Issuu

2% CUT RESTORATION

MLTC LOCK-IN

SEPSIS WEBINAR

LAWTALK

Providers should begin seeing a restoration of the 2% across-the-board cut (for SFY 2014-15) in two upcoming cycles, on July 11 and 18.

MLTC enrollees will be subject to a plan enrollment lock-in, starting Dec. 1, as required by the state budget. The oneyear lock-in includes a 90day grace period.

Users of HCA’s sepsis screening tool should register now for a July 18 webinar outlining the data collection process.

The legal team at Jackson Lewis offers the next installment of its LawTalk series explaining the little-known requirement that termination letters are required by labor law when an employee leaves your organization.

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Your Source for HOME CARE News, Policy and Advocacy

UPCOMING PROGRAMS Webinar: “The Aide’s Role in Understanding Hospice and End of Life Care” July 12 (3-4 p.m.) Webinar: Data Collection Process for HCA Sepsis Tool July 18 (1-2 p.m.) The Situation Report is on a biweekly summer schedule. We will not be publishing next week, July 16. Our next edition will be on July 23. HCA will notify you of breaking news by e-mail alert.

Vol. 3, Issue 30 | July 9, 2018

CMS Issues Proposed Home Health Rule with 2019 Rate Updates, HHGM in 2020 As summarized for members in an alert last week, the U.S. Centers for Medicare and Medicaid Services (CMS) on July 2 released its proposed 2019 payment rule for home health (see https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-14443.pdf). At nearly 600 pages, the proposed rule will require extensive analysis by HCA, and we will provide a more comprehensive summary as soon as possible. A CMS fact sheet on the proposed rule is at https://www.cms.gov/Newsroom/ MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-07-02.html. See HHGM p. 3

HCA Submits Comments on State DOL 24-Hour Rule HCA to present testimony at July 11 hearing HCA submitted comments last week on a state Department of Labor (DOL) proposed rule that would exclude sleep time and meal periods from compensable hours for an “employee” – not limited to a home care aide – who works on shifts of 24 hours or more. See RULE p. 2

INSIDE CMS Proposes Home Health Rule with 2019 Rates, HHGM in 2020.........................1 HCA Submits Comments on State DOL 24-Hour Rule..............................................1 A Message from HCA Sponsor RBC Limited............................................................4 Agencies to be Paid Back for 2% Medicaid Cut.......................................................5 MLTC Enrollment Lock-In Starts............................................................................5 Hinman Straub Memo Outlines AHHA Regs...........................................................6 PTA Extender Bill Signed into Law..........................................................................6 7/18 Webinar on Data Collection Process for HCA Sepsis Tool.................................7 Member Hiring Announcement............................................................................7 CMS Announces Initiatives for Medicaid Program Audits.......................................8 Walter Kaltenbach Appointed COO of Allen Health Care..........................................8 Register Today for Senior Financial Managers Retreat: Sept. 6 & 7..........................9

HCA Submits Comments on FY 2019 Hospice Proposed Rule.......................9 NYSOFA, HCA, IPRO, Statewide Aging Services Partner on Sepsis...............10 Revised OMIG CHHA Audit Protocols Posted............................................11 Upcoming Deadlines.............................................................................12 Home Care/Hospice Salary Information Available Soon..........................13 CMS Proposes Changes to Home Health Star Rating System......................13 CMS to Host July 11 Webinar on the CMS Data Element Library.................14 LawTalk: Terminations Letters Required When Employees Depart..........14 Next CMS Home Health and Hospice Open Door Forum on July 11............15 Guidance Issued on EVV ‘Good Faith’ Exemption Requests.......................16 Electronic Patient Care Alerts Expanded Statewide................................17 Temporary Schedule Changes Law Goes into Effect..................................18 DOH Provides Training on New Cost Report for TBI & NHTD Programs.........18 Resources............................................................................................19

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

RULE from p. 1 This proposed rule is similar to a home care-specific emergency rule issued by DOL in October 2017 and renewed numerous times under which DOL codified “the Commissioner’s long-standing 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 proposed rule on which HCA submitted comments will also be the focus of a state DOL hearing on July 11 in Brooklyn, at which HCA will testify. At the hearing, we will be focusing on the necessity of preserving the “13-hour rule” for home care aides, whereby aides on 24-hour/ live-in cases are paid for 13 hours if they are able to obtain 8 hours of sleep, 5 of which are uninterrupted, and 3 hours for meals. HCA members are encouraged to also testify and/or submit comments and can use our testimony and comments to support their position. Comments are due by July 16 (5 days past the hearing) and should be sent to comments@labor.ny.gov. Those who want to testify must register at https://www.labor.ny.gov/workerprotection/sleep-time.shtm. 

HCA’s comments are at: https://hca-nys.org/wp-content/ uploads/2018/07/DOL-24-hourlive-in-rule_comments_070318_FINAL.pdf



Our testimony is at: https://hca-nys.org/wp-content/ uploads/2018/07/Testimony_state-Dept-of-Labor-hearing_24hour-care_071118_FINAL.pdf

HCA has worked extensively to gain reinforcement of the "13-hour rule" for 24-hour/live-in cases, including advocating for DOL and state Department of Health guidance and support, submitting amicus briefs on important court cases that involve challenges to this standard, and holding member briefings and education programs on this vital labor issue. Editor’s note: a longer version of this article was sent to members in an alert (see https://conta.cc/2IWr3qF).

