COLLAB BILL
OFFSITE SERVICES
LHCSA REPORT
HOSPICE PAYMENTS
HCA presses for Assembly intro of homecarephysician collaboration bill already sponsored in Senate.
HCA continues efforts to ensure proper parameters on offsite services bill to ensure Article 36 and Article 40 protections.
HCA submits general and specific comments on the proposed changes to the LHCSA Statistical Report
Hospices: take note of payment correction process for RHC and SIA errors!
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Your Source for HOME CARE News, Policy and Advocacy
Vol. 2, Issue 23 | June 5, 2017
COMING UP “Ask HCA” Dine and Discuss Roadshow Sessions June 20 Albany, N.Y. 3 to 5 p.m. Wednesday, June 21 Westchester 11 a.m. to 1 p.m. LHCSA “Hot Topics” Forum June 22 New York, NY
HCA, MSSNY Seek Waivers, Streamlining of Medicaid F2F July 1 effective date on horizon HCA and the Medical Society of the State of New York (MSSNY) are working together proactively to mitigate provider and patient access challenges presented by the upcoming July 1 effective date of the Medicaid Face-to-Face (F2F) mandate in New York. This mandate would apply a F2F mandate in Medicaid home health and durable medical equipment cases, akin to the mandate that already exists for Medicare cases. HCA and MSSNY have drafted and submitted for state Department of Health (DOH) consideration a guidance document that physicians and home care agencies could use in Medicaid F2F implementation and compliance. It was developed with consultation and input from the associations’ joint Physician-Homecare Task Force that has been See F2F p. 4
Make Your Emergency Preparedness Plan CoP-Ready June 28 Suffern, NY 10901 For more information, visit http://hca-nys.org/ events-education/ upcoming-events
Budget “Side-Letter” Forms Basis for Ongoing Deliberation
Commissioner Zucker And HCA Team Up on Sepsis Initiative
As has been extensively covered by HCA, this year’s state budget adoption included an agreement through “side-letter” to examine methodology changes for improved premium and rate adequacy for
In affirmation of HCA’s home care sepsis intervention initiative, State Health Commissioner Dr. Howard Zucker invited HCA to an extensive meeting this past week to discuss collaboration and promotion of this initiative. See SEPSIS p. 3
See SIDE p. 2 INSIDE HCA, MSSNY Seek Waivers, Streamlining of Medicaid F2F...........................1 Budget “Side-Letter” Forms Basis for Ongoing Deliberation.......................1 Commissioner Zucker, HCA Team Up on Sepsis Initiative............................1 A Message from HCA Sponsor FBA of Syosset..............................................4 Avoid Costly Penalties, Invest Wisely, Get Your EP Plan CoP-Ready...............6 HCA seeks Assembly Health Intro of Physician-Homecare Collab. Bill.........6 Member Hiring Announcements...............................................................7 HCA to Convene HR Committee – Membership Input Sought.......................8 Conference Participation Scholarships Available....................................8
HCA, DOH Discuss Hospital/Clinic Offsite Services Parameters.............................9 HCA Submits Member Comments on LHCSA Statistical Report..............................10 CMS Guidance: Correcting Hospice RHC and SIA Payment Errors..........................11 Certain Web Browsers Can No Longer Access the HCS..........................................11 DFS Issues Paid Family Leave Final Rule, Announces Premium Rates....................12 HCA, Duke Faculty Conduct PCCP Training............................................................13 Care At Home Guidance Posted..........................................................................14 OIG Posts Semiannual Report to Congress..........................................................15 Encounter Reimbursement Process for Capitations Recovered in Audit...............15 Resources..............................................................................................................................16
The Situation Report: the Home Care Association of New York State
SIDE from p. 1 managed long term care plans (MLTC) and home care providers. Among the items, the letter specifically calls for examining the establishment of rate cells for nursing home and high-cost/highneed home care and personal care MLTC enrollees. In a meeting last week with the Legislature, HCA discussed the status of the side-letter and the activity under way for the required rate examination. HCA also raised the relationship between core issues impacting MLTC and home care and the side-letter’s charge, asserting that the mounting mandates and costs on plans and providers should be considered in the methodological improvement discussion. The side-letter implementation plan is expected to involve regular meetings between the Executive and Legislature over the summer and fall, leading to recommendations by year’s end, ostensibly as a foundation for 2018 state budget proposals. As the meetings proceed, this forum will necessarily become a broader venue for deliberation of related issues that affect financial status and operations. This will likely include, for example, workforce and infrastructure needs explored during the Assembly hearings and budget proposals, potential response to the courtState Department of Labor controversy over the Department’s payment standards for live-in home care cases, and so on. With this focus in mind, HCA will be working with the MLTC and provider membership to garner and provide ongoing input, as permissible, into the side-letter analyses and issue deliberations. For further information, contact Al Cardillo acardillo@hcanys.org.
