DATA
SEXUAL HARASSMENT
LTC COUNCIL SURVEY
LHCSA APPLICATIONS
HCA’s Data Page, for members only, includes two new benchmarking resources on Statistical Reports and HHPPS.
HCA’s Counsel reports on new state and NYC laws extending the obligations and potential liabilities of employers regarding sexual harassment policies.
The state has issued a survey, due by June 18, to provide input on LTC issues and planning by the newly formed LTC Council.
LHCSA Applications get tabled by PHHPC as a result of state budget’s newly enacted moratorium.
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Your Source for HOME CARE News, Policy and Advocacy
Vol. 3, Issue 17 | April 23, 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.
Important DOH State Budget Implementation Advisories Rate presentation scheduled for Wednesday, plus more information on LHCSA moratorium, contracting limits, plan transfers, nursing-home carve-out, and other items The state Department of Health (DOH) has announced a special rate presentation for MLTCs this Wednesday, April 25, at the Empire State Plaza (meeting room 5) in Albany. The meeting agenda includes a morning session beginning at 10:30 a.m. for mainstream managed care organizations and Health and Recovery Plans. The afternoon is devoted to MLTC reimbursement, from about from 1:15 to 3:30 p.m. See BUDGET p. 3
A Great Program Just Got Even Better With Edo Banach, National Palliative Care & Hospice Leader HCA is thrilled to add a dynamic speaker to our upcoming Annual Conference program: Edo Banach, President and CEO of the National Hospice and Palliative Care Organization. HCA’s Annual Conference on May 9-11 already had some big names like New York State Health Commissioner Dr. Howard Zucker and National Association for Home Care and Hospice (NAHC) President Bill Dombi. Now, with Edo Banach in the lineup (as well as nearly 20 other See CONFERENCE p. 2
INSIDE Important DOH State Budget Implementation Advisories....................................1 Edo Banach, Palliative Care & Hospice Leader, to Speak at HCA Annual Conf...........1 Feedback Sought on Universal Billing Codes.........................................................2 Message from HCA Sponsor RBC Limited..............................................................3 Your Help Needed for “HCA Alumni Search” as HCA Turns 40!.................................5 Memo Outlines JCOPE Reporting Requirements for HCA Members Who Lobby.......5 2015 LHCSA Stat Reports, 2015 HHPPS Data Posted to HCA Data Page...................6 Important Changes to Workplace Sexual Harassment Laws.................................6 HCA Represents Home Care at HEPC Statewide Meeting......................................7 Revisions to NYC Paid Sick Leave Law Effective May 5............................................8 CMS Develops Market Saturation and Utilization Data Tool..................................9
Hiring Announcements.................................................................................9-10 Important Upcoming Deadlines........................................................................11 State LTC Council Seeks Your Input for Strategic Plan...........................................12 LHCSA Applications Deferred at PHHPC Meeting.................................................12 CMS Posts New OASIS FAQs................................................................................13 New Maximum Weekly Benefit Rate for Workers’ Compensation.......................13 OIG Launches New Compliance Portal...............................................................13 Workers’ Compensation Board Issues Proposals..............................................14 NYS Health Foundation Announces New RFP.......................................................14 NGS Provides Guidance on OASIS Submission Error Code....................................15 Resources........................................................................................................16
The Situation Report: the Home Care Association of New York State CONFERENCE from p. 1 education sessions from experts in the field), the home care and hospice community has a lot to look forward to on May 9-11 in Saratoga. Please register today at http://hcaannualconference.com/ register-2018. As other sectors build on the philosophy of interdisciplinary, patientcentered care that hospice created, now is the time for leaders in the home and community-based care space to assert their leadership in adding to the portfolio of coordinated care in the home. Mr. Banach will address the current state and opportunity of hospice and palliative care and how this important sector continues to evolve. He’ll share his insights on how providers can leverage the solid foundation of hospice and palliative care to explore a more innovative, durable vehicle for providing care, offering examples of successful programs and models that the home care sector can learn from.
Feedback Sought on Universal Billing Codes HCA is seeking feedback from home care and MLTC members on the implementation of universal billing codes for Medicaid home and community-based long term care services provided to managed care plans. After numerous delays, universal billing codes were implemented on April 1. Since that time, we have heard from some members about billing issues needing further state attention, such as needed clarifications to modifier descriptions; new modifiers for adult day services; and new codes needed for certain services, including physical therapist assistants, occupational therapy assistants, nursing services per visit, telemonitoring per day, and medical social services per 15 minutes. HCA urges all members to notify us immediately of any other issues they have encountered so we can notify the state Department of Health (DOH) as soon as possible. Please send these comments to akoski@hcanys.org. We understand that DOH may be anticipating some refinements and we will keep members informed.
