DSRIP
BROOKLYN $
MW
EMERGENCY PREP
DSRIP PPSs open for additional providers seeking entry from March 15 to April 1.
Funds available for Brooklyn providers to meet infrastructure needs, gaps.
DOH approves minimum wage funding for FIDA, PACE; Medicaid Managed Care rates to get adjustments on 4/1.
WNY emergency drill reveals extent of Level I patients in region with intensive needs.
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Your Source for HOME CARE News, Policy and Advocacy
COMING UP HCA Bootcamp: Establishing and Maintaining an Effective Compliance Program March 23, 2017 Visiting Nurse Service of New York 107 East 70th Street (between Park and Lexington Ave) New York, NY “Unpack the Home Health CoPs” April 5, 2017 Albany Marriott 189 Wolf Road, Albany, NY
Registration for these programs and other events are at http:// hca-nys.org/eventseducation/upcomingevents.
Vol. 2, Issue 11 | March 13, 2017
ACA Repeal-and-Replace Bill Advances The U.S. House of Representatives has formally issued its repeal-and-replace bill for the Affordable Care Act (ACA), also known as Obamacare. The measure was quickly shepherded to two House committees – Ways and Means and Energy and Commerce – where it was passed along party-line votes, setting the stage for next phases in the process, which involves review by the Budget Committee. See BILL p. 2
Winter Storm Preparedness News HCA Postpones Senior Financial Managers Forum on Wednesday A Nor’easter with potential for blizzard conditions and large snow accumulations is expected to impact all regions of New York State, arriving late tonight and continuing through late Tuesday night or early in the day on Wednesday. For members who registered to attend HCA’s Senior Financial Managers Forum on Wednesday, please note that this event is now postponed, and we See STORM p. 14
HCA and Members Urge Home Care Support as Legislature Finalizes One-House Budget Proposals HCA and members this week pressed for inclusion of our provider and MLTC priorities in the budget as the Senate and Assembly continue honing their one-house proposals. See BUDGET p. 4
INSIDE ACA Repeal-and-Replace Bill Advances................................................................1 Senate, Assembly Finalize One-House Budget Proposals......................................1 Winter Storm Preparedness News.......................................................................1 DSRIP Networks Open Again: Interested Providers Urged to Contact Local PPSs....3 Revised Managed Care Contract Documents Posted...........................................4 Health Care Facility Transformation Funding Available for Brooklyn......................5 DOH Updates on Managed Care Funding for Minimum Wage.................................6 Member Hiring Announcement...........................................................................6 Value Based Payment Progression.......................................................................7 Home Care Providers Asked to Check NYS Home Care Agency Profiles....................8
OMIG Resumes Semiannual TPL Case Requests Using Traditional Appeals........8 HCA Bootcamp for LHCSAs Seeking VBP Readiness............................................9 Other Upcoming Education Programs..............................................................9 CMS Announces Rerun of Hospice Quality Measure Reports...........................10 Performant Has Received CMS Approval to Begin Audit Activity......................10 Home Care’s Powerful Showing in Emergency Preparedness Exercises...........10 December Global Cap Report: Spending $2M Below Projections.....................12 Additional Information on SSN Removal Initiative..........................................13 NGS Announces New NGSConnex Website.....................................................14 New Guidance Issued for Care At Home Providers..........................................14
The Situation Report: the Home Care Association of New York State BILL from p. 1 ACA’s individual coverage mandates have drawn the most attention in heated debates about the future of the program, which Republicans and the Trump Administration have long vowed to eliminate. The G.O.P’s newly unveiled plan would eliminate the coverage mandates – along with the subsidies and taxes to fund coverage expansion – opting, instead, for tax credits that Americans would use to buy insurance on the open market. Notably, insurance companies would be allowed to charge an additional 30 percent to beneficiaries whose coverage lapses beyond 63 days. These and other massive changes in the repeal-and-replace bill are cued for “scoring” by the Congressional Budget Office (CBO), a statistical process which will determine how much the legislation will cost the federal government, how many people would be covered by the bill, and other critical factors to be considered in the debate about health care and its future design. For community-based providers and managed care plans in New York