February 11, 2019 Edition of The Situation Report

ANDRYEYEVA CASE

HCA AWARDS

INTEROPERABILITY

EP CHANGES

The State Court of Appeals is set tomorrow to hear a high-profile case concerning compensable hours for 24-hour home care.

Please nominate a stellar member of your staff or colleague for HCA’s Awards, which will be presented during our Annual Conference in May.

HCA is further examining a new CMS proposal requiring nocost patient access to electronic health information.

CMS has updated the state operations manual to clarify exemptions from required emergency preparedness drills when an agency has experienced a real emergency.

PAGE 4

PAGE 5

PAGE 10

PAGE 12

Your Source for HOME CARE News, Policy and Advocacy

Vol. 4, Issue 6 | February 11, 2019

UPCOMING PROGRAMS Upstate LHCSA Forum Feb. 19, 2019 (Utica) WCEI 5-Day Onsite Skin and Wound Management Course March 4-8, 2019 (Herkimer, NY) WEBINAR: Understanding How to Run and Interpret CASPER Reports March 6, 2019 Downstate LHCSA Forum March 6, 2019 (NYC) Senior and Financial Managers Summit March 19, 2019 (Troy)

Policy Council and PAC Today, Lobby Day Tomorrow, and Your Commitment to Advocacy All Provide Vital Connections The next two days bring a strong course of HCA state advocacy, strategy and problemsolving efforts: first, our Policy Council and Board of Directors Meeting today; second, a Political Action Committee (PAC) reception this evening; and third, a culminating State Lobby Day tomorrow afternoon, when HCA’s Board and member leaders will meet with key Executive, Senate and Assembly offices.

See CONNECTIONS p. 2

Health Care Facility Transformation Awards Announced The state Department of Health (DOH) last week announced awards for the second phase of the Statewide Health Care Facility Transformation Program (SHCFTP).

The awards are posted at https://www.governor.ny.gov/news/governor-cuomo-announces204-million-funding-strengthen-and-preserve-access-high-quality-health. They include five home care providers, four of which are HCA members.

See AWARDS p. 4 Editor’s Note: HCA’s offices will be closed Monday, February 18, for President’s Day. We will publish next week’s edition of The Situation Report on Tuesday, February 19.

INSIDE Policy Council and PAC Today, Lobby Day Tomorrow..........................................1 Health Care Facility Transformation Awards Announced…...............................1 Member Hiring Announcements.....................................................................3 Andryeyeva Case on Tomorrow’s Court of Appeals Docket..................................4 CMS Announces January Home Health Compare Quarterly Refresh…...............5 2019 HCA Award Nominations Now Accepted…...............................................5 Webinars Held on Upcoming Emergency Preparedness Exercises….................6 Upcoming Deadlines and Due Dates…....................................................8

Emergency Preparedness Survey Available….............................................9 CMS Issues Medicare Home Health Billing Requirements Reminder….......9 CMS Proposal: Patients Must Be Allowed EHI Access at No Cost…...............10 New HCA Webinars on CASPER Reports, Documentation, ICD-10….............10 Guidance Issued on Treatments of ‘Exception’ Trusts…..............................11 CMS Issues Revised State Operations Manual on EP…................................12 CMS to Host Home Health Quality Reporting In-Person Program.................13 Health Resources…...............................................................................13

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

CONNECTIONS from p. 1 To set the stage for this effort, HCA last week held an Advocacy Essentials webinar for members that offered a preview of HCA’s advocacy positions for tomorrow and throughout budget negotiations. The session also offered some tips, process definitions and other insights to help demystify the advocacy process and, ultimately, cultivate members’ participation in the government-relations advocacy arenas throughout the course of this current state budget process and beyond.

All State Legislative offices have already received HCA’s core lobby day materials for tomorrow. These include our five-point State Budget Priorities sheet (https://hca-nys.org/wp-content/ uploads/2019/02/2019-20-State-Budget-Priorities.pdf) and our Financial and Program Trends report (https://hca-nys.org/wpcontent/uploads/2019/02/HCA-Financial-Condition-Report2019.pdf), which analyzes key metrics like operating margins, accounts receivable days outstanding, staff turnover rates and vacancies, and other data for New York’s home care, hospice and MLTC sectors.

