February 4, 2019 Edition of The Situation Report by Home Care Association of New York State

HCA DATA

MA BENEFIT EXPANSIONS

DRILL WEBINARS

LAWTALK

HCA’s membersonly HCA Data page has new directories and updated hospice Medicare data.

CMS posts yet-further details on proposed community-based supplemental benefit options under Medicare Advantage. Home care providers should consider exploring the new options.

DOH is holding a series of emergency preparedness drills from February to May. To learn what’s in store, join DOH for two webinars this week!

The latest edition of HCA’s monthly LawTalk column focuses on cybersecurity requirements and considerations.

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UPCOMING PROGRAMS Advocacy Essentials Webinar Feb. 6, 2019 10:30 a.m. to noon 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) Downstate LHCSA Forum March 6, 2019 (NYC) Senior and Financial Managers Summit March 19, 2019 (Troy)

Your Source for HOME CARE News, Policy and Advocacy

Vol. 4, Issue 5| February 4, 2019

What the Data Says & How to Use It for State Advocacy Join us for Feb. 6 advocacy webinar; contribute to the HCA PAC; and meet with lawmakers on Feb. 12 during HCA’s Advocacy Day As noted in our latest edition of the monthly HCA Capitol Report, HCA will soon release our industry financial analysis and member survey results. This analysis reveals that three-fourths of CHHAs and hospices, as well as two-thirds of LHCSAs, are operating with rates and premiums in the red. See ADVOCACY p. 3

3/19 HCA Finance Summit: Medicaid Rates, PDGM, Wage/Hour Law Impacts & More HCA’s Senior Financial Managers Summit on March 19 is timed to support your home care, hospice and MLTC revenue management going into a new state fiscal year, and on the eve of a new state budget, with key updates from the state’s Medicaid rate-setting officials. See FORUM p. 2

INSIDE What the Data Says & How to Use It for State Advocacy....................................1 HCA Summit: Rates, PDGM, Wage/Hour Law Impacts & More...........................1 Member Hiring Announcement.......................................................................3 HCA to Participate in State Long Term Care Planning Project.............................4 President Signs Medicaid Extenders Bill..........................................................5 New Home Care, Hospice Stats Posted to HCA Data Webpage...........................6 Downstate and Upstate Sessions of LHCSA Forum Coming Up............................6 HCA Issues January Edition of New Capitol Report Newsletter...........................7 DOH Issues Guidance to MLTC Plans on Plans of Care.........................................7 CMS Proposes MA Benefits for Chronically Ill Individuals..................................8

PDGM: 3 Learning Opportunities to Get Ready!..............................................10 DOH Webinars on Upcoming Emergency Prep. Drills: Feb. 5 & 6.......................11 Upcoming Trainings to Help Agencies with HCS...............................................12 Workplace Bill Bans Discrimination Based on Reproductive Health Decisions.....13 Sepsis Alliance Resources You Can Use on Sepsis Survivor Week: Feb. 10-16.....14 NYSHealth Funding Announced for Conference Participation.........................14 UAS Guidance Issued....................................................................................15 HHS Releases Cybersecurity Guidance..........................................................16 Upcoming Deadlines and Due Dates.................................................................18 Health Care Resources..................................................................................19

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

FORUM from p. 1 CPA consultants and managers from BKD, LLP will also delve deep into the Patient-Driven Groupings Model (PDGM), which is the biggest Medicare payment overhaul in decades, with financial impact analyses that reveal key performance indicators. Plus, wage-and-hour legal expert Emina Poricanin (Hodgson Russ) will help you get a handle on the latest developments in this dynamic area of regulation and potential finance liabilities, such as: 24-hour live-in services litigation, enforcement issues and trends, common mistakes found in office of the Medicaid Inspector General and Department of Labor audits, and joint employment issues that are arising in the Consumer Directed Personal Assistance Services program fiscal intermediary context. For home care, hospice and MLTC CFOs, finance leaders, controllers and other executives with financial responsibility, these three areas cover a major swath of territory under your scope. Register for this Forum today, and read more about the state Medicaid rate officials, consultants, and legal experts who will be joining the HCA policy team to provide you with these critical finance updates on March 19 in Troy, NY (near Albany). Registration is at https://hca-nys.org/wp-content/uploads/2019/ 01/HCA-CFO-Forum-Registration-Form-2019.pdf.

