January 12, 2018 Edition of The Situation Report

CoPs IN EFFECT TOMORROW

TRANSFORMATION GRANTS

CON CHANGES DISCUSSED

NGS, STATE EXECS MEET

HCA reminds members that the Home Health CoPs are in effect tomorrow; CMS is halting financial penalties for 1 year.

In Monday’s newsletter, HCA reported on the health care transformation grant RFA that was recently posted. Today’s newsletter has some important updates and clarifications.

HCA raised several concerns and pressed input at a DOH workgroup meeting to weigh certificate of need and other regulatory items, issues.

In a new meeting structure and agenda expected to occur long term, home care association executives, including HCA, met at NGS headquarters to discuss, find relief on major issues.

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COMING UP Northeast Home Health Leadership Summit Jan. 16-18, 2018 Boston Stop Sepsis at Home Training Sessions Jan. 24, 2018 Capital Region Webinar: Sexual Harassment Prevention in the Workplace Jan. 30, 2018 10-11 a.m.

State Advocacy Day, PAC Reception Feb. 5-6, 2018 Albany Register for these and other programs online at https:// hca-nys.org/eventseducation/ upcoming-events.

Your Source for HOME CARE News, Policy and Advocacy

Vol. 3, Issue 3 | January 12, 2018

Governor to Release State Budget Proposal Next Week, Eyeing Multi-Billion-Dollar Deficit HCA members: complete HCA’s Financial Survey ASAP to defend against potential cuts or adverse actions at this high-risk time Governor Cuomo is set to release his 2018-19 Executive Budget proposal this coming Tuesday, January 16. Though precise details are not yet known, the health care sector is bracing for the threat of potential cuts – based on signals from some voices in the Legislature, as well as the reality that the state faces a multi-billion-dollar shortfall which will likely put Medicaid in the cross-hairs.

See BUDGET p. 2

Rural Add-on Has Lapsed; Urge Congress to Re-Up It Today Without action, as of December 31, the Medicare home health rural add-on has tragically lapsed. This loss imperils vital primary care services throughout rural regions of New York State.

We ask members to write Congress and press your elected representatives to bridge this gap by reauthorizing the 3 See RURAL p. 3

Editor’s Note: This is a special Friday (early) edition of HCA’s newsletter, as our offices are closed on Monday for the Rev. Dr. Martin Luther King, Jr. Day holiday. We will resume Monday publication of our newsletter on January 22.

INSIDE Governor to Release State Budget Proposal Next Week.................................1 Rural Add-on Has Lapsed; Urge Congress to Re-Up It Today.............................1 CoPs In Effect Tomorrow..............................................................................3 Home Care Sepsis Training Comes to Cap. Region on 1/24.................................4 Renewing With HCA in 2018.............................................................................5 Important Upcoming Deadlines......................................................................5 More Info On Facility Transformation Grant RFA Announced Earlier This Week.....6 DOH CON Workgroup Weighs Draft Recommendations................................7 State Home Care Executives Hold Special Big-Picture Meeting with NGS........8 FI Authorization Application Update..........................................................10 CMS Unveils New Bundled Payment Model................................................11 CMS Outlines Low-Volume Appeals Settlement Option, Distinct from TPL...12

Coalition Surge Test Update.............................................................................13 FIDA Members Excluded From Health Homes............................................14 Nominations Accepted for HCA’s Board of Directors..................................15 Upcoming HCA Webinars..............................................................................15 Webinars to Provide Information on SHIN-NY Connection Requirements..........16 OMIG Posts Regulations Under Consideration.................................................17 DOH Holds Webinar on Conflict of Interest and NHTD/TBI Programs...................17 CMS Issues Guidance on Texting Patient Information.......................................19 VBP-MLTC FAQs Posted...................................................................................20 Senate Passes RAISE Family Caregivers Act.......................................................20 CMS to Host Home Health & Hospice Open Door Forum on Jan. 17......................21 NGS Requests Provider Feedback of its Website................................................21

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

BUDGET from p. 1 Estimates of the looming budget deficit vary widely, from $1.7 billion to as high as $6.8 billion. The Governor cited $4 billion as a figure in last week’s State of the State Address, while also mentioning an additional $2 billion cut in federal aid to New York State. The actual toll of these cuts, however, would depend on the rate of spending in this year’s budget. State officials have signaled that a 2-percent spending increase would put the deficit at about the $1.7 billion mark.

Next week’s budget release begins the process of feverish negotiations toward reaching a final budget agreement by the April 1 due date for the start of the state’s fiscal year. HCA will be analyzing the Governor’s proposal in detail and providing members with a summary of key components as we learn more throughout next week.

For the near future, Tuesday’s budget proposal will trigger a series of legislative hearings and deliberations, with both houses – the Senate and Assembly – traditionally releasing their own one-house budget proposals or blueprints as a basis for negotiations with the Governor in three-way talks.

The budget typically consumes most of the attention and energy during the first three months of the legislative session, and it has become an increasingly sprawling venue for policymaking beyond traditional fiscal measures.

Next week’s budget announcement will, therefore, be an essential milestone for HCA and members as we fine-tune our advocacy agenda leading up to our State Advocacy Day program on February 5 and 6. (Visit our website for a registration form to attend.) All member leaders are strongly urged to attend this important program to meet with lawmakers about the budget and other concerns for home care and hospice providers and managed long term care plans.

Our advocacy agenda will not only urge action on fiscal, programmatic and reimbursement matters, but it will also stress the need for regulatory, systemic and programmatic relief measures

Volume 3, No. 3 January 12, 2018 

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

Home Care Association of New York State (HCA) 388 Broadway, 4th Floor, Albany, NY 12207 Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org

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The Situation Report: the Home Care Association of New York State that are vital to the functioning of New York’s home and community-based care system. Look for more details soon.

