December 4, 2017 Edition of The Situation Report

MEDICAID NO.

SURVEY

TOKHTAMAN CASE

DEADLINE EXTENDED FOR FIs

Providers must have Medicaid provider number to bill under managed care, beginning Jan. 1.

It’s vital that all home care members answer HCA’s annual financial survey for our advocacy in 2018.

Court of Appeals denies motion to appeal in case centering on “24-hour/live-in” services. Learn about next steps in the ongoing litigation.

After much advocacy by HCA, the Fiscal Intermediary (FI) Authorization Application deadline has been extended to Friday, December 15.

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Your Source for HOME CARE News, Policy and Advocacy

COMING UP Local Emergency Preparedness Sessions: Lower Hudson Valley Dec. 7, 2017 Poughkeepsie 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

Vol. 2, Issue 44 | December 4 , 2017

HCA Presents StopSepsisAtHomeNY.org Register today for 8 regional sepsis training sessions coming to every part of the state, including next week in Syracuse, as part of HCA’s grant-funded sepsis initiative HCA is pleased to announce the new online home for our grant-funded sepsis initiative: www.stopsepsisathomeny.org.

We encourage you and your staff to bookmark this site. You can also find a new menu item labelled “sepsis” on HCA’s general website, as well as a slide image on HCA’s site (as show at right), both of which point to www.stopsepsisathomeny.org.

See SEPSIS p. 2

HCA Advocates in D.C. for Federal Home Health Payment Policy, Rural Add-On Extender Senate passes major tax bill with health care impacts, including potential Medicare cuts HCA met with the staff of New York Representatives on the House Ways and Means Committee last week to continue pressing for a more thoughtful and protective approach to the proposed Home Health Groupings Model (HHGM).

See D.C. p. 4

INSIDE HCA Presents StopSepsisAtHomeNY.org..............................................................1 HCA Advocates in D.C. for Home Health Payment Policy, Rural Add-On......................1 HCA Sepsis Initiative a Feature at National Health Webinar.................................3 DOH: Providers Must Apply ASAP for Required Medicaid Number..........................3 Your Response Needed: HCA’s Annual Home Care Financial Condition Survey......5 Court of Appeals Declines to Hear Appeal of Tokhtaman Decision..........................5 Uniform Billing Codes: Potential Change in Implementation Date?.......................6 FI Authorization Application Deadline Extended..................................................7 Featured Session at Northeast Summit: Advanced Care Transformation..............8 Reminder: 12/29 Deadline for 2016 Statistical Reports....................................8 HCA Comments on Draft Post-Acute Reg. Modernization Recommendations....9 HCA Offers Upcoming Webinars on HHPPS & Major CoP Changes....................10

Editor’s Note: Due to an HCA staff planning event on Monday, December 11, HCA will be publishing the next edition of The Situation Report on December 8, 2017, not December 11.

Emergency Prep Networking Meetings Canvas Central New York.....................11 "Lean In" with HCA’s Women in Healthcare Leadership Summit!.........................12 OIG Releases Semi-Annual Report..................................................................13 Important Upcoming Deadlines.....................................................................14 CMS Offers Additional Appeals Option............................................................15 OMIG Posts Webinar on Certification Process................................................15 Agencies Required to Submit UAS Information by Dec. 20.................................16 CMS Finalizes CJR Model Changes, Cancelation of Episodic & Cardiac Models...17 OHSA Delays Electronic Filing Requirement until December 15........................18 2017 Managed Care Annual Program Integrity Report Posted.........................18 CMS Provides Update on Hospice Compare Search Function............................18 OIG to Study Medicaid Telehealth Systems.....................................................19 Resources...........................................................................................19

The Situation Report: the Home Care Association of New York State SEPSIS from p. 1 The site includes sepsis-related news and information, tools and resources, background about our “Stop Sepsis at Home” initiative, and a calendar for upcoming training sessions which were recently announced to the membership and are again highlighted below.

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

Register Today for Training If you haven’t done so already, please register today for one of our eight upcoming sepsis training sessions, which begin next week with a December 15 session in the Syracuse region, followed by a December 18 session in Buffalo.

Other sessions and regions follow in January through March. A flyer with additional information is here: http://stopsepsisathomeny.org/ wp-content/uploads/2017/11/Regional-Sepsis-Training-and-CrossSector-Session-Brochure.pdf.

You can also register directly online for any of the sessions at https:/ /www.surveymonkey.com/r/SepsisRegionalTrainings or view the calendar listings at www.stopsepsisathomeny.org.

With 80 to 90 percent of sepsis cases originating in the community, among other compelling data, the New York State Health Foundation (NYSHealth) has awarded HCA a major grant to support home care’s statewide adoption and use of HCA’s sepsis screening and intervention tool, which was developed and piloted in conjunction with partner organizations over the past two years.

Supported by the NYSHealth grant, HCA and sepsis leaders (including IPRO, national Sepsis Alliance, Rory Staunton Foundation for Sepsis Prevention, and others) are holding eight in-depth training sessions across New York State for all home care and applicable providers on sepsis, steps for provider adoption and clinical application of the sepsis screening tool, clinical case application, integration into agency procedures and records, and more.

