April 29, 2019 Edition of The Situation Report

PAC

GRANTS

BILL DOMBI KEYNOTE

REMINDER: FLU REPORT

HCA’s Political Action Committee is holding its firstever PAC Chair’s Event with drinks, music and a chance to win a golf outing with HCA’s incoming Board Chair.

A health foundation stemming from the sale of Fidelis is offering grants for service delivery. Letters of inquiry are due May 9.

NAHC President Bill Dombi is the closing keynote speaker at HCA’s Annual Conference NEXT WEEK. Register today!

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

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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 17| April 29, 2019

CMS QIO Chief Dennis Wagner to Lead Pre-Con & Board Discussion at HCA Annual Conference As announced in an alert last week, the director in charge of the U.S. Centers for Medicare and Medicaid Services (CMS) Quality Improvement Organization program, Dennis Wagner, is on the lineup for HCA’s Annual Conference. During our pre-conference session, on May 8, Director Wagner will specifically discuss some of the ways that CMS’s Quality Improvement and Innovation Group is removing traditional silos and cultivating partnerships for home care, hospice and collaborating sectors. This will also provide a unique opportunity for HCA See WAGNER p. 2

ICYMI: Memo on Proposed Hospice Payment Rule As reported in last week’s edition of The Situation Report, the U.S. Centers for Medicare and Medicaid Services (CMS) has issued its proposed fiscal year 2020 hospice payment rule and wage index.

CMS estimates a 2.7 percent ($540 million) increase in national hospice payments for the fiscal year running from October 1, 2019 to September 30, 2020.

HCA has prepared a detailed memorandum on the proposed rule. In case you missed it, the memo is at https://tinyurl.com/yxfbbhqy.

HCA’s memo includes tables and summaries of the rebased rates for continuous home care, inpatient respite care and general inpatient care, as well as changes to the two tiers of routine home care, among other proposals in the rule.

INSIDE CMS QIO Chief Dennis Wagner to Key HCA Annual Conference.................................1 ICYMI: Memo on Proposed Hospice Payment Rule.................................................1 Join Us for HCA PAC Chair’s Event at Upcoming Annual Conference...........................3 Rivera: Single-Payer Bill Unlikely This Session........................................................4 Health Foundation from Fidelis Sale Invites Grant Applications.............................5 Get a Window Seat View of Home Care, Hospice with NAHC’s Bill Dombi..................5

CMS Invites States to Launch, Extend Dual-Eligible Initiatives.........................6 Flu Vaccination Report Due This Week: on May 1.............................................7 OIG Work Plan Additions May Impact Home Health, Hospice Providers...........7 eMedNY to Conduct Medicaid Enrollment Revalidation Webinar: April 30.......8 April Edition of HCA’s Capitol Report Newsletter..............................................8 HCA Education: PDGM, Labor Law, Coding, OASIS, Wound Care & More............9 Changes Made to the HCS Role Lookup and Coordinator’s Update Tools..........10

The Situation Report: the Home Care Association of New York State WAGNER from p. 1 members to share with Director Wagner innovative ideas and work you are cultivating in New York that could be the basis of active support from CMS. The session will also include a corresponding panel discussion on state-level partnership efforts, revealing ways that your peer home care and hospice organizations are seizing opportunities for regulatory flexibility and procedural streamlining in New York State under the Hospital-Home Care-Physician Collaboration statute and other models.

Panelists include representatives from Syracuse-based St. Joseph’s Health Home Care (HCA Board Member Melissa Allard, System Director for Home and Community-Based Services, and the hospital’s Chief Strategy Officer Mark Murphy), along with officials from Central New York Accountable Integrated Medicine (Executive Director Mike Endries) and VNSNY (Director of Population Health and Remote Patient Monitoring April Feld).

Wagner Also a Guest Speaker at Conference Board Meeting Open to Members Director Wagner will also be a guest at our Annual Conference Board of Directors meeting, following the pre-conference session on May 8, for a vital exchange of perspectives with HCA’s main governing body that will further strengthen New York’s engagement on federal quality improvement initiatives for home care and hospice.

A yearly tradition, this Annual Conference Board meeting is open to HCA members and is a great way to participate in the discussion with Mr. Wagner while also learning more about the body that shapes the direction of HCA policy, education, advocacy and operational priorities.

