MINIMUM WAGE RATES
ENROLLMENT REQUIREMENT
BRONX SEPSIS SESSION
IMPORTANT DEADLINES
DOH issues minimum wage rate adjustment for CHHAs & hospices; Personal care expected soon.
HCA continues to hear issues, plus some tips, on meeting the requirement that providers must be enrolled in Medicaid to serve patients under Medicaid Managed Care.
The next session of HCA’s ‘Stop Sepsis at Home’ Initiative is coming to the Bronx on Feb.8, followed by Manhattan and two Long Island sessions.
HCA tracks a series of implementation dates, deadlines and other upcoming timetables of note to help you plan and prioritize.
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Your Source for HOME CARE News, Policy and Advocacy
COMING UP Webinar: Sexual Harassment Prevention in the Workplace Jan. 30, 2018 10-11 a.m. State Advocacy Day, PAC Reception Feb. 5-6, 2018 Albany Senior Financial Managers Forum March 22, 2018 Albany Register for these and other programs online at https://hcanys.org/eventseducation/ upcoming-events.
Vol. 3, Issue 5 | January 29, 2018
Meet Maj. Leader Flanagan, Health Chair Hannon at HCA PAC on 2/5; Join Us for Advocacy Day! HCA’s State Advocacy Day and Political Action Committee (PAC) program are a week away. These two programs also accompany meetings of our Board of Directors and Policy Council over the course of February 5 to 6 in Albany. Please see the registration form for the full agenda at https://hca-nys.org/wp-content/ uploads/2018/01/2018-HCA-Advocacy-Events-Registration-Form-Updated-jk-3.pdf. See PAC p. 2
IBA Denies Petition Challenging “24-Hour/Live-In” Rule DOL extends emergency rule codifying 13hour standard On January 23, the New York State Industrial Board of Appeals (IBA) denied a petition by the Justice Center that challenged the state Department of Labor’s (DOL) emergency rule on “24-hour/live-in” cases. See RULE p. 6
INSIDE Meet w/ Senate Leaders at HCA PAC on 2/5; Join Us for Advocacy Day!...............1 IBA Denies Petition that Challenges “24-Hour/Live-In” Rule............................1 Act Now on Home Health Rural Add-on, NPP Authorization...............................1 Register for Senior Financial Managers Forum on 3/22........................................3 DOH Issues DALs on 2018 Minimum Wage Adjustments...................................5 Issues Continue with Medicaid Provider Enrollment Requirement..................7 Free Home Care Sepsis Training Heads to the Bronx........................................8 Takeaways from Recent Coalition Surge Tests.................................................9 Member Hiring Announcement......................................................................9 Submission Date Extended for WIOs.............................................................10 Updated CAHPS Survey Data Posted..............................................................11
Act Now on Home Health Rural Add-on, NPP Authorization Bill The national push for extension of the home health rural add-on continues, as Congress considers extender bills and other fiscal matters amid the ongoing debate over the continuing budget resolution. See ACT p. 4
PHHPC Committee Considers Applications......................................................12 NGS Issues Hospice Cap Reporting Reminder..................................................12 Alex Azar Picked as New HHS Secretary............................................................14 Reporting Changes in CHHA Ownership...........................................................14 VBP Information Posted for MAP, FIDA and PACE Plans.......................................15 New VBP Program Scheduled..........................................................................15 Family Caregivers Act Signed into Law.............................................................16 OPWDD Regulatory Agenda Posted.................................................................16 2018 Standard Mileage Rates Issued.............................................................17 Executive Order Signed to Combat Flu Epidemic...............................................17 CMS Transmittal on Calculating Hospice RHC after a Transfer............................18 Resources..........................................................................................................18 Important Upcoming Deadlines.....................................................................19
The Situation Report: the Home Care Association of New York State
Political engagement, through HCA’s PAC, is vital to you and your organization, and to our collective advocacy. The next time you present to your organization’s Board of Directors, wouldn’t it be powerful to report that you brought home care’s message to the Senate’s top leaders – and to show that you are a player in the political process on behalf of your organization? Your contribution will make a difference to your organization and to our overall cause.
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.
PAC from p. 1 Our previously announced PAC reception (on Feb. 5) has changed in two very big and important ways. First, it’s at a new location in Albany. And second, it will be attended by the Senate’s two most influential leaders when it comes to the issues facing HCA members. Our PAC program is a unique opportunity for you to meet and contribute to the campaigns of Senate Majority Leader John Flanagan and Senate Health Committee Chairman Kemp Hannon.
Volume 3, No. 5 January 29, 2018
Flanagan
Joanne Cunningham HCA President jcunningham@hcanys.org Roger L. Noyes Director of Communications, Editor of The Situation Report rnoyes@hcanys.org Al Cardillo Executive Vice President acardillo@hcanys.org Patrick Conole Vice President, Finance & Management pconole@hcanys.org
Hannon
Advocacy Day We also ask you to join HCA for our State Advocacy Day on February 6, also in Albany. As you know from our newsletter and member briefings, the state budget has a projected $4.4 billion deficit. Although the Governor proposes revenue actions to forestall any service cuts, the negotiations could very quickly change this calculus, especially given any further actions to cut Medicaid at the federal level. Beyond funding, the proposed budget also contains other provisions regarding eligibility and contracting in home care and Managed Long Term Care that we need to respond to. Furthermore, the
Andrew Koski Vice President, Program, Policy & Services akoski@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 Billi Wilson Manager, Meetings & Events bwilson@hcanys.org Teresa Brown Administrative Assistant tbrown@hcanys.org
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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budget and legislative session are necessary venues for HCA to address longstanding needs for workforce support, infrastructure and regulatory clarity/relief in home care, hospice and Managed Long Term Care. We need you in Albany to tell your organization’s story, to explain its importance to the health care system, and to seek legislative support for HCA’s advocacy requests, which we will be sharing with the membership later this week. Please also be on the lookout for the findings of our home care financial and program analysis, coming soon, which includes the results of survey responses from the HCA membership on an array of issues and trends. For those 90 members who completed the survey, we thank you. To join HCA’s Advocacy Day and PAC program, please complete the registration form (https://hcanys.org/wp-content/uploads/2018/01/2018-HCA-Advocacy-Events-Registration-Form-Updated-jk3.pdf) and make your own appointments with your Senate and Assembly representatives at the times indicated on the form. Note: If you are a member of HCA’s Board of Directors, HCA will be making appointments on your behalf, so Board Members should refrain from scheduling any appointments that may conflict with HCA’s planning. Please stay tuned for further information and resources to support you during our State Advocacy program.
