March 4, 2019 Edition of The Situation Report

CAPITOL REPORT

MANAGED CARE MEETING

LHSCA, SEPSIS BILLS

SCHEDULING RULE

The third edition of HCA’s legislative newsletter outlines HCA’s core state budget asks, workforce shortages, and a study on supportive housing.

Managed care rate meeting discusses impact of budget, 30-day amendments on methodologies.

The Senate has passed a bill allowing exceptions to the LHCSA moratorium.

Also, HCA’s sepsis bill was reported out of Health Committee.

The state Department of Labor is suspending a proposal for on-call pay and other scheduling circumstances after industries, like home care, showed it to be impracticable.

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Your Source for HOME CARE News, Policy and Advocacy

UPCOMING PROGRAMS 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) Hospice and Palliative Nurse Certification March 25-26, 2019 (Holyoke, MA) March 28-29, 2019 (Lawrence, MA) WEBINAR: Clinical Documentation Improvement (CDI) April 11, 2019

Vol. 4, Issue 9| March 4, 2019

HCA Unleashes Series of Grassroots State Budget Advocacy Campaigns: Act Now! In a week of vigorous HCA budget outreach to the state Legislature, HCA is enlisting members to fire out grassroots advocacy messaging through a series of four action campaigns posted on our Legislative Action Center.

If you have not participated in these campaigns yet, please do so now. All members must act on these budget priorities. Just click here: https://p2a.co/CrvM1NC. See GRASSROOTS p. 2

In Hill Visits, HCA Presses PDGM Fix and Key Home Care Supports HCA President Al Cardillo, Vice President Patrick Conole, and HCA Washington consultant Brett Heimov (Envision Strategies) met individually with seven key Congressional offices last week to urge their co-sponsorship of legislation to eliminate $1 billion of advance cuts embedded in the new federal Patient Driven Groupings Model (PDGM).

HCA has already reported to you on the specifics of S.433, a bill that would rework the prospective “behavioral adjustment” from PDGM and, instead, require that any such See HILL p. 5

INSIDE HCA Unleashes State Budget Advocacy Campaigns…....................................1 In Hill Visits, HCA Presses PDGM Fix, Other HCA Priorities, Concerns…...........1 Feb. Capitol Report: NYS Budget, Workforce Focus, Selfhelp Study….............3 Member Hiring Announcements…..............................................................4 Managed Care Plans, Associations, DOH Meet on Rate Setting....................6 DOH Meeting 2 on Future Integrated Care for Duals.....................................7 LHCSA Moratorium and Sepsis Legislation Gain Momentum...........................8 State DOL Employee Scheduling Rule Put on Hold.........................................9

Two Bills Would Extend MFP, Spousal Protections...................................10 Upcoming Deadlines and Due Dates.........................................................11 Population Health Summit Agenda Ripe for Home Care Participation......12 Healthcare Personnel Flu Vaccination Report Available Soon..................13 Next CST/MCM/IOC Exercises to be in WNY and Capital District.................13 CMS to Release MAC Satisfaction Indicator Survey in March....................15 NGS Advisory Meeting Yields Key Hospice Updates..................................16 Medicare Fee-for-Service Forms for Changes in Home Health Services.....16 CMS Webinar on Submitting Cost Reports Electronically..........................17 Health Resources................................................................................17

The Situation Report: the Home Care Association of New York State GRASSROOTS from p. 1 In recent weeks, HCA presented the State Legislature with a mark-up of the Article VII state budget bill to reflect our priorities, striking out harmful provisions, amending others and adding in new language.

These priorities are outlined in the four state budget advocacy campaigns on our Legislative Action Center, calling for: 

Rejection of across-the-board Medicaid cuts;

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Rate updates, a benchmark, transparency obligations upon the state, and unfunded mandate relief for providers and plans to help stabilize the home care and health plan system;

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The rejection of unnecessary and burdensome mandates or harmful program changes, like the National Provider Identifier requirement for home health and personal care aides, as well as the proposed repeal and replace of the Consumer Directed Personal Assistance program;

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Workforce support;

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The leveraging of public health/savings opportunities; and

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Addressing the financial implications of recent Medicaid MLTC plan closures by ensuring that payment obligations are met for service bills incurred by network providers.

HCA has communicated similar messages in our direct outreach to the Legislature and in our recent edition of the HCA Capitol Report where we further outline HCA’s priorities and asks. (See related p. 3 story.)

Lawmakers are just a month away from finalizing the state budget.

Soon, each house of the Legislature will release its budget proposals for the next stage of negotiations with the Governor’s office. The more that HCA members send messages, make calls and push for HCA’s budget amendments, the more likely it is that these proposals make it into a final budget agreement.

