March 11, 2019 Edition of The Situation Report

LHCSA FORUMS

PDN PROTOCOLS

OVERTIME

EMERGENCY PREP

LHCSA Forums discuss budget updates, 24-hour/ live-in cases, Workforce Investment Organizations, advanced aides, and more.

HCA is reviewing draft audit protocols on Private Duty Nursing services.

Member feedback is requested by March 14 as we provide input to OMIG.

The federal government proposes to raise the threshold on salary levels for meeting white-collar overtime requirements.

North country and Long Island HEPCs yield key updates on upcoming emergency preparedness drills.

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Your Source for HOME CARE News, Policy and Advocacy

UPCOMING PROGRAMS 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 Upstate and Downstate CHHA Member Forums Upstate: April 3, 2019 (Albany) Downstate: April 10, 2019 (NYC)

Vol. 4, Issue 10| March 11, 2019

HCA Continues to Advocate for Rate Stability, Program Protection and Mandate-relief as Legislature Preps One-House Budget Proposals The Senate and Assembly are expected to issue and act on their respective one-house budget proposals this week, potentially Wednesday, and may unveil these proposals as early as today, paving the way for final state budget negotiations.

Meanwhile, the Legislature and Governor recently found themselves in different places regarding the state’s projected revenue, further complicating an agreement on the state’s fiscal plan.

See BUDGET p. 2

March 19 HCA CFO Summit Eyes Imminent Medicaid Budget Rates, PDGM, Tangle of Wage & Hour Legal Impacts Must-attend program for all home care, MLTC CFOs, Finance Managers, Executives with fiscal responsibility HCA’s Senior Financial Managers Summit is one week away. Will you and your finance teams be there? Please register as soon as possible for this one-day deep-dive into home care and MLTC finance issues on March 19. Registration is at https://hca-nys.org/wp-content/ uploads/2019/01/HCA-CFO-Forum-Registration-Form-2019.pdf.

See SUMMIT p. 5

INSIDE HCA Continues Budget Push; One-House Measures Imminent.....................1 3/19 CFO Summit Eyes Rates, PDGM, Wage & Hour Impacts…........................1 HCA Concludes First Round of LHCSA Forums...............................................3 Member Hiring Announcements.............................................................…4 CMS Posts Hospice Provider Preview Reports.............................................5 DOH Extends Deadline for Managed Care Plans’ MWRCR............................6 Comments Sought on Draft OMIG Protocols on Private Duty Nursing..............6

Upcoming Deadlines and Due Dates…......................................................7 U.S. DOL Proposes Changes on Salary Thresholds for Overtime Pay….........8 Provider Enrollment Records Must be Updated….....................................9 Emergency Preparedness Update….......................................................10 CMS Issues Guidance on ‘Immediate Jeopardy’ Situations…....................11 DOH Issues DAL on Private Pay Home Care Services in ALRs…..................12 GAO Issues High Risk List…......................................................................13 Family Support Services Funding Available for Broome, other Counties....13

The Situation Report: the Home Care Association of New York State BUDGET from p. 1 By statute, the State Comptroller is required to weigh in whenever the Executive and Legislature differ on these revenue projections.

While the Senate and Assembly eventually came to agreement on their estimates last week, that agreement was still $500 million over the Governor’s projections, prompting State Comptroller Tom DiNapoli to issue a report pegging the revenue forecast far lower, yet still $190 million above the Governor’s forecast. Officials in the Cuomo administration have pledged to put any excess revenue into a reserve fund, further putting a potential squeeze on any spending changes that would vary from the Governor’s current proposals.

These forecasts will drive the next stage of negotiations as the Legislature’s imminent one-house bills either remove, amend or add to the Governor’s proposals within the agreed-to revenue profile.

The one-house proposals typically come in the form of a resolution and/or actual budget language, encompassing each chamber’s position for further negotiations among the houses and with the Governor.

