QIVAPP
ADVOCACY TOOLKIT
PREPAREDNESS DRILL
UAS-NY UPGRADE DELAY
QIVAPP funding has been approved for year five (2018-19). HCA awaits specific funding amounts, as managed care plans asked to send data to DOH on eligible hours by August 2.
New HCA advocacy toolkit provides tips for members, helping to demystify the lobbying process and inspire grassroots action.
DOH announces window for communications drill, to be held on August 12 to 16. Upcoming webinar to offer background.
The upgrade to version 1.6 of the Uniform Assessment System is getting delayed until August 13-14. DOH gives instructions for both online and offline users.
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UPCOMING PROGRAMS HCA Strategy Sessions Coming to You This Summer on Next-stage DSRIP, MRT II & More Aug. 6 (Newburgh) Aug. 13/14 (NYC) Aug. 20 (Farmingdale) Senior Financial Managers Retreat Sept. 5 & 6 Mohonk Mountain House (New Paltz) Blueprint for OASIS Accuracy – OASIS D Data Set September 23-24 (Workshop); September 25 (Optional COS-C Exam) in NYC Editor's note: HCA will resume our schedule of biweekly summer newsletters. There will be no editions on August 5 and August 19. We will alert you, as always, by e-mail for breaking news.
Your Source for HOME CARE News, Policy and Advocacy
Vol. 4, Issue 28| July 29, 2019
PDGM Readiness, Medicaid Rate Updates & More at Sept. 5-6 Finance Retreat Annual finance conference at scenic Mohonk Mountain House a first-class tradition! We invite you to download the brochure and register today for our highly anticipated Senior Financial Managers Retreat at the scenic Mohonk Mountain House in September! This signature finance program is for CHHAs, LHCSAs, hospice and MLTC to best prepare you for 2020 budgeting and forecasting. See RETREAT p. 2
A Deeper Analysis of Proposed 2020 Payment Rule, PDGM HCA’s Vice President for Finance and Management Patrick Conole has completed a detailed Public Policy Memo (https://hca-nys.org/wp-content/uploads/2019/07/ CMS2020ProposedRuleMemo071919.pdf) summarizing the newly proposed calendar year (CY) 2020 Medicare home health payment rule. See RULE p. 3
INSIDE A Deeper Analysis of Proposed 2020 Payment Rule, PDGM........................1 PDGM Readiness, Medicaid Rates & More at Finance Retreat...................1 A Newly Filed Legal Action on FI Payment Change.......................................4 QIVAPP Funding Approved for 2018-19......................................................4 DOH Posts Initial 2019 Personal Care Rates..............................................5 OMIG Conducts Medicaid Managed Care Program Integrity Reviews.........5 New Advocacy Toolkit Offers Tips for Connecting with Lawmakers, Public...6 CMS Features HCA Sepsis Tool in National Hospital Webinar......................7
Update on August IOC Drill...........................................................................8 HCA Co-Chairs NAHC Subcommittee on Medicare Advantage........................9 Advancing Home Care’s Roles in Primary, Preventive Care.............................9 UAS-NY Upgrade Delayed.........................................................................10 CMS to Host Home Health PDGM Operational Issues Call: August 21............11 OMIG Issues Revised Protocols for Private Duty Nursing.....................11 March Global Cap Report: Medicaid Spending $79M Above Projections......11 Submissions Using HIC Number Will Be Rejected January 1 Onward..............12 Health Resources......................................................................................13 Upcoming Deadlines.....................................................................................14
The Situation Report: the Home Care Association of New York State
RETREAT from p. 1 It will include rate and finance policy updates from state Department of Health officials, the HCA policy team and national experts, plus:
You’ll gain a final-stage PDGM readiness checklist to help ensure that you’ve considered what’s necessary to succeed, along with a comparative analysis of financial outcomes (pre- and post-PDGM) based on benchmark data using 2017-2018 claims.
We’ll cover the progress of changes to the payment and procurement of Fiscal Intermediary (FI) services.
