January 14, 2019 Edition of The Situation Report

BECKY GRAY RETIRING

UPDATE: POC COMPLIANCE ISSUE

HCA BOARD APPLICATION

EMERGENCY PREPAREDNESS

HCA has gained an important update to last week’s alert on POC compliance and Advance Directives. NGS NOT denying claims.

HCA extends our appreciation and well wishes to Becky Fuller Gray on her upcoming retirement as longtime DOH home care division director.

HCA invites candidates to apply for seats on HCA’s Board of Directors.

The Department of Health is holding a series of surge test and health alerting system drills in the coming months that are critical opportunities to reinforce your work in emergency preparedness.

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Your Source for HOME CARE News, Policy and Advocacy

UPCOMING PROGRAMS 2019 Northeast Home Health Leadership Summit Jan. 22-24, 2019 (Boston) HCA PAC Reception and State Advocacy Program Feb. 11, 2019 (PAC Reception) Feb. 12, 2019 (Advocacy Day) Albany Upstate LHCSA Forum Feb. 19, 2019 (Utica) WCEI 5-Day Onsite Skin and Wound Management Course March 4-8, 2019 (Herkimer)

Vol. 4, Issue 2| January 14, 2019

Be a Force in Albany for HCA PAC, State Advocacy Day on Feb. 11-12 State budget proposal to be released tomorrow; stay tuned for details HCA’s 2019 State Legislative Advocacy Program is one month away. HCA’s member leaders are needed in Albany on February 11 and 12 to advocate for home care, hospice and Managed Long Term Care priorities.

Please register using the form here: https://hca-nys.org/wp-content/uploads/2019/01/2019HCA-Advocacy-Events-Registration-Form.pdf.

See ADVOCACY p. 2

HCA Submits Comments on DOL Proposed Scheduling Rule Last week, HCA submitted comments on the state Department of Labor’s (DOL) revised proposed employee scheduling (“call-in pay”) rule.

Our comments are at https://hca-nys.org/wp-content/uploads/2019/01/Comment-Letter-onDOL-Scheduling-Regs_FINAL_011019.pdf.

See SCHEDULING p. 4

Editor’s Note: HCA’s offices will be closed on Monday, January 21, in observance of Martin Luther King, Jr. Day and will reopen on January 22. Our next edition of The Situation Report will be on January 22.

INSIDE Be a Force in Albany for HCA PAC, State Advocacy Day..................................1 HCA Submits Comments on DOL Proposed Scheduling Rule.........................1 HCA Obtains Important NGS Clarification on POC Compliance Issue.............5 DOH Home Care Leader Rebecca Fuller Gray Retiring...................................6 House Passes Medicaid Extenders Bill........................................................7 Independence Care System MLTC Plan to Close on March 31......................8 Monthly Managed Care Meeting Yields Key Updates....................................9 Get Connected Care Insights from Christy Dempsey at NELS 2019.............11

RFA for RRDC Posted.................................................................................12 We Need You: For a Seat on HCA’s Board of Directors......................................13 Upcoming Deadlines and Due Dates................................................................14 2019 Medicaid Transfer Penalty Rates Announced.......................................15 UAS-NY Upgrade..........................................................................................15 Emergency Preparedness Update................................................................16 CMS Home Health Open Door Forum on January 16.........................................19 NGS Updates........................................................................................19 Health Resources.........................................................................................20

The Situation Report: the Home Care Association of New York State ADVOCACY from p. 1 The program includes an HCA Political Action Committee (PAC) reception on February 11 followed by our 2019 Lobby Day and legislative visits on February 12. (An agenda is in the registration form.)

HCA is now preparing advocacy materials. These materials focus on payment sustainability, personnel/workforce, and infrastructure/ program support in home care, hospice and Managed Long Term Care.

While these core priorities are well-established, HCA’s materials must also respond directly to the Governor’s budget proposal, expected for release tomorrow. Once we tailor these materials to the Governor’s budget, we will send them to the membership.

One document is our financial and program trends report, which will profile the existing pressures you are experiencing on the cusp of the Governor’s budget based on survey responses. Have you completed our survey yet? The survey is a necessary feeder for our report — and for our effective messaging to the Legislature. The survey is at https://www.surveymonkey.com/r/201819industrysurvey. Please complete it as soon as possible and no later than close of business today, January 14.

Preparing for Advocacy Day: ‘Housekeeping’ Items To prepare for your participation on February 11-12, please consider the following: 

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First, plan to be at our PAC reception on February 11 or make a PAC donation if you are unable to attend (see the registration form for details). HCA’s PAC is a vital means of building home care’s voice in Albany. Please support the HCA PAC! Second, please participate in our Lobby Day on February 12, which is essential for supporting HCA’s efforts from the grassroots level, so that we can support you with our government-relations and policy development work throughout the coming months.

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

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

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Continued from previous page 

Our February 12 Lobby Day event will be headquartered in 711-A of the Legislative Office Building (LOB) in Albany. The morning will include remarks from lawmakers and representatives of the Governor’s office and Department of Health. Most importantly, we ask that you devote the afternoon to appointments with your elected officials. Members should be prepared to schedule their own legislative visits (as described in the agenda on our registration form).

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HCA staff will be available throughout the day on February 12 in Room 711-A to: assist you; accompany you on visits (if necessary); and equip you with advocacy materials, which we will also be e-mailing in advance of the program.