HCA, our government-affairs representatives at Hinman-Straub and individual HCA members, through our Legislative Action Center and other advocacy means, have been in continual outreach to legislative leaders seeking the inclusion of HCA’s mark-up language in each chamber’s one-house proposal as a counter to the Governor’s budget. Members have sent over 500 e-mails to lawmakers, advocating for our proposals. We urge members to continue to engage with their lawmakers during these critical days and weeks in the state budget process. Doing so will help put our proposals in play for final negotiations.

As extensively reported to the membership, our mark-ups and budget advocacy target urgent issues for providers and plans, especially the across-the-board 0.8 percent rate cuts included in the Governor’s 30day budget amendments.

Our proposals also seek an urgently needed cost-of-living adjustment in state-set home care rates, which hasn’t occurred in ten years, as well as language establishing a minimum benchmark that home care rates must at least meet. Our mark-up also would strengthen the standards for needed transparency in the state’s MLTC rates, by ensuring that actuarially sound rates are provided to MLTCs and network providers for their services, including for wages

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. 10 March 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 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

Volume 4, No. 10 March 11, 2019 

and labor compliance. This proposal further includes a mechanism for relief from unfunded mandates to plans and providers.

In addition, we are calling for a strike-out of: 1) the Governor’s wholesale transportation carve-out from MLTC; and 2) the proposed repeal-and-replace of the Consumer Directed Personal Assistance Program (CDPAP). On CDPAP, HCA seeks a more transparent and sound approach that ensures CDPAP/Fiscal Intermediary functionality, access and appropriate financing. Our markup also strikes the wholly unnecessary requirement that thousands of workers obtain a national provider identifier number.

Once the Senate and Assembly issue their one-house actions we will have a more definitive picture of the state budget landscape, including where to further target our advocacy. HCA will keep you informed of all critical developments.

In the meantime, please continue to write your legislator using the online advocacy campaigns posted to our Legislative Action Center at https://p2a.co/CrvM1NC.

HCA Concludes First Round of LHCSA Forums On Wednesday, March 6, HCA hosted its Downstate Licensed Home Care Services Agency (LHCSA) Forum in Manhattan. The event was sponsored by TSG Financial Services and attended by over 60 home care providers, managed long term care (MLTC) plans and associate members. The Upstate LHCSA Forum was held in mid-February in Utica.

The meetings began with a state budget update, followed by a briefing of the Association’s state budget priorities and recently released Financial Condition and Trends Report. Providers engaged in lengthy conversations about the importance of transparency related to statutory wage mandates, the Executive Budget Proposal requiring all home health and personal care aides to apply for a National Provider Identifier number, and the Executive’s proposal repealing the Consumer Directed Personal Assistance Program (CDPAP) statutory language and limiting the number of CDPAP Fiscal Intermediaries (FIs). HCA informed providers that all of the proposals remain under negotiation by the Legislature and Governor’s office, and that the Association will follow up with an update when each house of the Legislature releases its respective one-house budget bills later this week.

Members also discussed issues of priority concern to LHCSAs, including labor-related issues such as the pending court case on compensable hours for 24-hour/live-in services and the state’s proposed employee scheduling (call-in pay) regulations that the state Department of Labor recently suspended for the time being (see related p. 8 story).

Participants then discussed issues related to recruitment and retention, the advanced home health aide regulations and guidance, the Workforce Investment Program, inadequacy of the private duty nursing rate for children, and Value Based Payments. HCA also provided a brief update on the 2017 LHCSA Statistical Report and Registration Process, and concluded with an update on the status of a federal regulatory change in aide competency and the state’s efforts to replace the Fully Integrated Duals Advantage (FIDA) plan with some other integrated model(s).

HCA urged members to engage in the Association’s grassroots advocacy initiatives, and stressed the importance of sharing innovations and collaborations with HCA. Please contact Alyssa Lovelace at (518) 810-0658 with questions about the event and/or topics discussed.

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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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SUMMIT from p. 1 This program is well timed to prepare you for a new state fiscal year, as heated budget negotiations hinge on newly proposed across-the-board Medicaid rate cuts, MLTC program changes (such as the proposed carveout of transportation services), an overhaul of Consumer Directed Personal Assistance Program (CDPAP) services, and other rate changes that impact all community-based providers.