Together, these documents make concrete legislative budget recommendations – on sustainable financing, modification of long term care provisions in the budget, workforce support, infrastructure and the leveraging of community care cost savings – while providing evidence to support the merit of these recommendations and asks.

Please see both reports for critical background on HCA’s advocacy requests that you can help convey in the coming weeks. The Budget Priorities document identifies specific provisions, areas of law, or existing investment programs that should be rejected, amended, or further leveraged and enhanced to help facilitate the statutory changes necessary for home care, hospice and MLTC support in this year’s budget process.

If you are not able to join us in Albany for this week’s events, please consider a donation to the HCA PAC which plays a vital role in supporting champions of home care in the state Legislature (https://hca-nys.org/advocacy-pac/pac). Please also

Volume 4, No. 6 February 11, 2019 

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 V ice 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

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

2

Teresa Brown Administrative Assistant tbrown@hcanys.org

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

Volume 4, No. 6 February 11, 2019 

be ready for instructions on how you can conduct grassroots advocacy at the district level with your elected officials.

HCA, Coalition Continue United Front on Infrastructure Funds Meanwhile, HCA and eleven partner organizations are continuing our call for proportionate investment of windfall funds from the sale/for-profit conversion of Fidelis Care to Centene.

In a letter and draft legislative language shared with the Legislature this week, the group reiterates that the state has used its transformation fund program to allocate $675 million in proceeds from the Fidelis-Centene sale for most hospitals and nursing homes, but home and community based providers are neglected in this allotment.

“Going forward, we urge the State to allocate funds from this account to include substantial investment in community-based providers and the intensifying workforce crisis that threatens the stability of communitybased care,” the group writes, calling for a 25 percent allotment to community-based care, including home care. The letter can be read at https://hca-nys.org/wp-content/uploads/2019/02/CBOs-letter-2-11-19.pdf.

HCA will provide additional grassroots advocacy action items in follow-up to this week’s events.

HIRING Director of Patient Services Lourdes Home Care Description: Lourdes is looking for a Director of Patient Services for our home health and hospice (home care) program. The director will work with a robust team of experienced clinical managers to guide the strategic direction and growth of the home care program. Focus will include collaboration with the Lourdes Palliative Medicine Program and with other community based programs offered at Lourdes and in the community at large. The director will be responsible for the achievement of clinical/quality and financial goals, as well as maintaining a culture of safety and accountability. Both programs are growing, and we attribute that to low turnover and effective leadership. We are looking for a leader who will embrace shared governance and the principles of servant leadership.

The ideal candidate is a registered professional nurse, with a minimum of 5 years' experience in home care and at least two years of experience in leadership/management. A Master’s degree or combination of Bachelor’s degree and experience preferred.

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: Lourdes Home Care is a Certified Home Health Agency and Hospice that provides mission-based care to patients across Broome, Tioga, Chenango, and Delaware counties. Lourdes continues our 90+ year legacy of serving individuals in our community as part of Ascension, the largest nonprofit health system in the U.S and world’s largest Catholic health system. As a part of this system, Lourdes is able to access resources, tools, and best-practices from Ascension ministries across the country.

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 community-based 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.

If you’d like additional information, please contact Ann Fattarusso, our Lourdes Ascension Recruiter: ann.fattarusso@ascension.org; m: (607)206-5839.

To apply, please visit our website at: https:// www.besmith.com/job-details/farmingdale-new-yorkhome-health-1256636/.

3

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

Volume 4, No. 6 February 11, 2019 

AWARDS from p. 1 While the amount that was granted to home care providers (about $12.2 million of $203.5 million, or 6 percent) is higher than the amount given to home care entities in the first phase (which was less than 1 percent), this is still an inadequate amount and HCA continues to advocate that a higher portion of this program be allocated to home care, hospice, Managed Long Term Care and other community health care providers.