Don’t wait for HCA’s Lobby Day materials.

Please think now about how you can draw upon your organization’s own experiences with: payment issues; service trends/referral patterns that have challenged your organization; your workforce needs and capacities to admit patients or facilitate services; and other facts that you want your legislator to know about. You can also start now on your outreach to your own state Senate and Assembly offices to be sure they know you and your organization will be seeking their support for home care, hospice and MLTC in the upcoming state budget negotiations.

The focus of your messaging should be about your patients and staff first (after all, they are the constituents!) as you explain the various factors in the budget, legislative and regulatory frameworks driving those patientcare impacts.

Please stay tuned for more details.

In the meantime, please register and make your legislative appointments today!

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HCA, the New York State Association of Health Care Providers (HCP) and the Hospice and Palliative Care Association of New York State (HPCANYS) jointly hosted a home and community care 101 program last week at the state Legislative Office Building.

The session provided background on home care, hospice and MLTC entities, their service functions, issue challenges, case profiles and ways that the associations and their provider members can be a resource for the Legislature on policymaking and constituent support.

Top Photo: Assemblymen Andrew Raia (second from left) and Alfred Taylor (far right) join association leaders, from far left: HCP President Kathy Febraio and, at middle, HCA President Al Cardillo and HPCANYS President Carla Braveman.

Bottom Photo: Representatives of the three associations present on core home care, hospice and MLTC issues.

HCA recommends that all members download our slide presentation and share it with your elected representatives for further background on the structure of home and community-based services. The presentation is available at https://hca-nys.org/publications/slide-presentationlegislative-forum-on-home-and-community-care-services.

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SCHEDULING from p. 1 As explained to members in numerous communications (see our December 10 Alert and December 17 edition of The Situation Report) and a members-only education program, the proposed rule would require that employees receive “extra pay” for work situations categorized as “reporting to work,” “unscheduled shifts,” “cancelled shifts,” “on-call,” and “call for schedule.”

Our comments underscore that the proposed rule is “in direct conflict to the manner in which home care, hospice and MLTC services need to be provided, and which would be severely impacted in terms of access, cost and worker opportunity if not modified.” We provide numerous instances (from members) of how the rule is not compatible with the practice of home care. We specifically seek unrestricted exemptions for home care on the basis of public health and safety as noted below.

DOL did revise its originally proposed rule, posted on November 17, 2017. (HCA commented on this version as well. See https://hca-nys.org/letters-and-comments/4547.) Though this revision created some exceptions, we state that these exemptions will not provide the intended relief for most home care and hospice providers, and the proposed rule continues to threaten these services.

The modified rule creates a two-tier threshold for exemptions to the increased pay mandates for the “unscheduled shift,” “cancelled shift,” “on-call” and “call-for schedule,” providing that these mandates would not apply to: 1. “Employees whose duties are necessary to protect the health or safety of the public”; and 2. Employees whose compensation exceeds the minimum wage.

We point out that these exemptions would fail to apply for the vast majority of home care services delivered in the state, including New York City (NYC), Long Island (LI) and Westchester. While all such employees would meet DOL’s first tier of the exemption criteria (public health and safety), most would not meet the second tier (pay above the minimum wage) as state policies and reimbursement are in fact at odds with providing MLTC/provider funding to compensate employees above the minimum wage amount.

We urge that the rule be modified so that organizations qualify for an exemption based solely on the merit of the first tier – i.e., that the employee’s services are necessary for public health and safety.

We argue that the proposed rule is “contrary to and undermines the state’s recent reform efforts, including the Delivery System Reform Incentive Payment (DSRIP) program and Value Based Payment Reform, which rely on a flexible, seamless and expeditious direction of resources and case assignment.”

We also rebut DOL’s claim that the proposed rule will not impose any additional costs.

HCA will keep members informed of any new developments on this crucial issue.

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

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HCA Obtains Important NGS Clarification on Intricate POC Compliance Issue NGS says it is not denying claims for lack of detail about particular Advanced Directives on the Home Health Plan of Care Last week, our colleagues at the National Association for Home Care and Hospice (NAHC) and HCA alerted the home care community about a plan-of-care (POC) requirement that is causing potential audit vulnerabilities due to significant reports of provider noncompliance involving Advance Directives.

Last year, the plan of care (POC) Condition of Participation (CoP) under 42 CFR 484.60 also became a Condition of Payment under the home health benefit (42 CFR 409.43). This means that all required elements must be in the POC, effective January 13, 2018.

It appears that one of the new POC requirements – inclusion of “information related to any advance directives” – has created problems for many Certified Home Health Agencies (CHHAs) who may not have modified their POCs sufficiently to include this new element over the past year.

The U.S. Centers for Medicare and Medicaid Services (CMS) says its Comprehensive Error Rate Testing (CERT) program has uncovered significant noncompliance with this new requirement. At the same time, Medicare Administrative Contractor (MAC) audits have approved claims where the POCs do not include full information on a patient’s advance directives, thus creating a faulty impression of compliance.

NAHC has recommended the following measures: 

Review January 13, 2018 and later POCs to determine if they are compliant. For example, a POC will not be compliant on the Advance Directives requirement if the only entry references whether or not the patient has a Do Not Resuscitate (DNR) order as there are more types of Advance Directives than just DNRs.

