PAC MODELS
HOME HEALTH SUMMIT
CONTRACTING COMPLIANCE
FI AUTHORIZATIONS
MedPAC proposes payment redistributions under uniform PPS model for all post-acute (PAC) providers.
Northeast Home Health Summit on Jan. 16-18 includes preconference program on population health, palliative care issues and workforce. Register today!
HCA offers a brand new webinar for members to explore vital issue of home care-managed care contracting compliance. Join us on December 14.
Learn more about the fiscal intermediary authorization process in latest update from DOH, plus access recording of Nov. 8 statewide call.
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Your Source for HOME CARE News, Policy and Advocacy
Vol. 2, Issue 42 | November 20, 2017
COMING UP Bootcamp: How LHCSAs Can Survive and Thrive in a VBP World Upstate Edition (Syracuse): Dec. 4, 2017 The Second Annual Women in Health Care Leadership Summit Dec. 7 & 8, 2017 Saratoga Springs Webinar: Contracting Compliance Challenges in a Managed Care Environment Dec. 14, 2017 Northeast Home Health Leadership Summit Jan. 16-18, 2018 Boston
Tax Proposals Threaten Medicare Cuts, ACA Repeal House passes bill, but Senate measure, with different provisions, faces tighter margin Medicare and the Affordable Care Act (ACA) remain in the crosshairs, this time as part of Congressional tax reform legislation. The Senate’s tax plan calls for eliminating ACA’s individual mandate, while the House version of the tax bill (which passed on
HCA’s offices will be closed on Thursday, November 23, and Friday, November 24, in observance of the Thanksgiving holiday.
See TAX p. 6
House Proposes Rural Add-on Extender Funded by Offsets Signaling Payment Risk for Home Care Details of payment offsets unknown; House’s “five-year straight extension” proposal differs from Senate extender package The U.S. House Ways and Means Committee has announced a bipartisan agreement to continue a series of “Medicare extenders” which are set to expire absent Congressional action, including a “five-year straight extension” of the Medicare Home Health Rural Add-on. See EXTENDER p. 2
INSIDE Tax Proposals Threaten Medicare Cuts, ACA Repeal....................................................1 House Proposes Rural Add-on Extender Funded by Risky Offsets...............................1 Employee Scheduling Regulations Explained..........................................................3 MedPAC Eyes Uniform Post-Acute Payment Model...................................................5 Member Hiring Announcement..............................................................................6 Important Deadlines and Due Dates.......................................................................7 LHCSA Statistical Report Workgroup Meets, Provides Updates.....................8 Enter to Win a Free Room at Women in Healthcare Leadership Summit...........9 OIG Issues Updated Work Plan...................................................................10 DOH Publishes Updated Hospice Medicaid Rates......................................10 Population Health, Palliative Care, Workforce Issues at Home Health Summit..............10
Webinar: Contracting Compliance Issues in Home Care-Managed Care.......11 HCA Adds Upstate Edition of LHCSA-VBP Program.........................................12 Alex Azar Picked as New HHS Secretary........................................................12 HCA Submits Comments on Draft CDPAP OMIG Audit Protocols..................12 FI Authorization Process Update.................................................................13 Provider Ombudsman Announced for New Medicare Card..........................14 CMS Posts RAC Review Topics...................................................................14 NGS Updates............................................................................................15 PHHPC Committee on Establishment and Project Review Meets..................15 2018 Medicare Levels Announced.............................................................16 HHS Releases Report on Top Challenges...................................................17 Resources..................................................................................................17
The Situation Report: the Home Care Association of New York State EXTENDER from p. 1 Of concern, however, is how the extenders would be paid for. The Committee’s announcement merely lists a series of broad “payfor” areas to fund the extenders – among them, “modifications to home health agency payment, including Medicare Payment Advisory Commission (MedPAC) recommendations and building blocks to payment reform.” The reference to MedPAC “payment reform” – as one of several revenue raisers for the rural add-on and other extenders – is particularly concerning in light of a recent MedPAC meeting on payment changes. Commission members on November 2 to 3 reviewed a new MedPAC report outlining a post-acute care prospective payment system with possible risks for home care. (See related p. 5 story.) That system intends to calibrate reimbursement across various sectors of post-acute care; but the risk for home health is particularly salient in the context of MedPAC’s continued reference to “doubledigit” home care margins (and the need for payment reforms to address these margins) in the meeting’s transcript and in other venues. As HCA has repeatedly informed MedPAC, the U.S. Centers for Medicare and Medicaid Services (CMS) and Congress, the margins for home care vary widely from region to region. New York’s Medicare margins averaged -6.97 percent in 2015 (the most recent year available), and we’ve stressed that payment changes need to be responsive to these regional variations. Of additional concern is the fact that this very same committee – Ways and Means – recently introduced separate legislation to codify the Home Health Groupings Model (HHGM) in exchange for a rural add-on extension (H.R. 3992, sponsored by Rep. Kristi Noem of South Dakota). As extensively reported, the HHGM, which was recently rejected by CMS in its 2018 payment rule, is estimated to cut between $950 million (CMS estimates) and $3 billion (industry estimates). HCA, the National Association for Home Care and Hospice (NAHC), Elevating Home (formerly the Visiting Nurse Associations of America) and other groups nationally waged a successful advocacy effort to get CMS to