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

The Situation Report: the Home Care Association of New York State ADVOCACY from p. 1 In addition, 64 percent of MLTC plans had negative premium incomes (a level that has gotten substantially worse since 2012, when 42 percent of plans had negative premium incomes). This data was already reported by Crain’s Health Pulse, who reached out to HCA last week for context about the home care financial landscape with news that a New York City home care agency was pursuing layoffs. (See the article here: https://hca-nys.org/wpcontent/uploads/2019/02/MJHS-Home-Care-planslayoffs-in-challenging-market.pdf.) This coverage follows reports in Crain’s and elsewhere, including The Situation Report, that at least two MLTC plans have recently been forced to close and/or have been taken over due to inadequate state premiums, leaving outstanding debt to providers which exacerbates existing financial struggles across the system. Our survey also shows that many prospective patients are unable to access home care services or are delayed in start-of-care due to aide, RN/LPN and therapist shortages. HCA members ranked “recruitment and turnover-related costs” as the top contributor to your overall cost increases over the past year. Meanwhile, 20 percent of home care providers with DSRIP collaboration arrangements have not received any payments; for those who have received payments, the amount is less than $150,000 per agency in the majority of cases, even though home care is the backbone of the state’s multi-billion-dollar effort to reduce hospitalization rates by 25 percent. So, what do these numbers tell us? We know that Medicaid premiums and rates to plans and providers are not adequate to meet costs like minimum wage increases and operations. The

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HIRING: President of Home Care & Hospice The Position: Head strategic Home Care and Hospice operations for the health system, including growing specialty programs. Pave the way for clinical and technological innovation in both the home care and hospice programs including a heart failure readmission reduction program, implementation of a new EMR, growing the current telehealth program, expansion of community and facility based palliative care programs, and support for value based purchasing (VBP) initiatives. Must possess prior CHHA executive experience, financial/ budgetary experience, and a familiarity with Population Health strategies and initiatives. RN and/or Nurse Practitioner with Master’s degree required. The Organization: Catholic Health Services of Long Island includes six hospitals, three skilled nursing facilities, a regional home care service, a certified hospice and a communitybased agency for persons with special needs. The 1,928-bed system prides itself on the values of Integrity and Compassion. CHS serves hundreds of thousands of Long Islanders each year, providing care that extends from the beginning of life to helping individuals live their final years in comfort, grace, and dignity. At Catholic Health Services, there are 358,805 annual home care visits and 125,636 annual hospice days-of-care. To apply, please visit our website at: https://www.besmith.com/job-details/ farmingdale-new-york-home-health1256636/.

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community-based sector’s workforce and overall infrastructure also need support and investment. Help us tell this story, using these findings and your own agency’s experiences.

 First, participate in our February 6 webinar on “Advocacy Essentials,” which will equip you with concrete tips and methods for urging critical supports in the state budget for home care, hospice and MLTC. Registration is at https://www.surveymonkey.com/r/Feb6AdvocacyWebinar. (We will send webinar access instructions early this week to all who register).

 Second, join HCA for our February 11 PAC Reception and February 12 State Advocacy Day in Albany by registering at https://hca-nys.org/wp-content/uploads/2019/01/2019-HCA-AdvocacyEvents-Registration-Form.pdf. With the Senate’s change in leadership, there is an even greater need to raise awareness and bend the learning curve among all lawmakers about who you are, what you do for patients, and why the Legislature’s support is needed. Using the tips from our webinar, you are needed to make a big impact on February 12. As previously reported, this year’s state budget contains yet a new round of cuts and program overhauls to certain classes of home care services and to MLTCs. These changes fall on top of chronic underinvestment, as well as funding and support disparities, which HCA is working to address through budget language. Tomorrow, HCA will be pressing these issues during the Medicaid and Health legislative budget hearing, where we will be delivering testimony, and in our continual outreach to state budget and legislative officials. Please join us in vigorous advocacy throughout the coming weeks to advance our budget language and other supports for the community-based sector.

HCA to Participate in DOH/NYSOFA Long Term Care Planning Project Last week, the state’s Department of Health and Office for the Aging announced the launch of the Long Term Care Planning Project (LTCPP), which is designed to understand the projected and desired needs of older adults in New York by examining the state’s long term care system. According to the agency press release (https://www.health.ny.gov/press/releases/2019/2019-01-28_long_term_care_planning_project.htm), the LTCPP will analyze, evaluate and identify the existing service gaps in New York’s long term care system, determine the most cost-effective evidence-based interventions and prepare a strategic plan to meet the emerging needs of New York’s aging population over the next decade. The state will convene the first LTCPP public meeting today from 1:30 to 3:30 p.m. in Albany at the Empire State Plaza, Meeting Room 7. Prior to the launch of the Project, the state extended an invitation to HCA to participate in the LTCPP. HCA President and CEO Al Cardillo will represent the Association at today’s meeting. The meeting is open to the public; however, registration is required to attend at https:// ltcppmeeting1.eventbrite.com/. The LTCPP meeting topics will include:

 Aging and Long Term Care Services – Improving Coordination, Communication and the Consumer Experience Continued on next page

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Continued from previous page