Volume 3, No. 3 January 12, 2018 

RURAL from p. 1 percent add-on. Such an extension is already embodied by legislation in the Senate (S.353 Collins/Cantwell) that should be a model for both houses to act upon.

HCA Survey With a multi-billion-dollar deficit, your response to HCA’s financial condition survey is absolutely vital, as it arms HCA with data to quantify the fiscal experiences of home and community-based providers now facing the potential threat of new cuts.

Today is the official deadline to complete the survey, but HCA is keeping the survey link active through the weekend and early next week for providers to continue sending us your responses.

If your organization hasn’t done so, please answer this vital survey as soon as possible at https://www.surveymonkey.com/r/ 201718FinCondSurvey.

Of particular concern is the fact that both houses of Congress are considering “extender” legislation which would limit or scale back any reauthorization of the home health rural add-on. Our ask is simple: reauthorize the home health rural add-on without restrictions and at its standing rate of 3 percent.

It takes less than a minute of your time to act now. Simply click the link below, enter your contact information and hit “send” to reach New York Senators Charles Schumer and Kirsten Gillibrand as well as your Member of Congress.

Please urge your staff to do the same.

HCA has been in regular contact with New York’s Delegation on this matter, specifically with repeated outreach to Senator Schumer’s office over the past several days, so it is very important for members to amplify this outreach. Please take action here: http://p2a.co/HQThryo.

CoPs In Effect Beginning Tomorrow Civil Monetary Penalties on hold for one year in cases of non-compliance, but other sanctions could apply HCA reminds members that the Medicare Home Health Conditions of Participation (CoPs) will go into effect as scheduled tomorrow, January 13, barring any contrary announcement from the U.S. Centers for Medicare and Medicaid Services (CMS) after press time for The Situation Report.

We also stress that CMS has confirmed it is delaying the imposition of Civil Monetary Penalties (CMPs) on home health agencies for one year, acknowledging provider concerns about facing CMPs at a time when they are familiarizing themselves with the new, expansive changes in regulations. One exception, however, is in the case of “Immediate Jeopardy” situations identified on survey where agencies will face CMPs. Surveys conducted during the next year will result in citations for noncompliance. And if an agency does not make corrections to regain compliance, the agency could still be terminated or face an

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alternative sanction in lieu of termination (limit of 6 months).

As reported in the last edition of our newsletter, CMS has also yet to issue the final Interpretive Guidelines related to the CoP changes (and those final guidelines still have not been issued as of press time for today’s edition of The Situation Report).

The Interpretive Guidelines instruct surveyors on how to enforce the CoP changes. As we previously reported, surveyors will use the draft interpretive guidelines until the final version is issued; the final version is expected to be similar to the draft; and agencies should undertake a good-faith effort to achieve compliance with a focus on the underlying regulations over any draft guidance. We will immediately inform the membership upon the release of the final Interpretive Guidelines or any other updates related to the CoPs. For more information, please contact the HCA Policy staff.

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

Volume 3, No. 3 January 12, 2018 

Home Care Sepsis Training Comes to Capital Region on 1/24, Followed by NYC & LI Sessions in February and March Please notify your home care clinical teams, administrators and patient care directors who should all register to attend upcoming sessions!

On January 24, HCA is bringing the next installment of our Stop Sepsis at Home effort to the Capital Region. This campaign offers specialized, expert training for home care providers to use HCA’s first-ofits-kind, clinician-developed, community-based sepsis screening tool.

Other future sessions in different locations are listed on our Stop Sepsis at Home website. Simply view the calendar here: http://stopsepsisathomeny.org/events/.

Registrations for all sessions, including the January 24 program in Cohoes (Capital Region), are collected in the online form at https://www.surveymonkey.com/r/ SepsisRegionalTrainings. Please pre-register today!

Why attend? 

By participating in these sessions, your organization will gain one-stop training that meets the prerequisites for using the HCA-developed sepsis screening tool (subject to a signed user agreement with HCA).



This tool, which can be integrated into your EHR, helps your clinicians identify the risk of sepsis, prevent its onset, and ensure appropriate interventions in the event that sepsis is identified. The tool also supports your work meeting value based payment (VBP) arrangements.



We’ve also invited partner organizations from your community (hospital, physician practice, managed care and EMS representatives) to learn about the value of your work in sepsis prevention and mutually beneficial ways to partner.

If you are not aware of the life-threatening risks and grave statistics about sepsis, we strongly urge you to check out the information on our website at http://stopsepsisathomeny.org/, especially the importance for home care providers to take a lead role on this health crisis.

Our training sessions are free of charge, and are supported by a grant from the New York State Health Foundation, which is among several organizations that recognize the need for you, as a home care provider, to participate in staff training and use of the tool.

Please Notify Your Clinical Teams!

Please make sure to forward this announcement to your home care administrators, patient care directors and staff trainers/educators and ask them to attend one of these important sessions!

If you have any questions, please do not hesitate to write us back or visit our website where you can find tools, resources and other critical information.

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Volume 3, No. 3 January 12, 2018

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

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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

Important Upcoming Deadlines

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Requirement/Change

Effective/ Due Date

More Information

New York State Paid Family Leave program starts

January 1, 2018

https://www.ny.gov/newͲyorkͲstateͲpaidͲfamilyͲleave/paidͲfamilyͲleaveͲ informationͲemployers

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

January 1, 2018

https://www.emedny.org/info/ProviderEnrollment/ManagedCareNetwork/i ndex.aspx

Managed Care Annual Program Integrity Report

January 1 to January 31, 2018

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

Medicare Advantage Disenrollment Period during which individual can switch from Medicare Advantage managed care plan to feeͲforͲservice Medicare

