June 25, 2018 Edition of The Situation Report

EVV DELAY

13-HOUR RULE

MMCOR DATA POSTED

MedPAC

House passes legislation to delay federal requirement for state-led electronic verification programs to review personal care services.

The state Department of Labor again extends the emergency rule codifying the 13-hour standard for compensable hours in 24-hour/live-in cases.

HCA’s members-only data webpage has new spreadsheets with managed care data for members to view and download.

MedPAC’s annual report expresses concerns about the quality of postacute care providers, along with further analysis of its unified postacute payment system, as well as managed care and ACO findings.

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Your Source for HOME CARE News, Policy and Advocacy

EDITOR’S NOTE This is the last weekly edition of The Situation Report until September.

During the past few summers, HCA has implemented a biweekly schedule (every two weeks). Our next publication will be on July 9, followed by July 23 and continuing biweekly until September 3. As always, we will notify you by email of any important, breaking news stories or updates.

Vol. 3, Issue 29 | June 25, 2018

HCA President Advocates with New York Congressional Delegation to Protect and Advance Home Care HCA President Joanne Cunningham spent much of last week in Washington, DC for a series of meetings with members and staff of the New York Congressional Delegation including the Offices of Senator Kirsten Gillibrand, Representatives Brian Higgins (D-Buffalo/ Niagara Falls), Chris Collins, (R-Lancaster/ Geneseo), Joseph Crowley (D-Queens), Yvette Clarke (D-Brooklyn) and Grace Meng (DQueens).

See DELEGATION p. 2

See FIXES p. 4 HCA President Joanne Cunningham, left, with Rep. Yvette Clarke.

Legislature Concludes Scheduled Session, but Return is Likely The state Legislature gaveled out of its scheduled 2018 calendar on Thursday, concluding a very narrow funnel of state legislative activity as the summer political campaigns take hold.

See SESSION p. 5

INSIDE HCA President Advocates w/ NY Congressional Reps. to Protect, Advance Home Care.....1 Legislature Concludes Scheduled Session, but Return is Likely................................1 EVV Delay Legislation Passes House of Representatives.........................................3 Messages from HCA Supporters and Sponsors......................................................4,6 State DOL Extends Emergency Rule on 24-Hour/Live-in Care.....................................8 HCA Continues to Press on CHHA Minimum Wage Reimbursement Increase.............9 Member Hiring Announcements..........................................................................10 HCA Data Webpage Now Includes Q4 2017 MLTC & PACE MMCOR Data....................11 CMS Provides New Guidance for CERT Reviews......................................................11

MedPAC Report Makes Sweeping Analysis of Post-acute Quality, Payments....12 Settlement Conference Facilitation Program Expanded..........................15 Change to OPWDD Medicaid Service Coordination...................................16 HHCAHPS Preview Reports with Star Ratings Available.............................16 OMIG Posts Updated 2018-19 Work Plan.................................................17 Update on UAS for NHTD and TBI Posted....................................................18 Important Upcoming Deadlines..............................................................20 CMS Updates Hospital Transfer Policy for Early Discharges to Hospice.......21 CMS Launches Data Element Library Supporting Interoperability..............21 Resources......................................................................................................................22

The Situation Report: the Home Care Association of New York State DELEGATION from p. 1 In each of the meetings, Ms. Cunningham discussed the need to protect home care providers from upcoming changes in the Medicare home health payment system (called the Home Health Groupings Model – HHGM) including the need to: 

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

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Ensure that the U.S. Centers for Medicare and Medicaid Services (CMS) does not begin the new system before 2020, offering enough time for testing, demonstrations and industry technical guidance; Clarify that the newly created 30-day increments in HHGM work in a complementary fashion with the existing 60-day episode of care that is embedded within the home health payment, regulatory and operational structure. HCA urges a legislative fix so that this 30-day increment is defined as a “unit of service,” not a “unit of payment” as it is currently designed. This would ensure that providers will be paid for all services delivered in the episode and not just receive one payment for the first 30 days of care Instruct CMS to examine the physician record along with the home health agency record for compliance with the federal face-to-face requirement; Ensure that CMS does not include a “behavioral adjustment” in the new payment system which is not based on data derived from the actual new payment system.

Ms. Cunningham also emphasized the need for adoption of H.R. 1825/S. 445, the Home Health Planning Improvement Act. This legislation would allow non-physician practitioners such as nurse practitioners and physician assistants to order and certify home health services under Medicare. This legislation would increase access to home health services for the Medicare population and is strongly supported by a bipartisan group of Members of Congress in both chambers. HCA has been meeting over the past months with the office of Rep. Chris Collins to assist in strategizing on this bill, and we support his efforts, as the bill sponsor, to ensure its passage before Congress adjourns in the fall.

HCA also brought information to the Congressional Delegation regarding the announcement by CMS to restart its pre-claim review demonstration even after serious problems were identified in the Home Care Association of New York State (HCA) 388 Broadway, 4th Floor, Albany, NY 12207 Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org

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Volume 3, No. 29 June 25, 2018 

The Situation Report is a weekly publication of the Home Care Association of New York State (HCA). Unless otherwise noted, all articles appearing in The Situation Report are the property of the Home Care Association of New York State. Reuse of any content within this newsletter requires permission from HCA. Joanne Cunningham HCA President jcunningham@hcanys.org Roger L. Noyes Director of Communications, Editor of The Situation Report rnoyes@hcanys.org Al Cardillo Executive V ice President acardillo@hcanys.org Patrick Conole Vice President, Finance & Management pconole@hcanys.org Andrew Koski Vice President, Program, Policy & Services akoski@hcanys.org Laura Constable Senior Director, Membership & Operations lconstable@hcanys.org Celisia Street Director of Education cstreet@hcanys.org Mercedes Teague Finance Manager mteague@hcanys.org Jenny Kerbein Director of Governance & Graphic Design jkerbein@hcanys.org Billi Wilson Manager, Meetings & Events bwilson@hcanys.org Teresa Brown Administrative Assistant tbrown@hcanys.org

Volume 3, No. 29 June 25, 2018

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first round of the demo launched in Illinois two years ago. Those serious problems prompted a suspension of the program entirely, and a delay in its rollout to four other states in March of 2017. This newly revamped version of pre-claim review will again begin in Illinois (no earlier than October 2018) but it also pivots to some new states.

Though New York is not one of the states, CMS holds open the possibility of expanding this newer version of the demo, potentially spreading some of the problems that have beleaguered the program to date without any serious effort on CMS’s part to be transparent and accountable about those problems. HCA educated the New York Congressional Delegation about its impact and also its unprecedented construct that subjects Medicare providers to a front-end program integrity measure that has no relationship to whether the beneficiary qualifies or requires the service, but is, rather, focused on documentation. HCA and the home care industry at the national level believe that this is a radical shift from prior Medicare integrity efforts, which had exclusively used targeted post-payment audits.

HCA President Joanne Cunningham outside the U.S. Capitol.

In preparing for last week’s visits, HCA created a new set of position papers all of which are available at the bottom of our federal advocacy page at https://hca-nys.org/advocacy-pac/federal (see documents labelled “2018”).

EVV Delay Legislation Passes House of Representatives On June 18, the U.S. House of Representatives passed by voice vote a bill that extends the deadline for state Medicaid programs to implement Electronic Visit Verification (EVV) for personal care services for one year – until January 1, 2020.

