HOSPICE BILLING
HEALTH HOME MANDATE
LTC SPENDING
Wage parity among funding issues raised by HCA in meetings with Legislature on payment issues.
HCA works to provide input on new hospice billing guidelines under development for aligning state and federal (Medicaid and Medicare) policies.
Hospitals must refer certain eligible patients to health homes. HCA works to address procedural and operational questions.
AARP report: NYS would need to redirect over $2 billion to home & community services to be a topperforming state in reducing nursing home admissions.
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MLTC, HOME CARE FUNDING
COMING UP
Your Source for HOME CARE News, Policy and Advocacy
Vol. 2, Issue 25 | June 19, 2017
“Ask HCA” Dine and Discuss Roadshow Sessions
Final Push for Bills as Legislature Proceeds to Session Finale
June 20 Albany, N.Y. 3 to 5 p.m.
A final push is on for legislative action in this concluding week of the 2017 State Legislative Session. The last official legislative day is scheduled for Wednesday, June 21, but the possibilities are that session may continue a day or two beyond.
Wednesday, June 21 Westchester 11 a.m. to 1 p.m. LHCSA “Hot Topics” Forum June 22 New York, NY Make Your Emergency Preparedness Plan CoPReady June 28 Suffern, NY 10901 Note: the editorial deadline for this week’s edition of the newsletter was Friday afternoon (June 16). HCA will inform you, via alert, of any updates that may have occurred since that time.
HCA and our government relations team at Hinman-Straub are working strenuously to advocate the Legislature’s full passage of priority bills important to our field, and to keep vigilance over the movement or emergence of bills which pose risks. See FINALE p. 2
HCA Gains DOH Clarification on Payback of 2% Cut Contrary to information reported on April 24, retroactive payments for 2014-15 have not yet occurred, but are imminent HCA has learned that the state Department of Health (DOH) expects later this month or in July to pay back both the state and federal shares of the discontinued two-percent acrossSee CUT p. 3
HCA-MSSNY “F2F” Guidance Hoping for DOH Adoption by July 1 Enforcement of federal and state Face-to-Face (F2F) encounter requirements for coverage of home health services takes effect for Medicaid cases starting July 1 – unless word of delay or other reprieve is received prior to this date. As reported in previous HCA member communications, HCA and the Medical Society of the State of New York (MSSNY), consulting See F2F p. 4
INSIDE Final Push for Bills as Legislature Proceeds to Session Finale......................1 HCA Gains DOH Clarification on Payback of 2% Cut.....................................1 HCA-MSSNY “F2F” Guidance Hoping for DOH Adoption by July 1...................1 A Special Message from HCA Sponsor FBA of Syosset..................................3 HCA, Legislature Urging State Support for MLTC, Home Care Funding..........4 Due Date Again Changed for FLSA Attestations; Now June 23.....................5 DOH Releases Guidance on Wage Parity and CDPAS..................................5 Important Upcoming Deadlines...............................................................7 IMPORTANT: HCA Needs Your Agency’s Input in Critical Survey.....................8 HCA Advocating Care and Precision in New Hospice Billing Guidelines.......8
Member Hiring Announcements...............................................................................9 HCA Seeks Discussion on New “Health Home” Mandate............................................10 HCA Seeks Feedback on Draft Provider Reconciliation Cost Report............................10 HCA to Discuss Sepsis Efforts with Senior Action Council Members...........................11 AARP and Partners Score States on Nursing Home Reductions..................................12 Last Chance for LHCSA “Hot Topics” Forum this Thursday, June 22..............................12 MedPAC Releases Report........................................................................................13 CMS Call on Medicare Claims Appeal Process: June 29.............................................13 Social Security Numbers to be Removed from Medicare Cards..................................14 Resources..........................................................................................................................15
The Situation Report: the Home Care Association of New York State
Volume 2, No. 25 June 19, 2017
FINALE from p. 1 Bills of direct interest which we have been covering extensively for the membership, and one new bill, include:
HCA’s Physician-Homecare Collaboration for Primary Care, Public Health and Medical Management (S.6345 Hannon) – HCA has been asking the Assembly to match the Senate bill and both houses to pass it.
HCA’s Collaboration Model of Community Paramedicine bill (S.5588 Hannon/A.2733-A Gottfried) – HCA is seeking Assembly passage to match the Senate’s passage.