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

Volume 3, No. 30 July 9, 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

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

Volume 3, No. 30 July 9, 2018 

HHGM from p. 1 A cursory analysis shows that CMS intends to move forward with a version of long-anticipated payment changes, mirroring the Home Health Groupings Model (HHGM) that was included in the February 2018 Bipartisan Budget Act and variably proposed by CMS and Congress over the past year. That model calls for a 30-day payment unit, distinct from the 60-day episodic system, beginning in 2020, with related case-mix adjustments intended to treat early segments of the care episode differently from later ones under the CMS assumption that utilization tends to be higher during the first 30 days of an episode (compared to the last 30 days). CMS says the model would be implemented in a budget-neutral manner, with the major exception that CMS also includes a provision, repeatedly opposed by HCA, to allow for predictive changes in payments based on assumptions about behavior changes that could occur. This overly subjective provision could result in an estimated 6.42 percent reduction in base payment rates, as modeled in the rule. HCA will continue to urge corrections so that payment adjustments are made in a statistically sound manner based on evidence reflecting actual changes in care and operational practices, not predictions of change. For 2019, the proposed rule would increase rates by 2.1 percent using a proposed marketbasket update of 2.8 percent, minus a 0.7 percentage point for “multifactor productivity.” HCA’s upcoming analysis will dive deeper into the various 2019 rate components and calculations, including the case-mix-weights, the wage index factors, outlier adjustments, quality reporting changes and more that alter

the base episodic rates and requirements for providers. CMS’s proposal also includes a tiered version of the home health rural add-on, with variations in the payment rate based on whether a county is defined as “frontier” (a 4 percent add-on) or “high utilization” (a 2 percent add-on), with the remaining 1,162 counties receiving a 3 percent add-on. (As described in past communications, a “frontier” county is defined as having fewer than 6 residents per square mile.) The draft rule contains some changes that HCA will need to review in further detail, including the implementation of a new home infusion therapy benefit and the elimination of requirements that certifying physicians must state how much longer care would be needed when recertifying the need for continued home care. Also, CMS would permit the incorporation of home health agency records into physician records, including through the use of the plan of care. In addition, CMS is proposing to define remote patient monitoring in regulation for the Medicare home health benefit and to include the cost of remote patient monitoring as an allowable cost on the home health agency cost report. As repeatedly communicated to members over the past year, HHGM includes some of the most significant and severe changes to the home health payment system in nearly 20 years. CMS’s plan to include HHGM in the 2019 draft rule was highly anticipated, following last year’s CMS rule-making process, which shelved the proposal due to industry push-back, and Congress’s subsequent revival of HHGM during budget negotiations in February. Over the past several months, HCA has expressed various concerns to New York’s Congressional Delegation and federal officials on HHGM. Continued on next page

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

Volume 3, No. 30 July 9, 2018 

Continued from previous page (Please see our latest position paper at https://hca-nys.org/wp-content/uploads/ 2018/06/Vital-Corrections-SafeguardsNeeded-in-2018-Home-Health-PaymentReform-Act.pdf.) CMS’s latest proposed iteration of HHGM will require extensive analysis and advocacy by HCA in coordination with our federal partners at the National Association for Home Care and Hospice, ElevatingHOME (the Visiting Nurse Associations of America), state home care associations and others, as we plan to communicate the various details of the proposal, as well as HCA’s positions, in an upcoming deeper analysis. HCA will also be alerting the state Department of Health to the proposed changes to reinforce our message that Certified Home Health Agencies face financial challenges and need regulatory relief and payment adequacy.

HCA will be submitting comments on the proposed rule. Comments are due by August 31, and we urge members to do so as well. CMS customarily finalizes the rule in November. Please stay tuned for further information, including an in-depth analysis of the proposed rule and talking points for member submission of comments, in the coming days. Payment issues explained at September Retreat HCA’s September 6 and 7 Senior Financial Managers Retreat in New Paltz has a series of segments on Medicare payment issues (including the newly proposed rule), in addition to rate updates and other finance insights affecting all lines of home care, hospice and MLTC operations. All HCA member CEOs, CFOs, finance managers and others with budgeting responsibility and finance planning roles should attend. Download the brochure (at https:// hca-nys.org/wp-content/uploads/2018/06/HCASenior-Financial-Managers-Retreat-Brochure2018.pdf) and make your plans now for September 6 and 7.

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

Volume 3, No. 30 July 9, 2018 

Agencies to be Paid Back for 2% Medicaid Cut As reported to members in an alert last week, the state Department of Health (DOH) confirmed that it has started to pay back home care and other health care providers for the two percent across-the-board (ATB) reduction that was eliminated by a provision in the 2014-15 state budget. This cut had affected Certified Home Health Agencies (CHHAs) and personal care providers. The monies being restored cover the state and federal Medicaid share for dates of service April 1, 2014 to March 31, 2015, which is the only period for which providers are still owed money. (On May 8, 2015, DOH eliminated the two-percent ATB reduction for Medicaid claims with service dates on or after April 1, 2015.) According to DOH, due to the volume of affected providers, this restoration of funds is being paid back over the following two cycles:  

Cycle 2131: check date of 6/25/18 and check release date of 7/11/18 Cycle 2132: check date of 7/2/18 and check release date of 7/18/18

HCA had opposed the two-percent ATB reduction, advocating for its elimination and the restoration of funds. Using data on home care margins and financial challenges from our yearly cost report and survey analyses, HCA made the case that this ATB cut would destabilize the home care safety net amid other cooccurring rate changes being implemented or planned at that time, from the CHHA ceilings to newly imposed wage and labor costs, among others. Editor’s note: a longer version of this article was sent to members in an alert (see https://conta.cc/2Iugg6P).

MLTC Enrollment Lock-In Starts Due to a provision in the final state budget, enrollment into Managed Long Term Care (MLTC) Partial Capitation plans will have enrollment lock-in periods beginning December 1, 2018. This will apply to those who enroll either by new enrollment or plan-to-plan transfer effective December 1, 2018 or later. These individuals will have a 90-day grace period to elect a plan transfer and then experience a lock-in period for nine months after the end of their grace period (for a total period of one year from the date of enrollment). This will not apply to enrollees that were enrolled in an MLTC partial capitation plan prior to December 1, 2018, unless they elect to transfer to a new MLTC partial capitation plan. After the initial 90-day grace period, enrollees will have the ability to disenroll or transfer if they can present evidence of “good cause.” The following circumstances are some examples of good cause: the enrollee is moving from the plan’s service area, lack of access to covered services, poor quality of care, or it is determined the enrollment was non-consensual. MLTC plans will retain the ability to involuntarily disenroll members for the reasons specified in their contract, which includes failure to pay spend-down, hospitalization for greater than 45 days, or the enrollee was absent from the service area for more than 30 consecutive days. Continued on next page

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

Volume 3, No. 30 July 9, 2018 

Continued from previous page After the completion of the lock-in period, an enrollee may transfer without cause, but is subject to a grace period and subsequent lock-in as of the first day of enrollment with the new MLTC partial capitation plan. This change does not impact a consumer’s ability to enroll into any of the integrated plans including: Fully Integrated Duals Advantage (FIDA), Medicaid Advantage Plus (MAP), and the Program of All-Inclusive Care for the Elderly (PACE). Enrollees will have the ability to enroll into an integrated plan at any time, and the integrated plans do not have a lock-in period. This story is based on an Article in the June Medicaid Update. The June Update and past issues are at https://www.health.ny.gov/health_care/medicaid/program/update/main.htm.

