TRANSFORMATION GRANTS
MEDICARE CHANGES
LAW TALK
SURGE TEST
HCA provides updates on eligibility requirements and more from a recent state webinar outlining Round II of Healthcare Transformation Grants.
For Medicare Advantage, CMS is redefining healthrelated supplemental benefits to include coverage of non-skilled in-home supports.
In this issue, HCA introduces a new monthly series called LawTalk where our counsel at Jackson Lewis writes on legal issues of importance to the membership.
HCA encourages members to participate in the next installment of Coalition Surge Test drills to test your emergency preparedness.
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COMING UP State Advocacy Day, PAC Reception Feb. 5-6, 2018 Albany Senior Financial Managers Forum March 22, 2018 Albany Blueprint for OASIS Accuracy April 9-10, 2018 Workshop (8 a.m. to 4 p.m.)
Your Source for HOME CARE News, Policy and Advocacy
Vol. 3, Issue 6 | February 5, 2018
What We are Asking For and Why on Advocacy Day Tomorrow HCA issues two important reports HCA has two important documents for tomorrow’s state Advocacy Day program in Albany. All members are urged to read them (linked later in this article). They will familiarize you with our state budget requests and the results of our financial and program analysis, which is comprised in large part of survey answers from 90 HCA member organizations, like yours. Broadly, we are asking the Legislature for two things: 1) approve and build upon those Executive budget items that support MLTC and home care; and 2) reject funding cuts and program actions that are adverse to providers and plans. See ADVOCACY p. 3
April 11, 2018 COS-C Exam East Syracuse Register for these and other programs online at https://hcanys.org/eventseducation/ upcoming-events.
HCA Forum for CFOs, Execs to Cover Major Home Care, MLTC Finance Issues HCA’s upcoming Senior Financial Managers Forum is our popular daylong conference (on March 22 in the Capital Region) that covers every major finance and reimbursement issue confronting home care providers and MLTC plans on the state and federal levels. See FORUM p. 2
INSIDE What We are Asking For and Why on Advocacy Day......................................1 HCA Forum for CFOs, Execs to Cover Major Finance Issues..............................1 Details from Webinar on Transformation Grant Program.............................4 CMS Call To Explain Low Volume Appeals Initiative.......................................5 HHS to Expand Medicare Settlement Conference Facilitation Program.........6 MLTC VBP Quality Measure Data Posted....................................................6 CMS Proposes Medicare Managed Care Changes........................................7 VBP FAQs Issued for Plans...........................................................................7 New Medicare Cards to be Mailed...............................................................8
DOH to Open Influenza Vaccination Report...................................................8 New Resources on Targeted Probe and Educate Website.............................9 LawTalk: A New Feature on Legal Topics by Attorneys at Jackson Lewis......10 Additional Coalition Surge Tests Coming.................................................11 More Info Posted on BPCI Advanced Model.....................................................13 State’s Medicaid Cap Report Shows $35M Variance.......................................13 CMS Issues Corrections on Home Health Review & Correct Reports.............14 Important Upcoming Deadlines.....................................................................15 Revised Medicaid Program Integrity Manual Posted.....................................16 Resources......................................................................................................................16
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FORUM from p. 1 This forum is explicitly designed for CEOs, CFOs, Senior Financial Managers and others with oversight of your organization’s finances and budgeting. Our expert Policy team will be joined by state Department of Health reimbursement officials, consultants, federal policy leaders, and, new this year, a representative from New York’s Medicare Administrative Contractor, National Government Services. This program is timed to coincide with the crescendo of state budget negotiations, where HCA and state officials can provide you with the latest on: home care Medicaid rates and premium rate adjustments to MLTC; QIVAPP funding; Wage Parity and overtime adjustments; Medicaid cost reports; and other Medicaid reimbursement issues. You can expect a similar depth of information on Medicare issues, with Washington updates from federal policy expert Colin Roskey on the status of the Home Health Groupings Model (HHGM) and other methodology changes, plus NGS’s Lauri Domingo will review the latest: medical review and appeals data; Comprehensive Error Rate Testing (CERT) results and findings; NGS HHPPS utilization data for New York State; and more. Download the flyer to register at https://hca-nys.org/wp-content/ uploads/2018/01/HCA-Senior-Financial-Mgr-Forum-RegistrationForm.pdf.
