December 18, 2017 Edition of The Situation Report

DOL LIVE-IN REG

SCHEDULING RULE

SUMMIT

FLU MASK REQUIREMENT

A workers’ advocacy group has challenged DOL’s October emergency rule on “24-hour/ live-in” cases.

Following our December 6 informational call, HCA has prepared some message points for members to use in their comments to DOL on its new and costly scheduling proposal.

If you haven’t registered for the Northeast Home Health Summit in Boston, please do so today and hear from an MIT professor who has written extensively about home care workforce issues.

The Commissioner of Health has made a determination that flu is prevalent, triggering the requirement that staff wear masks if they have not received the vaccine.

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COMING UP Webinar: The 2018 Final Home Health Payment Rule and the Potential Impact of HHGM Dec. 20, 2017 The 2018 Home Health CoP Interpretive Guidelines: 2-Part Webinar Series Jan. 9 & 10, 2018 Northeast Home Health Leadership Summit Jan. 16-18, 2018 Boston

IMPORTANT: HCA STATE ADVOCACY DAY Feb. 5-6, 2018 Albany More details coming soon.

Your Source for HOME CARE News, Policy and Advocacy

Vol. 2, Issue 46 | December 18, 2017

Your Action Urgently Needed as 3% Rural Add-on Now at Risk in Congress The home health rural add-on is at risk. HCA needs your action today to write Congress urging a straight extension of this 3 percent add-on before it expires on December 31.

The Senate is reportedly considering a lower add-on rate and limiting the rate to “frontier” counties. Meanwhile, both houses of Congress continue to eye additional See RURAL p. 2

‘Stop Sepsis at Home’ Regional Training Sessions Begin, With More to Come in February and March

Editor’s Note: Holiday Schedule

Visiting Nurse Services in Westchester, an early adopter of sepsis tool, serves as model home care agency in its vigorous approach to the sepsis crisis

This is the final edition of the Situation Report for 2017. HCA’s offices will be closed next week, from December 25 through January 1, reopening on January 2. Our next edition of the Situation Report will be on Jan. 2, resuming our regular Monday publication schedule thereafter.

HCA’s “Stop Sepsis at Home” initiative headed to Syracuse on Friday and Buffalo today. These are the first two locations in our schedule of eight regional training sessions that are bringing together home care representatives with system partners – as

INSIDE Action Needed on Rural Add-on..................................................................1 ‘Stop Sepsis at Home’ Regional Training Sessions Begin.................................1 MUST-ACT: HCA’s Annual Home Care Financial Condition Survey.....................2 DOL Emergency Live-in Rule Challenged.......................................................4 ‘White-Collar’ Exemption Salary Levels to Increase in 2018........................5 HCA Message Points Support Your Comments on DOL Scheduling Proposal...6 Important Upcoming Deadlines..................................................................7 MedPAC Draft Recommendations Include Payment Reductions..................8 Renewing with HCA in 2018........................................................................9 MIT Home Care Workforce Specialist Coming to Northeast Summit...........10

See SEPSIS p. 3

Guidelines Posted for Winter Storm Season 2017 to 2018........................10 OMIG Posts Information on Self-Disclosure of Medicaid Overpayments...............12 OIG Issues Monthly Work Plan Update..............................................................12 Influenza Declared Prevalent, Triggering Flu Mask Requirement.........................13 DOH Posts More Information on LTC Workforce Organizations............................13 Transition to New Medicare Card Begins in Less Than 4 Months............................14 NGS Provides Hospice Cap Reporting Update, Holiday Schedule Closings...........15 2018 Spousal Impoverishment Levels Announced............................................17 New Bureau of Social Determinants of Health Established..................................17 NHTD/TBI Waiver Transition Materials Posted....................................................17 DOH to Conduct Coalition Surge Test.................................................................18 Resources...........................................................................................................................19

The Situation Report: the Home Care Association of New York State RURAL from p. 1 reimbursement changes that would entirely neutralize the add-on and/ or impose possible further reductions on all home health providers.

Our message is simple: Congress must pass a straight, 3 percent rural add-on extension with no additional strings attached.

HCA has posted an action campaign to our Legislative Action Center where you can write the Senate and House urging a straight extension of the 3 percent add-on. This action campaign takes less than a minute of your time. Please take action immediately and urge all of your staff to do the same.

Take action online now at http://p2a.co/f0xjE1p.

MUST-ACT: HCA’s Annual Home Care Financial Condition Survey HCA again reminds members to complete our annual financial and program survey of the home care industry. We will continue to send reminders directly to those agencies who have not yet entered this very important survey.

At 33 questions, the survey 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.

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. 46 December 18, 2017 

The Situation Report is a weekly publication of the Home Care Association of New York State (HCA). Unless otherwise noted, all articles appearing in The Situation Report are the property of the Home Care Association of New York State. Reuse of any content within this newsletter requires permission from HCA. Joanne Cunningham HCA President jcunningham@hcanys.org Roger L. Noyes Director of Communications, Editor of The Situation Report rnoyes@hcanys.org Al Cardillo Executive Vice President acardillo@hcanys.org Patrick Conole Vice President, Finance & Management pconole@hcanys.org Andrew Koski Vice President, Program, Policy & Services akoski@hcanys.org Laura Constable Senior Director, Membership & Operations lconstable@hcanys.org Celisia Street Director of Education cstreet@hcanys.org Mercedes Teague Finance Manager mteague@hcanys.org Jenny Kerbein Director of Governance & Graphic Design jkerbein@hcanys.org Billi Wilson Manager, Meetings & Events bwilson@hcanys.org Teresa Brown Administrative Assistant tbrown@hcanys.org

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

Volume 2, No. 46 December 18, 2017 

SEPSIS from p. 1 home care agencies learn to adopt HCA’s community-based sepsis screening tool and coordinate with other sectors on their sepsis response.

