WAIVERS
SPONSORS
24-HOUR, LIVE-IN CASES
FLU VACCINE REPORT
HCA seeks your examples of regulatory waivers that would help your organization as part of bill to test relief measures.
Two of HCA’s sponsors, HHAeXchange and TSG Financial, have a special message for members. Be sure to meet them at HCA’s Annual Conference.
HCA held a conference call this week to help illuminate some of the issues, risks and implications of recent court actions affecting 24-hour, live-in home care cases.
Reminder: the Healthcare Personnel Vaccination Report is due by May 1, 2017.
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Your Source for HOME CARE News, Policy and Advocacy
COMING UP Rediscover, Reimagine, Reinvent at HCA’s Annual Conference in Saratoga Saratoga Springs, NY May 3 to 5 Moving Beyond Personal Care to Meet the Challenge & Opportunities of Value-Based Care New York City, NY May 18, 2017 For more information on these and other programs, please visit the education and events section of HCA’s website at http://hca-nys.org/ events-education/ upcoming-events
Vol. 2, Issue 17 | April 24, 2017
HCA Joins Powerhouse Coalition Opposing Federal Health Care Bill HCA has joined a formidable group of nearly 30 organizations in a joint letter to Congress urging members of New York State’s Congressional Delegation to reject the American Health Care Act (AHCA), which is Congress’ plan to repeal the Affordable Care Act (ACA). See COALITION p. 6
CMS Approves SPA to Eliminate 2% Across-the-Board Reduction The U.S. Centers for Medicare and Medicaid Services (CMS) has approved the state Department of Health’s (DOH) state plan amendment (SPA) to eliminate the two percent across-the-board (ATB) reduction that applied to home care and other health services. See SPA p. 2
INSIDE HCA Joins Coalition Opposing Federal Health Care Bill........................................1 CMS Approves SPA to Eliminate 2% Reduction.....................................................1 DOH Guidance on FLSA Funding: Attestations Due May 5.....................................1 Your Ideas Sought on HCA-Authored Reg. Waiver Initiative..................................2 Message from HCA Sponsor HHAeXchange: 3 Simple Ways to Increase Your Agency Revenue................................................................................................4 Message from HCA Sponsor TSG Financial: Home Care Agencies in New York Taking a Fresh Perspective on Insurance Programs.......................................................4 Member Hiring Announcements..................................................................5,8 Member Call Explains Ramifications of 24-hour/Live-in Court Cases...................7 What’s Keeping Your Colleagues in Other States Up At Night?..............................8
DOH Guidance on FLSA Funds: Attestations Due 5/5 HCA Seeks DOH Meeting for Clarification on behalf of Plans and Providers The state Department of Health (DOH) has posted additional guidance on funds intended for use in meeting the 2015 Fair Labor Standards Act (FLSA) changes. The April 2017 “Dear Colleague” Letter on FLSA Implementation and accompanying attestation forms are available at https:// www.health.ny.gov/health_care/ medicaid/redesign/ fair_labor_standards_act.htm. See FLSA p. 5
Vaccination Report Due by May 1..........................................................................9 GAO Report Emphasizes Concerns with “Probe and Educate” Audit by MACs..........9 Medicaid Cap Report: Overall Spending Below Cap for Entire 2017 Fiscal Year......10 NEW Video: What Excites US about the Upcoming HCA Annual Conference...........11 Draft Policy Released for “In Lieu of Services”......................................................11 Care At Home Waivers Consolidated.................................................................12 FAQs Posted on FIDA Appeals for Non-Participating Providers.............................12 DOH Posts Report on MRT Projects.....................................................................13 CDC Issues Guidance for Managing Exposure to Zika...........................................13 Free Resource to Track Quality of Care................................................................14 Upcoming NGS Education Programs...................................................................14 Resources..............................................................................................................14
The Situation Report: the Home Care Association of New York State SPA from p. 1 The SPA approval is at https://www.health.ny.gov/regulations/ state_plans/status/non-inst/approved/docs/app_2017-0412_spa_14-30.pdf. The 2 percent ATB reduction applies to Medicaid fee-for-service from April 1, 2014 to March 31, 2015. As background, the final 2014-15 state budget discontinued the 2 percent ATB reduction after March 31, 2014, and DOH subsequently issued guidance in 2015 which advised affected providers that, effective May 8, 2015, the 2 percent ATB reduction was eliminated for claims with service dates on or after April 1, 2015. In the fall of 2016, HCA was advised by DOH that a key issue with this SPA had been resolved and DOH was then able to make a retroactive payment to providers for the state share of the 2 percent ATB reduction that had been collected from providers for April 1, 2014 to March 31, 2015. We understand that this payment was made sometime in October/November 2016. Now that CMS has approved the SPA, we anticipate that the state will send a retroactive payment for the federal share of the 2 percent ATB reduction for the April 1, 2014 to March 31, 2015 period. HCA will be seeking additional information from the Department as to the timing of this expected retrospective payment and will update the membership as further information is obtained.