Volume 3, No. 6 February 5, 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. 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 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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ADVOCACY from p. 1 Within these broader areas are several specific proposals outlined in our 2018 Budget and Legislative Action Proposals document at https://hca-nys.org/wp-content/uploads/2018/02/2018BudgetandLegislativeAsks.pdf. These proposals are supported by the findings of our financial and program report on Home Care, Hospice and Managed Long Term Care Financial and Program Trends 2018, which is posted at https://hca-nys.org/wpcontent/uploads/2018/01/HomeCareHospiceandMLTCProgramTrends2018.pdf. In summary, HCA’s proposals are:
Reject Budget Cuts to MLTCs and Home Care Support Budget Proposals to Reimburse MLTC, Home Care and Hospice for Minimum Wage & Health Care Infrastructure Ensure Appropriate, Actuarially Sound and Timely Payment for MLTCs and Providers Address Severe Workforce Needs Maintain NY Licensure Standards for Home Care and Act Against Scofflaws Facilitate Advances in Care, Community Health and Cost Savings through Home Care
How to Use These Documents If you are speaking with a legislator or legislative staff member on Advocacy Day, the specific proposals and bulleted recommendations in our reports are necessary to answer any questions you may be asked about what bills or legislative actions the legislator should take. Some of these bills or legislative actions already exist in the proposed budget, as indicated in the documents. Others have been drafted by HCA or will be submitted as direct amendments to the Governor’s proposed budget language. If you are asked technical questions about the bills or budget actions, feel free to point to HCA’s documents as a reference. However, in talking with legislative offices, it is best to stick with the broader themes outlined above and communicate your agency’s personal experiences with those themes. As a leader, manager or fiscal officer, consider using organization-specific data or concerns to share in most of these areas. But if you need further supporting evidence or would like to speak in more general terms about the trends driving our proposals, please reference the information, statistics, and language in our Home Care, Hospice and Managed Long Term Care Financial and Program Trends 2018 linked above. All State Advocacy Day documents are posted to our website at https://hca-nys.org/advocacy-pac/state.
Get resources and news; sign-up for training sessions at stopsepsisathomeny.org
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Details from Webinar on Transformation Grant Program Last week, the state Department of Health (DOH) held a webinar on the second round of the Statewide Health Care Facility Transformation Program (SHCFTP II). A recording is at https://meetny.webex.com/meetny/lsr.php?RCID=25843fd39d594bd084c32443acfdb8dd. The webinar material is at https://hca-nys.org/wp-content/uploads/2018/02/SHCFTP-Webinar-1-31-18-FINAL.pdf. Questions on the program are due February 9 and can be e-mailed to Statewide2@health.ny.gov. Q&As will be posted on or about February 21. Though applications are due on the Grants Gateway by 4 p.m. on March 14, DOH recommends submitting them 48 hours beforehand so there is time to address any issues. The grant announcement is at https://grantsgateway.ny.gov/intelligrants_NYSGG/module/nysgg/ goportal.aspx?NavItem1=4&ngoID=5000979. As mentioned in the January 12 edition of The Situation Report, this program provides grants for capital projects, debt retirement, working capital or other noncapital projects directly related to a capital project that facilitate health care transformation activities, including acquisition or other activities intended to create financially sustainable systems of care or preserve or expand essential health care services. Grants will not be made to support general day-to-day operating costs unrelated to the start-up expenses of the Eligible Project. A total of up to $203,782,888 is available. Due to advocacy by HCA and other community health providers, a minimum of $75 million was required to be awarded to community-based providers – defined as home care providers, diagnostic and treatment centers, mental health and alcohol and substance abuse treatment clinics, and primary care providers. However, $28,004,493 from the Statewide II appropriation was already awarded to community-based health care providers for Statewide I. As a result, the RFA indicates that a minimum of $46,995,507 ($75 million minus $28 million) must be awarded to community-based health care providers for Statewide II. Priority is given to projects not funded in response to the first round of SHCFTP funding. The RFA, however, indicates that such priority applies only after the application of the geographic statewide distribution. In addition, priority may be given to projects involving community- and facility-based post-acute care and long term care support services that: reduce unnecessary emergency department visits or inpatient readmissions through the innovative use of technology or workforce utilization; establish collaborations across health care provider types; provide services to patients/residents in a more home-like setting; or result in long-term financial sustainability of an essential community provider. Some important points made during last week’s webinar include:
Information technology (IT) expenses that are capital in nature can be considered eligible expenses for grant purposes. Continued on next page
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Continued from previous page
Cloud-based and certain software purchased “off the shelf” are not considered eligible expenses because they are counted as general operating expenses.
Terminals and laptops used to access a cloud-based system are covered if they have an expected useful life of at least 3 years.
Non-profit and for-profit/proprietary entities are eligible to apply for funding.
