Dec. 19, 2016 Edition of The Situation Report

QIVAPP

MEDPAC

CFCO

DATA

MLTC plans to soon receive QIVAPP funds for 2015-16. Funds must be passed to providers within 30 days.

MedPAC discussed its March Report to Congress, recommending further cuts to home care.

Community First Choice Option services will become part of the MLTC benefit in July 2017. Get the latest updates on implementation.

CMS data file includes information on utilizations, payments and more.

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Your Source for HOME CARE News, Policy and Advocacy

Vol. 1, Issue 15 | December 19, 2016

COMING UP Northeast Home Health Leadership Summit: “Extreme Makeover, Home Care Edition” Jan. 17-19, 2017 The Colonnade Hotel Boston HCA’s offices will be closed on Monday, December 26 through Monday, January 2 for the holiday and New Year’s week. We will not be publishing The Situation Report on these dates, but will have a next edition of The Situation Report on Tuesday, January 3.

We will send you alerts, as needed, for any breaking news developments.

Updates from Minimum Wage Funding Meeting with DOH Some clarification provided On Friday, the state Department of Health (DOH) held a meeting with HCA, the New York State Association of Health Care Providers (HCP) and 1199 SEIU to address the serious concerns raised by home care providers, MLTC plans and others over implementation of state funding adjustments to meet minimum wage (MW) costs.

See WAGE p. 2

With Big Changes in Washington, Hear From Insider Health Policy Experts at Northeast Home Health Summit This year’s elections have raised the biggest questions in years about the future policy and political landscape for health care in Washington.

What will happen to the Medicare and Medicaid programs? How would a repeal and/or replacement of the Affordable Care Act (ACA) touch existing requirements and programs, like the Medicare face-to-face rule, new models of care See SUMMIT p. 4

INSIDE Updates from Minimum Wage Funding Meeting with DOH..................................1 Hear From D.C. Policy Experts at Northeast Summit...........................................1 Update on 2015-16 QIVAPP Monies...................................................................5 MedPAC Poised to Recommend Rate Cuts for Home Health, Hospice.................5 HCA Meets with Senate on Legislative Priorities...............................................6 DOH Posts Initial 2017 CHHA Pediatric Medicaid Rates.....................................7 Information Provided to Plans on CFCO.............................................................8 Office of Management and Budget Approves OASIS-C2......................................10 VBP “Town Hall” Gathers Information on Provider Needs..................................10

CMS Releases Annual Home Health Utilization & Payment Data File........11 Upcoming Due Dates and Deadlines......................................................12 Medicare-Medicaid ACO Announced......................................................13 Medicare Observation Notice Posted....................................................13 Nonprofit Capital Investment Program Awards Announced.....................14 2017 Medicaid Transfer Penalty Rates Announced.................................14 OSHA Seeks Feedback on Workplace Violence........................................15 VA Increases Role of APRNs.....................................................................16 NGS Updates.........................................................................................16 Resources........................................................................................................17

The Situation Report: the Home Care Association of New York State WAGE from p. 1

At the outset of the meeting, HCA stressed (and DOH acknowledged) that DOH has a responsibility under the law to issue actuarially sound rates to MLTC plans, ensuring: 1) the plans’ ability to comply with state and federal laws; and 2) rates which must include adequate funding for MW and related labor expenses that, in turn, enables plans to reimburse at rates for home care providers to comply. The obligation to adequately fund MW applies to DOH, MLTCs and providers, and HCA reiterated the fundamental need and legal requirement that DOH provide adequate MLTC and provider funding for MW, irrespective of DOH’s specific MW add-on.

DOH requested the identification of those plans which: have yet to send contract rate amendments to their home care providers; have sent amendments that are unclear as to how much the rates will be adjusted; and/ or are providing inadequate amounts of hourly increases.

DOH said it has communicated with plans that provided unclear guidance and amendments. It expects those plans to send out revised language by today, December 19. In addition, DOH stated that it intends to immediately contact those plans that have not sent out amendments and those who sent out provisions that include amounts far below $1.33 per hour. DOH stated that the plan rates included adjustments close to $1.33 per hour even after being risk adjusted.

DOH confirmed that plans should be getting minimum wage monies at the end of December and then in their January, February and March payments.

