April 8, 2019 Edition of The Situation Report

SEPSIS

MA SUPPLEMENTAL BENEFITS

BUDGET MEMO

WAGE PARITY

HCA is collaborating with the state Office for the Aging on a new effort to link area aging networks with provider “sepsis champions.”

New CMS Call Letter further outlines allowed “supplemental benefits,” including in-home supports, under Medicare Advantage (MA).

HCA’s budget memo provides key details on all of the provisions directly affecting home care, hospice and MLTC.

The new state budget includes a provision applying the wage parity law to NHTD/TBI, now in effect, beginning at the April 1 start of the fiscal year.

PAGE 5

PAGE 7

PAGE 8

PAGE 10

Your Source for HOME CARE News, Policy and Advocacy

UPCOMING PROGRAMS

Vol. 4, Issue 14| April 8, 2019

HCA Appoints Rebecca Fuller Gray to Executive Role National home care, hospice expert brings unmatched experience and skills to HCA

Downstate CHHA Member Forums April 10, 2019 (NYC) WEBINAR: Clinical Documentation Improvement (CDI) April 11, 2019 WEBINAR: Lessons Learned from ValueBased Purchasing April 18, 2019 SupervisionPlus Online Managerial Training Self-paced online training module Registration deadline: May 8, 2019 HCA Annual Conference: Force For the Future May 8-10, 2019 Saratoga Springs

HCA President Al Cardillo and the HCA Board proudly and enthusiastically announce the appointment of state and national home care expert Rebecca Fuller Gray as HCA’s new Executive Vice President for Clinical and Program Affairs. Ms. Gray starts her position on May 1.

“Becky brings to HCA a truly unique and stellar asset for New York’s home care, hospice and managed long term care organizations,” said Mr. See GRAY p. 2

HCA, State Partners, NAHC Convene for Strategy, Advocacy

HCA Advances Post-Budget Legislative Strategy

Immediately following last weekend’s wrap-up of the state budget (see related post-budget story on this page), HCA headed to Washington for intensive strategy sessions and advocacy with state home care association partners and the National Association for Home Care and Hospice (NAHC).

See CONVENE p. 3

Since passage of the final state budget on April 1, HCA has been working to advance our post-budget legislative priorities related to home care, hospice and managed long term care (MLTC). HCA has requested meetings with both the Senate and Assembly Health Chairs and key legislative staff to assist with moving the Association’s priorities forward.

INSIDE HCA Appoints Rebecca Fuller Gray to Executive Role...................................1 HCA, State Partners, NAHC Convene for Strategy, Advocacy........................1 HCA Advances Post-Budget Legislative Strategy........................................1 HCA Applauds DOH’s Diane Jones on her Retirement..................................4 HCA and NYSOFA Launch Major Sepsis Partnership.....................................5 CMS Finalizes MA Payment and Policy Changes...........................................7 ICYMI: HCA Memo Details Final State Budget Outcome................................8

See STRATEGY p. 5

CMS to Re-Start Review Choice Demo in Illinois.................................................9 Wage Parity Now Applies to NHTD/TBI Cases....................................................10 CMS Announcements from MLN Connects.......................................................10 US DOL Issues Proposed Rule on Joint Employer Issues....................................11 RFP Issued by NYSHealth................................................................................12 Upcoming Due Dates and Deadlines...............................................................13 Claim Rejection, Denials Begin for Providers on the Preclusion List.................14 Workers Now Have Up to Three Hours of Paid Time Off to Vote..........................14 Health Resources..........................................................................................15

The Situation Report: the Home Care Association of New York State GRAY from p. 1 Cardillo. “There is only one Becky Gray. How thrilled and fortunate we are to have her combined clinical and program expertise for the members of HCA.” He added: “She will be invaluable to HCA member organizations at the individual, field, statewide and federal levels, and she will be a major new force complementing HCA’s overall program, operations and education teams.”

Ms. Gray is a consummate Registered Professional Nurse and accomplished administrator whose career has been dedicated to health care quality and excellence. Her experience spans a wide range of clinical and administrative work in home care, hospice, hospital reimbursement and other major areas of health care.