Register for Senior Financial Managers Forum on March 22 Registration is now open for HCA’s March 22 Senior Financial Managers Forum in Albany, our popular daylong conference that covers every major finance and reimbursement issue confronting home care providers and MLTC plans on the state and federal levels. As in past years, HCA Policy staff will be joined by state Department of Health reimbursement officials, consultants, federal policy experts, and, new this year, a representative from New York’s Medicare Administrative Contractor, National Government Services. Please join us on March 22 to hear from these experts and get all of your finance questions and information needs covered. A registration form and full agenda are at the back of this week’s edition of The Situation Report.
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ACT from p. 1 In a separate but important federal matter, HCA has also learned that key leaders are considering a priority bill for authorization of home care services as part of an omnibus package. The bill is sponsored by Buffalo-area Congressman Chris Collins and has strong support from New York’s Congressional Delegation who we need to press Congressional leaders for final adoption of this measure. HCA asks members to act on both issue areas today. Details are below.
Rural Add-on Update and Action Item (Act now at http://p2a.co/slm2gL2) While the home health rural add-on is in play, the proposal being considered at present in the U.S. Senate is extremely limited, and we need to push hard to change this. The current Senate proposal would increase the add-on to 4 percent in so-called “frontier counties,” which, we believe, may not include any (or very few) areas of rural New York. This frontier-designated add-on would be reduced a percentage-point each year to 0 by 2023. Other rural areas, meanwhile, would get a 3 percent add-on that is similarly phased out to 0 by 2021. A straight and permanent 3 percent rural add-on – as HCA and our partners at the National Association for Home Care and Hospice (NAHC) have been urging – would continue funding to rural providers in New York State who rely on this resource at a time when 69 percent of these agencies report negative operating margins. New York Senator Charles Schumer, the Senate’s Minority Leader, has gained important leverage in negotiations over the continuing budget resolution and other fiscal matters that require super-majorities in the closely divided Senate. Please take a minute on HCA’s Legislative Action Center to write all of the Congressional
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Delegation urging a straight 3 percent extension of the rural add-on in place of the limited plan now under consideration. Our online campaign is at http://p2a.co/ slm2gL2.
NPP-Authorization Bill Gains Traction: Support Needed in Omnibus Plan (Act now at http://p2a.co/ 6HlvMNa) Buffalo-area Congressman Chris Collins is sponsoring a bill (H.R. 1825) that has long been a priority of HCA’s: allowing nurse practitioners, physician assistants, clinical nurse specialists and other non-physician advanced-practice professionals to order and certify Medicare home health services. HCA members have responded strongly to our action alerts in the past for similar versions of this bill and we ask you to take a few minutes again to use our Legislative Action Center in support of this latest measure as part of an omnibus bill or Medicare package. Our online campaign is at http://p2a.co/6HlvMNa. Important: Our Legislative Action Center allows you to customize your message. If you are a provider in the Buffalo region represented by Rep. Collins, please tailor your message to Rep. Collins, thanking him for his sponsorship and urging his action to gather support of H.R. 1825 from House Speaker Paul Ryan and other House leaders. If you need any assistance with this customization, please do not hesitate to write HCA’s Communications Director Roger Noyes at rnoyes@hcanys.org or call him at (518) 810-0665.
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DOH Issues DALs on 2018 Minimum Wage Rate Adjustment for CHHAs & Hospices; Personal Care Expected Soon The state Department of Health (DOH) has issued two Dear Administrator Letters (DALs) on the 2018 minimum wage rate adjustment specifically for Certified Home Health Agencies (CHHAs) and Hospice providers. The CHHA DAL is at https://hca-nys.org/wp-content/uploads/2018/01/DAL_CHHA-MinimumWage-Funding_012618.pdf. The Hospice DAL is at https://hca-nys.org/wp-content/uploads/2018/01/ DAL_Hospice-Minimum-Wage-Funding_012618.pdf. HCA has learned that a similar DAL for Personal Care is expected very soon. DOH states the purpose of the DALs is to provide information regarding a rate change due to Article 19 of the State Labor Law that establishes new minimum wage increases that began January 1, 2018. At this time, DOH is revising the CHHA and Hospice Medicaid fee-for-service rates effective January 1, 2018 for the minimum wage increases. DOH states in both DALs that the rates were adjusted based on CHHA and Hospice providers’ attested survey data submitted for the period of April 1, 2017 through June 30, 2017 and annualized. As stated when the survey was released, if a CHHA or Hospice did not submit a survey, its 2015 Consolidated Fiscal Report data was used. According to the Department, the rates were adjusted to incorporate all additional costs to meet the minimum wage requirement as supplied in the survey; and these costs were included in the rate as a component add-on. DOH stresses in both DALs that providers cannot use these additional funds for any purpose other than appropriate statutory wage obligations directly associated with the minimum wage increase and shall return unspent funds to the state through a rate adjustment or some other mechanism to be determined by the Department. DOH also intends to issue a minimum wage supplemental cost report to ensure dollars were used appropriately. It will be released in the first quarter of each calendar year to collect data for the prior calendar year and will be due back to the Department in April. It will seek to verify provider wage scale and the specific wage-related fringe benefits to establish future reimbursement rates. The DALs note that the Office of Medicaid Inspector General (OMIG) will also conduct audits of all providers to ensure that payments were made in accordance with statutory requirements and that providers should maintain all records and reports required to verify that appropriate salary increases were directly associated with the minimum wage increase. Lastly, the DALs state that both the CHHA and Hospice minimum wage rate adjustment packages are awaiting Division of Budget (DOB) approval, so the rates have not been posted to the Health Commerce System (HCS) yet. DOH also says that, once approved by DOB, the increased rates will be loaded to the eMedNY payment system in the next available Medicaid payment cycle.
