ANDRYEYEVA APPEAL
FORUMS
SEPSIS
FLSA PILOT
In a major development, the state’s Court of Appeals will hear case examining compensable hours for 24hour/live-in services.
HCA’s Senior Financial Managers Forum and Downstate CHHA Forum to provide vital updates for members.
HCA’s “Stop Sepsis at Home” has one training session left on Long Island: March 23. Our initiative was also featured in a recent, high-profile radio segment.
A new federal pilot program will expedite resolution of inadvertent overtime and minimum wage violations of the FLSA.
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Your Source for HOME CARE News, Policy and Advocacy
COMING UP Downstate CHHA Member Forum Friday, March 16, 2018 New York City Senior Financial Managers Forum March 22, 2018 Albany ‘Stop Sepsis at Home’ Regional Training Sessions NEW DATE: March 23, 2018 Port Washington Register for these and other programs online at https://hcanys.org/eventseducation/ upcoming-events.
Vol. 3, Issue 11 | March 12, 2018
Senate, Assembly Drafting, Soon Passing One House Budget Bills The state budget process takes a critical step as the Senate and Assembly have compiled – and will start passing – one-house budget bills as soon as tomorrow. HCA and counsels at Hinman-Straub have been working to position our advocacy concerns, proposals and counter proposals to be addressed in one or both of these bills. It is vital that HCA’s priorities are incorporated in this formative process; after passage of the one-house bills, the Senate and Assembly will then reconcile differences in their positions and proceed to three-way negotiations with the Executive. See BUDGET p. 2
Registration Coming Soon for Banner HCA Annual Conference on May 9-11 in Saratoga: ‘40 Years Strong’ Conference to celebrate HCA’s 40th Anniversary, featuring NAHC’s Bill Dombi, other experts, networking sessions, vendors, awards ceremony, and festivities HCA will soon be announcing the full agenda for our upcoming Annual Conference “40 Years Strong,” celebrating four decades as your state association! Save the date and get ready for this exciting program, which will take place at the Saratoga Hilton in scenic Saratoga Springs on May 9-11. See STRONG p. 4
INSIDE Senate, Assembly Drafting, Soon Passing One-House Budget Bills...........................1 Registration Coming Soon for Banner HCA Annual Conference on May 9-11.............1 Sponsor Message: RBC Limited..............................................................................3 HCA Presses for Technical Changes in Medicare Payment Law..................................5 Andryeyeva Case Headed to State’s Highest Court...................................................6 With HHGM, F2F, Rural Add-on & Medicaid Changes, HCA CFO Forum Helps You........7 HCA Participates in MLTC Meeting on Program Growth...........................................8 Downstate CHHAs: Last Call for Must-Attend Forum on Friday.................................8 Radio Spot Features HCA’s Home Care Sepsis Effort.................................................9
DOL Pilot to Allow Resolution of Inadvertent FLSA Wage Violations............10 Important Upcoming Deadlines.................................................................11 CMS Announces Initiatives on Health Data Accessibility..............................12 DOH Posts FIDA Appeals FAQs and Three-Way Contract...............................12 CMS to Host 3/27 Hospice QRP Webinar......................................................13 CMS Survey on Value Based Purchasing Invites Input...................................13 NGS Updates.............................................................................................13 FAQs Issued on TBI Medicaid Waiver Changes............................................14 OPWDD Selects Care Coordination Organizations.......................................15 Resources.......................................................................................................16
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BUDGET from p. 1 The best scenario is where both houses’ bills are in agreement (and aligned with our position) on the inclusion, modification, or exclusion of proposals and language affecting our field. Of greatest concern at this phase is if neither house’s bills nor budget resolutions pick up our concerns, proposals or counterproposals. Currently, the areas of greatest risk include MLTC-LHCSA contract limits, MLTC cuts and the Governor’s uncontrolled in-home telehealth proposal. HCA will be analyzing each house’s budget proposal and advising the membership on grassroots advocacy steps you should be taking based on the outcome at this phase. Priority concerns continue to be:
Rejection of the ten-contract limit on MLTC plans and LHCSAs; and replacement of this proposal with a deliberative and transparent consideration of MLTC enrollee service utilization, costs and contracting needs.
Rejection of the across-the-board reimbursement cuts to MLTCs.
Modification of the Executive’s across-the-board carve-out of MLTC nursing home and transportation benefits so that the inclusion/exclusion of these benefits best supports the plan, its service region and enrollees.
