SURGE TEST
CFCO
FLU REPORTS
DEADLINES
HCA encourages members to participate in the next installment of Coalition Surge Test drills to test your emergency preparedness.
The state has outlined the process by which Community First Choice services are becoming part of managed care, starting April 1.
HCA reminds members that the flu vaccination report is open and data can be entered until the submission date of May 1.
HCA provides a running list of deadlines and due dates that you should be aware of for various reporting requirements, program or grant deadlines, and more.
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COMING UP CHHA Member Forum Feb. 23, 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.) April 11, 2018 COS-C Exam East Syracuse Register for these and other programs online at https://hcanys.org/eventseducation/ upcoming-events.
Your Source for HOME CARE News, Policy and Advocacy
Vol. 3, Issue 7 | February 12, 2018
State Advocacy Day Last Week, Budget Hearing This Week; HCA Presses Case for Home Care, Hospice, MLTC Priorities HCA Board members, government-affairs representatives and other key agency leaders came to Albany last week for HCA’s state advocacy program, policy council meeting, and Political Action Committee (PAC) reception (sponsored by TSG Financial), all aimed at advancing the needs of New York’s home care, hospice and Managed Long Term Care system. The two days of advocacy and policy programming – on February 5 and 6 – included a roundtable discussion and other formal and informal meetings with Executive See ADVOCACY p. 3
Managed Care-Contracted Providers Reminded to Enroll in Medicaid or Face Termination The January 2018 Medicaid Update includes a reminder that all Medicaid managed care (and Children’s Health Insurance Program /CHIP) network providers are required to enroll in Medicaid. SeeTERMINATION p. 2
INSIDE Advocacy Day Last Week, Budget Hearing Today; HCA Presses Case............1 MCO-Contracted Providers: Enroll in Medicaid or Face Termination...........1 Payment Change, Rural Add-on & More Pack Federal Budget Bill.................1 DOH Issues DAL on 2018 Personal Care Minimum Wage Rate......................4 Join Us for CHHA Forum to Exchange CHHA-specific Updates......................7 PAC POWER Courtesy of TSG Financial!..........................................................8 Coalition Surge Test Held on Long Island......................................................9 CMS Provides Hospice Updates..............................................................10 VBP FAQs Posted....................................................................................11
HHA Payment Change, Rural Add-on and More Pack Federal Budget Bill Signed into Law Attend HCA’s Finance Forum to learn more about the final rate and reimbursement model changes that impact you The federal budget bill signed into law on Friday includes major impacts on home care, including a limited extension of the home health rural add-on and a remake of See BUDGET p. 5
CFCO Services Become Part of Medicaid Managed Care...........................11 Work Schedule Changes Enacted for NYC Employees................................12 OT and Speech-Language Pathology Regulations Finalized.......................13 Guidance Issued to Managed Care on Flu Immunizations.........................13 eMedNY Trainings Available.....................................................................14 Healthcare Personnel Flu Vaccination Report Open.................................15 New Address for Submitting Additional Information for Claims..................16 NGS Updates...........................................................................................16 Important Upcoming Deadlines...............................................................17 OSHA Reminds Employers to Post Certain Information.............................18 Resources..........................................................................................................................18
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TERMINATION from p. 1
The article is at https://www.health.ny.gov/health_care/ medicaid/program/update/2018/jan18_mu.pdf (page 11). While this action is required by January 1, 2018, the state Department of Health (DOH) is still accepting Medicaid enrollment applications and encourages those home care and other health care entities that provide services to managed care enrollees to submit Medicaid applications immediately. The following resources are available through DOH’s provider enrollment website at: https://www.emedny.org/info/ ProviderEnrollment/ManagedCareNetwork/index.aspx:
Provider enrollment forms and instructions
Medicaid fee-for-service (FFS) active provider listing (updated monthly)
List of NYS Enrollable Provider Types
Frequently Asked Questions (FAQs)
PowerPoint presentations
HCA has repeatedly advised members of this Medicaid enrollment requirement and, unfortunately, still hears from those who are not aware of this mandate. Those who don’t enroll will face termination from their managed care contracts later this year (after prior notice). For more information, contact Andrew Koski at (518) 8100662 or akoski@hcanys.org.