State, the potential impacts of this bill are multi-fold. On the employer side, the new bill would eliminate ACA’s mandate to provide health insurance to employees or else pay penalties. These expenses are largely unfunded by Medicare, Medicaid and other payors. Analysts approximate that 500,000 direct-care workers nationally obtained coverage through ACA – mostly through Obamacare’s expansion of Medicaid coverage. However, in another layer of complication, New York’s Wage Parity Law separately requires agencies to provide certain health benefits, or a higher wage level in lieu of such benefits, if they employ aides in New York City, Long Island and Westchester. Medicaid would get a major overhaul, affecting home care consumers and employers alike. Specifically, the House bill proposes per-capita caps on Medicaid funding to states, like New York. Also known as “block grants,” this change is expected to substantially reduce the federal-share of state Medicaid funding, creating state budget gaps that the Governor and Legislature would need to manage by limiting benefits (a possible major impact on home care 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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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 Alexandra Fitz Blais Director of Public Policy ablais@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 & Special Projects 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 and/or changes in coverage for some employees), imposing provider funding reductions, or pursuing alternative revenue sources for the Medicaid program. Governor Cuomo issued a statement opposing the bill while sharing the results of a state analysis indicating that the House proposal would shift $4.5 billion in spending on Medicaid over the next four years to state and county governments, as well as safety net hospitals. “At least $2.4 billion of these costs will be shifted annually beginning in 2020,” he said. “This burden could grow even larger when the impact of Medicaid block grants is taken into account.” He also indicated that over one million New Yorkers would face “a significant loss in health care coverage.” All told, the per-capita caps would place enormous pressure on state resources that currently cover many direct-care employees through ACA’s Medicaid expansion and patients receiving home and community-based services. But even more directly for home care, the bill eliminates ACA’s 6 percent incentive payment to states for Home and Community Based Services under Medicaid. New York is among several states that have opted for the incentive payment through the Community First Choice Option. House Republicans enjoy a considerable elected majority favoring repeal-and-replace. The bill has near-universal opposition from Democrats in both chambers, including the Senate, which has a thin 52-to-48 Republican
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Majority. This means that the Senate Republican leadership, especially, would need to muster its entire conference’s support to pass the bill. Yet even some Republicans have given a tepid response or voiced outright opposition to the current measure, most notably Kentucky Senator Rand Paul, as well as Utah’s Mike Lee and Tom Cotton of Arkansas. Senate Majority Leader Mitch McConnell said the Senate will complete its review and analysis of the House bill by today. Large-scale changes likely must be made for the bill to navigate the Senate, though opposition has also been voiced by House Republicans. Some of the more conservative House members have specifically argued against the bill’s continuation of the Medicaid expansion beyond 2017. The current version of the bill would roll-back the Medicaid expansion by 2020. The legislation also faces opposition or concerns from influential associations representing physicians, hospitals and insurance sectors, including the American Medical Association, the American Hospital Association, America’s Health Insurance Plans, and others. HCA will be sharing further analysis and updates as this process unfolds in the coming weeks and months.
DSRIP Networks Open Again: Interested Providers Urged to Contact Local PPSs As part of midpoint activities in the Delivery System Reform Incentive Payment (DSRIP) Program, the state Department of Health (DOH) is reopening the Performing Provider System (PPS) networks to additional providers. This network reopening will begin on March 15 and close on April 1, 2017. During this time the PPSs will be able to add providers for inclusion in their DSRIP networks. If your organization is interested in PPS network integration, you are encouraged to reach out to your local PPS. PPS contact information is posted on the DSRIP website under the heading “PPS Information” at https:// www.health.ny.gov/health_care/medicaid/redesign/dsrip/providers_professionals.htm. Questions on Provider Network reopening can be sent to the DSRIP team at dsrip@health.ny.gov.
