April 9, 2018 Edition of The Situation Report

UNIFORM BILLING CODES

MEDICAID ENROLLMENT REQUIREMENT

CLINICIAN DATA SEMINAR

OMIG WORK PLAN

After announcing a onemonth delay of the uniform billing codes on Thursday, DOH reverts back to original April 1 implementation.

DOH posts further info on requirement that providers must enroll in Medicaid or else face termination of managed care contracts.

HCA presents a new daylong seminar for clinicians on datadriven QI.

OMIG Work Plan highlights areas of audit and investigation focus for 2018 to 2019.

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COMING UP

Your Source for HOME CARE News, Policy and Advocacy

Vol. 3, Issue 15 | April 9, 2018

Upstate LHCSA Forum April 16, 2018 Utica

Survey Seeks Your Input on Priorities, Member Services, Strategic Directions

Compliance Roundtable: Tackling Survey “Hot Spots” and Plans of Correction April 26, 2018 New York City

As reported in last week’s newsletter, HCA’s Board of Directors has been engaged in a series of discussions about strategic planning for HCA and our future priorities as an association.

This discussion, facilitated by experts at Fazzi Associates, includes the consideration of possible new organizational directions, enhanced lines of member services, and other changes to best fulfill our mission on behalf of members and the patients you serve.

HCA’s Annual Conference: 40 Years Strong!

May 9-11, 2018 Saratoga Springs Register for these and other programs online at https://hcanys.org/eventseducation/ upcomingevents.

See SURVEY p. 2

Register for HCA Member Call This Wednesday on State Budget: April 11 at 10:30 a.m.

This Wednesday, April 11 at 10:30 a.m., HCA is holding a free, members-only statewide call with the HCA policy team to brief you on the final, enacted state budget.

See CALL p. 2

INSIDE Survey Seeks Your Input on Priorities, Services, Directions............................1 Register for HCA Member Call This Wednesday on State Budget....................1 CMS Issues Final MA Provisions Allowing for Non-Skilled In-Home Supports....1 A Message from HCA Sponsor RBC Limited....................................................3 DOH Reverts to April 1 Implementation of Uniform Billing Codes...................5 DOH Posts FAQs on Medicaid Enrollment Requirement................................5 Deadline Extended for Low Volume Appeals Initiative..................................6 Hiring Announcements...............................................................................7

CMS Issues Final MA Provisions that Allow for Non-Skilled In-Home Supports HCA had submitted comments, continues advocacy Last week, the U.S. Centers for Medicare and Medicaid Services (CMS) issued a final Medicare Advantage (MA) managed care Call Letter that allows MA plans to include additional services which “increase health and improve quality of life, including coverage of non-skilled in-home supports and other assistive devices.”

See MA p. 3 Med Rec & Management Insights at HCA’s Annual Conference...................8 Driving Decisions with Data: A Seminar for Clinical Managers...................9 State’s Medicaid Cap Report Shows $23M Variance..................................9 DAL Posted on Provision of Nursing Services in ALPs................................10 Upcoming Deadlines and Due Dates....................................................11 OMIG Releases 2018-19 Work Plan.......................................................12 PHHPC Meeting Agenda Posted.............................................................13 RFI Issued on Elimination of PRI Tool........................................................14 DOH Issues Health Advisory on Measles Exposure..................................14 Resources....................................................................................................15

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

SURVEY from p. 1 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 HCA’s longstanding member services on your behalf.

HCA and Fazzi have developed a brief, 19-question survey to inform these efforts and to gauge what you believe should be our priorities. This survey was e-mailed on April 4 to all of the main contacts listed in our database for HCA member agencies.

We ask all member organizations to complete this survey no later than April 20.

If you have any questions – or would like to know who at your organization received the survey – please feel free to contact HCA’s Director of Communications Roger Noyes at (518) 8100665 or rnoyes@hcanys.org.

CALL from p. 1 To register for the call this week, please complete the information in the online form at the following link: https:// www.surveymonkey.com/r/finalbudgetbriefing. Dial-in information will be sent to you in advance of April 11.

HCA urges members to read our memo to the membership prior to the call (https://hca-nys.org/wp-content/uploads/2018/04/ Final201819BudgetMemoUpdate.pdf). It details the provisions affecting home care, managed long term care and hospice.

Our call on April 11 will cover these issues as well as other items identified in our continuing examination of the budget bills.

