February 19, 2019 Edition of The Situation Report

LHCSA REGISTRATIONS

PDGM

CFCO

TRANSPORT MODEL

In comments on LHCSA Registration rule, HCA seeks flexibility for agencies encountering logistical issues or obstacles, among other recommendations.

New instructions for Medicare Administrative Contractors provide important details about PDGM episode timing, clinical groupings, admission source, and more.

Community First Choice guidance explains eligibility, service delivery models and more.

CMS is testing a new payment model for ambulances when patients are transported to alternative settings (i.e., not just emergency departments).

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Your Source for HOME CARE News, Policy and Advocacy

UPCOMING PROGRAMS WCEI 5-Day Onsite Skin and Wound Management Course March 4-8, 2019 (Herkimer, NY)

Vol. 4, Issue 7| February 19, 2019

HCA Advocacy Day Pushes Budget Priorities; Governor’s Amendments Make Deeper Cuts HCA’s Board of Directors and member leaders braved snowy weather last week for HCA’s February 12 State Advocacy Day to voice our concerns with the Governor’s budget and press for HCA priorities like sustainable financing and modification of long term care actions and cuts.

WEBINAR: Understanding How to Run and Interpret CASPER Reports March 6, 2019

Among these adverse actions are the Governor’s proposed repeal-and-replace approach of the Consumer Directed Personal Assistance Program, a requirement for home care workers to

Downstate LHCSA Forum March 6, 2019 (NYC)

Court of Appeals Hears Andryeyeva and Moreno Cases on 13-Hour Rule

Senior and Financial Managers Summit March 19, 2019 (Troy) WEBINAR: Clinical Documentation Improvement (CDI) April 11, 2019

See ADVOCACY p. 5

Senate Bill Seeks to Nix $1B PDGM Behavioral Adjustment Cut

Last Tuesday, February 12, the state’s highest court, the Court of Appeals, heard arguments in Andryeyeva v. New York Health Care, Inc. and Moreno v. Future Care regarding wage requirements in 24hour/live-in home care cases.

See APPEALS p. 2

HCA heads to D.C. later this month to press for PDGM fix supporting CHHAs; use HCA’s Legislative Action Center to write Congress today!

New U.S. Senate legislation (S.433) would eliminate the so-called $1 billion “behavioral adjustment” cut under the Patient Driven Groupings Model (PDGM).

See PDGM p. 4

INSIDE HCA Advocacy Day Pushes Budget Priorities…..........................................1 Court of Appeals Hears Andryeyeva and Moreno Cases…...........................1 Senate Bill Seeks to Nix $1B PDGM Cut…...................................................1 HCA Submits Comments on Proposed LHCSA Registration Rule…...............3 New PDGM Claims Processing Instructions for MACs…..............................7 CFCO Guidance Posted….........................................................................8 OIG Posts Updated Work Plan…...............................................................9

Member Hiring Announcements............................................................…10 Upcoming Deadlines and Due Dates….....................................................11 Hospice Supplemental Medical Review Activity…......................................12 NYC RNs Eligible for WIO Funds Covering Hospice, Palliative Cert Courses...12 PHHPC Acts on Home Care Applications…..................................................13 CMS Announces Emergency Transport Model…..........................................13 NGS Updates….....................................................................................14 Health Resources…...............................................................................15

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

APPEALS from p. 1 The issue spotlights a difficult balancing act: recognizing the invaluable role of home care workers at the same time that government reimbursement policies — which dictate compensation levels — seek to ensure system affordability. At stake is a potential multi-billion-dollar cost liability for New York’s home care sector, and New York State as a whole, as the court determines the fate of state labor policy for compensable hours when an aide works a 24-hour/livein shift, and whether the pay thresholds for this category apply to “residential” as well as “non-residential” employees.

The state Department of Labor (DOL) has a long-established “13-hour standard” for compensation of such shifts, as long as the aide receives 8 hours of sleep, 5 of which are uninterrupted, and 3 hours for meals.

Plaintiffs are challenging this policy, arguing that aides are essentially “on call” for 24 hours regardless of sleep or meal periods.

A lower court sided with the plaintiffs, ruling that aides can be certified as a class and are therefore eligible for retroactive wages that could go back six years.

Much of last week’s hearing dealt with the question of deference to how DOL interprets its own statutes. Our government-relations team at Hinman-Straub has prepared a memo with further technical information on the hearing, noting that “the court has several options for how it could rule.” It could affirm or reverse the lower court rulings or it could “reverse the orders but, rather than denying the motions for class certification, return the cases to the lower courts for further consideration.”