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If you find non-compliance, review the patient record to determine if the needed information is available. For example, the OASIS info should include Advance Directive details.

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For non-compliant claims, secure a signed POC addendum from the certifying physician that includes the required information for the POC.

NAHC has indicated that New York’s principal MAC, National Government Services (NGS), is accepting these corrections without a need to cancel the original claim and submit a rebilling, as there is no reimbursement effect. HCA has since obtained an updated response from NGS (below).

Updated Response from NGS Late Friday afternoon, NGS provided the following updated guidance: NGS is not denying claims for lack of detail about particular Advanced Directives on the Home Health Plan of Care. The Home Health Conditions of Participation 42 CFR 484.60 state the POC must include “Information related to any advanced directives.” If a

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Medicare beneficiary has advanced directives, a home health agency is advised to indicate this on the POC, which signifies that the specific directives from the beneficiary have been obtained and documented in your records. It is not necessary to duplicate those specifics on the POC. For agencies that have received a denial from another Medicare contractor (possible a CERT contractor), NGS reminds providers that they may exercise their appeals rights. Appeals information can be found at NGS’s website (www.ngsmedicare.com) under “Claims & Appeals,” then “Levels of Appeals and Time Limits for Filing,” then “Appeals – What Documents Are Needed?” This page also has information such as a timeline calculator, addresses, and the CMS-20027 Medicare Redetermination Request Form.

Most importantly, NGS states that if a POC is updated with an addendum to show advance directive information, it is not necessary to submit adjustments to processed claims.

Next Steps for CHHAs NAHC recommends that CHHAs assume the correction process outlined on page 5 to protect themselves from the risk of retroactive claim denials in audits based on insufficient advance directives information on the POC. However, NGS’s Michael Davis, Manager, Provider Outreach and Education, does not think that is necessary. Specifically, Mr. Davis stated, “The reason NGS responded so swiftly is to head off any unneeded actions and to share the NGS approach. Providers can make a business decision on which direction offers them the highest level of comfort, but NGS has shared how we will be approaching the POC in relationship to advance directives.”

HCA is closely monitoring and engaging with partners on this issue and will provide you with any further insights as more information arises.

DOH Home Care Leader Rebecca Fuller Gray Retiring Joining with all of New York’s home and community based care community, HCA thanks and applauds colleague and New York State leader, Rebecca Fuller Gray, upon this week’s announcement of her planned retirement in February.

Ms. Gray has decided to take leave of her longstanding post as the state Department of Health’s (DOH) Director of the Division of Home and Community Based Services in the next several weeks, and looks forward to the opportunity to devote more time with her family, including husband Barry, daughter, two sons and daughters-in-law and their children.

Ms. Gray has been the state’s home care and hospice expert. Her work to promote quality home care on behalf of the Department has been unparalleled. She has also been a beacon for nursing, and home care/ hospice nursing in particular, having worked as a home care nurse clinician before joining the Department and bringing these roots into all of her state work and direction. Her presence will be deeply missed inside all of state government as well as in the field, across the state.

In a message to HCA, Ms. Gray wrote: “I have thoroughly enjoyed working with each of you and will miss your presence in my daily life. You have made my life here in the Department a thoroughly enjoyable,

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rewarding, and challenging experience. You are all remarkable professionals and it has been a pleasure serving in this role with you.”

HCA highest award recipient Last May, Ms. Gray was awarded HCA’s highest honor, the “Ruth F. Wilson Award,” to a standing ovation by the HCA membership. The award recognizes someone whose work has had a dramatic effect on home care, strengthening the practice of the profession, raising the standards of quality and care for patients, and advancing the level of understanding and mutual cooperation among the home care community, legislators, federal and state agencies, health care providers and the public.

Rebecca Fuller Gray, second from right, receives HCA’s

HCA extends our very best wishes to Becky Ruth F. Wilson Award last year.

Gray as she begins this next, well-earned new phase. We extend our deepest appreciation to her for all that she has done for HCA and for the home care, hospice and nursing fields, especially the countless patients across this state who have benefited in untold ways.

House Passes Medicaid Extenders Bill The U.S. House of Representatives last week passed the Medicaid Extenders bill (H.R. 259) by voice vote. The bill now moves to the Senate for consideration.

The bill extends the Medicaid Money Follows the Person (MFP) program and Spousal Impoverishment protections through March 31, 2019.

As reported in the December 17 edition of The Situation Report, both provisions passed the House last year (H.R. 7217) but were never part of a package that passed both chambers.

MFP, first authorized in the Deficit Reduction Act of 2005 and officially launched in 2007, is designed to help with rebalancing care from institutional to non-institutional settings. Funds are eligible to be used on home modifications, equipment, and services, such as home care, to keep people in their homes.

The Medicaid Extenders bill continues the guarantee of spousal impoverishment protections for older adults and people with disabilities when one is receiving Medicaid coverage for home and communitybased services (HCBS). Set to expire this past December 31, these protections allow married couples to protect certain assets while seeking Medicaid coverage for HCBS.

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Independence Care System MLTC Plan to Close on March 31 Members will transition to VNSNY CHOICE As reported in an HCA member alert last week, the state Department of Health (DOH) has confirmed that Independence Care System’s (ICS’s) managed long term care (MLTC) plan will close on March 31, 2019.