While the HCA-developed tool is situated within the home care setting, partners across the continuum are invited to each of these regional training sessions so they can learn how this effort also supports their work – whether it’s a physician practice gaining critical information on the sepsis risk for their patients served by home care; managed care plans seeking to partner with home care on clinical intervention strategies for sepsis; or hospitals looking to include home care in value-based payment projects and other clinical strategies to tackle readmission rates.

The next regional training sessions are coming up on January 11 in Westchester, and January 24 in the Capital Region, followed by dates in February and March for the New York City and Long Island regions. Please visit the calendar on our website for details and registration at http://stopsepsisathomeny.org/events/.

These sessions are free of charge and are a core component of HCA’s grant from the New York State Health Foundation with the goals of: facilitating statewide adoption of HCA’s sepsis screening tool; sepsis education; and technical support. Please help support this goal by participating in a training session nearest you.

If you have any questions about this initiative, do not hesitate to reach any of the HCA Policy staff or send a message using the contact form on our “Stop Sepsis at Home” website here: http:// stopsepsisathomeny.org/contact-us/. You can also use this contact form to request a copy of the user agreement required for use of the HCA screening tool.

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Dr. William T. Smith (far right) presents sepsis grant award to (left to right): VNSW President & CEO, Tim Leddy; Director of Development & Communications, Joyce Infante; and Director of Business Development and Community Relations, Mary Gadomski. See story below.

HCA will have further additional announcements soon on new components of our “Stop Sepsis at Home” campaign. In the meantime, if you have not yet registered for one of our upcoming regional training sessions, please do so today.

VNSW Takes Vigorous Approach on Sepsis HCA would like to congratulate and recognize the Visiting Nurse Services in Westchester, Inc. (VNSW), which was recently awarded a $25,000 grant from Aging in America, Inc. to support the integration of the Sepsis Screening, Education and Intervention Tool into its clinical practice. VNSW expects the funding will enable its workforce to screen more than 10,000 patients in their homes annually as part of its best practices in patient care.

The VNSW Foundation, Inc. provided a matching grant of $25,000 to underwrite staff training in identifying and managing sepsis in the home and in utilizing the screening tool for optimal patient outcomes.

“With the majority of our patients at high risk for developing sepsis, this is a pivotal moment for our agency to step in with early intervention tools to stem the tide of this serious condition at the point of care at home,” said VNSW President & CEO, Tim Leddy, who is also a member of HCA’s Board of Directors. “Through

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Volume 2, No. 46 December 18, 2017 

regular screenings for symptom identification, we can initiate early treatment interventions that will vastly reduce instances of the condition, prevent unnecessary hospital readmissions and save lives.”

By incorporating the tool into VNSW’s electronic medical records system, staff will be able to access sepsis identification and treatment protocols on their computer tablets during patient assessments at the start of care and on follow-up visits.

As an early adopter of the screening tool, VNSW will also play an integral role in sharing sepsis outcomes data with local and statewide medical, health and home care organizations.

HCA applauds VNSW on its proactive approach to this issue and its commitment to large-scale use of the sepsis protocols throughout its organization and patient care census.

DOL Emergency Rule on ‘24-Hour/Live-in’ Cases Draws Challenge from Workers Advocacy Group The state Department of Labor’s (DOL) emergency rule codifying the 13-hour compensation standard for “24-hour/live-in” cases has been challenged by the Urban Justice Center, a workforce advocacy group which filed a petition last week with the New York State Industrial Board seeking to invalidate the rule.

As extensively reported, DOL’s emergency rule – which is now being challenged by the Urban Justice Center – was finalized in October amid a series of court cases taking aim at DOL’s “13-hour standard,” arguing that the standard was at odds with underlying statutes.

Under this standard, set forth in a DOL opinion letter, an aide may be 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. (To read the latest from the courts on this matter, please see the December 4 edition of the Situation Report, p. 5.)

HCA and colleague associations worked vigorously to compel DOL’s issuance of the emergency rule and a corresponding impact statement which stated strongly that the purpose of the emergency regulation is to “preserve the status quo” (i.e., the “13-hour standard”), 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.

This issue has been among the top items of concern that HCA has addressed in recent meetings with the Governor’s office and the Legislature, among other interrelated funding issues for wages and labor costs, including the increasing state minimum wage and a newly proposed set of compensation requirements for certain scheduling circumstances (see related p. 6 story).

HCA has joined amicus briefs for two of the three court cases on this matter, in addition to our advocacy for relief from the Executive and Legislature. We will be further examining the legal options related to the State Industrial Board action and reporting back to members on next steps.

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

Volume 2, No. 46 December 18, 2017 

‘White-Collar’ Exemption Salary Levels to Increase on December 31, 2017 New York State income thresholds to classify employees as exempt from overtime pay (aka the “white-collar exemption”) will be increasing on December 31, 2017.

