July 10, 2017 Edition of the Situation Report

DEADLINES

LTHHCP COST REPORTS

WHITE COLLAR OT RULE

MLTC TRANSITIONS

As part of our ongoing feature, HCA lists upcoming effective dates, deadlines and implementation schedules for a series of forms, initiatives, reports.

LTHHCPs billing the Episodic Payment System or having patients on census in 2016 should file the 2016 CHHA Cost Report, DOH says.

The federal white-collar OT rules are the subject of litigation and potential changes by the Trump Administration. Meanwhile, the state has its own requirements that providers must navigate.

The state has delayed the transition of managed care implementation for community first choice and assisted living programs.

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COMING UP ‘Ask HCA’ Member Meetings Thursday, July 13 Rochester Noon to 2:00 p.m.

Friday, July 14 Buffalo 8:00 a.m. to 10:00 a.m.

Monday, July 17 Manhattan 11:00 a.m. to 1:00 p.m.

Monday, July 17 Brooklyn 4:00 to 6:00 p.m.

Tuesday, July 18 Suffolk County 8:00 to 10:00 a.m.

Tuesday, July 18 Nassau County Noon to 2:00 p.m.

Summer Schedule HCA is publishing The Situation Report on a biweekly schedule for the summer. Our next edition will be on July 24. We will notify you by e-mail of all important breaking updates.

Your Source for HOME CARE News, Policy and Advocacy

Vol. 2, Issue 27 | July 10, 2017

HCA and Peers Fight Medicaid Cuts in D.C. Congress returns this week, as Senate reworks its proposal With the debate about health care continuing to boil, HCA President Joanne Cunningham joined colleagues from a coalition of New York health care organizations in Washington on June 27 to oppose Congressional legislation that would make disastrous cuts to Medicaid.

See MEDICAID p. 4

CMS Makes Official HCA-Sought Delay in CoP Changes (Now January 13) Less than a week before scheduled implementation, the U.S. Centers for Medicare and Medicaid Services (CMS) has finalized its April 3, 2017 proposed rule to delay the new home health Conditions of Participation (CoPs) until January 13, 2018. See the official notice at

INSIDE HCA and Peers Fight Medicaid Cuts in D.C...................................................1 CMS Makes Official HCA-Sought Delay in CoP Changes (Now January 13)........1 HCA Anticipates Medicare HHPPS Proposal Soon........................................1 2016-17 QIVAPP Funding Approved for NYC Providers..................................3 Medicaid Face To Face Guidance Still Pending............................................4 Important Upcoming Deadlines................................................................5 LTHHCPs Serving Patients or Billing EPS Must File 2016 CHHA Cost Reports...6 DOH Delays Wage Parity Start for CDPAS.....................................................6 Update on White Collar Exemption Rule.....................................................7 HHCAHPS Data Submission Deadline Reminder..........................................9 CMS Revises Format for Plan of Correction..................................................9

See CoPs p. 2

HCA President Joanne Cunningham, fourth from right, joins peers in recent advocacy meetings, including with Rep. Peter King (pictured at center), in Washington.

HCA Anticipates Medicare HHPPS Proposal Soon By this date each year, and usually near the July 4 holiday, the U.S. Centers for Medicare and Medicaid Services (CMS) historically has issued its proposed payment rule for the Medicare Home Health Prospective Payment System (HHPPS). As of press time, the proposed rule has not yet been posted, but HCA is watching for it and anticipates it to be posted soon. We will immediately notify the membership by e-mail alert when it is.

CFCO Transition Delayed...........................................................................................10 OMIG Webinar: Retroactive Disenrollment Notification Process...............................10 U.S. DOL to Resume Issuing Opinion Letters...............................................................10 ALP Transition to Managed Care Delayed...................................................................11 Delay Proposed in Electronic Submission of Certain Employment Data.......................11 OPWDD Respite Services Change...............................................................................12 New Maximum Workers’ Compensation Benefit........................................................12 OMIG Posts Reminders about Compliance and Certification Forms............................13 Meeting to be Held on Future of Integrated Care.........................................................13 RFI Released on Social Isolation and Loneliness in Older Adults..................................14 NGS Updates............................................................................................................15 Resources.......................................................................................................15

The Situation Report: the Home Care Association of New York State  CoPs from p. 1 https://www.gpo.gov/fdsys/pkg/FR-2017-07-10/pdf/201714347.pdf.

HCA was among the first associations to formally call for a delay in the new CoPs, which were originally slated for a July 13 start date (this coming Thursday). Notably, we gained strong support from New York Congressional Rep. John Faso who wrote to CMS calling for a six-month delay. Within days of Rep. Faso’s letter, CMS issued the April 3 proposed rule to implement the delay, triggering a public comment period to gain stakeholder responses before CMS officially delayed the CoPs in a now-final rule, as posted last week. (Please see Rep. Faso’s press release at https:// faso.house.gov/news/documentsingle.aspx?DocumentID=246, which quotes HCA President Joanne Cunningham.)