The bipartisan bill, H.R. 6042, is sponsored by Rep. Brett Guthrie (R-KY-2) and co-sponsored by Reps. Jim Langevin (D-RI-2), Diana DeGette (D-CO-1), and Greg Walden (R-OR-2).

Having passed the legislation through the House, the bill’s sponsors now hope the Senate will soon pass its version with a unanimous consent vote.

The EVV requirement is different from a similar requirement in New York State for verification organizations (VOs) to use EVV for pre-claim review. That New York State law, by contrast, is applicable to home health aide and personal care aide services provided by organizations with more than $15 million in Medicaid fee-forservice and managed care revenues.

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Continued from previous page The federal 21st Century CURES Act requires that states implement an EVV system for personal care services by January 1, 2019 and for home health services by January 1, 2023. Personal care services include any personal care provided to individuals in Medicaid fee-for-service (and Medicaid managed care); consumer directed services; and personal care provided in Nursing Home Transition and Diversion (NHTD), Traumatic Brain Injury (TBI), or any other waiver program.

The EVV systems must verify the: type of services provided; individual receiving the service; date of the service; location of service delivery; individual providing the service; and time the service begins and ends.

HCA has already met with the state Department of Health (DOH) twice to discuss EVV implementation and has advocated for ways to minimize any disruptions to agency services and operations, adequate time to implement EVV, funding for this unreimbursed requirement, and our involvement in any stakeholder workgroup that would vet the design of EVV systems and policies.

New York State’s separate requirements on verification organizations (again, applicable to organizations with more than $15 million in Medicaid revenues) are at https://omig.ny.gov/information/ home-health-verification.

As described in the May 21 edition of The Situation Report, the U.S. Centers for Medicare and Medicaid Services (CMS) in mid-May released an Informational Bulletin and frequently asked questions (FAQs) document covering the EVV requirements specified in the 21st Century CURES Act. The Bulletin and FAQs, along with webinar materials, are available at https://www.medicaid.gov/ medicaid/hcbs/guidance/electronicvisit-verification/index.html.

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

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Volume 3, No. 29 June 25, 2018 

SESSION from p. 1 As HCA has emphasized in past communications, election-year dynamics were among the biggest impediments for lawmakers and the Governor to reach agreements on several measures including those advocated by HCA. Indeed, one Senate member’s mid-session departure for military service resulted in a 31-31 split of Republicans and Democrats. This, combined with the dissolution of the Senate’s Independent Democratic conference (who had, until recently, co-led the chamber as a voting coalition), left the house without majority control for its operations, bill processes and overall agenda.

Although the scheduled session calendar has concluded, some required actions remain, and the Governor and legislators are signaling a likelihood of returning to Albany for further work. Among these pending items are a number of local laws requiring extensions.

Throughout this process, HCA engaged the membership on messaging through a new landing page on our Legislative Action Center which had 1,000 visits and netted hundreds of e-mails to legislative sponsors on seven individual campaigns to support HCA-developed bills. We thank members who joined us on grassroots advocacy and ask that you use our Legislative Action Center in even greater numbers as you receive notifications on new campaigns prompted by additional ensuing developments. Your grassroots support is vital to the success of our legislative agenda, and an even higher level of member engagement is critical.

What follows is a preliminary report on the session’s conclusion, as conveyed in an e-mail alert to members on Friday, along with any further developments relating to home care, hospice and Managed Long Term Care (MLTC).

Bills that Passed Both Houses and Await Delivery to the Governor 

HCA-authored legislation to promote Home Care-Mental Health Provider Collaboration (S.8632 by Senator Robert Ortt and A.10938 by Assemblywoman Aileen Gunther) passed both the Senate and Assembly unanimously.

This legislation is part of a multi-level partnership plan that HCA, the State Office of Mental Health (OMH), and mental health providers and associations have been forging at the state and provider levels. It specifically amends the Geriatric Service Program in the State Mental Hygiene Law to add mental health-home health provider collaboration for the purpose of coordination, integration and improved access of health and mental health services for individuals with co-occurring mental health and physical health needs. HCA, OMH and partner associations will be working to promote these collaborative models to better assist individuals to age-in-place in their homes and communities, avoid hospitalizations, promote better care transitions from hospital to home, and support quality of health and life for New Yorkers with mental health conditions.

HCA will be providing guidance to the membership on outreach to the Governor to urge his signature of this HCA-developed measure.

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Continued from previous page 

The Physical Therapy Assistant Extender bill (S.8217 by Senator Kenneth LaValle and A.10381-A

by Assemblyman Victor Pichardo) passed both the Senate and Assembly. This legislation, supported

by HCA, would extend through June 30, 2022 the authorization of physical therapy assistants (PTAs) to provide services in home care settings. Originally enacted in 1993, the provision has been extended numerous times. The bill awaits delivery to the Governor for signature, ostensibly in time before the current extender lapses on June 30.

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Legislation (S.7713-B by Senator Kemp Hannon and A.10345-A by Assemblyman Richard Gottfried) to permit Nurse Practitioner authorization under the Health Care Proxy law passed the Senate and Assembly. The legislation authorizes nurse practitioners to witness a health care proxy, act as a health care agent and determine competency of the principal of such a proxy.

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Legislation Extending Various Health Laws (A.10221-A by Assemblyman Richard Gottfried and S.8093-A by Senator Kemp Hannon) passed the Senate and Assembly. This bill would extend a number of health-related programs currently in effect that are set to expire this year, including the approval of and reimbursement to Limited Licensed Home Care Services Agencies that serve individuals who are residents of adult homes and Enriched Housing Programs until June 30, 2019.

This is currently set to expire on June 30, 2018.

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Volume 3, No. 29 June 25, 2018 

Legislation developed by LeadingAge New York and the Empire State Association for Assisted Living (A.10459-A by Assemblywoman Donna Lupardo and S.8353-A by Senator Kemp Hannon) passed both houses to allow residents of an assisted living facility who are receiving Medicaid to be able to access hospice services while remaining in their assisted living facility. Currently, Assisted Living Program residents cannot access hospice services while also remaining in assisted living, forcing displacement of individuals and increased costs to the system. HCA will be guiding the membership on next steps in communications on this initiative.

Bills that Passed the Senate, Pending in the Assembly The following important home care, hospice and MLTC bills passed the Senate. HCA had secured prominent Assembly sponsorship of these measures and we will continue working with the sponsors and the Assembly leadership to mobilize support for these bills upon a return of the Legislature. 

HCA-authored legislation establishing a Labor Competitive Market Study for Home Care and Hospice, and Recommendations for Securing Home Care and Hospice Recruitment & Retention (S.8559 by Senator Susan Serino and A.10940 by Assemblywoman Donna Lupardo) passed the Senate unanimously. This bill responds to critical marketplace issues that impede home care and hospice recruitment and retention, and consequently also impede workforce adequacy for MLTC service delivery. The bill would authorize the state Commissioner of Labor, with collaborating state agencies, to conduct a competitive labor market study to assess and make recommendations for home care and hospice capability, including appropriate reimbursement and policy support to compete in the labor market for recruitment and retention of direct-care staff.