The current state levels were updated in December 2016 and range from $727.50 to $825 per week ($37,830 to $42,900 annually) depending on the location where the employee in an “executive” or “administrative” capacity works.

However, these salary thresholds will increase on December 31, 2017 to a range from $780 to $975 per week ($40,560 to $50,700 annually) depending on the location where the employee works. The new, applicable salary levels on this date are as follows:    

NYC – Large Employers (of 11 or more): $975 NYC – Small Employers (10 or fewer): $900 Long Island & Westchester: $825.00 Remainder of New York State: $780.00

In its “white collar” exemption, the state does not set a salary level for employees who work in a “professional” capacity; thus, “professional” employees are exempt from state minimum wage and overtime laws regardless of their salary, as long as they otherwise meet the professional exemption requirements, yet employers are still required to pay those employees the applicable separate – and lower – federal “white-collar” exemption salary level ($23,660) to qualify for an exemption from federal minimum wage and overtime laws.

As previously reported in the September 18, 2017 edition of the Situation Report, the U.S. District Court for the Eastern District of Texas (State of Nevada v. U.S. Dept. of Labor) this past summer held that the U.S. Department of Labor’s May 2016 Final Rule was invalid. This federal rule would have more than doubled the minimum salary necessary to satisfy the “executive, administrative or professional” overtime exemptions under federal law. This follows on the court’s November 2016 preliminary injunction halting implementation of the Final Rule. With the court’s decision, the minimum salary threshold for the federal white collar overtime exemptions remains at $23,660 per year. More information on the state definitions for “executive,” “administrative” and “professional” is at the following links: 

https://www.labor.ny.gov/legal/counsel/pdf/administrative-employee-overtime-exemption-frequentlyasked-questions.pdf



https://www.labor.ny.gov/legal/counsel/pdf/executive-employee-overtime-exemption-frequently-askedquestions.pdf



https://www.labor.ny.gov/legal/counsel/pdf/professional-employee-overtime-exemption-frequentlyasked-questions.pdf

This article was written by Frank J. Fanshawe, Attorney at Law, Jackson Lewis P.C. and HCA’s General Counsel

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Volume 2, No. 46 December 18, 2017 

HCA Provides Message Points for Your Comments on Proposed DOL Scheduling Rule HCA has developed a template of message points that members can use in developing their own comments on the newly proposed state Department of Labor (DOL) rule that would change the regulations regarding “callin” pay. Please see our instructions and message points at the following link: https://hca-nys.org/messagepoints-comments-on-department-of-labor-scheduling-rule.

During a December 6 member briefing on the rule, several members emphasized their intent to comment on the DOL rule and sought HCA’s support on message points to include in their formal comments.

Comments to DOL are due 45 days after publication of the rule, which is Saturday, January 6. HCA has confirmed with DOL that it will accept comments until Monday, January 8, 2018, and these should be sent to regulations@labor.ny.gov.

If you are submitting comments, please do so in letter form, presented on your organization’s official letterhead, which can be sent as a PDF attachment to the e-mail address above (and/or postal mailed). Further instructions for preparing your letter are at the link above.

HCA also requests that those members who send comments to DOL also send a copy to Andrew Koski at akoski@hcanys.org so that we can continue to assist on a coordinated response.

As described in numerous communications, this proposed rule would impose the following requirements on employers (with certain exceptions): 

An employee who reports to work for a shift not scheduled 14 days in advance must be paid an additional two hours of call-in pay.



An employee whose shift is canceled within 72 hours of the scheduled start time must be paid at least four hours of call-in pay.

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An employee who is required to be available to report to work (“on-call”) must be paid at least four hours of call-in pay or pay for the number of hours in a regularly-scheduled shift.

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An employee who is required to be “available to report to work for any shift” must receive at least four hours of call-in pay.

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An employee who is required to contact the employer and confirm whether to report to work within 72 hours of the shift start time must be paid at least four hours of call-in pay.

The proposed rule is at https://docs.dos.ny.gov/info/register/2017/nov22/pdf/rulemaking.pdf (pages 8 to 11).

Our message points include some of the concerns that have been expressed by members and others. We suggest that you pick whichever ones are most relevant to your organization and use examples or concrete data to explain how provisions of the rule will affect your particular agency, staff and patients.

These message points should be used to support the position that DOL must reject its proposed rule or include a carve-out for home care and hospice based on the unique impact of these proposed requirements on the delivery of such services. Again, for further information on this position and supporting arguments, please visit https://hca-nys.org/message-points-comments-on-department-of-labor-scheduling-rule.

