NPP ADVOCACY
SURVEY
MEDICARE CARDS
LAWTALK
HCA applauds group of 6 Western NY providers who urged support from House sponsor Collins on a bill allowing non-physician practitioner (NPP) authorizations of home care.
HCA will be surveying members soon on Boarddirected strategic planning priorities.
More info on the rollout of new Medicare cards with MBIs in place of SSN-based numbers.
HCA’s counsel at Jackson Lewis provides the next installment of their LawTalk column, a monthly feature on legal issues that HCA members should consider.
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Your Source for HOME CARE News, Policy and Advocacy
COMING UP Blueprint for OASIS Accuracy April 9-10, 2018 Workshop (8 a.m. to 4 p.m.) April 11, 2018 COS-C Exam East Syracuse Upstate LHCSA Forum April 16, 2018 Utica Register for these and other programs online at https://hcanys.org/eventseducation/ upcomingevents.
Vol. 3, Issue 14 | April 2, 2018
Budget Rejects Most MLTC Cuts, Increases Infrastructure Funds but Imposes Modified LHCSA Constraints & Telehealth Expansion Beyond Home Care As reported in an initial memo to members on Friday and a new revised memo issued today, the Senate, Assembly and Governor finalized the Article VII health budget bills just before the weekend and the April 1 deadline for a new budget. This was accompanied by a revenue bill with additional budget implications for health care. Friday’s memo was preliminary. We have since updated it with several new items that HCA has identified in our further analysis of the budget bills, including the revenue bill that was not passed until late Friday night. Please download the updated memo at https://hca-nys.org/wpcontent/uploads/2018/04/Final201819BudgetMemoUpdate.pdf. See BUDGET p. 4
Health Commissioner Zucker to Discuss Vision for Home Care & Hospice at HCA Annual Conference HCA is thrilled to announce that the state’s Health Commissioner, Dr. Howard Zucker, is confirmed to speak at HCA’s upcoming Annual Conference, 40 Years Strong, on May 9-11 in Saratoga Springs. If you’d like to hear from Dr. Zucker, the state’s top health official, on his vision for home care and hospice, please register for the conference online today at https:// events.eply.com/HCAAnnualConference20182357221. See ZUCKER p. 2
INSIDE State Budget Passes Before April 1 Deadline.....................................................1 Health Commissioner Zucker to Discuss Vision at HCA Annual Conference........1 WNY HCA Members Write to Rep. Collins on NPP Authorization Bill....................3 Upcoming HCA Survey to Gauge Your Priorities, Input on Member Services............3 Sepsis User Agreement & Other Resources Posted in Follow-up to Trainings......6 NYC Paid Care Division Issues Two Reports.......................................................7 AGs Endorse Bill Broadening Investigation Powers in Home Care Settings..........8 Member Hiring Announcement........................................................................8
Update on New Medicare Card Policy......................................................9 CMS Seeks Input on Draft Measure for Transitions from Hospice.............10 Emergency Preparedness Update........................................................11 LawTalk: Dusting Off and Refreshing Your Organization’s Policies...........12 Substantial Home Equity Amount Increased.........................................13 Trump Signs Bill Providing VA Coverage of Adult Day Health Care.............14 Resources...............................................................................................................14 Important Upcoming Deadlines and Due Dates...................................15
The Situation Report: the Home Care Association of New York State
ZUCKER from p. 1 This is a rare opportunity for the Commissioner to address HCA’s members in a home care and hospice-focused venue, which is vital to our ongoing discussions with him about health care program priorities. As the state’s chief physician, Dr. Zucker leads initiatives to combat the opioid crisis, strengthen environmental health, end the AIDS epidemic in New York, and other public health priorities while overseeing the state Department of Health (DOH) and its many divisions affecting home and community-based services as well as all other health sectors. HCA has engaged Dr. Zucker on several specific public health and program issues in recent years, including, specifically, our sepsis prevention and intervention initiative. (See related page 6 story.) Dr. Zucker has been especially receptive to this effort, as well as our mutual concerns about workforce shortages in the home and community-based sector. HCA is working to support home care’s efforts in addressing other core public health challenges, such as the opioid crisis and addiction management, asthma, behavioral health, social determinants of health, and other issues of great concern to Dr. Zucker. Please join us at HCA’s Annual Conference to learn how these developments will shape the direction of services you provide to the community. To learn about our other sessions at the HCA Annual Conference, please check out the brochure here: http://hcaannualconference.com/ wp-content/uploads/2018/03/2018-HCA-Annual-ConferenceBrochure.pdf.