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

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Volume 4, No. 9 March 4, 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 Teresa Brown Administrative Assistant tbrown@hcanys.org

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Continued from previous page Revenue outlook Meanwhile, the Senate and Assembly majorities last week issued their economic forecasts, both projecting more optimistic revenues than are assumed in the Governor’s budget and 30-day amendments.

The Assembly’s forecast for the upcoming 2019-20 state fiscal year is $762 million above the Governor’s.

The Senate’s projections are $306 million above the Governor’s forecast for this period. Both houses also forecast higher receipts for the current state fiscal year (2018-19).

Nevertheless, the Governor’s 30-day amendments operate from a position of austerity – in the form of a 0.8-percent across-the-board Medicaid provider rate cut and the repurposing of unspent infrastructure funds for non-health care purposes – meaning that HCA’s proposals will require major grassroots support as the revenue picture and legislative budget priorities fall into place within a context of projected shortfalls.

We will keep the membership apprised of all important developments in this process.

February Capitol Report: HCA Budget Amendments, Workforce, Selfhelp Supportive Housing Model HCA has issued the February edition of our monthly Capitol Report, which was circulated last week to all state legislative offices. The Capitol Report is a new publication, begun in December, which highlights home care issues, bills, laws and trends of interest or direct relevance to lawmakers and their constituents.

This month’s issue details HCA’s proposed amendments to the state budget. We also present a focus section on workforce issues, including outcomes from a recent study showing the impact of RN shortages on pediatric home care cases, along with a description of HCA’s own workforce proposals.

HCA is also delighted to highlight the excellent findings of a study examining the work of HCA downstate member Selfhelp Community Services, Inc. whose supportive housing model is shown to have better outcomes and cost-savings than a comparison group, with average Medicaid hospitalization costs at one-half to two-thirds, among other findings.

You can read this latest edition of the Capitol Report here: https://tinyurl.com/y2drra7b. Archives are at https://hca-nys.org/hca-capitol-report.

If you have ideas for contributions to this newsletter, please contact HCA’s Communications Director Roger Noyes at rnoyes@hcanys.org. We are specifically interested in unique programs that resonate with core issues on our legislative advocacy agenda, such as addressing health disparities, chroniccare management, disease-management technologies, collaborative models, and similar topics.

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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/.

RN Director of Patient Services Fort Hudson Health Systems is looking for a Director of Patient Services for our Certified Home Health Agency. The Director will be responsible for the clinical direction and supervision of patient care services. The DPS will be a professional member of the health care team that provides oversight for the patient services provided by the agency and assures compliance with regulations.

Requirements: Bachelor’s degree, with at least 2 years of supervising community health experience, or 2 years of home care nursing experience plus a Master’s degree in a health-related field. Position may also serve as Administrator with additional experience.

Fort Hudson CHHA is an affiliate of Fort Hudson Health System, a not-for-profit multilevel health care and housing provider located in the Glens Falls region of New York. Fort Hudson provides a full range of services including skilled nursing, rehabilitation, adult day care, licensed home care, care management, senior housing and certified home health. For nearly five decades, Fort Hudson has maintained its reputation as an innovative, high quality, and compassionate provider of senior services. Our strength, stability and tradition within the community places Fort Hudson Health System at the forefront of healthcare providers throughout the entire region.

To apply, contact Elizabeth Parsons, Director of Human Resources, at eparsons@forthudson.com or 518-747-2811, ext. 264.

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HILL from p. 1 adjustments be based on actual, observed evidence. The bill would also limit the rate of behavioral adjustment reductions.

S.433 is currently introduced in the U.S. Senate, and it is in the process of being introduced in the U.S. House of Representatives. The current version of the PDGM model is set to go into effect in less than a year.

At the conclusion of each meeting, Congressional members were eager to support and co-sponsor the legislation.

HCA will keep the membership apprised of House introduction and the Senate status of the bill.

If you have not done so already, please write to your Member of Congress using HCA’s Legislative Action Center in support of this legislation. A campaign is already loaded for you online and ready for delivery at https://p2a.co/ 6edUDeQ. Read our position paper for further details at https://hca-nys.org/wp-content/uploads/2019/ 03/Protect-Medicare-Home-HealthReimbursement-Supporting-Seniors-S.433.pdf.

Additional Discussion Priorities HCA also discussed with the delegation additional HCA federal priorities and concerns for their consideration, such as: the findings and needs demonstrated in HCA’s “State of the Industry” report; the lack of parity and reimbursement adequacy in the Home Health Prospective Payment System (HHPPS) wage index; the Medicare rural add-on and rural agency needs; other elements of Medicare reimbursement and regulatory rigidity (including continuing challenges with the Face-to-Face requirement); the need for investment in home

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HCA Vice President Patrick Conole, left, and HCA President Al Cardillo, right, meet with Congressional Member Yvette Clarke.

care clinical and health information technology; and other issues.