Hinman Straub Memo Outlines AHHA Regs HCA’s government relations firm, Hinman Straub, has prepared a memo summarizing the advanced home health aide (AHHA) regulations developed by the State Education Department (SED) and Department of Health (DOH). As reported to members, the SED regulation was implemented on an emergency basis and the DOH regulations are in proposed form, with a 60-day comment period expiring on July 30. Both aim to put into effect the advanced home health aide law enacted in 2016. The DOH regulations “focus on the role played by the AHHA in regulated environments, by defining AHHA and setting forth the requirements for AHHA employment and supervision and for AHHAs to be included on the Registry.” The SED regulations “focus on the scope of the AHHA authorized practice by defining the types of advanced tasks that AHHA can perform and it sets forth the qualifications, supervision, training, and competency requirements for AHHAs.” Given the different stages of the DOH and SED regulations, it appears that agencies remain limited at this time to planning activities. As noted in the memo, “For practical purposes, until the AHHA training programs are approved and operational and individuals are certified as AHHAs, no entity will be able to offer AHHA-provided advanced tasks.” To learn more, download the memo here: https://hca-nys.org/wp-content/uploads/2018/07/2018-07-03-Memoon-DOH-and-SED-AHHA-Regulations-Homecare-Association-of-NYS.pdf.

PTA Extender Bill Signed into Law As HCA notified members in an alert last week, Governor Cuomo signed into law a measure, S.8217 (LaValle)/ A.10381-A (Pichardo), which extends through June 30, 2022 the authorization of physical therapy assistants (PTAs) to provide services in home care settings. This legislation, originally enacted in 1993 with a sunset provision, has been extended numerous times and was due to end on June 30, 2018. HCA worked with the sponsors to get the bill passed and advocated with the Governor’s office to obtain timely approval. Each time the provision had been similarly scheduled to sunset in the past, HCA worked to mobilize support among our members and legislators and to advocate for extensions. We’ve pointed out the valuable

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

Volume 3, No. 30 July 9, 2018 

contribution that PTAs make in supporting individuals at home, and will continue to do so, including PTAs’ work to ensure the implementation of treatment plans and their strengthening of patient/family education that is important for rehabilitation services. Editor’s note: a longer version of this article was sent to members in an alert (see https://conta.cc/2KKh0qi).

HCA & IPRO Invite You to 7/18 Webinar on Data Collection Process for HCA Sepsis Tool to Share Outcomes HCA and our partners at IPRO are holding an important July 18 webinar training program (from 1-2 p.m.) on IPRO’s data collection process for all current and prospective users of HCA’s sepsis screening tool. This free webinar training will outline the process for submission of your agency’s data from the HCA Adult Sepsis Screening Tool into the REDCap Data Collection system. Registration is required by Monday, July 16, at https://tinyurl.com/y7man3d5. While the webinar is geared for individuals who have signed a user agreement to utilize HCA’s sepsis tool, this webinar is also open to individuals who have not yet signed an agreement but plan to do so and will need to catch up on the process of implementing the tool and collecting data. A user agreement link is available on our Stop Sepsis at Home New York website (see http://stopsepsisathomeny.org/tools-and-resources/.) Remember that you must meet the training prerequisites before HCA can authorize the agreement. The agreement and questions about it can be sent to sepsistool@hcanys.org. For more information and to register, please review the announcement already sent to members here: http:// stopsepsisathomeny.org/hca-ipro-invite-you-to-7-18-webinar-on-data-collection-process-for-hca-sepsis-toolto-share-outcomes/. HIRING Executive Vice President and Chief of Home Care Services, Visiting Nurse Service of New York 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. Reporting directly to the President and Chief Executive Officer, the Executive Vice President and Chief of Home Care Services will lead and direct our Certified Home Health Care Agency, Licensed Home Care Services Agency, and Hospice Organization and will also have oversight of Business Development, Community Mental Health, Population Health, and Care Management programs. He/she will be responsible for the overall strategies of our home care services, and will work closely with the senior leadership team to execute on VNSNY’s short and long-term objectives. Required Experience:  10+ years of progressively responsible leadership in a complex, integrated healthcare, hospital, and/or home health provider organization.  Excellent financial and operational track record; proven ability to manage a challenging and changing healthcare delivery system.  Master’s Degree in a healthcare-related field. If you are looking to contribute your skills and experience to an innovative organization that makes a difference for over 48,000 individuals in the community each and every day, email your CV to: Andrew Wise, VP, Talent Management and Organizational Development, Visiting Nurse Service of New York, Andrew.Wise@vnsny.org

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

CMS Announces Initiatives for Medicaid Program Audits The U.S. Centers for Medicare and Medicaid Services (CMS) recently announced new initiatives it says are aimed at Medicaid program transparency and accountability, as well as strengthening data and analytic tools. CMS says that total Medicaid spending has increased rapidly over the past five to six years and was driven by several factors, including Medicaid expansion, from $456 billion in 2013 to an estimated $576 billion in 2016. Much of this growth came from the program’s federal share that grew from $263 billion to an estimated $363 billion during that period. CMS’s initiatives include stronger audit functions, enhanced oversight of state contracts with private insurance companies, increased beneficiary eligibility oversight, and stricter enforcement of state compliance with federal rules. The following is a summary of each new initiative: 1. Emphasize program integrity in audits of state claims for federal match funds and medical loss ratios (MLRs). CMS will begin auditing some states based on the amount spent on clinical services and quality improvement versus administration and profit. The MLR audits will include reviewing states’ rate setting. Overall, audits will address issues identified by the Government Accountability Office (GAO) and Office of Inspector General (OIG), as well as other behavior previously found harmful to the Medicaid program. 2. Conduct new audits of state beneficiary eligibility determinations. CMS will audit states that OIG previously found to be high risk to examine how they determine which groups are eligible for Medicaid benefits. These audits will include assessing the effect of Medicaid expansion and its enhanced federal match rate on state eligibility policy. Current regulations will allow CMS to begin to issue potential disallowances to states based on Payment Error Rate Measurement (PERM) program findings in 2022. The PERM program measures improper payments in the Medicaid program and the Children’s Health Insurance Program (CHIP) on a rolling three-year cycle and produces national and statespecific improper payment rates. 3. Optimize state-provided claims and provider data. CMS will utilize advanced analytics and other innovative solutions to both improve Medicaid eligibility and payment data and maximize the potential for program integrity purposes. Additional information can be found at: https://www.medicaid.gov/stateresource-center/downloads/program-integrity-strategy-factsheet.pdf.