Regarding MW funding for consumer directed personal assistance services (CDPAS), DOH said that it had built monies into plan rates to ensure that their contracted providers can meet the MW increase for CDPAS. However, DOH was not adding new monies to plans for CDPAS MW obligations and indicated that its survey had shown that

Volume 1, No. 15 December 19, 2016 

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

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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Teresa Brown Administrative Assistant tbrown@hcanys.org

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

consumer-directed personal assistants were already being paid amounts at or above the new MW level.

Volume 1, No. 15 December 19, 2016 

Value Based Payment Conference

DOH advised those fiscal intermediaries who need increased plan rates for MW to present that position to the plan.

DOH also informed us that while Fully Integrated Duals Advantage (FIDA), Program for All-Inclusive Care for the Elderly (PACE) and Medicaid Advantage plans will receive MW funding adjustments, those adjustments will not come until after January. Plans can request that DOH advance those funds if they need the monies in order to meet the MW requirement.

HCA pointed out that plan rate adjustments start January 1, 2017 while providers are expected to pay higher wages starting on December 31, 2016. DOH agreed that the increased rates from plans to providers should start on December 31.

DOH will shortly hold a Stakeholder’s Workgroup meeting to discuss enforcement requirements, including a streamlined cost report for home care providers and a plan attestation form.

The minimum wage engagement process with plans and providers is very fluid and is expected to continue into this week. Look for further updates as HCA gains additional information.

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

HCA’s final education program of 2016 focused on the essentials of value-based payments for home care, including perspectives from payors, state contractors and officials, and data consultants.

At top, a panel of managed care representatives discusses their views on home care’s role. From left: Joseph Twardy, Vice President, Care Management, Fidelis Care; David Ackman, MD, MPH, Medical Director, Provider Engagement, Empire BlueCross BlueShield HealthPlus; and Robert Hinckley, Senior Vice President, Strategy and Communications and Chief Strategy Officer for CDPHP Health Plan.

At Bottom, Barbara Katz, RN, MSN, of BK Health Care Consulting, leads an interactive workshop on data assessment strategies for value-based payments.

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SUMMIT from p. 1 shepherded by the ACA-developed Centers for Medicare and Medicaid Innovation, as well as value-based payments and other projects?

You can start to get a better handle on these issues early in 2017 at the upcoming Northeast Home Health Leadership Summit in Boston on January 17 to 19. If you haven’t yet registered, please be sure to do so as soon as possible. You won’t want to miss this premier gathering of home health provider executives from throughout the northeast during the biggest, most important home care conference coming to the region early in 2017.

Colin Roskey, Executive Vice President for the Partnership for Quality Home Healthcare, is a leading expert who speaks with unparalleled clarity and insider knowledge on the Washington landscape for home health services. He has lots of insights to share for your consideration in the post-election environment.

In his presentation “Washington Landscape: How to Maximize Home Health’s Footprint,” Mr. Roskey will preview issues on the horizon for home health and how agency leaders can advance an agenda that will capture the interest and advocacy of Washington lawmakers. You’ll examine the issues, and gain a clearer outlook for the year ahead, with guidance and strategy to utilize in your messaging at the nation’s capital.

In a similar vein, the Summit also features Erin Smith, Executive Director of the Post-Acute Care Center for Research, who will discuss “The Federal Focus to Reform Post- Acute Care Delivery.”

Federal policymakers continue to focus on policy proposals that would reform Medicare post-acute care (PAC) delivery. Among these is the Medicare Post-Acute Care Transformation Act of 2014, which instructed the Medicare Payment Advisory Commission (MedPAC) to design and recommend a unified payment system.

Meanwhile, ACA prompted the development of several new payment models that focus on high quality and patient-centered care, including the Bundled Payment Care Initiative (BPCI), the Comprehensive Care for Joint Replacement (CJR) Model and other pilots. This session offers the perspective and insights from a respected Washington policy insider about the politics and possibilities in post-acute care payment and service delivery changes that offer new opportunities for home health providers, and the prospects for change in these systems within the new political landscape.

Everything you need to know about the conference, including hotel and registration options, can be found on the conference website at www.nehomehealthsummit.com. You can also register online directly at https:// www.eventville.com/Catalog/EventRegistration1.asp?EventId=1012027.

We look forward to seeing you in Boston on January 17-19.