Volume 2, No. 42 November 20, 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
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withdraw the HHGM from its 2018 rule; but CMS’s withdrawal doesn’t preclude Congress from continuing a separate avenue for adopting HHGM or some alternative package legislatively, possibly as a “pay-for” to extend the rural add-on. HCA has an advocacy campaign targeting H.R. 3992. Please act on this campaign today to continue building pressure against this bill (see http://p2a.co/4XYyf01). News of the House extender package also follows a Senate “discussion draft” – obtained from the Senate Finance Committee late last month – which includes an extension of the Home Health Rural Add-on in the Senate, except at graduated increases and with some variations for counties based on population density or in regions where access barriers are not deemed to be present. (See the October 30 edition of The Situation Report for details of this proposal.) HCA is working with our legislative affairs representative, Brett Heimov of Envision Strategies, as well as with our national partners, to obtain further information on the Ways and Means proposal. We will continue to weigh in with the various Senate and House committees on the need for a uniform rural add-on unaccompanied by counterproductive payment cuts.
Employee Scheduling Regulations Explained HCA to hold program on December 6 As a follow up to last week’s announcement that the state Department of Labor (DOL) has filed proposed rulemaking to address what is known as “just in time,” “call-in,” or “on-call” scheduling, HCA is providing a summary of the proposed rule. The proposed rule is at https://labor.ny.gov/workerprotection/laborstandards/pdfs/employee-schedulingproposed-rule.pdf. HCA will hold a members-only call on December 6 at 10 a.m. to explain this rule, and we will send out registration details separately. (Be on the lookout for an e-mail announcement soon.) The rule would impose the following requirements on employers: 1. An employee who reports to work for a shift not scheduled 14 days in advance must be paid an additional two hours of call-in pay. 2. An employee whose shift is canceled within 72 hours of the scheduled start time must be paid at least four hours of call-in pay. The four hours of call-in pay may be reduced to the lesser number of hours that the employee normally works for the particular shift, as long as the employee’s total hours worked, or scheduled to work, for that shift do not change from week to week. 3. An employee who is required to be available to report to work (“on-call”) must be paid at least four hours of call-in pay (current practice).
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4. An employee who is required to contact the employer and confirm whether to report to work within 72 hours of the shift start time must be paid at least four hours of call-in pay. There are certain exceptions to these requirements that include: 1. Where the employee earns wages on a weekly basis that exceed 40 times the applicable basic hourly minimum wage rate. As the minimum wage rate for NYC is $13 per hour in 2018, the requirement would not apply to any employee who earns more than $520 (40 x 13) in a week. Since the income exception applies on a week-to-week basis, should the employee’s wages fall below $520 in a given week, the requirement would apply. This exception does not apply to the requirement for at least four hours of call-in pay in cases where employees are “on-call (i.e., required to be available to report to work). 2. Employees who are covered by a collective bargaining agreement that provides for call-in pay. 3. New employees during the first two weeks of employment. 4. Certain voluntary work. For instance, the additional call-in pay (required for a shift not scheduled 14 days in advance) does not apply to any regularly scheduled employee who volunteers to cover: 1) a new and additional shift during the first two weeks that the shift is worked; or 2) a shift that had been scheduled at least fourteen days in advance to be worked by another employee. 5. Other situations. The call-in pay required for cancellation of a work shift within 72 hours of the shift does not apply: 1) when an employer cancels a shift due to an employee’s request for time off; or 2) when operations at the workplace cannot begin or continue due to “an act of God” or other cause not within the employer’s control, including, but not limited to, a state of emergency declared by federal, state, or local government. However, where operations can begin or continue but staffing needs are reduced due to the above reasons, the 72-hour period is reduced to 24 hours for regularly scheduled employees. In addition, the rule may not apply to certain non-profit institutions that filed a certification with state DOL within 6 months after they were organized (go to https://www.labor.ny.gov/workerprotection/ laborstandards/pdfs/faqs_nonprofit_and_state2016.pdf for more information). There are lots of questions about the proposed rule, including whether minimum wage or the employee’s regular rate of pay applies, how the hours count toward overtime, etc. Please be on watch for an announcement of our December 6 call to ask further questions. The above article was based on information provided by Hinman Straub, our Public Affairs Firm, and Jackson Lewis, the organization that provides our Legal Counsel.