 Evidence-Based Interventions in Aging and Long Term Care  Family Caregiving Support  Analyzing, Expanding and Supporting the Long Term Care Workforce  Financing Alternatives to Public Programs, including Medicaid The information gathered from each meeting will be developed into a list of recommendations that will inform a planning tool for the state. The guiding principles of all discussions will include the state’s existing financial commitment to the long term care system, evidence-based interventions, as well as technological innovations and programs that are currently working effectively and efficiently. The LTCPP stems from a 2018 statewide survey sent to gather information on the issues faced at all levels of care and by all involved in the long term care system. The long term care system is defined broadly to include clinical services as well as non-medical home and community-based services that address social determinants of health. HCA will provide an update on the meeting in next week’s edition of The Situation Report. For questions, please contact Andrew Koski, akoski@hcanys.org, Alyssa Lovelace, alovelace@hcanys.org, or DOH directly at ALTCteam@health.ny.gov.

President Signs Medicaid Extenders Bill President Donald Trump, on January 24, signed a bill into law (H.R. 259) which 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). These protections allow married couples to protect certain assets while seeking Medicaid coverage for HCBS.

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New Home Care, Hospice Stats Posted to HCA Data Webpage Page now includes 2019 DOH Home Care & Hospice Directories and 2016 Hospice Medicare Payment and Utilization Data The ‘HCA Data’ website now includes the latest 2019 state Department of Health (DOH) Home Care and Hospice Directories that list every DOH-approved Certified Home Health Agency (CHHA), Licensed Home Care Services Agency (LHCSA), Long Term Home Health Care Program (LTHHCP), Special Needs CHHA and Hospice in the state by region. HCA also posted new 2016 Medicare Hospice Payment and Utilization data from the U.S. Centers for Medicare and Medicaid Services (CMS). HCA Data is a members-only page that provides data reports to assist home care and hospice providers and managed care plans in their: benchmarking efforts; understanding of system-wide trends; and access to reimbursement and premium rates. The page is not visible on our site unless you are logged in with an HCA member website account. Our log-in page is here: http://hca-nys.org/login. Upon login, using your member username and password, the HCA Data link will appear in the site menu at the top right. You can also enter your e-mail address to obtain your password. Or, simply e-mail HCA’s Communications Director Roger Noyes (at rnoyes@hcanys.org) if you do not yet have an HCA website account. HCA has recently requested the 2017 CHHA Medicaid Cost Reports for each CHHA in the state, which we expect to receive from DOH later this month. HCA will then prepare a detailed spreadsheet summarizing key 2017 CHHA data, including such items as: revenue by payor source; total costs; net margins; key utilization and unit cost data; and other information. The HCA Data webpage currently has 2016 CHHA Cost Report data available to members. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

Downstate and Upstate Sessions of LHCSA Forum Coming Up Upstate Forum on Feb. 19 and Downstate Forum on March 6 As announced to members last week, HCA’s Upstate and Downstate LHCSA Forums are coming up with a session in Utica on February 19 and in New York City on March 6. HCA’s Forums, led by our Policy team of experts, provide a venue for focused attention on issues specific to certain segments of the home and community-based sector in certain regions of the state. For further information and to join us for either of these forums, please download the registration forms listed on HCA’s events page at https://hca-nys.org/events-education/upcoming-events. As we’ve reported to members, the newly proposed state budget continues to mount significant impacts on LHCSAs, including: major changes to the authorization and financing of the Consumer-Directed

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program; new proposed Medicaid Inspector General powers to collect overpayments from subcontractors; electronic visit verification; controls on personal care management; a National Provider Identifier (NPI) requirement for aides; and funding policies for minimum wage and other cost factors. Meanwhile, LHCSAs face a litany of recent, pressing and persistent regulatory changes, such as statistical reporting changes and the LHCSA registration process, contracting limits with managed care plan partners, and the continuing roll-out of Advanced Home Health Aides. This is an important opportunity to learn more about the above issues, how they impact you, and what HCA is doing about them; plus, we invite you to exchange information on local or agency-specific matters that HCA can work to resolve or to better inform our advocacy agenda on behalf of LHCSAs.

HCA Issues January Edition of New Capitol Report Newsletter HCA last week circulated the second edition of our new monthly newsletter, the HCA Capitol Report, which comes out on the final Wednesday of each month. The e-newsletter is sent to all state legislators’ offices to provide updates on what’s happening in the home care, hospice and Managed Long Term Care sectors. This month’s edition features our reaction to the state budget, resources from our Home and Community Care 101 Session earlier in the month (to update legislative offices who were unable to attend), an infographic on asthma management in home care, and a section on new “Bills and Laws” supported by HCA. HCA sent the newsletter to members as well, but if you missed it, you can see our archive at: https://hcanys.org/hca-capitol-report.

