TPL SETTLEMENT
MLTC-PACE SUMMITS
SEPSIS, PREPAREDNESS MONTH
JIMMO RULING
Facing enormous backlog, the state and federal governments settle on TPL cases pending appeals.
This summer, HCA held two summits with our MLTC and PACE members to discuss vital next steps on advocacy for plans and system partners alike.
September is an awareness month for sepsis and emergency preparedness. HCA offers some ideas to make the most of it!
CMS’s website provides guidance related to the Jimmo court ruling invalidating the so-called “improvement standard” for Medicare coverage.
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COMING UP Senior & Financial Manager’s Retreat September 7-8 Mohonk Mountain House New Paltz Optimizing Your Agency’s Revenue Cycle for Improved Financial Performance September 13, 2017 New York City Home Care Council of HCA Member Forum September 19, 2017 10 a.m. to 12:30 p.m. New York City Are You Prepared? Emergency Preparedness Essentials in Home Care & Hospice Settings September 27, 2017 Albany All HCA programs and registrations are posted at http://hca-nys.org/ events-education/ upcoming-events
Your Source for HOME CARE News, Policy and Advocacy
Vol. 2, Issue 31 | September 5, 2017
New Minimum Wage Survey for Home Care Providers Imminent Registration process must be completed first; webinar to be held soon As a prelude to an upcoming minimum wage survey for home care providers, the state Department of Health (DOH) is requiring that agencies complete a registration process with the state Office of Pool Administration (OPA) before providers will be able to complete and submit the survey, which will be used to determine minimum wage payments and is a requirement for minimum wage funding apportionments. OPA is developing the new electronic “Home Care Provider Minimum Wage Reconciliation Survey” on behalf of DOH and is assisting with data collection. See SURVEY p. 3
PHHPC Focuses on Major Policy Developments, Home Care
CMS to Begin Targeted Probe and Educate Program in the Fall
The state Public Health and Health Planning Council (PHHCP) is engaging in an intensive retreat this week focusing on areas of prevention, reform and postacute care, home care specifically.
The U.S. Centers for Medicare and Medicaid Services (CMS) has issued its plans for medical review after the completion of the second round of the “Probe-and-Educate” initiative.
See DEVELOPMENTS p. 6
INSIDE New Minimum Wage Survey for Home Care Imminent....................................1 PHHPC Focuses on Major Policy Developments, Home Care..........................1 CMS to Begin Targeted Probe and Educate Program in the Fall.........................1 Warm Wishes to HCA’s Alex Blais as She Heads to NYeC..................................2 Upcoming HCA Education.............................................................................4 OMIG, CMS Reach TPL Settlement on Pending Medicare Appeals....................8 New Q&As, Plus Sept. 26 Call on Tokhtaman Court Case.................................9 Final 2017 CHHA Pediatric Medicaid Rates Posted.......................................10 Update on Correcting ‘Hospice Compare’ Info.............................................10 HCA MLTC-PACE Summits and Advocacy Solutions.........................................11 OMIG Posts Compliance Program Reports, Alert........................................12
See PROBE p. 8
Help for Texas in Hurricane Harvey Aftermath..............................................14 Gear Up for Sepsis & Emergency Preparedness Month Outreach...................15 CMS Launches Jimmo Settlement Agreement Webpage...............................17 DOH Working on New CDPAP Authorization Process......................................17 HCA Summer Roadshow Sessions Drew Focus on Top Issues..........................19 DOH Revises Transportation Assistance Levels............................................19 Stakeholder Meetings to be Held on Integrated Care....................................20 DOH Issues Home Care, Hospice Guidance on C. auris...................................21 VBP University Semester 2 Launched............................................................22 Governor Signs Two Hospice Bills; Two More Await Action.............................23 TBI Waiver Update......................................................................................24 Resources....................................................................................................25
The Situation Report: the Home Care Association of New York State
Warm Wishes to HCA’s Alex Blais as She Heads to New Position at NYeC HCA extends congratulations and best wishes to HCA’s Director of Public Policy Alex Fitz Blais who is taking a new step in her career at the Statewide Services Team for the New York eHealth Collaborative. “Since joining HCA two years ago, Alex has been a fundamental member of our policy team,” said HCA President Joanne Cunningham, “engaging in advocacy and analysis on several important issue areas, including home care’s role in the Delivery System Reform Incentive Payment (DSRIP) program, Value Based Payments (VBP), estimates of the minimum wage impact on home care agencies, emergency preparedness and our collective work on regulatory and payment issues for home care, hospice and MLTC. We will miss her tremendously but wish her the very best in her new role and look forward to the possibilities of working with her in her new capacity.” NYeC works with the state Department of Health to coordinate the Statewide Health Information Network for New York (SHIN-NY) while promoting the power of electronic health records to improve the quality of health care and reduce costs. HCA has worked with NYeC in the past on collaborative efforts and has tapped its expertise for past education programs, including our Quality and Technology Conference. “While very excited for the new challenges and opportunities ahead, I will sincerely miss working with the incredible team at HCA,” Ms. Blais said. “It has been a privilege to work within an organization and group that is so committed to their advocacy for a membership that devotedly serves some of the most vulnerable individuals in New York. I look forward to every opportunity to work with HCA in the future.”
Home Care Association of New York State (HCA) 388 Broadway, 4th Floor, Albany, NY 12207 Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org
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The Situation Report is a weekly publication of the Home Care Association of New York State (HCA). Unless otherwise noted, all articles appearing in The Situation Report are the property of the Home Care Association of New York State. Reuse of any content within this newsletter requires permission from HCA.