Continued on next page 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 2, No. 44 December 4, 2017

Roger L. Noyes Director of Communications, Editor of The Situation Report rnoyes@hcanys.org Al Cardillo Executive Vice President acardillo@hcanys.org Patrick Conole Vice President, Finance & Management pconole@hcanys.org Andrew Koski Vice President, Program, Policy & Services akoski@hcanys.org Laura Constable Senior Director, Membership & Operations lconstable@hcanys.org Celisia Street Director of Education cstreet@hcanys.org Mercedes Teague Finance Manager mteague@hcanys.org Jenny Kerbein Director of Governance & Graphic Design jkerbein@hcanys.org Billi Wilson Manager, Meetings & Events bwilson@hcanys.org Teresa Brown Administrative Assistant tbrown@hcanys.org

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Continued from previous page Hospitals, physician practices, EMS, health plans and other community partners engaged in sepsis education, prevention, intervention and treatment should also plan (and are urged) to attend. These sessions will include cross-sector collaboration segments to exchange critical information, best practices and other planning.

HCA Sepsis Initiative a Feature at National Health Webinar HCA’s sepsis initiative has been selected as a feature in a national webinar that will take place next week, on December 12. (See related p. 1 story about upcoming developments and training sessions in HCA’s “Stop Sepsis at Home” initiative.)

The webinar, part of a national series sponsored by Sepsis Alliance, will provide organizations, providers, and professionals across the country with an introduction to HCA’s screening and intervention tool for sepsis. It will address essential background on how to adopt and clinically implement the tool at the provider level, explore case application, and discuss other innovative applications of the tool.

Presenting the initiative will be HCA Executive Vice President Al Cardillo, IPRO sepsis project director Eve Bankert, and HCA sepsis workgroup clinical leader Amy Bowerman, Executive Director at HCA member Senior Network Health.

Registration is at https://zoom.us/webinar/register/WN_DxnCH8-pSSOe-Grqho8ssw.

DOH: Providers Still Have Time to Apply for Required Medicaid Number, But Must Do So ASAP As previously reported, all Medicaid managed care and Children’s Health Insurance Program network providers, including home care agencies, must be enrolled with state Medicaid programs as of January 1, 2018.

HCA has received several calls from members who received notifications from managed care plan partners about the requirement. For those home care agencies that do not yet have the required Medicaid enrollment number, the state Department of Health (DOH) had requested applications by December 1.

HCA reached out to DOH asking if providers still had time to submit this application, and we were told that there is still time to do so but providers should act as soon as possible so that they can receive the required program enrollment number in time for the January 1, 2018 implementation date.

Information about enrollment is at www.emedny.org/info/ProviderEnrollment/index.aspx.

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

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D.C. from p. 1 In the meetings, HCA President Joanne Cunningham advocated for a legislative approach to the new payment policy that would ensure budget neutrality, a long phase-in, and pilot testing of the new model. We also urged a model that is built on the current 60-day episode of care rather than a 30day payment model.

In addition, Ms. Cunningham expressed appreciation for the strong support of the Ways and Means Members – including Representative Joe Crowley (DQueens), Brian Higgins (D-Buffalo) and Tom Reed (RCorning) – who all (in addition to 17 of their New York Colleagues) urged the U.S. Centers for Medicare and Medicaid Services (CMS) to withdraw HHGM from its final 2018 payment rule for home health.

Even with CMS’s withdrawal of HHGM at the administrative level, Republican health care leadership of the House Ways and Means Committee has begun work on a legislative proposal to reform the Medicare home health payment system. This proposal, which is in concept form only, would reportedly change the home health payment system to a 30-day model.

In addition to discussions with the New York Ways and Means member offices, Ms. Cunningham also discussed the payment change with Bill Dombi, President of the National Association for Home Care and Hospice (NAHC), urging him to continue NAHC’s intense advocacy. Mr. Dombi also participated on HCA’s recent Government Relations Committee conference call, reiterating NAHC’s opposition to drastic payment reforms that would modify the payment system to a 30-day model and institute other changes that would cause harm to home health providers.

In each of the meetings with the Congressional offices, Ms. Cunningham also sought support for the extension of the 3 percent add-on to the payment rates of rural home health providers. The rural addon is set to expire on December 31, 2017 and HCA is part of a national push that includes NAHC, Elevating Home/VNAA and other organizations asking Congress to include the extension of the home health rural add-on as part of a package of Medicare

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extenders which are gaining traction in Congress and are expected to be acted on before the end of the year.

While in Washington, D.C., Ms. Cunningham also participated in a national meeting of the Partnership for Medicaid Home-Based Care, an organization that is comprised of national home care companies and organizations who advocate for public policy to support and strengthen the nation’s Medicaid home care programs. Ms. Cunningham participated in the meeting as the Vice Chair of the Council of State Home Care Associations, which is a member of the Partnership.

Senate Tax Bill Passes, With Health Care Impacts The U.S. Senate, meanwhile, passed its version of tax legislation over the weekend. (The House has already passed its version, which differs from the Senate plan.) The Senate action now sets in motion feverish negotiations between the Senate and House to reconcile differences between the two bills, both of which have an impact on the nation’s health care system.

The Senate’s plan would infringe upon the Affordable Care Act’s “individual mandate” by removing the enforcement of tax penalties for individuals who don’t comply with the mandate.

Alarmingly, both the House and Senate bills could also trigger automatic Medicare 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 both the House and Senate tax bills would do (by as much as $1.4 trillion over ten years, according to some estimates). A previous Congressional Budget Office (CBO) estimate on the House plan estimated the potential Medicare impact at $25 billion.

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.