HCA submitted comments in support of CMS’s April 3 proposed rule (see http://hca-nys.org/wp-content/uploads/2017/05/ Medicare-CoPs-proposed-rule-delay_comments_final_051117.pdf).

The new CoPs are the most sweeping changes to federal home health regulations in 20 years, and HCA has recently held education programs to prepare providers for the rules, which touch on virtually all aspects of an agency’s operations. Simultaneously, we engaged with New York’s Congressional Delegation to seek a delay, as reflected in our briefing paper at http://hca-nys.org/wpcontent/uploads/2017/01/OneYearDelayCoPs2017.pdf. In seeking a delay, HCA and others stressed the incredibly short timeframe for providers to prepare (under the original implementation date) and the fact that CMS, still, has yet to circulate Interpretive Guidelines that would further outline the enforcement process for these new regulations.

In response to stakeholder comments on the April 3 proposed rule, CMS says its updates to the Interpretive Guidelines are “currently under development” and are expected for “informal input in the fall of 2017” with an expected final version ready by December.

While HCA recognizes that this timetable remains compressed, CMS emphasized that “even absent a final version of the Interpretive Guidelines ... surveyors will still be able to survey HHAs to assess compliance with the regulations. A delay in the release of Interpretive Guidelines would not require a further delay of the effective date for the new HHA CoPs.” Providers should take note that the federal emergency preparedness regulations, which were the subject of a daylong HCA workshop for members on June 28, still go into effect on Home Care Association of New York State (HCA) 388 Broadway, 4th Floor, Albany, NY 12207 Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org

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Volume 2, No. 27 July 10, 2017 

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

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Volume 2, No. 27 July 10, 2017 

November 16, 2017, which is earlier than other components of the CoP delay. CMS received some comments seeking a delay of the emergency preparedness components to align these provisions with other changes in the CoPs. However, CMS stressed that, though the emergency preparedness provisions are CoP-enforceable (as with the other now-delayed changes), “changing the effective date for the emergency preparedness requirements is outside the scope of this rule,” as they were “established in separate rulemaking.”

As with the April 3 proposed rule, CMS has delayed implementation of the CoPs’ Quality Assessment and Performance Improvement (QAPI) project requirement from January 13, 2018 to July 13, 2018. However, CMS notes that all other QAPI requirements are effective on January 13, 2018.

Lastly, as in the April 3 proposed rule, CMS will not apply new home health agency administrator requirements in cases where administrators are employed by home health agencies prior to January 13, 2018 (instead of July 13, 2017).

HCA will continue to keep you informed of all important developments, guidelines and education opportunities as the implementation deadlines approach over the coming months.

2016-17 QIVAPP Funding Approved for NYC Providers Last week, the state Department of Health (DOH) announced that it has approved funding for the Quality Incentive Vital Access Provider Pool (QIVAPP) program for the period from April 1, 2016 through March 31, 2017.

Funds apply to home care services provided in New York City only. Specific award amounts will be determined after DOH receives attestations from MLTC plans regarding the number of actual hours provided by their home care contractors. Those attestations are due by July 14, 2017.

DOH has confirmed that home care providers who received QIVAPP in 2015-16 will automatically qualify for funding in 2016-17. Those who did not qualify for QIVAPP in 2014-15 or 2015-16 will not be given an opportunity to demonstrate their eligibility for 2016-17.

QIVAPP has been available since the 2014-15 state fiscal year for New York City home care providers who contract with MLTCs and meet certain criteria. The eligibility criteria are as follows: 

Home care agencies receive at least $18.50 per hour from MLTC plans.



The home care agency maintains or participates in a specialty training program for home health aides (HHAs) and personal care aides (PCAs) that exceeds DOH’s training requirements (the standard 75 hours of training for HHAs or 40 hours for PCAs and/or the annually required in-service training of 12 hours for HHAs and 6 hours for PCAs).



The agency has a written, implemented and currently active quality assurance program.

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The agency participates in a health benefit fund for its home health care and/or personal care aides and/or provides comprehensive health insurance coverage to employees that meets certain requirements outlined by DOH.



At least 30 percent of the agency’s total New York City workforce is enrolled in the health benefits coverage.

More information on QIVAPP for past years is at https://www.health.ny.gov/health_care/medicaid/redesign/ mrt_61.htm.

