BREAKING: TRANSFORMATION GRANT RFA Today, DOH announced second-round application for health transformation grants totaling $203.78M. PAGE 7
COMING UP The 2018 Home Health CoP Interpretive Guidelines: 2-Part Webinar Series Jan. 9 & 10, 2018 Stop Sepsis at Home Training Sessions Jan. 11, 2018 (Hudson Valley) Jan. 24, 2018 (Capital Region) Northeast Home Health Leadership Summit Jan. 16-18, 2018 Boston HCA’s offices will be closed on Monday, Jan. 15, for the Dr. Martin Luther King, Jr. Holiday. We will publish the next edition of The Situation Report on Friday, Jan. 12.
SCHEDULING RULE
SEPSIS SESSIONS
HHCAHPS REPORTS
Senate hearing coincides with the deadline for comments on the state Department of Labor’s proposed rule requiring extra compensation in certain scheduling circumstances. HCA weighs in.
Attention Hudson Valley Providers: Our next sepsis training session is coming to your region on Jan. 11, with other regions to follow.
Home care providers are encouraged to review their latest HHCAHPS survey reports prior to public reporting on Home Health Compare.
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Your Source for HOME CARE News, Policy and Advocacy
Vol. 3, Issue 2 | January 8, 2018
Governor’s State of the State Address Outlines 2018 Priorities, Proposals HCA Members: Complete HCA’s Financial Condition Survey, Register for HCA’s State Advocacy Program Today! Governor Cuomo delivered his State of the State address on Wednesday of last week, formally kicking off a time of intense legislative and administrative policy activity, with a particular focus on the state budget, which is required to be passed by April 1. See ADDRESS p. 3
HCA Meets with DOH on Status of Wage Funding Urges process improvements and needed funding for plans and providers Last week, the state Department of Health (DOH) convened a call-in meeting with HCA and other association representatives to discuss the status of minimum wage See WAGE p. 2
HCA Submits Papers to Support DOL’s Emergency Rule and “13-Hour Standard” Now Facing Appeal Board Challenge HCA and the New York State Association of Health Care Providers (HCP) have jointly submitted papers in response to a challenge of the state Department of Labor’s (DOL) emergency rule for “24-hour/live-in” cases. See PAPERS p. 5
INSIDE Governor’s State of the State Address Outlines 2018 Priorities...................1 HCA Meets with DOH on Minimum Wage Funding.......................................1 HCA Submits Papers to Support “13-Hour Standard” Rule...........................1 2018 Medicaid Levels Announced.............................................................2 2017-18 Emergency HEAP Benefits Available.............................................4 CoP Changes Still Coming 1/13...................................................................6 Late Breaking: 2nd Round of Transformation Grants Announced................7 HCA Submits Comments, Senate Testimony on Proposed Scheduling Rule...8
Home Care Sepsis Training This Week in Hudson Valley.....................................9 Coalition Surge Test Webinars Start Next Week.............................................10 HHCAHPS Preview Reports with Star Ratings Available..................................11 Appeals Process to Change for Medicaid Managed Care Enrollees..................12 Electronic Hospice NOE Begins; NGS Reports on Error in Companion Guide.....12 OSHA Penalties Increase in 2018.................................................................13 Important Upcoming Deadlines..............................................................15 CMS Clarifies MAC Responsibilities Related to Revalidation..........................15 Resources...............................................................................................16
The Situation Report: the Home Care Association of New York State WAGE from p. 1 funding to managed long term care (MLTC) plans and home care providers. DOH indicated that it had been contacting plans to confirm the status of contract amendments for this next phase of the minimum wage increase, effective December 31, 2017, and asked the associations to share any particular feedback received from plans or providers on contract status. During the call, we reiterated that this state process must be improved for plans and providers, and that funding to MLTC plans and providers must be sufficient to meet the minimum wage cost. The simultaneous amendments required by the state – not only minimum wage but also value based payments and others all hitting the January 1, 2018 contract period – have compounded what was already a difficult process for both plans and providers in relation to this round of the minimum wage funding adjustment. We jointly appealed to DOH to work with all parties going forward and assure timely premium and rate adjustments to meet the new minimum wage and other costs as they are newly incurred. HCA pointed out that the statute requires that the state provide actuarially sound payments to cover all state and federal laws, regulations and requirements. HCA will continue close contact with DOH, our plans and providers on the conclusion to this year’s process, and will continue to advocate strenuously for due support to plans and providers on minimum wage and other necessary costs in our forthcoming meetings with the Administration and Legislature.
