November 19, 2018 Edition of The Situation Report

NEW POLICY DIRECTOR ALYSSA LOVELACE

SEPSIS

BUDGET PREVIEW

MLTC MEETING

Efforts are well underway to build a proactive agenda of state budget requests and prepare for any responsive work to overturn or mitigate adverse policy and payment actions.

DOH policy briefing with MLTC plans discusses latest updates as plans and associations press DOH and its contractor on actuarial rate soundness.

HCA welcomes a new member of our team, starting today, Policy Director Alyssa Lovelace.

HCA continues to present to national and statewide audiences on our Stop Sepsis at Home initiative.

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UPCOMING PROGRAMS Join HCA for Downstate & Upstate CHHA Forums in Late November Upstate (Albany): Nov. 27 Downstate (NYC): Nov. 29 HCA Bootcamp: Regulatory & Compliance Update for Fiscal Intermediaries Under NY’s CDPAP Dec. 5, 2018 (NYC) Dec. 10, 2018 (Albany) 2019 Northeast Home Health Leadership Summit Jan. 22-24, 2019 Boston

Your Source for HOME CARE News, Policy and Advocacy

Vol. 3, Issue 45 | November 19, 2018

HCA to Press Congress Next Week on PDGM Cuts, Regulatory Relief and Other Home Care Priorities HCA is heading to Washington next week, joining a coalition of state home care association executives opposing $1 billion in cuts assumed under the Patient Driven Groupings Model (PDGM) in 2020.

These cuts would surreptitiously change rates to Medicare home health providers by assuming future “behavioral changes” – i.e., that providers would alter their coding and other claim-submission practices to achieve higher payments, or to bypass new financial disincentives or corrections.

While the final payment rule doesn’t provide a specific percentage for the funding reduction in 2020, CMS initially proposed cuts of 6.42 percent, or $1 billion nationally.

See PDGM p. 3

Advocacy Continues on Minimum Wage Resolution

Register at https:// hca-nys.org/eventseducation/upcomingevents

HCA continues a daily, all-fronts effort to secure a state fix to the severe minimum wage funding chaos for managed long term care and home care, especially in recent weeks.

HCA’s offices are closed for Thanksgiving on November 22 and 23 and will reopen on November 26.

The state Department of Health (DOH), in response to intense advocacy, has stepped in with a communication to at least table the present confusion over plan-provider reconciliations, giving time to further analyze and guide a resolution of this issue.

See WAGE p. 2

INSIDE HCA to Press Congress Next Week on PDGM Cuts.........................................1 Advocacy Continues on Minimum Wage Resolution....................................1 Member Hiring Announcement...................................................................3 State Budget 2019 Preview: Challenges/Opportunities Taking Shape...........4 PDGM in 2020, HHPPS in 2019, Your Questions Answered on Jan. 22...............5 DOH Provides Critical Briefing on MLTC Finance.............................................6 HCA Welcomes New Policy Director Alyssa Lovelace.....................................7 HHQI Features HCA Sepsis Tool to National Members..................................8 SUNY Adirondack Features HCA, IPRO Sepsis Presentation...........................8

FAQs Posted on NYC’s Sexual Harassment Legislation.............................................9 2018 Managed Care Regional Consumer Guides Released......................................9 Home Care Salary & Benefits Reports Available..................................................10 OIG Updates Workplan.......................................................................................10 OIG Posts Top Management and Performance Challenges....................................10 US DOL Posts Semiannual Regulatory Agenda.......................................................11 Important Upcoming Deadlines..........................................................................12 August Report: Medicaid Spending $41M Above Projections................................13 CMS Continues Recognition of CHAP for Hospices................................................13 NGS Offices Closed November 22 & 23 for Thanksgiving..........................................14 Health Resources............................................................................................15

The Situation Report: the Home Care Association of New York State WAGE from p. 1

However, one particular plan continues to recoup provider monies, despite DOH instructions to cease and desist.

This week, HCA communicated forcefully with the Administration, demanding that this one plan be brought into compliance with state instructions, as other plans are doing. HCA awaits the state’s response on compliance options that we discussed.

