Nov. 21, 2016 Edition of The Situation Report

AHHA BILL

WORKFORCE $

WAGE PARITY

OASIS C2

Advanced Home Health Aide Bill now awaits the Governor’s signature into Law. Implementation process is key.

Workforce initiative taking shape, with $245M Center for Workforce Excellence Program.

Wage Parity levels are announced, with certifications coming due on December 1.

OASIS changes are on the horizon. Make sure your clinicians are ready with Nov. 30 webinar.

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COMING UP Bootcamp: Successfully Acting as a Fiscal Intermediary in the Consumer Directed Personal Assistance Program Dec. 1, 2016 Visiting Nurse Service of New York 107 East 70th Street (between Park and Lexington Ave) New York, NY 10021 9:30 to 10 a.m.

(Registration and continental breakfast) 10 a.m. to noon program Tools, Resources and Knowledge for VBP Readiness and Success Dec. 15, 2016 DoubleTree by Hilton Hotel Tarrytown 455 S. Broadway, Tarrytown, NY 10591

Your Source for HOME CARE News, Policy and Advocacy

Vol. 1, Issue 11 | November 21, 2016

Minimum Wage Funding Update Further Guidance Imminent HCA expects that further guidance is imminent from the state Department of Health (DOH) on funding to help home care providers pay for the December 31 minimum wage increase in New York City.

As communicated to members, DOH had issued guidance on October 28, but this raised a lot of questions over how much money MLTC plans have to pass on to their home care contractors, whether plans could reduce their rates prior to passing on funding for the minimum wage increase, and other issues.

See WAGE p. 4

Post-Election Political Landscape in D.C. Remains Uncertain for Medicare, Medicaid President-elect Donald Trump’s vow to repeal and replace the Affordable Care Act (ACA) leaves a long list of unanswered questions and speculation not only about the future of ACA’s health insurance provisions, but also about the status of many federal and state-level projects being undertaken in coordination with the U.S. Centers for Medicare and Medicaid Services (CMS).

See ELECTION p. 2

INSIDE Minimum Wage Funding Update....................................................................1 Post-Election Political Landscape in D.C. Uncertain........................................1 Advanced Home Health Aide Bill Delivered to Governor for Action....................4 $245 Million Center for Workforce Excellence Initiative Progressing...............5 DOH Issues Two Guidances for MLTC Plans......................................................6 2017 NYC, Long Island and Westchester Wage Parity Levels Posted................8 Dec. 1 Deadline: Wage Parity Certification Forms...........................................9 Dec. 15 Program offers VBP Insights from Managed Care Payors and More......10 Timely & Convenient Webinar on Upcoming OASIS C2 Changes.....................10 HCA Essential Personnel Bill Delivered to Governor: Act Now........................11

Providers, Local Managers Network Together on Emergency Prep.................11 New Applications Reviewed by PHHPC Committee......................................12 Guidance Issued on Influenza Vaccine.........................................................13 This Week’s Home Care Month Stories........................................................13 HCA Submits Comments on Draft NHTD Audit Protocols...............................15 HEAP Benefits Available.............................................................................16 New Upgrade for UAS to include CFCO...........................................................16 DSRIP Update: Revised Mid-Point Assessment Timeline..............................17 NGS Closed on Thanksgiving.................................................................18 Resources...........................................................................................................18

The Situation Report: the Home Care Association of New York State ELECTION from p. 1 One such initiative, already well in the thick of implementation, is New York’s multi-billion-dollar, CMSapproved Delivery System Reform Incentive Payment (DSRIP) project.

Anticipating questions about DSRIP’s status post-election, State Medicaid Director Jason Helgerson sent a message on November 11 to the lead performing provider system (PPS) entities under DSRIP, stressing that “DSRIP is not part of the Affordable Care Act (ACA) and would not be affected by legislative attempts related to the ACA.” DSRIP is part of a waiver amendment agreement with CMS, he said, authorized through March 2020 and run by the state government. “Health care system reform and Value Based Payment efforts will continue as these are industry drivers for improved quality and sustainability,” he added.

Mr. Helgerson advised the state’s PPS leads to “please keep focused on the DSRIP goals and projects, and maintain the collaborative and positive work you and your staff have accomplished so far. Proceed with fact-based optimism.”

While a prospective ACA repeal may not immediately affect DSRIP and other state-initiated waiver projects, it still remains to be seen how the Medicaid program in New York State – and nationally – would look under a Trump administration, though strong signals suggest a thinning of the program.

In addition to ACA’s repeal, the President-elect has also pledged to turn Medicaid into a block-grant system – a move long supported by Republicans who now hold majorities in both houses of Congress. This means that Medicaid would no longer function as an open entitlement; instead, states would receive a defined, lump-sum grant from the federal government to administer their programs, rather than the federal government matching what the state pays for Medicaid.

The future of current Medicare innovation projects also remains uncertain. Republican lawmakers have criticized

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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Volume 1, No. 11 November 21, 2016 

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 V ice President, Policy & Programs acardillo@hcanys.org Patrick Conole Vice President, Finance & Management pconole@hcanys.org Andrew Koski Vice President, Program, Policy & Services akoski@hcanys.org Alexandra Fitz Blais Director of Public Policy ablais@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 & Special Projects jkerbein@hcanys.org Billi Wilson Manager, Meetings & Events bwilson@hcanys.org Teresa Brown Administrative Assistant tbrown@hcanys.org

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CMS’s Center for Medicare & Medicaid Innovation (CMMI), characterizing its work as an overreach and, in some cases, signaling legislative efforts to repeal it or scale it back – an action which may or may not be embraced by a Trump Administration.

As Inside Health Policy reported this week, health care insiders “say an ACA overhaul might rename the center, give Congress more power over it and reduce the scale and scope of the demonstrations, but they don’t think Republicans will do away with it.”

The CMMI is responsible for many of the recent bundled payment initiatives that have been tested with providers, including the Comprehensive Care Joint Replacement Model and the Cardiac Bundled Payment Model.