Members can read the two-page Hinman-Straub memo at https://hcanys.org/wp-content/uploads/2019/02/2019-02-13-HCA-Oral-Argumentin-Andryeyeva-v-New-York-Health-Care.pdf.

The hearing was covered by Politico Pro which sought HCA’s reaction.

We noted the immediate service and cost impact that would result if the Court of Appeals upholds the lower court rulings. This includes the prospect of billions of dollars in back wages that would be shouldered by the home care system, and the need for immediate state Medicaid funding to cover this cost. (See the Politico report here: https://hcanys.org/wp-content/uploads/2019/02/Politico-Appeals-HearingAndryeyeva.pdf). HCA also fielded interviews with the Gothamist and other news outlets.

Continued on next page 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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Volume 4, No. 7 February 19, 2019 

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

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

Volume 4, No. 7 February 19, 2019 

Continued from previous page HCA filed an amicus brief in the Andryeyeva case and we’ve led the call for DOL’s emergency rulemaking to codify the 13-hour standard; however, this emergency rule was itself challenged in a separate court decision, creating yet additional exposure for home care providers on a prospective basis.

A recording of the hearing is accessible at https://www.nycourts.gov/ctapps/.

A decision is expected on or before April 2.

Gain Legal, Finance Insights at March 19 Finance Summit During HCA’s March 19 Senior Financial Managers Forum, legal expert Emina Poricanin, a Partner at Hodgson Russ, LLP, will provide further information on the intricacies of this court case and its potential impact for home care providers, among other wage-and-hour law updates.

Please be sure to attend this important summit that addresses a range of Medicare, Medicaid rate issues and finance updates.

Registration is here: https://hca-nys.org/wp-content/uploads/2019/01/HCA-CFO-Forum-Registration-Form-2019.pdf.

HCA Submits Comments on Proposed LHCSA Registration Rule Last week, HCA submitted comments on a proposed rule issued by the state Department of Health (DOH) to establish an annual Registration process for Licensed Home Care Services Agencies (LHCSA).

Our comments are at https://hca-nys.org/wp-content/uploads/2019/02/Comment-Letter-on-LHCSARegistration-Rule.pdf.

DOH’s proposed rule is at https://regs.health.ny.gov/sites/default/files/proposed-regulations/ New%20Requirements%20for%20Annual%20Registration%20of%20Licensed%20Home%20Care%20Services%20Agencies.pdf.

As members know, DOH rolled out the registration process as part of the 2017 LHCSA Statistical Report that was due in November, and HCA assisted members in completing the Report and contacted members who had not submitted it or submitted incomplete reports.

Under this provision that was part of the 2018-19 state budget, LHCSAs that don’t complete the registration process cannot provide nursing, home health aide or personal care services, or receive reimbursement from any source during any time on or after January 1, 2019.

Among other items in our comments, we request that language be added allowing DOH’s Commissioner to grant reasonable flexibility on the proposed November 16 deadline for authorization submission in situations where an agency encounters unforeseen logistical issues (i.e. problems with new or revised software and/or Statistical Report, etc.) or other unanticipated obstacles like an emergency event (i.e. storm, cyberattack, etc.).

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

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

Volume 4, No. 7 February 19, 2019 

PDGM from p. 1 This 6.42-percent cut (as originally proposed) is front-loaded at the outset of PDGM – the biggest overhaul to Medicare home health payments in nearly 20 years – as CMS, without foundation, conjectures that providers will alter their coding and other claim submission practices in order to achieve higher payments or to bypass new financial disincentives/corrections.

S.433, alternatively, requires that reimbursement adjustments be made only after – and to the extent that – behavioral adjustments do, indeed, occur, rather than merely anticipating or assuming that behavior will change.

The bill also limits any behavioral adjustment cut to two percent per year under PDGM. This provision was tweaked from a prior version of the bill after cost concerns were raised. The new bill allows the U.S. Centers for Medicare and Medicaid Services (CMS) to waive the rate adjustment phase-in after 2025 if necessary for budget-neutrality.

HCA and our national partners, the National Association for Home Care and Hospice, fellow state home care associations, and the Partnership for Quality Home Healthcare advocated aggressively for CMS’s establishment of budget-neutrality provisions; yet the “behavioral adjustment” instituted by CMS is a major deviation from the treatment of budget-neutral payment systems for other sectors.

Later this month, HCA President Al Cardillo and Vice President for Finance and Management Patrick Conole are heading to Washington for meetings with Congress where HCA will urge support for this vital legislative fix and a companion bill in the U.S. House of Representatives, as well as other federal priorities for New York’s home care providers.

