October 6, 2017 Edition of the Situation Report

UPCOMING CONFERENCES

MLTC MARKET CHANGES

BILLING CODES

Check out the full list of conferences, workshops, forums and other events that HCA has in store for the remainder of 2017, and register today!

State develops guidance on enrollee transitions, premium changes in event of MLTC market shifts.

The state has issued the final uniform billing codes for home care services under managed care, required for use by Jan. 1.

Registration is still open for HCA’s October 19 Compliance Symposium.

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COMING UP Corporate Compliance Symposium Oct. 19, 2017 Albany Blueprint for OASIS Accuracy OASIS C-2 Oct. 23 & 24 (Workshop) Oct. 25 (Optional COS-C exam) NYC Quality & Technology Symposium Nov. 16 & 17 Suffern The Second Annual Women in Health Care Leadership Summit Dec. 7 & 8 Saratoga Springs

 Note: HCA's offices are closed on Oct. 9 for Columbus Day and will reopen on Oct. 10.

Your Source for HOME CARE News, Policy and Advocacy

COMPLIANCE SYMPOSIUM

Vol. 2, Issue 36 | October 6, 2017

Breaking: HCA Learns of House Bill to Codify HHGM Payment Cuts Look for more details, confirmation and analysis next week

SPECIAL FRIDAY EDITION

HCA late today received word from staff within the U.S. House Ways and Means Committee about draft legislation that – if introduced in the form conveyed from our briefing – would be disastrous for home health services, by codifying the Home Health Groupings Model (HHGM) legislatively.

HCA is analyzing the proposal as it has been communicated to us and will provide details as soon as possible. We stress, however, that further conversations with Congressional staffers are needed to confirm the exact provisions, and the following information is very cursory in nature. The bill, as explained to HCA, could be introduced See HHGM p. 2

HCA & Association Partners Coalesce to Seek Urgent Clarity, Relief on 24-hour/live-in Cases Stemming from Court Rulings State DOL emergency regulation reportedly in the works, establishing 13-hour standard HCA and partners continued to engage vigorously throughout the past week with state officials at all levels as we collectively seek an urgently needed solution on the status of 24-hour/live-in home care services that remain in limbo as a result of recent Appellate Division court rulings.

See PARTNERS p. 3

INSIDE HCA Learns of House Bill to Codify HHGM Payment Cuts.....................................1 HCA & Association Partners Act on 24-hour/live-in Issue.................................…1 Member Hiring Announcements.......................................................................3 QAPI CoPs, Clinician Seminar and More at Nov. 16-17 Symposium….....................4 VBP Steering Committee Reports Latest Developments.....................................5 Valuable HHQI Webinar to Support VBP Efforts...................................................6 Upcoming HCA Conferences, Forums and Events..........................................7-8 MLTC Market Changes Prompt State Guidance...................................................9 Upcoming Deadlines....................................................................................10

Universal Billing Codes Required for Managed Care Home Care Services..........11 Managed Care Home Care Contractors Must be Enrolled in Medicaid...................11 HCA Extends Registration Deadline for Oct. 19 Compliance Symposium.................12 DOH Posts Influenza Surveillance and Reporting Requirements............................12 OIG Reports Many Hospice Election Statements Lack Required Information.........13 CMS Issues Hospice Compare Fact Sheet................................................................14 Registration is Open for the VBP Bootcamp in Lake Placid......................................14 New VBP Video Posted........................................................................................15 Webinar on TBI Waiver Renewal to be Held..........................................................15 Resources..........................................................................................................16

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

Volume 2, No. 36 October 6, 2017 

HHGM from p. 1 soon. Reportedly, it would codify and start the implementation of HHGM in 2020 (with a phase-in over three years), utilizing the model as presented by the U.S. Centers for Medicare and Medicaid Services (CMS) in its 2018 Home Health Prospective Payment System (HHPPS) rule proposal.

As extensively reported to the membership, the CMS-proposed HHGM calls for cuts of nearly $1 billion to home care services nationally, in large part by changing the unit of reimbursement from a 60-day episode to a 30-day increment that would be paid at different levels using a whole new set of complex scoring factors.

