March 25, 2019 Edition of The Situation Report

MEDPAC REPORT

FLU REPORT

UPCOMING HCA EDUCATION

COST REPORT WEBINAR

MedPAC issues its annual March Report to Congress, again calling for home health cuts, this time at 5% in 2020.

The state Department of Health has opened the flu vaccination report and posted FAQs on the requirement to count vaccinated personnel

by May 1.

From our Annual Conference to webinars on documentation and clinical topics to OASIS training ... see what’s in store for HCA’s education programming in coming months.

If filing electronically, providers must use the MCReF system to submit cost reports.

Learn more during CMS webinar this week (March 28).

PAGE 5

PAGE 8

PAGE 9

PAGE 13

Your Source for HOME CARE News, Policy and Advocacy

UPCOMING PROGRAMS 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

State Budget Pressure Builds as Deadline Nears: Your Advocacy Vital!

Despite many hours-long budget talks in recent days – including three-way meetings that proceeded well into pre-dawn this morning – few precise issue updates are known at this point from negotiations being held on a near-constant basis among Legislative and Executive offices in Albany.

A new state budget is due in one week; so, the pressure builds with each passing day.

It is expected that each of the individual budget conference subcommittees should soon be reporting back to the general conference committee for the budget, known colloquially as “the mothership,” at which point many of the core issues will have been settled.

Upstate and Downstate CHHA Member Forums Upstate: April 3, 2019 (Albany) Downstate: April 10, 2019 (NYC) WEBINAR: Clinical Documentation Improvement (CDI) April 11, 2019

Vol. 4, Issue 12| March 25, 2019

See BUDGET p. 2

HCA’s Annual Conference: Expertise for Entire Home Care Continuum HCA’s flagship Annual Conference serves up a carefully balanced program for every segment of the home care continuum, along with a rich finish of leadership insights that reach across all C-suite and managerial roles and disciplines in home and community-based care.

Keynote speaker Heather Sager will teach you how to “reclaim whitespace,” making the distinction between activity and productivity in your own work and in your workplace culture. Our program will also have multiple sessions on recruitment, retention and See EXPERTISE p. 5

INSIDE State Budget Pressure Builds as Deadline Nears: Your Advocacy Vital!........1 HCA’s Annual Conference: Expertise for Entire Continuum............................1 CMS Issues Two New Transmittals Updating Home Health Manual...............3 Member Hiring Announcements...............................................................4 MedPAC Again Recommends Home Health Cuts...........................................5 Corrected Managed Care Information for All Providers................................7 CMS Posts Hospice Provider Preview Reports..........................................7 DOH Opens Personnel Flu Vaccination Report..........................................8

PHHPC Committee Meeting Agenda Posted..............................................8 Upcoming HCA Events and Education......................................................9 Free CEU Programs for Clinicians, Plus WIO Education Listings................11 Upcoming Deadlines and Due Dates......................................................12 Nov. Cap Report: Medicaid Spending $79M Above Projections.................13 CMS Hosts March 28 Webcast on Electronic Cost Reports........................13 HCA Participates in HEPC Statewide Meeting........................................14 Rule Issued on State Medicaid Fraud Control Units................................15 Health Resources..............................................................................15

The Situation Report: the Home Care Association of New York State BUDGET from p. 1 However, at today’s report, much of this work has occurred at the rankand-file subcommittee levels and has yet to culminate in leaders’ meetings among the Governor, Senate Majority Leader and Assembly Speaker.

Last Thursday, March 21, Senate Majority Leader Andrea StewartCousins and Assembly Speaker Carl Heastie announced “table targets” for the spending amounts that each of the eleven individual budget conference subcommittees are to aim for in hashing out an agreement between the two legislative houses. Yet the specific give-and-take within those targets – including individual items of importance to home care and health care generally, not to mention the absence of a Medicaid amount in the target levels – remain fluid as of press time for The Situation Report. Further details and announcements are expected imminently, and HCA will continue to keep you informed as the window for advocacy closes and as a new budget marches toward completion.

Throughout the past week, HCA has held steady meetings with legislators and key staff of the health subcommittee to press for our 10 percent rate update/benchmark and transparency proposals, as extensively summarized for the membership. As you know, our rate/ benchmark proposal would be funded through the reinvestment of dollars leveraged by a separate HCA proposal to create a home-based asthma management plan. It is important for legislators to hear that our proposals will not only help stabilize home care providers but they are also cost-neutral – that is, funded through home care reinvestments yielded by programming that helps patients.