January 1 to February 14

www.medicare.gov

Revised Medicare Home Health Conditions of Participation in Effect

January 13, 2018

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

2017 Adult Care Facility 4th Quarter Statistical Information Report

January 31, 2018

https://commerce.health.state.ny.us

Medicare Bundled Payments for Care Improvement Advanced model

Applications due March 12, 2018

https://innovation.cms.gov/initiatives/bpciͲadvanced

HCA State Advocacy Day

February 6, 2018

https://hcaͲnys.org/wpͲcontent/uploads/2017/12/2018ͲHCAͲAdvocacyͲ EventsͲRegistrationͲForm.pdf

Health Care Facility Transformation Program

Applications due March 14, 2018

https://grantsgateway.ny.gov/intelligrants_NYSGG/module/nysgg/goportal. aspx?NavItem1=4&ngoID=5000979

Criminal history record check requirements apply to hospice

April 1, 2018

https://www.health.ny.gov/facilities/home_care/advanced_home_health_ai des/docs/ahha_legislation.pdf

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

April 1, 2018

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

Implementation of Universal Billing Codes for Home and CommunityͲBased 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

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Volume 3, No. 3 January 12, 2018 

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, timesaving 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.

More Info On Facility Transformation Grant RFA Announced Earlier This Week As reported in a breaking development for last week’s newsletter, the state has announced the availability of funds under a second round of the Statewide Health Care Facility Transformation Program (SHCFTP II). HCA has since obtained additional information for the membership.

This program provides grants in support of capital projects, debt retirement, working capital or other noncapital projects directly related to a capital project that facilitate health care transformation activities, including acquisition or other activities intended to create financially sustainable systems of care or preserve or expand essential health care services. Grants will not be made to support general day-to-day operating costs unrelated to the start-up expenses of the Eligible Project.

The grant announcement is at https://grantsgateway.ny.gov/intelligrants_NYSGG/module/nysgg/ goportal.aspx?NavItem1=4&ngoID=5000979.

A total of up to $203,782,888 is available. Due to advocacy by HCA and other community health providers, a minimum of $75 million was required to be awarded to community-based providers – defined as home care providers, diagnostic and treatment centers, mental health and alcohol and substance abuse treatment clinics, and primary care providers.

However, $28,004,493 from the Statewide II appropriation was already awarded to community-based health care providers for Statewide I. As a result, the RFA indicates that a minimum of $46,995,507 ($75 million minus $28 million) must be awarded to community-based health care providers for Statewide II. Priority Projects Priority is given to projects not funded in response to the first round of SHCFTP funding. The RFA, however, indicates that such priority applies only after the application of the geographic statewide distribution.

In addition, priority may be given to projects involving community- and facility-based post-acute care and longterm care support services that: reduce unnecessary emergency department visits or inpatient readmissions through the innovative use of technology or workforce utilization; establish collaborations across health care provider types; provide services to patients/residents in a more home-like setting; or result in long-term financial sustainability of an essential community provider.

Continued on next page

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Volume 3, No. 3 January 12, 2018 

Continued from previous page Eligible applicants must demonstrate how the grant would strengthen and protect continued access to health care services in communities. Eligible Applicants should describe: 

Steps to be taken to promote an integrated, patient-centered model of health care delivery or to create a financially sustainable system of care or to preserve or expand the ongoing availability of essential health care services to the people of the community or communities served by the Eligible Applicant.

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How the Eligible Project will maintain or improve the financial condition of the Eligible Applicant.

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An estimate of the total costs of carrying out health care transformation activities (other than the Eligible Project) and the sources of funding for such costs.

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Steps to be taken to engage the community in the development of the Eligible Project.

Project services should be consistent with Delivery System Reform Incentive Payment (DSRIP) Program principles of improving core population health, patient outcomes and patient experience, as well as incorporate, as part of a sustainable business model, a transition to a payment system which emphasizes cost efficiency and quality outcomes (value) over service volume.

An informational Applicant Webinar will be held on Wednesday, January 31, 2018, from 10:30 a.m. to noon. To register for the meeting, go to: https://meetny.webex.com/meetny j.php?RGID=r113594c23bbb4b2083d35f918506b9a7.

Questions on the RFA (No. 17648) are due by February 9, 2018, and can be e-mailed to Statewide2@health.ny.gov.

Applications must be submitted in Grants Gateway by 4 p.m. on Wednesday, March 14, 2018. At the time the application is submitted, applicants must be prequalified, if not exempt, in the New York State Grants Gateway HCA had worked with a coalition of community health providers to ensure that the first round of SHCFTP funding ($195 million) included at least $30 million targeted to home care and other community-based providers.

HCA will continue to advocate for capital and non-capital funding for home care providers as part of our state advocacy efforts.

DOH CON Workgroup Weighs Draft Recommendations The state Department of Health (DOH) regulatory modernization workgroup met to discuss draft recommendations prepared by the Department on areas of certificate of need (CON) policy and potential reform. HCA and several HCA members serve on this workgroup.

The draft recommendations extend to home care, hospice, nursing homes, and other long-term care services.

The draft document can be viewed at https://hca-nys.org/wp-content/uploads/2018/01/Draft-LTC-NeedMethodologies-Recommendations.pdf.

At this January 8 meeting, DOH invited substantial workgroup discussion on each recommendation, with HCA and HCA members principally contributing to the response. Based on the dialogue, DOH will be revising the recommendations, and potentially omitting at least one altogether.

Continued on next page

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Volume 3, No. 3 January 12, 2018 

Continued from previous page Many of the comments revolved around areas of the language that are either unclear, not well-defined or otherwise problematic – for example, those that propose new potential “quality” or “age-friendly” standards.

Ostensibly, many of the revisions will be to address such areas of the language. Also, the draft recommendation to “explore the development of a CON process for LHCSAs” drew concerns from many of the workgroup members and seems likely that it will be withdrawn, or significantly modified.

The majority of the workgroup’s discussion was devoted to CHHAs. One aspect not addressed in the draft recommendations, but discussed at length during the meeting, was whether the state should continue to maintain CON for CHHAs, and, if so, on what basis, and with what reforms.