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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 policymakers, such as Deputy Commissioner for the Office of Primary Care and Health Systems Management Dan Sheppard, and legislative leaders, such as Senate Health Committee Chairman Kemp Hannon, Assembly Health Committee Chairman Richard Gottfried, and Committee on Aging Chair Susan Serino. These sessions were followed by individual office meetings with lawmakers, counsel and other staff with jurisdiction over the budget and health care. HCA previously shared with members our one-page statement of legislative and budget requests which guided the discussions on both days, specifically focused on: MLTC and home care operational, eligibility and contracting limits or cuts; the need for infrastructure investment; a more streamlined process for minimum wage and other labor-related payment and attention to workforce needs; and issues related to the standards of home care licensure, which were a particularly lively and engaging point of discussion with lawmakers. “The proposed state budget contains funding cuts, limits on who can access the home care system and other constraints that would further squeeze a vital but already financially stressed system, as shown in our reports and addressed by our proposals,” said HCA President Joanne Cunningham in a press release on Monday. (See https://hca-nys.org/press-releases/ hca-issues-state-legislative-proposals-finance-report-on-thehome-care-hospice-and-managed-long-term-care-sectors.) Advocacy Day is one of many opportunities for members to engage with the Legislature and Governor’s office on our priorities, and we urge members to keep up your contact with elected representatives and respond to HCA’s calls for grassroots advocacy in the coming weeks as negotiations escalate. Today, after press time for The Situation Report, HCA is also delivering testimony before a joint hearing of the Senate and Assembly on the Medicaid and health provisions of the proposed state budget. Our written testimony is available at https://hcanys.org/wp-content/uploads/2018/02/ 201819HCAStateBudgetTestimonyFinal.pdf. HCA will inform the membership of any key highlights, areas of questioning or mentions of home care issues during today’s
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Top photo: Assembly Health Committee Chairman Richard Gottfried. Middle photo (center): Senate Committee on Aging Chair Susan Serino. Bottom photo: (from left) HCA Board Member Michelle Mazzacco, Vice President/Director at Eddy Community Services/St. Peter's Health Partners, explains regulatory concerns; HCA Executive Vice President Al Cardillo, HCA President Joanne Cunningham, and Department of Health Deputy Commissioner Dan Sheppard listen.
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hearings. Please be on watch for any specific advocacy instructions. We thank all of the Board members and other agency leaders who participated in last week’s advocacy activities and will look for your further participation in the coming weeks of negotiations.
DOH Issues DAL on 2018 Minimum Wage Rate Adjustment for Non-NYC Personal Care Providers The state Department of Health (DOH) has issued a Dear Administrator Letter (DAL) on the 2018 minimum wage rate adjustment specifically for all non-New York City Personal Care providers under fee-for-service (FFS). The DAL is at https://hca-nys.org/wp-content/uploads/2018/02/2018-Minimum-Wage-Non-NYC-PCARate-Adjustment.pdf. DOH has previous issued two other DALs on the 2018 minimum wage rate adjustment specifically for Certified Home Health Agencies (CHHAs) and hospice providers under Medicaid FFS. DOH says the rates were adjusted based on personal care provider attested survey data submitted for the period of April 1, 2017 through June 30, 2017 and annualized. If a personal care provider 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 these additional funds cannot be used for any purpose other than appropriate statutory wage obligations directly associated with the minimum wage increase. Unspent funds must be returned to the state via a rate adjustment or other mechanism. 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 include sufficient detail to verify provider wage scale and the specific wage-related fringe benefits to establish future reimbursement rates. DOH also states that it reserves the right to request any additional data necessary to assist with the future adjustments. The DAL notes 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. The minimum wage rate adjustment packages are awaiting state Division of Budget (DOB) approval, so the rates have not been posted to the Health Commerce System (HCS) yet. Once approved by DOB, the increased rates will be loaded to the eMedNY payment system in the next available Medicaid payment cycle. HCA has confirmed with the Department that once the rates are loaded into the Medicaid Management Information System (MMIS), the eMedNY Medicaid system will apply an automatic retrospective rate adjustment payment for Medicaid claims already submitted and paid between January 1 and the present. For further information, contact Patrick Conole at (518) 810-0611 or pconole@hcanys.org.
