providers and plans. HCA issued an alert last week on Governor Cuomo’s veto of legislation S.5878/A.8171 that would have ensured rates for home care were funded at levels reflected in the state budget agreement, along with our pursuit of next steps for restoration in the wake of that veto. HCA discussed the veto with the Legislature and potential administrative and legislative comeback measures. The discussions also included the new cost implications of the FLSA and other labor developments (e.g., minimum wage increases, court rulings, wage parity levels, etc.). HCA shared with the Legislature our proposal, previously shared with DOH, for a set-aside/stop-loss pool funding mechanism to ensure adequate compensation to MLTCs, home care agencies and workers for the new wage level requirements, and to provide a more accurate basis for direct premium and rate increases for plans and providers. Next week, HCA and other provider associations will be meeting with DOH to discuss the Department’s recent “Dear Colleague Letter” that outlines DOH’s proposed approach to addressing the new FLSA and related labor costs. HCA will be seeking clarification on the Department’s plan, as well as continuing the discussion with them about our “stop-loss” pool proposal. In response to our broader discussions about overall payment inadequacy to MLTCs and agencies, HCA was invited to prepare, and has now drafted, legislation to provide for MLTC premium/provider rate adequacy. The HCA legislation incorporates many of the current, real-time costs to plans and providers for managing, delivering and developing services in the new and changing system. The Legislature invited the HCA legislation for consideration in both the upcoming budget and in potential standalone legislation that would be introduced for the Legislative Session. Meanwhile, the Governor’s office has agreed to, and scheduled in the next two weeks, a major meeting with HCA to discuss these reimbursement issues.
Update on Managed Care Uniform Billing Codes Today, HCA met with the state Department of Health (DOH) and other health care provider associations to learn of DOH progress towards establishing standard billing codes for home and community-based services under managed care. This change, included in the 2015 state budget, was sought by HCA to help home care agencies and their contracted managed care plans simplify their billing procedures. Continued on next page 4
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Continued from previous page HCA already obtained feedback from members on the codes used by plans and worked with LeadingAge NY and the New York State Association of Health Care Providers to present such codes to DOH during the summer. In September, HCA met again with DOH, health care provider associations and plan representatives who raised issues with the accuracy and utility of such codes. DOH announced at today’s meeting that it will make some revisions to the list of services and codes developed by HCA and the other associations and send those back to us and the plan representatives next week. DOH will provide three weeks for all parties to give comments and then hopes to finalize the list of codes for personal care, home health and adult day (codes for waiver programs will be addressed later) by the end of the year or early January. Following this, plans and providers will be given a period of time to implement necessary changes to comply with the revised codes. HCA thanks DOH for working with us on this important effort toward efficiency and streamlining of the billing process.
HIRING Title: Director of Patient Services Organization: Winthrop University Hospital Home Health Agency Winthrop seeks a Director of Patient Services for the CHHA, which services Nassau, Suffolk and Queens. The DPS is responsible for the administrative, professional and clinical operations of the agency. Minimum qualifications include: BSN, NYS RN license, two years of professional nursing experience, two years of supervisory experience in a CHHA or related program, Master’s degree preferred. Send résumés to Anne Calvo via e-mail to acalvo@winthrop.org. Patient Relations Manager Americare, New York’s leader in home health care, seeks a high energy, dynamic, self-starter for an exciting career opportunity in its patient relations department. The Patient Relations Manager’s primary responsibility will be to develop relationships and educate MDs about home care and the benefits to their patients. The ideal candidate will have 2-3 years home care or pharmaceutical experience. An excellent compensation and benefits package is offered, including: 401K with company match, medical, dental and direct deposit. E-mail résumé to hrrecruiter@americareny.com. www.americareny.com. EOE Alpine Home Health Care
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
Statistical Report Reminder HCA reminds members that the 2014 LHCSA Statistical Report and the 2014 Hospice Cost and Utilization Report will open for completion starting December 14 and will be due by February 8, 2016. The CHHA and LTHHCP Statistical Reports opened on November 16 and are due January 11, 2016. Individuals assigned to the Administrator, Director of Patient Services, Health
Alpine Home Health Care seeks a part-time Director of Patient Services (DPS) for our Buffalo, NY location. The DPS is responsible for the administrative, professional and clinical operations of the home health care program. Minimum qualifications include licensed Registered Nurse in the state of New York, BSN and three years of experience as a professional nurse and two years administrative/supervisory experience. Send résumés to Avi Katz via e-mail to akatz@alpinehhc.org. EOE – M/F/D/V ABOUT US: Alpine Home Health Care, founded in 2008, is a Certified Home Health Agency (CHHA) proudly serving the Bronx, Kings, Queens, New York City and Rockland counties, along with expanded operations to Buffalo, NY.
