April 16, 2018 Edition of The Situation Report

MEMBER SURVEY

HOTEL EXTENSION

SALARY HISTORY BAN

MEDICAID RATES

HCA reminds members to complete an important survey that seeks feedback on HCA services and strategic directions.

The discount rate has been extended for attendees of HCA’s Annual Conference to reserve accommodations at the Saratoga Hilton. Make your reservations and register today.

Gov. Cuomo proposes a bill prohibiting employers (including private business) from inquiring about an applicant’s salary history.

The state has published Medicaid rates for hospice, personal care and CHHAs with release dates in early May.

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Your Source for HOME CARE News, Policy and Advocacy

Vol. 3, Issue 16 | April 16, 2018

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

HCA Sets Advocacy Path amid Budget Aftermath, Political Uncertainties As the state grapples with federal, electoral and post-budget uncertainties, HCA is working to map a strong advocacy path for the home care, hospice and MLTC sectors.

State policymakers return this week from post-budget and holiday recesses. Ahead of them is intensive work at all levels, including budget implementation, continued state health See ADVOCACY p. 2

20 Learning, Policy Sessions for Your Team at HCA Annual Conference Need help getting sign-off to attend? HCA offers a draft message you can send to decisionmakers at your organization communicating the value of this signature event HCA’s upcoming Annual Conference includes nearly 20 distinct learning and policy sessions with top content experts in the field. These in-depth sessions weave through the entire spread of critical issues facing your organization, with direct relevance to various staff roles.

Additional members of your team who register get a discount to attend. This is a great opportunity for team-building and to staff all of the concurrent sessions that will benefit your organization.

See CONFERENCE p. 5

INSIDE HCA Sets Advocacy Path amid Budget Aftermath, Political Uncertainties…............1 20 Learning, Policy Sessions at HCA Annual Conference…......................................1 A Message from HCA Sponsor RBC Limited….........................................................3 A Message from HCA Sponsor HHA eXchange…......................................................5 Hiring Announcements….....................................................................................6 Reminder: Complete Survey on HCA Priorities, Services……..................................7 Class Action Suit Has Potential to Impact CDPAP FIs…............................................7 Extended Hotel Discount for HCA Annual Conference….........................................7 Governor Announces Bill on Salary History Ban…..................................................9 NPI Crosswalk Issues Affecting EDI, DDE and Claim Submission…...........................9 Upcoming Deadlines…......................................................................................10

DOH Posts 2018 Hospice, Personal Care, CHHA Peds Medicaid Rates...........11-12 Driving Decisions with Data: A Seminar for Clinical Managers..............................12 Influenza Vaccination Report Due Soon…............................................................13 2018 Hospice PEPPER Recently Made Available…................................................14 May 1 Training on Electronic Submission of Medicare Cost Reports…....................15 CMMI Appoints Medical Care at Home CEO Boehler as Director….........................15 US Department of Labor Issues Opinion Letters…................................................15 New Medicare Card Update….............................................................................16 CMS Approves OPWDD Waiver Amendment…......................................................17 eMedNY Posts Private Duty Nursing Guidance and List of Managed Care Plans…...17 NYC Implements Asset Verification System…......................................................18 Revised Workers’ Compensation Medical Forms Posted................................…..18 Resources...............................................................................................................19

The Situation Report: the Home Care Association of New York State ADVOCACY from p. 1 reform, program and regulatory agendas, and the balance of the 2018 state legislative session.

This environment falls against a dynamic backdrop. There remain lingering controversies over recently adopted budget provisions and other political factors, like the sudden merger of the Independent Democratic Conference with the mainline Senate Democratic Conference, upcoming special elections in the Senate, and overall statewide election-year political positioning. Indeed, this year the Governor’s office and every state legislative seat are up for reelection, with the Governor specifically facing a highly publicized primary challenge from Cynthia Nixon. Meanwhile, in other changes, the Governor’s health care team has seen the departure of State Medicaid Director Jason Helgerson and the appointment of Interim Director Donna Frescatore in his place.

All of these factors affect what will get done and what will be tabled as policymakers hear input from a breadth of competing constituencies, the home care field among them.

HCA’s Agenda HCA is readying a two-tiered post-budget legislative and program advocacy agenda for MLTCs, CHHAs, LHCSAs, hospice and allied programs centered on: 1. Shaping implementation of the new budget actions to best accommodate the field, striving to optimize new positive budget items and mitigate the adverse ones, and, where necessary, proposing modifications in legislative language or design recommendations; and 2. Introducing and advancing legislative and state policy/ program initiatives to drive the field’s priority needs and concerns.