2018 Medicaid Levels Announced The Medicaid levels for 2018 have been announced. They are at https://www.health.ny.gov/health_care/medicaid/ publications/pub2017gis.htm (see GIS 17 MA/020) and http:// www.wnylc.com/health/afile/15/314/ (NYC Human Resources Chart). The Medicaid levels for individuals is $842 (up from $825) and couples is $1,233 (up from $1,209). The resource levels for individuals is $15,150 (up from $14,850) and couples is $22,200 (up from $21,750). 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 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
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ADDRESS from p. 1 The Governor’s office has been previewing many of his policy proposals over the past several weeks, all of which were detailed in his address. These include a range, from very specific regional proposals to broader ones addressing: sexual harassment; economic development and environmental initiatives; criminal justice, student loan and tax reforms; fighting homelessness and the opioid crisis; and more. Wednesday’s speech did not include any significant or specific focus on health care issues. However, as indicated by recent press articles, the threat of federal cuts could put an enormous strain on the state Medicaid budget, prompting discussions about cuts or other adverse actions in the imminent budget deliberations, which formally kick-off with the Governor’s scheduled January 16 release of his Executive Budget proposal. The Governor, in his live address, referred to the “federal assault” on New York State in the form of federal tax policies and health care cuts, pledging a series of proposals to challenge the federal actions and restructure the state’s tax system to mitigate the federal impact. Depending on the Governor’s spending proposal this year, the state faces a budget deficit as high as $4 billion to $4.5 billion, or higher, for fiscal year 2019 according to various estimates. Deficits this size, coupled with the uncertainty about federal revenue, create an enormously high-risk budget environment, especially for health care, where many of the federal changes are occurring in the form of threatened Medicaid cuts and certain cost-sharing reduction payments that have or could potentially gut the state’s revenue picture. These big financial issues aside, the printed version of the Governor’s address (https://
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www.governor.ny.gov/sites/governor.ny.gov/files/ atoms/files/2018-stateofthestatebook.pdf) included some more details on health care, including specific proposals to address the opioid crisis by restricting prescription refill periods, eliminating barriers to addiction treatment, and taking enforcement actions against opioid distributors for breach of legal duties to monitor, detect and report suspicious prescription orders. Other areas include insurance “price transparency,” uniform standards for hospital financial assistance, simplifications of medical billing and an external appeal database for consumers. These items, in particular, will require further elaboration and vetting to understand their potential impact or applicability to MLTC plans. For home care, MLTC and hospice members, HCA has identified the following additional items that could create opportunities, risks, or signal policy directions that will require HCA’s direct attention and/or participation in the coming months:
Implement recommendations of the “First 1,000 Days On Medicaid” working group. In addition to pediatric and group-based models of prenatal care, the Governor’s proposal references a plan to “enhance home visiting services,” though particulars are not mentioned.
Expand telehealth services “by proposing legislation for Medicaid coverage of telehealth services in a wider range of settings, including from an individual’s home and launching a new pilot program to address resource constraints of rural health care providers enabling them to make the necessary investments in telemedicine equipment and IT support.” Health infrastructure technology has long bypassed the home care sector – where it is needed and where home telehealth has long been an area of innovation. HCA will work to ensure that these telehealth
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policies remain adequately directed within the home care space, responding to and enhancing the work within home care.
Strengthen Emergency Medical Services (EMS) “by proposing legislation authorizing community paramedicine collaboratives and programs to expand the scope of services carried out by EMTs to include community settings beyond initial emergency care and transportation.” As extensively reported, HCA drafted and worked with association partners on a community paramedicine bill that duly involves and respects all key sector roles and jurisdictions, distinct from prior versions which had open-ended scope-of-practice provisions and other issues. HCA will use this proposal as a basis for further discussion with the Governor’s office in this area.
Launch a Long Term Care Planning Council “to understand the projected needs of older adults and examine New York’s long-term care system.”
Issue an Age Friendly Executive Order that “directs state agencies to consider the impact of their policies and procurements on health and health aging.”
Expand Advanced Care Planning by initiating a statewide Advanced Care Planning (ACP) campaign to encourage New Yorkers of all ages to complete ACP documents and re-design the DOH website to include additional functionality and resources.
Expecting a high-stakes budget season, HCA is preparing an advocacy agenda that not only attempts to anticipate fiscal threats or concerns but also seeks to address long-standing needs for provider and plan payment adequacy, especially in light of recent litigation and policies affecting minimum wage and wage obligations for certain scheduling or staff assignment situations, as well as protections of Article 36licensed home care services agencies, regulatory relief, and more. To support our advocacy, please be sure to complete HCA’s financial survey of the home care industry which is our main vehicle for substantiating the pressures you face in this current environment and to ward off the threat of future cuts. HCA has extended the survey deadline. It is now due by Friday, January 12, and all home care providers must complete it here: https://www.surveymonkey.com/r/ 201718FinCondSurvey. Please also be sure to register for our February 5 and 6 State Advocacy program in Albany. A registration form and agenda are provided at the back of this week’s newsletter.