Joanne Cunningham HCA President jcunningham@hcanys.org Roger L. Noyes Director of Communications, Editor of The Situation Report rnoyes@hcanys.org Al Cardillo Executive Vice 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
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SURVEY from p. 1 The Wage Reconciliation Survey will capture worker wage details, the number of employees impacted by title grouping, contractual relationships between home care agencies and managed care plans, as well as contractual relationships among home care agencies. DOH has confirmed with HCA that home care providers who don’t directly employ aides will have to complete the survey, unlike an earlier minimum wage survey distributed this past February where such agencies did not have to complete the survey. Home care agencies that completed the previous minimum wage survey in February were e-mailed instructions last week for completing the registration process. In response to an HCA inquiry, DOH has indicated that all other providers will receive hard copy letters via U.S. mail informing them of this process. The new Wage Reconciliation Survey is expected to be posted soon. In its communication to home care providers last week, DOH stated that the purpose of the survey is to “reconcile actual Medicaid minimum wage costs to actual Medicaid minimum wage funding distributions. While minimum wage projections have been included in current rates, effective 12/31/16, those figures will be reconciled using data from the survey. Data from the survey will also be used to assist in determining funding to include in future Medicaid Managed Care and Fee-for-Service rates.” Furthermore, “Medicaid minimum wage funding levels, including funding already received, will be dependent on submission of a satisfactory survey. Funding received in excess of needed funding documented in the survey must be returned to the State. Similarly, providers receiving inadequate funding for Medicaid services will be eligible to receive additional payments.” Home care provider agencies required to submit the survey include CHHAs, LHCSAs, LTHHCPs and Consumer Directed Personal Assistance program Fiscal Intermediaries. HCA, members and provider representatives participated in a LHCSA Workgroup meeting in June where DOH reviewed a draft of this survey. HCA then shared the draft with a group of members and submitted comprehensive recommendations that included: revisions to make it easier to complete; the need for an adequate timetable for submission; and a webinar to walk through its completion. HCA, along with other provider associations, has reiterated the need for DOH to hold a webinar on the Wage Reconciliation Survey, and has argued forcefully for the utility of such a webinar for provider assistance. The Department has since indicated that it is planning to hold a webinar for the week of September 11, and HCA will immediately inform the membership of any forthcoming details. HCA also awaits a preview of the survey to determine what, if any, of our recommended revisions were implemented. You will need to establish an OPA account with a User ID and Password to access and submit the Wage Reconciliation Survey. If you have difficulties establishing an OPA account, contact OPA at webpools@hcrapools.org or at (315) 671-3800. Questions about the survey can be directed to mltcrsmw@health.ny.gov (please copy Andrew Koski at akoski@hcanys.org). HCA will alert members once the survey is open for completion and when a webinar date is announced.
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HCA Education We have a lot in store over the next few months. Please share these programs, forums, webinars and conferences with your colleagues and be sure to register yourself. Registration information is all online at http://hca-nys.org/events-education/upcoming-events. Optimizing Y our Agency’ oved Financial Performance Your Agency’ss Revenue Cycle for Impr Improved September 13, 2017 New York City
This workshop, led by an expert on end-to-end revenue cycle management, will show how to analyze and target under-performing areas of the revenue cycle through the use of metrics as an efficient and effective means of improving revenue and cash flow. Webinar to Outline ICD-10 Changes Effective in October September 13, 2017
Approximately 3,392 new ICD-10 codes are coming in October 2017 for the 2018 fiscal year. Is your team ready? This webinar, hosted in conjunction with the Home Care Association of New Hampshire, will identify the coding changes that affect home health and hospice, with a review of changes to case-mix diagnoses, updates and changes to the Coding Guidelines, and case examples to illustrate the new coding changes. Home Care Council of HCA Member Forum September 19, 2017 New York City
Please join the staff of HCA and member colleagues from the Association and the home care community for the next Home Care Council of HCA Member Forum. Participation in HCA Member Forums gives you an opportunity to interact with HCA staff and members, and exchange valuable information with your colleagues. Ar e Y ou Pr epar ed: Emer gency Pr epar edness Essentials in Home Car e & Hospice Settings Are You Prepar epared: Emergency Prepar eparedness Care September 27, 2017 Albany
HCA presents a comprehensive full-day program on September 27 in Albany that will delve into all critical and timely aspects of home care and hospice emergency preparedness affecting your operation. The program features state health and emergency preparedness officials. Most urgently, with the fast-approaching November 16 effective date for the new emergency preparedness Conditions of Participation (CoPs), we’ll also have state DOH officials helping you to sort out the differences between the new federal CoP requirements and existing state regulations so that you know how much work is ahead of you in order to ramp up fully for federal compliance. Plus, join us for a tabletop exercise that meets one of the new CoP requirements!
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Continued from previous page Downstate LHCSA Forum October 11, 2017 New York City
Please join your LHCSA and HCC colleagues, HCA staff and Board Members for this exchange of valuable information, advocacy concerns and recommendations for action. Corporate Compliance Symposium October 19 Albany
One of our signature conferences, the Corporate Compliance Symposium draws CEOs, COOs, corporate compliance officers and other managers who have responsibility for planning, operationalizing, and establishing a compliance-conscious culture at your organization. From big-picture considerations to the concrete mechanics of maintaining a compliance program, this conference will: emphasize the focus areas targeted by government auditors (i.e., OMIG and OIG); provide takeaways and best-practice guidance based on real-world cases of HIT- and HIPAA-related breaches and enforcement actions; help you overcome exposure and identify new risks introduced by your participation in new integrated models of care; and examine growing segments of the home care continuum that are drawing scrutiny and new regulatory activity from state compliance agencies. Blueprint for OASIS Accuracy OASIS C-2 Data Set October 23 & 24 (Workshop) October 25 (Optional COS-C exam) New York City
Clinician leaders from OASIS Answers are bringing the acclaimed Blueprint for OASIS Accuracy C-2 Data Set workshop to New York City on October 23 and 24, with the option to take the COS-C exam at the same location on October 25. Through guided, expert instruction, problemsolving discussions and application scenarios, participants will achieve mastery of the OASIS items, conventions and the latest data collection rules. Webinar: From Frailty to Functionality: Evidence-Based Rehabilitation Strategies for Deconditioned Patients November 1, 2017
Deconditioning is a complex process of physiological change following a period of inactivity that results in functional losses including mental status, continence and ability to accomplish activities of daily living. This webinar will delve into the operational definitions for frailty and deconditioning as well as examine the scope and prevalence of the problem in today’s patient populations compared to similar patients ten or 20 years ago. Although these limitations are exacerbated with physiological consequences of low activity levels and extended bed rest, gains can be achieved and maintained by developing an evidenced-based practice for re-conditioning.