Your Ideas Sought as HCA, DOH Work on HCAAuthored Reg. Waiver Initiative HCA has developed legislation, passed by the Legislature, allowing home care providers to request waivers on an individual basis for achieving more meaningful participation in care delivery opportunities (i.e., DSRIP, VBP, etc.). We need your input (using the survey link on the next page) to gather examples of state waiver possibilities for consideration by the state Department of Health (DOH) as part of this initiative. These waivers could apply to regulations, procedures, and other requirements to support your: agency staff (i.e. RNs, aides, 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 2, No. 17 April 24, 2017
The Situation Report is a weekly publication of the Home Care Association of New York State (HCA). Unless otherwise noted, all articles appearing in The Situation Report are the property of the Home Care Association of New York State. Reuse of any content within this newsletter requires permission from HCA. Joanne Cunningham HCA President jcunningham@hcanys.org Roger L. Noyes Director of Communications, Editor of The Situation Report rnoyes@hcanys.org Al Cardillo Executive V ice President acardillo@hcanys.org Patrick Conole Vice President, Finance & Management pconole@hcanys.org Andrew Koski Vice President, Program, Policy & Services akoski@hcanys.org Alexandra Fitz Blais Director of Public Policy ablais@hcanys.org Laura Constable Senior Director, Membership & Operations lconstable@hcanys.org Celisia Street Director of Education cstreet@hcanys.org Mercedes Teague Finance Manager mteague@hcanys.org Jenny Kerbein Director of Governance & Special Projects jkerbein@hcanys.org Billi Wilson Manager, Meetings & Events bwilson@hcanys.org Teresa Brown Administrative Assistant tbrown@hcanys.org
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therapists, etc.); operational efficiency; quality of care; staff/patient satisfaction; or other areas. Participating providers would report their experiences from the waivers back to DOH, who could then evaluate whether the result was potentially appropriate for statewide application as an “innovation opportunity.” This HCA legislation was passed and subsequently signed in August 2011, but its application was paused because, at that time, DOH was also faced with implementation of all the Medicaid Redesign Team (MRT) initiatives. This year, HCA and DOH specifically reengaged in conversations about this program, especially in light of timely opportunities for flexibility under VBP, DSRIP and other models. DOH has since invited HCA to gather examples from providers of waivers that DOH could potentially include in its implementation guidance. As an example, for patients requiring both OASIS and UAS, would DOH waive the duplicative assessment requirement? HCA invites providers to submit your ideas for waivers of state (not federal) regulatory, procedural, documentation, reporting, or other requirements that would promote the goals stated above. All HCA member home care providers and MLTCs are invited to submit their examples using the online survey at: https:// www.surveymonkey.com/r/CY8RKRT. Please direct questions related to the legislation to Al Cardillo at acardillo@hcanys.org; and questions related to the submission of examples to Alexandra Blais at ablais@hcanys.org.
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A message from HCA sponsor Sandata
The Situation Report: the Home Care Association of New York State
Three Simple Ways to Increase Your Agency Revenue By Greg Strobel, president, HHAeXchange, HCA Platinum Sponsor Electronic visit verification (EVV) is valuable, but in a complex home care ecosystem like New York, it’s only the beginning. Home care providers need more than a tool to track when an aide clocks in and out – they need technology that drives bottom-line revenue. Capturing data from an EVV solution won’t help reduce readmissions, maximize referrals, manage aide certifications and schedules, ensure holistic compliance or manage authorizations. Typically, these tasks require long hours of manual work – and even then, they are often incompletely or inaccurately performed. Comprehensive, enterprise-class technology can simplify these processes and drive revenue in three important ways: 1. By fostering agency growth: When you’re growing, you don’t have time to manually review every case and claim. Workflow by exception technology is a highly efficient alternative that simplifies the process while keeping you compliant. 2. By allowing you to easily bill – and keep your money: These systems were built for multi-payer markets, and they are specially designed to allow agencies to efficiently manage their payers’ needs. 3. By giving you more referrals: To build revenue, you need to take on more business. With these solutions, independent agencies can connect referrals from anywhere, and track their marketing efforts to see what’s working. HHAeXchange was built for New York State and offers the most robust solution on the market today. Maximize your agency revenue by implementing a platform that takes you beyond EVV. Greg Strobel is the president of HHAeXchange, a NY-based company that is tackling one of the country’s greatest challenges: home care. We connect payers, providers and members to allow our most vulnerable populations to stay in their homes longer. Visit hhaexchange.com, or find them on Twitter at @HHAeXchange. Greg is on Twitter at @GregStrobelHHAX.