2017-18 Emergency HEAP Benefits Available Emergency Home Energy Assistance Program (HEAP) benefits for the 2017-18 season are now available to help eligible individuals heat their home if they are in a heat or heat-related emergency. The benefits and eligibility are based on income, resources and the type of emergency. Benefits range from $140 to $525. Those with an emergency must contact their local district HEAP contacts at https://otda.ny.gov/ programs/heap/contacts/ for assistance.
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PAPERS from p. 1 The challenge, by the Urban Justice Center, takes aim at DOL’s emergency rule, which was issued in October and reinforces the “13-hour standard” for compensation in such cases. (According to today’s edition of Crain’s Health Pulse, DOL renewed the emergency rule on Friday). The Urban Justice Center’s challenge was made to the New York State Industrial Board of Appeals (IBA), an independent review board made up of five attorneys appointed by the Governor. IBA has the authority to review and modify or revoke all DOL rules, regulations, and orders. Although it frequently upholds DOL regulations, IBA earlier this year overturned a different DOL regulation, so the outcome of the Urban Justice Center’s challenge is not predictable. An IBA hearing on the matter was held on Friday, January 5. According to news reports, a decision is expected later in the month after IBA probes the legal issues and merits of the petition and papers submitted by the industry, DOL and other parties. In our written action, HCA and HCP requested “leave from the Board to be heard or intervene” in the challenge to DOL’s October regulation. We note that our collective members “who employ thousands of workers, and who are responsible for servicing thousands of 24-hour cases, depend on the Emergency Wage Order to continue providing 24-hour care to patients. This application to intervene is being submitted in order to preserve home care agencies’ ability to continue to provide 24-hour care.” DOL also submitted a lengthy written response to the Board on this challenge stating that petitioners “are not entitled” to relief from the Board, and essentially backing up their procedural decisions in issuing the emergency rule. DOL’s papers state: For almost 50 years the Commissioner has taken the position that hours worked by employees assigned to shifts of 24
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hours or more may exclude meal and sleep time, and that position has been reflected in public and private rules, rates, policies and practices, and in the terms and conditions that home health aides worked under.
HCA, if given the opportunity to do so, will be submitting an amicus brief to the IBA at a later date. As extensively reported to HCA members, DOL’s emergency rule was finalized in October 2017 amid a series of court cases taking aim at DOL’s “13-hour standard.” Plaintiffs in those cases have argued that the standard was at odds with underlying statutes. Under this standard, set forth in a 2010 DOL opinion letter, an aide may be paid for 13 hours of a 24-hour shift, provided the aide is afforded 8 hours of sleep time, 5 of which are uninterrupted, and 3 hours for meals. HCA and colleague associations worked vigorously to compel DOL’s issuance of the October emergency rule and a corresponding impact statement which stated strongly that the purpose of the emergency regulation is to “preserve the status quo” (i.e., the “13-hour standard”), prevent the collapse of the home care industry, and avoid unnecessarily unavoidable institutionalization of patients in the face of the recent court decisions. This issue has been among the top items of concern addressed by HCA in recent meetings with the Governor’s office and the Legislature, among other interrelated funding issues for wages and labor costs, including the increasing state minimum wage and a newly proposed set of compensation requirements for certain scheduling circumstances. On the scheduling proposal, specifically, HCA provided testimony before a New York State
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Senate legislative hearing on this matter last week. (See separate story on page 8.) Related to the “13-hour standard” and litigation, HCA has joined amicus briefs for two of the three court cases on this matter, in addition to: our advocacy for relief from the Executive and Legislature; our successful call for an emergency regulation definitively reinforcing the 13-hour standard that providers have been following in good faith; and, now, our action before the IBA. We will report back to the membership on all substantive developments with the IBA. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
Even Without Final Interpretive Guidelines, CoP Changes Still Coming 1/13 The National Association for Home Care and Hospice (NAHC) has obtained an important update from the U.S. Centers for Medicare and Medicaid Services (CMS) regarding the new federal Conditions of Participation (CoPs) soon set to go into effect. In a message to members last week, NAHC President Bill Dombi noted that many NAHC member questions on the CoPs have dealt with the fact that CMS has yet to finalize its Interpretive Guidelines for the CoP changes, even though the new CoPs themselves go into effect on January 13, in just a few days. The Interpretive Guidelines are important because they instruct surveyors on how to enforce the CoP changes. NAHC has learned that despite the absence of final Interpretive Guidelines, the effective date of the new CoPs will remain January 13, 2018. Mr. Dombi also cited a message from a CMS official indicating and reiterating that:
Surveyors will use the draft Interpretive Guidelines until the final version is issued;
The final version is expected to be much in line with the draft;
The actual CoP regulation, not the guidelines, control survey determinations; and
Both the regulations and the guidelines offer flexibility on compliance, with CMS removing “guidance that may have been overly prescriptive.”