Volume 3, No. 30 July 9, 2018 

Walter Kaltenbach Appointed COO of Allen Health Care Walter Kaltenbach was recently appointed Chief Operating Officer of Allen Health Care Services. Mr. Kaltenbach has 26 years of leadership experience in home health care services, most recently serving as COO for MZL Home Care Agency (an affiliate of the Gefen Senior Care group) as well as People Care, Premier Health Care and Able Health Care Service, where he served as CEO for sixteen years. He has been an active and engaged member of HCA’s Policy Council for several years, providing insight and expertise on emerging issues facing home care policy, and was appointed to the HCA Board of Directors in 2015.

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

Volume 3, No. 30 July 9, 2018 

Register for Senior Financial Managers Retreat at Mohonk Mtn. House Sept. 6 & 7 HCA’s Senior Financial Managers Retreat on September 6 and 7 gives your executives, CFOs and finance managers a critical one-stop update and answer program on the critical rate and payment components of home care (for CHHAs and LHCSAs), MLTC and hospice. All of these domains touch your organization and its financial standing, with segments offering direct insights for your program type – and the entities you contract with. HCA’s September retreat is especially well timed for your 2019 budgeting, particularly with the onset of rate changes set to go into effect under the Medicare home health and hospice payment rules (see related stories on this page and page 1), as well as the cascade of mid-year and calendar-based rate changes and activities that affect labor and service costs under Medicaid home health, MLTC and hospice. Beyond these urgent “here and now” demands on your financial planning, the retreat also offers strategic insights for your long-term planning on target issues such as: 

Value based payment Level 2 contracting



Developing a viable private duty program



What to expect under recent Medicare payment reforms (specifically the Home Health Groupings 30day model)



Newly emergent issues like the state budget requirements for LHCSA/MLTC contracting as well as the LHCSA moratorium and exceptions to it



Highly-sought Medicare benchmarking information

View the brochure and register today at https://hca-nys.org/wp-content/uploads/2018/06/HCA-SeniorFinancial-Managers-Retreat-Brochure-2018.pdf.

HCA Submits Comments on FY 2019 Hospice Proposed Rule As reported in an alert last week to members, HCA submitted extensive written comments on the Fiscal Year (FY) 2019 proposed rule for Medicare hospice payment updates, wage index changes and quality reporting. The proposed rule was posted in April by the U.S. Centers for Medicare and Medicaid Services (CMS) and previously summarized to the HCA membership in our newsletter. Our comments are here: https://hca-nys.org/wp-content/uploads/2018/06/ HCAComments_CMSFY2019_HospiceProposedRule.pdf. Continued on next page

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Volume 3, No. 30 July 9, 2018 

Continued from previous page On the payment side, our comments specifically address several items in the proposed rule, including: 

Continuation of the two-tier routine home care (RHC) payment rate and CMS’s plans to monitor long length-of-stay patients. HCA requested a data analysis from CMS on the new payment system to better assess its impact.



Our recommendation that Licensed Practical Nurses (LPNs) be included as part of the service intensity add-on payment.



Concerns about the wage index calculations, which are especially problematic for hospice providers in New York City, given the inclusion of non-New York counties in the regional designation and other refinements that are needed. HCA again called for revisions in this area.

HCA also reacted to CMS’s concerns about the prevalence of non-hospice spending within a beneficiary’s hospice benefit, CMS’s analysis of the revised hospice Medicare cost report and four different areas within the Hospice Quality Reporting Program (HQRP). Editor’s note: a longer version of this article was sent to members in an alert (see https://conta.cc/2KsVuX0).

NYSOFA, HCA, IPRO, Statewide Aging Services Partner on Sepsis New York State Office for Aging (NYSOFA) Director Greg Olsen is putting NYSOFA and the statewide aging service organization network into proactive motion in joint work with HCA and IPRO to combat sepsis in older New Yorkers. The effort is in conjunction with HCA’s Stop Sepsis at Home initiative (see http:// www.stopsepsisathomeny.org/). HCA and Director Olsen, who also is a member of the HCA Sepsis Steering Committee, have been discussing some concrete steps in recent months for our respective organizations to tackle the sepsis crisis. These include initiatives ranging from joint promotion of senior education and awareness of sepsis, specific patient/ caregiver training, and broader programmatic efforts. NYSOFA Webinar on Sepsis and HCA Sepsis Tool As one of the opening steps in this effort, Director Olsen hosted and led off a webinar for the statewide aging services network last week, emphasizing sepsis risk in older individuals, the prevalence of high risks in home care’s catchment population, the reality that 80 to 90 percent of sepsis-related infections occur in the home and community – not in hospitals, as is commonly assumed – and introducing the home care sepsis tool to the network. HCA and IPRO provided in-depth information on sepsis, the HCA sepsis screening and intervention tool and proposals for collaboration between local aging network organizations and home care agency users of the sepsis tool in community outreach. Director Olsen outlined a multi-part plan that includes steps to pair aging organizations and home care agencies in sepsis and sepsis tool training, sepsis resource sharing, joint conferencing, public service communications, and other concrete work. Continued on next page

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Volume 3, No. 30 July 9, 2018 

Continued from previous page All-Sector Sepsis Summit on October 3 – Save the Date! Save the date for a state and nationally leading continuum-wide sepsis summit being planned for October 3 in Albany. All sector partners (hospitals, home care, physicians, EMS, health plans, nursing homes, aging services organizations and others) will be strongly encouraged to participate in this multi-level summit that will combine presentations from government officials, medical experts, association representatives discussing the sepsis prevention and treatment landscape in every sector, newest developments, bestpractices for continuum partners, the latest data, and more. For further information, please contact Al Cardillo at acardillo@hcanys.org.