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The Situation Report: the Home Care Association of New York State BUDGET from p. 1 As the Legislature’s proposals take shape, HCA has engaged with key offices of both houses throughout the past week, urging support for:
Home care and MLTC funding (including support for minimum wage and broader workforce needs, agency infrastructure);
Revised Managed Care Contract Documents Posted The state Department of Health (DOH) has just posted revised managed care contracts. These include:
Our draft legislative budget language (addressing rates, premiums, workforce and working capital); and
New York State Department of Health Provider Contract Guidelines for Article 44 Managed Care Organizations (MCOs), Independent Practice Associations (IPAs), and Accountable Care Organizations (ACOs).
Standard Clauses for Managed Care Provider/ IPA/ACO Contracts.
Provider Contract Statement and Certification form (DOH-4255).
Critical modifications to the Governor’s proposed budget, including rejection of the proposed MLTC cuts and adverse actions, and rejection of the Governor’s proposed hospice Medicare-Medicaid coordination-ofpayment language.
We also rallied members to send advocacy messages to legislators echoing support on these core items. Just this past week, HCA home care and MLTC members sent over 500 messages to their elected representatives using our Legislative Action Center, calling for “adequate Medicaid reimbursement for home care providers and MLTCs; a fix for long-neglected infrastructure investment needs in home care; and a plan to address workforce gaps and retention that limit accessibility of home care, even as the demand for home care is profoundly rising.” As of press time for The Situation Report, the Senate has reportedly developed a draft of its one-house budget measure and is deliberating today, with the expectation of acting on its proposals tomorrow. (However, with a major winter storm forecasted, this schedule could change.) The Assembly, meanwhile, is gearing up to finalize and vote on its one-house measure by Wednesday. These actions in each house will then kick-off a series of conference committees that will meet and reconcile the Assembly’s and Senate’s bills with the Governor’s proposals as the three parties negotiate a final budget, due by April 1. HCA will immediately inform the membership of key elements in the one-house bills, once they are made public, as well as the opportunities for grassroots advocacy as the conference committees deliberate.
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They are at https:// www.health.ny.gov/health_care/ managed_care/hmoipa/ hmo_ipa.htm. According to DOH, these documents were revised to modify the contract submission and review process to reflect Value Based Payment arrangements pursuant to the New York State Value Based Payment Roadmap and the Regulatory Impact Subcommittee. HCA will be reviewing the documents to determine any effect on plans and home care providers.
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Health Care Facility Transformation Funding Available for Brooklyn The state Department of Health (DOH), Office of Primary Care and Health Systems Management (OPCHSM) and the Dormitory Authority of the State of New York (DASNY) have announced funding available for provider application (including home care) under the “Health Care Facility Transformation Program: Kings County.” Funds are intended “to strengthen and protect continued access to health care services in communities within Kings County whose residents are experiencing significant levels of health care disparities and health care needs compared to other communities within Kings County.” A total of up to $700 million is available to one or more health care providers in Kings County. Home care providers are listed among the eligible entities, including general hospitals, residential health care facilities, diagnostic and treatment centers and primary care providers for projects that “replace inefficient and outdated facilities as part of a merger, consolidation, acquisition or other corporate restructuring activity intended to create a financially sustainable system of care.” To receive funding, eligible applicants must demonstrate how the proposed use of the grant is consistent with the recommendations for facility investments included in “The Brooklyn Study” for restructuring health care services in central and northeastern Brooklyn. That study, fully titled “The Brooklyn Study: Reshaping the Future of Healthcare,” was commissioned by DOH and prepared by Northwell Health. The final report is available at https://www.northwell.edu/about/our-organization/northwell-ventures/ brooklyn-study. The study says that projects should align with a holistic vision of health care which addresses social determinants of health through the integration and coordination of the services of the new health care system with programs that provide access to affordable and supportive housing, healthy food, exercise in a safe and supportive environment, and/or other programs that enhance a state of wellness in the community. Applications must be submitted in the Grants Gateway by 4 p.m. on Friday, May 5, 2017. Application information is at https://health.ny.gov/funding/rfa/1701230306/index.htm or on the Grants Gateway website at https://grantsgateway.ny.gov. The due date for submitting questions is March 24, 2017. Questions regarding the Health Care Facility Transformation Program for Kings County (RFA # 1701230306/Grants Gateway # DOH01-HCFTKC-2017) can be sent to kingscounty@health.ny.gov. As noted in prior communications, this year’s proposed state budget includes $500 million for the Health Care Facility Transformation program, of which at least $30 million is directed to home and communitybased health care providers under the Governor’s proposal. In recognition of state efforts to decrease hospital stays by 25 percent, and rely more on home-based providers, HCA is advocating that the targeted $30 million be increased to $125 million (or 25 percent of the overall $500 million). In addition to the $125 million for all community health providers, HCA has submitted other approaches to the Legislature and Governor in an effort to support home care infrastructure.