As for the Medicare program as a whole, the President-elect’s campaign message did not call for explicit changes. However, House Republican Leader Paul Ryan has since reinvigorated the GOP’s call for a premium-supported system under Medicare and the possibility of increasing the Medicare eligibility age threshold, among other key provisions. According to several news analysts, the Trump Transition Team website and other sources suggest an alignment with these goals, as both the Congressional GOP leadership and President-elect Trump are using the same vernacular about “Modernizing Medicare,” which, say some, is code for the Republican House’s proposed changes.

Meanwhile, business regulations, especially those enacted with the Executive’s pen, could also see some changes, including those affecting health care and home care providers. In a recent article entitled “14 Obama regs Trump could undo,” The Hill, an online news source, named the white-collar exemption overtime rule as one that is likely to be targeted for repeal. The rule, recently covered in past editions of The Situation Report, raises the salary threshold so that fewer “white-collar” workers are exempt from overtime.

An incoming Trump Administration’s anti-regulation stance leaves questions about the status of other similar rules, be it the Fair Labor Standards Act requirements for aide overtime or the Medicare Face-toFace rule. Though part of ACA, the F2F regulation may or may not get cued for removal along with other parts of an attempted ACA repeal measure. Many federal regulations could be undone without Congress, as Mr. Trump has said he will use his executive authority on several measures.

One commonsense regulatory change remains a continued target of HCA advocacy: a bill allowing nonphysician practitioners to order and refer for home health services. Senator Charles Schumer, now lined up to be the Senate’s Minority Leader, has championed this bill, and HCA has led efforts nationally to write the Senator to bolster his continued support.

So far over 1,000 messages have been sent to Senator Schumer using HCA’s Legislative Action Center, including activism from other state home care associations that have pointed their members to HCA’s online campaign. If you haven’t yet written Senator Schumer on this bill, please do so by visiting the campaign link at http://p2a.co/U4PrIKi. All you need to do is enter your contact information and press “send” to deliver a message of support to Senator Schumer. It takes less than a minute of your time.

HCA will continue to provide you with analysis and updates as the political environment becomes more defined in the weeks to come. We are also designing a federal advocacy strategy that responds to this changing political environment as we press for policies in support of New York’s home care priorities.

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WAGE from p. 1 Time is of the essence as plans have to send contract amendments to home care providers and then providers will have to return the signed document in time for the plans to establish new rates to account for the December 31 minimum wage increase.

HCA has strenuously advocated that the minimum wage increase should be an “add-on” to the existing rates between plans and providers and that there should not be rate reductions prior to the minimum wage increase.

Once DOH releases further guidance, we will alert our members.

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

Advanced Home Health Aide Bill Delivered to Governor for Action Advanced Home Health Aide legislation has been delivered to the Governor for his signature.

The bill (S.8110/A.10707) passed both houses of the Legislature earlier this year after months of deliberations and following concerns during prior years that resulted in the bill being introduced but ultimately tabled.

Governor Cuomo has expressed strong support for the bill. Having now received approval in the Legislature this year, the bill is expected to gain the Governor’s signature into law.

The bill specifically creates a designation of “Advanced Home Health Aides” (AHHAs) who can perform certain advanced tasks, including the administration of certain medications, under the supervision of a registered professional nurse and pursuant to an authorized practitioner’s ordered care.

The legislation directs the state departments of Education and Health to formulate many details in rules and regulation, including the array of permissible tasks, the required training and qualifications, and other implementing elements. The legislation requires that a workgroup be convened to provide input from the field.

In past years, HCA initiated and led similar legislation that would provide increased flexibility for nurses in home care and hospice agencies to work with aides and patients to enable a greater span of service, where appropriate. Those efforts were designed in a manner consistent with existing nurse discretion to educate, train and assign family members in a patient’s care.

Assuming the Governor signs this legislation into law, the implementation and stakeholder process will be critical in shaping the ultimate procedures, safeguards and tasks allowable for AHHAs. HCA will be seeking to address several specific areas during any ensuing implementation process, especially the need for funding for training, compensation and oversight of AHHAs. We will also seek to minimize excessive requirements or regulations that would accompany the

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increased flexibility for AHHA, the need for fair liability protection for nurses and agencies utilizing AHHAs in good faith, a better alignment between managed care plan procedures and the bill’s AHHA procedures, and the need for clear provisions that pave the way for existing home health aide training programs to qualify for AHHA training.

HCA will keep the membership closely apprised of the developments with this legislation.

$245 Million Center for Workforce Excellence Initiative Progressing State Department of Health (DOH) officials have informed HCA that the $245 million Center for Workforce Excellence (CWE) education and training initiative is progressing toward finalization on a number of fronts.

This initiative, covered extensively in previous HCA communications, would allocate $245 million (aggregated through MLTC plans) to CWEs for expenses related to direct care long term care worker education and training. Under the program, home care provider direct care employers could refer their workers for advanced, specialized and/or new emerging areas of education and training, particularly in conjunction with skill priorities in the evolving health care system. HCA has provided a great deal of input to DOH in an effort to shape an effective design and allowable funding purposes under this program; however, the final program parameters and allocation methods for the funding will be subject to DOH determination and, further, negotiation with the U.S. Centers for Medicare and Medicaid Services (CMS).

DOH informs HCA that the Department has drafted language to provide DOH authority to designate CWEs in regions across the state. DOH officials indicate the language is expected to be finalized imminently.

DOH is also awaiting CMS approval of its proposed protocol for program operation and flow of funds.

DOH indicates that it is very close to renewing the state’s 1115 Medicaid waiver and CMS has verbally committed to either including approval of the state’s CWE protocol with the 1115 renewal, or making it a priority after the renewal is granted.

Further developments are anticipated by DOH later this week or immediately after Thanksgiving.