“NAHC recommends that HHAs undertake a good faith effort to achieve compliance with the regulations by January 13,” Mr. Dombi says. “Survey management should focus on the regulations over any guidance issued in draft by CMS. If an HHA is cited for a deficiency, but believes that its conduct complied with the applicable regulation, NAHC advises that the HHA bring the CMS Regional Office into the matter.” On a separate but related matter, HCA has raised with the state Department of Health (DOH) the issue of the CoP cost impact on Medicaid home care and MLTC operations. HCA is arguing that these new costs must be reflected in positive rate and premium adjustments for providers and MLTCs.
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Late Breaking: 2nd Round of Health Care Facility Transformation Grants Announced Due to HCA advocacy, a minimum of $46.9M slated for community care provider applicants Today, just before this week’s edition of The Situation Report was slated to go to press, the state Department of Health (DOH) and the Dormitory Authority of the State of New York (DASNY) announced the availability of funds under the second round of the Statewide Health Care Facility Transformation Program (SHCFTP II). This program provides grants in support of capital projects, debt retirement, working capital or other noncapital projects directly related to a capital project that facilitates health care transformation activities including, but not limited to, merger, consolidation, 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 through this Request for Applications (RFA #17648) to health care providers that are deemed by the DOH Commissioner to fulfill or will fulfill a health care need for acute inpatient, outpatient, primary, home care or residential health care services in a community. Due to advocacy by HCA and other community health providers, a minimum of $46,995,507 of this total amount is available for community-based health care providers, which are defined as home care providers, diagnostic and treatment centers, mental health and alcohol and substance abuse treatment clinics, and primary care providers. To receive funding, the eligible applicant must demonstrate how the proposed use of the grant will strengthen and protect continued access to health care services in communities. Eligible Applicants should describe:
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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.
How the Eligible Project will maintain or improve the financial condition of the Eligible Applicant.
An estimate of the total costs of carrying out health care transformation activities (other than the Eligible Project as hereafter defined) and the sources of funding for such costs.
Steps to be taken to engage the community in the development of the Eligible Project.
Health care services developed as a result of the Eligible Project 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 regarding the Statewide Health Care Facility Transformation Program II
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(RFA #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 5 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 Submits Comments and Senate Testimony on Proposed Scheduling Rule HCA last week submitted comments to the state Department of Labor (DOL) and testimony for a state Senate Hearing on DOL’s proposed scheduling/call-in pay rule, which would have major implications for health care providers, especially home care. Our comments are at https://hca-nys.org/wp-content/uploads/2018/01/Comments_state-DOL-proposedscheduling-rule_FINAL_010418_.pdf. Our testimony is at https://hca-nys.org/wp-content/uploads/2018/01/ Senate-Hearing_state-DOL-proposed-scheduling-rule_010418_FINAL-3.pdf. As described in numerous communications, the rule would impose the following requirements on employers (with certain exceptions):
An employee must be paid an additional two hours of call-in pay if reporting for a shift that was not scheduled 14 days in advance.
An employee whose shift is canceled within 72 hours of the scheduled start time must be paid at least four hours of call-in pay.
An employee who is required to be available to report to work (“on-call”) must be paid at least four hours of call-in pay or pay for the number of hours in a regularly-scheduled shift (if the regularly scheduled shift is less than four hours).
An employee who is required to be “available to report to work for any shift” must receive at least four hours of call-in pay.
An employee who is required to contact the employer and confirm whether to report to work within 72 hours of the shift start time must be paid at least four hours of call-in pay.
The proposed rule is at https://docs.dos.ny.gov/info/register/2017/nov22/pdf/rulemaking.pdf (pages 8 to 11). In our comments and testimony, HCA strongly urges DOL to withdraw the proposed rule or, in the least, carve-out and exempt home care and hospice services from the rule. We support this position by making the following points:
The proposed rule places significant impediments to the manner in which home care and hospice services are structured and delivered, including the variable employer scheduling practices that are fundamental to meeting unpredictable and dynamic needs of patients and families.