The call will also offer an opportunity for members to ask questions and we will detail follow-up steps in the wake of the budget, including post-budget advocacy and legislation for the remainder of the legislative session.

Volume 3, No. 15 April 9, 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 V ice 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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The Situation Report: the Home Care Association of New York State

Volume 3, No. 15 April 9, 2018 

 MA from p. 1 The 2019 Call Letter is at https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/ Announcements-and-Documents.html and a fact sheet is at https://www.cms.gov/Newsroom/ MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-04-02-2.html.

With this significant change — supported by HCA in comments and advocacy to CMS and Congress — CMS is expanding the scope of allowed services beyond the primarily health-related supplemental benefit standard. Previously, CMS has not allowed an item or service to be eligible within the scope of a supplemental benefit if the primary purpose includes daily maintenance.

However, in the final Call Letter, CMS discusses a reinterpretation of the statute to permit an expanded scope. Under this reinterpretation, CMS would allow supplemental benefits if they are used to diagnose, prevent, or treat an illness or injury, compensate for physical impairments, act to ameliorate the functional/psychological impact of injuries or health conditions, or reduce avoidable emergency and health care utilization.

According to CMS, this expansion will effectively increase the number of allowable supplemental benefit options and provide patients with benefits and services that may improve their quality of life and health outcomes.

Continued on next page

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Volume 3, No. 15 April 9, 2018 

Continued from previous page In March, HCA had sent comments (https://hca-nys.org/wp-content/uploads/2018/03/CMS-Call-Letter_HCAsComments_030218-FINAL.pdf) to CMS on its then-proposed Call Letter, supporting CMS’s proposal. We had urged CMS to: 

Allow MA coverage of home health aide (HHA) and personal care aide (PCA) services to Medicare beneficiaries who do not also need skilled services.



Require MA plans to proactively screen Medicare beneficiaries for their eligibility for skilled home care services as well as appropriateness and need for HHA/PCA services.



Apply this policy change to Medicare fee-for-service beneficiaries too.



Open up participation to include those home care providers that meet federal or state licensure requirements, including Certified Home Health Agencies and Licensed Home Care Services Agencies.



Take steps to educate the MA plans on the importance of this new benefit and closely monitor its utilization by MA plans to ensure that it is being used to its fullest potential.

HCA is taking a very active national role in coordinating efforts by other state home care associations to support the implementation of this change and will be seeking HCA member engagement on this issue. HCA has already discussed this new change with Senator Charles Schumer’s health care team and will be working with the entire New York Congressional Delegation to promote widespread adoption by MA plans of these new benefits.

For more information, contact the HCA Policy staff.

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

Volume 3, No. 15 April 9, 2018 

DOH Reverts to April 1 Implementation of Uniform Billing Codes, Following Initial Delay Announcement The state Department of Health (DOH) sent a notice last Friday morning on the implementation of universal billing codes for Medicaid home and community-based long term care services provided to managed care plans, reversing course from a prior-day notice which had announced a one-month delay due to unspecified issues.

In the April 6 notice, DOH says these issues need not delay implementation; thus, uniform billing codes are in effect, as previously scheduled. The implementation date remains April 1, 2018.

“The Department of Health has received several inquiries regarding the delay of the implementation of universal billing codes for home care and adult day home care services from April 1, 2018 to May 1, 2018,” DOH officials state in their message on Friday. “We understand there to be several open issues that will need to be addressed but that these issues should not delay the implementation past April 1. Therefore, we would like to revert back to the April 1 implementation date.”

Following the unexpected notice of delay on Thursday, HCA had joined with colleagues in making immediate inquiries to DOH to determine the nature of the problem. It is not known what information prompted this earlier determination of delay or the conflicting communications from DOH. DOH also indicates that it is working to schedule a meeting to address some of the open issues that ostensibly prompted the original delay announcement, now reversed. Providers or plans with questions can contact DOH at nfrates@health.ny.gov.

HCA will keep the membership apprised of follow-up steps with DOH, including progress on any issues reported by members.

DOH Posts FAQs on Medicaid Enrollment Requirement The state Department of Health (DOH) has posted Frequently Asked Questions (FAQs) on the requirement that health care providers who contract with managed care plans must enroll in Medicaid and obtain a Medicaid provider number.

The FAQs are on eMedNY at https://www.emedny.org/info/ProviderEnrollment/ManagedCareNetwork/ FAQs.aspx?new=true#.