The proposed 2019-20 Executive State Budget allocates up to $300 million (of the $525 million) from State Fiscal Year (SFY) 2018-19 funds to applications already submitted under Phase II of SHCFTP. Awards would have to be distributed no later than May 1, 2019. In addition, the proposed budget includes a Request for Proposals to be issued for the remaining $225 million under SHCFTP Phase III. SHCFTP, administered by DOH, is intended to help support the goals of the Delivery System Reform Incentive Payment (DSRIP) program, which aims to reduce hospital inpatient costs and improve outcomes across the state. HCA has advocated for years that the state set aside funding specifically for home and community based providers in order to increase capital to support caring for patients in their homes and communities, and out of the hospital. During last year’s budget negotiations, we succeeded in obtaining increased targeted funding for home and community-based care.

As part of this year’s advocacy, HCA is also advocating that home care and hospice be included in any funding pool allocations from the conversion of Fidelis to Centene. (See our two-page budget advocacy priorities sheet for more information at https://hca-nys.org/wp-content/uploads/2019/02/2019-20-StateBudget-Priorities.pdf; see also the p. 1 story.) To date, these funds have been targeted to institutional providers.

Andryeyeva Case on Tomorrow’s Court of Appeals Docket As previously reported, the Andryeyeva v. New York Health Care, Inc. case concerning 24-hour/live-in services is on tomorrow’s February 12, 2019 docket for arguments before the New York State Court of Appeals, the state’s highest court.

HCA has covered this case extensively, including this appeal. Most recently, HCA filed an amicus brief in support of the industry. We will provide updates from tomorrow’s oral arguments in a follow-up communication. A decision in the Court of Appeals case is expected within 30 days of the oral arguments.

At issue is the fate of the state Department of Labor’s (DOL’s) “13-hour standard” for determining compensable hours when an aide works a 24-hour/live-in shift.

This “13-hour standard” for compensable hours has traditionally applied, and been mandated by DOL, for such shifts as long as the aide receives 8 hours of sleep, 5 of which are uninterrupted, and 3 hours for meals.

DOL issued an emergency regulation codifying the “13-hour standard” beginning in October of 2017, though this emergency regulation was recently vacated by the state Supreme Court. As DOL noted in its regulatory impact statement, the rule’s purpose was to “preserve the status quo, prevent the collapse of

4

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

Volume 4, No. 6 February 11, 2019 

the home care industry, and avoid institutionalizing patients who could be cared for at home, in the face of recent decisions by the State Appellate Divisions.”

HCA has worked extensively in our advocacy on the “13-hour rule” for 24-hour/live-in cases, including: our calls for affirmation of the DOL and state Department of Health (DOH) guidance and support; submitting comments on DOL’s emergency rule; testifying in support of DOL’s emergency rule at a hearing in July of this year; submitting amicus briefs in the Andryeyeva case and other important cases that challenged the 13hour standard; and holding member briefings and education programs on this vital provider and patient issue.

To read the docket filing and related documents, including HCA’s amicus, visit the Court of Appeals website (at https://www.nycourts.gov/ctapps/courtpass/Docket.aspx) and enter the APL number 2018-00038.

CMS Announces January Home Health Compare Quarterly Refresh The January 2019 quarterly Home Health Compare refresh is now available at https://www.medicare.gov/ homehealthcompare/search.html. It includes new quality measure results based on data submitted to the U.S. Centers for Medicare and Medicaid Services (CMS).

In addition to the Home Health Quality Reporting Program (HHQRP) measures previously displayed on Home Health Compare, the following four quality measures are newly reported on Home Health Compare. 

Assessment-based measures: 1) “Percent of Residents or Patients with Pressure Ulcers that Are New or Worsened (Short Stay)” (NQF#0678); and 2) “Drug Regimen Review Conducted with Follow-Up for Identified Issues.”



Claims-based measures: 1) “Medicare Spending Per Beneficiary-Post Acute Care HHQRP”; and 2) “Discharge to Community-Post Acute Care HHQRP.”

CMS has decided not to publish a 5th quality measure, “Potentially Preventable 30-Day Post-Discharge Readmissions,” at this time, as CMS seeks to further test the measure and ensure its dependability as an accurate picture of provider quality.

Additional information can be found on CMS’s HHQRP website at: https://www.cms.gov/Medicare/QualityInitiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/index.html.

2019 HCA Award Nominations Now Accepted HCA has opened the nomination process for our 2019 Annual Awards!

Last year, we had a record audience at our awards ceremony. We hope to bring the same spirit to this year’s ceremony, with a packed room recognizing your staff – and their achievements on behalf of your organization – during a special reception at HCA’s Annual Conference, on May 8-10.