Volume 3, No. 14 April 2, 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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WNY HCA Members Write to Rep. Collins on NPP Authorization Bill HCA members serving Buffalo, Rochester and surrounding counties sent a letter this week to Western New York Congressman Chris Collins bolstering his support for legislation (H.R. 1825) to allow non-physician-practitioners (NPPs) to order and refer for home health services. Rep. Collins is sponsor of this priority bill and has indicated his support to move it forward this Congressional session. The bill has widespread bipartisan co-sponsorship, including from 11 members of the New York House Delegation. Please see the list of House cosponsors at https://tinyurl.com/ ycywod6v. If Representatives serving your patients are not on this list, please contact their offices to urge their co-sponsorship of H.R. 1825 so that we can keep up momentum on this priority bill. If you need any assistance, please contact HCA’s Communications Director Roger Noyes at rnoyes@hcanys.org. “At a time when the health care system is looking to home care as a less costly alternative setting, it only makes sense to allow for equitable standards of service authorization,” providers state in the letter (available at https://hcanys.org/wp-content/uploads/2018/03 LetterofSupporttoChrisCollinsHR1825.pdf). “NPP ordering and referring permissions for home care would properly incentivize community-based services and allow for the prompt facilitation of services in the setting where most patients prefer to be – at home. This flexibility is especially important in many of the rural areas we serve throughout Western New York, including in the counties of Erie, Niagara, Orleans, Genesee, Wyoming, Monroe, Livingston and Ontario, where access to primary care services is enough of a struggle without the added demand on physicians to be the sole gatekeeper for facilitating access to home care.” Further background on the bill is summarized in the full letter to Rep. Collins, as well as in our recent position papers on federal mandates (https://hca-nys.org/ wp-content/uploads/2017/01/HomeCareRegulationsandMandates.pdf). HCA has engaged members in grassroots advocacy on this bill in the past, including through action items posted to our Legislative Action Center, where providers have sent well over a 1,000 messages on this bill. We need to keep up the momentum of co-sponsorship, support, and eventual passage of this critical bill. HCA thanks the following members for signing-on to this letter: Judy Baumgartner, President of the Visiting Nurse Association of Western New York, Inc.; Elizabeth Zicari, President of HCR Home Care and a Member of HCA’s Board of Directors; Jane Shukitis, President and CEO of UR Medicine Home Care and a member of HCA’s Board of Directors; Randy Gerlach, President and CEO of Schofield Care; Stephen H. Cohen, MD, President of Lifetime Care; and Joyce Markiewicz, President & CEO of Home & Community Based Care and Executive Vice President at Catholic Health.
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Upcoming HCA Survey to Gauge Your Priorities, Input on Member Services HCA’s Board of Directors has been engaged in a series of discussions about strategic planning for the future, including possible new organizational directions, new lines of member services and other changes to best fulfill our mission on behalf of members and the patients you serve. These discussions remain formative, and HCA very much seeks input from the membership on specific ideas that are under consideration, as well as your assessment of how we are doing in terms of our longstanding member services on your behalf. HCA will be sending members a brief survey to inform these efforts and to gauge what you believe should be our priorities. Please look for this survey soon and complete it as soon as possible.
