April 30, 2018 Edition of The Situation Report

HOSPICE PEPPER

FLU REPORT DUE TOMORROW

ALZHEIMER’S SESSION

CLINICIAN PROGRAMS

Hospices should download their PEPPER reports which support your compliance efforts by flagging potential outlier risk areas for payment vulnerabilities.

As HCA notified members in an alert last week, the flu vaccination report is due tomorrow, and the related flu mask requirement remains in effect.

HCA’s Annual Conference, on May 9-11, includes a session to help your organization stem Alzheimer’s-related hospitalizations

HCA is hosting several programs on clinical topics, including webinars for convenient access, plus CEUs!

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COMING UP Webinar: OASISD Snapshot May 1, 2018 2:30 to 4 p.m.

HCA’s Annual Conference: 40 Years Strong!

May 9-11, 2018 Saratoga Springs Webinar: Surveys Under the New Conditions of Participation May 31, 2018 11:30 a.m. to 1 p.m.

Register for these and other programs online at https://hcanys.org/eventseducation/ upcomingevents.

Your Source for HOME CARE News, Policy and Advocacy

Vol. 3, Issue 18 | April 30, 2018

24-hour/Live-in Emergency Rule Extended, with New Rule Proposed and Upcoming Hearing The April 25 New York State Register includes an extension until June 3 of the emergency rule, originally promulgated on October 25, under which the state Department of Labor (DOL) codified “the Commissioner’s longstanding and consistent interpretation that compensable hours worked under the State Minimum Wage Law do not include meal periods and sleep time of home care aides who work shifts of 24 hours or more.”

See RULE p. 2

DOH Provides Walk-through of MLTC Rate Development The state Department of Health’s Bureau of Managed Long Term Care Rate Setting conducted a meeting last week for Managed Long Term Care plans (MLTCs) and plan-member associations which provided a detailed walkthrough and opportunity for See RATE p. 3

INSIDE DOH Provides Walk-through of MLTC Rate Development.......................................1 24-hour/Live-in Rule Extended, Plus Upcoming Hearing on New Rule.....................1 Join Us for Champagne Toast to Award Winners & 40 Years of HCA on May 9-11.......1 A Word from HCA Sponsor RBC Limited..................................................................3 Proposed Hospice Payment Rule Would Increase Payments by $340 Million........6 Hiring Announcements....................................................................................7,9 Ohio Hospitals and Affiliates Convene on HCA Sepsis Initiative............................8 Domestic Worker Bill of Rights Reminder..............................................................8 Hospice Q4 2017 PEPPER Data Reports Available..................................................9

Join Us for Champagne Toast to Award Winners & 40 Years of HCA on May 9-11 A toast of bubbly, a splendid banquet, special guest alums from HCA’s history – and, we hope, you – will greet our 2018 award winners at HCA’s fast-approaching 40th anniversary Annual Conference.

See TOAST p. 5 CMS Transmittal on Enhancements to Hospice RHC Payments......................10 NHTD & TBI Update......................................................................................11 FAQs Posted on New Medicare Cards...........................................................11 Healthcare Personnel Influenza Vaccination Report Due Tomorrow..............12 OPWDD Posts Rule Covering Care Coordination Organizations......................13 Reduce Alzheimer’s-Related Hospitalizations at Annual Conference............13 State’s Medicaid Cap Report Shows $36M Variance from Projections............14 Upcoming Deadlines..................................................................................15 New Clinician Training & Webinars on COPs, OASIS-D, Data Strategies..........16 CMS Updates Hospital Transfer Policy for Early Discharges to Hospice...........16 Resources...................................................................................................17

The Situation Report: the Home Care Association of New York State RULE from p. 1 In addition, the April 25 State Register includes an announcement of a proposed rule that would not count meals periods and sleep time for any employee (not just home care aides) that works a shift of 24 hours or more, and that there will be a hearing held on July 11 at the state Department of Labor’s office in Brooklyn on this proposed rule. Comments on this proposed rule will be accepted until July 16.

The April 25 State Register is at https://docs.dos.ny.gov/ info/register/2018/april25/toc.html.

A notice of the July 11 hearing is at https:// www.labor.ny.gov/workerprotection/sleep-time.shtm. HCA urges members to plan on testifying and will be preparing further background to assist you in doing so.

As described in several previous communications to members, HCA has been actively involved in trying to obtain a successful resolution of the “24-hour/live-in” issue. This has included: submitting amicus briefs on relevant court cases and challenges before the New York State Industrial Board of Appeals; urging state DOL to address this issue; and advocating that the state Department of Health recognize the potential retroactive and prospective costs to providers and plans in the Medicaid program if aides must be paid for all 24 hours of work even if they have meals and sleep time.

In early March, the Second Department, Appellate Division granted a motion to appeal in a pertinent case on this issue, Andryeyeva v. New York Health Care, Inc., permitting the case to be considered by the Court of Appeals – New York’s highest court. In that case, the Second Department ruled that DOL’s opinion letter setting forth the “13-hour rule” is inconsistent with the plain language of underlying state regulation.

HCA intends to submit an amicus to the Court of Appeals and will consider whether to testify at the July 11 hearing.

We will keep members informed of any new developments on the “24-hour/live-in” issue.