Home Care Association of New York State (HCA) 388 Broadway, 4th Floor, Albany, NY 12207 Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org
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The Situation Report is a weekly publication of the Home Care Association of New York State (HCA). Unless otherwise noted, all articles appearing in The Situation Report are the property of the Home Care Association of New York State. Reuse of any content within this newsletter requires permission from HCA. Joanne Cunningham HCA President jcunningham@hcanys.org Roger L. Noyes Director of Communications, Editor of The Situation Report rnoyes@hcanys.org Al Cardillo Executive V ice President acardillo@hcanys.org Patrick Conole Vice President, Finance & Management pconole@hcanys.org Andrew Koski Vice President, Program, Policy & Services akoski@hcanys.org 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
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BUDGET from p. 1 DOH indicates that this is an in-person meeting only, and is targeted to managed care plan finance and actuarial staff. HCA will be attending and will report to members on any important information disseminated. With so many factors affecting MLTC rates – including those not contained in budget language and which DOH is pursuing “administratively” – this should be an important session for obtaining more details on rate determinations. The session should also allow individual plans and associations to pose myriad questions on the rate factors (affected in the new budget or otherwise) at play in the 2018 rates. DOH indicates that future dates will be provided for FIDA, PACE and MAP rate presentations. LHCSA Moratorium DOH circulated the following notice about the recently enacted moratorium on Licensed Home Care Services Agency (LHCSA) applications. The newly enacted State Budget for 2018-2019 includes a moratorium on processing or approving LHCSA applications, with limited exceptions. The Department is reviewing the moratorium language and developing guidance for applicants. Once the guidance has been developed it will be distributed through the CON listserv and will be posted on the Department’s CON webpage. Additionally, applicants who have already submitted applications will receive correspondence with directions on how to proceed.
To receive the forthcoming LHCSA guidance, when distributed, interested parties should subscribe to the CON listserv by sending an e-mail to listserv@listserv.health.state.ny.us. In the body of the message,
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type: SUBSCRIBE CON-L YourFirstName YourLastName (e.g., if your name is “John Doe”, you would type: SUBSCRIBE CON-L John Doe). DOH Budget Action Summary Letter to MLTCs DOH prepared and circulated a letter to all MLTCs providing an overview of Division of Long Term Care items in the 2018-19 Enacted Budget, some additional details, and preliminary comments on next steps, mostly in anticipation of further guidance that DOH plans to issue. The letter can be viewed at https://hca-nys.org/wp-content/uploads/2018/04/Dear-Health-Plan-letterbudget.pdf. The following items are addressed in the letter:
LHCSA Contract Restrictions. The letter outlines the formula and provisions adopted in the budget (and extensively described by HCA for our MLTC and provider membership in our prior communications) for determining contract limits per plan. DOH indicates that it will be providing further guidance to affected plans, and that plans needing to reduce their number of contracts to comply will have to consider continuity of care, workforce adequacy, quality and value in selecting their contracted plans.
The three-month limit on the MLTC nursing home benefit. The letter indicates that the threemonth period is to begin once “any available Medicare coverage has been maximized,” and that “generally those who were permanently placed in the nursing home in April 2018 will be disenrolled to Medicaid fee-for-service (FFS) as of July 2018.” There is no change to the nursing home benefit for MAP, PACE FIDA or Medicaid Managed Care. DOH indicates that further guidance will be issued shortly and that, effective May 3, the mandated enrollment of newly identified permanently placed duals into MLTCs will end. Consumers who are disenrolled due to three months of permanent placement will be deemed eligible for community based services should they wish to return to a community setting.
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Restriction on Enrollee Plan Transfers. DOH will be providing guidance outlining good-cause exceptions to allow members to transfer between plans during the new 12-month lock-in period. Also, template model member notices and an insert for Member Handbooks will be developed.
Utilization and Authorization. MLTCs will be required to develop and use systems to better track utilization and immediately disenroll members who are not using authorized services and supports during a calendar month. Members disenrolled under this change will be considered “involuntarily” disenrolled using the existing process and will receive a notice from the MLTC with Fair Hearing rights. DOH will be providing further guidance to plans, including model member notices and an insert for Member Handbooks.