A special breakout session for LHCSAs will discuss revenue-cycle principles to help you track and quantify bonus and penalty payments under valuebased payment (VBP) risk arrangements.
The Retreat will also preview what’s to come in the next stage of the Delivery System Reform Incentive Payment (DSRIP) program and VBP, as the Medicaid Redesign Team may soon reconvene for discussions about waiver renewals and Medicaid program model changes. This is just a snapshot of issues and insights you’ll gain at this signature retreat for home care, hospice and MLTC finance and executive leaders. Don’t miss out. Read the full agenda and register today at https://hca-nys.org/wp-content/uploads/2019/07/HCASenior-and-Financial-Managers-Retreat-2019-BrochureFinal.pdf.
Volume 4, No. 28 July 29, 2019
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. Al Cardillo President and CEO acardillo@hcanys.org Roger L. Noyes Director of Communications, Editor of The Situation Report rnoyes@hcanys.org Rebecca Fuller Gray Executive V ice President for Clinical and Program Affairs rgray@hcanys.org Patrick Conole Vice President, Finance & Management pconole@hcanys.org Andrew Koski Vice President, Program, Policy & Services akoski@hcanys.org Alyssa Lovelace Director for Policy and Advocacy alovelace@hcanys.org Lauren Ford Director of Program Research, Development and Policy lford@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
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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Teresa Brown Administrative Assistant tbrown@hcanys.org
Volume 4, No. 28 July 29, 2019
The Situation Report: the Home Care Association of New York State
RULE from p. 1 It describes in detail the transition to the Patient Driven Groupings Model (PDGM) in 2020 as well as the following key items:
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A continuation of the CY 2019 home health prospective payment system (HHPPS) for home health episodes of care that begin anytime in CY 2019 but carry over into CY 2020. These episodes, beginning in 2019 and ending in 2020 (with an end date no later than February 28, 2020), are subject to a 60-day episodic rate calculation, with 30-day PDGM payment units subsequently applicable. Major revisions to the Request for Anticipated Payment (RAP) process and the implementation of a “Notice of Admission” process beginning in CY 2021. Another recalibration of the PDGM casemix weights (CMWs) using the most current cost and utilization data. Updated tables for the CY 2019 standardized 60-day episodic payment rate and Low Utilization Payment Adjustment (LUPA) rates (in cases where episodes span the calendar years between the current HHPPS structure and the new PDGM methodology), as well as new tables for the CY 2020 PDGM 30-day unit payment structure. The proposed wage index for CY 2020, including a summary of those areas seeing increases or decreases in the wage index factor, as well as changes to the labor and non-labor share of the calculation. Continuation of the tiered home health rural add-on. Changes to the fixed dollar loss (FDL) ratio used in the outlier calculation.
The elimination of one question in the Home Health Consumer Assessment of Healthcare Providers and Systems Survey (HHCAHPS).
Changes to the Home Health Quality Reporting Program (HHQRP).
Continuation of the changes implemented last year to the home infusion therapy benefit.
A proposal for public reporting of certain performance data under the Home Health Value-Based Purchasing (HHVBP) model, which is currently operating in nine model states. (New York is not one of them.)
A proposed regulatory change to allow Therapist Assistants to perform maintenance therapy.
Advocacy As earlier reported, among our core concerns is CMS’s proposed behavioral adjustments under PDGM, particularly the change from a -6.42 percent adjustment to an even more severe -8.01 percent adjustment. These adjustments are a main target of HCA’s federal advocacy. We’ve recently posted tools on our Legislative Action Center for HCA members to gain support from Congress on legislation (S.433/ H.R. 2573) that would mitigate these destabilizing cuts. If you have not yet done so, please join nearly 700 of your colleagues who have acted already on this vital campaign at https://p2a.co/ fwWNZT0. Every member of New York’s Congressional Delegation must hear from you in large numbers seeking their co-sponsorship and support of S.433/H.R. 2573. Act today!