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Update on 2015-16 QIVAPP Monies The state Department of Health (DOH) informed HCA this week that the state Division of Budget has approved the funding for the Quality Incentive Vital Access Provider Pool (QIVAPP) program for 2015-16.

A request has been submitted to send payment to MLTC plans which should receive money within the next couple of weeks. Plans will then have up to 30 days to pass funds on to their eligible home care contractors. Unlike the funding for 2014-15, which was in two payments, the state will be issuing one QIVAPP payment for 2015-16.

As communicated to members, DOH had earlier decided that the 2015-16 funding ($70 million) would be provided to those found QIVAPP-eligible for 2014-15 and to any additional home care agencies found eligible after submitting documentation. In early September, DOH announced that five additional agencies – which did not receive funding for the 2014-15 period – were qualified to receive QIVAPP for 2015-16.

QIVAPP was initially intended to help New York City home care agencies with the added labor costs that resulted from the state Wage Parity law. However, DOH added restrictive eligibility criteria that limited which agencies qualified during the 2014-15 period, a point that HCA has targeted in our advocacy as being contrary to the program’s intent.

HCA has contacted members eligible for 2015-16 QIVAPP, sharing a list of the amounts they should receive from each plan. If you did not get it, please send an e-mail to Andrew Koski at akoski@hcanys.org.

The state has yet to decide if there will be QIVAPP funding for 2016-17.

MedPAC Poised to Recommend Rate Cuts for Home Health and Hospice Services The Medicare Payment Advisory Commission (MedPAC) met last week to discuss upcoming recommendations to Congress for its annual March Report regarding Medicare payment policies and payment rates. Similar to several past years, MedPAC said it is planning to recommend not only dramatically reducing rates for Medicare home health and hospice services but also plans to recommend some overall reimbursement policy changes.

During its meeting, MedPAC noted that margins for free-standing providers have increased between 2014 and 2015, even though payment rates to providers were reduced by 4.5 percent. MedPAC continues to believe the home health margins are excessive and Medicare is spending too much for home care services. Specifically, MedPAC stated that additional overpayments were related to an increase in therapy visits, which is used as a payment factor. As a result, MedPAC is planning to recommend that Medicare no longer consider home health therapy use as a condition of payment as part of its March Report to Congress. It will also recommend reducing overall payments by 5 percent in 2018, and implementing a twoyear Medicare home health rebasing of the Prospective Payment System (PPS) beginning in 2019.

HCA has continually communicated to the U.S. Centers for Medicare and Medicaid Services (CMS) and New York’s Congressional Delegation that CMS’s current rebasing methodology is rooted in incomplete data and

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assumptions, causing New York providers to shoulder negative operating margins for thirteen years in a row, with an unweighted average margin of -16.4 percent in 2013. We have also repeatedly sought postponement or suspension of any rate rebasing, pending a more complete impact analysis and a recalculated formula using more accurate and up-to-date data. HCA asks that providers continue to share your financial experiences by completing HCA’s 2016-17 Financial Condition Report at: https:// www.surveymonkey.com/r/HCAfinancesurvey.

Furthermore, MedPAC also addressed the adequacy of hospice payments under Medicare. During the discussion, members of MedPAC considered a draft recommendation related to the payment update for Fiscal Year (FY) 2018, and agreed to submit a recommendation to Congress to eliminate the legislativelymandated update for FY 2018 hospice payments. Currently, the hospice payment update is capped at 1 percent for FY 2018.

HCA members can learn more about MedPAC’s recommendation by reviewing the entire transcript of last week’s meeting at http://www.medpac.gov/docs/default-source/meeting-materials/ dec2016_meeting_transcript.pdf?sfvrsn=0.

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

HCA Meets with Senate on Legislative Priorities Following Recent Discussions with Administration, Assembly Officials Following last week’s meetings with Cuomo Administration and State Assembly officials, HCA extended our route of advocacy meetings with key Senate leadership and Health Committee representatives.

As reported in the December 12 edition of The Situation Report, HCA has been pressing a set of priority proposals for home care in 2017, meeting, over the past two weeks, with the Governor’s office, the state Division of Budget, the state Department of Health, as well as Senate and Assembly leadership and health committees.