Beyond immediate needs, HCA intends to fashion proposals for handling minimum wage funding in ways that avoid these continued problems. While the Administration continues to treat minimum wage funding and procedures distinct from other MLTC adjustments, HCA also believes that the state’s general funding/underfunding of MLTCs and network providers is inextricably linked to the current state of problems. It is deeply concerning that the cascade of cuts and mandates (at risk of worsening in the next state budget) are undermining the state’s legal requirement to set MLTC payments based on rate adequacy and actuarial soundness, including for coverage to providers.

HCA will keep plans and providers closely apprised of the efforts to resolve the current problem, and of our efforts to secure a permanent fix.

Volume 3, No. 45 November 19, 2018 

The Situation Report is a weekly publication of the Home Care Association of New York State (HCA). Unless otherwise noted, all articles appearing in The Situation Report are the property of the Home Care Association of New York State. Reuse of any content within this newsletter requires permission from HCA. Al Cardillo President and CEO acardillo@hcanys.org Roger L. Noyes Director of Communications, Editor of The Situation Report rnoyes@hcanys.org Patrick Conole Vice President, Finance & Management pconole@hcanys.org Andrew Koski Vice President, Program, Policy & Services akoski@hcanys.org Alyssa Lovelace Director for Policy and Advocacy alovelace@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 & Graphic Design jkerbein@hcanys.org

https://hca-nys.org/general-news/homecareconnect Home Care Association of New York State (HCA) 388 Broadway, 4th Floor, Albany, NY 12207 Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org

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Billi Wilson Manager, Meetings & Events bwilson@hcanys.org Teresa Brown Administrative Assistant tbrown@hcanys.org

The Situation Report: the Home Care Association of New York State

Volume 3, No. 45 November 19, 2018 

PDGM from p. 1 Specifically, we are urging members of New York’s Congressional Delegation to co-sponsor and help pass three bills (H.R. 6932, S. 3545 and S.3458) that would: 

Prevent PDGM “behavioral adjustment” cuts from occurring prospectively, and only allow rate adjustments upon evidence that behavioral changes have occurred;



Ensure budget-neutrality in the new payment model and limit any rate decreases to 2 percent per year; and



Allow for waiving of the homebound requirement under Medicare Advantage and waiver programs as an additional area of flexibility.

HCA has prepared a one-page issue paper that we have already shared with New York’s Congressional Delegation on these measures. HCA members are encouraged to read the document (at https://hca-nys.org/wp-content/uploads/2018/11/Co-Sponsor-andPass-Bipartisan-Bills-to-Protect-Medicare-Home-HealthReimbursement.pdf) and press your federal Congressional representatives to sign-on to H.R. 6932, S. 3545 and S.3458.

HCA’s meetings next week will target other regulatory concerns as well, including our continued call for relief from the Medicare faceto-face rule and the removal of existing limits preventing nonphysician advanced practice clinicians from ordering or referring for Medicare home health services.

We will also be presenting Congressional offices some of the positive initiatives taking place in New York’s home care system, such as HCA’s work on sepsis prevention (through the Stop Sepsis at Home initiative) and other work to address potentially avoidable hospitalizations.

HCA will report back to the membership on these developments and ways you can participate in grassroots efforts to support federal advocacy efforts aimed at payment support and regulatory relief.

Conference call tomorrow on PDGM and HHPPS rule HCA reminds members that we are holding a members-only call tomorrow (November 20 at 10 a.m.) to outline the new Home Health Prospective Payment System (HHPPS) rule, including further information about PDGM. If you haven’t registered for the call, there’s still time to do so by sending an e-mail today to Roger Noyes at rnoyes@hcanys.org and we will forward you the dial-in information in advance of the call.

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HIRING: RN / Staff Development Education Supervisor – Home Health Full Time 9 am-5 pm Driven to Be the Best.

NYU Winthrop Hospital’s Home Health Agency ranks as a topperforming US Home Health Agency!

Come join our stellar team of nurses, therapy professionals and social workers who provide home health care to our maternal, child and adult population.

We have an exceptional opportunity for a Staff Development Education Supervisor to be responsible for home health staff education, development and professional growth, including orientation program (didactic and practical components). With collaboration of the Director of Quality Management/Staff Development and the departments’ management team, you will identify, develop and plan appropriate staff development programs to support agency needs to provide optimum patient outcomes.