This same legislation would also establish a Temporary State Task Force to Promote Occupations in Home Care and Hospice. This taskforce would be led by the Commissioners of Labor and Aging, with collaboration from the Commissioners of Health, Education and Mental Health, to promote entrance, practice, career development and retention in home health and hospice occupations, including home health aide, nursing, physical therapy, occupational therapy and social work.

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HCA-authored legislation to support HCA and providers’ work in implementing the HCA Home Care Sepsis Screening and Intervention Initiative (S.8669 by Senator Kemp Hannon and A.11078 by Assemblyman John McDonald) unanimously passed the Senate. The legislation would add a new section in Article 36 of the public health law to further engage state Department of Health support for home care sepsis screening, prevention, intervention, mitigation, cross-sector collaboration and public education. The bill has a series of provisions which the Department may undertake to promote home care’s work on sepsis, such as support for electronic health record (EHR) integration of the HCA-developed sepsis tool, provider/clinician training, public education, health information exchange across continuum partners and cross-sector collaboration to foster seamless, timely response to sepsis.

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Legislation to add an additional category of exemption to the LHCSA moratorium (S.8942 by Senator Kemp Hannon and A.11126 by Assemblyman Richard Gottfried) passed the Senate. The bill would add a provision allowing the Commissioner of Health to provide an exemption to the moratorium for applications which, based on the Commissioner’s discretion, are consistent with the

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Continued from previous page state’s goals of consolidation and improving care delivery. With the blunt provisions for the moratorium enacted as part of the 2018-19 state budget, this legislation would provide flexibility for exemptions not delineated in the budget language list. 

Legislation relating to Minimum Wage Adjustments for home and community based long term care services providers and fiscal intermediates (S.8473-A by Senator Kemp Hannon and A.11200 by Assemblyman Richard Gottfried) passed the Senate. The legislation seeks to address provider financing needs but does not simultaneously address the adequacy or timing of state payments to health plans.

HCA will provide further details on the status of all HCA priority home care, hospice and MLTC-related legislation that were kept from action in the extremely tight session calendar (such as legislation to address MLTC-nursing home enrollment in rural areas. HCA will continue to seek support for Assembly passage of our priority bills that have passed the Senate, along with the support of both chambers and the Executive for additional bills and issues we have advanced.

HCA thanks the members of the Legislature who sponsored and supported our priority bills, and also the individual members of HCA who acted at the grassroots level to call and write with their support. HCA looks forward to the Governor’s support and approval of bills upon delivery to him.

State DOL Extends Emergency Rule on 24-Hour/Live-in Care The state Department of Labor (DOL) has posted an extension until July 30, 2018 of its emergency rule that codifies “the Commissioner’s longstanding and consistent interpretation that compensable hours worked under the State Minimum Wage Law do not include meal periods and sleep time of home care aides who work shifts of 24 hours or more.”

The posting is in the June 20 State Register at https://docs.dos.ny.gov/info/register/2018/june20/toc.html (page 12).

As noted in many articles for The Situation Report and alerts to members, the DOL emergency rule was initially posted on October 25, 2017. It was the result of vigorous efforts by HCA and other provider associations and entities to solidify DOL’s so-called “13-hour rule” guidance for “24-hour/live-in” cases in the face of court decisions ruling that aides on 24-hour cases were to be paid for all 24 hours, regardless of whether they were afforded 8 hours of sleep (including 5 hours of uninterrupted sleep time) and three hours for meals.

HCA reminds members that state DOL is holding a hearing on July 11, 2018 on a proposed rule that would not count meals periods and sleep time for any employee (not just home care aides) who works a shift of 24 hours or more. That rule was announced in the April 25, 2018 State Register (https://docs.dos.ny.gov/info/register/ 2018/april25/toc.html; page 43). DOL requests that comments on the proposed rule be submitted prior to the hearing, but DOL will accept them until five days after the hearing – until July 16.

A notice of the July 11 hearing and registration form to testify are at https://www.labor.ny.gov/ workerprotection/sleep-time.shtm. HCA plans to testify and urges members to submit comments and/or testify.

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Continued from previous page

In early March, the Second Department, Appellate Division granted a motion to appeal in a pertinent case on this issue – Andryeyeva v. New York Health Care, Inc. – permitting the case to be considered by the Court of Appeals, which is New York’s highest court. In that case, the Second Department ruled that DOL’s opinion letter setting forth the “13-hour rule” is inconsistent with the plain language of underlying state regulation.

HCA will be submitting an amicus to the Court of Appeals on this case.

HCA Continues to Press on CHHA Minimum Wage Reimbursement Increase Last week, HCA met again with the state Department of Health (DOH) to discuss the need for minimum wage adjustments to the Certified Home Health Agency (CHHA) episodic/fee-for-service (FFS) rates for 2018.

This was a follow-up to a previous meeting with DOH (see the June 11 edition of The Situation Report) that followed DOH’s decision not to raise the 2018 CHHA FFS rates to account for the December 31, 2017 minimum wage increase. DOH based this action on responses it got from CHHAs on a fall 2017 survey that showed that the minimum wage increase resulted in very minimal new direct costs to CHHAs for aide services.

At last week’s meeting, DOH said that only about 57 of the 120 existing CHHAs completed the survey. For CHHAs that contracted out for aide services, DOH estimated the minimum wage costs by multiplying the number of hours for contracted aide services by the December 31, 2017 minimum wage increase.

DOH said that those CHHAs who incurred FFS minimum wage expenses for 2018 and want to obtain funding for these costs will be able to utilize a “reconciliation” process that DOH intends to develop. HCA will alert members when any information on such a reconciliation process is available.

DOH also offered to share with HCA some information it used to develop an approximate 6 percent increase in 2017 to the CHHA episodic rate to account for the December 31, 2016 minimum wage increase. In addition, DOH sought HCA input on how to determine any adjustments to the CHHA episodic rate for future years to account for minimum wage increases.

HCA advises all home care providers and plans to respond to all DOH wage (and other) surveys as the findings are used to calculate future provider and plan payments.

For more information, contact the HCA Policy staff.

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HIRING BRANCH DIRECTOR: QUEENS LOCATION Able Health Care Services believes in quality care for our clients. Join us for an exciting career in Health Care. Currently, we are looking for a Branch Director to join our team. We offer competitive salary and benefits.

Position Summary 

Management and supervision of a team of professional, paraprofessional and clerical employees; accountable for providing competent care and achieving optimal patient/client outcomes for the Certified Agency.

As the nation’s largest not-for-profit home- and community-based health care organization, VNSNY is transforming to become a leading home- and community-based care management organization.

VNSNY is hiring for the Executive Vice President and Chief of Provider Services to move the organization forward on this continuum by providing strategic planning, leadership, and direction to all VNSNY Provider Services operations and our population health and clinical support services; business development; and clinical education departments.

Responsibilities

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Supervises Inquiry/Intake referrals for home care services to individual patients/ clients and their families.

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Oversees strategies for Provider Services programs consistent with established VNSNY financial targets and corporate objectives.

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Provides nursing education and training as deemed necessary to increase the value of patient care as well as enhance the agency’s ability to offer new clinical initiatives.



Plans, directs, and coordinates the efforts of corporate sales and marketing functions to achieve VNSNY short- and long-term strategic goals.