Last May, Ms. Gray was recognized with HCA’s highest honor, the Ruth F. Wilson Award. The award recognizes an individual whose work has had a dramatic effect on home care, strengthening the practice and raising the standards of quality and care for patients.

“Becky’s work to promote quality home care has been unparalleled,” said Mr. Cardillo. “She has been a beacon for home care and hospice nursing. Adding Becky to HCA’s current five-star team takes the Association to even further heights of innovation, expertise and member service.”

“I encourage all members to welcome Becky to HCA at our Annual Statewide Meeting and Conference, on May 8 to 10 in Saratoga Springs.”

Volume 4, No. 14 April 8, 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

www .hcaannualconfer ence.com www.hcaannualconfer .hcaannualconference.com 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

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. 14 April 8, 2019 

 CONVENE from p. 1 The sessions were held in conjunction with the Forum of State Home Care Associations and NAHC’s “March on Washington.”

The Forum and NAHC meetings included in-depth sessions with the U.S. Department of Labor, Centers for Medicare and Medicaid Services, America’s Health Insurance Plans (AHIP) association, representatives from major Congressional committees, Congressional sponsors of home care bills, federal health consultants, and more. HCA and partners were able to garner important information from these officials while teeing up valuable advocacy messages in each category of concern.

Strategic discussions and planning centered on: 

The new Patient Driven Groupings Model (PDGM) legislation and further needed education/ analytical efforts;



Legislation enabling nurse practitioners and physician assistants to order and refer for home care services;



Implications and advocacy concerning the Medicare Payment Advisory Commission’s (MedPAC) recommendation for a hospice carve-in to the Medicare Advantage (MA) plan model;



The “Review Choice Demonstration” related to electronic visit verification;



NAHC’s plans for a national workforce development strategy and advocacy; and



The rural add-on.

These strategy and policy discussions were followed by Capitol Hill meetings with each state’s Congressional Delegation members.

The meeting topics substantially followed the priority strategic areas outlined above, with additional areas customized by each state’s advocacy team. In addition to these priorities, HCA discussed the specific financial factors that set New York apart from MedPAC’s and CMS’s analyses of home care in other parts of the country. HCA extensively utilized our own data compilations and analytical studies to emphasize: the urgency of a PDGM fix; issues related to rural home care access; the faultiness of CMS’s current wage index methodology; and the need for workforce interventions.

HCA also provided information on the technology needs and capabilities of New York’s providers, as well as innovations that HCA and members are implementing to benefit patients and leverage cost savings.

At the sessions, HCA President Al Cardillo was joined by HCA member VNSNY, represented by Vice President Daniel Lowenstein. VNSNY and Mr. Lowenstein conducted two solid days of advocacy meetings, further joined by HCA’s federal government-relations director Brett Heimov of Envision Strategies. HCA applauds VNSNY and Mr. Lowenstein for their efforts.

HCA encourages all members to meet with Congressional representatives in either their local or Washington offices. It is critical that your officials know you, your agency, your services to their

3

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

Volume 4, No. 14 April 8, 2019 

constituents and the impact you make to their community as an employer. HCA’s Director of Policy and Advocacy, Alyssa Lovelace (alovelace@hcanys.org), and Mr. Heimov (Brett@envisionstrategy.com) are available to assist you in arranging these meetings. All of HCA’s briefing documents on the PDGM fix, rural add-on, wage index and other issues are on our Federal advocacy page at https://hca-nys.org/advocacy-pac/federal.

HCA is especially urging the membership to focus their grassroots advocacy directly on two key federal bills at this time: 

S.433, sponsored by U.S. Senator Susan Collins (R-ME), which seeks to preempt CMS’s upfront cuts to PDGM; this bill is expected to be introduced imminently in the House by U.S. Rep. Terri Sewell (D-AL).



S.296, sponsored by Senator Collins and expected to be introduced imminently by Rep. Ronald Kind (D-WI), which would authorize nurse practitioners and physician assistants to order home care services.