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DEVELOPMENTS from p. 1 The retreat seeks draft recommendations in:
Public health
The state’s prevention agenda
Health reform and health care delivery restructuring
Balancing regulatory flexibility for health providers with accountability, access and cost
Public engagement, transparency and access
Structure and operations of PHHPC
Regulatory framework
Cross-agency issues, including DOH, Office of Mental Health, Office of Substance Abuse Services and the State Education Department
Certificate of Need (CON) and need methodologies
Role of quality in character and competence
Facility governance and ownership structures
Structure and operations of PHHPC
Critical considerations for home care The retreat’s deliberations may have implications for home care in many of the recommendation areas. More specifically, however, the retreat includes a segment on Achieving Better Alignment Between Current Statute/Regulation and Emerging Models and Systems of Care, with discussion topics very focused on home care. These include:
Post-acute care models: the Article 28 to Article 36 Continuum
Redefining standards for determining need for long term care beds and home care agencies
Incorporating quality in licensure/establishment CON determinations
DOH has asked HCA Executive Vice President Al Cardillo to address the Council and to participate in these deliberations. Mr. Cardillo sits on the Department’s post-acute workgroup (see next page). His tenure in the field also provides a formative and longitudinal perspective on New York’s programs, laws and regulations over time. Continued on next page
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Continued from previous page The Council’s meeting coincides with major DOH regulatory reviews and changes. DOH has recently begun a Regulatory Modernization initiative. It has spawned a series of workgroups, including a PostAcute Management Model Workgroup (on which HCA sits) that raises potentially significant opportunities and concerns. Issues before this workgroup include: the parameters of state public health law for Article 28 facilities (e.g., general hospitals) and Article 36 providers (e.g., home care agencies), specifically in post-acute care management. The group is examining the roles and relationships that should govern hospitals and home care agencies – presently and in the evolving health system. This process will examine the regulatory structure for post-acute management, along with workgroup input on changes, if any, which are needed for better system alignment. HCA has for several years urged a collaborative effort to educate Performing Provider Systems (PPSs), hospitals, Accountable Care Organizations and other entities about opportunities for collaboration with home care and hospice to achieve system goals. We’ve urged DOH to conduct education expressing the clear criteria under which Article 36 applies to in-home services. We’ve also authored legislation creating public health law article 2805-x (aka, the state’s “HospitalHomecare-Physician Collaboration” law), for regulatory flexibility, waivers and reimbursement adjustments to support collaborative care. This year, Senator Hannon sponsored HCA-drafted legislation adding further specific criteria to the statute. This legislation, in conjunction with DOH implementation guidance, would enable extremely nimble and streamlined capability for home care agencies and hospital/group/clinic/independent physicians to partner in care models. As the state Legislative Session concluded, the Assembly felt that HCA and DOH should work on these changes through the existing provisions of 2805-x – an effort that is now underway. HCA’s proposals have resulted in multiple law changes providing avenues for regulatory flexibility and waivers. This includes the Delivery System Reform Incentive Payment (DSRIP) program waiver authority which resulted directly from HCA’s work with State Medicaid Director Jason Helgerson. Other legislation authored by HCA is also now the basis for work with DOH on innovation waivers for efficiency, staffing, access and quality, and more, based in large part on HCA’s surveys of members inviting input on areas for regulatory innovation. HCA again invites members to provide areas they would prioritize for state regulatory flexibility. Please write directly to acardillo@hcanys.org. High stakes – high implications for home care; statewide call to be scheduled The stakes for all providers could not be greater in this current DOH planning process. HCA will be scheduling a statewide call with the membership to discuss further details and developments, engage your involvement, and describe next steps to leverage the positive opportunities of this process. For further information, please contact Al Cardillo at acardillo@hcanys.org.
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PROBE from p. 1 (For details, please see the Home Health Probe and Educate website at: https://www.cms.gov/ResearchStatistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-Review/ Home_Health_Medical_Review_Update.html.) As part of its Probe-and-Educate audit process, CMS has instructed every home health Medicare Administrative Contractor (MAC) in the country to select a sample of 5 claims for pre-payment review from every agency within its jurisdiction. At the completion of round two of Probe-and-Educate, which CMS expects to end in September 2017, the MACs will begin what’s called a Home Health Targeted Probe and Educate (HHTPE). Rather than target all agencies, HHTPE will focus on specific agencies that have been identified, through data analysis, as being a potential risk to the Medicare trust fund or who vary significantly from their peers. This HHTPE effort is a probe review of 20 to 40 claims per round, for a total of up to three rounds of review. After each round, providers will be offered individualized education based on the results of their reviews. In addition to education at the conclusion of each 20-40 claim review, MACs may also educate agencies throughout the review process when easily resolved errors are identified, so that providers can avoid additional similar errors later in the probe. CMS’s website has a flowchart describing the process (https:// www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-CompliancePrograms/Medical-Review/Downloads/TPE-Pilot-Flow-chart06-20-17v9-final.pdf). Agencies with continued high error rates after three rounds may be referred to CMS for additional action, which could include: 100 percent prepay review; extrapolation; referral to a Recovery Audit Contractor (RAC); etc. Providers may be removed from the review process after any of the three rounds if they demonstrate low error rates or sufficient improvement in error rates, as determined by CMS. The program is set to begin in the fall of 2017. CMS does not state the threshold of denied claims from round two Probe and Educate that would place a provider in this new initiative. Nor do they define “low error rates or sufficient improvement in error rates” that would allow a provider to be removed from the initiative. HCA will update the membership as additional information becomes available. For further information, contact Patrick Conole at (518) 810-0661 or at pconole@hcanys.org.
OMIG and CMS Reach TPL Settlement on Pending Medicare Appeals According to an article in the state’s August Medicaid Update (https://www.health.ny.gov/health_care/ medicaid/program/update/2017/aug17_mu.pdf), the state Office of the Medicaid Inspector General (OMIG) is working with the U.S. Centers for Medicare and Medicaid Services (CMS) under a Settlement Conference Facilitation (SCF) pilot to overcome the significant delays in receiving Medicare coverage determinations for appeals filed as part of the Third Party Liability (TPL) process. The current backlog of appeals resides at the federal Office of Medicare Hearings and Appeals (OMHA) and the Medicare Appeals Council (Council). These appeals are submitted under a contract between OMIG and the University of Massachusetts Medical School (UMass) to maximize Medicare or TPL reimbursement for
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dual-eligible Medicare/Medicaid recipients. To help reduce the current backlog, CMS and OMIG have reached an agreement that will produce settlement payments to home health providers that have appeals pending at OMHA and Council. According to the Medicaid Update article, “The original pending appeals included in this agreement will be formally dismissed by Medicare, and settlement payments will commence directly to home health providers from the Medicare Administrative Contractor in September 2017. Due to the fact that all providers have been compensated in-full via the Medicaid payment, any Medicare payments received through this process are required to be returned to the state.” UMass will issue notification letters to all home health providers that receive a Medicare payment as a result of this settlement. These letters will contain detailed information, including instructions on remitting the settlement payment to OMIG. HCA members involved in the TPL project can also expect to receive a detailed letter from the Office of Medicare Hearings and Appeals entitled “Notice of Dismissal” which will inform you of agency-specific cases that are part of this settlement agreement between OMIG and CMS. For questions on this issue, please contact the UMass Medicare Appeals Team at 1-866-626-7594.