HCA has opposed this new model and called for CMS to reject HHGM from its 2018 HHPPS for a variety of reasons as spelled out in our comments to CMS (http://hca-nys.org/letters-and-comments/hca-comments-on-2018hhpps-with-focus-on-hhgm-payment-cuts) and a position paper to Congress (http://hca-nys.org/wp-content/uploads/2017/09/Reject-DrasticNew-HHGM-Payment-System-for-Home-Care.pdf). We are, therefore, extremely troubled by reports that a version of CMS’s proposal is now being considered in a legislative maneuver to codify HHGM separately from the CMS rulemaking process.

According to our briefing from Congress, the large majority of savings from this HHGM proposal would be used to pay for tax cuts. HCA believes this is an irresponsible maneuver to leverage funds for such purposes.

Congressional staff have also indicated that the bill intends to use some of the savings to extend the home health rural add-on for five years (it expired on January 1, 2016). However, a bipartisan plan was already in the works in both houses to do so, thus subjecting the home care industry to destabilizing cuts under HHGM while using the rural add-on as a token justification despite the fact that a funding mechanism was already under consideration separate from this bill.

While HCA has called upon Congress to extend the rural add-on in the past to address disparities in service delivery, this extension should be addressed without payment cuts elsewhere in the home care reimbursement methodology – in this case, in the form of an untested HHGM model that would otherwise decimate access to services.

Please stay tuned for further information and analysis as we learn more and work to confirm the status of these proposals. HCA has already reached out to New York’s Congressional Delegation directly and through our federal government affairs representatives. Please also be on the lookout for advocacy action items as we learn more.

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

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

Volume 2, No. 36 October 6, 2017 

PARTNERS from p. 1 On Thursday, the leadership of HCA, the New York State Association of Health Care Providers, LeadingAge New York, and our respective legislative affairs and legal representatives met to coordinate our advocacy actions. These actions include our calls for: a state Medicaid funding mechanism to cover any potential cost liabilities (retrospective and prospective) being propelled by the court decisions; an emergency regulation to resolve the disjunction in state regulations/guidance that remains at issue in the court cases; and our involvement in next steps on potential legal avenues, including an amicus brief that is in development.

Chief Financial Executive Oneonta, New York Bassett Healthcare Network: At Home Care, Inc. (AHC), a nationally recognized and progressive Medicare Certified Home Health Care agency, seeks to hire an executive level financial leader.

Operating across five predominantly rural counties in Central NY, AHC is an integral healthcare network partner. With a data driven integrated financial and clinical leadership approach, the individual will be responsible for planning, oversight and directing all fiscal operations of the organization.

Candidate Qualifications x Experienced home health financial leader with McKesson Horizon IS experience, preferred x MS Office and accounting software experience required x A clear and concise communicator, written and oral x Education: bachelor’s degree in accounting or finance required; Masters or CPA, preferred

Throughout the day on Friday, HCA heard reports of the state soon issuing a possible emergency regulation affirming the 2010 “13hour” standard for compensation of 24-hour/ live-in cases. As of the editorial deadline for today’s edition of The Situation Report, however, no regulation had been issued, though HCA is monitoring developments after press time and will immediately inform the membership via e-mail alert of any updates.

HCA has written extensively about the three court cases surrounding 24-hour/live-in services and we recently gathered members for a statewide call, on September 26, to provide a detailed briefing on their implications. Two of these cases (Andryeyeva v. New York Health Care, Inc. and Moreno v. Future Care Health Servs., Inc.) upheld lower court rulings, and one (Tokhtaman v. Human Care, LLC) rejected a lower court ruling. All three, however, reached similar conclusions about the conflict between a state Department of Labor (DOL) “opinion letter” and DOL’s own underlying regulations pertaining to 24-hour/live-in cases.

In effect, the courts have ruled that DOL’s guidance stipulating a 13-hour standard for live-in

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Competitive salary and benefit package offered.

For more information, or to submit a CV in confidence, please direct to: Patricia Brown, Director HR; 25 Elm Street, Oneonta NY 13820 Or, E-mail: pbrown@ahcnys.org

SEEKING ASSISTANT DIRECTOR OF HOME CARE New York, NY 10018 Responsible for managing the day-to-day Home Care operation for NY City-based not-for-profit organization. Provides direct supervision of the Service Manager and In-take Department. This includes ensuring that the quality and quantity of service provided is consistent with agency mission, policies, and goals, plus compliance with all relevant government regulations.

WHY WORK FOR US? JASA is a challenging and rewarding place in which to work.