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RULE from p. 1 In its decision, the IBA stated that it did not have jurisdiction to review DOL’s emergency rulemaking and thus ruled against the Justice Center on procedural grounds and not on the merits of the rule. The IBA’s decision may be appealed to the Appellate Division, Third Department, within 60 days; if it is, we will inform the membership. That Court would review whether the IBA’s decision is “contrary to law.” It is possible that, if the IBA’s decision is appealed, the Appellate Division could conclude that the IBA in fact had the power to decide the validity of the October 2017 Emergency Regulations. If so, the case would likely return to the IBA for resolution on the merits. As previously communicated to members, the IBA is an independent review board that has statutorilydefined authority to review and modify or revoke DOL rules, regulations or orders; although in this particular instance, the IBA decided that this authority did not extend to DOL’s emergency rule. HCA, along with the New York State Association of Health Care Providers, had submitted an amicus brief to the IBA in support of DOL’s emergency rule. Our amicus brief argued the following: The Emergency Regulation correctly establishes the standards for determining the hours of work for aides who are assigned to shifts of 24 hours or more. Thus, the Petition should be dismissed because the Petitioner failed to prove that the Department’s Emergency Regulation is unreasonable or invalid. The Board must dismiss (the Justice Center’s) Petition and allow home care providers to continue providing these critical services to New York’s elderly and disabled individuals in accordance with the Emergency Regulation.
DOL’s emergency rule was finalized in October 2017 to codify DOL’s longstanding “13-hour standard” for aide compensation, amid a series of court cases taking aim at this standard. Plaintiffs in those cases have argued that the standard was at odds with underlying statutes. Under this standard, set forth in a 2010 DOL opinion letter, an aide may be paid for 13 hours of a 24-hour shift, provided the aide is afforded 8 hours of sleep time, 5 of which are uninterrupted, and 3 hours for meals. HCA and colleague associations had worked tirelessly to compel DOL’s issuance of the October emergency rule and a corresponding impact statement which stated strongly that the purpose of the emergency regulation is to “preserve the status quo” (i.e., the “13-hour standard”), prevent the collapse of the home care industry, and avoid institutionalization of patients in the face of the recent court decisions. HCA had submitted amicus briefs on two cases that challenged the 13-hour standard, all of which are at different stages. HCA will notify members if there are any new developments with these cases. This issue has been among the top items of concern addressed by HCA in recent meetings with the Governor’s office and the Legislature, among other interrelated funding issues for wages and labor costs,
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including the increasing state minimum wage and a newly proposed set of compensation requirements for certain scheduling circumstances. We will continue to advocate with the state on all of these issues. More information on the IBA appeal and the “24-hour/live-in” issue is in a memo prepared by HCA’s legislative affairs representatives, Hinman Straub, at: https://hca-nys.org/wp-content/uploads/2018/01/ Hinman-Memo-on-IBA-case_012418.pdf. Emergency Rule Extended Meanwhile, DOL has extended its “24-hour/live-in” emergency rule until April 4. The emergency rule must be periodically extended until (or if) permanently adopted under ordinary state procedures. The announcement was published in the January 24 New York State Register at https://docs.dos.ny.gov/info/register/2018/jan24/ pdf/Rule%20Making.pdf (page 7). The rule’s provisions, including new regulatory language, justification for changes, regulatory impact statement and flexibility analysis, are similar to the initial rule that was posted in the October 25, 2017 State Register and was effective on October 6 for 90 days. The October 2017 and January 2018 Emergency Regulations clarify that state minimum wage rules “shall not be construed to require that the minimum wage be paid for meal periods and sleep times that are excluded from hours worked under the Fair Labor Standards Act … for a home care aide who works a shift of 24 hours or more.”
Issues Continue with Medicaid Provider Enrollment Requirement HCA continues to hear from home care members who are being told by their managed care partners that they cannot document the provider’s enrollment in Medicaid. Many providers have recently enrolled as part of a new requirement that providers who serve managed care patients must do so. In these situations, HCA advises members and plans to check a website which lists enrolled providers. The site is https://health.data.ny.gov/Health/Medicaid-Fee-for-Service-Provider-Listing/keti-qx5t (bottom of page). The search option allows users to verify by Medicaid Management Information System (MMIS) number, National Provider Identifier (NPI) and MMIS name. According to DOH, plans have been advised to check by MMIS number, in addition to NPI, as many home care providers, particularly LHCSAs, don’t have NPIs. HCA has informed members numerous times about the Medicaid enrollment requirement – and that those who have not enrolled by January 1, 2018 will be terminated from their managed care contracts (after prior notice). For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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Free Home Care Sepsis Training Heads Downstate with Feb. 8 Program in the Bronx, Then Manhattan & Two Long Island Sessions Please notify your home care clinical teams, administrators, patient care directors and your hospital, PPS and EMS partners who should all register to attend upcoming sessions! HCA is offering the next installment of our Stop Sepsis at Home effort on February 8 in the Bronx. Please register today. Stop Sepsis at Home offers specialized, expert training for home care providers to use HCA’s first-of-its-kind, clinician-developed, community-based sepsis screening tool. Other future sessions in Manhattan and on Long Island are listed in our flyer (http://stopsepsisathomeny.org/wpcontent/uploads/2017/12/Regional-Sepsis-Training-andCross-Sector-Session-Brochure.pdf), which also outlines the program agenda and expert faculty. No matter which region you serve, please register using the online form (https://www.surveymonkey.com/r/ SepsisRegionalTrainings) to pick the location closest to you.