ICS sent out a notification of its closure to contracted home care providers. The notification includes the following: 

ICS has developed a plan to transition its members (5,825 in December) to another MLTC – VNSNY CHOICE.

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ICS indicates that it has worked with DOH on a plan related to ICS provider liabilities and will be communicating about this plan with providers. HCA will be advocating in the budget process that the state make providers whole and have a permanent mechanism to protect providers, plans and enrollees in any future instabilities such as this. HCA will continue to underscore the overriding concerns that state payment methodologies for home care and MLTC are underpaying the system.

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ICS members were to have received an informal notice last week and will be officially notified

by February 1.

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Members who want to enroll in VNSNY CHOICE do not need to do anything — they can stay with ICS and will be automatically enrolled in VNSNY CHOICE as of April 1.

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Members who are enrolled with ICS and who transition to VNSNY CHOICE will be guaranteed a minimum of one year of the same level of care they have now. (Members can decide to select another plan, but if they do, they will only be guaranteed continuity of care for 120 days.)

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ICS will contract with VNSNY CHOICE to provide care management services for its qualifying members with physical disabilities. Qualified members enrolled in VNSNY CHOICE will be automatically assigned to ICS care management; there is no need for members to take any action to receive these services.

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DOH has designated ICS to begin a new care management organization — a Health Home — with a continued focus on serving people with physical disabilities.

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The ICS Health Home will launch on April 1, 2019. More information about the Health Home is at https://www.icsny.org/health-home-brochure/.

HCA will provide more details once they become available.

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Monthly Managed Care Meeting Yields Key Updates on Requirements, Implementation of Budget Measures The state Department of Health’s (DOH) monthly meeting with Managed Long Term Care (MLTC) plans and associations focused on the status of state requirements and implementation of state budget actions. The meeting’s main points follow.

LHCSA Contracts A DOH survey was due in December regarding the LHCSA network limitations statute. The survey asked MLTC plans to indicate: 

Current LHCSA contracts and terminated LHCSA contracts;

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Single case agreement for continuity-of-care purposes; and

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Exceptions from the LHCSA network requirements.

DOH says the survey is used to monitor compliance with the mandatory ratios set forth by law, and to track the allowable exceptions.

DOH also gave an update on LHCSA registrations. LHCSAs that have not registered with the Department through the statistical report are not permitted to operate or to receive payment for services as of January 2, 2019. DOH reported that 1,319 LHCSAs have registered with DOH and 169 LHCSAs are not registered as of January 11.

Community First Choice Option (CFCO) DOH held a December 20 webinar to give local districts and plans a status update on CFCO progress and next steps for 2019. The implementation date for CFCO will now be July 1, 2019 for the following services:       

Assistive Technology (AT) Environmental Modification (E-Mod) Vehicle Modification (V-Mod) Moving Assistance Community Transitional Services (CTS) Skill Acquisition Maintenance and Enhancement (SAME) Home-Delivered/Congregate Meals

CFCO documents are available on DOH’s CFCO website at: https://www.health.ny.gov/health_care/medicaid/redesign/community_first_choice_option.htm.

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Continued from previous page As previously reported, HCA has expressed concern in state meetings that, while DOH and the state Division of Budget draw attention to MLTC and community-based spending trends, DOH continues unabated to add more services, more requirements and more individuals — and this includes CFCO. HCA has urged DOH to at least consider streamlined and compatible approaches that will work with the current MLTC/provider system. As one possible option, DOH is considering an HCA proposal whereby plans could opt to deliver services under consolidated “CFCO providers.” Under this concept, providers would put the CFCO package together and act as a consolidated, contracted partner to MLTCs and Managed Care Organizations (MCOs) to provide them. This would be distinct from the current model which has sought to mandate that the MLTCs and MCOs directly locate, broker, negotiate and arrange for each discrete CFCO service, in addition to the MLTC/MCO standard benefit package. This alternative route would permit plans to tap existing resources, such as the Long Term Home Health Care Program, for facilitating this structure.

Integrated Duals Stakeholder Discussion On December 17, 2018, the Department held its first stakeholder session designed to discuss integrated care benefits for Medicare-Medicaid dual-eligible members. The Fully Integrated Duals Advantage (FIDA) program will end on December 31, 2019 and FIDA for the IDD (intellectual and developmental disabilities population) ends on December 31, 2020. Slides from the meeting can be accessed at: https:// www.health.ny.gov/health_care/medicaid/redesign/integrated_care/. Comments and questions should be directed to the: dualintegration@health.ny.gov. DOH is working on a date to reconvene the next meeting.

Minimum Wage DOH continues to review weekly surveys of MLTCs to ensure that provider contracts and Consumer Directed Personal Assistance Services (CDPAS) Fiscal Intermediary Administrative Agreements reflect wage adjustments for minimum wage. DOH asked that submissions and questions be directed to HCWorkerParity@health.ny.gov.

Value Based Payment (VBP) On December 21, 2018 the Department held a webinar providing guidance for Year 2 VBP implementation.

Due to Statewide Planning and Research Cooperative System (SPARCS) completeness issues for the fourth quarter of 2017, the baseline period has changed to January-June 2017 for the upcoming (2019) VBP year.