On Thursday, HCA President Al Cardillo sent a letter to all members of the health budget conference subcommittee as well as legislators in Western New York reiterating our call for rate stabilization on the basis of a Buffalo Business First article quoting HCA’s financial data and some of the workforce pressures faced by providers in Western New York. (You can read the cover letter and appended Buffalo Business First report at https://hca-nys.org/wp-content/uploads/2019/ 03/HCA-Letter-on-Workforce-News-Article-and-Rate-Needs.pdf.)

Advocacy Vital Now! Your advocacy is especially vital right now. If your Assembly or Senate representative is a member of the health budget conference Home Care Association of New York State (HCA) 388 Broadway, 4th Floor, Albany, NY 12207 Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org

2

Volume 4, No. 12 March 25, 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. 12 March 25, 2019 

subcommittee, it is imperative that you call their offices today, as it may be your last opportunity to do so before the budget provisions are permanently settled.

On Wednesday we sent you an alert with instructions, a call script and a list of legislators serving on those key health committees, which include representatives in Suffolk and Nassau, Brooklyn, the Bronx, Queens, Manhattan, Kingston, Rockland/Westchester, and the Buffalo area.

If you live in these regions or your agency is based in these regions, please see if your elected representative is on the conference committee. All the details you need are in last week’s alert here: https://conta.cc/2JRNPFV. It includes a list of conference committee members, a link to our legislator search tool (if you want to find out whether your legislator is among those on the committee), and a simple call script urging support for our rate update/benchmark, reimbursement transparency and asthma management program – all of which would help MLTCs, CHHAs and LHCSAs alike in the payment landscape.

While you are making these phone calls, your staff can be supporting the grassroots effort in a very timeefficient way using our online Legislative Action Center message. All they have to do is click a link, enter their contact information and send a pre-written message to their legislators. At last count, 366 messages were sent; but with nearly 400 HCA members collectively employing thousands of staff, there is no reason why this count can’t reach quadruple digits. Share our campaign today (at https://p2a.co/BK3D5Dq), get your team engaged, make your phone calls, and keep up the pressure!

CMS Issues Two New Transmittals Updating Home Health Manual The U.S. Centers for Medicare and Medicaid Services (CMS) has recently issued two Transmittals as part of Change Request (CR) 11104, Manual Updates Related to Home Health Certification and Recertification Policy Changes.

Transmittal 870 (https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/ 2019Downloads/R870PI.pdf) updates the Program Integrity Manual, Chapter 6 to reflect that the physician does not need to estimate the length of home health services on re-certifications.

Transmittal 258 (https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/ 2019Downloads/R258BP.pdf) updates the Benefit Policy Manual, Chapter 7 to reflect the same. It also includes requirements of the updated plan of care (POC) that were outlined in CMS’s Home Health Prospective Payment System (HHPPS) final rule for 2019.

Our colleagues at the National Association for Home Care and Hospice (NAHC) have confirmed with CMS that the Chapter 7 policy change requires that the POC contain elements within Section 484.60(a) which support medical necessity. These must be included for purposes of compliance with the home health Conditions of Participation CoPs, which are enforced during post-payment audits or on survey.

Continued on next page

3

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

Volume 4, No. 12 March 25, 2019 

Continued from previous page For ongoing claims cycling, however, the POC only needs to include those items in Section 484.60(a) that are material for payment. Not all CoP-enforceable POC items may be material for payment. (This applies to any claim submitted since the January 13, 2018 effective date for the revised CoPs).

Therefore, agencies do not need to re-bill claims if all of the items listed in Section 484.60(a) are not on the POC, as long as the item is not required to support medical necessity (for example, the patient’s advanced directives).

Nevertheless, the items in Section 484.60(a) must be included on the POC for compliance with CoPs, separate from the billing process.

CMS also clarified that the implementation and effective date of April 22, 2019 in the CR reflects the date for when the home health manuals are to be updated.

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/.

4

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

Volume 4, No. 12 March 25, 2019 

EXPERTISE from p. 1 workforce strategies, including the often-overlooked area of office-staff performance management. Plus, learn about home care technology must-haves from nationally acclaimed tech guru Tim Rowan, along with insights on how to institute lasting operational change at all levels of your organization with Jennifer Maxwell of Maxwell Healthcare Associates.