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Commerce System (HCS) Coordinator and Data Reporter roles in the HCS Communications Directory may enter data into a statistical report. Only an Administrator may submit data. According to the state Department of Health (DOH), agencies not submitting all appropriate forms for these required surveys will be cited and subject to enforcement action. Certificate of Need and licensure applications of delinquent agencies will not be processed. Questions and requests for assistance should be sent to HCStatRpts@health.state.ny.us.
HCA Concludes National Home Care Month Digital Campaign During this season of thanks and the coming New Year, HCA has been sharing special messages of gratitude from Members of Congress in honor of National Home Care Month, in November. As previously reported, throughout November, HCA has been posting Home Care Month infographic messages from Congress while also participating in events to celebrate home care with members. We wanted to again share these messages of thanks from elected officials, all of which are posted to our social media feeds on Facebook and Twitter. If you have a Facebook or Twitter account, we ask that you “like” or “follow” HCA’s pages (at the links below). Please also share some of our content, including the messages shown here and on the next page from Members of Congress, especially if these members represent your district. HCA’s National Home Care Month campaign was a great way to get Members of Congress to think about the value of home care and to provide thanks for the work you and your staff do on behalf of patients. https://www.facebook.com/HCANYS/ https://twitter.com/HCANYS 6
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DSRIP Update As a follow-up to the Opt-Out Webinar held on October 5, 2015, the state Department of Health (DOH) has posted a Frequently Asked Questions (FAQs) document related to the Delivery System Reform Incentive Payment (DSRIP) program. The document, along with the webinar materials and other information on the opt-out process, is at http:// www.health.ny.gov/health_care/ medicaid/redesign/dsrip/. The FAQs address: what information will be shared and why; differences between two opt-out mailings; contents of the opt-out letter and opt-out form; and other issues.
Rep. Tom Reed on home care visit with VNS of Ithaca and Tomkins County patient Tina Champion for National Home Care Month.
VAP exception process During the DSRIP demonstration period, Performing Provider System (PPS) lead entities may decide to pursue different corporate structures to facilitate DSRIP implementation. For this purpose, DOH will permit current PPS lead entities only to submit new corporation Vital Access Provider (VAP) exception applications for safety-net designation. PPSs may submit their proposal and rationale for the new legal corporation. The requirements for any new PPS corporation are delineated in the PPS NewCo VAP Exception Process guidance issued on September 11, 2015 at http://www.health.ny.gov/ health_care/medicaid/redesign/ dsrip/safety_net_definition.htm. Such applications will be reviewed 7
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by DOH and then posted for a 30-day public comment before submission to CMS for review and approval.
Governor Signs Bill Related to CDPAS Another CDPAS measure awaits action On November 21, Governor Cuomo signed legislation, A.7532A (Morelle)/S.5712A (Felder), that allows parents to provide consumer directed personal assistance services (CDPAS) to their adult disabled children, starting April 1, 2016. Prior to the signing of this bill, a consumer’s spouse, parent or designated representative could not be hired by a consumer as a personal assistant to provide CDPAS services. The legislation also lists some responsibilities assumed by consumers in this program, including recruiting, hiring and supervising their personal assistants. Other legislation – A.7535B (Gottfried)/S.5565B (Hannon), which would establish a new licensure process for fiscal intermediaries who provide services to consumers receiving CDPAS – passed the state Assembly and Senate, and has been sent to the Governor but he has not acted upon it yet.