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MedPAC Report Eyes Uniform Post-Acute Payment Model to “Redistribute” Payments across Settings Further details are needed to assess precise impact on home care; but broad outlines of plan target therapy utilization, MedPAC-assumed profit margins, and include other watch points for home care The Medicare Payment Advisory Commission (MedPAC) recently reviewed a report outlining a possible unified post-acute-care (PAC) prospective payment system (PPS) to bring payment consistency and “redistribution” across various subsectors of PAC, including home care, nursing homes, rehabilitation facilities, and others. Slides and a transcript of the discussion are available at http://www.medpac.gov/public-meetings- (see November 2-3 meeting). MedPAC’s study on uniform PAC models is required by the Congressional IMPACT Act (“Improving Medicare PostAcute Care Transformation Act”). MedPAC is considering issuing this proposal/report as a recommendation in the future for consideration by the U.S. Centers for Medicare and Medicaid Services (CMS); however, if MedPAC does so, CMS is not obligated to adopt or embrace MedPAC’s nonbinding recommendations, though it may. According to MedPAC’s materials, the intention of the proposal is to “correct known biases” of the current payment systems and “redistribute payments within each setting.” The proposed redistribution would, in effect, increase payments for medically complex patients and decrease payments for rehabilitation care that is “unrelated” to a patient’s condition. “The redistribution would narrow the relative profitability across conditions, and, as a result, providers would have less incentive to admit certain types of patients over others,” states a MedPAC policy analyst in the meeting transcript. MedPAC asserts that the current, disparate payment systems encourage providers to furnish unnecessary therapies and avoid taking on medically complex cases, resulting in different costs for the same conditions in the various settings. An example from the slide presentation shows a base rate of $6,000. Under the current relative case-mix weights, an orthopedic episode payment is $7,200 and a medically complex episode is $4,800. The proposed relative weights under a uniform PAC PPS would change the orthopedic payment to $5,400 and the medically complex payment to $6,600. More detail is certainly needed, but the proposal raises several significant concerns, including the Commission’s mention of “program spending [which] is high relative to the cost of care, with Medicare margins in the double digits for three of the settings.” MedPAC has repeatedly emphasized double-digit margins in home care as a justification for past payment reform recommendations, and it appears that this view is reflected in MedPAC’s report on post-acute care reimbursement changes and possible methodologies for redistribution of payments across sectors. As HCA has repeatedly informed MedPAC, CMS and Congress, the margins for home care vary widely from region to region. New York’s Medicare margins averaged -6.97 percent in 2015 (the most recent year available), and we’ve stressed that payment changes need to be responsive to these regional variations. The report also appears to rely on 2013 PAC data, using 8.9 million PAC stays and focusing on 30 different patient groupings. Further details of the data set, modelling and case scenarios are needed to understand the full implications of this proposal. The proposal calls for full implementation in 2021 (and a blended implementation with existing payment models in 2019 and 2020). HCA will be following MedPAC’s continued deliberations, including its January recommendations to CMS to see if this proposal is included, and we will be urging industry involvement, data transparency and more current data in any future discussion of payment changes at CMS.
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TAX from p. 1 Thursday of last week) would cut Medicare by $25 billion in 2018, according to the Congressional Budget Office (CBO). HCA has staunchly opposed both efforts – to the extent that they harm critical access to health care services – and we’ve remained in communication with New York’s Congressional Delegation to urge the rejection of any tax plan that further cuts Medicare or infringes on ACA. Several New York Republicans did, in fact, join Democrats in voting “no” on the House measure last week, though the bill otherwise passed on what was substantially a party-line vote. The House bill’s Medicare impact comes in the form of automatic cuts, similar to sequestration, which stem from requirements of the Pay-As-You-Go Act of 2010. This Act requires program cuts, including to Medicare, for legislation that increases the deficit, as the tax bill would do (by as much as $1.4 trillion over ten years, according to some estimates). The Senate is eyeing a vote on its version of tax reform legislation for after the Thanksgiving break, though the margin of Republicans to Democrats in that chamber is much tighter – thus the outcome is less certain. Speculation abounds as to the position of some key Republican Senators, especially those who bucked traditional party lines by voting “no” in previous Congressional attempts to repeal ACA. Even after Senate action, should the bill pass, it would have to undergo a conference committee process to iron out differences between the House and Senate, which could result in further changes in such an event. HCA will keep the membership apprised of all relevant updates as this process unfolds over the coming days and weeks.