Fiscal Intermediary (FI) Marketing. Effective April 1, FIs must submit all advertising to DOH for review and prior approval. DOH indicates that it will be issuing further guidance to FIs.
Social Day Care Benefits. DOH indicates that MLTCs will face premium cuts as a means of incentivizing” plans to “more efficiently provide this service.”
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Your Help Needed for “HCA Alumni Search” as HCA Turns 40! HCA seeks contact information to invite distinguished HCA alums to our upcoming 40th annual conference In preparation for HCA’s 40th anniversary celebration at our upcoming Annual Conference – on May 9-11 in Saratoga Springs – we are seeking to contact some of our distinguished alumni, including past HCA Board Members, staff and other prominent members of the HCA community. We’ve already compiled a great list, but need help completing it. Please let us know if any of the following people are on your contact lists or social networks, and please forward their contact information to HCA’s Director of Membership Laura Constable – or ask them to contact her directly at (518) 810-0660 or lconstable@hcanys.org:
Jim Zadoorian Deb Childs Terry Goodwin Maxine Hochhauser Alex Janisewski
Pam Kane Sheila Loughlin Karen O’Kane Frances Sadler Indi Shelby Carol Raphael
Joe Bloss Eleanor Haley Warren Bielinski Sally Leiter Mary Bromirski Marion Ebner
Memo Outlines JCOPE Reporting & Registration Requirements for HCA Members who Attend Lobby Day or Engage in Other Lobbying Efforts HCA’s legal representatives have prepared a memo on potential New York State registration and reporting requirements for HCA members who participate in our annual lobby day and other advocacy initiatives, individually or as organized by HCA. The memo describes what constitutes “lobbying,” as defined by statute, and the various factors that would trigger registration and reporting requirements with the New York State Joint Commission on Public Ethics (JCOPE). Generally, lobbying activities would require reporting or registration if an individual expends $5,000 or more in a calendar year on such activities. However, the memo describes certain proposed regulations that would impact these requirements. HCA members can download the memo at https://hca-nys.org/wp-content/uploads/2018/04/ 042318LobbyDayMemoJacksonLewis.pdf. It was prepared by HCA’s Counsel, Frank Fanshawe, Principal at Jackson Lewis, and Anthony Bargnesi, Law Clerk at Jackson Lewis.
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HCA Data Webpage Now Includes 2015 LHCSA Statistical Reports and 2015 HHPPS Utilization and Payment Data This week, HCA staff posted to our HCA Data webpage an HCA-developed spreadsheet that includes 2015 Medicare home health prospective payment system (HHPPS) utilization and payment data along with another spreadsheet that includes – for the first time – Licensed Home Care Services Agency (LHCSA) Statistical Report data, from 2015. Important: HCA Data is a members-only page that provides data reports to assist home care and hospice providers and managed care plans in their benchmarking efforts, understanding of system-wide trends, and access to reimbursement and premium rates. The page is not visible on our site unless you are logged in with an HCA member website account. Our log-in page is here: http://hca-nys.org/login. Upon login, the HCA Data link will appear in the site menu at the top right. (You may have to refresh your browser.) You can also enter your e-mail address to obtain your password. Or, simply e-mail HCA’s Communications Director Roger Noyes at rnoyes@hcanys.org if you do not yet have an HCA website account. HCA data for assisting plans and agencies HCA’s 2015 LHCSA Statistical Report data includes multiple sheets summarizing key LHCSA data, including such items as: patient census; contract and direct revenue; costs; staff wages and other information. HCA’s spreadsheet of the 2015 HHPPS data (which came from the U.S. Centers for Medicare and Medicaid Services) provides the following information for every Medicare Certified Home Health Agency (CHHA) in New York State: total episodes; distinct Medicare beneficiaries; average number of visits per episode; average number of visits by discipline; total agency cost or charges; total Medicare payment amount; total number of low utilization payment amount (LUPA) episodes; percent of outliers; and other information. Upon receipt of raw data from the state, HCA will be posting spreadsheets summarizing the fourth quarter 2017 Medicaid Managed Care Operating Reports (MMCORs) for each MLTC and Program of All-Inclusive Care for the Elderly (PACE) plan in the state, as well as for the 2016 Medicaid Cost Reports for all non-hospital based CHHAs in the state. HCA expects to receive both requests next month and will notify the membership when that data is posted to the HCA Data page. (This data from prior years is already posted to the HCA Data page.) For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
Important Changes to Workplace Sexual Harassment Laws The state Legislature and New York City Council recently passed significant legislation designed to prevent sexual harassment in the workplace. Signed into law by Governor Cuomo, the Fiscal Year 2019 state budget includes provisions that require all employers to adopt a sexual harassment prevention policy and provide related training; extend sexual harassment protections to non-employees in the workplace; ban enforcement of arbitration clauses for