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BUDGET from p. 1 This year’s budget process had many high-stakes proposals, including big revenue assumptions such as those based on insurance law changes accruing $2 billion in state revenue from the sale of non-profit Fidelis Care to the for-profit Centene. It also included many provisions of direct consequence to home care, hospice and Managed Long Term Care (MLTC) plans. The final budget was greatly improved over the Executive’s original budget, mitigating areas of major concern to HCA throughout the process. The final budget rejected many of the Executive’s proposed MLTC cuts and actions which would have had a major adverse impact on MLTC stability as well as services across all home and community based subsectors. The final budget also fought back what would have been the Executive’s disastrous limit on MLTC-LHCSA contracts, originally proposed as a hard limit of 10 LHCSA contracts per plan. While less draconian, the alternative adopted by the Governor and Legislature at the close of the budget is nevertheless problematic in other ways. The final budget will also factor public need into the approval of new LHCSAs (which article 36 has long prohibited) and applies a temporary moratorium while Certificate of Need (CON) changes are instituted. By requiring all LHCSAs to register and file requisite information with the state, the budget also responds to concerns (including those of our industry itself) that some agencies have not been compliant in providing required statistical reports or cases where licenses exist with sponsors who are not implementing the license to provide services. Among the MLTC cuts or changes rejected were: the carve-out of transportation services; MLTC audit and reporting language; and the requirement of a Uniform Assessment System score of 9 (up from 5) for MLTC service eligibility. The budget does, however, place limits on MLTC coverage of nursing home care (HCA had worked for a more flexible option for coverage based on MLTC plan-specific factors) and arrived at a compromise point related to patients’ ability to switch plans. (Several other MLTC provisions have been added to our updated memo linked at the beginning of this article, building on the items summarized for members on Friday). Regarding the LHCSA changes, the budget provides that the Commissioner of Health may establish the following schedule of contract limits:
MLTCs operating in New York City and/or Nassau, Suffolk and Westchester will be limited to one LHCSA contract for 75 enrolled members as of October 1, 2018, and to one contract per 100 members as of October 1, 2019. (For instance, if an MLTC had 750 enrollees, it would be limited to 10 contracts as of October 1, 2018. If an MLTC had 1,000 enrollees, it would be limited to 10 contracts as of October 1, 2019.)
MLTCs serving all other counties in the state would be limited to one contract for 45 members enrolled as of October 1, 2018, and to one contract per 60 members enrolled as of October 1, 2019. Continued on next page
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Continued from previous page While these provisions do not impose a hard limit on contracts – as the Governor’s proposal had initially proposed – they nevertheless create an arbitrary mechanism for managing MLTC and provider network arrangements, risking service and system instability. Intensive HCA advocacy will be required during the Administrative implementation phase of these provisions. HCA will also be directing our post-budget advocacy at a set of newly adopted telehealth provisions in the budget, enabling the home to be an originating site for telehealth providers beyond just home care agencies. HCA advocated extensively to modify these provisions to ensure appropriate safeguards for patients and the system, so that in-home telehealth is within the lawful licensure and scope of practice of the provider for delivering this type of service in the home. The final, enacted proposal, as extensively covered in past communications to the membership, does not contain such safeguards to protect the quality and standardization of services to patients. HCA will work to see that the implementation process further specifies these standards. Another major prong of our advocacy work this year was to urge an increase in health care infrastructure funds – and a specific allocation for home care and hospice providers. The budget authorizes a Phase III of the state’s health care transformation program for such purposes. This program will provide up to $525 million. (Our memo last Friday stated a lower figure based on our cursory analysis, which has since been updated in the new memo.) Of this $525 million, a minimum of $60 million is to be available to community based health care providers, including home care and hospice; $45 million is to be made available for nursing homes; and $20 million for assisted living programs. Furthermore, the late-finalized revenue bill creates an additional Health Transformation Pool and a health care charitable asset fund intended to be supported by a portion of the funds derived from the Fidelis-Centene acquisition. The Governor also announced the creation of a new $175 million workforce initiative, and the creation of a health care shortfall “contingency” fund in the event need is triggered by changes at the federal level. These and other new items are outlined in our updated memo. Important for hospice, the final budget provides hospices with a 10 percent reimbursement rate increase, and the proposed surcharge on opioids was tabled for an alternative “Opioid Stewardship” program. HCA will continue our budget analysis and engagement with the Legislature and Executive on next critical steps in the budget process. We will provide the membership with further updates and analysis accordingly. We will also be announcing a statewide member call to summarize these provisions in greater detail with you and to provide a forum for you to ask questions.