Home Care Association of New York State (HCA) 388 Broadway, 4th Floor, Albany, NY 12207 Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org
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Volume 2, No. 23 June 5, 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
The Situation Report: the Home Care Association of New York State
SEPSIS from p. 1 Joining Commissioner Zucker were the Department’s Medical Director, Dr. Marcus Friederich; Special Advisor to the Commissioner Mark Kissinger; Deputy Commissioner of the Office of Primary Care and Health Systems Management Dan Sheppard; Division of Home and Community Based Services Director Rebecca Fuller Gray; and Aging and Long Term Care Team member Heather Bennett. The discussion focused on steps that the Department and HCA will consider in supporting broader awareness, provider adoption, clinician training, data and research support, and related actions to further the initiative and, ultimately, New York’s health system response to sepsis.
Volume 2, No. 23 June 5, 2017
Agencies in New York State and around the country, including full health systems, continue to contact HCA to engage in this important and far-reaching sepsis intervention effort. Statewide sepsis webinar planned for managed care/MLTC In initial follow-up to the meeting with Commissioner Zucker, HCA and DOH have discussed conducting and offering a statewide webinar for managed care plans and managed long term care plans. As sepsis gains prominence as a top public health and cost concern, especially within value based payment discussions, the webinar will provide key background for health plans who may directly – or through their providers – adopt the new home and community based sepsis initiative launched by HCA. State training funds
Commissioner Zucker was enthusiastic about HCA’s work and the prospect of collaboration, recognizing the potential for home care and New York State to lead on this preventive and early intervention action. Participating with HCA President Joanne Cunningham and Executive Vice President Al Cardillo were IPRO’s Sara Butterfield and Eve Bankert (also members of HCA’s Sepsis Workgroup) and Mohawk Valley Health System/VNA of Utica’s Amy Bowerman (also HCA’s Sepsis Workgroup clinical leader). Contact HCA to adopt this sepsis initiative Agencies or plans wishing to incorporate the HCA sepsis screening, intervention and patient education tools should contact sepsistool@hcanys.org to request further background and the HCA user agreement.
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HCA also followed up the meeting by further inquiring whether the impending $245 million in new health workforce training and education monies to be channeled through MLTCs will continue to include home care sepsis training as one of its allowed purposes. Sepsis training had been among the allowed purposes on the prior draft iterations for this program right up through the last public version. Statewide Senior Action Council Features Sepsis “Teach-in” The New York Statewide Senior Action Council has asked HCA and the National Sepsis Alliance to conduct a statewide teach-in on the HCA sepsis initiative for geriatric professionals, advocates and senior consumers. The teach-in is scheduled for June 27. The session is intended to increase statewide awareness of sepsis and of the HCA initiative, setting the stage for further support and advocacy.
Volume 2, No. 23 June 5, 2017
The Situation Report: the Home Care Association of New York State
F2F from p. 1 meeting for the past year to make recommendations on supporting collaboration between providers. Much of the focus has sought to address obstacles in engagement, especially the challenges created by the Medicare F2F requirement. As the Task Force continues working at the state and federal levels to mitigate F2F overall (for Medicare and Medicaid), the Task Force moved to take proactive steps to try to avoid a repeat layer of burden from the onset of F2F for Medicaid cases specifically, given what is, ostensibly, a still-formative process. In addition to streamlining the procedures and language of the prospective state guidance, the HCAMSSNY draft seeks to widely apply to Medicaid F2F the exemption currently granted to managed care cases under Medicare F2F. We propose exempting all traditional managed care cases, as well as cases in any and all of New York’s managed care models. Moreover, HCA and MSSNY propose that – since models like DSRIP and VBP are functioning under a
total managed care waiver in NY, inclusive of home care – ultimately, all NY Medicaid home care under these care models should qualify for such an exemption. HCA and MSSNY thus urge DOH to also seek a full exemption from CMS. In the meantime, HCA and MSSNY offer a concrete document to assist DOH, providers and physicians. As the July 1 date nears, unless there is state or federal rollback, home care agencies should begin preparations for F2F compliance for Medicaid cases. Simultaneously, HCA and MSSNY are urging state DOH leaders to quickly move forward with the consideration of our draft, or of a similar alternative, that avoids additional layers of administrative burden, cost and access challenge to patients. HCA appreciates the opportunity for DOH engagement, and especially thanks our colleagues at MSSNY. For further information, please contact Al Cardillo, at acardillo@hcanys.org, or Patrick Conole, at pconole@hcanys.org.