HCA and other representatives asserted that categorical elimination of CON for CHHA services, particularly in the current highly changing and unstable environment, risks complete instability in the system. HCA redirected the discussion, stressing the need for reinforcement and support of existing CHHA capacity to meet the significant mission and systemic role expected of the agencies. HCA stressed that the state’s discussion of “need” should be focused not so much on agency “numbers,” but on whether the agencies we have are truly being supported in their capacities needed to meet community and health system need. Adequate workforce, critical infrastructure (like technology), finance, workable regulations, and channels of collaboration with key partners (i.e., hospitals, physicians, health plans, etc.) were cited as among the core supports necessary to this goal. These comments appeared to resonate strongly with workgroup members.

Workgroup members have an additional short window of time to send further input. This presumably included additional items that were not reflected on the DOH draft list.

HCA invites our full membership to review the draft document linked above and share comments and recommendations with us. Comments can be directed to HCA’s Executive Vice President Al Cardillo at acardillo@hcanys.org.

State Home Care Executives Hold Special Big-Picture Meeting with NGS Associations will now be meeting quarterly with NGS to discuss big-picture issues and create solutions This week, HCA and eight other state home care association executives participated in a first-of-its-kind meeting with Michael Davis, Manager of National Government Services (NGS), the Medicare Administrative Contractor (MAC) in Jurisdiction 6 (J6) and Jurisdiction K (JK).

The meeting was held at NGS headquarters in Indianapolis, Indiana and included State Home Care Executives from New York, New Jersey, Connecticut, New Hampshire, Vermont, Michigan, Arizona, Washington and California. HCA was represented by Patrick Conole, Vice President, Finance and Management.

HCA already participates in three meetings a year as part of NGS’s Provider Outreach and Education (POE) Home Health and Hospice Advisory Group, where the primary objective is to get general Medicare updates and assist NGS in the creation, implementation, and review of provider education strategies and efforts. The primary goal of this new meeting structure is to discuss and collaborate with NGS on big-picture Medicare home health and hospice issues so that we can work together to try and create solutions and, when necessary, get assistance or involve the U.S. Centers for Medicare and Medicaid Services (CMS).

Continued on next page

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Continued from previous page The following is a summary of some of the significant issues discussed during the meeting.

Ongoing Problems with the Face-to-Face (F2F) Requirement NGS staff provided a medical review update where it was noted that the top home health denial reason was for a missing, incomplete or untimely physician certification as it pertains to the F2F encounter requirement.

During the meeting, HCA and other state executives explained to NGS that the original intent of the F2F requirement in the Affordable Care Act (ACA) was to make sure a Medicare home health beneficiary actually saw a certifying physician – not for the physician to have detailed clinical notes outlining how the beneficiary meets the home health criteria, like home care providers already do.

Executives throughout the room provided numerous examples of how problematic this requirement has been, how subjective NGS’s Medical Review representatives are, and the significant administrative burden this places on agencies.

Mr. Davis said NGS will be establishing a workgroup that will consist of two to three NGS Medical Review representatives along with a subgroup of our state home care executive members and some actual providers within J6 and JK to produce a check-off document that providers can use to make sure the documentation requirements are adequate with the goal of reducing the number of F2F and other denials in both jurisdictions. Mr. Davis said NGS will also share with CMS the group’s concerns about the physician documentation requirements as part of the F2F requirement to see if any relief is possible in the future.

Targeted Probe and Educate (TPE) Mr. Davis provided an update on the new Targeted Probe and Educate (HHTPE) program which is being implemented for all Part A and B Medicare providers, including home health and hospice. It focuses on specific agencies and their utilization that have been identified, through detailed data analysis, as being a potential risk to the Medicare trust fund. Included in this data analysis, NGS will review an agency’s prior billing practices, CMS’s PEPPER reports, along with agencies whose claims denials vary significantly from their peers. Essentially, what NGS is looking for are agency “outliers” compared to other agencies in the same state or across J6 or JK. Also during the meeting, HCA learned that NGS has already begun a home health pre-claim review audit as part of this HHTPE initiative, in cases where any home health agency submits a claim that includes 10 or more therapy visits. This was not announced by NGS on its website, and state executives strongly encouraged NGS to announce this via an alert more formally, which Mr. Davis agreed to do.

Finally, HCA requested that NGS provide more state-by-state data analysis with regards to its HHTPE program so that state association executives can analyze how their states are impacted compared to the others.

NGS Education within State Association Meetings While NGS conducts numerous webinars and conference calls throughout the year for home health and hospice providers, it also wants to increase its presence at various education events conducted by the State

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Home Care Associations throughout J6 and JK. Mr. Davis said NGS is willing to provide updates and have discussions at State Home Care & Hospice Annual Meetings and other important venues as well.

Prior to the meeting, HCA requested that NGS provide an update at HCA’s upcoming Senior Financial Managers meeting on March 22 in Troy, NY (agenda and brochure to be issued soon) and Mr. Davis confirmed that NGS will attend our meeting and provide important updates on issues such as HHTPE, F2F, Home Health Prospective Payment System data analysis and more.

MAC/RAC/CERT/ZPIC Overlapping Audits During the meeting, multiple Executives expressed their frustration to Mr. Davis about the increasing number of audits that long-standing historically compliant providers are experiencing. The audits are not only being conducted by NGS in J6 and JK, but also by Recovery Audit Contractors (RACs), Comprehensive Error Rate Testing (CERT) contractors and Zone Program Integrity Contractors (ZPICs). The reasons for many of these audits often overlap and seem redundant and unnecessary.

Mr. Davis stated that, unfortunately, each of the various audit contractors have different missions and goals and that audits overlapping can easily happen. However, Mr. Davis did state that if NGS providers in J6 and JK are experiencing an audit from either a RAC or ZPIC (not CERT) which overlaps (is looking at the same things) with an audit target being conducted by the MAC, then NGS should be notified and it will be willing to share NGS’s results with the other audit contractor to see if that can expedite that contractor’s review.