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sexual harassment claims; set forth a mandatory waiting period and revocation period for non-disclosure agreements related to sexual harassment claims; and require entities that bid for state contracts to affirm compliance with sexual harassment training laws. Similarly, the Stop Sexual Harassment in NYC Act mandates employer training on sexual harassment prevention (for employers of 15 or more employees); expands New York City Human Rights Law coverage for gender-based harassment claims to all employers; extends the statute of limitations for gender-based harassment claims under the Human Rights Law from one to three years; and extends protections to nonemployees in the workplace. Mayor Bill de Blasio is expected to sign the NYC Act into law shortly. HCA’s counsel, Frank J. Fanshawe, Principal at Jackson Lewis P.C., and Associate Nicholas V. Brdar, have prepared a detailed summary of these provisions available to the HCA membership. This summary is available here: https://hca-nys.org/wp-content/uploads/2018/04/042318SexualHarrassmentMemoJacksonLewis.pdf.
HCA Represents Home Care at HEPC Statewide Meeting On April 12 and 13, HCA participated in a Health Emergency Preparedness Coalition (HEPC) Statewide Administrators Meeting. The conference, held annually, brings together county, state and local emergency preparedness officials and health care provider state association representatives who comprise HEPCs from across the state. The purpose of the Administrators Meeting is to discuss and coordinate the statewide and sector-specific roles (i.e., home care, hospital, adult home, nursing home, etc.) and initiatives in emergency preparedness. HCA and each sector collaborate and contract with the state Department of Health (DOH) on emergency preparedness. On the first day of the conference, HCA Vice President Andrew Koski represented the home care sector in a panel discussion on the recent Coalition Surge Test and Interoperable Communications (CST/IOC) drill that was held in five regions of the state. HCA had publicized the drill to members and encouraged them to participate. Mr. Koski discussed both provider and HCA experiences in the drill, and expressed appreciation to the state for including home care, and for coordinating home care’s participation through HCA. Mr. Koski also identified key logistical issues for consideration and adjustment such as: problems with the notification of home care providers even if their contact information was correctly entered in the Health Commerce System; need for more timely notification of providers to participate in the 90-minute exercise; an opportunity for input from home care and hospice providers in discussions held after the drill; the lack of communications/follow-up from hospitals to providers on their ability to address surge capacity; and other issues. HCA also requested assistance in completion of After Action Reports and DOH said it would do so. The CTS/IOC debrief once again emphasized the critical importance of every provider in every sector maintaining updated and accurate contact information on the HCS. All home care, hospice and MLTC Health Commerce System Coordinators should check to ensure that your HCS contacts are updated. Take two minutes to do this now. The conference also included excellent presentations on cybersecurity and relief efforts to help Puerto Rico recover from destructive hurricanes. In addition, HCA met with other health sectors to review each sector’s state-federal emergency preparedness deliverables for the July 1, 2018 to June 30, 2019 period. HCA will next be bringing our local district emergency preparedness meetings to Nassau and Suffolk Counties. The purpose of these sessions is to promote local collaboration among home care, hospice, county health
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preparedness and county emergency management department representatives. The 2018-19 initiatives also include technical assistance on the federal Conditions of Participation (CoP) emergency preparedness provisions. Coming Soon Also coming soon is a resource toolkit for providers – compiled over the past year by HCA, the New York State Association of Health Care Providers (HCP), and a provider workgroup – that will assist providers in supporting the emergency preparedness tasks of patients and families. HCA encourages providers and plans to become involved with their local HEPCs, a valuable resource for addressing your emergency preparedness responsibilities and meeting key partners. Additionally, providers and plans should be regularly checking the websites of the Regional emergency preparedness training centers at Stony Brook (https://www.stonybrookmedicine.edu/MARORTC/preparedness-and-response-tools-resources), Central New York/Upstate Medical Center (http://www.upstate.edu/cnyrtc/index.php), and the University of Rochester (https://www.urmc.rochester.edu/emergency-preparedness/calendar.aspx) for training and exercise opportunities and other valuable resources. Those interested in participating with their local HEPC should contact Andrew Koski at akoski@hcanys.org. A list of upcoming HEPC meetings is below. HEPC Capital District– North Country Sub Regional Capital District Region – Capital District Sub Regional Lower Hudson Valley Long Island Western New York Sub Regional meeting Central New York Finger Lakes Emergency Preparedness Coalition of Manhattan
MEETING DATE May 2 May 11 June 6 June 7 June 14 June 14 June 18 August 15
For more information on HEPC meetings, visit https://www.urmc.rochester.edu/emergency-preparedness/calendar.aspx.