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Volume 2, No. 46 December 18, 2017 

Important Upcoming Deadlines

Requirement/Change

Effective/ Due Date

More Information

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 or 518Ͳ408Ͳ1021

2016 Adult Care Facility Financial Report

December 22

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

2016 CHHA/LTHHCP Statistical Report

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

2018 State Minimum Wage Levels

December 31, 2017

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

State Compliance Program Certification Form Submission

December 31, 2017

https://omig.ny.gov/sslͲcertification

December 31, 2017

https://omig.ny.gov/draͲcertification

January 1, 2018

https://www.emedny.org/info/ProviderEnrollment/ManagedCareNetwork/i ndex.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, https://www.gpo.gov/fdsys/pkg/FRͲ2017Ͳ01Ͳ13/pdf/2017Ͳ00283.pdf 2018

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

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

April 1, 2018

https://www.health.ny.gov/facilities/long_term_care/reimbursement/letter s/dal_2017Ͳ12Ͳ07_billing_codes.htm

Federal Deficit Reduction Act Compliance Certification Form Submission Home Care and other providers who contract with Managed Care Organizations must be enrolled in Medicaid

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Volume 2, No. 46 December 18, 2017 

MedPAC Makes Draft Recommendation for Home Care, Hospice Reductions The Medicare Payment Advisory Commission (MedPAC) meets each year at this time to consider payment recommendations for its annual March Report to Congress. Last week the Commission met to consider, among other topics, the adequacy of payments under Medicare to home health and hospice providers.

At the meeting, MedPAC made the recommendation to reduce payments to home health agencies by five percent in 2019 and for the U.S. Centers for Medicare and Medicaid Services (CMS) to implement a two-year rebasing of the payment system beginning in 2020. In addition, the draft recommendation urges Congress to direct CMS to revise the payment system to eliminate the use of therapy visits as a factor in payment determinations, in line with rebasing.

MedPAC also outlined an interim post-acute care payment system for CMS to implement until a unified system is put in place in 2021, as is required by the federal Improving Medicare Post-Acute Care Transformation (IMPACT) Act. The interim system would keep total payments to each post-acute care setting at set levels, while redistributing pay across conditions within each sector. (HCA first reported on this proposal in the November 20 edition of our newsletter.) The blended system would feature redistribution based on patient mix and therapy practices, with payments increasing to nonprofits and hospital-based providers, while payments fall in the case of for-profit providers.

Regarding hospice payments, MedPAC officials recommended that Congress eliminate the update for Fiscal Year (FY) 2019. The imposition of a zero update, or any update change for hospice providers, would require a statutory change. Under current law for FY 2019, hospice payment updates would be increased by a factor equal to the annual market basket less a “productivity adjustment,” with a subsequent 2 percent reduction due to the automatic sequester.

Additional MedPAC analysis indicates that Medicare financial margins for hospice providers increased nationally, on average, from 8.2 percent in 2014 to 10 percent in 2015. This figure excludes non-reimbursable costs for bereavement and volunteer services. If those costs were included, they would reduce margins by as much as 1.6 percentage points. As has historically been the case, MedPAC found that margins are variable by hospice type as well as based on average length of stay.

Of note in MedPAC’s analysis is the first available data examining the impact of the payment changes that were instituted in January of 2016. MedPAC found that, on average, payments increased about 3 percent for the quintile of hospices with the fewest long-stay patients while payment decreased approximately 3 percent for the quintile of hospices with the most long-stay patients.

MedPAC projects the 2018 hospice margin to be 8.7 percent. Based on the projected margin and other factors, the general consensus among MedPAC commissioners was to support a MedPAC recommendation of a zero update for FY 2019. Given that consensus, the Commission will bring the recommendation back in January under an expedited approval process, which nearly guarantees that it will be included in the March Report to Congress.

All of the home health draft recommendations are expected to come for a vote in January and many commissioners indicated they would also support those recommendations as well. Congress has the authority to support or reject these recommendations, which can only become effective with an act of Congress.

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

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Volume 2, No. 46 December 18, 2017 

Renewing with HCA in 2018 By now your organization should have received HCA’s membership renewal materials, including your dues invoice and our member value statement, which outlines some of the ways HCA provides value to you, including this very newsletter which is only available to you and your organization if you maintain your membership in HCA. To read our value statement, please visit https://hca-nys.org/membership/.

As announced in a special message to CHHAs, we’ve added another incentive to the list of HCA member offerings in 2018: a comprehensive new resource, compiled by clinician experts, to help you understand and track compliance with the imminent changes to the home health Conditions of Participation (CoPs).

As you know, the CoPs are undergoing the most sweeping changes in federal home health regulations since 1989 and they impact virtually every aspect of your operation. This new “Guide to Compliance” packet has been procured by HCA through an affiliation agreement with the Home Care Alliance of Massachusetts which permits us to offer this Guide (a $500 value) exclusively to our CHHA members, and we are doing so on a complimentary basis if you renew in 2018.

This is just one of several ways that HCA supports your operation with information, technical assistance, time-saving resources, education and advocacy.

Please renew with HCA in 2018 today to continue receiving all of the great benefits that HCA offers.

If you have any questions about membership or need renewal materials, please don’t hesitate to contact HCA’s Senior Director of Membership Laura Constable at lconstable@hcanys.org or (518) 810-0660.

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Volume 2, No. 46 December 18, 2017 

MIT Prof’s Home Care Workforce Study Draws Major Public Interest – and Your Attention At Northeast Summit in January With better supports and fewer constraints on home health aides, “we’d save on unnecessary calls to 911 and emergency room visits. We’d have better transitions out of acute care episodes at hospitals. We’d reduce the use of nursing homes,” says MIT Human Resources and Management Professor Paul Osterman in his recent study of the long-term care workforce.

Osterman’s acclaimed book, Who Will Care for Us? Long-Term Care and the Long-Term Workforce, is drawing major attention, from the Wall Street Journal to the PBS News Hour and more.