All applications must be submitted online via the Grants Gateway. Not-for-profit applicants must register and be prequalified in Grants Gateway by the application due date. Assistance is at: http://grantsreform.ny.gov/ grantees; Grantsreform@its.ny.gov; and 518-474-5595. DOH hopes to post Frequently Asked Questions by about February 21. The new budget proposed for 2018-19 includes another $425 million for this program, with a minimum of $60 million for community-based care. HCA is also advocating that the minimum for community-based care be no less than 25 percent, or $106.25 million.
CMS Call To Explain Low Volume Appeals Initiative The U.S. Centers for Medicare and Medicaid Services (CMS) will be holding another call to provide further information on its “Low Volume Appeals (LVA) Settlement Option.” The call will take place on February 13, from 1:30 to 3 p.m.; registration is at https://blh.ier.intercall.com/. This option is limited to home care and other providers with a low volume of appeals pending at the Medicare Hearings and Appeals (OMHA) and the Medicare Appeals Council. To be eligible, providers must have fewer than 500 of such pending claims (combined Part A and Part B) as of November 3, 2017, with a total billed amount of $9,000 or less per appeal. CMS will settle eligible appeals at 62 percent of the net allowed amount. As communicated to members previously, this new appeals option is completely separate and distinct from the Third-Party Liability (TPL) Settlement between the state Office of the Medicaid Inspector General (OMIG) and CMS. Also, claims that are part of an extrapolation appeal (similar to TPL) are not eligible for this option. The most recent update on this Settlement is in the November 6, 2017 edition of The Situation Report at https://hca-nys.org/wp-content/uploads/2017/11/SitReport110617.pdf. During the February 5 call, providers can learn more about the appeal option, the current status, and how the settlement process works. CMS speakers will discuss how to identify whether you are eligible and which of your pending appeals may be settled. A question and answer session follows the presentation; however, attendees may e-mail questions in advance to MedicareSettlementFAQs@cms.hhs.gov with “Low Volume Appeals Settlement February 13 Call” in the subject line. These questions may be addressed during the call or used for other materials following the call. Continued on next page
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Continued from previous page Agencies that want to utilize this process must submit an Expression of Interest/EOI (http://go.cms.gov/LVA) to CMSMedicareAppealsSettlement@cms.hhs.gov during the allotted submission timeframes below:
For agencies with National Provider Identifiers (NPIs) ending in an even number (0,2,4,6,8), EOIs will be accepted between February 5, 2018 and March 9, 2018.
For agencies with NPIs ending in an odd number (1,3,5,7,9), EOIs will be accepted between March 12, 2018 and April 11, 2018.
More information is at https://www.cms.gov/Medicare/Appeals-and-Grievances/OrgMedFFSAppeals/ Appeals-Settlement-Initiatives/Low-Volume-Appeals-Initiative.html.
HHS to Expand Medicare Settlement Conference Facilitation Program The federal Office of Medicare Hearings and Appeals (OMHA) is expanding its current Settlement Conference Facilitation (SCF) program to reach additional providers and suppliers in April 2018. SCF is an alternative dispute resolution process, which gives certain providers and suppliers an opportunity to resolve their eligible Part A and Part B appeals. Note that SCF is separate and distinct from the Low Volume Appeals Settlement Option. (see related p. 5 story.) Several eligibility requirements apply. Among other requirements, the appellant must be a Medicare provider with a National Provider Identifier (NPI). The appeals also must involve request(s) for Administrative Law Judge (ALJ) hearing or Medicare Appeals Council review at the Departmental Appeals Board filed on or before November 3, 2017 for appellants: with 500 or more appeals pending at OMHA and the Council combined; and with any number of appeals pending at OMHA and the Council that each have more than $9,000 in billed charges. For appellants with fewer than 500 appeals, those individual appeals with $9,000 or less in billed charges may potentially be resolved under the CMS LVA Settlement Option. Information on additional eligibility requirements, which appeals will be ineligible for the expanded SCF program, and other materials are at https://www.hhs.gov/about/agencies/omha/about/special-initiatives/ settlement-conference-facilitation/index.html.
MLTC VBP Quality Measure Data Posted The state Department of Health (DOH) has released the Managed Long Term Care (MLTC) Value Based Payment (VBP) Quality Measure Data Reporting Timeline, a supplement to the 2018 Value Based Payment (VBP) Reporting Requirements Technical Specifications Manual. This new document (https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/vbp_library/2018/2018jan_mltc_vbp_qmd_rpt_timeline.htm) provides Partially Capitated MLTC Plans with a visual tool that outlines the timing of the data elements and information flow for VBP quality measurement. All questions can be sent to DOH at MLTCVBP@health.ny.gov.