Our budget implementation advocacy will target the following areas: 

MLTC-LHCSA contract limits and the arcane formula adopted for these limits. HCA will press for a reasonable and functional approach to implementation, work to shape

Home Care Association of New York State (HCA) 388 Broadway, 4th Floor, Albany, NY 12207 Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org

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Volume 3, No. 16 April 16, 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 V ice 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

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

Volume 3, No. 16 April 16, 2018 

the public need methodology for LHCSAs, and provide input into all aspects of the calculations, parameters for certificate approval, need/impact assessments, etc. 

New provisions for in-home telehealth services. HCA will work on appropriate parameters so that in-home telehealth services are aligned with the lawful scope and licensure of providers otherwise permitted to provide in-person services in patients’ homes.



A reasonable scope and framework for the new LHCSA registration requirements and cost reporting requirements for both LHCSAs and fiscal intermediaries (FIs), as well as appropriate standards – geared toward program integrity, and not limits on vital information to patients – in the new marketing restrictions on FIs and MLTCs-LHCSAs (the latter of which is expected to be implemented administratively).

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Modifying the new limits on nursing home patient eligibility for MLTC, permitting the option of continued nursing-home patient enrollment in cases where MLTCs and regions are adversely affected by this new parameter, and mitigation of reductions in MLTC payment for administrative expenses.

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Maximizing the availability and flexibility of minimum wage and infrastructure funds, including the $450 million in new minimum wage funding for MLTCs and providers, the Continued on next page

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

Volume 3, No. 16 April 16, 2018 

Continued from previous page $525 million in new Health Care Facility Transformation funding, and other new health capital/ infrastructure funds adopted with the new budget. 

Timely and appropriately implemented hospice rate increases.

HCA is also pursuing legislative and state administrative policy and program actions in the following areas: 

Reimbursement of plans and providers for adequacy and state transparency, ensuring appropriate compensation of MLTCs for labor and program mandates, and enabling MLTCs to appropriately compensate providers and workers.



Further infrastructure support, including clinical technology and health information or health information exchange capacity.

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Workforce needs, such as discipline and geographic shortages and procedural conditions which overburden and divert direct-care resources. HCA had advanced a series of workforce proposals during the budget negotiations, some of which were embraced by the Senate and which HCA will now seek to separately introduce in the post-budget session.

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Supporting home care’s collaborative work in new models of care and coverage, including opportunities through the new “collaborative care” Dear Administrator Letter (DAL), passage of a collaborative community paramedicine statute (with home care as a design and operative partner with EMS, hospitals and physicians), and other efforts.



Advancing the roles and capacities of home care in contributing to public health, prevention and primary care priorities and solutions.

HCA will also be vigilant both in pursuing opportunities and mitigating risk areas associated with further proposals of the Executive’s regulatory modernization initiative.

Broad and grassroots advocacy a major need A major challenge that was clearly evident throughout this year’s budget process was the extreme lack of understanding and education about in-home care on the part of governmental negotiators and decisionmakers: what home care is, how it works, who provides it, how the health care system is entirely dependent upon it, and just how under-supported and taken for granted it is.

Every HCA member is reminded to be actively meeting with your local officials in their district offices and/or in Albany to help bring much-needed education about home care’s value.

Meanwhile, HCA will be updating the membership regularly on the status of our post-budget advocacy work and further discussing MLTC, home care and hospice priorities at our statewide annual conference coming up in just a few weeks.

For further information, contact Al Cardillo at acardillo@hcanys.org.

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

Volume 3, No. 16 April 16, 2018 

CONFERENCE from p. 1 

Your executive teams will want to hear how to implement the Advanced Home Health Aide law (during our pre-conference session with Department of Health officials) or gain process and data insights for succeeding under the new Home Health Conditions of Participation (CoPs) with experts from Forcura and Blacktree Healthcare Consulting.



Your human resources and operations managers will want to hear from recruitment experts like Eric Scharber of Simione Healthcare Consultants and OneGroup’s experts on the Paid Family Leave law (specifically on the new law’s implications for assessing leave requests, payroll decisions, and coverage of critical staff services). Greg Hicks, best-selling author and founder of the FosterHicks model (used by the Mayo clinic and many other organizations) will help your business build a HighTrust, High-Performance Team and Organization using the latest insights in behavioral science.



Your clinical managers will be engaged by topics like: post-discharge medication reconciliation; reducing hospital readmissions in the treatment of populations with dementias; and chronic-care strategies using telehealth.

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And everyone on your team will want to hear Bill Dombi, President of the National Association for Home Care and Hospice (NAHC), as well as Dr. Howard Zucker, the state’s Health Commissioner.

All we need is you! Register online at https://events.eply.com/ HCAAnnualConference20182357221 or visit the conference website at www.hcaannualconference.com.

Need Assistance Getting Sign-off to Attend?

If you need assistance gaining sign-off to attend (or approval to register more than one member of your team), HCA has prepared a draft e-mail message that you can customize and send to decision-makers (i.e., an administrator, CEO, COO or finance manager) to communicate the value-proposition of this conference for your organization. This sample template and instructions are at http:// hcaannualconference.com/gainingapproval-to-attend/.