We continue our intensive effort for advocating a final design that will best meet the needs of home care patients, workers and agencies. Workforce education, training and capacity issues are critical throughout the state, and especially in high shortage areas. Concerns have prompted statewide consumer organizations this fall to begin mounting an intensive governmental advocacy effort aimed for the coming state budget and legislative sessions to address what they have characterized as a “shortage crisis” in many areas.

HCA will keep the members informed of developments with this program.

For further information, please contact Al Cardillo acardillo@hcanys.org.

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DOH Issues Two Guidances for MLTC Plans On Friday, the state Department of Health (DOH) posted two guidance documents for MLTC plans: Guidance on Notices Proposing to Reduce or Discontinue Personal Care Services or Consumer Directed Personal Assistance Services (MLTC Policy 16.06) and Guidance on Task-based Assessment Tools for Personal Care Services and Consumer Directed Personal Assistance Services (MLTC Policy 16.07).

They are at http://www.health.ny.gov/health_care/medicaid/redesign/mrt90/mltc_policies.htm.

Service Reductions or Discontinuations Policy 16.06 provides further guidance to MLTC plans concerning appropriate reasons and notice language to be used when proposing to reduce or discontinue personal care services (PCS) or consumer directed personal assistance services (CDPAS). In particular, it addresses notices that propose to reduce or discontinue PCS or CDPAS for either of the following reasons: a change in the enrollee’s medical or mental condition or social circumstances; or a mistake that occurred in the previous authorization or reauthorization.

The notice states that a plan cannot reduce or discontinue services without considering the facts of the individual enrollee’s circumstances and thus cannot reduce services as part of an “across-theboard” action that does not consider each individual enrollee’s particular circumstances and need for assistance. Furthermore, an MLTC plan may not reduce or discontinue an enrollee’s PCS or CDPAS unless there is a legitimate reason for doing so, and plans must advise their enrollees of the specific reason for a proposed action.

Plans are also reminded that enrollees are entitled to timely (i.e. 10-day prior notice) and adequate notice whenever plans propose to reduce or discontinue PCS or CDPAS or other services. All partially capitated plans must also use the state-mandated fair hearing notices, and plans must comply promptly with all aid-continuing directives issued by the state Office of Temporary and Disability Assistance.

Task-Based Assessment Tools Policy 16.07 provides guidance regarding the appropriate use of task-based assessment tools for PCS or CDPAS, also known as aide task service plans, client-task sheets, or similar names.

While DOH has not approved the use of any particular task-based assessment tool, MLTC plans may choose to use such tools as guidelines for determining an enrollee’s plan of care.

If a plan chooses to use a task-based assessment tool, including an electronic task-based assessment tool, it must do so in accordance with the following guidance: 

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Task-based assessment tools cannot be used to establish inflexible or “one size fits all” limits on the amount of time that may be authorized for an instrumental activity of daily living (IADL) or an activity of daily living (ADL) or the frequency at which such tasks can be

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performed. Plans must conduct individualized assessments of each enrollee’s need for assistance with IADLs and ADLs. 

When an enrollee requires safety monitoring, supervision or cognitive prompting to assure the safe completion of one or more IADLs or ADLs, the task-based assessment tool must reflect sufficient time for such safety monitoring, supervision or cognitive prompting for the performance of those particular IADLs or ADLs.



Plans cannot use task-based assessment tools to authorize or reauthorize services for enrollees who need 24-hour services, including continuous services, live-in 24hour services, or the equivalent provided by formal services or informal caregivers.



All plans, including those that use taskbased assessment tools, must evaluate and document when and to what extent the enrollee requires assistance with IADLs and ADLs and whether needed assistance can be scheduled or may occur at unpredictable times during the day or night.

MLTCs must seek approval of task-based assessment tools for PCS or CDPAS prior to use.

Similarly, if an MLTC proposes to modify an existing task-based assessment tool, the MLTC must seek approval of such modification.

Questions about either guidance can be sent to the Bureau of Managed Long Term Care at: mltcworkgroup@health.ny.gov.

 HCA held our Quality and Technology Symposium last week, gathering clinical and quality improvement leaders for a range of topics related to health IT, bundled payment initiatives, state quality and technology program initiatives, sepsis-prevention, data analysis, population health, social determinants of health, and more. At top is HCA Member Amy Bowerman, RN, Director of Quality Improvement/Privacy Officer at Mohawk Valley Health Systems-Home Care Services and Director of Patient Services, Senior Network Health, discussing the sepsis screening tool for home care. At bottom is Pat Roohan, Director, Office of Quality and Safety, state Department of Health.

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2017 NYC, Long Island and Westchester Wage Parity Levels Posted The state Department of Health (DOH) has posted the 2017 state Home Care Worker Wage Parity levels for New York City, Long Island and Westchester. In order to reflect the new minimum wage levels effective December 31, 2016 and in future years, the wage parity rates will be in effect for the period of December 31, 2016 through December 31, 2017.

The new parity levels and corresponding Dear Administrator Letters (DALs), which were posted on November 18 for each region, can be viewed here: http://www.health.ny.gov/health_care/medicaid/redesign/mrt_61.htm.

NYC The levels for NYC have been revised to reflect the new minimum wage that goes into effect on December 31, 2016. According to the DAL for NYC, the minimum rate of home care aide “total compensation” will be $15.09 per hour for “large” employers with 11 or more total employees and $14.59 for “small” employers with 10 or fewer total employees. This rate consists of a “base wage” of at least $11 per hour ($10.50 per hour for small employees), and “additional wages” of up to $1.69 per hour and “supplemental wages” of up to $2.40 per hour for both large and small employers.

The DAL also includes overtime rates of $16.50 for large employers and $15.75 for small employers (based on a calculation of 1.5 multiplied by a regular rate of pay of $11 or $10.50, respectively, for large or small providers).

Total compensation, base wage, additional wages and supplemental wages are defined in the DAL. Long Island and Westchester The levels for Long Island and Westchester will remain the same as the current period of March 1, 2016 through February 28, 2017. This includes a minimum rate of home care aide “total compensation” of $13.22, consisting of a “base wage” of at least $10 per hour and “supplemental wages” of up to $3.22 per hour. The overtime rate is also listed as $15 per hour (based on a calculation of 1.5 multiplied by a regular rate of pay of $10).