As previously mentioned, NGS plans to conduct quarterly meetings with this J6 and JK State Association group and HCA will update the membership after each of these meetings.

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

FI Authorization Application Update HCA has obtained a list of the entities that submitted Fiscal Intermediary (FI) Authorization applications. The list was also sent to managed care plans.

The list includes all FI applications received so far, including previously operating and new FIs. HCA has already contacted most of our members who are on that list; however, if you were not contacted by us, send an e-mail to Andrew Koski at akoski@hcanys.org.

As DOH received over 500 applications, we are not sure when it will complete reviewing the applications.

DOH has instructed managed care plans to reach out to the FIs in their networks who are not on the list to confirm that they have submitted an Authorization application. If these FIs did not submit the application, it is our understanding that DOH is still accepting applications.

Should DOH decide not to authorize an existing FI, it will notify the FI, as well as affected plans and consumers. In such situations, plans have been instructed to follow provider termination protocols that

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Volume 3, No. 3 January 12, 2018 

require a 90-day continuity of care with the provider from the date of notice to the enrollee of the provider’s disaffiliation with the plan.

As communicated numerous times over the past few months, last year’s final state budget included a requirement that FIs operating under the Consumer Directed Personal Assistance Program (CDPAP) had to undergo an Authorization process. Existing FIs were required to submit an FI Authorization application to the state Department of Health by mid-December.

CMS Unveils New Bundled Payment Model The U.S. Centers for Medicare and Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (Innovation Center) has announced a new voluntary bundled payment model called Bundled Payments for Care Improvement Advanced (BPCI Advanced).

This announcement follows CMS’s recent cancelling of the previous mandatory Episode Payment Model and the Cardiac Rehabilitation Payment Model, and its reduction in the number of mandatory geographic areas for the Comprehensive Care for Joint Replacement model.

Under the BPCI Advanced payment model, participants can earn additional payment if all expenditures for a beneficiary’s episode of care fall below a spending target which factors in quality. Participants bear financial risk, have payments tied to quality performance, and are required to use Certified Electronic Health Record Technology.

Participants may receive payments for performance on 32 different clinical episodes, such as major joint replacement of the lower extremity (inpatient) and percutaneous coronary intervention (inpatient or outpatient).

Participants will start on October 1, 2018, and the Model Period Performance will run through December 31, 2023. CMS will provide a second application opportunity in January 2020.

The following link provides more information about the model and its requirements, along with a Request for Applications document (RFA), the application template, and the necessary attachments: https:// innovation.cms.gov/initiatives/bpci-advanced.

Applications must be submitted via the Application Portal (https://app1.innovation.cms.gov/bpciadvancedapp) which will close at 11:59 p.m. on March 12, 2018. Applications will not be accepted by e-mail.

A Q&A Open Forum will be held on Tuesday, January 30, 2018 from noon to 1 p.m. Registration is here: https:// preaward.adobeconnect.com/e3cdwg6hgx9f/event/registration.html.

HCA will be reviewing this new model to determine the role of home health agencies and opportunities for participation.

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Volume 3, No. 3 January 12, 2018 

CMS Outlines Low-Volume Appeals Settlement Option, Distinct from TPL Appeals Expressions of interest must be submitted soon This week, the U.S. Centers for Medicare and Medicaid Services (CMS) held a webinar on its “Low Volume Appeals Settlement Option.”

The materials are at https://www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/2018-01-09Appeals-Settlement-Presentation.pdf.

This new appeals option is completely separate and distinct from the Third-Party Liability (TPL) Settlement between the state Office of the Medicaid Inspector General (OMIG) and CMS. (The most recent update on this Settlement is in the November 6, 2017 Situation Report at https://hca-nys.org/wp-content/uploads/2017/11/ SitReport110617.pdf.

The Low Volume Appeals (LVA) Settlement option is limited to home care and other providers with a low volume of appeals pending at the Medicare Hearings and Appeals (OMHA) and the Medicare Appeals Council. Providers with fewer than 500 Medicare Part A or Part B claim appeals pending at OMHA and the Council, combined, as of November 3, 2017, with a total billed amount of $9,000 or less per appeal could potentially be eligible, if certain other conditions are met. Claims that are part of an extrapolation appeal (similar to TPL) are not eligible for this option.

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

The National Association for Home Care and Hospice (NAHC) estimates that there are about 25,000 to 30,000 home health claims pending at the OMHA level.

Agencies that want to utilize this process must submit an Expression of Interest (http://go.cms.gov/LVA) to CMSMedicareAppealsSettlement@cms.hhs.gov during the allotted submission timeframes below:  

For agencies with National Provider Identifiers (NPIs) ending in an even number (0,2,4,6,8), Expressions of Interest (EOIs) will be accepted between February 5, 2018 and March 9, 2018.

For agencies with NPIs ending in an odd number (1,3,5,7,9), EOIs will be accepted between March 12, 2018 and April 11, 2018.

EOIs submitted outside the above defined timeframes will be rejected and agencies will be told to resubmit them during the allotted time periods. There are tight timeframes for CMS and the agency to meet which are explained in the webinar materials.

In cases where providers are not eligible for the LVA option, the Office of Medicare Hearings and Appeals (OHMA) has been expanding the Settlement Conference Facilitation Process. Information on the Settlement Conference Facilitation Process is available at the following location: https://www.hhs.gov/about/agencies/ omha/about/special-initiatives/settlement-conference-facilitation/index.html.

More information, including Frequently Asked Questions and forms, is at https://www.cms.gov/Medicare/Appealsand-Grievances/OrgMedFFSAppeals/Appeals-Settlement-Initiatives/Low-Volume-Appeals-Initiative.html.