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BUDGET from p. 1 the Medicare home health reimbursement system, akin to the Home Health Groupings Model (HHGM) long under discussion over the past several months. The budget also includes tweaks to the Medicare face-to-face requirement, along with several other health provisions of interest to HCA’s membership. HCA and federal partners pushed hard in recent weeks for a straight extension of the rural addon, engaging HCA members in five separate Legislative Action Center online advocacy campaigns that netted well over 1,200 messages from HCA members to their Congressional Representatives and Senators Charles Schumer and Kirsten Gillibrand. We also engaged you and other members on three campaigns related to HHGM, which deployed a nearly equal number of messages to Congress. HCA, the National Association for Home Care and Hospice (NAHC), ElevatingHOME, the Partnership for Quality Home Care and other groups engaged in all-out advocacy on these issues. As the broader outlines of a budget deal emerged, this advocacy focused on minimizing the impact, where cuts or adverse actions were gaining momentum (as in HHGM), or maximizing supportive policies to the extent that the fiscal pressures in Washington provided any leeway for home care support (as in the incremental rural add-on extension and face-to-face changes).
HCA’s Stop Sepsis at Home session in New York City last week included a special highlight: remarks from Ciaran (far right) and Orlaith Staunton (far left) of the Rory Staunton Foundation for Sepsis Prevention, a national leader in tackling the sepsis crisis and a major partner of HCA’s efforts to bring sepsis training to home care providers. With the Stauntons in the photo above are (second from left): HCA Executive Vice President Al Cardillo, IPRO Quality Improvement Specialist Eve Bankert, and HCA member and clinical specialist Amy Bowerman, Director of Quality Management/Privacy Officer at Utica-based Visiting Nurse Association of Utica and Oneida County of the Mohawk Valley Health System. Ms. Bankert and Ms. Bowerman are on the faculty of HCA’s Stop Sepsis at Home initiative, which includes two more upcoming sessions on Long Island on March 8 and 9 following sessions already delivered throughout other regions of the state. To learn more and register, visit http:// stopsepsisathomeny.org.
be 1.5 percent in 2019 and 0.5 percent in 2020.
Rural Add-on The modified rural add-on includes a five-year extension. The add-on will remain at 3 percent for 2018. In 2019 and onward, the rural add-on will have more targeted percentages as follows:
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For counties in the highest quartile of home health usage per 100 people, based on 2015 data, the rural add-on will
For agencies serving in counties with six or fewer individuals based on 2010 Census data, the rural add-on will be 4 percent in 2019; 3 percent in 2020; 2 percent in 2021; and 1 percent in 2022.
For all other patient services (outside of the tiers mentioned above), the add-on will be 3
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percent in 2019; 2 percent in 2020; and 1 percent in 2021. Home Health Payment Model Change The budget deal also includes a revised payment model akin to HHGM, starting on January 1, 2020. The home care industry was able to achieve some important concessions that make this payment regime less severe from the original design that was proposed, and later rejected, by the U.S. Centers for Medicare and Medicaid Services (CMS) in its rulemaking process last year. That proposal was not budget neutral and would have assumed cuts of up to $1 billion from the home health sector. The version of payment reform signed into law last week is budgetneutral and builds upon the technical advisory panel process already in motion, with a report from the panel and its recommendations due by April 1, 2019. Though budget neutral, this provision is included in a budget bill which, by nature, has fiscal consequences and rebalancing that HCA will be working to further analyze. Long at the heart of HHGM was a change in the episode increments from 60 to 30 days. Reports from ElevatingHOME and other sources indicate that the new increments are defined as a 30-day “unit of service” rather than a “30-day payment,” suggesting that these units of service would be encompassed by the traditional, existing 60-day episode, rather than an actual change in the episode. The final budget also includes a market-basket update of 1.5 percent for 2020. HCA had urged a payment reform discussion outside the pressures and constraints of a budget extender bill. We will be further analyzing this new payment design and
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examining opportunities to refine or alter it through the review process and/or any legislative vehicle that may be necessary based on the specifications which emerge in the development process. Face-to-face Reforms to the onerous face-to-face requirement have long been an HCA priority, which we’ve approached from multiple advocacy angles. The budget language includes a nominal change that is a step in the right direction, but it is not the kind of fundamental relief which is needed – and has been repeatedly sought by HCA and federal partners – to minimize the regulatory burden and required procedures for documenting F2F compliance. The budget bill allows for the home health record to be used along with the physician record. Specifically, it would allow CMS to determine if a beneficiary is eligible for Medicare coverage of home health services through a review of the entire patient medical record, including the home health agency’s patient record. In places where the physician’s record may be insufficient to determine eligibility, the home health agency’s record could be used as supporting material to attest eligibility for home health services. Other provisions A more complete summary of the budget provisions is available in the document at https://hca-nys.org/wp-content/uploads/ 2018/02/Bipartisan-Budget-Act-of-2018-HCProvisions.pdf. It contains other items of interest to providers, including: an extension and enrollment increase (to 15,000) of the Independence at Home demonstration; an extension of the Maternal, Infant, Early Childhood Visiting Program through 2022;