Professional employment possibilities are available to those who have the requisite skills, experience, and commitment to our essential mission. In addition to a competitive salary, JASA offers a comprehensive benefits package to its full-time and regular parttime employees. This includes major medical, dental, and life insurance; 401k tax-deferred savings plan; flexible spending account; pre-tax transit; and a generous leave policy.

CHECK OUR WEBSITE FOR THE FULL JOB DESCRIPTION FOR THIS POSITION http://www.jasa.org/careers HOW TO APPLY Email résumé and cover letter to: jobs@jasa.org.

Indicate Assistant Director - Home Care - Manhattan in subject line.

SUBJECT TO REVIEW FOR PURPOSES OF ADAAA JASA is committed to Equal Opportunity Employment

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

workers – which providers have followed in goodfaith, based on a 2010 DOL opinion letter – is in conflict with its actual regulation language. The courts have, thus, determined that, based on the regulation language itself, non-residential aides should be paid the minimum wage for all 24 hours of their shifts, regardless of whether they were afforded 8 hours for sleep (including 5 hours of uninterrupted sleep time) and three hours for meals (aka, “13-hour rule”).

The cases open up major exposure for massive wage liabilities that can go back six years. In communications with DOL, the state Department of Health (DOH) and the Governor’s office, HCA has stressed the gravity of this issue, urging an immediate, emergency action that: 1) protects providers, plans, workers and patients in the form of either fully protective guidance or reimbursement to compensate workers and hours commensurate with the court’s ruling, while the case is adjudicated; and 2) regulatory clarification affirming DOL’s own interpretive guidance, both retroactive and prospective.

The Governor’s office and departments of jurisdiction are reportedly engaged at high levels on this issue as recent media reports have laid bare the regulatory and funding questions complicated by the cases, as well as concerns about provider financial viability to maintain 24-hour/live-in services and patient ability to live at home with 24hour care or face institutionalization. Please see HCA’s recent Home Care News clips for article links, including our October 4 distribution at https:/ /app.meltwater.com/api/public/newsletters/ 571e2811d2524440bfeeea68/newsletter/ distribution/59d281e6fed90f423c4a2292/html.

Other recent articles are at http://hca-nys.org/ category/hca-in-the-news.

HCA will immediately inform the membership of any critical developments on this urgent issue as we continue to press for expeditious state action.

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Volume 2, No. 36 October 6, 2017 

QAPI CoPs, Clinician “Roadmap to Sanity” Among 10 Hot Topics at HCA Quality & Tech Symposium: Nov. 16-17 HCA’s upcoming Quality and Technology Symposium, on November 16 & 17 in Suffern, NY, is our signature conference geared for home care clinical managers, directors of patient services, quality improvement officers and strategic planners, including the executive teams at your organization who need to think big about the many quality and technology imperatives in home care.

BK Health Care Consulting chief Barbara Katz got rave reviews for her segment at one of HCA’s value-based payment programs last year, and we are thrilled to tap her unique expertise again for two exceptional sessions on November 16 and 17: 

An interactive seminar on clinician time and taskmanagement to help you “climb out of chaos” and gain a “roadmap to sanity” while juggling constant change and running an effective operation; plus



A segment on what is perhaps the biggest hot-topic in quality of care: meeting the new Conditions of Participation (CoPs) for implementing a Quality Assurance/Quality Improvement (QAPI) program.

These are just two of the ten sessions packed into this comprehensive program, which opens on November 16 with stage-setting by state Department

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Volume 2, No. 36 October 6, 2017 

of Health officials revealing all the state’s focus areas and directions in the quality arena.

You’ll also learn about “disruptive technologies” and other new competitive forces in the delivery of consumer-driven models of care that providers need to adjust to and be mindful of. State regulatory officials will discuss the evolving “advanced home health aide” (AHHA) designation, with important insights about the quality-of-care procedures that providers must consider in deploying and overseeing AHHA services. Plus, hear case studies on the use of disease-management platforms; how to integrate behavioral health into chronic care; insights for community-based sepsis interventions; the quality and value proposition for palliative care integration; and best-practices for quality managers.

Learn more by downloading the full brochure below, and register today online, by fax or by e-mail.

Download the brochure at http://hca-nys.org/wp-content/uploads/2017/10/2017-Quality-and-TechnologySymposium-Brochure.pdf.

Register online at https://www.eventville.com/Catalog/EventRegistration1.asp?EventId=1012269.