HCA’s “Essential Personnel” bill for home care and hospice access to patients in public emergencies (S.5016-A Lanza/ A.6549-A Cusick) – HCA has worked with the bill sponsors to craft amendments aimed to garner the Governor’s approval and will be urging passage in both houses. Sepsis Education in Schools and in State Education Infection Control Curricula for Health Professionals (S.4971-A Marcellino/A.6053-A Nolan) – this is a recently introduced bill for multi-level education in sepsis, conceptually interfacing with HCA’s work in sepsis screening and roles in home care; HCA has reached out to the sponsors, and this bill is currently positioned to pass in both houses. Hospice and Palliative Care Legislation – a series of bills are making their way through the Legislature in support of hospice and palliative care. These include bills: clarifying the hospice criminal history record check law (S.6347 Hannon/ A.7846 Gottfried, has passed the Assembly and awaits Senate action); and expanding capacity for hospices to swing their residence beds to inpatient beds (S.6364 Hannon/A.7775 Gottfried, has passed the Assembly and is in Senate Finance). Another bill HCA reported on last week (S.966 Funke/A.2316 Morelle) would provide for the establishment of a “MOLST” (medical orders for life sustaining treatment) registry and is in the Senate and Assembly Health Committees.
HCA will alert the membership of developments and report on the final action on all of these bills as well as any others that are acted on with implications for home care, MLTC, hospice and related concerns. For additional information, contact Al Cardillo at 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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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
Volume 2, No. 25 June 19, 2017
The Situation Report: the Home Care Association of New York State
CUT from p. 1 the-board cut for the April 1, 2014 to March 31, 2015 period (state fiscal year 2014-15) following federal approval of a State Plan Amendment to do so. In the April 24 edition of The Situation Report, an incorrect report to HCA was published stating that DOH already repaid the state-share portion of this two-percent cut, but this did not occur. Please take note of this update. The payback stems from state budget language to discontinue the two-percent cut that was in effect for state fiscal year 2014-15, requiring a retrospective payback to those affected home health and other providers for this period. As HCA reported on April 24, the state just recently gained federal approval to restore both the state and federal portions of these cuts. While the cut was supposed to be discontinued after March 31, 2015, a delay in changes to the payment processing system resulted in continuation of the cuts through May 7, 2015. DOH has already paid back providers for the April 1, 2015 through May 7, 2015 period when the cut remained active past the statutory discontinuation date (between Medicaid payment cycles 1963 and 1969). DOH has indicated that it will issue a notice when the payback for state fiscal year 2014-15 hits the Medicaid payment cycle, completing the remaining retroactive adjustments. HCA will notify the membership as soon as the Department notice is issued. A message from HCA sponsor FBA of Syosset
Are You Compliance Ready for CDPAP?
Don’t Get Caught Out of Compliance! i i
i i i
Did you know that starting on July 1
st
, 2017, Wage Parity will be required for
all CDPAP Cases?? Employees working for the Consumer Directed Personal Assistance Program, better know as CDPAP, will now be equivalent to Home Health Aides in terms of Wage Parity Compliance! Do you know what is considered to be “compliant”? In order to be Wage Parity compliant, a Home Health Care Agency must provide its Aides with a “Bona Fide Benefit Plan” But what qualifies as a “Bona Fide Benefit Plan”?
*FBA
of Syosset is the leader in Wage Parity Benefits and Compliance. To find out how FBA can help you keep in compliance, call our Director of Sales, Stephen Squires, before July 1st at 516-289-9009.
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The Situation Report: the Home Care Association of New York State
Volume 2, No. 25 June 19, 2017
F2F from p. 1 with the joint MSSNY-HCA Physician-Home Care Task Force, co-developed and submitted to the state Department of Health draft guidance for consideration for providers and physicians in explaining and meeting this new Medicaid F2F requirement. The HCA-MSSNY draft, which is under review at the Department, works to convey the Medicaid F2F background and requirements in streamlined language and procedures. Moreover, the draft proposes exception from F2F for managed care cases, with proposed wide application to all of New York’s managed care models and enrollees. In an overarching proposal, HCA and MSSNY have urged the state to petition the U.S. Centers for Medicare and Medicaid Services for a complete waiver of F2F for New York on the basis that our entire Medicaid program is under a federally governed managed care waiver. In the meantime, however, unless otherwise informed, home care agencies and physicians must plan on the requirement being enforced, and HCA and MSSNY will continue to seek state approval of our streamlined implementation guidance. HCA will keep members closely apprised of the draft’s reception in the Department of Health, and all other developments related to the coming July 1 effective date for Medicaid F2F. HCA appreciates the Department’s openness and support in considering our proactive document and effort, as well as the contributions of our home care, MLTC and physician MSSNY-HCA Task Force members, and those efforts of our policy partners at MSSNY. For further information, please contact Al Cardillo (acardillo@hcanys.org) or Patrick Conole (pconole@hcanys.org).