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 3, No. 18 April 30, 2018 

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. Joanne Cunningham HCA President jcunningham@hcanys.org Roger L. Noyes Director of Communications, Editor of The Situation Report rnoyes@hcanys.org Al Cardillo Executive V ice President acardillo@hcanys.org Patrick Conole Vice President, Finance & Management pconole@hcanys.org Andrew Koski Vice President, Program, Policy & Services akoski@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 3, No. 18 April 30, 2018 

 RATE from p. 1 questions/comments on the MLTC Partial Capitation rate development for April 2018 through March 2019.

Among the associations attending were HCA, MLTC Coalition, the Health Plan Association (HPA), Blue Cross Blue Shield Conference, and LeadingAge New York. DOH was joined by representatives from Deloitte, the Department’s new rate setting consultant.

Deloitte provided the following summary of the various MLTC rate components: 

Base Rate – Comprised of blended data using the 2016 Fourth Quarter Medicaid Managed Care Operating Reports (MMCORs) from MLTCs, Fully Integrated Duals Advantage (FIDA) plans and Medicaid Advantage plans which are separated by MLTC region.

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Base Rate Adjustment – Includes adjustments to separate the community and nursing home transition (NHT) populations in the MMCORs, historical home health recruitment and retention monies, reinsurance and other provider incentives.

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Program Change Adjustments – Includes critical Minimum Wage increases in 2018 and 2019 and prospective home health recruitment and retention allocations.

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Managed Care Efficiency Adjustment – This adjustment is contrived to account for DOH-expected efficiencies in the MLTC mandatory population.

Continued on next page

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The Situation Report: the Home Care Association of New York State Continued from previous page 

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Trend Adjustment – Includes a trend application to the base rate from the midpoint of the base period to the midpoint of the rating period as well as an adjustment for a nursing home fee schedule increase.

Acuity Factor & Risk Adjustment – Accounts for relative acuity of each MLTC in each region.

Spend-down/Net Available Monthly Income (NAMI) – Separate adjustments are made for community spend-down and NHT NAMI based on 2016 Supplemental Nursing Home Operating Reports.

Administrative Costs, Taxes and Surplus – The rates include application of administrative and care management cost components, applicable taxes and surplus component.

During the meeting HCA and other participants raised numerous questions and concerns on a variety of MLTC rate development issues including: 



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Non-Benefit expenses, including a reduction in the administrative cost component (being lowered by $15) to reflect a cut effectuated by the 201819 State Budget, as well as a reduction in care management (by $45) for MLTCs in the New York City Area or Region 1.

Other state budget actions such as the upcoming LHCSA contracting limit with MLTC plans, the restriction of MLTC members from plan transitioning for 12 months and a change to the Social Adult Day Health Benefit. Each of these actions is seen as an efficiency type reduction to the plan, but participants expressed concerns that

Volume 3, No. 18 April 30, 2018 

some of these actions, such as the LHCSA contracting limit, could actually increase costs for plans in the short term. 

The timing of other MLTC rate adjustments such as the high-cost high-need risk pool allocation, the quality pool allocation and the ongoing pass-through of monies for the Quality Incentive Vital Access Provider Pool (QIVAPP) program.

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A further detailed walkthrough jointly for plans and providers, with state transparency in its rate assumptions for the plans and for providers.

In an overall comment on the rate build and all of the detailed adjustments being discussed and questioned, HCA underscored the need for the cumulative assumptions, adjustments and impacts to ultimately render realistic and statutorily required funding adequacy to plans. HCA emphasized the many moving fiscal and program parts being simultaneously applied across MLTCs as well as the provider networks, and stressed the need for the rate assumptions and development to account for the: new and higher costs in the 2018 rate year; escalating 2018 program mandates; the significant cost increases and payment requirements for the next phase of minimum wage; impact of the coming MLTC contract limit mandate with LHCSAs; impact of the other state budget-driven changes; next phase of Value Based Payment contracting; and others.

The presentation from DOH and the Deloitte team are available as follows: 

Deloitte slides: https://hca-nys.org/wp-content/ uploads/2018/04/NY-MLTCP-RatePresentation_SFY18-19.pdf

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DOH slides: https://hca-nys.org/wp-content/ uploads/2018/04/MLTC-Powerpoint-Slides-for-SFY2018-19-Partial-Cap_042418.pdf

DOH agreed to conduct a statewide conference call or webinar in the coming weeks for all of the MLTCs, so that plans can receive the same detailed summary on the upcoming 2018-2019 MLTC rate setting activities.

HCA will notify members as more information becomes available on the entire rate build, as well as on the upcoming DOH conference call and requested walk-throughs.

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

Volume 3, No. 18 April 30, 2018 

 TOAST from p. 1 HCA is thrilled to present awards to ten exceptional home care and hospice clinicians, caregivers, leaders in quality innovation, advocates, and physicians. Look for more information about the award winners in a press release and award program soon.

For now, please help us honor these exceptional individuals the right way, by attending HCA’s Annual Conference and award reception with a full “40 Years Strong” force. Registration is here: http:// hcaannualconference.com/register-2018/.