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Volume 3, No. 16 April 16, 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 7 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 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.

EOE/M/F/D/V

Staff Development Supervisor .

Driven to be the Best.

Mineola, NY. NYU Winthrop Hospital’s Home Health Agency ranks as a top-performing US Home Health Agency. We currently seek a full time Staff Development Supervisor responsible for staff education development and professional growth; teaching orientation classes to new staff & coordinating student nursing, clinical pharmacy and medical student rotations; and teaching post orientation follow-up modules in collaboration with specialty nurses and the education coordinators. You will participate in the ongoing evaluation and development of the orientation program, perform field evaluations of new staff as necessary, convey appraisals of staff to management, and make recommendations; prepare quarterly and annual reports/statistics of each program. We require: 

BSN, required; Master’s in Nursing preferred.

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NYS RN License, required.

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2-3 years Clinical Nursing Practice and Community Health Nursing required.

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2 years Nursing experience in a supervisory capacity in a HHA required.

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1-2 years Trainer, Instructor or Education Coordinator in a Certified Home Health Agency preferred.

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Good presentation, communication, PowerPoint & computer skills are vital.

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Ability to conduct education sessions and conduct skills lab to develop competencies a must.

Apply@ www.nyuwinthrop.org/careers, #18-22843, e-mail HRHomeCare@nyuwinthrop.org, or call 516.663.8000. An EOE.

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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

Reminder: Complete Survey on HCA Priorities, Services, Strategic Directions On April 4, HCA sent a survey to the “main contacts” in our member database. This survey is intended to support strategic planning initiatives that HCA and our Board of Directors are considering for future priorities as an association.

If your organization has already completed the survey, that’s great.

Thank you. We are now reaching out to a broader group of members through our newsletter and other means to assure as high a response rate as possible for this important survey. Please make sure that your organization has input into this important process.

HCA’s strategic planning discussions, 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. This is why your input is vital. Survey results will be reviewed during an upcoming meeting of HCA’s Board of Directors, so we ask that you please complete this brief, 19question survey by April 20 at the following link: https:// www.surveygizmo.com/s3/4286748/HCA-NYS-Member-Survey.

If you have any questions, please feel free to call HCA’s Director of Communications Roger Noyes at (518) 810-0665 or rnoyes@hcanys.org.

Class Action Suit Has Potential to Impact CDPAP FIs A class-action complaint alleging state labor law violations by a fiscal intermediary (FI) has survived the defendant’s motion for dismissal.

The suit specifically alleges unpaid wages for services rendered by personal assistants to consumers in New York’s Consumer Directed Personal Assistance Program (CDPAP).

Though the litigation (Jimenez v. Concepts of Independence) is in its early stages, this case should be closely monitored by organizations providing CDPAP FI services. One major implication is whether or not the FI will be found to be a joint-employer of a consumer’s personal assistant and, therefore, responsible for payment of any unpaid wages due.

By way of background, on June 15, 2016, the plaintiff, Janeth Jimenez, brought this class action in New York County Supreme

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Volume 3, No. 16 April 16, 2018 

Extended Hotel Discount for HCA Annual Conference Make reservations by April 18 The Saratoga Hilton’s hotel deadline for HCA’s Annual Conference has been extended until this coming Wednesday, April 18. Take advantage of this newly extended window to receive the HCA room-block discount rate before it expires finally.

All the information you need for reserving your accommodations is on our conference website at http:// hcaannualconference.com/ hotel/, including a phone number for the reservations desk, a map to the conference location and a link to online reservations at the special conference rate.

While making your hotel reservations, please also make sure you are registered for the conference. HCA has provided several avenues for registration including the brochure and online registration available on our conference website at http:// hcaannualconference.com/ register-2/.

We can’t wait to see you at HCA’s 40th anniversary Annual Conference for a banner program of nearly 20 education sessions covering topics that affect all major aspects of your organization.

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

Volume 3, No. 16 April 16, 2018 

Court against Concepts of Independence, Inc. on behalf of all individuals “employed” as home care aides in New York City since March 1, 2012, and in Westchester, Nassau, and Suffolk Counties since March 1, 2013.

The complaint alleges six causes of action against the defendant for violations of New York labor law, including failure to pay minimum wage, overtime, spread-of-hours pay, and wages “due and owing”; breach of contract for failure to comply with the Wage Parity law; and unjust enrichment.

The plaintiff alleges that she and other aides providing personal assistant services under CDPAP were employed by the defendant, worked 24-hour shifts, earned approximately half of minimum wage, and worked more than 40 hours per week without receiving any overtime pay. According to the plaintiff’s complaint, these shifts took place at the homes of consumers participating in CDPAP, but the aides lived in their own homes, where they returned after each shift.