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The rule’s “unscheduled shift” and “cancelled shift” provisions are incompatible with how care at home is delivered, where hours are started, increased, decreased, eliminated or otherwise adapted
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due to reasons unique to home care and hospice agencies and their patients, and typically beyond the control of the employer.
The rule’s limited exceptions don’t help home care/hospice.
The proposed rule would be contrary to and undermine the state’s recent reform efforts, including the Delivery System Reform Incentive Payment (DSRIP) program and Value Based Payments, which rely on a flexible, seamless and expeditious direction of resources and case assignment.
Contrary to the state DOL’s claim that the rule does not impose any mandatory costs, the rule would impose enormous costs on home care, hospice and managed care plans from the imposed rigidities on services and from the payment “penalties” that would be constantly and unfairly triggered from the natural patterns that require home care and hospice to revolve around the patient and the patient’s variable and changing needs.
This Senate Hearing was led by the Standing Committee on Commerce, Economic Development, and Small Business, chaired by Senator Phil Boyle, and the Senate Administrative Regulations Review Commission, chaired by Senator Chris Jacobs. HCA has already reached out to and met with the Governor’s staff, as well as Senate and Assembly officials, about the detrimental effects to patient care and agency operations if the rule is finalized. We will continue to advocate this position in all of our state advocacy efforts. Our comments and testimony were based on feedback from numerous members and we thank all who communicated their concerns.
Home Care Sepsis Training This Week in Hudson Valley, 1/24 in Capital Region and Other Sessions Offer Tool to Combat Crisis, Help Patients Please notify your home care clinical teams, administrators and patient care directors who should all register to attend upcoming sessions! HCA is offering the next installment of our Stop Sepsis at Home effort this week, providing specialized, expert training for home care providers to use HCA’s first-of-its-kind, clinician-developed, community-based sepsis screening tool. Our next session, on January 11, is for Hudson Valley home care providers (CHHAs, LHCSAs, LTHHCPs), who should register as soon as possible to attend in Brewster, NY (hosted by the Visiting Nurse Services in Westchester). Advance registration is required. Continued on next page
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Continued from previous page Other future sessions in different locations are listed in the flyer at http://stopsepsisathomeny.org/wpcontent/uploads/2017/12/Regional-Sepsis-Training-and-Cross-Sector-Session-Brochure.pdf. The flyer also outlines the program agenda and expert faculty. No matter which region you serve, please register using the online form (https://www.surveymonkey.com/r/ SepsisRegionalTrainings) to pick the location closest to you. 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.
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.
Coalition Surge Test Webinars Start This Week Webinars to prepare providers for upcoming voluntary drills that will meet CoP requirement HCA reminds members who serve counties outside of New York City that the state Department of Health (DOH) will be holding webinars starting this week to prepare providers for Coalition Surge Test (CST) and Interoperable Communications (IOC) drills that will be occurring throughout the beginning of this year. 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 as part of the emergency preparedness Conditions of Participation (CoPs). Some Licensed Home Care Services Agencies may also have to participate in such an exercise under their contract with CHHAs or managed care plans. The first of these webinars was held earlier today, with another on Wednesday for providers in the Capital District and Central New York areas. The January 10 webinar is from 10 to 11 a.m. No registration is required. Continued on next page
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Continued from previous page Participants can join the webinar at https://meetny.webex.com/meetny/ j.php?MTID=m107c702b688e2771daeca9cb205f5746. The dates for providers in the Western New York and Metropolitan Area Regional Office/MARO regions (not including New York City) are below (no registration is required):
February 1, from 1 to 2 p.m. Join the webinar at https://meetny.webex.com/meetny/ j.php?MTID=me79c7b7503914f2ad3bdad66d29eb404.
February 2, from 10 to 11 a.m. Join the webinar at https://meetny.webex.com/meetny/ j.php?MTID=ma0073b30cd3d893e80a5b6e00a30aa74.