We invite HCA members to make nominations for our mainstay Caring and Advocacy awards, as well as our highest recognition, the Ruth F. Wilson Award.

Continued on next page

5

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

Volume 4, No. 6 February 11, 2019 

Continued from previous page Also, for the second year in a row, we are also seeking applications for the Triple-Aim Home Care Quality & Innovation Award and the Physician Home Care Champion Award.

These awards are a great way to recognize your team, draw attention to the work your organization does on behalf of patients, and celebrate colleagues or exemplary system partners.

To make a nomination for any of these five award categories, please read the instructions posted to our online form at https://www.surveymonkey.com/r/2019-HCA-Awards. As you scroll to page two of this online form (by clicking “next” after the instructions), you will find detailed descriptions of the award categories as well as space to provide background for your nomination.

Nominations are due by March 28.

If you have any questions or would like to e-mail your nomination directly to HCA, please contact Jenny Kerbein at jkerbein@hcanys.org.

Webinars Held on Upcoming Emergency Preparedness Exercises The state Department of Health (DOH) held two similar webinars last week with information about upcoming emergency preparedness exercises. These upcoming exercises include Coalition Surge Test (CST), Medical Countermeasure (MCM) and Interoperable Communications (IOC) drills. These drills will be held for agencies outside of New York City.

The handouts are at https://hca-nys.org/documents/Integrated%20Exercise%20Nonacute%20Partners%20Webinar%20FINAL.pdf. An audio recording of one of last week’s webinars is at https://meetny.webex.com/meetny/lsr.php?RCID=2fa989655d0447c4a64ded6579025d40.

Your involvement in these drills/exercises can count toward meeting one of the federal and/or state emergency preparedness requirements. Those who do participate must also complete an After Action Report (AAR) for the IOC drill in order to meet the requirements. The AAR is retained by the agency for three years and not sent to DOH, but must be available for review by DOH surveyors.

A blank AAR is at https://hca-nys.org/wp-content/uploads/2019/01/AAR-IP_Template-IOC-DrillSAMPLE.docx. A sample completed AAR is at https://hca-nys.org/wp-content/uploads/2019/02/AARIP_Template-IOC-Drill-SAMPLE.pdf.

CST Drill The CST drill will involve a simulated emergency where up to three hospitals have to evacuate patients to other settings, including home care. The purpose of the drill is to test the ability of “evacuating” hospitals to assess which patients can be “decompressed” – that is, discharged home, discharged home with home care, discharged and admitted to a nursing home and/or transferred to a “receiving” facility. The “receiving” hospitals will determine the number of beds available for patients evacuated from other facilities and which patients can be decompressed to free up additional beds.

Continued on next page

6

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

Volume 4, No. 6 February 11, 2019 

Continued from previous page DOH regional office staff will notify certain staff roles in the Health Commerce System (HCS) Communications Directory about the drill, so it is vital to keep your HCS directory listings up-todate. 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 drill will last 90 minutes even though hospitals will be allowed to participate past that time.

The drill will be followed by a facilitated discussion to discuss issues that arose during the drill. 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

MCM and IOC Drills While the MCM drill is for local health departments and involves an anthrax outbreak, home care, hospice and other providers can participate in an IOC drill held in conjunction with the MCM. For this drill, DOH regional offices will send agencies an Integrated Health Alerting and Notification System (IHANS) message regarding an anthrax outbreak. The drill alert will be sent to certain individuals in the HCS Communications Directory, not by e-mail directly to agencies.

Agencies will be asked to click on a link in the IHANS message to a Health Electronic Response Data System (HERDS) survey and to submit the survey. The IHANS notice will go out 90 minutes prior to the drill, and providers will have 60 to 90 minutes to complete the survey.

The IOC drill is intended to demonstrate the ability to use a primary and back-up communications system (internet, including Voice over Internet Protocol/VOIP, radio, cellular and satellite phone) to communicate with coalition partners (local health departments, hospitals, police, fire, EMS, local emergency management officials, and others).