Wide support for these bills can help position them as parts of larger Congressional packages for movement during this Congressional year.

For further information, please contact a member of the HCA Policy staff.

HCA Applauds and Thanks DOH Home Care Leader Diane Jones on her Retirement State Department of Health home care leader Diane Jones, RN, has announced her retirement, effective Friday, April 5.

Ms. Jones has been a key leader and asset to DOH home care for over decade. She has epitomized devotion to the field, the highest professional standards, excellence in her work and wonderful collegiality to HCA. “I know that I speak for all of HCA in thanking Diane for always being there for guidance, direction, assistance and answers to some of the most complicated state and federal policy and procedural questions,” said HCA President Al Cardillo. “Moreover, she has been a regular and superb faculty contributor to HCA’s educational programing.”

Diane Jones has worked in the Division of Home and Community Based Services at DOH. The Division is now under the leadership of Margaret Willard, its Acting Director, who has been a champion in home care at the local and state levels for decades, and also an exceptional colleague to HCA.

4

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

Volume 4, No. 14 April 8, 2019 

STRATEGY from p. 1 Specifically, HCA seeks to secure rate enhancements for certified home health agencies (CHHAs); a CHHA benchmark; and rate adequacy for MLTC and network providers.

Throughout negotiations, HCA urged the Legislature to include language in the final budget that would increase the episodic payment system (EPS) and fee-for-service rates by 10 percent, in addition to other state methodology adjustments to cover costs that are not currently reflected in base rates.

Though these proposals were not included in a final state budget agreement, the Senate originally included HCA’s proposal mandating transparency in the state’s reimbursement of MLTCs and providers.

The purpose of this provision is to ensure accountability with requirements that the state achieve actuarial soundness for rate adequacy, including for wage and labor compliance.

In addition to the legislation mentioned above, HCA has already advanced a workforce bill package that applies to home care, hospice and MLTC. As mentioned in last week’s Situation Report, Assembly Member Harry Bronson introduced two pieces of HCA-developed legislation (already introduced in the Senate by Senator Susan Serino) that would establish a labor market study for home care and hospice, as well as legislation that addresses home care and hospice worker shortage areas and disciplines.

HCA is also seeking support for a series of additional bills that will help better position home care within the overall system, including legislation related to sepsis, the Geriatric Demonstration Program and health disparities.

The Legislature has only eight weeks remaining in Albany until lawmakers adjourn in June. During this time, interest groups will flood the halls of the Capitol seeking support for their priorities. It is critical that HCA members assist the Association on grassroots advocacy efforts as we issue calls for action. HCA Public Policy staff will be sure to alert the memberships as the Association’s priorities are advanced.

Please contact Director for Public Policy and Advocacy, Alyssa Lovelace, alovelace@hcanys.org with questions or concerns related to HCA’s post-budget strategy.

HCA and State Office For Aging Launch Major Sepsis Partnership County Offices for Aging to pair with HCA “home care sepsis champions” HCA and the New York State Office for Aging (NYSOFA) are preparing to launch a major partnership between our two organizations to facilitate pairing and joint collaboration among County Departments for Aging, local aging network organizations, and home care agencies on screening and intervening for sepsis through the HCA sepsis initiative.

HCA and NYSOFA will be announcing further details of this initiative soon.

Last June, NYSOFA invited HCA and IPRO to conduct a statewide webinar for County Departments for Aging and local network organizations on sepsis and the elderly, featuring HCA’s Stop Sepsis at Home initiative.

In a follow-up survey, local offices overwhelmingly responded enthusiastically to the idea of having local home care “sepsis champions” help train personnel in sepsis, conducting joint education sessions for elderly

5

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

Volume 4, No. 14 April 8, 2019 

citizens and family caregivers, and promoting all home care agencies’ adoption of the sepsis screening tool at the heart of HCA’s Stop Sepsis at Home initiative.

This is a tremendous opportunity at both the state and local levels. Stay tuned for details.