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expansion of telehealth benefits under Medicare Advantage and through Accountable Care Organizations; repeal of the Independent Payment Advisory Board (IPAB); and a reduction of payment for outpatient therapy services furnished by a physical or occupational therapy assistant. These provisions will require further analysis by HCA. Finance Forum If you need more information about these and other important federal rate and fiscal changes, we strongly encourage you and your executive teams (especially finance managers and CFOs) to attend HCA’s Senior Finance Managers Forum on March 22 where we will have a special segment on the payment reforms outlined in this article. Ed Buckley of Select Data will provide insights on how to succeed under HHGM or similar payment models by delineating the care delivery priorities of your patients, better classifying their needs, and developing new cost control measures and models. We will also have top federal health policy expert Colin Roskey walking members through the intricacies of the budget outcome and other federal changes. Please register today at https://hca-nys.org/wp-content/ uploads/2018/01/HCA-Senior-Financial-Mgr-Forum-Registration-Form.pdf. HCA will inform the membership of any new details that arise from our ongoing analysis.
Join Us for CHHA Forum: a Venue to Exchange CHHA-specific Updates, Info and Concerns On February 23, HCA is holding a CHHA Member Forum in Albany. HCA is presenting our first CHHA Member Forum in many years to gather our CHHA members from every region of the state for a focused discussion on issues that matter to CHHAs and to exchange valuable information. Some of the issues to be discussed include:
Update on state budget provisions impacting CHHAs and home care providers The financial condition of CHHAs and operational and contracting concerns Challenges facing CHHAs in integrated models of care and payments Compliance challenges
Please join us and be prepared to engage with HCA in support of our advocacy on your behalf. CHHA Member Forum Friday, February 23, 2018 10:30 a.m. to 2 p.m. Jackson Lewis Offices 677 Broadway, 9th Floor Conference Room Albany, New York 12207 Lunch will be served. Download the form here to register: https://hca-nys.org/wp-content/uploads/2018/02/CHHAForum22318.pdf.
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PAC POWER Courtesy of TSG Financial! HCA Thanks and Expresses Appreciation for the support of TSG Financial in Sponsoring HCA's Political Action Committee (PAC) Fundraiser on February 5 in Albany. Their support provided a vital opportunity for HCA and members to meet and contribute to the campaign of Senate Health Committee Chairman Kemp Hannon and to grow HCA’s PAC. TSG Financial has been an ardent supporter of HCA's advocacy, education and program work, including and, especially, our PAC. Through their Homecare Specialty Group, led by Paul Essner and Bryan Pendrick Pendrick, TSG Financial organizes and actively works with the home care community throughout the Northeast on a range of employee benefit solutions designed to properly reflect the challenge of insuring HHAs, PCAs, Professional Staff, Administrative Staff and Executives. .tsgfin.com To learn more, visit http://www http://www.tsgfin.com .tsgfin.com. 8
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Coalition Surge Test Held on Long Island Three more to be held On February 8, the state Department of Health (DOH) held a Coalition Surge Test and Interoperable Communication (CST/IOC) drill on Long Island. During the drill, three hospitals on Long Island reported a simulation in which they would be evacuating all of their patients (1,400) due to critical infrastructure failure during a 4-day heat wave of over 95 degrees. Other hospitals, home care and hospice providers, and nursing homes participating in the CST/IOC were asked to indicate if they could accept some of those patients. As part of the exercise, providers were given about one hour to complete a survey via the Health Electronic Response Data System (HERDS). Providers are also expected to complete an After Action Report (AAR) after the CST/IOC. An AAR template is at https://hca-nys.org/wp-content/uploads/2018/01/AAR-IP_Templatemodified-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-Drill-Packet_January2018.pdf. After the drill, providers were invited to participate in a teleconference discussion to explore issues that arose during the exercise related to continuity of operations, bed placement of evacuated patients, communications and transportation. DOH had previously held CST/IOC drills for Capital District and Central New York providers on January 23 and 25, respectively, and will be holding three additional CST/IOC drills. These additional drills are expected to be held within a two-week period in the following regions: Western Region (Finger Lakes and Buffalo) – February 12 to February 23 MARO-Lower Hudson Valley – February 19 to March 2 In January, DOH held webinars for providers to prepare for the drills; the materials from those programs are at https://hca-nys.org/wp-content/uploads/2018/01/CSTIOC-Drill_January-2018.pdf. 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). HEPCs provided education, training, outreach and planning activities. 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. Continued on next page