Wage Parity Levels by Region for 2017

Region

New York City

2017 Required "Base Wage" $11/hour for “large” employers and $10.50/hour for “small” employers

Nassau/Suffolk/ $10/hour Westchester

Required Required "Additional "Supplemental Wages" Wages"

$1.69/hour

Ͳ

2017 Minimum Rate Of Total Compensation

$2.40/hour

$15.09/hour for large employers and $14.59/hour for small employers

$3.22

$13.22/hour

Continued on next page

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Continued from previous page Overtime Pay In changes to last year’s DALs on wage parity, both directives include language clarifying that while employers may use overtime pay to satisfy the total compensation requirement under the wage parity law for a given hour of overtime, overtime pay cannot be used more generally to also satisfy the total compensation requirement for non-overtime hours. As such, if a worker is being paid $16.50 an hour for overtime work in New York City ($15 per hour in Long Island and Westchester), this level will fully satisfy and encompass the required total compensation rate of $15.09 for NYC (or $13.22 for Long Island and Westchester) for overtime hours only. However, in new language, both DALs state that “no part of the $16.50 (NYC) or $15 (Long Island and Westchester) paid for a given hour of overtime can be used to satisfy the total compensation rate for all hours, generally, or for non-overtime hours, specifically.”

HCA already sought clarification on this section of the DAL. HCA continues to strenuously advocate that the premiums of managed care plans and rates paid to home care providers under managed care and fee-forservice Medicaid be increased to account for the increased labor costs of minimum wage, overtime, travel, Workers’ Compensation and other expenses.

December 1 Deadline: Wage Parity Certification Forms The next round of the state-required vendor Home Care Worker Wage Parity certification forms is due December 1 for LHCSAs and other entities that contract with Managed Care Organizations (MCOs), CHHAs and/or LTHHCPs serving New York City, Long Island and Westchester.

MCOs, CHHAs and/or LTHHCPs that contract with LHCSAs are required to obtain a written certification from the LHCSA or other entity attesting to its Wage Parity compliance for defined certification periods on a quarterly and prospective basis. The form, due December 1, 2016, covers the period December 1, 2016 through February 28, 2017 and is sent to the appropriate MCO, CHHA and/or LTHHCP, not the state Department of Health (DOH).

The 2016 certification forms are at http://www.health.ny.gov/health_care/medicaid/redesign/2016/2016-0217_wage_parity_alert.htm. In completing the form, HCA recommends adding a date after the signature and noting on the form that the certification covers the December 1, 2016 to February 28, 2017 period.

The Home Care Worker Wage Parity rates for March 1, 2016 through February 28, 2017 are at http:// www.health.ny.gov/health_care/medicaid/redesign/mrt_61.htm. Please note that, as discussed in the p. 6 story, this period includes two different wage parity levels for New York City — one covering December 1 to December 31, 2016 and another covering the first two months of calendar year 2017.

Since the inception of the Wage Parity Law, HCA has pressed for full wage parity funding. With the transition of most cases to managed care plans, HCA has advocated that the plans receive rates sufficient for wage parity compliance and that Medicaid fee-for-service (FFS) rates be increased to account for these requirements. HCA has also been involved in two different legal challenges to the Wage Parity Law (one federal and one state) which have been previously described to the membership.

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December 15 Program offers VBP Insights from Managed Care Payors and More

Timely & Convenient Webinar on Upcoming OASIS C2 Changes

Home care providers can always gain important lessons hearing from managed care plans or other payors about their expectations for service delivery, including what providers can do to enhance your value-proposition.

Your team’s OASIS expertise impacts reimbursement, quality outcomes, survey findings, and your agency’s public ratings.

What’s more, CMS has also released the final OASIS C2 form and manual for mandated use in assessments beginning January 1. This is the third revision to OASIS in less than two years.

This is especially so in a value-based payment (VBP) environment, which is fast becoming the new paradigm for Medicaid services in New York State, with similar approaches being tested in the Medicare marketplace.

During HCA’s December 15 program on Tools, Resources and Knowledge for VBP Readiness and Success in Tarrytown, we are featuring a panel of three managed care plan representatives offering “VBP Insights for Home Care from the Payor’s Perspective.”

Your success in a VBP environment hinges on strong partnerships with managed care plans, which are already a driving force for payment, serviceauthorization, care management and shared-risk arrangements in home care, and increasingly so under VBP. This panel will discuss: what drives decisionmaking in their contracting relationships; the most important value-driven elements in a home care relationship; and what data home care agencies need to bring to the table in their contracting discussions with plans.

Our managed care panel is just one of five sessions offering insights on: VBP operational readiness for home care; VBP workforce investment opportunities for home care; VBP-focused data assessment; as well as other tools and inside knowledge to help you position your organization for VBP. Don’t miss this final signature HCA program of 2016. Registration links are below.

Download the brochure: http://hca-nys.org/wp-content/ uploads/2016/11/VBP-Readiness-and-Success-BrochureDec-15-2016.pdf.

Register online: https://www.eventville.com/Catalog/ EventRegistration1.asp?EventId=1012048.

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HCA is offering a timely education program on the latest OASIS changes during a November 30 webinar (from 11:30 a.m. to 1 p.m.) for clinicians, supervisors and quality coordinators called OASIS C2: Are Your Ready For The Changes?

This program will: review the content and intent of the new OASIS C2 items; explain how wound-related directions in the official OASIS C2 guidance will have a potentially negative impact on PPS case-mix and non-routine supply calculation; discuss the new National Pressure Ulcer Advisory Panel definitions within OASIS; describe key positive and negative impacts of OASIS C2; and identify what agencies need to do now to prepare for implementing OASIS C2.