A message from HCA sponsor FBA of Syosset
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The Situation Report: the Home Care Association of New York State
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Volume 2, No. 23 June 5, 2017
The Situation Report: the Home Care Association of New York State
Volume 2, No. 23 June 5, 2017
Avoid Costly Penalties, Invest Wisely in Planning, and Get Your EP Plan CoP-Ready on June 28 According to analysts, the work you and colleagues must do to prepare for imminent emergency preparedness (EP) requirements will cost as much as $75.6 million for home care providers and $22.4 million for hospices nationally in the first year alone. With price tags that size and the prospect of hefty enforcement penalties (including potential termination from Medicare for noncompliance with the EP rule or other federal Conditions of Participation), it is incumbent on all provider CEOs, COOs, Operations Managers, Compliance Staff and Emergency Preparedness Planners to get as much information as possible in time for the fast-approaching November 16, 2017 implementation date. On June 28, in Suffern, NY (conveniently located for upstate and downstate agencies alike), HCA is hosting RBC President and emergency preparedness expert Barbara Citarella for a comprehensive workshop to help get your emergency preparedness plan in shape to meet these federal rules and the corresponding changes to the Conditions of Participation. This session will help you understand the four major components of this regulation; plan for required continuity of operations (COOP); operationalize required policies and procedures; establish compliant communication protocols; and conduct/test a required training program related to your emergency plans. Be sure to reserve your space in this vital workshop to help you invest wisely in your planning resources and avoid compliance risks. A full brochure and registration form are below. Download the brochure: http://hca-nys.org/wp-content/uploads/2017/04/Make-Your-EP-Plan-CoP-Ready-June28-2017.pdf Register online: https://www.eventville.com/Catalog/EventRegistration1.asp?EventId=1012193
HCA seeks Assembly Health Intro of Physician-Homecare Collaboration Bill Community Paramedicine and EP bills are the focus of upcoming stakeholder meetings HCA met with Assembly Health Committee staff to seek Chairman Richard Gottfried’s introduction of HCA’s legislation for physician-homecare collaboration in support of primary care, public health and medical management. The legislation, S.6345, introduced in the Senate by Health Committee Chairman Kemp Hannon, would enable streamlined agency engagement with physicians for discrete patient or public health services under the physician’s direction. The services that could be provided under the physician plan of care might include, for example, care transition assistance, a post-surgical or medical treatment visit, home immunization, a home evaluation for asthma or falls risk or other public health screening, a visit for timely evaluation of a patient unable to get to
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The Situation Report: the Home Care Association of New York State the physician, etc. Further detail on this bill was provided in the May 30 edition of The Situation Report, and HCA will be following up with more background and updates. HCA has met with the state Department of Health to also discuss the proposal, and has reached out to physician practices, hospital-based medical practices, home care members and other stakeholders on the potential benefits of the legislation. HCA hopes to secure Assembly introduction this week, following the Legislature’s return from last week’s Memorial Day observances. With just a few weeks left in the 2017 session calendar, vocal support and momentum will be critical to securing action in both chambers. Community Paramedicine bill update Further negotiations on community paramedicine legislation (S.5588 Hannon/A.2733-A Gottfried) await pending meetings with stakeholders, including the New York State Nurses Association and EMS providers, particularly on finding common ground related to the level of service emergency medical technicians might provide in non-emergency situations under the legislation, and the appropriate line between these services and the Nurse Practice Act. The current legislation, co-drafted by HCA, holds all provider and practitioner lines constant, and does not permit crossover into nursing practice by a non-nurse or crossover into home care practice by a nonarticle 36 provider. Agreement on
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Are you dedicated to making a difference in an individual’s life? iCircle is hiring for Care Managers to join their rapidly growing Care Management team! iCircle believes in their employees by offering: x x x x x x x
Competitive pay Paid time off (including your Birthday!), Vacation time, Personal time Health care coverage including health, dental, vision 403(B) Retirement plan Health and Wellness Reimbursement Tuition Reimbursement Employee referral program
Locations: iCircle currently covers over 22 counties in the upstate and central New York. Corporate Headquarters is located in Webster, NY and we have both in house and remote Care Management positions available. Qualifications:
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New York State RN, Bachelor’s degree preferred OR Licensed Master’s Social Worker Minimum five years in healthcare related field, with 2 years as a care manager in managed care environment or community health Must be at least 18 years of age Reliable transportation (NYS Drivers’ Licensed required) Maintain all required certifications/training by State regulations and iCircle policy Bilingual a plus High attention to detail Experience utilizing computer software including Microsoft Word and clinical applications iCircle Care offers tremendous growth opportunities.