The overall tenor of our meetings was extremely positive, with Congressional offices voicing recognition for the importance of home care’s key roles and benefits to citizens and to the health system overall.

In addition to our “asks,” HCA also described and offered ideas stemming from state-level home care and hospice initiatives that the delegation could consider in their federal actions to both support our work and to advance as part of national health policy. The delegation was extremely receptive to these concepts.

The delegation was especially engaged by our sepsis initiative. Every office expressed interest in researching further ways of support for New York’s initiative in this arena, and most also stated their interest in us working with them on Congressional bills to advance our model nationally. (See related p.

8 story for state-level legislative developments.)

Delegation offices were also interested in home care’s work on asthma management and in HCA’s

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proposals to address health care disparities through home care collaboration models with physicians, hospitals and other partners.

HCA will be following up with Senate and Congressional offices on next steps with PDGM, other federal priority areas, and on the delegation’s interest in supporting our public health innovations through home care. HCA will keep the membership apprised of further details of this work as well as member advocacy guidance.

HCA thanks the following Members and offices with whom we met, including our meetings with Reps. Tom Reed, Brian Higgins, Paul Tonko and Yvette Clarke, along with key staff from the offices of Senator Chuck Schumer, Senator Kirsten Gillibrand and Rep. Eliot Engel.

Managed Care Plans, Associations, DOH Meet on Rate Setting The State Department of Health (DOH) held a meeting February 27 to discuss rate setting developments with mainstream managed care plans, managed long term care plans (MLTCs), and state associations (including HCA) representing health plan members.

DOH presented updates on several upcoming rate packages: 

A package with adjustments for 2017-18.

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Two packages for 2016-17, one with adjustments for minimum wage, and another reflecting the home care worker recruitment and retention funding.

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A package for 2018-19 with the frozen risk score dated to June 2017.

Meeting participants asked whether the Governor’s 30-day budget amendments were impacting the rate methodologies, and DOH replied that no methodological impacts are anticipated.

DOH was further asked about the impact of the 0.8-percent across-the-board Medicaid cut proposed in the 30-day amendments, and whether DOH expected to apply this to the minimum wage funding. It does not appear as of this time that the cut would apply to the minimum wage amount.

Some plan representatives raised questions about how plan reimbursement to Fiscal Intermediaries (FIs) would be impacted by the Executive’s budget proposals, including the 30-day amendments. DOH reiterated the intent of the Governor’s proposal to reduce the administrative reimbursement to $100 per member per month; but this proposal remains subject to the outcome of budget negotiations with the Legislature.

Also raised was the possibility of consumers electing to migrate from the Consumer Directed Personal Assistance Program (CDPAP) to traditional care under the MLTC-Licensed Home Care Services Agency (LHCSA), accompanied by their Consumer Directed Personal Assistant if trained and employed by the LHCSA. Representatives from Deloitte, the state’s fiscal agent, provided an update on the MLTC alignment base data by MLTC region for the April 2019-2020 rate setting.

Continued on next page

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Continued from previous page Among the relevant points were: 

Representatives could not yet speak to what the care management payment would be.

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The 15 percent administrative cap, as well as the reduction attributable to the LHCSA contract limit, would be continued as an ongoing part of the program.

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A request was made to provide MLTCs with comparisons of the rates (with minimum wage adjustments excluded) for each year for 2017-18, 2018-19 and 2019-20, to give MLTCs and representatives the ability to see the extent of budget cuts over time.

A discussion ensued on the method of incorporating the home care worker recruitment, training and retention adjustment in the MLTC rates. DOH was asked whether the adjustment would be folded into the base or continue to be separate. DOH indicated that the Legislature has repeatedly rejected the Administration’s proposals to fold the adjustment into the base, which is why the Executive did not include the proposal again in this year’s budget.

Deloitte also presented data depicting preliminary draft MLTC cost and utilization trends for personal care/ CDPAP and home health care by region. Trends by region showed personal care/CDPAP utilization upward, and home health care downward.

Deloitte said it will be continuing the MLTC rate-setting processes throughout the year including program change adjustments such as to minimum wage, ongoing trend development, acuity factor and risk adjustment and non-benefit expenses.

DOH Meeting 2 on Future Integrated Care for Duals The state Department of Health (DOH) on February 28 held its second in a series of stakeholder meetings to discuss concepts and plans for the future of integrated care for dually eligible Medicare-Medicaid patients in New York State.

The Department is moving forward on plans to phase down and transition the Fully Integrated Dual Advantage (FIDA) plans into models aligned with Medicaid Advantage Plus (MAP) and Medicare Advantage plans.