Registration and all conference-related information are online at http://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

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Volume 4, No. 17 April 29, 2019 

The Situation Report is a weekly publication of the Home Care Association of New York State (HCA). Unless otherwise noted, all articles appearing in The Situation Report are the property of the Home Care Association of New York State. Reuse of any content within this newsletter requires permission from HCA. Al Cardillo President and CEO acardillo@hcanys.org Roger L. Noyes Director of Communications, Editor of The Situation Report rnoyes@hcanys.org Patrick Conole Vice President, Finance & Management pconole@hcanys.org Andrew Koski V ice President, Program, Policy & Services akoski@hcanys.org Alyssa Lovelace Director for Policy and Advocacy alovelace@hcanys.org Lauren Ford Director of Program Research, Development and Policy lford@hcanys.org Laura Constable Senior Director, Membership & Operations lconstable@hcanys.org Celisia Street Director of Education cstreet@hcanys.org Mercedes Teague Finance Manager mteague@hcanys.org Jenny Kerbein Director of Governance & Graphic Design jkerbein@hcanys.org Billi Wilson Manager, Meetings & Events bwilson@hcanys.org Teresa Brown Administrative Assistant tbrown@hcanys.org

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

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Volume 4, No. 17 April 29, 2019 

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

Volume 4, No. 17 April 29, 2019 

Rivera: Single-Payer Bill Unlikely This Session HCA prevention and public health bill on committee agenda tomorrow Single-payer health care in New York – likely the most consuming and contentious health policy item of the current state legislative session – appears to be getting put on hold until at least 2020, according to media reports.

One of the bill’s sponsors, Senate Health Committee Chairman Gustavo Rivera, said during a forum last week that his committee’s action on the measure would wait until after a series of as-yet unscheduled hearings occur around the state. At least one joint hearing of the legislature is expected before session adjourns in June.

Single-payer health care has long been a priority of the Assembly Health Committee Chairman, Richard Gottfried, who was the initiating sponsor of the bill in the Assembly. While versions of the plan have been floated for several years, the latest iteration includes universal long-term care coverage, including home care, for the first time.

The legislation, known as the New York Health Act would provide state-sponsored health coverage – including all the health care services covered by Medicare, Medicaid and commercial health insurance – with funds raised through new taxes, including payroll taxes.

HCA will be continuing our analysis of the legislation, including details gained from the bill sponsors during the upcoming hearings and our ongoing outreach to health committee offices. The consequences of this program for the health care system as a whole are enormous, and the exact implications for financing and coordination with existing programs remains a work in progress that, even with passage of a bill, would require years to implement.

HCA will keep the membership apprised of all key developments.

Legislation Integrating Home Care, Prevention and Public Health on Senate Committee Agenda HCA-developed legislation, S.1816 by Senator G. Rivera/A.3836 by Assembly Member J. McDonald, was placed on the Senate Health Committee Agenda for Tuesday, April 30.

The legislation aims to support the incorporation of home care in the state’s public health, prevention and primary care settings. It would strategically leverage home care in areas such as asthma, sepsis, diabetes, heart disease, minority health disparities, medication management, and preventable falls among other public health areas.

This bill is part of a package of bills developed by HCA that works to promote public health improvement, savings and reinvestment. HCA will update members as priority legislation advances.

For questions or concerns on this bill or other legislation advanced by HCA, please contact Alyssa Lovelace, alovelace@hcanys.org or (518) 810-0658.

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

Volume 4, No. 17 April 29, 2019 

Health Foundation from Fidelis Conversion Now Accepting Grant Applications The 2019 grant application process for the Mother Cabrini Health Foundation is now available online (https://www.cabrinihealth.org/apply). Letters of Inquiry will be accepted from eligible applicants through May 9 and are expected to be announced in the fourth quarter of 2019.

The Foundation’s 2019 grant opportunities will prioritize health and human services provided to: low-income individuals and families; young children, pregnant women and new mothers; youth and young adults; older adults; persons with special needs; immigrants and migrant workers; veterans; and formerly incarcerated individuals. The opportunities are open to the public and are funded through the Statewide Grants Program.

The Foundation, which originated from the recent sale of Fidelis Care, grants up to $150 million annually. It has three grant-making programs including: the Statewide Grants Program, which is open to the public and focuses on identifying projects that best serve the Foundation’s 2019 grant priorities; the Regional Grants Program, which is designed to ensure proportionate regional funding for targeted, mission-aligned projects identified by the Foundation and that are accepted on an invitation-only basis; and the Special Initiatives Grants Program that seeks to fund innovative projects that help further the mission of the Cabrini Foundation (applications are also accepted on an invitation-only basis).

View grant availability and eligibility information here: https://www.cabrinihealth.org/apply.

Get a Window Seat View of the Federal Home Care, Hospice Landscape with NAHC’s Bill Dombi PDGM, non-physician practitioner authorization of home care, the CoPs, HHPPS and the rural add-on, the new hospice proposed rule, the face-to-face requirement, CMMI models of care, FLSA and federal labor rules ... the list of federal home care and hospice issues is daunting.

National Association for Home Care and Hospice (NAHC) President Bill Dombi is fluent on all of these issues, and more.

Join his closing keynote session at HCA’s Annual Conference on May 10 and we guarantee you will walk away with a clearer, more coherent and more cohesive picture of all the complex variables affecting home care and hospice at the federal level.