HCA-NYSOFA joint public service announcement HCA and NYSOFA’s collaboration has also included a joint public service announcement (PSA) on sepsis and the elderly, initiated by NYSOFA Director Greg Olsen. The announcement, recorded by Director Olsen and HCA President Al Cardillo, has been sent to NYSOFA’s entire aging network throughout the state.

HCA members are encouraged to view the PSA, and circulate it on social media.

Please share it from HCA’s Facebook page (at https://www.facebook.com/HCANYS) or view the video directly on YouTube at https://youtu.be/QZHLaVaNaJc. State of Illinois Home Care and Hospital Associations adopt HCA Sepsis Tool The Illinois State Home Care Association and the Illinois State Hospital Association have partnered to adopt the HCA sepsis tool and model, and to promote the tool’s further adoption and use by all home care agencies in their state.

The Illinois hospital sector is also actively working to assist home care agencies in adopting the tool. The hospitals have reached out to HCA for helpful data and evidence from our experience here in New York State.

Illinois state home care executive Sara Ratcliff has been leading the Illinois charge to embrace HCA’s home care sepsis effort.

Additional states and multistate organizations continue to explore and adopt the HCA tool. Currently, nearly every county in New York is served by a provider that has been trained and authorized by HCA to use the tool with patients. If your agency or managed long term care plan has not yet adopted this tool, write to sepsistool@hcanys.org.

HCA and NY providers’ sepsis work featured in national Geriatric Medicine Journal HCA and New York’s home care sepsis initiative is prominently featured in a newly published article in the journal Today’s Geriatric Medicine.

The article (“Sepsis: When Infections Turn Deadly”) provides core background on sepsis and cites HCA’s sepsis tool noting that “in order to see nationwide change, it’s important that more providers follow suit.

Sepsis deaths are preventable, but only if caught early, making proper protocols vital.”

The article is at http://www.todaysgeriatricmedicine.com/archive/MA19p20.shtml.

6

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

Volume 4, No. 14 April 8, 2019 

CMS Finalizes Medicare Advantage Payment and Policy Changes Supplemental benefits outlined Last week, the U.S. Centers for Medicare and Medicaid Services (CMS) released its 2020 Medicare Advantage (MA) Call Letter that outlines payment and policy changes for 2020.

The Call Letter is at https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/ Announcements-and-Documents.html; a fact sheet is at https://www.cms.gov/newsroom/fact-sheets/2020medicare-advantage-and-part-d-rate-announcement-and-final-call-letter-fact-sheet.

In the Call Letter, CMS provides clarification regarding “supplemental benefits.” Beginning in 2019, CMS expanded its interpretation of the criterion that supplemental benefits be “primarily health related.” This expanded criterion considers an item or service as primarily health related if it is used to diagnose, compensate for physical impairments, acts to ameliorate the functional/psychological impact of injuries or health conditions, or reduces avoidable emergency and health care utilization.

An April 27, 2018 guidance indicated these benefits could include non-skilled in-home supports, home-based palliative care, portable wheelchair ramps and other assistive devices and modifications when patients need them.

Separately, the Bipartisan Budget Act of 2018 further expanded the types of supplemental benefits that may be offered by MA plans to “chronically ill” enrollees. These benefits, referred to as Special Supplemental Benefits for the Chronically Ill (SSBCI), include supplemental benefits that are not primarily health related and may be offered non-uniformly to eligible chronically ill enrollees.

The Call Letter and new supplemental services create new opportunities for home care and hospice to partner with MA plans to provide expanded services. However, they also pose important and potentially concerning questions. The federal guidance is not particularly clear on whether and which services require delivery through licensed home care providers and hospices, versus allowing these services to be provided through non-home care entities or directly by the MA plan itself. Cases of articles 36 and 40 overreach are already a serious concern in the state, both as explicit violations by non-home care entities, or in such organizations’ desire to cross jurisdictional lines. This suggests the merit of proactive work by home care agencies to strategically partner with MA plans to be collaborating providers for these services. HCA will be further exploring these opportunities, questions and recommended strategies.