The MCM/IOC drills are scheduled for the following dates:     

Feb. 27: Central NY April 4: Western NY (Buffalo and Finger Lakes) April 11: Capital District April 18: Long Island May 9: Lower Hudson Valley

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.

7

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

Volume 4, No. 6 February 11, 2019 

Upcoming Due Dates and Deadlines Requirement/Change

Effective/Due Date

More Information

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

February 1 to April 30, 2019

https://www.osha.gov/recordkeeping/RKforms.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 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%20Registration% 20of%20Licensed%20Home%20Care%20Services%20Agencies.pdf

Upstate LHCSA Forum

February 19, 2019

https://hcaͲnys.org/wpͲcontent/uploads/2019/01/HCAͲUpstateͲLHCSAͲ ForumͲFebruaryͲ19ͲRegistrationͲForm.pdf

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

February 27, 2019

megan.kash@health.ny.gov

Annual Wage Parity certification forms due to state Department of Health from CHHAs, LTHHCPs and Managed Care Organizations

Due March 1, 2019 for period of March 1, https://www.health.ny.gov/health_care/medicaid/redesign/2016/2016Ͳ 02Ͳ17_wage_parity_alert.htm 2019 to February 29, 2020

Quarterly Wage Parity certification forms due from LHCSAs and CDPAP FIs to contracted CHHAs, LTHHCPs and Managed Care Organizations

Due March 1, 2019 for https://www.health.ny.gov/health_care/medicaid/redesign/2016/2016Ͳ period of March 1, 02Ͳ17_wage_parity_alert.htm 2019 to May 31, 2019

Downstate LHCSA Forum

March 6, 2019

https://hcaͲnys.org/wpͲcontent/uploads/2019/02/MarchͲ6ͲDownstateͲ LHCSAͲandͲHCCͲForumͲRegistrationͲForm.pdf

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) April 1, 2018 to or new Medicare Beneficiary December 31, 2019 Identifier (MBI)

8

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

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

Volume 4, No. 6 February 11, 2019 

Emergency Preparedness Survey Available The U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE) is examining the current role of home health and hospice agencies in supporting the health and medical response to disasters or emergencies.

ASPR TRACIE is conducting a 15-minute anonymous online survey, open to home health and hospice agencies across the country, to learn about capacity, willingness, and preparedness to respond and impediments to participation. See:https://www.surveymonkey.com/r/TRACIEHome-Hospice.

The survey is voluntary and confidential. Unless you participate in a follow-up phone interview, HHS will not ask for any personal information.

The deadline to complete the survey is March 7.

Questions can go to askasprtracie@hhs.gov.

CMS Issues Medicare Home Health Billing Requirements Reminder As previously reported in December, there are new billing requirements for all home health agencies beginning January 1, 2019. Specifically, Change Request 10782 (https://www.cms.gov/Regulations-andGuidance/Guidance/Transmittals/2018Downloads/R4106CP.pdf) requires that home health agencies put value code 85 on all claims, not just rural claims.

The U.S. Centers for Medicare and Medicaid Services (CMS) clarified this in a Home Health and Hospice Open Door Forum on November 14, 2018.

Specifically, CMS stated said that “claims for episodes ending in 2019 must include the new value code 85 and report the Federal Information Processing Standard Publication (FIPS) state and county code for the beneficiaries in the associated value amount.”

The following are some key points to know: 

CMS requires both value code 85 and 61, which reports the CBSA code for the beneficiary. Value code 61 will continue to be used to adjust (i.e. weight) the home health agency’s payment. Value code 85 will be used to determine the category of rural add-on that applies.



When value code 85 is not on the claim for use in rural payment calculations, the claim will be returned to the provider, so they can add the code and resubmit.

CMS is reminding home health agencies that ALL claims, whether rural or not, must include the value code 85 and corresponding FIPS code. CMS edits will only return to providers those claims that do not contain the value code 85 when it is a claim where the rural add-on applies; however, just because a claim processes

9

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

Volume 4, No. 6 February 11, 2019 

through the CMS system does not mean it is compliant. Home health agencies run the risk of having the claim denied if all required information is not included.

The FIPS codes can be found at https://www.census.gov/geographies/reference-files/2017/demo/popest/ 2017-fips.html.

