April 22, 2019 Edition of The Situation Report

FI WORKGROUP

PDGM CODING

MLTC RATES

REMINDER: FLU REPORT

A new state workgroup is now under development to make recommendations on CDPAP and Fiscal Intermediary (FI) changes.

In response to member requests, HCA is offering a June 12 program to make your coding and clinical teams PDGMready!

State Department of Health MLTC financing meeting outlines four phases of upcoming retrospective rate releases.

HCA reminds members that the state-required personnel flu vaccination report is due next week, on May 1.

PAGE 3

PAGE 6

PAGE 7

PAGE 8

Your Source for HOME CARE News, Policy and Advocacy

UPCOMING PROGRAMS SupervisionPlus Online Managerial Training Self-paced online training module Registration deadline: May 8, 2019 WCEI 5-Day Onsite Skin and Wound Management Course: Become Board Certified May 6-10 Windsor, CT HCA Annual Conference: Force For the Future May 8-10, 2019 Saratoga Springs, NY WEBINAR: 4-Part ICD-10 Coding Webinar Series Thursdays in May May 4, 9, 16, 23 1-2 p.m.

Vol. 4, Issue 16| April 22, 2019

HCA Presses Support for Legislative Priorities While the Legislature is out on recess and back in their districts, HCA used the relatively calm period in state governance to meet with key legislative offices last week, discussing the Association’s post-budget legislative priorities.

HCA and HCA’s retained counsel, Hinman Straub, met with representatives of the Assembly and Senate Health Committees, the Senate Finance Committee, Senate Majority Counsel, and Governor’s office. HCA focused on the Association’s rate adequacy and workforce development proposals that we initiated and which gained momentum in the state budget negotiations. These included HCA proposals to: 

Increase Certified Home Health Agencies’ (CHHAs) rates and modify the state’s Episodic Payment System methodology to enable the coverage of costs not currently represented in the base.

See PRIORITIES p. 2

CMS Issues Proposed FY 2020 Hospice Payment Rule 2.7% payment update and wage index changes among significant rule changes The U.S. Centers for Medicare and Medicaid Services (CMS) has released its hospice proposed rule (CMS – 1714-P) to update the fiscal year (FY) 2020 (October 1, 2019 through September 30, 2020) Medicare payment rates and the wage index for hospices serving Medicare beneficiaries.

See HOSPICE p. 5

INSIDE HCA Presses Support for Legislative Priorities.........................................................1 CMS Issues Proposed FY2020 Hospice Payment Rule.............................................1 FI Workgroup Under Development.........................................................................3 Shifting to VBP: A Message from HCA Platinum Sponsor HHAeXchange......................4 Wage Parity Needs: A Message from HCA Platinum Sponsor TSG Financial................4 6 Legal Experts, 1 Day of Hot Topics in Labor Law June 13: NYC...................................5 PDGM “Coding Essentials” Joins Lineup of HCA Education, Resources on PDGM.......6 HCA Tapped for State Business Acumen Initiative....................................................7 DOH Provides MLTC Rate Update at Financing Meeting...........................................7 Reminder: Flu Vaccination Report Due May 1..............................................8

Maximum Workers’ Comp Benefit Rises....................................................9 Hospice Medicaid Rates Posted................................................................9 CMS Updates its Extended Repayment Schedule and Interest Rates.........10 CMS Posts Revised OASIS-D/D1 Instruments.............................................10 NYC Bill Bans Pre-Employment Testing for Cannabis..................................11 Upcoming Deadlines and Due Dates....................................................12 OIG Posts Monthly Work Plan Update......................................................13 Westchester Posts Materials on Earned Sick Leave Law...........................13 NYSHealth Announces New RFP...............................................................13 Medicare Cost Report Changes Proposed................................................14 NGS Updates..........................................................................................14 Health Resources.............................................................................15

The Situation Report: the Home Care Association of New York State PRIORITIES from p. 1 

Ensure rate adequacy for Managed Long Term Care (MLTC) plans and providers, state transparency in the actuarial soundness of its rate calculations for MLTCs/providers, and relief from the continuing cascade of unfunded mandates.