The FIDA demonstration ends December 31, 2019. Currently, there are six FIDA plans remaining in operation: Centers Plan, Elderplan, RiverSpring, Healthfirst, Senior Whole Health, and the VNSNY plan.

Each of these plans also has a MAP aligned with a Dual Eligible Special Needs Plan (D-SNP). DOH’s plan is to transition current FIDA members into an affiliated MAP, subject to continued planning and approval by CMS, upon meeting financial, benefit and network tests.

Ultimately, DOH is seeking to continue its ongoing goal of enrolling dually eligible patients into fully integrated models, capturing broad benefits and aligning and/or merging programs as necessary. DOH has been most closely studying Minnesota’s model. There, the state and D-SNPs agree by contract to delegate

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both Medicaid and Medicare enrollments to a mutually agreed upon designated entity through a trading partner agreement (TPA) for integrated enrollment functions.

DOH provided stakeholders with a timeline and broad overview of its planned steps, while openly seeking and inviting ongoing stakeholder input on any and all dimensions of the discussions. The meeting slides, overview and timeline can be viewed at: https://health.ny.gov/health_care/medicaid/redesign/ integrated_care/.

HCA will be providing our agency and MLTC membership with all of the information and analysis possible not only to track and prepare, but to cultivate the Association’s fullest input in the Department’s thinking, planning and actions.

This state direction will have major implications at all levels, and for all sectors and participants in the health care system.

Stay tuned for major, upcoming focus on these state proposals.

LHCSA Moratorium and Sepsis Legislation Gain Momentum Last week, the New York State Senate passed legislation, S.1820 (Chair of the Senate Health Committee Senator Gustavo Rivera), amending the licensed home care services agency (LHCSA) moratorium statute that was included in the 2018-19 enacted state budget. The Assembly passed its version of the bill, A.976 (Chair of the Assembly Health Committee Assembly Member Richard Gottfried) on February 4.

The legislation would allow the state Commissioner of Health to provide exceptions to the LHCSA moratorium when he or she deems an application to be consistent with the state’s goals for consolidation and improving care delivery. The current restrictions of the moratorium language have needlessly blocked meritorious proposals. The LHCSA moratorium remains in effect until March 31, 2020.

Currently, there are only three exceptions for a LHCSA application to receive establishment approval or contingent approval by the Public Health and Health Planning Council (PHHPC):

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An application seeking licensure of a LHCSA that is submitted with an application for approval as an Assisted Living Program;

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An application seeking approval to transfer ownership for an existing LHCSA that has been licensed and operating for a minimum of five years for the purpose of consolidating ownership of two or more LHCSAs; and

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An application seeking licensure of a LHCSA where the applicant demonstrates to the satisfaction of the Commissioner of Health that submission of the application to the PHHPC for consideration would be appropriate on grounds that the application addresses a serious concern such as a lack of

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access to home care services in the geographic area or a lack of adequate and appropriate care, language and cultural competence, or special needs services.

The legislation must now be acted upon by the governor who has the authority to approve or veto the legislation. If approved, the new law would take effect immediately.

HCA will continue to monitor the status of the legislation, and update members as more is learned. To read the legislation, click here: https://www.nysenate.gov/legislation/bills/2019/S1820.

HCA’s Sepsis Legislation Gains Momentum in the Senate On Wednesday, February 27, the Senate Health Committee advanced HCA’s Sepsis legislation (see https:// www.nysenate.gov/legislation/bills/2019/s1817). The bill, S.1817 (Senator Gustavo Rivera)/A.3839 (Assembly Member John McDonald), was advanced to the Senate Finance Committee.

This legislation would specifically create a new article 36 section devoted to home care sepsis intervention that would authorize the state Department of Health to provide support for our statewide efforts in numerous ways. The scope would include support for prevention, screening, intervention and education.

Specific areas include: provider/clinician training; integration with electronic health records and vital information exchange; collaboration of key clinical partners; public education; and more. The bill would also authorize provider support in the form of grants or rate supplementation to assist in the program’s sepsis goals.

As previously reported in the Situation Report, the bill has received strong support from partners at the Sepsis Alliance who circulated a memo to the Legislature, saying the bill would “support a state and nationally groundbreaking sepsis initiative of the Home Care Association of New York State to screen, prevent, mitigate and educate about sepsis through the home care system,” adding that “NYS and HCA are first nationally to break the ground of utilizing the home care system to address sepsis.”

HCA is also seeking inclusion of this legislation in the state budget. To learn more about HCA’s sepsis initiative, please visit our Stop Sepsis at Home website at http://stopsepsisathomeny.org/.