Defendants in this case have sought a motion for dismissal based on the assertion that the plaintiffs failed to state a “cause of action.” However, in its most recent decision, the court stated that while the plaintiff (Janeth Jimenez) did not adequately allege that the defendant was her sole employer, the plaintiff alleged enough to suggest that a joint employer relationship is “plausible.” The court concluded that “whether defendant is plaintiff’s employer, and what that means for plaintiff, are fact intensive questions that the court cannot readily decide on a motion to dismiss.”

For example, while the consumer is responsible for hiring, retention, training and supervision, the court recognized that pursuant to CDPAP regulations, at 18 NYCRR 505.28, the defendant is responsible for maintaining records for both aides and consumers, monitoring aides’ health status and compliance with applicable regulations, monitoring abilities of consumers and their representatives to comply with CDPAP requirements, and for establishing appropriate wages.

Due to an exemption based on the defendant’s not-for-profit status, the court did dismiss claims relating to the failure to pay overtime and spread-of-hours pay. The court also dismissed the breach-of-contract claim due to the inapplicability of the Wage Party Act to CDPAP at the time the defendant allegedly employed the plaintiff.

As indicated, the court’s decision to deny the motion to dismiss comes at the early stages of this litigation, requiring the defendant to answer the complaint and allowing the case to proceed to preliminary conference and discovery.

HCA will continue to monitor the outcome of this litigation and keep members apprised of developments.

This article was written by Meghan McNamara, Esq., a principal at Hinman Straub P.C. and member of the firm’s Health Law Department. Ms. McNamara concentrates her practice on representing health care providers and provider organizations, including HCA. Hinman Straub is HCA’s state government affairs firm.

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

Volume 3, No. 16 April 16, 2018 

Governor Announces Bill on Salary History Ban Governor Cuomo has advanced legislation prohibiting New York State employers – both public and private – from inquiring about a prospective employee’s salary history.

HCA is still reviewing the proposed bill which ostensibly has a similar purpose as a New York City bill, signed into law in October, applicable to employers in New York City. HCA last reported on this City law in the November 6 edition of The Situation Report (https://hca-nys.org/wp-content/uploads/2017/11/ SitReport110617.pdf), though it will be important to examine the Governor’s bill for any critical differences in the specific requirements or exemptions.

According to the Governor’s office, this new legislation builds on two executive orders signed by the Governor last year prohibiting state entities from evaluating candidates based on wage history and requiring state contractors to disclose data on the gender, race and ethnicity of employees. The Governor’s bill would broaden the scope of Executive Order No. 161 to encompass all employers, not just state entities.

The Governor’s office indicates that the bill is intended to close the gender gap, citing a newly released state Department of Labor report with recommendations to this effect. The report found that New York currently has the narrowest wage gap in the U.S., with women earning the equivalent of 89 cents to a dollar earned by men.

The report is available at https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/ Pay_Equity_Advancement_WageGap_.pdf.

HCA will provide further analysis of the legislation in a future report.

NGS Reports NPI Crosswalk Issues Affecting EDI, DDE and Claim Submission National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), recently became aware of a widespread issue with the National Provider Identification (NPI) crosswalk file that is causing some providers to have Electronic Data Interchange (EDI) claim files rejected in error, as well as issues with Direct Data Entry (DDE) claim submissions, and possibly affecting eServices and EDI enrollment.

What This Means Affected providers will have issues with EDI and DDE claim submissions. In addition, providers attempting to enroll in eServices or EDI enrollment changes may also be affected. Affected providers should contact NGS’s Provider Contact Center (PCC) at 1-866-275-3033 to report the issue and expect ten full business days for a resolution. NGS will contact the provider once the issue is resolved.

NGS also noted that Hospice providers may be granted exceptions for late Notices of Election (NOEs) due to this issue.

No additional provider action, other than reporting the issue, is required at this time.

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Volume 3, No. 16 April 16, 2018

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



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/Manag edCareNetwork/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 _home_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 CommunityͲBased Long Term Care April 1, 2018 Services under Managed Care

https://www.health.ny.gov/facilities/long_term_care/reim bursement/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/redesig n/community_first_choice_option.htm

Submission of Expression of Interest for the Medicare Low Volume Appeals Initiative

April 12 to June 8

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, April 30, 2018 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

Training on Electronic Submission of Medicare Provider Cost Report

May 1, 2018

https://blh.ier.intercall.com

Changes in appeals system for Medicaid managed care enrollees

May 1, 2018

https://www.health.ny.gov/health_care/managed_care/pl ans/appeals/index.htm

May 16, 2018

https://nyshealthfoundation.org/rfp/2018ͲspecialͲ projectsͲ fund/?utm_source=Reminder+to+Apply%3A+2018+SPF+RF P&utm_campaign=2018+SPF%3A+2nd+Reminder+to+Appl y+%28w%2Fvideo%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. 16 April 16, 2018 

DOH Posts 2018 Hospice Residence and Non-Residence Medicaid Rates Includes base rates, minimum wage & RTR add-ons The state Department of Health (DOH) has published the Medicaid hospice residence and non-residence rates, both of which are for the current 2018 calendar year (January 1 through December 31, 2018).