There is no limit to the number of attendees from your agency who may participate in the webinar at your site using one phone line and a computer with internet access. This format saves you time and eliminates travel expenses. It also provides the opportunity for group training, led by Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, HCS-O, a home care veteran with 30 years spent in home health and hospice, both as an RN and as an attorney practicing exclusively in home care.

Simply register (or have your team do so) using the online form at http://hca-nys.org/wpcontent/uploads/2016/10/OASIS-C2-Are-YouReady-for-the-Changes-11-30-16.pdf.

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HCA Essential Personnel Bill Delivered to Governor: Act Now to Urge His Signature Please send two important messages using our online advocacy system which takes only a few minutes of your time As reported in an alert to members last week, the HCA-developed essential-personnel bill for emergency preparedness and response has been delivered to Governor Cuomo’s desk for his signature. This is a critical time for you to get on record in support, and urge the Governor to sign this commonsense measure into law.

We need you and your staff to act today and throughout the coming days to voice support and bolster the work of Legislative Sponsors. Please make sure the Assembly, Senate and Governor’s office have a big file of support letters from you!

HCA’s Legislative Action Center has two messages for you to send on this bill (S.6692B/A.9381B). The messages have been updated to reflect the fact that this bill is now ready for the Governor’s signature. Even if you’ve done so already, we ask that you and your staff send messages to the Legislature and Governor as soon as possible. The messages are ready for you; all you have to do is enter your contact information. It takes just a few minutes.

The first message (at http://p2a.co/m4goCRr) thanks Assembly and Senate sponsors (Assemblyman Cusick and Senator Lanza) for their vigorous support of the bill and urges their work with Governor Cuomo to have him sign it.

The second message (at http://p2a.co/1v4njaL) is addressed to Governor Cuomo, explaining the merits of the bill and urging his signature.

As extensively reported, this bill has enjoyed unanimous, bipartisan support in both houses of the State Legislature but has been vetoed based on concerns raised by county emergency managers. HCA and sponsors have worked to address and clarify those areas of concern. Our message to Governor Cuomo specifically emphasizes that “this bill provides for access solely according to procedures, plans and designs adopted by each locality’s emergency management plan and official. The bill abides and does not override these local roles, nor does it impose any mandate or new role for local governments.”

We need as many providers as possible sending these messages today as the Governor considers the outcome of this important HCA-developed measure.

Providers, Local Managers Network Together on Emergency Preparedness HCA and the New York State Association of Health Care Providers (HCP) have continued our locally-focused emergency preparedness sessions for home care, hospice, county emergency managers and county health preparedness leaders, this time with stakeholders serving the broader Capital/Northeast region of the state.

The sessions are being conducted under HCA/HCP’s collaborative statewide roles with the state Department of Health Office of Health Emergency Preparedness.

The State University of New York at Cobleskill and the University at Albany College of Emergency Preparedness (the nation’s first such college) served as perfect community-oriented venues for our most recent sessions,

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with Cobleskill hosting our session for Otsego, Schoharie, Fulton and Delaware county participants on November 10, and Albany hosting for Montgomery, Schenectady, Albany, Rensselaer, Columbia and Greene counties that same day.

The sessions, which included a county-specific breakout component, offered an important exchange between providers and emergency/health preparedness managers, leading to new plans and recommendations for strengthened engagement and collaboration. Next steps include both immediate/local actions for providers and managers, as well as suggested statewide issues and improvements to explore.

Providers and local managers in 34 of the state’s 62 counties have now participated in these sessions since April. HCA and HCP will next be debriefing with DOH on the content and follow-up to these sessions, and identifying the next geographic region of the state for scheduling.

Further Emergency Preparedness Initiative Planning with DOH HCA, HCP and DOH also met this week to review the status and planned steps for companion emergency preparedness initiatives simultaneously being pursued under the state’s plan, including: assistance for providers in implementing the new federal emergency preparedness rule; compilation of a toolkit for providers to assist patients and families in home care emergency preparedness; assistance with situational awareness; development of exercises and drills honed to home care and hospice; and others. Stay tuned for further updates.

For more information, please contact Al Cardillo at acardillo@hcanys.org or Alex Blais at ablais@hcanys.org.

New Applications Reviewed by PHHPC Establishment and Project Review Committee This week, the Public Health and Health Planning Council (PHHPC) Establishment and Project Review Committee met and approved applications related to one CHHA and several LHCSAs. These approved applications have now been sent to the full PHHPC for consideration. These included applications by: 

One CHHA to acquire and merge with another CHHA.



One hospice to open a 12-bed hospice inpatient unit (in Nassau) and another hospice to convert two dedicated inpatient-only beds to two residence beds, resulting in a final hospice residence bed count of ten (in Rockland).



Three entities to establish LHCSAs associated with Assisted Living Programs (ALPs), to serve: Monroe; Northeast counties (12); and Western counties (nine).



Eleven LHCSAs for changes of ownership.

The materials of the Committee meeting are at http://www.health.ny.gov/facilities/ public_health_and_health_planning_council/meetings/2016-11-17/.

The next meeting of the full PHHPC will be held on December 8 in New York City; it will also be webcast at http://www.health.ny.gov/events/webcasts/.

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

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

Volume 1, No. 11 November 21, 2016 

Guidance Issued on Influenza Vaccine The state Department of Health (DOH) has issued an informational message on the use of live attenuated influenza vaccine (LAIV). DOH strongly recommends that health care personnel be vaccinated with inactivated influenza vaccine (IIV), not LAIV, in the 2016-17 influenza season. Data has demonstrated low effectiveness of LAIV in the previous three seasons. This comes in addition to a recommendation from the U.S. Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) not to use LAIV in the 2016-17 influenza season.

While the CDC’s advisory committee does not recommend LAIV for use in the 2016-17 influenza season, LAIV remains an FDA-licensed vaccine and, therefore, it is an “influenza vaccine” pursuant to state regulations (Title 10, section 2.59). Accordingly, health care personnel who receive LAIV in the 2016-17 season will satisfy the requirements for vaccination and, thus, not trigger the corresponding flu-mask mandate. This flumask mandate specifically instructs home care and other health care personnel to wear a surgical or procedure mask in cases where the personnel have not been vaccinated against influenza for the current influenza season.