For licensed agencies and their partners, we’ll have Paul Essner of TSG Financial and Emina Poricanin of Hodgson Russ examining the Wage Parity Law from an employee-benefits perspective, including key areas for internal compliance monitoring. Plus, our value-based payments (VBP) track will offer principles to help LHCSAs adapt to the VBP environment.

On the Medicare-certified side, closing keynote speaker Bill Dombi, President of NAHC, and Clinician Consultant Shelley Eggleton of Quality in Real Time, will each offer different sessions exploring the PDGM puzzle.

Our pre-conference session will better acquaint you with the “Hospital-Homecare-Physician Collaboration” statute, demonstrating specific provider models that have already begun to seize on this new paradigm.

Plus, a leading telehealth project manager and business development strategist will get you thinking about how to adapt (or newly adopt) your home telehealth program in the current policy landscape.

All the information you need, including conference registration and hotel information for this signature event, is on the conference website. Register today to reserve your seat at this exciting, premier conference event at www.hcaannualconference.com/.

MedPAC Again Recommends Home Health Cuts in Annual Report to Congress The Medicare Payment Advisory Commission (MedPAC) is again calling for home health reductions, at five percent in 2020, as part of its annual March Report to Congress.

The annual March Report is required by statute as a way of advising Congress, but it is non-binding; Congress does not have to accept MedPAC’s recommendations.

An HCA analysis, echoed in comments from the National Association for Home Care and Hospice (NAHC), shows that MedPAC’s report again relies on selective data, simple averages in calculating industrywide finance profiles, and the exclusion of hospital-based certified home health agencies, among other shortcomings, to arrive at calculations that are the basis for recommending its reductions.

Those calculations largely rest on MedPAC’s allusion to double-digit positive operating margins in home care and adequate access to care.

The Report says that over 98 percent of beneficiaries live in a ZIP code with at least one home health agency, and 84 percent live in a ZIP code with five or more agencies. This nevertheless does not address other factors, such as workforce shortages, that limit access to care, as HCA’s own data reveals.

While MedPAC continues to report a 16 percent average national home health operating margin for Medicare in 2019, NAHC puts that average margin at 2 percent, and HCA’s New York data shows providers operating at a net average loss for the seventeenth year in a row.

Continued on next page

5

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

Volume 4, No. 12 March 25, 2019 

Continued from previous page Such disparities are not only evident in MedPAC’s data samples but also, for New York, in our state’s unique position of having a larger relative volume of hospital-based agencies (not reflected in MedPAC’s analysis), a costly labor and regulatory market (which the U.S. Centers for Medicare and Medicaid Services routinely fails to reflect in its wage index classifications), a high volume of complex-care cases and dual-eligible beneficiaries, and a host of other factors.

What’s more, this report recommends reductions at a time when the system is already otherwise transitioning to the biggest payment overhaul in two decades, the Patient Driven Groupings Model (PDGM), which is intended to better align payments with costs and already will trigger a proposed 6.42 percent “behavioral adjustment” cut at the outset of the new model.

It is unclear how the MedPAC recommendations align with PDGM. This report adds yet further challenge in our advocacy on the federal front, as HCA pushes to forestall and mitigate the PDGM behavioral adjustment cut through legislation.

Meanwhile, the President’s budget proposal calls for massive Medicaid and Medicare cuts while also embracing MedPAC’s long-discussed uniform post-acute payment system. While this budget, particularly the health care cuts, faces stiff opposition in Congress, the President’s fiscal agenda nevertheless drives the negotiation process and overall positioning, further demanding a major grassroots push to bolster opposition in Congress, along with a needed bipartisan PDGM fix.

HCA will be sounding this message at NAHC’s March on Washington next week. If you haven’t yet registered for NAHC’s April 1-2 program, please do so now at https://www.nahc.org/meetings-education/2019-nahcmarch-on-washington/.

Please also let us know if you’d like us to schedule Congressional office visits for you on April 2, as part of the NAHC program. For assistance, you can contact HCA’s contract federal government-affairs representative, Brett Heimov, directly at Brett@en-visionstrategy.com.

6

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

Volume 4, No. 12 March 25, 2019 

Corrected Managed Care Information for All Providers Now Available The ‘Information for All Providers – Managed Care Information’ document has been updated with corrections to the Medicaid Advantage Plus Plan data on the eMedNY website: https://www.emedny.org/ ProviderManuals/AllProviders/PDFS/Information_for_All_Providers_Managed_Care_Information.pdf.

