November 13, 2017 Edition of the Situation Report

HHPPS MEMO

EMERGENCY PREP SESSIONS

QUALITY CONFERENCE

FI AUTHORIZATIONS

Get all of the details about the newly finalized 2018 HHPPS rule in HCA’s comprehensive memo.

HCA has scheduled a series of regional emergency preparedness sessions in our effort to connect providers and local officials in every county of the state.

Time is running out to register for this week’s HCA Quality and Technology Symposium, which is one of our final signature conferences of 2017.

Last week’s HCA conference call and new DOH information further outline fiscal intermediary (FI) authorization process.

PAGE 3

PAGE 6

PAGE 7

PAGE 9

Your Source for HOME CARE News, Policy and Advocacy

Vol. 2, Issue 41 | November 13, 2017

COMING UP Quality & Technology Symposium Nov. 16 & 17 Suffern Bootcamp: How LHCSAs Can Survive and Thrive in a VBP World Nov. 30, 2017 NYC The Second Annual Women in Health Care Leadership Summit Dec. 7 & 8, 2017 Saratoga Springs Northeast Home Health Leadership Summit Jan. 16-18, 2018 Boston

National Home Care Month Profile: Alicia (Melia) Gagne-Giuffo Alicia (Melia) Gagne-Giuffo has worked as a coordinator of care at MJHS since July 2016, demonstrating exemplary practice as a home care nurse consistently providing high quality care to her patients. She is constantly selected to take new nurses and others out in the field to See MONTH p. 3

HCA Submits Comments on Draft CoP Interpretive Guidelines CoP effective date remains January 13, 2018 Last week, HCA submitted comments on draft Interpretive Guidelines for the revised Medicare and Medicaid Conditions of Participation (CoPs) for home health agencies.

Our comments were based on feedback from members and were sent to our national partners, the National Association for Home Care and Hospice (NAHC) and Elevating See CoP p. 2

INSIDE Home Care Month Profile: Alicia (Melia) Gagne-Giuffo.....................................1 HCA Submits Comments on Draft CoP Interpretive Guidelines...........................1 HCA Memo Details 2018 HHPPS Rule................................................................3 2018 Home Health Summit Reveals Full Line-up..............................................4 Important Upcoming Due Dates and Deadlines................................................5 Local Preparedness Sessions for CNY and Lower Hudson Valley ........................6 Gain a “Roadmap to Sanity” at HCA’s Quality and Tech Symposium Next Week....7 HCA Details Sepsis Grant Rollout, Opportunities, Trainings.............................8 MLTC Quality Advisory Committee Meets.........................................................9 Fiscal Intermediary Authorization Process Update..........................................9 Employee Scheduling Regulations Released................................................10

HCA Finalizes Comments on Draft CDPAP OMIG Audit Protocols..................11 CMS Makes Changes to State Plan Amendment & Waiver Processes..........11 Changes Made to NYC Paid Sick Leave Law..................................................12 Quarterly Wage Parity Certifications Due December 1..............................13 CMS Sets Freeze Date of Nov. 15 for Hospice Compare Refresh......................14 DOH Seeks Comments on NHTD Waiver Application...................................14 HEAP Benefits Start..................................................................................15 CMS to Host Home Health, Hospice Forum on Nov. 15..................................15 Agenda Posted for the PHHPC Committee Review.....................................16 NGS Closed November 23 & 24, Plus NGS Enrollment Application Update....16 Resources....................................................................................................17

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

CoP from p. 1 Home, who have been asked to compile feedback for submission to the U.S. Centers for Medicare and Medicaid Services (CMS).

As noted in previous communications, the CoPs contain the most sweeping regulatory changes to home care since 1989.

HCA was the first association to call upon CMS to delay the CoP effective date, leveraging Congressional support to achieve a six-month delay – from July 13, 2017 to January 13, 2018.

(Please note, however, that the emergency preparedness regulations still go into effect on November 16, 2017; and Quality Assessment and Performance Improvement/QAPI project requirements are effective on July 13, 2018).

In response to NAHC’s request for a further delay in the CoPs’ implementation, CMS has confirmed that the effective date remains January 13, 2018. However, CMS indicated it will not impose Civil Monetary Penalties on any re-certification survey for the first year following the effective date, unless there is an Immediate Jeopardy situation.

Our comments urge relief from burdensome paperwork requirements while still maintaining the provision of streamlined material and/or verbal information to patients in many areas of the CoPs related to patient information and communication, with an option for patients to receive written materials if requested.

We also seek: confirmation on what comprises the “individualized plan of care” that must be given to patients; revisions to certain guidelines that are inconsistent with the regulations; and clarification on what comprises supervision of LPN services by an RN and therapy assistant services by a therapist. In addition, we question the necessity of home health aides participating in interdisciplinary meetings of home health agency staff.