DOH Issues Guidance to MLTC Plans on Plans of Care On January 22, 2019, the state Department of Health (DOH) issued a Dear Health Plan Administrator letter on Managed Long Term Care Plan (MLTC) enrollee assessments, informal supports, and development of the Person-Centered Service Plan (PCSP). The letter is at https://hca-nys.org/wp-content/uploads/2019/01/Dear-Administrator-Letter_01.22.2019.pdf. The letter states that the PCSP is based on the initial assessment and reassessments. It also explains: which services are included in it; what a person-centered process is; how any unscheduled needs will be met by informal supports, adaptive or specialized equipment; and more. The plan must provide a copy of the PCSP to the enrollee after each assessment and a new PCSP must be provided if changes are made to the PCSP for a change in condition, reassessment, or other reasons. If a plan is notified that an informal support will not be able to assist the enrollee, the plan must “use reasonable efforts to cover those hours and/or tasks taking into account the amount of notice and the

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availability of additional service providers.” Plans don’t have to update the PCSP to reflect temporary changes in the enrollee’s schedule, or other scheduling changes unrelated to the type, amount, or scope of services between assessments. However, if revisions are needed to incorporate this information on the current PCSP, the plan must submit the PCSP to DOH for its approval no later than 60 days after receiving this information.

CMS Proposes Medicare Advantage Benefits for Chronically Ill Individuals May provide further opportunities for home care providers Last week, the U.S. Centers for Medicare and Medicaid Services (CMS) issued a Draft Call Letter for Medicare Advantage (MA) Managed Care plans that allows them to offer benefits that are not “primarily health related” for chronically ill individuals. A fact sheet on this notice and other changes related to MA and Medicare drug plans is at https:// www.cms.gov/newsroom/fact-sheets/2020-medicare-advantage-and-part-d-advance-notice-part-ii-and-draftcall-letter. The Draft Call Letter is at https://www.cms.gov/Medicare/Health-Plans/ MedicareAdvtgSpecRateStats/Downloads/Advance2020Part2.pdf (select “2020 Advance Notices”). For 2020, MA plans will have the ability to offer a “non-primarily-health-related” item or service to “chronically ill” enrollees, under the Special Supplemental Benefits for the Chronically Ill (SSBCI), if the plan has a reasonable expectation of improving or maintaining the health or overall function of the enrollee as it relates to the chronic disease. Such items and services may include, but are not limited to, transportation for non-medical needs, home-delivered meals (beyond the current allowable limited basis), food and produce. However, such items and services may not include capital or structural improvements to the home of the enrollee that could potentially increase property value (e.g., permanent ramps, and widening hallways or doorways). CMS notes that plans may contract with community-based organizations to provide new supplemental benefits. The Bipartisan Budget Act of 2018 separately expanded MA supplemental benefits for chronically ill enrollees to include those that are not primarily health related. It defines a chronically ill enrollee as an individual who: 

Has one or more comorbid and medically complex chronic condition that is life threatening or significantly limits the overall health or function of the enrollee;

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Has a high risk of hospitalization or other adverse health outcomes; and

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Requires intensive care coordination.

For 2020, CMS will consider chronically ill enrollees to be those with a chronic condition listed in section 20.1/2 of chapter 16b of the Medicare Managed Care manual (https://www.cms.gov/Regulations-andGuidance/Guidance/Manuals/Downloads/mc86c16b.pdf section 20.1.2) to meet the statutory criterion of

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having one or more comorbid and medically complex chronic conditions that is life threatening or that significantly limits the overall health or function of the enrollee. This includes: cardiovascular disorders; chronic heart failure; dementia; diabetes mellitus; autoimmune disorders; and more. In a Call Letter issued last year for the 2019 plan year, CMS expanded its interpretation of how a benefit may be a “health care benefit” that is approvable as a supplemental benefit offered by an MA plan. This interpretation considers items or services used to “diagnose, compensate for physical impairments, act to ameliorate the functional/psychological impact of injuries or health conditions, or reduce avoidable emergency and healthcare utilization.” These included non-skilled in-home supports, portable wheelchair ramps and other assistive devices and modifications when patients need them. HCA provided comments on the then-proposed proposed letter. Among other recommendations, we specifically urged CMS to allow MA coverage of home health aide and personal care aide services to Medicare beneficiaries who don’t also require skilled services. Our comments are at https://hca-nys.org/wp-content/uploads/2018/03/CMS-Call-Letter_HCAs-Comments_030218-FINAL.pdf. The Call Letter was issued in April of 2018, joined by an April 27, 2018 guidance in which CMS indicated that such benefits could include: In-home support services to assist individuals with disabilities and/or medical conditions in performing Activities of Daily Living and Instrumental Activities of Daily Living within the home to compensate for physical impairments, ameliorate the functional/psychological impact of injuries or health conditions, or reduce avoidable emergency and healthcare utilization. Services must be provided by individuals licensed by the state to provide personal care services, or in a manner that is otherwise consistent with state requirements.