The ‘Managed Care Information’ document contains insurance coverage code descriptions, website links and phone numbers for managed care plans.

CMS Posts Hospice Provider Preview Reports Hospice Providers Should Review Your Data by March 31 The U.S. Centers for Medicare and Medicaid Services (CMS) has made available the following two reports in Hospices’ Certification and Survey Provider Enhanced Reports (CASPER) non-validation reports folder: 

Hospice provider preview report: Review Hospice Item Set (HIS) quality measure results from the third quarter of 2017 to the second quarter of 2018.



Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey provider preview report: Review facility-level CAHPS survey results from the third quarter of 2016 to the second quarter of 2018.

CMS encourages hospice providers to review their HIS and CAHPS results by March 31. You can request a CMS review if you believe the denominator or other HIS quality metric is inaccurate or if there are errors in the results from the CAHPS survey data. Instructions for doing so are at: https://www.cms.gov/Medicare/ Quality-Initiatives-Patient-AssessmentInstruments/Hospice-QualityReporting/Public-Reporting-HISPreview-Reports-and-Requests-forCMS-Review-of-HIS-Data.html.

Information on the CAHPS Preview Reports and Requests for CMS Review Access Instructions can also be found at: https://www.cms.gov/Medicare/ Quality-Initiatives-Patient-AssessmentInstruments/Hospice-QualityReporting/Public-Reporting-CAHPSPreview-Reports-and-Requests-forCMS-Review-of-CAHPS-Data.html.

7

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

Volume 4, No. 12 March 25, 2019 

DOH Opens Personnel Flu Vaccination Report Last week, the state Department of Health (DOH) released a Dear Administrator Letter (DAL) announcing that the Healthcare Personnel Influenza Vaccination Report opened on Thursday, March 21, 2019. This report must be electronically submitted to DOH by May 1, 2019. See the DAL here: https://hca-nys.org/wp-content/ uploads/2019/03/Notification_101112.pdf.

State regulations require home care and other providers to document the number and percentage of personnel vaccinated against influenza for the current season and to complete this report upon DOH’s request.

This year’s report covers health care personnel employed by or affiliated with your organization from October 1, 2018 through March 31, 2019. Employers should enter available data now and then resubmit it as often as necessary until the May 1 deadline for new personnel or incoming documentation.

The report is on the Health Electronic Response Data System (HERDS) at https://commerce.health.state.ny.us/public/hcs_login.html.

The DAL includes an instruction card on how to access, complete and submit the HERDS report, and Frequently Asked Questions (FAQs).

A pre-recorded webinar training on the flu vaccination report is available at https://www.health.ny.gov/ diseases/communicable/influenza/seasonal/providers/prevention_of_influenza_transmission/ under the heading “Training.” The person completing the report is advised to first view the webinar and FAQs. According to the FAQs, any health care personnel that received an influenza vaccine after July 1, 2018 should be counted as vaccinated in the Report. The FAQs also include important information about: reporting by organizations that have a CHHA and a LHCSA (each agency type should complete a separate report); personnel employed or affiliated with more than one agency (each agency should count the employees); how to count employees who have only given verbal indication of vaccination (categorize them as “unknown vaccination status”); how to count employees with religious objections or a contraindication to the vaccine (they fall under the “declined vaccination” category).

Questions about the report should be directed to DOH’s Bureau of Immunization at either (518) 473-4437 or immunize@health.ny.gov.

Technical questions about the report or on the use of HERDS should be directed to the Health Emergency Preparedness Program at (518) 408-5163 or hseppny@health.ny.gov.

PHHPC Committee Meeting Agenda Posted The state Department of Health (DOH) has posted the agenda and supporting documents for the Public Health and Health Planning Council (PHHPC) Establishment and Project Review Committee meeting on March 28.

The information is at https://www.health.ny.gov/facilities/public_health_and_health_planning_council/ meetings/2019-03-28/.

Continued on next page

8

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

Volume 4, No. 12 March 25, 2019 

Continued from previous page The agenda includes the following home care/hospice applications:       

One entity to become the new sole member of an existing hospice.

One entity to become the new sole member of an existing Certified Home Health Agency (CHHA).