Provide a new rate adjustment for home care, hospice and MLTCs targeted to workforce shortage areas and disciplines.





Promote pipeline development in schools, professional programs and the broader workforce to increase entrance into the home care/hospice fields.

Make structural changes to enable home care/hospice competitiveness for workforce in the overall labor market.



Direct state promotion of home care and hospice as valued careers.



Facilitate workforce efficiencies, such as allowing home care providers to use the Home Care Worker Registry to input/track mandatory annual in-service hours of home health aides and personal care aides.

We specifically asked the Health Committee Chairs to introduce our home care and MLTC reimbursement bills, as well as our aide inservice education bill. The Legislature has already introduced the balance of our workforce package and we will be meeting with the sponsors of these bills to discuss strategies to advance the bills for passage prior to the end of session in June.

The meetings also gave HCA the opportunity to learn of next steps and interests on the part of legislative and Executive health leaders in the aftermath of the budget, and even looking ahead into 2020. HCA will be reporting further on these developments, including the Executive’s plans to initiate a “round-two” Medicaid Redesign Team process.

Legislative and state agency staff also welcomed further information and education from HCA on the importance of home care and hospice during upcoming meetings.

The Senate and Assembly are scheduled to return to Albany on Monday, April 29. In the meantime, HCA members are encouraged to connect with lawmakers while your representatives are back in their 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. 16 April 22, 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. 16 April 22, 2019 

district offices. This should include meetings with your lawmakers where you introduce your organization or reacquaint legislator s regarding basic information about your agency and its role within the local community. Visit HCA’s Legislative Action Center (https://hca-nys.org/advocacy-pac/state) to find your lawmakers’ contact information.

For assistance scheduling district meetings, please contact HCA’s Director for Public Policy and Advocacy Alyssa Lovelace at alovelace@hcanys.org, or call (518) 810-0658. HCA will continue to meet with legislative staff to garner support for the Association’s priorities.

FI Workgroup Under Development The state Department of Health (DOH) Fiscal Intermediary (FI) Workgroup, established under the final state budget, is under development and HCA has advanced recommendations for representation. The workgroup is required to convene by May 15, 2019 as per the state budget. HCA will notify the membership once the workgroup has been announced.

The mission of the workgroup is to: identify and develop best practices for FI services; formulate criteria for the selection of FIs; develop quality reporting requirements; and establish transition plans for consumers that need to transition to another FI. The workgroup includes: representatives of independent living centers; provider, plan and FI associations; consumers; consumer advocacy groups; and local departments of social services.

As previously reported to members, the state final budget made changes to FIs and the Consumer Directed Personal Assistance Program. Changes include: 

Establishment of a per-member per-month payment for FI administrative services.



Elimination of the existing FI authorization process and requirements related to advertising.



Establishment of a procurement/application process, effective January 1, 2020, for selection of FIs that would include, but not be limited to, independent living centers and FIs operating since prior to January 1, 2012 who have been continuously providing such services.



A requirement that all entities providing FI services on or before April 1, 2019 must apply for a state contract to continue providing FI services. Such entities shall be deemed authorized to provide such services unless the entity fails to submit an application or its application is denied.



Addition of new responsibilities to FIs that may include, as determined by the DOH Commissioner, assisting consumers to perform their responsibilities in a manner that does not infringe upon the consumer’s responsibilities and self-direction.



Inclusion of certain responsibilities for FIs that cease to operate, including notices to affected consumers, personal assistants, local departments of social services, DOH and managed care plans; the transfer of records; not preventing a personal assistant from moving to a new FI; and others.

HCA will continue to keep the membership posted as workgroup developments take place. For questions or concerns, please contact Andrew Koski, akoski@hcanys.org or Alyssa Lovelace, alovelace@hcanys.org.

Editor’s Note: This article was updated on April 23, 2019, to reflect the more formative nature of the workgroup and its members, which are still under consideration.