HCA, Legislature Urging State Support for MLTC, Home Care Funding The Legislature voiced heightened concern this week over the state’s lack of fund distribution for new wage parity costs to MLTCs and providers. The concerns specifically center on new wage parity costs the budget has mandated under the Consumer Directed Personal Assistance Program. (See p. 5 story.) The Legislature specifically reached out to advise HCA and other concerned organizations. In response, HCA underscored to the Legislature its call for the state’s release of the budgeted wage parity funds intended for support of MLTCs, providers and workers. HCA also again voiced to the Legislature our overarching concerns for the broad and growing consequences of the state’s accumulating mandates, program initiatives, cuts, and other requirements impacting MLTCs and providers. HCA stressed that the full impact of these measures, their costs and the consequent support needs of plans and providers be taken into account. HCA urged that these be fully considered in the payment methodology discussions underway between the Legislature, State Health Department and State Division of the Budget. HCA provided data which demonstrates the financial fragility across many of the plans
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The Situation Report: the Home Care Association of New York State
Volume 2, No. 25 June 19, 2017
and providers in the state – a condition which compels release of the new state budgeted dollars and major upgrades in the overall state payment methodology. The adopted 2017-18 state budget included an agreement via “side-letter” to explore methodological improvements to MLTC funding via rate cells for MLTC nursing home and high-cost and high-need home and personal care patients. Legislative discussions have indicated that meetings on the side-letter are expected to broaden and encompass other relevant cost factors. HCA once again this week urged that all relevant costs be captured in these discussions and in the contemplated rate improvements, and that the impacts of the aggregate actions and mandates on plans and providers be addressed in these improvements. Contact Al Cardillo at acardillo@hcanys.org for further information.
Due Date Again Changed for FLSA Attestations; Now June 23 The state Department of Health (DOH) announced last week that it has again extended the due date for the Fair Labor Standards Act (FLSA) attestations. The new due date is June 23. DOH has already extended the deadline twice before, from May 5 to June 9, and then to June 16, to allow DOH to address certain issues raised by plans and providers. In mid-April, DOH had posted guidance on funds intended for use in meeting the 2015 FLSA changes, including an April 2017 Dear Colleague Letter on FLSA Implementation and accompanying attestation forms available at https://www.health.ny.gov/health_care/medicaid/redesign/fair_labor_standards_act.htm. DOH is requiring that plans and providers alike sign and submit attestations by June 23 directly to the Department (FLSA@health.ny.gov). DOH strongly encourages providers to also send their attestations to their contracted managed care plan, and asks plans to distribute and obtain all signed attestations 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 its letter. HCA will communicate new information regarding this issue as it becomes available.
DOH Releases Guidance on Wage Parity and CDPAS HCA, Legislature continue push for MLTC/Provider funding Last week, the state Department of Health (DOH) issued a Dear Administrator Letter (DAL) on the recent applicability of the Home Care Worker Wage Parity law to personal assistants (PAs) providing Consumer Directed Personal Assistance Services (CDPAS) in New York City, Long Island and Westchester. The DAL is at http://hca-nys.org/wp-content/uploads/2017/06/CDPAS-FIWPGuidance-.pdf. Continued on next page
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The Situation Report: the Home Care Association of New York State
Volume 2, No. 25 June 19, 2017
Continued from previous page The recent final state budget included a provision that added PAs to the definition of “home care aide” for purposes of the state Wage Parity law, also requiring fiscal intermediaries (FIs) to verify compliance with the law’s provisions. This is effective July 1, 2017. The DAL reviews the provisions of the Wage Parity law and states that, effective July 1, 2017, wage parity will apply to CDPAS FIs that have signed Administrative Agreements with Managed Care Organizations (MCOs), including managed long term care and mainstream Medicaid managed care plans. CDPAS FIs will be required to provide their contracted MCOs with a certification form (see http://hca-nys.org/wp-content/uploads/2017/06/CDPASWPAttestation61417.pdf) on a quarterly basis. The first form covers the period of July 1 to September 30. (The form should be submitted prior to July 1.) DOH asks MCOs to submit a list of all the FIs they have signed agreements with and a notation as to whether the FIs have completed the certification. The DAL includes a document that explains what is included in the rates for the PAs under the Wage Parity law. An especially crucial issue is that DOH has not released funds approved in the state budget intended to assist managed care plans to meet these new costs. Despite the Legislature appropriating $9 million for this new expense, DOH has so far refused to commit to adding those funds to plan rates. HCA has met with DOH and state legislative officials to urge that these monies be paid to MLTC plans and that, overall, adequate funds be provided to plans and FIs to meet this new cost. (See related p. 4 story.) In addition, on June 13, Senator Kemp Hannon and Assemblyman Richard Gottfried, chairs of their respective Health Committees, sent a letter to DOH urging it to appropriate the $9 million for PA wage parity so that MLTCs and FIs are compensated adequately to pay CDPAP workers appropriately and on schedule. We have been stressing to DOH that the many accumulating layers of cost mandates on MLTC and providers, combined with the inadequacy and irregularity in state compensation of these mandates, are taking its toll on the entire system. HCA will be seeking clarification of the above issues and will keep members informed of any new developments. Members can also send questions or concerns to DOH at HCWorkerParity@health.ny.gov. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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The Situation Report: the Home Care Association of New York State
Volume 2, No. 25 June 19, 2017
Important Upcoming Deadlines Requirement Hospice Item Set preview reports available for Quarter 4, 2015 to Quarter 3, 2016 data
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Effective/Due Date Available June 1, 2017 through June 30, 2017
More Information https://www.cms.gov/Medicare/QualityͲInitiativesͲPatientͲ AssessmentͲInstruments/HospiceͲQualityͲReporting/HospiceͲ QualityͲPublicͲReporting.html
Revised Advanced Beneficiary Notice Must be used of Noncoverage for Medicare feeͲ by June 21 forͲservice
https://www.cms.gov/Medicare/MedicareͲGeneralͲ Information/BNI/ABN.html
Fair Labor Standards Act (FLSA) attestations due from managed long term care plans, CHHAs, LTHHCPs, LHCSAs and fiscal intermediaries
NEW DUE DATE: June 23, 2017
https://www.health.ny.gov/health_care/medicaid/redesign/fa ir_labor_standards_act.htm
“Rate Hotline” Appeals for 2017 Initial Personal Care Rates
June 30, 2017
https://commerce.health.state.ny.us/public/hcs_login.html (Health Commerce System) for rate sheets; questions go to bltcrͲpc@health.ny.gov
State Home Care Worker Wage Parity Certification forms for Fiscal Intermediaries that contract with managed care plans for Consumer Directed Personal Assistance services provided in NYC, Long Island and Westchester
Due by July 1 for the period of July 1 to September 30, 2017
http://hcaͲnys.org/wpͲ content/uploads/2017/06/CDPASWPAttestation61417.pdf
Executive Order (EO) 38 Disclosure Form for CHHAs
August 15, 2017
https://executiveorder38.ny.gov/
CHHA 2016 Medicaid Cost Report
August 15, 2017
https://commerce.health.state.ny.us/public/hcs_login.html
EO 38 Disclosure Form for Personal Care Providers
August 16, 2017
https://executiveorder38.ny.gov/
Personal Care 2016 Medicaid Cost Report
August 16, 2017
https://commerce.health.state.ny.us/public/hcs_login.html
Federal Emergency Preparedness Rule
November 16, 2017
https://www.cms.gov/Medicare/ProviderͲEnrollmentͲandͲ Certification/SurveyCertEmergPrep/EmergencyͲPrepͲ Rule.html; https://www.gpo.gov/fdsys/pkg/FRͲ2016Ͳ09Ͳ 16/pdf/2016Ͳ21404.pdf
State Home Care Worker Wage Parity Certification forms for Fiscal Intermediaries that contract with managed care plans for services provided in NYC, Long Island and Westchester
Due by July 1 for the period of July 1 to September 30, 2017
http://hcaͲnys.org/wpͲ content/uploads/2017/06/CDPASWPAttestation61417.pdf
The Situation Report: the Home Care Association of New York State
Volume 2, No. 25 June 19, 2017
IMPORTANT: HCA Needs Your Agency’s Input in Critical Survey Please respond by close of business today, June 19 HCA has sent several requests to members throughout the spring asking agencies to complete a critical survey related to their technology assets, capabilities, and needs. We have received a limited response, and feel that the current results do not reflect a representative sample of our membership. This Technology Survey is critical because the data gathered will be used to help HCA advocate on your behalf regarding the need to fund home care providers for their technology needs. With a truly representative sample, we will be better able to show state agencies, legislators and others the dire need to help home care providers with their technology essentials so that you will be better able to partner with managed care plans, Delivery System Reform Incentive Payment (DSRIP) Performing Provider System (PPS) networks, Accountable Care Organizations, etc. Additionally, HCA has been asked to provide input imminently for the State Health Information Network’s (SHIN-NY) strategic plan, and we would like to be able to reference solid data provided from our membership to truly demonstrate the limitations and needs. If you have already completed this survey, we offer our sincere thanks. If you have not yet completed this survey, we would greatly appreciate it if you would do so as soon as possible so that we gain stronger data points on which to make our argument. We ask that you complete the survey no later than close of business today, Monday, June 19. The survey should take between 10-15 minutes, and is available at: https://www.surveymonkey.com/r/HCAtechsurvey2017.