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Volume 2, No. 44 December 4, 2017 

Your Response Needed: HCA’s Annual Home Care Financial Condition Survey Attention home care executives and finance staff: Your responses are needed on HCA’s annual financial and program survey of the home care industry.

This year’s streamlined survey, at 33 questions, is significantly shorter than in prior years, asking critical questions to help establish our advocacy on your behalf.

Please complete one survey for your organization by January 8, 2018. You may want to share parts of the survey with different staff, so we’ve prepared a PDF version of the survey (in addition to the online version).

The survey can be completed here: https://www.surveymonkey.com/r/201718FinCondSurvey.

Survey results will be analyzed in conjunction with other data sources for our annual report on the home care industry, which is a centerpiece of our state advocacy documents as the legislative and state budget sessions begin early next year. Only aggregate results will be reported, and no identifying provider-level information.

We can’t stress enough how important it is to have a statistically sound survey sample. Please complete the survey as soon as possible. We greatly appreciate your taking the time to do so.

If you have any questions, please feel free to contact HCA’s Roger Noyes at rnoyes@hcanys.org.

Court of Appeals Declines to Hear Appeal of Tokhtaman Decision On November 21, the state’s Court of Appeals – New York’s highest court – dismissed a motion for appeal in the Tokhtaman v. Human Care case concerning “24-hour/live-in” cases.

In its motion, Human Care sought permission to appeal an April decision by the First Department, Appellate Division, which is an intermediate state appellate court covering the Bronx and Manhattan. The Court of Appeals, in dismissing Human Care’s motion, ruled largely on technical and procedural grounds, given that the court does not generally consider an appeal in cases where the matter hasn’t otherwise been exhausted in the lower courts.

HCA, the New York State Association of Health Care Providers (HCP) and the Home Care Association of America (HCAOA) filed an amicus brief in support the appeal motion. Amicus briefs are submitted by persons or groups that are not parties to the legal action but nevertheless have a strong interest in the matter and are petitioning the court to state their position.

This is not necessarily the end of the road. The First Department’s Tokhtaman decision still could potentially be appealed to the Court of Appeals in the future, following the case’s final adjudication at the trial court. To do so, Human Care would need to again make a motion to appeal at that time, though it is not clear whether the Court of Appeals would grant such a motion.

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Continued from previous page This is the second time Human Care has made a motion for permission to appeal the First Department’s Tokhtaman decision. As previously reported, the Appellate Division’s First Department in August denied Human Care’s initial motion for permission to appeal the decision to the Court of Appeals.

Absent a settlement by the parties, the case will now return to the trial court (Supreme Court, New York County) for further proceedings, including discovery and possibly a final resolution of the defendant’s wage obligations under applicable law.

As HCA has extensively reported, the case has implications for the state Department of Labor’s (DOL) so-called “13-hour” rule for the compensation of “live-in” home care aides (i.e., the standard by which an aide is paid for 13 hours of a 24-hour shift, provided the aide is afforded 8 hours of sleep time, 5 of which are uninterrupted, and 3 uninterrupted hours for meals).

In rejecting the 13-hour rule, the First Department held that, even though the plaintiff was a “live-in” home health aide, she could recover unpaid wages for hours worked in excess of 13 hours for each 24-hour shift if she could demonstrate that she was not a “residential employee” – one who lives on the premises of the employer.

Two other cases centering on this issue were recently decided by the Second Department adversely to the home care industry: Andryeyva v.

New York Health Care, Inc. (HCA also submitted an amicus brief in this appeal) and Moreno v. Future Care Health Services. The Second Department is an intermediate state appellate court covering the counties of Richmond, Kings, Queens, Nassau, Suffolk, Westchester, Dutchess, Orange, Rockland and Putnam.

Meanwhile, DOL posted emergency regulations in response to the recent court decisions and strenuous efforts by HCA and others to address the issues created by those court decisions.

While the emergency revised regulations appear to provide a basis for the 13-hour rule, they do not address the massive retroactive legal or cost exposure for providers prompted by these recent court decisions. However, a DOL impact statement posted in the State Register on October 25 stated strongly that the purpose of the emergency regulation is to preserve the status quo, prevent the collapse of the home care industry, and avoid unnecessarily unavoidable institutionalization of patients in the face of the recent decisions in the state Appellate Divisions. The State Register can be accessed at https://www.dos.ny.gov/info/register/2017.html.

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Uniform Billing Codes: Potential Change in Implementation Date?

A system glitch in MCO enrollment and in claims/claims payment has reportedly affected a number of managed-care plans in the state, and is requiring extensive reconciliation at the plan level. This and other issues have prompted a possible need for a quarter delay in the date for implementing uniform billing codes that have otherwise been scheduled to take effect January 1.

HCA has also reached out directly to our MLTC plan members who are also providers, and have received feedback similarly urging postponement. HCA has also discussed this issue with LHCSA members who have expressed concern with being in a position of having to simultaneously maintain two sets of codes, thus suggesting the difficulty of the issue and further pointing to the need for an across-the-board delay if plans affected by the “glitch” need this additional time.

HCA has a scheduled consultation with the state Department of Health early next week to review the exact issues and discuss the requested delay.

Meanwhile, with the January 1 day looming, HCA wants all providers and plans to be aware of these developments. We will update you immediately once a determination is made.

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Continued from previous page The emergency rule and accompanying impact statement could be a new factor in the ongoing court cases related to this issue, as litigants can now use that authority in their motions and appeals.