Modification of the Executive’s proposed home telehealth expansion to ensure that any such services are within the lawful license and scope of the provider performing the telehealth (e.g., telehealth services constituting the practice of medicine should be performed by physicians, and telehealth services constituting “home care” should be performed by article 36 home care agencies). Such service changes should not create a loophole for jurisdictional/licensure crossover, scofflaw practices and further system overlap and fragmentation. Expansion of the proportion of Health Care Facility Transformation Program funding for home and community
Volume 3, No. 11 March 12, 2018
The Situation Report is a weekly publication of the Home Care Association of New York State (HCA). Unless otherwise noted, all articles appearing in The Situation Report are the property of the Home Care Association of New York State. Reuse of any content within this newsletter requires permission from HCA. Joanne Cunningham HCA President jcunningham@hcanys.org Roger L. Noyes Director of Communications, Editor of The Situation Report rnoyes@hcanys.org Al Cardillo Executive V ice 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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health providers to be at least twenty-five percent of the total pool (an expansion to $106 million if the total pool amount remains as the Governor proposed), and more flexibility for use of these funds by providers. HCA is also working to incorporate our proactive policies in any open window that arises. This includes: insertion of our workforce proposals for home care, hospice and MLTCs; promotion and support of home care’s roles in addressing public health priorities (like asthma, sepsis, opioid overuse, health disparities, etc.) and savings opportunities; home care-mental health provider collaboratives; an end to scofflaw facilities and entities illegally providing home care outside of article 36 licensure; and other MLTC, home care and hospice concerns and opportunities. Next Steps Legislative leaders have scheduled budget conference committees to begin immediately after the one-house budget bills pass. HCA will inform you of the conference committee members and provide guidance on outreach to their offices for advocacy of priority budget positions in this venue. Your active engagement in these next steps, and throughout the remainder of the budget process, remains “a must” to best secure the potential for favorable budget outcomes on major concerns and opportunities.
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STRONG from p. 1 We’ll be joined by special guest closing keynote speaker Bill Dombi, President of the National Association for Home Care and Hospice (NAHC), as well as other expert presenters offering insights on all facets of home care, hospice and Managed Long Term Care operations. Mr. Dombi has been involved in nearly every major home care and hospice issue over the past 40 years, and has now begun taking on new responsibilities as the recently confirmed NAHC President. His insights offer a perfect capstone for the conference, drawing on a unique understanding of home care’s place in the last 40 years as well as where it is headed in an environment of political upheaval, Medicaid funding threats, the near-certain prospect of a Home Health Groupings Model or other similar payment overhauls, the pivot toward uniform postacute care payment methodologies, and the continued struggles with federal regulatory burdens. As another feature, our program will begin with a special pre-conference session delving into “Compliance and Finance Considerations for Advanced Home Health Aides.” The Advanced Home Health Aide (AHHA) law is set to go into effect by the end of May; as such, this pre-conference offers a well-timed opportunity for provider executives, clinical managers and human resources or operations leaders to get information and insights to fine-tune your AHHA implementation plans. These and other sessions throughout the conference, networking opportunities, exhibitors and more will help your organization plan for the future by tackling emerging issues, enhancing your team’s performance, confronting public health and population health challenges, and optimizing your success with some of the biggest changes happening to home care in decades. We’ll also have our annual Political Action Committee party, our Annual Awards ceremony and more festivities as HCA celebrates 40 Years Strong. Look for a full program brochure and registration soon on our conference website at www.hcaannualconference.com. There you can find an agenda-at-a-glance, hotel information and more as you prepare to join us on May 9-11 in Saratoga. We can’t wait to celebrate 40 Years Strong with you.
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HCA Presses for Technical Changes in Medicare Payment Law to Protect Home Care In follow-up meetings this past week with key members of New York’s Congressional Delegation, HCA again pressed for technical changes to the home care provisions included in the recently passed Continuing Resolution. These include parameters around the creation of a new payment system (the Home Health Groupings Model, or HHGM), potential relief on the Face-to-Face regulation, and the continuation of the rural add-on for rural home health providers. HCA President Joanne Cunningham met with the offices of Representatives Nita Lowey (D-Westchester) and Jose Serrano (D-Bronx), who serve on the House Appropriations Committee, and Representative Chris Collins (R-Clarence), who serves on the House Energy and Commerce Committee. Both of these Committees will be pivotal for including technical changes to an upcoming funding bill that will clarify the recent provisions impacting home care. Specifically, HCA is asking for clarification of the HHGM payment system language to ensure that:
The new 30-day payment provision is a “unit of payment” rather than a “unit of service” (ensuring that the payment in a 60-day episode would include two 30-day payments, rather than one);
Any payment changes in the new system would be adjusted based on actual data, and not assumptions or anticipated behavior changes;
The technical expert group created under this legislation has adequate time to meet and analyze data; and
An optional demonstration program is established.
HCA advocated for an additional clarification in the new law regarding F2F – ensuring that the physician record shall be used when determining compliance with the F2F requirement, rather than merely allowing the Medicare contractors to use this information. Nurse Practitioner Access Legislation In discussions with Rep. Collins’ office, HCA extended strong support for enactment of legislation, H.R. 1825, also known as the Home Health Care Planning Improvement Act. This legislation, which is a top priority of Rep. Collins (the House lead sponsor of the bill), would allow Nurse Practitioners and other advanced practice clinicians to certify home health for Medicare patients. Rep. Collins has redoubled his commitment on this important legislation and has indicated that he intends to aggressively advocate for the enactment of this bill before Congress adjourns in the fall. HCA will continue to mount a vigorous advocacy campaign to support Rep. Collin’s efforts.