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The Situation Report: the Home Care Association of New York State  MEDICAID from p. 1 The visit, in which Ms. Cunningham and peers met with members of New York’s Congressional Delegation, coincided with a decision the same day by Senate Majority Leader Mitch McConnell to suspend action on the Senate’s latest Obamacare repeal-and-replace measure, as advocates on all sides of the debate flocked to Washington to register their positions. However, the Senate this week is back in session and is reportedly working on a redraft of its bill in order to secure support from at least 50 of the Senate’s 52 Republicans needed for passage of any bill.

HCA and other colleagues in the coalition focused their efforts on meeting with the majority of the nine New York Congressional Republicans from New York State. During the meetings, the coalition secured commitments from Representatives Peter King, John Katko and Dan Donovan that they would not support the Senate bill if it passed the Senate and was sent to the House of Representatives for a vote. The group reinforced the message to others in the House Republican delegation and the Senate offices that the House-passed repeal bill as well as the Senate repeal-and-replace bill would decimate New York’s Medicaid program and health care system.

As previously reported, a House version of the Obamacare repealand-replace measure already passed on May 4; but as a separate version came to fruition in the Senate over the last few weeks, it did not gain the support needed for a decisive vote and, so, was tabled by the GOP majority for further negotiations this week.

The Senate proposal thus far mirrors key aspects of the House legislation, which cuts as much as $800 billion from Medicaid over a ten-year period in its attempt to repeal-and-replace the Affordable Care Act (ACA), though the Senate bill appears to cut Medicaid even further. Both plans would shift Medicaid to a capped block-grant program while phasing out the Medicaid expansion option under ACA. Given the threat to Medicaid, specifically, Ms. Cunningham went to Washington armed with a new HCA publication that: emphasizes the implications of the Medicaid changes and explains why “Medicaid works.” The piece (available at http://hca-nys.org/wp-content/uploads/ 2017/07/SitRep071017.pdf) specifically stresses that: 

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One in five Americans is covered by Medicaid; these individuals range from the elderly to the chronically ill, to lowincome families to persons with disabilities. And, nearly 8 in 10 Medicaid recipients are part of working families struggling

Volume 2, No. 27 July 10, 2017 

Medicaid Face To Face Guidance Still Pending HCA and our members are still awaiting guidance from the state Department of Health (DOH) on the new face to face (F2F) requirement for Medicaid home health services.

While the mandate was supposed to be effective July 1, DOH has not posted any guidance yet despite our repeated communications to the state about the immediate need for such direction. Once any directives or guidance are issued, we will advocate that surveys of agencies not include F2F prior to such guidance.

As reported to the membership, HCA has worked with the Medical Society of the State of New York (MSSNY) to draft an implementation document for Medicaid F2F which would streamline the procedures and not apply Medicaid F2F to managed care cases.

While DOH has indicated it would be moving forward with guidelines substantially in line with the HCA-MSSNY proposal, we will have to wait until we review any final instructions.

As soon as we learn more, we will send out an Alert to members.

Volume 2, No. 27 July 10, 2017

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

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to maintain health care coverage while supporting loved ones financially.

gatherings where the public has been vocal with opinions on health care.



Medicaid covers populations with some of the most complex and costliest health conditions who otherwise would go without care.



Current spending caps, like New York’s, and other program constraints help control costs to state and federal governments. The current federal and state cost-sharing mechanism provides flexibility for getting people covered in the event of unforeseen economic downturns, disasters, or other regional trends.



The current structure of Medicaid offers leverage for federal innovations to drive down costs through reinvestment programs like New York’s Delivery System Reform Incentive Payment (DSRIP) program.

It remains to be seen how, or if, the past week’s Congressional recess and constituent interactions will alter the margin of support for the Senate bill once the chamber reconvenes this week – and whether, as reports suggest, the Senate may consider a more stripped down version of ACA repeal or other changes that are amendable to a majority of Senators. Senate Majority Leader McConnell has suggested resorting to a “market stabilization” measure that would help brace insurance carriers in a period of ongoing instability and uncertainty over the future of ACA. Outside groups and insurance representatives have floated ideas like the continued funding of ACA cost-sharing subsidies, payments to insurers for high-cost consumers to shield risk, and other coverage provisions to ensure marketplace stabilization.

As always, HCA will keep you posted on all critical developments.

Important Upcoming Deadlines

Requirement



Medicaid is virtually the only program that consistently – or at all – covers long term care services and supports in the home. These services are cost-effective, as they provide interventions that reduce the need for nursing home care or the prevalence of hospitalizations.

Many recent reports by the Kaiser Family Foundation, the New York Times, AARP and other outlets also echo this last bullet – that, contrary to public perception, Medicaid, not Medicare, is the predominant payor for long term care (both home care and nursing home care), supporting a diverse spectrum of Americans and affected constituencies.

Both Houses of Congress were adjourned last week for the Independence Day holiday.