State DOL Employee Scheduling Rule Put on Hold The state Department of Labor (DOL) last week announced that its proposed “Employee Scheduling” rule, will not be promulgated at this time, due to comments raised by HCA and other organizations who argued that the approach was impracticable to certain industries or sectors, like home care and hospice.

The rule, first proposed on November 22, 2017 and released with revisions on December 12, 2018, would have required employers to pay additional hours for “unscheduled shifts,” “cancelled shifts,” “on-call” and “call for schedule.” HCA had argued that the proposal was incompatible with how care at home is delivered, where hours are started, increased, decreased or eliminated due to reasons unique to home care and hospice and their patients, and beyond the control of the employer.

Continued on next page

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Continued from previous page DOL, in commenting on its decision not to pursue a final rule, said: “Based on extensive feedback in the subsequent comment period, it was clear the Department’s initial intent to support workers while being fair to businesses was viewed as a one-size-fits-all approach that was not appropriate for every industry.”

DOL added: “At this time, due to the constraints of the regulatory process, the best course of action is to let this process expire and re-evaluate in the future, likely in concert with the Legislature, which would have a broader authority and better legal standing than Department of Labor regulations alone to balance the various needs of workers, businesses and industries.”

When the rule was first proposed, and that proposal later amended, HCA submitted comments and spoke numerous times to DOL officials to describe how the rule was contrary to the operation of home care and hospice and would adversely affect the delivery of services. In addition, we submitted testimony for a state Senate hearing on the proposed rule, and provided education programs on the rules for members.

We thank DOL for listening to our concerns and we will seek to work with DOL and the Legislature on this issue.

Two Bills Would Extend Money Follows the Person Program and Spousal Impoverishment Protections A bipartisan group in Congress has introduced legislation extending one home care initiative for five years (“Money Follows the Person”) and making another policy permanent: spousal impoverishment protections under Medicaid home care.

The first bill is known as the EMPOWER Act or “Ensuring Medicaid Provides Opportunities for Widespread Equity, Resources.” The second bill is called the “Protecting Married Seniors from Impoverishment Act.” They were both introduced by Reps. Debbie Dingell (D) and Fred Upton (R) of Michigan, along with Kentucky Rep. Brett Guthrie (R).

Both of these policies were recently extended on a short-term basis in a bill signed by the President in February. That extender legislation allocated $112 million for Money Follows the Person (MFP) – the estimated cost of a three-month extension – and extends the Medicaid Spousal Impoverishment protection policy until March 31, 2019.

MFP allows certain Medicaid recipients to more seamlessly transition from a nursing home or institution back to a home setting. To be eligible, participants must be Medicaid beneficiaries residing in an institution for 90 days or more who then move to a “qualified residence in the community.” Once enrolled, the beneficiary is eligible for qualified home and community-based Long Term Services and Supports, among other services. The program began in 2005 and has supported an estimated 88,000 individuals.

Medicaid Spousal Impoverishment Protections allow for the protection of a large portion of a couple’s income and resources when one spouse needs Medicaid long-term care at home similar to the protections afforded couples when one spouse must enter an institution.

HCA will keep the membership apprised of the bills’ progress, along with possible Senate action or further developments with these measures.

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

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Upcoming Deadlines and Due Dates

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Requirement/Change/Meeting

Effective/Due Date

More Information

Posting of OSHA Form 300A: Summary of Work Related Injuries and Illnesses

February 1 to April 30, 2019

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

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

March 1, 2019 for period of March 1, 2019 to February 29, 2020

https://www.health.ny.gov/health_care/medicaid/redesign /2016/2016 02 17_wage_parity_alert.htm

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

March 1, 2019 for period of March 1, 2019 to May 31, 2019

https://www.health.ny.gov/health_care/medicaid/redesign /2016/2016 02 17_wage_parity_alert.htm

Downstate LHCSA Forum

March 6, 2019

https://hca nys.org/wp content/uploads/2019/02/March 6 Downstate LHCSA and HCC Forum Registration Form.pdf

Lower Hudson Valley Health Emergency Preparedness Coalition (HEPC) meeting

March 6, 2019, 9 a.m. to noon

https://www.nylearnsph.com/Public/default.aspx (registration)

Long Island Health Emergency Preparedness Coalition (HEPC) meeting

March 7, 2019, 9:30 a.m. to noon

https://www.nylearnsph.com/Public/default.aspx (registration)

North Country Health Emergency Preparedness Coalition (HEPC) meeting

March 7, 2019, 10 a.m. to 4 p.m.

Maureen Casale Reidy, MPH, Public Health Emergency Preparedness Representative, Capital District Region: maureen.casale reidy@health.ny.gov

Western NY Health Emergency Preparedness Coalition (HEPC) meeting

March 13, 2019, 8:30 a.m. to 3 p.m.