CDS Life Transitions, the parent company for iCircle. iCircle Care is an equal opportunity/Affirmative Action Employer Minorities/Female/Disabilities/Veteran.
DIRECTOR OF CLINICAL PRACTICE AND INNOVATION OVERVIEW: VNA Home Health is a CHHA providing services in Albany and surrounding counties. At VNA Home Health, you will have a unique opportunity to apply your transformative skills to lead a caring, professional team. We are seeking a dynamic homecare leader to fill the position of Director of Clinical Practice and Innovation. Reporting directly to the CEO, this senior leader will be responsible for overseeing the delivery of all Nursing, Rehabilitation, Social work, and home health aide services. He/she will develop and execute innovative clinical models and programs to promote excellence in clinical practice, optimal patient outcomes, and successful positioning for new and innovative reimbursement models; as well as lead the development of strategies to expand clinical programs and promote growth QUALIFICATIONS: We are looking for someone with strong organization, management, and communication skills, along with enthusiasm and creativity. The successful candidate must have a Baccalaureate Degree in Nursing, Master’s Degree in nursing or related field highly desirable; a current NYS RN license and a Minimum of five (5) years Supervisory/ Management experience, two (2) of which should be in Community Health. VNA Home Health is proud to offer an excellent compensation and benefits package including competitive salary, health/Dental and vision insurance, paid time off, life insurance and 403 (b) with employer match. Relocation Expenses are included. Candidates meeting the desired qualifications are encouraged to submit a cover letter, resume/CV and salary requirement to careers@vnaalbany.org.
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language related to these parameters will be a threshold issue as to whether a viable bill is possible this session.
HCA to Convene HR Committee – Membership Input Sought
The current (HCA) bill is a collaborative model, requiring the participation and agreement of home care, hospital, physician and EMS partners, who together would collaboratively form and operate a community medicine program.
HCA is developing a Human Resources (HR) committee to assist agencies in dealing with common issues and concerns related to employment. We would like your input on which issues the committee should address. Please complete the short survey at the link below as soon as possible, and no later than June 30.
Emergency Preparedness bill update https://www.surveymonkey.com/r/VXJTGPS HCA’s “essential personnel” legislation for home care and hospice emergency preparedness and response (S.5016 Lanza/ A.6549 Cusick) is once again backed by the Legislature. Given Governor Cuomo’s three-time veto of the bill – despite repeated clarifications, negotiated amendments and widespread support of need – the sponsors will be looking to see what other language or angles on the proposed policy might persuade the Governor to agree to the bill. Further discussions with the Governor’s office and relevant state agency officials will help determine next steps by the sponsors, at which point we will know the plan and prospect for passage this session, and will target our advocacy accordingly. Meanwhile, any case-examples from home care and hospice that support this critical bill should be sent to HCA to share with the sponsors and the Governor’s office. Case examples can be directed to either Al Cardillo acardillo@hcanys.org or Alexandra Blais at ablais@hcanys.org. For further information, please contact Al Cardillo at acardillo@hcanys.org.
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Conference Participation Scholarships Available The New York State Health Foundation (NYSHealth) has announced that its Sponsoring Conference Participation in Support of Healthy Communications request for proposals (RFP) is open. Through this RFP, NYSHealth will sponsor community-based organizations, health departments, and other low-resource organizations to attend and present at local, State, and national conferences related to building healthy communities. Applications will be accepted on a rolling basis. Applicants must complete and submit an online application here: http://tinyurl.com/y9zrr2sg. All applicants will be notified about the outcome of their applications within three weeks of online submission. Programmatic questions should be addressed to Program Officer Bronwyn Starr at starr@nyshealth.org. Technical questions regarding the online application system should be e-mailed to grantsmanagement@nyshealth.org. More information is at http://tinyurl.com/y88nq36l.