OMIG Report Highlights Managed Care Activities The 2014 Annual Report of the state Office of the Medicaid Inspector General (OMIG) highlights OMIG’s activities related to managed care plans. The report is at https://www.omig.ny.gov/images/stories/annual_report/2014_annual_report.pdf. It lists some examples of program integrity additions to the managed care model contract. These include: •
Plans must refer cases of fraud to the state Department of Health (DOH) and OMIG.
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Plans must check OMIG’s exclusion list monthly.
•
Plans must terminate its Medicaid Participating Provider Agreements with any participating provider who has been terminated by Medicare, the Medicaid program of any state, or the Children’s Health Insurance Program of any state.
•
If the plan makes payments to an excluded or terminated provider for dates of service after the provider’s exclusion or termination effective date, the plan must report and explain within 60 days of identifying the payment, when and how the payment was identified, and the date on which the plan adjusted the encounter data to reflect the recovery.
•
All participating providers entering into Participating Provider Agreements with Managed Care Organizations (MCO) who meet the requirement to adopt and implement a compliance program (under New York’s Social Services Law Section 363-d and Title18 of the New York Codes, Rules, and Regulations Section 521.3) must submit a certification to DOH within 30 days of entering this agreement attesting that the participating provider has a compliance program meeting those requirements. (HCA will seek clarification on the relationship between this new requirement to certify to DOH and the long-standing requirement – see 8
ASAP – a publication of the Home Care Association of New York State p. 9 story – to certify to OMIG.) The participating provider must recertify every December thereafter that the provider has a compliance program meeting the previously referenced requirements. The report announces that a new Managed Care Unit was created in OMIG’s Division of Medicaid Investigations (DMI) that focuses investigative resources exclusively in the area of managed care. The unit is responsible for the coordination, triage and investigations of complaints received from MCOs relating to provider fraud. It also works collaboratively with MCO Special Investigation Units (SIUs) in the development of comprehensive investigative plans to combat fraud, waste, and abuse in the Medicaid program. The Unit reviews the quarterly and annual reports submitted by the MCOs, and also the results of the functional assessments conducted by DOH of the MCOs. The report also notes that OMIG faces many challenges as Medicaid reimbursement continues to transition from fee-for-service (FFS) to a managed care capitation payment system, stating: Historically, data used to perform program integrity oversight of Medicaid was produced from the FFS billing process whereby providers submit claims directly to the state for payment. With the shift to a managed care model, collection of encounter data is separate from payment information, diminishing the collection of accurate, complete and timely encounter information about the services delivered to Medicaid enrollees and the providers paid for these services. To improve integrity of the data, the format and processing of Medicaid encounters will change with the implementation of a new payment database.
HCA has and will continue to work with OMIG on auditing practices and procedures and compliance expectations in the context of the transition to managed care, as with our discussions with OMIG on its traditional work activities under FFS.
2015 OMIG Compliance Forms Posted The new 2015 Compliance Program Certification forms and information for the December 2015 certification period are now available. They are on the state Office of the Medicaid Inspector General (OMIG) website at: www.omig.ny.gov/compliance/certification. Continued on next page 9
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2016 Medicare Outpatient Therapy Cap Levels Announced The U.S. Centers for Medicare and Medicaid Services (CMS) has announced the 2016 outpatient Medicare Part B therapy cap amounts. The limits do not apply to therapy services delivered through a home health episode of care. As of January 1, 2016, there will be a limit of $1,960 for outpatient physical and speech-language pathology services combined and a separate $1,960 cap for occupational therapy (both limits were $1,940 in 2015). There is an exceptions process for cases where the provider believes that therapy services in excess of the outpatient limits are necessary. More information is at https:/ /www.cms.gov/Regulationsand-Guidance/Guidance/ Transmittals/Downloads/ R3417CP.pdf and https:// www.cms.gov/Outreach-andEducation/MedicareLearning-Network-MLN/ MLNMattersArticles/ Downloads/MM9448.pdf.