Grassroots Advocacy and Education Last week HCA sent an alert to members urging them to write Congress in support of this bill. Have you sent HCA’s message? It takes less than two minutes of your time. Do so now, and invite your colleagues to join you in taking action at https://p2a.co/6edUDeQ. HCA also continues to provide members with education about PDGM, including our upcoming March 19 Senior Financial Managers Summit in Troy. The HCA Policy team will discuss PDGM among our updates about all relevant home care, hospice and MLTC Medicaid and Medicare rate issues; but the summit is also featuring M. Aaron Little, CPA, Managing Director, and Karen Vance, BSOT, Senior Managing Consultant, at BKD, LLP for a session sharing the results of an agency-specific PDGM financial impact analysis. This analysis will reveal the financial elements of the PDGM model as well as related operational strategies and key performance indicators. To register, download the brochure at https://hcanys.org/wp-content/uploads/2019/01/HCA-CFO-Forum-Registration-Form-2019.pdf.

Members can expect a strong focus on PDGM during our Annual Conference and future education programs to support your readiness as well.

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

Volume 4, No. 7 February 19, 2019 

ADVOCACY from p. 1 obtain a National Provider Identifier, Medicaid Inspector General over-layers of audit and recoupment activity, and the Governor’s Managed Long Term Care cuts. HCA is also urging a rate increase (“trend factor”) for Certified Home Health Agencies (CHHAs) as well as advancing a series of workforce support measures and reinvestment proposals that draw on home care’s ability to provide cost-savings interventions for an array of conditions. If you haven’t yet read our advocacy priorities sheet, please do so at https://hca-nys.org/ wp-content/uploads/2019/02/2019-20-State-BudgetPriorities.pdf.

Despite the weather challenges, HCA and members met with key Senate, Assembly and Division of Budget officials. We also had an invaluable series of discussions during our morning program on February 12 where several legislators addressed HCA’s Advocacy Day participants on health care issues and heard members’ concerns directly in a roundtable-style discussion.

Our advocacy efforts take on additional urgency now that the Governor has issued his 30-day amendments.

These amendments, issued late last week, call for $190 million in additional state-share cuts to health care over the coming state fiscal year and an additional $190 million in state-share cuts for the next fiscal year.

When federal shares are considered, that figure likely grosses to a $380 million impact for the 2019-20 state fiscal year and $380 million for the 2020-21 state fiscal year.

The new budget language permits the Commissioner to make uniform or across-the-board cuts in Medicaid provider reimbursements (of approximately 0.8 percent). It also allows for alternative approaches that would achieve comparable savings.

Another potentially significant amendment we are examining is a proposed change to the home telehealth statute allowing the commissioner to “promulgate regulations governing Medicaid coverage and reimbursement of such services, including development Continued on next page

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HCA President Al Cardillo and Board Chair Susan Larman, CEO of VNA Home Health/ Visiting Nurses Home Care, join guest presenters from the Legislature at HCA's State Advocacy Day last week, including: (top photo) Assembly Health Committee Chairman Richard Gottfried; (middle photo) Assemblyman John McDonald; and Mandy Sheridan (left), Senior Counsel to the Senate Majority and Michela Paniccia (second from right) of Senate Finance.

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

Volume 4, No. 7 February 19, 2019 

Continued from previous page of a covered services list which may be limited to higher priority services and procedures.” The precise intention and implication of this proposal requires further explanation from the Executive.

The amendments also include what appear to be technical changes to the Governor’s proposed overhaul of Fiscal Intermediaries under the Consumer Directed Personal Assistance program that, again, require further examination.

In addition, the Governor proposes cuts in Indigent Care Payments to hospitals, and the new budget language “redeploys” undistributed Health Care Transformation Funding for housing services, according to a press release issued last week. We have heard, but not yet confirmed, that this relates to the Fidelis/Centene windfall funds, originally slated in part for institutional Medicaid rate investments. HCA had been urging proportionality in the use of these funds which are now being reallocated for other purposes.

Funds such as the Centene pool, transformation program and general Medicaid allocations are urgently needed in this budget to support the current, severe underpayments in the home care, hospice and MLTC systems. These funds, as well as methodological remedies, are among the advocacy priorities HCA has been seeking in our budget meetings with the Legislature and Governor.

We will continue this effort while also working with associations across all sectors to address a now-additional problem in the budget process under the 30-day amendments.

The Governor is also calling upon the Department of Health to reconvene the Medicaid Redesign Team (MRT) “to conduct a comprehensive evaluation of the Medicaid program and offer recommendations to further improve access to high quality and cost-effective medical services and stabilize the long-term fiscal condition of the Medicaid Global Cap.” Proposed topics for review would include but not be limited to: “addressing the needs of vulnerable populations, responding to the current federal landscape, evaluating options to enhance affordable health insurance coverage and access, sustaining the future of our long-term care system and stabilizing fiscally distressed health care providers.”