HCA Advocating Care and Precision in New Hospice Billing Guidelines The state Department of Health will be developing new state guidelines on billing for hospice enrollees to promote alignment with state and federal Medicare/Medicaid policy. The guidelines are being pursued administratively by the Department as part of its intentions for implementing the 2017-18 State Budget. HCA has requested opportunity for direct input as well as input from the membership in the Department’s drafting process. HCA is urging great caution and care in the expression of these guidelines so as to avoid any inadvertent, chilling effect on referrals to or use of hospice, as well as adjunct services, where both are appropriate and necessary for the patient’s care. These guidelines must be very carefully delineated especially in the case of dually eligible MedicareMedicaid hospice patients who are simultaneously receiving both hospice services and the services of other programs or entities, including MLTCs. Ideally, the guidelines must assist in determining appropriate distinctions and parameters in billing for each entity, but must not create uncertainty or gaps in service or reimbursement for hospice or collaborating entities, or create risk of subjective audit practices by state or federal reviews. Increased access to and earlier entry into hospice are clinical and policy priorities. Recent laws have sought to ensure the provision of hospice-related patient information and referral to hospice whenever
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The Situation Report: the Home Care Association of New York State
appropriate. Related policy and professional actions are being undertaken to reduce and overcome the obstacles and challenges to hospice referral and enrollment. Critically, the aforementioned guidelines must be drafted with an accommodating eye on these priorities – and with recognition that these goals, as well as the providers, plans and practitioners who seek to fulfill them, are not inadvertently set back.
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:
x x x x x x x x
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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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!
HCA will keep members informed of the developments on this important issue. For further information, please contact Al Cardillo at acardillo@hcanys.org.
Volume 2, No. 25 June 19, 2017
The Situation Report: the Home Care Association of New York State
Volume 2, No. 25 June 19, 2017
HCA Seeks Discussion on New “Health Home” Mandate Effective June 1, the state Department of Health’s (DOH) DHDTC DAL 17-04 took effect, mandating hospitals to refer eligible patients to health homes (Medicaid patients with two or more chronic conditions, or who have one single qualifying condition of HIV/AIDS or serious mental illness). The DAL is viewable at http://hca-nys.org/wp-content/uploads/2017/06/Health-Home-Directive-by-DOH-Feb-2017.pdf and an accompanying Question and Answer document is at http://hca-nys.org/wp-content/uploads/2017/06/2017-04_qa_dhdtc_dal_hospital_referral_health_homes_requirement.pdf. According to the DAL, the referral requirement is part of the terms and conditions of the state’s federal waiver. Hospitals have been required to submit an attestation to DOH that requisite referral policies and procedures have been put into place. The referral requirement applies to patients entering the emergency room. HCA has been reaching out to discuss with DOH this directive and its operational, procedural and programmatic implications for home care and for MLTCs. HCA will provide further information as the discussion ensues. HCA members should in the meantime be familiar with the background documents linked to this article and should contact HCA (acardillo@hcanys.org) with any notable experiences you may have already had based on the new mandate. For further information, contact acardillo@hcanys.org.
HCA Seeks Feedback on Draft Provider Reconciliation Cost Report HCA is seeking member feedback on a draft Provider Reconciliation Cost Report that the state Department of Health (DOH) has developed to verify that staff funding for the recent minimum wage increase is being using appropriately. The draft Provider Reconciliation Cost Report is at the following links in PDF and Excel formats:
http://hca-nys.org/wp-content/uploads/2017/06/Provider-Reconciliation-Cost-Report-06-05-17-1.pdf
http://hca-nys.org/wp-content/uploads/2017/06/Provider-Reconciliation-Cost-Report-1.xlsx
As mentioned in last week’s edition of The Situation Report, the form was reviewed at the June 7 Licensed Home Care Services Agency (LHCSA) Statistical Report Workgroup meeting. Once finalized, DOH plans to send the form to about 700 agencies that submitted a minimum wage survey in February and then will send it to additional agencies that are listed in DOH directories. At the LHCSA Workgroup meeting, HCA and other associations urged DOH to hold a webinar on the new Cost Report and it agreed to do so. Continued on next page
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The Situation Report: the Home Care Association of New York State
Volume 2, No. 25 June 19, 2017
Continued from previous page HCA is seeking member feedback on the form, including:
Parts that need clarification or explanations so that you can complete them
Any information that you are unable to obtain
About how long it will take to gather this information
Anything else you feel is important for DOH to know
This is the only opportunity we have to suggest revisions to this form. Please send your comments to Andrew Koski at akoski@hcanys.org by Wednesday, June 21 so that we can gather all of them and send to DOH in one document.