Revisions to NYC Paid Sick Leave Law Are Effective May 5 Revisions made to New York City’s Paid Sick Leave law are effective on May 5. In brief, NYC’s Paid Sick Leave requires five annual paid sick leave days for certain defined reasons to NYC workers at businesses with five or more employees, and requires employers with fewer than five employees to provide unpaid sick leave. The revisions include a new category for paid sick leave when the employee or a family member has been the victim of a “family offense matter,” “sexual offense,” “stalking,” or “human trafficking.” Those affected employees will be entitled to “safe time” for absence from work due to the following purposes:
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Obtaining services from a domestic violence shelter, rape crisis center, or other shelter or services program for relief from a family offense matter, sexual offense, stalking, or human trafficking;
Participating in safety planning, temporarily or permanently relocating, or taking other actions to increase the safety of the employee or employee’s family members from future family offense matters, sexual offenses, stalking, or human trafficking; Continued on next page
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Continued from previous page
Meeting with a civil attorney or other social service provider to obtain information and advice on, and prepare for or participate in any criminal or civil proceeding;
Filing a complaint or domestic incident report with law enforcement;
Meeting with a district attorney’s office;
Enrolling children in a new school; or
Taking other actions necessary to maintain, improve, or restore the physical, psychological, or economic health or safety of the employee or the employee’s family member or to protect those who associate or work with the employee.
The law also expands the definition of “family member” to include “any other individual related by blood to the employee; and any other individual whose close association with the employee is the equivalent of a family relationship.” More information on Paid Sick Leave is at http://www1.nyc.gov/site/dca/about/paid-sick-leave-law.page. The new law is at http://legistar.council.nyc.gov/LegislationDetail.aspx?ID=2867849&GUID=DCC83D1C0D6A-4E38-9FEB-6974CA947D6F&Options=ID|Text|&Search=1313-A.
CMS Develops Market Saturation and Utilization Data Tool The U.S. Centers for Medicare and Medicaid Services (CMS) has released an updated version of its Market Saturation and Utilization Data Tool that includes interactive maps and a dataset of national, state, and county-level provider services and utilization for many health service sectors, including Medicare home health services.
Cnical Man
The seventh release of the data tool can be found at https://data.cms.gov/market-saturation. It contains updated market saturation and utilization data for the April 1, 2016 through March 31, 2017 time period. CMS uses the data for program integrity purposes. The data can also reveal the relationship between service use and the number of providers covering a geographic region. Additional information is in the CMS Fact Sheet at https://tinyurl.com/ybvvbo5z. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
Clinical Manager, Private Care/MLTC Manhattan Partners in Care, a respected leader in home health care, is currently seeking a Clinical Manager. The Clinical manager is accountable to the Associate Clinical Director to ensure quality and safe delivery of home care services in a cost effective manner, and to coordinate provision of home care services that reflects the agency’s philosophy and ensures standards of care are maintained. To qualify you must be a New York State licensed/certified RN with three (3) years clinical background. The ideal candidate will have excellent problem solving, organizational, interpersonal, written and verbal communication skills. Previous managerial experience with at least two (2) years’ experience in LHCSA or CHHA also preferred. Please email resume to: Joyann.thompson@partnersincareny.org
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Staff Development Supervisor
DIRECTOR of CLINICAL OPERATIONS
Driven to be the Best. At Home Care, Inc., a nationally recognized “top 500” certified home health agency located in the Leatherstocking Region of Central New York, seeks to hire a Director of Clinical Operations. This key leadership position will operate within a patient-centered and technology progressive healthcare environment. Responsibilities include generation, implementation and oversight of clinical policy, to ensure high quality, safe and effective patient care. Successful candidate will have:
BSN / Master’s degree preferred
Two years of experience in a clinical leadership role, with a proven record of effective clinical and change leadership
Two years certified home health care experience
Strong written and verbal communication skills
Knowledge of Joint Commission and Federal homecare regulations
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.