Under this law, a chronically ill enrollee (authorized to receive expanded benefits) is defined as an individual who: 1) has one or more comorbid and medically complex chronic condition(s) that is life threatening or significantly limits the overall health or function of the enrollee; 2) has a high risk of hospitalization or other adverse health outcomes; and 3) requires intensive care coordination.

For 2020, CMS will consider chronically ill enrollees to be those with a chronic condition listed in section 20.1/2 of chapter 16b of the Medicare Managed Care manual (https://www.cms.gov/Regulations-andGuidance/Guidance/Manuals/Downloads/mc86c16b.pdf section 20.1.2) to meet the statutory criterion of having one or more comorbid and medically complex chronic conditions that is life threatening or that

7

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

Volume 4, No. 14 April 8, 2019 

significantly limits the overall health or function of the enrollee. This includes: cardiovascular disorders; chronic heart failure; dementia; diabetes mellitus; autoimmune disorders; and more.

In addition, the law requires that the specific SSBCI item or service have a reasonable expectation of improving or maintaining the health or overall function of the enrollee as it relates to the chronic condition or illness. In the 2020 Call Letter, CMS states that such items or services may include, but are not limited to: meals furnished to the enrollee beyond a limited basis, transportation for non-medical needs, pest control, indoor air quality equipment and services, and benefits to address social needs, so long as such items and services have a reasonable expectation of improving or maintaining the health or overall function of an individual as it relates to their chronic condition or illness.

Contrary to its draft 2020 Call Letter, CMS has decided that services or items can also include capital or structural improvements (e.g., permanent ramps, and widening hallways or doorways).

While the 2019 Call Letter was released too late for most managed care organizations to offer these benefits to their members, it is expected that more plans will provide such benefits in 2020.

ICYMI: HCA Memo Details Final State Budget Outcome In case you missed it, HCA has prepared a comprehensive memo on the recent state budget outcome for members. It is available at https://hca-nys.org/wp-content/uploads/2019/04/Final-budget-memo040319.pdf.

The memo outlines core issues such as the outcome of proposed Medicaid reductions (which were substantially rejected in the final budget, restoring critical funds), as well as: 

Payment issues within and outside the Medicaid Global Cap (i.e. minimum wage);



Payment or program extenders;



New state Office of the Medicaid Inspector General (OMIG) oversight and audit authorities;



Mandates (including those rejected, such as the National Provider Identifier requirement for home care aides);



Additional fund allocations for accounts-receivable related to the closure of Independence Care System Managed Long Term Care (MLTC) plan;



“Legacy” cost-containment actions that are carried over from past budgets; and



Changes to payments for the administrative costs of fiscal intermediaries under the Consumer Directed Personal Assistance Program.

Continued on next page

8

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

Volume 4, No. 14 April 8, 2019 

Continued from previous page We also discuss HCA’s advocacy on these and other issues aimed at rate updates and transparency measures for home care, hospice and Managed Long Term Care (MLTC) program stabilization. (See related p. 1 story.)

In addition to the narrative memo, we’ve provided a chart at the end showing over two dozen issue areas, the treatment of each in the Governor’s proposed budget, how the Senate and Assembly initially responded, and the final outcome.

CMS to Re-Start Review Choice Demo in Illinois Demonstration Does Not affect New York CHHAs in NGS’s Jurisdiction 6 Last week, the U.S. Centers for Medicare and Medicaid Services (CMS) received Paperwork Reduction Act (PRA) approval for the Review Choice Demonstration for home health.

The Office of Management and Budget (OMB) has reviewed the demonstration documents and CMS’s responses to public comments and approved the collection of information. The updated online status is available at: https://www.reginfo.gov/public/Forward?SearchTarget=PRA&textfield=0938-1311.

In response to public comments, the demonstration incorporates more flexibility and choice for Certified Home Health Agencies (CHHAs) in Illinois as well as risk-based changes to reduce burden on providers demonstrating compliance with Medicare home health policies. CHHAs will select from three initial choices:   

Pre-claim review; Post-payment review; or Minimal post-payment review with a 25 percent payment reduction.