Plans should submit their Level 2 contracts, including Social Determinants of Health (SDH) and Community Based Organization (CBO) requirements, to MLTCContract@health.ny.gov. Requests for final results of MLTC VBP Category 1 measures at a provider level for July-December 2016 or January-June 2017 period should be sent to nysqarr@health.ny.gov, while other VBP questions can be directed to: VBP@health.ny.gov.

Plan Transactions DOH provided the following MLTC plan transition updates: 

GuildNet has terminated its participation in New York State’s Managed Long Term Care Programs (MLTC Partial, MAP, and FIDA), effective January 1, 2019.

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Continued from previous page 

UnitedHealthcare plan is withdrawing from 8 counties effective February 1, 2019.

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Independence Care System (ICS) will end its MLTC plan by March 31 and transition members to VNSNY Choice. (See related p. 8 story.)

Enrollment Update Below are the enrollment statistics by managed care category, as of the end of December, for the total population of 247,152 enrollees:     

MLTC partial capitation: 223,568 PACE: 5,796 Medicaid Advantage: 13,120 FIDA: 3,489 FIDA IDD: 1,179

The 247,152 total enrollment represents a 14.02 percent increase from the end of 2017.

Get Safety, Quality & Connected Care Insights from Press Ganey’s Chief Nursing Officer Christy Dempsey Northeast Home Health Leadership Summit begins next week! Register Today!

As Press Ganey’s Chief Nursing Officer Christy Dempsey reveals, “it takes just 56 seconds to make a connection with a patient” (watch the video here: https://youtu.be/_vauyLW8Kvs.) This kind of connection helps drive what’s called the “patient experience of care.” Your attention to the “patient experience of care” on a global level not only fulfills a core Triple Aim fundamental, but it also influences all aspects of your organization’s performance.

Indeed, the data shows a direct and profound correlation between “experience of care” rankings and your organization’s readmission rates, average length of stay, and core measure scores.

During her session at the upcoming Northeast Home Health Leadership Summit, Dempsey will help you make these trends work for your staff and patients. She’ll share illuminating research on the far-reaching impact of patient experience factors for your agency as well as some helpful tactics for successfully fostering a connected care mindset within the existing workflow of your organization.

The Northeast Home Health Leadership Summit is just over a week away in Boston. Please register today to take advantage of premier education, networking and ideas that support you as a home care leader. All the information you need is on the Summit website at http://nehomehealthsummit.com/.

A Note about Hotel Accommodations Please note that rooms at the Colonnade Hotel, site of the conference, are officially sold out. If you have not yet made a reservation, you will find some other hotels in the vicinity listed on our website here: http://nehomehealthsummit.com/hotel-information/.

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Reminder: Bonus Medical Directors Meeting Please also consider registering yourself and inviting your agency’s medical director to a special bonus program we are holding in conjunction with the conference: a Home Care & Hospice Special Medical Directors Meeting on January 23 from 8:30 to 10 a.m.

See the flyer on the Summit’s home page for more details and pre-register by e-mailing mburton@thinkhomecare.org.

We look forward to seeing you in Boston!

RFA for RRDC Posted The state Department of Health (DOH) has posted a Request for Applications (RFA) for a not-for-profit agency to operate as the Regional Resource Development Center (RRDC) to assist DOH with the administration of both the Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury waiver programs in New York City.

The RFA is at https://grantsgateway.ny.gov/intelligrants_NYSGG/module/nysgg/ goportal.aspx?NavItem1=4&ngoID=5001318.

According to the RFA, approximately $1.6 million will be available per year for the administration of NHTD and the TBI services in New York City. The funding will be approximately $766,000 for NHTD services per year and $830,200 for TBI services per year. The resulting contract will be awarded for a five-year period expected to begin May 1, 2019 and ending on April 30, 2024 dependent upon continued funding availability and satisfactory contractor performance. The total funds expected to be made available over the entire multi-year period (60 months) is approximately $7.981 million.

No letter of interest is requested to respond to this RFA nor will an Applicant Conference be held. Questions are due today, January 14, 2019; questions and answers will be posted January 17, 2019; and applications are due February 13, 2019.

The contractor must have three years’ experience in NHTD and/or providing services to seniors and/or providing services to people with disabilities and/or TBI services; and the contractor must currently hold or be willing to lease sufficient Americans with Disabilities Act (ADA) compliant facility space in the region to host meetings and training sessions. In addition, the applicant must be prequalified in the New York State Grants Gateway, if not exempt, on the date applications are due.

The RFA includes the roles and responsibilities of the RRDC and the operational and administrative functions that it performs on behalf of DOH.

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Volume 4, No. 2 January 14, 2019

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

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Upcoming Deadlines and Due Dates

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Requirement/Change

Effective/Due Date

More Information

LHCSA Registration Process

Must be submitted with LHCSA Statistical Report; if not submitted by January 1, 2019, https://commerce.health.state.ny.us/public/hcs_login.html agency will not be able to operate or receive reimbursement from any source

Minimum Wage Increase

December 31, 2018

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

OASISͲD for Certified Home Health January 1, 2019 Agencies

OASISͲD Guidance Manual: https://www.cms.gov/Medicare/QualityͲInitiativesͲPatientͲ AssessmentͲ Instruments/HomeHealthQualityInits/Downloads/OASISͲDͲ GuidanceͲManualͲfinal.pdf