HCA will update members on any new developments with Tokhtaman or other related cases.

FI Authorization Application Deadline Extended FAQs Posted After much advocacy by HCA, the Fiscal Intermediary (FI) Authorization Application deadline has been extended to Friday, December 15.

HCA thanks the state Department of Health (DOH) for granting this extension so that existing FIs have more time to compile the multiple documents and information that is required.

The December 15 deadline applies to existing FIs. All FIs currently operating must apply by the deadline to continue operating. Entities who want to become an FI can apply anytime but they cannot operate until they submit an application and obtain DOH’s approval and a Medicaid provider number.

In addition, DOH has posted Frequently Asked Questions (FAQs) about the FI authorization process. These FAQs are at https://hca-nys.org/wp-content/uploads/2017/11/Consumer-Directed-FI-Authorization-FAQs-1128-17.pdf. They are also at https://www.health.ny.gov/health_care/medicaid/redesign/mrt_10003.htm.

As discussed in numerous communications, this year’s final state budget established a new FI authorization process that DOH says will “improve oversight” of the Consumer Directed Personal Assistance Program (CDPAP).

DOH posted the new FI Authorization application on November 1 and initially gave FIs thirty days to submit their applications. Existing FIs were permitted to continue operating while their applications are under review.

If the FI is not already enrolled as a Medicaid provider, the FI must enroll with the state Medicaid program after receiving its FI authorization approval, and the FI authorization approval letter must be included as part of that provider enrollment application package.

The state’s Division of Long Term Care will conduct a preliminary review of the application and all attachments. If any documentation is missing, the applicant will be notified via e-mail with instructions to complete the missing information.

More information about the authorization process, including the application, is at https://www.health.ny.gov/ health_care/medicaid/redesign/mrt_10003.htm.

Questions about the FI authorization process should be sent to FIAuthorization@health.ny.gov (please copy Andrew Koski at akoski@hcanys.org).

On November 8, HCA held a program that reviewed the FI authorization process and, as a follow up, made available an archived recording of the program to all registered participants.

Those who did not participate in the live program can still register using the form at https://hca-nys.org/wpcontent/uploads/2017/11/HCA-FI-Authorization-Teleconference-Nov-8.pdf to access the program recording.

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Volume 2, No. 44 December 4, 2017 

Featured Session at Northeast Home Health Summit: Advanced Care Transformation on January 18 Early-bird registration deadline is in two weeks!

The Coalition to Transform Advanced Care (C-TAC) is dedicated to the ideal that all Americans with advanced illness – especially the sickest and most vulnerable – receive comprehensive, high-quality, person- and family-centered care that is consistent with their goals and values and honors their dignity.

The Coalition’s newly launched “Campaign to Transform Advanced Care” is the largest industry-leaderled movement to advance change in care delivery, payment, regulation and measurement.

During her session at the Northeast Home Health Leadership Summit, health care leader Khue Nguyen will share the eight steps to transformation, as well as how to design and implement this kind of program at your organization.

Nguyen has extensive experience in the design and development of population health management programs, spanning chronic diseases management to advanced illness. She’s developed clinical programs for providers and payers through alternative payment models including Bundled Payments, Independence at Home and Medicare Shared Savings programs. Khue is a co-author of C-TAC’s Advanced Care Report and leads the development of alternative payment models.

Visit the Summit website for details on this session and others at http://nehomehealthsummit.com/. You can also download the brochure directly at https://hca-nys.org/wp-content/uploads/2017/11/2018-NELeadership-Summit-Brochure.pdf/.

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

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

Reminder: Dec. 29 is the Deadline to Submit DOH’s 2016 CHHA, LTHHCP & Hospice Statistical Reports The state Department of Health (DOH) Division of Home and Community Based Services has issued a Dear Administrator Letter (DAL) to remind Certified Home Health Agencies (CHHAs), Long Term Home Health Care Programs (LTHHCPs) and Hospices that they must complete the 2016 CHHA and LTHHCP Statistical Report and the 2016 Cost and Utilization Report for Hospices by December 29, 2017.

DOH activated these reports on November 1, 2017 via the Health Commerce System (HCS).

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Continued from previous page DOH’s DAL, which also includes instructions for completing and submitting the reports, can be downloaded at: https://hca-nys.org/wp-content/uploads/2017/10/DAL_CHHALTHHCP-2016-StatisticalReport-Hospice-Report_102517.pdf.

After December 29, 2017, these reports will be de-activated from the HCS. DOH uses these reports to collect qualitative and quantitative information for policy decisions regarding the home care and hospice industries. DOH stresses the importance of complete and accurate data, given “the rapid changes occurring in the health care delivery system and the increased emphasis and reliance on the availability of home and community based services.”

All operating CHHAs, LTHHCPs, and Hospices are required to complete and submit the 2016 reports.

Failure to submit all required information in the appropriate format may subject the agency to an enforcement action under Section 12 of the Public Health Law resulting in the agency being liable for civil penalties in violation of Article 36 (for CHHAs and LTHHCPs) or Article 40 (for Hospices) of the Public Health Law and New York State Medical Facilities Code.

Administrators should be aware that DOH’s ability to make an affirmative statement to the agency’s character and competence will be negatively impacted if an enforcement action for failure to submit is pursued. Furthermore, any pending certificate of need (CON) applications will not be processed for agencies determined to be delinquent.

Provider agencies are strongly encouraged to enter and submit data as early as possible. Agencies that wait until the last week to enter data may encounter extended system delays and wait times for support due to limited system and personnel resources.