One CHHA to become the new operator of an existing CHHA. Merger of two existing Licensed Home Care Services Agencies (LHCSAs).

Change of ownership and merger of two existing LHCSAs. Two entities to become LHCSAs associated with an Assisted Living Program (ALP).

Two LHCSAs for changes in membership and to become associated with ALPs.

Once acted upon, the applications will go to the full PHHPC for review at its April 11 meeting.

All committee and full PHHPC meetings are webcast at https://www.health.ny.gov/events/webcasts/.

Upcoming HCA Events and Education Registration flyers and more information for the programs below are on our events page at https://hcanys.org/events-education/upcoming-events.

WCEI 5-Day Onsite Skin and Wound Management Course: Become Board Certified Philadelphia, PA (April 1-5) Windsor, CT (May 6-10) This five-day course from the Wound Care Education Institute (WCEI) is held at over 100 locations across the country including in nearby states in April and May. It offers an evidence-based approach to wound management, helping clinicians stay current with the standards of care. HCA members receive a discount.

Upstate and Downstate CHHA Member Forums Upstate: April 3 (Albany) Downstate: April 10 (NYC) HCA’s Forums provide you with an opportunity to interact with HCA staff and peer members in an exchange of valuable information specific to your organization type. For CHHAs, HCA is holding two upcoming Forums: one for upstate members and another for downstate members.

WEBINAR: Clinical Documentation Improvement (CDI) Webinar April 11 (1-2 p.m.)

Clinical documentation improvement (CDI) helps you ensure optimal patient outcomes, contribute to data quality metrics and drive accurate reimbursement, fundamental to success under the Patient Driven Groupings Model (PDGM). This program is a must for administrators, compliance officers, clinical management, billing, coders, OASIS reviewers and your medical records team to better utilize CDI strategies and achieve better outcomes.

Continued on next page

9

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

Volume 4, No. 12 March 25, 2019 

Continued from previous page WEBINAR: Lessons Learned from Value-Based Purchasing April 18 (1-2 p.m.)

The U.S. Centers for Medicare and Medicaid Services (CMS) began the home health value based purchasing model demo (HHVBP) in 2016 for nine states. The lessons learned from this demo are invaluable for all home care agencies, especially if CMS extends HHVBP to other states like New York, but also given New York’s own value-based initiatives. This webinar for administrators, compliance staff, clinical management and medical records staff will discuss different methods that agencies have used to increase their performance scores and measure improvement.

SupervisionPlus Online Managerial Training Through Fazzi Associates Register by May 3 for 8-week online training module, but you can start the self-paced course as early April 29 when the first module goes live.

HCA is partnering with Fazzi Associates on discounted pricing for HCA members to participate in Fazzi’s acclaimed SupervisionPlus online training course for front-line home care managers. Front-line managers can have the single largest impact on your organization. This practical, how-to training will teach the fundamentals of supervision, like: assessing employee competency; increasing motivation and commitment among employees; improvement strategies; retention and engagement; productivity; and more.

HCA Annual Conference: Force For the Future May 8-10 (Saratoga Springs) It’s almost flight time, and we’re calling on you to be a Force for the Future at HCA’s Annual Conference.

Online registration, a full brochure, and other information are on the conference website at www.hcaannualconference.com.

Our ‘navigation experts’ will help you get the right crew in place – one that can see new horizons beyond the cloud line of transitioning to PDGM and other challenges. We’ll show you how to glide in tandem with system partners and make a smooth connection for the benefit of improved patient care coordination. Technology experts will reveal some exciting solutions that offer field level clinical data and operational analytics, enhancing the efficiency of your “flight time” and your clinical outcomes.

And we’ll help you become more productive by reclaiming “white space” … so that you can look clear eyed at the vast universe of opportunity and priorities before you out the cockpit window.

WEBINAR: 4-Part ICD-10 Coding Webinar Series: Thursdays in May May 4, 9, 16, 23 (1-2 p.m.)

This series will prepare coders for PDGM. With PDGM’s 64 percent increase in case-mix categories (for a total of 432 possible case-mix-adjusted-groups), coders need to be prepared and ready for: the coding of comorbidities, understanding the complexities of wound coding, and correctly coding for dementia, Alzheimer’s and other cognitive deficits.