The Situation Report: the Home Care Association of New York State
A Newly Filed Legal Action on FI Payment Change A new Article 78 court action has been filed in response to the state’s establishment of permember per-month payment rates for fiscal intermediary (FI) administrative services beginning September 1. An Article 78 proceeding is used to appeal the decision of a New York State or local agency to the New York courts. This specific Article 78 action on FI payments was filed last week by FI service entities and state associations representing FIs. HCA is examining this legal action in greater detail as the state and stakeholders continue to examine FI structural, programmatic, procedural and procurement issues within a workgroup process (HCA is a member) that has been meeting throughout the summer. A final meeting is scheduled for next week. HCA, FIs and partner associations have been sounding the alarm repeatedly in recent months about the impact of the state’s payment changes on FI viability. We’ve argued for a delay in the rates as well as more transparency about the methodology, which was required to be implemented by July 1. DOH announced the rates on that date for the first time, with very little advance notice to stakeholders on the proposed rate tiers or modelling of how the rates flowed from the state’s data assumptions. As we consider the implications of this new legal development, HCA will continue to press for a full cost analysis to obtain an accurate picture of administrative expenses in the program.
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QIVAPP Funding Approved for 2018-19 The state Department of Health has informed HCA that Quality Incentive Vital Access Provider Pool (QIVAPP) funding has been approved for the Year 5 period, from April 1, 2018 through March 31, 2019. Qualified providers were determined by Island Peer Review Organization (IPRO) in Year 2 of QIVAPP. Award amounts will be based on reports of actual hours by managed care plans. DOH has requested that managed care plans send data on hours provided by eligible providers in this time period. The data is requested by August 2, 2019. HCA has already notified those HCA Licensed Home Care Services Agency (LHCSA) members who are on the list of qualified providers for QIVAPP Year 5 (2018-2019), but not yet the dollar amounts to be distributed. Once HCA receives a list of the amount of monies that each LHCSA will receive (probably sometime in September), we will send members a personalized list of those amounts (by contracted plan) as we have done in past years. QIVAPP is targeted to LHCSAs in New York City that meet certain criteria. More information on QIVAPP is at https://www.health.ny.gov/ health_care/medicaid/redesign/ mrt_61.htm.
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DOH Posts Initial 2019 Personal Care Rates The state Department of Health (DOH) recently posted to the Health Commerce System (HCS) the initial 2019 Medicaid fee-for-service (FFS) rates for Personal Care agencies and/or Consumer Directed/Personal Care programs. According to DOH, the rates can be found in a newly created section of the HCS entitled “HCS – “Hlthcare Financial Gateway” Logon. Once providers log-in, they should then see “My Content” on the toolbar and, under “My Applications,” select “Hlthcare Financial Data Gateway” and then click on the “+” to add it to your Applications on the left of your screen. The initial personal care rates reflect a zero “roll” factor adjustment as well as an overall zero trend factor for the rate period of January 1, 2019 through December 31, 2019. Furthermore, the final 2019-20 state budget eliminated the possibility of any Medicaid trend factor through March 31, 2020. A Dear Administrator Letter (DAL) accompanying the rates provides information on the statewide aggregate Administrative and General (A&G) cap, which is limited to no more than 28 percent of total costs. (The A&G cap remains 18 percent specifically for consumer directed services.) The DAL also discusses aide and training ceilings; capital costs; profit/surplus percent; the worker recruitment and retention adjustment addon of 6.08 percent; minimum wage rate adjustments; and the rate appeals process. Payment for the January 1, 2019 initial rates will be made in Medicaid Cycle 2188, which has a check release date of August 14, 2019. For rate questions, e-mail DOH at PersonalCare-Rates@health.ny.gov.