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CMS Proposes Medicare Managed Care Changes Non-skilled in-home supports included as benefit On February 1, 2018, the U.S. Centers for Medicare and Medicaid Services (CMS) released proposed changes for the Medicare Advantage (MA) plans and Part D (prescription drug) programs in 2019. A fact sheet on this issue is at https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/ 2018-Fact-sheets-items/2018-02-01.html. As a part of these changes, CMS is redefining health-related supplemental benefits to include services that increase health and improve quality of life, including coverage of non-skilled in-home supports, portable wheelchair ramps and other assistive devices and modifications when patients need them. According to CMS, it has previously not allowed an item or service to be eligible as a supplemental benefit if the primary purpose included daily maintenance. Under the new policy, CMS would allow supplemental benefits if they compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization. CMS estimates the proposed policy changes would result in a 1.84 percent pay increase for plans, not including a 3.1 percent increase in pay that CMS expects plans to generate by coding more intensely. Other proposed changes cover risk adjustment models and star ratings. The 2019 Advance Notices (Part I and Part II) and Draft Call Letter that includes all of the proposed changes can be viewed by going to: https://www.cms.gov/Medicare/Health-Plans/ MedicareAdvtgSpecRateStats/Announcements-and-Documents.html. See “2019 Advance Notices.” Comments on the proposed Advance Notices and Draft Call Letter must be submitted by March 5, 2018. The 2019 Final Rate Announcement and Call Letter will be published on Monday, April 2, 2018. HCA will be reviewing the proposed changes related to supplemental health-related benefits.
VBP FAQs Issued for Plans The state Department of Health (DOH) has released a frequently asked questions document on Value Based Payments (VBP) for Medicaid Advantage Plus (MAP), Fully Integrated Duals Advantage (FIDA) plans, and Programs of All-Inclusive Care for the Elderly (PACE). Questions and answers will be updated or added to the document on a periodic basis to continue to address related stakeholder questions. The FAQ document 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.
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New Medicare Cards to be Mailed Starting April 2018, CMS will begin mailing new Medicare cards to all people with Medicare on a flow basis, based on geographic location and other factors. The cards will have new Medicare Beneficiary identifiers (MBIs) instead of Social Security Number-based Health Insurance Claim Numbers. The mailing timetable is here: https://www.cms.gov/Medicare/New-Medicare-Card/NMC-MailingStrategy.pdf. The mailings will be staggered throughout the year, with completion expected by April 2019. The U.S. Centers for Medicare and Medicaid Services (CMS) has developed messaging guidelines that are intended to help providers and advocates. They are here: https://www.cms.gov/Medicare/New-MedicareCard/New-Medicare-Card-Messaging-Guidelines-July-2017.pdf/. To help providers prepare for the transition to the MBI on Medicare cards beginning April 1, 2018, CMS suggests that providers review the new information about remittance advices. Beginning in October 2018, through the transition period, when providers submit a claim using a patient’s valid and active Health Insurance Claim Number (HICN), CMS will return both the HICN and the MBI on every remittance advice. The following are examples of different remittance advices:
Medicare Remit Easy Print (Medicare Part B providers and suppliers): https://tinyurl.com/yce74et7.
PC Print for Institutions: https://tinyurl.com/ybhack4d.
Standard Paper Remits: FISS (Medicare Part A/Institutions), https://tinyurl.com/y89s24kg; MCS (Medicare Part B/Professionals), https://tinyurl.com/ycse6fzq; VMS (Durable Medicare Equipment), https://tinyurl.com/y8e6ax4d.
Starting January 1, 2020, providers will have to submit claims using MBIs (with a few exceptions), no matter the date of the service. More information on the New Medicare Card is at https://www.cms.gov/Medicare/New-Medicare-Card/Providers/Providers.html.