HCA has covered this issue in multiple Situation Report articles and reiterates the necessity of submitting Medicaid enrollment applications now or face termination of your managed care contracts by July 1.

The FAQs include the following information: 

Licensed Home Care Services Agencies (LHCSAs) need to enroll in Medicaid (even if they don’t bill Medicaid directly); Continued on next page

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Volume 3, No. 15 April 9, 2018 

Continued from previous page 

The Community First Choice Option services being implemented as of April 1, 2018 are services that are already in place in both Managed Long Term Care (MLTC) and mainstream Medicaid managed care plans and will not require “non-traditional” Medicaid managed care providers to enroll;



Enrollment applies to MLTC plans but not to Program of All-inclusive Care for the Elderly (PACE) and Fully Integrated Duals Advantage (FIDA) network providers; and



Social Day Centers are not subject to the enrollment requirement.

A list of Medicaid enrolled providers is at: https://health.data.ny.gov/Health/Medicaid-Fee-for-Service-Provider-Listing/keti-qx5t.

More information, including a list of providers that have submitted enrollment applications and webinar materials, is at https://www.emedny.org/info/ProviderEnrollment/ManagedCareNetwork/index.aspx.

Deadline Extended for Low Volume Appeals Initiative New appeals initiative is a voluntary option for providers distinct from TPL settlements The U.S. Centers for Medicare and Medicaid Services (CMS) has extended the deadline to submit an expression of interest (EOI) for the Medicare Low Volume Appeals (LVA) Initiative. The new deadline is June 8, 2018.

As reported in past editions of The Situation Report, this new appeals option is completely separate and distinct from the Third-Party Liability (TPL) settlement between the state Office of the Medicaid Inspector General (OMIG) and CMS. (The most recent update on this settlement is in the March 5, 2018 Situation Report at https://hca-nys.org/wp-content/uploads/2018/03/SitRep030518.pdf.)

Specifically, CMS will make available an administrative settlement process for appellants with fewer than 500 appeals pending at the Office of Medicare Hearing and Appeals (OMHA) and the Medicare Appeals Council (Council) at the Departmental Appeals Board, combined, as of November 3, 2017. Such providers may settle the portion of their pending appeals that have total billed amounts of $9,000 or less per appeal in exchange for timely partial payment of 62 percent of the net Medicare approved amount.

More information, including Frequently Asked Questions, is at https://www.cms.gov/Medicare/Appealsand-Grievances/OrgMedFFSAppeals/Appeals-Settlement-Initiatives/Low-Volume-AppealsInitiative.html.

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Volume 3, No. 15 April 9, 2018

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

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HIRING ANNOUNCEMENTS DIRECTOR OF BUSINESS DEVELOPMENT – MANAGED CARE Premier Home Health Care Services, Inc., is a leading multi-state established home care agency. We are currently looking for a Director of Business Development-Managed Care.

The role of this position is to develop and implement comprehensive business development plans and secure contract service opportunities related to managed care programs that will support and expand contracts onto the company’s business development pipeline. We would also expect that these initiatives will increase our business footprint within existing territories and out of state opportunities. This individual will be responsible for marketing the company’s Care Management/UAS, Chronic Care and Transitional Care Management programs.

The position requires a minimum of a Bachelor Degree but an MA/MPH/MBA is preferred. Five to seven years in a business development role with demonstrated revenue growth within a Managed Care, or other health/home care program is essential.

Excellent salary and benefits package available. Exciting bonus potential based on revenue growth. Interested candidates should forward résumés to: josullivan@phhc.com.

DIRECTOR OF PATIENT SERVICES: Visiting Nurse Services in Westchester 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 highactivity 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.

EOE/M/F/D/V

Experienced RNs - Looking for a change?

Nassau, Suffolk, Queens – Full Time & FFS If you’re an experienced RN looking for a new & exciting opportunity, talk to us at NYU Winthrop Home Care – We have the perfect job for you!

NYU Winthrop Hospital’s Home Health Agency ranks as a top-performing US Home Health Agency. Join our stellar team of nurses, therapy professionals and social workers and receive superior training through a preceptor program and one-on-one support from our staff development team. You’ll have the opportunity to utilize your skills to provide care to our community patients (all ages) through our case management model.