Awards HCA’s two highest honors are being presented to a national leader on the home care stage (National Association for Home Care and Hospice President Bill Dombi, recipient of HCA’s Advocacy Award), as well as one of New York State’s most thoughtful and expert regulatory policymakers (Becky Fuller Gray, Director of the state Department of Health’s Division of Home and Community Based Services, recipient of the 2018 Ruth F. Wilson Award).

Our Caring Award winners represent the very best in compassionate care and support for the home care workforce as well as patients with debilitating illnesses, rehabilitation needs and during end-of-life care. And, new this year, our ‘Triple-Aim Quality and Innovation Award’ is going to two nurses who are making a difference through home-based primary care and in spearheading New York City’s first dedicated program to support the home care needs of patients recovering from gender reassignment surgery.

Plus, also for the first time, HCA is recognizing two physician champions in home care who are very actively supporting patients at home during the often fragmented discharge-planning process, raising the visibility of home care among their peer physicians, and so much more.

Awardees Caring Awards are being presented to: 

Vicky Gentile, Home Health Aide at New York City-based Selfhelp Community Services

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Amy Marshall Uber, Home Health Aide at Eddy Licensed Home Care Agency, which is part of St. Peter’s Health Partners and serves New York’s Capital Region

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Julio Vega, Doctor of Physical Therapy at HCR Home Care, based in Rochester, New York

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Josh Klein, CEO of New York City-based Royal Care

‘Triple-Aim’ Quality and Innovation Awards are presented to: 

Kim Gendron, Family Nurse Practitioner at St. Peter’s Health Partners Medical Associates/Eddy VNA Home Based Primary Care, which serves New York’s Capital Region Continued on next page

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Volume 3, No. 18 April 30, 2018 

Continued from previous page 

Shannon Whittington, Interdisciplinary Care Team Manager and Director of the Gender Affirmation Program at New York City-based Visiting Nurse Service of New York

Physician Champion Awards are being presented to:  

Kevin Costello, MD, Albany Medical Center Internal Medicine, Albany, New York John “Jack” McIntyre, MD, Medical Director, HCR Home Care, based in Rochester, New York

Advocacy Award is presented to: 

William Dombi, President and CEO of the National Association for Home Care and Hospice (NAHC), based in Washington, DC

Ruth F. Wilson Award is presented to: 

Rebecca Fuller Gray, Director of the Division of Home and Community Based Services, New York State Department of Health (DOH), based in Albany.

Proposed Hospice Payment Rule Would Increase Payments by $340 Million On April 27, the U.S. Centers for Medicare and Medicaid Services (CMS) issued a proposed rule (CMS-1692-P) updating the Medicare hospice wage index and cap amount for fiscal year (FY) 2019.

CMS expects to publish the proposed rule in the Federal Register on May 8.

As proposed, hospices nationally would see an estimated 1.8 percent ($340 million) increase in Medicare payments for FY 2019. The rule updates the Hospice Wage Index and cap amounts for FY 2019. The rule also proposes to make regulation text changes to recognize physician assistants as designated hospice attending physicians effective January 1, 2019.

CMS’s proposed rule also describes monitoring activities intended to identify potential impacts related to the hospice reform policies finalized in the FY 2016 Hospice Wage Index and Payment Rate Update final rule and analyzes current trends in hospice utilization and expenditures.

Finally, CMS is proposing updates to the Hospice Quality Reporting Program (HQRP), including: data review and correction timeframes for data submitted using the Hospice Item Set (HIS); extension of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey participation requirements, exemption criteria and public reporting policies to future years; procedures to announce quality measure readiness for public reporting and public reporting timelines; removal of routine public reporting of the seven HIS measures; and public display of public use file data on the Hospice Compare website.

HCA will be reviewing the proposed rule in further detail and will provide the membership with additional information in the near future.

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

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Volume 3, No. 18 April 30, 2018

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



Staff Development Supervisor

DIRECTOR of CLINICAL OPERATIONS

Driven to be the Best.

At Home Care, Inc., a nationally recognized “top 500” certified home health agency located in the Leatherstocking Region of Central New York, seeks to hire a Director of Clinical Operations. This key leadership position will operate within a patient-centered and technology progressive healthcare environment.

Responsibilities include generation, implementation and oversight of clinical policy, to ensure high quality, safe and effective patient care.

Successful candidate will have: 

BSN / Master’s degree preferred

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Two years of experience in a clinical leadership role, with a proven record of effective clinical and change leadership

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Two years certified home health care experience

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Strong written and verbal communication skills

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Knowledge of Joint Commission and Federal homecare regulations

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Mineola, NY. NYU Winthrop Hospital’s Home Health Agency ranks as a top-performing US Home Health Agency. We currently seek a full time Staff Development Supervisor responsible for staff education development and professional growth; teaching orientation classes to new staff & coordinating student nursing, clinical pharmacy and medical student rotations; and teaching post orientation follow-up modules in collaboration with specialty nurses and the education coordinators. You will participate in the ongoing evaluation and development of the orientation program, perform field evaluations of new staff as necessary, convey appraisals of staff to management, and make recommendations; prepare quarterly and annual reports/statistics of each program. We require: 

BSN, required; Master’s in Nursing preferred.

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NYS RN License, required.

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2-3 years Clinical Nursing Practice and Community Health Nursing required.