Learn what specific rate areas will be impacted by the proposed across-the-board cuts, and what providers can expect from the state’s planned minimum wage distributions and procedures, as allocated in the proposed budget, among other Medicaid fiscal issues that will affect your balance sheet in the coming state fiscal year.

The Summit also offers HCA’s next installment of education on the biggest payment overhaul to hit Medicare home health in decades: the PDGM model, set for implementation in January of 2020. M. Aaron Little, CPA, Managing Director at BKD, LLP has been featured nationally at NAHC’s PDGM Summits and will be joining forces with Karen Vance, BSOT, Senior Managing Consultant at BKD, to model an agency-specific PDGM impact analysis, helping you to further your PDGM readiness here in New York.

The state’s budget deadline is April 1, PDGM is coming on January 1, but far less predictable is the outcome of major wage-and-hour litigation at the Court of Appeals level, with a verdict expected soon. At stake are billions of dollars in possible retroactive liabilities and/or prospective changes in state labor policy for compensable hours when aides work a 24-hour/live-in shift.

Hodgson Russ legal Expert Emina Poricanin will provide you with the latest update and potential scenarios for 24-hour/live-in cases, along with lessons learned from OMIG and Department of Labor audits among other key wage-and-hour law considerations that must be on your compliance and fiscal planning radar.

CMS Posts Hospice Provider Preview Reports The U.S. Centers for Medicare and Medicaid Services (CMS) has recently made available the hospice provider preview reports as well as the hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey preview reports.

These two separate reports are available in providers’ Certification and Survey Provider Enhanced Reports (CASPER) non-validation reports folder. Hospice providers are encouraged to review their Hospice Item Set (HIS) quality measure results from Quarter 3, 2017 to Quarter 2, 2018 and their facility-level CAHPS survey results from Quarter 3, 2016 to Quarter 2, 2018.

Providers have 30 days to review their HIS and CAHPS results (March 1, 2019 through March 31, 2019) prior to the May 2019 Hospice Compare site refresh, during which this data will be publicly displayed.

Providers may request CMS review if they believe there are inaccuracies in the denominator or other HIS quality metric or an error within the CAHPS Survey data results.

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Continued from previous page This process is explained in two areas: the HIS Preview Reports and Requests for CMS Review of HIS Data website (https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospiceQuality-Reporting/Public-Reporting-HIS-Preview-Reports-and-Requests-for-CMS-Review-of-HIS-Data.html) and the Public Reporting: CAHPS Preview Reports and Requests for CMS Review of CAHPS Data website (https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-QualityReporting/Public-Reporting-CAHPS-Preview-Reports-and-Requests-for-CMS-Review-of-CAHPS-Data.html).

DOH Extends Deadline for Managed Care Plans’ MWRCR Additional functionality to be available for report The state Department of Health (DOH) has extended the due date for managed care organizations to submit the Supplemental Minimum Wage Reconciliation Cost Report (MWRCR), covering services through March 31, 2018. The new due date is April 5, 2019.

The report is submitted via the state Office of Pool Administration (OPA) website.

DOH notes that OPA has built some additional functionality on the website which will allow plans to not only upload a set of providers from an Excel file, but also the corresponding Minimum Wage expenses and hours of service for each provider for a specific quarterly report. This new functionality will be an option in the Action area for each Quarterly Report that has been initiated.

Similar to the Upload Excel Providers option that is currently available from the Dashboard, an instructional template will be available from the new Excel file upload page to provide guidance for proper formatting of the Excel file.

DOH expects this new functionality to be promoted to the OPA Managed Care Organization Dashboard sometime this week.

Comments Sought on Draft OMIG Protocols on Private Duty Nursing The Office of the Medicaid Inspector General (OMIG) has shared draft audit protocols on Private Duty Nursing (PDN) services by Licensed Home Care Services Agencies (LHCSAs) and requested our input for the final version.

The draft protocols can be found here: https://hca-nys.org/wp-content/uploads/2019/03/OMIG-LHCSA-PDNDraft-Audit_Protocols_030519.pdf.