Working with the Administrator and the Director of Patient Services, you will research, coordinate and establish new programs for the agency.

We require:  

  

NYS Registered Nurse License BSN with 2 years’ experience in Education in a Certified home care agency; Master’s degree in Nursing, preferred 2-3 years clinical nursing practice 2 years’ community health nursing Good communication and basic computer skills, knowledge of agency clinical and business functions

To apply for our Staff Development Education Supervisor position, visit https://jobs.winthrop.org/job/8799934/ registered-nurse-staff-developmentsupervisor-home-care-mineola-ny/ An EOE m/f/d/v.

The Situation Report: the Home Care Association of New York State

Volume 3, No. 45 November 19, 2018 

State Budget 2019 Preview: Challenges/Opportunities Taking Shape Although a new state budget announcement is just over two months away, the preparation work by the Administration is actually right now deep in the process. Among the major concerns presented to us at this time are a projected $4.5 billion budget gap, and an anxious focus by the departments of Health and Budget on the upward trajectory of Medicaid spending, including once again, managed long term care services.

In addition to these concerns are new and as-of-yet unknown dynamics accompanying the state Senate’s Democratic takeover, including the Senate leadership’s orientation with the Assembly Speaker, and with the Governor. New health and other major committee chairs, beginning in January 2019, will also reflect and influence these dynamics.

With the leadership changes may come new challenges and opportunities, but, simultaneously, a need for new and very extensive levels of outreach, familiarization with our sectors’ issues and priorities, and effective engagement with new officials and new legislative staff to garner support for urgent system needs.

HCA and our counsels at Hinman-Straub have been meeting with state health leaders since August to outline both current and upcoming issues, and discussing our proactive proposals for the 2019 budget and legislative session. While we have been working hard to establish a strong foundation for home care, managed long term care and hospice needs, the new dynamics in New York’s governance, combined with the budget deficit, Medicaid growth, and new health policy priorities among the leaders, will require an all-hands-on-deck participation in the advocacy effort.

In the very near period, HCA will be advancing a set of formalized proposals and language for consideration by the Administration and the Legislature for the new session. These will align with the input of the HCA membership, the HCA Board, and the parameters that may be laid out by state officials. We will outline these for the membership as well as the steps we will urge members to take in support of these efforts.

While proactive HCA-driven policies are vital, we must also respond to the proposals soon-to-be advanced by state officials, which may include cuts or adverse programmatic actions. For example, when the Executive last year proposed a rigid 10-agency LHCSA-MLTC contract limit, our advocacy and explanation of the consequences helped mitigate the final policy, resulting in enrollee-based contract limit ratios – a far cry from the original hard cap of 10 LHCSA contracts per MLTC. Thus, while an actual, identifiable budget proposal is still more than a couple of months away, the action to shape the initial budget proposal is deep in motion and is “now” on the timeline.

HCA will be working to shape a greatly elevated and robust advocacy effort, in which all members must play an active part.

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The Situation Report: the Home Care Association of New York State

Volume 3, No. 45 November 19, 2018 

PDGM in 2020, HHPPS in 2019, and Your Questions Answered on Jan. 22 in Boston Register by December 3 for the early-bird discount Surely your head is swimming with the same four letters that have saturated the home health trade press headlines in recent weeks: PDGM. 

How big will the behavioral adjustment cut actually end up being; and how will it affect your organization directly, even if CMS forecasts that PDGM will not harm your agency financially in the long run?



How will the new resource groupings change Medicare claim processing for your current casemix and clinical patient profiles, and what does this mean for the patients you currently serve?

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What are the split-percentage RAPs and how will this affect cash-flow?



Are your systems and overall operation able to handle the new 30-day units of payments or episodes and the overlap of compliance and reporting requirements still tied to the 60-day episodic structure and frequencies?

The Northeast Home Health Leadership Summit in January has a whole pre-conference session devoted to questions like these under the PDGM changes for 2020, not to mention the Home Health Prospective Payment System (HHPPS) and other federal impacts coming your way sooner, on January 1, 2019.