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2 years Nursing experience in a supervisory capacity in a HHA required.

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1-2 years Trainer, Instructor or Education Coordinator in a Certified Home Health Agency preferred.

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Good presentation, communication, PowerPoint & computer skills are vital.

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Ability to conduct education sessions and conduct skills lab to develop competencies a must.

Financial and reimbursement understanding

For consideration, please submit your resume in confidence, to Patricia Brown, Director of Human Resources e-mail: pbrown@ahcnys.org Fax: 607-432-5836 Direct: 607-353-7413 AHC is an EOE

Apply@ www.nyuwinthrop.org/careers, #18-22843, e-mail HRHomeCare@nyuwinthrop.org, or call 516.663.8000. An EOE.

DIRECTOR OF BUSINESS DEVELOPMENT – MANAGED CARE Premier Home Health Care Services, Inc., is a leading multi-state established home care agency. We are currently looking for a Director of Business Development-Managed Care.

The role of this position is to develop and implement comprehensive business development plans and secure contract service opportunities related to managed care programs that will support and expand contracts onto the company’s business development pipeline. We would also expect that these initiatives will increase our business footprint within existing territories and out of state opportunities. This individual will be responsible for marketing the company’s Care Management/UAS, Chronic Care and Transitional Care Management programs.

The position requires a minimum of a Bachelor Degree but an MA/MPH/MBA is preferred. Five to 7 years in a business development role with demonstrated revenue growth within a Managed Care, or other health/home care program is essential.

Excellent salary and benefits package available. Exciting bonus potential based on revenue growth. Interested candidates should forward résumés to: josullivan@phhc.com.

EOE/M/F/D/V

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

Volume 3, No. 18 April 30, 2018 

Ohio Hospitals and Affiliates Convene on HCA Sepsis Initiative The Ohio State Hospital Association recently convened a special webinar on the HCA home care sepsis initiative for its hospitals and affiliates.

Ohio hospital leaders have been in steady communication with HCA since December for briefings and planning discussions on the HCA sepsis screening tool (learn more at http://stopsepsisathomeny.org/).

The discussions led to an in-depth presentation of all aspects of the HCA sepsis initiative – i.e., the development, training, collaboration partners, presentation of the tool and cases, provider adoption guidance, and more – to the Ohio statewide hospital membership and affiliates.

The presentation was given by HCA Executive Vice President Al Cardillo, IPRO/CMS Sepsis Special Innovations Project Director Eve Bankert, and HCA Sepsis Workgroup Clinical Leader Amy Bowerman, Executive Director of Senior Network Health and Quality Director for the VNA of Utica.

Ohio’s briefing comes on the heels of a statewide briefing of New York State hospitals hosted by our state’s hospital association (the Healthcare Association of New York State) to promote hospitals’ education on the tool and hospital recognition of benefits and collaboration with home care agencies using this tool.

Other states in pursuit Last week, HCA presented to six New England State home care associations who asked for a presentation of the HCA sepsis initiative at their joint Annual Conference.

Meanwhile, state associations and organizations in Washington State, Michigan, Illinois, Wisconsin, Florida, Massachusetts, Colorado, Texas, and others in multiple states and with national presence are engaged with HCA for implementation of our tool and initiative.

HCA’s priority focus continues to be working to assist all home care agencies across New York State to adopt the HCA sepsis screening tool and become continuum partners in the sepsis prevention and mitigation effort.

Many additional initiatives are in the works in relation to this tool and sepsis response overall.

If you are not already a user of the HCA tool, contact sepsistool@hcanys.org to sign up.

Domestic Worker Bill of Rights Reminder HCA reminds home care agencies of their obligations under the state Domestic Worker Bill of Rights.

While home care agency aides were not initially covered under this law, due to the federal “companionship exemption,” this exclusion changed when the federal companionship exemption was eliminated in 2015 for home care agency staff.

Since that time, domestic workers must be given one day (24 hours) of rest per week – or, if the employee agrees to work on that day, the employee must be paid at an overtime rate (even if their hours do not exceed Continued on next page

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Volume 3, No. 18 April 30, 2018 

Continued from previous page 40 for the week). In addition, among other provisions, domestic workers are entitled to at least three paid days off after one year of work for the same employer.

This law does not cover domestic workers who are relatives of their employers or of the person(s) for whom they offer care; thus it would not apply in certain cases.

Agencies who have questions about the initial date that the Domestic Worker Bill of Rights applied to their staff should consult counsel, as there is some question about the correct effective date of the elimination of the companionship exemption in 2015.

Information on this law, including fact sheets for employers and employees and Frequently Asked Questions, is at https://www.labor.ny.gov/legal/domestic-workers-bill-of-rights.shtm.

In addition, employers in New York City may have additional obligations under the City’s Earned Sick Time Act (Paid Sick Leave Law). Information on those requirements is at https://www1.nyc.gov/site/dca/about/paidsick-leave-what-employers-need-to-know.page.

Hospice Q4 2017 PEPPER Data Reports Available to Support Compliance 55% of Hospices in New York Have Retrieved Their PEPPER The 2018 Hospice Program for Evaluating Payment Patterns Electronic Report (PEPPER) was released by TMF Health Quality Institute on April 9, 2018 and includes data and statistics through September 2017.