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Continued from previous page 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) e-mail. 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). 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. Also, under state regulations, LHCSAs are required to participate in at least one community-wide disaster drill or exercise annually and participation in the CST/IOC drill will meet that requirement. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
CMS Provides Hospice Updates The U.S. Centers for Medicare and Medicaid Services (CMS) has recently issued the following update to Hospices providing Medicare services. HQRP Fiscal Year 2020 Requirements Fact Sheet Now Available This Hospice Quality Reporting Program (HQRP) fact sheet outlines specific compliance requirements for Hospice Item Set (HIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) for the Fiscal Year 2020 reporting year (data collection period January 1 to December 31, 2018), to support providers in compliance with HQRP requirements. The fact sheet can be downloaded at: https:// www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/ Downloads/FY-20-HQRP-Requirements.pdf. HQRP Quarterly Update Document for the Fourth Quarter of 2017 Now Available The HQRP Quarterly Update features frequently asked questions that were received by the Hospice Quality Help Desk during the fourth quarter of 2017, as well as general HQRP updates and events from the fourth quarter, and upcoming events in the first quarter of 2018. The HQRP Quarterly Update – 4th Quarter 2017 document is on the HQRP Requirements and Best Practices website at: https:// www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/ HQRP-Requirements-and-Best-Practices.html. For further information, contact HCA’s Patrick Conole at (518) 810-061 or pconole@hcanys.org.
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VBP FAQs Posted The state Department of Health (DOH) has posted frequently asked questions (FAQs) on Value Based Payments (VBP) for Medicaid Advantage Plus (MAP) and Fully Integrated Duals Advantage (FIDA) Plans, and Programs of All-Inclusive Care for the Elderly (PACE). This FAQ document is designed to address questions related to the implementation of VBP within MAP and FIDA plans, and PACE organizations. 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 here: https:// www.health.ny.gov/health_care/medicaid/redesign/dsrip/vbp_library/index.htm. Questions can be sent to NYSDOH at MLTCVBP@health.ny.gov.
CFCO Services Become Part of Medicaid Managed Care Benefits Two weeks ago, the state Department of Health (DOH) notified Medicaid Managed Long Term Care (MLTC) Partial Capitation, Medicaid Managed Care (MMC), Medicaid Advantage Plus (MAP), and Program of AllInclusive Care for the Elderly (PACE) plans that it was modifying the plan benefit package to include Community First Choice Option (CFCO) State Plan Services. Effective April 1, 2018, plans will be responsible for identifying enrollees eligible for CFCO services and reporting this information to the state’s enrollment broker to facilitate identification on the individual’s enrollment file, in accordance with Department guidance. In order to be eligible for CFCO services, enrollees must meet each of the additional criteria: 1) Medicaid eligible for community coverage with community-based long term care; 2) determined to be in need of a nursing home level of care, based on the Uniform Assessment System; and 3) live in one’s own residence or the resident of a family member. As of April 1, the following services are available to CFCO-eligible enrollees:
Durable Medical Equipment (DME) Medical/Surgical Supplies Non-Emergent Medical Transportation Home Health Care Aide Consumer Directed Personal Assistance Services Personal Emergency Response Systems Personal Care
Effective July 1, 2018, the following CFCO service will be included in the benefit package:
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Activities of Daily Living and Instrumental Activities of Daily Living skill acquisition, maintenance and enhancement. Continued on next page
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Continued from previous page Effective January 1, 2019, the following CFCO services will be included:
Assistive Technology beyond DME Community Transitional Services Moving Assistance Home Delivered/Congregate Meals Environmental Modifications Vehicle Modifications Social Transportation
Plans will be responsible for providing and coordinating CFCO services according to the phase-in dates indicated in the notices, and will be required to enhance networks and update policies, procedures and plan benefit materials accordingly. Prior to April 1, 2018, DOH will conduct reviews to assure plan readiness. The Department will provide further details on implementation of the CFCO services into managed care at a later date. HCA had advocated that home care programs, including Long Term Home Health Care Programs, Certified Home Health Agencies and Licensed Home Care Services Agencies, be allowed to provide CFCO “waiver services” since some of them already have experience in arranging and coordinating such services, but DOH did not implement the benefits in this manner. DOH had earlier provided plans with lists of providers of these services under the Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) programs, and the Fully Integrated Duals Advantage (FIDA) demonstration. Those lists are at https://www.health.ny.gov/health_care/medicaid/redesign/ community_first_choice_option.htm. HCA members who are not on those lists should contact their MLTC partners if they provide any of the services.