Monitors and evaluates issues, trends, and needs for Provider Services programs; formulates strategies to address trends/needs.

The candidate for this position must be a NYS licensed Registered Nurse, bachelor’s prepared with:

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A minimum of 5 years work experience in Licensed and Certified Home Care agencies.

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Strong Knowledge of Medicare/Medicaid/ MLTC and managed care regulations.

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Excellent communication, human relations and organizational skills are needed.



Self-motivator, assertiveness and independent decision-making skills are essential.

Please e-mail inquiries to Sandra Weintraub at SandraW@ablehealthcare.com.

Able Health Care Services, Inc. is an Equal Opportunity Employer

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Executive Vice President and Chief of Provider Services, VNSNY

Required Experience

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10+ years of progressively responsible leadership or program implementation experience in complex, integrated health care, hospital, and/or home health provider organization.

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Excellent financial and operational track record; proven ability to manage a challenging and constantly changing health care delivery system in a competitive environment and within the context of health care reform.

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Master’s Degree in a health care-related field.

Interested candidates should e-mail their CV to: Andrew Wise, Vice President, Talent Management and Organizational Development, at Andrew.Wise@vnsny.org.

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HCA Data Webpage Now Includes Q4 2017 MLTC & PACE MMCOR Data This week, HCA staff posted to our HCA Data website an HCA-developed spreadsheet of the fourth quarter 2017 Medicaid Managed Care Operating Reports (MMCORs) from each Managed Long Term Care (MLTC) and Program of All-Inclusive Care for the Elderly (PACE) plan in the state.

HCA Data is a members-only page that provides data reports to assist home care and hospice providers and managed care plans in their benchmarking efforts, understanding of system-wide trends, and access to reimbursement and premium rates. The page is not visible on our site unless you are logged in with an HCA member website account.

Our log-in page is here: http://hca-nys.org/login. Upon login, the HCA Data link will appear in the site menu at the top right (though you may have to refresh your browser first). Simply e-mail HCA’s Communications Director Roger Noyes at rnoyes@hcanys.org if you do not yet have an HCA website account or would like further information.

HCA’s spreadsheets include multiple sheets summarizing key MMCOR data, including such items as: plan enrollments; per-member-per-month premium revenue and premium income; balance sheet data; contingent reserves and escrow balances; additional funding for minimum wage; unit costs; utilization data; and other information.

Earlier this year, HCA posted a spreadsheet with data from the 2016 Medicaid Cost Reports for all non-hospital based CHHAs in the state, as well as, for the first time, 2015 Statistical Report data from all reporting Licensed Home Care Service Agencies (LHCSAs) in the state.

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

CMS Provides New Guidance for CERT Reviews The U.S. Centers for Medicare and Medicaid Services (CMS) recently issued Change Request (CR) No. 10778 offering guidance to Medicare Administrative Contractors (MACs) on Comprehensive Error Rate Testing (CERT) findings.

Specifically, CR No. 10778 instructs MACs on procedures when the CERT contractor identifies providers who have not responded to additional documentation requests (ADRs) or when there is insufficient documentation to support the decision to pay the claim. The CR (at https://www.cms.gov/Regulations-and-Guidance/ Guidance/Transmittals/2018Downloads/R800PI.pdf) is effective July 17, 2018.

If the CERT contractor receives no response to an ADR request, it informs the MAC. In turn, the MAC can do the following: 1. Contact those providers who have failed to submit medical records and encourage them to submit the requested records to the CERT review contractor for review; 2. Collect the overpayment immediately; and/or Continued on next page

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Continued from previous page 3. Collect the overpayment within 10 business days of the deadline for entering final MAC feedback.

CMS’s policy has always provided MACs with an opportunity to contact providers and request the documentation if the provider did not respond to a CERT audit. However, the CR also instructs the MACs to reach out to providers to submit requested documentation to the CERT contractor when there is insufficient documentation to support payment of the claim (i.e., documentation submitted is inadequate to support payment for the service/item billed, or if the auditor could not conclude that the billed service/item was actually provided, was provided at the level billed, and/or was medically necessary).

The majority of CERT contractor improper payment decisions are related to insufficient documentation. It is unclear how this process will impact the CERT improper payment rates since the determination of insufficient documentation would have been made prior to contacting the MAC. HCA recommends that CMS work towards reducing the CERT improper payment rate by allowing providers to submit additional documentation when requested by the contractor.

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

MedPAC Report Includes Sweeping Analysis of Post-Acute Care Quality, Integrated Payment Systems and More The Medicare Payment Advisory Commission (MedPAC) has issued its annual Report to Congress titled “Medicare and the Health Care Delivery System,” which examines a variety of Medicare payment system issues.

The full report is available at http://medpac.gov/docs/default-source/reports/ jun18_medpacreporttocongress_sec.pdf?sfvrsn=0.

The report has ten chapters. Some key highlights follow.

Encouraging Medicare Beneficiaries to Use “Higher Quality Post-Acute Providers”

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About 40 percent of Medicare acute inpatient hospital discharges result in the use of post-acute care (PAC). “The selection of a provider within a PAC category can be crucial because the quality of care varies widely among providers.” Medicare discharge planning regulations make hospitals responsible for educating beneficiaries about their PAC provider choices, but hospitals cannot recommend specific PAC providers, the report states.

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The Commission’s analysis of referral patterns of Medicare beneficiaries who were discharged to home health agencies (HHAs) and skilled nursing facilities (SNFs) indicate that many beneficiaries had another nearby provider that offered “better quality care” (though not all of the “higher-quality” providers may have had available capacity). Ninety-four percent of beneficiaries who used HHA or SNF services had at least one provider within a 15-mile radius that was of “higher quality” than the provider that served them. MedPAC’s report uses different indicators for its definition of “higher quality,” though it generally refers to “composite quality indicators,” with specific references to

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publicly reported staffing ratios, quality measures for short-stay patients, compliance survey results and vehicles such as the Star Ratings system, Nursing Home Compare and Home Health Compare. 

MedPAC asserts that allowing hospital discharge planners to recommend specific PAC providers, based on the quality of care they provide, could help beneficiaries select “better quality PAC providers.” Medicare could expand the authority of discharge planners to recommend “higher quality” PAC providers in a number of different ways, ranging from prescriptive approaches that provide specific metrics that hospitals must use, to more flexible approaches that allow hospitals to decide on the metrics they use to identify “high-quality” PAC providers. Ultimately, beneficiaries should retain freedom of choice, but have “better information” to make that choice.

Paying for Sequential Stays in a Unified PPS for Post-Acute Care 

Medicare uses separate prospective payment systems (PPSs) to pay for stays in each of the four PAC settings: SNFs, HHAs, inpatient rehabilitation facilities (IRFs), and long-term care hospitals (LTCHs).

As a result, Medicare’s fee-for-service (FFS) payments can differ substantially for similar patients treated in different settings, MedPAC states. As mandated by Congress, in June 2016, the Commission developed a prototype design and estimated the impacts of a unified PAC PPS. MedPAC concluded that it is feasible to design a PAC PPS that spans the four settings and uniformly bases payments on patient characteristics. (HCA has reported on these designs extensively in prior editions of our newsletter.)