During the recess, representatives from both houses visited with constituents in town hallstyle meetings and other local district

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Effective/Due Date

Revised Advanced Beneficiary Notice of Must be used Noncoverage for Medicare by June 21, 2017 feeͲforͲservice

More Information https://www.cms.gov/Medicare/Medicar eͲGeneralͲInformation/BNI/ABN.html

2016Ͳ17 QIVAPP Funding for qualified NYC home care providers

MLTC plan attestations due to https://www.health.ny.gov/health_care/ state DOH by July 14, medicaid/redesign/mrt_61.htm 2017

Executive Order (EO) 38 Disclosure form for CHHAs

August 15, 2017

https://executiveorder38.ny.gov/

CHHA 2016 Medicaid Cost Report

August 15, 2017

https://commerce.health.state.ny.us/pub lic/hcs_logout.html

EO Disclosure form for Personal Care Providers

August 16, 2017

https://executiveorder38.ny.gov/

Personal Care 2016 Medicaid Cost Report

August 16, 2017

https://commerce.health.state.ny.us/pub lic/hcs_logout.html

LTHHCP 2016 Medicaid Cost Report (LTHHCPs that only bill under CHHA EPS must file a CHHA Medicaid Cost Report)

September 30, 2017

https://commerce.health.state.ny.us/pub lic/hcs_logout.html

State Home Care Worker Wage Parity law applies to CDPAS

October 13, 2017

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

November 16, 2017

https://www.cms.gov/Medicare/Provider ͲEnrollmentͲandͲ Certification/SurveyCertEmergPrep/Emer gencyͲPrepͲRule.html

https://www.gpo.gov/fdsys/pkg/FRͲ2016Ͳ 09Ͳ16/pdf/2016Ͳ21404.pdf

Federal Emergency Preparedness Rule

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Volume 2, No. 27 July 10, 2017 

LTHHCPs Serving Patients or Billing EPS Must File 2016 CHHA Cost Reports HCA recently alerted LTHHCP providers about a new Dear Administrator Letter (DAL) from the state Department of Health (DOH) stating that LTHHCPs which have billed or intend to bill the Medicaid Episodic Payment System (EPS) should file a 2016 CHHA Cost Report. The DAL is at http://hca-nys.org/wp-content/ uploads/2017/06/2016-LTHHCP-cost-report-DAL.pdf.

Also, LTHHCPs that had any cases on census in 2016 should likewise file the 2016 CHHA Cost Report even if they have not (or don’t intend to) bill Medicaid EPS. The report is due on September 30, though a different due date applies for “traditional” CHHAs (non-LTHHCPs), as mentioned later in this article.

Over the past several years, HCA has worked to clarify opportunities for LTHHCP providers to serve patients and bill Medicaid in the changing health care system. Though the federal LTHHCP waiver has expired, the state has since clarified that LTHHCPs are permitted to admit and serve patients in a manner otherwise available to CHHAs, including through the EPS, managed care contracting and other opportunities.

Last year, DOH sent a notice reinforcing this status, stating that LTHHCP providers “with valid operating certificates may directly admit and serve patients under their LTHHCP/CHHA-authorization.” DOH’s communication also specifically permitted LTHHCPs to use CHHA EPS rate codes, effective October 1, 2016.

As a follow-up, in the latest DAL, DOH also stated that “LTHHCP providers which take advantage of this [EPS] opportunity will be required to file the appropriate Certified Home Health Agency (CHHA) Cost Report each year,” including the 2016 CHHA Cost Report posted to the HCS at https:// commerce.health.state.ny.us/hpn/cgi-bin/applinks/chhar/chhar.cgi.

LTHHCPs must file the 2016 CHHA Cost report no later than September 30, 2017. The operator’s and accountant’s certification must also be received on or before September 30, 2017. However, the due for traditional CHHAs to submit the 2016 CHHA Report remains August 15, 2017.

For questions regarding the HCS or the electronic mail network, contact the DOH helpline at 1-866-5291890. Specific questions regarding the CHHA cost report should be directed to DOH’s Russ Smith at (518) 473-4421.

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

DOH Delays Wage Parity Start for CDPAS As previously reported in an HCA Alert, the state Department of Health (DOH) on June 29 announced that October 13, 2017 is the effective date when the state Home Care Worker Wage Parity Law (“wage parity” requirement) is extended to personal assistants providing Consumer Directed Personal Assistance Services (CDPAS) in New York City, Long Island and Westchester.

The original announced date of July 1, 2017 was changed due to provisions of the wage parity law [Public Health Law section 3614-c(7)] that require at least a 120-day notice of the minimum rates of home care aide compensation.

Continued on next page

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Continued from previous page DOH had earlier released a Dear Administrator Letter (DAL), dated June 14, 2017, that describes this new requirement and the amount of the minimum rate for home care aide total compensation, along with a certification form that CDPAS fiscal intermediaries must provide their contracted Managed Care Organizations (MCOs) on a quarterly basis.