Changes to New York’s Paid Family January 1, 2019 Leave program

https://paidfamilyleave.ny.gov/2019

2018 Adult Care Facility 4th Quarter Statistical Information Report

January 31, 2019

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

2017 CHHA and LTHHCP Statistical Report

February 1, 2019

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

2017 Hospice Cost and Utilization Report

February 1, 2019

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

Andryeyeva court case to be heard

by New York State Court of February 12, 2019 Appeals

https://www.nycourts.gov/ctapps/courtpass/Docket.aspx (enter the APL number 2018Ͳ00038)

Comments due on LHCSA Registration Proposed Rule

February 17, 2019

https://regs.health.ny.gov/sites/default/files/proposedͲ regulations/New%20Requirements%20for%20Annual%20Regis tration%20of%20Licensed%20Home%20Care%20Services%20A gencies.pdf

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

April 1, 2018 to December 31, 2019

https://www.cms.gov/Medicare/NewͲMedicareͲ Card/index.html

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

Volume 4, No. 2 January 14, 2019 

2019 Medicaid Transfer Penalty Rates Announced The state Department of Health (DOH) has announced the Medicaid regional rates for calculating penalty periods due to transfers of assets made for those who apply for Medicaid in 2019.

The penalty periods apply to individuals who transfer assets during the 60-month “look-back period” and require nursing home services. The 2019 monthly rates are: 

New York City: $12,419



Long Island: $13,407



Northern Metropolitan: $12,636 (Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster and Westchester)



Northeastern: $11,280 (Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren and Washington)



Central: $10,068 (Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tioga and Tompkins)



Rochester: $12,342 (Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne and Yates)



Western: $10,556 (Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans and Wyoming)

DOH’s notice is at https://www.health.ny.gov/health_care/medicaid/publications/docs/gis/19ma01.pdf.

Information on the Medicaid transfer of assets rules is at http://www.wnylc.com/health/entry/38/.

UAS-NY Upgrade The state Department of Health (DOH) has announced that it will be releasing a version 1.5 upgrade to the Uniform Assessment System of New York (UAS-NY).

The upgrade will begin at 6 p.m. on Wednesday, February 6, 2019 and will be completed no later than 8 a.m. on Thursday, February 7, 2019. (The application may be available sooner.)

In addition, DOH will be releasing v.1.5 of the UAS-NY Offline Client. This is a required upgrade for all Offline Client users. Complete instructions for upgrading the UAS-NY Offline Application will be available in the UAS-NY Training Environment Reference and Resources 8500 Online and Offline Application by close of business Friday, February 1, 2019. Users are advised to not install v.1.5 of the UAS-NY Offline Client prior to 6 p.m. on Wednesday, February 6.

Continued on next page

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Volume 4, No. 2 January 14, 2019 

Continued from previous page

As the UAS-NY houses multiple assessment instruments across multiple domains, DOH plans to release notes specific to each domain in the future.

Questions can be addressed to the UAS-NY Project Team at uasny@heath.ny.gov.

Emergency Preparedness Update Much has happened this winter in emergency preparedness (EP), including the planning of new drills and exercises, release of an EP Toolkit and numerous educational programs and trainings related to EP. On January 9, HCA met with state Department of Health (DOH) officials from the Office of Health Emergency Preparedness (OHEP) and the Office of Primary Care and Health Systems Management (OPCHSM) for our monthly meeting with the state’s home care associations – HCA and the New York State Association of Health Care Providers (HCP) – who receive funding to work with all home care and hospice providers to support their emergency preparedness roles.

CST Exercises During February to May of this year, DOH will hold Coalition Surge Tests (CST), Interoperable Communications (IOC) and Medical Countermeasures (MCM) exercises outside of New York City and in the Long Island, Lower Hudson Valley, Capital District, Central New York and Western New York regions. Home care providers can, but are not required to, participate in the drills and can use them to meet one of their federal and/or state emergency preparedness requirements.

At HCA’s request, DOH will provide two webinars – on February 5, from 11 a.m. to noon and February 6 from 1 to 2 p.m. – to review the exercises. (Details to follow.)

The CST drill will involve a simulated emergency that results in a number of hospitals having to evacuate a certain amount of patients and seek placement in other acute-care hospitals, nursing homes or back to the patient’s home with home care. Central DOH staff will notify agencies with offices in these regions about the drill and will send notifications to certain staff roles in the Health Commerce System (HCS) Communications Directory for each agency.

These roles include: Administrator; HPN Coordinator; Emergency Response Coordinator; Director of Home Care Patient Services (for home care agencies); and Director of Patient Services (for hospice).

Agencies, therefore, want to ensure that their Communications Directory is updated.

During the drill, there will be no survey to complete. Instead, home care providers might receive phone calls from hospitals participating in the drill who want to know if they can take any patients and provide home care to them. This can be a critical opportunity for home care to reinforce its importance in the emergency preparedness structure and in the overall health system.

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

Volume 4, No. 2 January 14, 2019 

Continued from previous page IOC/MCM Exercise On the day of the IOC/MCM, agencies will receive an Integrated Health Alerting and Notification System (IHANS) message informing them of an anthrax outbreak and asking them to submit a Health Electronic Response Data System (HERDS) survey. Providers will receive the IHANS message about 90 minutes prior to the drill being activated and will have 60 to 90 minutes to complete the survey. Again, the drill alert will be sent to certain individuals in the HCS Communications Directory, not by e-mail directly to agencies, so it is vital to keep your HCS directory listings up-to-date.