As a Home Health RN, you’ll enjoy more quality one-on-one time with patients, allowing you to focus on individuals and their families. You’ll have a direct impact on all aspects of care utilizing a team approach to reduce patient suffering and improve patient well-being.

Home care encompasses all types of specialties. We have an exciting array of programs for all types of experience including cardiac, diabetic management, telehealth, wound care, supportive/palliative care, pediatrics, maternal/child care.

MAKE A DIFFERENCE!!

1-2 years acute care or Homecare experience required.

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Full job description available at www.vns.org. Apply directly on website or with résumé to hrdept@vns.org.Competitive Salary/ Benefits Package Available

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

Volume 3, No. 15 April 9, 2018 

Med Reconciliation & Management Insights for QI at HCA’s 40th Annual Conference: Register Today!

Medication reconciliation and management are vital to fulfilling a patient’s home health plan of care in coordination with physicians. The Home Health Quality Improvement (HHQI) National Campaign specifically features medication management as an area for performance improvement projects under the new Quality Assurance and Performance Improvement (QAPI) requirements of the home health conditions of participation (CoPs).

There are countless other reasons why your organization must pay attention to medication reconciliation/ management for the improvement of patient health and safety. This is why HCA has two sessions devoted to this issue at our upcoming Annual Conference, on May 9-11 in Saratoga Springs.

This year’s conference, celebrating our 40th year as an association, is packed with operational, clinical, policy, public health, workforce and other topics specifically identified by the membership as areas where providers are eager for insights and information. (Please see the full conference brochure here: http:// hcaannualconference.com/wp-content/uploads/2018/03/2018-HCA-Annual-Conference-Brochure.pdf.)

Our breakout sessions on May 10 will include two segments addressing medication and pharmacy collaboration.

The first of these sessions, Processes, Challenges and Strategies for Post-Discharge Medication Reconciliation (presented by Anne Myrka, Director of Drug Safety at IPRO), will define medication reconciliation (especially as a post-discharge priority), discuss the impact of discrepancies, and explore challenges for home health care. The session will also offer strategies for successful implementation of post-discharge medication reconciliation and medication support, as well as identify and resolve problems related to high-risk drugs, such as opioids and anticoagulants.

A second segment, on Advancing Better Patient Outcomes through Pharmacy-Home Care Collaboration (by pharmacists John Croce and Steve Moore of Upstate-NY Community Pharmacy Enhanced Services Network) will explain the role pharmacists can play in supporting home care patients’ health. They’ll also highlight ways home care can build successful collaborations with pharmacists that synchronize with many of the state and federal provider partnership models, value based payments, and other carecoordination initiatives.

These are just a few of the many conference sessions that support your work. See all that’s in store for this banner HCA conference, just one month away. Please register now and check out all the conference details on our special conference website: www.hcaannualconference.com.

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

Volume 3, No. 15 April 9, 2018 

Driving Decisions with Data: A Seminar for Clinical Managers “Barbara Katz — Impeccable! Please do a full day with BK Consulting!!”

“I would recommend a front-line leader conference using BK Consulting & the utilization of data.”

“Barbara was a great speaker; kept us all engaged throughout the afternoon.”

“REALLY enjoyed Barbara Katz’s presentation...realistic, actionable, useful info.”

You asked for it ... and now HCA is delivering. Join us on June 6 in Albany for Driving Decisions with Data: A Seminar for Clinical Managers with Barbara Katz of BK Consulting, who received the rave reviews above from her presentation at HCA’s value-based payment conference almost two years ago. (Register here today at: https://hca-nys.org/wp-content/uploads/2018/03/Driving-Decisions-with-Data-Seminar-June-6-2018.pdf.)

This practical and interactive seminar will help clinical managers understand their role in using data to drive decisions for your agency’s Quality Assurance and Performance Improvement (QAPI) process and in daily clinical work. Managers will leave with essential tools and techniques for obtaining data, step-by-step data analysis methods and practical methods for achieving target goals. Participants will also have an opportunity to analyze clinical and business data, to develop action plans and to apply data-driven decisions to real operational work problems.

Presenter Barbara Katz is an experienced clinician, manager, trainer and health care consultant. She is a graduate of the Yale School of Nursing, has a Certificate in Training and Development from Fairfield University, and a Coaching Certification from the American Talent Development Association. She has been a hospital nurse, an Advanced Practice Registered Nurse (APRN), a training manager, a director of quality improvement and a clinical manager for a group of medical practices. She has also been a marketing director for a home health care agency and has managed operations for a private duty home care agency.