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CHIEF FINANCIAL OFFICER The Chief Financial Officer assists the Chief Executive Officer in the administration of all financial aspects of the Visiting Nurse Service & Hospice of Suffolk, Inc. The Chief Finance Officer provides overall direction and supervision of all finance and related budgetary functions, and participates in agency strategic planning. Qualifications: x Graduation from an accredited college with a Bachelor’s degree in Accounting or Finance. x Master’s in business administration preferred. x CPA desirable. x Five years progressive financial responsibility. x Two years experience in health care finance preferred. x Demonstrated ability to utilize data processing systems. x Demonstrated ability to communicate. A complete job description may be viewed at https://secure3.entertimeonline.com/ta/6140706.jobs?ShowJob=151203473&prevScreenX=0&prevScreenY=0 To apply for this position, please email your résumé to jobs@vnshs.org Visiting Nurse Service and Hospice of Suffolk offers a rich benefits package and a competitive salary commensurate with credentials and experience. EOE
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Important Upcoming Deadlines Requirement/Change
Effective/Due Date More Information
Fiscal Intermediary (FI) Authorization Application due from Existing FIs
Dec. 1, 2017
https://www.health.ny.gov/health_care/medicaid/redesign/mrt_10003.htm https://www.health.ny.gov/health_care/medicaid/program/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/redesign/mrt_61.htm
Medicare Open Enrollment Period
Oct. 15 to Dec. 7, 2017
www.medicare.gov
2016 Adult Care Facility Financial Report
Dec. 22, 2017
https://commerce.health.state.ny.us/public/hcs_login.html
2016 CHHA/LTHHCP Statistical Report
Dec. 29, 2017
https://commerce.health.state.ny.us/public/hcs_login.html (HERDS application)
2016 Hospice Cost and Utilization Report
Dec. 29, 2017
https://commerce.health.state.ny.us/public/hcs_login.html (HERDS application)
2018 State Worker Wage Parity Levels
Dec. 31, 2017
https://www.health.ny.gov/health_care/medicaid/redesign/mrt_61.htm
2018 State Minimum Wage Levels
Dec. 31, 2017
https://www.labor.ny.gov/workerprotection/laborstandards/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 Jan. 1, 2018 Care Services under Managed Care
https://www.health.ny.gov/facilities/long_term_care/reimbursement/letters/dal_2017Ͳ09Ͳ 22_billing_codes.htm
Revised Medicare Home Health Conditions of Participation in Effect
https://www.gpo.gov/fdsys/pkg/FRͲ2017Ͳ01Ͳ13/pdf/2017Ͳ00283.pdf
January 13, 2018
Start of Transition Period for Using Health Insurance Claim Number (HICN) or Medicare April 1, 2018 Beneficiary Identifier (MBI)
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https://www.cms.gov/Medicare/NewͲMedicareͲCard/index.html
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LHCSA Statistical Report Workgroup Meets, Provides Updates On November 13, HCA and some member agencies participated in the state Department of Health’s Licensed Home Care Services Agency (LHCSA) Statistical Report Workgroup meeting. This was the fourth meeting of the Workgroup whose goals, as outlined in numerous HCA Situation Report articles, are to: increase compliance rates of the Report; capture data relevant to service delivery; ensure quality data is collected timely; ensure common terminology in the Report; and streamline data reporting. DOH indicated that only about 53 percent of LHCSAs have submitted the 2016 Statistical Report (as of November 9). HCA and other colleague associations asked for a list of non-respondents so that we could contact any members that are among the list. (DOH did provide such a list after the meeting, and HCA followed up with most of our member agencies on the list.) DOH has taken enforcement actions against 90 agencies that did not submit the 2015 LHCSA Statistical Report and will continue such actions against those who don’t submit the 2016 Report. DOH also reviewed some of the provider and association recommendations to simplify, streamline and improve the Report. Then, DOH spent most of the meeting discussing which changes were made to the 2016 Statistical Report in response to those recommendations, and then which revisions are being planned for the 2017 Report. There was much discussion over a proposed new schedule for collecting workforce information. Members had concerns that some of the data collection would result in duplicate counting of cases and suggested that DOH approach payor and referral sources for this data. Lastly, DOH reviewed a new Universal Data Collection System that will be used for the 2017 LHCSA Statistical Report and for other Statistical and Cost Reports in the future. Under this system, LHCSAs would download free software and enter data on Excel-like spreadsheets (instead of using a web-based program). Users would be able to run edits before submitting the Report and the software will identify missing information and alert the user if the data does not meet certain conditions set up by DOH. DOH hopes to run a test of the new system in February and is looking for LHCSAs to participate. For more information about the changes planned for the 2017 LHCSA Statistical Report and/or to volunteer to test the Universal Data Collection System, contact Andrew Koski at akoski@hcanys.org or (518) 810-0662, or Patrick Conole at pconole@hcanys.org or (518) 810-0661.