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DOH Updates on Managed Care Funding for Minimum Wage This week’s state Department of Health (DOH) Managed Care Policy and Planning meeting reported some important updates on minimum wage funding for managed care. Minimum Wage Funding for FIDA and PACE DOH reported that the state Division of Budget has approved minimum wage funding for FIDA (Fully Integrated Duals Advantage) and PACE (Program of All-Inclusive Care for the Elderly) managed long term care plans (for services provided in New York City). While the funds have not been sent to the plans yet, the funding will be retroactive to January 1, 2017 and guidance will be issued about passing through the monies to home care providers. Once we learn more, we will notify members. Minimum Wage Funding for Mainstream Medicaid Managed Care Mainstream Medicaid managed care plans will receive minimum wage funding in their rates starting April 1, 2017. DOH is still working on how this adjustment is going to be made and plans to issue a memo/guidance to the mainstream plans in the near future on this adjustment. The funds will be retroactive to January 1, 2017. DOH could not provide information on the amount of the funding yet and expects this adjustment to be included as part of the mainstream plans’ final 2017-18 rate package. A representative from Mercer, the state’s actuary, said that it expects to issue the final 201718 MLTC rate packages in early to mid-April, and these will include the risk adjustment update. For further information, contact the HCA Policy staff.
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Value Based Payment Progression The state’s value based payment (VBP) steering committee met last week to discuss the latest implementation recommendations. HCA is a committee member. The recommendations addressed the areas of:
Health information exchange between VBP partners.
Key principles, population traits, and goals for pediatric VBP models.
Initial sets of quality measures for some of the key VBP categories, including integrated primary care, behavioral health and HIV/AIDS.
The meeting materials can be viewed at http://hca-nys.org/wp-content/uploads/2017/03/ SlidesVBPMeetingMarch7.pdf. Participants discussed the status of VBP “pilots.” These are an initial set of opportunities for providers and plans to achieve a quick start in the process. The Department of Health (DOH) required “pilot” contracts by April 1. However, provider and plan representatives on the committee sought more time and data in order to proceed with and/or finalize contracts. Department officials maintained the April deadline, but said that missing the deadline would not otherwise limit any plan or provider from pursuing VBP arrangements through the normal process. The VBP “innovator program” was another major agenda item. This initiative within the overall VBP program is intended to provide an accelerated opportunity for extensively-resourced, experienced, and advanced partners to establish and facilitate large-scale VBP arrangements, such as for total care and cost for an entire population. Based on comments, the Department plans to revise and soon release the innovator application for public comment, concluding the process by mid-to-late March and resubmitting it to the Committee by April, followed by a May 1 launch. HCA continues to strongly encourage providers, managed care plans and strategic partners (e.g., hospitals, physicians, behavioral health providers) to explore innovative possibilities for VBP, as we advocate for the most supportive state environment for such arrangements. Coming up soon, HCA’s Annual Conference, on May 3 to 5, will offer VBP-focused sessions that we will shortly be announcing to the membership, along with the full conference agenda in Saratoga Springs. HCA Bootcamp for LHCSAs Also, as noted on page 9, HCA is holding a special bootcamp education program on May 18 called “Moving Beyond Personal Care to meet the Challenge and Opportunities of Value-based Care.” This special program will show LHCSAs how to fine-tune their operations in line with the new reimbursement models governing Managed Long Term Care under VBP. Please register today at http://hca-nys.org/wpcontent/uploads/2017/03/HCA-Bootcamp-Moving-Beyond-Personal-Care-May-18-2017.pdf. For further information, contact Al Cardillo at acardillo@hcanys.org.