Awaiting registration link

Capital District Health Emergency Preparedness Coalition (HEPC) meeting

March 14, 2019, 10 a.m. to 4 p.m.

Maureen Casale Reidy, MPH, Public Health Emergency Preparedness Representative, Capital District Region: maureen.casale reidy@health.ny.gov

Finger Lakes Health Emergency Preparedness Coalition (HEPC) meeting

March 18, 2019, 9:30 a.m. to 4:30 p.m.

https://www.eventbrite.com/e/finger lakes all partners flap meeting tickets 56670504003

Coalition Surge Test (CST) Exercise for Western NY and the Capital District

Sometime between April 1 and April 12, 2019

Andrew Koski at akoski@hcanys.org or (518) 810 0662

IOC/MCM exercise – Western NY

April 4, 2019

Shaun.sharp@health.ny.gov

IOC/MCM exercise – Capital District

April 11, 2019

Maureen.casale reidt@health.ny.gov

Coalition Surge Test (CST) Exercise for Long Island

Sometime between April 15 and April 26

Andrew Koski at akoski@hcanys.org or (518) 810 0662

IOC/MCM exercise – Long Island

April 18, 2019

Drew.Fried@health.ny.gov

Coalition Surge Test (CST) Exercise for Lower Hudson Valley

Sometime between April 29 and May 10, 2019

Andrew Koski at akoski@hcanys.org or (518) 810 0662

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/New Medicare Card/index.html

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Volume 4, No. 9 March 4, 2019 

Population Health Summit Celebrates Agenda Ripe for Home Care Participation Last week’s Population Health Summit VI at the Empire State Plaza underscored just how important it is for home care to be visible, engaged and better understood by policymakers and partners as a solution for preventive health, beyond home care’s traditionally viewed long term care or post-acute functions.

The purpose of this year’s summit – attended by HCA’s Director of Program Research, Development and Policy Lauren Ford – was to deepen and extend the understanding of ongoing efforts in New York State that demonstrate effective collaboration between public health, health care and other sectors to advance population health.

Earlier this year, the state’s Public Health and Health Planning Council completed its updated Prevention Agenda for 2019-2024. This plan seeks to improve the health and well-being of all New Yorkers through state and local actions. New on the agenda is a ‘Health Across All Policies’ approach, calling on all state agencies to identify and strengthen their work’s positive impact on health. Also included is a renewed focus on ‘Healthy Aging’ to reflect New York’s designation as the first ‘Age Friendly State.’ The 2019-2024 agenda also builds on the five priority-specific action plans from previous agendas:     

Prevent Chronic Diseases Promote a Healthy and Safe Environment Promote Healthy Women, Infants and Children Promote Well-Being and Prevent Mental and Substance Use Disorders; and Prevent Communicable Diseases

The summit celebrated recent progress in each of these priority areas, exceptional programs that promote good health, and brought attention to how health and non-health agencies/organizations can utilize the Prevention Agenda to achieve community health goals and discover opportunities for further progress.

Programs that were profiled included those designed for the management of asthma, diabetes, arthritis and cardiovascular disease, as well as programs which address health disparities – all areas where HCA is seeking to raise the profile and participation of home and community-based providers.

Indeed, many of these efforts fall squarely in home care’s domain, as comprised in a series of HCA legislative proposals for: statewide adoption of our sepsis training and protocols; home care solutions to overcome health disparities; program models aimed at addressing social determinants of health, like our mental health/home-care collaboration program; and home care’s advances to address all of the main clinical drivers of potentially avoidable hospitalizations.

More information can be found at: https://www.health.ny.gov/prevention/prevention_agenda/2019-2024/docs/ship/nys_pa.pdf Contact information for local partners that can help support local Prevention Agenda activities is at: https://www.health.ny.gov/prevention/prevention_agenda/2019-2024/contacts.htm.

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

Volume 4, No. 9 March 4, 2019 

Healthcare Personnel Influenza Vaccination Report Available Soon HCA has been advised by the state Department of Health (DOH) that this influenza season’s Healthcare Personnel Influenza Vaccination Report should be available very soon.

It has been delayed due to a change in the reporting responsibilities of hospitals (not home care or hospice providers).

Under state regulations, home care and other health care providers are required to document the number and percentage of personnel vaccinated against influenza for the current season and this Vaccination Report is the vehicle for such data.

This year’s report, once released, is expected to cover personnel employed by or affiliated with your agency from October 1, 2018 through March 31, 2019. Your organization will be able to enter data once the report is open and then will be able to reenter data as often as necessary as personnel join and/or submit documentation of vaccination until the expected May 1 deadline.

This season’s Vaccination Report is expected to be the same as last year’s except for some nonsubstantive changes, such as new dates and revisions to the previous Frequently Asked Questions document will be revised.