NYS RN License, required.
2-3 years Clinical Nursing Practice and Community Health Nursing required.
2 years Nursing experience in a supervisory capacity in a HHA required.
1-2 years Trainer, Instructor or Education Coordinator in a Certified Home Health Agency preferred.
Good presentation, communication, PowerPoint & computer skills are vital.
Ability to conduct education sessions and conduct skills lab to develop competencies a must.
Financial and reimbursement understanding
For consideration, please submit your resume in confidence, to Patricia Brown, Director of Human Resources e-mail: pbrown@ahcnys.org Fax: 607-432-5836 Direct: 607-353-7413 AHC is an EOE
Apply@ www.nyuwinthrop.org/careers, #18-22843, e-mail HRHomeCare@nyuwinthrop.org, or call 516.663.8000. An EOE.
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. EOE/M/F/D/V
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Upcoming Deadlines Requirement/Change
Effective/Due Date
More Information
Home Care, Fiscal Intermediaries and other providers who contract with Managed Care Organizations must be enrolled in Medicaid
Still being accepted, but providers are advised to submit now
https://www.emedny.org/info/ProviderEnrollment/ ManagedCareNetwork/index.aspx
Posting of OSHA Form 300A
February 1 to April 30, 2018
https://www.osha.gov/recordkeeping/RKforms.html
Start of Transition Period for Using Health Insurance Claim Number (HICN) or Medicare April 1, 2018 Beneficiary Identifier (MBI)
https://www.cms.gov/Medicare/NewͲMedicareͲ Card/index.html
Implementation of Universal Billing Codes for Home and CommunityͲBased Long Term Care Services under Managed Care
April 1, 2018
https://www.health.ny.gov/facilities/long_term_care /reimbursement/letters/dal_2017Ͳ12Ͳ 07_billing_codes.htm
Submission of Expression of Interest for the Medicare Low Volume Appeals Initiative
April 12 to June 8, 2018
https://www.cms.gov/Medicare/AppealsͲandͲ Grievances/OrgMedFFSAppeals/AppealsͲSettlementͲ Initiatives/LowͲVolumeͲAppealsͲInitiative.html
April 30, 2018
https://commerce.health.state.ny.us
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_ca re/plans/appeals/index.htm
Changes to NYC Paid Sick Leave Law Become Effective
May 5, 2018
http://www1.nyc.gov/site/dca/about/paidͲsickͲ leaveͲlaw.page
NYS Health Foundation ‘Patients as Partners’ RFP
May 16, 2018 for online inquiry form
https://nyshealthfoundation.org/rfp/patientsͲasͲ partners/?utm_source=Patients+as+Partners+RFP+Re lease+April+2018&utm_campaign=Patients+as+Partn ers+RFP+Release&utm_medium=email
2018 Adult Care Facility 1st Quarter Statistical Information Report (January 1 to March 31, 2018) Request for Information (RFI) on eliminating the Hospital and Community (H/C) Patient Review Instrument (PRI)
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State LTC Council Seeks Your Input for Strategic Plan A new state survey seeks provider responses to inform a strategy “to help meet the needs of our aging population now and in the future” through the efforts of the newly launched Long Term Care Planning Council. State Health Commissioner Dr. Howard Zucker and Office for the Aging Acting Director Greg Olsen recently issued a letter to providers and stakeholders, urging completion of the survey by June 18 at the following link: https://www.surveymonkey.com/r/HM9DM97. Their offices also requested HCA support in spreading the word about this important survey, which we urge members to complete for use and deliberation by the Long Term Care Planning Council in activities and policies that could have a major impact on the delivery system. The Council’s charge includes: analyzing, evaluating and identifying existing gaps in the long term care system; determining the most cost-effective community-based interventions; and preparing a strategic plan. Dr. Zucker and Mr. Olsen are both confirmed to speak at HCA’s upcoming Annual Conference (May 9-11 in Saratoga Springs) during our Board of Directors meeting. Both speakers have a profound knowledge and influence over state policy-making that affects the HCA membership, so we encourage you to attend the conference and hear their perspectives along with the education, insights and networking opportunities that abound on May 9-11, our 40th anniversary conference. You can register and find other information on our conference website at www.hcaannualconference.com.