Questions about the “flu mask” mandate can be directed to DOH at FluMaskReg@health.state.ny.us; inquiries about influenza vaccine recommendations should be sent to immunize@health.ny.gov.

The full message is available at: https://apps.health.ny.gov/pub/ctrldocs/alrtview/postings/ Notification_21348.pdf.

This Week’s Home Care Month Stories: VNS Westchester Delivers Cheer to Patients; VNA Homecare Brings The Vote Home In our continuing series this November, HCA is sharing two more stories about the community service work of home care providers during National Home Care Month.

Both stories, and previous installments of this series, are posted to our home care month website at www.nationalhomecaremonth.com.

At VNS Westchester, A Little Creativity Goes a Long Way in Bringing Cheer to Patients VNS Westchester (VNSW) has a long history of community service. Its staff provides free health screenings at community sites, contributes to food and clothing drives, arranges for donated medical equipment and more.

As the “giving season” approaches, VNSW staff is busier than ever finding ways to give back to community members in need. This year, the agency will be providing personalized holiday gift baskets to many of its vulnerable patients, including at-risk families and children, the frail elderly who live alone, veterans and others who could use some extra holiday cheer. The contents of the baskets are tailored for each person or family based on the recommendations of nurses, therapists and home health aides.

“Because of the close bonds they form with our patients, nurses, therapists and aides develop a keen understanding of items that would be useful or meaningful in fulfilling a need or desire that the patients may

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

Volume 1, No. 11 November 21, 2016 

not be able to provide for themselves,” says Joyce Infante, VNSW’s Director of Development and Communications.

Contents might include stationery and stamps for a homebound patient; scented lotion and special socks for a diabetic patient; a flowering plant for a gardening enthusiast; warm mittens and toys for young children.

“The creativity that goes into the holiday baskets was matched this year with a creative enterprise to raise money to fund them,” says Infante. “Last year we raffled off a quilt created by staff to raise funds for a staff member’s service mission to help orphans in China. This year, for our second quilt raffle, six members of our nursing and support staff worked for several months to create a beautiful autumn-themed quilt, titled ‘Fall into Pieces.’ The quilters decided to raffle off the quilt to generate funds for the gift baskets.”

“VNSW Quilters” created and raffled off a quilt to raise funds for its holiday community service project this year. They are (left to right): Sandy Ogburn, Supervisor-Support Staff; Claudia Weiner, RN, CWON; Sally Wilson, RN; Mindy Kendall, RN, Intake Coordinator; Jill Foscaldi, Executive Assistant (not shown, Janice Malett, RN, CWON).

According to VNSW’s Director of Patient Services, Suzanne Moses, “I’m proud of the creative ways multiple groups of staff work together on community service projects that benefit our patients in need. The attention to detail that goes into personalizing the holiday gift baskets means a great deal to our patients and to our staff as well. It is characteristic of the level of personalized care that patients come to expect from our home care team, not just during the holiday season, but all year long.”

VNA Homecare Helped Bring The Vote Home to Patients in Central New York In the summer and fall of 2016, HCA embarked on a campaign called Bring The Vote Home-New York, which engaged home care providers to deliver voting materials to elderly, homebound, disabled and chronically ill New Yorkers so they can register and vote from home using an absentee ballot.

As part of the process, HCA delivered 10,000 packets to home care agencies throughout the state, along with instructions for their staff to engage voters at home during the normal course of their nursing or home health aide visits, making it possible for patients to vote from home when it is difficult – or impossible – for them to travel to the polls.

Syracuse-based VNA Homecare was eager to become a part of the initiative, assigning a summer intern to the project who researched both the program and all the necessary information for voter registration and absentee voting.

Continued on next page

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Volume 1, No. 11 November 21, 2016 

Continued from previous page “Once we received all the information (brochures and other handout materials) on the initiative from HCA, our clinical teams were given all that they needed to ‘bring home the vote’ and they very enthusiastically started sharing and distributing the materials to patients during the months of August, September and October,” said VNA’s Kim Graf, Vice President of Public Relations & Corporate Communications. “According to our leadership, the overall response was receptive. Patients found the information useful and we are confident that it was a good reminder to patients on the importance of casting their own vote.

Pictured from left are: Lucrecia Agcaolli-White, Occupational Therapist; Kenneth Chrestler, RN, Case Manager; and Kathy Salvaterra, RN, Associate Director of Patient Services, as they prepare to “Bring The Vote Home.”

Bring The Vote Home is just one way in which home care providers can assist their patients civically, just as they do every day to help with medical, social, environmental, self-care and assistive needs to remain home and connected in the community.

Associate Director of Patient Services with VNA Homecare, Kathy Salvaterra, RN was part of the team leading this initiative on behalf of VNA Homecare. She stated: “We are so grateful to HCA for giving us the opportunity to participate in this initiative. I have seen first-hand how beneficial it has been to our patients and what a great reminder is was to them that their vote does matter and how easy it was for them to cast it.”

HCA Submits Comments on Draft NHTD Audit Protocols Last week, HCA, along with the New York State Association of Health Care Providers and LeadingAge New York, submitted comments on draft audit protocols – developed by the state Office of Medicaid Inspector General (OMIG) – for the Nursing Home Transition and Diversion (NHTD) waiver program.

We provided feedback on the following draft protocols: Missing Recipient Record; Missing Service Plan/ Revised Service Plan; Failure to Meet Service Coordination Requirements; Service Coordination Caseload Exceeds Limit; Service Performed by Unqualified Structured Day Program Staff; and Failure to Complete Required Annual HCSS In-Service Training.