This process may provide risk as well as opportunity. As HCA members are aware, many of the system cuts, mandates (like wage parity), and long term care overhauls during the past several years have emanated from the MRT. HCA is also verifying reports of possible attempts to include minimum wage expenditures under the Global Cap, which would apply potentially enormous additional pressure on Medicaid and the cap.

All of these changes make it vital that you reach out directly to your elected officials, especially this week while the Legislature is adjourned for the President’s Day break. This is an opportunity to schedule appointments with your Assembly and Senate representatives in their district offices to oppose further cuts to home care providers.

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

Volume 4, No. 7 February 19, 2019 

New PDGM Claims Processing Instructions for MACs Offer Important Details to Help Agencies Prepare The U.S. Centers for Medicare and Medicaid Services (CMS) has recently issued Change Request 11081 which provides claim processing instructions to Medicare Administrative Contractors (MACs) that will be necessary to process home health claims with the implementation of the Patient Driven Groupings Model (PDGM). See https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2019Downloads/ R4228CP.pdf.

The Change Request was also substantially the focus of a Home Health, Hospice & DME Open Door Forum on Thursday.

According to CMS, PDGM will assign 30-day periods of care into one of 432 case-mix groups based on the following variables: 

Timing: The first 30-day period of care is an early period of care. The second or later 30-day period of care is a late period of care;



Admission Source: If the patient was referred to home health from the community or an acute or post-acute care referral source;

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Clinical Group: The primary reason the patient requires home care, represented by distinct clinical groups as determined by the principal diagnosis reported on the home health claim;

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Functional Impairment Level: The patient’s functional impairment level is based on Outcome and Assessment Information Set (OASIS) items for activities of daily living; and



Comorbidity Adjustment: If the patient has certain comorbid conditions reported on the home health claim, the 30-day period of care can receive a no, low, or high comorbidity adjustment.

In conjunction with the PDGM, there is a change to the Low-Utilization Payment Adjustment (LUPA) threshold from the current four or fewer visits per 60-day episode of care to thresholds that vary based on the 10th percentile of visits in a 30-day period of care for each case-mix group in the PDGM. Finally, beginning in 2020, newly enrolled home health agencies on or after January 1, 2019 will no longer receive split-percentage payments. Agencies that are certified for participation in Medicare effective on or after January 1, 2019, will be required to submit a “no pay” Request for Anticipated Payment (RAP) at the beginning of care to establish the home health period of care, as well as every 30 days thereafter upon implementation of the PDGM in 2020. Existing agencies will continue to receive RAP payments upon implementation of PDGM in 2020. For split percentage payments to be made, existing home health agencies would have to submit a RAP at the beginning of each 30-day period of care. For the first 30-day period of care, the split percentage payment would be 60/40 and all subsequent 30-day periods of care would be a split percentage payment of 50/50.

The PDGM model also changes significantly how home health claims will be processed. Under the current payment model, the Health Insurance Prospective Payment System (HIPPS) code is derived entirely from the OASIS. Inputs from the OASIS are grouped at the agency level to determine the HIPPS

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

Volume 4, No. 7 February 19, 2019 

code on the claim. CMS validates the agency-calculated HIPPS code against the HIPPS code calculated by the Medicare quality data repository for the OASIS when the claim is submitted. Under PDGM, the Grouper software is incorporated in Medicare claims processing systems. The Grouper will use claims data and OASIS data from the CMS quality data repository to determine the HIPPS code used for payment.

For RAPs with “From” dates on or after January 1, 2020, agencies may submit the HIPPS code they expect will be used for payment if they choose to run grouping software at their site for internal accounting purposes. If not, they may submit any valid HIPPS code in order to meet this requirement. In all cases, grouping of the claim to determine the HIPPS code used for payment will occur in Medicare systems and the submitted HIPPS code will be replaced with the system-calculated code.

A treatment authorization code will no longer be required but agencies will be required to include on the claim Occurrence Code 50 and the date the OASIS assessment was completed.

In addition, two new Occurrence Codes have been assigned to indicate when a 30-day period is eligible for the institutional adjustment. Occurrence Code 61 applies if the patient has been discharged from an acute care hospital within 14 days of the “From” date on the claim and Occurrence Code 62 applies when a patient has been discharged from a skilled nursing facility, inpatient rehabilitation facility, long term care hospital, or an inpatient psychiatric facility within 14 days prior to the admission date on the claim.