To further advance the unified PAC PPS, the Commission now examines two payment issues that would “increase the accuracy of payments” for sequential stays, which is defined as PAC stays within seven days of each other. The first issue has to do with the way the cost of a stay can vary, depending on where it falls in a sequence of PAC stays. The second issue involves how to identify, for payment purposes, distinct phases of care for a PAC provider that treats a patient “in place” as care needs evolve. Under a unified PAC PPS, there needs to be a way to trigger payments for different phases of care so that such providers are not financially disadvantaged, MedPAC states.



MedPAC finds that costs of a sequence of home health care stays decline over the course of an episode more than payments would under its prototype PAC PPS, suggesting that payments for sequential home health stays need to be adjusted downward (as they are in the current HHA PPS). In contrast, PAC PPS payments for institutional stays “would remain reasonably well aligned” with the cost of stays throughout a sequence of care.



To make accurate payments to providers offering a range of services under the PAC PPS, Medicare could make a single payment for all post-acute care provided during an episode of PAC. The Commission will continue to explore episode-based payments for PAC.

Managed Care Plans for Dually Eligible Beneficiaries 

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Dual-eligible beneficiaries often have complex health needs but are at risk of receiving fragmented or low-quality care because of the challenges in obtaining services from two distinct programs. Many argue that the two programs could be better integrated by developing managed care plans that provide both Medicare and Medicaid services. Integrated plans could improve quality and reduce

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

Volume 3, No. 29 June 25, 2018 

federal and state spending because they would have stronger incentives to coordinate care.

However, these plans have been difficult to develop, and only 8 percent of full-benefit dual-eligible beneficiaries are now enrolled in a plan with a high level of Medicare and Medicaid integration. This mirrors New York’s experience with Fully Integrated Duals Advantage (FIDA) plans whereby enrollment has been much less than anticipated while enrollment in partial capped (managed long term care) plans continues to grow. 

There are four types of plans that serve dual-eligible beneficiaries: The Medicare-Medicaid Plans (MMPs) under the financial alignment demonstration, Medicare Advantage dual-eligible special needs plans (D-SNPs), fully integrated dual-eligible SNPs (FIDA SNPs), and the Program of AllInclusive Care for the Elderly. There are significant differences among these plans in several key areas, including their level of integration with Medicaid, ability to use passive enrollment, and payment methodology.



Three potential policies to encourage the development of integrated plans are: limiting how often dual eligible beneficiaries can change their coverage, limiting enrollment in D-SNPs to dual eligibles who receive full Medicaid benefits, and expanding the use of “passive” (automatic) enrollment.

Recent Performance of Long Term Care Issues Confronting Medicare Accountable Care Organizations 

Medicare Accountable Care Organizations (ACOs) were created to reduce growth in Medicare spending and improve the quality of care for beneficiaries by giving providers greater responsibility for costs and quality of care. The Commission finds that “two-sided” ACOs have been more successful at producing savings than “one-sided” ACOs, and MedPAC considers six issues that are important to sustaining two-sided ACOs in Medicare: the role of hospitals as participants in ACOs; the trade-offs of asymmetric models; setting appropriate benchmarks; an alternative for distributing the 5 percent bonus for clinicians in advanced alternative payment models; the role of specialists in ACOs; and the long-term viability of two-sided ACOs in the Medicare program.

The various MedPAC reports, issued each year, are non-binding. These reports reflect advisory recommendations that would require legislation from Congress and/or administrative action from the U.S. Centers for Medicare and Medicaid Services (CMS).

HCA has long challenged the underlying assumptions of MedPAC’s data analysis, in position papers to Congress and in our direct advocacy with both MedPAC and CMS. HCA has specifically noted MedPAC’s use of selective data sets that do not reflect the financial struggles of many home care providers, especially in states like New York where unique system and patient-demographic factors have resulted in providers operating at a loss on Medicare for fifteen years in a row. The items identified in this report are sweeping in nature and will require further extensive analysis and continued education of both MedPAC and Members of Congress to ensure that any changes to payment models or assumptions about quality-of-care and discharge planning processes do not inhibit access to care or the viability of the home care infrastructure.

HCA’s federal advocacy efforts with Congress have sought to counter many of MedPAC’s home health recommendations, including reductions in HHA payments, and we will continue to focus our activities in this area.

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

Volume 3, No. 29 June 25, 2018 

Settlement Conference Facilitation Program Expanded The federal Low Volume Appeals program expired on June 8, 2018. That program applied to outstanding claims at the Administrative Law Judge (ALJ) or Medicare Appeals Council.

However, the Office of Medicare Hearings and Appeals (OMHA) has expanded the criteria to allow providers and suppliers with low volume appeals to participate in a separate and distinct Settlement Conference Facilitation (SCF) program.

As reported in past newsletters, SCF is an alternative dispute-resolution process giving certain providers and suppliers an opportunity to resolve their eligible Part A and Part B appeals.

To make an appeal under SCF, the provider or supplier: 

Must be a Medicare provider or supplier that has been assigned a National Provider Identifier (NPI);



Must have 25 or more SCF-eligible appeals pending at OMHA and the Council combined; or fewer than 25 SCF-eligible appeals pending at OMHA or the Council and at least one appeal that has more than $9,000 in billed charges;



Cannot have filed for bankruptcy and/or expect to file for bankruptcy; and



May be excluded from participation if he or she has or has had False Claims Act litigation or investigations pending against them, or other program integrity concerns, including pending civil, criminal, or administrative investigations.

SCF-eligible appeals must meet the following tests: 

The appeals must involve request(s) for ALJ hearing or Council review filed on or before November 3, 2017;



The request(s) for ALJ hearing and/or Council review must arise from a Medicare Part A or Part B Qualified Independent Contractor (QIC) reconsideration decision;



All jurisdictional requirements for OMHA or Council review must be met for the eligible appeals;



All pending OMHA and Council appeals associated with a single NPI and corresponding Provider Transaction Access Number (PTAN) must be included in SCF;



Appeals must not be scheduled for an ALJ hearing or an ALJ hearing must not have been conducted;



The billed amount of each individual claim must be $1,000,000 or less; and



Appeals must not be actively engaged in a U.S. Centers for Medicare and Medicaid Services (CMS) Medicare appeals initiative that was available on or after November 3, 2017 (i.e., CMS’s Low Volume Appeals settlement option, the QIC Demonstration Project, or the CMS Serial Claims Initiative).

More information, including forms and frequently asked questions, is at https://www.hhs.gov/about/ agencies/omha/about/special-initiatives/settlement-conference-facilitation/index.html.

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

Volume 3, No. 29 June 25, 2018 

Change to OPWDD Medicaid Service Coordination The state Department of Health (DOH) has posted a General Information System (GIS) message to inform local departments of social services (LDSS) of a change to the Medicaid Service Coordination (MSC) program for individuals served through the state Office for People With Developmental Disabilities (OPWDD).

The GIS is at https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/18ma009.pdf.

Effective July 1, 2018, coordination of services will be transitioned from Medicaid Service Coordination, identified by Restriction/Exception (R/E) code 35-Case Management, to comprehensive care management provided by Care Coordination Organizations (CCOs).

Each county will have a minimum of two different CCOs that will provide two products of care management from which individuals can choose – CCO Health Home services (CCO/HH) and CCO HCBS Basic Plan Support.