Our proposals – developed with extensive input from the HCA Board, Policy Council and other key committees and members – aim to address longstanding fundamental needs in home care as well as urgent issues, such as our call for an immediate fix to the state’s minimum wage funding procedures. (See related p. 1 story.)

As extensively reported to the membership, funds to meet the minimum wage increase in home care have either been inadequate or not materialized altogether, in large part due to the lack of clear guidelines and methods in the state’s pass-through of necessary adjustments to the managed care plans, and from the managed care plans to providers. Moreover, the current funding process has thus far only commenced for New York City, and it covers just one quarter of the fiscal year. HCA is therefore also pressing for a broader and more lasting solution, with a funding commitment beyond the first quarter of the state fiscal year, applicable to all regions of the state.

Beyond the specific issue of minimum wage, our legislative proposals would ensure a sound premium and payment mechanism for providers and health plans to cover all essential operating and patient service costs, inclusive of minimum wage as well as other cost factors. Additional HCA proposals would help position and facilitate home care’s participation in new alternate service delivery and payment models,

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including the Delivery System Reform Incentive Payment (DSRIP) program, Value Based Payments (VBP), patient centered medical homes/advanced primary care practices, Accountable Care Organizations (ACOs), bundled payments, etc., as well as support for critical public health contributions by home care that can produce significant returns in both quality and savings.

We are also calling for: a comprehensive home care workforce and infrastructure plan that is sufficient to meet growing needs, with special focus on underserved areas and populations; a dedicated mechanism for home care working capital; clinical and health information technology support; and health care quality initiatives and innovation in home care.

HCA also has proposals to address additional, critical areas involving hospice and palliative care, emergency preparedness, commercial insurance coverage for home care, primary care in home care, pediatrics and other areas.

Your participation is vital To assist these advocacy efforts, we ask that all home care agencies complete HCA’s 2016-17 Home Care Industry Survey recently shared with the membership. This survey will help us provide hard evidence about the financial and operational needs of home care in support of our advocacy on your behalf. To complete the survey, visit https://www.surveymonkey.com/r/HCAfinancesurvey.

DOH Posts Initial 2017 CHHA Pediatric Medicaid Rates Includes FLSA and NYC Wage Parity and minimum wage adjustments The state Department of Health (DOH) has posted to the Health Commerce System (HCS) the initial 2017 Medicaid fee-for-service (FFS) rates for CHHAs who are serving pediatric patients (under 18 years of age).

DOH has not yet posted the initial 2017 Medicaid rates for the Personal Care program but expects to do so soon and providers are encouraged to regularly check the HCS over the holidays.

The initial non-Episodic Payment System (EPS) CHHA rates reflect a zero roll factor adjustment as well as an overall zero trend factor for the rate period January 1, 2017 through December 31, 2017.

The initial 2017 CHHA rates also include the 3-percent adjustment for purposes of improving recruitment and retention of non-supervisory home care services workers with direct patient care responsibilities, along with a 4.7 percent rate add-on adjustment for the newer Recruitment, Training and Retention (RT&R) initiative ($100 million statewide).

The Dear Administrator Letter (DAL) for the initial CHHA rates includes additional information on: the statewide aggregate Administrative and General (A&G) cap, which is 27.44 percent in 2017; regional guidelines or ceilings; worker recruitment and retention adjustments; the rate hotline process; revisions to the 2016 annual cost report; and the rate appeals process.

FLSA Adjustment Beginning on October 13, 2015, $0.34 was added to the CHHA pediatric hourly rates for home health aide services to reflect changes which were effective on that date in the federal Fair Labor Standards

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Act (FLSA). Because the 2017 rates are based on CHHAs’ 2015 Cost Reports, approximately 2.5 months of increased FLSA costs are already included in the base year cost data. Consequently, DOH has increased the home health aide rates for 2017 by $0.27.

DOH notes that this additional FLSA funding is provided under the RT&R methodology authorized by Public Health Law Section 3614 paragraph 9 and 10. As such, to the extent such funding is not utilized to meet new overtime and travel requirements, CHHAs must use such funds for the purpose of RT&R of nonsupervisory direct care workers only and CHHAs are prohibited from using such funds for any other purpose.