DOH will make the initial rate payments in Medicaid Payment Cycle 2121 (with an expected release date of May 2, 2018).

Providers should have received a Dear Administrator Letter (DAL) with the rates attached. Rates are also posted to: https://www.health.ny.gov/facilities/long_term_care/reimbursement/hospice/.

Specific questions about the rates should be e-mailed to DOH at: Hospice-Rates@health.ny.gov.

The hospice residence base rates represent 94 percent of the weighted average calendar year Medicaid rates of nursing facilities in each wage equalization factor (WEF) region. The rates also include a payment add-on of $9.92 per day for agencies that have filed certifications for Recruitment, Training and Retention (RTR). These funds are solely for the purposes of improving recruitment, training and retention of non-supervisory personnel with direct patient care responsibility.

The formula for the non-residence rates was promulgated in accordance with Article 40 of the Public Health Law (PHL) and Title 10 Part 86-6 of DOH regulations. They include a 3 percent add-on payment authorized by Section 3614.9 of the PHL for hospices that have filed an RTR certification. Additionally, minimum wage increases have been incorporated into these rates based on survey data that was submitted and attested to by hospice programs.

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

DOH Posts Initial 2018 Personal Care Rates The state Department of Health (DOH) recently posted the initial 2018 Medicaid fee-for-service (FFS) rates for Consumer Directed/Personal Care programs outside of New York City.

The initial Personal Care rates reflect a zero “roll” factor adjustment as well as an overall zero trend factor for the rate period of January 1, 2018 through December 31, 2018. Furthermore, the final 2017-18 state budget eliminated the possibility of any Medicaid trend factor through March 31, 2019.

A Dear Administrator Letter (DAL) accompanying the rates provides information on the statewide aggregate Administrative and General (A&G) cap, which is limited to no more than 28 percent of total costs. The A&G cap specifically for consumer directed services continues to be 18 percent. The DAL also discusses aide and training ceilings; capital costs; profit/surplus percent; the worker recruitment and retention adjustment add-on of 6.06 percent; and the rate appeals process.

The DAL notes that the 2018 rates no longer include an add-on for Fair Labor Standards Act (FLSA) costs. This uniform additional FLSA add-on amount should now be captured with the expenses of the cost report.

Continued on next page

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The Situation Report: the Home Care Association of New York State Continued from previous page However, the 2017 recruitment and retention percentage addon of 8.16 percent includes the adjustment to reimburse nonNYC personal care providers for the uniform additional hourly FLSA add-on amount as determined in the FLSA adjustment rates effective October 13, 2015.

Payment for the January 1, 2018 initial rates will be made in Medicaid Cycle 2121, which has a check release date of May 2, 2018.

For rate questions, e-mail PersonalCare-Rates@health.ny.gov.

DOH Posts Initial 2018 CHHA Pediatric Medicaid Rates Includes NYC wage parity, workforce add-on monies and minimum wage adjustments The state Department of Health (DOH) has posted the initial 2018 Medicaid fee-for-service (FFS) rates for CHHAs serving pediatric patients (under 18 years of age).

These rates reflect a zero “roll” factor adjustment as well as an overall zero trend factor for the rate period January 1, 2018 through December 31, 2018. Furthermore, the final 2017-18 state budget eliminated the possibility of any Medicaid trend factor through March 31, 2019.

A Dear Administrator Letter (DAL) accompanying the rates provides additional information on the statewide aggregate Administrative and General (A&G) cap, which is 27.65 percent in 2018; regional guidelines or ceilings; worker recruitment and retention adjustments; and the rate appeals process.

The initial 2018 CHHA rates also include the 3-percent adjustment for purposes of improving recruitment and retention of non-supervisory home care services workers with direct patient care responsibilities, along with a 4.7 percent rate add-on adjustment for the newer Recruitment, Training and Retention (RT&R) initiative ($100 million statewide).

NYC Wage Parity and Minimum Wage Adjustments Home health aide payment rates for New York City (NYC) providers were adjusted to a minimum of $20.95 per hour beginning March 1, 2014, to enable CHHAs to meet the Wage

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Volume 3, No. 16 April 16, 2018 

Driving Decisions with Data: A Seminar for Clinical Managers Join HCA on June 6 in Albany for Driving Decisions with Data: A Seminar for Clinical Managers with Barbara Katz of BK Consulting.

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.

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 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 models for home care.