The Situation Report: the Home Care Association of New York State
Volume 2, No. 23 June 5, 2017
HCA, DOH Discuss Hospital/Clinic Offsite Services Parameters The May 22 edition of The Situation Report described the release of a state Department of Health (DOH) Dear Administrator Letter (DAL) announcing implementation of a new hospital/clinic “offsite services law.” (Please refer to this May 22 article.) This law will permit hospitals and diagnostic and treatment centers (D&TCs) to provide, “offsite,” the same primary care services that they otherwise are licensed to provide “onsite” in their facilities. The law will enable primary care services to be conducted in patients’ homes (essentially, “house calls”) when: 1) patients have an existing relationship with the hospital or D&TC primary care provider, and 2) they are either homebound or would experience undue burden in making the primary care visit on-site. Upon notice of the recent DAL, HCA immediately contacted DOH to discuss the required parameters of the new law, which expressly excludes hospitals and clinics from exercising offsite authority for service disciplines provided by home care agencies under article 36. The exclusion was specifically framed and negotiated into the bill by HCA prior to its passage last year. This week, HCA and DOH convened a lengthy meeting on the home care service exclusion, with HCA outlining the background and exact parameters of the exclusion, as well as the intended parameters of the in-home primary care referenced by the bill. HCA stressed the need for DOH to amend and/or followup the recently issued DAL with detailed guidance to hospitals and clinics on these exact parameters. HCA emphasized the already widespread unlawful crossovers into article 36 (home care) and article 40 (hospice) occurring prior to this law’s implementation, underscoring all the more the importance of explicit guidance to ensure compliance and avoid unintended violation under this new law. HCA also noted to DOH that a new homecare-physician collaboration bill written by HCA and introduced by Senator Hannon (S.6345) could creatively work in tandem with the offsite/house calls law to position home care agencies, hospital physicians and clinic practitioners in broad collaboration for patients’ primary care and home care. DOH will be drafting additional guidance as well as accompanying regulations for the offsite services law. Home care will have input into these new rules, as the law requires consultation with HCA, home care providers and hospitals on any guidance or regulations issued. This assurance of input and protection was another HCA language insert into the final legislation. HCA will keep the membership apprised of any developments and asks that members notify us immediately if you detect signs of implementation or service practices that are contrary to the parameters of this law. For further information, contact acardillo@hcanys.org.
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HCA Submits Member Comments on LHCSA Statistical Report HCA has submitted comments to the state Department of Health (DOH) on its Licensed Home Care Services Agency (LHCSA) Statistical Report. The comments, based on member feedback, were submitted last week prior to this week’s upcoming meeting of the workgroup organized by DOH to make revisions to the Statistical Report. As reported in numerous communications, the goal of the workgroup is to “redesign and restructure the report to increase the timely and accurate submission of information by identifying areas of reporting that can be streamlined to increase compliance and accuracy in data reporting.” The workgroup held its first meeting on May 1 and the next meeting is June 7. The first meeting was attended by DOH staff, HCA and other associations, and a number of HCA members. Our comments provide general as well as section-specific recommendations for various parts of the report. Some of our general recommendations include:
DOH should consider allowing LHCSAs with multiple licenses to submit one report. One report can capture details surrounding all geographic locations. This would save significant time and resources for affected LHCSAs.
The instructions should be more comprehensive and detailed. Many terms are unclear and all should be fully defined, along with detailed sample answers for each question.
Agencies need at least one year to implement any changes to the LHCSA Statistical Report to allow for software developers and system engineers to capture and generate the requested information.
DOH should consider providing a csv (excel) file template for agencies (so they can copy and paste data from their internal records) to upload to the DOH portal; this would be more efficient than requiring agencies to manually enter all of the data to DOH’s site.
Some recommendations on specific forms include:
LSR6 (Staffing and Wages) should be changed to require annual, not quarterly, data.
LSR7 (Disease and Disability Services by County) should be eliminated or greatly reduced.
LSR8 (Subcontracts) needs to be streamlined to account for the multiple subcontracting arrangements LHCSAs may have.
HCA thanks those members who took the time to give us very valuable feedback. HCA will keep members informed on the deliberations of the LHCSA Statistical Report workgroup and any actions by DOH. DOH intends to release the 2016 LHCSA Statistical Report in August; it will be similar to the 2015 Report. DOH hopes to incorporate any changes to the 2016 Report in time for the release of the 2017 Report in the summer of 2018. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org, or Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
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CMS Guidance: Correcting Hospice RHC and SIA Payment Errors A recent Medlearn Matters (MLN) article (SE17014) by the U.S. Centers for Medicare and Medicaid Services (CMS) explains the steps hospices should take to submit claim adjustments for payment errors that CMS is not able to mass-adjust. Beginning on January 1, 2016, Medicare hospice payments were revised to apply a two-tiered payment rate for Routine Home Care (RHC) services and to make Service Intensity Add-on (SIA) payments at the end of life. Since then, CMS discovered and corrected various payment errors associated with these policies; but two additional errors, discovered in February, could not be mass-adjusted in the following instances:
If the prior days used are greater than 99, Medicare systems are calculating an incorrect payment. Medicare will correct its systems to eliminate this error on August 21, 2017.