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Enter to Win a Free Room at Dec. 7-8 Women in Healthcare Leadership Summit The discount hotel room deadline for HCA’s Women in Healthcare Leadership Summit has been extended to tomorrow, November 21. Want to make it a free room? All participants who register for the conference and make their room reservations by November 21 will be entered into a drawing. One randomly selected winner will have their room reservation billed to HCA. This includes all current registrants, as well as any new registrations made by November 21. The winner will be announced by December 1. (Registration options and hotel information are below.) Please remember that we are also offering a special mentor/mentee rate for additional savings. Mentors and sponsors play a vital role in supporting women leaders on the rise. Indeed, according to a recent study reported by the Harvard Business Review (https://hbr.org/2017/11/we-interviewed-57-female-ceos-to-findout-how-more-women-can-get-to-the-top), “when women reach the senior executive level, crucial support relationships shift from mentors, who offer encouragement and advice, to sponsors, who take a hands-on role in managing career moves and promoting executives as potential CEOs.” If you are a C-level executive, please consider taking this sentiment to heart by actively working to support a colleague’s advancement in health care at our upcoming conference. We have several exceptional consultants, business leaders and women entrepreneurs on hand to give you tools, insights and information to excel. Registration Options Download the brochure: http://hca-nys.org/wp-content/uploads/2017/09/HCA-Women-In-HealthcareLeadership-Summit-Brochure-2017.pdf Register online: https://www.eventville.com/catalog/eventregistration1.asp?eventid=1012182 Hotel Accommodations Courtyard by Marriott Saratoga Springs 11 Excelsior Avenue, Saratoga Springs, NY 12866 Phone: (866) 210-9325 HCA has reserved a limited block of rooms at the Courtyard by Marriott Saratoga Springs for the night of Thursday, December 7 at a discount rate of $129 per night. To receive this special rate, please call (866) 210-9325 and ask for the Home Care Association of NYS group rate. You can also make reservations online at https://tinyurl.com/yaldrwn9.
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OIG Issues Updated Work Plan The U.S. Office of the Inspector General (OIG) has issued the monthly update to its Work Plan. It is at https://oig.hhs.gov/reports-and-publications/workplan/updates.asp. The one area of interest to HCA members is “Use of Funds by Medicaid Managed Care Organizations.” While OIG previously updated its work plan once or twice a year, it has been updating its plan every month since June 2017. Additional information on OIG work plans is at https://oig.hhs.gov/reports-and-publications/workplan/index.asp.
DOH Publishes Updated Hospice Medicaid Rates The state Department of Health’s (DOH) Bureau of Residential Health Care this week published the Hospice Medicaid rates for October 1, 2017 through September 30, 2018. The rates were forwarded to the Division of Program Operation and Systems (and eMedNY) for payment. The rates, designated by the Standard Metropolitan Statistical Area (SMSA), have been posted to the Department’s public website at: http://www.health.ny.gov/facilities/long_term_care/reimbursement/hospice/. For hospices that have filed their Certification for Recruitment, Training and Retention (RT&R), the published rates include a 3 percent add-on payment authorized by Section 4013 of the Public Health Law (PHL) and a payment of $9.92 per day as the allocable portion of the payments authorized by Section 3614.9 of the PHL. Hospices are prohibited from using such funds for any other purposes than improving recruitment, training and retention of non-supervisory personnel with direct patient care responsibility. For specific questions about the rates, HCA hospice providers can contact DOH’s Russ Smith at (518) 473-4421. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
Population Health, Palliative Care & Home Care Workforce Thought-Leaders Kick-Off Northeast Home Health Summit in Boston Get an aerial view of the population health, long term care, and palliative care landscape for home care during a top-flight pre-conference session at the upcoming Northeast Home Health Superhero Summit in Boston! This pre-conference, on January 16, includes three exceptional, hour-long segments setting the table for the entire conference. We’ll begin with Paul Osterman, author of Who Will Care For Us? Long-Term Care and the Long-Term Workforce, whose work explores perhaps the biggest challenge and imperative for home care leaders: attracting and retaining a workforce to meet the demands of a growing elder population. Continued on next page
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Continued from previous page Geriatrician Dr. Charles Pu, Medical Director at Care Continuum, Partners Center for Population Health, will provide insights on home health’s role in Accountable Care Organizations (ACOs) and other population health redesigns. The pre-conference closes with Dr. Kate Lally, a hospice and palliative care medical director, who will help your organization become more conversation-ready in ways that improve care transitions and enhance the patient’s experience of care in line with the Triple Aim. She will specifically share the elements and outcomes of a “conversation nurses” training program for RNs that has achieved excellent results, as reported in a recent article for the Journal of Hospice and Palliative Care Nursing. Outcomes include: a “15-fold increase in hospice and palliative care consults” and “a 41% increase in average daily census and an 18% increase in length of stay on hospice.” This pre-conference is just the beginning of policy updates, hot-topic workshops, networking opportunities and more that await you on January 16 to 18 in Boston. Visit our conference website at http:// nehomehealthsummit.com/ for registration and other information. The Northeast Home Health (Superhero) 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 is one of the lead organizers, along with the Home Care Alliance of Massachusetts.