HCA will inform members when the Interpretive Guidelines are finalized.

Volume 2, No. 41 November 13, 2017 

The Situation Report is a weekly publication of the Home Care Association of New York State (HCA). Unless otherwise noted, all articles appearing in The Situation Report are the property of the Home Care Association of New York State. Reuse of any content within this newsletter requires permission from HCA. Joanne Cunningham HCA President jcunningham@hcanys.org Roger L. Noyes Director of Communications, Editor of The Situation Report rnoyes@hcanys.org Al Cardillo Executive 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

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

2

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



MONTH from p. 1

HCA Memo Details 2018 HHPPS Rule

demonstrate home visits due to the quality of her care. She works well with all members of the team, communicating information in a timely and professional manner. She demonstrates commitment and caring to her patients by taking extraordinary measures to ensure that they receive the follow up they need.

HCA has prepared a detailed memo on the final Home Health Prospective Payment System (HHPPS) rule for 2018.

See https://hca-nys.org/wp-content/uploads/2017/11/ 110617CMS2018FinalRule.pdf.

Melia is regularly recognized by her patients for providing excellent customer service, and she has participated in special projects such as MJHS’s Visit Design program that allows excellent clinicians to offer their expertise in standardizing processes for all staff. She has taken initiative to ensure consistency of care in the treatment of challenging cases.

In one particular intervention, Melia prevented a potential rehospitalization by responding quickly to a patient call late in the day regarding a foley catheter which was not draining. The home care team did not have an order to change the foley, but Melia strongly advocated for the patient and was able to obtain an order from the doctor to change the foley, allowing the patient to remain safely at home.

During National Home Care and Hospice Month in November, HCA is highlighting stories about some of the individuals providing exceptional care at our provider member agencies. You can read more stories on our National Home Care Month website at www.nationalhomecaremonth.com. If you have a story to tell, please write HCA’s Communications Director Roger Noyes at rnoyes@hcanys.org.

3

Volume 2, No. 41 November 13, 2017

As reported to members in last week’s newsletter, the final HHPPS rule includes an overall 0.4 percent reduction in national Medicare home health payments (or $80 million) in 2018.

Most significantly, however, the U.S. Centers for Medicare and Medicaid Services (CMS) has decided to withdraw its Home Health Groupings Model (HHGM) from the final rule. The HHGM payment overhaul included massive cuts, ranging from a CMS-estimated $950 million and as high as $3 billion nationally, according to some industry estimates.

With the removal of HHGM, the final rule is otherwise substantially status quo, in terms of maintaining the other payment and regulatory items that CMS outlined in its proposed rule (issued in July). HCA stresses, however, that payment reform remains a major focus of federal policymaking. The withdrawal of HHGM at this time does not preclude CMS from reintroducing it (or some successor payment proposal in like form) as part of future rule-making.

In addition to the base payment rates, the final HHPPS rule includes several upside and downside adjustments affecting payments, similar to past years. These include: the mandated home health payment update that replaces the regularly proposed market-basket update; another recalibration of the case-mix weights; application of the budget neutrality adjustment factor; Low Utilization Payment Adjustment (LUPA) payments; the elimination of the rural add-on; and other rate adjustments. All of these calculations are detailed in the memo.

CMS also finalizes some important updates to its home health value-based purchasing (HHVBP) model which is currently operating in nine randomly selected states. (New York is not one of the states.)

Other important highlights of the rule include: 

Another recalibration of the HHPPS case-mix weights (CMWs), using the most current cost and utilization data. The CMWs in the recalibrated adjuster would

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

Volume 2, No. 41 November 13, 2017 

result in a slight overall decrease, thereby necessitating a higher budget neutrality adjustment. 

Updated tables for the final 2018 standardized 60-day episodic payment rate and LUPA PerVisit rates.



Details on the final wage index for 2018, including a summary of those areas seeing increases or decreases in the wage index factor.



Updates to the Home Health Quality Reporting Program (HHQRP).



OASIS requirements to avoid payment rate reductions in 2018 and 2019.

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

2018 Home Health Summit Reveals Full Line-up of Dynamic Speakers for Premier Gathering of Northeast Execs The Northeast Home Health Superhero Summit is proud to announce the lineup of insightful and dynamic policy and leadership sessions for home health leaders joining together in Boston as the premier league of executives from the “Amazing Eight” of northeast states (ME, NH, VT, NY, MA, CT, RI, NJ)! Check out the newly posted brochure at https://hca-nys.org/wp-content/uploads/2017/11/ 2018-NE-Leadership-Summit-Brochure.pdf.