Register here today at: https://hcanys.org/wp-content/uploads/2018/03/ Driving-Decisions-with-Data-Seminar-June6-2018.pdf.

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Parity law requirements of Section 3614.14 of the state Public Health Law. Effective January 1, 2018, the minimum payment rate for New York City CHHAs has been increased to $24.84 to additionally reflect the scheduled increase in the minimum wage in New York City. The additional amount consists of $2.00 per hour in wages and $0.56 per hour in payroll taxes and fringe benefits, as well as $1.33 for minimum wage in 2017.

Home Health Aide payment rates for Long Island and Westchester have also been increased by $1.28 to reflect the scheduled minimum wage increase for Long Island and Westchester. The additional amount consists of $1 per hour in wages and $0.28 cents per hour in payroll taxes and fringe benefits.

Home Health Aide payment rates for the rest of the state have also been increased by $0.90 to reflect the scheduled minimum wage increase for Long Island and Westchester. The additional amount consists of $0.70 per hour in wages and $0.20 cents per hour in payroll taxes and fringe benefits.

Unlike last year, DOH did not include a Fair Labor Standards Act (FLSA) adjustment in the 2018 rates. While no information was included in the DAL, we believe DOH expects the uniform additional FLSA add-on amount should now be captured with the expenses of the 2016 cost report (as indicated in rate announcements for other provider types).

Payment for the January 1, 2018 initial rates will be made in Medicaid Cycle 2122, which has a check release date of May 9, 2018.

For CHHA FFS rate questions, HCA members can e-mail DOH at CHHA-Rates@health.ny.gov.

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

Influenza Vaccination Report Due Soon HCA reminds members that the Healthcare Personnel Influenza Vaccination Report is due May 1, 2018.

As in past years, home care and other health care providers are required to document the number and percentage of personnel vaccinated against influenza for the current season.

This year’s report covers personnel employed by or affiliated with facilities or agencies from October 1, 2017 through March 31, 2018. Organizations were able to enter available data starting in February and then resubmit as often as is necessary as new personnel join and/or submit documentation of vaccination until the May 1 deadline.

The report is on the Health Electronic Response Data System (HERDS) at https://commerce.health.state.ny.us/.

Information on the Report, including Frequently Asked Questions, is at https://www.health.ny.gov/diseases/ communicable/influenza/seasonal/providers/prevention_of_influenza_transmission/ (see Data Collection and Reporting & Training).

Questions about the report should be directed to the DOH Bureau of Immunization at either (518) 473-4437 or immunize@health.ny.gov.

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Continued from previous page Technical questions about the report or on the use of HERDS should be directed to the Health Emergency Preparedness Program at (518) 408-5163 or hseppny@health.ny.gov.

Flu Mask Requirement Influenza is still considered prevalent, which means that home care, hospice and other health care providers are still required to ensure that all personnel not vaccinated against influenza for the current season are wearing a surgical or procedure mask while in areas where patients or residents are typically present.

Information on this mandate is at https://www.health.ny.gov/diseases/communicable/influenza/seasonal/ providers/prevention_of_influenza_transmission/.

2018 Hospice PEPPER Recently Made Available TMF Health Quality Institute – under contract with the U.S. Centers for Medicare & Medicaid Services (CMS) – has recently made available the fourth quarter 2017 statistics of the Hospice Program for Evaluating Payment Patterns Electronic Report (PEPPER). The statistics run through September 2017.

PEPPER is an educational tool that summarizes provider-specific data statistics for Medicare services that may be at risk for improper payments. Providers can use the data to support internal auditing and monitoring activities.

To obtain your hospice’s PEPPER, the Chief Executive Officer, President, Administrator or Compliance Officer of your hospice should: 1. Review the Secure PEPPER Access Guide.

2. Review the instructions and obtain the information required to authenticate access. Note: A new validation code will be required. A patient control number (UB04 form locator 03a) or medical record number (UB04 form locator 03b) from a claim for a traditional Medicare FFS beneficiary with a claim “from” or “through” date between July 1 to September 30, 2017 will be required.

3. Visit the PEPPER Resources Portal at: https://securefile.tmf.org/#.

4. Complete all the fields and then download your PEPPER. The 2018 Hospice PEPPER will be available to download for approximately two years. A webinar to review the new PEPPER is scheduled for Thursday, April 26 at 2 p.m. For more information, visit the Hospice Training and Resources page at: https://pepperresources.org/Training-Resources/Hospices.

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

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May 1 Training on Electronic Submission of Medicare Cost Reports As previously reported, the U.S. Centers for Medicare and Medicaid Services (CMS) has created a new portal to submit Medicare provider cost reports. (See the February 26 edition of The Situation Report at https://hcanys.org/wp-content/uploads/2018/02/SitRep022618.pdf.)