HCA Executive Vice President Al Cardillo (right) joined Dr. Alan Sanders, President and Partner of Upstate Infectious Diseases Associates, to discuss sepsis and home care’s work to combat the sepsis crisis during WAMC’s Medical Monday call-in show last week.
Our training sessions are free of charge, and are supported by a grant from the New York State Health Foundation, which is among several organizations that recognize the need for you, as a home care provider, to participate in staff training and use of the tool.
HCA’s “Stop Sepsis at Home” campaign is continuing our series of training sessions to give home care clinicians the tools to combat sepsis in the home care setting during their routine contact with at-risk patients. Learn more at www.stopsepsisathomeny.org.
By participating in these sessions, your organization will gain one-stop training that meets the prerequisites for using the HCA-developed sepsis screening tool (subject to a signed user agreement with HCA). This tool, which can be integrated into your EHR, helps your clinicians identify the risk of sepsis, prevent its onset, and ensure appropriate interventions in the event that sepsis is identified. We strongly urge you to check out the information on our website at http://stopsepsisathomeny.org/, especially about the importance for home care providers to take a lead role on this health crisis. If you have any questions, please do not hesitate to write any of the HCA Policy staff or use the online contact form on our sepsis website.
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Takeaways from Recent Coalition Surge Tests for Home Care and Other Settings Four more to occur outside of NYC On January 23 and 25, the state Department of Health held Coalition Surge Tests and Interoperable Communication Drills (CST/IOC) for Capital District and Central New York providers, respectively, to test the overall health care system’s response to a simulated unexpected event. Specifically, the goals of the CST/IOC drills are to test: functional surge capacity and identify gaps in surge planning by providers; the ability of providers to perform the tasks with existing on-site staff without excessive guidance; and whether the evacuating facility knows who to contact in an evacuation scenario, and its ability to reach partners on a moment’s notice. Under the January 23 exercise, three hospitals in the Capital District reported that they would be evacuating their patients due to extensive roof damage and internal flooding, while the January 25 exercise involved three hospitals in Central New York that had to evacuate all their patients due to inconsistent heating issues. Other hospitals, home care and hospice providers, and nursing homes participating in the CST/IOC were supposed to indicate if they could accept some of those patients. During the exercises, providers had to complete a survey via the Health Electronic Data System (HERDS). Providers are also expected to complete an After Action Report (AAR) after the CST/IOC. An AAR template is available at https://hcanys.org/wp-content/ uploads/2018/01/AARIP_Template-modified-929-17.docx. After the drill, providers were invited to participate in a discussion via teleconference to explore issues raised during the exercise with the primary focus on the evacuating hospitals related to continuity of operations, bed placement of evacuated patients, communications and transportation. This CST/IOC drills are two of six that are expected to be held statewide outside of
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Montefiore Home Care is currently seeking, Patient Service Managers and Registered Nurses for full time Home Care staff positions. QUALIFICATIONS: Current NYS Registered Nurse License/Registration; Two years or more experience as a home care RN; Current NYS Driver’s License/Registration and automobile insurance; Experience in long term patient care and chronic disease management.
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New York City. The other four locations for drills are Lower Hudson Valley, Finger Lakes, Buffalo, and Long Island. DOH has provided us with the following two-week range of the dates that the CST/IOC will be held in each region of the state: MARO – Long Island – February 5 to February 16 Western Region – February 12 to February 23 MARO – Lower Hudson Valley – February 19 to March 2 HCA members should ensure the accuracy of staff listings in the Health Commerce System so that the correct staff will be contacted regarding any drills. To help providers prepare for the remaining CST/IOC drills, DOH is holding webinars for providers in Western New York and Metropolitan Area Regional Office/MARO regions (not including New York City). Registration is not required for the following programs:
February 1, 1 to 2 p.m.: https://meetny.webex.com/meetny/ j.php?MTID=me79c7b7503914f2ad3bdad66d29eb404
February 2, 10 to 11 a.m.: https://meetny.webex.com/meetny/ j.php?MTID=ma0073b30cd3d893e80a5b6e00a30aa74
Earlier in January, DOH held two webinars for Capital District and Central New York providers to prepare for the just-completed drills in those regions; the material from those programs is at https://hca-nys.org/wp-content/uploads/2018/01/CSTIOC-Drill_January-2018.pdf. Although participation is voluntary, the CST/IOC will fulfill the requirement that Certified Home Health Agencies (CHHAs) and hospices participate in a full-scale community-based exercise for the period of November 16, 2017 to November 15, 2018. Some Licensed Home Care Services Agencies (LHCSAs) may have to participate in such an exercise under their contract with CHHAs or managed care plans. HCA has confirmed with DOH that CHHAs and LHCSAs who serve New York City and also Nassau and/or Suffolk and/or Westchester can participate in this drill and meet the requirement for a full-scale community based exercise. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
Submission Date Extended for WIOs The state Department of Health (DOH) has extended the deadline to February 2 for submission of Plan Agreements and Value Based Payment (VBP) addendums for the Long Term Care Workforce Investment Organizations (LTC-WIO) initiative. As mentioned in the December 18 edition of The Situation Report, DOH had posted the draft agreement language for LTC-WIOs and managed long term care (MLTC), along with an appendix outlining the proposed roles and responsibilities of the LTC-WIO and MLTC plan. Continued on next page
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Continued from previous page The materials, along with a list of awarded LTC-WIOs and eligible MLTC plans, are at https:// www.health.ny.gov/health_care/medicaid/redesign/2017/mltc_invest.htm. In addition, DOH is seeking a two-page document which demonstrates the LTC-WIO/MLTC partnerships’ capacity and approach to support the achievement of VBP goals. The intent of this exercise is to establish a baseline measure for sustainability. This must be included for LTC-WIO and plan partnerships to be considered. Recently, DOH had also posted guidance on the parameters of the LTC-WIO and plan partnership development. This workforce initiative is making available up to $245 million (during 2018-2020) for “initiatives to retrain, recruit and retain health care workers in the long term care (LTC) sector.” DOH will require MLTC plans to contract with the DOH-designated LTC-WIOs to: invest in initiatives to attract, recruit and retain LTC workers; develop plans for reducing health disparities through placement of LTC workers in high-need areas; analyze the training needs of each region the center serves; and support the expansion of home care and respite care, enabling those in need of LTC to remain at home and reduce Medicaid’s costs associated with LTC. Funds will be allocated to plans based on the percentage of each plan’s enrollment relative to all plan enrollment, and distributed via increases to their capitated rates. Plans will need to notify their participating providers that they can send workers to LTC-WIOs to participate without charge. Plans will distribute funds to the LTC-WIOs with which they contract to reimburse them for providing workforce development initiatives. HCA members should review the list of eligible MLTCs and LTC-WIOs in your regions to prepare for your staff’s participation in these training opportunities, where applicable, and reach out to your plan contractors regarding eligibility for LTC-WIO training for your staff. Questions and comments can be submitted to MLTCWorkforce@health.ny.gov.