New Q&As, Plus Sept. 26 HCA-Member Call on Tokhtaman Court Case On September 26, from 1 to 2 p.m., HCA will be holding a members-only statewide call to provide updates and a review of the Tokhtaman v. Human Care court case, which has implications for the financial obligations of home care providers in paying aides for “24-hour, live-in” cases. The call will be led by legal experts at Jackson Lewis, the firm for HCA’s legal counsel. HCA has written extensively about the case in member alerts and in our newsletter, along with other cases that deal with similar questions about compensation for “24-hour, live-in” cases. To help clarify the procedural evolution of this case, and to answer some common inquiries from members, HCA has also prepared a new questions-and-answers document entitled “Q&As on Tokhtaman v. Human Care Court Case: Implications and Next Steps” (see http://hca-nys.org/wp-content/uploads/2017/08/ QAsTokhtamanCaseAug282017.pdf). We encourage you to read the document and share it with your legal counsel as a reference. Our statewide call on September 26 will address some of the recent developments in the case, provide an opportunity for you to ask additional questions, and discuss any further developments from the courts. To register for this free, members-only call, please complete the online form at https:// www.surveymonkey.com/r/Tokhtaman and HCA will send dial-in information to you in advance of the call.
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Final 2017 CHHA Pediatric Medicaid Rates Posted The state Department of Health (DOH) last week posted the 2017 final fee-for-service (FFS) “Hotline” Medicaid rates for non-hospital-based CHHAs that filed a properly certified, full-year 2015 cost report. (This should not be confused with the medically fragile children’s rate; HCA is advocating on the medically fragile children’s rate and a host of pediatric home care concerns.) These agency-specific rates should be used for patients who are exempt from the CHHA Episodic Payment System (EPS), such as pediatric patients. They are located in the “Rate Publication Selection List” drop-down under the date of August 24, 2017 on the Health Commerce System (HCS). DOH has also posted a corresponding Dear Administrator Letter (DAL). These rates, effective January 1, 2017, reflect a zero percent roll factor adjustment. They also include a 4.7 percent uniform percentage rate add-on payment for the Recruitment, Training & Retention (RT&R) funding (Section 3614.9) to qualifying providers for the period of January 1, 2017 through December 31, 2017 as well the 3 percent rate add-on for the RT&R funding (Section 3614.8) to qualifying providers (CHHAs who submitted a signed attestation) for the same time period. According to DOH, the statewide administrative and general (A&G) cap for CHHAs in 2017 is 27.11 percent. CHHAs have 30 days (from the receipt of the DAL) to file an appeal with DOH’s Bureau of Managed Long Term Care. However, the appeals process only applies in cases where the 2017 final rates have changed from the 2017 initial rates. For specific questions about your rates, contact DOH’s Division of Finance and Rate Setting at: bltcrch@health.ny.gov. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
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Update on Correcting ‘Hospice Compare’ Info The U.S. Centers for Medicare and Medicaid Services (CMS) has recently issued new guidance for hospice providers needing to update their demographic information (such as address, telephone number, and ownership) with their state ASPEN for purposes of Hospice Compare. (Please see: https://www.cms.gov/Medicare/QualityInitiatives-Patient-Assessment-Instruments/ Hospice-Quality-Reporting/Downloads/ Hospice-Compare-Update-8-24-17.pdf.) As reported in the August 21 edition of The Situation Report, organizational demographic information displayed on the Hospice Compare website has been incorrect for some hospices. HCA encourages all hospices in New York to review closely all of the information on CMS’s Hospice Compare website and to contact your CASPER/ASPEN and Regional Office coordinator if there are any errors that need to be corrected. Hospice Compare stems from a provision in the Affordable Care Act that required established procedures for making hospice quality data available to the public. The site provides a snapshot of the CMS-defined quality of care measures for each hospice facility. Consumers are able to search for all Medicare-approved hospice providers that serve their city or ZIP code and then find agencies, along with provider quality information. The Hospice Compare website also further explains the due dates for changes to demographic information. Please see: https://www.cms.gov/Medicare/QualityInitiatives-Patient-Assessment-Instruments/ Hospice-Quality-Reporting/Hospice-QualityPublic-Reporting.html. Continued on next page
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Continued from previous page HCA’s Senior and Financial Manager’s Retreat later this week will feature an in-depth session on national hospice updates, including issues related to Hospice Compare, as well as other crucial finance updates and insights for home care, hospice and MLTC. There’s still time to register. See: http://hcanys.org/wp-content/uploads/2017/08/HCA-Senior-Financial-Managers-Retreat-Brochure-2017.pdf.
HCA MLTC-PACE Summits and Advocacy Solutions Last week, HCA convened the second of two recent summits gathering our MLTC-PACE Forum members. The first summit was on July 19 in New York City, and a second session was held on August 22 in Rochester. The summits focused on issues of highest priority to MLTC-PACE programs and their provider networks, including reimbursement, the progression to value based payment (VBP), new state mandates and programs, data analysis, implementation concerns related to the Community First Choice Option (CFCO), new draft state guidelines on multiple areas, compliance and other issues. HCA will be working with the Forum to craft next steps. We’ve already reached out to DOH with proposals stemming from the summits, specifically related to VBP and CFCO implementation. We have also incorporated summit input into comments, now under DOH consideration, for two guidance drafts being formulated by DOH on: 1) hospice/MLTC billing, and 2) the transition of patients when plans withdraw from a service area. HCA participates on the main DOH steering committees for both VBP and CFCO, as well as on the MLTC clinical advisory group and VBP sub-workgroups. HCA and a small group of member plans and providers are working on an instructive document relating to quality alignment. This document will provide important technical and best practice information for plan-provider collaboration aimed toward mutual Five-Star quality. HCA will update the Forum and the membership broadly on the status of these efforts. HCA thanks our Forum co-chairs Marianne Grady of Empire Blue Cross Blue Shield and June Castle of VNA Homecare Options, as well as summit hosts Empire Blue Cross Blue Shield and iCircle MLTC (with special thanks to Vice President of Clinical Operations Debbie Litzenberger). For further information, please contact acardillo@hcanys.org.
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OMIG Posts Compliance Program Assessment Report and New Alert on Risk Assessments The state Office of the Medicaid Inspector General (OMIG) has posted two important updates related to compliance program planning by Medicaid providers. These include: 1) the results of “Compliance Program Assessments,” from January 2015 through June 30, 2017; and 2) a reminder that risk assessments, due to changes in Medicaid reimbursement systems, must be part of any compliance program required under New York State’s Medicaid program. Program Assessments OMIG’s “Compliance Program Assessment” report (https://omig.ny.gov/compliance/compliance-programassessment-results) shows the percentage of times that providers were observed by OMIG to be insufficient in meeting requirements under each of the eight elements of a mandatory compliance program. The results will be updated and posted annually on OMIG’s website. Some results are summarized below.