HCA to Discuss Sepsis and Home Care Screening Efforts with Senior Action Council Members In our continued efforts to promote clinical protocols and education related to the sepsis crisis, HCA is joining the Statewide Senior Action Council on a telephone teach-in program to discuss national and home care initiatives in sepsis identification and treatment. HCA Executive Vice President Al Cardillo will present during the June 27 call-in program (from 10 to 11 a.m.), along with HCA Member Amy Bowerman, the RN Clinical Leader on HCA’s sepsis project, and Thomas Heymann, Executive Director of Sepsis Alliance. The session will highlight: the public health concerns related to sepsis; how it affects the elderly and caregivers; information on prevention, detection and treatment; policy and program efforts to address the sepsis problem; and HCA’s new screening tool, previously announced to the membership. HCA members interested in learning more about our first-in-the-nation screening tool – which can be incorporated into your clinicians’ work flow and electronic health records – should contact sepsistool@hcanys.org. Use of the tool, pending a user agreement, is complimentary with your HCA membership and holds promise in tackling the sepsis crisis from the home care setting. The Senior Action Council proclaims that it “has flagged the prevention of sepsis as a major patient safety concern for our network,” which includes senior citizens and groups that represent or organize this constituency. As previously reported, 80 to 90 percent of sepsis cases originate in the home and community, making home care providers and elder-care advocates a powerful resource to intervene and raise awareness. The Council has been an important partner with HCA on key advocacy initiatives and public education, including this important opportunity to raise awareness about the sepsis crisis. A flyer for the June 27 teach-in is available at http://hca-nys.org/wp-content/uploads/2017/06/Patients-Advocates-Telephone-Teach-ins-for-June-27-2017.pdf.
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The Situation Report: the Home Care Association of New York State
Volume 2, No. 25 June 19, 2017
AARP & Partners Score States on Reducing Medicaid Nursing Home Admissions According to report, NYS would need to redirect over $2 billion to home and community based services in order to be a top-performing state AARP, The Commonwealth Fund and the Scan Foundation have teamed up to publish an online scorecard on the effectiveness of each state’s long term care service program to keep Medicaid enrollees out of nursing homes. According to the scorecard, New York State ranked twentieth in the nation based on a methodology that rated such factors as: affordability and access; choice of setting and provider; quality of life and quality of care; support for family caregivers; and effective transitions. Only nine states and the District of Columbia spent more on home- and community-based services than on nursing home care, according to the report. (New York is not one of the nine states.) Notably, the report indicates that the following would need to occur if New York State were to “improve its performance to the level of the average of the top-five-performing states”:
$2,152,500,000 more would go to home- and community-based services instead of nursing homes.
9,294 more low-/moderate-income adults with disabilities would have Medicaid coverage.
111,570 more people of all ages would receive Medicaid LTSS to help them with daily activities.
The report did find, however, that New York’s supply of home health and personal care aides was at or above the level of the top-five-performing states. To read the New York State scorecard, please visit http://www.longtermscorecard.org/databystate/state?state=NY.
Last Chance for LHCSA “Hot Topics” Forum this Thursday, June 22 Now is your last chance to join us on June 22 (this Thursday) in New York City for our LHCSA “Hot Topics” Forum. A registration form is at the back of this week’s newsletter. We’ve identified three areas of focus. First, we’ll be joined by Jackson Lewis attorney Frank Fanshawe who will delve into labor law issues and recent court rulings, which are among the most alarming new developments affecting LHCSA operations. Mr. Fanshawe and HCA Vice President Andrew Koski will specifically address: court cases and litigation affecting 24-hour/live-in cases; Fair Labor Standards Act and Quality Incentive/Vital Access Program Pool funding; consumer directed personal assistant services (i.e., wage parity applicability starting on July 1, the new fiscal intermediary “authorization” process in the final state budget, and any other current issues); and white-collar overtime changes, including the “salary” and “duties” tests, differences between state and federal mandates and timetables, and ways to minimize exposure. Continued on next page
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Continued from previous page Next, a representative from the state Workers’ Compensation Board will discuss New York’s Paid Family Leave program that starts January 1, 2018. The presentation will cover the obligations of employers and the rights and responsibilities of employees. Importantly, HCA Board Member Russell Lusak, Senior Vice President, Selfhelp Community Services, Inc., will be joined by Elizabeth Amato, Senior Director, Statewide Services for the New York eHealth Collaborative (NYeC) to identify the merits of Regional Health Information Organization (RHIO) connectivity for LHCSAs as a step toward future success in an increasingly competitive service delivery marketplace. You’ll also learn how your agency can connect for less by accessing available funds for this purpose. With the rapid move to value based payments and further care integration, this is a must-attend session. This program is specially designed for LHCSA CEOs, COOs, compliance staff, finance managers and operators.