3

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

Volume 4, No. 16 April 22, 2019 

How to Prepare for the Shift to Value-Based

By Scott Schwartz, SVP of Sales & Marketing at HHAeXchange, a Platinum HCA Sponsor Value-based incentives and contracts are increasingly becoming the new norm in home health care. Recently, BAYADA, one of the largest home health providers in the U.S., announced it has partnered with AmeriHealth Caritas on a new value-based contract. As part of this partnership, BAYADA will receive financial incentives for meeting quality-based goals such as preventable hospital admissions, readmissions, and emergency room visits.

New York agencies have been the true innovators in home health care, and HHAeXchange is proud of our New York roots and the customers we’ve worked with over the past decade. That’s why we are here to help support New York for the shift to value-based care with our industry-leading Care Pathways tool.

Developed by an expert team of clinicians, HHAeXchange’s Care Pathways helps you deliver value-based care with real-time observations and analysis.

To date, most patient outcome data has been retrospective. However, with Care Pathways, your caregivers are your ears and eyes on the ground – informing you of what’s happening in the home so you can provide better care for patients and prevent accidents or readmissions.

Care Pathways prompts caregivers with pre-defined questions regarding the patient’s condition, enabling agencies to collect information in real-time. Caregivers can also add non-diagnosis-related observations in order to track changes such as a broken railing that may lead to a fall, or a patient running low on medication, for example.

Case coordinators and nurses are then able to view the reported patient information in real-time on the Alert Dashboard for accelerated intervention management.

To learn more about Care Pathways and how HHAeXchange can help you prepare for the shift to value-based care, visit info.hhaexchange.com/ care-pathways.

4

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

Volume 4, No. 16 April 22, 2019 

 HOSPICE from p. 1 The proposed rule is currently at https://s3.amazonaws.com/public-inspection.federalregister.gov/201908143.pdf. Beginning on April 25, CMS will post this proposed rule in the Federal Register (https:// www.federalregister.gov/) as well as on the CMS Hospice Website at https://www.cms.gov/Center/ProviderType/Hospice-Center.html.

CMS estimates that hospices nationally will see an estimated 2.7 percent ($540 million) increase in their payments for FY 2020 over FY 2019.

In addition to the payment updates, wage index update and guidance surrounding plans for the Hospice Quality Reporting Program, CMS is also proposing major changes that include: 

Rebasing of Continuous Home Care (CHC), Inpatient Respite Care (IRC), and General Inpatient Care (GIP) to better reflect the costs of care.



Reduction in Routine Home Care (RHC) payments of 2.71 percent to achieve budget neutrality due to the rebasing of CHC, IRC, and GIP.



Elimination of the one-year “lag” in use of the hospital wage index so that hospices are not a “year behind” in the applicable wage index used.



A proposed FY 2020 aggregate Cap amount of $29,993.99.



Significant changes to the patient election statement and addendum to ensure greater transparency and safeguard patient rights.



A Request for Information (RFI) on the role of hospice and coordination of care at the end of life, including ways to include hospice in other care delivery models outside of fee-for-service to alleviate payment fragmentation (including Medicare Advantage, Accountable Care Organizations, and other models).

Comments on the rule will be accepted until 5 p.m. on June 18, 2019.

HCA will be providing our hospice members with a detailed policy memorandum later in the week.

6 Legal Experts, 1 Day of Hot Topics in Labor Law on June 13 in NYC On June 13, HCA is bringing you six legal experts (yes, 6!) from Bond Shoeneck & King who will cover paramount issues in home care labor law, helping you curb risk and appropriately fulfill requirements.

This session, moderated by Tracy Miller, chair of the firm’s Health Care Practice Group, will examine: 24hour/live-in cases and the recent Court of Appeals Ruling; Paid Family and Sick Leave laws; State and City Sexual Harassment Laws; current developments in immigration law; and updates to the Fair Labor Standards Act “Regular Rate” of pay requirements for overtime.

Learn more about the program and register here: https://hca-nys.org/wp-content/uploads/2019/04/HCAHot-Topics-in-Labor-Law-Program-Brochure.pdf.

5

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

Volume 4, No. 16 April 22, 2019 

PDGM Coding Essentials Joins Lineup of HCA Education, Resources to Prepare You Bookmark our new PDGM page for updates at https://hca-nys.org/pdgm-resources-education-andadvocacy.