In the DAL, DOH asks MCOs to submit a list of all the FIs they have signed agreements with and a notation as to whether the FIs have completed the certification.

HCA continues to advocate strongly that DOH release the $9 million in legislatively appropriated funds to assist managed care plans and their contracted FIs to meet these new costs, and that, overall, adequate funds must be provided to plans and FIs for the wage parity requirement.

Questions about wage parity and CDPAS can be sent to DOH at HCWorkerParity@health.ny.gov.

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

Update on White Collar Exemption Rule As you may recall, the Obama-era U.S. Department of Labor (DOL) issued a final rule raising the annual salary thresholds for the federal overtime white collar exemptions from $23,660 to $47,476, which was set to become effective December 1, 2016. But in November 2016, a federal district court judge in Texas issued a nationwide preliminary injunction blocking the rule. DOL (under President Obama) appealed to the Fifth Circuit Court of Appeals asking for an expedited hearing of the case, but that appeal changed course under the current President Trump’s DOL, which delayed the appeal and asked for more time to consider the issue.

On June 30, 2017, DOL (under President Trump) filed its first brief in the appeal asking the Fifth Circuit to reaffirm DOL’s authority to set a salary level while also saying it does not support the $47,476 level set by the previous Administration and will work on a new rule. It did not state what the new level would be; but some believe it will be in the low- or mid- $30,000 range. DOL’s brief states it is not going to issue a proposed rule, however, until the litigation is resolved. So it could be some time before a new rule is issued.

If the Fifth Circuit reverses the district court decision, the nationwide preliminary injunction may be lifted and the original salary level will go into effect (maybe even retroactively to the December 1, 2016 original effective date). Or, the District Court could also continue the preliminary injunction based on different grounds – i.e., that the salary level set by the final rule was arbitrary, an issue the DOL has specifically asked the Fifth Circuit not to address.

Regardless of what happens with the white collar exemptions under federal law, employers should take note that New York State has its own version of these exemptions with their own corresponding salary levels. These levels were updated in December 2016 and range from $727.50 to $825.00 per week ($37,830 to $42,900 annually) depending on the location where the employee in an “executive” or “administrative” capacity works. These figures are included in a chart at https://www.labor.ny.gov/formsdocs/wp/ part142.pdf.

The state does not set a salary level for employees who work in a “professional” capacity; thus, “professional” employees are exempt from state minimum wage and overtime laws regardless of their

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salary, but employers are required to pay those employees the applicable federal salary levels to comply with federal minimum wage and overtime laws.

Obviously, the original salary level enacted by DOL under President Obama would have been higher than New York’s salary levels and rendered them immaterial; but now with the uncertainty surrounding the federal law salary level, employers in New York State should ensure that they are in compliance with the New York State salary level for their geographic area of the state.

More information on the state definitions for “executive,” “administrative” and “professional” is at https:// www.labor.ny.gov/legal/counsel/pdf/administrative-employee-overtime-exemption-frequently-askedquestions.pdf; https://www.labor.ny.gov/legal/counsel/pdf/executive-employee-overtime-exemptionfrequently-asked-questions.pdf; and https://www.labor.ny.gov/legal/counsel/pdf/professional-employeeovertime-exemption-frequently-asked-questions.pdf.

This article was written by Damian J. Privitera, Attorney at Law, Jackson Lewis P.C., the firm for HCA’s General Counsel.

SSenior Financial Managers Retreat SSeptember 7-8, 2017 Mohonk Mountain House- New Paltz, NY M H HCA’s Senior Financial Managers Retreat offers financial leaders innovative perspectives and expert analysis by HCA’s Policy Team as well as targeted insights from subject-matter experts who e will provide a comprehensive update of the home care and hospice financial landscape. w

Corporate Compliance Symposium C October 19, 2017 O Hilton- Albany, NY H H HCA’s Corporate Compliance program is a must-attend, highly anticipated annual event that brings together top legal experts, state regulators and organizational compliance specialists to b kkeep your team up to date on: new requirements, changes in laws and regulations, tools, rresources and best-practices for fulfilling your compliance responsibilities.

Quality and Technology Conference Q November 16-17, 2017 N Crowne Plaza- Suffern, NY C H HCA’s Quality & Technology Symposium will present some of the unique technological and programmatic approaches driving positive clinical outcomes, and focusing your clinical p intervention strategies on core priority areas. in

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HHCAHPS Data Submission Deadline Reminder The data submission deadline for the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey data for Quarter 1 of calendar year 2017 is Thursday, July 20, 2017.