Bill Dombi’s been at the vanguard of every major federal home care reimbursement battle or program change in the last 40 years. As President and, previously, as the longtime Vice President for Law at NAHC, Mr. Dombi specializes in legal, legislative, and regulatory advocacy on behalf of patients and providers of home health and hospice care.

HCA’s Annual Conference is next week! Don’t miss out. Register online or use the brochure at http://hcaannualconference.com/.

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

Volume 4, No. 17 April 29, 2019 

CMS Invites States to Launch, Extend Dual-Eligible Initiatives Letter to state Medicaid Directors coincides with Citizens Budget Commission report urging “revitalization” of FIDA, which NYS is currently planning to phase out Five years into New York’s own experiment with fully integrated managed care, the U.S. Centers for Medicare and Medicaid Services (CMS) last week sent a letter to all state Medicaid Directors encouraging them to test similar kinds of models for serving dual-eligible beneficiaries.

New York is currently planning to phase out it its Fully Integrated Duals Advantage (FIDA) plan, whose enrollment has declined to 2,941 members as of March, in favor of an alternative model based on the integration of duals into Medicare Advantage Plans, Medicaid Advantage Plus, Programs of All-Inclusive Care for the Elderly (PACE) and other possibilities.

HCA has been participating in state stakeholder meetings to vet the progressive steps contemplated in the FIDA phase-out/replacement, and DOH officials have accepted our invitation to present to the HCA Board and membership on the status of this movement and to hear member feedback. A time and venue have yet to be determined.

The CMS letter to state Medicaid Directors, from Administrator Seema Verma, makes much the same case as did New York in its original focus on integrating care for its large dual-eligible population through FIDA. “Historically, dually eligible individuals have accounted for 20 percent of Medicare enrollees, yet 34 percent of Medicare spending,” Administrator Verma writes. “The same individuals have accounted for 15 percent of Medicaid enrollees and 33 percent of Medicaid spending.”

You can read the letter here: https://www.medicaid.gov/federal-policy-guidance/downloads/smd19002.pdf.

Administrator Verma specifically invites states to participate in three options, including the FIDA-type arrangement already underway in New York State, crediting the Medicare-Medicaid financial alignment programs in nine states for lowering administrative costs and driving other outcomes nationally.

CMS’s appeal coincides with a just-issued April “Discussion Paper” from the Citizens Budget Commission with recommendations for likewise enhancing the coordination of care for dual-eligibles. Among its recommendations is a “revitalization” of the FIDA model, which the Commission refers to as the “optimal model of care integration,” noting that more can be done to facilitate its growth. (You can read the report at https://hca-nys.org/wp-content/uploads/2019/04/Report-about-Duals.pdf.)

While CMS’s letter is largely directed at states that haven’t adopted a strategy for service integration, CMS does offer specific new options for states, like New York, which have already begun taking this route, including multi-year extensions “based on promising evidence, or the need for more time to collect and analyze data, when coupled with adjustments.” The letter also invites “changes to the geographic scope of [existing] demonstrations, where such geographic changes are consistent with state priorities and allow for more efficient administration.”

HCA will continue to seek an active role in providing input on this critically important and consequential paradigm change, which will have implications across the board for patients, providers, plans, and the entire continuum of care.

For more information, please contact a member of HCA’s Policy staff.

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

Volume 4, No. 17 April 29, 2019 

Flu Vaccination Report Due This Week: on 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 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.

OIG Work Plan Additions May Impact Home Health, Hospice Providers The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently made some additions to its annual work plan that could directly or indirectly impact home health agency and hospice providers and partners.

Medicaid Personal Care Services OIG will determine whether improvements have been made to states’ oversight and monitoring of personal care services and whether those improvements have reduced the number claims not in compliance with federal and state requirements.

Examples of past non-compliance identified by OIG include home health agencies billing Medicaid for personal care services performed by individuals who did not meet state qualification requirements and not having the proper documentation (i.e. plan of care, medical supervision, etc.).

Providers are reminded to ensure that all state qualification and documentation requirements are met, in addition to federal requirements, while ensuring care coordination with any Medicaid personal care services

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Volume 4, No. 17 April 29, 2019 

Continued from previous page providers. Chapter 7, Section 50.7 of the Medicare Benefit Policy Manual includes standards that should be met for Medicare-covered home health services, and Chapter 9, Sections 40.1.7 and 40.5 address hospice services.

Medicaid Managed Care Organization Denials OIG will also review Medicaid Managed Care Organizations (MCOs) to determine whether they complied with federal requirements when denying access to requested medical services and drug prescriptions that required prior authorization.