VBP Steering Committee Reports Latest Developments The state’s value based payment (VBP) steering committee, on which HCA is a member, this week discussed the latest developments in the state’s move to a statewide VBP model, as summarized below.

Pediatrics The committee discussed recommendations for children’s health quality measures. HCA noted that clinical effectiveness in some of these measures rests on broader familial and/or environmental factors, beyond those capable of being addressed in the pediatrician’s office alone. HCA suggested that these speak to the importance of collaborative interventions inclusive of home care and behavioral health working in conjunction with pediatricians in VBP. The committee was also presented with prospects for subcapitated payments to pediatricians to cover the array of child health services. HCA prompted clarification that such services within the capitated rate would be those provided by a pediatrician (and not also a currently separately paid collaborating provider, such as home care).

While the agenda focused on primary care-related services for children, HCA also brought to the discussion the significant issues and needs in servicing medically fragile children at home. HCA stressed that solutions and supports are needed now for these providers and children. HCA has been pressing DOH on critical issues in pediatric home care, including sustainable reimbursement rates, and barriers occurring in schools for children needing access to their home care nurses during school hours.

MLTC VBP The committee heard updates on the quality measures and contract template for VBP under MLTC. HCA asked DOH to report on its methodology for determining baseline versus performance period measurements for MLTC VBP. DOH indicated that it will be compiling and comparing key metrics (derived

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

primarily from data in the Statewide Planning and Research Cooperative System, or SPARCS, on potentially avoidable hospitalizations) on a per-plan, per-provider basis. HCA asked that this performance data be shared with both plans and providers.

On the contract template, DOH reported that it is currently being finalized with consideration of input from MLTC stakeholders, including HCA. (HCA provided background for the membership on this template in the last edition of The Situation Report.) DOH emphasized that the template is designed for MLTC/provider Level I VBP arrangements, and is intended as an option for MLTC and provider use. HCA will alert and guide plans and providers as soon as this template is released.

HCA acknowledged the help and usefulness that the template should provide to MLTCs and providers in the very tight timeframe to meet the DOH January 1 VBP mandate. HCA also reiterated our recommendation for additional guidance that could help point plans and providers to practices and service strategies conducive of VBP performance targets.

VBP Bootcamps DOH announced a new round of VBP bootcamps for plans and providers. (See related p. 13 story.) These bootcamps are planned across the state and begin as soon as October 10 in Albany and October 18 in New York City.

Please see the meeting slide deck at http://hcanys.org/wp-content/uploads/2017/10/VBP-Work-GroupPresentation-10022017-Final.pdf. It covers additional important issues discussed at the committee meeting, including DOH survey results on MLTC VBP “readiness.”

For additional information, please contact acardillo@hcanys.org.

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Volume 2, No. 36 October 6, 2017 

Valuable HHQI Webinar to Support VBP Efforts On October 19, from 2 to 3 p.m., please join the Home Health Quality Improvement (HHQI) National Campaign for its October Underserved Population webinar with guest expert Debra Cherry, BA, MA, PhD, Executive Vice President of the Greater Los Angeles Alzheimer’s Association, presenting Creating Dementia-Capable Systems of Healthcare. The learning objectives are: 

Identify two key indicators of a dementia-capable system.



Describe why community partnerships are beneficial for successful dementia-capable systems of health care.



Identify two ideas to begin to improve clinical training to care for patients/families with dementia.

This activity is pending approval of 1.5 hours of continuing education (CE) credit from the Alabama State Nurses Association—an accredited approver of nursing continuing education through the American Nurses Credentialing Center’s Commission on Accreditation (ANCC)—and the National Association of Social Workers (NASW).

To receive CE credit, participants must watch the 60-minute webinar and complete an additional 30 minutes of related coursework in HHQI University.

Learn more or register now at http:// homehealthquality.org/UP/Oct-2017.aspx.

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

Volume 2, No. 36 October 6, 2017 ď Žď€

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/eventseducation/upcoming-events.

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, 2017 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, problem-solving discussions and application scenarios, participants will achieve mastery of the OASIS items, conventions and the latest data collection rules.

Continued on next page

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Volume 2, No. 36 October 6, 2017 

Continued from previous page 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 twenty 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.