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Volume 2, No. 17 April 24, 2017
Home Care Agencies in New York Taking a Fresh Perspective on Insurance Programs By TSG Financial, HCA Platinum Sponsor ACA Changes, Workers’ Compensation Reform, Cyber Liability, Legal and Compliant Wage Parity Programs, the NEW Family Medical Leave…the risks are all around and have major impact on business success and bottom-line expense. Now, more than ever, agencies are seeking the services of an insurance practice committed specifically to home care. Finding the right firm has become a challenge as “taking a leap of faith” away from current brokers and consultants can seem daunting. Fortunately, there is a Fresh Perspective available with decades of dedicated, NYS based home care experience. The best solution to that Fresh Perspective is, and always was, TSG Financial (www.tsgfin.com). In 2017, as part of the prestigious national firm Risk Strategies Co. (www.risk-strategies.com), TSG Financial has teamed with Risk Strategies Health Care practice leader Dubraski and Associates (www.dubraski.com) to extend its specialization to Property, Casualty, Liability and Workers’ Compensation. Together, TSG Financial and Dubraski and Co.’s market reach provides new options to improve programs and reduce cost. This also includes New York State Disability and the new requirement of Family Medical Leave in 2018. Your agency and your financial statement NEED a Fresh Perspective from TSG Financial.
The Situation Report: the Home Care Association of New York State FLSA from p. 1 According to the April 14, 2017 letter, DOH has included FLSA-intended funding in both the April 2016 and October 2016 managed long term care (MLTC) premium rate packages. Furthermore, the “per-hour” amount for fee-for-service providers was factored into rate adjustments, retroactive to October 13, 2015. DOH states an expectation that “funds issued to plans will be passed through to providers in their entirety, consistent with previous guidance.” Moreover, “funds paid directly to providers are subject to the same expectation. Providers are responsible for ensuring that funds received are applied to the home care worker’s total wage.” For purposes of this guidance, providers are defined as Licensed Home Care Services Agencies (LHCSAs), Certified Home Health Agencies (CHHAs), Long Term Home Health Care Programs (LTHHCPs), and Consumer Directed Fiscal Intermediaries (FIs) for both managed care and fee-for-service.
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from their contracted providers and retain them for their records. The submitted attestation, according to DOH, confirms that funds received were disbursed in compliance with this Letter. HCA has significant concerns regarding this guidance as it raises issues and complications for plans and providers. HCA has requested a meeting with DOH to discuss our concerns and the significant confusion and difficulties the letter has generated for plans and providers. These funds are intended to cover the following FLSA-related costs: requirements to pay overtime at time-and-a-half of the aide’s regular rate of pay instead of time-and-a-half of the minimum wage; pay for travel expenses; pay for more than 13 hours on 24-hour/live-in cases if the aide did not receive at least 8 hours of sleep, including at least 5 uninterrupted hours of sleep, and at least three hours for meals. HCA will continue its aggressive advocacy on this important issue and will communicate new information regarding this guidance as it becomes available. Comments can be communicated to the HCA policy team at akoski@hcanys.org. In addition, questions for DOH staff should be e-mailed to FLSA@health.ny.gov.