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Dec. 14 Webinar on Contracting Compliance Challenges in Home CareManaged Care Compliance and program integrity are pressing concerns for all home care agencies and managed care plans functioning in today’s competitive marketplace. Join HCA for a new December 14 webinar on this important topic (from 10 to 11:30 a.m.) by completing the registration form at the link below. You’ll hear from one of the state’s preeminent compliance experts, at Arent Fox, about common pitfalls and trouble spots that, if not handled properly, can result in violations of federal and state law, as well as recoupments or sanctions during federal and state audits. This interactive webinar, led by Rachel Hold-Weiss, RPA-C, JD, Partner, Arent Fox, LLP, will discuss common contracting compliance issues which stem from violations of federal and state Anti-kickback Statutes, improper incentive payments, potential violations of federal and state False Claims Acts and other program integrity issues. Webinars offer you a convenient, cost effective way to access critical information. There’s no travel expense, nor time away from the office, and you can invite as many colleagues as you’d like to listen-in through a single registered site connection. Webinar: Contracting Compliance Challenges in a Managed Care Environment December 14, 2017 10 to 11:30 a.m. (Registration Deadline is December 8, 2017) Register using the form at https://hca-nys.org/wpcontent/uploads/2017/11/Contracting-ComplianceChallenges-in-a-Managed-Care-Environment.pdf.
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HCA Adds Upstate Edition of LHCSA-VBP Program HCA is offering an upstate version of our program How LHCSAs Can Survive and Thrive in a VBP World. The program will examine your agency’s role as a “VBP contractor” and focus on successfully working with MLTC partners in navigating the path to the VBP world. Please note that both of our previously announced New York City sessions for this program (on November 30) have officially sold out. The state is requiring all MLTC contracts to include VBP provisions by December 31, 2017, which is little more than a month away. Home care agencies need to get ready for this imminent requirement as soon as possible. Information about our upstate session, in Syracuse, is below. Newly Added Upstate Session December 4, 2017 The Centers at St. Camillus 813 Fay Road Syracuse, NY 13219 9:30 a.m. to noon Register for this session here: https://hca-nys.org/wp-content/uploads/2017/11/HCA-Bootcamp-How-LHCSAs-CanSurvive-and-Thrive-in-a-VBP-Dec-4-2017-Registration-Form.pdf
Alex Azar Picked as New HHS Secretary Last week, President Donald Trump announced Alex Azar as his choice to be the next Secretary for Health and Human Services (HHS), following the resignation of former Rep. Tom Price (R-GA), who stepped down at the end of September. Unlike Price, who spent 12 years in Congress, Azar has worked in the executive branch, serving as general counsel at HHS during the Bush administration from 2001 to 2005 and has deputy secretary of the department from 2005-2007. Until very recently Azar was president of U.S. operations for pharmaceutical giant Eli Lilly. Mr. Azar’s appointment must undergo confirmation hearings in the Senate.