The Call Letter for 2019 was released too late for most managed care organizations to include these benefits in their plans and only a limited number did so for this year. However, more are expected to offer such non-skilled benefits in 2020. HCA has taken a very active national role in coordinating efforts by other state home care associations to support the implementation of the 2019 change and has provided information to HCA members on this issue. HCA had already discussed the 2019 change with Senator Charles Schumer’s health care team and will be working with the entire New York Congressional Delegation to promote widespread adoption of these new benefits by MA plans. For more information, contact Andrew Koski at akoski@hcanys.org or (518) 810-0662.

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PDGM: 3 Learning Opportunities to Get Ready! With the biggest overhaul of Medicare home health payments coming in eleven months, providers need to plan now for their financial forecasting, clinical operations, understanding of newly realigned episode payments, data analytics and monitoring, plus technological systems changes for all of these functions. Below are three upcoming opportunities offered by HCA, our association partners, and the U.S Centers for Medicare and Medicaid Services (CMS) to help you in all of these areas when it comes to the Patient Driven Groupings Model (PDGM). Feb. 12: CMS Webinar CMS is holding a February 12 webinar (1:30 to 3 p.m.) to provide an overview of the PDGM model, including low utilization, partial, and outlier payment adjustments, followed by questions and answers. Registration is at https://blh.ier.intercall.com/details/52b3eed973ec47d296600bfc8ac16b3c. March 13: NAHC PDGM Summit (Northampton, MA) Our partners at the National Association for Home Care and Hospice (NAHC) are holding a series of “PDGM Summits” throughout the country. HCA is a state-level sponsor of the summits, so HCA members can join the March 13 session in nearby Massachusetts at a discounted rate by registering through the Home Care Alliance of Massachusetts and using the promo code PDGM2019. (This is an overflow session to follow a previous one that sold out.) Registration is at https://www.thinkhomecare.org/events/EventDetails.aspx?id=1196898&group. March 19: HCA Senior Financial Managers Summit (Troy, NY) PDGM will be a focus, among many other finance topics, at HCA’s must-attend Senior Financial Managers Summit in Troy, near Albany. The HCA Policy team will include PDGM among our updates about all relevant home care, hospice and MLTC Medicaid and Medicare rate issues; but the summit is also featuring M. Aaron Little, CPA, Managing Director, and Karen Vance, BSOT, Senior Managing Consultant, at BKD, LLP for a session sharing the results of an agency-specific financial impact analysis that reveals not only the financial elements of the PDGM model but also related operational strategies and key performance indicators. Registration is at https://hca-nys.org/wp-content/uploads/2019/01/HCA-CFO-Forum-Registration-Form2019.pdf.

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DOH Webinars on Upcoming Health Emergency Preparedness Drills: Feb. 5 & 6 Aware Prepare Update Also Posted The state Department of Health (DOH) will host two webinars to help home care and hospice providers prepare for upcoming emergency preparedness drills. The webinars are on February 5 (11 a.m. to noon) and February 6 (1 to 2 p.m.) The upcoming drills will be held outside of New York City in February to May. Agencies outside of NYC should plan on participating in one of the two webinar sessions (both will provide the same information) as well as the drills. Though not required, your involvement in these exercises can meet one of the federal and/or state emergency preparedness requirements. More information about the drills is below. See also the flyer at https://hca-nys.org/wp-content/uploads/2019/01/EP-Exercise-Drills_Webinar_Feb-2019.pdf. Registering for the Webinars Registration for the webinars is at https://www.nylearnsph.com/Public/Default.aspx. You might have to get a username and password if this is your first time on the site (at https://www.nylearnsph.com/ Public/Register/). Then, go to “Course Catalog” on the left side and search for OHEP-HEPCEX-2019. Coalition Surge Test (CST) Drill The CST drill will involve a simulated emergency where some hospitals have to evacuate patients to other settings, including home care. Central DOH staff will notify certain staff roles in the Health Commerce System (HCS) Communications Directory. 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 the home care provider can take any patients and provide care. The CST drill is expected during the following timeframes in the regions below. February 14 to 28: Central NY April 1 to 12: Western NY (Buffalo and Finger Lakes) April 1 to 12: Capital District April 15 to 26: Long Island April 29 to May 10: Lower Hudson Valley Interoperable Communications (IOC) and Medical Countermeasures (MCM) Drill For the IOC/MCM drill, agencies will receive an Integrated Health Alerting and Notification System (IHANS) message regarding an anthrax outbreak. Agencies will be asked to submit a Health Electronic Response Data System (HERDS) survey. The IHANS notice will go out 90 minutes prior to the drill, and providers will