Chief Financial Officer Oneonta, New York
DOH is requiring that plans and providers alike sign and submit attestations by May 5, 2017 directly to the Department (FLSA@health.ny.gov). DOH strongly encourages providers to also send their attestations to their contracted managed care plans. Plans are directed to distribute and obtain all signed attestations
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Bassett Healthcare Network: At Home Care, Inc. (AHC), a nationally recognized and progressive Medicare Certified Home Health Care agency, seeks to hire an executive level financial leader. Operating across five predominantly rural counties in Central NY, AHC is an integral healthcare network partner. With a data driven integrated financial and clinical leadership approach, the individual will be responsible for planning, oversight and directing all fiscal operations of the organization. Candidate Qualifications x Experienced home health financial leader with McKesson Horizon IS experience, preferred x MS Office and accounting software experience required x A clear and concise communicator, written and oral x Education: bachelor’s degree in accounting or finance required; Masters or CPA, preferred Competitive salary and benefit package offered. For more information, or to submit a CV in confidence, please direct to: Patricia Brown, Director HR; 25 Elm Street, Oneonta NY 13820 Or, E-mail: pbrown@ahcnys.org
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COALITION from p. 1 The letter comes at a time as Congress looks to reinvigorate its efforts on the health care measure after suspending action in March, once it became clear that divisions within the House made it unlikely to pass the bill. Various media reports have indicated that efforts are underway within the House GOP majority to amend the bill for a continued advance. The coalition letter is published in its entirety below. A link to the letter is at http://hca-nys.org/wp-content/ uploads/2017/04/Letter-to-Congressional-Delegation.pdf. While the Affordable Care Act (ACA) can be improved, replacing it with the AHCA would have significant adverse consequences to millions of New Yorkers. The entire New York Congressional Delegation should instead fight for healthcare policies that:
Ensure uninterrupted healthcare coverage for the 24 million Americans, including the850,000 New Yorkers who gained coverage under the ACA
Do not harm New York State’s budget and do not shortchange New York’s Medicaid program
Protect the more than 600,000 New Yorkers who gained coverage under the Essential plan
Do not harm health care consumers and providers
Maintain and improve our insurance markets for individuals, families, and small employers
April 20, 2017 To the New York State Congressional Delegation: On behalf of consumers, health care workers, providers, and insurers throughout New York State, the undersigned organizations strongly urge you to reject the American Healthcare Act (AHCA). The AHCA would strip health insurance from millions of New Yorkers, profoundly restructure and cut billions of dollars from the New York State Medicaid program, and cut reimbursement to the state’s already financially fragile health care providers.
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We urge you to work together with your colleagues and New York’s healthcare and human service community to advance policies to benefit our state’s residents. We stand ready to work with you on such an effort. Thank you.
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Member Call Explains Ramifications of 24-hour/Live-in Court Cases Future HCA Advocacy Planned This week, HCA held a conference call in which about 100 members participated to gain updates on the recent Nina Tokhtaman, etc. v. Human Care, LLC case and other court decisions that covered the provision of 24-hour/live-in care. These cases all have a major impact on the care provided by home care agencies and managed care plans. Rosemary McKenna, a Principal in the Albany, New York, office of Jackson Lewis P.C., discussed the ramifications of Tokhtaman; gave updates on other court decisions that cover 24-hour/live-in care and related labor issues; and suggested actions that agencies and provider associations can take.
obligations and rights in their managed care plan contracts (i.e. whether contract language accounts for changes in reimbursement attributable to changes in regulations); and look to include new language/ provisions in any collective bargaining agreements. Ms. McKenna also suggested that the Associations representing home care providers and plans should meet with the state Department of Health (DOH) and state DOL to discuss what each agency can do, including additional reimbursement, further DOL guidance, and revised DOL regulations.
The Court found that a widely cited state Department of Labor (DOL) opinion letter (March 11, 2010) conflicted with separate DOL regulations [12 NYCRR, section 142-2.1(b)], and thus it refused to follow the DOL opinion.
The call generated lots of questions, including how home care providers who have relied on guidance from DOH and DOL can face risk for their past actions; the likelihood and timeframe of an appeal in Tokhtaman; the impact of the case on aroundthe-clock (two 12 hour shifts) care; the effect on consumers if home care agencies refuse to provide 24-hour/live-in care; the distinction between “residential” and “non-residential” employees under state regulations; and the relevance of arbitration clauses in contracts.
That March 11, 2010 state DOL opinion letter advised that all “live-in employees,” regardless of whether or not they are “residential employees” must “be paid not less than for thirteen hours per twenty-four hour period provided that they are afforded at least eight hours for sleep and actually receive five hours of uninterrupted sleep, and that they are afforded three hours for meals.”
HCA will be following up with both DOH and DOL, in addition to meeting with our governmentrelations team as well as with other Associations next week to discuss a joint strategy. HCA had previously submitted an amicus brief in Andryeyeva v. New York Health Care, Inc. and oral arguments were held on that and another case (Moreno v. Future Health Services, Inc.) in January of this year.
This DOL opinion letter has been relied on by home care providers and the state. If this decision or a similar one is upheld, it will have major consequences for the delivery of 24-hour/live-in care.
HCA stresses that the decisions in these cases – all involving 24-hour, live-in services – have various implications, including the potential for class-action status in some instances, as well as the applicability to specific service regions in others. Also, these cases are at various procedural stages, meaning further court action, or the prospect of appeal, are all possible. HCA will keep members informed of any new developments on Tokhtaman and related cases through our newsletter, Alerts and/or future education programs.