Revised OMIG CHHA Audit Protocols Posted The Office of Medicaid Inspector General (OMIG) has posted updated Certified Home Health Agency (CHHA) audit protocols. The revised protocols are at https://omig.ny.gov/images/stories/audit_protocols/CHHA_Protocol-6_26_18.pdf. In the June 4 Situation Report, HCA had reported that OMIG shared a draft of the revised protocols with HCA and advised us that the revised version included changes to the regulatory references and to protocol No. 4 (“Failed to Obtain Authorized Practitioner’s Signature Within Required Time Frame”) so that this protocol reflects revisions to the time frames for obtaining physician orders. After a comprehensive review, HCA learned that protocol No. 19 (“Supervision Visit Not Performed Within Required Time Frame”) was revised to state that “if the patient is not authorized to receive skilled services, the RN must make a supervisory visit every 60 days and the visit must occur (bolded language is new) while the home health aide is providing patient care.” In addition, protocol No. 21 (“Failed to Maximize Third Party/Medicare Benefit”) was revised so that a “note” section was removed, and HCA had requested clarification on this removal. OMIG has now clarified that the note under this protocol was removed because it has no bearing on the finding itself, but rather is a statement of work being conducted by an OMIG contractor. Lastly, HCA had recommended to OMIG that Protocol No. 32 (“Missing Documentation of a PPD Skin Test or Follow-up”) be revised to allow for either tuberculin skin test or Food and Drug Administration (FDA) approved blood assay for the detection of latent tuberculosis infection (bolded language is new). Instead of making this exact change, the protocol was revised so that tuberculin skin test was replaced with tuberculosis test. This is a more generalized term and aligns with the Assisted Living Program audit protocols. In addition, “yearly” was added to tuberculosis test. OMIG’s audit protocols and other areas of its work plan are a prominent part of HCA’s annual Corporate Compliance Symposium, along with other insights necessary to support your compliance officers and teams. Please save the date for this important program on October 17, with more details coming soon, including registration and a full agenda. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.

Volume 3, No. 30 July 9, 2018

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



Upcoming Deadlines Requirement/Change

Effective/Due Date

More Information

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/NewͲ MedicareͲCard/index.html

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

Due July 6, 2018

https://www.health.ny.gov/health_care/med icaid/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 https://commerce.health.state.ny.us/public/ granted, as per HCA’s hcs_login.html request to DOH; contact HCA for details)

Changes to NYC Fair Workweek Law

July 18, 2018

Personal Care Provider 2017 Medicaid New Due Date: July 30, Cost Report 2018

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

2018 Adult Care Facility 2nd Quarter Statistical Information Report

Due July 31, 2018

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

MLTC Enrollment LockͲIn Starts

December 1, 2018

https://www.health.ny.gov/health_care/med icaid/program/update/2018/2018Ͳ 06.htm#mltc

https://www1.nyc.gov/site/dca/index.page

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Home Care/Hospice Salary Information Available Soon Survey participants receive discounts on reports The 2018-2019 Home Care and Hospice Salary & Benefits reports, compiled by Hospital & Healthcare Compensation Service (HCS), are being developed now. Participants in the studies gain substantial discounts on the published Reports and save over 50 percent off the price for this important benchmarking data to help your human resources and operations teams know the marketplace for wages, compensation and benefits. Completed questionnaires for both studies should be submitted to HCS by August 6. The Home Care Report will be published in October; the Hospice Report will be available in November. Questionnaires may be downloaded at https://www.hhcsinc.com/survey-questionnaires.html. The Reports include regional data on more than 60 jobs including CEO, CFO, RN, LPN, MSW, aide-level staff and clinical support roles. Data reported include salary, hourly and per-visit rates. The results also include 19 fringe benefits, turnover rates, shift differentials, productivity data and more. Data are reported by core based statistical area (i.e., regional), state, revenue size, profit type, and agency type. Last year’s Home Care Report contained data from over 1,800 home health agencies. The Hospice Report had data from more than 890 hospice agencies. For further information, contact Rosanne Zabka at rzabka@hhcsinc.com or (201) 405-0075, ext. 11.

CMS Proposes Changes to Home Health Star Rating System The U.S. Centers for Medicare and Medicaid Services (CMS) recently announced proposed changes to the Home Health Quality of Patient Care (HHQoPC) Star Rating system. CMS plans to remove the “Drug Education on All Medications Provided to Patient/Caregiver” from the HHQoPC Star Ratings and add the “Improvement in Management of Oral Medications” measure. The “Drug Education on All Medications Provided to Patient/Caregiver” measure is considered to be “toppedout,” exhibiting very little variation across agencies. As a result, there is little room left for improvement in the measure and the small variation limits the ability to meaningfully discriminate quality across home health agencies, according to CMS. CMS believes the “Improvement in Management of Oral Medications” measure is an appropriate replacement for the “Drug Education on All Medications Provided to Patient/Caregiver” measure, since: management of oral medications is important for home health patients; inclusion of this measure would keep the number of HHQoPC Star Ratings measures at eight; allowing for better reportability by home health agencies; and the measure exhibits positive statistical properties, with room for improvement. Additionally, simulations by the CMS contractors for the HHQoPC Star Rating system were able to demonstrate no change in quarter-to-quarter stability of the HHQoPC Star Ratings, with the average star rating among home health agencies remaining at 3.27. Continued on next page

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Continued from previous page Despite CMS’s reasons for adding the “Improvement in Management of Oral Medications” measure, our colleagues at the National Association for Home Care and Hospice (NAHC) have had a general concern with replacing a process measure with an outcome measure that measures improvement to the HHQoPC Star Rating. NAHC also voiced concerns with adding this particular outcome measure since some home health agencies have struggled to show improvement on it given that the patient population largely served by home health agencies is not expected to show improvement in their ability to manage their medications. The goal for home health agencies is to develop strategies for medication management that takes into account physical and cognitive deficits which this measure does not capture. Although the risk adjustment model may help address these concerns, it is impossible to risk-adjust for all potential variables. HCA members can download CMS’s presentation at: https://www.cms.gov/Outreach-and-Education/ Outreach/NPC/National-Provider-Calls-and-Events-Items/2018-06-27-HHA-QualityCall.html?DLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending.