OMIG Conducts Medicaid Managed Care Program Integrity Reviews The state Office of the Medicaid Inspector General (OMIG) will start reviews of managed care organizations (MCOs) for compliance with program integrity sections of the Medicaid Managed Care/Family Health Plus/ HIV Special Needs Plan Contract. These reviews are authorized by Social Services Law Section 364-j (36) and 18 New York Codes Rules and Regulations Part 517. Newly enacted Social Services Law section 364-j(36)(b) requires that OMIG publish on its website a list of contractual obligations subject to review. The “Matrix of Contract Obligations and Performance Standards” (https://omig.ny.gov/images/stories/Matrix/MMC_2018_Matrix.pdf) identifies the contract sections OMIG will review and how performance shall be measured. Some of the covered areas include: submission of state Department of Health Certification; conducting reviews of state and federal databases of excluded provider lists; having a mandatory compliance plan; establishing a service verification process; submission of Provider Investigative Reports; and more. OMIG will issue an Audit Notification Letter to MCOs identified for review detailing the review process, timeframe, document submission instructions, and OMIG contact information. Questions should be e-mailed to mmcreporting@omig.ny.gov.
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New Advocacy Toolkit Offers Tips for Connecting with Lawmakers, Public The term “public affairs” is broadly defined as the combined functions of government-relations and media communications – in essence, an organization’s work to inform and influence action by stakeholders. These stakeholders can include the public and health care business partners; but much of public-affairs work is intended to drive decisions by policymakers and other officials. HCA has a policy team that develops legislative proposals. We also have government-relations and communications teams that seek to inform policymakers and persuade them into action on our proposals or other issues of concern. However, we rely greatly on HCA members in the field to channel your volume in the same direction – what’s called “grassroots” advocacy. HCA’s grassroots advocacy seeks to enlist you, as an expert in the field and as a constituent, to lobby with local, state, or federal lawmakers on behalf of an issue or cause, with HCA providing guidance, messaging (i.e., what to say or write), and tools for action. To provide you with more information on this process, as well as tips and resources, HCA’s Director of Public Policy and Advocacy Alyssa Lovelace has developed a new “Grassroots Advocacy Toolkit: Inform, Mobilize and Engage.” You can download it at https://hca-nys.org/wp-content/uploads/2019/07/Advocacy-Toolkit.pdf. We hope this guide convinces you that your grassroots advocacy is vital to HCA’s success as an organization on behalf of the home care, hospice and MLTC fields. We also hope that this guide helps demystify the process of grassroots advocacy, by giving you confidence and a sense of empowerment to act. Now is an opportune time to learn how you can support HCA’s legislative advocacy. Please read the toolkit today, and come back to it every time you see an advocacy alert from HCA. As stressed in the toolkit, it’s also important that you consider grassroots advocacy to be part of your day-to-day community-level work, regardless of the legislative calendar or prerogatives coming from Albany or Washington – because it is good for your organization, for your patients, and for the accurate flow of information to legislators and system partners. If you have any questions, do not hesitate to contact Ms. Lovelace at alovelace@hcanys.org or (518) 8100658.
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The Situation Report: the Home Care Association of New York State
CMS Features HCA Sepsis Tool in National Hospital Webinar The U.S. Centers for Medicare and Medicaid Services (CMS) last week featured HCA’s sepsis screening and intervention tool in a webinar to Hospital Innovations Improvements Networks across the country. Presenting for CMS, HCA President Al Cardillo described HCA’s sepsis initiative, progression and impacts to date. The presentation also included the Illinois Hospital Association, an Illinois hospital and home care agency. These associations have adopted and are implementing the HCA tool under a licensing agreement that is being similarly pursued by other organizations nationally and internationally. Such licensing agreements and fee structure provide a base of revenue support for HCA’s operations and programming broadly while supporting national efforts on sepsis prevention, with HCA’s work at the forefront. During last week’s webinar, CMS asked Illinois representatives to speak from the perspective of a partnering hospital system and state also implementing the HCA tool. CMS anticipates further outreach with HCA during September (National Sepsis Awareness Month), in upcoming meetings of the CMS Hospital Innovations Improvement Networks, and in reports from HCA on the data and results being generated by New York providers who have pioneered in their work with the sepsis tool. If you are not already a user of the HCA tool, contact sepsistool@hcanys.org. Steps for licensing the tool are outlined at https:// stopsepsisathomeny.org/about-us/sepsisscreening-tool. Continued on next page
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HCA is hosting a series of regional strategy sessions with our CHHA and LHCSA provider members, with recent sessions in Albany, Utica and Rochester. The next upcoming sessions and dates are below. They are a great way for members to connect with HCA and provide input on the best ways to represent home care in the next stages of DSRIP, MRT II, and other big upcoming policy discussions. Aug. 6 (Newburgh) Aug. 13/14 (NYC) Aug. 20 (Farmingdale) Please register here to join us on the remaining dates: https://tinyurl.com/y3lkg8ps.