Occurrence Codes 61 and 62 are not required for claims processing but will allow agencies to manually indicate on Medicare home health claims that an institutional admission had occurred prior to the processing of an acute/post-acute Medicare claim so that they can more quickly receive the higher payment associated with the institutional admission source.

HCA has been providing continuous PDGM education for the membership, including at our upcoming March 19 Senior Financial Managers Summit in Troy. Registration is at https://hca-nys.org/wp-content/ uploads/2019/01/HCA-CFO-Forum-Registration-Form-2019.pdf.

CFCO Guidance Posted The state Department of Health (DOH) has posted an Administrative Directive (ADM) to provide local Departments of Social Services (LDSS) with guidance regarding the Community First Choice Option (CFCO) program and how the required CFCO services are authorized, assessed, and delivered.

The ADM is at https://www.health.ny.gov/health_care/medicaid/publications/pub2019adm.htm.

As covered in past editions of The Situation Report, CFCO provides a six percent increase in federal matching payments to states that expand and enhance Medicaid State Plan home and community-based attendant services to individuals in need of long-term care for Activities of Daily Living (ADLs), Instrumental Activities of Daily Living (IADLs) and health-related tasks which can be performed by an aide under state law.

CFCO has been available through Mainstream Medicaid Managed Care (MMC) and Managed Long Term Care (MLTC) and, now, guidance has been issued for fee-for-service (FFS) Medicaid.

In January, DOH held trainings for MLTC plans on rate codes as well as questions and answers to follow up on a December 20 webinar.

Continued on next page

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The Situation Report: the Home Care Association of New York State Continued from previous page For FFS cases, as per the ADM, oversight, assessment, reassessment and service planning for individuals seeking CFCO services will continue to be the responsibility of the LDSS. For individuals enrolled in the Traumatic Brain Injury (TBI) or Nursing Home Transition and Diversion (NHTD) 1915(c) waivers seeking CFCO services, the Regional Resource Development Center (RRDC) will continue to have responsibility for oversight, assessment, reassessment and service planning.

For all individuals enrolled in MMC and MLTC plans seeking CFCO services, the Managed Care Organization (MCO) will continue to have responsibility for oversight, assessment, reassessment, service planning, and authorization.

An individual eligible to receive CFCO services must: 

Be Medicaid eligible for community coverage with community-based long term care (with or without a spenddown) or be Medicaid eligible for coverage of all care and services;

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Have an assessed institutional level of care; and

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Reside in his/her own home, or the home of a family member.

Volume 4, No. 7 February 19, 2019 

OIG Posts Updated Work Plan The federal Office of Inspector General (OIG) has posted its updated Work Plan.

It is at https://oig.hhs.gov/ reports-and-publications/ workplan/index.asp.

The Work Plan includes two new items: 

Characteristics of Part Medicare Part D Beneficiaries at Serious Risk of Opioid Misuse or Overdose. OIG will conduct a study to provide information about: 1) the characteristics of beneficiaries at serious risk of misuse or overdose, including their demographics and diagnoses; 2) the opioid utilization of these beneficiaries; and 3) the extent to which these beneficiaries have had adverse health effects related to opioids and any overdose incidents.



Ensuring Dual-Eligible Beneficiaries’ Access to Drugs Under Part D Mandatory Review. OIG will review the extent to which drug formularies developed by Part D sponsors include drugs commonly used by dualeligible beneficiaries as required.

The ADM reviews: covered CFCO services; service delivery models; service providers; conflict-of-interest standards; Medicaid eligibility and level-of-care determinations; person-centered service planning; authorizations, reassessments and reauthorizations; and more.

The ADM includes a good resource for consumers that covers how to select, manage and dismiss attendants.

Some CFCO services have already been implemented for managed care and HCA has been at the forefront of recommending a streamlined and consolidated approach to the program, including implementation in a way that would relieve logistical problems for MLTCs and support provider delivery of these services.

In December, DOH announced that it had delayed the initiation of certain services until July 1, 2019.

More information on CFCO, including draft rate codes for MLTC plans and other recent updates, is at https://www.health.ny.gov/ health_care/medicaid/redesign/ community_first_choice_option.htm.

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

Volume 4, No. 7 February 19, 2019 

HIRING Director of Patient Services Lourdes Home Care Description: Lourdes is looking for a Director of Patient Services for our home health and hospice (home care) program. The director will work with a robust team of experienced clinical managers to guide the strategic direction and growth of the home care program. Focus will include collaboration with the Lourdes Palliative Medicine Program and with other community based programs offered at Lourdes and in the community at large. The director will be responsible for the achievement of clinical/quality and financial goals, as well as maintaining a culture of safety and accountability. Both programs are growing, and we attribute that to low turnover and effective leadership. We are looking for a leader who will embrace shared governance and the principles of servant leadership.