The most deficiencies observed were with respect to “Element 3: Training and Education.” OMIG noted that 55 percent of providers were deficient in demonstrating that required periodic training and education on compliance issues and expectations had been provided, and that in 47 percent of the cases reviewed, the provider could not demonstrate that compliance training had been provided as part of orientation.
Forty-seven percent of agencies were cited deficient in having a method for anonymous and confidential good-faith reporting of potential compliance issues for all of the following categories of affected individuals: employees; executives; governing body members; and persons associated with the provider.
Forty-four percent of agencies were deficient in having a policy of non-intimidation and nonretaliation for good-faith participation in the compliance program, including but not limited to reporting potential issues, investigating issues, self-evaluations, audits and remedial actions, and reporting to appropriate officials.
According to OMIG, the results can serve as a valuable tool for required providers to target areas of additional focus in self-assessing their compliance programs, operating their compliance programs, and developing compliance work plans and risk assessments. Other helpful resources on OMIG’s website are the Compliance Program Self-Assessment form (http://tinyurl.com/y7m8oqtr) and the Compliance Program Review Guidance (http://tinyurl.com/ybzz7tuu). The eight elements of a compliance program include: written policies and procedures; designating an employee vested with responsibility; training and education; lines of communication to the responsible compliance position; disciplinary policies to encourage good faith participation; a system for routine
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identification of compliance risk areas; a system for responding to compliance issues; and a policy of nonintimidation and non-retaliation. The provider’s compliance programs apply to: billings; payments; medical necessity and quality of care; governance; mandatory reporting; credentialing; and other risk areas that are or should be identified (with due diligence) by the provider. Any questions can be directed to OMIG’s Bureau of Compliance at (518) 408-0401 or compliance@omig.ny.gov. Compliance Alert: Risk Assessments Due to Changes in Medicaid Reimbursement System A recent OMIG Compliance Alert reminds Medicaid providers to consider how new and developing reimbursement program requirements may affect their compliance program risk assessment factors, processes and outcomes. OMIG reminds providers that risk assessments must be part of any compliance program required under New York State’s Medicaid program. New and developing Medicaid reimbursement and payment systems (e.g., capitation, value based payments, etc.) create the potential for additional program integrity concerns regarding Medicaid billing and payment. OMIG recommends that those risks be considered as part of an operating compliance program. The Alert states that in a fee-for-service environment, billing systems primarily track whether a covered, medically necessary service was: delivered, coded correctly, billed accurately and timely, and met established quality of care standards. OMIG encourages providers to closely review new reimbursement methodologies so they can identify where they may need to update risk-assessment activities. Furthermore, OMIG advises that risk assessments may need to expand beyond the integrity of the billing and payment process to include an assessment of the processes involved in the delivery of Medicaid reimbursable services. Questions can be directed to OMIG’s Bureau of Compliance at (518) 408-0401 or compliance@omig.ny.gov. HCA’s Corporate Compliance Program As noted in numerous communications, HCA will be holding its annual Corporate Compliance Symposium on October 19, in Albany. Rosemary McKenna, Principal at Jackson Lewis, will highlight “NYS Auditing Priorities: The Home Care Impact.” Her segment is just one of several expert sessions providing insights and updates to your leadership and compliance teams on the laws that impact your financial integrity, your audit vulnerability and your reputation. You can download the registration form at http://hca-nys.org/wp-content/uploads/2017/08/HCA-2017Corporate-Compliance-Brochure-and-Registration.pdf or register online at https://www.eventville.com/ Catalog/EventRegistration1.asp?EventId=1012248.
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Help for Texas in Hurricane Harvey Aftermath HCA President Joanne Cunningham this past week reached out to her counterpart at the Texas Association for Home Care and Hospice to determine what HCA and our members could do to assist with the devastating effects of Hurricane Harvey and the needs of home care providers in the relief effort. No specific home-care-related charity has been established, as of yet, for assisting patients or services. However, HCA Member Bayada Home Health Care, which has a national presence, has set up a donation site in conjunction with the American Red Cross at https://www.crowdrise.com/o/en/team/bayada-caresfor-texas/bayadahome-health-care. The following organizations have additionally been identified for charitable giving to assist our fellow citizens stricken by the flood. Please consider donating. HCA will let you know of any other assistance that can be provided. Texas Organizations
Houston Food Bank: https://www.charitynavigator.org/index.cfm?bay=search.summary&orgid=5673
Food Bank of Corpus Christi: https://www.charitynavigator.org/ index.cfm?bay=search.summary&orgid=8060
Houston Humane Society: https://www.charitynavigator.org/ index.cfm?bay=search.summary&orgid=5661
San Antonio Humane Society: https://www.charitynavigator.org/ index.cfm?bay=search.summary&orgid=6354
United Way of Greater Houston: https://www.bbb.org/houston/Charity-Reviews/charity-local/ united-way-of-greater-houston-in-houston-tx-60125
National Relief Organizations
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American Red Cross: http://www.give.org/charity-reviews/national/human-services/american-redcross-in-washington-dc-679
Americares: http://www.give.org/charity-reviews/national/relief-and-development/americaresfoundation-inc-in-stamford-ct-1739
Save the Children: http://www.give.org/charity-reviews/national/relief-and-development/save-thechildren-federation-in-fairfield-ct-893
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Gear Up for September Sepsis & Emergency Preparedness Month Outreach Important opportunities for home care outreach, planning, PR on sepsis and Emergency Preparedness September is Sepsis Awareness Month and Emergency Preparedness Month. HCA encourages members to use this time for outreach, planning and public relations on these critical areas. Sepsis Month In particular, if you have not yet adopted HCA’s innovative home care sepsis screening tool and protocol, please act now to do so. You’ll need to sign a user agreement for the tool. Simply e-mail sepsistool@hcanys.org for details. Now is also the perfect time to let your community and hospital partners know you are in the game on this priority public health problem in New York and nationally. Last week, HCA, IPRO and the National Sepsis Alliance conducted a statewide call with current users of the sepsis tool which provided excellent feedback on experiences. Later this month the state Department of Health (DOH) will be conducting a webinar to encourage all managed care plans in the state to explore the HCA sepsis tool for their value based payment planning and provider networks. HCA has also been working directly with State Health Commissioner Dr. Howard Zucker on joint work in sepsis intervention. HCA is a partner of the National Sepsis Alliance, the IPRO/CMS sepsis pilots in New York State, the Rory Staunton Foundation to Prevent Sepsis, the U.S. Centers for Disease Control and Prevention and others involved in the sepsis effort. Some links to their resources are below:
https://www.sepsis.org/ https://rorystauntonfoundationforsepsis.org/ https://ipro.org/qualitywatch/ipros-sepsis-awareness-training-schedule-in-place
Also, see IPRO’s spotlight on sepsis at http://hca-nys.org/wp-content/uploads/2017/09/TskSIP-SEPSIS-17-06SepsisSpotlt_6optimized.pdf. HCA encourages you to reach out to your staff and communities on sepsis, and to share with us your efforts and experiences! Emergency Preparedness for Home Care, Hospice and MLTC The tragic events in Texas remind us that emergency preparedness is a continuous activity focused on an all-hazards approach. During Emergency Preparedness Awareness Month, HCA encourages agencies to: review your preparedness plans; conduct outreach with local preparedness partners; and be sure to update your 24-hour and emergency preparedness contacts on the state’s Health Commerce System (HCS). Continued on next page
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Continued from previous page
Some education opportunities for your staff are below:
Regional Health Emergency Preparedness Coalition and Regional Training Center calendars: https://www.urmc.rochester.edu/emergency-preparedness.aspx.