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Sepsis User Agreement, Info Guides, Data Sheets & Other Resources Posted in Follow-up to Training Sessions Much more to come on ‘Stop Sepsis at Home’ initiative, including technical support, education and collaboration activities HCA has completed our wintertime Stop Sepsis at Home Regional Training sessions, which drew participation from hundreds of home care provider representatives and partners throughout New York State. Whether or not you participated in one of these eight sessions, you can still incorporate HCA’s sepsis screening tool into your home care operations by signing a user agreement with HCA. We stress that the user agreement is required of all organizations wishing to use HCA’s screening tool, including participants in our regional training sessions. You can find a PDF of the user agreement on the Tools and Resources page of our Stop Sepsis at Home website at: http://stopsepsisathomeny.org/tools-and-resources/. Now that the training sessions have concluded, HCA has posted several other important resources to this webpage, including slides from the training sessions, fact sheets and guides, information related to our Stop Sepsis at Home grant (supported by the New York State Health Foundation), links to our partner organizations’ websites, and more. We’ve also posted an archive of webinars (hosted by IPRO) which are a prerequisite for organizations who did not attend the regional training sessions but would like to sign a user agreement to use the sepsis screening tool. In summary, if you attended the regional training session or have participated in the IPRO webinars, then make sure to sign the user agreement and send it to HCA at sepsistool@hcanys.org so that you can receive the screening tool. If you did not attend a training session, nor viewed the webinars, make sure you view the archive of the webinars and then send a signed user agreement to HCA. The archive is hosted by IPRO at http://atlanticquality.org/initiatives/sepsis-initiative/educational-eventswebinars/. There’s still more to come in our Stop Sepsis at Home initiative, including:
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A recent webinar hosted for all New York State hospitals by the Healthcare Association of New York State to present the tool and promote hospitals’ collaboration with home care partners on sepsis. Continued on next page
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Continued from previous page
Plans now underway with the state Office for the Aging on local caregiver sepsis education and training throughout the state, which would pair local aging network organizations with home care agencies using the sepsis tool.
A joint, statewide educational presentation for EMS and home care providers.
An all-partner Sepsis Summit being planned for home care providers, hospitals, physician practices, health plans, EMS and others.
State legislation and related work with the Department of Health to support provider implementation of sepsis initiatives, including electronic health records integration.
Further assistance to providers and continuum partners via HCA’s grant for sepsis from the New York State Health Foundation.
Please stay tuned for announcements in each of these areas.
NYC Paid Care Division Issues Two Reports The New York City Department of Consumer Affairs Paid Care Division has issued two reports – one that describes its activities in year one of its operation, and the other that reports on findings from focus groups of care workers. The reports are at http://www1.nyc.gov/assets/dca/downloads/pdf/workers/Lifting-up-Paid-Care-Work.pdf and http://www1.nyc.gov/assets/dca/downloads/pdf/workers/Making-Paid-Care-Work-Visible.pdf. The Paid Care Division report incorporates some of the focus group findings. It provides an overview of paid care work in New York City, the Division’s operations and accomplishments in 2017, and an action plan. It concludes that:
Care workers are a large and growing segment of the New York City workforce.
Care workers are overwhelming low-income immigrant women of color.
The physical and emotional labor that care work entails is difficult.
Low pay and unpredictable hours are commonplace for care workers, as are provider compliance issues with labor laws.
The Paid Care Division works in partnership with paid care worker organizations, employers, and other stakeholders. It engages in policy development, outreach and education for workers and employers, intake and referral to outside resources for paid care workers, and original research. The Division also draws on Department of Consumer Affairs (DCA) resources and enforcement authority, including its enforcement of NYC’s Paid Sick Leave Law, which is investigating possible violations of the law.