The ideal candidate is a registered professional nurse, with a minimum of 5 years’ experience in home care and at least two years of experience in leadership/management. A Master’s degree or combination of Bachelor’s degree and experience preferred.

President of Home Care & Hospice The Position: Head strategic Home Care and Hospice operations for the health system, including growing specialty programs. Pave the way for clinical and technological innovation in both the home care and hospice programs including a heart failure readmission reduction program, implementation of a new EMR, growing the current telehealth program, expansion of community and facility based palliative care programs, and support for value based purchasing (VBP) initiatives. Must possess prior CHHA executive experience, financial/budgetary experience, and a familiarity with Population Health strategies and initiatives. RN and/or Nurse Practitioner with Master’s degree required.

The Organization: Lourdes Home Care is a Certified Home Health Agency and Hospice that provides mission-based care to patients across Broome, Tioga, Chenango, and Delaware counties. Lourdes continues our 90+ year legacy of serving individuals in our community as part of Ascension, the largest nonprofit health system in the U.S and world’s largest Catholic health system. As a part of this system, Lourdes is able to access resources, tools, and best-practices from Ascension ministries across the country.

The Organization: Catholic Health Services of Long Island includes six hospitals, three skilled nursing facilities, a regional home care service, a certified hospice and a community-based agency for persons with special needs. The 1,928-bed system prides itself on the values of Integrity and Compassion. CHS serves hundreds of thousands of Long Islanders each year, providing care that extends from the beginning of life to helping individuals live their final years in comfort, grace, and dignity. At Catholic Health Services, there are 358,805 annual home care visits and 125,636 annual hospice days-of-care.

If you’d like additional information, please contact Ann Fattarusso, our Lourdes Ascension Recruiter: ann.fattarusso@ascension.org; m: (607)206-5839.

To apply, please visit our website at: https:// www.besmith.com/job-details/farmingdale-new-yorkhome-health-1256636/.

RN Director of Patient Services Fort Hudson Health Systems is looking for a Director of Patient Services for our Certified Home Health Agency. The Director will be responsible for the clinical direction and supervision of patient care services. The DPS will be a professional member of the health care team that provides oversight for the patient services provided by the agency and assures compliance with regulations.

Requirements: Bachelor’s degree, with at least 2 years of supervising community health experience, or 2 years of home care nursing experience plus a Master’s degree in a health-related field. Position may also serve as Administrator with additional experience.

Fort Hudson CHHA is an affiliate of Fort Hudson Health System, a not-for-profit multilevel health care and housing provider located in the Glens Falls region of New York. Fort Hudson provides a full range of services including skilled nursing, rehabilitation, adult day care, licensed home care, care management, senior housing and certified home health. For nearly five decades, Fort Hudson has maintained its reputation as an innovative, high quality, and compassionate provider of senior services. Our strength, stability and tradition within the community places Fort Hudson Health System at the forefront of healthcare providers throughout the entire region.

To apply, contact Elizabeth Parsons, Director of Human Resources, at eparsons@forthudson.com or 518-747-2811, ext. 264.

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

Volume 4, No. 7 February 19, 2019 

Upcoming Due Dates and Deadlines

Requirement/Change/Meeting

Effective/Due Date

More Information

Posting of OSHA Form 300A: Summary of WorkͲRelated Injuries and Illnesses

February 1 to April 30, 2019

https://www.osha.gov/recordkeeping/RKforms.html

Upstate LHCSA Forum

February 19, 2019

https://hcaͲnys.org/wpͲcontent/uploads/2019/01/HCAͲUpstateͲ LHCSAͲForumͲFebruaryͲ19ͲRegistrationͲForm.pdf

Central New York Health Emergency Preparedness Coalition (HEPC) meeting

February 20, 2019, 9 to 11 a.m. (webcast only)

https://meetny.webex.com/meetny/k2/j.php?MTID=tf15a74746faea3 9d9a1cbce0e7ec9aad (registration)

Interoperable Communications/Medical Countermeasures (IOC/MCM) exercise – Syracuse

February 27, 2019

megan.kash@health.ny.gov

Annual Wage Parity certification forms due to state Department of Health from CHHAs, LTHHCPs and Managed Care Organizations

March 1, 2019 for period https://www.health.ny.gov/health_care/medicaid/redesign/2016/2016 of March 1, 2019 to Ͳ02Ͳ17_wage_parity_alert.htm February 29, 2020

Quarterly Wage Parity certification forms due from LHCSAs and CDPAP FIs to contracted CHHAs, LTHHCPs and Managed Care Organizations