CMS to Host July 11 Webinar on the CMS Data Element Library The U.S. Centers for Medicare and Medicaid Services (CMS) has announced it will host a July 11 webinar on the recently launched Data Element Library (DEL) from 1-2 p.m. CMS launched the first DEL on June 21, 2018. It is a public resource for providers, vendors, researchers, and other stakeholders that use CMS assessments. Users of the Library are able to search and obtain reports in one location on CMS post-acute care assessment contents, including questions, response options, relevant details, and their associated health information technology (IT) standards. According to CMS, the availability of the DEL will further support interoperability and the use and exchange of data across post-acute and other providers by using common assessment standards and definitions to facilitate coordinated care and improved health outcomes. During this webinar, CMS will also review the Improving Medicare Post-Acute Care Transformation Act (IMPACT) Act, standardization, and interoperability, as well as provide an overview and demonstration of the DEL. A question and answer session will follow the presentation. HCA members interested in participating can register at: https://engage.vevent.com/rt/cms/index.jsp?seid=1083.

LawTalk: Terminations Letters are Required When Employees Depart Employment By Frank J. Fanshawe, Principal, and Rose Weaver McKenna, Principal, Jackson Lewis P.C. Home care agencies, hospices and managed long term care plans, like any other employer, have employees who retire, quit or are terminated. This can be almost a daily occurrence for larger employers. However, many home care agencies, hospices and managed care plans give little thought to their compliance obligations for departing employees. New York law requires employers to furnish written notice (e.g., a brief letter) to employees whose employment ceases for any reason. This New York requirement has been in place since 1989. Even so, many employers are unaware of this long-standing requirement and in many cases do not provide departing employees with the required notice. So, what is the downside? Well, the state Department of Labor is

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authorized to impose financial penalties on employers who fail or otherwise neglect to provide the required notice. And the penalties can be significant ($5,000 per employee), particularly where there are multiple instances of non-compliance. Compliance is the single best way to prevent liability for these financial penalties. New York Labor Law Section 195(b) provides that employers are obligated to furnish written notice to any employee terminated from employment with the “exact date of such termination as well as the exact date of the cancellation of employee benefits connected with such termination.” This written notice must be provided to the departing employee within five working days after the employment ends. Importantly, this notice requirement applies to any employee, whether exempt or non-exempt, and applies regardless of the reason for the termination of the employment relationship. It applies if an employee is terminated, retires, quits or stops working for any reason. Compliance with the Section 195(b) notice requirement is relatively simple. Home care agencies, hospices and managed long term plans should create a brief form letter that is distributed to every departing employee upon the termination of the employment relationship. The letter should specify the last date of the employee’s employment, and identify the last date of the employee’s participation in any employer benefit plans. If the employee participates in the employer’s health benefit plan, the employer should state the date participation in that plan will end and inform the employee that he or she will receive a separate letter that describes the employee’s rights to continuation of health benefit coverage. The letter should close by inviting the employee to contact Human Resources or another appropriate representative with questions. Compliance with New York Labor Law Section 195(b) is essential to prevent liability for significant DOL penalties. Please contact Jackson Lewis P.C. with questions about Section 195(b) compliance or any other employment law obligations. LawTalk is a monthly series of articles prepared by attorneys at the firm for HCA’s counsel. Please note that HCA LawTalk articles: are for general, informational purposes; are not legal “advice”; and do not create an attorneyclient relationship. Because each case is unique, the information provided should be considered to be general in nature, and should never be considered a substitution for legal counsel. Readers should not take, or refrain from taking, any action based on information in this article without first seeking legal advice from competent counsel.

Next CMS Home Health and Hospice Open Door Forum on July 11 The U.S. Centers for Medicare and Medicaid Services (CMS) will host its next Home Health and Hospice Open Door Forum on Wednesday, July 11, 2018, from 2 to 3 p.m. The following are expected agenda items: 

Recent CMS announcements and updates;

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MLN article SE 18007 – Recent and Upcoming Improvements in Hospice Billing and Claims Processing;

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2019 Home Health Prospective Payment System (HHPPS) Proposed Rule;

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Home Health CAHPS Survey (HHCAHPS) Announcements; and Continued on next page

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Continued from previous page 

Hospice CAHPS Survey Announcements.

The dial-in and passcode are below:  

Dial In: 1-800-837-1935 Conference Code: 33333438.

CMS recommends that participants dial in at least 10 minutes prior to the meeting.

Guidance Issued on EVV ‘Good Faith’ Exemption Requests Two weeks, ago the U.S. Centers for Medicare and Medicaid Services (CMS) posted guidance on a provision in the federal CURES Act that allows states to delay the implementation of Electronic Visit Verification (EVV) for up to one year if they can demonstrate that they have made a good-faith effort to comply and have encountered unavoidable delays. Requests by states for good-faith effort exemptions should be submitted between July 1, 2018 and November 30, 2018. States are required to include the actions they have taken to adopt EVV; the proposed EVV model; unavoidable system delays or barriers to implementation; and the state’s stakeholder process. As communicated many times to members, the 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 provide feedback on the design of EVV systems and policies. DOH has expressed interest in requesting a delay in EVV implementation and HCA will notify members if it does so. 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 EVV for personal care services for one year – until January 1, 2020. 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

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aide and personal care aide services provided by organizations with more than $15 million in Medicaid fee-for-service and managed care revenues. The state expects that those agencies currently using a VO will have to make some adjustments to their system to accommodate the federal requirement. HCA will keep members informed on any new developments with EVV. In mid-May, CMS released an Informational Bulletin and frequently asked questions (FAQs) document covering the EVV requirements specified in the CURES Act. The Bulletin and FAQs, along with webinar materials, are available at https://www.medicaid.gov/medicaid/hcbs/guidance/electronic-visit-verification/index.html. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.