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

Volume 3, No. 3 January 12, 2018 

Coalition Surge Test Update Drills to begin next week for CNY, 1/22 in Capital Region and in February for other regions At webinars this week, the state Department of Health (DOH) provided additional information on upcoming Coalition Surge Test and Interoperable Communication (CST/IOC) drills that will be occurring sometime early this year for providers outside of New York City.

The materials from the January 8 and 10 webinars (held for Capital District and Central New York providers) are at https://hca-nys.org/wp-content/uploads/2018/01/CSTIOC-Drill_January-2018.pdf. DOH has also scheduled the following webinars for providers in Western New York and Metropolitan Area Regional Office/MARO regions (not including New York City):  

February 1, 1 to 2 p.m.: https://meetny.webex.com/meetny/ j.php?MTID=me79c7b7503914f2ad3bdad66d29eb404 February 2, 10 to 11 a.m.: https://meetny.webex.com/meetny/ j.php?MTID=ma0073b30cd3d893e80a5b6e00a30aa74

The materials for these February webinars should be very similar to the ones referenced above for January 8 and 10; thus providers in Western New York and the MARO regions excluding New York City may want to review them too.

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

Other hospitals, home care and hospice providers, and nursing homes will participate in the exercise and be asked if they can accept some of those patients. During the drill simulation, home care agencies may be asked to provide home care services to hospital patients who are discharged and/or send home care patients to a hospital if they cannot provide services to such patients at home.

There will be a total of six CST/IOC drills held statewide. One will occur for each of the following areas: Capital District, Central New York, Lower Hudson Valley, Long Island, Finger Lakes and Buffalo.

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 (AAR) following the CST, whereby the agency analyzes its responses to the exercise and outlines its strengths, weaknesses, and areas for improvements and recommends changes which are then incorporated into its emergency preparedness training, policies and programs. DOH has provided an AAR template which is available in MS Word format at: https://hca-nys.org/wp-content/uploads/2018/01/AARIP_Template-modified-9-29-17.docx.

Members are advised to review the accuracy of their staff in the Health Commerce System (HCS) before the drill to ensure that their agency receives information about the survey.

DOH has provided us with the following two-week range of the dates that the Coalition Surge Test will be held in each region of the state.

Region Capital District Central New York

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Dates January 22 to February 2 January 17 to January 31

The Situation Report: the Home Care Association of New York State MARO – Long Island Western Region MARO – Lower Hudson Valley

Volume 3, No. 3 January 12, 2018 

February 5 to February 16 February 12 to February 23 February 19 to March 2

The goals of the CST/IOC drills are to test: functional surge capacity and identify gaps in surge planning by providers; the ability of providers to perform the tasks with existing on-site staff without excessive guidance; and whether the evacuating facility knows who to contact in an evacuation scenario, and its ability to reach partners on a moment’s notice.

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 (LHCSAs) may have to participate in such an exercise under their contract with CHHAs or managed care plans.

HCA has confirmed with DOH that CHHAs and LHCSAs who serve New York City and also Nassau and/or Suffolk and/or Westchester can participate in this drill and meet the requirement for a full-scale community based exercise.

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

FIDA Members Excluded From Health Homes According to January 1 guidance from the state Department of Health (DOH), Medicaid Members enrolled in a Fully Integrated Duals Advantage (FIDA) plan are excluded from enrollment in the Health Home Program, effective January 1, 2018. Outreach for Medicaid members enrolled in a FIDA Plan must also be discontinued.

The guidance is at https://hca-nys.org/wp-content/uploads/2018/01/Updated-Guidance-for-FIDA-andHH_1.1.18-Start-Date.pdf.

This action is being taken because DOH has determined that the care management provided by FIDA Plans and the Health Home program are both comprehensive and comparable.

Medicaid members will continue to have a choice between enrolling in FIDA or enrolling in a Health Home.

Those currently enrolled in both programs will be contacted by a third party vendor who will explain each program and ask the member to either select the FIDA plan or the Health Home Program. If a member chooses to remain in the FIDA plan, the Health Home will be notified by the DOH Health Home Team to disenroll the member.

Members who are currently enrolled in both a Health Home and a FIDA plan must make a choice or be disenrolled from the Health Home Program effective March 31, 2018. The Health Home Team will provide a list of these members on Monday, March 19, 2018 to the Lead Health Home. Health Homes must send a Notice of Determination by Wednesday, March 21, 2018.

Questions about this new policy can be directed to the Health Home Program at (518) 473-5569 or by sending a question through the online form at https://apps.health.ny.gov/pubdoh/health_care/medicaid/program/ medicaid_health_homes/emailHealthHome.action (select “Health Home Policy” as the subject).

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Volume 3, No. 3 January 12, 2018 

Help Drive the Agenda: Nominations Accepted for HCA’s Board of Directors HCA is now accepting nominations from members to be considered for a spot on our Board of Directors, which is HCA’s main governing body.

See https://www.surveymonkey.com/r/BoardNomination2018 for an online application, along with further background and instructions, including criteria. The application is due by February 9, 2018.

Candidate applications will be reviewed by the HCA Nominating and Governance Committee. Those candidates selected for consideration will be contacted and vetted for approval by the HCA Board of Directors, and slated for vote at the HCA Membership Annual Meeting in May 2018.

The principal task of HCA’s 25-member Board is to promote and implement a vision and strategic policy direction for the home care industry and the Association. The Board is comprised of LHCSA, CHHA, Hospice, MLTC and LTHHCP representatives. Board meetings are held five times per year; however, the Chairperson may convene the Board throughout the year by conference call. Appointments are for a two-year term.

Please read the online form before completing any nominations for further details on Board duties, committees, terms and criteria for candidates. If you have any questions, feel free to contact HCA’s Jenny Kerbein at jkerbein@hcanys.org.