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AGs Endorse Bill Broadening MFCU Investigation Powers in Home Care Settings The National Association of Attorneys General (AGs) has issued a March 28 letter to Congress, signed by nearly all state AGs, supporting a federal bill (H.R. 3891) that would expand the authority of Medicaid Fraud Control Units (MFCUs) to use federal funds for investigation of patient abuse and neglect in non-institutional settings, such as home care. New York Attorney General Eric Schneiderman is included among the co-signers on the letter available at http://www.naag.org/assets/redesign/files/sign-on-letter/Final%20NAAG%20letter%20to%20Expand%20MFCU.pdf. MFCUs are currently operated out of state AG offices and are authorized by statute to investigate and prosecute individuals and all types of providers who engage in improper or fraudulent Medicaid billing schemes, but they are limited by statute to investigate and prosecute patient abuse and neglect only in facility settings. MFCUs are not currently authorized to investigate or prosecute patient abuse or neglect in nonfacility settings, such as in a home care setting. “Other cases of abuse and neglect of Medicaid patients – such as in a home health care setting – fall outside the Unit’s authority,” says a press release from the Association, noting substantial growth in home and community-based services and others since the MFCU statute was enacted decades ago. “States electing to operate under the expanded authority of H.R. 3891, if enacted, would be able to use their MFCUs to investigate and prosecute cases of abuse or neglect of Medicaid patients in non-institutional settings.” As of September, the bill was referred to the House Subcommittee on health.
DIRECTOR OF PATIENT SERVICES
For home care and other community-based settings, this bill has potentially significant ramifications for broadening the investigation authority of the Attorney General’s office beyond billing schemes, which currently are under the purview of MFCU and are additionally enforced by bodies like the Office of the Medicaid Inspector General. The state Department of Health operates complaint and surveillance divisions with oversight of patient care violations, but a broader legal authority for action by the Attorney
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The Director of Patient Services has overall responsibility for the planning, interpretation and delivery of patient care services within the framework of the Agency's Mission and Strategic Plan. Ensures that services are provided within Agency, governmental and accrediting body requirements. Administrative areas of responsibility include clinical policy formulation and implementation, staffing and resource allocation, establishing goals and systems to provide high quality, safe and effective care. Qualifications: 1. 8-10 years of experience as Supervising Public Health Nurse in Certified Home Health Agency (CHHA) or Long Term Home Health Care Program (LTHHCP) 2. BSN/Master’s Degree in Nursing, Health Care Administration, or Public Health from an accredited college or university. 3. License and current registration to practice in the State of New York as an RN. 4. Strong interpersonal and communication skills. 5. Ability to work effectively in high- activity situations and under pressure and to meet the necessary time and schedule requirements as related to the position. 6. Able to work in close contact with leadership team, management staff, department staff, and community. Full job description available at www.vns.org. Apply directly on website or with resume to hrdept@vns.org. Competitive Salary/ Benefits Package Available
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General’s office significantly elevates the resources and legal mechanisms for investigation, enforcement and penalties. HCA believes that there must be zero-tolerance for the abuse of elderly and medically needy and vulnerable individuals in health care settings, regardless of whether facility based or community based. We strongly support efforts to prevent, control and eradicate any instances of such violations. At the same time, it is important that any new laws or layers of state and/or federal audit and investigatory practices are coordinated and avoid the too-frequent smothering effects from multiple, simultaneous, overlapping and procedurally demanding audit efforts. HCA will be further reviewing and discussing with national and other state partners the provisions and status of this legislation and any change in policy on the part of the state Attorney General’s office as a consequence.
Update on New Medicare Card Policy Effect on MLTC plans highlighted National Government Services (NGS) has provided an update on the new Medicare cards being assigned to beneficiaries. As noted in numerous communications, the Medicare Beneficiary Identifier (MBI) is replacing use of the Social Security Number-based Health Insurance Claim Number (HICN) on Medicare cards. The official transition period for the new Medicare card is April 2018 through December 2019. Medicare providers can use either the HICN or MBI during the transition period. Below are some scheduled milestones. April 2018
The U.S. Centers for Medicare and Medicaid Services (CMS) will begin to mail the new cards, and mailing will be based on geographic location along with other factors.
The HIPAA (Health Insurance Portability and Accountability Act) Eligibility Transaction System (HETS) will read a message back to providers looking for eligibility that the beneficiary’s new card has been mailed.
A job aid at https://www.cms.gov/Medicare/New-Medicare-Card/NMC-Mailing-Strategy.pdf is available to help you determine the general time period for your patients.
June 2018
NGS providers will have access to MBI look-up tools at NGSConnex.