NYC Wage Parity and Minimum Wage Adjustments Home Health Aide payment rates for New York City (NYC) providers were adjusted to a minimum of $20.95 per hour beginning March 1, 2104, to enable CHHAs to meet the “Wage Parity” requirements of Section 3614.14 of the state PHL. Effective January 1, 2017, the minimum payment rate for NYC CHHAs has been increased to $22.28 to additionally reflect the scheduled increase in the minimum wage in New York City.

The additional amount consists of $1.00 per hour in wages and $0.33 per hour in payroll taxes and fringe benefits. The $0.27 FLSA adjustment detailed above is in addition to the $22.28 minimum.

DOH notes that both the FLSA adjustment and the NYC wage adjustments (if applicable), have been applied to the bottom-line “Revised 2017 Rates,” usually on Page 3 of the CHHA rate sheet, through an override to the “2017 Medicaid Rate,” which follows the A&G adjustment and prior to the addition of the two workforce percent adjustments.

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

Information Provided to Plans on CFCO The state Department of Health (DOH) has issued guidance to MLTC plans about the implementation of Community First Choice Option (CFCO) services into MLTC benefit packages on July 1, 2017.

As previously reported, CFCO includes a package of state plan services similar to what is offered under home and community-based waiver programs.

These include: 

Assistive Technology (beyond the scope of Durable Medical Equipment)



Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) skill acquisition, maintenance, and enhancement



Community Transitional Services



Moving Assistance



Environmental Modifications (beyond the scope of social and environmental supports) Continued on next page

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Continued from previous page 

Vehicle Modifications



Social Transportation

To be eligible to receive CFCO services, enrollees must: 

Require a nursing home level of care as determined by the Uniform Assessment System (UAS);



Be able to live safely in the community if they receive CFCO services; and



Live in their own residence or the residence of a family member.

Plans are responsible for arranging an assessment of the enrollee that will record the enrollee’s needs, strengths, preferences, goals and objectives for maximizing independence and community integration. It will also include an assessment of potential risk and vulnerabilities. All outcomes of the functional needs assessment must be incorporated into the person centered service plan (PCSP), including those needs that are met by family or other informal supports.

The MLTC plan will review the assessment and the request for services to determine whether the enrollee meets the eligibility requirements for CFCO services and whether the enrollee needs the requested services. If the assessment indicates that the enrollee is eligible and the requested services are needed, the MLTC plan is responsible for overseeing the development of the PCSP, which will include: the amount, duration, and scope of the requested services that have been authorized; identification of service providers; risk assessment; and risk management plan. The enrollee must sign the PCSP. If the enrollee is found ineligible for CFCO services due to not meeting eligibility requirements, the MLTC plan must consider if the enrollee’s request for services and needs may be met through other MLTC plan benefit package services.

The MLTC plan will reassess the enrollee at least every six months, upon a significant change in the enrollee’s condition/circumstances, or if requested by the enrollee.

MLTC plans will provide contracted providers with authorization for service provision, including, if applicable, the number of visits per week, level, and duration in accordance with: the approved PCSP; applicable federal and state laws, rules and regulations; and Medicaid MLTC program noticing requirements.

DOH has provided MLTC plans with a list of providers with whom plans may contract for CFCO services.

MLTC plans must contract with a minimum of two providers per county for each service.

The state will establish new rate codes to reflect the additional CFCO services. These rates codes will be utilized for fee-for-service claims and can inform provider-plan billing. Appropriate coding will be identified for encounter reporting. For federal claiming and plan reporting purposes, enrollees

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determined by a plan to be eligible for CFCO services will be identified by Restriction/Exemption (R/E) code CF. DOH intends to convene a workgroup with trade associations and plan representatives on January 5, 2017 to discuss implementation and operational issues.

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

Office of Management and Budget Approves OASIS-C2 The U.S. Centers for Medicare and Medicaid Services (CMS) has gotten approval from the federal Office of Management and Budget for the Outcome and Assessment Information Set (OASIS) C2 form.

Beginning January 1, 2017, CHHAs and vendors should begin using the OASIS-C2 in submitting assessments.

As a reminder, the guidance manual for OASIS-C2 is available at: https://www.cms.gov/Medicare/QualityInitiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/HHQIOASISUserManual.html.

Providers or vendors can direct any questions about using the OASIS-C2 to: HomeHealthQualityQuestions@cms.hhs.gov.