As announced on Friday, HCA is offering a dynamite new program to support your team’s coding readiness for the Patient-Driven Groupings Model (PDGM).

On a technical, day-to-day, operational basis, no other area of PDGM readiness is more important than diagnosis and coding best-practices in a PDGM environment. This June 12 session, in Schenectady, is directed at your quality, coding, education, clinical and performance improvement teams on the intricacies necessary to make them PDGM ready.

Trish Tulloch of RBC Limited will provide your teams with an in-depth understanding of the nuances of PDGM coding under the new clinical groupings and sub-groups that impact case-mix, and more.

Participants will learn to: 1. Detail critical elements of PDGM, including both OASIS-D1 and ICD-10-CM diagnosis code updates; 2. Recognize the PDGM clinical groupings and sub-groups that impact home health case-mix in PDGM; 3. Discuss and apply ICD-10-CM code guidelines and coding clinic updates to complex home health case scenarios; 4. List strategies to support provider PDGM transition work plans.

Learn more about the program and register here: https://hca-nys.org/wp-content/uploads/2019/04/PDGMCoding-Essentials-Workshop-Registration-Form.pdf.

Comorbidities, Primary Diagnoses, LUPAs & More at Annual Conference PDGM Session Shelley Eggleton is part of the team from Quality in Real Time (QIRT) who has been bringing top-notch PDGM training to the national stage in recent months. She’ll be sharing her expertise for New York providers during a breakout workshop at HCA’s upcoming Annual Conference on May 8-10 in Saratoga.

As QIRT’s Director of Clinical Consulting, and formerly the director of a New York-based CHHA, Eggleton knows the specific billing, clinical, coding and operational strategies needed to make PDGM work for your organization. Her approach is also fun, challenging participants to a round of “PDGM Jeopardy” in a competitive bid that is no less rigorous than the game show.

She’ll cover: the various OASIS response categories and how the point totals correspond to the new clinical groupings; the top 20 questionable or Returned to Provider (RTP’d) codes; how LUPAs, or Low Utilization Payment Adjustments, work in PDGM; and a look at behavioral assumptions and comorbidities that generate high and low adjustments. Register for the conference today at http://hcaannualconference.com/register-2/.

Find these and other PDGM education and resource updates in one place on HCA’s new PDGM page at https://hca-nys.org/pdgm-resources-education-and-advocacy.

6

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

Volume 4, No. 16 April 22, 2019 

HCA Tapped for State Business Acumen Initiative HCA has been tapped as a member of a new Business Acumen Initiative advisory group to the state. The group will include key stakeholders in the state’s health care and community based organization ecosystems, health policy representatives, and other subject matter experts.

In January 2019, the New York State Office for the Aging (NYSOFA) launched a statewide Business Acumen Training initiative to advance Governor Cuomo’s goals of addressing social determinants of health and better integrating health services and social services to improve outcomes.

The project is sponsored by NYSOFA in conjunction with state and national partners, including LeadingAge. The principal goals are to: enhance strategic growth in the local Area Agencies on Aging (AAAs); help AAAs more broadly engage in health care partnerships that will improve coordination; and address the social determinants of health across the communities that AAAs serve through an intensive participatory curriculum.

In conjunction with this effort, the Business Acumen Advisory Group will: advance the state’s integrated care initiatives; promote engagement among the state’s aging services network, community-based organizations (CBOs), and health care systems; and help inform curriculum development.

Advisory group members will help shape perspectives across the state that foster continued development of integrated care initiatives such as the Delivery System Reform Incentive Payment (DSRIP) program and transition to Value Based Payment (VBP) reform, as well Medicare Advantage Plans and additional supplemental benefits.

This work will also inform the project team’s environmental scanning, policy review, analyses of integration barriers/opportunities, and development of the AAA training curriculum. The advisory group will convene monthly in the beginning of the project.

Business acumen is an important element for development in the home care field, including a broader sense of the real “business needs” of the provider and service community and support for provider organizations across all levels. HCA appreciates this opportunity and looks forward to participating on this project.

DOH Provides MLTC Rate Update at Financing Meeting At a finance meeting for Managed Long Term Care (MLTC) plans and association representatives, state Department of Health (DOH) officials discussed the partial cap rate revisions that will be implemented in state fiscal year (SFY) 2019-20, among other rate and budget actions affecting plans.