Clearly he speaks our language in home care. This is why the Northeast Home Health Superhero Summit in Boston is especially thrilled to have his voice for our pre-conference session on January 16, kicking off three days of the biggest home care leadership conference that the Northeast has to offer.

With so much public interest about what Osterman has to say, home care providers will find him particularly engrossing because his observations fall squarely in home care’s wheelhouse, raising some of the most fundamental questions that providers need to grapple with to assure access to care and costsavings. (You can read a question-and-answer interview with him here: http://mitsloan.mit.edu/newsroom/ articles/how-better-trained-home-care-workers-could-save-the-us-billions/.)

Osterman is one of nearly twenty presenters offering a cohesive agenda of leadership topics, information and insights to support home health executives at this fast-approaching summit.

Learn more by visiting the conference website at http://nehomehealthsummit.com.

Guidelines Posted for Winter Storm Season 2017 to 2018 The state Department of Health (DOH) has released actions that home care, hospice and other health care providers should take to prepare for the winter weather season.

First, all providers’ leadership and managers should review their Emergency Response and Evacuation Plans to be ready to activate these plans. They should ensure procedures are up to date and understood by staff, and also ensure that contact information for all key staff and response partners is current.

All facility-based, outpatient, home care and hospice providers are encouraged to review plans for staff response that include: necessary notifications and alerts to staff; adjustment of shifts and management of staffing shortages due to transportation impacts; securing needed supplies; and accommodations for staff that must remain on site and failover communications if primary methods are impacted. If warranted, facility-based providers should consider bringing in additional staff in advance of the storm to ensure sufficient coverage during the storm event and recovery period.

Continued on next page

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Volume 2, No. 46 December 18, 2017 

Continued from previous page Home Care and Hospice Specifics Home care agencies and hospices are encouraged to review patient care needs and consider adjustment of visits to ensure that Level One High Priority patients are visited prior to the start of a forecasted storm, and that all patients are reminded of how to call for assistance if they lose power or have a medical emergency.

Providers should also make plans for adjusting staff schedules/prioritizing patient visits in the days immediately following the storm, particularly if travel is still impeded, with a focus on reassigning staff based on proximity to patients to limit travel and reduce staff exposure to hazardous conditions. Agencies should additionally ensure that staff and their patients have enough supplies to cover a period of at least 72 hours following the start of the storm.

Furthermore, agencies should: 

Be ready to contact staffing services if a large proportion of their regular staff are unable to travel and perform any of their normal visits for a period of time following the storm.



Be ready to communicate with their patients during and immediately following the storm to perform checks on their safety and condition of their health.



Develop a plan for managing situations where patients refuse to evacuate a hazardous situation, and include these items in the Agency’s emergency response plan.

Critical Communications Every facility must ensure that all computers and networks, necessary for disaster planning and response, are supported by generator power. The following key data systems must be used by the provider, where applicable, during the emergency: 

The DOH Communications Directory. All business and emergency contact information for key administrative and functional roles in the Communications Directory must be updated and accurate to assure alerts and notifications are received by the facility.



The Health Electronic Response Data System (HERDS). HERDS surveys may need to be conducted to capture important information regarding a provider’s status during an emergency, and providers must be able to respond to any survey that might be activated.

The Guidelines also describe the procedures that agencies should follow when requesting suspension or modification of requirements of state or federal regulations. HCA, along with other associations, had developed a guide for health care providers on the temporary suspension or modification of statutes and regulations during emergencies. This publication is at https://hca-nys.org/wp-content/uploads/2017/12/ healthcare_emergency_guidebook.pdf.

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

Volume 2, No. 46 December 18, 2017 

OMIG Posts Information on Self-Disclosure of Medicaid Overpayments The Office of the Medicaid Inspector General (OMIG) has updated the information on its website regarding the self-disclosure of Medicaid overpayments to better assist providers with the reporting of Medicaid overpayments.

Updates include: 

A comprehensive overview of what a self-disclosure is, and the statutes and regulations that require the reporting of Medicaid overpayments;



A new, convenient, easy-to-complete self-disclosure form;



Easy-to-follow self-disclosure submission information and secure file transfer instructions; and



A submission checklist with Frequently Asked Questions.

To view these updates or learn more about how to self-disclose a Medicaid overpayment, visit https://omig.ny.gov/self-disclosure.

For more information about the reporting of Medicaid overpayments, you can contact OMIG’s Self-Disclosure Unit at (518) 402-7030, or by e-mail at: selfdisclosures@omig.ny.gov. You should also consult with your counsel prior to contacting OMIG.

OIG Issues Monthly Work Plan Update The federal Office of Inspector General (OIG) has issued its monthly Work Plan Update.

It is at https://oig.hhs.gov/reports-and-publications/workplan/updates.asp.

Two topics of interest are:

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

Status Update on States’ Efforts on Medicaid-Provider Enrollment: OIG will determine the extent to which states have completed fingerprint-based criminal background checks and site visits.



Review of U.S. Centers for Medicare and Medicaid Services (CMS) Systems Used to Pay Medicare Advantage Organizations: Medicare Advantage (MA) organizations submit to CMS diagnoses on their beneficiaries; in turn, CMS categorizes certain diagnoses into groups of clinically related diseases called hierarchical condition categories (HCC). OIG will review instances in which CMS made an increased payment to an MA organization for an HCC and determine whether CMS’s systems properly contained a requisite diagnosis code that mapped to that HCC.