CCO/HH care managers will coordinate a variety of health care, wellness and developmental disability services to achieve a holistic and integrated approach to meet the full range of needs of OPWDD individuals.

CCO/Basic HCBS Plan Support care managers will coordinate developmental disability supports and services only.

HHCAHPS Preview Reports with Star Ratings Available Preview Reports reflecting results from the Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey from January 2017 through December 2017 are now available for home health agencies (HHAs).

They can be accessed at https://homehealthcahps.org under the “For HHAs” tab. You must be logged into the website to view your report. These same data will be updated on Home Health Compare (HHC) on www.medicare.gov in July 2018.

The Preview Reports present the publicly reported results with star ratings for those agencies with a sufficient number of completed interviews to receive star ratings. Agencies must have data for 40 or more patient surveys in the reporting period in order to have star ratings.

To access your agency’s HHCAHPS Preview Report, log into the HHCAHPS website. Select the “Preview Reports” link under the “For HHAs” tab. (Passwords can be reset by typing your username, clicking “reset password” and following instructions e-mailed to you.)

Comments about your HHCAHPS Star Ratings on the Preview Report can be e-mailed to hhcahps@rti.org by July 6, 2018. Comments should include your name, your facility name, your CMS Certification Number (CCN), and your contact information.

If you believe your HHCAHPS star ratings are not correct, your comments should include evidence showing why. However, if you’ve “historically had higher ratings than are shown, this is not considered evidence,”

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according to HHCAHPS officials. “You must provide information showing that the data submitted by your vendor for the most recent quarter are incorrect and therefore may have impacted the assigned HHCAHPS Star Ratings for your agency.”

For more information about the Preview Reports, refer to this document on the HHCAHPS website, accessible once you are logged in: https://homehealthcahps.org/LinkClick.aspx?fileticket=rEmqINcxYK8%3d&tabid=277 For more information about HHCAHPS star ratings, including Frequently Asked Questions, please go to https://homehealthcahps.org/GeneralInformation/StarRatingsInformation.aspx.

If you have any questions about the HHCAHPS star ratings or your HHCAHPS Preview Report, contact the HHCAHPS Survey Coordination Team via e-mail at hhcahps@rti.org or call toll-free at (866) 354-0985.

OMIG Posts Updated 2018-19 Work Plan The state Office of the Medicaid Inspector General (OMIG) has posted an update to its 2018-19 Work Plan (https://omig.ny.gov/information/work-plan).

The following are new action items: 

Compliance Certification Change: OMIG is transitioning from a system that utilizes the Federal Employer Identification Numbers (FEIN) to a system based on Provider Identification Numbers in order to make the annual compliance certification process more efficient.



Drug Utilization Alerts: OMIG is working to proactively educate providers where a substance utilization review indicates that a recipient may have an accumulation of a controlled substance but did not meet the criteria for restriction under OMIG’s Recipient Restriction Program. A “Controlled Substance Accumulation” notice will be sent to alert providers of the potential overutilization and abuse.



Transportation Review: OMIG is conducting Credential Verification Reviews (CVR) throughout the state to ensure Medicaid transportation providers are adhering to all requirements of the Department of Health (DOH) Transportation Manual policy guidelines.



Medi-Medi Crossover: OMIG is collaborating with Unified Program Integrity Contractors (UPIC) and Recovery Audit Contractors (RAC) to identify duplicative payments occurring between Medicare and Medicaid. Providers who are not properly using the Medicare crossover process – and, therefore, obtaining duplicative payments – will be identified and repayment of Medicaid claims will be sought.

The Work Plan also includes current action items for compliance; home health and community-based services; long term care; Medicaid managed care; ongoing program integrity; and data analytics.

Some important current activities include: 

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Continuing to conduct both CHHA fee-for-service audits and CHHA Episodic Payment System (EPS) audits.

Continued on next page

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Volume 3, No. 29 June 25, 2018 

Continued from previous page 

Continuing to audit and investigate personal care services (PCS) fee-for-service (FFS) Medicaid claims, as well as managed care organization (MCO) PCS services.



Auditing and investigating Consumer Directed Personal Assistance Program (CDPAP) providers to ensure compliance with rules and regulations, including services reimbursed through FFS and MCOs.



Continuing to examine Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) FFS claims to determine compliance with program requirements.



Continue reviews and collaborative work with DOH and the state Department of Labor to ensure that home care providers are providing wage and fringe benefit compensation to employees in compliance with wage parity laws.



Continued reviews and collaborative work with DOH to ensure that MCOs are appropriately passing on supplemental Medicaid payments to home care providers, in compliance with DOH directives.



Auditing MLTCs to ensure enrollees are eligible to qualify for the program and that appropriate care management is being provided by the MLTC plans.



Reviewing enrollment records, recipient plans of care and claims data to determine if the MLTC plans are providing the specific services deemed medically necessary. Additionally, OMIG will examine case/care management system notations to confirm that appropriate care management is also being rendered to MLTC members. OMIG will continue to assess MLTC plans to ensure that their contractual obligations in serving their recipient population are being met.



Audits of Medicaid managed care operating reports (MMCOR). These audits will focus on the review of reported pertinent medical and administrative costs for accuracy and allowability to ensure only proper costs were utilized in the development of respective rate components.



OMIG’s Value-Based Payments (VBP) Project Team will continue to work with DOH to: gain an understanding of how value-based payments will be reflected in the Medicaid data; to discuss ways of ensuring integrity within the data; and to ensure access to information is readily available to OMIG to be able to audit and investigate in a VBP environment.

Update on UAS for NHTD and TBI Posted Last week, eMedNY posted an update on the use of the Uniform Assessment System (UAS-NY) tool for the Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) programs.

Upon approval by the U.S. Centers for Medicare and Medicaid Services (CMS) – effective April 1, 2014 for the NHTD program and September 1, 2017 for the TBI program – the state implemented the use of the UAS-NY assessment tool for both initial and annual level-of-care determinations for NHTD and TBI waiver applicants and participants.

Continued on next page

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Volume 3, No. 29 June 25, 2018 

Continued from previous page

NHTD For NHTD recipients, each Regional Resource Development Center (RRDC) is required to maintain accurate participant enrollment for the UAS-NY in the Health Commerce System (HCS) and to maintain a case list.

Should an assessment determine that an individual does not meet the Nursing Facility Level of Care (NFLOC), the individual may seek a second assessment with the assistance of the RRDC. All negative eligibility determinations are afforded due process through the fair hearing system.

Questions regarding NHTD waiver services and level-of-care assessments can be sent to: nhtdwaiver@health.ny.gov.

TBI Should an assessment determine that an individual with TBI does not meet NFLOC, the individual may seek a second assessment with the assistance of the RRDC. If the second assessment fails to support NFLOC, the TBI waiver applicant/participant may seek a clinical evaluation from specialists with expertise in TBI disability and/or cognitive deficit examinations.

The clinical evaluation must demonstrate evidence of neurocognitive, behavioral and/or functional deficits on a physical exam or diagnostic testing and/or meet DSM-5 criteria for major neurocognitive disorder. This is referred to as “alternate route.”

Upon completion of the evaluation, the specialist must clearly determine and prescribe that the applicant/ participant meets NFLOC as a result of TBI and should be considered for waiver eligibility. This specialist’s report is submitted to the RRDC who submits it to the state Department of Health for review by an independent assessor. The RRDC is advised of the assessment findings.