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Continued from previous page HCA will be engaging all sepsis tool users for a discussion of experiences as well as to provide technical assistance and share recommendations for next steps. These include steps now underway with electronic health record companies to overcome integration barriers, development of a pediatric iteration of the tool, care models for post-sepsis discharges, data collaboration with the hospital industry and state Health Department, and more. Stay tuned for details.
Update on August IOC Drill The state Department of Health (DOH) has announced the one-week window – August 12 to August 16 – when it will hold an Interoperable Communications (IOC) drill. As mentioned in many communications, the IOC drill will be targeted to home care, hospice and other providers across the entire state; though voluntary, it can be used to fulfill federal and/or state requirements for agencies to hold emergency preparedness exercises. The drill’s objectives are to:
Demonstrate the ability to use a primary and back-up communication system (internet – including VOIP, radio, cellular and satellite phone) to communicate with coalition partners (local health departments, hospitals, EMS, emergency managers, and others); and
Complete a Health Commerce System (HCS) Health Emergency Response Data System (HERDS) survey within the timeframe outlined in an Integrated Health Alerting and Notification System (IHANS) alert that will be sent to providers.
On the day of the drill, agencies will receive a cell phone and text notification regarding an IHANS message that outlines the emergency scenario and directs recipients to their e-mail for the HERDS survey. To explain more about the nature of this drill, DOH will be holding two webinars (with repeat content) from 2 to 3 p.m. on two days: Tuesday, July 23 and Tuesday, July 30. No registration is required. Click the links below on the day of the program, approximately 20 minutes before the 2 p.m. program start time.
July 23 webinar (https://meetny.webex.com/meetny/ j.php?MTID=m723113b30ca6e58d5355e043d4e40cdf); meeting Number 644 122 680; password: welcome2
July 30 webinar (https://meetny.webex.com/meetny/ j.php?MTID=mde10f4cb2c8638945550a240a130549c); meeting number 649 589 371; password: welcome 2
DOH has also made available an After Action Report (AAR) that must be completed if agencies want to use the drill in fulfilling the state and/or federal requirements (agencies should retain the AAR for at least three
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years). The AAR is at https://hca-nys.org/wp-content/uploads/2019/05/AAR-IP_Template-BLANK-for-CMSEP-exercises.docx. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org; or Alyssa Lovelace at (518) 810-0658 or alovelace@hcanys.org.
HCA Co-Chairs NAHC Subcommittee on Medicare Advantage HCA President Al Cardillo is co-chairing a new subcommittee on engagement with Medicare Advantage plans under the direction of the National Association for Home Care and Hospice (NAHC). The subcommittee has representatives from several states and disciplines, and is forming a roadmap to examine the various domains where plan-provider operations and outcomes can be supported. The subcommittee will be reporting to a larger policy advisory committee and ultimately to NAHC. The committee held its first meeting last week and will continue meeting regularly toward a recommended plan. HCA applauds NAHC for convening this committee and for taking a deep dive into an increasing area of importance for Medicare beneficiaries, providers and MA plans. Plan-provider engagement is ever more critical, as more of the Medicare population enrolls in Medicare Advantage (MA) plans, with federal officials and commissions seeking to further expand MA plans’ service flexibility and coverages. The role of home health agencies and hospices – in coordinating care across the span of managed care and fee-for-service structures – is hugely consequential to outcomes and overall system vitality. HCA looks forward to the group’s deliberations and will report back to the membership on any key developments.