The Tokhtaman decision would expand the category of live-in aides who would be entitled to be paid for each hour of a 24-hour shift.
Rosemary McKenna discussed the risk for agencies of: retroactive liability for unpaid wages, overtime and spread of hours; liquidated damages; and attorneys’ fees, if any of these cases are upheld. She suggested that agencies should: assess their risk in providing 24hour/live-in care; examine their contracting
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What’s Keeping Your Colleagues in Other States Up At Night? Learn and Prepare at HCA’s Annual Conference HCA President Joanne Cunningham kicks-off the 2017 HCA Annual Conference (May 3-5) with a unique panel session engaging her state executive peers from the diverse states of Florida, Massachusetts and North Carolina to discuss the pressing challenges, hot topics and opportunities that are facing your home care community colleagues in other states. Don’t miss this engaging discussion to learn what’s on the minds of fellow leaders and tips to prepare for trends that may come your way! Take advantage of this panel session and many other exciting programs at HCA’s Annual Conference on May 3-5, 2017; plus network with your peers, mingle with exhibitors, attend HCA’s town hall meeting and celebrate the 2017 honorees at our Annual Awards luncheon. Reserve your seat today!
HCA President Joanne Cunningham
From left to right are home care association leaders joining HCA President Joanne Cunningham for a unique panel session at HCA's Annual Conference: Pat Kelleher, Executive Director, Home Care Alliance of Massachusetts; Bobby Lolley, RN, Executive Director, Home Care Association of Florida; Timothy Rogers, President & CEO, Association for Home & Hospice Care of North Carolina
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Vaccination Report Due by May 1 HCA reminds members that the Healthcare Personnel Vaccination Report is due by May 1, 2017. As covered in past HCA communications, home care, hospice and other health care providers are required to document the number and percentage of personnel vaccinated against influenza for the current season and to report this data through the Healthcare Personnel Vaccination Report. This season’s report covers health care personnel employed by or affiliated with your agency from October 1, 2016 through March 31, 2017. If health care personnel work in or are affiliated with more than one agency or facility, then they must be counted in the total number of personnel for each agency or facility where they work. The report may be accessed on the Health Electronic Response Data System (HERDS) at https://commerce.health.ny.gov. The Dear Administrator Letter, instructions and a Frequently Asked Questions document on the report are at http://hcaannualconference.com/wp-content/uploads/2017/04/ ctrlaccamstmpNotification_21226.pdf. Questions about the report should be directed to the state Department of Health’s Bureau of Immunization at either (518) 473-4437 or immunize@health.ny.gov. Technical questions about the report or HERDs should be directed to the Health Emergency Preparedness Program at (518) 408-5163 or hseppny@health.ny.gov.
GAO Report Emphasizes Concerns with “Probe and Educate” Audit by MACs The Government Accountability Office (GAO) recently released a report regarding “Medicare Provider Education: Oversight of Efforts to Reduce Improper Billing Needs Improvement.” The report (at http://www.gao.gov/assets/690/683312.pdf) examines the role of Medicare Administrative Contractors (MACs) with a specific focus on their education and outreach with home health agencies (HHAs) and hospitals. It concluded that the MACs have not focused their efforts on areas vulnerable to improper payments, that there is a lack of education by the MACs to referring providers (physicians), and that the home health “probe and educate” program has been determined to be ineffective by the U.S. Centers for Medicare and Medicaid Services (CMS) due to lack of evaluation metrics. GAO recommends:
For any future probe-and-educate reviews, CMS should establish performance metrics that will help the agency determine the reviews’ effectiveness in reducing improper billing.
CMS should require sufficient detail in MAC reporting so that CMS can determine the extent to which MACs’ provider education department efforts focus on areas identified as vulnerable to improper billing. Continued on next page
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Continued from previous page
CMS should explicitly require that Part A & B providers – including HHAs, Durable Medical Equipment (DME) providers and MACs – work together to educate referring providers on documentation requirements for home health and DME services.