Electronic Patient Care Alerts Expanded Statewide The New York eHealth Collaborative (NYeC) has announced the expansion of patient care alerts across the state’s eight regional health information exchanges through the Statewide Health Information Network for New York (SHIN-NY). Alerts allow participating SHIN-NY providers and care team members who have treating relationships to receive real-time updates about their patients. For example, a subscribing provider can receive an Admittance, Discharge, or Transfer alert if their patient enters or is discharged from a hospital. This promotes timelier interventions and improved planning for a patient’s care at home or at another facility. Alerts are a core service offered free of charge to SHIN-NY participants. Prior to the expansion of the service, health care professionals could only subscribe to and receive alerts from other participating health care professionals within their Qualified Entity’s (QEs) region. Now, alerts will be more comprehensive, as the status of patients across regions will be available regardless of where in the state a patient receives care. The SHIN-NY connects New York’s eight regional networks, or QEs, that allow participating health care professionals, with patient consent, to quickly access and securely exchange electronic health information statewide. NYeC offers a Data Exchange Incentive Program (DEIP), which is intended to increase health information exchange adoption across the state by helping to defray the cost for an organization when connecting to local QEs. DEIP participants are incentivized to contribute a predefined set of data elements to their local QE. Limited funding is available and this program is operated on a first-come, first-served basis, with incentive funding of up to $13,000 per organization. It is open to Article 28 nursing homes, Article 36 home care agencies and programs, Article 40 hospice facilitates, Behavioral Health providers and others. More information is at https://www.nyehealth.org/services/hie-adoption/. Additional information on NYeC, including past newsletters, is at https://www.nyehealth.org/.

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Temporary Schedule Changes Law Goes into Effect An amendment to New York City’s “Fair Workweek” Law, enacted January 22, 2018 and effective July 18, 2018, will affect employees working in NYC who seek temporary changes to their work schedule for a “personal event.” According to the bill summary, the bill (Int. No. 1399-A) requires an employer to allow employees to take two temporary schedule changes per calendar year – including paid time off, remote work, changing work hours and unpaid leave – relating to a personal event that includes the need for a caregiver to provide care to a minor child or care recipient, a legal proceeding or hearing for subsistence benefits, or any circumstance that would constitute a basis for permissible use of safe time or sick time under NYC’s Earned Sick Time Act. The bill also establishes a written process for employees and employers to communicate regarding requests for such changes. This bill prohibits employers from retaliating against employees for requesting a temporary schedule change. In addition, it imposes an administrative penalty, payable to the employee, of $500 for employer violations. The legislation does not affect leave granted under the city’s earned sick and safe time act and won’t apply to employees under certain collective bargaining agreements or to certain employees in the entertainment industry. More information on the legislation is at http://legistar.council.nyc.gov/ LegislationDetail.aspx?ID=2900941&GUID=68DC01AE-C577-4B86-B3E5B9D98836C1E2&Options=ID|Text|&Search=1399-A. HCA is awaiting any guidance from the New York City Department of Consumer Affairs, which is the agency responsible for implementing the law, and will notify the membership if any comes out.

DOH Provides Training on New Cost Report for TBI & NHTD Programs On June 18, the state Department of Health (DOH) provided a webinar on the new cost report, Consolidated Fiscal Report (CFR), that will be required for the Traumatic Brain Injury (TBI) and Nursing Home Transition and Diversion (NHTD) waiver programs. The webinar slides are at https://hca-nys.org/wp-content/uploads/2018/07/NHTD-TBI-Cost-ReportTraining_061818.pdf. The CFR is at https://hca-nys.org/wp-content/uploads/2018/07/NHTDTBI-1915_Cost_Report_FINAL_.xlsx. The CFR manual is at https://hca-nys.org/wp-content/uploads/2018/07/TBINHTD-Cost-Report-Manual_2018.pdf. Some important points from the June 18 webinar include: 

The U.S. Centers for Medicare and Medicaid Services (CMS) is requiring that DOH engage in a retrospective reimbursement reconciliation process using service provider cost by service compared to the final allowable Medicaid reimbursement rate. Continued on next page

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Continued from previous page



Once the cost is received and the reconciliation is complete, DOH will meet with providers to discuss results.

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If a provider fails to file a complete and compliant annual CFR for any reporting period, the provider will be considered delinquent and out of compliance with the waiver agreement.

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The CFR will include all expenses of the service provider.

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The cost report beginning date will be July 1, 2018 and will be due 90 days from the end of the reporting period.

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The initial Cost Reporting Period will be: July 1, 2018 to June 30, 2019 for Fiscal Year filers and July 1, 2018 to December 31, 2018 for Calendar Year filers.



After the initial Cost Report year, the reporting periods will be July 1 to June 30 for Fiscal Year filers and January 1 to December 31 for Calendar Year filers.



Both reporting periods will be reconciled to the cost of all services compared to the final allowable Medicaid reimbursement rate by service.

Questions on the new form can be sent to 1915CR@health.ny.gov.

Resources 

“Medicare-Medicaid Coordination Office Fiscal Year 2017 Report to Congress,” by the U.S. Centers for Medicare and Medicaid Services http://nasuad.org/sites/nasuad/files/RTC_MMCO_FY2017_06072018.pdf



“Measuring What Matters Most to People with Complex Needs,” Health Affairs (June 26, 2018) https://tinyurl.com/y9b4xtwu



“Medicaid Eligibility Verification System (MEVS) and Dispensing Validation System (DVS) Provider Manual,” eMedNY (June 2018) https://www.emedny.org/ProviderManuals/AllProviders/supplemental.aspx



“Managed Care Reference Guide: Enrollee Rosters,” by eMedNY https://www.emedny.org/ProviderManuals/ManagedCare/PDFS/ManagedCare-EnrolleeRosters.pdf

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

September 6-7, 2018

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Mohonk Mountain House

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New Paltz, NY

September 6-7, 2018 Mohonk Mountain House New Paltz, NY

HCA’s Senior Financial Manager’s Retreat gives your executives, CFOs and finance managers a critical one-stop update and answer program on all of the critical rate and payment components of your work in home care (for CHHAs and LHCSAs), MLTC and hospice. All of these domains touch your organization and its financial standing, with segments offering direct insights for your program type – and the entities you contract with. HCA’s September retreat is especially well timed for your 2019 budgeting, particularly with the onset of rate changes set to go into effect under the Medicare home health and hospice payment rules, as well as the cascade of mid-year and calendar-based rate changes and activities that affect labor and service costs under Medicaid home health, MLTC and hospice. Beyond these urgent “here and now” demands on your financial planning, the retreat also offers strategic insights for your long-term planning on target issues such as: value based payment Level 2 contracting, developing a viable private duty program, what to expect under recent Medicare payment reforms (specifically the HHGM 30-day model), newly emergent issues like the state budget requirements for LHCSA contracting and certificate approvals, highly-sought Medicare benchmarking information, and more.