This summit, now in its 16th year, is sponsored by a consortium of state home care associations in the northeast who invite their member providers and prospective members to learn a range of topics on population health, workforce, palliative care, health IT, cross-sector partnership opportunities, leadership insights from nationally renowned speakers, and more ... not to mention networking with colleagues from neighboring states.

Among the featured speakers are Bill Dombi, President of the National Association for Home Care and Hospice (NAHC) who has unparalleled expertise on federal issues for home care, and Nancy Frates, creator of the ALS Ice Bucket Challenge, a phenomenon that changed the dynamics of marketing and philanthropy.

The hotel deadline for a discounted room block is January 2. The early-bird registration deadline for the conference is December 15.

Everything you need to know is on the summit website (http://nehomehealthsummit.com/) including: hotel accommodations; online registration; speaker bios; sponsorship opportunities; and more.

The Northeast Home Health Leadership Summit, now in its 16th year, is sponsored by the Northeast Home Health Leadership Collaborative, a consortium of state home care trade associations representing provider and associate members in the Northeast. HCA and the Homecare Alliance of Massachusetts are the engineers of this event. Members of the collaborative work closely together to bring you this insightful program.

4

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

Volume 2, No. 41 November 13, 2017 

Important Upcoming Deadlines

5

Requirement/Change

Effective/ Due Date

MLTC Cost Report and Supplemental Minimum Wage Reconciliation Cost Report

Nov. 15, 2017 mltcrsmw@health.ny.gov

Federal Emergency Preparedness Rule in Effect

Nov. 16, 2017

https://www.gpo.gov/fdsys/pkg/FRͲ2016Ͳ09Ͳ 16/pdf/2016Ͳ21404.pdf

2016 & 2017 CHHA Special Needs Semi Annual Reports

Nov. 17, 2017

https://commerce.health.state.ny.us/public/hcs_log in.html (HERDS application)

Fiscal Intermediary (FI) Authorization Application due from Existing FIs

Dec. 1, 2017

https://www.health.ny.gov/health_care/medicaid/r edesign/mrt_10003.htm https://www.health.ny.gov/health_care/medicaid/p rogram/update/2017/2017Ͳ10.htm#consumer

Wage Parity Certification Forms due from LHCSAs and Fiscal Intermediaries for December 1, 2017 to February 28, 2018

Dec. 1, 2017

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

2016 Adult Care Facility Financial Report

Dec. 22, 2017

https://commerce.health.state.ny.us/public/hcs_log in.html

2016 CHHA/LTHHCP Statistical Report

Dec. 29, 2017

https://commerce.health.state.ny.us/public/hcs_log in.html (HERDS application)

2016 Hospice Cost and Utilization Report

Dec. 29, 2017

https://commerce.health.state.ny.us/public/hcs_log in.html (HERDS application)

2018 State Worker Wage Parity Levels

Dec. 31, 2017

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

2018 State Minimum Wage Levels

Dec. 31, 2017

https://www.labor.ny.gov/workerprotection/laborst andards/workprot/minwage.shtm

State Compliance Program Certification Form Submission

Dec. 31, 2017 https://omig.ny.gov/sslͲcertification

Federal Deficit Reduction Act Compliance Certification Form Submission

Dec. 31, 2017 https://omig.ny.gov/draͲcertification

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

Jan. 1, 2018

https://www.health.ny.gov/facilities/long_term_car e/reimbursement/letters/dal_2017Ͳ09Ͳ 22_billing_codes.htm

Revised Medicare Home Health Conditions of Participation in Effect

Jan. 13, 2018

https://www.gpo.gov/fdsys/pkg/FRͲ2017Ͳ01Ͳ 13/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/NewͲMedicareͲ Card/index.html

More Information

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

Volume 2, No. 41 November 13, 2017 

Local Emergency Preparedness Sessions for CNY, Lower Hudson Valley Partners All home care agencies and hospices serving patients in the Central New York and lower Hudson Valley areas should attend the upcoming local emergency preparedness sessions being conducted by HCA and the New York State Association of Health Care Providers (HCP). Dates and logistics are below.

A registration link with locations to choose from is at https://www.surveymonkey.com/r/EPTrngs.

The sessions are the most recent in a series of emergency preparedness networking sessions that HCA and HCP have been conducting progressively across the state since 2016, reaching 24 counties to date. The sessions are supported by a federal/state-administered grant.

Each session pairs county emergency managers and county public health department health preparedness representatives with home care and hospice representatives to discuss needs, challenges, best practices and recommendations.

Sessions for each of the following regions and counties are below: Jefferson, Lewis, St. Lawrence Counties Thursday, November 30 10 a.m. to noon Dulles State Office Building 11th Floor, Room 1 317 Washington Street Watertown, NY 13601 Cayuga, Cortland, Onondaga, Oswego Counties Thursday, November 30 2 to 4 p.m.