PEPPER gives provider-specific Medicare data statistics for discharges/services vulnerable to improper payments. PEPPER can support a health care provider’s compliance efforts by identifying where it is an outlier for these risk areas. This data can help identify both potential overpayments as well as potential underpayments.

Cnical Man

Clinical Manager, Private Care/MLTC Manhattan Partners in Care, a respected leader in home health care, is currently seeking a Clinical Manager. The Clinical manager is accountable to the Associate Clinical Director to ensure quality and safe delivery of home care services in a cost effective manner, and to coordinate provision of home care services that reflects the agency’s philosophy and ensures standards of care are maintained. To qualify you must be a New York State licensed/certified RN with three (3) years clinical background. The ideal candidate will have excellent problem solving, organizational, interpersonal, written and verbal communication skills. Previous managerial experience with at least two (2) years’ experience in LHCSA or CHHA also preferred.

Twenty-five of New York’s 45 Hospice providers (55 percent) have downloaded or retrieved their individual PEPPER reports between April 9 and April 24, 2018.

Please email resume to: Joyann.thompson@partnersincareny.org HCA encourages our hospice provider

members to download their reports on the PEPPER Report website portal at https:// securefile.tmf.org/#. The Hospice PEPPER will be available to download for approximately two years.

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

Volume 3, No. 18 April 30, 2018 

CMS Transmittal on Enhancements to Hospice Routine Home Care Payments The U.S. Centers for Medicare and Medicaid Services (CMS) recently released Transmittal 4035 (https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2018Downloads/R4035CP.pdf) which provides significant regulatory relief for hospice providers.

Specifically, Transmittal 4035 creates new fields on the hospice pricer output to display the number of days paid at the high and low routine home care rates, respectively. It also instructs the Fiscal Intermediary Shared System (FISS) to create an output record to match the updates to the hospice pricer output and for the Common Working File (CWF) to store with FISS the number of prior days retained for the life of the claim.

The following are other key provisions of the transmittal, which goes into effect for hospices beginning October 1: 

Hospices shall report a monthly charge total for all drugs (i.e., report a total charge amount for the period covered by the claim) using revenue code 0250;



Hospices shall report a monthly charge total for durable medical equipment (DME) – i.e., report a total charge amount for the period covered by the claim – including DME infusion drugs, using revenue center 029X for the item of DME and 0294 for DME infusion drugs;



CMS will no longer require hospices to report: a charge total and amount dispensed per drug, injectable drugs using revenue code 0636, nor HCPCS codes for DME infusion pumps or DME drugs.

Additionally, CMS intends to supply information related to the number of high routine home care and low routine home care days in the Medicare Administrative Contractor’s online claims history.

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

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

Volume 3, No. 18 April 30, 2018 

NHTD & TBI Update The state Department of Health has posted materials from an April 11, 2018 webinar for the Nursing Home Transition and Diversion (NHTDW) and Traumatic Brain Injury (TBI) Waiver Transition to Managed Care Stakeholder Workgroup.

The materials are at https://www.health.ny.gov/health_care/medicaid/redesign/mrt90/meetings/docs/ 2018-04-11_presentation.pdf.

Some highlights include: 

Cost reports will be required for NHTD and TBI providers – initially for the July 1, 2018 to June 30, 2019 period and then for every July 1 to June 30 period;

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The final state budget delays the transition of NHTD and TBI to managed care until January 1, 2022;

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The NHTD waiver renewal application was submitted to the U.S. Centers for Medicare and Medicaid Services on December 29, 2017 and the current application is operating under a temporary extension until July 16, 2018;



Money Follows the Person program information, NHTD and TBI enrollment statistics, NHTD and TBI complaint procedures, an update on the home and community-based services final rule, and an explanation of the TBI ‘Alternate Route Process.’

FAQs Posted on New Medicare Cards The U.S. Centers for Medicare and Medicaid Services (CMS) has posted Frequently Asked Questions (FAQs) on implementation of the new Medicare cards.

The FAQs are at https://www.cms.gov/Medicare/New-Medicare-Card/NMC-FAQs.pdf.

They address: the effect on dual-eligibles; how providers can determine the accuracy of a patient’s Medicare Beneficiary Identifier (MBI) number; the effect on Medicare Advantage and Medicare Prescription Drug plans; and others.

As communicated to members on many occasions, Medicare beneficiaries are getting new Medicare cards with an MBI number to replace their existing cards that have a Social Security Number-based Health Insurance Claim Number (HICN).

CMS began mailing new cards in April 2018 and will replace all Medicare cards by April 2019. Patients who are new to the Medicare program starting in April 2018 and later will only have a card with the new Medicare number. Medicare beneficiaries in New York and many other states will start to receive their new Medicare cards sometime after June 2018.

The official transition period for the new Medicare card is April 2018 through December 2019, during which Medicare providers can use either the HICN or MBI.

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

Volume 3, No. 18 April 30, 2018 

Healthcare Personnel Influenza Vaccination Report Due Tomorrow Flu Mask Requirement Still in Effect HCA reminds members that the Healthcare Personnel Influenza Vaccination Report is due tomorrow, May 1, 2018.

As in past years, home care and other health care providers are required to document the number and percentage of personnel vaccinated against influenza for the current season.