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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. The IOC/MCM drills are scheduled for the following dates. February 27: Central NY April 4: Western NY (Buffalo and Finger Lakes) April 11: Capital District April 18: Long Island May 9: Lower Hudson Valley February Aware Prepare Now Available The February 2019 issue of the state’s Aware Prepare update is now available online at https://hca-nys.org/ wp-content/uploads/2019/02/2019_February_AP.pdf. The update contains upcoming preparedness trainings, such as webcasts, webinars and in-person trainings, as well as archived exercises and on-demand e-learning. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org; or Alyssa Lovelace at (518) 810-0658 or alovelace@hcanys.org.

Upcoming Trainings to Help Agencies with HCS The state Department of Health (DOH) is holding free webinars to help agencies gain access to and navigate the Health Commerce System (HCS). These include:   

CTI-100 Introduction to the Health Commerce System on February 5, from 11 a.m. to noon. CTI-200 Communications Directory Certification on February 7, from 9 to 10:30 a.m. CTI-120 HERDS Reporting on February 15, from 10 to 11 a.m.

Registration is at the Learning Management System at https://www.nylearnsph.com. If you have never registered at this website, you should click on “New to the system, Register Here” and you will have to first set up a username and password. Next, go to “Course Catalog” on the left side of the site and search the course catalog for the above webinars. As most members know, the HCS is DOH’s primary communication vehicle during emergencies, as well as for normal operational issues. These operational items include such applications as the Criminal History Record Check, the Home Care Worker Registry, and the Electronic Plan of Correction. It is also the mechanism for collecting cost and statistical information from providers, as well as guidance and communications, such as Dear Administrator Letters (DALs). Continued on next page

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Continued from previous page Regulations require that all Licensed Home Care Services Agencies, Certified Home Health Agencies, Long Term Home Health Care Programs and hospice providers maintain current HCS accounts, including provider contact information. Every home care and hospice provider is required to keep the HCS Communications Directory current and updated, assign staff to certain key roles in the HCS and check the HCS daily, but more frequently during an emergency. Additional information is included in a state DOH DAL at https://hca-nys.org/wp-content/uploads/2018/06/ DAL_HCS_Requirements_020316.pdf. Since last August, HCS users are being asked every six months during log-in to verify their emergency and business contact information. More information is at https://hca-nys.org/wp-content/uploads/2018/08/ HCS-Contact-Verification_August-2019.pdf.

Bill Passes That Bans Discrimination Based on Employee’s Reproductive Health Decision Making On January 22, the state Senate and Assembly passed legislation, S.660 (Metzger)/A.584 (Jaffee), which prohibits employers from discriminating against employees based on the employees’ or a dependent’s reproductive health decisions, and provides remedies for such violations. The Governor is expected to sign it. The legislation prohibits an employer from accessing an employee’s personal information on reproductive health decision making, including, but not limited to, the decision to use or access a particular drug, device or medical service without the employee’s prior informed, affirmative written consent. Employers who provide an employee handbook to their employees must include, in the handbook, a notice of employee rights and remedies under these bills. Under this bill, the court in a civil action alleging violations, may award the plaintiff damages that include back pay, benefits and reasonable attorney’s fees and costs. In addition, the court may order reinstatement or afford injunctive relief against an employer in violation of this law. The court may also award the plaintiff liquidated damages. Separate civil penalties would apply for retaliation against an employee exercising rights under the law. HCA will keep members informed on when the bill is signed and any implementation dates that affect home care and hospice providers.

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Sepsis Alliance Resources You Can Use on Sepsis Survivor Week: Feb. 10-16 HCA’s partners at Sepsis Alliance are launching “Sepsis Survivor Week,” starting on February 10. HCA will be taking part by sharing infographics and other excellent and informative content created by our friends at the Alliance. Download the Sepsis Alliance toolkit to learn more and spread the word from February 10 to 16 at https:// www.sepsis.org/sepsis-survivor-week-toolkit/. There you will find a series of infographics, a video and more that can be shared on social media by tagging @Sepsis Alliance and using the hashtag #SepsisSurvivor. Also, as part of Sepsis Survivor Week, Sepsis Alliance is hosting a free webinar (February 12) on “Caring for Sepsis Survivors: From ICU to post-hospital care.” To register and learn more about this webinar, please visit https://tinyurl.com/ybmoue4o. The Sepsis Alliance resources offer some of the following facts relevant to community-based providers especially: 

1.4 million Americans survive sepsis, a lethal condition, each year.



As many as 60 percent of survivors are left with physical, mental and emotional challenges, including amputations or worsened cognitive functioning.