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. 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) after the CST. DOH has provided an AAR template which is available in MS Word format at: https://hca-nys.org/wp-content/uploads/2018/01/AAR-IP_Template-modified-9-29-17.docx. HCA has confirmed with DOH that CHHAs who serve New York City and also Nassau and/or Suffolk and/or Westchester can participate in this drill and meet their requirement for a full-scale community based exercise. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
HHCAHPS Preview Reports with Star Ratings Available Preview reports are now available reflecting results from the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) Survey from July 2016 through June 2017 (third quarter of 2016 to second quarter of 2017). These same data will be updated on Home Health Compare (www.medicare.gov) in January 2018. The reports can be obtained at https://homehealthcahps.org under the “For HHAs” tab. Home health agencies (HHAs) must be logged into the website to view their report. The reports show the publicly reported results with star ratings for those agencies with a sufficient number of completed interviews to receive star ratings. Agencies must have data for 40 or more patient surveys in the reporting period to have star ratings. Comments about your HHCAHPS star ratings on the Preview Report should be e-mailed to hhcahps@rti.org by January 12, 2018. Please include your name, your facility name, your CCN, and your contact information with your comments. Providers who believe their HHCAHPS star ratings are not correct should submit evidence showing why. However, if you have historically had higher ratings than are shown, CMS indicates that “this is
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not considered evidence. You must provide information showing that the data submitted by your vendor for the most recent quarter are incorrect and therefore may have impacted the assigned HHCAHPS star ratings for your agency.” For more information about the Preview Reports, please refer to this document on the HHCAHPS website, accessible once you are logged in: https://homehealthcahps.org/ LinkClick.aspx?fileticket=rEmqINcxYK8%3d&tabid=277. For more information about HHCAHPS star ratings, including Frequently Asked Questions, please visit: https:// homehealthcahps.org/GeneralInformation/StarRatingsInformation.aspx. Questions can be conveyed to hhcahps@rti.org or (866) 354-0985.
Appeals Process to Change for Medicaid Managed Care Enrollees New Model Forms Available Starting March 1, 2018, Medicaid managed care plan enrollees will have to first request an internal appeal with their plan and the plan must deny that appeal before the enrollee can request a Fair Hearing. This change is due to revisions in federal Medicaid regulations. Prior to this change, consumers were able to request a Fair Hearing before requesting an internal appeal. There is a narrow exception to this new requirement which allows a member to request a Fair Hearing directly without receiving the plan’s appeal decision, under a “deemed exhaustion” provision. The regulations state that where the managed care plan “fails to adhere to the notice and timing requirements,” the enrollee is “deemed to have exhausted” the plan’s appeals process. “The enrollee may initiate a state Fair Hearing.” If a Mainstream Medicaid Managed Care or Managed Long Term Care plan sends notice that it intends to reduce hours of home care services, or reduce or stop any other service, the member will now have to request an internal plan appeal within the 10-day window needed to secure “aid continuing,” or continuation of services at the original current amount, without the proposed reduction going into effect. More information, along with state Department of Health model notices, is in an article written by the New York Legal Assistance Group at http://www.wnylc.com/health/news/80/#deemed exhaustion.
Electronic Hospice NOE Begins; NGS Reports on Error in Companion Guide NGS offices closed on Monday for Martin Luther King, Jr. Holiday Beginning this month, hospices are supposed to be able to submit Notices of Election (NOE) and related transactions electronically. However, New York’s Medicare Administrative Contractor, National Government Services (NGS), reports that the companion guide, issued by the U.S. Centers for Medicare and Medicaid Services (CMS) in September, was missing information that will affect transactions. According to NGS and other sources, the guide – for software vendors developing systems for NOE – failed to specify that a description of the required default procedure code (Q5009) must be included in the service
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Volume 3, No. 2 January 8, 2018
line. As a result, electronic NOE submissions that do not contain a description for the Q5009 procedure code are being rejected in Electronic Data Interchange (EDI) front-end editing. Hospice providers that use the Ability PC-ACE free billing software can use the software to create the NOE transactions for submission to the NGS EDI Gateway, as the software vendor has addressed this issue to ensure the transactions will pass the EDI front-end edit. CMS has recommended that any provider should ensure that this change has been made to ensure they can successfully submit EDI NOEs. The revised Companion Guide is available here: https://www.cms.gov/ Medicare/Medicare-Fee-for-Service-Payment/Hospice/Downloads/Companion-Guide-Electronic-NoticesElection.pdf. NGS Offices Closed for Martin Luther King, Jr. Day 2018 In observance of Martin Luther King, Jr. Day, NGS’s offices will be closed Monday, January 15. Electronic claim files transmitted after 5 p.m. on Friday, January 12, 2018 will have a claim receipt date of Tuesday, January 16, 2018. EDI front-end acknowledgement transactions will be created as expected as EDI claim files are received. The FISS/DDE Provider online System will be available during regular hours. While DDE will be available, there will be no support available to respond to any issues. Providers will be able to access NGSConnex and use the Interactive Voice Response (IVR) system at 1-866275-3033.