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Continued from previous page In addition, Webinar No. 24: Mandatory Compliance Program Obligation and Webinar No. 35: Certification Process: Mandatory Compliance Programs & Deficit Reduction Act of 2005 are available at: www.omig.ny.gov/resources/webinars. Certifying providers are reminded that the 2014 certification forms are no longer applicable and will not be accepted for the 2015 annual certification. Under the federal Deficit Reduction Act (DRA), health care entities receiving or making $5 million or more in Medicaid payments during a federal fiscal year must certify that they are in compliance with this federal law which requires that they establish written policies and procedures informing their employees, contractors and agents about federal and state false claim acts and whistleblower protections. More information on the DRA certification is at https://www.omig.ny.gov/certification-header?type=dra. In addition, home care and other health providers must complete the State Social Services Compliance Certification to certify that a compliance program is in place that meets the state’s requirements, including eight elements outlined at https://www.omig.ny.gov/certification-header?type=ssl. 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. While both certification forms are due by the end of December, OMIG has recommended in past years that they be filed in mid-December to avoid any delays. Revalidation DOH is revalidating providers’ enrollment in the Medicaid program – a process that requires providers to submit evidence that they met the DRA certification obligation in December. Certifying in December and retaining a copy of the certification confirmation and/or confirmation e-mails will help those Medicaid providers who are required to have a compliance program when they complete the revalidation process. Providers with questions may contact OMIG’s Bureau of Compliance at compliance@omig.ny.gov.
HCA Palliative Care and Hospice Forum Breaking New Ground The HCA Palliative Care and Hospice Forum met this week in an intensive working session on a package of initiatives to break new and very critical ground in palliative care/hospice care education, training, access, coverage, and quality innovation. Among the new initiatives, HCA presented for the Forum’s input and “markup” a package of potential legislative and budget proposals in support of palliative care and hospice care that HCA specifically developed based on the Forum’s ongoing discussions and efforts. The new proposals included HCA-drafted bills to: •
Create a Hospice and Palliative Care Quality Innovation program to promote and support these services. Continued on next page 10
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•
•
Provide for coverage of palliative care within the scope of services covered by MLTCs and to provide for a positive premium adjustment for MLTCs to accommodate the addition of the service. Include palliative care in the multi-million dollar funding pools for managed care plan quality incentive payments, such that the metrics for quality incentive payments to plans include a positive fiscal incentive for palliative care. Build upon/enhance the Hospice Supplemental Financial Assistance Program to reflect new costs and needs for hospice in the current and evolving health care context for hospice.
The Forum also took new steps in providing input on the implementation of our 2014 state legislation for palliative care education, training and resource needs for nurses and social workers. The Forum analyzed survey data provided by HCA agencies on the state of their palliative care education, training and resource needs, and explored innovative models for addressing home care, hospice and system goals. Special presenters and participants in this discussion included the Center to Advance Palliative Care, the State Palliative Care Education and Training Council, the State Boards of Nursing and Social Work, the Healthcare Association of New York State and the National Association for Home Care and Hospice. This robust, accumulating package of palliative care and hospice initiatives by the Forum is creating a valuable and timely opportunity for the field. Stay tuned for updates.