Representatives from the state’s actuary, Deloitte, presented on the trend application for SFY 2019. (See: https://hca-nys.org/wp-content/uploads/2019/04/DOHMLTCTrendUpdate_Deloitte_April-2019.pdf.)

Meanwhile, Daniel Carmody, Director of the Bureau of Managed Long Term Care Rate Setting, outlined how the overall rate revisions will occur in four phases.

Phase 1, effective April 1, 2019 (with an expected retrospective rate release in May 2019) includes: 

7

Update the base rates from calendar year (CY) 2016 to 2017 data;

Continued on next page

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

Volume 4, No. 16 April 22, 2019 

Continued from previous page 

Apply an updated trend adjustment to base data;



Continue the minimum wage adjustment;



Update plan enrollment projections;



Apply a preliminary risk score; and



Continue 2018-19 budget actions, including limitations on Licensed Home Care Services Agency (LHCSA) contracts, administrative reductions and social day care efficiencies.

Phase 2, effective April 1, 2019 (with an expected retrospective rate release in May 2019) will maintain: updated base rates from CY 2016 to 2017 data; updated trend adjustment to base data; the minimum wage adjustment; and updated plan enrollment projections. It will also: 

Apply final risk score update;



Maintain SFY 2018-19 budget actions;



Apply certain new SFY 2019-20 budget actions, including modernizing long term care regulations involving fair hearings and continue the transformation funding.

During this discussion, many plan representatives asked that DOH make the final risk score update prospective to July 1, 2019, rather than retrospective to April 1, 2019. Mr. Carmody said DOH is open to that suggestion and that plans and associations should e-mail DOH of their preference.

Phase 3, effective July 1, 2019 (with an expected retrospective rate release in October 2019), will maintain: updated base rates from CY 2016 to 2017 data; updated trend adjustment to base data; the minimum wage adjustment; updated plan enrollment projections; final risk score update; and SFY 2018-19 budget actions. It will also: 

Apply certain new SFY 2019-20 budget actions, including the to-be-determined fiscal intermediary adjustment and an updated nursing home case-mix adjustment.

Phase 4, effective January 1, 2020 (with an expected release date of December 2019), will include details on Community First Choice Option (CFCO) readiness.

Reminder: Flu Vaccination Report Due May 1 HCA reminds providers that they must electronically submit the Healthcare Personnel Influenza Vaccination Report by May 1.

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 personnel employed by or affiliated with your organization from October 1, 2018 through

8

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

Volume 4, No. 16 April 22, 2019 

March 31, 2019. Employers can enter and resubmit data regularly until the May 1 deadline for new personnel or incoming vaccination records.

Users are reminded to first save, then press the Review and Submit button in order to successfully submit data. (Just pressing “Save” will not submit the data.)

The report is on the Health Electronic Response Data System (HERDS) on the Health Commerce System.

A Dear Administrator Letter (DAL) from the state Department of Health (DOH) is at https://hca-nys.org/wp-content/uploads/2019/03/Notification_101112.pdf.

A pre-recorded webinar on the flu vaccination report is under “Training” at http://www.health.ny.gov/FluMaskReg. Questions about the report go to (518) 473-4437 or immunize@health.ny.gov.

Technical questions go to the Health Emergency Preparedness Program at (518) 408-5163 or hseppny@health.ny.gov.

Maximum Workers’ Comp Benefit Rises The maximum weekly benefit rate for workers’ compensation will increase to $934.11 for claims with dates of accident during the period from July 1, 2019 through June 30, 2020.

This amount is based on two-thirds of the New York State average weekly wage for the previous calendar year ($1,401.17), as determined by the state’s Department of Labor.

The new maximum amount is posted at http://www.wcb.ny.gov/content/main/SubjectNos/sn046_1159.jsp.

Hospice Medicaid Rates Posted The state Department of Health (DOH) has published the Hospice Medicaid rates for the federal fiscal year period (October 1, 2018 to September 30, 2019) and transmitted the rates to eMedNY for payment.