Incident Command System (ICS) online training through FEMA (https://www.lanecc.edu/epal/icsfema-training). Every agency should encourage staff to participate in ICS training, which is available at a basic level, and at progressive levels of depth.
HCA daylong conference on preparedness essentials On September 27, HCA will be conducting a major emergency preparedness conference. Participants will have the opportunity to: discuss HCA’s work and planned initiatives in emergency preparedness; engage with state emergency preparedness leaders and trainers, asking critical questions and conveying important challenges in a town-hall format; delve further into the new federal Conditions of Participation; participate in tabletop exercises that will qualify for meeting state requirements; and other segments. Please register for this important meeting at http://hca-nys.org/wp-content/uploads/2017/08/HCA-EPEssentials-Program-Registration.pdf. Essential Personnel Status for Home Care and Hospice As previously reported, HCA and state legislative sponsors for home care-hospice emergency preparedness (Senator Andrew Lanza and Assemblyman Michael Cusick) worked diligently once again this year to secure unanimous legislative passage of HCA’s “Essential Personnel” bill (S5016-A/A6549-A). HCA engaged directly the Governor’s office to fashion amendments that we hope, this year, will secure the Governor’s signature on this bill. HCA still needs data from providers to demonstrate the need for this bill, specifically the number and extent of “Priority One” patients in home care. In July, HCA polled agencies for this data from your rosters. HCA thanks the agencies who participated; however, the agency response rate was far from adequate. HCA needs every home care provider within the membership to complete the survey. HCA’s alert with a link to the survey is at: http://campaign.r20.constantcontact.com/ render?m=1103899746204&ca=9a91382c-6784-4ad3-b39d-4e91b7f43e4d Please complete this survey immediately, today! For further information on sepsis or emergency preparedness, please contact acardillo@hcanys.org.
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CMS Launches Jimmo Settlement Agreement Webpage The U.S. Centers for Medicare and Medicaid Services (CMS) has launched a new webpage on the Jimmo Settlement Agreement. The website (https://www.cms.gov/Center/Special-Topic/Jimmo-Center.html) includes background on the settlement, links to resources, and Frequently Asked Questions (FAQs). The Jimmo Settlement Agreement (January 2013) clarified that Medicare covers skilled nursing and therapy services in home care and other settings when the care is needed in order to “maintain function” or to “prevent or slow decline or deterioration” (provided that all other coverage criteria are met). As extensively reported to the membership, this clarification is in response to a practice known as the so-called “improvement standard,” by which some Medicare contractors purportedly denied coverage to patients whose condition did not improve. The Jimmo case subsequently determined this “improvement standard” was contrary to regulations, and that coverage is permitted in order to maintain function or prevent decline in a patient’s condition, not just for cases where the patient’s condition improves. The Jimmo Settlement Agreement required manual revisions to restate this “maintenance coverage standard” for both skilled nursing and therapy services under these benefits:
Skilled nursing services would be covered where such skilled nursing services are necessary to maintain the patient’s current condition or prevent or slow further deterioration so long as the beneficiary requires skilled care for the services to be safely and effectively provided.
Skilled therapy services are covered when an individualized assessment of the patient’s clinical condition demonstrates that the specialized judgment, knowledge, and skills of a qualified therapist (“skilled care”) are necessary for the performance of a safe and effective maintenance program. Such a maintenance program to maintain the patient’s current condition or to prevent or slow further deterioration is covered so long as the beneficiary requires skilled care for the safe and effective performance of the program.
HCA is working to determine the implications of this most recent development for Medicare coverage of home care services.
DOH Working on New CDPAP Authorization Process In its August Medicaid Update, the state Department of Health (DOH) reported on a recently enacted new authorization process for entities operating as Fiscal Intermediaries (FIs) for the Consumer Directed Personal Assistance Program (CDPAP). The August Medicaid Update is at https://www.health.ny.gov/health_care/medicaid/program/update/2017/ index.htm. Continued on next page
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Continued from previous page
As reported to members in numerous communications, the legislature established a new authorization process for FIs aimed at improving oversight. The process also:
Defines the responsibilities of FIs and what they are not responsible for;
Grants DOH the authority to revoke, suspend, limit or annul an FI’s Authorization in the event the FI is found to be out of compliance; and
Provides FIs with the option to challenge determinations by DOH to revoke, suspend, limit or annul an FI’s Authorization.
HCA had provided feedback at different stages of the-then proposed authorization process (and a previously proposed certification process). We have asked for the opportunity to provide input into the development of the new authorization process. We have also established an internal CDPAP workgroup to discuss issues that impact our FI members and ways to address them. These new provisions are effective April 1, 2017; however, legislation has been passed by the Senate and Assembly that would delay the effective date until January 1, 2018. Further, the bill also allows some existing entities more time (one year, or until January 1, 2019) to become authorized if they were operating as an FI prior to April 1. This bill has yet to be delivered to the Governor for action. Meanwhile, DOH continues to move forward with the creation of the new FI Authorization process. Once a timeline for implementation is complete, DOH will provide more detailed information which HCA will report to the membership, including updates to the process should the Governor sign into law the bill amending the FI authorization process and timetable. Questions or comments regarding the FI Authorization process can be sent to FIAuthorization@health.ny.gov (please copy Andrew Koski at akoski@hcanys.org). CDPAP FI Session at Corporate Compliance Symposium At HCA’s Corporate Compliance Symposium, on October 19, state officials will provide further information about the state’s plan to implement the new authorization process for FIs, along with other priority areas of DOH compliance focus that impact CDPAP. The session, “Avoiding Compliance Pitfalls for Fiscal Intermediaries under CDPAP,” will be led by Eric Henderson, DOH’s Deputy Director for the Division of Long Term Care, and Karis Browder, Long Term Care Service Specialist II, Division of Long Term Care. Please join us for this segment and others at the Symposium by registering at the links below.