Updated CAHPS Survey Data Posted Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) Survey results are now reported based on responses from patients who received Medicare-certified home health agency (HHA) services from July 2016 through June 2017. They are on the Home Health Compare link at http://www.Medicare.gov/. HHCAHPS Survey results are updated each calendar year quarter. These data are also available on the HHCAHPS website through the “Archived Publicly Reported Data” link under the “General Information” tab. On this webpage, you can access:
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HHA-level data State and national averages
Continued on next page
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Continued from previous page
Star ratings cut points Patient mix adjustment coefficients for the linearized data used to construct the Star Ratings.
Information on how the star ratings were constructed is at https://homehealthcahps.org/Portals/0/ HHCAHPS_steps_calculate_composites.pdf?ver=2016-11-07-101103-157.
PHHPC Committee Considers Applications On January 25, the Public Health and Health Planning Council (PHHPC) Committee on Establishment and Project Review considered home care applications. The agenda and supporting documents are at https://www.health.ny.gov/facilities/ public_health_and_health_planning_council/meetings/2018-01-25/. Some of the applications and the Committee’s recommendations include:
One application by an existing Certified Home Health Agency (CHHA) for a 3-year extension to its limited life operating certification – this was deferred at the applicant’s request.
Six applications by existing Licensed Home Care Services Agencies (LHCSAs) for changes in ownership were approved.
One application by an entity to become a LHCSA affiliated with an assisted living program was approved.
Seventeen applications to establish new LHCSAs were approved.
The Committee’s recommendations on these applications will be considered by the full PHHPC at its February 8 meeting. Both Committee and full PHHPC meetings can be viewed at https://www.health.ny.gov/events/webcasts/.
NGS Issues Hospice Cap Reporting Reminder National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), has recently issued the following reminder about the Hospice Self-Reporting Cap requirement. Hospice Self-Reporting Cap The U.S. Centers for Medicare and Medicaid Services’ (CMS) 2016 Hospice Final Rule finalized the proposals to align the cap accounting year for both the inpatient cap and the hospice aggregate cap with the Federal Fiscal Year (FY) starting in FY 2017 and to align the timeframe for counting the number of beneficiaries with the FY. Continued on next page
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Continued from previous page This alignment eliminates timeframe complexities associated with counting payments and beneficiaries differently from the FY, helping to avoid mistakes. It also better aligns with the intent of the new cap calculation methodology required by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. 2017 Year (October 1, 2016 to September 30, 2017) The per-beneficiary cap amount for calculating the hospice aggregate cap for the 2017 transition year will not be prorated for the shorter time frame. Instead, hospices and the MACs are to count payments, count beneficiaries, and determine the percentage of inpatient days as follows for the 2017 cap year:
For hospices using the patient-by-patient method, the beneficiary count period for the aggregate cap determination is from November 1, 2016 to September 30, 2017. If using the streamlined method, the count period is from September 28, 2016 to September 30, 2017, which is 12 months plus 3 days.
The payment period (using either method) is November 1, 2016 to September 30, 2017. This is 11 months of payments;
For the inpatient cap, MACs, like NGS, are to calculate the percentage of all hospice days of care that were provided as inpatient days (GIP care and respite care) from November 1, 2016 through September 30, 2017 (11 months).
2018 Cap Year (October 1, 2017 to September 30, 2018)
Hospices and MACs are to count both beneficiaries and payments for hospices using the streamlined or the patient-by-patient proportional methods from October 1, 2017 to September 30, 2018;
Hospices and MACs are to calculate the percentage of all hospice days of care that were provided as inpatient days (GIP care or respite care) from October 1, 2017 to September 30, 2018.
Finally, NGS notes that CMS changed the due date of the 2017 self-determined aggregate cap, which is now February 28, 2018, after which a payment suspension will apply. Once hospice providers have self-reported, NGS will send a confirmation letter within 45 days of receipt. When applicable, the confirmation letter will also serve as a demand letter for the provider with an amount due to the Medicare Program. NGS will also perform a cursory review of the submitted self-determination within 60 days of receipt. Completing the Pro-Forma Before completing the CMS-issued pro-forma, hospice providers should review the “Instructions for completing the Pro-Forma for Provider Self-Determination of Aggregate Cap Limitation” tab of the pro-forma. Providers should download and use the CMS-issued pro-forma calculation form. The pro-forma and instructions can be found on the HH+H page of NGS’s website. The Provider Statistical and Reimbursement (PS&R) data used in
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filing the self-reported cap cannot be earlier than December 31 of the applicable cap year. The statutory cap amount to be used for the 2017 self-reported hospice cap calculation is $28,404.99. Submitting the Pro-Forma Hospice providers should submit the pro-forma calculation along with supporting documentation and a copy of submitted check (if applicable) to NGS no later than March 31. Repaying an Overpayment If the self-reported cap calculation indicates an amount due to Medicare, checks must be made payable to NGS.