A Dear Administrator Letter (DAL) is at https://hca-nys.org/wp-content/uploads/2019/04/DAL_hospice-rates_041519.pdf.

The rates have also been posted at: https://www.health.ny.gov/facilities/long_term_care/reimbursement/hospice/.

According to the DAL, the payment for the October 1, 2019 hospice rates will be made in cycle number 2175, check release date of May 15, 2019.

DOH has posted two files on the website regarding the rates: a file for “high intensity” rates (days 1-60) and a file for “low intensity” rates (days 61 and over).

Questions can be submitted to Hospice-rates@health.ny.gov, attention Russ Smith.

9

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

Volume 4, No. 16 April 22, 2019 

CMS Updates its Extended Repayment Schedule Info and Interest Rates Two new transmittals from the U.S. Centers for Medicare and Medicaid Services (CMS) provide an update to the Extended Repayment Schedules (ERS) and applicable interest rates.

The ERS transmittal updates the language in Chapter 4 of the Program Integrity Manual. (See https:// www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2019Downloads/R312FM.pdf.)

CMS’s transmittal announcing the interest rate change is here: https://www.cms.gov/Regulations-andGuidance/Guidance/Transmittals/2019Downloads/R313FM.pdf.

Providers can request an ERS if they have received an overpayment from Medicare and if repaying it within 30 days would constitute a “hardship” for the provider. The current policy states that Medicare Administrative Contractors (MACs) shall only approve/disapprove ERS requests of at least 12 months up to 36 months. The updated language states that MACs should “consider ERS requests for 6-11 months on a case-by-case basis.” The new language adds: Approval should only be for cases where it is clear that the debt can be repaid in this short period. Requests for 6-11 month ERSs do not require submitting financial documentation if the provider meets the hardship qualifications and does not fall within a scenario found in section 50.3(1).

Also new is a policy that “the contractor should not grant an ERS to a provider where there is a previously defaulted ERS that was not resolved (reinstated, paid up to date, or paid in full).”

The interest rate to be paid on Medicare overpayments and underpayments is updated quarterly. The rate effective April 17, 2019 is 10.375 percent. A table of the quarterly rate for previous periods is part of the transmittal.

CMS Posts Revised OASIS-D/D1 Instruments The U.S. Centers for Medicare and Medicaid Services (CMS) has posted revised OASIS-D instruments, which become effective January 1, 2020. These revisions stem from changes in the 2019 Home Health Prospective Payment System (HHPPS) final rule.

The changes include the addition of two existing items to the “Follow-Up” assessment instrument (with corresponding revisions to the “All-Items” instrument) and changes from “required” to “optional” data collection at certain time points for 23 items. (CMS is not issuing a revised version of the OASIS-D Guidance Manual for 2020, so providers should note that these OASIS-D1 versions supersede the versions in Chapter 2 of the manual.)

Two existing items are added to the “Follow-Up” time point for data collection (M1033, Risk for Hospitalization, and M1800, Grooming). Home Health Agencies must collect data on these items at “FollowUp,” in addition to all other required time points. Any OASIS “Follow-Up” assessment with an M0090 Date Assessment Completed of January 1, 2020 or later should use the revised OASIS-D1 “Follow-Up” assessment.

Data collection at certain time points for 23 existing OASIS items is optional. For OASIS assessments with an “M0090 Date Assessment Completed” of January 1, 2020 or later, home health agencies may enter an equal

10

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

Volume 4, No. 16 April 22, 2019 

sign (=) for these items, at the specified time points only. This is a new valid response for these items, at these time points; the items themselves are unchanged.

CMS has posted the revised OASIS-D1 “All-Items” and “Follow-Up” instruments – along with the other, unchanged time points versions of the instrument – in a zip file on the CMS OASIS Data Sets website at: https:// www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/OASISData-Sets.html.

HCA OASIS Training These changes underscore the importance of OASIS training for your assessors and other members of your clinical team. Each year, HCA offers at least two OASIS trainings – one upstate and one downstate. Our upcoming trainings are on June 17-19 (including an optional COS-C exam) in Webster, NY (near Rochester) and September 23-25 (including an optional COS-C exam) in New York City. Visit our education and events page for details and registration: https://hca-nys.org/events-education/upcoming-events.