Work Schedule Changes Enacted for NYC Employees Legislation passed by the New York City Council on December 19, 2017 that allows employees in New York City to seek temporary changes to their work schedules for a “personal event” was enacted on January 19, 2018 and will go into effect 180 days later (July 18). The bill, Int. 1399-A, along with a summary and other information, can be viewed at http:// legistar.council.nyc.gov/LegislationDetail.aspx?ID=2900941&GUID=68DC01AE-C577-4B86-B3E5B9D98836C1E2. According to the bill summary, this law would require an employer to allow employees to take two temporary schedule changes per calendar year – including paid time off, remote work, changing work hours and unpaid leave – relating to a “personal event.” A personal event includes a caregiving
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emergency, a legal proceeding or hearing for subsistence benefits, or any circumstance that would constitute a basis for permissible use of safe time or sick time under New York City’s Earned Sick Time Act. The bill would also establish a written process for employees and employers to communicate requests for such changes. This bill would also protect employees from employers retaliating against them for making schedule change requests, because an existing prohibition on retaliation would apply. This bill would not affect leave granted under the city’s earned sick and safe time act or apply to employees under certain collective bargaining agreements or to certain employees in the entertainment industry.
OT and Speech-Language Pathology Regulations Finalized The February 7 New York State Register includes final rules that cover the definition of occupational therapy (OT) practice and a limited license in speech-language pathology (SLP). The final regulations are at https://docs.dos.ny.gov/info/register/2018/feb7/toc.html and their proposed versions are at https://docs.dos.ny.gov/info/register/2017/nov1/toc.html. The OT rule amends the definition of the scope of practice of OT to conform the regulations to state legislative changes made in 2011. These include: adding the development and utilization of a treatment program and consultation with the client, family, caregiver or organization; adding activities done in order to restore performance abilities designed to achieve cognitive functioning; and others. The SLP rule subjects speech-language pathology licensure applicants who are issued a limited license by the state Education Department (SED) to the same experience requirements as licensure applicants who have not been issued such a license. Both rules were effective February 7, 2018.
Guidance Issued to Managed Care Plans on Influenza Immunizations The state Department of Health (DOH) Division of Health Plan Contracting and Oversight has issued guidance to all Medicaid Managed Care plans encouraging them to take steps to ensure patient access to flu vaccination, especially when presenting at a pharmacy. The guidance is at https://hca-nys.org/wp-content/uploads/2018/02/Influenza-VaccinationGuidance_Feb2018.pdf. Plans are reminded that the Governor declared a “Disaster Emergency” on January 25 and issued an Executive Order which allows pharmacists to administer flu vaccinations to patients between 2 years and 18 years of age. In the guidance, DOH provides the following information:
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Plans should work with providers to ensure that members have access to flu vaccinations and should afford flexibility to members in obtaining them. Continued on next page
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Continued from previous page
If members need flu vaccinations and present at a pharmacy that is unable to provide it due to plan parameters, plans should work with these members and their providers to ensure they have access to flu vaccinations.