March 1, 2019 for period https://www.health.ny.gov/health_care/medicaid/redesign/2016/2016 of March 1, 2019 to May Ͳ02Ͳ17_wage_parity_alert.htm 31, 2019

Downstate LHCSA Forum

March 6, 2019

https://hcaͲnys.org/wpͲcontent/uploads/2019/02/MarchͲ6Ͳ DownstateͲLHCSAͲandͲHCCͲForumͲRegistrationͲForm.pdf

Lower Hudson Valley Health Emergency Preparedness Coalition (HEPC) meeting

March 6, 2019, 9 a.m. to noon

https://www.nylearnsph.com/Public/default.aspx (registration)

Long Island Health Emergency Preparedness Coalition (HEPC) meeting

March 7, 9:30 a.m. to noon

https://www.nylearnsph.com/Public/default.aspx (registration)

IOC/MCM exercise – Western NY April 4, 2019

Shaun.sharp@health.ny.gov

IOC/MCM exercise – Capital District

April 11, 2019

Maureen.casaleͲreidt@health.ny.gov

IOC/MCM exercise – Long Island

April 18, 2019

Drew.Fried@health.ny.gov

IOC/MCM exercise – Lower Hudson Valley

May 9, 2019

gyongyi.mcqueston@health.ny.gov

April 1, 2018 to December 31, 2019

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

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

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Volume 4, No. 7 February 19, 2019 

Hospice Supplemental Medical Review Contractor Activity The U.S. Centers for Medicare and Medicaid Services (CMS) Supplemental Medical Review Contractor (SMRC), Noridian Healthcare Solutions, LLC, has posted an update on its current hospice project entitled “General Inpatient Hospice.”

CMS contracted with Noridian on February 13, 2018 to help lower improper payment rates and increase efficiencies of Medicare and Medicaid medical review.

The SMRC conducts medical review of Medicare Part A and B claims nationwide to determine whether claims were billed in compliance. The focus may include vulnerabilities identified by CMS’s internal data analysis, the Comprehensive Error Rate Testing (CERT) program, professional organizations and federal oversight agencies.

Noridian sends affected providers/suppliers an Additional Documentation Request (ADR) letter to begin a review. It then notifies CMS of any identified improper payments and noncompliance with documentation requests. The provider’s Medicare Administrative Contractor (MAC) may initiate claim adjustments and/or overpayment recoupment actions through the standard overpayment recovery process.

With hospice reviews, the SMRC will assess the Medicare election statement and certification of terminal illness (including the face-to-face encounter) for compliance as well as eligibility for hospice care.

Additional reviews will be conducted for the selected topic.

HCA will update our hospice members as additional information becomes available.

NYC Nurses Eligible for WIO Funds Covering Hospice, Palliative Care Nurse Certification Courses in March HCA previously announced our partnership with the Home Care Alliance of Massachusetts on a member rate for HCA members to attend the March 25-26 or March 28-29 Hospice and Palliative Nurse Certification courses in Holyoke and Lawrence, MA, respectively.

RNs at agencies located in New York, Kings, Bronx, Richmond and Queens Counties are eligible to participate at no charge (the regular member rate is $299) by registering through the Audacia Foundation Workforce Investment Organization (WIO). Qualifying RNs may also be able to obtain assistance with their certification exam fee as well.

If your agency is located in New York City, please invite your RNs to take advantage of this opportunity by contacting wio@audaciafoundation.org or calling (212) 425-5050.

More information about the program and this WIO offering are in the flyer here: https://hca-nys.org/wpcontent/uploads/2019/02/HOSPICE-PALLIATIVE-Nurse-Certification-Review-Course-Training-WIO-FlyerFinal.pdf.

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

Volume 4, No. 7 February 19, 2019 

PHHPC Acts on Home Care Applications The Public Health and Health Planning Council (PHHPC) met last week and took action on a number of home care applications.

The agenda and supporting documents are at https://www.health.ny.gov/facilities/ public_health_and_health_planning_council/meetings/2019-02-14/.

The PHHPC approved: 

A proposal, including a service area waiver, to create a complex care collaborative submitted under the Hospital-Homecare-Physician Collaboration Program. The program is under Section 2805-x of the Public Health Law, and DOH’s corresponding Dear Administrator Letter is DHCBS 17-07, RMI Post-acute care.



Three CHHAs for a transfer of ownership, change in the controlling entity, and change in ownership, respectively.



One Licensed Home Care Services Agency (LHCSA) for an asset purchase of an existing LHCSA; one LHCSA for a change in ownership and to be associated with an Assisted Living Program (ALP); and one LHCSA for a change of ownership.