OSHA Penalties Increase in 2018 Starting January 1, 2018, the Occupational Safety and Health Administration (OSHA) is increasing civil penalties (adjusted for inflation) for violations of standards and regulations. In a Federal Register notice (https://www.gpo.gov/fdsys/pkg/FR-2018-01-02/pdf/201728224.pdf?utm_campaign=subscription%20mailing%20list&utm_source=federalregister.gov&utm_medium=email) issued on January 2, the U.S. Department of Labor increased civil penalties for a variety of regulated areas, including, Wage and Hour, and OSHA. OSHA penalties increased for other-than-serious, serious, and failure-to-abate violations, from $12,615 per violation to $12,934 per violation. The penalty for willful and repeat violations increased from $126,749 to $129,336, an increase of $2,587. The 2018 maximum penalties are as follows:
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Other-than-Serious: $12,934 Serious: $12,934 Repeat : $129,336 Willful: $129,336
The Situation Report: the Home Care Association of New York State
Volume 3, No. 2 January 8, 2018
Important Upcoming Deadlines Requirement/Change
Effective/ Due Date
More Information
2018 State Worker Wage Parity Levels
December 31, 2017
https://www.health.ny.gov/health_care/medicaid/redesign/mrt_61.htm
2018 State Minimum Wage Levels
December 31, 2017
https://www.labor.ny.gov/workerprotection/laborstandards/workprot/minwage.shtm
State Compliance Program Certification Form Submission
December 31, 2017
https://omig.ny.gov/sslͲcertification
Federal Deficit Reduction Act Compliance Certification Form Submission
December 31, 2017
https://omig.ny.gov/draͲcertification
New York State Paid Family Leave program starts
January 1, 2018
https://www.ny.gov/newͲyorkͲstateͲpaidͲfamilyͲleave/paidͲfamilyͲleaveͲinformationͲemployers
Home Care and other providers who contract with Managed Care Organizations must be enrolled in Medicaid
January 1, 2018
https://www.emedny.org/info/ProviderEnrollment/ManagedCareNetwork/index.aspx
Managed Care Annual Program Integrity Report
January 1 to January 31, 2018
https://omig.ny.gov/information/mcoͲreports
Revised Medicare Home Health Conditions of Participation in Effect
January 13, 2018
https://www.gpo.gov/fdsys/pkg/FRͲ2017Ͳ01Ͳ13/pdf/2017Ͳ00283.pdf
2017 Adult Care Facility 4th Quarter Statistical Information Report
January 31, 2018
https://commerce.health.state.ny.us
HCA State Advocacy Day
February 6, 2018
https://hcaͲnys.org/wpͲcontent/uploads/2017/12/2018ͲHCAͲAdvocacyͲEventsͲRegistrationͲ Form.pdf
Criminal history record check requirements apply to hospice
April 1, 2018
https://www.health.ny.gov/facilities/home_care/advanced_home_health_aides/docs/ahha_legi slation.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 CommunityͲ Based Long Term Care Services under Managed Care
April 1, 2018
https://www.health.ny.gov/facilities/long_term_care/reimbursement/letters/dal_2017Ͳ12Ͳ 07_billing_codes.htm
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CMS Clarifies MAC Responsibilities Related to Revalidation On December 29, 2017, the U.S. Centers for Medicare and Medicaid Services (CMS) issued Change Request 10386/Transmittal 762, which clarifies the requirements for Medicare Administrative Contractors (MACs) to issue revalidation approval letters and release information to callers over-the-phone. The changes are effective January 29, 2018. The transmittal is at https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/ R762PI.pdf. The transmittal indicates that the following information can be made available over-the-phone to a caller who is able to provide a provider/supplier’s name, Provider Transaction Access Number (PTAN), Tax Identification Number or Social Security Number, and National Provider Identifier number: revalidation status (i.e., whether or not a provider/supplier has been revalidated); revalidation due date; revalidation approval date; the specific information related to a revalidation development request; and the date a provider/supplier was deactivated due to non-response to a revalidation or non-response to a development request. The caller does not need to be listed on the provider/supplier’s enrollment record as a contact person. In addition, if a provider or supplier is to experience a gap in billing due to failure to respond to a revalidation request or failure to respond to a development request during revalidation, the MAC shall include the following in the reactivation approval letter: While your PTAN(s) and effective date(s) remain the same, you will have a gap in billing privileges from [deactivation date] through [reactivation date] for failing [to timely submit your revalidation application or to respond to a development request related to a revalidation application]. You will not be reimbursed for services provided to Medicare beneficiaries during this time period since you were not in compliance with Medicare requirements.