VBP “Town Hall” Gathers Information on Provider Needs State Medicaid Director Jason Helgerson and members of the state’s Value Based Payment (VBP) team convened a “town hall” meeting Friday of state health and community based services associations to discuss provider needs for VBP participation.

Following a VBP update by Mr. Helgerson, state association representatives, including HCA, offered feedback on ideas for assistance put forth by the VBP team, as well as on additional actions to consider. Concepts vetted by the VBP team included:        

Individual VBP team meetings with association representatives Subpopulation learning events VBP contracting templates VBP implementation opportunities Educational “how to” videos VBP bulletins Mailbox analysis News flashes

Citing the critical roles of associations on provider/plan assistance, Mr. Helgerson referenced numerous times HCA’s VBP symposium held last week, and the participation from the state’s team, as a prototype for associations to assist and help lead members toward successful VBP arrangements.

HCA and fellow associations offered a steady stream of additions to the state-suggested list, pointing out the innumerable challenges and needs of the provider community. The state invited the associations and their

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respective memberships to send these and any additional recommendations for assistance to DSRIP@health.ny.gov.

We also especially stressed the challenges to VBP (and consequent assistance needs) stemming from such elements as the financially fragile base of the majority of providers in the continuum; the challenge to most community hospitals and community based agencies (without existing large margins or deep reserves/ backing) to enter into higher-tier risk arrangements with plans; the widespread lack of understanding (especially by large DSRIP leads and larger health plans) of the unique roles and competencies of community based providers for achieving VBP goals; and more.

HCA has, on an ongoing and aggressive basis, been reaching out and cultivating home care and MLTC membership input on areas of need and recommendations in VBP, and we encourage you to take this next, important opportunity to share your further recommendations with us, along with the state’s VBP team. HCA members can e-mail input directly to HCA’s Director of Public Policy Alexandra Blais at ablais@hcanys.org.

HCA members can view the entire VBP town hall slide deck and the initial state team’s recommendation list at http://hca-nys.org/wp-content/uploads/2016/12/VBPTownHallFinal.pdf.

Since HCA is a member of the state’s core VBP committee, HCA will also be part of further discussion and vetting of recommendations and proposals received by the state for provider assistance. Along with direct recommendations that we provide in this process, HCA has drafted and discussed legislation with the Governor’s office, Division of Budget, Department of Health and key Assembly and Senate offices to better position home care for VBP/DSRIP, physician and hospital partnering, and other evolving models.

In addition, HCA plans regular education, outreach and technical assistance to the membership to further assist your readiness and success in this system-wide move to VBP. For further information, contact Al Cardillo acardillo@hcanys.org or Alex Blais at ablais@hcanys.org.

CMS Releases Second Annual Home Health Utilization & Payment Data File The U.S. Centers for Medicare and Medicaid Services (CMS) has posted a new Home Health Agency Public Use File (PUF), using data for 2014. The PUF compiles data from over ten thousand agencies, accounting for over 6 million in claims and nearly $18 billion in payments. It provides the following information about Medicare services provided by home health agencies:      

Utilizations Payment Submitted charges Demographic and chronic condition indicators by CMS certification number (new elements in this year’s file) Home Health Resource Group (HHRG) State of service

The updated 2014 PUF and other information can be found here: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MedicareProvider-Charge-Data/HHA.html

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Important Upcoming Deadlines

Requirement

More Information

Independent Assessor’s initial recommendations related to its MidͲPoint Assessment of all 25 Performing Provider Systems under DSRIP

Comments due by December 21, 2016

http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/pps_map/ midpoint/index.htm

2015 CHHA/LTHHCP Statistical Report

Dec. 30, 2016

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

2015 Hospice Cost and Utilization Report

Dec. 30, 2016

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

State and federal compliance program certification forms

Dec. 31, 2016

https://www.omig.ny.gov/compliance/certification

Minimum Wage Increases to: $11 for New York City; $10 for Long Island and Westchester; and $9.70 for rest of the state

Dec. 31, 2016

http://www.labor.ny.gov/legal/laws/pdf/minimumͲwage/19aͲamendedͲ rule.pdf

Healthcare Personnel Influenza Vaccination Report for personnel employed from October 1, 2016 to March 31, 2017

May 1, 2017

http://hcaͲnys.org/wpͲ content/uploads/2016/10/ctrlaccamstmpNotification_21226.pdf

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Medicare-Medicaid ACO Announced This week, the U.S. Centers for Medicare and Medicaid Services (CMS) announced the Medicare-Medicaid Accountable Care Organization (ACO) Model, a new initiative designed to “improve the quality of care and lower costs for beneficiaries who are enrolled in both Medicare and Medicaid.”