HCA Submits Comments on Draft CDPAP OMIG Audit Protocols Last week, HCA and 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 – submitted comments on draft Office of the Medicaid Inspector General (OMIG) audit protocols for the Consumer Directed Personal Assistance Program (CDPAP). In a time when CDPAP is undergoing more scrutiny by the state (see separate article on new fiscal intermediary authorization process), the protocols include:
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Missing Documentation of Service Missing Recipient Record
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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
Our comments seek to clarify the role and responsibilities of the FI, as distinct from the consumer, in some of the protocols and suggested revisions to comply with existing regulations on health immunizations and tests. HCA had shared the draft protocols with members and received valuable feedback which was incorporated into our final comments. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org
FI Authorization Process Update As the December 1 deadline approaches for existing Fiscal Intermediaries (FIs) to submit authorization applications, HCA and members continued to reach out to the state Department of Health (DOH) for clarification on the application process. HCA advises members that the December 1 deadline applies to existing FIs and not to those entities which plan to offer FI services for the first time(though these entities also must undergo the application process). The November 13 edition of The Situation Report included additional information based on communications with DOH. We suggest that members review it before submitting the application. DOH confirmed that it will soon post Frequently Asked Questions (FAQs) and HCA encouraged them to be released as soon as possible. HCA will alert members when the FAQs are posted. Last week, HCA announced the availability of an archived recording of our FI Authorization education program held on November 8. Those who had registered for the program can download the recording at https://hca-nys.org/ uncategorized/recording-november-8-hca-call-on-fi-authorization-process. A password is required and was sent to participants who registered and participated in the live call. Those who did not register can download a registration form to obtain the recording at https://hca-nys.org/ wp-content/uploads/2017/11/HCA-FI-Authorization-Teleconference-Nov-8.pdf. HCA continues to advise members to submit questions to DOH at FIAuthorization@health.ny.gov. HCA greatly appreciates the timeliness of DOH’s responses to questions sent by members and HCA. For those who are just starting to review the FI Authorization process, the application and helpful background information are at https://www.health.ny.gov/health_care/medicaid/redesign/mrt_10003.htm. HCA reminds members that they have to submit marketing materials with the FI application. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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Volume 2, No. 42 November 20, 2017
Provider Ombudsman Announced for New Medicare Card The U.S. Centers for Medicare and Medicaid Services (CMS) has appointed a Provider Ombudsman, Dr. Eugene Freund, who will serve as a CMS resource for the provider community on the new Medicare Card initiative. Under this change, CMS is removing Social Security numbers from Medicare cards and will replace them with a randomly generated number on new Medicare cards which will be issued starting in April 2018. The Ombudsman’s role is to ensure that CMS hears and understands any implementation problems experienced by clinicians, hospitals, suppliers, and other providers. He will also communicate about the new Medicare card to providers and collaborate on implementation solutions for any problems that arise. Provider systems and business processes must be ready to accept the new Medicare number (which is called the Medicare Beneficiary Identifier, or MBI) by April 2018 for transactions, such as billing, claim status, eligibility status, and interactions with their Medicare Administrative Contractors (MACs). Under a transition period, providers can use either the Health Insurance Claim Number (HICN) or the MBI to exchange data and information with the MACs. The transition period will start April 1, 2018 and run through December 31, 2019. However, systems must be ready to accept the new MBI by April 1, 2018. More information is at https://www.cms.hhs.gov/Medicare/New-Medicare-Card/Providers/Providers.html. To reach the Ombudsman, contact: NMCProviderQuestions@cms.hhs.gov.
CMS Posts RAC Review Topics The U.S. Centers for Medicare and Medicaid Services (CMS) has begun to post a list of topics that have been proposed, but not yet approved, for Recovery Audit Contractors (RACs) to review. These topics will be listed, on a monthly basis, on CMS’s Provider Resources page (https://www.cms.gov/ Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/RecoveryAudit-Program/Provider-Resources.html) along with details about the proposed reviews, such as:
Name of the Review Topic Description of what is being reviewed State(s)/MAC regions where reviews will occur Review type (complex review/automated review) Provider type Affected code(s) Applicable policy references.
This month’s posting includes: Inpatient Rehabilitation Facility (IRF) Stays; Respiratory Assistive Devices; Excessive or Insufficient Drugs and Biologicals Units Billed; and Physician Evaluation and Management services.
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Volume 2, No. 42 November 20, 2017
NGS Updates National Government Services (NGS), New York’s home health Medicare Administrative Contractor (MAC), recently posted to its Jurisdiction 6 Home Health website (www.ngsmedicare.com) the following Medlearn Matters (MLN) articles that may be of interest to HCA’s membership:
Therapy Cap Values for Calendar Year (CY) 2018 – For physical therapy and speech-language pathology combined, the CY 2018 cap is $2,010. For occupational therapy, the CY 2018 cap is $2,010. Make sure that your billing staffs are aware of these therapy cap value updates. Note that these caps do not apply to therapy provided as part of a home health episode of care.
Annual Update of HCPCS Codes Used for Home Health Consolidated Billing Enforcement – This article provides the 2018 annual update to the list of Healthcare Common Procedure Coding System (HCPCS) codes used by Medicare systems to enforce consolidated billing of home health services. Make sure your billing staffs are aware of these updates.
Common Working File (CWF) to Modify CWF Provider Queries to Only Accept National Provider Identifier (NPI) as Valid Provider Number – This notice is intended for providers, physicians and suppliers querying Medicare’s CWF for checking eligibility and entitlement status for Medicare beneficiaries.