Cayuga-Onondaga BOCES Conference Rooms 1 and 2 1879 W. Genesee Street Rd. Auburn, NY 13021 Broome, Chenango, Tioga, Tompkins Counties Friday, December 1 10 a.m. to noon Lourdes Community Room, 2nd Floor 3101 Shipper’s Road Vestal, NY 13850 Continued on next page

6

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

Continued from previous page Herkimer, Madison, Oneida Counties Friday, December 1 2 to 4 p.m.

State Preparedness Training Center 5900 Airport Road Oriskany, NY 13424 Ulster, Sullivan, Orange, Rockland Counties Thursday, December 7 10 a.m. to noon Rockland County Fire Training Center 35 Fireman’s Drive Pomona, NY 10970 Dutchess, Putnam, Westchester Counties Thursday, December 7 2 to 4 p.m.

NYS Department of Homeland Security North Conference Room 10 Ross Circle Poughkeepsie, NY 12601 For further information, please contact Billi Wilson at bwilson@hcanys.org, Andrew Koski at akoski@hcanys.org, or Al Cardillo at acardillo@hcanys.org.

Volume 2, No. 41 November 13, 2017

“Climb Out of Chaos” & Gain a “Roadmap to Sanity” at HCA’s Quality and Tech Symposium Next Week Time is running short to register for this week’s HCA Quality and Technology Symposium ... but we don’t want to add to your stress; in fact, our conference features an enlightening session that aims to relieve stress, in the form of “clinician burnout,” which a Health Affairs article last year called an “epidemic” and a “national crisis.”

“Work compression,” the article says, “occurs on a backdrop of steadily increasing medical complexity in the forms of multimorbidity and increased prevalence of chronic disease,” threatening the success of triple-aim goals. (See http://www.healthaffairs.org/do/10.1377/ hblog20160421.054511/full/.)

Clinician burnout is not only physically, mentally and emotionally taxing, but it clearly poses a threat to quality of care, as well, making it a particularly apt segment for our quality conference.

In her interactive session, Climbing Out of Chaos, A Roadmap to Sanity for Clinical Managers, Barbara Katz, RN, MSN of BK Health Care Consulting will show clinicians and clinician managers how to: balance change and daily work; use data to distinguish real work from wasted effort; apply proven time management techniques to gain control of their time; and create a personal resilience recipe.

These strategies are not only valuable for clinicians but also for agency leaders seeking to maintain a highly functioning team. The program will use concrete self-assessment tools and class exercises to provide managers with a toolkit of practical techniques for staying sane while working efficiently in the new world of health care.

This is just one of ten sessions to help you prepare for the quality imperatives of the upcoming home health Conditions of Participation (CoPs), adopt disease-management technologies and protocols to improve outcomes, learn the state requirements and goals for quality of care and how they impact your agency, get a handle on the upcoming advanced home health aide changes, and much more!

Please register today at the links below!

Download the brochure: https://hca-nys.org/wp-content/uploads/ 2017/11/2017-Quality-and-Technology-Symposium-Brochure.pdf.

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

7



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

Volume 2, No. 41 November 13, 2017 

HCA Details Sepsis Grant Rollout, Opportunities, Training Dates for Providers HCA and its sepsis grant partners, IPRO and national Sepsis Alliance, conducted a statewide webinar last week for providers and stakeholders detailing the rollout, scheduled training and provider opportunities under HCA’s special sepsis grant from the New York State Health Foundation.

An in-person rollout of this initiative will be presented at this week’s HCA Quality and Technology Symposium on November 16 (the first of two days) in Suffern, NY. The sepsis grant is intended to promote and facilitate the adoption of HCA’s sepsis tool by all New York State home care agencies and other applicable sectors.

Eighty to ninety percent of sepsis cases originate in the community, contrary to the frequent misperception that sepsis is primarily a problem of hospital origin. This is among several data points supporting home care’s work to tackle the problem.

Last week’s webinar outlined the grant’s major supported activities, including: 

Upcoming in-depth training sessions for home care clinicians and agency leaders in the adoption of HCA’s sepsis tool, along with collaborative cross-sector sessions involving home care, hospital, physician, EMS. These sessions will be conducted at eight regions of the state.



Media and other public outreach to increase awareness and education.



Data compilation, analysis and data sharing with providers and officials for evaluation and improvement, reporting, and recommendations for policy and system-wide sepsis support. Data compilation will be conducted through an IPRO-sponsored HIPAA-compliant portal, which will enable tracking of every screen, every screen entry, follow-up and intervention recorded.



Creation of a dedicated website that will house all of the project materials, resources, schedules and related information.



A steering committee to advise on and support training and implementation. The committee is comprised of sepsis leaders and organizational and professional clinical experts, key health sectors, government officials, consumers and other strategic partners.