Medicare beneficiaries will have access to an MBI look-up tool through their MyMedicare.gov personal account.
October 2018
The Medicare paper and electronic remittance advice will display both the HICN and the MBI when a valid HICN is submitted on a claim. Continued on next page
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Continued from previous page January 2020 January 2020 is the final implementation date/time period. At this point in time:
The HICN will no longer be accepted on claims received on and after January 1, 2020. The HICN cannot be used for eligibility inquiries either.
Effect on MLTC Plans The state Department of Health has provided information on how this affects managed long term care (MLTC) plans. Beginning in April 2018, CMS will complete its system and process updates to be able to transmit the MBI. There will be a transitional period where the MBI is not available and the HICN will continue to be utilized. The transition period will run from April 2018 through December 31, 2019. MLTC plans could begin receiving the MBIs on the Managed Care Primary and Secondary Rosters during the transition period. Medicare Identification Roster Changes are as follows:
The MBI will occupy the same field as the HICN on the existing roster. The MBI will contain 11 alpha and numeric characters. CMS Example: 1EG4-TE5-MK73. The current HICN field length is 12 bytes; the MBI will appear in that field as “MBI + Space”. No changes are expected to be made to the roster layout. After December 31, 2019, HICNs will no longer be sent on rosters. If an individual has Medicare and does not have an MBI, a message will display “Pending MBI.”
Test roster files are available for MLTCs to confirm your ability to accept the roster files with the MBI information. MLTC plans should contact doh.sm.MLTC.System.Issues@health.ny.gov to request the test file for their plan. Further information is at https://www.cms.gov/medicare/new-medicare-card/nmc-home.html.
CMS Seeks Input on Draft Measure for Transitions from Hospice Care, Followed by Death or Acute Care The U.S. Centers for Medicare and Medicaid Services (CMS) has contracted with RTI International to develop quality measures for the Hospice Quality Reporting Program (HQRP). The purpose of this project is to complement the existing HQRP measure set, which includes quality measures based on the Hospice Item Set (HIS) and the Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS), with measures that address additional identified gaps in hospice quality measurement. The CMS contract name is Hospice Quality Reporting Program Measure Development, Maintenance, and Support and the contract number is HHSM-500-2013-13015I. As part of its measure development process,
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CMS requests interested parties to submit comments on candidate measures that may be suitable for this project. CMS will accept comments from March 27 through April 25, 2018 sent to: HQRPTransitions@rti.org The measure currently under development – “Transitions from Hospice Care, Followed by Death or Acute Care” – uses Medicare fee-for-service claims data to assess potentially concerning patterns of care posthospice discharge. To date, RTI International has conducted an environmental scan of the literature, convened a technical expert panel, performed empirical analysis, and drafted measure specifications. CMS also welcomes the public to provide comments on any aspect of this measure. To comment, review the “draft” RTI document at: https://www.cms.gov/Medicare/Quality-Initiatives-PatientAssessment-Instruments/MMS/Downloads/Development-of-Draft-HQRP-Transitions-MeasureSpecifications.pdf.
Emergency Preparedness Update This week, HCA participated in the Long Island Sub-Region Health Emergency Preparedness Coalition (HEPC) meeting. HEPC meetings are held around the state and engage participation from county, state and local emergency preparedness and public health officials and health care providers to plan and evaluate key areas for emergency preparedness. HCA works with the HEPCs and HEPC partners across the state to support the home care/hospice role and capabilities in emergency preparedness. HCA encourages all home care providers and MLTCs to attend these meetings and become active with their local HEPCs. At the Long Island meeting, participants: were briefed on an end-stage renal disease provider’s preparations for disasters; reviewed a threat and hazard assessment tool; and conducted a “hot wash” (comprehensive review) on the Coalition Surge Test/ Interoperable Communication drill held on February 8. The next HEPC meetings are: May 2 for North Country; May 15 for Capital District; June 6 for Lower Hudson Valley; June 7 for Long Island; June 14 for Western New York; June 14 for Central New York; and June 18 for Finger Lakes. For information on HEPC meetings, visit https://www.urmc.rochester.edu/emergency-preparedness/calendar.aspx. For further details, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org. Education Meanwhile, the state Department of Health (DOH) Office of Emergency Preparedness has posted its April 2018 Aware Prepare Update, which includes many educational opportunities. These include: Incident Command Training (April 3 on Long Island and recorded webinars available); Introduction to the Health Commerce System/HCS (April 4, online); Integrated Data Reporting in HERDS (April 9, online); HCS Communications Directory Certification (April 10, online); Safety and Violence Education Training (April 27 in Rochester); and more.