After a six-month period, CHHAs demonstrating compliance with Medicare rules through pre-claim review or post-payment review will have additional choices, including relief from most reviews except for a review of a small sample of claims. Full demonstration details will be available in the Operational Guide published in the ‘Downloads’ section at the link below.

The choice selection period for CHHAs located in Illinois will begin on April 17, 2019 and end on May 16, 2019.

CMS will continue to post updated information on this demonstration at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFSCompliance-Programs/Review-Choice-Demonstration/Review-Choice-Demonstration-for-Home-HealthServices.html.

CMS will provide notice on this website before phasing in the demo to other demonstration states: Ohio, Texas, North Carolina and Florida.

9

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

Volume 4, No. 14 April 8, 2019 

Wage Parity Now Applies to NHTD/TBI Cases in NYC, Westchester and Long Island Within the state budget is a provision that we wanted to make sure didn’t escape notice from providers of Nursing Home Transition and Diversion (NHTD) or Traumatic Brain Injury (TBI) waiver programs.

Effective April 1, 2019, when the state budget was finalized, home care aides delivering care under the NHTD and TBI waiver programs are added to the definition of “home care aide” for purposes of wage parity requirements.

The Wage Parity Law establishes higher wage and non-wage benefit levels compared to the rest of the state in New York City, Westchester and on Long Island. The levels for minimum rate of total compensation are posted under “Official Notices” at https://www.health.ny.gov/health_care/medicaid/redesign/mrt_61.htm.

This law is already otherwise in place generally for home care services in these regions, as provided by LHCSAs or CHHAs under fee-for-service or managed care. Providers subject to wage parity also must report quarterly and/or annually.

CMS Announcements from Medicare Learning Network (MLN) Connects The U.S. Centers for Medicare and Medicaid Services (CMS) made the following announcements in Medicare Learning Network (MLN) Connects, its weekly publication.

Public Reporting of Measures on Hospice Visits when Death is Imminent The “Hospice Visits when Death is Imminent” measures assess whether a hospice patient and caregiver’s needs were addressed by hospice staff in the last three and seven days of life: 

The three-day measure will be publicly reported on Hospice Compare in the summer of 2019, as planned; and



The seven-day measure will not be publicly reported at this time because it does not meet readiness standards for public reporting.

CMS has provided additional information on this hospice measure at: https://www.cms.gov/Medicare/ Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/Downloads/Public-Reportingof-the-Hospice-Visits-when-Death-is-Imminent-Measure-Pair-Fact-Sheet.pdf.

Mapping Medicare Disparities Tool: New Enhancements CMS has recently expanded its Mapping Medicare Disparities (MMD) Tool Population View (https://www.cms.gov/About-CMS/Agency-Information/OMH/OMH-Mapping-Medicare-Disparities.html) to include: 

10

Data by rural and urban areas (view and compare health outcome, spending, and utilization rates across rural and urban counties).

Continued on next page

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

Volume 4, No. 14 April 8, 2019 

Continued from previous page 

Four opioid use disorder indicators (view prevalence, cost, and utilization rates).



2017 data.

Users of the MMD Tool can view and download maps and data files to learn more about health outcomes in your community. The web-based tool provides health outcome measures for disease prevalence, costs, and hospitalization for 55 specific chronic conditions, emergency department utilization, readmissions rates, mortality rates, and preventable hospitalizations.

Questions about the tool can be sent to HealthEquityTA@cms.hhs.gov.

Medicare-Medicaid Crossover Bad-Debt Accounting Classification Providers claiming Medicare bad debt must meet 42 CFR 413.89 and all requirements from Chapter 3 of the Provider Reimbursement Manual (https://go.usa.gov/xEuwD). It is important to correctly classify unpaid deductible and coinsurance amounts for Medicare-Medicaid crossover claims in your accounting records. For bad debt amounts: 

Do not write off to a contractual allowance account; and



Charge to an expense account for uncollectible accounts (bad debt).