The Report will be available via the Health Electronic Response Data System (HERDS) on the Health Commerce System (HCS).

HCA will notify members once the Report is available for data entry.

Next CST/MCM/IOC Exercises to be in Western New York and Capital District Western New York and the Capital District are next to undergo Coalition Surge Test (CST) and Medical Countermeasures (MCM)/Interoperable Communications (IOC) exercises similar to those held on February 21 and 27 in Central New York, as reported in the February 25 edition of the Situation Report.

The state Department of Health (DOH) has provided an approximate two-week window – April 1 to April 12 – during which the CST exercises will occur in these regions (dates for MCM/IOC exercises are below).

The CST drill involves 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.

DOH regional offices 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-to-date. Also, as the drill notification may come prior to when agencies officially open, home care and hospice providers must have

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

Volume 4, No. 9 March 4, 2019 

a system in place to accept, review and act on any notifications (e-mail and phone) that occur outside of their normal business hours.

For the CST held in Central New York, agencies started to receive e-mails and phone calls at about 7:30 a.m. and were asked to participate in a webinar at 8 a.m. and complete a survey by 8:30 a.m., with another survey following later that morning.

The drill was followed by a facilitated discussion with hospitals, HCA and other associations to discuss issues that arose during the drill.

The surveys were completed by 56 percent of the Certified Home Health Agencies and 52 percent of the Licensed Home Care Services Agencies.

Home care and/or hospice 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-Drill-SAMPLE.docx.

A sample completed AAR is at https://hca-nys.org/wp-content/uploads/2019/02/AARIP_Template-IOC-DrillSAMPLE.pdf.

CST exercises for other parts of the state outside of New York City (NYC) are expected to be held during the following periods:  

April 15 to 26: Long Island April 29 to May 10: Lower Hudson Valley

As agencies who serve NYC are not part of these drills, HCA has reached out to emergency preparedness officials in NYC to learn of any upcoming drills or exercises in which home care and hospice can participate.

Meanwhile, if your agency is involved in preparedness activities in NYC and know of any drills, please contact Andrew Koski at akoski@hcanys.org or (518) 810-0662.

MCM and IOC Drills In addition to the CST drills, a Medical Countermeasures (MCM) drill will be held for local health departments outside of NYC that involve an anthrax outbreak. Home care, hospice and other providers will be able to participate in an Interoperable Communications (IOC) drill held in conjunction with the MCM. For this IOC 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.

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

Volume 4, No. 9 March 4, 2019 

Continued from previous page The Central NY MCM/IOC exercise scenario was as follows: Al-jihan, an offshoot of al Qaida, has been threatening soft targets in the United States – including hospitals – with a release of weaponized anthrax. Several large hospitals in New York State have received credible threats and determined that they must evacuate their patients either to home or to other facilities. Within 24 hours of the threats, anthrax is detected in the counties’ public libraries. Local health departments have been directed to activate their County Staging Sites (CSS) to receive antibiotics for public Points of Dispensing (PODs).

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 HERDS survey for the Central NY MCM/IOC exercise asked: to which persons within an agency and outside the agency would the survey respondent share information about the exercise scenario; and which communication modalities would be used.

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

April 4: Western New York April 11: Capital District April 18: Long Island May 9: Lower Hudson Valley

In February, DOH held two webinars on the CST/MCM/IOC drills. The webinar handouts are at https://hcanys.org/documents/Integrated%20Exercise%20Non-acute%20Partners%20Webinar%20FINAL.pdf.

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.

CMS to Release MAC Satisfaction Indicator Survey (MSI) in March The U.S. Centers for Medicare and Medicaid Services (CMS) has announced recently that its Medicare Administrative Contractor (MAC) Satisfaction Indicator (MSI) survey will be sent to all Medicare providers this month.

The following are ways that New York’s MAC, National Government Services (NGS), has acted on past surveys: 

Numerous improvements to NGSConnex, the Interactive Voice Response (IVR) system and NGS’s website.

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Added crossover/supplemental insurer information to NGSConnex.

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

Volume 4, No. 9 March 4, 2019 

Continued from previous page 

Added Qualified Medicare Beneficiary (QMB) information to NGSConnex and the IVR.

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More YouTube educational videos.

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Additional training to Customer Service Representatives (CSRs) in NGS’s Provider Contact Center to increase their knowledge and reduce transfers to Tier 2 CSRs.

HCA encourages our Medicare provider members to complete CMS’s MSI upon request.

NGS Advisory Meeting Yields Key Hospice Updates HCA Vice President for Finance and Management Patrick Conole participated in a hospice advisory meeting last week with the state’s Medicare Administrative Contractor (MAC), National Government Services (NGS), which yielded important updates for the hospice membership.