The Secretary of Health and Human Services (HHS) agreed with the GAO’s recommendations and HHS’ written comments are included in the report. The GAO report confirms HCA’s concerns with the ongoing “Probe and Educate” audits and that the high rates of initial denials do not necessarily represent fraud and abuse but, rather, problems with the design of the initiative. HCA has consistently stated that multiple factors outside the control of HHAs regularly result in inappropriate payment denials and raise false suspicions as to the integrity of the Medicare home health benefit. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
Medicaid Cap Report: Overall Spending Below Cap for Entire 2017 Fiscal Year The state Department of Health’s latest (March 2017) Medicaid Global Spending Cap Report this time covers the entire 2017 fiscal year (as opposed to segments of the fiscal year), reporting that spending was $8 million below the targeted $18.555 billion cap. Total expenditures for the fiscal year were $18.547 billion. The state’s fiscal year runs from April 1 to March 31. Of the provider and managed care expenditures, however, most sectors exceeded their individual caps, according to the report, with DOH crediting most of the underspending to “Medicaid Administrative Costs,” the “OHIP Budget/State Operations” and the “All Other” categories. The only provider or managed care sector that fell below the cap, according to the report, was mainstream managed care (at $29 million below its cap). This is “primarily the result of delays in processing the July 2016 premiums, which will be implemented the next fiscal year,” DOH states in the report. “Additionally, the state made cash advances to several plans that are expected to be recouped the next fiscal year.” As with all other provider or managed care categories, the category “other long term care” (which includes home care, but also other long term care sectors) and managed long term care both exceeded the cap, by $35 million and $66 million respectively. For both categories, DOH cited higher enrollment as a cause. For MLTC, there were 1,204, or 0.5 percent, more recipients than anticipated. The Department continues to lump home care into “other long term care,” so it is not clear exactly how home care providers performed as an isolated category, but the report does indicate that there were 2,676 more personal care recipients than anticipated. Overall Medicaid enrollment reached 6,103,200 recipients, a net decrease of 64,090 enrollees over the fiscal year. The full report is at https://www.health.ny.gov/health_care/medicaid/regulations/global_cap/monthly/ sfy_2016-2017/docs/mar_2017_report.pdf. These reports, particularly the annual report, are important given the superpowers, recently augmented in the 2017-18 State Budget, allowing executive actions to cut rates in the event that spending exceeds the cap. As
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Washington continues to debate a health care overhaul, with billions of dollars in Medicaid funding and expansion dollars at stake, HCA will continue to advocate for a funding mechanism that sustains vital services, and accurately accounts for reasonable cost factors, such as enrollment changes and wages and related labor costs, in a flexible interpretation of provider performance relative to the cap.
NEW Video: What Excites US about the Upcoming HCA Annual Conference Join us for the excitement on May 3-5 in Saratoga The team here at HCA is getting super excited about our Annual Conference next week! We made a fun little YouTube video (at https://youtu.be/ AWPDZR1oWM8) to share with you all the things we are most looking forward to ... meeting with members, networking, our annual awards ceremony, expert presenters and learning sessions, visiting with exhibitors, and more. Please watch the video. There’s a special discount code at the end, but it expires today (Monday, April 24), so please register as soon as possible. We can’t wait to see you in Saratoga!
Draft Policy Released for “In Lieu of Services” The state Department of Health (DOH) has released for comment a draft policy on “in lieu of services” (ILS) to be provided by Medicaid managed care organizations. ILS are defined as alternative services or settings that are not included in the State Plan, but are medically appropriate, cost effective substitutes for State Plan services included within the Medicaid Managed Care Model Contract benefit package. According to the draft policy, managed care plans that want to provide an ILS in place of a covered State Plan service must complete a request form and submit it to DOH. DOH will be responsible for coordinating review with other agencies such as the Office of Mental Health and the Office of Alcohol and Substance Abuse Services, where appropriate. The review will be based on clinical and financial factors. In order to be approved, the ILS must result in a savings, or be cost neutral, from the State Plan service it is replacing. If approved, the ILS must be added to the managed care plan’s (MCP) model contract. Approved ILS requests will be posted publicly. Continued on next page
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Continued from previous page Once approved and included in the model contract, MCPs will be required to notify members of the new ILS benefit and include a description of the benefit in the MCPs’ member handbooks. Members denied coverage for the ILS will have appeal, external appeal, and fair hearing rights regarding any denial.
Care At Home Waivers Consolidated Effective January 20, 2017, the U.S. Centers for Medicare and Medicaid Services (CMS) approved the consolidation of the Care at Home (CAH) III, IV, and VI waivers into the “Office for People With Developmental Disabilities Care at Home Waiver.” The new waiver will continue to serve medically fragile children under the age of eighteen who have a developmental disability and live at home with their parent(s) or legal guardian(s). Children who are currently enrolled under the CAH III, CAH IV or CAH VI Waivers, and who continued to meet eligibility requirements as of January 20, 2017, are automatically included in the new consolidated waiver. According to the state Department of Health (DOH), there will be no disruption in services for children served under the OPWDD Care at Home Waiver. Effective for dates of service beginning April 1, 2017, all CAH case management services must be billed using the following rate codes, regardless of which waiver the child was enrolled in prior to April 1, 2017:
2326-OPWDD CAH Case Management 2320-CAH Case Management Per Diem 2311-CAH Case Management one-quarter Hour
More information is at http://www.health.ny.gov/health_care/medicaid/program/update/2017/ mar17_mu.pdf (page 10).