The U.S. Centers for Medicare and Medicaid Services (CMS) encourages home health agencies to begin submitting their client files as soon as possible.

Some important points to remember include:  Data files must pass both the initial validation checks and the “overnight” validation checks.  To ensure that files can be accepted by the deadline (11:59 p.m. Eastern Time on July 20, 2017), you must submit all Quarter 1 files on or before Wednesday, July 19, 2017.  Since CMS will not accept any files after the data submission deadline, make sure you check your data submission reports to verify that all of your submitted files were accepted. And, correct and resubmit all files before the data submission deadline.

More information is at https://homehealthcahps.org/General-Information/Announcements/EntryId/394/ CY17-Qtr-1-Data-Submission-Deadline-Reminder.

CMS Revises Format for Plan of Correction The U.S. Centers for Medicare and Medicaid Services (CMS) has recently issued new guidance regarding the format of plans of correction (POC) for survey deficiencies.

The guidance can be downloaded at: http://tinyurl.com/yb5zc5mm.

CMS states it will no longer require providers and suppliers, which include home health and hospice, to write their POC on the right side of the statement of deficiencies and plan of correction, CMS Form 2567.

The POC may be submitted as a separate document attachment, or agencies may continue to document the POC on the right side of the CMS Form 2567 if they choose to do so.

In order for a POC to be accepted by the Medicare state survey agency, providers/suppliers have been required to document on the right side of CMS form 2567 all the required corrective actions listed below for each deficiency: 

The plan for correcting the specific deficiency and the processes that led to the deficiency cited;



The procedure for implementing the acceptable POC for the specific deficiency cited;



The monitoring procedure to ensure that the POC is effective and that the specific deficiency cited remains corrected and/or in compliance with the regulatory requirements;



The title of the person responsible for implementing the acceptable POC. Continued on next page

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Continued from previous page This change in policy should provide agencies with some relief associated with the burden of having to document the POC in a prescribed format.

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

CFCO Transition Delayed The state Department of Health (DOH) has announced that the transition of the Community First Choice Option (CFCO) into managed care has been delayed until April 1, 2018.

HCA and member plans have been participating in numerous workgroups, including PACE, Benefits Management, and Clinical Management, and a Steering Committee.

A major focus of those groups includes the definition of CFCO services, particularly social transportation, and adequate parameters to determine the authorization, range, content, scope, contracting and provision of benefits.

For more information, contact HCA Policy staff.

OMIG Webinar: Retroactive Disenrollment Notification Process The state Office of the Medicaid Inspector General (OMIG) has posted on its website a webinar entitled “Retroactive Disenrollment Notification Process.”

The webinar is available at: https://omig.ny.gov/resources/webinars/1050-omig-webinar-37-retroactivedisenrollment-process.

This webinar provides a detailed review of OMIG’s retroactive disenrollment notification process, including the electronic retroactive disenrollment notification form and submission instructions that must be used by Local Departments of Social Services (LDSS), New York State of Health (NYSoH), and New York City’s Human Resources Administration (HRA) to notify Medicaid managed care plans and OMIG of an enrollee’s retroactive disenrollment.

Questions regarding the retroactive disenrollment notification process may be submitted to: retrodata@omig.ny.gov.

U.S. DOL to Resume Issuing Opinion Letters On June 27, the U.S. Department of Labor (DOL) announced it will reinstate the issuance of opinion letters. According to DOL, this action allows the department’s Wage and Hour Division to use opinion letters as one of its methods for providing guidance to covered employers and employees.

An opinion letter is an official, written opinion by the Wage and Hour Division of how a particular law applies in specific circumstances presented by an employer, employee or other entity requesting the

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opinion. The letters were a division practice for more than 70 years until being stopped and replaced by general guidance in 2010.

DOL has established a webpage (https://www.dol.gov/whd/opinion/) where employers and employees can see if existing agency guidance already addresses their questions or submit a request for an opinion letter.

The webpage explains what to include in the request, where to submit the request, and where to review existing guidance. The division will decide on a case-by-case basis which requests for opinion letters will be responded to, and the appropriate form of guidance to be issued.

ALP Transition to Managed Care Delayed The state Department of Health (DOH) has delayed the transition of Assisted Living Program (ALP) residents and benefits into managed care.

The intended transition to managed long term care and mainstream Medicaid managed care plans on July 1, 2017 has been changed to October 1, 2018 in New York City and January 1, 2019 in the rest of the state.

DOH says the delay is needed so DOH can develop an implementation work plan amid other managed care initiatives.

In response to DOH’s request for comments on this new timetable, HCA offered support as long as this gives DOH adequate time to address programmatic and reimbursement issues related to the transition, such as billing and adequate payment, and other simultaneous changes, including the Community First Choice Option (see related p. 10 story), Value Based Purchasing, wage parity for the Consumer Directed Personal Assistance Program, 24-hour/live-in cases, etc.