The purpose of the meeting (for provider representatives in Jurisdiction 6) was to discuss important MAC issues, information, or developments, and for HCA and colleagues to pose questions or concerns on behalf of hospice providers.

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Medicare FeeͲforͲService Forms for Changes in Home Health Services

Form

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Reason

Form & Date

Link

Advance Beneficiary Notice of Noncoverage (ABN)

Given in situations where Medicare is not likely to provide coverage and payment would be denied

CMSͲRͲ131 (Expires 03/2020)

https://www.cms.gov/Medicare/MedicareͲGeneralͲ Information/BNI/Downloads/ABNͲFormsͲEnglishͲandͲSpanishͲInclͲ LargeͲPrint.zip

Home Health Change of Care Notice (HHCCN)

Covers planͲofͲcare changes when agency plans to reduce or terminate services due to a physicianͲordered change in the plan of care, a lack of orders to continue the care, or agency limitation in providing the specific service

CMSͲ10280 (Approved 06/2016)

https://www.cms.gov/Medicare/MedicareͲGeneralͲ Information/BNI/Downloads/HHCCNͲFormsͲEnglishͲandͲSpanish.zip

Notice of Medicare NonͲCoverage (NOMNC)

Given at least two calendar days prior to ending MedicareͲcovered home health services

CMSͲ10123Ͳ NOMNC (Approved 12/31/2011)

https://www.cms.gov/Medicare/MedicareͲGeneralͲ Information/BNI/Downloads/NoticeͲofͲMedicareͲNonͲCoverageͲ NOMNCͲFormsͲInclͲLargeͲPrintͲEnglishͲandͲSpanish.zip

Detailed Explanation of NonͲCoverage (DENC)

Delivered to patient after the Quality Improvement Organization notifies home health agency that patient is appealing a termination of services

CMSͲ10124Ͳ DENC (Approved 12/31/2011)

https://www.cms.gov/Medicare/MedicareͲGeneralͲ Information/BNI/Downloads/DetailedͲExplanationͲofͲNonͲCoverageͲ DENCͲFormsͲInclͲLargeͲPrintͲEnglishͲandͲSpanish.zip

General link to Beneficiary Notices, including instructions for each form, is at https://www.cms.gov/Medicare/MedicareͲGeneralͲInformation/BNI/index.html?redirect=/BNI/03_HHABN.asp#TopOfPage

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

Volume 4, No. 9 March 4, 2019 

Continued from previous page HCA has prepared a detailed memo with updates from the meeting (see https://hca-nys.org/wp-content/ uploads/2019/03/030119NGSHospiceMtgSummary-1.pdf). These updates include audit and reimbursement issues, top reason codes for claim denials and tips from the Medicare regulations to avoid denials, Comprehensive Error Rate Testing (CERT) results, the status of the Targeted Probe-and-Educate initiative, NGS education and new online functionalities, and other important items.

A similar meeting for home health issues will be held on March 14, after which HCA will provide an update.

CMS to Host Webinar on Submitting Your Medicare Part A Cost Report Electronically: March 28 The U.S. Centers for Medicare and Medicaid Services (CMS) will host a webinar on Thursday, March 28, from 1 to 2:30 p.m. for all Medicare Part A providers on how to use the new Medicare Cost Report e-Filing (MCReF) system. Registration is at https://blh.ier.intercall.com/details/7f14f9957db8431e9fb44af3888ab48f.

The new MCReF system can be used to submit cost reports with fiscal years ending on or after December 31, 2017. Providers still have the option to mail or hand deliver it to your Medicare Administrative Contractor (MAC). However, providers must use MCReF if choosing to electronically submit the cost report.

The webinar will explain how to access the MCReF system, provide a detailed overview of the system, and discuss Frequently asked questions (FAQs).

A question and answer session follows the presentation; however, attendees may e-mail CMS questions in advance at OFMDPAOQuestions@cms.hhs.gov with “Medicare Cost Report e-Filing System Webcast” in the subject line. These questions may be addressed during the webcast or used for other materials following the webcast.

Additional information on the MCReF system can be found at: https://www.cms.gov/Medicare/Complianceand-Audits/Part-A-Cost-Report-Audit-and-Reimbursement/MCReF.html.

Health Resources 

“The Promise and Pitfalls Of Medicare Advantage Encounter Data,” Health Affairs Blog (February 25, 2019) https://tinyurl.com/y6esxypn

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“Capacity-Building Toolkit for including Aging and Disability Networks in Emergency Planning,” U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response https://www.naccho.org/uploads/downloadable-resources/Capacity-Building-Toolkit-for-Aging-andDisability-Networks-2-5-19.pdf

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

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