Regional Training and Multi-Sector Collaboration Sessions – Save the Dates!

The eight regional in-person training and cross-sector sessions are scheduled for the following dates and locations:   

Central NY Region – December 15 (Syracuse) Western NY Region – December 18 (Buffalo) Hudson Valley Region – January 11 (Newburgh) Continued on next page

8

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

Volume 2, No. 41 November 13, 2017 

Continued from previous page   

Capital Region – January 24 (Albany) NYC Region – February 8 (Bronx) and February 9 (Manhattan) Long Island Region – March 8 (Nassau) and March 9 (Suffolk)

Announcements with host sites and registration are coming soon. In the meantime, all providers, plans and EHR companies should mark their calendars and plan to participate.

For further information, please contact Al Cardillo at acardillo@hcanys.org or Jennifer Kerbein at jkerbein@hcanys.org.

MLTC Quality Advisory Committee HCA is participating today in a meeting of the Managed Long Term Care (MLTC) Quality Advisory Committee, hosted by the state Department of Health.

The committee is reviewing and providing input on DOH’s proposed methodology for assessing, financially incentivizing and reporting on MLTC quality performance.

The methodology develops a weighted score for each MLTC based on their measurements of quality outcome, enrollee satisfaction, plan efficiency (largely measured by plan performance in potentially avoidable hospitalizations) and compliance measures.

The Advisory Committee will review the 2017 and proposed 2018 methodology. The methodology will have additional implications this year with the onset of Value Based Payments (VBP) and the DOH requirement that all MLTC contracts with home care for 2018 be value based to at least level I VBP. For further information, please contact Al Cardillo at acardillo@hcanys.org.

Fiscal Intermediary Authorization Process Update Last week, HCA provided an education program on the new Fiscal Intermediary (FI) Authorization process for the Consumer Directed Personal Assistance Program, which was supplemented by additional information from the state Department of Health (DOH) on the application process.

DOH has confirmed that: 

Entities must have a separate Medicaid provider number for their FI. The first step is to apply for the FI authorization. Once approved, you should then apply for a Medicaid provider identification number through DOH’s provider enrollment department.



DOH does not have a timeline yet regarding how long it expects for an entity to complete the authorization process.

Continued on next page

9

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

Volume 2, No. 41 November 13, 2017 

Continued from previous page 





The FI Authorization application can be submitted as more than one PDF file. You can send multiple PDFs in one e-mail, or you can send more than one e-mail if needed. You can put the multiple PDFs into one zip file and send the zipped file to DOH. If an FI does not submit an authorization application by December 1, it will be considered to be out of compliance with the statute. As a non-compliant provider, the FI is not authorized to provide FI services. Until DOH receives the authorization application, the FI will remain out of compliance. Additionally, the managed care plan is expected to follow contract termination protocols as identified in the CDPAS Administrative Agreement signed by the FI. The plan is also responsible for ensuring that the enrollees receiving CDPAS from that FI get transferred to another FI or appropriate service.

Under “section I: Identifying Data, Contractual Obligations, for cooperative agreements,” DOH does not need to see the fully executed contract.

Entities can submit the cover page, the rate sheet, and the signature page for each contract.

Also, it would be helpful if you include a quick document listing the contracts you currently hold to serve as a point of reference for DOH.

During HCA’s education program last week, we reviewed every section of the authorization application and took many questions from the participants. HCA plans to send DOH some of the questions that require further clarification, and will inform members of any responses we receive.

Meanwhile, HCA encourages members to send questions to FIAuthorization@health.ny.gov (and copy Andrew Koski at akoski@hcanys.org).

DOH intends to post Frequently Asked Questions (FAQs) soon; sending questions now (at the above e-mail address) will ensure that they are included in the upcoming FAQs.

10

Employee Scheduling Regulations Released The state Department of Labor (DOL) has filed proposed rulemaking to address what is commonly known as “just-in-time,” “call-in” or “on-call” scheduling.

The proposed rule is at https:// labor.ny.gov/workerprotection/ laborstandards/pdfs/employeescheduling-proposed-rule.pdf.

The full rulemaking package will be in the November 22, 2017 issue of the State Register, and will be subject to a comment period for 45 days from that date.

The proposed rule covers: “reporting to work,” “unscheduled shift,” “cancelled shift,” “on-call,” “call to schedule,” and includes the calculation of “call-in pay.”

DOL states that it developed these regulations after conducting four hearings and receiving testimony. The scope of these hearings focused on scheduling practices for workers subject to the Minimum Wage Order for Miscellaneous Industries and Occupations.

A webcast of the hearings and testimony submitted is at https:// labor.ny.gov/workerprotection/ laborstandards/oncallscheduling.shtm.