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Andryeyeva Case Headed to State’s Highest Court for Final Ruling On March 8, the Second Department, Appellate Division (an intermediate state appellate court covering the counties of Richmond, Kings, Queens, Nassau, Suffolk, Westchester, Dutchess, Orange, Rockland and Putnam) granted a motion to appeal in Andryeyeva v. New York Health Care, Inc., permitting the case to be considered by New York’s highest court, the Court of Appeals. This is a victory for home care agencies and an opportunity to overturn recent intermediate state appellate court decisions that rejected the state Department of Labor’s (DOL) “13-hour rule” for “24hour/live-in” cases. Briefing on the appeal to the Court of Appeals will begin in the coming weeks. Based on historical court practice, a decision on the appeal will likely be issued in about six months. This appeal has significant public policy considerations for the home care industry. HCA will evaluate whether it is in the industry’s best interest to submit an amicus brief to the Court of Appeals seeking a reversal of the Second Department’s decision in Andryeyeva. HCA had earlier submitted an amicus on the Andryeyeva case when it was before the Second Department. In that decision, the Second Department ruled that DOL’s opinion letter setting forth the “13-hour rule” is inconsistent with the plain language of underlying regulation. According to the court, DOL’s regulations require payment of at least the minimum wage for all 24 hours of a live-in shift for aides who are not “residential” employees – those aides who live on the premises of their employer and who are “required to be available for work.” The 13-hour standard, by contrast, exempts some hours during meal or uninterrupted sleep times. In the time since the Second Department decision, the state Department of Labor (DOL) has adopted an emergency regulation, effective October 6, 2017, reaffirming DOL’s long-standing “13-hour rule” for compensation of “24-hour/live-in” home care employees. It is not known how this will affect the Court of Appeals deliberations. State DOL had submitted an amicus in support of the motion to appeal to the Court of Appeals. Once the case is heard by the Court of Appeals, a final decision will be rendered, which will determine whether the home care industry is exposed to massive wage liabilities in the form of back pay owed to employees dating back six years. HCA will continue to update members on forthcoming developments with Andryeyeva and other related cases, as well as the implications of these cases in relation to DOL’s emergency rule.
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With HHGM, F2F, Rural Add-on & State Budget Medicaid Changes All Afoot, 3/22 HCA Forum Helps Your Finance Teams The Home Health Groupings Model (HHGM) will bring about a sweeping overhaul of the clinical groupings, payment increments, and other methodological changes in Medicare home health reimbursement. Do you have a firm handle on what’s proposed? Have you assessed the payment risk, or developed processes to mitigate those risks? If not, you need to be doing so! At our Senior Financial Managers Forum on March 22 in Troy (near Albany), HCA will provide an update on the recently enacted HHGM, as well as insights on process adjustments to help you respond to this biggest home health payment overhaul in nearly 20 years. Select Data CEO Ed Buckley will specifically discuss new classification systems that providers can use to manage care and expenses under HHGM. These robust models will help your organization better distinguish between acutecare and chronic-care service patterns and mixes. Meanwhile, HCA and federal partners are working to push a set of modifications to the HHGM structure that was included in the February 8 federal budget bill. The budget measure also included changes to the Face-to-Face requirement, a more complex phasing schedule for the rural add-on (with different percentages based on regional demographics), as well as other factors that experts will address at the March 22 Forum, including updates from HCA Policy staff and D.C. policy expert Colin Roskey. We’ll also have a representative from New York’s Medicare Administrative Contractor (NGS) focusing specifically on the home health targeted probe-and-educate (HHTPE) audit initiative: how providers can avoid being identified for HHTPE, acceptable claim error rates, and impact statistics. You’ll also get the latest NGS medical review and appeals data review (including the top claim denial reasons), as well as tips to avoid those denials, along with other results that affect claims. These issues, plus an equal measure of state budget and Medicaid updates, make this a can’t-miss program for your organization’s CFO, CEO, COO, finance managers and others with responsibility over budgeting or financial strategic planning. This daylong focus on burning reimbursement issues is offered for the premium value of $149 (HCA member rate) and $299 (prospective member rate). Please make sure your finance teams join us! Register here today at https://hca-nys.org/wp-content/uploads/2018/01/HCA-Senior-Financial-Mgr-ForumRegistration-Form.pdf.
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HCA Participates in MLTC Meeting on Program Growth Last Friday, HCA was invited to participate in a meeting with the state Department of Health (DOH) and other provider associations that represent managed care plans to discuss the growth of enrollment in managed long term care (MLTC) plans. Some of the data presented included:
New MLTC enrollees comprise an increasingly large portion of total MLTC enrollees (27 percent in state fiscal year 2016-17, up from 23 percent in 2014-15).
Member demographics from 2014 to 2017: remain stable for the 65 and under population; are slightly higher for those age 65 to 74; and are slightly lower for those age 75 and older.
The percentage of lower acuity as measured by the Uniform Assessment System tool has dropped while the percentage of higher level acuity has risen from 2014 to 2017.
The amount of money attributed to consumer directed personal assistance services (CDPAS) provided to MLTC plan enrollees grew 111 percent from 2014 to 2015; 109 percent from 2015 to 2016; and 50 percent from 2016 to the third quarter of 2017.
Most enrollment growth of the MLTC population is coming through the Conflict Free Evaluation and Enrollment Center (CFEEC). The referral sources to the CFEEC for 2017 are: home care agencies (24 percent); health plans (19 percent); family/friend/neighbor (16 percent); and doctor/hospital (12 percent).