Quality & T echnology Symposium Technology November 16 & 17 Suffern, NY

To be truly effective, all health care quality programs must embrace innovative technological solutions for achieving process improvements, data sharing, and communication capabilities that drive improvements in patient care, analytics and oversight. Health care technologies, for their part, are only useful to the extent that they support the quality of care that you deliver to patients – which is the lifeblood of your overall mission and a marker of your agency’s reputability and viability in an increasingly competitive health care marketplace.

HCA’s signature Quality and Technology Symposium, on November 16 and 17, is designed for home care clinical managers, Directors of Patient Services, quality improvement officers, and other strategic planners (including the leadership executives at your agency) who need to know the latest trends, policy developments, quality program requirements, and technological opportunity areas to fulfill your mission at this fundamental intersection of quality and technology in the home care, managed care and hospice arenas.

The Second Annual Women in Healthcare Leadership Summit Own Your Voice: Leading with Strength, Certainty & Style December 7 & 8 Saratoga Springs, NY

Building on the success of last year’s inaugural program, HCA is excited to present the second annual Women in Healthcare Leadership Summit on December 7-8 to help women leaders from across the health care spectrum cultivate their unique talents and strengths as leaders. Hear from women executives, leadership consultants and other engaging presenters who will help you leverage tools and insights for professional advancement, enhance your potential for leadership growth, and further develop your talents as women leaders in health care.

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

Volume 2, No. 36 October 6, 2017 

MLTC Market Changes Prompt State Guidance Changes in the MLTC market have prompted state policy responses to concerns about patient, plan and provider needs and protocols associated with shifting enrollment and service.

These policy responses include guidance related to enrollment transfers, absorption of care requirements, continuity-of-care obligations and adjustments for financial impact (see the “transition” guidance below).

Northwell Withdrawal from MLTC The most recent announced market shift involves a decision by Northwell LIJ Health Plan to no longer participate in the MLTC program as of January 1, 2018. Notices of the plan’s withdrawal have been sent to the plan’s 5,645 enrollees in Nassau, Suffolk and New York City.

The plan’s members have been advised that they can enroll into Centers Plan for Healthy Living or choose another plan; and if they have not chosen a plan by November 10, members will be auto-enrolled in Centers Plan for Healthy Living effective December 1, 2017.

Standardized Transition Guidance Changes at Northwell, the ongoing GuildNet and Elderplan transitions, and any prospective transitions will be subject to newly developed state guidance and procedures standardizing this process. (See https:// www.health.ny.gov/health_care/medicaid/redesign/mrt90/mltc_policy/17-02.htm.)

The policy applies to plans and enrollees affected by involuntary transition from one MLTC plan to another MLTC plan, as the result of: a plan closure; a plan’s service area reduction or withdrawal; or a merger, acquisition or other arrangement approved by the state Department of Health (DOH). This includes Partially Capitated plans, Programs of All-Inclusive Care for the Elderly (PACE), and Medicaid Advantage Plus (MAP) plans.

According to the guidance:

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

Requests to withdraw from the market are to be submitted to DOH and receive approval, prior to any action by the plan.



Members of a plan that is discontinuing services are provided 60 days to select an alternative plan; if no selection is made, the state will auto-assign the member to a new plan. New York Medicaid Choice will provide information to the members regarding their options and which plans include the member’s current providers in their networks.



The new plan must accept the transfer enrollment of all enrollees that select or are auto-assigned to the plan. These transferring enrollees are presumed to meet the eligibility requirements for MLTC and are not required to be assessed prior to enrollment.



The guidance requires that the new plan continues to provide services under the enrollee’s existing plan of care, and utilize existing providers, for the earlier of the following: 1) 120 days after

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

Volume 2, No. 36 October 6, 2017 

enrollment; or 2) until the new plan has conducted an assessment and the enrollee has agreed to the new plan of care. 

The new plan is required to conduct an assessment within 30 days of the transfer enrollment effective date, unless a longer time frame is authorized by DOH.



When plans close or reduce their service area, DOH will track the membership and dispersion and adjust rates prior to the next rate cycle if necessary. For mergers and acquisitions, DOH will blend the most recent premium rates of the consolidating plans.

HCA had submitted extensive comments on prior drafts of this policy. HCA urged timely reimbursement adjustments for plans receiving new cases as well as for servicing providers. We also sought the elimination of administrative and/or regulatory provisions that add extra burden to plans and providers. HCA advocated protections for unpaid liabilities, which, while not addressed in the issued guidance itself, is reportedly under consideration at DOH. For additional information, please contact akoski@hcanys.org.