For the home care population, older sepsis patients experience on average 1 to 2 new limitations on activities of daily living (e.g. bathing, dressing, managing money) after hospitalization.

Sepsis Alliance is a core partner on the HCA Stop Sepsis at Home initiative, which has brought training sessions and an HCA-developed, evidence-based community sepsis screening tool to home care clinicians throughout New York State. HCA encourages all members to adopt the tool and protocols. Learn more at www.stopsepsisathomeny.org.

NYSHealth Funding Announced for Conference Participation Funding is now available through a New York State Health Foundation (NYSHealth) Request for Proposals (RFP) called “Sponsoring Conference Participation in Support of Healthy Communities, Consumer Empowerment, and Veterans’ Health.” Through this RFP, NYSHealth will sponsor community-based organizations, health departments, and other organizations with limited resources to attend and present at local, state, and national conferences related to these funding areas. Applications will be accepted on a rolling basis. Scholarships of up to $2,000 per person will be available for up to two attendees at each organization (a maximum of $4,000). Scholarship funding will be used to cover the costs of registration fees, travel and lodging, and incidentals for attendees while at the conference. Continued on next page

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Continued from previous page

More information is at https://nyshealthfoundation.org/rfp/sponsoring-conference-participation-rfp-2019/ ?utm_source=Conference+Scholarships+RFP+2019&utm_campaign=Conference+Scholarship+RFP+Jan+2019&utm_medium=email.

UAS Guidance Issued The state Department of Health (DOH) recently issued two policy documents related to the Uniform Assessment System of NY (UAS-NY) – one on procedures for using a paper version of the assessment and the other on maintaining accurate case lists. The documents are at https://hca-nys.org/wp-content/uploads/2019/01/Notification_100772.pdf. Paper Assessment Form The only circumstances where a paper assessment may be conducted by a Registered Nurse or Social Worker are during times of unscheduled UAS-NY online application outages or when an assessor experiences an unexpected technical failure while conducting an assessment in a person’s home or community-based environment. If an assessor conducts an assessment on paper because of an unscheduled outage of the UAS-NY Online Application, the assessor must enter the paper responses into the UAS-NY application as soon as the system is back online. If the assessor conducts an assessment on paper because of an unexpected technical failure, the assessor must report the technical failure to the agency’s Information Technology (IT) department, as well as the RN Supervisor, who must authorize the assessor to conduct the assessment on paper. Assessments conducted on paper should not be signed, as they do not meet regulatory requirements for conducting and signing/finalizing an assessment. An assessment conducted on paper is only considered to be a valid assessment when the RN who conducted the assessment has entered responses recorded on the paper instrument into the UAS-NY Online Application (including supplements, as required) and has signed and finalized the assessment and assessment outcomes within the Online Application. Assessors must ensure that completed paper forms are secured against unauthorized or inappropriate access and securely destroyed/disposed of once the assessment has been entered into the UAS-NY Online Application. Case List All organizations that access the UAS-NY for UAS Community Assessment, Pediatric Assessments, or to review associated data must build and accurately maintain a case list. The case list is a subset of UAS-NY

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case file records that an organization has a legitimate business need to access. Failure to accurately maintain an organization’s case list poses a serious security issue and may result in corrective action. Organizations are required to attest to a legitimate business need to access individual UAS records; when that legitimate business need no longer exists, organizations must ensure that business processes are in place so that programs and plans remain compliant with HIPAA, HITECH, and state and federal privacy laws. The guidance identifies issues that agencies may encounter with case lists and how to address them. In addition, the policy document discusses how enrolling programs and plans (Managed Long Term Care and Managed Care Plans, Adult Day Health Care Programs, Assisted Living Programs, Local Districts of Social Services, and Regional Resource Development Centers) are required to maintain accurate enrollments and disenrollments in member records. It gives examples of enrollment issues and actions that organizations must take. If UAS users need assistance on these issues, they should contact the UAS-NY Support Desk at (518) 4081021; e-mail notifications will not be accepted. The UAS-NY Support Desk will work with the user (and supervisor, if necessary) to resolve the reported issues.