Some of the possible causes of MLTC growth outlined by DOH are that there are no service limitations, caps on enrollment, nor “slot” systems. There was much discussion on the growth of CDPAP services; whether there should be a limit on the number of fiscal intermediaries (FIs); how, if at all, the recent FI authorization process will affect CDPAP services; whether there should be a limit on the number of Licensed Home Care Services Agencies (LHCSAs) that contract with MLTCs; if there should be a moratorium on new LHCSAs and/or a certificate of need process for LHCSAs; and what other factors may be contributing to the growth of MLTC expenditures. In addition, there was a short discussion on some issues related to the DOH Contract with MLTCs and general burdens faced by plans. DOH suggested that there be a separate meeting after the state budget is adopted to review the problematic areas and suggestions for relief.
Downstate CHHAs: Last Call for Must-Attend Forum on Friday HCA’s Downstate CHHA Forum, this Friday, will provide a focus session on CHHA-specific information and updates. If you are a downstate CHHA director, executive or operations manager concerned about CHHA workforce, fiscal, regulatory, quality/clinical or system issues, then you shouldn’t miss this important session in New York City. And if you can’t attend, make sure someone from your organization does, with questions ready to ask us. HCA’s forums are a way of reaching particular segments of our membership, with updates unique to select member types. Our CHHA Forum will focus on such CHHA-specific issues as: your readiness for the Home Health CoPs; the Face-to-Face mandate; the Home Health Prospective Payment System; the Medicaid Episodic Payment System
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audit by OMIG; state budget updates; a discussion of regulatory modernization, certificate of need, and postacute care changes that will fundamentally impact your agency’s role and CHHA marketplace dynamics; the recent, HCA-prompted Dear Administrator Letter implementation of hospital-homecare-physician collaboration opportunities which all CHHAs should be considering as a mechanism to stake new territory for services; DSRIP, VPB, managed care; and more. HCA’s Policy team will provide updates in all of these areas as well as an opportunity for your input on advocacy or program development to support you in these areas. We want to know what concerns you are facing and ways that HCA can help. Please register today for this critical forum by downloading the form here: https://hca-nys.org/wp-content/ uploads/2018/02/CHHAForum-3-16-18-Registration-Form.pdf. Downstate CHHA Member Forum Friday, March 16, 2018 10:30 a.m. to 1:30 p.m. Selfhelp Community Services, Inc. 520 Eighth Avenue, 5th Floor New York, NY 10018 Lunch will be served
Major Radio Spot Features HCA’s Home Care Sepsis Effort HCA’s “Stop Sepsis at Home” training initiative reached Suffolk County last week, with one more scheduled session left to go on Long Island (March 23) HCA Executive Vice President Al Cardillo and IPRO Senior Director for Quality Sara Butterfield were tapped for a prominent radio spot to discuss the problem of sepsis and our work on home and community based sepsis intervention. The program aired multiple times this past weekend on several stations in the northeast U.S. corridor. (You can hear the segment at https://wgy.iheart.com/content/2018-03-07-upstate-issues-life-threatening-sepsis/.) The program’s anchor and public affairs director, Diane Donato of 103.1 FM and 810 AM WGY, led the discussion with HCA and IPRO’s teams on critical sepsis facts, sepsis prevalence, signs and symptoms, and HCA’s “Stop Sepsis at Home” campaign. HCA thanks WGY, Ms. Donato, and affiliate stations for carrying this segment across the northeast, and educating the public about sepsis and the sepsis initiatives HCA is undertaking. “Stop Sepsis at Home” Training Continues HCA is continuing our training for home care agencies on HCA’s home care sepsis tool with grant support from the New York State Health Foundation, in collaboration with IPRO, the Rory Staunton Foundation for Sepsis Prevention, the Sepsis Alliance and other partners. Our most recent regional presentation and training session was last Friday, March 9, for providers serving Suffolk County. We also rescheduled our Nassau session, due to last week’s winter storm, and invite providers
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to register for this last remaining scheduled session on March 23 in Port Washington. Providers and MLTCs can register now for this session if you have not already done so at https://www.surveymonkey.com/r/ LISepsisSessions. In other related news, HCA has also been invited to participate this Wednesday in an award ceremony honoring Governor Cuomo for his leadership on sepsis. At this session, HCA will discuss our sepsis initiatives in New York and, indeed, nationally, as our campaign continues to draw participation and requests for adoption from home care providers, hospitals and health systems around the country.
DOL Pilot Program to Allow Voluntary Resolution of Inadvertent FLSA Wage Violations The Wage and Hour Division of the U.S. Department of Labor (DOL) has announced a new pilot program, the Payroll Audit Independent Determination (PAID) program, which expedites resolution of inadvertent overtime and minimum wage violations under the Fair Labor Standards Act (FLSA). The program seeks to resolve such claims expeditiously and without litigation, to improve employers’ compliance with overtime and minimum wage obligations, and to ensure that more employees receive the back wages they are owed, without having to pay any litigation expenses, attorneys’ fees, or other costs that may be applicable to private actions. This program covers potential violations of the FLSA’s overtime and minimum wage requirements. This could include, for example, violations based on alleged “off-the-clock” work, failures to pay overtime at one-andone-half times the regular rate of pay, or misclassification of employees as exempt from the FLSA’s minimum wage and overtime requirements. The Division will not impose penalties or liquidated damages to finalize a settlement for employers who choose to participate in the PAID program and proactively work with the Division to fix and resolve their potential compensation errors. Employers may not participate in the PAID program if they are in litigation or currently under investigation by the Division for the practices at issue. Employers likewise cannot use the pilot program repeatedly to resolve the same potential violations, as this program is designed to identify and correct potentially non-compliant practices. Settlements will be limited in scope to only the potential violations at issue. The program further requires employers to review the Division’s compliance assistance materials, carefully audit their pay practices, and agree to correct the pay practices at issue going forward. More information concerning the pilot program, including Questions and Answers, is available at https:// www.dol.gov/whd/PAID/. Home care providers should consult with their counsel before utilizing this new program.