For cost reporting periods beginning on or after October 1, 2019, providers must comply with these longstanding Medicare bad-debt requirements.

US DOL Issues Proposed Rule on Joint Employer Issues Last week, the U.S. Department of Labor (DOL) proposed a rule to revise and clarify responsibilities in joint employer arrangements. The Department has not meaningfully revised its joint employer regulation since 1958.

According to DOL, the proposed changes are designed to reduce uncertainty over joint employer status and clarify for workers who is responsible for their employment protections, promote greater uniformity among court decisions, reduce litigation, and encourage innovation in the economy.

Under the Fair Labor Standards Act (FLSA), an employee may have – in addition to his or her employer – one or more joint employers. A joint employer is any additional individual or entity who is jointly and severally liable with the employer for the employee’s wages. DOL states that this proposal would

11

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

Volume 4, No. 14 April 8, 2019 

ensure that employers and joint employers clearly understand their responsibilities to pay at least the federal minimum wage for all hours worked and overtime for all hours worked over 40 in a workweek.

The Department proposes a four-factor test that would consider whether the potential joint employer actually exercises the power to: 

Hire or fire the employee;



Supervise and control the employee’s work schedules or conditions of employment;



Determine the employee’s rate and method of payment; and



Maintain the employee’s employment records.

The proposal provides guidance on how to apply this multi-factor test; explains what additional factors should and should not be considered; and clarifies that a particular business model, certain business practices, and certain contractual agreements do not make joint employer status more or less likely.

Regarding existing regulatory guidance for situations where the employee works separate sets of hours for multiple employers in the same workweek, the Department is proposing only non-substantive revisions.

The proposal also includes a set of examples for comment that would further help clarify joint employer status.

More information about the proposed rule is available at www.dol.gov/whd/flsa/jointemployment2019.

RFP Issued by NYSHealth The New York State Health Foundation (NYSHealth) has released a Request for Proposals (RFP) to support federally qualified health centers (FQHCs), multispecialty group practices, hospital-affiliated physician groups, independent physician practices, and other health care settings across New York State in adopting or spreading OpenNotes.

OpenNotes is a national effort to give patients access to the visit notes written by their doctors, nurses, or other clinicians. Established in 2010, OpenNotes creates partnerships toward better health and health care by giving everyone on the medical team, including the patient, access to the same information. When patients have access to their own visit notes written by health care providers, they better remember what was discussed during the visit; feel more in control of their care; are more likely to take medications as prescribed; and can share notes with their caregivers.

Awards of up to $100,000 will be granted per organization. Proposals will be due on May 2, 2019.

More information is at https://nyshealthfoundation.org/rfp/growing-opennotes-across-new-york-state/.

12

Volume 4, No. 14 April 8, 2019

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



Upcoming Deadlines and Due Dates

13

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/RKforms.html

Virtual Tabletop Exercise for Home Health Agencies – Western region

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

https://tinyurl.com/yymwldwo

Western Region HEPC After Action Report Workshop

April 9, 2019 from 1 to 2:30 p.m.

https://tinyurl.com/y63lmmx7

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) 810Ͳ April 15 and April 26, 2019 0662

Interoperable Communications/Medical Countermeasures (IOC/MCM) exercise – Long Island

April 18, 2019

Drew.Fried@health.ny.gov

2019 Adult Care Facility 1st Quarter Statistical Information Report (and Roster of Adult Home Residents, if applicable)

April 30, 2019

https://commerce.health.state.ny.us/public/hcs_logi n.html

Healthcare Personnel Influenza Vaccination Report

May 1, 2019

https://www.health.ny.gov/diseases/communicable/ influenza/seasonal/providers/prevention_of_influen za_transmission/