When viewing the FIPS code, providers will notice that the most recent version is dated 2017. When updates are made, CMS posts them at http://www.nber.org/data/ssa-fips-state-county-crosswalk.html and providers should always use the most current version.

CMS Proposed Rule: Patients to Be Allowed Health Electronic Information Access at No Cost A new proposed rule by the U.S. Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health would require that a patient be able to access electronic health information at no cost.

The proposal specifically requires that Medicaid, the Children’s Health Insurance Program, Medicare Advantage and qualified plans in the health exchanges must provide “immediate” electronic access to medical claims and other health information electronically by 2020.

According to a press release on the proposal, CMS would also publicly report providers that “unreasonably limit the availability, disclosure, and use of electronic health information,” known as “information blocking.”

CMS is also calling on the health care industry to adopt standardized application programming interfaces (APIs) that help allow individuals to securely access certain Electronic Health Records.

The proposal is available at https://www.cms.gov/Center/Special-Topic/Interoperability/CMS-9115-P.pdf. Once published in the Federal Register, stakeholders have a 60-day period to submit comments.

HCA will be examining the proposal in more detail to determine its precise applicability to home care, hospice and MLTC providers, including the delineation of responsibilities among providers and payors, as well as the relationship of these proposed interoperability standards with existing state health information technology infrastructures like the Qualified Entities (also known as Regional Health Information Organizations).

New HCA Webinars on CASPER Reports, Clinical Documentation, ICD-10 & More HCA’s education page is chock full of brand-new offerings, including four just-posted webinar programs and several on-site sessions, all coming up in March through the first half of 2019.

Don’t forget to check out our education page for the full array of upcoming offerings that come at a discount or exclusively for HCA members. The programs listed on the next page are for members and nonmembers alike.

Continued on next page

10

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

Volume 4, No. 6 February 11, 2019 

Continued from previous page These and other programs are on HCA’s education page at https://hca-nys.org/events-education/upcomingevents. Please bookmark this link and check it regularly for new topics, conferences, programs and other learning opportunities.

March 6 Webinar: Understanding How to Run and Interpret CASPER Reports CASPER reports are the foundation for Home Health Compare and other reported measures that can help with your outcomes and self-auditing. Get tips on how to run and utilize them.

March 25-26 (Holyoke, MA) and March 28-29 (Lawrence, MA): Hospice and Palliative Nurse Certification In partnership with the Home Care Alliance of Massachusetts, we invite your hospice nurses for a two-day course delivered via multi-media tools, handouts and lectures, individual and group exercises. The goal: promote and review the special knowledge of hospice nursing care for nurses taking the nurse certification or continuing education.

April 11 Webinar: Clinical Documentation Improvement (CDI) A robust CDI program is fundamental to your success under the Patient-Driven Groupings Model (PDGM). This webinar is a must for administrators, compliance officers, clinical management, billers/coders, OASIS reviewers and your medical records team to better utilize CDI strategies and achieve better outcomes.

April 18 Webinar: Lessons Learned from Home Health Value-Based Purchasing (HHVBP) Learn the different methods that HHVBP-participating agencies have used to increase their performance scores and corresponding improvements in OASIS measures or HHCAHPS scores.

May 4, 9, 16, 23: 4-Part ICD-10 Coding Webinar Series With a 64 percent increase in case-mix categories under PDGM (totaling 432 possible case-mix-adjustedgroups), coders need to be prepared and ready for: the coding of comorbidities; understanding the complexities of wound coding; and correctly coding for dementia, Alzheimer’s and other cognitive deficits. This four-part series covers all of these issues.

Guidance Issued on Treatments of ‘Exception’ Trusts The state Department of Health (DOH) has issued a General Information System (GIS) notice to local departments of social services (LDSS) clarifying the treatment of income placed in “exception trusts.” It informs districts of an additional insert (“Explanation of the Effect of Trusts on Medicaid Eligibility,” OHIP0119) that must be included with excess income notices. This insert explains generally the effect of trusts on an applicant/recipient’s Medicaid eligibility.

The GIS is at https://www.health.ny.gov/health_care/medicaid/publications/pub2019gis.htm (see 19 MA/04).