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Important Upcoming Deadlines Requirement/Change
Effective/ Due Date
More Information
Home Care, Fiscal Intermediaries and other providers who contract with Managed Care Organizations must be enrolled in Medicaid
Still being accepted, but providers are advised to submit now
https://www.emedny.org/info/ProviderEnrollment/ManagedCareNetwork/index.aspx
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/AppealsͲandͲGrievances/OrgMedFFSAppeals/AppealsͲSettlementͲ Initiatives/LowͲVolumeͲAppealsͲInitiative.html
Medicare Bundled Payments for Care Improvement Advanced model
Applications due March 12, 2018
https://innovation.cms.gov/initiatives/bpciͲadvanced
NYS Health Foundation Special Funds RFP
March 13, 2018 for online inquiry form
https://nyshealthfoundation.org/rfp/2018ͲspecialͲprojectsͲ fund/?utm_source=Reminder+to+Apply%3A+2018+SPF+RFP&utm_campaign=2018+SPF%3A+2nd+Remind er+to+Apply+%28w%2Fvideo%29+Feb+2018&utm_medium=email
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/AppealsͲandͲGrievances/OrgMedFFSAppeals/AppealsͲSettlementͲ Initiatives/LowͲVolumeͲAppealsͲInitiative.html
Health Care Facility Transformation Program
Applications due March 14, 2018
https://grantsgateway.ny.gov/intelligrants_NYSGG/module/nysgg/goportal.aspx?NavItem1=4&ngoID=500 0979
Criminal history record check requirements apply to hospice
April 1, 2018
https://www.health.ny.gov/facilities/home_care/advanced_home_health_aides/docs/ahha_legislation.pdf
Submission of COI Compliance Implementation Plan forms by Regional Resource Development Centers to state Department of Health
April 1, 2018
https://hcaͲnys.org/wpͲcontent/uploads/2018/01/ConflictͲofͲInterestͲComplianceͲImplementationͲ Plan.docx; https://hcaͲnys.org/wpͲcontent/uploads/2018/01/COIͲComplianceͲImplemenationͲPlanͲPowerͲ 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/NewͲMedicareͲCard/index.html
Implementation of Universal Billing Codes for Home and CommunityͲ Based Long Term Care Services under Managed Care
April 1, 2018
https://www.health.ny.gov/facilities/long_term_care/reimbursement/letters/dal_2017Ͳ12Ͳ 07_billing_codes.htm
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_option.htm
Healthcare Personnel Influenza Vaccination Report
May 1, 2018 for personnel employed from October 1, 2017 to March 31, 2018
immunize@health.ny.gov or (518) 473Ͳ4437
Changes in appeals system for Medicaid managed care enrollees
May 1, 2018
https://www.health.ny.gov/health_care/managed_care/plans/appeals/index.htm
NYS Health Foundation Special Funds RFP
May 16, 2018
https://nyshealthfoundation.org/rfp/2018ͲspecialͲprojectsͲ fund/?utm_source=Reminder+to+Apply%3A+2018+SPF+RFP&utm_campaign=2018+SPF%3A+2nd+Remind er+to+Apply+%28w%2Fvideo%29+Feb+2018&utm_medium=email
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CMS Announces Initiatives to Make Health Data More Readily Available to Patients The U.S. Centers for Medicare and Medicaid Services (CMS) has announced a new initiative called “MyHealthEData” along with other efforts aimed at giving patients more control over their health care data, allowing patients to share data with whomever they wish and to take data with them from provider to provider. This initiative stems from an Executive Order to promote health care choice and competition. It will be led by the White House Office of American Innovation with participation from the Department of Health and Human Services (HHS) and CMS, the Office of the National Coordinator for Health Information Technology (ONC), National Institutes of Health (NIH), as well as the Department of Veterans Affairs (VA). CMS also announced the launch of Medicare’s Blue Button 2.0 – a new and secure way for Medicare beneficiaries to access and share personal health data in a universal digital format. This platform will allow a patient to access and share health care information, previous prescriptions, treatments, and procedures with a new doctor which can lead to less duplication in testing and provide continuity of care. Additionally, CMS intends to overhaul its Electronic Health Record (EHR) Incentive Programs to refocus the programs on interoperability and to reduce the time and cost required of providers to comply with the programs’ requirements. CMS has also implemented laws regarding information blocking – a practice in which providers prevent patients from getting their data. Under some CMS programs, hospitals and clinicians must show they have not engaged in information-blocking activities. Additional information can be found at: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Factsheets/2018-Fact-sheets-items/2018-03-06.html. HCA will be examining these initiatives to determine their impact on home care providers, specifically any work that providers must undertake for participation, technological readiness, communication with beneficiaries and patients, or collaboration with partners and payors on data transferability.