Providers that have questions about completing or submitting the reports can send them to DOH at: HCStatRpts@health.state.ny.us.

HCA Comments on Draft Reg. Modernization Team Post-Acute Recommendations The state Department of Health has distilled draft recommendations compiled from a special state workgroup on the hospital-to-home, post-acute care continuum. The recommendations are being sorted for potential advancement by the Department and its regulatory modernization team’s (RMT) goals.

Many of the draft recommendations were drawn extensively from input and proposals provided by HCA, vetted through our Policy Council, Board of Directors and discussions across the membership. Major areas of the DOH draft are also founded upon HCA’s legislative and program/policy work in recent years to better position home care and the health system for collaborative approaches to care.

Among the draft proposals, DOH would implement a section of the New York public health law called the “Hospital-Homecare-Physician collaboration program,” which is an initiative authored by HCA in conjunction with the Iroquois Hospital Association and enacted into law in 2015. That law provides the framework for a range of innovations which align with solutions that both DOH and major stakeholders

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are seeking to pursue in improving the post-acute transition and overall system. These include, for example, collaborative approaches in care management, care transitions, telehealth, finance innovation and cross training in use of workforce.

Other areas of DOH’s draft include clarifications for all stakeholders on the jurisdiction of public health law article thirty-six for governing in-home care and licensure and standards required for entities in the state seeking to provide in-home care. As extensively reported, the issue of non-home-care providers crossing over into home care – without either sponsoring or collaborating with home care agencies – has been a serious and growing concern.

The draft also addresses opportunities for regulatory and procedural streamlining, targeted state support for discharge planning, advancement and support for palliative care, modernization of the state insurance law provisions for home care coverage, and clarifications regarding the extent of waivers under the Delivery System Reform Incentive Payment (DSRIP) program.

HCA will keep the membership apprised of next steps.

HCA Offers Webinars on HHPPS & Major CoP Changes that Await Providers in 2018 Among the big items changing with the turn of the calendar are the 2018 Home Health Prospective Payment System (HHPPS) rule, followed soon-after with the new, expansive revisions to the home health Conditions of Participation (CoPs).

HCA is offering a set of upcoming webinars covering both of these signature issues for 2018.

Webinar session summaries are below. To register and learn more, visit our education and events page at https://hca-nys.org/events-education/upcoming-events.

Both programs are offered in partnership with the Association for Home & Hospice Care of North Carolina.

Webinar: The 2018 Final Home Health Payment Rule and the Potential Impact of HHGM December 20, 2017 3 to 4:30 p.m.

The final HHPPS for 2018 was released on November 1; even though the Home Health Groupings Model (HHGM) was not finalized in the rule at this time, implementation may still be on the horizon in 2019 or 2020.

HHGM, as earlier proposed, would have cut at least $1 billion from home health.

Beyond HHGM, the HHPPS rule will have other major impacts on agencies, including rate changes for 2018, changes to the Value Based Purchasing Pilot, and numerous considerations for HHQRP changes.

In this webinar, industry expert Melinda Gaboury will provide updates on what to expect in 2018, as well as how HHGM would affect you if finalized in later years.

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Continued from previous page The 2018 Home Health Conditions of Participation Interpretive Guidelines: 2-Part Webinar Series January 9 & 10, 2018 3 to 4:30 p.m.

The long-awaited revised CoPs will be fully implemented on January 13, 2018. This two-part webinar series will review the final Interpretive Guidelines for the CoPs. Every home health agency must become familiar with these Guidelines to prepare for how and what official surveyors will look at when they come to your home health agency to determine compliance.

This series is led by Judy Adams, RN, BSN, HCS-D, an AHIMA Approved ICD-10-CM Trainer at Adams Home Care Consulting, Inc., who is a well-known health care consultant and speaker with over 30 years of health care experience.

Emergency Prep Networking Meetings Canvas Central New York; Lower Hudson Valley Upcoming Last Thursday and Friday, HCA and the New York State Association of Health Care Providers (HCP) partnered to jointly conduct local emergency preparedness networking sessions. The sessions canvassed the entire 14-county Central New York region.

The local sessions were conducted for home care and hospice providers, county emergency managers and public health preparedness directors. The sessions are a continuing series of meetings across the state to facilitate connections and collaboration among providers and local emergency management and preparedness officials.

HCA and HCP are charged by the State Department of Health Office of Health Emergency Preparedness, under a state-federal program and grant, to conduct these local networking sessions. In addition to the local providers and managers, HCA and HCP further coordinated with regional officials from the Departments of Health and Homeland Security, and representatives from both participated in the sessions.

The sessions provided a forum for exchange of key information and perspectives between the associations, the providers, local managers and preparedness officers. We also included “breakout” components where providers and county officials could explore the specific emergency preparedness challenges, needs and best practices for their localities, and formulate recommendations for strengthened approaches and procedures for collaboration going forward.

Over the past year and a half, HCA and HCP have conducted these sessions for providers and local officials in over 40 counties; the next set of sessions is scheduled for Friday, December 7, for providers and officials in the lower Hudson Valley area. If your agency services this area, and you have yet to register, you can do so today at https://www.surveymonkey.com/r/EPTrngs.

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Continued from previous page In follow-up, HCA and HCP will be compiling the major issue topics, recommendations and ideas formulated in these meetings to inform providers and managers statewide and take up any necessary issues with state emergency planning and policy officials for needed support.