Important Upcoming Deadlines

Requirement

Effective/Due Date

More Information

Applicability of State Home Care Worker Wage Parity Law to Consumer Oct. 13, 2017 Directed Personal Assistance Program

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

Home Care Provider Minimum Wage Survey

Oct. 16, 2017

https://www.hcrapools.org/HomeCare_RCR/HomeCare_login.cfm

2016 LHCSA Statistical Report

Nov. 3, 2017

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

Federal Emergency Preparedness Rule Nov. 16, 2017 in Effect

https://www.gpo.gov/fdsys/pkg/FRͲ2016Ͳ09Ͳ16/pdf/2016Ͳ21404.pdf

Implementation of Universal Billing Codes for Home and CommunityͲ Based Long Term Care Services under Managed Care

Jan. 1, 2018

Revised Medicare Home Health Conditions of Participation in Effect

Jan. 13, 2018

https://www.gpo.gov/fdsys/pkg/FRͲ2017Ͳ01Ͳ13/pdf/2017Ͳ00283.pdf

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

April 1, 2018

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

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Volume 2, No. 36 October 6, 2017 

Universal Billing Codes Required for Managed Care Home Care Services The state Department of Health (DOH) has posted a “Dear Providers and Plans” letter that requires universal billing codes for Medicaid home and community-based long term care services delivered by home care and adult day providers to managed care enrollees as of January 1, 2018.

The letter is at https://www.health.ny.gov/facilities/long_term_care/reimbursement/letters/dal_2017-0922_billing_codes.htm.

It also includes a requirement that claims for such services be paid electronically.

Some of the services with universal codes and modifiers include: personal care; consumer directed personal assistance; home health aide; nursing; occupational, physical, speech and respiratory therapies; telehealth; medication dispensers; and adult day health care.

The provisions for universal billing were included in the 2015-16 state budget and were supposed to be effective January 1, 2016. This change was long sought by HCA to help home care agencies and their managed care partners by simplifying billing procedures and facilitating timely payments.

HCA and other provider associations had worked hard to develop uniform codes for over a year to meet the statutory deadline of January 2016, but additional time was needed to obtain support from all parties, and to meet technical issues with the codes expressed by the U.S. Centers for Medicare and Medicaid Services.

The codes and modifiers underwent numerous iterations and implementation dates before becoming finalized.

Managed Care Home Care Contractors Must be Enrolled in Medicaid Effective January 1, 2018, all Medicaid managed care and Children’s Health Insurance Program network providers, including home care agencies, must be enrolled with state Medicaid programs.

This is a requirement of a May 6, 2016 final rule: “Medicaid and Children’s Health Insurance Program (CHIP) Programs; Medicaid Managed Care, CHIP Delivered in Managed Care, and Revisions Related to Third Party Liability,” and then further addressed by the federal 21st Century Cures Act. The final rule is at https://www.gpo.gov/fdsys/pkg/FR-2016-05-06/pdf/2016-09581.pdf.

Enrollment as a Medicaid provider does not require agencies to accept Medicaid fee-for-service patients.

Managed care plans are sending notices to their contractors about this requirement and asking them to submit an application to enroll in Medicaid by December 1, 2017. Information about enrollment is at www.emedny.org/info/ProviderEnrollment/index.aspx; you can select your agency type (i.e. personal care agency, consumer directed personal assistance program, etc.) and print out instructions and an enrollment form.

Continued on next page

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Volume 2, No. 36 October 6, 2017 

Continued from previous page HCA has heard of at least one agency that was contacted by multiple plans about the need to enroll in Medicaid when it had already done so and advises all providers to look for correspondence from their contracted plans on this issue.

HCA wants to know if your agency already has enrolled in Medicaid and is contacted by your contracted plan to enroll. Please notify Andrew Koski at (518) 810-0662 or akoski@hcanys.org.

HCA Extends Registration Deadline, Secures Bigger Space for Record RSVPs to Oct. 19 Compliance Symposium: Join the Crowd!

HCA has gotten a record response of registrations for our Corporate Compliance Symposium, so we’ve secured a bigger room at the Albany Hilton (the same location as before) and extended the registration deadline (originally October 4).

The conference is just two weeks away, on October 19, so please register as soon as possible, if you have not already, to secure your spot.