North Country HEPC meeting

May 2, 2019

Maureen.casaleͲreidt@health.ny.gov

Capital District HEPC meeting

May 7, 2019

Maureen.casaleͲreidt@health.ny.gov

CST Exercise for Lower Hudson Valley

Sometime between April 29 and May 10, 2019

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

IOC/MCM exercise – Lower Hudson Valley

May 9, 2019

gyongyi.mcqueston@health.ny.gov

Western Region HEPC All Partners meeting

June 12, 2019, from 8:30 a.m. to 4:30 p.m.

https://tinyurl.com/yyk5vr3q

Transition Period for Using Health Insurance Claim Number (HICN) or new Medicare Beneficiary Identifier (MBI)

April 1, 2018 to December 31, 2019

https://www.cms.gov/Medicare/NewͲMedicareͲ Card/index.html

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

Volume 4, No. 14 April 8, 2019 

Claim Rejection, Denials for Providers on the Preclusion List Began April 1 Effective April 1, 2019, Medicare Advantage (MA) and Part D plans were expected to begin rejecting or denying claims submitted for MA services and Part D drugs prescribed or furnished by an individual or entity on the Preclusion List.

The Preclusion List consists of individuals and entities that fall within either of the following categories: 1. Are currently revoked from Medicare, are under an active reenrollment bar, and the U.S. Centers for Medicare and Medicaid Services (CMS) determines that the underlying conduct that led to the revocation is detrimental to the best interests of the Medicare program; or 2. Have engaged in behavior for which CMS could have revoked the individual or entity to the extent applicable if they had been enrolled in Medicare, and CMS determines that the underlying conduct that would have led to the revocation is detrimental to the best interests of the Medicare program.

Prior to being added to a Preclusion List, providers and prescribers are notified by CMS of their potential inclusion on the Preclusion List and their applicable appeal rights. CMS will add a provider or prescriber to the Preclusion List only if the provider or prescriber’s appeal is denied at the first level or the timeframe for the provider or prescriber to request a first level appeal has been exhausted.

CMS has made the Preclusion List available to the MA plans and Part D plans. MA plans will be required to deny payment for a health care item or service furnished by an individual or entity on the Preclusion List.

MA plans and Part D plans will have 30 days to review the Preclusion List and notify the impacted beneficiaries. Impacted beneficiaries are required to be given at least 60 days’ advance notice before claims begin to reject or deny.

The first list of precluded providers was made available to the MA plans and Part D plans on December 31, 2018. Approximately 1,300 providers and prescribers appeared on the initial Preclusion List.

More information is at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/ MedicareProviderSupEnroll/PreclusionList.html.

Workers Now Have Up to Three Hours of Paid Time Off to Vote A revision to New York’s election law, part of the final state budget, gives workers in New York State up to three hours of paid time off to vote.

Under the new law, all employees may request up to three hours of paid time off to vote, regardless of their work schedules, as long as the request is made at least two working days prior to the election. The employer may designate that any requested time be taken at the beginning or the end of shift.

Previously, the election law provided that employees were entitled to time off to vote only if they did not have four consecutive hours in which to vote between the opening of the polls and the beginning of the

14

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

Volume 4, No. 14 April 8, 2019 

employee’s work shift or the end of the employee’s work shift and the close of the polls. The law also limited an employer’s pay obligation to two hours.

More information is at https://www.jacksonlewis.com/publication/new-york-employees-get-three-hours-paid-time-vote.

This article is based on information provided by Jackson Lewis, the firm for HCA’s counsel.

Health Resources 

“Home Health Care CAHPS (HHCAHPS) Coordination Team Quarterly Review (April 2019)” https://homehealthcahps.org/Portals/0/Newsletter/CTQR_Newsletter_Apr_2019.pdf



“Medicaid Home and Community-Based Services Enrollment and Spending,” by the Kaiser Family Foundation http://files.kff.org/attachment/Issue-Brief-Medicaid-Home-and-Community-Based-ServicesEnrollment-and-Spending



“Key State Policy Choices About Medicaid Home and Community-Based Services,” by the Kaiser Family Foundation http://files.kff.org/attachment/Issue-Brief-Key-State-Policy-Choices-About-Medicaid-Home-andCommunity-Based%20Services

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

15