DOH Posts FIDA Appeals FAQs and Three-Way Contract The state Department of Health (DOH) has posted frequently asked questions (FAQs) on the Fully Integrated Duals Advantage (FIDA) integrated appeal and grievance process and the revised FIDA Three-Way Contract. The FAQs are at https://www.health.ny.gov/health_care/medicaid/redesign/fida/mrt101/faq/docs/2018-0301_iagp_faq.pdf and the contract is at https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-andMedicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/Downloads/ NYFIDAContract01012018.pdf. The FAQs cover: aid continuing; timeframes for notices and appeals; verbal appeals; standard for an expedited review; use of the appeals process by participating and non-participating providers; appeals held at enrollee’s home; and more. Additional information on FIDA is at https://www.health.ny.gov/health_care/medicaid/redesign/fida/mrt101/faq/index.htm.
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Volume 3, No. 11 March 12, 2018
CMS to Host March 27 Hospice Quality Reporting Program Webinar The U.S. Centers for Medicare and Medicaid Services (CMS) will be hosting a webinar on the Hospice Quality Reporting Program on Tuesday, March 27 from 1:30 to 3 p.m. Participants will learn about updated coding guidance for the Hospice Item Set (HIS) and how to navigate the Hospice Quality Reporting Program websites. The session will also provide an update on the Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey. For additional information and to register, visit: https://www.cms.gov/Medicare/Quality-InitiativesPatient-Assessment-Instruments/Hospice-Quality-Reporting/Hospice-Quality-Reporting-TrainingAnnouncements-and-Registration.html.
CMS Survey on Value Based Purchasing Invites Input from Participating and Non-Participating States The U.S. Centers for Medicare and Medicaid Services (CMS) has recently sent a letter to some Certified Home Health Agencies (CHHAs) on a study CMS is conducting to learn more about the impact of the Medicare Home Health Value Based Purchasing (HHVBP) model on home health agencies and the care being provided to Medicare beneficiaries. At least one HCA CHHA member has received the letter. While New York is not one of the nine states required to participate in HHVBP, the letter says that it is important for CMS to gather information on home health agency operations in all states for purposes of assessing HHVBP. CMS has contracted with Arbor Research Collaborative for Health and Morpace to survey providers as part of its information gathering in order to inform CMS, Congress and other policymakers on next steps for HHVBP. The questionnaire should only take 20 minutes to complete. HCA encourages any CHHA member receiving the letter to participate in this voluntary questionnaire, so New York agencies can have a voice in this study. HCA also would like to know of other members that have received this letter and invitation to participate in the questionnaire. Please notify Patrick Conole at pconole@hcanys.org.
NGS Updates National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), has recently provided the following updates on its website at: www.ngsmedicare.com. MSI Coming in March 2018 The 2018 MAC Satisfaction Indicator (MSI), a survey administered by the U.S. Centers for Medicare and Medicaid Services (CMS), is coming sometime this month. The MSI measures your satisfaction with NGS’s processes and service delivery. NGS says that provider MSI feedback in 2017 led NGS to simplify
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The Situation Report: the Home Care Association of New York State
Volume 3, No. 11 March 12, 2018
the NGSConnex registration process, improve the usability of beneficiary eligibility information, add educational features, and more. Provider Enrollment Application Process Timeline Update All MACs, including NGS, have a goal to finalize an Internet-based PECOS application within 45 days and a CMS-855 paper application within 60 days, if all required information is available. The following is a summary of that process:
An acknowledgment notice with a case number will be mailed or e-mailed (PEDoNotReply@anthem.com) to the contact on the submitted application;
If additional documentation is needed, a request will be faxed, mailed, or e-mailed to the contact giving 30 days to respond;
When all information is available, the application will go through a series of steps before the final step of completion;
The contact can follow the status of the application by calling the interactive voice response (IVR) system or using the Provider Enrollment Status Inquiry Tool; and
It will take up to seven days after the application has finalized for the response letter to be received by fax, mail or e-mail.
For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
FAQs Issued on TBI Medicaid Waiver Changes The state Department of Health (DOH) has posted a Frequently Asked Questions (FAQs) document regarding upcoming changes to the Traumatic Brain Injury (TBI) program. The FAQs are at https://www.health.ny.gov/health_care/medicaid/redesign/mrt90/docs/2018-02-16_tbicoi_criteria_faq.pdf. The FAQs cover: use of Patient Review Instrument (PRI) and Uniform Assessment System (UAS) instrument; payment for UAS; provider qualifications; conflict of interest rules; incident reporting; service coordination supervision; housing subsidy; and more. Some important information includes:
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DOH is revising the TBI manual, but no date has been set for its release.
DOH will soon hold a webinar on cost reports.
There are no separate rate codes assigned to completing the UAS. Additional Home and Community Support Service (HCSS) hours are allowed for an HCSS or Licensed Home Care Services Agency
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Volume 3, No. 11 March 12, 2018
(LHCSA) to complete an assessment, or the assessment time may be billed as a nursing visit for a Certified Home Health Agency (CHHA).