The revised protocols would replace current protocols (https://omig.ny.gov/images/stories/audit_protocols/ LHCSA_protocols_12_8_16.pdf) that were established in 2016. The revisions include two new protocols (“Incorrect Procedure Code Billed” and “Excluded Individual Providing Service”), elimination of the prior “Professional Assessment Not Documented” protocol, and new language for the Tuberculosis Test protocol.

HCA sent the draft protocols to members identified as providing PDN services for their input, and encourages members who are interested in providing feedback to share comments with Alyssa Lovelace at alovelace@hcanys.org by Thursday, March 14.

Questions can be directed to Alyssa Lovelace at (518) 810-0658.

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Volume 4, No. 10 March 11, 2019

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



Upcoming Deadlines and Due Dates Requirement/Change/Meeting

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/RKform s.html

Home Health Exercise Primer – Western Region

March 11, 2019 at 10 a.m. https://tinyurl.com/yyx9ogt2

Western NY Health Emergency Preparedness Coalition (HEPC) meeting

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

https://www.eventbrite.com/e/q3ͲwrͲhepcͲ allͲpartnersͲbusinessͲmeetingͲticketsͲ 54240500798

Capital District Health Emergency Preparedness Coalition (HEPC) meeting

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

Maureen CasaleͲReidy, MPH Public Health Emergency Preparedness Representative, Capital District Region maureen.casaleͲreidy@health.ny.gov

Finger Lakes Health Emergency Preparedness Coalition (HEPC) meeting

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

https://tinyurl.com/y52pfp45

Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) Cost Reports due

March 31, 2019

1915CR@health.ny.gov

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) 810Ͳ0662

Interoperable Communications/Medical Countermeasures (IOC/MCM) exercise – Western NY

April 4, 2019

Shaun.sharp@health.ny.gov

Virtual Tabletop Exercise for Home Health Agencies – Western region

April 8, 2019 from 1 to 3 p.m.

https://tinyurl.com/yymwldwo

Virtual Tabletop Exercise for Home Health Agencies – Western region

April 11, 2019 from 10 a.m. to 12 p.m.

https://tinyurl.com/y6tkoqcs

IOC/MCM exercise – Capital District

April 11, 2019

Maureen.casaleͲreidt@health.ny.gov

Coalition Surge Test (CST) Exercise for Long Island

Sometime between Andrew Koski at akoski@hcanys.org or (518) April 15 and April 26, 2019 810Ͳ0662

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) 810Ͳ0662

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/NewͲ MedicareͲCard/index.html

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U.S. DOL Proposal Would Require Overtime for Higher-Salaried Workers Federal rule seeks to raise salary threshold that must be met for employers to claim “white-collar” exemptions from paying overtime – yet state regulations already require overtime for employees at these higher-salary levels

By Frank J. Fanshawe, Principal, and Joe de Perio, Law Clerk, Jackson Lewis The U.S. Department of Labor (DOL) recently proposed a new regulation that would increase the salary thresholds which must be met in order for employers to exercise the so-called “white-collar” exemptions from paying overtime.

In effect, this means that – at least for purposes of federal law – more employees would ostensibly be eligible for required overtime pay.

However, state regulations already exceed these proposed federal thresholds, meaning that, in general, employees eligible for overtime under the newly proposed federal thresholds must currently be paid overtime by state standards, as outlined below.

Dependent on size and location in the state, the New York White-Collar Exemption salary thresholds range from $43,264 ($832 per week) to $58,500 ($1,125 per week). These thresholds are as follows (per week):    

NYC – Large Employers (11 or more): $1,125 NYC – Small Employers (10 or fewer): $1,012.50 Long Island & Westchester: $900 Remainder of New York State: $832

These state thresholds generally take precedence over those in the proposed federal regulation because they are higher than DOL’s proposal at the federal level. DOL’s proposal would raise the threshold nearly 50 percent to $35,308 ($679 per week) – well below any of the thresholds in New York State’s tiers. Those labeled as “highly compensated employees” under the federal proposal would also see a threshold increase from $100,000 to $147,414. These proposed increases are based on the salary level for the 20th percentile full-time salaried workers in the lowest census region and on salaries of those in the retail industry nationwide.