Make sure to notify your entire clinical management team about this exciting program to support their work to achieve system goals under value based payments, the Delivery System Reform Incentive Payment (DSRIP) program and other emerging clinically focused models for home care.

State’s Medicaid Cap Report Shows $23M Variance from Projections In April through December The state Department of Health (DOH) this week posted the October, November, and December 2017 Medicaid Global Cap Spending Reports.

The state’s latest report (for the current fiscal year through December 2017) finds that overall spending was $23 million above the global cap projections, across all sectors, a difference of $15.9 billion in actual spending versus $15.877 billion in estimated spending for the period.

The fiscal year (FY) begins on April 1 and ends on March 31, so this December report represents the end of the third quarter for state fiscal year 2017-18.

Continued on next page

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

Volume 3, No. 15 April 9, 2018 

Continued from previous page Nearly all of the provider and plan categories were above the cap projections. “Other Long Term Care” (which includes home care) was $21 million above projections. DOH notes that there were 2,568 more personal care recipients during this period, driving the costs. Managed Long Term Care was $13 million over projections due to there being 716 more recipients than anticipated during the report period.

In other report highlights: 

The Accounts Receivable (A/R) ending balance for FY 2017 was $204 million. The state is expected to recoup $135 million by the end of FY 2018, resulting in a projected A/R balance of $69 million by March 2018. Through the end of December, retroactive rates owed to the state were $150 million.

This reflects net recoveries of $54 million since March 2017.



Total Medicaid enrollment reached 6,136,996 at the end of December 2017. This reflects a net increase of 15,405 enrollees since March 2017.

The report contains multiple other data, including tables or summaries of: Medicaid Rate Packages, Beneficiary Transition Schedule to Managed Care, Phase VII Medicaid Redesign Team (MRT) Initiatives, Regional Medicaid spending, and more. The full report is at: https://www.health.ny.gov/health_care/ medicaid/regulations/global_cap/monthly/sfy_2017-2018/docs/dec_2017_report.pdf.

For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

DAL Posted on Provision of Nursing Services in ALPs Service must be conducted by a CHHA or LTHHCP-employed nurse; LHCSA nurse can perform assessment/ reassessment for ALP eligibility The state Department of Health (DOH) has posted a March 28, 2018 Dear Administrator Letter with updated Questions and Answers on the provision of nursing services in an Assisted Living Program (ALP), along with a DAL dated June 7, 2012, to highlight ALP changes.

The DAL s are at https://hca-nys.org/wp-content/uploads/2018/04/DAL_ALP-Nursing-Services_032818.pdf and https://hca-nys.org/wp-content/uploads/2018/04/DAL-_ALP_060712.pdf.

According to the postings, if an ALP is not certified as a Certified Home Health Agency (CHHA) or Long Term Home Health Care Program (LTHHCP), the ALP must contract with a CHHA or LTHHCP for the provision of nursing and therapy services.

Nursing services are permitted to be performed by a Registered Nurse (RN), or a Licensed Practical Nurse (LPN) under the supervision of an RN, who is licensed to provide nursing services in New York State and who is under the guidance and direction of a physician, as per requirements in the New York State Education Law at Article 139 Section 6902.

A nurse directly hired by an Adult Care Facility, which is not certified as a CHHA or LTHHCP, cannot provide nursing services in such setting. The Licensed Home Care Services Agency (LHCSA) RN can conduct initial assessments and reassessments for determining ALP eligibility.

Questions about both DALs can be directed to the Division of ACF/Assisted Living Surveillance at (518) 408-1133.

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

Volume 3, No. 15 April 9, 2018 

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/ManagedCar eNetwork/index.aspx

Posting of OSHA Form 300A

February 1 to April 30

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

Criminal history record check requirements apply to hospice

April 1, 2018

https://www.health.ny.gov/facilities/home_care/advanced_ho me_health_aides/docs/ahha_legislation.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/NewͲMedicareͲ Card/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/reimburse ment/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/co mmunity_first_choice_option.htm

Submission of Expression of Interest Open from April 12, 2018 for the Medicare Low Volume to June 8, 2018 Appeals Initiative

https://www.cms.gov/Medicare/AppealsͲandͲ Grievances/OrgMedFFSAppeals/AppealsͲSettlementͲ Initiatives/LowͲVolumeͲAppealsͲInitiative.html