Our “Reactor Panel” on “Creating a Winning PDGM Reimbursement Strategy” includes: Stacey Ashworth of Select Data; Chris Attaya of Strategic Healthcare Programs; and Nick Seabrook of BlackTree Healthcare Consulting. These three experts have done a lot of thinking and analysis covering each of the potential PDGM touch points for your organization.

Our pre-conference also includes leading federal policy expert Colin Roskey, Principal at Lincoln Policy Group, and Partner at Scully Roskey & Missmar, who will provide an overview of the more immediate landscape of home care and hospice payment and regulatory changes for 2019.

Join us on January 22-24 to get a better handle on the biggest upcoming changes to Medicare home health payments in decades, as well the near-term HHPPS and hospice regulatory impacts coming your way in just over a month.

Registration details and more are on the conference website at: http://nehomehealthsummit.com.

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The Situation Report: the Home Care Association of New York State

Volume 3, No. 45 November 19, 2018 

DOH Provides Critical Briefing on MLTC Finance On Friday, the state Department of Health (DOH) briefed managed long term care plans and MLTC member associations on the status of MLTC rates and financing, including reconciliations, prospective adjustments, the status of 2018 state budget actions, the just-circulated risk scores, and more.

Considerable discussion focused on risk scores that DOH had shared the day before with MLTCs. Plans questioned the validity of the score reductions and expressed urgency regarding the potential fiscal consequences. At the request of virtually all plan and association representatives, DOH officials agreed to hold off on any action associated with these scores pending further study and discussion with plans and associations.

Another major focus was the state’s position with regard to the “rate adequacy and actuarial soundness” of MLTC rates. Plan representatives questioned the state’s contractor, Deloitte, on its assessment that the rates meet the “range for actuarial soundness.” Deloitte and DOH reasserted their conclusions that “rates are within the range.” HCA and other participants rebutted this assessment, contending that the actual experience of plans and providers did not comport with the agent’s conclusion, and we asserted that the net combination of the rates, costs, mandates and budget cuts was not producing a payment level capable of meeting MLTC cost obligations.

Participants requested evidence substantiating Deloitt’s claim of rate soundness, arguing the need for transparency.

HCA has previously advanced both budget and statutory language to tighten the standards around state adherence to actuarial soundness in the payment levels provided to MLTCs. The Legislature has repeatedly helped advance such language in the negotiations, only to have the measures turned back by the Administration. A statutory fix will continue to be an HCA priority in the 2019 Legislative Session and budget that we will take up anew with the incoming health leadership teams.

Other fiscal updates, revisions and adjustments were discussed at the meeting including: 

October 2016 revision (released November 1), addressing state fiscal year 2016-17 minimum wage reconciliation and recruitment and retention funding

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A target November release of state fiscal year 2017-18 revisions, addressing nursing home transition enrollment from the July 2018 survey, updated risk scores, high cost/high need risk pool, nursing home price mitigation pool

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November 8, 2018 release of the April 2018 rate revision, including a minimum wage adjustment for transportation providers, risk score update, budget cut attributable to LHCSA contract limitation, and social day care efficiency budget cut

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Target December 2018 release of October 2018 rate revision with transformation fund nursing home update Continued on next page

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The Situation Report: the Home Care Association of New York State

Volume 3, No. 45 November 19, 2018 

Continued from previous page 

March 2019 release of January 2019 rate revision, with update for nursing home enrollment, transportation congestion pricing update, reflection of 2018 budget cuts associated with the nursing home benefit limitation and restriction on MLTC enrollee transfer



Similar updates on PACE, MAP and MA programs

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Risk Adjustment Workgroup – DOH has survey information and will meet again soon following opportunity to review



Quality Incentive/Vital Access Provider Pool (QIVAPP) funding awards will be released in cycle No. 2151

DOH briefly addressed the projected upcoming state budget fiscal deficit and expectations for cost cutting pressures. Responses underscored the need for state budget planners to appreciate and abide the distinction between cuts to the state’s General Fund programs versus insurance-based models which must operate under federal and state actuarial standards. We reiterated grave concerns over the existing MLTC and provider under-funding and fragility, and the alarm over a potential new onslaught of cuts. See related p. 4 story previewing HCA’s work to prepare for upcoming state budget talks.