RHC visits are overpaid when there is a transfer within the benefit period because the days prior to the transfer are not being recognized. Medicare will correct its systems in a future release, but a workaround allows claims to be adjusted in the interim.
Mass-adjustments are not possible because CMS cannot identify hospice provider claims from information in the Medicare Administrative Contractor’s (MAC’s) claims history. Payment errors depend on information only available in Medicare’s Common Working File (CWF). Systematic correction would require adjusting nearly all hospice claims processed in 2016. On many claims, this would not result in payment changes but would have a disruptive effect on accounting at all hospices nationwide. The hospices themselves have the best available information about which claims need to be adjusted, CMS says. Required Action Hospices should now submit adjustments to claims with outstanding SIA and RHC payment errors, except for those where the prior benefit days are greater than 99. Hospices can identify adjustments to be made by reviewing the CWF hospice benefit file to see if the benefit days used on prior election periods total more than 99 with no 60-day gap in between periods. Hospices may adjust claims with greater than 99 prior days after August 21, 2017. For additional guidance on how to access the CWF hospice benefit file, contact New York’s principal MAC, National Government Services (NGS), at: 866-590-6728. Additional information is in MLN article SE17014 at: https://www.cms.gov/Outreach-and-Education/MedicareLearning-Network-MLN/MLNMattersArticles/Downloads/SE17014.pdf.
Certain Web Browsers Can No Longer Access the HCS Starting June 1, the Health Commerce System (HCS) has discontinued access for computers running Windows XP and Microsoft Internet Explorer 9 (IE9) and older web browsers, as they pose a security risk to HCS applications. Windows XP users must upgrade their operating system and IE9 users must upgrade their browser by June 1, 2017 to continue using the HCS, as the HCS will block connections from computers running Windows XP and IE9 browser and older. Continued on next page
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Continued from previous page The following applications could be affected:
Home Care Worker Registry; Criminal History Record Check; and Electronic Plan of Correction.
Please see the May 8 edition of The Situation Report for instructions on how to update your browsers for HCS compatibility. Users of MacOS, OSX, Windows 7, Windows 8, or Windows 10 and users of Google Chrome, Microsoft Internet Explorer 10 or newer, or Safari on the Mac platform, are not affected by this change.
DFS Issues Paid Family Leave Final Rule, Announces Premium Rates for Benefits Paid Family Leave highlighted at June 22 HCA program The state Department of Financial Services (DFS) has issued a final rule on the new Paid Family Leave program. The rule is at http://www.dfs.ny.gov/insurance/r_finala/2017/rf211txt.pdf. The rule was issued one week after the state Workers’ Compensation Board (WCB) issued its own rule on Paid Family Leave (see the May 30 edition of The Situation Report). DFS has also established the premium rate for Paid Family Leave benefits (see http://www.dfs.ny.gov/ insurance/r_other/dec_prem_rate_flb_06012017.pdf). The DFS Superintendent has determined that the premium rate for Family Leave Benefits and the maximum employee contribution for coverage (beginning January I, 2018) shall be 0.126 percent of an employee’s weekly wage up to and not to exceed the statewide average weekly wage. Under the final DFS rule:
Family leave benefits will be community rated and risk adjusted. According to DFS, community rating ensures that all employees are charged a rate based upon the same principles and are not subject to cost variations based upon age, gender, geographic location, or any other demographic factor.
Family leave benefits coverage may be subject to a risk adjustment mechanism to prevent issuers from experiencing disproportionate losses due to high utilization of benefits and also to eliminate any disincentives that the statewide community rate would have on the issuance of policies to employers with high utilization of benefits.
The DFS Superintendent will set the maximum employee contribution on or before June 1, 2017 and annually in future years on or before September 1.
Insurance companies may charge an additional premium for “enhanced” benefits.
If the issuer of family leave benefits decides to discontinue such coverage, it must send a notice of discontinuance to affected employers and a separate notice to employees that will be distributed by the employer.