In current Medicare ACO initiatives, beneficiaries who are Medicare-Medicaid enrollees may be attributed to ACOs. However, Medicare ACOs often do not have financial accountability for the Medicaid expenditures for those beneficiaries. The Medicare-Medicaid ACO Model will allow Medicare Shared Savings Program ACOs to take on accountability for the quality of care and both Medicare and Medicaid costs for Medicare-Medicaid enrollees.

CMS is accepting letters of intent from states that wish to work with CMS to design certain state-specific elements of the model. The Medicare-Medicaid ACO Model is open to all states and the District of Columbia that have a sufficient number of Medicare-Medicaid enrollees in fee-for-service Medicare and Medicaid. CMS will enter into participation agreements with up to six states with preference given to states with low Medicare ACO saturation. Once a state is approved to participate in the model, a request for application will be released to ACOs and health care providers in that state.

HCA will further explore and advocate the opportunities for home care in this new model and share this with the membership.

In the meantime, more information on the Medicare-Medicaid ACO Model, including a fact sheet, is at: https:/ /www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-12-15-2.html.

Medicare Observation Notice Posted The U.S. Centers for Medicare and Medicaid Services (CMS) has posted the final Medicare Outpatient Observation Notice.

The final notice, required under the Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act, is a standard form that hospitals must provide to beneficiaries who receive “observation services” to let them know they are receiving outpatient care and have not been admitted to the hospital.

The notice is important for Medicare beneficiaries because not being admitted to the hospital affects their out-of-pocket expenses and their eligibility for Medicare-covered nursing home care which requires a prior three-day hospital stay under Medicare fee-for-service. As such, HCA will be examining the possible ramifications for home care.

Observation services are considered hospital outpatient care and are billed under Medicare Part B which requires copayments after the Part B deductible has been met.

Hospitals have 90 days to implement the new notice, and must provide it to beneficiaries under observation starting March 8.

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When delivering the notice, hospitals must explain its contents and document that an oral explanation was provided.

The notice and instructions are at https://www.cms.gov/Medicare/Medicare-General-Information/BNI/ index.html?redirect=/bni/.

New York State also has rules about the provision of hospital observation services. These are outlined at http:// www.health.ny.gov/professionals/hospital_administrator/letters/2016/2016-06-06_dal_1605_observation_services.htm.

Nonprofit Infrastructure Capital Investment Program (NICIP) Awards Announced The Dormitory Authority of the State of New York (“DASNY”) has announced the 237 applicants who have been awarded Nonprofit Infrastructure Capital Investment Program (NICIP) grants totaling approximately $100 million.

The awardees list is at http://www.dasny.org/RFP-BidOpportunities-Solicitations/Details.aspx?id=578a9f69355f-45ad-bb0e-a7803aca0fef.

According to DASNY, award recipients were chosen through a competitive RFP process, and applications were evaluated based on the scope of the proposed project; the number of clients who will benefit; how critical the project is for helping the nonprofit serve its target population; how the project is necessary for allowing the nonprofit to serve a new population; as well as other factors.

As described in previous stories, NICIP will make targeted investments throughout the state in capital projects that will improve or maintain the quality, efficiency, accessibility, and reach of nonprofit human services organizations. Qualified organizations include those that provide direct services to New Yorkers through state contracts, state payment rates, or state authorized payments which represent funding appropriated by the state and passed through to a local government which then provides that money directly to the nonprofit organization.

Home care and hospice providers were potentially eligible for funding if they met all of the RFA eligibility criteria.

As in the past, HCA will continue to advocate for a dedicated funding mechanism to cover home care working capital as one of our major priorities during the legislative session.

2017 Medicaid Transfer Penalty Rates Announced The state Department of Health (DOH) has announced the Medicaid regional rates for calculating penalty periods due to transfers of assets made for those who apply for Medicaid in 2017.