Emergency Preparedness Primer Our emergency preparedness “Primer” document for home care and hospice was updated for these latest sessions.

You can download it at https://hca-nys.org/wp-content/uploads/2017/12/EP-Primer-Updated-11-27-17.pdf. This document is especially helpful for use in engaging local emergency preparedness partners across the continuum on home care and hospice.

Follow-up on Essential Personnel Law Simultaneous with these sessions, HCA is also reaching out to state officials on planned steps to implement the new “Essential Personnel” bill that Governor Cuomo signed into law on October 23. HCA will be providing advisory information for providers and plans regarding implementation and the anticipated roles you can play in maximizing the law’s statutory authority on behalf of your operation and patients.

Aware Prepare: December Edition In addition, the December edition of “Aware Prepare” has been issued by the state. It contains numerous resources and reference information on emergency preparedness. See: https://hca-nys.org/wp-content/ uploads/2017/12/2017DecemberAP.pdf.

We Know It's on Your Wish List, So "Lean In" with HCA’s Women in Healthcare Leadership Summit!

We know it's on your (or a colleague's) year-end wish-list, so why not make it a check mark today! Invest in your professional and leadership development at HCA's Women in Healthcare Leadership Summit later this week. Where else can you ... 

Network with like-minded women peers in health care sharing similar goals and aspirations?



Gain tips from women health care entrepreneurs on how to raise your “enterprising spirit” and advance personal and professional goals in health care?



Learn about tools and resources you may not have considered for cultivating your leadership acumen?



Take part in an engaging workshop with a sought-after women’s business consultant who has worked with leaders at all levels of some of the largest brands?

The Summit includes a full day of programming this coming Friday, with a fun and restorative networking cocktail session the night before.

Continued on next page

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

Volume 2, No. 44 December 4, 2017 

Continued from previous page To borrow a term made popular by Facebook COO Sheryl Sandberg, "lean in," take hold of the moment, and join us for next week's Women in Healthcare Leadership Summit to "Own Your Voice: Lead with Strength, Certainty and Style."

If you have any questions, don't hesitate to contact HCA's Education Director Celisia Street at cstreet@hcanys.org or (518) 810-0656 for further details.

Register today at https://hca-nys.org/events-education/upcoming-events.

OIG Releases Semi-Annual Report The U.S. Office of Inspector General (OIG) has released its Semi-Annual Report (April 1 to September 30) to Congress which summarizes its activities for the six-month period that ended September 30, 2017.

It is at: https://oig.hhs.gov/reports-and-publications/archives/semiannual/2017/sar-fall-2017.pdf.

OIG investigates allegations of fraud, waste, and abuse in all programs overseen by the U.S. Department of Health and Human Services (HHS). Its largest body of work involves investigating matters related to the Medicare and Medicaid programs, such as patient harm, improper or illegal billing practices and transactions, and other integrity issues.

During fiscal year 2017, OIG reported the following:    

$4.13 billion in expected investigative recoveries; 881 criminal actions against individuals or entities that engaged in crimes against HHS programs; 3,244 exclusions of individuals and entities from federal health care programs; and 826 civil actions against individuals or entities.

OIG’s report only includes two incidents of home care fraud. The first report involved a home care owner in Texas that was engaged in a large-scale, sophisticated scheme to defraud Medicare and Medicaid.

According to evidence presented at trial, the defendant and his co-defendants were involved in a scheme to recruit patients to receive unnecessary home visits and home health services. In some instances, the home health agency paid recruiters kickbacks to find Medicare beneficiaries at a homeless shelter.

The second report involved another home health agency owner in Ohio and three of her employees who were involved in a scheme to submit false claims to Medicare, Medicaid, and other Federal health programs. Together, the four individuals engaged in a conspiracy to prepare and submit forged or false records in support of previously submitted and reimbursed billings for patients who were not actually provided face-to-face services.

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

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Volume 2, No. 44 December 4, 2017 

Important Upcoming Deadlines

Requirement/Change

Effective/Due Date

More Information

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

December 1, 2017

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

Medicare Open Enrollment Period

October 15 to December 7, 2017

www.medicare.gov

Fiscal Intermediary (FI) Authorization Application due from Existing FIs

December 15, 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

LHCSAs and CHHAs must submit certain documents in order to have continued access to UASͲNY for March 2018 and later

December 20, 2017

uasny@health.ny.gov

December 22, 2017

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

December 29, 2017

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

2016 Hospice Cost and Utilization Report

December 29, 2017

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

2018 State Worker Wage Parity Levels

December 31, 2017

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

December 31, 2017

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

December 31, 2017

https://omig.ny.gov/sslͲcertification

December 31, 2017

https://omig.ny.gov/draͲcertification

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

January 1, 2018

https://www.health.ny.gov/facilities/long_term_care/reimbursement/letters/dal_2017Ͳ09Ͳ22_billing_codes.htm

Home Care and other providers who contract with Managed Care Organizations must be enrolled in Medicaid

January 1, 2018

https://www.emedny.org/info/ProviderEnrollment/ManagedCareNetwork/index.aspx

Managed Care Annual Program Integrity Report

January 1 to January 31, 2018

https://omig.ny.gov/information/mcoͲreports

Revised Medicare Home Health Conditions of Participation in Effect

January 13, 2018

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

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

April 1, 2018

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

2016 Adult Care Facility Financial Report 2016 CHHA/LTHHCP Statistical Report

2018 State Minimum Wage Levels State Compliance Program Certification Form Submission Federal Deficit Reduction Act Compliance Certification Form Submission

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

Volume 2, No. 44 December 4, 2017 

CMS Offers Additional Appeals Option The U.S. Centers for Medicare and Medicaid Services (CMS) recently announced that it will make available an additional settlement option for providers and suppliers (appellants) with appeals pending at the Office of Medicare Hearings and Appeals (OMHA) and the Medicare Appeals Council (the Council) at the Departmental Appeals Board.