As communicated in numerous articles, when fully implemented, Paid Family Leave (starting January 1, 2018 and phased in over 2018 to 2021) will provide employees up to 12 weeks of paid family leave in any given
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Volume 2, No. 23 June 5, 2017
52-week benefit period to: 1) care for a family member (including a child, parent, grandparent, grandchild, spouse or domestic partner) with a serious health condition; 2) bond with an employee’s newborn or newly placed adoptive or foster child during the first 12 months following birth or placement; or 3) address any qualifying exigency to a spouse, domestic partner, child or parent who is serving on active military duty. Paid Family Leave is employee-funded, through payroll deductions, with the exception of any administrative costs incurred by employers. Employee participation is also mandatory, with certain exceptions. Benefits will be phased in, starting on January 1, 2018, at which time employees may receive up to eight weeks of paid benefits in 2018. Benefits will be paid at 50 percent of the employee’s average weekly wage, not to exceed 50 percent of the state average weekly wage. These benefits will gradually increase until January 1, 2021, when they will provide 12 weeks of coverage at 67 percent of the employee’s average weekly wage. More information on Paid Family Leave is at https://www.ny.gov/programs/new-york-state-paid-familyleave and http://www.wcb.ny.gov/PFL/pfl-regs.jsp. HCA will be holding a June 22 program in New York City that includes a representative from the state Workers’ Compensation Board on New York’s Paid Family Leave program discussing the obligations of employers and the rights and responsibilities of employees. The program also covers other LHCSA “Hot Topics,” such as labor law issues and health information technology integration tips. Registration for this program is at http://hca-nys.org/wp-content/uploads/2017/05/LHCSA-Hot-TopicsForum-Registration-Form.pdf.
HCA, Duke Faculty Conduct PCCP Training HCA Executive Vice President Al Cardillo joined with Duke University faculty in once again conducting the onsite portion of the Duke Population Care Coordinator Program (PCCP), hosted by the Visiting Nurse Service (VNS) of New York at its New York City offices. The PCCP is a multi-week curriculum, blending on-site and online training for intensive skill development integrating population health, evidence-based practice, patient-centered care and other skills critical for practice in the new and evolving models of care. The program is targeted to clinicians, primarily nursing, but also commonly includes therapists, clinical social workers, physicians and/or other primary practitioners. In his role in the PCCP training, Mr. Cardillo links the skill sets in PCCP training to the major models and elements of the health system. HCA provider or MLTC members wishing to learn more about the program for their staffs’ training can access the program’s homepage at http://pccp.nursing.duke.edu/ or contact Al Cardillo at acardillo@hcanys.org.
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The Situation Report: the Home Care Association of New York State
Volume 2, No. 23 June 5, 2017 ď Žď€
Care At Home Guidance Posted The state Department of Health (DOH) has posted two General Information System (GIS) guidances on the Care At Home (CAH) I/II Waiver Program. One guidance addresses approval by the U.S. Centers for Medicare and Medicaid Services (CMS) for renewal of the program and the other covers application and eligibility determination processes. Both guidances are posted at: https://www.health.ny.gov/health_care/medicaid/publications/ pub2017gis.htm (GIS 17 MA/09 and MA/10). According to GIS 17 MA/09, CAH I/II has been approved by CMS effective April 1, 2017. The approved application includes language indicating that the waiver will transition into managed care via the 1115 authority on January 1, 2018. This waiver provides services to children 17 years old and younger who have physical disabilities and require either a skilled nursing facility or hospital level of care. The waiver will continue to serve children living at home with parents or legal guardians. Approved waiver services include: Case Management, Bereavement Services, Expressive Therapies, Massage Therapy, Home and Vehicle Modifications and Family Palliative Care Education (Training). Pain and Symptom Management and Respite Services are removed as services from the CAH I/II waiver program. All Case Management services will continue to be reimbursed using the existing rates and 15-minute unit fee schedule. CAH I/ II waiver program will implement a caseload size limit of no more than thirty individuals per case manager effective October 1, 2017. Case Management services are limited to 120 hours annually, not to exceed 10 hours monthly, unless otherwise indicated in the participant’s plan of care and authorized by the local Department of Social Services. All waiver participants must have a monthly face-to-face visit with their case manager. The GIS also reviews changes to family palliative care education, bereavement, home modifications and other services. GIS 17 MA/10 reviews the enrollment process and eligibility determination procedures for CAH I/II, including the timeframe and documentation requirements. Questions about either GIS can be directed to DOH at (518) 473-6020 or cah@health.ny.gov.