Other NGS News
Home Health Rejected Claims with U6815, U6816, U6817 and U6818 – NGS is informing home health providers of an issue involving claims and requests for anticipated payments (RAPs) that are again being rejected by the Fiscal Intermediary Standard System (FISS) system for CWF reason codes U6815, U6816, U6817 and U6818. As a result, home health providers may be receiving inappropriate claim rejections for CWF reason codes: U6815, U6816, U6817 and U6818. No provider action is necessary at this time. The FISS maintainer is aware of the issue and currently working on a correction, which is being tracked by NGS. Please continue to check the Production Alerts section of NGS’s website and email updates for additional information regarding this issue.
For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
PHHPC Committee on Establishment and Project Review Meets On November 16, the Public Health and Health Planning Council (PHHPC) Committee on Establishment and Project Review met to act on provider applications. The 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 included applications by:
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37 entities to establish new Licensed Home Care Services Agencies (LHCSAs);
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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.
All the CHHA and LHCSA applications were approved, except for two new LHCSA applications whose applicants have been asked to provide additional information. Those approved will be taken up at the next full meeting of the PHHPC on December 7.
2018 Medicare Levels Announced The U.S. Centers for Medicare and Medicaid Services (CMS) has announced the 2018 Medicare premiums, deductibles and copayment amounts. They are at https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/ 2017-11-17.html. Medicare Part B The Medicare Part B monthly premium will be $134 and some beneficiaries who pay an additional incomerelated premium (about 30 percent of the Medicare population) will pay more. The annual Part B deductible will be $183 (the same as 2017). Medicare Part A The Medicare Part A amounts are:
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Hospital deductible for the first 60 days: $1,340 (up from $1,316);
Hospital daily copayment for days 61 to 90 : $335 (up from $329);
Hospital daily copayment for days 91 to 150 : $670 (up from $658);
Skilled nursing facility daily copayment for days 21 to 100: $167.50 (up from $164.50);
Part A premium for those who are not automatically eligible and have less than 30 quarters of coverage : $422 per month (up from $413); and
Part A premium for those who are not automatically eligible and have from 30 to 40 quarters of coverage: $232 per month (up from $227).
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HHS Releases Report on Top Challenges The Department of Health and Human Services (HHS) has released a report, entitled: “Top Management and Performance Challenges Facing HHS.” It is at https://oig.hhs.gov/reports-and-publications/top-challenges/2017/2017-tmc.pdf. Some of the challenges include: Ensuring Program Integrity in Medicare Ensuring Program Integrity in Medicaid Curbing the Opioid Epidemic Improving Care for Vulnerable Populations Ensuring Integrity in Managed Care and Other Programs Delivered Through Private Insurers Improving Financial and Administrative Management and Reducing Improper Payments Protecting HHS Data, Systems, and Beneficiaries from Cybersecurity Threats The report describes the challenges, what actions have been taken to address them, and what still needs to be done. In addition, resources from the federal Office of Inspector General are included. HCA advises members to have their compliance staff review the report.
Resources
“The Challenges of Enhancing Effective Engagement of Community Based Organizations in Performing Provider Systems,” by the Citizens Budget Commission https://cbcny.org/research/challenges-enhancing-effective-engagement-community-basedorganizations-performing
“Medicare Delivery System Reform: The Evidence Link, The latest facts and results on Medicare ACO, medical home, and bundled payment models,” by the Kaiser Family Foundation https://www.kff.org/medicare-delivery-system-reform-the-evidence-link/?utm_campaign=KFF-2017November-Medicare-Delivery-SystemReform&utm_source=hs_email&utm_medium=email&utm_content=58373213&_hsenc=p2ANqtz— jIEVHiZlQjmCUDf4vesjj1zYf8C_k7j3YDROJQuiLPVKpmPqDETsJnXtHdBHcadC9o5Ytv7hHQkYYojS9HMqjliWTgQ&_hsmi=58373213
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“Changing The Conversation: New Model Of Home-Based Palliative Care For Patients With Serious Illnesses” (Health Affairs Blog) http://www.healthaffairs.org/do/10.1377/hblog20171108.84627/full/
“Use of Paid and Unpaid Personal Help by Medicare Beneficiaries Needing Long-Term Services and Supports,” by Commonwealth Fund www.commonwealthfund.org/publications/issue-briefs/2017/nov/paid-unpaid-help-medicare-ltss
“Effects of Medicare Advantage Enrollment on Beneficiary Risk Scores,” by the Congressional Budget Office www.cbo.gov/publication/53270
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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