Revised ABN Posted for Public Comment As mentioned in the November 13 ASAP, the U.S. Centers for Medicare and Medicaid Services (CMS) has proposed minor revisions in the Advance Beneficiary Notice of Noncoverage (ABN) form. The revised form, instructions and other materials are at https:// www.cms.gov/Re gulations-and-Guidance/Legislation/ PaperworkReductionActof1995/PRA-Listing-Items/CMS-R131.html?DLPage=1&DLEntries=10&DLSort=1&DLSortDir=descending. According to CMS, non-substantive changes were made to the form to include language informing beneficiaries of CMS nondiscrimination practices and the beneficiary’s right to request 11
2016 Medicaid Spousal Impoverishment Levels Released On November 20, the U.S. Centers for Medicare and Medicaid Services (CMS) announced the 2016 Medicaid spousal impoverishment levels. The levels are at http:// www.medicaid.gov/Federal-PolicyGuidance/downloads/ CIB11202015.pdf. The amounts are the same as in 2015. They include: • The maximum monthly maintenance needs allowance is $2,980.50; • The maximum community spouse resource allowance is the greater of $74,820 or the amount of the spousal share up to $119,220; and • The amount of equity interest an individual can have in a home and still be eligible for Medicaid coverage is $828,000. The home equity limitation does not apply if the individual’s spouse, minor child or certified blind or disabled child lawfully resides in the home, and the state can waive the home equity limit in cases of “undue hardship.”
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this publication in an alternative format if needed. In addition, minor language and grammar edits were made to the ABN instructions to improve readability for comprehension and decrease the probability of provider/supplier error in completing the form. CMS will take comments on the revised form for 60 days and then decide whether to make any other changes or post the revised form. The ABN is given to individuals before an agency provides home health care (and/or other items or services) usually paid for by Medicare but that may not be paid for in a particular case because: •
It is not considered medically reasonable and necessary;
•
The care is custodial;
•
The individual is not confined to the home; or
•
The individual does not need intermittent skilled nursing care.
In the October 30 ASAP, HCA alerted members that non-substantive changes were also made to the Home Health Change of Care Notice (HHCCN). The HHCCN is used to notify fee-for-service Medicare beneficiaries receiving home health care services of plan of care changes. Home health agencies (HHAs) must provide the HHCCN whenever they plan to reduce or terminate a Medicare beneficiary’s home health services due to a physician ordered change in the plan of care or a lack of orders to continue the care, or limitation of the HHA in providing the specific service (i.e. staffing shortages or safety concerns in a beneficiary’s home). For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
OIG Releases Semi-Annual Report The U.S. Office of Inspector General has released its Semi-Annual Report (April 1 to September 30) to Congress which summarizes its activities for the six-month period that ended September 30, 2015. It is at http://oig.hhs.gov/reports-and-publications/archives/semiannual/2015/sar-fall15.pdf. For fiscal year 2015, OIG reported expected recoveries of nearly $3.35 billion, consisting of nearly $1.13 billion in audit receivables, and over $2.22 billion in investigative receivables. The report discusses the OIG publications, legal and investigative activities related to Medicare and Medicaid, and testimony for this period. One report which home care providers should take note of is entitled CMS’s Reliance on New York Qualification Requirements Could Not Ensure the Quality of Care Provided to Medicaid Beneficiaries Receiving Home Health Services (A-02-11-01013) at http://oig.hhs.gov/oas/reports/region2/21101013.pdf. HCA will be examining this report and determining its implications and any advocacy actions HCA should take. 12
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The New York Medicaid Management Information System (NYMMIS) Update The state Department of Health and Xerox Healthcare, LLC are continuing work on the design and development of NYMMIS, which would replace the current eMedNY developed by Computer Science Corporation (CSC). In early 2016, all new provider enrollments (enrollments for providers who are not currently enrolled in the New York State Medicaid program) will be handled by NYMMIS. Other functionality and activities will be added in releases throughout 2016 and 2017. In order for providers and interested parties to stay up-to-date on process changes related to NYMMIS, all are being encouraged to sign up for the ListServ on the Interim NYMMIS website: http://www.interimnymmis.com/. In addition, training opportunities for NYMMIS are now available. Please visit “Training & Event Calendar” on the interim website listed above. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