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The Situation Report: the Home Care Association of New York State
Volume 2, No. 23 June 5, 2017
OIG Posts Semiannual Report to Congress The federal Office of Inspector General (OIG) has posted its Semiannual Report to Congress that covers October 1, 2016 to March 31, 2017 (first half of federal fiscal year 2017). It is at https://oig.hhs.gov/reports-and-publications/archives/semiannual/2017/sar-spring-2017.pdf. The Report describes OIG’s investigative work relating to the administration of programs and operations under the U.S. Department of Health and Human Services (HHS). Historically, about 80 percent of OIG’s resources are directed to work related to Medicare and Medicaid. This includes a series of efforts to combat fraud, waste and abuse and other integrity efforts driving OIG’s work planning for audits and evaluations as well as OIG’s approach to enforcement. During the first half of fiscal year 2017, OIG reported expected investigative recoveries of over $2.04 billion. OIG also reported 468 criminal actions against individuals or entities that engaged in crimes against HHS programs, 461 civil actions, and 1,422 exclusions of individuals and entities from participation in federal health care programs. During this period, OIG focused on fraud in non-institutional settings, including Medicare home health personal care services and home and community based services. Home care providers should familiarize themselves with OIG’s work when developing and making changes to their compliance activities.
Information Posted on Encounter Reimbursement Process for Capitation Payments Recovered in Audit The state Department of Health (DOH) has posted information in the May 2017 Medicaid Update on the Medicaid managed care encounter reimbursement process for capitation payments recovered in audits. The May Medicaid Update is at http://www.health.ny.gov/health_care/medicaid/program/update/2017/ may17_mu.pdf. During the audit process, the Office of Medicaid Inspector General (OMIG) may identify and recover any inappropriately paid capitation payments, including those months with encounters, consistent with state laws, regulations and the Medicaid Managed Care Model Contract (Contract). However, a managed care plan may subsequently receive reimbursement for costs following the issuance of the Final Audit Report, and after the plan has repaid all identified overpayments. When these conditions are met, DOH will reimburse the plan for costs incurred during the recovered capitation month. The reimbursement will be based on encounters which the plan has successfully submitted to DOH. Encounters not eligible for reimbursement include administratively denied encounters and encounters for which the plan has already been reimbursed for the cost of services. Continued on next page
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The Situation Report: the Home Care Association of New York State
Volume 2, No. 23 June 5, 2017
Continued from previous page The article includes a chart of scenarios approved by the U.S. Centers for Medicare and Medicaid Services (CMS) where plans may be reimbursed for services. DOH’s reimbursement procedure for costs incurred is as follows:
On a semi-annual basis, DOH will receive plan audit recovery information from OMIG. This information will be reviewed and matched to plan-submitted and accepted header-level encounter data, with a minimum six months of runout from the applicable recovery period.
Upon completion of the data-matching process, DOH will share results with plans to review for a period of 30 days prior to payment effectuation. In instances where a plan may have discrepancies with DOH’s calculated “lump sum” reimbursement amount, DOH will develop a process to review the expenditure analysis with plans. Plans will not be allowed to amend or submit encounter data which would alter the results of services provided. Note: encounter reimbursement audits post Encounter Intake System (EIS) implementation will take place after a validation of the data is complete.
Once the 30–day review period has expired, DOH will initiate plan-specific reimbursements, based on a calculated summary of plan encounter expenditures incurred. Payments will then be processed in subsequent plan cycle remittance checks. Plans will be notified of the pending reimbursement amounts and supporting detail via a plan-specific remittance statement generated by DOH.
Questions regarding enrollment or eligibility should be directed to DOH at mcsys@health.ny.gov. Questions or issues related to the OMIG audit process should be directed to OMIG at ManagedCareAudit@omig.ny.gov. Questions or issues regarding the DOH reimbursement process should be directed to DOH at bmcr@health.ny.gov.
Resources
“The Aging Apple: Older Immigrants a Rising Share of New York’s Seniors,” Center for an Urban Future https://nycfuture.org/research/the-aging-apple
“Medicare Care Choices Model (MCCM) – Per Beneficiary per Month Payment (PBPM) – Implementation (Eligibility Updates and Clarification),” by the U.S. Centers for Medicare and Medicaid Services https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/ downloads/MM10094.pdf
“Multiple Chronic Conditions in the United States,” by the Rand Corporation http://www.fightchronicdisease.org/sites/default/files/TL221_final.pdf
“Building Additional Serious Illness Measures Into Medicare Programs,” Health Affairs Blog (May 25, 2017) http://healthaffairs.org/blog/2017/05/25/building-additional-serious-illness-measures-into-medicareprograms/
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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