Alex Azar Picked as New HHS Secretary The U.S. Senate has confirmed Alex Azar as the next Secretary for Health and Human Services (HHS), following the resignation of former Rep. Tom Price (R-GA), who stepped down at the end of September. President Trump nominated Mr. Azar in November. Unlike Price, who spent 12 years in Congress, Azar has worked in the executive branch, serving as general counsel at HHS during the Bush administration from 2001 to 2005 and was deputy secretary of the department from 2005-2007. Until very recently, Azar was president of U.S. operations for the pharmaceutical company Eli Lilly. The Senate vote was 55 to 43, with seven Democrats voting for his nomination, and one Republican (Rand Paul) voting against. The HHS Secretary oversees a massive Department with jurisdiction over the U.S. Centers for Medicare and Medicaid Services (CMS), the Office of the Inspector General (OIG), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration, among approximately two dozen offices and divisions.
Reporting Changes in CHHA Ownership The U.S. Centers for Medicare and Medicaid Services (CMS) is reminding Certified Home Health Agencies (CHHAs) that providers must update their enrollment information to reflect changes in ownership within 30 days. Owners are individuals or corporations with a 5 percent or more ownership or controlling interest. Failure to comply could result in loss of Medicare billing privileges. A 2016 Office of the Inspector General report noted that providers may not be informing CMS of ownership changes. Continued on next page
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Continued from previous page Some resources for providers are:
MLN Matters article on “Timely Reporting of Provider Enrollment Information Changes” (https:// www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/ Downloads/SE1617.pdf)
42 CFR 424.516 (https://www.gpo.gov/fdsys/pkg/CFR-2011-title42-vol3/pdf/CFR-2011-title42-vol3sec424-516.pdf)
OIG Report on “Medicare: Vulnerabilities Related to Provider Enrollment and Ownership Disclosure” (https://oig.hhs.gov/oei/reports/oei-04-11-00591.asp)
PECOS Enrollment Tutorial – Change of Information for an Organization/Supplier (https:// www.youtube.com/watch?v=U0fJnhQ0egk&list=PLaV7m2-zFKpia1McB1WKKkw2esAdiZRem&index=4)
MLN Matters Article on “Updated Manual Guidelines for Electronic Funds Transfer Payments and Change of Ownership” (https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNMattersArticles/Downloads/SE17012.pdf)
VBP Information Posted for MAP, FIDA and PACE Plans The state Department of Health (DOH) has posted Value Based Payment (VBP) guidance documents for Medicaid Advantage Plus (MAP), Fully Integrated Duals Advantage (FIDA), and Program of All-Inclusive Care for the Elderly (PACE) plans. The purpose of these documents is to make stakeholders aware of the VBP goals. A Frequently Asked Questions (FAQ) document with additional information for MAP, FIDA, and PACE plans is forthcoming. The guidance documents can be found in the MLTC folder of the VBP Resource Library at https:// www.health.ny.gov/health_care/medicaid/redesign/dsrip/vbp_library/index.htm. All questions can be sent to DOH at MLTCVBP@health.ny.gov.
New VBP Program Scheduled: Registration Deadline Today The state Department of Health (DOH) will be hosting a second Value Based Payment (VBP) Bootcamp in Albany on February 2. It will be held in the Empire State Plaza Meeting rooms (1 Empire State Plaza, South Mall Arterial, Albany, NY, 12203) from 8 a.m. to 4:30 p.m. Registration is open until today, January 29, on a first-come, first-served basis. To register for this event click here: https://www.eventbrite.com/e/vbp-bootcamp-20-the-capital-region-tickets-41947573321. Continued on next page
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Continued from previous page
Though the content of this Bootcamp will be the same as previous sessions, its focus will be on training state agency staff in attendance. As a reminder, VBP Bootcamps are considered the “4th semester” of “VBP University.” If you attend a VBP Bootcamp, and have completed all 3 semester quizzes of VBP University with a passing grade of 80 percent or higher, you will receive a printed diploma. Participation in VBP University is recommended but not required to attend a VBP Bootcamp. To learn more and participate in VBP University, visit www.health.ny.gov/VBP. Questions should be sent to VBP@health.ny.gov.
Family Caregivers Act Signed into Law Last week, President Trump signed into law the Recognize, Assist, Include, Support and Engage (RAISE) Family Caregivers Act. According to the National Association for Home Care and Hospice (NAHC), the RAISE Family Caregivers Act will:
Implement the federal Commission on Long-Term Care’s bipartisan recommendation that Congress require the development of a national strategy to support family caregivers.
Create an advisory body of relevant federal agencies and others from the private and public sectors to advise and make recommendations.
Identify specific actions that government, communities, providers, employers, and others can take to recognize and support family caregivers and be updated annually.
More information is at https://www.baldwin.senate.gov/imo/media/doc/ 8.3.15%20RAISE%20Family%20Caregivers%20Act%20Fact%20Sheet.pdf.
OPWDD Regulatory Agenda Posted The Office for People With Developmental Disabilities (OPWDD) has posted rules that are under consideration in 2018. The information is at https://docs.dos.ny.gov/info/register/2018/jan24/pdf/Reg%20Agenda.pdf. Some of the issues that could be covered are: conflict of interest and case management requirements; delegation of nursing tasks to direct support professionals; home and community-based services requirements for residences; managed care enrollment; telehealth; and more.
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2018 Standard Mileage Rates Issued Last month, the Internal Revenue Service issued the 2018 optional standard mileage rates used to calculate the deductible costs of operating an automobile for business, charitable, medical or moving purposes. (See https://www.irs.gov/newsroom/standard-mileage-rates-for-2018-up-from-rates-for-2017.) Beginning on January 1, 2018, the standard mileage rates for the use of a car (also vans, pickups or panel trucks) are:
54.5 cents for every mile of business travel driven, up 1 cent from 2017. 18 cents per mile driven for medical or moving purposes, up 1 cent from 2017. 14 cents per mile driven in service of charitable organizations (unchanged).