Advancing Home Care’s Roles in Primary, Preventive Care HCA has begun a new round of meetings with state Department of Health (DOH) leaders to advance awareness and support for home care roles in public health, primary care and prevention in the health care system. The first of these meetings took place last week, involving HCA President Al Cardillo and DOH leaders of the advanced primary care/state health improvement program. Mr. Cardillo mapped out an array of areas (maternal and child health, asthma, diabetes, congestive heart failure, sepsis, mental health, health care screenings, etc.) – in combination with nearly all the local public health functions – where home care is an integral mainstay or critical partner in the care. He further described a number of new and unique innovations being carried out by HCA members in these areas, stressing the potential for better outcomes, improved community health and cost-savings through more deliberate state support and partner engagement for home care in these areas. Continued on next page
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Continued from previous page HCA has long emphasized how DOH and other partners could work together to promote these goals and key primary care/public health partnerships among home care, physicians, hospitals and other partners. Along these lines, Mr. Cardillo underscored the value that this proactive effort could bring to the state’s health transformation goals (i.e., the state’s “Prevention Agenda”) and contribution to upcoming budget priorities. Opportunity for you to share case examples DOH invited HCA to compile a write-up of case examples from providers to help illustrate and expand the understanding of home care’s involvement and impact in the public health and primary care areas, and to be able to utilize this information in planning and next steps. Please share your work and innovations with HCA at info@hcanys.org under the subject heading: “Primary Care, Public Health and Prevention.” This effort builds on the initiatives HCA has advanced in the state budget and in the Legislative session. It is also an important complement to our work in upcoming state health policy discussions under the Medicaid waiver, the Delivery System Reform Incentive Payment (DSRIP) program, and potential reconvening of the Medicaid Redesign Team (MRT) for a second phase of major policy changes.
UAS-NY Upgrade Delayed Upgrade now occurring August 13 to 14 A previously planned upgrade to the Uniform Assessment System (UAS-NY) software is now being delayed, due to defects identified and fixed during the testing cycle, state officials announced. The online upgrade to version 1.6 will now start at 5 p.m. on August 13 and be completed no later than 8 a.m. on August 14 (though the system may be available sooner). During this time, both the online and offline applications will be unavailable. The state Department of Health (DOH) has issued a notice outlining the software changes that users can expect in the new release, including new reporting, calculation and display functions. See https://hca-nys.org/wp-content/uploads/2019/07/Notification_101721.pdf. A training video on these changes in the new release will also be posted by close of business on August 2 in the UAS-NY Training Environment, References and Resources Course. The DOH notice also offers important instructions for offline users of UAS-NY who must upgrade to version 1.6.
Offline users should first synchronize and remove all records from their laptops by 4 p.m. on August 13 to avoid data loss.
Offline users should wait until Wednesday, August 14 (at 8 a.m. or later) to install the offline upgrade to version 1.6, which will not function until that time.
More instructions will be posted in the Training Environment Reference and Resources 8500 Online and Offline Application by close of business on August 8, 2019.
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CMS to Host Home Health PDGM Operational Issues Call: August 21 The U.S. Centers for Medicare and Medicaid Services (CMS) will host a conference call/webinar on Wednesday, August 21 from 1:30 to 3 p.m. on multiple operational issues related to the upcoming Patient Driven Groupings Model (PDGM). The following topics will help agencies prepare for PDGM billing changes. Topics will include:
Billing and claims processing overview. How OASIS data will be used in the claims system. Reporting new occurrence codes. Period timing and admission source scenarios. Transition scenarios.
A question and answer session follows the presentation. Registration is at: https://blh.ier.intercall.com/.
OMIG Issues Revised Protocols for Private Duty Nursing Last week, the Office of the Medicaid Inspector General (OMIG) issued revised audit protocols for private duty nursing performed by Licensed Home Care Services Agencies (LHCSAs). The OMIG states that, “Audit protocols assist the Medicaid provider community in developing programs to evaluate compliance with Medicaid requirements under federal and state statutory and regulatory law. Audit protocols are intended solely as guidance in this effort.” HCA members can access the revised audit protocols from OMIG’s website at: https://omig.ny.gov/images/stories/audit_protocols/PDN_LHCSA_Protocol_07-24-19.pdf.