LHCSA Applications Deferred at PHHPC Meeting The Public Health and Health Planning Council (PHHPC), at its April 12 meeting, deferred action on certain Licensed Home Care Services Agency (LHCSA) applications that had been recommended for approval at the March 22 meeting of the PHHPC Establishment and Project Review Committee. The applications included: fifteen entities to establish new LHCSAs; two existing LHCSAs for a change of ownership; and five new LHCSAs that are affiliated with an application for an Assisted Living Program (ALP). Some or all of these LHCSA applications may be considered at the next full PHHPC meeting on June 7 under new rules that result from provisions in the final state budget. These provisions placed a two-year moratorium 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:
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 Continued on next page
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Continued from previous page 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. At the April 12 PHHPC meeting, two applications related to Certified Home Health Agencies (CHHAs) were approved. One was for a CHHA to establish one entity as its parent and another entity as its grandparent; and the other was for a CHHA for a full asset merger of another entity into its operations. The April 12 PHHPC meeting can be viewed at https://www.health.ny.gov/events/webcasts/archive/.
CMS Posts New OASIS FAQs The U.S. Centers for Medicare and Medicaid Services (CMS) has recently posted a new set of Outcome and Assessment Information Set (OASIS) frequently asked questions (FAQs) on the QIES Technical Support Office (QTSO) website at: https://qtso.cms.gov/hhatrain.html. This is the first set of OASIS FAQs posted by CMS since October 2016. There are 11 new FAQs that address changes to the one-clinician rule, the change in the regulation that permits a timely resumption of care (ROC) date to be based on a physician’s order, and several other issues. HCA will update the membership if CMS posts any additional OASIS FAQs in the future. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
New Maximum Weekly Benefit Rate for Workers’ Compensation The Workers’ Compensation Board has announced that the maximum weekly benefit rate for Workers’ Compensation will increase to $904.74 (from $870.61) for compensable lost time for workers’ compensation claims with dates of accident during the period from July 1, 2018 through June 30, 2019. This rate is based on two-thirds of the New York State average weekly wage for the previous calendar year. More information is at http://www.wcb.ny.gov/content/main/SubjectNos/sn046_1061.jsp.
OIG Launches New Compliance Portal The federal Office of Inspector General has launched a new compliance resource portal. The portal is at https://oig.hhs.gov/compliance/compliance-resource-portal/. It includes toolkits; provider compliance resources and training; advisory opinions, voluntary compliance and exclusions resources; special fraud alerts, other guidance, and safe harbor regulations; resources for health care boards; and more.
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The Situation Report: the Home Care Association of New York State
Volume 3, No. 17 April 23, 2018
Workers’ Compensation Board Issues Proposals The Workers’ Compensation Board has posted a series of proposals that would increase provider fees, adopt the universal CMS-1500 form, institute other changes to reduce administrative burden, and allow additional provider types to treat injured workers. According to the Board, this is being done to increase provider participation and “improve injured workers’ access to timely, quality medical care.” The Board will be advancing a regulatory proposal in June to raise provider fees that will be effective for services provided on or after October 1, 2018. The proposal will include an overall statewide fee increase for all provider types, with additional increases for certain specialty provider groups that have an extreme shortage of authorized providers. According to the Board, its current medical fee schedule has remained relatively unchanged since 1996 and remains a significant obstacle to attracting new providers and retaining existing ones. CMS-1500 Form The Board will also be consolidating and eliminating forms, including converting to the use of the CMS-1500 form. The CMS-1500 is the universal claim form used by medical providers to bill health insurers. The Board proposes replacing the current Board treatment forms (C-4 and C-4.2, and equivalent OT/PT and PS forms) with the CMS-1500. As the CMS-1500 is already used by medical providers and insurance carriers to process claims, the Board anticipates an easy transition to the CMS-1500 and will be working towards a January 1, 2019 implementation date. Access to Different Medical Providers The Board is also exploring options that will increase access to expanded medical care provider types. Currently only physicians, chiropractors, podiatrists, and psychologists can be authorized to treat injured workers. The proposed legislation would permit medical providers who are licensed in New York State to become authorized, opening participation to nurse practitioners, physician’s assistants, licensed clinical social workers, and other providers. In most instances, injured workers would be able to seek treatment for their workers’ compensation illness and injuries with the same providers they use for non-work-related illness and injuries. More information is at http://www.wcb.ny.gov/content/main/SubjectNos/sn046_1058.jsp.