NYC Bill Bans Pre-Employment Testing for Cannabis The New York City Council has passed legislation that would prohibit New York City employers from requiring a prospective employee to submit to testing of THC, the active ingredient in marijuana, as a condition of employment.

The bill, along with other information, is at https://legistar.council.nyc.gov/ LegislationDetail.aspx?ID=3860393&GUID=7040463F-8170-471C-97EC-A61AE7B1AA2F&Options=&Search.

It lists exceptions for which pre-employment marijuana and THC testing will be permitted. State Department of Health (DOH) regulations require health assessments for personnel, including “drugs or substances which may alter an individual’s behavior.” HCA believes that home care and hospice workers would fit under at least one of these exceptions and/or be required to test or assess for marijuana use. We await further clarification on the applicability of the DOH regulations and their “fit” to these exemptions, which include: 

Any position requiring the supervision or care of children, medical patients, or vulnerable persons as defined in paragraph 15 of section 488 of the social services law. “Vulnerable person” means a person who, due to physical or cognitive disabilities, or the need for services or placement, is receiving services from a facility or provider agency.



Any position with the potential to significantly impact the health or safety of employees or members of the public. (The law outlines a process for determining this.)



Where any federal or state statute, regulation, or order requires drug testing of prospective employees for safety or security.



Where a collective bargaining agreement specifically addresses the pre-employment drug testing of applicants.

The bill awaits the Mayor’s signature, at which point it would become effective one year later. The City Commission on Human Rights will be responsible for implementing it.

11

Volume 4, No. 16 April 22, 2019

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



Upcoming Deadlines and Due Dates

12

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

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 Health Emergency Preparedness Coalition (HEPC) meeting

May 2, 2019

Maureen.casaleͲreidt@health.ny.gov

Capital District HEPC meeting

May 7, 2019

Maureen.casaleͲreidt@health.ny.gov

Coalition Surge Test Exercise for Lower Hudson Valley

Sometime between April 29 and May 10, 2019

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

Interoperable Communications/Medical Countermeasures exercise – Lower Hudson Valley

May 9, 2019

Gyongyi.McQueston@health.ny.gov

State Department of Health and Office for May 13, 2019 (Albany) the Aging Long Term Care Planning Project

https://www.eventbrite.com/e/evidenceͲbasedͲ programsͲandͲinnovativeͲmodelsͲinͲagingͲandͲlongͲ termͲcareͲticketsͲ56430626523

Central NY HEPC Meeting

May 15, 2019

judy.homer@health.ny.gov

Fully Integrated Duals Advantage (FIDA) plans closed to new enrollment

May 20, 2019

https://hcaͲnys.org/wpͲ content/uploads/2019/04/IntegratedͲ Care_stakeholder_session2_022819.pdf

Quarterly Wage Parity Certification forms due from LHCSAs and Fiscal Intermediaries June 1, 2019 who operate in NYC, Long Island and Westchester

https://www.health.ny.gov/health_care/medicaid/re design/2016/2016Ͳ02Ͳ17_wage_parity_alert.htm

Lower Hudson Valley HEPC meeting

June 5, 2019

Gyongyi.McQueston@health.ny.gov

Long Island HEPC meeting

June 6, 2019

drew.fried@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. 16 April 22, 2019 

OIG Posts Monthly Work Plan Update The federal Office of Inspector General (OIG) has posted its monthly Work Plan update at https://oig.hhs.gov/reports-and-publications/workplan/index.asp.

Some new issues that affect home care and/or managed care plans include the following: 

Medicaid Personal Care Services: OIG will determine whether improvements have been made to the oversight and monitoring of personal care services (PCS) and whether those improvements have reduced the number of PCS claims not in compliance with federal and state requirements. “Prior OIG reviews identified significant problems with states’ compliance with PCS requirements. Some reviews also showed that program safeguards intended to ensure medical necessity, patient safety, and quality, and prevent improper payments were often ineffective.”



Quality of Medicaid Encounter Data: OIG will determine whether managed care encounter data for selected states contain the required elements and include the quality data needed “to more effectively oversee the Medicaid program.”