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Home Care Providers Asked to Check NYS Home Care Agency Profiles The state Department of Health (DOH) has asked HCA to have our members check the information posted on the New York State Home Care Agency Profile website. That site is at https://profiles.health.ny.gov/home_care/index. DOH is requesting that home care providers check the accuracy of their profile information, including: website; phone number; address; counties served; services, etc. DOH recently revised the site and wants to ensure that the information is correct. Any changes should be sent to homecare@health.ny.gov.
OMIG Resumes Semiannual TPL Case Requests Using Traditional Appeals The state Office of the Medicaid Inspector General (OMIG) has resumed its semi-annual demandbilling process for the second half of federal fiscal year (FFY) 2016. Details are outlined in a letter that some Medicare-certified home care providers (CHHAs or LTHHCPs) should have received from OMIG and its Third Party Liability (TPL) contractor, the University of Massachusetts Medical School (UMMS). The letter identifies which cases have been selected to undergo appeals (through demand billing), with dates of services that occurred in the third and fourth quarters of FFY 2016 only (April 1, 2016 through September 30, 2016). UMMS’s letter also instructs providers to continue to monitor the status of your demand bill claim(s) once submitted. Providers are required to correct any claims that are rejected or suspended by the Medicare Administrative Contractor (MAC), National Government Services (NGS). In addition, providers are required to timely submit a complete medical record to NGS once the Additional Development Request (ADR) is issued. If your agency is selected for future quarterly initiatives, a separate notification letter and “Case Selection Report” will be sent at that time. HCA members interested in knowing whether they should have received a letter from OMIG can e-mail HCA at info@hcanys.org. For specific questions about the letters, contact UMMS’s Laurie Burns at (866) 626-7594.
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HCA Bootcamp: Moving Beyond Personal Care to Meet the Challenge & Opportunities of Value-Based Care May 18, 9:30 a.m. to noon in NYC As New York State races toward a system of value-based payment metrics and financial incentives, LHCSAs must deliver on the quality-of-care expectations being driven by their managed care plan contract partners in the evolving landscape. This program will show LHCSA operators how to fine-tune their operations in line with the new reimbursement models governing managed long term care for enhancing LHCSA appeal in contract negotiations and readying LHCSAs to meet the standards of a fundamentally changing system. Learn more and register at http://hca-nys.org/wp-content/uploads/2017/03/HCA-Bootcamp-MovingBeyond-Personal-Care-May-18-2017.pdf.
Other Upcoming Education Programs HCA Bootcamp: Establishing and Maintaining an Effective Compliance Program March 23, 9:30 a.m. to noon | NYC Compliance affects all aspects of your agency’s operation. Addressing compliance, in a comprehensive way, shouldn’t happen after your next audit. Refine your compliance plan today, and avoid costly problems down the road. “Unpacking the Home Health CoPs” April 5, 9 a.m. to 4 p.m. (8 a.m. breakfast) | Albany The biggest federal home health regulatory changes in thirty years are coming in just four months. Yes, four months! This daylong program will explain the rules, and get your organization ready for the wave of new requirements. Blueprint for OASIS Accuracy: OASIS C-2 Data Set April 19-20 Workshop (8 a.m. to 4 p.m.) April 21 COS-C Exam (9 a.m. to 11:30 a.m.) Schenectady OASIS coding is complicated, and CMS keeps adding new items and item number changes. Ensure that your clinical team can master OASIS C-2, for high-quality care and success on performance measures. Registration for all of these programs is on our website at http://hca-nys.org/.