Upcoming HCA Webinars: Sexual Harassment Prevention, Spiritual Care and Practical Education for Aides In the coming weeks, HCA is holding several webinars that offer convenient, cost-effective education and training for you and your staff on: sexual harassment prevention procedures; the basics of spiritual care (offering contact hours for attendees); and a full series of practice-area training webinars for home health and hospice aides.

See the summaries below and visit our website for registration forms at https://hca-nys.org/events-education/ upcoming-events. Please also share these programs with your relevant staff or management teams to encourage participation.

Please also note that there is no limit on the number of people who can participate in any of these sessions through a single phone line and computer display, offering great cost-savings for agencies with multiple staff who could benefit.

Webinar: Sexual Harassment Prevention in the Workplace January 30, 2018 10-11 a.m.

The law regarding sexual harassment in the workplace has not substantially changed in more than 30 years.

Nonetheless, claims of sexual harassment in the workplace are grabbing headlines like never before. Now is an important time for employers to: review, redistribute and educate staff on their sexual harassment and other EEO policies. In this webinar, attorneys Vincent Polsinelli and Kristi Rich Winters of Jackson Lewis will discuss

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steps employers should take to ensure they have practices in place to prevent harassment in the workplace, and to address it meaningfully and effectively.

Webinar on Ethical, Existential and/or Spiritual Care for Persons of All Faiths and Ideologies: What All Disciplines Can Do Gain Contact Hours!

February 28, 2018 11:30 a.m. to 1 p.m.

When we provide competent spiritual care, outcomes are improved for patients, families, professionals, and agencies. Research indicates patients want to talk with their clinicians about spiritual concerns, but providers’ discomfort with the topic, lack of training, and a fear of breaching boundaries serve as significant barriers to these conversations.

This presentation will discuss: the literature behind why ethical, existential and/or spiritual care is important; methods of screening for and responding to spiritual distress; resources to help make it all easier; and clear boundaries to protect everyone involved in the process. Presenter Rev. Dr. Carla Cheatham is the Principal and Lead Trainer for Carla Cheatham Consulting Group, LLC and serves as a national keynote speaker and educator.

Webinars for Home Health and Hospice Aides HCA is sponsoring a series of webinars to provide training for home health and hospice aides. These programs are being offered on various dates through June 2018.

Here are the next installments in the series: 

February 8, 2018: The Aide’s Role in Dealing with Combative Dementia Patients (registration deadline is February 1)



March 8, 2018: The Aide’s Role in Confidentiality and HIPAA (registration deadline is March 1)



April 12, 2018: The Aide’s Role in Assisting a Patient with Chronic Pain (registration deadline is April 5)

Webinars to Provide Information on SHIN-NY Connection Requirements Article 36 CHHAs and LTHHCPs among regulated entities, with certain exceptions As part of the SHIN-NY Regulation, some Article 36 CHHAs and LTHHCPs are required to be connected and contributing data to the SHIN-NY by March 9, 2018. The New York eHealth Collaborative has announced two consecutive and identical webinar opportunities, on January 29 and 30, to learn “What Regulated Facilities Need to Know” about SHIN-NY and funding opportunities for connecting.

Providers who are not already working with a Qualified Entity to connect to the SHIN-NY should register for the webinar to learn if your organization is required to connect and how to get started. The webinar times and registration links are below: 

Monday, January 29 (3:30-4:30 p.m.): https://attendee.gotowebinar.com/register/2418544438565739265 Continued on next page

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Continued from previous page 

Tuesday, January 30 (8:30 to 9:30 a.m.): https://attendee.gotowebinar.com/register/ 6111957927893225217

Home care providers should note that the regulation requiring SHIN-NY connection only impacts providers using an electronic health records product certified by the Office of the National Coordinator for Health Information Technology (ONC), and many home care providers do not use these platforms. Nevertheless, Article 36 entities are subject to the regulation in the event that they are currently using these products or when they use one at a later time. Also, if a provider utilizing an ONC-Certified product feels it is unable to meet the deadline in March, it can submit a request for a waiver.

These and other components will be covered in the webinars.

OMIG Posts Regulations Under Consideration The state Office of the Medicaid Inspector General (OMIG) has posted regulations under consideration for proposed rulemaking in 2018.

The list is at https://docs.dos.ny.gov/info/register/2018/jan3/pdf/regulatoryagenda.pdf (page 93).

The regulations include: unacceptable practices; authority to sanction and immediate sanctions; mandatory exclusions; audit and record retention; overpayment liability, recovery and recoupment; withholding of payments; and more.

DOH Holds Webinar on Conflict of Interest and NHTD/TBI Programs Providers must complete compliance implementation forms by March 1 This week, the state Department of Health (DOH) held a webinar on the Conflict of Interest (COI) standards that will affect services delivered in the Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) waiver programs.

Webinar materials are at https://hca-nys.org/wp-content/uploads/2018/01/COI-Compliance-ImplemenationPlan-Power-Point.pdf.

Federal regulations, known as the home and community-based services (HCBS) settings rule, require that person-centered service plan development cannot be performed by the individual’s provider of direct services unless there is no other willing and qualified entity available to that individual. Case managers, however, are able to develop service plans, as case management is not considered to be a direct service in conflict with person-centered planning.

Conflict occurs not just if the entity is a provider, but if the entity has an interest in a provider or if it is employed by a provider.

In some cases, a “rural” exemption or “cultural” exemption may apply in areas with limited providers, and an exemption may be granted from certain COI requirements.

Continued on next page

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Continued from previous page The U.S. Centers for Medicare and Medicaid Services (CMS) has defined COI as: 

When the same entity helps an individual gain access to services and provides services to that individual;



When the same entity is responsible for assuring and honoring free choice of providers and is a service provider;



When the same entity is responsible for overseeing quality and outcomes on behalf of the individual and is a service provider; and



When the case management agency for an individual has a fiduciary relationship with a provider of services to that individual.

New York is required to: 

Assure that entities separate case management and service provision (different staff perform these services).