This report will close on May 1, 2018 and it must be submitted through the Health Electronic Response Data System (HERDS) on the Health Commerce System (HCS).

This year’s report covers personnel employed by or affiliated with your facility or agency from October 1, 2017 through March 31, 2018. Your organization was able to enter data starting in February and then could resubmit information as often as is necessary as new personnel joined and/or submitted documentation of vaccination until the May 1 deadline.

As soon as possible, agencies should log into HCS and enter their agency’s data in the Healthcare Personnel Influenza Vaccination Report. If your facility has already saved or submitted data in the report, you should review the data for accuracy and update or correct data as necessary. The report can be updated and resubmitted as many times as necessary until May 1, 2018.

Users are reminded to first Save, then press the Review and Submit button in order to successfully submit data to the state Department of Health (DOH). Pressing the Save button alone does not submit data to DOH. Information on the Report, including Frequently Asked Questions, is at https://www.health.ny.gov/diseases/ communicable/influenza/seasonal/providers/prevention_of_influenza_transmission/ (see Data Collection and Reporting & Training).

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

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

Flu Mask Requirement Influenza is still considered prevalent which means that home care, hospice and other health care providers are still required to ensure that all personnel not vaccinated against influenza for the current season are wearing a surgical or procedure mask while in areas where patients or residents are typically present.

Information on this mandate is at https://www.health.ny.gov/diseases/communicable/influenza/seasonal/ providers/prevention_of_influenza_transmission/.

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

Volume 3, No. 18 April 30, 2018 

OPWDD Posts Rule Covering Care Coordination Organizations The Office for People With Developmental Disabilities (OPWDD) has posted a notice of emergency adoption and a notice of proposed rulemaking that would allow individuals to be enrolled into Care Coordination Organizations (CCOs), through certain parties, in situations where there is no other person to make that election for them.

The emergency rule is at https://opwdd.ny.gov/regulations_guidance/opwdd_regulations/care/text and also in the April 25 New York State Register at https://docs.dos.ny.gov/info/register/2018/april25/toc.html.

The rule would apply to both individuals regardless of whether or not they reside in a residential facility operated or certified by OPWDD or a family care home.

CCOs provide two care coordination services for individuals who receive OPWDD-certified Home and Community Based Services (HCBS). The first service is a federally-authorized Medicaid Health Home service, which provides enhanced care coordination for individuals who want coordination of health and developmental disability services funded by Medicaid.

Individuals who just want coordination of their OPWDD-certified HCBS services may enroll in the Basic HCBS Plan Support services offered by the CCO.

Reduce Alzheimer’s-Related Hospitalizations with Dr. Craven at HCA’s 40th Annual Conference According to the Alzheimer’s Association, one in three seniors dies with Alzheimer’s or related dementias, and such deaths have increased 123 percent at the same time that deaths from heart disease dropped 11 percent. These conditions cost the nation $277 billion annually, with an estimated rise to $1.1 trillion by 2050.

The toll is equally enormous in terms of the emotional, health and wellbeing impact on families and unpaid caregivers.

These are among countless reasons why home care providers should revisit their strategies for addressing the condition and its impact on co-morbidities.

HCA’s 40th Annual Conference will feature an important segment on Reducing Hospital Readmissions in the Elderly Population with Alzheimer’s Disease and Related Dementias, presented by Dr. Amy Craven, Vice President at C&V Senior Care Specialists, which helps organizations nationally on their strategies for tackling this tragic condition.

Because of its effect on memory, thinking and behavior, Alzheimer’s disease can significantly interfere and complicate the management of other chronic conditions, increasing the risk for hospitalizations that may be preventable with proactive care.

Dr. Craven will address caregiver education to recognize the behavior issues and teach strategies to deal with those behaviors in ways that can ultimately reduce avoidable hospitalizations, improve patient outcomes,

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Volume 3, No. 18 April 30, 2018 

and lower costs. These lessons can be incorporated by your agency’s clinical directors as part of a cohesive approach to managing the risks of Alzheimer’s and other cognitive conditions.

This is just one of nearly 20 stellar sessions on clinical topics, Advanced Home Health Aides and other workforce issues, home telehealth, the CoPs, and star presenters like State Health Commissioner Dr. Howard Zucker, NAHC President Bill Dombi and National Hospice and Palliative Care Organization President Edo Banach.

Please register now and help HCA celebrate “40 Years Strong.” All the information you need is on our conference website at www.hcaannualconference.com.

State’s Medicaid Cap Report Shows $36M Variance from Projections In April through January The state’s latest Medicaid Global Cap Spending Report (for the past fiscal year through January 2018) finds that overall spending was $36 million above the global cap projections, across all sectors, a difference of $17.573 billion in actual spending versus $17.537 billion in estimated spending for the period.

The state fiscal year (SFY) begins on April 1 and ends on March 31.

Nearly all of the provider and plan categories were above the cap projections. “Other Long Term Care” (which includes home care) was $36 million above projections. DOH notes that there were 3,119 more personal care recipients during this period, driving the costs. Managed Long Term Care was $47 million over projections due to there being 1,042 more recipients than anticipated during the report period.