Should the assessment determine the individual to be in need of NFLOC, the Notice of Decision will be withdrawn by the RRDC. Should the assessment and related documents determine the individual does not meet NFLOC, the participant may continue to seek adjudication through fair hearing. All negative eligibility determinations are afforded due process through fair hearing.

All waiver participants are required to have an annual re-assessment of waiver eligibility regardless of the method for the previous eligibility determination.

Any questions regarding TBI waiver services and level-of-care assessments should be directed to tbi@health.ny.gov.

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Upcoming Deadlines

Requirement/Change

Effective/ Due Date

More Information

Home Care, Fiscal Intermediaries and other providers who contract with Managed Care Organizations must be enrolled in Medicaid

Still being accepted, but providers are advised to submit now

https://www.emedny.org/info/ProviderEnrollment/ManagedCareNetwork/ index.aspx

Transition Period for Using Health Insurance Claim Number (HICN) or new Medicare Beneficiary Identifier (MBI)

April 1, 2018 to December 31, 2019

https://www.cms.gov/Medicare/NewͲMedicareͲCard/index.html

Rural Health Network Development Program RFA

Due June 28, 2018

https://hcaͲnys.org/wpͲcontent/uploads/2018/05/RuralͲHealthͲNetworkͲ DevelopmentͲProgramͲ_RFP_MayͲ2018.pdf

Call for Social Determinants of Health Innovations

Application due June 29

https://www.surveymonkey.com/r/SDH_Innovations

Managed care organizations will initiate termination of contracted providers who have not enrolled in Medicaid

July 1, 2018

https://www.emedny.org/info/ProviderEnrollment/ManagedCareNetwork/ index.aspx

OSHA 2017 Form 300A form (A Summary of WorkͲRelated Injuries and Illnesses)

Due July 1, 2018

https://www.osha.gov/injuryreporting/index.html.

MLTC Plans must report to the state Department of Health the number of Due July 6, 2018 aide hours for QIVAPP program allocations in New York City

https://www.health.ny.gov/health_care/medicaid/redesign/mrt_61.htm

Hearing on state Department of Labor’s proposed rule to exclude meals and sleep time for all employees

July 11, 2018

www.labor.ny.gov

Certified Home Health Agency 2017 Medicaid Cost Report

Due July 16, 2018 (extensions may be granted, as per HCA’s https://commerce.health.state.ny.us/public/hcs_login.html request to DOH; contact HCA for details)

Personal Care Provider 2017 Medicaid Cost Report

New Due Date: July 30, 2018

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https://commerce.health.state.ny.us/public/hcs_login.html

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

Volume 3, No. 29 June 25, 2018 

CMS Issues Change Request on Updated Hospital Transfer Policy for Early Discharges to Hospice Care The U.S. Centers for Medicare and Medicaid Services (CMS) recently issued Change Request (CR) No. 10602 that will update the transfer policy as required by recent legislation for discharges occurring on or after October 1, 2018 when provided hospice care by a hospice program.

CR No. 10602 can be downloaded at: https://www.cms.gov/Regulations-and-Guidance/Guidance/ Transmittals/2018Downloads/R2094OTN.pdf.

Prior to CR No. 10602, when a patient is transferred to another hospital and his or her length of stay is less than the geometric mean length of stay for the Medicare Severity Diagnosis-Related Group (MS-DRG), the transferring hospital would be paid based on a graduated per-diem rate for each day of stay, not to exceed the full MS-DRG payment. For discharges to certain post-acute care settings, this per-diem-based payment adjustment is limited to discharges to certain MS-DRGs. Currently, the regulation limits post-acute care transfers to those where the patient is transferred to a distinct part of a hospital unit, a skilled nursing facility, or discharged with a written plan for home health services commencing within three days of discharge.

However, Section 53109 of the Bipartisan Budget Act of 2018 modified the law, extending it to hospice care. Now the regulations require that, beginning in Federal Fiscal Year (FFY) 2019, discharges to hospice care would also qualify as a post-acute care transfer and be subject to payment adjustments.

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

CMS Launches Data Element Library Supporting Interoperability The U.S. Centers for Medicare and Medicaid Services (CMS) announced last week the agency’s first Data Element Library. This is a new CMS database that supports the exchange of electronic health information.

It is at: https://del.cms.gov/DELWeb/pubHome.

This free, centralized resource, allows the public to view the specific types of data that CMS requires postacute care facilities (such as home health agencies, nursing homes and rehabilitation hospitals) to collect as part of the health assessment of their patients.

These assessments include questions and response options (data elements) about patients, such as demographics, medical problems and other types of health evaluations. Many of these data elements have been standardized, which means that they are exactly the same no matter which type of post-acute care facility is using them.

This information is used for multiple purposes, such as payment by CMS, quality measurement and quality improvement. The Data Element Library does not contain any patient-identifiable data.

It also includes the health information technology (health IT) standards that support the collection of health information, which are the nationally agreed upon methods for connecting electronic health systems together. Integrating these data elements into Electronic Health Records (EHRs) will ultimately

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allow health information to flow more easily from one provider to another because the systems will all be “speaking the same language,” CMS says.

This database is just one part of the MyHealthEData (https://www.cms.gov/Newsroom/ MediaReleaseDatabase/Press-releases/2018-Press-releases-items/2018-03-06.html) initiative. CMS is also proposing to overhaul the Medicare and Medicaid Electronic Health Record Incentive Programs to increase flexibility and reduce burden for providers, promote information sharing between providers and patients, and incentivize providers to make it easier for patients to obtain their medical records electronically.

Additional information on CMS’s new database can be found at: https://www.cms.gov/Newsroom/ MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-06-21.html.

Questions can be sent to DELHELP@cms.hhs.gov.

Resources 

“Revised government data reveals moderation in health spending growth,” by the Altarum Center for Value in Health Care https://altarum.org/sites/default/files/uploaded-related-files/SHSS-Spending-Brief_June_2018.pdf



“The Facts on Medicare Spending and Financing,” by the Kaiser Family Foundation http://files.kff.org/attachment/Issue-Brief-Facts-on-Medicaid-Spending-and-Financing

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

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Webinars for Home Health and Hospice Aides 2018 - 2019

E NJOY

THE B ENEFITS OF W E B I N A R B A S E D E D U C AT I O N

• Convenient

• Cost-Effective • No travel expenses or time • No limit to the number of participants from your agency through your registered site connection.

www.hca-nys.org

July 12, 2018: The Aide’s Role in Understanding Hospice and End of Life Care (registration deadline is July 6) Speaker: Cindy Morgan, RN, MSN, CHC, CHPN What does End-of-Life and Hospice care really mean? This presentation will clarify the meaning of hospice and EOL care.

Some of the misconceptions about hospice and EOL care will be discussed and explained. Participants will have a better understanding of helping patients live until they die and strategies that will promote quality of life at the end of life for patients and families.

August 9, 2018: The Aide’s Role in Caring for Older Adults in Home Care (registration deadline is August 3) Speaker: Kathie Smith, RN, BSN According to Healthy People 2020 from the Office of Disease Prevention and Health Promotion, as Americans live longer, growth in the number of older adults is unprecedented. In 2014, 46.3 million of the US population was aged 65 or older and is projected to reach 98 million by 2060. In 2012, 60% of older adults managed 2 or more chronic conditions. Many of the clients you provide care for in the home will be older adults with chronic conditions such as heart, lung, kidney disease, diabetes, cancer or other conditions. This presentation will focus on providing care for the older population.