More information is at https://www.cms.gov/Medicare/Appeals-and-Grievances/OrgMedFFSAppeals/AppealsSettlement-Initiatives/index.html.

The low volume appeals settlement option (LVA) will be limited to appellants with a low volume of appeals pending at OMHA and the Council. Specifically, appellants could potentially be eligible if they have fewer than 500 Medicare Part A or Part B claim appeals (combined) pending at OMHA and the Council as of November 3, 2017, with a total billed amount of $9,000 or less per appeal, if certain other conditions are met.

CMS will settle eligible appeals at 62 percent of the net allowed amount.

Separately, OMHA will be expanding the Settlement Conference Facilitation Process for certain appellants that are not eligible for the LVA option. More information will be available on the OMHA website at https:// www.hhs.gov/about/agencies/omha/about/special-initiatives/settlement-conference-facilitation/index.html.

CMS is taking these actions to address a large backlog of cases whose appeals have not been resolved. In 2016, it was estimated that there were over 800,000 appeals awaiting adjudication at the Administrative Law Judge level.

OMIG Posts Webinar on Certification Process The Office of the Medicaid Inspector General (OMIG) has posted a new webinar: OMIG’s Certification Process: Mandatory Compliance Programs & Deficit Reduction Act of 2005.

This webinar provides links to resources for the state compliance program and certification obligations and the federal Deficit Reduction Act of 2005 (DRA), along with tips for completing both certification forms.

The webinar is available at: https://omig.ny.gov/information/webinars.

State law requires that health care providers certify annually (in December) that they have adopted, implemented, and maintain an effective compliance program that meets eight elements. These elements are reviewed at the following links:

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

https://omig.ny.gov/images/stories/compliance/compliance_program_review_guidance.pdf



https://omig.ny.gov/images/stories/compliance compliance_program_self_assessment_form_021215.doc

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https://omig.ny.gov/images/stories/provider_compliance/ssl_faqs.pdf.

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

Volume 2, No. 44 December 4, 2017 

Continued from previous page In addition, entities that receive at least $5 million in Medicaid payments during a federal fiscal year must submit a certification form showing compliance with the DRA. (The amounts an individual or organization may receive through its contract with a Medicaid managed care organization should not be counted when calculating the $5 million in payments.)

By law, such entities must have written policies and procedures informing their employees, contractors and agents about federal and state false claim acts and whistleblower protections.

More information on the DRA certification is at https://omig.ny.gov/images/stories/provider_compliance/ dra_faqs.pdf.

Questions can be directed to OMIG’s Bureau of Compliance at (518) 408-0401 or compliance@omig.ny.gov.

Agencies Required to Submit UAS Information by Dec. 20 Licensed Home Care Services Agencies (LHCSAs) and Certified Home Health Agencies (CHHAs) are both required to submit certain information to the state Department of Health (DOH) by December 20 so that they can continue to have access to the Uniform Assessment System (UAS) starting March 2018.

With the release of 1.4 of the UAS-NY application, sometime in March of 2018, DOH will be changing how the UAS and Health Commerce System (HCS) interact. According to DOH, this is being done to accommodate new and more stringent security requirements.

In order to have UAS access starting March 2018 and beyond, LHCSAs and CHHAs must submit the following documents to the UAS-NY Project Team at uasny@health.ny.gov no later than December 20, 2017 (the documents should be sent collectively): 1. A letter from your CEO/COO/executive director indicating that your LHCSA/CHHA requires access to the UAS-NY for the purpose of conducting UAS Long-Term Care Assessments. Please include your organization’s HCS ID in this letter.

2. A letter from each program/plan with whom your LHCSA/CHHA has a vendor relationship. The letter from the program/plan must be on the organization’s letterhead and must indicate that your LHCSA/ CHHA has a contractual relationship to conduct UAS Long-Term Care Assessments on their behalf.

The program/plan letter must include the beginning and end date of the contract that they have with your LHCSA/CHHA and must be signed by the program/plan CEO/COO/executive director.

The UAS-NY authorization process for LHCSAs and CHHAs will be required annually.

Any questions can be directed to Lisa Howard or Danielle Mancino from the UAS-NY Support Desk at 518408-1021 or by e-mail to uasny@health.ny.gov.

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

Volume 2, No. 44 December 4, 2017 

CMS Finalizes CJR Model Changes, Cancelation of Episodic Payment and Cardiac Rehab Models The U.S. Centers for Medicare and Medicaid Services (CMS) has finalized a proposed rule to scale back or entirely rescind a series of payment and clinical delivery models.

The now finalized rule, which was initially proposed during the summer, will: 

Reduce the number of mandatory geographic areas participating in the CMS Innovation Center’s Comprehensive Care for Joint Replacement (CJR) model, from 67 to 34. For New York State, the CJR model is currently operating in Erie and Niagara counties, New York City, Long Island and the northern metropolitan area. CMS’s rule makes the CJR model voluntary in Erie and Niagara Counties but it remains mandatory in New York City, Long Island and the northern metropolitan area.