All Part A providers (including Certified Home Health Agencies) will have the option to electronically transmit reports through the Medicare Cost Report e-Filing (MCReF) system. MCReF will be available for cost reporting periods ending on or after December 31, 2017. Starting July 2, providers must use MCReF for electronic submission.

A training webcast with instructions on MCReF will be held on May 1 from 1 to 2:30 p.m. Registration is at https://blh.ier.intercall.com/.

Access to MCReF will be controlled by the CMS Enterprise Identity Management (EIDM) system. Security officials and backup officials registered in EIDM for access to the Provider Statistical and Reimbursement (PS&R) system will have access to MCReF through their existing accounts. Providers that are not registered in EIDM as PS&R users must register and assign a “security official” for their organization.

A question and answer session will follow the presentation but participants may e-mail questions in advance to OFMDPAOQuestions@cms.hhs.gov with “Medicare Cost Report e-Filing System Webcast” in the subject line.

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

CMMI Appoints Medical Care at Home CEO Boehler as Director The U.S. Centers for Medicare and Medicaid Services (CMS) has appointed a former medical care at home CEO to head its Center for Medicare and Medicaid Innovation (CMMI). The appointee, Adam Boehler, is the former CEO of Landmark Health, a provider group that delivers in-home medical care to chronically ill populations, including in New York State.

CMMI was created under the Obama administration as an incubator to pilot cost savings and efficiency initiatives in the Medicare and Medicaid programs, including bundled payment programs and Accountable Care Organizations (ACOs). One such initiative, the Comprehensive Care for Joint Replacement (CJR) model, was recently converted to a voluntary model after being implemented on a mandatory basis in certain regions of the country.

US Department of Labor Issues Opinion Letters Last week, the U.S. Department of Labor (DOL) published opinion letters on various issues, including payment for travel time and rest breaks, and a Fact Sheet on overtime pay.

The letters are at https://www.dol.gov/whd/opinion/FLSA/2018/2018_04_12_01_FLSA.pdf and https:// www.dol.gov/whd/opinion/FLSA/2018/2018_04_12_02_FLSA.pdf. The Fact Sheet is at https://www.dol.gov/ whd/overtime/whdfs17s.pdf.

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Continued from previous page While the opinion letters don’t specifically discuss instances of employees working in home care, the guidance is still helpful. The first one reiterates that compensable work time generally does not include time spent commuting between home and work, even when the employee works at different job sites.

The second letter discusses whether 15-minute rest breaks due to an employee’s serious health condition (covered under the Family and Medical Leave Act) are compensable.

Even though the Fact Sheet covers higher education institutions and overtime, the discussion on the overtime exemption for those who perform executive, administrative, or professional duties (“white collar” employees) is useful for home care agencies.

DOL’s Wage and Hour Division publishes Fact Sheets on a variety of other topics at: https://www.dol.gov/whd/regs/compliance/whdcomp.htm.

New Medicare Card Update Starting in June 2018, providers can log into a secure portal of their Medicare Administrative Contractor (MAC) for Medicare beneficiary card information as the federal government rolls out its effort to replace the beneficiary’s Social Security number (SSN) with a Medicare Beneficiary Identifier (MBI).

If the U.S. Centers for Medicare and Medicaid Services (CMS) already mailed a new card to this Medicare patient, the MAC portal will provide the Medicare MBI. If your organization doesn’t already have access to MAC portals, you can view the sample letter and print-friendly fact sheet that contains specific information regarding access to the MAC portal look-up tool. Click the links below: 

https://www.cms.gov/Medicare/New-Medicare-Card/Providers/New-Medicare-Card-ProviderLetter.pdf



https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/ MLN-Publications-Items/ICN909365.html

CMS began mailing the new cards in April 2018 and will replace all Medicare cards by April 2019. Patients who are new to the Medicare program starting in April 2018 and later will only have a card with the new Medicare number. Medicare beneficiaries will start to receive their new Medicare cards sometime after June 2018.

Click here for a comparison between the HICN and the MBI: https://hca-nys.org/wp-content/uploads/ 2018/04/MedicareCardChart.pdf.

More information is at https://www.cms.gov/medicare/new-medicare-card/nmc-home.html.

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CMS Approves OPWDD Waiver Amendment New York State has received approval of “Amendment 03” to the 1915(c) Office for People With Developmental Disabilities (OPWDD) Comprehensive Home and Community-Based Services (HCBS) Waiver.

The effective date is April 1, 2018.

“Amendment 03” includes the:    

Sunset and transition of the 1915(c) HCBS Waiver to the 1115 Waiver.

Transition of care management services to the 1115 Waiver and Health Home State Plan authorities (Care Coordination Organizations).

A change to transportation costs for Day Habilitation and Prevocational Services.

Revisions to higher-needs funding for Supervised Residential Habilitation and Day Habilitation.