Delay Proposed in Electronic Submission of Certain Employment Data On June 28, the U.S. Department of Labor (DOL) issued a proposed rule to delay the date by which certain employers are required to electronically submit the information from their completed 2016 Form 300A to the Occupational Safety and Health Administration (OSHA).

DOL proposes to delay the deadline from July 1, 2017 to December 1, 2017 to allow affected entities sufficient time to familiarize themselves with the electronic reporting system, which will not be available until August 1, 2017, and to give the new Administration an opportunity to review the new system prior to implementation.

Information on the electronic submission requirement for Form 300A (“Summary of Work-Related Injuries and Illnesses”) is at https://www.osha.gov/recordkeeping/finalrule/index.html.

This requirement was part of a final rule issued on May 12, 2016. In the June 28, 2017 notice, DOL states that it intends to “issue a separate proposal to reconsider, revise, or remove other provisions of the prior final rule.”

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

Volume 2, No. 27 July 10, 2017 

OPWDD Respite Services Change Effective July 1, 2017, respite services provided under the Office for People with Developmental Disabilities (OPWDD) Home and Community Based Services (HCBS) Waiver are changing.

Prior to July 1, 2017, each agency authorized to deliver respite services utilized a single, agency-specific reimbursement rate. As of July 1, 2017, the reimbursement methodology will be configured based on a regional fee structure with various service types which include the following: 1) In Home Respite; 2) Site Based Respite; 3) Recreational Respite; 4) Camp Respite; and 5) Intensive Respite. For In Home Respite, there will be agency supported rate codes to accommodate service provision to individuals self-directing with employer authority.

Respite services will continue to be billed in quarter-hour units unless an individual receives more than 42 overnight respite services between the July 1 to December 31 period or the January 1 to June 30 period.

When the 42-day threshold of overnight respite has been exceeded, any additional claims exceeding the Supervised Individualized Residential Alternative (IRA) regional average will be billed as a per diem. In these instances, the reimbursement will be paid at the specified Supervised IRA regional average fee levels. The limit of 42 overnight respite services is applicable to the In Home and Site Based service models. Further guidance concerning respite service policy will be made available in both regulation and in an Administrative Memorandum.

Respite services are provided to individuals unable to care for themselves and are provided on a short-term basis because of the absence or need for relief of the individual’s unpaid primary caregiver. The charts at https://www.health.ny.gov/health_care/medicaid/program/update/2017/jun17_mu.pdf (pages 8 and 9) identify nine new rate codes established to accommodate the new categories of respite service for voluntary agencies.

OPWDD is finalizing an Administrative Directive Memoranda (ADM) that will outline the service documentation requirements associated with the new respite categories. The ADM will be available at http://www.opwdd.ny.gov/opwdd_regulations_guidance/adm_memoranda.

Questions regarding service documentation requirements can be directed to OPWDD’s Waiver Management Bureau at peoplefirstwaiver@opwdd.ny.gov. Questions regarding the billing changes can be directed to OPWDD’s Central Operations Bureau at (518) 402-4333.

New Maximum Workers’ Compensation Benefit The maximum weekly benefit rate for workers’ compensation claimants is $870.61 for July 1, 2017 through June 30, 2018.

This is based on two-thirds of the New York State average weekly wage for the previous calendar year, as determined by the state Department of Labor ($1,305.92).

The announcement is at http://www.wcb.ny.gov/content/main/SubjectNos/sn046_951.jsp.

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

Volume 2, No. 27 July 10, 2017 ď Ž

OMIG Posts Reminders about Compliance and Certification Forms The state Office of the Medicaid Inspector General (OMIG) has posted reminders about two certification forms that home care and other health care providers must complete in December.

State law requires that health care providers certify annually that they have adopted, implemented, and maintain an effective compliance program that meets eight elements. These elements are reviewed at https:/ /omig.ny.gov/images/stories/compliance/compliance_program_review_guidance.pdf and https:// omig.ny.gov/images/stories/compliance/compliance_program_self_assessment_form_021215.doc, along with FAQs at https://omig.ny.gov/images/stories/provider_compliance/ssl_faqs.pdf.

OMIG recommends that providers test the operation of their compliance program and make any adjustments necessary so that, in December, the Medicaid provider is prepared to certify compliance with the state requirements.

Also, as part of the Medicaid revalidation process, providers will be asked to submit evidence that they met the December certification obligation.

In addition, entities that receive at least $5 million in Medicaid payments during a federal fiscal year must submit a certification form showing compliance with the federal Deficit Reduction Act (DRA) of 2005. (The amounts an individual or organization may receive through its contract with a Medicaid managed care organization should not be counted when calculating the $5 million in payments.) By law, such entities must have written policies and procedures informing their employees, contractors and agents about federal and state false claim acts and whistleblower protections.