There is, however, one distinction in the federal versus state regulations. New York’s regulations do not include a minimum salary requirement for “professional” exempt employees and, thus, New York State employers need to follow the federal guidelines for such workers.

The $35,308 exemption threshold is still significantly less than what was adopted by DOL during the Obama administration (which also included annual adjustments). Importantly, as previously reported, a federal court struck down the Obama-era rule and it was never implemented.

Exemptions are not based solely on pay and hours, but also on whether the employee is labelled as “professional,” “executive,” or “administrative.”

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Continued from previous page For more information regarding New York State thresholds, and to whom they apply, please refer to the links listed here: 

https://www.labor.ny.gov/legal/counsel/pdf/administrative-employee-overtime-exemption-frequentlyasked-questions.pdf



https://www.labor.ny.gov/legal/counsel/pdf/executive-employee-overtime-exemption-frequentlyasked-questions.pdf



https://www.labor.ny.gov/legal/counsel/pdf/professional-employee-overtime-exemption-frequentlyasked-questions.pdf

Employers can submit comments to DOL for 60 days. DOL intends to publish a final rule after the 60-day comment period closes. The proposed regulation, if adopted, will likely be effective in January 2020. It is critical that employers in New York State be aware of how their current practices comply with New York State thresholds and look at how their practices may be impacted by federal regulations in the future. More information is at www.dol.ny.gov/whd/overtime2019.

Please note that this article is for general, informational purposes, is not legal “advice,” and does 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.

Provider Enrollment Records Must be Updated The state Department of Health (DOH) advises providers that, effective March 1, applications and change of address forms will be rejected if a telephone number is not associated with each service address.

The federal 21st Century Cures Act requires all state Medicaid programs to develop and maintain a Provider Directory. Required elements of the directory include the provider’s name, specialty, service address and telephone number for each service address.

A directory of providers enrolled in the fee-for-service program is available at https://health.data.ny.gov/ Health/Medicaid-Fee-for-Service-Provider-Listing/keti-qx5t. Medicaid providers must immediately notify DOH of any changes to the provider enrollment agreement, including a change in service location and/or ownership. To keep the provider enrollment agreement up to date, use the maintenance forms found on the Provider Enrollment web page at: https://www.emedny.org/info/ProviderEnrollment/index.aspx.

Additionally, notification letters are continually sent to providers informing them of the requirement to complete a periodic revalidation of enrollment. Completion of these forms is required for continued enrollment in the state Medicaid program. Failure to complete and submit these forms will result in termination of the provider’s enrollment.

For questions about the provider directory, maintaining the provider enrollment file, or the revalidation process, contact the eMedNY call center at 800-343-9000 or providerenrollment@health.ny.gov.

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Emergency Preparedness Update HCA participated in two Health Emergency Preparedness Coalition (HEPC) meetings last week – Long Island and the North Country.

The Long Island HEPC meeting on March 7 included updates and information on the Veterans Administration National Disaster Medical System, upcoming education programs, local emergency management and public health preparedness efforts, and the upcoming Coalition Surge Test (CST), Medical Countermeasures (MCM) and Interoperable Communication (IOC) drills.

The Long Island CST will take place on one day sometime during April 15 to April 26 while the MCM/IOC will occur on April 18. Like the CST held in Central New York on February 21 (see the February 25 Situation Report), home care providers will not be notified about the exercise once it is initiated nor be asked to complete any surveys. They will only get involved if a hospital calls to inquire if the home care agency can take patients who are being evacuated from hospitals during the drill.

Home care providers, however, will be asked to complete a survey as part of the IOC exercise on April 18 and as, in past events, notifications will be sent to certain staff roles in the Health Commerce System (HCS) Communications Directory, so it is important to ensure that your listings are up-to-date.

In addition to the Long Island HEPC meeting, HCA also participated in the Capital District HEPC third quarter North Country Sub Regional Business Meeting.