In our comments, HCA and partner associations: 

Recommended that OMIG consider “extenuating circumstances” beyond the home care provider’s control before determining that a protocol is not met;



Requested flexibility in determining when claims would be denied if the protocol is not met; Continued on next page

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Volume 1, No. 11 November 21, 2016 

Continued from previous page 

Identified any inaccuracies in the protocols; and



Requested necessary clarifications.

HCA thanks those members who reviewed the protocols and provided feedback. We will let members know when the protocols are finalized.

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

HEAP Benefits Available The 2016-17 Regular Home Energy Assistance Program (HEAP) benefit opened on November 14, 2016.

Benefit amounts range from $21 to over $500. Eligibility and benefits are based on: 

Income (up to $2,300/month for individuals and $3,007 for couples);



Household size;



The primary heating source; and



The presence of a household member who is under age 6, age 60 or older or permanently disabled.

More information is at http://otda.ny.gov/programs/heap/.

New Upgrade for UAS to include CFCO The state Department of Health (DOH) has announced another upgrade to the UAS-NY on November 30 associated with the implementation of the Community First Choice Option (CFCO) program.

The UAS-NY Online application upgrade from v.1.2.14 to v. 1.2.59 will begin on Wednesday, November 30 at 6 p.m. and will be completed by no later than Thursday, December 1 at 8 a.m.

Offline Users In addition to the Online Upgrades, DOH will also be releasing v.1.2.59 of the Offline Client. This is a required upgrade for all Offline Client users. Complete instructions for upgrading the UAS-NY Offline Application will be available by November 18 in the UAS-NY Training Environment Reference and Resources 8500 Online and Offline Application.

Offline users should not install v.1.2.59 prior to Wednesday, November 30, at 6 p.m. It will not work until Thursday, December 1, 2016 when the upgrade of the online application is complete. In addition, offline users should synchronize before 6 p.m. on Wednesday, November 30.

Questions can be directed to the UAS-NY Project Team at (518) 408-1021 or uasny@health.ny.gov.

16

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

Volume 1, No. 11 November 21, 2016 ď Žď€

DSRIP Update: Revised Mid-Point Assessment Timeline The Delivery System Reform Incentive Payment (DSRIP) program mid-point assessment timeline has been revised and can be found at http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/midpt_assessment/2016-06-21_timeline-and-updates.htm.

DSRIP Mid-Point Assessment Timeline

17

Date

Action

July 1, 2016

Mid-Point Assessment Begins

July 31, 2016

PPS DSRIP Year (DY) 2, Quarter (Q)1 Quarterly Reports Submitted to Independent Assessor (IA)

August 2016

PPS Networks Opened for Additions Only

August 31, 2016

Primary Care Plans Due from PPS

August to September 2016

IA on-site reviews of all PPS

September 30, 2016

DY2, Q1 PPS Quarterly Reports Finalized

October 28, 2016

IA finalizes initial Mid-Point Assessment recommendations

November 22, 2016

IA recommendations released for PPS review

November 29, 2016

IA recommendations released for public comment

December 21, 2016

PPS response and public comment period ends

January 3, 2017

Mid-Point Assessment revised recommendations released for second public comment period

January 23, 2017

Mid-Point Assessment second public comment period ends

January 31 to February 3, 2017

Project Approval and Oversight Panel (PAOP) convenes to review MidPoint Assessment recommendations (includes 1 day of public comment)

February 8, 2017

PAOP recommendations submitted to Commissioner of Health

February 10, 2017

Commissioner of Health submits recommendations to U.S. Centers for Medicare and Medicaid Services

March 3, 2017

PPS complete Mid-Assessment Project Plan modifications and submit for IA review and approval

March 2017

PPS networks opened for additions and IA approved removals

March 31, 2017

IA Approves Mid-Point Assessment Action Plans for PPS Implementation in DY3

April 1, 2017

DY3 Begins

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

Volume 1, No. 11 November 21, 2016 

NGS Closed on Thanksgiving National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), will be closed November 24 and 25, for the Thanksgiving Holiday.

Electronic claim files transmitted after 5 p.m. on Wednesday, November 2 will have a claim receipt date of Monday, November 28. 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 24 and 25, 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 28, 2016 for normal business hours.

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

Resources 

“2017 Annual Update to the Therapy Code List (outpatient therapy),” by the U.S. Centers for Medicare and Medicaid Services https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3654CP.pdf



“Implementation of Policy Changes for the CY 2017 Home Health Prospective Payment System,” by the U.S. Centers for Medicare and Medicaid Services https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3655CP.pdf



“Comprehensive Care for Joint Replacement Model (CJR) Provider Education,” by the U.S. Centers for Medicare and Medicaid Services http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNMattersArticles/Downloads/MM9533.pdf



“Disrupting Aging in the Workplace: Profiles in Intergenerational Diversity Leadership,” by AARP Public Policy Institute http://www.aarp.org/content/dam/aarp/ppi/2016-08/ Disrupt%20Aging%20in%20the%20Workforce%20Report_FINAL_WEB.pdf



“What Would Block Grants or Limits on Per Capita Spending Mean for Medicaid?”, by the Commonwealth Fund http://www.commonwealthfund.org/~/media/files/publications/issue-brief/2016/nov/ 1913_rosenbaum_medicaid_block_grants.pdf

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

18

HCA Presents

Tools, Resources and Knowledge for

VBP Readiness and Success

Thursday, December 15, 2016 DoubleTree by Hilton Hotel Tarrytown 455 S. Broadway, Tarrytown, NY 10591

Tools, Resources and Knowledge for

VBP Readiness and Success Medicare and Medicaid policymakers are moving aggressively and deliberately toward Value Based Payment (VBP) systems. These systems will induce health care providers to assume a greater level of risk – as well as potential reward – in their relationships with payors and other providers. Home care is no exception!

To succeed and gain rewards under value-based payments, you must understand your data, prepare your staff, know your value-proposition, and position your agency wisely to mitigate risk and avoid cost liability. This December 15 conference, entitled “Tools, Resources and Knowledge for VBP Readiness and Success,” will provide you with all of these necessary methods and insights.