Continued on next page

10

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

Volume 4, No. 12 March 25, 2019 

Continued from previous page Blueprint for OASIS Accuracy – OASIS D Data Set June 17-18 (Workshop) June 19 (Optional COS-C Exam) Acclaimed OASIS training is back with a session for upstate providers in Webster, NY (near Rochester). This 13 contact hour program is accompanied by an optional Certificate for OASIS Specialist exam (COS-C) at the same location. Your clinicians and RN leaders need regular OASIS training, especially to keep their COS-C certification current and even more so this year with the onset of OASIS-D changes. These changes include the removal of more than two dozen items, as well as the addition or revision of several others.

Free CEU Programs for Clinicians Through HCA Associate Members, Plus WIO Education Listings HCA strives to build an education agenda that suits your needs. Our associate members also do an incredible job offering education that reaches different disciplines or areas of focus as a complement to HCA’s offerings.

HCA recently invited associate members to share any free-of-charge educational programs that are open to HCA members. We continue to invite any calendar items or flyers from Associate Members describing webinars, teleconferences and other educational opportunities.

We also have posted a page on our website featuring information about the state’s Workforce Investment Organization (WIO) program, which additionally include free trainings for your staff.

Byram trainings Byram Healthcare, in particular, has a full calendar of Continuing Education programs, including a monthly accredited webinar for case managers, nurses, social workers, WOCNs, certified diabetes educators and registered dieticians. These free-of-charge webinars are based on a specific topic related to one of Byram’s services: Diabetes, Ostomy, Wound Care, Urology, Home Health and Managed Care. All of the courses are one hour, board-approved and count as 1 Continuing Education Unit (CEU).

Download the flyers to learn more at https://hca-nys.org/wp-content/uploads/2019/03/2019-CE-Calendareditable-v2.pdf and https://hca-nys.org/wp-content/uploads/2019/03/2019-Continuing-Education-CourseRoster.pdf.

WIO trainings As extensively reported to the membership, the state’s WIO program requires certain managed care plans to contract with designated WIOs to educate direct-care workers, with the goals of supporting the critical long term health care workforce infrastructure through retraining, redeployment, and enhancing skill sets.

Each WIO is approved to service one or more regions across the state. Included on HCA’s website is a list of the approved WIOs and their service areas in addition to information they have provided to HCA for distribution to members. Visit our WIO page for further information at https://hca-nys.org/no-costworkforce-training-available-through-regional-wios.

11

Volume 4, No. 12 March 25, 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

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

Healthcare Personnel Influenza Vaccination Report

May 1, 2019

https://www.health.ny.gov/diseases/commun icable/influenza/seasonal/providers/preventio n_of_influenza_transmission/

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

12

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

Volume 4, No. 12 March 25, 2019 

November Global Cap Report: Medicaid Spending $79M Above Projections The state’s latest Medicaid Global Cap Report finds that overall spending was $79 million above projections for the first eight months of the state fiscal year (as of November 2018) across all sectors, a difference of $15.950 billion in actual spending versus $15.871 billion in estimated spending.

The report is here: https://www.health.ny.gov/health_care/medicaid/regulations/global_cap/monthly/ sfy_2018-2019/docs/nov_2018_report.pdf.

The Medicaid Global Spending Cap has increased 6.7 percent, from $19.5 billion in fiscal year (FY) 2018 to $20.8 billion in FY 2019. Specifically, the state Department of Health (DOH) mentions the following two significant pressures on the Global Cap: 

Medicaid spending in major Medicaid Managed Care categories was $69 million over projections.



Medicaid spending in major fee-for-service categories was $91 million over projections with clinic spending $14 million above estimates. This is a result of total claims billed being 9.7 percent higher than anticipated through November.

In other important items: 

DOH reports that total Managed Long Term Care (MLTC) spending exceeded its monthly cap by $52 million due to higher-than-expected enrollment. There were approximately 8,000 more individuals enrolled in the MLTC partial capitation plan than budgeted.



Total Medicaid enrollment reached 6,165,415 at the end of November 2018. This reflects a net increase of 43,824 enrollees since March 2018.



The state’s Accounts Receivable (A/R) ending balance for FY 2018 was $224 million. DOH is expected to recoup $174 million by the end of FY 2019, resulting in a projected A/R balance of $50 million by March 2019. Through the end of November, retroactive rates owed to the state were $93 million. This reflects net recoveries of $131 million since March 2018.