HCA will be examining the proposed regulation and will provide further information at a later time.

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

Volume 2, No. 41 November 13, 2017 

HCA Finalizes Comments on Draft CDPAP OMIG Audit Protocols Last week, HCA worked to finalize its comments on draft state audit protocols for the Consumer Directed Personal Assistance Program (CDPAP). The protocols were developed by the state Office of the Medicaid Inspector General (OMIG).

HCA is working with three other Associations – the New York State Association of Health Care Providers (HCP), LeadingAge New York, and the Consumer Directed Personal Assistance Association of New York State – to submit joint comments.

At a time when CDPAP is undergoing more scrutiny by the state (see separate p. 9 article on the state’s new fiscal intermediary authorization process), the protocols include the following areas:         

Missing Documentation of Service Missing Recipient Record Billed More Units than Documented Services Performed by a Precluded Individual Failure to Complete Required Health Assessment Missing Certificate of Immunization Missing Documentation of PPD Skin Test or Follow-Up Missing Personnel Records Failure to Process Consumer Directed Personal Assistant’s Wages and Benefits

HCA has already shared the draft protocols with members and received valuable feedback which will be incorporated into our final comments.

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

CMS Makes Changes to State Plan Amendment and Waiver Processes On November 6, the U.S. Centers for Medicare and Medicaid Services (CMS) issued two Informational Bulletins that address changes to State Plan Amendment (SPA) and waiver processes.

The Informational Bulletins are at https://www.medicaid.gov/federal-policy-guidance/federal-policyguidance.html?filterBy=bulletin%23dynamic-list (click on “Federal Policy Guidance” and scroll down).

One of the Bulletins states that “CMS is developing a four-pronged approach to increase transparency, enhance efficiency, reduce burden and address a backlog of SPAs on hold due to a request for additional information (RAI) from CMS to the state to which the state has not responded.”

This effort includes: calls with states within 15 days of receipt of each new SPA or section 1915 waiver submission; compilation of tools to help states develop complete SPA and section 1915 waiver submissions; strategies to reduce the pending SPA backlog; expanding the use of MACPro, a web-based system for SPAs;

11

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

Volume 2, No. 41 November 13, 2017 

and development of additional tools for states, including standardized lists of review questions, as well as checklists for use during SPA and waiver development to ensure submissions are complete.

In the Bulletin on section 1115 Demonstration waivers, the described improvements include: 

Revising the application template to streamline and simplify it;



Continuing to work with states to ensure that Special Terms and Conditions (STCs) reflect the policy agreements, and do not limit states’ abilities to operate their programs within the extent of flexibility permitted by law;



Developing parameters for expedited approval of certain waiver authorities under demonstrations (or particular elements of demonstrations) that are substantially similar to those approved in other states;



Approving, under certain conditions, the extension of routine, successful, non-complex section 1115(a) waiver and expenditure authorities in a state for a period up to 10 years, with the flexibility to approve more complex waiver and expenditure authorities for shorter periods to allow CMS to assess the impact and continuation of these authorities;



Establishing a fast-track process for reviewing proposals from states to extend established Medicaid and CHIP section 1115 demonstrations that reauthorize longstanding policies with proven program outcomes; and others.

Changes Made to NYC Paid Sick Leave Law On November 6, Mayor Bill de Blasio signed legislation that amends New York City’s (NYS) Paid Sick Leave law.

The legislation is at http://legistar.council.nyc.gov/LegislationDetail.aspx?ID=2867849&GUID=DCC83D1C0D6A-4E38-9FEB-6974CA947D6F&Options=ID|Text|&Search=1313-A. The law is effective on May 5, 2018 (180 days after being signed).

The law includes a new category for qualifying for paid sick leave that includes when the employee or a family member has been the victim of a “family offense matter,” “sexual offense,” “stalking,” or “human trafficking.”

Those affected employees will be entitled to “safe time” for absence from work due to:

12



Obtaining services from a domestic violence shelter, rape crisis center, or other shelter or services program for relief from a family offense matter, sexual offense, stalking, or human trafficking;



Participating in safety planning, temporarily or permanently relocating, or taking other actions to increase the safety of the employee or employee’s family members from future family offense matters, sexual offenses, stalking, or human trafficking; Continued on next page

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

Volume 2, 41 November 13, 2017 

Continued from previous page 

Meeting with a civil attorney or other social service provider to obtain information and advice on, and prepare for or participate in any criminal or civil proceeding;



Filing a complaint or domestic incident report with law enforcement;



Meeting with a district attorney’s office;



Enrolling children in a new school; or



Taking other actions necessary to maintain, improve, or restore the physical, psychological, or economic health or safety of the employee or the employee’s family member or to protect those who associate or work with the employee.