DOH to Open Healthcare Personnel Influenza Vaccination Report The state Department of Health (DOH) has released a Dear Administrator Letter (DAL) announcing that the Healthcare Personnel Influenza Vaccination Report will open on Monday, February 5, 2018 and must be electronically submitted to the state Department of Health (DOH) by May 1, 2018. The DAL can be read at https://hca-nys.org/wp-content/uploads/2018/01/DAL_Healthcare-Personnel-Influenza-VaccinationReport_013018.pdf. Under state regulations, home care and other health care providers are required to document the number and percentage of personnel vaccinated against influenza for the current season and to complete this report upon DOH’s request. This year’s report covers personnel employed by or affiliated with your facility or agency from October 1, 2017 through March 31, 2018. Your organization should enter available data in February and then resubmit as often as is necessary as new personnel join and/or submit documentation of vaccination until the May 1
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deadline. The report is on the Health Electronic Response Data System (HERDS) at https:// commerce.health.state.ny.us/. The DAL includes an instruction card for guidance on how to access, complete and submit the report on HERDS, and Frequently Asked Questions (FAQs). A pre-recorded webinar training session for the Healthcare Personnel Influenza Vaccination Report is available online at www.health.ny.gov/FluMaskReg under the heading “Training.” DOH advises agencies to ensure that the person completing the report views the pre-recorded webinar and the FAQs before completing the report. The FAQs include the following important information:
If an organization has a Certified Home Health Agency and a Licensed Home Care Services Agency, it must submit an individual report for each agency.
If personnel work in or are affiliated with more than one agency, these individuals must be counted in the total number of personnel for each agency where they work.
All personnel who worked at an agency for any amount of time from October 1, 2017 to March 31, 2018 should be included in the report.
Any personnel that received the influenza vaccine after July 1 should be counted as vaccinated in the Report.
Those personnel who indicate that they have a religious objection to vaccination or report a contraindication to influenza vaccination should be counted in the “declined influenza vaccination” category.
Questions about the report should be directed to the DOH Bureau of Immunization at either (518) 473-4437 or immunize@health.ny.gov. Technical questions about the report or on the use of HERDS should be directed to the Health Emergency Preparedness Program at (518) 408-5163 or hseppny@health.ny.gov.
CMS Provides New Resources to its Targeted Probe and Educate Website The U.S. Centers for Medicare and Medicaid Services (CMS) has updated its Targeted Probe and Educate (TPE) website which was designed to helps providers and suppliers reduce claim denials and appeals through one-on-one education. The updated TPE website is at https://www.cms.gov/Research-Statistics-Data-and-Systems/MonitoringPrograms/Medicare-FFS-Compliance-Programs/Medical-Review/Targeted-Probe-and-EducateTPE.html. It contains the following new resources:
Common claim errors TPE process graphic One-pager about the program to download and share Questions & Answers
For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
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LawTalk: A New Monthly Feature on Legal Topics from the Attorneys at Jackson Lewis Welcome to our first HCA LawTalk article! Each month, attorneys at Jackson Lewis (the firm that represents HCA as its counsel) will provide a brief, informational article on a legal topic relevant to HCA’s members. This month’s topic focuses on documenting corporate governance and other corporate activities. Many small business owners or not-for-profit organizations forget or ignore these requirements, despite possible adverse consequences. Broadly, the main forms of governing documents for home care agencies, hospices and MLTC plans are below. 1. For Corporations (both business and not-for-profit): formation certificates, bylaws, minutes, and, if applicable, a shareholders’ agreement. To be validly organized in New York, a Corporation must have filed a certificate, formally adopted bylaws and taken certain other official governance actions, such as electing board members and officers. 2. For Limited Liability Companies (LLCs): formation articles, operating agreements and minutes. New York LLCs must file articles of organization, adopt an operating agreement (even if there is only one member of the LLC), and publish and file a certificate of publication with New York’s Department of State. Most HCA members would have completed these steps at the time the provider was established. Some steps, however, such as publication by LLCs, are frequently overlooked. Although this misstep does not negatively impact the LLC’s status for most purposes, it can impact the LLC’s ability to bring a lawsuit or obtain financing. Given that the publication process takes six weeks – with another 1 to 2 weeks before the certificate of publication can be filed – overlooking this step can result in unwanted delays. But then what happens? Corporate activities continue and governance decisions are made, but they are not always properly documented. Corporations will most often memorialize annual meeting board and officer elections in minutes. (Unlike a corporation which should have a formal annual meeting each year, LLCs are not required by law to meet annually, but may be required to do so by virtue of their operating agreements.) Yet, many other activities may not get properly documented by both Corporations and LLCs, and these are worth noting, such as: clarifying officer or staff signatory authority, approval of policies, formation of committees, approval of loans, leases, pension plans, or review (and approval) of executive compensation. While seemingly a mere formality, failure to appropriately document corporate activities could impact the organization’s liability (and in some cases, the owner’s as well), and call
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into question the validity of actions that were not properly documented as approved. In some unfortunate cases, the lack of proper minutes could also lead to expensive litigation. Given the potential negative impact, but relatively simple task of doing so, all organizations should be sure to document corporate actions and governance decisions. Minutes should outline who participated in the decision (and who did not), provide a brief summary of any important discussion points, designate an individual to take any additional steps necessary to implement the action or decision, and include a ratification of all actions taken by officers or staff in connection with the action or decision. Bear in mind, however, that minutes may be subject to disclosure and, therefore, should be properly phrased. An ounce of documentation prevention certainly will cost less than a pound of cure. Please note that HCA LawTalk articles are for general, informational purposes, are not legal “advice,” and do not create an attorney-client relationship. Because each case is unique, the information provided should be considered to be general in nature, and should never be considered a substitution for legal counsel. Readers should not take, or refrain from taking, any action based on information in this article without first seeking legal advice from competent counsel.