HCA Welcomes New Policy Director Alyssa Lovelace

By HCA President Al Cardillo HCA is thrilled to announce our appointment of Alyssa Lovelace as Director for Policy and Advocacy.

She comes with much experience, excitement and enthusiasm for her work in home care and for becoming part of HCA. Alyssa previously held health policy and program posts at the New York State Association of Health Care Providers (HCP) and LeadingAge New York, following prior work in marketing and business development.

She is an extremely well-known, respected and talented representative for home care, hospice and managed long term care, a skilled professional in government relations and a highly effective, successful and well-liked collaborator with key partners and associations across the continuum.

Alyssa Lovelace

She has served on state policy workgroups, co-directed association emergency preparedness efforts, led advocacy, participated in state budget and policy analysis and outreach in the Legislature and Executive, and participated in high-priority negotiations.

Continued on next page

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The Situation Report: the Home Care Association of New York State

Volume 3, No. 45 November 19, 2018 

Continued from previous page Alyssa is a tremendous addition to HCA and toward our membership’s unanimous priority goal of further investing in HCA advocacy. She will be working very closely at the member level to engage and support your advocacy for our sector’s service, operational and health system needs.

Alyssa was also recognized this year as one of the “40 under 40” Rising Stars by City and State Magazine.

Alyssa’s first day at HCA is today, November 19. Please join the entire HCA team in welcoming Alyssa Lovelace, who so looks forward to hearing from you. Her e-mail address is alovelace@hcanys.org.

HHQI Features HCA Sepsis Tool to National Members The National Home Health Quality Improvement (HHQI) campaign featured the HCA sepsis tool on a national webcast this past week. The presentation to home care associations, providers and quality coordinators across the country was hosted by Cindy Sun, HHQI’s Lead Project Coordinator. It was jointly delivered by Sepsis Alliance Chief Executive Thomas Heymann, HCA President Al Cardillo, and HCR Home Care’s Senior Director of Clinical Innovation, Chris Chimenti.

Mr. Heymann provided the overall sepsis epidemiological profile and the host of sepsis resources available through Sepsis Alliance; Mr. Cardillo described the development, design and application of the tool, and how providers nationwide could access and incorporate it; and Mr. Chimenti provided experience and data from an individual provider using the HCA tool with its patients.

Mr. Chimenti stated that, using the tool, his agency has identified and intervened in over 240 cases of severe sepsis, and over 120 cases of sepsis. HCR’s intervention in these cases promises to achieve enormous improvements in health outcomes for these individuals, along with avoidance of major, catastrophic health care costs.

SUNY Adirondack Features HCA, IPRO Sepsis Presentation SUNY Adirondack hosted a sepsis workshop at the college that featured IPRO Sepsis Program Director Eve Bankert, along with HCA President Al Cardillo.

The workshop targeted nurse alumni of SUNY Adirondack, who attended from diverse positions.

The session led to numerous “next steps” identified by SUNY hosts, participating clinicians and HCA/ IPRO for follow-up efforts that could further the education, circulation and use of the HCA tool, and sepsis awareness and intervention overall.

HCA looks forward to these follow-up efforts!

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The Situation Report: the Home Care Association of New York State

Volume 3, No. 45 November 19, 2018 

FAQs Posted on NYC’s Sexual Harassment Legislation The New York City Commission on Human Rights has posted a Frequently Asked Questions (FAQs) document on the “Stop Sexual Harassment Act in NYC.” The FAQs are at https://www1.nyc.gov/site/cchr/law/stop-sexual-harassment-act-faqs.page.

As highlighted in the April 23 edition of The Situation Report and in a detailed memo summarizing recent city and state legislation (https://hca-nys.org/wp-content/uploads/2018/04/ 042318SexualHarrassmentMemoJacksonLewis.pdf), the Stop Sexual Harassment in NYC Act does the following: mandates employer training on sexual harassment prevention (for employers of 15 or more employees); expands New York City Human Rights Law coverage for gender-based harassment claims to all employers; extends the statute of limitations from one to three years for gender-based harassment claims under the Human Rights Law; and extends protections to non-employees in the workplace.