This signature HCA program will delve into: OMIG and OIG audit focus areas (which have been especially prominent in the news recently); HIPAA Privacy and Security Rule considerations; compliance and integrity issues under value-based payments (the subject of a recent OMIG directive); insights for active management of your compliance monitoring operations; and a specific look at compliance pitfalls (and a new authorization program) for CDPAP fiscal intermediaries, which are a growing segment of the home and community-based marketplace.

We have a lot packed into this one-day conference for CEOs, COOs, corporate compliance officers and other managers who have responsibility for planning, operationalizing and establishing a compliance-conscious culture at your organization. Registration is below.

Download the brochure at http://hca-nys.org/wp-content/uploads/2017/09/HCA-2017-Corporate-ComplianceBrochure-and-Registration.pdf.

Register online at https://www.eventville.com/Catalog/EventRegistration1.asp?EventId=1012248.

DOH Posts Influenza Surveillance and Reporting Requirements Flu mask requirement NOT in effect On October 2, the state Department of Health (DOH) posted “Health Advisory: Influenza Surveillance and Reporting Requirements, 2017-18” to the Health Commerce System (HCS).

This Health Advisory is not a declaration of influenza prevalence by the DOH Commissioner and thus does not trigger the flu mask requirement. Once declared, this requires that home care and other health care clinicians wear a mask in patient care environments if they have not received the influenza vaccine for the current influenza season. When this happens, HCA will notify members.

According to the Health Advisory, all health care providers must immediately report suspected or confirmed cases of any novel influenza A virus influenza by phone to the local health department (LHD) of the patient’s

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county of residence. Contact information for LHDs can be found at http://www.nysacho.org/i4a/pages/ index.cfm?pageid=3713.

In addition, “outbreaks” of influenza or influenza-like illness occurring in community or facility settings (such as state institutions, day care centers, schools, colleges, group homes, adult homes, home care agencies and assisted living facilities) must be reported by the director of the facility to the LHD in which the facility is located. An outbreak is defined as an increase in the number of persons ill with laboratory-confirmed influenza or influenza-like illness above a commonly observed baseline in a particular community.

In late October, DOH will start posting weekly state influenza surveillance information, including the currently circulating influenza virus types, subtypes, and antiviral resistance information on the HCS. General resources on influenza, including vaccine information, are available at http:// www.health.ny.gov/diseases/communicable/influenza/seasonal/ and http://www.cdc.gov/flu/.

Information for health care workers about documentation of vaccination against influenza, or wearing of a surgical or procedure mask, is available at http://www.health.ny.gov/flumaskreg.

OIG Reports Many Hospice Election Statements Lack Required Information Based on a random sample review of hospice election statements and certifications of terminal illness, the U.S. Office of the Inspector General (OIG) reports that more than one-third of hospice General Inpatient (GIP) stays nationally lack required information or had other vulnerabilities.

According to OIG, hospice election statements did not always mention, as required, that the beneficiary was waiving coverage of certain Medicare services by electing hospice care or that hospice care is palliative rather than curative.

The report also states that in 14 percent of GIP stays, the physician did not meet requirements when certifying that the beneficiary was terminally ill and appeared to have limited involvement in determining that the beneficiary’s condition was appropriate for hospice care.

Hospices can improve their election statements and ensure that physicians meet requirements when certifying beneficiaries for hospice care by reviewing the following resources: 

Hospice Payment System Booklet, which includes a section on the hospice election statement at: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/ Downloads/hospice_pay_sys_fs.pdf



Documentation Requirements for the Hospice Physician Certification/Recertification (MLN Matters Article) at: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-NetworkMLN/MLNMattersArticles/Downloads/SE1628.pdf

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

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CMS Issues Hospice Compare Fact Sheet The U.S. Centers for Medicare and Medicaid Services (CMS) has posted a new Hospice Compare Fact Sheet in the downloads section of the Hospice Quality Public Reporting website at: https://www.cms.gov/ Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/Hospice-QualityPublic-Reporting.html.

The Fact Sheet contains information related to Hospice Compare and how the site can serve as a resource to providers in understanding their current quality ratings. The fact sheet also suggests approaches to communicating with patients and family members about how to use the Compare site for decision-making.

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

Registration is Open for the VBP Bootcamp in Lake Placid Registration is now open for the Value Based Payment (VBP) Bootcamp in Lake Placid. It will take place on October 23, 2017 at The High Peaks Resort (2384 Saranac Ave, Lake Placid, NY 12946) from 8 a.m. to 5 p.m.