All meetings of the PHHPC and its committees can be viewed via webcast, including archived ones, at https://www.health.ny.gov/events/webcasts/.

CMS Announces Emergency, Triage, Treat and Transport Model Last week, the U.S. Centers for Medicare and Medicaid Services (CMS) announced the Emergency, Triage, Treat, and Transport (ET3) model.

Under ET3, CMS will pay participating ambulance suppliers and providers to: 1) transport an individual to a hospital emergency department (ED) or other destination covered under the regulations; 2) transport to an alternative destination (such as a primary care doctor’s office or an urgent care clinic); or 3) provide treatment in place with a qualified health care practitioner, either on the scene or connected using telehealth.

Currently, Medicare regulations only allow payment for emergency ground ambulance services when individuals are transported to hospitals, critical access hospitals, skilled nursing facilities, and dialysis centers. According to CMS, most beneficiaries who call 911 with a medical emergency are therefore transported to one of these facilities, and most often to a hospital ED, even when a lower-acuity destination may more appropriately meet an individual’s needs.

Under this model, any individual who calls 911 and is connected to a dispatch system that has incorporated a medical triage line under the model would be screened for eligibility for medical triage services prior to

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ambulance initiation. Upon arriving on scene, participating ambulance suppliers and providers may triage Medicare fee-for-service (FFS) beneficiaries to one of the model’s interventions upon ambulance dispatch following a 911 call. As part of a multi-payer alignment strategy, CMS will encourage ET3 model participants to partner with additional payers, including state Medicaid agencies, to provide similar interventions to all people in their geographic areas.

The CMS Innovation Center intends to release a Request for Applications (RFA) in the summer of 2019 to solicit Medicare-enrolled ambulance suppliers and providers. Once participants have been selected and announced, the Innovation Center anticipates issuing a Notice of Funding Opportunity (NOFO) in the fall of 2019 for up to 40 two-year cooperative agreements, available to local governments, their designees, or other entities that operate or have authority over one or more 911 dispatches in geographic locations where ambulance suppliers and providers have been selected to participate.

The ET3 model will have a five-year performance period. The anticipated start date is January 2020.

HCA will be exploring whether home care can be a collaborating partner under this new model.

More information is at https://innovation.cms.gov/initiatives/et3/.

NGS Updates National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), has recently posted the following information to its website.

Downtime for Self-Service Tools Due to scheduled maintenance, certain self-service tools will be unavailable on February 22 at 8:30 p.m. to February 23, at 12:30 p.m. These include the Interactive Voice Response (IVR) system; NGSConnex.com; and the MBI Look-up Tool. All other transactions (claims, appeals, financials, etc.) will be available.

Submitting Cost Reports Electronically Via MCREF Medicare cost reports can no longer be submitted via NGSConnex or e-mail. NGS recommends using the new Medicare Cost Report e-Filing System, known as MCReF (https://mcref.cms.gov), for cost reports with a fiscal year end date of December 31, 2017 or later.

MCReF is a secure file transport method. Cost report files provided via MCReF that are encrypted or password protected will be rejected.

Providers are reminded to check the box on Worksheet S stating your intent to electronically sign your cost report.

If using MCReF, providers should not also mail their cost report. Submitting duplicate copies and methods can result in processing delays.

Additional information is at: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-NetworkMLN/MLNMattersArticles/downloads/MM10611.pdf.

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Health Resources 

“Medicare Advance Written Notices of Noncoverage Booklet— Revised,” by the U.S. Centers for Medicare and Medicaid Services https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNProducts/Downloads/ABN_Booklet_ICN006266.pdf



“Medicare Parts A & B Appeals Process Booklet— Revised,” by the U.S. Centers for Medicare and Medicaid Services https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNProducts/Downloads/MedicareAppealsProcess.pdf



“The Illusion of Choice: Why Decisions About Post-Acute Care Are Difficult for Patients and Family Caregivers,” by the United Hospital Fund https://uhfnyc.org/media/filer_public/ca/45/ca451839-bd0e-4203-a31b-9f63871da53b/ptcaregiver-diffdecisions2-190107.pdf



“Health Care Provider Perspectives on Discharge Planning: From Hospital to Skilled Nursing Facility,” by the United Hospital Fund https://uhfnyc.org/media/filer_public/43/8d/438dde0f-cda6-485f-a1ea-532cf4861ece/diffdecisions_provider-perspective-190107.pdf



“Targeting High-Need Beneficiaries in Medicare Advantage: Opportunities to Address Medical and Social Needs,” by the Commonwealth Fund https://www.commonwealthfund.org/publications/issue-briefs/2019/feb/targeting-high-needbeneficiaries-medicare-advantage

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

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