March Global Cap Report: Medicaid Spending $79M Above Projections The state’s latest Medicaid Global Cap Report finds that overall spending in State Fiscal Year (SFY) 201819 was $4 million below the $20.8 billion target. Spending for SFY 2018-19 resulted in total expenditures of $20.814 billion compared to the projection of $20.818 billion. The report is at: https:// www.health.ny.gov/health_care/medicaid/regulations/global_cap/monthly/sfy_2018-2019/docs/ mar_2019_report.pdf. Spending in managed care categories was $690 million below projections with the following factors highlighted by DOH:
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Mainstream Managed Care spending was $238 million below estimates because payments were delayed into the next fiscal year. Spending for the program would have exceeded projections primarily due to an increase in stop-loss claims. The state processed 25 percent more stop-loss claims this fiscal year over the prior year, driving higher-than-projected spending, DOH reports.
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Long Term Managed Care was $452 million below estimates through March because payments were delayed into the next fiscal year. Spending for the program would have exceeded projections primarily due to higher-than-expected enrollment. Enrollment for the year grew by 12 percent compared to budgeted growth of 5 percent. Through March 2019, there were 10,000 more enrollees than anticipated.
Higher spending trends and other pressures resulted in a significant Global Cap deficit during the SFY 201819 cap reporting period, DOH says. The deficit was driven by higher-than-anticipated spending over and above the enacted budget estimates, unachieved savings initiatives, and other factors described below.
MLTC enrollment increased by 12 percent annually or 28,124 individuals, more than double the projected enrollment. As a result, DOH says, long term care services accounted for 46 percent of the total category of service deficit.
Acute care services experienced higher utilization. Spending was impacted by the statutorily required inpatient rebasing rate adjustment. According to DOH, while rebasing is budget-neutral for the base year used to develop the rates, higher spending resulted when those rates are applied to the utilization of the rate year.
Managed care services saw a 25 percent year-to-year increase in the number of stop-loss claims processed.
The state experienced higher cost sharing payments due to the Medicare Part A & B and Part D clawback programs.
DOH also reports unachieved Medicaid savings from delays in the value based payment quality improvement organization transition (thus rolling Medicaid cap relief into the next year); federal delays in approving 1115 waiver designed to limit MLTC eligibility to fewer than three months in nursing homes; and other Medicaid Redesign Team (MRT) initiative delays.
Medicaid total enrollment reached 6,154,030 enrollees at the end of March 2019. This reflects a net increase of 5,996 enrollees since March 2018. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
Submissions Using HIC Number Will Be Rejected January 1 Onward Starting January 1, 2020, the U.S. Centers for Medicare and Medicaid Services (CMS) will reject claims that are submitted with the Health Insurance Claim Number which is being phased out. All eligibility transactions using the Health Insurance Claim Number will be rejected after that date, with no exceptions. Providers must use the Medicare Beneficiary Identifier (MBI). The MBI was created for security reasons. CMS indicates that most providers have already begun widely using the MBI – in as much as 76 percent of fee-for-service claims submitted for the week ending July 5, 2019. Continued on next page
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If agencies do not have an MBI for a patient, you should:
Ask your patients for their card. If they did not get a new card, give them the “Get Your New Medicare Card” flyer in English or Spanish.
Use your Medicare Administrative Contractor’s (MAC) look-up tool.
Check the remittance advice. CMS will return the MBI on the remittance advice for every claim with a valid and active Health Insurance Claim Number.
If your patients accidentally discarded their new Medicare card, ask them to call 1-800-MEDICARE and request a replacement. Your patients can also sign into MyMedicare.gov to print an official card. They must create an account if they do not already have one. Additional information on this issue can be found at:
Transition to New Medicare Numbers and Cards Fact Sheet (https://www.cms.gov/Outreachand-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ TransitiontoNewMedicareNumbersandCards-909365.pdf).