Additional Coalition Surge Tests Coming The state Department of Health (DOH) will be holding four additional Coalition Surge Tests and Interoperable Communication Drills (CST/IOC) throughout February that will cover the Lower Hudson Valley, Finger Lakes, Buffalo and Long Island (not New York City). DOH has alerted the associations of a two-week range of the dates that the CST/IOC drills will be held in the following regions: MARO – Long Island – February 5 to February 16 Western Region – February 12 to February 23 MARO – Lower Hudson Valley – February 19 to March 2 As relayed to members in numerous articles and alerts, 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. The drills are being held in conjunction with local Health Emergency Preparedness Coalitions (HEPCs). HEPC contacts for each region of the state are at https://hca-nys.org/wp-content/uploads/2018/02/ POC-Coalitions-1-10-18.pdf. Home care and hospice provider staff listed in the Health Commerce System (HCS) Communications Directory will be notified on the day of the CST/IOC drill via an Integrated Health Alert Notification System (IHANS) email. Continued on next page
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Continued from previous page It is vital that providers update their contacts in the HCS, specifically the following home care and hospice roles who will be sent the IHANS notification: Administrator; HPN Coordinator; Emergency Response Coordinator; Director of Home Care Patient Services (for home care agencies); and Director of Patient Services (for hospice). We were informed that many agencies did not receive the IHANS notification about CST/IOC drills held on January 23 and January 25 because the provider information in the HCS was incomplete or inaccurate. The CST will involve a simulated disaster in which three hospitals in a region must evacuate their patients. Other hospitals, home care and hospice providers, and nursing homes will participate in the exercise and be asked if they can accept some of those patients. During the drill simulation, home care agencies may be asked to provide home care services to hospital patients who are discharged and/or send home care patients to a hospital if they cannot provide services to such patients at home. Providers will be given about one hour to complete a survey using the Health Electronic Data System (HERDS) on the Health Commerce System (HCS). They will also be 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-9-29-17.docx . DOH has also made available a CST/IOC Drill Packet to assist agencies in their completion of the AAR. That document is at https://hca-nys.org/wp-content/uploads/2018/02/HEPC-CST-and-IOC-DrillPacket_January-2018.pdf. After the drill, providers are invited to participate in a discussion via teleconference to explore issues that arose during the exercise related to continuity of operations, bed placement of evacuated patients, communications and transportation. DOH has already held four webinars, including two last week, for providers to review the upcoming drills. The material from those programs is at https://hca-nys.org/wp-content/uploads/2018/02/CST-and-IOC-Drill-Webinar_Feb2018.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 if they are accredited by an organization that requires such participation or if they are mandated to do so under their contracts 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.
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Volume 3, No. 6 February 5, 2018
More Info Posted on BPCI Advanced Model The U.S. Centers for Medicare and Medicaid Services (CMS) has posted additional information on its recently announced Bundled Payments for Care Improvement Advanced (BPCI Advanced) model. The resources are at https://innovation.cms.gov/initiatives/bpci-advanced. They include a fact sheet, model overview slides, Frequently Asked Questions (FAQs), overview webcast, episode definitions, and more. CMS also held an Advanced Open Door Forum on the new model last week and the materials from that program should be posted soon. Under this new model, as mentioned in the January 12 edition of The Situation Report, participants can earn additional payment if all expenditures for a beneficiary’s episode of care fall below a spending target which factors in quality. Participants bear financial risk, have payments tied to quality performance, and are required to use Certified Electronic Health Record Technology. Participants may receive payments for performance on 32 different clinical episodes, such as major joint replacement of the lower extremity (inpatient) and percutaneous coronary intervention (inpatient or outpatient). Applications must be submitted via the Application Portal (https://app1.innovation.cms.gov/ bpciadvancedapp) which will close at 11:59 p.m. on March 12, 2018.