FAQs Posted on FIDA Appeals for Non-Participating Providers The state Department of Health (DOH) has posted Frequently Asked Questions (FAQs) on Non-Participating Provider Appeals. They are at https://www.health.ny.gov/health_care/medicaid/redesign/fida/mrt101/faq/docs/201704_ppa_faq.pdf. The FAQs address: time frame for appeals; submission of waiver of liability; dismissal letter template; partial denial of a claim; and others.
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DOH Posts Report on MRT Projects The state Department of Health (DOH) has posted highlights of certain Medicaid Redesign Team (MRT) projects. The list is at http://hca-nys.org/wp-content/uploads/2017/04/MRTreport.pdf. The report includes: managed long term care technology demonstration; health homes; managed care entities for behavioral health; independent senior housing opportunities; and cost-sharing for Medicare Part B services. For more information about the MRT, go to https://www.health.ny.gov/health_care/medicaid/redesign/; you can view a list of all MRT work plans by going to https://www.health.ny.gov/health_care/medicaid/ redesign/mrt_progress_updates.htm.
CDC Issues Guidance for Managing Exposure to Zika The U.S. Centers for Disease Control and Prevention (CDC) has issued interim guidance for managing occupational exposures to the Zika virus for healthcare personnel. The guidance is at https://www.cdc.gov/zika/hc-providers/infection-control/managing-occupationalexposures.html. To prevent occupationally-acquired infections and reduce the possibility of spreading infectious diseases, including Zika virus, in health care settings, the guidance advises that health care personnel should adhere to Standard Precautions for all patient care activities (https://www.cdc.gov/hicpac/pdf/isolation/ Isolation2007.pdf) Employers must comply with the Occupational Safety and Health Administration’s Bloodborne Pathogens standard (29 CFR 1910.1030), or similar OSHA State Plan standards, whenever employees have occupational exposure to blood, body fluids, or other potentially infectious materials. If health care personnel have an occupational exposure (see 3. Definition of Occupational Exposure) while caring for a patient with known or suspected Zika virus infection, they should follow facility/employer procedures including an occupational health assessment for potential exposure to infectious diseases (including bloodborne pathogens, such as HIV, hepatitis B virus, and hepatitis C virus), in addition to evaluation for potential Zika virus exposure. If a possible occupational exposure occurs, exposed personnel should follow the established work-site exposure procedures, including:
Immediately washing wounds and skin sites that have been exposed to blood or body fluids with soap and water, and immediately flushing mucous membranes with copious clean water.
Immediately reporting the exposure to the appropriate department and individual(s) (e.g., Occupational Health Clinic, supervisor).
The CDC expects to update its guidance as new information becomes available.
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The Situation Report: the Home Care Association of New York State
Volume 2, No. 17 April 24, 2017
Free Resource to Track Quality of Care Axxess Technology Solutions has a complimentary resource, made available to HCA members and other home health agencies, to view their U.S. Centers for Medicare and Medicaid Services (CMS) quality care measures and patient engagement ratings. The tool is at https://cahps.axxessweb.com/preview. The Preview dashboard displays agency-specific information and star ratings with graphics for both patient care and patient experiences. It also provides a snapshot of the most-improved quality measure, as well as the quality measure most in need of improvement, to help agencies quickly identify successes and opportunities to achieve better patient outcomes.