The New York City Commission on Human Rights is partnering with the New York State Division of Human Rights and the New York State Department of Labor so that NYC-based employers can meet compliance with both the state and city training requirements by utilizing the forthcoming online training provided by the New York City Commission on Human Rights. The online training will be available on or before April 1, 2019.

Information on the NYC law, including required workplace notices and an employee fact sheet, is at https://www1.nyc.gov/site/cchr/law/stop-sexual-harassment-act.page.

Information on the state sexual harassment law is at https://www.ny.gov/programs/combating-sexual-harassment-workplace.

In October, the state Department of Labor had posted final guidance, including revised FAQs, on combatting sexual harassment in the workplace (see the October 8 edition of The Situation Report).

2018 Managed Care Regional Consumer Guides Released The state Department of Health has released the 2018 Managed Care Regional Consumer Guides.

The guides are at https://www.health.ny.gov/health_care/managed_care/consumer_guides/.

They are available for Mainstream Medicaid Managed Care, Child Health Plus, Commercial Health Maintenance Organizations, and Commercial Preferred Provider Organizations, and contain a star rating for each insurer based on preventive and well-care, quality of care, and patient satisfaction.

There are six regions for each product: Central, Hudson Valley, Long Island, New York City, Northeast, and Western.

To find a particular table of Consumer Guide ratings, select a Region and Payor from the dropdown lists, and click the “Produce Visualization” button.

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The Situation Report: the Home Care Association of New York State

Volume 3, No. 45 November 19, 2018 

Home Care Salary & Benefits Reports Available The 2018 Home Care Salary & Benefits Report, published by Hospital & Healthcare Compensation Service (HCS), is now available.

The Report, published in partnership with the National Association for Home Care and Hospice (NAHC), had nearly 1,500 participants and covers 64 jobs reporting on salaries, bonuses, and hourly and per-visit rates.

Data include the percentiles, total number of employees, and total number of agencies. Data are reported by state, core based statistical area (CBSA), region, agency type, and revenue size. Also included are 20 fringe benefits, planned percent increases, productivity, and personnel policies.

The Home Care Report price is $350; the Hospice Report, published in early December, is $300.

To order, visit the HCS website at www.hhcsinc.com or call (201) 405-0075.

In addition, the HCS Corporate Compensation study is currently being developed. The study covers executive compensation in home health/hospice agencies with revenues greater than $25 million, as well as those with multiple locations. There is a significant savings on the cost of the report for those who participate in the survey – Participants pay only $195 compared to the non-participant price of $650.

Questionnaires for the study, due December 3, are available at https://www.hhcsinc.com/surveyquestionnaires.html.

OIG Updates Workplan The federal Office of Inspector General has updated its Workplan.

The November update is at https://oig.hhs.gov/reports-and-publications/workplan/updates.asp.

One item of interest to HCA members is: Protecting Medicare Hospice Beneficiaries From Harm.

According to this activity, OIG will conduct a study that is a companion to Trends in Hospice Deficiencies and Complaints (report #OEI-02-17-00020), in which OIG determines the extent and nature of hospice deficiencies and complaints and identifies trends. For this new study, OIG will use the survey reports to provide more detail about poor quality care that resulted in harm to beneficiaries. It will describe specific instances of harm to Medicare hospice beneficiaries and identify the vulnerabilities in Medicare’s process for preventing and addressing harm.

OIG Posts Top Management and Performance Challenges The federal Office of Inspector General (OIG) has posted its top management and performance challenges for 2018.

It is at https://oig.hhs.gov/reports-and-publications/top-challenges/2018/.

Continued on next page

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The Situation Report: the Home Care Association of New York State

Volume 3, No. 45 November 19, 2018 

Continued from previous page Some of these include: 

Ensuring Program Integrity in Medicare Fee-for-Service and Effective Administration of Medicare



Ensuring Program Integrity and Effective Administration of Medicaid



Ensuring Value and Integrity in Managed Care and Other Innovative Healthcare Payment and Service Delivery Models



Improving Financial and Administrative Management and Reducing Improper Payments



Protecting U.S. Department of Health and Human Services (HHS) Data, Systems, and Beneficiaries from Cybersecurity Threats



Ensuring Effective Preparation and Response to Public Health Emergencies

US DOL Posts Semiannual Regulatory Agenda The U.S. Department of Labor has posted its semiannual regulatory agenda in the November 16, 2018 Federal Register. It is at https://www.govinfo.gov/content/pkg/FR-2018-11-16/pdf/2018-24168.pdf.