Allow CJR participants in the 33 remaining non-mandatory areas (and for low-volume and rural hospitals in all selected geographic areas) to participate on a voluntary basis.



Make technical refinements and clarifications for certain payment, reconciliation and quality provisions of the CJR model and increase the pool of eligible clinicians that qualify as affiliated practitioners under the Advanced Alternative Payment Model (APM) track.



Cancel the Episode Payment Models (EPMs) and the Cardiac Rehabilitation (CR) incentive payment model, which were scheduled to begin on January 1, 2018.

In its proposed rule, CMS justified the proposed changes by stating: “Many providers are currently engaged in voluntary initiatives with CMS, and we expect to continue to offer opportunities for providers to participate in voluntary initiatives, including episode-based payment models. We are concerned that engaging in large mandatory episode payment model efforts at this time may impede our ability to engage providers, such as hospitals, in future voluntary efforts” [emphasis added].

HCA pointed out this language in our advocacy effort opposing the Home Health Groupings Model (HHGM) – a massive change to the episodic payment system for home health services broadly under Medicare.

In calling for CMS to reject HHGM, we noted the precedent for CMS to use demonstrations and voluntary mechanisms – not forced, large-scale changes like HHGM – to test major reimbursement changes, particularly in the case of new risk models.

While HHGM was ultimately rejected from CMS’s 2018 payment rule for home health, there remain several avenues for CMS or Congress to revisit the plan.

To learn more about the final rule on CJR, the episodic and cardiac rehabilitation models and their significance to home care, please read our August 21 edition of the Situation Report where we covered the proposed version of this rule. See p. 8 at https://hca-nys.org/wp-content/uploads/2017/08/ SitRep082117.pdf.

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

Volume 2, No. 44 December 4, 2017 

OHSA Delays Electronic Filing Requirement until December 15 The Occupational Safety and Health Administration (OSHA) has delayed the required date for certain employers to electronically submit their injury and illness recordkeeping forms. The date was extended from December 1 to December 15.

An announcement of this delay, applicable to OSHA Forms 300, 300A and 301, was in the November 24 Federal Register at https://www.gpo.gov/fdsys/pkg/FR-2017-11-24/pdf/2017-25392.pdf.

Information on the rule requiring electronically submission of injury and illness information is at https:// www.osha.gov/recordkeeping/finalrule/index.html.

2017 Managed Care Annual Program Integrity Report Posted The Office of the Medicaid Inspector General (OMIG) has posted the 2017 Annual Program Integrity Report Information and Submission Instructions.

The Annual Program Integrity Report must be submitted to OMIG between January 1, 2018 and January 31, 2018.

The Report Instructions are available at: https://omig.ny.gov/information/mco-reports.

This reporting obligation only applies to Managed Care Organizations and Managed Long Term Care plans.

Questions about the Managed Care Annual Program Integrity Report form or the reporting instructions should be directed to mcopireport@omig.ny.gov or (518) 408-0692.

CMS Provides Update on Hospice Compare Search Function The U.S. Centers for Medicare and Medicaid Services (CMS) has responded to reports that the location search on Hospice Compare may return incorrect results.

As a result, CMS has provided a message on the Hospice Compare home page informing users that, when searching by location, the list of agencies provided may not serve the zip code, city, or state they entered.

The message also recommends that consumers call hospice providers to confirm their service areas.

CMS is currently working to improve the search functionality and will update the Hospice Compare website (at https://www.medicare.gov/hospicecompare/) as soon as possible. CMS encourages hospice providers to monitor CMS’s Hospice Quality Public Reporting website (at https://www.cms.gov/Medicare/QualityInitiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/Hospice-Quality-PublicReporting.html) for updates.

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

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

Volume 2, No. 44 December 4, 2017 

OIG to Study Medicaid Telehealth Systems The November update to the work plan of the federal Office of the Inspector General (OIG) announces that OIG will review Medicaid services delivered using telecommunications systems.

OIG states: “Medicaid pays for telemedicine, telehealth, and telemonitoring services delivered through a range of interactive video, audio or data transmission (telecommunications). Medicaid programs are seeing a significant increase in claims for these services and expect this trend to continue. We will determine whether selected States’ Medicaid payments for services delivered using telecommunication systems were allowable in accord with Medicaid requirements.”

According to the announcement, OIG will issue a report sometime in 2019.

This and other updates to the OIG work plan can be viewed at https://www.oig.hhs.gov/reports-and-publications/workplan/updates.asp.

Resources 

“Medicare Spends More on Socially Isolated Older Adults,” by the AARP Public Policy Institute https://www.aarp.org/content/dam/aarp/ppi/2017/10/medicare-spends-more-on-socially-isolatedolder-adults.pdf



“Evaluation of the Community-based Care Transitions Program,” by MATHEMATICA Policy Research https://downloads.cms.gov/files/cmmi/cctp-final-eval-rpt.pdf



“Use of Paid and Unpaid Personal Help by Medicare Beneficiaries Needing Long-Term Services and Supports,” by the Commonwealth Fund http://www.commonwealthfund.org/publications/issue-briefs/2017/nov/paid-unpaid-help-medicareltss



“An Overview of Medicare,” by the Henry J. Kaiser Family Foundation https://www.kff.org/medicare/issue-brief/an-overview-of-medicare/

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

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