The law also expands the definition of “family member” to include “any other individual related by blood to the employee; and any other individual whose close association with the employee is the equivalent of a family relationship.”

In brief, NYC’s Paid Sick Leave requires five annual paid sick leave days for certain defined reasons to NYC workers at businesses with five or more employees, and requires employers with fewer than five employees to provide unpaid sick leave.

More information on Paid Sick Leave is at http://www1.nyc.gov/site/dca/about/paid-sick-leave-law.page.

HCA advises members in New York City to check this site as there are requirements for employers to give notices to their employees regarding this benefit, and to revise their paid sick leave policies.

Quarterly Wage Parity Certifications Due December 1 The next round of state-required Wage Parity certification forms is due December 1, 2017 for Licensed Home Care Services Agencies (LHCSAs) and other entities, including Fiscal Intermediaries (FIs), that contract with Managed Care Organizations (MCOs), Certified Home Health Agencies (CHHAs) and/or Long Term Home Health Care Programs (LTHHCPs) serving New York City, Long Island and Westchester.

The Wage Parity law, and related certification requirement, does not apply to areas outside of New York City, Long Island and Westchester.

MCOs, CHHAs and/or LTHHCPs that contract with LHCSAs and FIs are required to obtain a written certification on a quarterly basis from the LHCSA or other entity which attests to the LHCSA/FI’s compliance. The form due December 1, 2017 covers the period December 1, 2017 through February 28, 2018 and is sent to the MCO, CHHA and/or LTHHCP, not the state Department of Health (DOH).

The 2017 certification forms and required wage parity levels for 2017 and 2018 are at https:// www.health.ny.gov/health_care/medicaid/redesign/mrt_61.htm. HCA recommends adding a date after

13

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

Volume 2, No. 41 November 13, 2017 ď Žď€

the signature and noting on the form that the certification covers the December 1, 2017 through February 28, 2018 period, and retaining copies of all certifications for your own records.

As noted in earlier HCA communications, the state Wage Parity law has applied to consumer directed personal assistance services (CDPAS) in New York City, Long Island and Westchester since October 13, 2017.

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

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

CMS Sets Freeze Date of Nov. 15 for February 2018 Hospice Compare Refresh The U.S. Centers for Medicare and Medicaid Services (CMS) recently announced that the freeze date is November 15, 2017 for the Hospice Item Set (HIS) data that will be included in quality measure calculations for the February 2018 Hospice Compare refresh.

The February refresh will include HIS data from the second quarter of 2016 to the first quarter of 2017 (April 1, 2016 to March 31, 2017). All HIS records, including modifications/corrections and inactivations, need to be submitted and accepted by the Quality Improvement and Evaluation System (QIES) Assessment Submission and Processing (ASAP) system by midnight on November 15, 2017 to be reflected in the Hospice Provider Preview Report that will be available on December 1, 2017.

Additional information about the freeze date, preview reports, and key public reporting dates for providers can be found at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospiceQuality-Reporting/Hospice-Quality-Public-Reporting.html.

DOH Seeks Comments on NHTD Waiver Application The state Department of Health (DOH) is seeking feedback on its renewal application for the Nursing Home Transition and Diversion (NHTD) waiver program that will be sent to the U.S. Centers for Medicare and Medicaid Services (CMS).

The document is available for review at https://www.health.ny.gov/health_care/medicaid/redesign/mrt90/ docs/2017_1915c_nursinghomeapp.pdf; DOH will accept comments until December 1, 2017.

Any comments or questions related to the content of this document must be provided in writing to nhtdwaiver@health.ny.gov.

The NHTD waiver is currently operating under a temporary extension that runs until January 17, 2018.

Additional information on NHTD is at https://www.health.ny.gov/health_care/medicaid/redesign/mrt90/.

14

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

Volume 2, No. 41 November 13, 2017 

HEAP Benefits Start Applications for home heating assistance under the Home Energy Assistance Program (HEAP) will begin today, Monday, November 13 throughout New York State.

Eligibility and benefits are based on:    

Income Household size The primary heating source The presence of a household member who is under age 6, is age 60 or older, or is permanently disabled.

Regular benefits are paid directly to the vendor that supplies the household’s primary source of heat.

A household may be eligible for a Regular benefit if: 

The individual and household members are U.S. citizens or qualified aliens; and



The household’s gross monthly income is at or below the current income guides for the household size, or the individual receives Supplemental Nutrition Assistance Program (SNAP) benefits, Temporary Assistance or Supplemental Security Income (SSI Living Alone).

More information, including the income guidelines, is at http://otda.ny.gov/programs/heap/.