MedPAC Releases Report The Medicare Payment Advisory Commission (MedPAC) has released its June report, entitled: “Medicare and the Health Care Delivery System.” It is at www.medpac.gov/docs/default-source/reports/jun17_reporttocongress_sec.pdf. The report covers: Implementing a unified payment system for post-acute care; Provider consolidation-the role of Medicare policy; Using premium support in Medicare;
The relationship between physician and other health professional services and other Medicare services;
An overview of the medical device industry;
Hospital and skilled nursing facility services use by Medicare beneficiaries who reside in nursing facilities; and
Other issues.
CMS to Conduct Conference Call on Improvements to the Medicare Claims Appeal Process and Statistical Sampling Call: June 29 The U.S. Centers for Medicare and Medicaid Services (CMS) will conduct a conference call on “Improvements to the Medicare Claims Appeal Process and Statistical Sampling” on Thursday, June 29 from 1 to 3 p.m. During this call, CMS and the Office of Medicare Hearings and Appeals (OMHA) will discuss the U.S. Health and Human Services (HHS) Medicare Appeals Final Rule, published on January 17, 2017. Participants will learn
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about changes intended to streamline the administrative appeal processes, reduce the backlog of pending appeals, and increase consistency in decision-making across appeal levels. For an overview of the final rule, see the HHS fact sheet at: https://www.hhs.gov/sites/default/files/medicare-appeals-final-rule-fact-sheetjan2017.pdf A question and answer session will follow the presentation. Interested HCA members can register for the call at: https://blh.ier.intercall.com/.
Social Security Numbers to be Removed from Medicare Cards Providers can take steps now As communicated to members in previous articles, Medicare is taking steps to remove Social Security numbers from Medicare cards. The U.S. Centers for Medicare and Medicaid Services (CMS) is doing this to “prevent fraud, fight identity theft and protect essential program funding and the private health care and financial information of our Medicare beneficiaries.” CMS will issue new Medicare cards with a unique, randomly-assigned number called a Medicare Beneficiary Identifier (MBI) to replace the existing Social Security-based Health Insurance Claim Number (HICN) both on the cards and in various CMS systems it uses. CMS will start mailing new cards to people with Medicare benefits in April 2018. All Medicare cards will be replaced by April 2019. CMS is developing capabilities where doctors and other health care providers will be able to look up the new MBI through a secure tool at the point of service. To make this change easier for providers, there is a 21-month transition period where all health care providers will be able to use either the MBI or the HICN for billing purposes. Therefore, even though your systems will need to be able to accept the new MBI format by April 2018, providers can continue to bill and file health care claims using a patient’s HICN during the transition period. CMS encourages you to work with your billing vendor to make sure that your system will be updated to reflect these changes as well. The following are four steps providers can take now to prepare for this change: 1. Go to CMS’s provider website (https://www.cms.gov/Medicare/SSNRI/Index.html#target) and sign-up for the weekly MLN Connects newsletter. 2. Attend CMS quarterly calls to get more information (see https://www.cms.gov/Outreach-and-Education/ Outreach/OpenDoorForums/ODF_SSNRI.html). CMS will let you know when calls are scheduled in the MLN Connects newsletter. 3. Verify all of your Medicare patients’ addresses. If the addresses you have on file are different than the Medicare address you get on electronic eligibility transactions, ask your patients to contact Social Security (see https://faq.ssa.gov/ics/support/KBAnswer.asp?questionID=3704) and update their Medicare records. Continued on next page
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Continued from previous page 4. Test your system changes and work with your billing office staff to be sure your office is ready to use the new MBI format (see https://www.cms.gov/Medicare/SSNRI/Understanding-the-MBIwith-Format.pdf). To learn more, visit: cms.gov/Medicare/SSNRI/Providers/Providers.html.