NYS Health Foundation Announces New RFP The New York State Health Foundation (NYSHealth) has announced a Request for Proposals (RFP) to support projects that seek system improvements, practice innovations, or policy reforms to benefit and empower patients and consumers. This RFP is open only to organizations based in New York State. Applicants can partner or subcontract with a non-New York-based organization if it offers resources and expertise beneficial to the project. Through this
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The Situation Report: the Home Care Association of New York State
Volume 3, No. 17 April 23, 2018
RFP, awards of up to $250,000 will be granted to up to six organizations for New York-targeted projects spanning one to three years. Applicants must first complete an online letter of inquiry form, with a deadline of May 16, 2018. Selected organizations will be invited to submit full proposals, with a deadline of July 23, 2018. More information is at https://tinyurl.com/ybrejgln.
NGS Provides Guidance on OASIS Submission Error Code After receiving numerous inquiries, National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), has posted the following notice regarding the 37253 reason/error code. NGS Notice The Fiscal Intermediary Standard System (FISS) verifies certain items from the Quality Improvement Evaluation System (QIES) to determine if an OASIS has been submitted for a home health episode (and claim submission), and if certain information matches what was submitted on the OASIS. NGS recommends reviewing the OASIS requirements job aid on its website (www.ngsmedicare.com) to review the fields that are required to have matching information in QIES and FISS. The U.S. Centers for Medicare and Medicaid Services (CMS) has also published an article (https:// www.cms.gov/Outreach-and-Education/Outreach/FFSProvPartProg/Provider-Partnership-Email-Archive-Items/ 2017-10-12-eNews.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending#_Toc495475520) which confirms that, instead of denying claims for no matching assessment, the claims will be returned to provider (RTP’d) until further notice in order to give home health agencies the opportunity to correct and resubmit the episode claim for processing. The CMS article explains that when a claim is RTP’d, it can be sent back for processing (F9) after one of the following actions has been taken by the home health agency:
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Update the Medicare number on the OASIS assessment to match the current information – there are times when a beneficiary’s Medicare number is automatically corrected in FISS to match the correct number in the common working file (CWF), but the automatic correction does not happen in QIES. If a Medicare number has been changed (e.g., from a ‘B’ to a ‘D’ at the end), the OASIS must be corrected so that QIES will have the correct information. Verify that the Medicare number stored in QIES matches the Medicare number on the claim.
Correct the assessment completion date reported in the claim treatment authorization code to match the OASIS assessment – the OASIS must be transmitted and accepted timely in order for the claim to process. If the OASIS was transmitted after the 30-day requirement without errors, the OASIS will be accepted in QIES with a warning that it was late. There is no corrective action for a late assessment. Home health agencies should review the validation report to verify the OASIS was transmitted and accepted. QIES will accept an OASIS with minor errors; however, the validation report will have warning messages. It is important to pay attention to these warning messages and submit a corrected OASIS to modify the appropriate information required for OASIS claim match. Once the OASIS information has been corrected in QIES, it’s important to delete and re-key the 0023 revenue line before resubmitting the RTP’d claim. Please review the job aid titled FISS DDE System:
The Situation Report: the Home Care Association of New York State
Volume 3, No. 17 April 23, 2018
Deleting Revenue Lines for the appropriate steps to delete and re-key the 0023 revenue line information.
Resubmit for denial using condition code 21 and type of bill 320 if the assessment was not submitted – if the episode claim was submitted before the OASIS was transmitted and accepted, the claim must be resubmitted as a claim denial. It is a condition of payment that the OASIS must be submitted and accepted prior to submitting the claim. HHAs should only submit the claim for denial if there was no OASIS submitted for the episode.
It is essential to review all information submitted to QIES and the information in FISS to ensure the OASIS/claim match.
Resources
“Racial, Ethnic, and Gender Disparities in Health Care in Medicare Advantage,” by the U.S. Centers for Medicare and Medicaid Services and the Rand Corporation http://nasuad.org/sites/nasuad/files/2018-National-Level-Results-by-Race-Ethnicity-andGender.pdf
“Integrating Health and Human Services,” by the Human Services Council of New York https://humanservicescouncil.org/wp-content/uploads/Initiatives/ValueBasedPayment/ValueBased-Care-Report.pdf
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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