NYC Commuter Benefits Law Takes Effect Jan. 1 Beginning January 1, for-profit and non-profit employers with 20 or more full-time non-union employees working in New York City must offer their full-time employees the opportunity to use pretax income to purchase qualified transportation fringe benefits to pay for their commute. While expected to be of assistance to workers, including home care, the law adds an additional unfunded mandate to employers. Under federal tax law, employees can currently deduct up to $130 a month from pre-tax income to pay for qualified transportation. Employers must offer this benefit by January 1, 2016 or four weeks after an employee begins full-time work, whichever is later. However, the law gives employers a six-month grace period (until July 1) before facing penalties for not complying with the law. A full-time employee is an employee who works an average of 30 hours or more per week, any portion of which was in New York City, for a single employer. It does not matter where the employees 13
Volume 20, No. 42 December 4, 2015
CMS Announces Provider Enrollment Application Fee for 2016 This week, the U.S. Centers for Medicare and Medicaid Services (CMS) announced the 2016 application fee amount for home health and institutional providers that are initially enrolling in the Medicare or Medicaid program, adding a new Medicare practice location, or revalidating their Medicare or Medicaid enrollment. The amount will be $554, up from $553 in 2015. There is a hardship exception for agencies that can demonstrate why they cannot pay the fee; a written letter requesting this exception must accompany the application or certification statement. HCA reminds members to follow up on any letters they receive about their Medicare and Medicaid revalidation.
HCS Changes The state Office of Information Technology Services has announced that, starting February 2016, the Health Commerce System (HCS) will not allow access to those using Windows XP and Internet Explorer version 9 and older. The state recommends that HCS users upgrade to the newest version of Explorer (Explorer 11), or another browser. Questions can be directed to hcsoutreach@health.ny.gov by December 11. If any program wants to request an exception, it needs to be submitted by December 18 to hcsoutreach@health.ny.gov.
ASAP – a publication of the Home Care Association of New York State
Volume 20, No. 42 December 4, 2015
reside, only that they work in the city. Employers should calculate the average hours worked in the most recent four weeks. Not covered are employers whose employees are covered by a collective bargaining agreement (CBA). If the employer has 20 or more full-time employees who are not covered by the CBA, however, the employer must offer commuter benefits to these employees. Employees may use pre-tax income to pay for transit passes that could be used on public or privately owned mass transit or commuter vans, but not for carpooling or parking expenses. Employers must keep records that demonstrate that each eligible full-time employee was offered the opportunity to use pre-tax income to purchase transit benefits and indicate whether the employee accepted or declined the offer. Employers may use the form available on the Department of Consumer Affairs (DCA) website to document compliance. The form, along with a Frequently Asked Questions document, the law and other materials, are at http://www1.nyc.gov/site/dca/about/pre-tax-transit-benefits-law.page. The Commuter Benefits Law requires employers to keep records for two years, but agencies are advised to consult their tax professional to determine any other recordkeeping requirements under state and federal laws. Questions about the law’s requirements can be e-mailed to commuterbenefits@dca.nyc.gov.
NGS Connex Website Maintenance Scheduled this Weekend The Connex (NGSConnex) website of National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), will be unavailable for users beginning Friday, December 4 at 9 p.m. through Saturday, December 5 at 1 p.m., due to scheduled maintenance. The NGSConnex website allows users to perform numerous functions such as: check claims status, check beneficiary eligibility, see financial data, filing an appeal and more. NGS Connex should be available after 1 p.m. on Saturday, December 5. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
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Volume 20, No. 42 December 4, 2015
ASAP – a publication of the Home Care Association of New York State
Update on NHTD and TBI Transition to Managed Care This week, the Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) Waiver Transition Workgroup met to continue its work related to the transition of these programs to managed care. The transition timeline includes the following important dates: •
A draft transition plan will be shared with the workgroup on January 27, 2016;
•
The public comment period on the plan will run from about February 1 through May 1, 2016;
•
The final transition plan will be submitted to the U.S. Centers for Medicare and Medicaid Services (CMS) on June 30 and the state expects CMS approval by November 30;
•
Written announcements about the transition will be sent to participants on December 15;
•
60-day notices about the need to enroll in a managed care plan will be sent on January 1, 2017, followed by 30-day notices on February 1, 2017; and
•
Current participants will be enrolled into managed care plans on March 1, 2017.