Resources •
“An Overview of Home-Based Primary Care: Learning from the Field,” by the Commonwealth Fund http://tinyurl.com/y9zafmmv
•
“Health Spending By State 1991–2014: Measuring Per Capita Spending By Payers And Programs,” Health Affairs (June 14, 2017) http://content.healthaffairs.org/content/early/2017/06/13/hlthaff.2017.0416.full.pdf+html https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ NationalHealthExpendData/NationalHealthAccountsStateHealthAccountsResidence.html
•
“Factors Affecting States’ Ability to Respond to Federal Medicaid Cuts and Caps: Which States Are Most At Risk?,” by the Kaiser Family Foundation http://files.kff.org/attachment/Issue-Brief-Factors-Affecting-States-Ability-to-Respond-toFederal-Medicaid-Cuts-and-Caps-Which-States-Are-Most-At-Risk
•
“Provider Enrollment Revalidation – Cycle 2,” by the U.S. Centers for Medicare and Medicaid Services https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNMattersArticles/Downloads/SE1605.pdf
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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Forum LOCATION: VNSNY Auditorium 107 E. 70th Street (between Park and Lexington Avenues) New York, NY 10021
DATE & TIME: Thursday, June 22 9:00 to 9:30am Registration and Continental Breakfast 9:30am to 12:30pm Program
Whether it’s labor mandates, regulations, litigation, or obstacles to participating in integrated networks, LHCSAs find themselves besieged by increasing challenges in their day-to-day functions and operations. Join HCA and your LHCSA colleagues for a special session to help you get a handle on burning labor law, regulatory and infrastructure issues specific to LHCSAs, and to learn about HCA’s advocacy plan to address all of these concerns. This program is specially designed for LHCSA CEOs, COOs, compliance staff, finance managers and operators. Please see the agenda below.
AGENDA Thursday, June 22, 2017 9:30am to 12:30pm
REGISTRATION FEES: HCA Member: $99 Non-Member $199
Labor Law Updates Frank Fanshawe, HCA Counsel and Principal at Jackson Lewis – Albany Andrew Koski, Vice President for Program Policy and Services, HCA Frank Fanshawe, a veteran health care legal expert, will discuss the following labor law updates: • Court cases and litigation affecting 24-hour/live-in cases.
REGISTRATION DEADLINE: June 15
• Fair Labor Standards Act funding. • Consumer directed personal assistant services (i.e., wage parity applicability starting on July 1, the new fiscal intermediary “authorization” process in the final state budget, any other current issues). • White-collar overtime changes, including the “salary” and “duties” tests; differences between state and federal mandates and timetables; and ways to minimize exposure.
Agenda continues…
Forum
Thursday, June 22, 2017
Registration Information Name: _______________________________________________
AGENDA – Continued
Title: ________________________________________________
Paid Family Leave Update
Organization:__________________________________________
Representative from New York State Workers' Compensation Board
Mailing Address: _______________________________________
A representative from the state Workers’ Compensation Board will discuss New York’s Paid Family Leave program that starts January 1, 2018. When fully implemented, it will provide employees up to 12 weeks of paid family leave to: care for a family member with a serious health condition; bond with an employee’s newborn or newly placed adoptive or foster child during the first 12 months following birth or placement; or address any qualifying exigency to a spouse, domestic partner, child or parent who is serving on active military duty. The presentation will cover the obligations of employers and the rights and responsibilities of employees.
The Value of LHCSA Connectivity to Health Information Exchange (RHIO) Russell Lusak, Senior Vice President, Selfhelp Community Services, Inc.and RHIO representative (TBD) While connection to a Regional Health Information Organization (RHIO) may seem too costly of an endeavor to justify such an expense, this session will identify the merits of connectivity for LHCSAs as a step toward future success in an increasingly competitive service delivery marketplace. Hear from a LHCSA representative who partners with RHIOs about the value of connection, and learn how your agency can connect for less by accessing available funds for this purpose.
City/State/Zip:_________________________________________ Email:________________________________________________ Phone:_______________________________________________ (Required for registration)
Payment Information □ HCA Member = $99 □ HCA Non-Member = $199 Please check method of payment: ____MasterCard ____VISA ____Am Exp
____Check*
*Make checks payable to: HCA and mail to 388 Broadway, 4th Floor, Albany, NY 12207. Checks must be received by June 15. ______________________________________________________ Card Number _________________________________ Expiration Date
_________________ Security Code
______________________________________________________ Billing Address of Card Holder ______________________________________________________ City, State, Zip ______________________________________________________ Name on Card ______________________________________________________ Authorized Signature Cancellation Policy Cancellations received by June 15 will receive a full refund less 25% of total due as an administrative fee. Cancellations received on June 16 or later will forfeit their registration fee along with those who register and do not attend. Substitutions are permitted. Please contact Teresa Brown at (518) 426-8764 or tbrown@hcanys.org to cancel.
Please FAX this completed form to: (518) 426-8788