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Volume 2, No. 46 December 18, 2017 

Influenza Declared Prevalent, Triggering Flu Mask Requirement On December 13, the state Department of Health (DOH) Commissioner Dr. Howard Zucker declared influenza to be prevalent in New York State for the 2017-18 influenza season. See https://www.health.ny.gov/ diseases/communicable/influenza/seasonal/providers/prevention_of_influenza_transmission/.

As a result, home care, hospice and other health care providers are required to ensure that all personnel not vaccinated against influenza for the current influenza season are wearing a surgical or procedure mask while in areas where patients or residents are typically present.

This declaration shall remain in effect until the Commissioner declares influenza no longer prevalent in New York State.

Frequently Asked Questions regarding the regulation and other resources are available at http:// health.ny.gov/FluMaskReg. This influenza season, New York has had 1,820 laboratory-confirmed cases of influenza in 54 counties and all boroughs of New York City. During this period, there have been 612 influenza-related hospitalizations reported, and no reports of pediatric deaths from influenza. Over the last three seasons, there have been 19 pediatric influenza deaths in New York and an average of 11,183 influenza-related hospitalizations each season.

During the week ending December 9, there were 571 laboratory-confirmed influenza reports, a 45 percent increase over the prior week; the number of patients hospitalized with laboratory-confirmed influenza was 190, a 44 percent increase over the prior week.

Last year, influenza was declared prevalent on December 28 and the declaration lasted until May 4, 2017.

For more information, send questions to FluMaskReg@health.ny.gov.

DOH Posts More Information on LTC Workforce Investment Organizations The state Department of Health (DOH) has posted the plan draft agreement language for Long Term Care Workforce Investment Organizations (LTC-WIOs) and managed long term care (MLTC), along with an appendix outlining the proposed roles/responsibilities of the LTC-WIO and MLTC plan.

The materials, along with a list of awarded LTC-WIOs and eligible MLTC plans, are at https:// www.health.ny.gov/health_care/medicaid/redesign/2017/mltc_invest.htm.

According to DOH, the draft agreement and appendix should not be considered a template, but an outline which includes the essential elements to be incorporated in the agreements executed by LTC-WIOs and plans.

In addition, DOH is seeking a two-page document which demonstrates the LTC-WIO and plan partnerships’ capacity and approach to support the achievement of value-based payment (VBP) goals. The intent of this

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exercise is to establish a baseline measure for sustainability. This document must be submitted for approval of LTC-WIO and Plan partnership applications.

Recently, DOH had also posted guidance on the parameters of the LTC-WIO and plan partnership development (see the December 8 edition of The Situation Report).

As communicated to members on numerous occasions, this program is making available up to $245 million (during 2018-2020) for “initiatives to retrain, recruit and retain health care workers in the long term care (LTC) sector.” DOH will require MLTC plans to contract with the DOH-designated LTC-WIOs to: invest in initiatives to attract, recruit and retain LTC workers; develop plans for reducing health disparities through placement of LTC workers in high-need areas; analyze the training needs of each region the center serves; and support the expansion of home care and respite care, enabling those in need of LTC to remain at home and reduce Medicaid’s costs associated with LTC. Funds will be allocated to plans based on the percentage of each plan’s enrollment relative to all plan enrollment, and distributed via increases to their capitated rates. Plans will need to notify their participating providers that they can send workers to LTC-WIOs to participate without charge. Plans will distribute funds to the LTC-WIOs with which they contract to reimburse them for providing workforce development initiatives.

Providers should review the list of eligible MLTCs and LTC-WIOs in your regions to prepare for your staff’s participation in these training opportunities, where applicable, and reach out to your plan contractors regarding eligibility for LTC-WIO training for your staff.

Transition to New Medicare Card Begins in Less Than Four Months On April 1, 2018, the U.S. Centers for Medicare and Medicaid Services (CMS) will start mailing Medicare cards with new Medicare Beneficiary Identifiers (MBIs) to everyone with Medicare.

The MBI will replace the Social Security Number (SSN)-based Health Insurance Claim Number (HICN) for transactions like billing, eligibility status, and claim status after a transition period (https://www.cms.gov/ Medicare/SSNRI/Index.html#target).

Agencies must be ready to accept the MBI beginning April 1. People new to Medicare after April 1 will only get a card with the MBI. The transition period will begin no earlier than April 1, 2018 and run through December 31, 2019.

During the transition period, CMS will monitor the use of HICNs and MBIs to see how many providers are ready to use only MBIs by January 2020. CMS will also monitor the transition and adjustment to the new MBIs. After the transition period ends on January 1, 2020, agencies will need to use MBIs on their claims with a few exceptions.

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Continued from previous page CMS offers the following tips: 

Get ready to use the new MBI Format (https://www.cms.gov/Medicare/New-Medicare-Card/ Understanding-the-MBI-with-Format.pdf). Ask your billing and office staff if your system(s) will be ready to accept the 11 digit alpha-numeric MBI. If you use vendors to bill Medicare, ask them about their MBI practice management system changes and make sure they are ready.