2018 Adult Care Facility 1st Quarter Statistical Information Report (January 1 to March 31, 2018)

April 30, 2018

https://commerce.health.state.ny.us

Request for Information (RFI) on eliminating the Hospital and Community (H/C) Patient Review Instrument (PRI)

April 30, 2018

https://www.health.ny.gov/funding/rfi/pri/index.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/a ppeals/index.htm

May 16, 2018

https://nyshealthfoundation.org/rfp/2018ͲspecialͲprojectsͲ fund/?utm_source=Reminder+to+Apply%3A+2018+SPF+RFP&ut m_campaign=2018+SPF%3A+2nd+Reminder+to+Apply+%28w%2 Fvideo%29+Feb+2018&utm_medium=email

NYS Health Foundation Special Funds RFP

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

Volume 3, No. 15 April 9, 2018 

OMIG Releases 2018-19 Work Plan The state Office of the Medicaid Inspector General (OMIG) recently posted its 2018-19 Work Plan. It details OMIG’s program integrity focus areas in the Medicaid program for the State Fiscal Year (SFY) from April 1, 2018 to March 31, 2019.

OMIG’s 2018-19 Work Plan, as well as Work Plans from previous years, can be viewed at: https://omig.ny.gov/information/work-plan.

Where previous Work Plans have been updated annually, OMIG says it will be updating its Work Plans throughout the year. Updates will be posted at https://omig.ny.gov/index.php and update alerts will also be issued via OMIG’s listserv.

As part of its Work Plan, OMIG outlines three overarching goals: 1) provider compliance and OMIG compliance monitoring; 2) addressing waste, fraud and abuse in Medicaid; and 3) the development of data mining and analysis, cost-savings measures, pre-payment reviews, and other analytic capabilities.

HCA recommends that members read the detailed list of OMIG focus areas at the link above. The Work Plan identifies the following organizational focuses: 

Certified Home Health Agency (CHHA) fee-for-service (FFS) and Episodic Payment System (EPS) audits.



Personal Care Services (PCS) FFS Medicaid claims, as well as PCS services provided through Medicaid Managed Care Organizations (MCOs). When auditing or investigating matters related to personal care assistants, OMIG also “assesses the responsibilities of any entity associated with the personal caregiver and takes appropriate actions when those responsibilities are not being met.”



The Consumer Directed Personal Assistance Program (CDPAP) to ensure compliance with rules and regulations, including audits of services reimbursed through FFS and MCOs.



Managed Long-Term Care to ensure enrollees are eligible for the program and “that appropriate care management is being provided by the MLTC plans.” OMIG will also review enrollment records, plans of care and claims data to determine medical necessity of services. Additionally, OMIG will examine Case/Care Management system notations and “assess MLTC plans to ensure that their contractual obligations in serving their recipient population are being met.”



Mainstream Medicaid Managed Care audits of Medicaid managed care operating reports (MMCOR) to ensure only proper costs were utilized in the development of respective rate components. OMIG will also perform audits of providers within MCOs’ networks to ensure the accuracy of encounter claim submissions and identify improper encounter claims that contribute to inflated capitation payments.



Social Adult Day Care (SADC) Centers investigations and joint work with other government entities to review complaints, and discuss investigations and new initiatives.

Continued on next page

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Volume 3, No. 15 April 9, 2018 

Continued from previous page 

Traumatic Brain Injury (TBI) and Nursing Home Transition and Diversion Waivers Waiver services entities to monitor claims for compliance with program requirements.

The report also indicates the following areas for compliance review and audits: wage and fringe benefit compensation under the Wage Parity Law; appropriate pass-through of supplemental minimum wage and Fair Labor Standards Act (FLSA) payments from MCOs to providers; the integrity of encounter data and other plan-submitted data; integrity of value based payment (VBP) data; and OMIG’s collaboration with its Recovery Audit Contractor (RAC), Health Management Systems Inc. (HMS), which will focus reviews on home health and other areas in fiscal year 2019.

PHHPC Meeting Agenda Posted The state Department of Health (DOH) has posted the agenda for the Public Health and Health Planning Council (PHHPC) meeting on April 12.

The agenda and supporting documents are at https://www.health.ny.gov/facilities/ public_health_and_health_planning_council/meetings/2018-04-12/.