For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

CMS Hosts March 28 Webcast on Submitting Electronic Cost Reports The U.S. Centers for Medicare and Medicaid Services (CMS) is hosting a repeat March 28 webinar (1 to 2:30 p.m.) on how to use the new Medicare Cost Report e-Filing (MCReF) system.

Medicare Part A providers, including home health and hospice, can use MCReF for fiscal years ending on or after December 31, 2017. Providers have the option to electronically transmit their cost report through MCReF or mail or hand deliver it to your Medicare Administrative Contractor. Providers must use MCReF if you choose electronic submission of your cost report.

Continued on next page

13

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

Volume 4, No. 12 March 25, 2019 

Continued from previous page A question and answer session follows the presentation; attendees may e-mail questions in advance to OFMDPAOQuestions@cms.hhs.gov with “Medicare Cost Report e-Filing System Webcast” in the subject line.

Registration is at https://blh.ier.intercall.com/.

Additional MCReF information is at: https://www.cms.gov/Medicare/Compliance-and-Audits/Part-A-CostReport-Audit-and-Reimbursement/MCReF.html.

HCA Participates in HEPC Statewide Meeting Last week, HCA attended the Annual Health Emergency Preparedness Coalition (HEPC) Statewide Meeting hosted by the state Department of Health Office of Health Emergency Preparedness (OHEP).

HEPCs are regional coalitions of health care providers, local and state emergency management and local public health preparedness officials who work together to develop and coordinate emergency preparedness activities across the continuum.

Under an OHEP grant, HCA and the New York State Association of Health Care Providers (HCP) are responsible for participating in HEPC meetings across the state outside of New York City.

The Statewide Meeting brought together all of the HEPC partners for a day and a half of discussions centered on the Schoharie County limousine accident; strategic plans and deliverables for all health care sectors covering 2019-20; and sector collaboration with HEPCs. HCA and meeting participants discussed HEPC successes and areas for improvement; ways to better involve home care, hospice and other providers; agenda items that would be appropriate for all sectors; experiences with recent and past exercises; and more.

HCA was part of the planning committee for the meeting and worked towards an agenda that was relevant to all health care sectors.

HCA again advocated for more meaningful involvement by home care and hospice agencies in exercises and all HEPC activities. We also reiterated problems from recent exercises, including providers not being notified of drills due to the location of their main offices, even though they serve regions otherwise covered by the drill. We are encouraged that the Western Region has addressed this issue and was just informed that this will be addressed in other regions.

Any questions on emergency preparedness can be directed to Andrew Koski at (518) 810-0662 or akoski@hcanys.org; or Alyssa Lovelace at (518) 810-0658 or alovelace@hcanys.org.

14

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

Volume 4, No. 12 March 25, 2019 

Rule Issued on State Medicaid Fraud Control Units The U.S. Department of Health and Human Services (HHS) has issued a final rule that amends the regulation governing State Medicaid Fraud Control Units (MFCUs). See https://www.govinfo.gov/ content/pkg/FR-2019-03-22/pdf/2019-05362.pdf.

MFCUs investigate and prosecute Medicaid provider fraud as well as patient abuse or neglect in health care facilities. MFCUs are usually a part of the State Attorney General’s office and employ teams of investigators, attorneys, and auditors. They must be separate and distinct from the State Medicaid agency.

The rule incorporates statutory changes affecting MFCUs as well as policy and practice changes that have occurred since the regulation was initially issued in 1978. These changes include a recognition of the federal government’s delegated authority; MFCU authority, functions, and responsibilities; disallowances; and issues related to organization, prosecutorial authority, staffing, recertification, and the MFCUs’ relationship with Medicaid agencies.

According to HHS, the rule is designed to assist the MFCUs in understanding their authorities and responsibilities under the grant program, clarify the flexibilities the MFCUs have to operate their programs, and reduce administrative burden, where appropriate, by eliminating duplicative and unnecessary reporting requirements.

HCA will be reviewing the rule to determine how it may affect home care providers.

Health Resources 

“Data Note: Public’s Experiences With Electronic Health Records,” by the Kaiser Family Foundation https://www.kff.org/other/poll-finding/data-note-publics-experiences-with-electronic-healthrecords/



“Report To The Congress: Medicare Payment Policy,” by the Medicare Payment Advisory Commission www.medpac.gov/docs/default-source/reports/mar19_medpac_entirereport_sec.pdf?sfvrsn=0

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

15