Provide full disclosure to participants and assurances that participants are supported in exercising their right of free choice in providers.



Describe the individual dispute resolution process.



Provide direct oversight and periodic evaluation of safeguards.



Demonstrate to CMS that the only willing and qualified case manager for the individual is also, or affiliated with, a direct service provider.

To ensure compliance with COI, temporary measures must be taken that include firewalls to avoid conflicts. In addition, DOH has developed the COI Compliance Implementation Plan form. The form is at https://hca-nys.org/wp-content/uploads/2018/01/Conflict-of-Interest-Compliance-ImplementationPlan.docx.

Entities providing services under NHTD and/or TBI must complete one Compliance Implementation Plan form for each region that it provides NHTD and one form for each region that it provides TBI services.

The forms must be submitted to the appropriate Regional Resource Development Center (RRDC) by March 1, 2018 and the RRDCs must submit the forms to DOH by April 1, 2018. Those who don’t submit their forms by March 1 will be put on “vendor hold” by DOH. The RRDCs are expected to send providers the COI Compliance Implementation Plan form in an MS Word document and providers must use that format.

Some of the information requested on the form includes: (i) approved regions, locator codes and services approved in those regions; (ii) any other corporate entities within the corporate structure and

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copy of agency’s organizational chart; (iii) geographic breakdown of all waiver services provided and number of individuals served in each county; (iv) complete listing of all service coordinator assignments; (v) whether any service coordinators are physically co-located with any other service staff; (vi) criteria used to accept a case; (vii) copies of relevant personnel and procedural guidelines developed or implemented to avoid COI; and more.

Providers completing the form also have to attest to a number of provisions that include: 

Service Coordinators and Service Coordinator Supervisors may not complete functional assessments for individuals on their caseloads;



Service Coordinators and Service Coordinator Supervisors may not provide other waiver services to people on their caseloads;



The RRDC, as designees of DOH, shall have full access to all provider and participant records regarding the provision of HCBS Waiver services.



Effective January 1, 2019, Service Coordination providers will implement full compliance with the HCBS CIO regulations.

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

CMS Issues Guidance on Texting Patient Information The U.S. Centers for Medicare and Medicaid Services (CMS) has issued guidance to State Survey Agency Directors on texting patient information.

The Survey letter is at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/ SurveyCertificationGenInfo/Downloads/QSO-18-10-ALL.pdf.

According to the guidance, texting of orders by physicians or other health care providers is prohibited.

However, texting of other patient information is permissible if accomplished through a secure platform.

In order to be compliant with the Conditions of Participation (CoPs), all providers must utilize and maintain systems/platforms that are secure, encrypted, and minimize the risks to patient privacy and confidentiality as per HIPAA regulations … It is expected that providers will implement procedures/processes that routinely assess the security and integrity of the texting systems/ platforms that are being utilized, in order to avoid negative outcomes that could compromise the care of patients.

Questions about this survey letter can be sent to Marie.Vasbinder1@cms.hhs.gov.

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VBP-MLTC FAQs Posted The state Department of Health (DOH) has posted Frequently Asked Questions (FAQs) related to value based payments (VBP) and managed long term care (MLTC) plans.

The FAQs are at https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/vbp_library/201712_vbp_for_pcp_faqs.htm.

All partially-capitated MLTC plans were required to enter into VBP arrangements with their home care and nursing home contracted providers by December 31, 2017. These VBP contracts were mandated to utilize the potentially avoidable hospitalization (PAH) measures at a minimum in determining any incentive payments. PAH measures include: anemia; congestive heart failure; electrolyte imbalance; respiratory infection; sepsis; and urinary tract infection.

The FAQs cover many issues, including: the attribution process; applicability to fully integrated MLTC plans; inapplicability to consumer directed services; contract requirements; performance targets; timeframes for data reporting; and more.

Additional VBP resources are available at https://www.health.ny.gov/health_care/medicaid/redesign/ dsrip/vbp_library/index.htm.

Senate Passes RAISE Family Caregivers Act This week, the U.S. Senate passed the RAISE (Recognize, Assist, Include Support and Engage) Family Caregivers Act. It earlier passed the U.S. House of Representatives and is expected to be signed into law by the President.

According to the National Association for Home Care and Hospice (NAHC), the RAISE Family Caregivers Act will: 

Implement the federal Commission on Long-Term Care’s bipartisan recommendation that Congress require the development of a national strategy to support family caregivers.



Create an advisory body of relevant federal agencies and others from the private and public sectors to advise and make recommendations.



Identify specific actions that government, communities, providers, employers, and others can take to recognize and support family caregivers and be updated annually.

More information is at https://www.congress.gov/bill/115th-congress/senate-bill/1028/text.

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CMS to Host Home Health & Hospice Open Door Forum on January 17 The U.S. Centers for Medicare and Medicaid Services (CMS) will be hosting a Home Health and Hospice Open Door Forum on Wednesday, January 17 from 2-3 p.m.

During the call, CMS will provide updates on the following:     

New Home Health Conditions of Participation Medicare Care Choices Model Home Health Star Ratings Home Health and Hospice CAHPS Survey Hospice EDI Notice of Election

The following is the call-in number and passcode for HCA members interested in participating:  

Call-In # 1-800-837-1935 Passcode: 31077154

NGS Requests Provider Feedback of its Website Please Complete the ForeSee Survey when Prompted In 2018, New York’s Medicare Administrative Contractor, National Government Services (NGS) seeks to increase its focus on improving NGS’s website (www.ngsmedicare.com) and self-service portal.

NGS asks providers to complete its ForeSee survey whenever it pops up on the NGS website. Most questions contain a rating scale of 0 to 10, with 10 being the highest. When scoring NGS below 8, providers are asked to list specific comments or recommendations for NGS improvements.

Website users who need assistance navigating NGS’s website or portal experience can also leave their email address and/or phone number when completing the ForeSee survey for follow-up by NGS.

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