The agenda includes two topics of interest to home care and hospice providers: Emergency Response and Preparedness; and Prevention of Workplace Violence in Health Care and Social Assistance.

Emergency Response and Preparedness The Occupational Safety and Health Administration (OSHA) currently regulates aspects of emergency response and preparedness; some of these standards were promulgated decades ago, and none were designed as comprehensive emergency response standards.

Consequently, they do not address the full range of hazards or concerns currently facing emergency responders, nor do they reflect major changes in performance specifications for protective clothing and equipment. OHSA has acknowledged that current OSHA standards also do not reflect all the major developments in safety and health practices that have already been accepted by the emergency response community and incorporated into industry consensus standards.

OSHA is considering updating the Emergency Preparedness standards with information gathered through a Request for Information (RFI) and public meetings. OSHA expects to take some action by the end of this year.

Prevention of Workplace Violence in Health Care and Social Assistance OSHA was petitioned for a standard preventing workplace violence in health care by a broad coalition of labor unions, and in a separate petition by the National Nurses United. On January 10, 2017, OSHA granted the petitions. OSHA expects some action to be taken in March 2019.

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The Situation Report: the Home Care Association of New York State

Volume 3, No. 45 November 19, 2018 

Upcoming Deadlines and Due Dates

Requirement/Change

Effective/ Due Date

More Information

Transition Period for Using Health Insurance Claim Number (HICN) or new Medicare Beneficiary Identifier (MBI)

April 1, 2018 to December 31, 2019

https://www.cms.gov/Medicare/NewͲMedicareͲCard/index.html

Medicare Open Enrollment: Beneficiaries can change their Medicare coverage from October 15 to www.medicare.gov managed care plan to December 7, 2018 feeͲforͲservice or vice versa, and can join or switch prescription drug plan

2017 LHCSA Statistical Report Due

LHCSAs will face fines if submitted between November 16, 2018 and December 31, 2018

https://commerce.health.state.ny.us/public/hcs_login.html

LHCSA Registration Process

Must be submitted with LHCSA Statistical Report; if not submitted by November 16, 2018, agency will incur fines

https://commerce.health.state.ny.us/public/hcs_login.html

CMS Regulatory Relief Proposed Rule

Comments due November 19

https://www.gpo.gov/fdsys/pkg/FRͲ2018Ͳ09Ͳ20/pdf/2018Ͳ19599.pdf

MLTC Enrollment LockͲIn https://www.health.ny.gov/health_care/medicaid/program/update/2018 December 1, 2018 Starts /2018Ͳ06.htm#mltc

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The Situation Report: the Home Care Association of New York State

Volume 3, No. 45 November 19, 2018 

August Global Cap Report: Medicaid Spending $41M Above Projections The state Department of Health (DOH) has issued its latest monthly Medicaid Global Cap report (see https://www.health.ny.gov/health_care/medicaid/regulations/global_cap/monthly/sfy_2018-2019/docs/ aug_2018_report.pdf.

The Medicaid Global Spending Cap has increased 6.7 percent, from $19.5 billion in fiscal year (FY) 2018 to $20.8 billion in FY 2019. This August 2018 report marks the fifth report for the new fiscal year. It finds that overall spending for this period was $41 million above projections, across all sectors, a difference of $10.444 billion in actual spending versus $10.403 billion in estimated spending for the first five months of the state fiscal year.

Specifically, DOH mentions the following two significant pressures on the Global Cap: 

Medicaid spending in major Medicaid Managed Care categories was $45 million over projections.



Medicaid spending in major fee-for-service categories was $45 million over projections with clinic spending $16 million above estimates. This is a result of total claims billed being 11 percent higher than anticipated through August.

In other report highlights: 

Total Managed Long Term Care (MLTC) spending exceeded its monthly cap, by $27 million, due to higher-than-expected enrollment. There were approximately 4,000 more individuals enrolled in the MLTC partial capitation plan than budgeted.