The applications include: 

One Certified Home Health Agency (CHHA) to establish one entity as its parent and another entity as its grandparent;



One CHHA for a full asset merger of another entity into its operations; and



Five new Licensed Home Care Services Agencies (LHCSAs) that are affiliated with an Assisted Living Program (ALP).

Applications by two existing LHCSAs for a change of ownership and eleven entities to establish new LHCSAs that were approved at the PHHPC Establishment and Project Review Committee meeting on March 22 were not included on the agenda for the April 12 PHHPC meeting.

We assume that this is due to provisions in the final state budget that placed a moratorium for two years on the processing and approval of applications for LHCSAs that have not yet received establishment approval or contingent establishment approval by the PHHPC, except for:

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

An application for a LHCSA submitted with an application for an ALP.



An application to transfer ownership from an existing agency that has been licensed and operating for a minimum of five years for the purpose of consolidating ownership of two or more agencies.



An application seeking licensure where the applicant demonstrates to the satisfaction of the DOH Commissioner that the application would be appropriate on grounds addressing a serious concern such as a lack of access to home care in the region or lack of adequate and appropriate care, language and cultural competence, or special-needs services.

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Volume 3, No. 15 April 9, 2018 

Continued from previous page For more details on these LHCSA provisions, please be sure to read HCA’s detailed memo on the state budget outcome at https://hca-nys.org/wp-content/uploads/2018/03/Final201819BudgetMemoPreliminary.pdf.

RFI Issued on Elimination of PRI Tool The state Department of Health (DOH) has issued a Request for Information (RFI) to determine the implications of eliminating the Hospital and Community (H/C) Patient Review Instrument (PRI) and to seek recommendations for a replacement assessment tool, if necessary.

As part of the Regulatory Modernization Initiative, the Post-Acute Care Management Models workgroup recommended eliminating the use of the H/C PRI. The RFI is available on the Department’s website at https://www.health.ny.gov/funding/rfi/pri/index.htm.

Responses should be sent to ALTCteam@health.ny.gov no later than 5 p.m. on April 30, 2018.

DOH Issues Health Advisory on Measles Exposure On April 4, the state Department of Health (DOH) posted a Health Advisory on Measles Exposure (dated March 29).

DOH was been notified that an international traveler has been diagnosed with measles and potentially exposed people while infectious at a bar mitzvah in Rockland County on March 18 and at the Catskill Regional Medical Center on March 19 and 20.

Anyone who visited the following locations may have been exposed to measles: 

Viznitz Hall, 20 Ashel Lane, Monsey, NY on March 18-19 between 7 p.m. and 1 a.m.



Catskill Regional Medical Center Emergency Department on March 19 between 3 p.m. and 7:15 p.m.



Catskill Regional Medical Center outpatient laboratory on March 20 between 10:50 a.m. and 2 p.m.

DOH advises that anyone who was exposed and not immune to measles could develop signs and symptoms of measles 7 to 21 days after exposure. Furthermore, providers should have a high index of suspicion in patients who present with symptoms consistent with measles and have visited the locations listed.

To expedite public health containment strategies, providers should implement appropriate infection-control measures when measles is suspected and New York State providers should report immediately to the local health department (LHD) where the patient resides to facilitate specimen collection and appropriate follow-up.

New York City providers should report immediately and call 1-866-692-3641.

Further information is in the Advisory at https://hca-nys.org/wp-content/uploads/2018/04/HealthAdvisory_Measles-Exposure_032918.pdf.

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

Volume 3, No. 15 April 9, 2018 

Resources 

“Health Disparities among Asian New Yorkers,” by the New York City Department of Health and Mental Hygiene http://www1.nyc.gov/assets/doh/downloads/pdf/epi/databrief100.pdf



“Medicaid Fraud Control Units Fiscal Year 2017 Annual Report (OEI-09-18-00180),” by the federal Office of Inspector General https://go.usa.gov/xQru8



“What is CMMI?” and 11 other FAQs about the CMS Innovation Center,” by the Kaiser Family Foundation http://files.kff.org/attachment/Fact-Sheet-What-is-CMMI-and-other-FAQs-about-the-InnovationCenter



“Electronic Health Information: CMS Oversight of Medicare Beneficiary Data Security Needs Improvement,” by the Government Accountability Office https://www.gao.gov/assets/700/690481.pdf

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

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