Continued on next page
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Continued from previous page The Update is available at https://hca-nys.org/wp-content/uploads/2018/03/2018_April_AP.pdf. POD Exercises A Point of Dispensing (POD) exercise involves responding to a simulated biological, chemical or radiological public health emergency and includes dispensing strategies, dispensing sites, dispensing modalities, and other approaches as necessary to achieve the dispensing goals appropriate to the targeted population. A March 28 POD held for certain counties in Central New York included a Medical Countermeasure Exercise based on a vaccine administration scenario. The local health departments were required to set up a POD clinic to provide vaccinations based on the exercise scenario. Some upcoming POD exercises include: April 3 in Schenectady; April 10 for Finger Lakes; April 26 for other counties in Central New York; May 1 for the Lower Hudson Valley; and May 9 for Long Island. HCA, along with the New York State Association of Health Care Providers, receives funding from the DOH Office of Health Emergency Preparedness to support the roles of home care and hospice in emergency preparedness in the whole state.
LawTalk Spring Cleaning: Dusting Off and Refreshing Your Organization’s Policies By Frank Fanshawe and Rose McKenna, Jackson Lewis PC The March storms have subsided, bringing the promise of Spring – a season of renewal and a great time to tie up loose ends. It’s also a great opportunity to do some organizational spring cleaning. This month’s LawTalk column focuses on the importance of reviewing and refreshing organizational policies. This (admittedly) tedious task may often compete with myriad other operational, financial and regulatory responsibilities that home care agencies, hospices and Managed Long Term Care (MLTC) plans face. But it needs to be revisited from time to time. There are several drivers of the policies and procedures that home care agencies, hospices and MTLC plans must implement:
Corporate/governance policies, such as company signatory authority for contracts and financial matters, annual tax reporting review, record retention policies and conflict-of-interest policies.
Employment-related policies, including workplace harassment, use of company electronic systems and whistleblower policies.
Regulatory and compliance policies, such as state Department of Health (DOH)-required policies and policies pertaining to billing. Continued on next page
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Continued from previous page
Cybersecurity policies, including incident response plans and emergency preparedness plans.
Privacy policies as well as policies stemming from the Health Insurance Portability and Accountability Act (HIPAA) and Health Information Technology for Economic and Clinical Health (HITECH) Act.
Generally, organizational policies are drafted by management and staff. In order to be finalized, however, organizational policies should be presented to and approved by the organization’s governing body. This process can have important compliance, liability and other implications for the organization. It is not uncommon for many organizational policies to then sit on the shelf without change, barring some notable circumstance which compels that they be revised. There have been many different legal and legislative changes over recent years which have an impact on organizational policies and these should be accounted for, such as: the Not-for-Profit Revitalization Act; continual changes to regulatory billing processes and protocols; court decisions and regulatory guidance; and policies to address more contemporary topics such as bed bugs and human trafficking, not to mention the changes to an organization’s operations, personnel and systems. When a new policy is implemented or an existing policy is changed, a review should be completed to determine what other policies may need to be refreshed as a result. Additionally, there are some policies, such as compliance plans and incident response plans, for which annual review is a legal requirement. Annual review of policies and procedures, while tedious, improves an organization’s knowledge of its policies and increases consistency among policies, leading to compliance and other benefits. It is, therefore, important to review these documents at least annually, and update them as needed. Spring is a great time to schedule this review. Each month, attorneys at Jackson Lewis (the firm that represents HCA as its counsel) will provide a brief, informational article on a legal topic relevant to HCA’s members. Please note that HCA LawTalk articles are for general, informational purposes, are not legal “advice,” and do not create an attorney-client relationship. Because each case is unique, the information provided should be considered to be general in nature, and should never be considered a substitution for legal counsel. Readers should not take, or refrain from taking, any action based on information in this article without first seeking legal advice from competent counsel.