In other report highlights: 

The Accounts Receivable (A/R) ending balance for FY 2017 was $204 million. The state is expected to recoup $135 million by the end of SFY 2018, resulting in a projected A/R balance of $69 million by March 2018. Through the end of January, retroactive rates owed to the state were $151 million. This reflects net recoveries of $53 million since March 2017.



Total Medicaid enrollment reached 6,157,961 at the end of January 2018. This reflects a net increase of 42,308 enrollees since March 2017.

The report contains multiple other data, including tables or summaries of: Vital Access Provider program award amounts; Inventory of Medicaid Rate Packages, Regional Medicaid spending and enrollment estimates; and more.

The full report is at: https://www.health.ny.gov/health_care/medicaid/regulations/global_cap/monthly/ sfy_2017-2018/docs/jan_2018_report.pdf.

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

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Volume 3, No. 18 April 30, 2018

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



Upcoming Deadlines

15

Requirement/Change

Effective/Due Date

More Information

Home Care, Fiscal Intermediaries and other providers who contract with Managed Care Organizations must be enrolled in Medicaid

Still being accepted, but providers are advised to submit now

https://www.emedny.org/info/ProviderEnrollment/ ManagedCareNetwork/index.aspx

Transition Period for Using Health Insurance Claim April 1, 2018 to Number (HICN) or new Medicare Beneficiary December 31, 2019 Identifier (MBI)

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

Implementation of Universal Billing Codes for Home and CommunityͲBased Long Term Care Services under Managed Care

April 1, 2018

https://www.health.ny.gov/facilities/long_term_care /reimbursement/letters/dal_2017Ͳ12Ͳ 07_billing_codes.htm

Submission of Expression of Interest for the Medicare Low Volume Appeals Initiative

April 12 to June 8

https://www.cms.gov/Medicare/AppealsͲandͲ Grievances/OrgMedFFSAppeals/AppealsͲSettlementͲ Initiatives/LowͲVolumeͲAppealsͲInitiative.html

2018 Adult Care Facility 1st Quarter Statistical Information Report (January 1 to March 31, 2018)

April 30, 2018

https://commerce.health.state.ny.us

Request for Information (RFI) on eliminating the Hospital and Community (H/C) Patient Review Instrument (PRI)

April 30, 2018

https://www.health.ny.gov/funding/rfi/pri/index.htm

Healthcare Personnel Influenza Vaccination Report

May 1, 2018 for personnel employed from October 1, 2017 to March 31, 2018

immunize@health.ny.gov or (518) 473Ͳ4437

Training on Electronic Submission of Medicare Provider Cost Report

May 1, 2018

https://blh.ier.intercall.com

Changes in appeals system for Medicaid managed care enrollees

May 1, 2018

https://www.health.ny.gov/health_care/managed_ca re/plans/appeals/index.htm

Changes to NYC Paid Sick Leave Law become effective

May 5, 2018

http://www1.nyc.gov/site/dca/about/paidͲsickͲ leaveͲlaw.page

NYS Health Foundation ‘Patients as Partners’ RFP

https://nyshealthfoundation.org/rfp/patientsͲasͲ May 16, 2018 for online partners/?utm_source=Patients+as+Partners+RFP+Re lease+April+2018&utm_campaign=Patients+as+Partn inquiry form ers+RFP+Release&utm_medium=email

Long Term Care Planning Council Survey

June 18

https://www.surveymonkey.com/r/HM9DM97

Hearing on state Department of Labor’s proposed rule to exclude meals and sleep time for all employees

July 11, 2018

https://www.labor.ny.gov/workerprotection/sleepͲ time.shtm

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

Volume 3, No. 18 April 30, 2018 

New Clinician Training & Webinars on COPs, OASIS-D, Data Strategies, plus CEUs! HCA has a score of new home care and hospice clinician-oriented education programs. These and other programs are posted on our education and events page at https://hca-nys.org/events-education/upcomingevents.

Best yet, most of these new and upcoming programs are webinars, which means your team can remain onsite for online learning that occupies just an hour or two in a day. Plus, many of these programs offer contact hours or CEUs! Collectively, these programs cover major areas to: 

Support your organization’s Quality Assurance and Performance Improvement (QAPI) requirements and overall clinical process management work, like our daylong seminar on Driving Decisions with Data, presented by the acclaimed Barbara Katz of BK Healthcare Consulting (June 6 in Albany). Also, newly announced, we are offering a series of four webinars and four self-directed online modules to give your clinicians the tools to engage patients, reduce unnecessary utilization and promote high-level patient satisfaction through Integrated Care Management (ICM) Specialist Certification (June 5-26).



Better meet existing requirements like the new CoPs, during a webinar on Surveys Under the New Home Health Conditions of Participation, offering effective strategies to prepare for surveys and learn how to stay CoP-compliant (May 31, from 11:30 a.m. to 1 p.m.).

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Plan for looming policy requirements and changes (like the imminent OASIS-D) during an OASIS-D Snapshot webinar that will guide you and your staff through the proposed OASIS-D changes, which will be implemented in January, and explain their rationale (May 1, from 2:30 to 4 p.m.).

All the information you need is at https://hca-nys.org/events-education/upcoming-events.