The penalty periods apply to individuals who transfer assets during the 60-month “look-back period” and require institutional services. The 2017 monthly rates are:

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New York City: $12,157

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Long Island: $12,811

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Continued from previous page 

Northern Metropolitan: $12,198 (Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster and Westchester)

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Northeastern: $10,242 (Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren and Washington)

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Central: $9,511 (Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tioga and Tompkins)

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Rochester: $11,237 (Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne and Yates)

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Western: $10,078 (Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans and Wyoming)

DOH’s notice is at http://www.health.ny.gov/health_care/medicaid/publications/docs/gis/16ma016.pdf.

DOH has also updated its Actuarial Life Expectancy Table. It is at http://www.health.ny.gov/health_care/ medicaid/publications/pub2016gis.htm (see GIS 16 MA/015).

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

OSHA Seeks Feedback on Workplace Violence The Occupational Safety and Health Administration (OSHA) of the U.S. Department of Labor is considering whether a standard is needed to protect health care and social assistance employees from workplace violence and is interested in obtaining information about the extent and nature of workplace violence in the industry and the nature and effectiveness of interventions and controls used to prevent such violence.

OSHA’s request for information (RFI) provides an overview of the problem of workplace violence in the health care and social assistance sector and the measures that have been taken to address it. It also seeks information on issues that might be considered in developing a standard, including the scope and types of controls that might be required.

The RFI is at https://www.gpo.gov/fdsys/pkg/FR-2016-12-07/pdf/2016-29197.pdf, and comments are due April 6, 2017.

Home health services are among the categories in a chart listing the incident rate for violence and other injuries for workers. “Nursing-psychiatric and home health aides” are noted as having high rates of violence.

OSHA is requesting information on agencies’ experiences with state laws that address workplace violence; how to define the workplace violence that OSHA might cover in a standard; which sectors should be included

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

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in a standard; any workplace violence prevention programs that have been implemented by agencies and their costs, economic impacts and benefits; recordkeeping and operating procedures; and other areas.

VA Increases Role of APRNs The U.S. Department of Veterans Affairs (VA) has issued a final rule with comment period that amends its medical regulations to permit full practice authority of three roles of VA advanced practice registered nurses (APRN) when they are acting within the scope of their VA employment. HCA is seeking further information as to whether this change allows for nurse practitioners to order home care under the VA benefit.

The final rulemaking establishes the professional qualifications an individual must possess to be appointed as an APRN within VA, establishes the criteria under which VA may grant full practice authority to an APRN, and defines the scope of full practice authority for each of the three roles of APRN. The services provided by an APRN under full practice authority in VA are consistent with the nursing profession’s standards of practice for such roles.

The three APRN roles include Certified Nurse Practitioner, Clinical Nurse Specialist, and Certified NurseMidwife. Certified Registered Nurse Anesthetists (CRNA) will not be included in VA’s full practice authority under this final rule, but comments are requested on access issues or other unconsidered circumstances that might warrant their inclusion in a future rulemaking.

The rule is at https://www.gpo.gov/fdsys/pkg/FR-2016-12-14/pdf/2016-29950.pdf. It is effective January 13, 2017.

NGS Updates National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), has recently posted the following information to its website. 

NGS Closed on Christmas and New Year’s – NGS will be closed Monday, December 26 and Monday January 2 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 23 and Friday, December 30 will have a claim receipt date of Tuesday, December 27, 2016 or Tuesday, January 3, 2017, respectively.

EDI front-end acknowledgement transactions will be created as expected as EDI claim files are received. The Direct Data Entry (DDE) Provider Online System will be available on 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.

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NGS to Conduct EDI Maintenance on December 30 – On Friday, December 30, 2016, NGS will take down the Electronic Data Interchange (EDI) gateway at 5 p.m. for approximately six hours in order to implement EDI system updates in preparation for the January 2017 quarterly release implementation.

During the outage timeframe, trading partners will be unable to connect to the EDI Gateway to exchange transactions with EDI. If you have any questions, please contact the Jurisdiction 6 EDI Help Desk at (877) 273-4334.

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

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Resources 

“Fiscal Year 2015 Recovery Audit Program Report to Congress” https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFSCompliance-Programs/Recovery-Audit-Program/index.html

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“Medicare: Initial Results of Revised Process to Screen Providers and Suppliers, and Need for Objectives and Performance Measures,” by the Government Accountability Office http://www.gao.gov/assets/690/681074.pdf

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

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