DOH encourages all plans to allow for flu vaccines to be administered by in-network certified pharmacists for adults and children that are two years of age or older.
eMedNY Trainings Available The eMedNY Training Schedule for February and March is available. Some of the topics offered include:
ePACES for Dental, DME, Free Standing and Hospital Based Clinics, Institutional, Professional (Real-Time), Physician, Private Duty Nursing, and Transportation
Medicaid Eligibility Verification System (MEVS)
eMedNY Website Review
New Provider/ New Biller
eMedNY training seminars are being held at the following locations:
Canandaigua East Syracuse Hauppauge Poughkeepsie Rensselaer Utica Warsaw
The training schedule, including webinars, is at https://www.emedny.org/training/index.aspx. Questions can be directed to the eMedNY Call Center at 800-343-9000.
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The Situation Report: the Home Care Association of New York State
Volume 3, No. 7 February 12, 2018
Healthcare Personnel Influenza Vaccination Report Open Efforts continue to address increased flu diagnoses The Healthcare Personnel Influenza Vaccination Report is open and agencies can enter data in it until it is submitted on May 1, 2018. 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 deadline. The report is on the Health Electronic Response Data System (HERDS) at https://commerce.health.state.ny.us/. Questions about the report should be directed to the DOH Bureau of Immunization at either (518) 4734437 or immunize@health.ny.gov. Technical questions about the 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. Efforts to Address Increased Flu Cases Meanwhile, last week, Governor Cuomo authorized emergency assistance funding to help fund expanded efforts to promote and increase access to flu vaccines statewide. The Governor also directed local health departments to re-focus enhanced outreach to vulnerable populations, including daycares, nursing homes, senior centers, and homeless shelters, to reemphasize the need for flu vaccinations, provide targeted education regarding the signs and symptoms of flu, and to identify and assist those populations with low vaccine rates. For the week ending February 3: there were 15,753 laboratory-confirmed influenza reports, a 35 percent increase over the previous week; the number of patients hospitalized with laboratory-confirmed influenza was 2,349, a 2 percent increase over the previous week; and there were two influenzaassociated pediatric deaths reported. There have been three influenza-associated pediatric deaths reported this season.
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The Situation Report: the Home Care Association of New York State
Volume 3, No. 7 February 12, 2018
New Address for Submitting Additional Information for Claims Effective February 7, 2018, certain request types should be mailed to a new address. The following requests should be mailed to NYS Department of Health, 43B Broadway, Menands, NY 122042836:
Requests for waiver of the regulation regarding submission of claims greater than two years from the date of service. (Attn: Two Year Claim Review).
Pended claims (edits 00127, 01283, 02015 & 02255) waiting for remittance advice (Attn: Medical Pended Claims).
For more information on these processes, refer to the Information for All Providers General Billing Guidelines available at https://www.emedny.org/ProviderManuals/AllProviders/PDFS/Information_for_All_ProvidersGeneral_Billing.pdf.
NGS Updates National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), provided the following important updates on its website.
April 2018 Dark Days for the Common Working File (CWF) – In anticipation of the April 2018 release, the CWF Host will not process claims beginning Friday, March 30 through Sunday, April 1. During this period, which is commonly referred to as “dark days,” the CWF Hosts will install the April 2018 release, complete processing activities, and perform scheduled data center maintenance. These dark days will limit access to information provided by the Interactive Voice Response (IVR) system and to NGS’s portal, NGSConnex. Providers may experience limited or no access to claims, eligibility, claim overlap, patient status, check inquiry, reopening/redetermination status, offset information, and financial claim information.
Upcoming Annual Logon ID Recertification for FISS DDE Users – NGS will begin the annual logon identification recertification for users who access the New York and/or Connecticut Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE) region the week of February 12, 2018. Users will be issued an access code by email, sent to the current authorized e-mail address on file with NGS Electronic Data Interchange (EDI). All Logon IDs will be required to have completed the recertification within ten business days of receiving the access code to prevent losing access. Any logon ID that has been assigned new or reinstated on or after January 22, 2018 will not be required to recertify until the following year’s recertification. If you do not receive an e-mail by Wednesday, February 15, 2018 and you are an active DDE user whose user ID was active prior to January 22, 2018, you should submit a Recertification Inquiry Form. The inquiry form is located on NGS’s website under Claims & Appeals, Annual Logon Recertification.
For further information, contact Patrick Conole at (518) 810-061 or at pconole@hcanys.org.