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Hospice Quality Reporting Program: CMS Announces Rerun of Quality Measure Reports The U.S. Centers for Medicare and Medicaid Services (CMS) recently identified and corrected an issue with calculations for the following reports with implementation dates of December 18, 2016 through February 26, 2017:
Hospice-Level Quality Measure Report Hospice Patient Stay-Level Quality Measure Report
Hospice providers should rerun any reports during this date range. For additional information, go to the Hospice Item Set Technical Information website at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-QualityReporting/HIS-Technical-Information.html.
Performant Approved to Begin Audit Activity Performant, the Region 1 Recovery Audit Contractor (RAC) for multiple states, including New York, has received approval from the U.S. Centers for Medicare and Medicaid Services (CMS) to begin recovery audit activity. National Government Services (NGS), New York’s Medicare Administrative contractor, encourages providers to visit the Performant Provider Portal website at https://www.performantrac.com/ ContentPages.aspx?Page=ProviderPortal for information. The site includes a CMS-approved “issues list” for “complex” or “automated” review, such as “inappropriate billing of Home Health codes during inpatient” admission and other watch-areas for providers. The site contains additional information such as frequently asked questions (FAQs), forms and sample documents. Providers should make sure their contact information is up-to-date. Performant Customer Service Representatives are available on weekdays from 8 a.m. to 4:30 p.m. at 866-201-0580 or at info@performantrac.com.
Home Care’s Powerful Showing in Emergency Preparedness Exercises Home care has shown itself as both a dedicated participant, and a significant service provider, in recent state/regional emergency preparedness exercises. The state Department of Health (DOH) presented a debrief last Thursday on the results of its WRECK-IT exercise in Western New York. WRECK-IT stands for “Western Region Emergency Communications Knowledge and Information Tests.” The exercise involved a staged weeklong, progressive emergency event simulating a winter storm impact. Actual, real-case statistics from the exercise revealed 2,469 priority level 1 home care patients residing in the western New York affected areas. These are patients with highly unstable or deteriorating conditions,
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in urgent need of care and uninterrupted services, and a projected need of hospital admission if home care is not present during a public emergency. These drill results validate the acuity level of patients at home, the need for home care and hospice personnel access to patients in emergencies, and the daily urgency of home care support. The data also underscores the consequences to patients, the system and costs in home care’s absence, substantiating our call for proper state support of the home care system – in rates, workforce, operations, and policy. DOH specifically praised the 99 percent home care participation rate – the highest exercise participation rate among sectors in the multi-year WRECK-IT program. HCA was a collaborative partner with DOH in preparing and reaching out to home care providers on this exercise and we are proud of this strong home care showing. HCA will be utilizing the data in our advocacy, and we thank the home care providers for their participation and significant contribution. DOH conducted another exercise over the past two weeks, staging a simulated severe flu outbreak. This statewide exercise (conducted with region-specific focus) included a home care agency prospective role for possible hospital decompression from surge admissions due to flu. Participation from home care neared 90 percent in some counties. Participation benefits agencies and the entire home care sector directly in terms of home care preparedness and the overall system’s integration of home care into emergency preparedness coordination and support.