September 13, 2018: The Aide’s Role in Quality Improvement in Home Care (registration deadline is September 7) Speaker: Jane Garrett, RN, BSN, MHSA What is QAPI? This session will describe the requirement for home health and hospice agencies to conduct Quality Assessment and Performance Improvement (QAPI) activities including a family satisfaction survey. How your agency performs on these measures is available to the public. In-home aides will learn how they play a role in supporting QAPI.

October 11, 2018: The Aide’s Role in HIPAA and Confidentiality (registration deadline is October 5) Speaker: Michelle White, DNP, RN, CNL This workshop will focus on assisting your In-Home Aides in understanding HIPAA and confidentiality guidelines.

This workshop will offer practical tips to ensure that the para-professional adheres to the required privacy standards. Also included: the impact of social media such as Facebook, My Space, YouTube and cell phones, text messages, etc.

November 8, 2018: The Aide’s Role in Managing Stress in the Workplace (registration deadline is November 2) Speaker: Kathie Smith, RN, BSN Stress is the body’s reaction to any change that requires an adjustment or response. The body reacts to these changes with physical, mental, and emotional responses. You can experience stress from your environment, your body, your thoughts. Even positive life changes such as a promotion, or the birth of a child produce stress. Taking care of yourself is an important part of your overall wellbeing and stress management is a component of that. This presentation will cover tips on managing stress.

December 13, 2018: The Aide’s Role in Post-Traumatic Stress Disorder (registration deadline is December 7) Speaker: Cindy Morgan, RN, MSN, CHC, CHPN An estimated 8% of Americans or 24.4 million people – have PTSD at any given time. Learn the risk factors related to PTSD, how to best work with your patients who have PTSD and strategies to help promote their best quality of life by attending this webinar.

All Live Webinars Are Held From 3:00 – 4:00 PM. A Recording of Each Webinar Will Be Accessible for 30 Days Following The Live Event.

January 10, 2019: The Aide’s Role in Ethical Issues Facing Nursing Assistants (registration deadline is January 4) Speaker: Jane Garrett, RN, BSN, MHSA In this webinar, commonly accepted principles of health care ethics will be discussed. This program will help the learner explore examples of difficult situations and how to put these principles into practice and make ethical decisions in the home health care environment.

February 14, 2019: The Aide’s Role in TBD (registration deadline is February 1) Speakers: John Conrad and Libby Hart, RN This session has not been finalized at this time.

March 14, 2019: The Aide’s Role in Infection Prevention and Control (registration deadline is March 1) Speaker: Michelle White, DNP, RN, CNL This workshop will focus on understanding the basic principles of infection prevention and control. This workshop will also focus on Blood Borne Pathogens and the principles surrounding transmission and methods in which the aide can protect themselves and the patient.

April 11, 2019: The Aide’s Role in Professionalism and Work Ethic in Home Care (registration deadline is April 5) Speaker: Kathie Smith, RN, BSN Providing care in a setting that enables one-to-one care offers opportunities for the client to be able to stay in their home and for the In-home aide to build strong relationships with the client and family. These relationships can feel rewarding to both the client and the In-home aide. While having that positive and caring relationship is important to the client’s care, it is also important to remember that as an employee of an agency and as a home care provider in the home, certain standards need to be upheld. These standards help you to maintain a professional relationship with the client and family. This presentation will cover professionalism for the In-home aide.

May 9, 2019: The Aide’s Role in Understanding Legal Issues for the Nurse Assistant (registration deadline is May 3) Speaker: Cindy Morgan, RN, MSN, CHC, CHPN No health care provider is immune from the potential for legal issues. When providing care for patients it must be done in a legal and ethical manner. This presentation will list ethical principles we should consider when delivering care as well as the more common allegations such as negligence, assault and battery and abuse that Nurse Aides should understand. Increased knowledge promotes adherence to standards of care and compliance with regulations and your agency’s policies and procedures.

June 13, 2019: The Aide’s Role in Understanding CVAs (registration deadline is June 7) Speaker: Jane Garrett, RN, BSN, MHSA In this webinar, it will be discussed how 80% of all strokes can be prevented with healthy behaviors, long term effects of a stroke may be minimized with immediate treatment and more people are surviving and beating stroke.

This webinar series is presented by the Association for Home & Hospice Care of North Carolina in partnership with HCA Education & Research, Inc. offering providers valuable information, tools and techniques to enhance practice skills. Please be aware that NYS laws and regulations may differ from that discussed in the webinar. All NYS providers must adhere to all relevant state and local laws.

2018-2019 Webinars for Home Health & Hospice Aide’s REGISTRATION FORM Agency Name: _____________________________________________________________________________________ Street Address: ____________________________________________________________________________________ City/State/Zip: _____________________________________________________________________________________ Contact Name and Title: _____________________________________________________________________________ Phone:_____________________________________________ Fax: _________________________________________

Email: ___________________________________________________________________________________________ (Required)

REGISTRATION FEE Check all that apply (Please note: all webinars take place from 3:00 pm – 4:00 pm) ____ July 12 ____ August 9

____ Sept. 13 ____ Oct. 11 ____ Nov. 8

_____ Dec. 13

____ Jan. 10 _____ Feb. 14

____ March 14 ____ April 11 _____ May 9

_____ June 13

HCA Member

$149 per program X _____ (# of programs) = $___________ TOTAL DUE

Non-Member

$199 per program X _____ (# of programs) = $___________ TOTAL DUE

Check here to register for the Full Series of 12 Webinars and save $240!!  HCA Member- $1,548  Non-Member- $2,148

There is no limit to the number of attendees from your agency who may participate through your single site connection.

Registration fees are based on each connection and may not be shared between agencies or sites within an agency. For multi-site participation, each location must be registered. Prior to each webinar, you will receive an e-mail containing your dial-in and log-in information, handouts, and a sign-in sheet for your site participants.

Recording of each webinar will be made available after the program, and will be accessible for 30 days following the live event.

Certificate of Completion: Following the webinar, a certificate of completion will be emailed to the primary registrant. The agency supervisor may sign a certificate for each HHA participating in the webinar for documentation of their training.

PAYMENT Check method of payment (If paying by check, check must be received 2 days prior to program date). ________MasterCard

________VISA

________ Check*

*Make checks payable to: HCA Education and Research and Mail to: 388 Broadway, 4th Floor, Albany, NY 12207 Credit Card # : _________________________________ Exp. Date:________ Security Code: ____________ ________________________________________________ ________________________________________________ Street Address (Billing for Card) City/State/Zip (Billing for Card)

________________________________________________ Name on Card ________________________________________________ Authorized Signature

Cancellation Policy: Fees will be refunded only if written cancellation is received by HCA at info@hcanys.org one week prior to the selected program(s). In the event you cancel, HCA will retain, or charge, $40 of the initial fee per registrant, to cover administrative processing.

No refunds after handouts are provided. Please contact info@hcanys.org if you need assistance, or call 518-426-8764.

Fax to (518) 426-8788