Some new information presented included: •
The state Department of Health (DOH) proposes to transition NHTD/TBI benefits not currently in the managed care benefit packages except for home visits by medical personnel and peer mentoring.
•
The Regional Resource Development Center will continue to have a role in the coordination of services including, but not limited to, service coordination and other non-state plan services.
•
Service coordination will be offered as a benefit in addition to care coordination, based on need.
•
In order to receive service coordination, participants must have a nursing-home-level of care and a diagnosed moderate cognitive impairment.
•
DOH is proposing a two-year continuity-of-care period for participants and service providers.
•
Managed care organizations will be required to contract with current service providers for a minimum of two years: 1) if the service provider is serving five or more current waiver participants; 2) if the service provider continues to serve participants unless a health or safety concern exists; and 3) as long as the service provider assures that there are appropriately licensed personnel to provide and/or supervise services.
•
Current waiver participants will have the choice to maintain their existing services and the providers of these services for 90 days, but will have the option to keep the same providers for up to two years if their needs remain the same after 90 days and the provider meets the conditions in the previous bullet.
The handouts for this meeting will be posted at http://www.health.ny.gov/health_care/medicaid/redesign/ mrt_90.htm. (This link also provides materials from prior workgroup meetings.) 15
ASAP – a publication of the Home Care Association of New York State
Volume 20, No. 42 December 4, 2015
Guidance Issued on UAS and Nursing Home Transition to Home This week, the state Department of Health (DOH) posted guidance to clarify the Conflict-Free Evaluation and Enrollment Center (CFEEC) and Uniform Assessment System (UAS-NY) requirements for Medicaid recipients seeking Community Based Long Term Care Services (CBLTCS) and enrollment into an MLTC plan upon discharge from a nursing home. The guidance is at: http://www.health.ny.gov/health_care/medicaid/redesign/docs/mltc_policy_15.06_nursing_home_trans.pdf Nursing home residents not enrolled in an MLTC Those nursing home residents who are not enrolled in an MLTC and who are approaching conclusion of a short term rehabilitative stay and seek to access CBLTCS upon discharge must be routed to CFEEC to establish eligibility for MLTC enrollment. Any nursing home resident who was permanently placed prior to the effective dates of the nursing home transition and subsequently seeks return to the community with the support of CBLTCS and MLTC enrollment must be routed to CFEEC to establish eligibility for enrollment. Those individuals are not automatically deemed eligible for MLTC enrollment. Nursing home residents who enroll in an MLTC Effective October 1, 2015, permanently placed nursing home residents may voluntarily enroll in an MLTC plan. Those permanently placed residents who enroll in an MLTC may continue to progress and eventually consider returning to the community with the services of the plan. The MLTC plan is not required to route that member to the CFEEC to establish eligibility. New community applicants Individuals who are residing in the community and approach an MLTC about enrollment must be referred to the CFEEC which will conduct an evaluation to determine eligibility. Dual-eligibles in receipt of CBLTCS who have been notified by New York Medicaid Choice of the need to transition to an MLTC plan are not required to have a CFEEC evaluation prior to enrollment in the plan. The MLTC is required to conduct a UAS-NY community assessment within 30 days of the member’s enrollment in the plan.