Notice 2018-03 (see https://www.irs.gov/pub/irs-drop/n-18-03.pdf) contains the standard mileage rates, the amount a taxpayer must use in calculating reductions to basis for depreciation taken under the business standard mileage rate, and the maximum standard automobile cost that a taxpayer may use in computing the allowance under a fixed and variable rate plan.
Executive Order Signed to Combat Flu Epidemic On Friday, January 26, Governor Cuomo signed an executive order to combat the flu epidemic in New York. (See https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/EO_176.pdf). The executive order allows pharmacists to administer flu vaccines to children ages 2 to 18. This action is being taken as the number of reported cases across the state continues to rise. Over the past week, 7,779 laboratory-confirmed influenza cases were reported to the state, a 28 percent increase since the prior week, and 1,759 New Yorkers have been hospitalized with confirmed influenza, the highest weekly numbers in both categories since reporting began in 2004 and surpassing last week’s previous high of 1,606 hospitalizations. Governor Cuomo has also called on the state Department of Health to immediately expand the state’s influenza public service advertising campaign targeting the areas of the state hardest hit by influenza. Since December 13, influenza has been considered “prevalent,” which triggers the “flu mask” requirement whereby home care, hospice and other health care providers are required to ensure that all personnel not vaccinated against influenza for the current season are wearing a surgical or procedure mask while in areas where patients or residents are typically present. Information on this requirement is at https://www.health.ny.gov/diseases/communicable/influenza/seasonal/ providers/prevention_of_influenza_transmission/. For more information about the flu, visit: www.health.ny.gov/diseases/communicable/influenza/seasonal.
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CMS Issues Transmittal on Calculating Hospice Routine Home Care Payments after a Transfer The U.S. Centers for Medicare and Medicaid Services (CMS) recently issued Change Request (CR) 10180 which corrects the number of days used to determine the 60 days of the higher Routine Home Care (RHC) payments on hospice claims. These 60 days are counted on a beneficiary level across any hospice benefit periods that are not separated by a 60-day gap. The number of prior service days cannot be identified in all cases by the Fiscal Intermediary Shared System (FISS) from the face of the claim. The Common Working File (CWF) must read data from services provided at other hospices and return additional days that apply to the payment calculation to FISS. To date, Medicare has instructed the CWF to identify prior service days based on prior benefit periods. This overlooks the possibility that service days may have occurred at another provider prior to a transfer within the same benefit period. When a transfer occurs during a benefit period, the admitting (second) hospice submits a transfer notice (TOB 08xC) which establishes the second hospice’s start date (START DATE 2) on the benefit period record in CWF. When the second hospice bills for services, the days between the original start date of the current benefit period (START DATE 1) and the second hospice’s start date (START DATE 2) should be included in the prior service days used in RHC payment calculations. Currently, Medicare has instructed hospices to account for this by reporting the benefit period start date as the admission date on their claim in the case of transfers. While this workaround results in correct payments, it is understood that this approach cannot serve as a permanent solution because of informational discrepancies. CR 10180 ensures that the count includes the days provided by another hospice when there is a transfer during a benefit period and instructs the CWF to identify prior days correctly in transfer situations, so hospices no longer need to use this workaround.
Resources
“Using Community Partnerships to Integrate Health and Social Services for High-Need, High-Cost Patients,” by Commonwealth Fund http://nasuad.org/hcbs/article/using-community-partnerships-integrate-health-and-socialservices-high-need-high-cost
“Medicaid Home and Community-Based Services: Results From a 50-State Survey of Enrollment, Spending, and Program Policies,” by the Kaiser Family Foundation http://files.kff.org/attachment/Report-Medicaid-Home-and-Community-Based-Services
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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Important Upcoming Deadlines Requirement/Change
Effective/ Due Date
More Information
New York State Paid Family Leave program starts
Jan. 1, 2018
https://www.ny.gov/newͲyorkͲstateͲpaidͲfamilyͲleave/paidͲfamilyͲleaveͲinformationͲemployers
Home Care and other providers who contract with Managed Jan. 1, 2018 Care Organizations must be enrolled in Medicaid
https://www.emedny.org/info/ProviderEnrollment/ManagedCareNetwork/index.aspx
Managed Care Annual Program Integrity Report
Jan. 1 to Jan. https://omig.ny.gov/information/mcoͲreports 31, 2018
Medicare Advantage Disenrollment Period during which individual can switch from Medicare Advantage managed care plan to feeͲforͲservice Medicare
Jan. 1 to Feb. 14
www.medicare.gov
Revised Medicare Home Health Conditions of Participation in Effect
Jan. 13, 2018
https://www.gpo.gov/fdsys/pkg/FRͲ2017Ͳ01Ͳ13/pdf/2017Ͳ00283.pdf
2017 Adult Care Facility 4th Quarter Statistical Information Report
Jan. 31, 2018
https://commerce.health.state.ny.us
Submission of Long Term Care Workforce Investment Organization & Plan Agreements and VBP Addendum
Feb. 2, 2018 https://www.health.ny.gov/health_care/medicaid/redesign/2017/mltc_invest.htm
HCA State Advocacy Day
Feb. 6, 2018 https://hcaͲnys.org/eventsͲeducation/upcomingͲevents
Submission of Conflict of Interest (COI) Compliance Implementation Plan forms by NHTD/TBI providers to their Regional Resource Development Centers
March 1, 2018
Medicare Bundled Payments for Care Improvement Advanced model
Applications due March https://innovation.cms.gov/initiatives/bpciͲadvanced 12, 2018
Health Care Facility Transformation Program
Applications due March https://grantsgateway.ny.gov/intelligrants_NYSGG/module/nysgg/goportal.aspx?NavItem1=4&ngoID=5000979 14, 2018
https://hcaͲnys.org/wpͲcontent/uploads/2018/01/ConflictͲofͲInterestͲComplianceͲImplementationͲPlanͲ1.docx; https://hcaͲnys.org/wpͲcontent/uploads/2018/01/COIͲComplianceͲImplemenationͲPlanͲPowerͲPoint.pdf
Criminal history record check requirements apply to hospice April 1, 2018 https://www.health.ny.gov/facilities/home_care/advanced_home_health_aides/docs/ahha_legislation.pdf Submission of COI Compliance Implementation Plan forms by Regional Resource Development Centers to state Department of Health
April 1, 2018
Start of Transition Period for Using Health Insurance Claim Number (HICN) or Medicare Beneficiary Identifier (MBI)
April 1, 2018 https://www.cms.gov/Medicare/NewͲMedicareͲCard/index.html
Implementation of Universal Billing Codes for Home and CommunityͲBased Long Term Care Services under Managed Care
April 1, 2018 https://www.health.ny.gov/facilities/long_term_care/reimbursement/letters/dal_2017Ͳ12Ͳ07_billing_codes.htm
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https://hcaͲnys.org/wpͲcontent/uploads/2018/01/ConflictͲofͲInterestͲComplianceͲImplementationͲPlan.docx; https://hcaͲnys.org/wpͲcontent/uploads/2018/01/COIͲComplianceͲImplemenationͲPlanͲPowerͲPoint.pdf
Senior Financial Managers Forum
March 22, 2018
Senior Financial Managers Forum March 22, 2018
HCA’s Senior Financial Managers Forum is our popular daylong conference that covers every major finance and reimbursement issue confronting home care providers and MLTC plans on the state and federal levels. Traditionally, HCA’s Forum has been reserved for HCA members only, but this year we are opening registration to all home care providers and MLTCs, with a premium registration rate for HCA members. As in past years, HCA Policy staff will be joined by state Department of Health reimbursement officials, consultants, federal policy experts, and, new this year, a representative from New York’s Medicare Administrative Contractor, National Government Services. Please join us on March 22 to hear from these experts and get all of your finance questions and information needs covered.