HHS Releases Cybersecurity Guidance By Frank Fanshawe, Principal, and Ashley Solowan, Associate While technology is absolutely vital for home care agencies and other health care providers, it comes with an ever-increasing exposure to cyber vulnerabilities. These vulnerabilities create risks with potential highimpact consequences for both home care agencies and their patients. Ransomware and similar cyberattacks can pose significant risk for patient health and safety and compel health care providers to ensure their technologies are safe and secure. To enhance the collective response of the health care sector to these cyber vulnerabilities, the Department of Health and Human Services (HHS) recently released the voluntary “Health Industry Cybersecurity Practices (HICP): Managing Threats and Protecting Patients” publication for health care organizations of every size – ranging from the smallest home care agencies to the largest health systems – with the goal of cost-effectively reducing cybersecurity risk through the development and implementation of cybersecurity controls. This guidance was, according to HHS, developed over the course of two years by more than 150 cybersecurity and health care experts from both government and industry and comes in response to a mandate set forth in the Cybersecurity Act of 2015. The publication identifies five current and most relevant cybersecurity threats facing the health care industry. These include: 1) e-mail phishing attacks; 2) ransomware attacks; 3) loss or theft of equipment or

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data; 4) insider, accidental, or intentional data loss; and 5) attacks against connected medical devices that may affect patient safety. To best mitigate these threats, the publication recommends that health care providers of every size develop and implement the following ten broad cybersecurity practices:          

E-mail protection systems Endpoint protection systems Access management Data protection and loss prevention Asset management Network management Vulnerability management Incident response Medical device security Cybersecurity policies

Recognizing the disparity in health care provider size, complexity and resources, the publication includes two technical volumes geared for IT professionals, one addressing these ten cybersecurity practices, along with a number of possible sub-practices, for small health care providers, and one addressing these ten cybersecurity practices for medium to large health care providers. Health care providers of all sizes should review this publication, including its technical volumes, in detail to ensure they are familiar with and understand the best practices for their particular organization. Although these are voluntary practices, the cybersecurity threat to health care providers is constant and ever increasing. Implementing best practices and procedures is instrumental in protecting your organization from a cyber-attack. For more information on the Health Industry Cybersecurity Practices: Managing Threats and Protecting Patients, please visit https://www.phe.gov/Preparedness/planning/405d/ Documents/HICP-Main-508.pdf. LawTalk is a monthly column by legal experts at Jackson Lewis, the firm for HCA’s general counsel. Please note that LawTalk articles are for general, informational purposes, are not legal “advice,” and do not create an attorney-client relationship. Because each case is unique, the information provided should be considered to be general in nature, and should never be considered a substitution for legal counsel. Readers should not take, or refrain from taking, any action based on information in this article without first seeking legal advice from competent counsel.

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Volume 4, No. 5 February 4, 2019 

Upcoming Deadlines and Due Dates Requirement/Change

Effective/Due Date

More Information

LHCSA Registration Process (part of 2017 LHCSA Statistical Report)

if not submitted by January 1, 2019, agency will not be able to operate or receive reimbursement from any source

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

Posting of OSHA Form 300A: Summary of WorkͲRelated Injuries and Illnesses

February 1 to April 30, 2019

https://www.osha.gov/recordkeeping/RKforms.html

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

Health and Medicaid Joint Legislative Hearing

February 5, 2019

https://nyassembly.gov/Press/files/20190115b.php

Webinar on Upcoming Emergency Preparedness Exercises

February 5, 2019 – 11 a.m. to noon

www.NYLearnsPH.com (search course catalog for OHEPͲ HEPCEXSͲ2019)

Webinar on Upcoming Emergency Preparedness Exercises

February 6, 2019 – 1 to 2 p.m.

www.NYLearnsPH.com (search course catalog for OHEPͲ HEPCEXSͲ2019)

HCA Advocacy Day

February 12, 2019

https://hcaͲnys.org/wpͲcontent/uploads/2019/01/2019ͲHCAͲ AdvocacyͲEventsͲRegistrationͲForm.pdf

Andryeyeva court case to be heard by New York State Court of Appeals

February 12, 2019

https://www.nycourts.gov/ctapps/courtpass/Docket.aspx (enter 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%20Registr ation%20of%20Licensed%20Home%20Care%20Services%20Age ncies.pdf

Interoperable Communications/Medical Countermeasures (IOC/MCM) exercise – Syracuse

February 27, 2019

megan.kash@health.ny.gov

IOC/MCM exercise – Western NY

April 4, 2019

Shaun.sharp@health.ny.gov

IOC/MCM exercise – Capital District

April 11, 2019

Maureen.casaleͲreidt@health.ny.gov

IOC/MCM exercise – Long Island

April 18, 2019

Drew.Fried@health.ny.gov

IOC/MCM exercise – Lower Hudson Valley

May 9, 2019

gyongyi.mcqueston@health.ny.gov

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

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Health Care Resources 

“Are Older Americans Getting the Long-Term Services and Supports They Need,” by the Commonwealth Fund https://www.commonwealthfund.org/sites/default/files/2019-01/ Willink_are_older_americans_getting_LTSS_ib.pdf



“The Financial Hardship Faced by Older Americans Needing Long-Term Services and Supports,” by the Commonwealth Fund http://www.nasuad.org/sites/nasuad/files/ Willink_financial_hardship_older_americans_LTSS_ib_0.pdf

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