SAVE THE DATE 2ND Annual
State and Regional Coalition Meetings This week, HCA participated in state and regional emergency preparedness coalition partner meetings. HCA met with DOH and colleagues from the New York State Association of Health Care Providers to discuss progress with state emergency preparedness initiatives in home care, including further work on local networking sessions with providers and emergency managers. We also discussed a planned toolkit to assist agencies with aspects of the new federal Conditions of Participation (CoPs) for emergency preparedness, along with other education initiatives in this area. HCA also participated in regional Health Emergency Preparedness Coalition (HEPC)
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JUNE 7 AND 8, 2017
Sponsorship Opportunities Available! For details contact Billi Wilson at (518) 810-0666 or bwilson@hcanys.org
EXCELSIOR SPRINGS AT THE COURTYARD MARRIOTT 47 EXCELSIOR AVENUE SARATOGA SPRINGS, NY 12866
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meetings in the Hudson Valley and Long Island regions, discussing all-sector as well as home carespecific emergency preparedness issues and initiatives. Providers are urged to regularly check their region’s HEPC calendars for training and education opportunities. Please see https://www.urmc.rochester.edu/emergency-preparedness/calendar.aspx (which is hosted for all regions by the University of Rochester Medical Center). Essential Personnel Bill Reintroduced – S.5016/A.6549 HCA’s “essential personnel” bill for home care and hospice has been reintroduced by Senator Andrew Lanza and Assemblyman Michael Cusick. The legislation helps ensure home care and hospice access to patients during emergencies through an “essential personnel” designation. The legislation also assures incorporation of home care and hospice input in the development and operation of local emergency plans. Prior versions of the bill have been vetoed by Governor Cuomo, despite overwhelming statewide need and support, and HCA is seeking to have this latest measure included by the Senate and Assembly as part of the new state budget. For further information, please contact Al Cardillo acardillo@hcanys.org or Alex Blais ablais@hcanys.org.
December Global Cap Report: Spending $2M Below Projections The state Department of Health (DOH) has issued its monthly Medicaid Global Cap report. This latest report, for December, covers the period of April 1, 2016 to December 31, 2016. The full report is at: https://www.health.ny.gov/health_care/medicaid/regulations/global_cap/monthly/ sfy_2016-2017/docs/dec_2016_report.pdf. It finds that overall spending for this period was $2 million below Medicaid Global Cap projections, across all sectors, a difference of $15.424 billion in actual spending versus $15.426 billion in estimated spending for the nine-month period. Specifically, DOH mentions the following two significant pressures on the Global Cap:
Managed Long Term Care was $29 million above projections due to higher-than-forecast enrollment. Through December, there were 6,392 more recipients (3.9 percent higher) than anticipated; and
“Other Long Term Care” spending was $5 million above estimates (a category that includes home care). This is a result of higher-than-forecast utilization through December. There were 2,211 more individuals receiving personal care services than forecast. The Department shows actual spending of $477 million versus projected spending of $472 million.
It should be noted, however, that DOH confirmed in a 2016 meeting with HCA and other association representatives that the Medicaid Global Cap projections will not include any additional Medicaid
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spending due to the phase-in of the $15-per hour statewide minimum wage, as these expenses will be kept outside the cap. In other report highlights:
Total Medicaid Managed Care (MMC) spending was $41 million over projections, a difference of $11.331 billion (actual spending) versus $11.290 billion (estimated spending).
Total Medicaid enrollment reached 6,125,152 enrollees at the end of December 2016. This reflects a net decrease of 42,138 enrollees, or 0.7 percent, since March 2016.
HCA is analyzing these global cap reports carefully in an information gathering effort, combined with other data analysis, to ensure accurate reflections of home care and MLTC finances, with an eye toward any indication of rate or payment decisions stemming from the state’s analysis of system performance. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
Additional Information on SSN Removal Initiative The U.S. Centers for Medicare and Medicaid Services (CMS) has posted additional information on its Social Security Number Removal Initiative. The revised information for providers is at https://www.cms.gov/Medicare/SSNRI/Providers/ Providers.html. It includes: coordination of benefits with other payors; and where to direct your patients to correct their addresses so they receive new Medicare cards. Under this initiative, Social Security Numbers (SSNs) will be removed from all Medicare cards by April 2019. A new Medicare Beneficiary Identifier (MBI) will replace the SSN-based Health Insurance Claim Number (HICN) on the new Medicare cards for Medicare transactions like billing, eligibility status, and claim status. Under the new system, each person enrolled in Medicare will be assigned a new MBI and sent a new Medicare card. CMS advises providers that the MBI is confidential, like the SSN, and should be protected as Personally Identifiable Information. Beginning in April 2018, CMS will start mailing new Medicare cards with MBIs to people with Medicare. Beginning in October 2018, through the transition period, when providers submit a claim using your patient’s HICN, CMS will return both the HICN and the MBI on every remittance advice. The MBI will be in the same place you currently get the “changed HICN.” More information is at https://www.cms.gov/Medicare/SSNRI/Index.html.