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Download the brochure: http://hca-nys.org/wp-content/uploads/2017/08/HCA-2017-CorporateCompliance-Brochure-and-Registration.pdf.
Register online: https://www.eventville.com/Catalog/EventRegistration1.asp?EventId=1012248.
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HCA Summer Roadshow Drew Focus on Issues of Most Concern to Members Over the summer, HCA held a series of “Ask HCA” Road Show sessions where we visited 10 cities throughout the state to hear from members. We thank members who took time out of their busy schedules to participate and meet with HCA staff over a meal to ask questions and hold an informal discussion of issues that are keeping you up at night. We’ve collected a great list of issue areas that HCA will continue to work on and address, based on your input. As a whole, these issues included: audits and surveys; workforce shortages; the Medicare and Medicaid faceto-face rules; your experiences with the Delivery System Reform Incentive Payment program and Value Based Payments; the upcoming federal Conditions of Participation changes; coordination between home care and managed care; emergency preparedness; specific questions about court rulings related to payments for 24-hour, live-in cases (see related p. 7 story); and more. HCA hopes you found value in these regional meetings throughout every part of the state and we plan to conduct them again sometime next year. If you have any feedback on the meetings or want to follow up on some of the issues discussed, please don’t hesitate to e-mail any of the HCA staff at the addresses on our masthead (p. 2).
DOH Revises Transportation Assistance Levels The state Department of Health (DOH) has revised the Transportation Assistance Levels (TALs) “to further streamline and coordinate evacuations statewide.” The TALs classifications are used by health care professionals to assess the type of transportation resources needed by each patient/resident at a facility (including the home) during a planned evacuation. TALs are not intended for use during an emergent situation such as a fire. HCA has arranged for DOH Office of Health Emergency Preparedness officials to address participants at HCA’s September 27 conference on Home Care and Hospice Emergency Preparedness Essentials conference and will offer the opportunity for questions and answers on these changes to the TALs. Non-ambulatory (TAL 1) has been sub-categorized to include the following types of ambulance transport resources (the gurney icon is used for all three):
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Non-ambulatory-Stretcher. Clinically unable to be moved in a seated position, and may require equipment including but not limited to oxygen, cardiac monitors, or other biomedical devices to accompany them during movement.
Non-ambulatory-Vent. Clinically unable to be moved in a seated position, and require equipment including but not limited to mechanical ventilators, oxygen, cardiac monitors, or other biomedical devices to accompany them during movement. Continued on next page
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Non-ambulatory-Bariatric. Clinically unable to be moved in a seated position, and may require equipment including but not limited to oxygen, mechanical ventilators, cardiac monitors, or other biomedical devices to accompany them during movement. These patients/residents require transportation using a wider stretcher.
Wheelchair (TAL 2) has been revised to reflect the Bureau of Emergency Medical Services (BEMS) policy regarding transport of individuals with intravenous infusion lines:
Intravenous infusion lines should be converted to saline locks or discontinued for transport. These patients/residents may be escorted by a non-clinical staff member.
Patients/residents with a continued IV infusion must be escorted by a nurse or paramedic during transport.
Ambulatory (TAL 3). There have been no changes for this TAL.
Stakeholder Meetings to be Held on Integrated Care The state Department of Health (DOH), along with the U.S. Centers for Medicare & Medicaid Services (CMS), will start a stakeholder process to review the future of integrated care for New York’s dual-eligibles. These will be follow up meetings held after a stakeholder meeting was convened in July where presentations were made on the value of integrating Medicare and Medicaid services and what is occurring in other states. The Future of Integrated Care Stakeholder Workgroup will meet four times over the next few months. Stakeholders can participate in person or via webinar/conference call. Below is the schedule of meetings and the topics to be addressed.
September 7, 2017, 11:30 a.m. to 2 p.m. (Albany). Topics include: Target Population; Covered Services; Care Coordination/Care Management Elements, Assessment and Service Planning Requirements.
October 16, 2017, 11:30 a.m. to 2 p.m. (New York City). Topics include: Network Adequacy and Access; Participant Rights and Protections; Marketing Rules and Flexibilities; Quality Standards and Measures.
November 16, 2017, 11:30 a.m. to 2 p.m. (Albany or Rochester, location to be announced). Topics include: Payment and Rate Considerations; Outreach, Education, and Engagement of Participants and Providers; MCO/Plan Requirements and Qualifications; Enrollment.
December 8, 2017, 11:30 a.m. to 2 p.m. (New York City). Topics include: Geographic Scope; Consolidation of Existing Programs; Platform for Integrating with Medicare; Considerations for Transition. Continued on next page
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Continued from previous page HCA has been actively involved in discussions on the future of integrated care and will continue to advocate for approaches that improve care for consumers, but don’t create regulatory barriers and burdens for plans and providers. To attend in person, RSVP to FutureofIntegratedCare@health.ny.gov. To participate via webinar, go to: https:// www.health.ny.gov/events/webcasts/.
DOH Issues Home Care & Hospice Guidance on Invasive Infections Caused by the Multidrug-Resistant Yeast Candida auris The state Department of Health (DOH) has released guidance for the prevention and control of the multidrugresistant yeast Candida auris (C. auris) among patients in home health care and hospice. The document is available at http://hca-nys.org/wp-content/uploads/2017/08/Candida-auris_guidance_082317.pdf. As previously reported to the membership, C. auris is a fungal infection that has become increasingly resistant to treatments, causing severe illness in patients who have serious underlying medical conditions. Cases of C. auris in New York are primarily concentrated among hospital patients and nursing home residents in New York City; however, the guidance has been developed for home care and hospice providers in the event C. auris is encountered in the community. It includes: links to three DOH Health Advisories regarding C. auris; infection prevention and control recommendations for home health and hospice personnel; patient/ family education suggestions; and links to reference materials. The home care and hospice guidance references a U.S. Centers for Disease Control and Prevention (CDC) Clinical Alert issued in June 2016 that includes the following information:
Reports from health care facilities outside the U.S. indicate that C. auris is causing healthcareassociated infections with high mortality and that C. auris has a high potential to cause outbreaks in health care facilities.
Infections caused by C. auris often do not respond to commonly used antifungal drugs, making them difficult to treat.
Patients who have long stays in intensive care units or who have central venous catheters or other indwelling devices, and who have previously received antibiotics or antifungal medications, appear to be at highest risk of infection.
Specialized laboratory methods are needed to accurately identify C. auris.