Throughout the meeting, participants reviewed HEPC preparedness and response plans; emergency codes; the emPower and Social Vulnerability Index; as well as the area’s upcoming CST, MCM and IOC drills. The Capital District CST will take place between April 1 and April 15. The MCM/IOC is scheduled for April 11.

HEPCs are coalitions of health care providers, local and state emergency management and local public health preparedness officials that develop and coordinate emergency preparedness across the continuum, including readiness among individual health sectors, holding exercises and ‘hot washes,’ conducting hazard and vulnerability assessments and other important activities. HCA and the New York State Association of Health Care Providers (HCP) are responsible for participating in HEPC meetings across the state.

CNY Home Care Meeting Home care providers in Central NY (CNY) are invited to attend the first meeting of the CNY Home Care Emergency Preparedness Coalition on April 17, from 1:30 to 3 p.m. For more information, contact Dawn Richey, Corporate Compliance Officer at Nascentia Health, at drichey@477home.org or (315) 477-9321.

CNY Access and Functional Needs Workgroup The CNY HEPC includes an Access and Functional Needs Workgroup that has been working to identify those agencies that provide services to those with access and functional needs in order to help the HEPC in emergency preparedness planning activities. For more information, contact Judy Homer at (315) 477-8442 or judyhomer@health.ny.gov.

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Continued from previous page Western Region Home Care Tabletop Exercise The Western Region Health Emergency Preparedness Coalition (HEPC) will hold a Virtual Tabletop Exercise for home care agencies and their partners. The same exercise will be held on two separate dates: April 8, from 1 to 3 p.m. or April 11, from 10 a.m. to noon.

The Western Region HEPC will also hold a Home Health Exercise Primer on March 11, from 10 to 11 a.m., which will be recorded. HCA will notify members of a link to the program.

The virtual tabletop exercise seeks to gain better insight into the plans, needs and capabilities of the home health sector. It will explore the abilities of home care providers to: share information; activate ahead of, or in response to, a significant event; respond to surge requests; and request resources.

HCA encourages all Western Region providers to participate in the tabletop exercise; registration is at https://hca-nys.org/wp-content/uploads/2019/01/Virtual-Tabletop-Flyer-Updated.pdf.

Additional CST drills will be held during the following timeframes in the regions below.  

April 1 to 12: Western NY (Buffalo and Finger Lakes) April 29 to May 10: Lower Hudson Valley

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

April 4: Western NY (Buffalo and Finger Lakes) May 9: Lower Hudson Valley

March Aware Prepare Now Available The March 2019 issue of the state’s Aware Prepare update is now available online. The Update contains upcoming preparedness trainings, such as webcasts, webinars and in-person trainings, as well as archived exercises and on-demand e-learning. It is available at https://hca-nys.org/wp-content/uploads/2019/03/ 2019_March_AP.pdf.

CMS Issues Guidance on ‘Immediate Jeopardy’ Situations Last week, the U.S. Centers for Medicare and Medicaid Services (CMS) issued revised guidance on violations of health and safety regulations that cause serious harm or death to a patient and require immediate action to prevent further serious harm (immediate jeopardy situations).

These violations carry the most serious penalties for Medicare- and Medicaid-certified health care providers, suppliers, and laboratories.

This new guidance can be found in Appendix Q of the State Operations Manual that federal and state inspectors use, and is at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/ SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/QSO19-09-ALL.html.

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Continued from previous page In order to cite immediate jeopardy, under the Appendix Q guidelines, surveyors must determine that: 1) noncompliance exists; 2) there is a likelihood that serious injury, harm, impairment or death to a recipient would occur or recur as a result of identified noncompliance; and 3) immediate action is necessary to prevent the occurrence or recurrence of serious injury, harm, impairment or death to one or more recipients.

The following are some changes: 

The revised Core Appendix Q makes it clear that in order to cite immediate jeopardy in situations where recipients have not already suffered serious injury, harm, impairment or death, the nature and/ or extent of the identified noncompliance creates a likelihood (reasonable expectation) that such harm will occur if not corrected, not simply the potential for that level of harm to occur.