HCA, through a series of education programs in 2015 and 2016, has already provided home care agencies with a glimpse of how VBP is designed, how it is intended to work, and how agencies can position themselves for success in VBP provider arrangements. As a next step, on December 15, HCA has assembled some of the most knowledgeable policymakers to provide tangible tools, resources and inside knowledge to promote your organizational readiness for VBP. Don’t miss this program – the first of its kind – which will provide tailored guidance to agencies seeking positive partnerships and contracts in a VBP environment.

This event is appropriate for provider agencies at any point in the VBP process, whether your organization is just beginning to discuss VBP, or if you’ve already entered into value based arrangements with others.

Thursday, December 15, 2016 DoubleTree by Hilton Hotel Tarrytown 455 S. Broadway, Tarrytown, NY 10591

AGENDA 8:00 – 8:45AM Registration and Breakfast 8:45 – 9:00AM HCA Welcome 9:00 – 10:15AM Agency Operational Readiness for Value Based Payment Relationships (TBA) Knowledge of VBP policy directives and the State’s vision is essential to preparing to participate in VBP. What’s even more important is to assess your own agency’s readiness and strengths and weaknesses. Learn about tools and resources that will enable you to assess your organization’s readiness to: participate in VBP arrangements; determine your gaps in readiness; identify critical next steps; and better understand how to position your organization effectively for VBP success.

10:15 – 10:30AM Break

10:30 – 11:30AM Workforce Investment – the State MLTC Workforce Initiative Kalin Scott, Director, Medicaid Redesign Team Project Management Office, NYS Department of Health The New York State Department of Health (DOH) is poised to grant $250 million in new funding for workforce training aimed at ensuring that home care workers, in a new managed care environment, are adequately trained to meet the needs of a frail, elderly and disabled population. DOH officials are still determining how the funds will be made available, as well as the types of training programs that will likely be offered and the launch process for this program.

However, there is already tremendous work being done in the design of these new workforce funds, and home care agencies can benefit from getting an early tip on what’s to come.

Hear from the state’s point person on the outline of this workforce training program, including how home care agencies can access the funding, as this initiative could be key to preparing your workforce for the VBP transition and ensuring that your agency has a workforce ready to move with you as policies and payment models shift.

Tools, Resources and Knowledge for VBP Readiness and Success 11:30AM – 12:30PM VBP Insights for Home Care from the Payor’s Perspective Joseph Twardy, Assistant Vice President, Care Management, Fidelis Care Robert Hinckley, SVP, Strategy and Communications, and Chief Strategy Officer, CDPHP Health Plan David Ackman, MD, MPH, Medical Director, Provider Engagement, Empire Blue Cross Blue Shield Health Plus (Invited) Your success in a VBP environment hinges on strong partnerships with managed care plans, which are already a driving force for payment, service-authorization, caremanagement and shared-risk arrangements in home care, and increasingly so under VBP. Hear from a panel of payor representatives who will discuss: what drives decision-making in their contracting relationships; the most important value-driven elements in a home care relationship; and what data home care agencies need to bring to the table in their contracting discussions with plans.

12:30 – 1:15PM Lunch 1:15 – 4:15PM Data Workshop: Using Agency Data to Drive Decisionmaking Barbara Katz, RN, MSN Internal data assessment is one of the most powerful and proactive steps a home care agency can take on the eve of Value Based Payment implementation in the Medicaid and Medicare marketplaces. This session will provide a deep dive into your clinical data through an established and proven four-step process (Ask, Assemble, Analyze, Act) using powerful tools, including: benchmarking, percentages and rates, graphs and charts, check-sheets, stratification and trending. Don’t know what all of that means? That’s okay! This interactive workshop will teach you the techniques for using data to improve outcomes, lower costs and improve patient satisfaction – all critical to success in a VBP environment.

4:15PM Closing Remarks and Adjourn

Tools, Resources and Knowledge for

VBP Readiness and Success Thursday, December 15, 2016 DoubleTree by Hilton Hotel Tarrytown 455 S. Broadway, Tarrytown, NY 10591

Hotel Information

REGISTRANT INFORMATION – Please register by December 8.

Name: __________________________________________________________________________ Title:____________________________________________________________________________

A small block of rooms has been secured at the DoubleTree by Hilton Hotel Tarrytown, 455 S. Broadway, Tarrytown, NY 10591 for the evening of December 14 at a discounted rate of $159.

Agency:_________________________________________________________________________ Address:_________________________________________________________________________ City/State/Zip:____________________________________________________________________ Phone:________________________________ Ext._________ Fax: _________________________ Email: ___________________________________________________________________________ (Required)

Attendees may make reservations using the Group Code HC1 by either logging in to www.tarrytown.doubletree.com or calling the hotel direct

914-524-6418. before November 15.

HCA REGISTRATION FEE □ HCA Members

$219 per person

$________

HCA Cancellation Policy

□ Prospective Member

$319 per person

$________

HCA registration cancellations received by December 1 are refundable less a 25% administrative fee. No refunds will be issued after this date.

PAYMENT – Please check method of payment: ________MasterCard

_______VISA

______American Express

______Check*

*Make checks payable to: HCA Education and Research and mail to 388 Broadway, 4th Floor, Albany, NY 12207. Checks must be received by December 15. ______________________________________________________________________________ Card Number _____________________________________ _______________________________________ Expiration Date Security Code ______________________________________________________________________________ Mailing Address of Card Holder ______________________________________________________________________________ City, State, Zip ______________________________________________________________________________ Name on Card ______________________________________________________________________________ Authorized Signature

Cancellations must be received in writing at info@hcanys.org.

Substitutions are permitted.

Please note DoubleTree’s cancellation policy when making your reservation.

Special Needs In accordance with the Americans with Disabilities Act, or special dietary needs, please let us know how we can accommodate you:

________________________________ ________________________________ ________________________________ ________________________________ ________________________________

FAX completed form to HCA at (518) 426-8788 - or - Register online at: https://www.eventville.com/hcanys