More information on the DRA certification is at https://omig.ny.gov/images/stories/provider_compliance/ dra_faqs.pdf.

OMIG will post a webinar in November on both the state and federal certification forms.

Additional information is in the June Medicaid Update at https://www.health.ny.gov/health_care/medicaid/ program/update/2017/jun17_mu.pdf (pages 16-18).

Meeting to be Held on Future of Integrated Care The state Department of Health’s (DOH) Division of Long Term Care and the U.S. Centers of Medicare and Medicaid Services will be convening a stakeholder meeting on the future of integrated care in New York State.

This will be the first of a series of sessions designed to facilitate the conversation on what DOH envisions for the state’s integrated care programs after 2019.

The meeting will take place Thursday, July 20 from 11:30 a.m. to 2 p.m. Stakeholders are invited to either attend in-person at rooms 1-2 on the 30th floor of 290 Broadway (at Duane Street) in New York City, or via webinar/conference call.

Continued on next page

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

Volume 2, No. 27 June 10, 2017 

Continued from previous page Space is limited for this first meeting and only two people from each organization will be permitted to attend in-person. Once in-person attendance has reached maximum capacity, attendees will be asked to participate via webinar/conference call.

To attend in-person, RSVP by July 17 with the first and last names of attendees to fida@health.ny.gov. Only those people listed on the building’s security sheet will be permitted to enter the building; substitute attendees will not be permitted.

If you would like to participate via webinar/call, go to https://meetny.webex.com/meetny/onstage/ g.php?MTID=e94b956494bdff1b166315f3b2021353e.

RFI Released on Social Isolation and Loneliness in Older Adults The New York State Office for the Aging (NYSOFA) has posted a Request for Information (RFI) to gather information from New York State providers on recommendations to best initiate a community-based pilot hotline program targeted at socially isolated and/or lonely older adults.

The RFI is at http://hca-nys.org/wp-content/uploads/2017/07/RFI_Social-Isolation_071017.pdf.

Providers should submit information and data on best practices currently in use and recommendations on how to effectively and efficiently implement a successful community-based volunteer program targeted at socially isolated and lonely older adults. The information gathered in the RFI may be used to develop a Request for Application (RFA) to pilot a program targeted for this at-risk population.

Providers are asked to review the RFI questionnaire as a guide for their responses and recommendations.

Responses and recommendations should be sent to laura.palmer@health.ny.gov with the subject line “Social Isolation RFI”. Responses should be sent no later than 5 p.m. on August 25, 2017.

Responses to the RFI may be reflected in future funding opportunity announcements.

Funding is being considered that would be provided to an eligible applicant to:

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

Establish a hotline-based pilot program that incorporates additional supportive services based on community need;

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Examine and analyze the assumption that social isolation and loneliness contribute to poor health outcomes for older adults;

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Establish a knowledge base of best practice interventions; and

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Develop a robust data set that identifies and recommends interventions for unmet service needs of socially isolated and lonely older adults.

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

NGS Updates National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), has recently posted the following information to its website: 

Important Notice Regarding Handwriting on Claims Submitted to Medicare – Beginning July 10, NGS will return to the provider any paper claim submitted with handwriting on the face of the claim that is not a signature field (i.e., Items 12, 13, or 31). A notice will be attached to the front of the returned claim and you will need to submit a new claim.

The U.S. Centers for Medicare and Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, Chapter 26, Section 30, “Printing Standards and Print File Specifications Form CMS-1500” (700 KB) contains the printing specifications for the CMS-1500 claim form. These printing specifications do not provide instructions to submit handwritten claims. Please use this CMS IOM reference to ensure you are completing paper claims correctly.

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How to Use NGS’s CERT Denial Finder Tool – NGS’s Comprehensive Error Rate Testing (CERT) Denial Finder allows providers to quickly access additional information when CERT finds an error with a claim and/or documentation. The tool will also indicate the status location and status date of the claim selected by CERT for review. If CERT did not assess an error, this tool will indicate “No” in the Claim Error Field. Go to the “Provider Resources” tab on the NGSMedicare.com website, then click on the “Calculator & Tools” link for the CERT Denial Finder. Access this tool and enter the CID for details on your denial.

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

Resources 

“Growth Of ACOs And Alternative Payment Models In 2017,” Health Affairs Blog (June 28, 2017) http://healthaffairs.org/blog/2017/06/28/growth-of-acos-and-alternative-payment-models-in2017/

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“HHCAHPS Coordination Team Quarterly Review Newsletter”( July 2017) https://homehealthcahps.org/Portals/0/Newsletter/CTQR_Newsletter_Jul_2017.pdf

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

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