As of August 18, 2017, DOH reports the New York State case count is as follows:
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C. auris clinical case count: 78. This group includes individuals who were ill and had C. auris detected during their clinical care.
C. auris screening case count: 72. This group includes individuals who were not ill from C. auris and were tested specifically for C. auris as part of a public health investigation.
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Continued from previous page Note: one individual is reflected above as both a screening case and a clinical case based on a Council of State and Territorial Epidemiologists (CSTE) definition. Questions can be directed to the HCA Policy staff or DOH at icp@health.ny.gov.
VBP University Semester 2 Launched The state Department of Health (DOH) has announced the launch of Value Based Payment (VBP) University Semester 2. VBP University is an online, educational resource created to raise awareness, knowledge and expertise in the move to VBP. It combines informational videos and supplemental materials that stakeholders interested in VBP can use to advance their understanding of this model.
Semester One
Date of Release Released in July 2017
Semester Two
August 2017-Now Live!
Semester Three Semester Four**
September 2017 October and November 2017**
Area of Study Background and foundational information on VBP Topic specific information such as governance, business strategy, stakeholder engagement, finance, and data VBP Contracting VBP Bootcamps**
**VBP Bootcamps will take place in October and November 2017 in locations throughout the state. More information including dates and locations will be distributed shortly. To watch an overview of the VBP University curriculum from NYS Medicaid Director, Jason Helgerson, go to: http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/vbp_u/docs/vbpu_welco me_overview.mp4.
Semester 2 Overview Semester 2 is designed to educate users on specific, important topic areas in the move to VBP, including governance, stakeholder engagement, business strategy, finance, and data. The curriculum for semester 2 includes videos on each of the topics as well as detailed guidance documents targeted towards Primary Care Physicians, Behavioral Health Providers, and Community Based Organizations. Semester 2 also includes VBP arrangement fact sheets to serve as a continuation of the arrangements curriculum in Semester 1. The fact sheets provide an overview of each of the state VBP arrangements,
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including the types of care included in the arrangement, the method used to define the attributed population for the arrangement, calculation of associated costs under the arrangement, and the quality measures recommended for use in the arrangement. To view semesters one and two of VBP University, visit www.health.ny.gov/VBP. The schedule and details for the semesters of VBP University are as follows: Graduation from VBP University Semesters one through three conclude with a quiz on the topics covered. Those who pass all three quizzes with grades of 80 percent or higher will receive a certificate of completion. You may take the quiz multiple times until you pass. Results are automatically sent to DOH. Any questions can be sent to MRTUpdates@health.ny.gov.
Governor Signs Two Hospice Bills; Two More Await Action HCA advocacy continues on DOH hospice/MLTC billing guidance As announced in a member alert on August 24, Governor Cuomo recently signed two bills related to hospice. These include:
S.6347 (Hannon)/A.7846 (Gottfried), which adds hospice to the list of providers who may offer provisional employment while a criminal background check is pending, and makes technical changes related to the criminal background check law for hospice. HCA was pleased to support this legislation and the state Hospice Association in securing its enactment.
S.6364 (Hannon)/A.7775 (Gottfried)-A authorizes, upon approval of the commissioner of health, a hospice residence to have up to 50 percent of its resident capacity be dually certified hospice inpatient beds. Similarly, HCA was pleased to support the efforts to secure the enactment of this legislation.
Two additional bills of benefit to hospice passed the legislature this year but still await the Governor’s “call” for delivery to his desk for action. These include:
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S.5016-A (Lanza) and A.6549-A (Cusick), providing for hospice and home care input into local emergency management plans, including input for hospice and home care personnel to obtain essential access to their patients in emergencies. This is a bill which HCA initiated and has resolutely worked to enact for the past several years. In addition to our close work with the sponsors, HCA engaged with the Governor’s office to shape amendments to hopefully secure the Governor’s approval.
S.5662-A (Valesky) and A.6408-A (Dinowitz), which updates hospice residence reimbursement to include an efficiency factor that adjusts hospice rates to reflect nursing home rates for the managed long term care nursing home reimbursement region in which the hospice is located.
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HCA was pleased to lend strong support for the enactment of this bill shaped by HCA’s Government Relations team at Hinman Straub. Hospice/MLTC Billing During the past budget session, the Governor proposed new language to enforce state/federal policy prohibiting Medicaid coverage of hospice services that are covered by Medicare. HCA strongly opposed, and the Legislature rejected, this proposal. Our concerns centered on what the new procedures might entail and how they might affect patients, MLTCs and hospices. HCA was specifically concerned about the proposal’s potential to create new provider burdens as well as a chilling effect on collaborative care between hospice, MLTC and other partners. In the budget aftermath, DOH has proceeded administratively to implement new enforcement, preparing draft guidelines on hospice billing for both MLTCs and providers, including notice of audit following implementation. HCA provided substantial feedback on initial drafts of this guidance issued earlier in the summer, leading to major draft revisions recently compiled and shared by the Department for further input. While the matter is progressing substantially, HCA remains concerned about provisions in the draft that risk problems for patients, hospice and MLTCs. In particular, we are concerned regarding the delineation of services and billing that will be permitted for the two entities, especially the potential subjectivity in interpretation and audit. HCA will be seeking to engage DOH on language that does not compromise the good-faith delivery of joint hospice-MLTC care.
TBI Waiver Renewal Approved by CMS Last week, the state Department of Health (DOH) announced that the U.S. Centers for Medicare and Medicaid Services (CMS) has approved its request to renew the Traumatic Brain Injury (TBI) program, effective September 1, 2017. DOH’s current plan is to break things out into program components and to review and discuss the following issues with all stakeholders via webinar:
Changes in the application content and how it will impact participants and providers. This will include discussions about the UAS-NY and “alternate route” provisions and best mechanisms to review upcoming system changes with participants.
Criteria for implementation of the firewalls and compliance needed to meet Conflict of Interest (COI) standards.
Rates and cost reporting.
Quality improvement and audit functions.
Additionally, the TBI Housing Program Manual and the General Program Manuals for the Nursing Home Transition and Diversion (NHTD) and TBI waivers will all need amendments. Continued on next page
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Continued from previous page DOH hopes to have its first webinar in early September and intends to post the approved TBI application as soon as possible. Questions regarding the TBI waiver may be sent to tbi@health.ny.gov. NHTD Waiver The NHTD waiver remains on temporary extension until October 19, 2017 and the application for renewal is pending formal submission. Questions regarding the NHTD waiver may be directed to: NHTDwaiver@health.ny.gov.
Resources
“Private Duty Nursing Manual Prior Approval Guidelines (updated in August 2017),” eMedNY https://www.emedny.org/ProviderManuals/NursingServices/index.aspx
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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