Substantial Home Equity Amount Increased HCA advises members that the maximum allowable home equity threshold increased from $840,000 to $858,000 as of January 1, 2018. The Home Equity value is calculated by subtracting all legal encumbrances (such as liens, mortgages etc.) from the fair market value of the home. Aged, blind and disabled individuals whose equity interest in their homes exceeds the above limit are not eligible for the following services:
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Nursing facility services;
Community-based Long Term Care (LTC); and
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Volume 3, No. 14 April 2, 2018
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An increase in coverage for LTC
Medical bills may not be used to offset the value of an individual’s equity interest in the home. However, consumers may reduce the home equity value through a reverse mortgage or a home equity line of credit. The home equity limit does not apply:
If one or more of the following individuals resides in the home: spouse, minor child under 21, or a certified blind or disabled child of any age.
To individuals who were in receipt of LTC services before January 1, 2006 and have not experienced a break in eligibility for such services.
In addition, this provision is not to be applied if it creates an “undue hardship” that would deprive the consumer of:
Medical care such that the individual’s health or life would be endangered; or
Food, clothing, shelter or other necessities of life, and there is a legal impediment that prevents him/ her from being able to access his/her equity interest in the property.
Trump Signs Bill Providing VA Coverage of Adult Day Health Care President Trump has signed into law the “State Veterans Home Adult Day Health Care Improvement Act.” At present, only three veterans’ home facilities in the U.S. offer Adult Day Health Care, according to the office of New York Congressman Lee Zeldin, one of the bill’s sponsors. The new law defines Adult Day Health Care as a reimbursable treatment option through the Department of Veterans Affairs, providing the coverage at no cost for veterans with a 70 percent or more service-connected disability. Rep. Zeldin’s office says the bill would expand this option to any of the 153 veterans’ homes across the U.S. HCA will be examining the bill for potential opportunity areas for home care and VA collaboration on services. We applaud Congressman Zeldin for his efforts in community-based care for veterans.
Resources
“Including Hospice Care In The Medicare Advantage Benefits Package: Considering The Implications And Opportunities,” Health Affairs Blog (March 27, 2018) https://www.healthaffairs.org/do/10.1377/hblog20180322.994092/full/
“Medicaid Section 1115 Waiver Trends in an Era of State Flexibility,” by the National Association of Medicaid Directors http://medicaiddirectors.org/wp-content/uploads/2018/03/Section-1115-Waiver-Trends-NAMD-Whitepaper-1.pdf
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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Volume 3, No. 14 April 2, 2018
The Situation Report: the Home Care Association of New York State
Upcoming Deadlines
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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
Applications still being accepted, but providers must submit now
https://www.emedny.org/info/ProviderE nrollment/ManagedCareNetwork/index. aspx
Posting of OSHA Form 300A
February 1 to April 30
https://www.osha.gov/recordkeeping/R Kforms.html
Criminal history record check requirements apply to hospice
April 1, 2018
https://www.health.ny.gov/facilities/ho me_care/advanced_home_health_aides /docs/ahha_legislation.pdf
Submission of COI Compliance Implementation Plan forms by Regional Resource Development April 1, 2018 Centers to state Department of Health
https://hcaͲnys.org/wpͲ content/uploads/2018/01/ConflictͲofͲ InterestͲComplianceͲImplementationͲ Plan.docx; https://hcaͲnys.org/wpͲ content/uploads/2018/01/COIͲ ComplianceͲImplemenationͲPlanͲPowerͲ 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/NewͲ MedicareͲCard/index.html
Implementation of Universal Billing Codes for Home and CommunityͲBased Long Term Care Services under Managed Care
April 1, 2018
https://www.health.ny.gov/facilities/lon g_term_care/reimbursement/letters/dal _2017Ͳ12Ͳ07_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_cho ice_option.htm
Healthcare Personnel Influenza Vaccination Report
May 1, 2018 for personnel employed from immunize@health.ny.gov or (518) 473Ͳ 4437 October 1, 2017 to March 31, 2018
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