Senior Financial Managers Forum
AGENDA
March 22, 2018
8:00am – 8:30am
12:00pm – 1:00pm
HCA Registration & Continental Breakfast
Lunch
8:30am – 9:30am
1:00pm – 2:15pm
HCA Update
What’s in Store for Home Care in 2018 on the Federal Regulatory and Reimbursement Front?
HCA staff will provide a state legislative update, focusing on the Governor’s proposed 2018‐19 Executive Budget and its impact on home care and Medicaid managed long term care, along with an update on our advocacy efforts in Albany and in Washington. HCA staff will highlight our annual financial condition report as well as discuss the latest on minimum wage funding, 24-hour live in cases, Value Based Payments, the Quality Incentive Vital Access Provider Pool (QIVAPP) and the 2018 Medicare Home Health Prospective Payment System (HHPPS). 9:30am – 10:30am
Department of Health Update John Ulberg, Jr., Medicaid Chief Financial Officer, Division of Finance and Rate Setting, Office of Health Insurance Programs, NYS Department of Health (Invited) Mr. Ulberg and/or staff from his Division will provide updates on the following: provisions in the 2018‐19 Executive State Budget that impact home care, personal care and Medicaid Managed Long Term Care (MLTC) plans; the Medicaid Global Cap; CHHA Episodic Payment System (EPS) re-basing; premium rate adjustments to MLTC; QIVAPP funding; Wage Parity and Overtime adjustments to plans and home care providers; the CHHA, LTHHCP and Personal Care fee‐for‐service Medicaid rates; the Medicaid cost reports; and other Medicaid reimbursement issues. 10:30-10:45am
Break
10:45am – 12:00pm
Targeted Probe and Educate Lauri Domingo, Home Health Clinical Consultant, Jurisdictions 6 and K, Provider Outreach & Education, National Government Services (NGS) Ms. Domingo will provide an update on the new Medicare Home Health Targeted Probe and Educate (HHTPE) – an audit program which focuses on specific agencies that NGS has identified as at-risk for documentation noncompliance (including for face-to-face documentation). Ms. Domingo will also review: the latest medical review and appeals data (including the top claim denial reasons) and tips to avoid those denials; the latest Comprehensive Error Rate Testing (CERT) results and findings; NGS HHPPS utilization data specifically for New York State; and updates on important upcoming NGS educational webinars that may be of interest to HCA participants.
Colin Roskey, Principal, Lincoln Policy Group; Partner, Scully Roskey & Missmar (Invited) Washington, D.C.-based federal home health policy expert Colin Roskey is one of the most knowledgeable voices on Medicare home health and hospice regulatory and reimbursement issues. During his session, Mr. Roskey will provide an overview of the national health care landscape, as well as provide insight into upcoming methodology changes to the Medicare HHPPS, including the prospect that Congress or the federal government will revive the Home Health Groupings Model (HHGM). Mr. Roskey will also present on other regulatory and legislative items percolating at the federal level, including opportunities to revise the current face-to-face regulations and the status of legislation/bills that would be helpful to our industry. 2:15pm – 3:30pm
Payment Reform: Aligning Services, Costs, Risks, and Outcomes with Reimbursement Ed Buckley, Chief Executive Officer, Select Data Above all else, CMS wants Medicare home care payment reform that includes a new Home Health Groupings Model (HHGM). Reform means change and change can mean opportunity, but it can also mean risk. Since this reform, if enacted, will affect agencies uniquely, it is imperative that agencies think about implementing a new classification system to control costs and manage care. These classifications will require robust models to distinguish between patients in need of services for recovering from acute conditions and those in need of chronic care management. In this session, Ed Buckley of Select Data will provide insights on how to succeed under HHGM by delineating the care delivery priorities of your patients, better classifying their needs, and developing new costcontrol measures and models. 3:30pm – 3:45pm
HCA Closing Remarks & Adjourn
Senior Financial Managers Forum March 22, 2018
Registration
Registration Fee and Payment â–Ą â–Ą
HCA has reserved a limited block of rooms at the Hilton Garden Inn in Troy, NY for the night of Wednesday, March 21 at a discounted rate of $119 per night. To receive this special rate, please call (888) 224-9761 prior to February 21, and ask for the group code HCAC.
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