Total Medicaid enrollment reached 6,169,335 enrollees at the end of August 2018. This reflects a net increase of 21,301 enrollees since March 2018.



The state’s Accounts Receivable (A/R) ending balance for FY 2018 was $224 million. DOH is expected to recoup $174 million by the end of FY 2019, resulting in a projected A/R balance of $50 million by March 2019. Through the end of July, retroactive rates owed to the state were $145 million. This reflects net recoveries of $79 million since March 2018.

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

CMS Continues Recognition of CHAP for Hospices The U.S. Centers for Medicare and Medicaid Services (CMS) has approved the Community Health Accreditation Partner (CHAP) for continued recognition as a national accrediting organization for hospices that wish to participate in the Medicare or Medicaid programs.

The approval is effective November 20, 2018 through November 20, 2024.

The announcement is at https://www.govinfo.gov/content/pkg/FR-2018-11-16/pdf/2018-25066.pdf.

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The Situation Report: the Home Care Association of New York State

Volume 3, No. 45 November 19, 2018 

NGS Offices Closed November 22 & 23 for Thanksgiving National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), will be closed on November 22 and 23, for the Thanksgiving Holiday. This includes the Electronic Data Interchange (EDI) Help Desk, Provider Contact Center, Provider Enrollment Line, and Telephone Reopening Unit.

Electronic claim files transmitted after 5 p.m. on Wednesday, November 21 will have a claim receipt date of Monday, November 26. EDI front-end acknowledgement transactions will be created as expected as EDI claim files are received.

The Direct Data Entry (DDE) Provider Online System will be available on November 22 and 23, during regular hours. Providers will be able to access NGSConnex and use the Interactive Voice Response (IVR) system at 1-866-275-3033. NGS will reopen on Monday, November 26, 2018 for normal business hours.

In other NGS news:

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January 2019 Dark Days for the Common Working File Hosts – For the upcoming January 2019 Release, the common working file (CWF) will be observing “Dark Days” starting January 4, 2019 through January 6, 2019. These dark days will limit access to information provided by the Interactive Voice Response (IVR) system and to NGSconnex. Providers may experience limited or no access to claims, eligibility, claim overlap, patient status, check inquiry, reopening/redetermination status, offset information and financial claim information.

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Hospice Item Set Freeze Date: November 15 – November 15 was the freeze date for Hospice Item Set (HIS) data included in quality measure calculations for the February 2019 Hospice Compare refresh. The February refresh will include HIS data from the second quarter of 2017 to the first quarter of 2018. All HIS records, including modifications/corrections and inactivations, had to be submitted and accepted by the Quality Improvement and Evaluation System (QIES) Assessment Submission and Processing (ASAP) system by 11:59 p.m. on November 15 to be reflected in the Hospice Provider Preview Report that will be available on December 3.

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Hospices 4.5 Month Data Correction Deadline for Public Reporting – CMS instituted a 4.5month data correction deadline for hospice public reporting beginning January 1, 2019. For further information, see the CMS Fact Sheet at: https://www.cms.gov/Medicare/QualityInitiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/Downloads/45-MonthData-Correction-Deadline-for-Public-Reporting-Fact-Sheet.pdf.

The Situation Report: the Home Care Association of New York State

Volume 3, No. 45 November 19, 2018 

Health Resources 

“Improving Care for Patients with Serious Illness: Part One,” by the Bipartisan Policy Center https://bipartisanpolicy.org/wp-content/uploads/2018/10/Improving-Care-for-Patients-with-SeriousIllness-Part-One.pdf

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“Improving Care for Patients with Serious Illness: Part Two,” by the Bipartisan Policy Center https://bipartisanpolicy.org/wp-content/uploads/2018/11/Improving-Care-for-Patients-with-SeriousIllness-Part-Two.pdf

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“A Policy Roadmap for Individuals with Complex Care Needs,” by the Bipartisan Policy Center https://bipartisanpolicy.org/wp-content/uploads/2018/01/BPC-Health-Policy-Roadmap-ForIndividuals-With-Complex-Care-Needs.pdf

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“Difficult Decisions About Post-Acute Care and Why They Matter,” by the United Hospital Fund http://uhfnyc.org/assets/1785

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

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