VBP Bootcamps are a regional learning series created by the state Department of Health (DOH) to equip VBP contractors and interested parties (such as Managed Care Organizations, Providers, Associations and Community Based Organizations) with the knowledge to implement payment reform. The day-long VBP Bootcamp is designed to be an interactive training session that will give participants a thorough understanding of VBP. This event is free and open to all interested parties. Space is limited, and on a first-come, first-served basis. DOH asks that all organizations limit participation to no more than four individuals.

The schedule and locations for all VBP Bootcamps are as follows: Date

Region

Location

Address

Oct. 10, 2017

Capital Region

The EggͲSwyer Theater**

1 Empire State Plaza, S Mall Arterial, Albany, NY 12203

New York City

The New York Academy of Medicine

1216 5th Ave, New York, NY 10029

Oct. 18, 2017

Registration

Registration closed October 3, 2017

https://www.eventbrite.com/e/vbpͲ bootcampͲ20ͲnewͲyorkͲcityͲticketsͲ 37805168276 (Registration closes

October 11, 2017)

https://www.eventbrite.com/e/vbpͲ bootcampͲ20ͲnorthͲcountryͲ mohawkͲvalleyͲtugͲhillͲseawayͲ ticketsͲ37808834241

Oct. 23, 2017

North Country

High Peaks Resort

2384 Saranac Ave, Lake Placid, NY 12946

Nov. 3, 2017

Central New York

Rochester Radisson Riverside

120 E Main St, Rochester, NY 14604

Registration coming soon

Nov. 15, 2017

Long Island

The Long Island Marriott

101 James Doolittle Blvd, Uniondale, NY 11553

Registration coming soon

Continued on next page

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Continued from previous page As a reminder, VBP Bootcamps are being considered the ‘4th semester’ of VBP University. If you attend a VBP Bootcamp, and have completed all three semester quizzes of VBP University with a passing grade of 80 percent or higher, you will receive a printed copy of your ‘VBP University diploma’ at the session you attend.

Participation in VBP University is recommended but not required to attend a VBP Bootcamp. To learn more and participate in VBP University visit, www.health.ny.gov/VBP. Questions can be sent to VBP@health.ny.gov.

New VBP Video Posted The state Department of Health (DOH) has announced another video in its whiteboard series entitled “What CBOs Need to Know to Be Successful in VBP.” In the video, New York State Medicaid Director Jason Helgerson describes the top five things that Community Based Organizations (CBOs) need to know in order to be successful in the move to Value Based Payment (VBP). He also discusses how CBOs can get involved in the transition to VBP. To view the video, visit https://youtu.be/eQ-0AmRTiiU. To learn more about Value Based Payment, visit www.health.ny.gov/vbp.

Questions can be sent to VBP@health.ny.gov.

Webinar on TBI Waiver Renewal to be Held The state Department of Health (DOH) will hold the first in a series of webinars about the provisions of the newly approved Traumatic Brain Injury (TBI) waiver renewal.

The first webinar, to be held online only, will be on October 12, 2017 from 1 to 3 p.m. Registration is at http://tinyurl.com/ybqb8xk3.

As part of the renewal process, DOH plans to engage the Office of Medicaid Inspector General (OMIG) in future discussions regarding compliance issues. Additionally, there will be modifications to the Program Manual in order to address more details not specified in the application. DOH continues to review changes with the regional resource development centers (RRDCs); an FAQ is in draft and more webinars are forthcoming.

The U.S. Centers for Medicare and Medicaid Services (CMS) approved the TBI waiver renewal effective September 1, 2017. The waiver application is at http://hca-nys.org/wp-content/uploads/2017/09/ApprovedTBI-Waiver-Application-9-1-17.pdf.

Questions can be directed to tbi@health.ny.gov.

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Resources 

“CMS Fraud Prevention System Uses Claims Analysis to Address Fraud,” by the U.S. Accountability Office http://www.gao.gov/assets/690/686849.pdf



“Transition to New Medicare Numbers and Cards,” by the U.S. Centers for Medicare and Medicaid Services https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/ Downloads/MedicareCard-FactSheet-TextOnly-909365.pdf



“2017 Cost of Long Term Care,” (September 2017) by Genworth www.genworth.com/about-us/industry-expertise/cost-of-care.html

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

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