The OIG Work Plan is now updated monthly to reflect changes in the oversight agency’s investigation, audit and review of integrity issues across a range of services and programs. Your compliance teams are urged to review the Work Plan closely, including any monthly updates, for tips about potential target areas and regulatory citations for informing your internal controls. The Work Plan home page is at https://oig.hhs.gov/reports-and-publications/workplan/index.asp.

eMedNY to Hold Medicaid Enrollment Revalidation Webinar Tomorrow, April 30 The eMedNY Medicaid transaction system is accepting registration for a Medicaid Revalidation webinar tomorrow, April 30, at 1:30 p.m. See: https://www.emedny.org/training/index.aspx.

This webinar is intended to familiarize providers and their staff with the Medicaid enrollment revalidation process and review the resources available to accomplish revalidation successfully. Broadly, this process begins when the state Department of Health (DOH) sends a notification to providers that Medicaid enrollment revalidation is required.

If you received a notification that it’s time to revalidate, consider attending the webinar.

HCA members can refer to the eMedNY training schedule for future sessions that may be added.

Questions can be directed to the eMedNY Call Center at 1-800-343-9000 or emednyalert@csra.com.

April Edition of HCA’s Capitol Report Newsletter In the April edition of HCA’s monthly Capitol Report, issued last week, we invite legislators to visit constituents receiving home care. Plus, HCA highlights our post-budget legislative priorities.

Also featured: HCA President Al Cardillo’s participation in an Industry Roundtable hosted by the Capital District Business (transcript included); a new study showing the successes of post-acute home care for joint replacement therapy; a new state budget initiative aimed at cultivating private-pay home care; and a worker retention program in Western New York.

Read it here: https://tinyurl.com/yy5qb8cz.

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

Volume 4, No. 17 April 29, 2019 

Upcoming HCA Education: PDGM, Labor Law, Coding, OASIS, Wound Care & More Registration for all of these programs is at https://hca-nys.org/events-education/upcoming-events.

PDGM HCA’s PDGM page (https://hca-nys.org/pdgm-resources-education-and-advocacy) includes education programs offered by HCA and partners, including our June 12 program on PDGM Coding Essentials in Schenectady. 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. Trish Tulloch of RBC Limited will provide your quality, coding, education, clinical and performance improvement 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.

Managers, Executives, Administrators Join us for HCA’s Annual Conference (May 8-10), our flagship annual event.

SupervisionPlus with Fazzi Associates: Beginning today, April 29 (registration open until May 3), HCA is offering self-paced online management training through Fazzi Associates to teach your management teams the fundamentals of supervision: assessing employee competency; increasing motivation; improvement strategies; productivity and more.

Labor Law: On June 13 in New York City, 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: 24-hour/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.

Coders and Billers Our four-part webinar series on ICD-10 Coding (May 2, 9, 16 and 23) will help prepare your coders for the 432 possible case-mix-adjusted groups under PDGM and more.

Aides Each month, HCA offers a webinar to support your paraprofessional staff on clinical topics, patient care interactions, and more. The next topic: The Aide’s Role in Understanding Legal Issues on May 9. See the full program list for 2018-19 online.

Nursing, OASIS OASIS: Your clinicians need regular OASIS training to stay up-to-date and maintain certification, plus OASISD includes the removal of more than a dozen items, along with other additions or revisions. HCA is

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

Volume 4, No. 17 April 29, 2019 

sponsoring Blueprint for OASIS Accuracy Workshops and an optional COS-C Exam both upstate and downstate on: June 17-18 (with optional exam on June 19) near Rochester; and September 23-24 (with optional exam on September 25) in NYC. Wound Care: Upcoming, intensive five-day education from the Wound Care Education Institute will provide your clinicians with an evidence-based approach to wound management and current standards of care on May 6-10 in Windsor, CT. LTC-WIOs The new Long Term Care Workforce Investment Organization (LTC-WIO) program is a state initiative that contracts with organizations to make free workforce education available to your staff, including with wage replacement funds. Have you checked out the LTC-WIO yet in your region? HCA has a dedicated page on our website with information at https://hca-nys.org/no-cost-workforce-training-available-throughregional-wios.

Changes Made to the HCS Role Lookup and Coordinator’s Update Tools Based on user feedback, some changes have been made to the Role Lookup and Coordinator’s Update Tools on the Health Commerce System (HCS).

Under the Role Lookup Tool, the user’s HCS ID has been added to the users’ detailed information. Also, the list of organization(s) on the main menu of the Coordinator’s Update Tool is now alphabetized. Additionally, the Add Role Assignments and Remove Role Assignments list of users is now alphabetized by user’s last name. Upon adding or removing users within a role, the Coordinator will now be able to remain on the Role Assignments screen to continue to add or remove users from the role.

Log in to the HCS and view screenshots of the improvements at https://commerce.health.state.ny.us/hpn/help/hcs_updates.4.18.19.pdf.

Questions regarding the updates may be sent to hcsoutreach@health.ny.gov.

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