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Consider automatically accepting the new MBI from the remittance advice (835) transaction. Prepare to process Railroad Retirement Board (RRB) claims: Ensure your staff can identify the RRB Medicare card (https://www.rrb.gov/sites/default/files/2017-10/New%20Medicare%20Card%20Sample_0.pdf).

Program your system to send these patients’ claims to the Specialty Medicare Administrative Contractor (the MBI itself will not indicate it is an RRB beneficiary).

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Make and internally test changes to your practice management systems and business processes before April 2018.

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Sign up for your Medicare Administrative Contractor’s portal now, so you can use the provider MBI look-up tool starting in June 2018 (https://www.cms.gov/Medicare/New-Medicare-Card/Providers/ MACs-Provider-Portals-by-State.pdf).

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Subscribe to the weekly MLN Connects newsletter for updates and new information (https:// www.cms.gov/Medicare/New-Medicare-Card/Providers/MACs-Provider-Portals-by-State.pdf).

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Participate in CMS’s quarterly calls (https://www.cms.gov/Medicare/New-Medicare-Card/Open-DoorForums.html) to learn more. CMS will let you know when calls are scheduled in MLN Connects.

More information is at https://www.cms.gov/Medicare/New-Medicare-Card/index.html; https:// www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ TransitiontoNewMedicareNumbersandCards-909365.pdf; and https://www.cms.gov/Medicare/NewMedicare-Card/Providers/Providers.html.

NGS Provides Hospice Cap Reporting Update and Holiday Schedule Closings National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), has recently posted the following information to its website.

Hospice Cap Reporting Update The U.S. Centers for Medicare and Medicaid Services’ (CMS) 2016 Hospice Final Rule finalized the proposals to align the cap accounting year for both the inpatient cap and the hospice aggregate cap with the Federal Fiscal Year (FY) starting in FY 2017 and to align the timeframe for counting the number of beneficiaries with the FY. Continued on next page

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Continued from previous page This alignment eliminates timeframe complexities associated with counting payments and beneficiaries differently from the FY and will help hospices avoid mistakes in calculating their aggregate cap determinations. Additionally, shifting the cap accounting year timeframes to coincide with the hospice rate update year (the FY) better aligns with the intent of the new cap calculation methodology required by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014.

2017 Year (October 1, 2016 to September 30, 2017) The per-beneficiary cap amount for calculating the hospice aggregate cap for the 2017 transition year will not be prorated for the shorter time frame. Instead, hospices and the MACs are to count payments, count beneficiaries, and determine the percentage of inpatient days as follows for the 2017 cap year: 

The beneficiary count period for the aggregate cap determination for hospices using the patient-bypatient method is from November 1, 2016 to September 30, 2017;

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The beneficiary count period for the aggregate cap determination for hospices using the streamlined method is from September 28, 2016 to September 30, 2017, which is 12 months plus 3 days;

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The payment period for the cap calculation for both the streamlined and patient-by-patient methods is November 1, 2016 to September 30, 2017. This is 11 months of payments;

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For the inpatient cap, MACs, like NGS, are to calculate the percentage of all hospice days of care that were provided as inpatient days (GIP care and respite care) from November 1, 2016 through September 30, 2017 (11 months).

2018 Cap Year (October 1, 2017 to September 30, 2018) 

Hospices and MACs are to count both beneficiaries and payments for hospices using the streamlined or the patient-by-patient proportional methods from October 1, 2017 to September 30, 2018;

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Hospices and MACs are to calculate the percentage of all hospice days of care that were provided as inpatient days (GIP care or respite care) from October 1, 2017 to September 30, 2018.

Finally, NGS notes that CMS changed the due date of the 2017 self-determined aggregate cap and it is due no later than February 28, 2018. Hospice providers can begin to submit the self-determined cap starting on December 31, 2017.

NGS Closed on Christmas and New Year’s NGS will be closed Monday, December 25 and Monday, January 1 for the Christmas and New Year’s Holidays.

This includes the Electronic Data Interchange (EDI) Help Desk, Provider Contact Center, Provider Enrollment Line, and Telephone Reopening Unit.

Electronic claim files transmitted after 5 p.m. on Friday, December 22 and Friday, December 29 will have a claim receipt date of Tuesday, December 26, 2017 or Tuesday, January 2, 2018, respectively. EDI front-end

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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 December 26 and January 2 during regular hours and providers will also be able to access NGSConnex and use the Interactive Voice Response (IVR) system at 1-866-275-3033 during the closure days.

2018 Spousal Impoverishment Levels Announced The U.S. Centers for Medicare and Medicaid Services (CMS) has announced the 2018 spousal impoverishment levels.

They are as follows: 

The maximum monthly maintenance needs allowance is $3,090; the community spouse resources level is the greater of $74,820 or the amount of the spousal share up to $123,600; and

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The maximum home equity limit is $858,000.

More information is at https://www.medicaid.gov/federal-policy-guidance/downloads/cib120517.pdf.

New Bureau of Social Determinants of Health Established The Office of Health Insurance Programs (OHIP) within the state Department of Health has announced the establishment of the Bureau of Social Determinants of Health within the Division of Program Development and Management (DPDM).