The previous version of Appendix Q made culpability a required component to cite immediate jeopardy. Because the regulatory definitions of immediate jeopardy do not require a finding of culpability, that requirement has been removed and has been replaced with the key component of noncompliance, since the definitions of immediate jeopardy require noncompliance to be the cause of the serious injury, harm, impairment or death, or the likelihood thereof.



Core Appendix Q now includes a section instructing surveyors to consider whether noncompliance has caused or made likely serious mental or psychosocial harm to recipients. In situations where the psychosocial outcome to the recipient may be difficult to determine or incongruent with what would be expected, the guidance instructs surveyors to use the “reasonable person” concept to make that determination.

DOH Issues DAL on Private Pay Home Care Services in ALRs The state Department of Health (DOH) issued a Dear Administrator letter (DAL) on Tuesday, March 5, providing guidance to assisted living residence (ALR) operators on the use of private pay home care services.

To ensure services are properly coordinated, DOH outlined minimum requirements for ALRs to follow in the development of policies and procedures, which are listed within the DAL at https:// commerce.health.state.ny.us/HCSRestServices/HCSContentServices/docs?docPath=/hcs_Documents/Source/ hpn/hpnSrc/835DDB2784505D01E0530547A8C0F715.pdf.

According to the DAL, Public Health Law requires that residents have the right to choose their health care providers. However, the operator must not invoke this practice to absolve their responsibility under licensure and certification. The Department’s expectation is that operators support their residents’ individual preferences by engaging in supervision and strong case management practices to ensure that any outside provider (including privately paid providers, when applicable) are meeting the personal care needs of the resident.

DOH says the guidance is not intended to replace the social and non-personal care supports provided by companions referenced in a 2009 DAL No. 09-02 (see https://hca-nys.org/wp-content/uploads/2019/03/ doc04516420190311115710.pdf), although the guidance may be updated in the future to comport with evolving Department initiatives.

Continued on next page

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Continued from previous page The DAL lists what ALRs must have in their written policies and procedures; what the home care provider must do prior to providing services; the ALR operator’s and home care provider’s responsibilities after private pay home care starts; and more.

Questions can be directed to the DOH Division of Adult Care Facility and Assisted Living Surveillance at (518) 408-1133.

GAO Issues High Risk List Last week, the U.S. Government Accountability Office (GAO) issued its latest High Risk List, which reports on federal programs and operations that are “vulnerable to waste, fraud, abuse, and mismanagement, or that need broad reform.” The list includes 35 areas, with the rankings for more than half of them largely unchanged and three regressing. Ratings for seven areas improved, two to the point of coming off the list.

The list is at https://www.gao.gov/products/GAO-19-157sp.

Some of the areas on the list that affect home care, hospice, managed care plans and other health care providers include: Medicare Program & Improper Payments; Strengthening Medicaid Program Integrity; and Ensuring the Cybersecurity of the Nation.

The list is updated every two years at the start of each new Congress. GAO uses five criteria to assess progress on high-risk areas: leadership commitment, agency capacity, an action plan, monitoring efforts, and demonstrated progress.

Family Support Services Funding Available for Broome and other Counties The Broome Developmental Disabilities Regional Office (DDRO), Region 2 and the Broome DDRO Family Support Services (FSS) Advisory Council have announced funding to provide supports and services to families that care for a family member with a developmental disability living at home. The goal is to assist families to remain intact for as long as they desire and avoid unnecessary out-of-home placement.

Only incorporated not-for-profit agencies or other governmental agencies may apply. Broome DDRO serves families and individuals in Broome, Tioga, Chenango, Tompkins, Otsego and Delaware Counties.

Applications are due no later than 11 a.m. on April 26, 2019. All applications and required components must be entered into the Grants Gateway by that date and time.

Funding information on this program is at https://grantsgateway.ny.gov (search “Family Support Services”).

The primary contact is Maggi Frommer at (607) 771-7784, extension 155, or margaret.frommer@OPWDD.ny.gov.

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