Upcoming NGS Education Programs National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), will be hosting the following upcoming webinars:
Home Health Third Party Liability Demand Billing, Tuesday, April 25, from 10 to 11 a.m. Registration is at: https://attendee.gotowebinar.com/register/4106163938549854721
Provider Enrollment: Getting Connected to PECOS, Tuesday, May 2, from 10 to 11 a.m. Registration is at: https://attendee.gotowebinar.com/register/1880903037596224258
Provider Enrollment Revalidation Overview, Tuesday, May 2, from 2 to 3 p.m. Registration is at: https:/ /attendee.gotowebinar.com/register/3409136239273825282
Ordering and Certifying Medicare Home Health Services, Tuesday May 9, from 1 to 2 p.m. Registration is at: https://attendee.gotowebinar.com/register/2637031684140812034
For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
Resources
“Medicaid Program Integrity: CMS Should Build on Current Oversight Efforts by Further Enhancing Collaboration with States,” by the U.S. Government Accountability Office http://www.gao.gov/assets/690/683376.pdfn
“Half Of Older Americans Seen In Emergency Department In Last Month Of Life; Most Admitted To Hospital, And Many Die There,” Health Affairs (2012) http://content.healthaffairs.org/content/31/6/1277.abstract
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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FINANCIAL MANAGEMENT ASPECTS OF NEW OASIS C2 Webinar
Webinar May 11, 2017 11:00 AM to 12:00 PM
This webinar is FREE to all paid registrants of HCA’s Senior Financial Managers Forum held on April 7, 2017 as part of the originally scheduled program. If you were not a registrant of the April 7th forum, you may register for this webinar at the following rate: HCA Members: $49 Prospective Members: $149
All health care finance managers know the important connection between clinician activities and budgeting. Now that the OASIS C2 is in effect, this parallel understanding of clinician assessment procedures and their cost impact will help drive top-to-bottom improvements in the function and efficiency of your organization. During this session, Ms. Gaboury will review how to calculate the HHRG, corresponding HIPPS code and determine case-mix weight, all of which are fundamental to a home care agency’s operation-wide understanding of the clinician’s role in patient care and financial outcomes. The session will also establish processes that agencies need to strengthen regarding OASIS-C2 completion and review, as well as the specific OASIS-C2 M items that have a direct impact on patient outcomes and costs.
About the Presenter: Melinda Gaboury – a favorite national speaker, is the co-founder and Chief Executive Officer of Healthcare Provider Solutions, Inc. (HPS). Melinda Gaboury and Mark Cannon founded the company in April 2001 and currently provide financial, reimbursement and clinical consulting services to the home health and hospice industries. Ms. Gaboury has many years of firsthand experience in the following key areas: Medicare Home Health PPS & Hospice Billing Training- Chart Reviews as a result of OIG Corporate Integrity Agreements - Chart Reviews for Billing, ICD-10Coding & OASIS Integrity Issues- Coordination of Clinical and Financial Staff Communications-Home Health PPS & Hospice Billing, Collections & Case Mix Calculations-Medicare Revenue Recognition Models- Due Diligence Procedures– and Management of a Medical Billing Department. She has developed and taught clinician and billing Medicare PPS Training Workshops in a variety of venues. Ms. Gaboury’s priority remains bridging the gap between clinical and financial issues in home care agencies. Gaboury is also the author of The Home Health Pocket Guide to OASIS-C2 which is soon to be released.
ENJOY THE BENEFITS OF WEBINAR BASED EDUCATION •
CONVENIENT
•
COST-EFFECTIVE
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NO TRAVEL EXPENSES OR TIME
www.hca-nys.org
FIINANCIAL NANC IAL M A ANAGEMENT N AG E M E N T A S SPECTS PEC TS O OF F NE EW WO OASIS ASIS C C22 Webinar W ebinar REGISTRATION Name: ________________________________________________________________________________________________ Title:__________________________________________________________________________________________________ Agency:_______________________________________________________________________________________________ Address:_______________________________________________________________________________________________ City/State/Zip:__________________________________________________________________________________________ Phone:______________________________________ Email: ____________________________________________________ (Required)
REGISTRATION FEE (per site/phone connection) HCA Members
$49
Prospective Members
$149
Paid Registrant of April 7, 2017 Senior Financial Managers Forum FREE
Registration Deadline May 8, 2017
1-2 days prior to the webinar, you will receive an e-mail containing your access information and any related material. Cancellation Policy: Fees will be refunded less a 25% administrative fee only if written cancellation is received by HCA at: info@hcanys.org five business days prior to the selected program(s). No refunds after handouts are provided. Substitutions are permitted. Please contact info@hcanys.org if you need assistance, or call 518-426-8764
PAYMENT – Please check method of payment: (Checks must be received by date of program). ____MasterCard ____VISA ____ American Express _____Check* *Make checks payable to: HCA Education and Research – Mail to: 388 Broadway, 4th Floor, Albany, NY 12207 Please print clearly.
Credit Card #: _____________________________________________ Exp. Date:____________ Security Code: ____________ _________________________________________________________________________________________________________ Name and/or Company Name on Card _________________________________________________________________________________________________________ Billing Address of card (including City, State and Zip Code) ___________________________________________________________________________________ Authorized Signature
Fax to (518) 426-8788