The RN assessment and supervision visit (not to exceed four hours per visit) for supervision of HCSS staff are billable within this service definition (billed at a rate of up to four hours/units per visit, three times per year). Subsequent visits made by the selected provider’s supervising RN for on-the-job training of the HCSS staff are considered administrative costs and, therefore, are not billable and, as such, are incurred by the provider. To avoid duplicate billing, HCSS staff should not provide care during the RN visits .
Providers are expected to be in full compliance with the Conflict of Interest (COI) standards by January 2019. (see the January 12 and 22 editions of The Situation Report for information on the COI standards.)
Current providers will lose their grandfathered status when a grandfathered staff person’s employment is terminated. If an agency closes or no longer provides a particular service, then the employee will be unable to transition to a new agency under the previously approved provider qualifications. Additional considerations will be applied should a provider merge or acquire another provider. This will be addressed on a case-by-case basis and is contingent on the terms associated with the new agency.
For more information, contact Andrew Koski at 518-810-0662 or akoski@hcanys.org.
OPWDD Selects Care Coordination Organizations The Office for People With Developmental Disabilities (OPWDD) has selected six new Care Coordination Organizations (CCOs) that will begin providing Care Management services on July 1, 2018. Those chosen include:
Advance Care Alliance (http://www.advancecarealliance.org/) Care Design NY (http://caredesignny.org/) LifePlan (http://lifeplanccony.com/) Person Centered Services (https://personcenteredservices.com/) Prime Care Coordination (https://www.primecareny.org/) Tri-County Care (http://www.tricountycare.org/)
The Medicaid Service Coordination (MSC) program, which is currently used to coordinate services, will be replaced by a new program called Health Home Care Management. Health Home Care Management will continue to provide the service coordination that people currently receive; it will also provide coordination of other services, such as health care and behavioral health supports. CCOs, which are new entities formed by existing providers of developmental disability services, will coordinate all the services a person receives for their developmental disability as well as the coordination of health, wellness, and mental health services through one individualized Life Plan. The new organizations will be staffed by Care Managers. To maintain existing relationships as much as possible, the new Care Managers in many cases will be current Medicaid Service Coordinators who will receive additional training for this new role. Care Managers will help coordinate services across systems, including
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Volume 3, No. 11 March 12, 2018
OPWDD, the Department of Health, and the Office of Mental Health, providing one place to plan all of a recipient’s service needs. OPWDD states that there will be no changes to a person’s supports and services as this transition from MSC to Health Home Care Management takes place, unless changes are requested by the person receiving services, or by their decision-makers. Health Home Care Management should not be confused with Managed Care. Managed Care will be offered statewide to people with developmental disabilities at a future date. People who choose not to receive comprehensive care management can choose to receive Basic HCBS Plan Support which will also be offered by CCOs. Basic HCBS Plan Support will be a very limited coordination option, similar to Plan of Care Support Services (PCSS) offered in the current system. People currently receiving supports and services through OPWDD will be hearing from their service coordinator between April and July with more information so they can choose their CCO, and whether they would like to receive Health Home Care Management or Basic HCBS Plan Support services.
Resources
“Ready or Not? Assessing the Capacity of New York State Health Providers to Meet the Needs of Veterans,” by the Rand Corporation https://nyshealthfoundation.org/wp-content/uploads/2018/02/RAND-Ready-or-Not-Veterans-CareMarch-2018.pdf
“Reliance on Unverified Patient Lists Creates a Vulnerability in Home Health Surveys,” by the Office of Inspector General https://oig.hhs.gov/oei/reports/oei-05-16-00510.pdf
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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CHHA MEMBER Forum Please join the staff of HCA and member colleagues from the Association and the home care community for the first HCA CHHA MEMBER Forum. Participation in HCA Member Forums gives you an opportunity to interact with HCA staff and members, and exchange valuable information with your colleagues.
CHHA Member Forum Friday, February 23, 2018 10:30am to 2:00pm Jackson Lewis Offices 677 Broadway, 9th Floor Conference Room Albany, New York 12207 Lunch will be served.
Some of the important issues to be discussed include: • • • • •
Update on state budget provisions impacting CHHAs and home care providers; Financial condition of CHHAs and operational and contracting concerns; Challenges facing CHHAs in integrated models of care and payment; Compliance challenges; and Other issues of concern to CHHAs.
Payment of $39 per person
Registration
Please check method of payment:
Name: ________________________________________________________
*Make checks payable to: HCA and mail to 388 Broadway, 4th Floor, Albany, NY 12207. Checks must be received by February 15.
Title: _________________________________________________________
____MasterCard ____VISA ____Am Exp
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Organization:___________________________________________________
______________________________________________________ Card Number
_______________________________________________________________ Mailing Address
_________________________________ _________________ Expiration Date Security Code
City/State/Zip:__________________________________________________
______________________________________________________ Billing Address of Card Holder
Email:_________________________________________________________ Phone:_________________________________________________________ (Required for registration) Cancellation Policy Cancellations received by February 15 will receive a full refund less 25% of total due as an administrative fee. Cancellations received on February 16 or later will forfeit their registration fee along with those who register and do not attend. Substitutions are permitted. Please contact Teresa Brown at (518) 426‐8764 or tbrown@hcanys.org to cancel.