Exception trusts are required to be disregarded as available income and resources for the purposes of determining Medicaid eligibility. They include “special needs trusts” (sometimes referred to as “supplemental needs trusts”) and pooled trusts.

Continued on next page

11

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

Volume 4, No. 6 February 11, 2019 

Continued from previous page The guidance describes each type of trust and includes the new form that must be given to applicants.

Home care members whose patients have one of these trusts may want to review this guidance.

More information on trusts, including a list of pooled supplemental needs trusts, is at http:// www.wnylc.com/health/14/.

CMS Issues Revised State Operations Manual on EP Last week, the U.S. Centers for Medicare and Medicaid Services (CMS) issued a revised State Operations Manual (Appendix Z) that includes some changes to the emergency preparedness requirements for home care and hospice providers.

The revised Appendix Z includes a letter to State Survey Agency Directors and is at https:// www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/ QSO19-06-ALL.pdf.

The revisions include: 

Addition of “emerging infectious diseases” (EIDs) to the definition of an “all-hazards” approach so that home care, hospice and other health care providers need to conduct an all-hazards approach that includes EIDs which consist of Influenza, Ebola, Zika Virus and others.



Clarification that an actual emergency event or response – if it requires activation of the relevant emergency plans due to the event’s magnitude – meets the annual exercise requirement and exempts the facility for engaging in a community-based full-scale exercise or individual, facilitybased mock disaster drill for one year following the actual event.



Clarification that if an agency activates its emergency plan twice in one year, then it would be exempt from both kinds of exercises (community-based full-scale exercise and the secondary exercise-individual, facility-based mock disaster drill, table top exercise) for one year following the actual events.



Changes to the home health agency citations from 482.22 to 484.102.

As described in many past communications, the federal emergency preparedness rule, effective November 15, 2017, requires home health and hospice providers to develop, maintain, and update annually: an emergency preparedness plan; policies and procedures; communications plan; and training and testing.

In September 2018, CMS proposed regulatory relief in a number of areas, including the following preparedness requirements: the annual review of emergency preparedness programs; documentation of cooperation efforts; annual emergency preparedness training programs; and annual testing. HCA submitted comments (https://hca-nys.org/wp-content/uploads/2018/11/CMS-Proposed-RegulatoryRelief_092018_HCA-comments.pdf) and awaits CMS’s determination on any final relief measures.

For more information, contact Andrew Koski at akoski@hcanys.org or (518) 810-0662; or Alyssa Lovelace at alovelace@hcanys.org or (518) 810-0658.

12

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

Volume 4, No. 6 February 11, 2019 

CMS to Host Two-Day Home Health Quality Reporting In-Person Program The U.S. Centers for Medicare and Medicaid Services (CMS) is hosting a two-day in-person Home Health Quality Reporting Program (QRP) “Train the Trainer” event for providers on March 5 and 6 in Baltimore.

It will provide home health agency training staff with information about the Home Health QRP and associated changes between the OASIS-C2 and the OASIS-D that became effective, January 1, 2019.

Registration is at: https://www.eventbrite.com/e/home-health-quality-reporting-program-provider-trainingregistration-55238498837.

Topics will include Section J on Health Conditions; Section GG on Functional Abilities and Goals; the Pressure Ulcer/Injury Quality Measure (M1311); and the Drug Regimen Review Quality Measure.

It will also include an interactive session on the use of reports to identify opportunities for process improvement and utilize information contained in the Certification and Survey Provider Enhanced Reports (CASPER) system to develop quality improvement plans.

Registration is limited to 250 people. CMS has negotiated a discounted room rate of $149 per night with the hotel for a limited number of rooms. To receive the room discount, you must make hotel reservations by 5 p.m. on February 22 following instructions sent to you in your registration confirmation.

Certificates of completion will only be available for those who attend the training in person; however, a webcast URL will be provided prior to the event.

Health Resources 

“International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs),” by the U.S. Centers for Medicare and Medicaid Services https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2019-Transmittals-Items/ R2243OTN.html?DLPage=1&DLEntries=10&DLSort=1&DLSortDir=descending



“Spotlight: Older Americans Act,” by the AARP Public Policy Institute https://www.aarp.org/content/dam/aarp/ppi/2019/02/older-americans-act.pdf

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

13