Sept. Medicaid Global Cap Report: Spending $51M Over Projections The state Department of Health (DOH) has issued its monthly Medicaid Global Cap report. This latest report, for September, covers the period of April 1 to September 30, 2015. It finds that overall spending for this period was $51 million above Medicaid Global Cap projections, across all sectors, a difference of $9.327 billion in actual spending versus $9.276 billion in estimated spending for the six-month period. The category that includes home care (“Other Long Term Care”) was $34 million over projections, a difference between actual spending of $354 million versus projected spending of $320 million “as a result of more recipients
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ASAP – a publication of the Home Care Association of New York State
Volume 20, No. 42 December 4, 2015
billed than anticipated in personal care, 7.1 percent. This likely reflects a slower than expected transition to Long Term Managed Care,” according to the report. Medicaid Managed Care was $81 million over projections, a difference of $6.292 billion (actual spending) versus $6.211 billion (estimated spending). The report states that Mainstream Managed Care enrollment continues to be on target with estimates, however there is higher than anticipated enrollment in the 50 percent Federal Medical Assistance Percentage (FMAP) eligibility group versus the enhanced FMAP groups resulting in higher state costs. The MLTC category was also above projections by $45 million due to higher than expected enrollment in the partial capitation program. Through September there were about 9,000 (or 7.7 percent) more recipients than anticipated. The full report is at: http://www.health.ny.gov/health_care/medicaid/regulations/global_cap/monthly/ sfy_2015-2016/docs/september_2015_report.pdf. HCA is surveying these reports carefully in an information gathering effort, combined with other data analysis, related to home care’s performance under the Global Cap. The Medicaid Global Cap for the current fiscal year (April 1, 2015 to March 31, 2016) is $17.7 billion for all sectors. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
Publications •
“Bundled Payments for Care Improvement Initiative,” Health Affairs (November 23, 2015) http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_148.pdf
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“Navigating the New York State Value-Based Payment Roadmap,” by the United Hospital Fund https://www.uhfnyc.org/assets/1439
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“New Permanent Nursing Home Residents in NYS Required to Enroll in Medicaid Managed Care Plans or MLTC Plans – Effective since October 2015 Statewide,” by the New York Legal Assistance Group http://www.wnylc.com/health/print/199/
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“Dementia Care Coordination Workforce and Practices in Seven Duals Demonstration States,” by the UCSF Health Workforce Research Center on Long-Term Care http://healthworkforce.ucsf.edu/sites/healthworkforce.ucsf.edu/files/Research_BriefDementia_Care_Coordination_Workforce_and_Practices_Seven_Duals_Demonstration_States.pdf
•
“Changes in Medicare Spending Per Beneficiary by Age: Working Paper 2015-08,” by the Congressional Budget Office https://www.cbo.gov/sites/default/files/114th-congress-2015-2016/workingpaper/51027MedicareSpending.pdf
•
“National Health Spending In 2014: Faster Growth Driven By Coverage Expansion And Prescription Drug Spending,” Health Affairs ( January 2016) http://content.healthaffairs.org/content/early/2015/11/25/hlthaff.2015.1194.full.pdf+html
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org. 17
Achieving Compliance with the New Companionship Services and Live-in Overtime Compensation Rules January 6, 2016 - AGENDA 9:00am Registration 9:30 to 9:45am HCA Welcome
Wednesday, January 6 9:00am to 11:45am
Location: Conference Center 130 East 59th Street (near Lexington Ave.) 7th Floor New York, NY 10022
Fee: $79 for HCA Members; $139 for Non-Members
9:45 to 11:45am Littler Mendelson Law Firm Join Angelo Spinola and Lisa Griffith for a discussion of compliance strategies in light of the U.S. Department of Labor’s new rules that narrow the companionship and live-in domestic worker exemptions from federal minimum wage and/or overtime obligations for home care agencies. In addition to discussing the outcome and next steps related to their law firm’s challenge to these new rules, Angelo and Lisa will also discuss recent court cases that challenge the application of the “13 hour payment” practice for New York’s “live-in 24 hour care” cases and other agency practices. Further important topics to be covered include the essentials of an effective compliance program for New York employers, including best practices for compensating extended-shift and live-in employees. Get detailed tips on how to restructure your staffing, care delivery, and time-tracking policies and procedures to reduce labor costs and ensure compliance. Angelo Spinola, Shareholder, Littler Mendelson P.C. Lisa M. Griffith, Shareholder, Littler Mendelson P.C.
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