Thanks to our Sponsors and Exhibitors!

Interested in participating as a sponsor at this event? Contact Billi Wilson at 518-810-0666 or via email at bwilson@hcanys.org 1

September 6-7, 2018 – Mohonk Mountain House, New Paltz, NY

Senior Financial Managers Retreat

Getting Awayfrom it all!

Mohonk Mountain House Rates and Other Information

Your combined hotel and event registration rate includes your room, all meals, breaks, valet parking and meeting amenities. A single room rate is $349 per person, per day; double rates are $249 per person, per day; plus local taxes and a 12% administrative fee.

Things to do at the Mohonk Mountain House Activities listed below are at no charge (except where noted) for overnight guests: • Visit the Barn Museum • Take a Row Boat, Paddle Boat, Canoe or Kayak out on the Lake • Play Croquet • Tour the award-winning Gardens & Maze • Explore the Greenhouse • Discover 85 Miles of Hiking (hike to skytop is recommended) • Challenge Colleagues to a game of Horseshoes • Lawn Bowling • Platform Tennis • Rock Scrambles • Shuffleboard • Basketball and Volleyball • 18-hole putting green

All Mohonk reservations should be made by August 5th to receive the HCA conference rate and be guaranteed a room. After this date, higher rates will apply based on availability. To make your room reservation, please call:

800-772-6646 and ask for the HCA rate.

Not Staying Overnight at Mohonk?

The following are activities available for a fee and advanced reservations are recommended.

Since this is a remote resort in the mountains, and Mohonk wants to also be prepared for those not staying overnight, a “per-day guest rate”of $110 is charged. This day rate includes lunch, breaks, property amenities, and selfparking. Day guests must register with HCA as well in order to access the property. Please include the fee(s) with your HCA registration (page 6).

The Spa at Mohonk Mountain House – Named number one resort spa in the United States by Condé Nast Traveler Magazine! HCA registered participants receive a 15% discount on spa services and spa retail purchases on Wednesday, September 5 & Thursday, September 6. Make sure to mention that you are with HCA when making your reservation to receive this discount. For Spa information and reservations call 877-781-1590. Golfing: Reservations for Tee Times are required and may be reserved up to 30 days in advance. Call the Pro Shop at 845-256-2154. Horse Back Riding: Contact the Stables at 845-256-2784

Plus: Receive 10% off purchases in the Gift Shop!

Senior Financial Managers Retreat AGENDA Thursday, September 6th

The Mountain Lake Conference House 8:30AM

Registration Opens 9:00 – 10:00AM

HCA Overview of Policy Priorities that Impact Your Bottom Line HCA’s Policy and Executive Team

Learn what your association is doing to support the financial stability of New York’s home care provider community. This session will discuss the top-tier federal and state policy initiatives affecting providers, reinforcing the engaging and informative dialogue throughout the Retreat on your most pressing financial problems, your questions, and your biggest organizational challenges. 10:00 – 11:00AM

NYS DOH Home Health & Hospice Reimbursement Update

Michael Ogborn & Daniel Carmody, Bureau of Managed Long Term Care Rate Setting, Office of Health Insurance Programs, NYS Department of Health (Invited) Hear from leading reimbursement experts at New York State’s Health Department about various reimbursement policy priorities, including updates to the rates that affect MLTC plans as well as home care providers. Participants will also hear the latest about the state’s plans for upcoming rate adjustments to account for mandatory minimum wage increases throughout the state, updated risk scores, and associated QIVAPP rate adjustments as well as next steps in the move to Value Based Payments. Lastly, participants will hear about a DOH reconciliation report that coincides with ongoing and future minimum wage rate adjustments. 11:00 – 11:15AM - Break 11:15AM – 12:30PM - Breakout

Sessions

Medicare PPS and CHHA Medicaid EPS Benchmarking Data William J. Simione III, Managing Principal, Simione Healthcare Consultants In this session, Mr. Simione will share the latest aggregate benchmarking data for the Medicare HHPPS, Medicaid EPS and managed care using comparisons from clients of Simione’s Financial Monitor in New York versus national averages, offering detailed data on case-mix comparisons, utilization by discipline, visits, outlier episodes and more.

The Value Proposition of Private Duty – Earn your Seat at the Value-based Purchasing Table Guy Tommasi Jr., Executive Director of LIFETIME Care at Home LIFETIME Care at Home grew its revenue by 5% in one year by developing and implementing a private-duty model that aligns with the imperative of value-based care. This session will focus on the mechanics of how they made that happen, including strategies for transitioning to a new way of doing business, tracking key metrics that align with the “Triple Aim” of health care (i.e. rehospitalization rates and consumer experiences with their care), and the development of measurable quality metrics/outcomes in order to support the value proposition of non-medical home care services as a supportive partner to stakeholders.

12:30–1:45PM

Network with Your Peers over Lunch in the Main Dining Room

AGENDA Thursday, September 6 – continued The Mountain Lake Conference House 1:45 – 3:00PM

Update on New LHCSA Regulatory Changes

Meghan McNamara, Esq., Principal, Hinman Straub P.C. Get the latest updates on the changes included in the 2018-19 state budget that are poised to effect a fundamental reconfiguration of longstanding marketplace dynamics. Such changes include: complex, multi-tiered limits on the number of LHCSAs that can contract with MLTC plans; a two-year moratorium on the processing and approval of LHCSA applications; exceptions to the moratorium for certain transfers or changes of LHCSA ownership; and more. Still other LHCSA changes, including a new registration process and limits on provider marketing, are also expected, depending on future state guidance. This session – for LHCSAs, MLTC plans or other entities that contract with LHCSAs – will highlight the intricacies of these new requirements to support your long-term business and strategic planning as a LHCSA or in partnership with LHCSAs. 3:00 – 5:00PM

It’s Time to Relax and Recharge!

Enjoy the leisure activities of your choice at the exceptional Mohonk Mountain House! 5:00–6:15PM

Networking Reception – The Porch (Main Bldg)