A copy of the approved “Amendment 03” and Response to “Amendment 03” Public Comment is available at: https://opwdd.ny.gov/opwdd_services_supports/people_first_waiver/HCBS_waiver_services.

eMedNY Posts Private Duty Nursing Guidance and List of Managed Care Plans eMedNY has posted guidance to clarify acceptable assessments for prior approval of Private Duty Nursing (PDN) as well as an updated list of managed care plans.

The list of managed care plans includes plan name, identification number, and phone number. It is at https:// www.emedny.org/ProviderManuals/AllProviders/PDFS/Information_for_All_Providers_Managed_Care_Information.pdf.

According to the PDN guidance (https://www.emedny.org/ProviderManuals/NursingServices/ communications.aspx), private duty nursing services may be provided when a written assessment indicates that the member needs either continuous nursing services which are beyond the scope of care available from a certified home health agency, or for intermittent nursing services which are normally provided by the certified home health agency but which are unavailable.

Written assessment can be performed by the following entities:   

Certified Home Health Agency (CHHA) The local Social Services department A recognized agent of a local Social Services department

Written assessments meeting the standard for use in review of PDN Prior Approval include, but are not limited to:    

Uniform Assessment System Community Assessment (UAS) CHHA Outcome and Assessment Information Set (OASIS) DMS-1 M-27r

The assessment should include independent recommendations addressing the level and frequency of care to be provided to the member. The nurse completing the written assessment should not be the provider that will be

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performing the Private Duty Nursing services nor shall they be affiliated with the member’s family or the member’s physician.

If an assessment is not listed above, it may be considered if it is substantially equivalent to the listed assessments.

Please contact the Prior Approval unit for guidance and use of alternate assessments.

Questions regarding PDN Prior Approval should be directed to the Bureau of Medical Review at 1-800-3423005, option 1 or OHIPMEDPA@health.ny.gov.

NYC Implements Asset Verification System The New York City Human Resources Administration (HRA) has issued a Medicaid Alert stating that it is implementing the Asset Verification System (AVS) for purposes of determining Medicaid eligibility for aged, blind and disabled (“SSI related”) applicants/recipients in New York City.

The Alert, which includes applicant/recipient notices, is at https://hca-nys.org/wp-content/uploads/2018/04/Asset-Verification-System-040918.pdf.

This system has already been implemented for all applications and renewals in the rest of New York State and was described in the December 8 edition of The Situation Report. That article referenced a state Department of Health (DOH) Administrative Directive that is available at https://www.health.ny.gov/health_care/medicaid/ publications/pub2017adm.htm.

This AVS allows for electronic exchange of financial account information with national and local financial institutions, and real property information with public records databases.

Initial implementation by HRA began in October 2017 with new applications submitted through EDITS by 25 nursing homes for non-spousal applications. Effective January 22, 2018, use of AVS was expanded to all nonspousal new nursing home applications submitted through the Eligibility Data and Image Transfer System (EDITS). Effective Monday, March 26, the use of AVS was again expanded to include new spousal Nursing Home applications submitted through EDITS. An SSI-related applicant/recipient and his or her spouse, with some limited exceptions, must authorize the electronic verification of assets as a condition of Medicaid eligibility. This requirement applies regardless of whether an applicant is attesting to the value of resources for community coverage without long term care or seeking Medicaid coverage of community-based long-term care or nursing home care.

In most instances, HRA will be budgeting the resource information provided by AVS. If coverage is denied or discontinued due to excess resources, clients will have 30 days to dispute these results.

Revised Workers’ Compensation Medical Forms Posted The Workers’ Compensation Board has posted revised medical authorization forms.

These include five forms that physicians complete and have been revised to include a place for providers to include their National Provider Information (NPI) number. The forms also expand the certification area by adding a space for more than one fax number or e-mail address.

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Continued from previous page The Board cautions medical providers that they will run the risk of not having the requested treatment authorized if they submit the form to a fax number or email address other than the designated contact.

More information, including the revised forms, is at http://www.wcb.ny.gov/content/main/SubjectNos/ sn046_1048.jsp.

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



“The Department of Health and Human Services And The Department of Justice Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2017" https://oig.hhs.gov/publications/docs/hcfac/FY2017-hcfac.pdf



“The Health Care Workforce in New York Trends in the Supply and Demand for Health Workers,” by the Center for Health Workforce Studies http://www.chwsny.org/our-work/reports-briefs/httpwww-chwsny-orgwpcontentuploads201804full_chws_ny_tracking_report-2018-pdf/



“2018 Alzheimer’s Disease Facts and Figures,” by the Alzheimer’s Association www.alz.org/facts/



“Taking It to the Next Level: Using Innovative Strategies to Expand Options for Self-Direction,”

by AARP http://longtermscorecard.org/promising-practices/taking-it-to-the-next-level

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

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