Frequently Asked Questions (https://www.cms.gov/Medicare/New-Medicare-Card/NMCFAQs-5-18.pdf).
Medicare patients should be reminded that when they get their new Medicare cards, they should destroy the old red, white, and blue Medicare cards but not their Social Security, Medicare Advantage plan, or drug plan cards. If they belong to a Medicare Advantage plan or a Medicare drug plan (Part D), they should continue to use these cards when they get health care services or fill a prescription.
Health Resources
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“Medicare: Limited Information Exists on the Effects of Synchronizing Medication Refills,” by the Government Accountability Office https://www.gao.gov/products/GAO-19520?utm_campaign=usgao_email&utm_content=topic_health&utm_medium=email&utm_source=govdelivery
“Caregiving for Family and Friends — A Public Health Issue,” by the U.S. Centers for Disease Control and Prevention https://www.cdc.gov/aging/agingdata/docs/caregiver-brief-508.pdf
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UPCOMING Deadlines Requirement/Change/Meeting
Effective/Due Date
More Information
CHHA Cost Report Due
July 29, 2019
https://commerce.health.state.ny.us/public/hcs_login.html; CHHAͲRates@health.ny.gov
Interoperable Communications Drill Webinar
July 30, 2019, 2 to 3 p.m.
https://meetny.webex.com/meetny/j.php?MTID=mde10f4cb2 c8638945550a240a130549c
2019 Adult Care Facility 2nd Quarter Statistical Information Report
July 31, 2019
https://commerce.health.state.ny.us
HCA CHHA Regional Strategy Session (Newburgh)
August 6, 2019, 10 a.m. to 12 p.m.
https://www.surveymonkey.com/r/regionalsess2019
HCA LHCSA Regional Strategy Session (Newburgh)
August 6, 2019, 1 to 3 p.m.
https://www.surveymonkey.com/r/regionalsess2019
Fiscal Intermediary Workgroup meeting
August 7, 2019, 11 a.m. to 2 p.m.
akoski@hcanys.org
Emergency Preparedness Coalition of Manhattan (EPCOM) meeting
August 7, 2019, 12 to 1:30 p.m.
Caitlin.Flynn@nyulangone.org
Comments due on CMS Request for Information on Regulatory Relief
August 12, 2019
https://www.cms.gov/newsroom/pressͲreleases/cmsͲseeksͲ publicͲinputͲpatientsͲoverͲpaperworkͲinitiativeͲfurtherͲ reduceͲadministrativeͲregulatory
Interoperable Communications Drill
Week of August 12 to August 16, 2019
akoski@hcanys.org or alovelace@hcanys.org
HCA LHCSA Strategy Session (NYC)
August 13, 2019, 1 to 3 p.m. https://www.surveymonkey.com/r/regionalsess2019
HCA CHHA Strategy Session (NYC)
August 14, 2019, 10 a.m. to 12 p.m.
https://www.surveymonkey.com/r/regionalsess2019
HCA CHHA Strategy Session (Long Island)
August 20, 2019, 10 a.m. to 12 p.m.
https://www.surveymonkey.com/r/regionalsess2019
HCA LHCSA Strategy Session (Long Island)
August 20, 2019, from 1 to 3 p.m.
https://www.surveymonkey.com/r/regionalsess2019
Personal Care Cost Report
August 27, 2019
https://commerce.health.state.ny.us/public/hcs_login.html; PersonalCareͲRates@health.ny.gov
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/NewͲMedicareͲ Card/index.html
Changes in MLTCͲLHCSA Contracting Limits
October 1, 2019
https://www.health.ny.gov/health_care/medicaid/redesign/mr t90/mltc_policy/lhsca_contract_guidance.htm
Medicare will only accept claims submitted with the Medicare Beneficiary Identifier (MBI)
January 1, 2020
https://www.cms.gov/Medicare/NewͲMedicareͲ Card/index.html
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