______________________________________________________ City, State, Zip ______________________________________________________ Name on Card ______________________________________________________ Authorized Signature
FAX TO: (518) 426‐8788 For more information, contact Andrew Koski at (518) 810‐0662 or at akoski@hcanys.org
Senior Financial Managers Forum
March 22, 2018
Senior Financial Managers Forum March 22, 2018
HCA’s Senior Financial Managers Forum is our popular daylong conference that covers every major finance and reimbursement issue confronting home care providers and MLTC plans on the state and federal levels. Traditionally, HCA’s Forum has been reserved for HCA members only, but this year we are opening registration to all home care providers and MLTCs, with a premium registration rate for HCA members. As in past years, HCA Policy staff will be joined by state Department of Health reimbursement officials, consultants, federal policy experts, and, new this year, a representative from New York’s Medicare Administrative Contractor, National Government Services. Please join us on March 22 to hear from these experts and get all of your finance questions and information needs covered.
Senior Financial Managers Forum
AGENDA
March 22, 2018
8:00am – 8:30am
12:00pm – 1:00pm
HCA Registration & Continental Breakfast
Lunch
8:30am – 9:30am
1:00pm – 2:15pm
HCA Update
What’s in Store for Home Care in 2018 on the Federal Regulatory and Reimbursement Front?
HCA staff will provide a state legislative update, focusing on the Governor’s proposed 2018‐19 Executive Budget and its impact on home care and Medicaid managed long term care, along with an update on our advocacy efforts in Albany and in Washington. HCA staff will highlight our annual financial condition report as well as discuss the latest on minimum wage funding, 24-hour live in cases, Value Based Payments, the Quality Incentive Vital Access Provider Pool (QIVAPP) and the 2018 Medicare Home Health Prospective Payment System (HHPPS). 9:30am – 10:30am
Department of Health Update John Ulberg, Jr., Medicaid Chief Financial Officer, Division of Finance and Rate Setting, Office of Health Insurance Programs, NYS Department of Health (Invited) Mr. Ulberg and/or staff from his Division will provide updates on the following: provisions in the 2018‐19 Executive State Budget that impact home care, personal care and Medicaid Managed Long Term Care (MLTC) plans; the Medicaid Global Cap; CHHA Episodic Payment System (EPS) re-basing; premium rate adjustments to MLTC; QIVAPP funding; Wage Parity and Overtime adjustments to plans and home care providers; the CHHA, LTHHCP and Personal Care fee‐for‐service Medicaid rates; the Medicaid cost reports; and other Medicaid reimbursement issues. 10:30-10:45am
Break
10:45am – 12:00pm
Targeted Probe and Educate Lauri Domingo, Home Health Clinical Consultant, Jurisdictions 6 and K, Provider Outreach & Education, National Government Services (NGS) Ms. Domingo will provide an update on the new Medicare Home Health Targeted Probe and Educate (HHTPE) – an audit program which focuses on specific agencies that NGS has identified as at-risk for documentation noncompliance (including for face-to-face documentation). Ms. Domingo will also review: the latest medical review and appeals data (including the top claim denial reasons) and tips to avoid those denials; the latest Comprehensive Error Rate Testing (CERT) results and findings; NGS HHPPS utilization data specifically for New York State; and updates on important upcoming NGS educational webinars that may be of interest to HCA participants.
Colin Roskey, Principal, Lincoln Policy Group; Partner, Scully Roskey & Missmar (Invited) Washington, D.C.-based federal home health policy expert Colin Roskey is one of the most knowledgeable voices on Medicare home health and hospice regulatory and reimbursement issues. During his session, Mr. Roskey will provide an overview of the national health care landscape, as well as provide insight into upcoming methodology changes to the Medicare HHPPS, including the prospect that Congress or the federal government will revive the Home Health Groupings Model (HHGM). Mr. Roskey will also present on other regulatory and legislative items percolating at the federal level, including opportunities to revise the current face-to-face regulations and the status of legislation/bills that would be helpful to our industry. 2:15pm – 3:30pm
Payment Reform: Aligning Services, Costs, Risks, and Outcomes with Reimbursement Ed Buckley, Chief Executive Officer, Select Data Above all else, CMS wants Medicare home care payment reform that includes a new Home Health Groupings Model (HHGM). Reform means change and change can mean opportunity, but it can also mean risk. Since this reform, if enacted, will affect agencies uniquely, it is imperative that agencies think about implementing a new classification system to control costs and manage care. These classifications will require robust models to distinguish between patients in need of services for recovering from acute conditions and those in need of chronic care management. In this session, Ed Buckley of Select Data will provide insights on how to succeed under HHGM by delineating the care delivery priorities of your patients, better classifying their needs, and developing new costcontrol measures and models. 3:30pm – 3:45pm
HCA Closing Remarks & Adjourn
Senior Financial Managers Forum March 22, 2018
Registration
Registration Fee and Payment â–Ą â–Ą
HCA has reserved a limited block of rooms at the Hilton Garden Inn in Troy, NY for the night of Wednesday, March 21 at a discounted rate of $119 per night. To receive this special rate, please call (888) 224-9761 prior to February 21, and ask for the group code HCAC.
Become an HCA Member
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