CMS to Host Home Health & Hospice Open Door Forum: November 15 The U.S. Centers for Medicare and Medicaid Services (CMS) will host the next Home Health and Hospice Open Door Forum on Wednesday, November 15, 2017, from 2 to 3 p.m.

Agenda items include:

15



The 2018 Home Health Prospective Payment System (HHPPS) final rule including payment policy provisions, changes to the Home Health Value-Based Purchasing (HHVBP) Program and quality reporting program provisions.



Conversion of subunits under the revised home health Conditions of Participation.



Home health claims update.



Home health and hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey updates.



Hospice claims and quality reporting program update.



Hospice Item Set “Timeliness Compliance Threshold Report Fact Sheet.”

Continued on next page

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

Volume 2, No. 41 November 13, 2017 

Continued from previous page The call-in number and conference identification number are: 

Call-In Number: 1-800-837-1935; Conference ID: 61718392

Agenda Posted for the PHHPC Committee on Establishment and Project Review The state Department of Health (DOH) has posted the agenda for the November 16 meeting of the Public Health and Health Planning Council (PHHPC) Committee on Establishment and Project Review.

This agenda, along with supporting materials, is at https://www.health.ny.gov/facilities/ public_health_and_health_planning_council/meetings/2017-11-16/index.htm.

The agenda includes applications by: 

37 entities to establish new Licensed Home Care Services Agencies (LHCSAs);



One entity to establish a new LHCSA affiliated with an Assisted Living Program;



Six existing LHCSAs for a change in ownership;



An existing Certified Home Health Agency (CHHA) to merge with another CHHA; an existing CHHA to be established as sole corporate member; and another CHHA to change its corporate member.

The next meeting of the full PHHPC is December 7.

NGS Closed November 23 & 24, Plus NGS Enrollment Application Update National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), will be closed November 23 and 24 for the Thanksgiving Holiday. This includes the Electronic Data Interchange (EDI) Help Desk, Provider Contact Center, Provider Enrollment Line, and Telephone Re-opening Unit.

Electronic claim files transmitted after 5 p.m. on Wednesday, November 22 will have a claim receipt date of Monday, November 27. EDI front-end acknowledgement transactions will be created as expected as EDI claim files are received. The Direct Data Entry (DDE) Provider Online System will be available on November 23 and 24, during regular hours. Providers will be able to access NGSConnex and use the Interactive Voice Response (IVR) system at 1-866-275-3033. NGS will reopen on Monday, November 27, 2017 for normal business hours.

Provider Enrollment Application Process Timeline Update NGS and other MACs have outlined a process for finalizing Internet-based PECOS applications within 45 days and a CMS-855 paper application within 60 days if all required information is available. The process is as follows: 

16

An acknowledgment notice with a case number will be mailed or e-mailed (PEDoNotReply@anthem.com) to the contact on the submitted application.

Continued on next page

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

Volume 2, No. 41 November 13, 2017 

Continued from previous page 

If additional documentation is needed, a request will be mailed or e-mailed to the contact, giving 30 days to respond.



When all information is available, the application will go through a series of steps before the final step of completion.



The contact can follow the status of the application by calling the IVR system at 1-866-275-3033.



Please allow up to seven days after the application has finalized for NGS’s response letter to be received by mail or e-mail.

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

Resources 

“Using Medicaid Levers to Support Health Care Partnerships with Community-Based Organizations,” by the Center for Health Care Strategies http://nasuad.org/sites/nasuad/files/CBO-HCO-Partnership-Medicaid-FactSheet_102417_chcs.pdf



“Medicare Spending on Older Adults Who Need Long-Term Services and Supports,” by the LongTerm Quality Alliance http://www.ltqa.org/wp-content/themes/ltqaMain/custom/images//Medicare-Spending-forOlder-Adults-Who-Need-LTSS_Research-Brief_Final.pdf



“Influenza Vaccine Payment Allowances – Annual Update for 2017-18 Season,” by the U.S. Centers for Medicare and Medicaid Services http://click.email.ngsmedicare.com/ ?qs=d826849cd7e606277852b7fb37168f2a03f454a736712abf6cd1fcfb9b55837d34f2ff3c1934d3a736f7a1d7d7dfea55



“Emerging Innovations in Managed Long-Term Services and Supports for Family Caregivers,” by the AARP Public Policy Institute http://www.longtermscorecard.org/~/media/Microsite/Files/2017/2017%20Scorecard/ AARP1202_EI_EmerInnovationLTSS_Oct31v2.pdf



“No Wrong Door: Supporting Community Living for Veterans,” by the AARP Public Policy Institute http://longtermscorecard.org/promising-practices/supporting-community-living-veterans



“Therapy Cap Values for Calendar Year (CY) 2018,” by the U.S. Centers for Medicare and Medicaid Services https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/ R3918CP.pdf

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

17