Medicaid Managed Care Organization Denials: OIG will determine whether Medicaid Managed Care Organizations complied with federal requirements when denying access to requested medical and dental services and drug prescriptions that required prior authorization.

Westchester Posts Materials on Earned Sick Leave Law The Westchester County Human Rights Commission has posted materials on the county’s recent Earned Sick Leave Law. (See https://humanrights.westchestergov.com/resources/earned-sick-leave-law.)

Effective April 10, covered employees have the right to use sick leave for the care and treatment of themselves or a family member. Employers with five or more employees in Westchester County must provide paid sick leave. Employers with fewer than five employees must provide unpaid sick leave.

Questions about the Earned Sick Leave Law can be directed to the Westchester County Human Rights Commission at (914) 995-7710 or HRC-Inquiries@westchestergov.com.

NYSHealth Announces New RFP The New York State Health Foundation (NYSHealth) has announced a request for proposals (RFP) that will sponsor community-based organizations, health departments, and other low-resource organizations to attend and present at local, state, and national conferences related to building healthy communities, empowering health care consumers, and meeting the needs of returning veterans and their families.

Applications will be accepted on a rolling basis. Applicants must complete and submit an online application.

More information is at https://nyshealthfoundation.org/rfp/sponsoring-conference-participation-rfp-2019/.

13

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

Volume 4, No. 16 April 22, 2019 

Medicare Cost Report Changes Proposed The U.S. Centers for Medicare and Medicaid Services (CMS) has published a notice of plans to revise the existing home health freestanding cost reporting instructions and forms (1728-94) with revised forms and instructions (1728-19).

See https://www.govinfo.gov/content/pkg/FR-2019-04-16/pdf/2019-07500.pdf.

CMS has also posted several related documents, including the proposed forms and instructions, a crosswalk of the proposed changes, and a document outlining its justification for making the proposed changes. These are at https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing-Items/ CMS-1728-19.html?DLPage=1&DLEntries=10&DLSort=1&DLSortDir=descending.

CMS says the forms are revised to capture a cost-per-visit by type of clinician, report bad-debt, and account for negative wound pressure therapy paid under the Outpatient Prospective Payment System (OPPS).

Additionally, the forms are revised to remove obsolete data collections, such as unduplicated census counts and per-beneficiary limits, as well as to eliminate worksheets for a rural health clinic and a federally qualified health center.

CMS anticipates that the changes will reduce the paperwork burden on freestanding home health agencies by an average of 32 hours (from 227 to 195 hours).

NGS Updates National Government Services (NGS), New York’s principal home health Medicare Administrative Contractor (MAC) for Jurisdiction 6, has provided some new updates on its website at www.ngsmedicare.com.

Using NGS’s Interactive Voice Response (IVR) System For HCA members that find it difficult entering the required elements into the interactive voice response (IVR) system, NGS has created an IVR conversion tool which allows providers to convert a beneficiary’s name, transaction access numbers, Medicare numbers, or Document Control Numbers. You can find the tool in the Provider Resources tab under “Calculator & Tools.”

YouTube Video on Home Health Therapy Medical Review Coming soon: this video provides updates on significant findings of the targeted probe and educate (TPE), reminders and suggestions for documentation of therapy, and education on maintenance versus rehabilitative therapy.

MAC Satisfaction Indicator Survey HCA members that have NGS as their MAC can take the Jurisdiction 6 survey at: https://www.surveygizmo.com/s3/4826847/?MAC_BRNC=5&MAC=J6-NGS.

14

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

Volume 4, No. 16 April 22, 2019 

Health Resources 

“Medicare Overpayments,” by the U.S. Centers for Medicare and Medicaid Services https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/ MLN-Publications-Items/ CMS1243389.html?DLPage=1&DLEntries=10&DLFilter=medicare%20over&DLSort=0&DLSortDir=descending



“Home Alone Revisited: Family Caregivers Providing Complex Care,” AARP Public Policy Institute https://www.aarp.org/content/dam/aarp/ppi/2019/04/home-alone-revisited-family-caregiversproviding-complex-care.pdf

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

15