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The Situation Report: the Home Care Association of New York State
NGS Announces New NGSConnex Website Last week, National Government Services (NGS), which is New York’s Medicare Administrative Contractor, announced updates to its NGSConnex portal. Some changes include an Internet browser verification, an e-mail verification, multi-factor authentication, and some navigation changes. NGSConnex will also provide notification in the form of a visual graphic to let users know when a transaction or inquiry is processing. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
New Guidance Issued for Care At Home Providers eMedNY has posted a new guidance for Care At Home care management providers. The instructions are at https://www.emedny.org/ ProviderManuals/communications/ CAH_Medicaid_Update_-_3-9-17.pdf. According to the guidance, effective January 20, 2017, the U.S. Centers for Medicare and Medicaid Services (CMS) approved the consolidation of the Care at Home III, IV, and VI waivers into the “OPWDD Care at Home Waiver.” The new waiver will continue to serve medically fragile children under the age of eighteen who have a developmental disability and live at home with their parent(s) or legal guardian(s). Children who are currently enrolled under the CAH III, CAH IV or CAH VI Waivers, and who continued to meet eligibility requirements as of January 20, 2017, are automatically included in the new consolidated waiver. There will be no disruption in services for children served under the OPWDD Care at Home Waiver. The guidance includes three rate codes for case management services that must be used for dates of services starting April 1, 2017, regardless of which waiver the child was in prior to April 1.
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Volume 2, No. 11 March 13, 2017
STORM from p. 1 will provide an update by email alert regarding a new date. For emergency response activities, providers should be reviewing their Emergency Response and Evacuation Plans and be ready to activate these plans, according to a guidance issued today by the state Department of Health. (That guidance is available at http://hca-nys.org/wp-content/ uploads/2017/03/ ctrlaccamstmpNotification22063.pdf). Providers must “ensure procedures are up to date, understood by staff and that contact information for all key staff and response partners is current.” All home care and hospice providers are also encouraged to review plans for staff response. These include: any necessary notifications and alerts to staff, adjustment of shifts and management of staffing shortages due to transportation impacts, securing needed supplies and preparations for staff that remain on site if roadways are not passable, and what to do if communications are impacted. Home care agencies and hospices must also consider adjustment of visits to ensure that Level 1 patients are visited prior to the start of a forecasted storm, and that these (and all) patients are reminded of how to call for assistance if they lose their power or have a medical emergency. Providers should also:
Make plans for adjusting staff schedules/prioritizing patient visits in the days immediately following the storm, particularly if travel is still impeded, with a focus on reassigning staff based on proximity to patients.
Ensure that staff and their patients have enough supplies to cover a period
The Situation Report: the Home Care Association of New York State
Volume 2, No. 11 March 13, 2017
of at least 72 hours following the start of the storm.
Be ready to contact staffing services if a large proportion of their regular staff are unable to travel and perform any of their normal visits for a period of time following the storm.
Be ready to communicate with patients during and immediately following the storm to perform checks on their safety and condition of their health.
Have a plan for managing situations where patients refuse to evacuate a hazardous situation.
Please also note that the Department may initiate surveys or other data collection to assess the needs of patients and providers as the storm progresses, and agencies should be sure to routinely check the Health Commerce System (HCS) for key updates.
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