The new bureau will focus its work on the social determinants of health and the important role these social determinants play in the health outcomes of New York’s most vulnerable populations. The Bureau will focus on special initiatives including, but not limited to, supportive housing, nutrition, and education. The Bureau will work closely with Performing Provider Systems (PPS), value-based payment contractors, health plans, and providers. It will also continue to enhance the role of community-based organizations (CBOs) within the health care sector. The Bureau will be led by Denard Cummings and report to Elizabeth Misa, Deputy Medicaid Director.

HCA has stressed the importance of considering the social determinants of health in all discussions related to health care restructuring, including the Delivery System Reform Incentive Payment (DSRIP) program, Value Based Payments and others.

NHTD/TBI Waiver Transition Materials Posted The state Department of Health (DOH) has posted materials from the December 7 meeting of the Nursing Home Transition and Diversion (NHTD)/Traumatic Brain Injury (TBI) Waiver Transition Workgroup.

The materials include a PowerPoint presentation and a series of questions and answers that arose from the December 7 meeting.

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Continued from previous page The materials are at https://www.health.ny.gov/health_care/medicaid/redesign/mrt90/meetings/docs/201712-07_presentation.pdf; and https://www.health.ny.gov/health_care/medicaid/redesign/mrt90/meetings/ docs/2017-12-07_faqs.pdf.

It is anticipated that announcement letters will be sent to NHTD/TBI recipients on about December 1, 2018 to inform them about the transition of their services to managed care plans. January 1, 2019 will start a 60-day voluntary enrollment period. In March 2019, recipients will receive a notice about the need to enroll in a plan or be mandatorily enrolled. Services will start with managed care plans on April 1, 2019.

The materials include information on: services covered; role of service coordination and managed care plan care managers; responsibilities of Regional Resource Development Centers; the contract amendment process; continuity of care; continued use of current waiver providers; rates guaranteed for two years; and quality assurance.

DOH plans to hold training sessions for providers, participants and family members about the transition to managed care.

DOH to Conduct Coalition Surge Test Webinars scheduled in January and February The state Department of Health (DOH) will hold Coalition Surge Test (CST) and Interoperable Communications (IOC) drills for providers outside of New York City sometime early next year and provide more information about these drills at webinars scheduled for January and February.

The CST will involve a simulated disaster in which three hospitals in a region must evacuate their patients.

As part of this exercise, other hospitals, home care and hospice providers, and nursing homes will participate to test their ability to accept some of those patients.

Although participation is voluntary, the CST/IOC will fulfill the requirement that Certified Home Health Agencies (CHHAs) and hospices participate in a full-scale community-based exercise for the period of November 16, 2017 to November 15, 2018 (some Licensed Home Care Services Agencies may have to participate in such an exercise under their contract with CHHAs or managed care plans).

The webinar dates for providers in the Capital District and Central New York areas are as follows (no registration is required): 

January 8, from 10 to 11 a.m. The webinar can be accessed on January 8 at https:// meetny.webex.com/meetny/j.php?MTID=mfc1a95f0006485f699031b23f3ef3d10; and

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January 10 from 10 to 11 a.m. The webinar can be accessed on January 10 at https:// meetny.webex.com/meetny/j.php?MTID=m107c702b688e2771daeca9cb205f5746.

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Continued from previous page The dates for providers in the Western New York and Metropolitan Area Regional Office/MARO regions (not including New York City) are as follows (no registration is required): 

February 1, 1 to 2 p.m. The webinar can be accessed on February 1 at https://meetny.webex.com/ meetny/j.php?MTID=me79c7b7503914f2ad3bdad66d29eb404; and

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February 2, 10 to 11 a.m. The webinar can be accessed on February 2 at https://meetny.webex.com/ meetny/j.php?MTID=ma0073b30cd3d893e80a5b6e00a30aa74.

DOH will issue a brief survey via the Health Electronic Response Data System (HERDS) on the day of the CST, and providers will have only 90 minutes to complete the survey. Providers will also be expected to complete an After Action Report following the CST. DOH will provide a template to assist in its completion, which HCA will share once we obtain it.

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

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

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

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“Home Care Worker Training and People with Alzheimer’s Disease and Related Dementias: Ideas for State Policymakers,” by PHI https://phinational.org/wp-content/uploads/2017/11/Home-Care-Workers-and-Alzheimers-PHI-Nov-2017.pdf

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“Empowering New Yorkers with Quality Measures that Matter to Them,” by the United Hospital Fund http://uhfnyc.org/publications/881269

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“Medicare Delivery System Reform: The Evidence Link The latest facts and results on Medicare ACO, medical home, and bundled payment models,” by Kaiser Family Foundation https://www.kff.org/medicare-delivery-system-reform-the-evidence-link/ ?utm_source=Medicare+Rights+Center&utm_campaign=e5d9bd6850Medicare_Watch_2017_10_05&utm_medium=email&utm_term=0_1c591fe07f-e5d9bd685077210477&mc_cid=e5d9bd6850&mc_eid=21633aea3f

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“Medicaid Fraud Control Units: Investigation and Prosecution of Fraud and Beneficiary Abuse in Medicaid Personal Care Services,” by the Office of Inspector General https://oig.hhs.gov/oei/reports/oei-12-16-00500.pdf

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“The Evolution of Private Plans in Medicare,” by the Commonwealth Fund http://www.commonwealthfund.org/publications/issue-briefs/2017/dec/evolution-of-private-plans-in-medicare

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

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