Medicare-participating providers and suppliers are required to revalidate their enrollment with Medicare on a routine basis. The initial step in the revalidation process is usually receipt of a letter from the provider’s MAC. Additional information regarding the revalidation process is at https://www.cms.gov/Medicare/ProviderEnrollment-and-Certification/MedicareProviderSupEnroll/Revalidations.html.
Webinar to be Held on Conflict of Interest Standards for NHTD/TBI The state Department of Health (DOH) will hold a webinar on certain conflict of interest (COI) standards that will apply to the Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) waiver programs. The webinar will be held on January 9 from 10:30 a.m. to 12:30 p.m. Registration is at https://tinyurl.com/ yby7nwwt. Federal regulations, known as the home and community-based services (HCBS) settings rule, require that states separate case management from service delivery functions. Thus, entities providing case management
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or care coordination cannot also provide services to an individual. The webinar will address how this requirement will affect delivery of services under NHTD and TBI. More information on the HCBS settings rule is at https://www.health.ny.gov/health_care/medicaid/ redesign/home_community_based_settings.htm.
Resources
MAX Series: Improving Care for High Utilizers and Sustaining Change (January 2017 – July 2017) , by the state Department of Health https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/pps_workshops/docs/2017-janjul_imp_care_for_high_utilizers.pdf
“Medicaid Fraud Control Units: Investigation and Prosecution of Fraud and Beneficiary Abuse in Medicaid Personal Care Services,” by the Office of Inspector General https://oig.hhs.gov/oei/reports/oei-12-16-00500.pdf
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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State Advocacy Events FEBRUARY 5 & 6, 2018 ALBANY, NEW YORK
Albany Legislators Need to Hear from You! Join HCA for a day of focused Home Care Advocacy! See next page for details.
Monday, February 5, 2018
Tuesday, February 6, 2018
10AM – 4:30PM
8:00am – 4:00pm
HCA Policy and Board Meeting Renaissance Albany Hotel – DeWitt Ballroom 144 State Street Albany, New York 12205 10AM – 12Noon
HCA Policy Council Meeting (Council Members Only)
HCA State Lobby Day Room 711-A Legislative Office Building Albany, New York 8:00 AM – 12:00 NOON
State Leaders Address HCA Board and Members 12:00 NOON – 12:30 PM
12Noon – 4:30PM
HCA Board of Directors Meeting (Board Members Only)
Lunch 12:30 PM – 4:00 PM
Meeting will start with lunch at Noon. In addition to the regular business meeting, the Board will prepare for advocacy visits the next day.
HCA Member Agency Appointments
5:00 PM – 6:30 PM
HCA Provider/Associate Members
HCA PAC Reception HCA Office 388 Broadway, 4th Floor Albany, New York 12207
HCA will arrange specific appointments with key legislators for HCA Board Members and all other members are urged to make appointments on their own.
If you would like HCA to assist you in arranging legislative visits for this afternoon, please contact Jenny Kerbein at jkerbein@hcanys.org with your specific requests and availability.
(Open to ALL HCA Members) Entrance is on Hudson Avenue under the green awning. Elevator is located to the right of the stairs and will take you directly to the HCA lobby on the 4th floor.
REGISTRATION
Drinks and hors d’oeuvres will be served at the reception. A $50 minimum HCA PAC donation is requested for your participation.
Organization:_______________________________________________
*Corporate and LLC checks are acceptable under NYS Election Law. 501(c)(3) Organizations are prohibited from making political contributions. Contributions to the PAC are not tax deductible.
Participant(s) will attend:
Participant’s Name:_____________________________________________________
Email:______________________________________________________
______ *PAC Reception on February 5th @ $50 per person ______ State Lobby Day on February 6th (No Fee) HCA PAC RECEPTION DONATION INFORMATION *Please make personal check payable to: HCA PAC and mail to 388 Broadway, 4th Floor, Albany, NY 12207; or pay by personal credit card:
______ American Express
______ MasterCard
______ VISA
HOTEL INFORMATION
(3 digit code on reverse) __________ Exp. Date ____/____/____
Renaissance Hotel 144 State Street, Albany, NY 12205
Card Number______________________________________________
HCA has arranged for a room block at the Renaissance Albany Hotel located at 144 State Street, Albany, NY. HCA’s Group rate is $194/night and must be booked before January 5, 2018. To make your reservation, call (888)236-2427. Early reservations are encouraged as the hotel is likely to sell out the evening of February 5th.
Cardholder’s Name ________________________________________ Cardholder’s Address _______________________________________ __________________________________________________________ Signature __________________________________________________
FAX completed form to (518) 426-8788