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The Situation Report: the Home Care Association of New York State
Volume 3, No. 7 February 12, 2018 ď Žď€
Important Upcoming Deadlines
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Requirement/Change
Effective/Due Date
More Information
Home Care and other providers who contract with MCOs must be enrolled in Medicaid
January 1, 2018
https://www.emedny.org/info/ProviderEnrollment/ManagedCareNetwork/index.aspx
Medicare Advantage Disenrollment Period during which individual can switch from Medicare Advantage managed care plan to fee-for-service Medicare
January 1 to February 14
www.medicare.gov
Posting of OSHA Form 300A
February 1 to April 30
https://www.osha.gov/recordkeeping/RKforms.html
CMS Low Volume Appeals Settlement for CHHAs with NPIs ending in an even number
Expression of Interest must be submitted from February 5 to March 9
https://www.cms.gov/Medicare/Appeals-andGrievances/OrgMedFFSAppeals/Appeals-Settlement-Initiatives/Low-VolumeAppeals-Initiative.html
Submission of Conflict of Interest (COI) Compliance Implementation Plan forms by NHTD/TBI providers to their Regional Resource Development Centers
March 1, 2018
https://hca-nys.org/wp-content/uploads/2018/01/Conflict-of-Interest-ComplianceImplementation-Plan-1.docx; https://hca-nys.org/wp-content/uploads/2018/01/COICompliance-Implemenation-Plan-Power-Point.pdf
Medicare Bundled Payments for Care Improvement Advanced model
Applications due March 12, 2018
https://innovation.cms.gov/initiatives/bpci-advanced
CMS Low Volume Appeals Settlement for CHHAs with NPIs ending in an odd number
Expression of Interest must be submitted from March 12 to April 11
https://www.cms.gov/Medicare/Appeals-andGrievances/OrgMedFFSAppeals/Appeals-Settlement-Initiatives/Low-VolumeAppeals-Initiative.html
Health Care Facility Transformation Program
Applications due March 14, 2018
https://grantsgateway.ny.gov/intelligrants_NYSGG/module/nysgg/goportal.aspx?NavI tem1=4&ngoID=5000979
Criminal history record check requirements apply to hospice
April 1, 2018
https://www.health.ny.gov/facilities/home_care/advanced_home_health_aides/docs/a hha_legislation.pdf
Submission of COI Compliance Implementation Plan forms by Regional Resource Development Centers to state Department of Health
April 1, 2018
https://hca-nys.org/wp-content/uploads/2018/01/Conflict-of-Interest-ComplianceImplementation-Plan.docx; https://hca-nys.org/wp-content/uploads/2018/01/COICompliance-Implemenation-Plan-Power-Point.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/New-Medicare-Card/index.html
Implementation of Universal Billing Codes for Home and Community-Based Long Term Care Services under Managed Care
April 1, 2018
https://www.health.ny.gov/facilities/long_term_care/reimbursement/letters/dal_201712-07_billing_codes.htm
Community First Choice Option Services Available to Medicaid Managed Care Enrollees
April 1, 2018
https://www.health.ny.gov/health_care/medicaid/redesign/community_first_choice_op tion.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) 473-4437
The Situation Report: the Home Care Association of New York State
Volume 3, No. 7 February 12, 2018
OSHA Reminds Employers to Post Certain Information The federal Occupational Safety and Health Administration (OSHA) has reminded employers they must post a copy of the agency’s “Summary of Work-Related Injuries and Illnesses, Form 300A” summarizing job-related injuries and illnesses logged during 2017. The form and instructions are at https://www.osha.gov/recordkeeping/RKforms.html. Each year, between February 1 and April 30, employers must display the Summary in a common area where notices to employees are usually posted. Employers must fill out and post the Summary annually, even if no recordable work-related injuries or illnesses occurred during the year. Under its recordkeeping regulation, OSHA requires certain covered employers to prepare and maintain records of serious occupational injuries and illnesses using the “Log of Work-Related Injuries and Illnesses, form OSHA 300.” More information is at https://www.osha.gov/recordkeeping/index.html.
Resources
“Enabling Sustainable Investment in Social Interventions: A Review of Medicaid Managed Care Rate-Setting Tools,” by the Commonwealth Fund http://www.commonwealthfund.org/~/media/files/publications/fund-report/2018/jan/ bachrach_investment_social_interventions_medicaid_rate_setting.pdf
“Case Studies of Telehealth Programs in New York,” by the Center for Health Workforce Studies https://chwsny.us7.list-manage.com/track/ click?u=b7960dfcf756f94605561779d&id=23beb40e9e&e=054ed16857
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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