Agencies will also be expected to submit an After Action Report (AAR). A blank AAR is at https://hcanys.org/wp-content/uploads/2019/01/AAR-IP_Template-IOC-Drill-BLANK.docx and a sample AAR is at https://hca-nys.org/wp-content/uploads/2019/01/AAR-IP_Template-IOC-Drill-SAMPLE.docx.

DOH has provided the following two-week window during which the CST will be held (on one day):     

Central NY – February 14 to February 28 Western NY (Buffalo and Finger Lakes) – April 1 to April 12 Capital District – April 1 to April 12 Long Island – April 15 to April 26 Lower Hudson Valley – April 29 to May 10

DOH has informed us that the IOC/MCM drills will be held on the following dates:     

Central NY – February 27 Western NY (Buffalo and Finger Lakes) – April 3 Capital District – April 11 Long Island – April 18 Lower Hudson Valley – May 9

As in past discussions with DOH, HCA reviewed issues encountered by members in past drills, including home care providers that serve Long Island or the Lower Hudson Valley (where the drills were held) not being notified of the drills because their offices are located in New York City, and the need for education and assistance on completion of the AARs. Toolkit In November, DOH sent an IHANS notice to all home care providers with a link to the Emergency Preparedness Toolkit – a resource developed for home care and hospice providers, their patients and families. The Toolkit is at https://commerce.health.state.ny.us/HCSRestServices/HCSContentServices/ docs?docPath=/hcs_Documents/Source/hpn/hpnSrc/799C5FFA24CC00B8E053C0A80FB600B8.pdf (If the Toolkit does not appear, go to “My Content,” “Documents by Group,” “View all Document Groups,” “Long Term Care,” and then “Preparedness.”)

HCA and HCP compiled the Toolkit, with the assistance of a workgroup of providers and DOH.

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Volume 4, No. 2 January 14, 2019 

The Toolkit is a compilation of resources for agencies to use in assisting patients and families on preparations for any type of emergency situation. The information can be provided to patients and their families at the time of admission so that the planning process is begun and in place as intended – well before an emergency event takes place. The resources address a variety of issues and considerations necessary for effective preparedness planning.

This Toolkit should also assist agencies and patients under the new federal Conditions of Participation for emergency preparedness, which require patient-specific emergency plans.

HEPC Statewide Meeting Last week, HCA participated in a meeting of a committee that is planning the Health Emergency Preparedness Coalition (HEPC) Statewide Meeting.

This conference, to be held on March 20 and 21, brings together county, state and local emergency preparedness officials and health care provider association representatives who comprise HEPCs across the state. The purpose of the conference is to discuss emerging issues and state policies in emergency preparedness and the roles of the home care, hospice, hospital, adult home and nursing home sectors.

At last year’s conference, HCA participated in a panel discussion on a past CST/IOC drill where we discussed experiences with the drill from the perspective of HCA and member providers.

Education The January 2019 issue of the state’s Aware Prepare Update includes upcoming preparedness trainings, such as webcasts, webinars and in-person trainings, as well as archived exercises and on-demand elearning.

The Aware Prepare Update can be downloaded at https://hca-nys.org/wp-content/uploads/2019/01/2019_January_AP.pdf.

Updates are also posted at https://www.urmc.rochester.edu/emergency-preparedness/training.aspx.

Some programs that would be helpful for home care staff are Incident Command System (ICS) 100 and 200. ICS 100 describes the history, features and principles, and organizational structure of the Incident Command System. ICS 200 will include ICS principles for personnel to operate efficiently during an incident or event.

The ICS is a standardized management tool for small or large emergency or nonemergency situations. It has become the standard for emergency management across the country and may be used for planned events, natural disasters, and acts of terrorism.

The ICS is used by all levels of government, including federal, state, and local governments, as well as private-sector and non-governmental organizations.

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

Volume 4, No. 2 January 14, 2019 

CMS Home Health Open Door Forum on January 16 The next Home Health, Hospice & Durable Medical Equipment (DME) Open Door Forum is scheduled for Wednesday, January 16, 2019 from 2 to 3 p.m.

Some of the topics on the agenda include: 

Home Health Patient-Driven Groupings Model (PDGM)



Choice Demonstration for Home Health Services



Hospice Consumer Assessment of Healthcare Providers and systems (CAHPS)

 Home Health CAHPS Annual Training 

Change Request 11049 – Ensuring Only the Active Billing Hospice Can Submit a Revocation



Home Health Quality Reporting Program

To participate, call 1-800-837-1935 and Reference Conference ID: 9749859. An audio recording of the call is available for two business days after January 16 and can be accessed one hour after the call at 1-855859-2056.

NGS Updates National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), has recently posted the following updates.

Hospice Pricer Tool Now Available NGS has implemented a new provider tool to assist with calculating individual hospice claim reimbursement. Hospice providers that believe they have received an incorrect hospice claim reimbursement can use it to check reimbursement before calling the Provider Contact Center.

The Hospice Pricer Tool is located on the NGSMedicare.com website. From the home page click on “Claims & Appeals,” then “Fee Schedules and Pricers,” then “Hospice Pricer Tool.” A Hospice Pricer Tool Quick Reference Tool is available to assist with using the tool. The Hospice Pricer Tool Quick Reference Guide is available on the “Hospice Payment Rates” web page and is also available within the hospice Job aids section.