State’s Medicaid Cap Report Shows $35M Variance from Projections In April through September The state’s latest Medicaid Global Cap Spending Report (for the current fiscal year through September 2017) finds that overall spending was $35 million above the global cap projections, across all sectors, a difference of $10.702 billion in actual spending versus $10.667 billion in estimated spending for the period. The fiscal year (FY) begins on April 1 and ends on March 31, so this September report is the mid-year State Fiscal Year report. Nearly all of the provider and plan categories were above the cap projections. “Other Long Term Care” (which includes home care) was $29 million above projections. DOH notes that there were 1,691 more personal care recipients during this period, driving the costs. Managed Long Term Care was $73 million over projections due to there being 3,678 more recipients than anticipated during the report period. In other report highlights:
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The Accounts Receivable (A/R) ending balance for FY 2017 was $204 million. The state is expected to recoup $135 million by the end of FY 2018, resulting in a projected A/R balance of $69 million by
The Situation Report: the Home Care Association of New York State
Volume 3, No. 6 February 5, 2018
March 2018. Through the end of September, retroactive rates owed to the state were $157 million. This reflects net recoveries of $47 million since March 2017.
Total Medicaid enrollment reached 6,098,864 at the end of September 2017. This reflects a net decrease of 22,727 enrollees since March 2017.
The report contains multiple other data, including tables or summaries of: Vital Access Provider program award amounts; Inventory of Medicaid Rate Packages, Regional Medicaid spending, enrollment estimates; and more. These reports, particularly this semi-annual report and the annual report are important given the superpowers allowing executive actions to cut rates in the event that spending exceeds the cap. As Washington continues to debate a health care overhaul, with billions of dollars in Medicaid funding and expansion dollars at stake, HCA will advocate for a funding mechanism that sustains vital services and accurately accounts for reasonable cost factors, such as enrollment changes and wages and related labor costs. The full report is at: https://www.health.ny.gov/health_care/medicaid/regulations/global_cap/ monthly/sfy_2017-2018/docs/sept_2017_report.pdf. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
CMS Issues Corrections on Home Health Review & Correct Reports The U.S. Centers for Medicare and Medicaid Services (CMS) has determined that the denominator counts for the Percent of Residents or Patients with Pressure Ulcers That Are New or Worsened (NQF No. 0678) on the home health Review and Correct reports are incorrect. Specifically, they do not include episodes where M1313 was coded as a valid skip, when the response to M1306 was “0” (No). The numerator counts on these reports were calculated correctly. The forthcoming confidential feedback reports for this measure (the HH on-demand Risk Adjusted Outcome Reports), as well as public reporting on Home Health Compare starting in 2019, will both correctly incorporate episodes with valid skips in the denominator. As a result, Home Health Agencies (HHAs) can expect to see much lower rates for the measure relative to the values on their Review and Correct reports to date. The Review and Correct reports going forward will also include this update. As a result, measure calculation will be standardized across postacute care settings. If you have questions concerning this information, please contact the QTSO Help Desk at help@qtso.com.
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The Situation Report: the Home Care Association of New York State
Volume 3, No. 6 February 5, 2018
Important Upcoming Deadlines Requirement/Change
Effective/ Due Date
More Information
Home Care and other providers who contract with Jan. 1, 2018 Managed 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. 31, 2018
https://omig.ny.gov/information/mcoͲreports
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
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
CMS Low Volume Appeals Settlement for CHHAs with NPIs ending in an even number
Expression of Interest must https://www.cms.gov/Medicare/AppealsͲandͲGrievances/OrgMedFFSAppeals/AppealsͲ be submitted from Feb. 5 to SettlementͲInitiatives/LowͲVolumeͲAppealsͲInitiative.html March 9
HCA State Advocacy Day
Feb. 6, 2018
https://hcaͲnys.org/wpͲcontent/uploads/2018/01/2018ͲHCAͲAdvocacyͲEventsͲRegistrationͲFormͲ UpdatedͲjkͲ3.pdf
Submission of Conflict of Interest (COI) Compliance Implementation Plan forms by NHTD/TBI providers to their March 1, 2018 Regional Resource Development Centers
https://hcaͲnys.org/wpͲcontent/uploads/2018/01/ConflictͲofͲInterestͲComplianceͲImplementationͲ PlanͲ1.docx; https://hcaͲnys.org/wpͲcontent/uploads/2018/01/COIͲComplianceͲImplemenationͲ PlanͲPowerͲPoint.pdf
Medicare Bundled Payments for Care Improvement Advanced model
https://innovation.cms.gov/initiatives/bpciͲadvanced