Hospice Revocations – Processing in the CWF The U.S Centers for Medicare and Medicaid Services (CMS) has released Change Request No. 11049/ Transmittal No. 4187 – “Ensuring Only The Active Billing Hospice Can Submit a Revocation.”

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

Volume 4, No. 2 January 14, 2019 

Continued from previous page CR No. 11049 can be downloaded at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2018Downloads/R4187CP.pdf.

This transmittal corrects part of the problem experienced with upgrades to how the Common Working File (CWF) updates and stores hospice election and benefit period information, effective with hospice claims received on or after July 1, 2019.

Specifically, it creates an edit to ensure that the provider identifier on Type of Bill (8xB) matches the most recent provider identifier on a hospice benefit period.

Health Resources 

“Long-Term Care Services Use-Rates in the United States – U.S. Maps Supplement: National Study of Long-Term Care Providers, 2015-2016,” December 2018 U.S. National Center for Health Statistics Report https://www.cdc.gov/nchs/data/nsltcp/2016_UseRateMaps.pdf



“Supplemental Benefits under Medicare Advantage–Part 1: An In-Depth Look at What They Are Today,” AARP Public Policy Institute https://www.aarp.org/content/dam/aarp/ppi/2019/january-2019/supplemental-benefitsunder-medicare-advantage-part-one.pdf



“Supplemental Benefits in Medicare Advantage: What’s Changing in 2019 and What’s Not,”

by AARP https://blog.aarp.org/2018/10/30/supplemental-benefits-in-medicare-advantage-whatschanging-in-2019-and-whats-not/

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

20

State Advocacy Day Events DAY ONE Monday, February 11, 2019 5:00pm – 6:30pm

HCA PAC Reception

Parking for Legislative Office Building If you are driving and would like to park at the Empire State Plaza, we recommend the V-Lot which is closest to the Legislative Office Building, where we will be meeting. Elevators are accessible in the V-Lot to the Concourse level. Identifications must be shown when entering to park in the V-Lot.

Hyland Library Renaissance Hotel 144 State Street Albany, New York 12205 HCA will hold a special HCA PAC fundraising reception. Attendees are asked to make a minimum $100 donation to the HCA PAC. See back page for registration and donation details. The HCA PAC is a vital resource for building relationships with influential elected officials and getting our message heard.

DAY TWO Tuesday, February 12, 2019 8:00AM – 4:00PM

HCA State Lobby Day ID Required for Access to LOB The Legislative Office Building is a Government building; therefore you will need to go through a security check point to access this area. Please be sure to bring a valid photo ID and allow additional time to go through the security process.

Breakfast and Lunch Provided in Room 711-A A light breakfast will be provided at the beginning of our Advocacy Day on February 12th. A deli style lunch will be available at 12:00pm.

Room 711‐A Legislative Office Building 198 State Street Albany, New York 12210 8:00 AM – 12:00PM

State Leaders Address HCA Board and Members HCA is inviting key Senate and Assembly Committee Chairs, legislative fiscal and program staff leaders, as well as key representatives from the Governor’s office, Department of Health, and Division of Budget to meet with and present to Advocacy Day participants. A schedule of presenters will be provided prior to the meeting.

12:00PM – 12:30 PM

Lunch 12:30PM – 4:00PM

Legislative Office Visits Meeting Room Day Access You are welcome to utilize Room 711A throughout the day as needed and light refreshments will be available in the afternoon.

For HCA Board Members: HCA will schedule your afternoon legislative visits.

For all other HCA Members – Please schedule your own appointments during this period.

DAY ONE REGISTRATION

DAY TWO REGISTRATION

and/or DONATION

Monday, February 11, 2019

Tuesday, February 12, 2019

5:00pm – 6:30pm

8:00AM – 4:00PM

HCA PAC Reception

HCA State Lobby Day

Hyland Library Renaissance Hotel 144 State Street Albany, New York 12205 HCA will hold a special HCA PAC fundraising reception. Attendees are asked to make a minimum $100 donation to the HCA PAC.

Room 711‐A Legislative Office Building 198 State Street Albany, New York 12210

A minimum $100 donation is requested. ______ I will attend the Fundraising Reception on February 11th (See donation instructions below) ______ I cannot attend but would like to make a donation as indicated. (See instructions below)

ADVOCACY DAY REGISTRATION _____________________________________________________ Name _____________________________________________________ Organization

___ VISA ___ MasterCard ___ AmExp

_____________________________________________________ Email

Card Number_______________________________________

_____________________________________________________ Phone

Expiration Date________________ Security Code_______ Name on Card______________________________________ Card Billing Address_________________________________

# _________ Additional guests will attend Advocacy day with me from my organization.

__________________________________________________ City/State/Zip_______________________________________ Cardholder’s Signature_______________________________ Email________________________ Phone_______________

Please make your donation checks payable to: HCAPAC Checks will be accepted at the door that evening. However, if you are unable to attend but would like to make a donation, please mail your donations to: HCA PAC, 388 Broadway, 4th Floor, Albany, NY 12207 Anonymous contributions are prohibited. However, if you do not want your name to be published in recognition materials, please check this box. 

PLEASE FAX COMPLETED FORM TO (518) 426-8788