Applications due March 12, 2018 Expression of Interest must CMS Low Volume Appeals Settlement for CHHAs with NPIs be submitted from March 12 ending in an odd number to April 11 Applications due March 14, Health Care Facility Transformation Program 2018 Criminal history record check requirements apply to April 1, 2018 hospice Submission of COI Compliance Implementation Plan forms by Regional Resource Development Centers to state April 1, 2018 Department of Health
https://www.cms.gov/Medicare/AppealsͲandͲGrievances/OrgMedFFSAppeals/AppealsͲSettlementͲ Initiatives/LowͲVolumeͲAppealsͲInitiative.html https://grantsgateway.ny.gov/intelligrants_NYSGG/module/nysgg/goportal.aspx?NavItem1=4&ngoID =5000979 https://www.health.ny.gov/facilities/home_care/advanced_home_health_aides/docs/ahha_legislati on.pdf https://hcaͲnys.org/wpͲcontent/uploads/2018/01/ConflictͲofͲInterestͲComplianceͲImplementationͲ Plan.docx; https://hcaͲnys.org/wpͲcontent/uploads/2018/01/COIͲComplianceͲImplemenationͲPlanͲ PowerͲPoint.pdf
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_2017Ͳ12Ͳ 07_billing_codes.htm
Healthcare Personnel Influenza Vaccination Report
May 1 for personnel employed from October 1, 2017 to March 31, 2018
immunize@health.ny.gov or (518) 473Ͳ4437
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The Situation Report: the Home Care Association of New York State
Volume 3, No. 6 February 5, 2018
Revised Medicaid Program Integrity Manual Posted The U.S. Centers for Medicare and Medicaid Services (CMS) has posted a revised Medicaid Program Integrity Manual (PIM). It is at https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2018Downloads/ R3MPI.pdf. It completely revamps the current Medicaid PIM within CMS’s Internet-Only Manuals (IOMs) 100-15, Medicaid Integrity Program and replaces the current 17 chapters with 2 chapter revisions. Some issues covered include: sample close-out letter; coordination with law enforcement agencies; state program integrity reviews; Medicaid integrity audits; national audit program; provider screening and enrollment requirements; and more. HCA will be reviewing the revisions and provide more information at a later date.
Resources
“Information for all Providers General Billing” (updated January 29, 2018), eMedNY https://www.emedny.org/ProviderManuals/AllProviders/PDFS/Information_for_All_ProvidersGeneral_Billing.pdf
“Your Rights as a Hospital Patient in New York State,” by the state Department of Health https://www.health.ny.gov/publications/1449.pdf
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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CHHA MEMBER Forum Please join the staff of HCA and member colleagues from the Association and the home care community for the first HCA CHHA MEMBER Forum. Participation in HCA Member Forums gives you an opportunity to interact with HCA staff and members, and exchange valuable information with your colleagues.
CHHA Member Forum Friday, February 23, 2018 10:30am to 2:00pm Jackson Lewis Offices 677 Broadway, 9th Floor Conference Room Albany, New York 12207 Lunch will be served.
Some of the important issues to be discussed include: • • • • •
Update on state budget provisions impacting CHHAs and home care providers; Financial condition of CHHAs and operational and contracting concerns; Challenges facing CHHAs in integrated models of care and payment; Compliance challenges; and Other issues of concern to CHHAs.
Payment of $39 per person
Registration
Please check method of payment:
Name: ________________________________________________________
*Make checks payable to: HCA and mail to 388 Broadway, 4th Floor, Albany, NY 12207. Checks must be received by February 15.
Title: _________________________________________________________
____MasterCard ____VISA ____Am Exp
____Check*
Organization:___________________________________________________
______________________________________________________ Card Number
_______________________________________________________________ Mailing Address
_________________________________ _________________ Expiration Date Security Code
City/State/Zip:__________________________________________________
______________________________________________________ Billing Address of Card Holder
Email:_________________________________________________________ Phone:_________________________________________________________ (Required for registration) Cancellation Policy Cancellations received by February 15 will receive a full refund less 25% of total due as an administrative fee. Cancellations received on February 16 or later will forfeit their registration fee along with those who register and do not attend. Substitutions are permitted. Please contact Teresa Brown at (518) 426‐8764 or tbrown@hcanys.org to cancel.
______________________________________________________ City, State, Zip ______________________________________________________ Name on Card ______________________________________________________ Authorized Signature
FAX TO: (518) 426‐8788 For more information, contact Andrew Koski at (518) 810‐0662 or at akoski@hcanys.org
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.
Become an HCA Member
388 Broadway Fourth Floor Albany, New York 12207 PH (518) 426-8764 WEB www.hca-nys.org