CMS Transmittal Provides Update to the Hospital Transfer Policy for Early Discharges to Hospice The U.S. Centers for Medicare and Medicaid Services (CMS) recently released Transmittal 2055 (https:// www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2018Downloads/R2055OTN.pdf) which extends the hospital post-acute “transfer” policy to hospice, effective October 1, 2018.

Specifically, the regulations state that when a patient is transferred to another hospital and his or her length of stay (LOS) is less than the geometric mean LOS for the Medicare Severity Diagnosis-Related Group (MS-DRG), the transferring hospital would be paid based on a graduated per-diem rate for each day of stay, not to exceed the full MS-DRG payment.

For discharges to certain post-acute care settings, this per-diem-based payment adjustment is limited to certain MS-DRG discharges. Currently, the regulation limits post-acute care transfers to those where the

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Volume 3, No. 16 April 16, 2018 

patient is transferred to a distinct part of a hospital unit, a skilled nursing facility, or discharged with a written plan for home health services commencing within three days of discharge.

Section 53109 of the Bipartisan Budget Act of 2018 (BBA 2018) modified the law to require that, beginning in fiscal year 2019, discharges to hospice care would also qualify as a post-acute care transfer and be subject to payment adjustments.

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

Resources 

“Racial, Ethnic, and Gender Disparities in Health Care in Medicare Advantage,” by the U.S. Centers for Medicare and Medicaid Services and the Rand Corporation http://nasuad.org/sites/nasuad/files/2018-National-Level-Results-by-Race-Ethnicity-andGender.pdf 

“Building Healthy Communities: One Funder’s Place-Based Approach to Help NeighborhoodsTransform Themselves,” by the NYS Health Foundation https://nyshealthfoundation.org/resource/building-healthy-communities-one-funders-place-basedapproach-to-help-neighborhoods-transform-themselves/ ?utm_source=BHC+Reports+April+2018&utm_campaign=BHC+Reports+April+2018&utm_medium=email



“One Size Doesn’t Fit All: The Need for Local Approaches to Improve Neighborhood Health,” by the NYS Health Foundation https://nyshealthfoundation.org/resource/one-size-doesnt-fit-all-the-need-for-local-approaches-toimprove-neighborhood-health/ ?utm_source=BHC+Reports+April+2018&utm_campaign=BHC+Reports+April+2018&utm_medium=email



“How Integrating Health Care With Other Services Offers Significant Potential Benefits,” Health Affairs (April 24, 2018) https://tinyurl.com/yc7pxjnd

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

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Driving Decisions with Data A Seminar for Clinical Managers

June 6, 2018 – Albany Marriott Hotel – Albany, NY

Driving Decisions with Data A Seminar for Clinical Managers

Meet the Presenter Barbara Katz, RN, MSN President, BK Health Care Consulting

Barbara is an experienced clinician, manager, trainer and health care consultant. She is a graduate of the Yale School of Nursing, She has a Certificate in Training and Development from Fairfield University and a Coaching Certification from the American Talent Development Association. Barbara was the 2013 winner of the Connecticut Association for HealthCare at Home’s Judith A. Hriceniak Award for Excellence in Nursing Leadership.

Barbara has been a hospital nurse, an APRN, a training manager, a director of quality improvement and a clinical manager for a group of medical practices. She has also been a marketing director for a home health care agency and has managed operations for a private duty home care agency.

She has designed and taught seminars on process improvement, data analysis, management, motivational interviewing and team-building. Barbara frequently speaks on topics including the practical use of data to improve outcomes, motivational interviewing, health literacy, collaboration and care transitions and adapting to the new world of health care.

Driving Decisions with Data A Seminar for Clinical Managers June 6, 2018 Albany Marriott 189 Wolf Road, Albany, NY 12205 Registration & Continental Breakfast: 8:30AM Program: 9 – 4:30PM

Home health care agencies will survive and thrive in the new value based health care world if their clinical managers use data to improve population health outcomes, lower costs, reduce waste in work and improve the patient and clinician experience. The new Medicare Conditions of Participation for home health care also require agencies to adopt a data driven approach to Quality Assurance/Quality Improvement (QAPI).

This practical and interactive seminar will help managers understand their role in using data to drive decisions for both the agency QAPI process and in daily clinical work.

Managers will leave with essential tools and techniques for obtaining data, step by step data analysis methods and practical methods for achieving target goals. Participants will have an opportunity to analyze clinical and business data, to develop action plans and to apply data-driven decisions to real operational work problems.

By the end of this program, participants will be able to:  Explain why data-driven decisions are vital in the new world of health care  Describe the role of data in meeting the Medicare Conditions of Participation for QAPI  List key home health care measures  Describe four key steps to making data-driven management decisions  Utilize basic data analysis techniques to turn data into actionable information  Use data to solve operational problems and to achieve agency QAPI goals

Driving Decisions with Data – A Seminar for Clinical Managers June 6, 2018 – Albany Marriott Hotel – Albany, NY HOTEL INFORMATION Albany Marriott 189 Wolf Road, Albany, NY 12205 HCA has reserved a limited block of rooms at the Marriott – Wolf Road, Albany, NY for the night of Tuesday, June 5 at a discounted rate of $139 per night. To receive this special rate, please call 1‐800‐228‐9290 prior to May 16, and ask for the Home Care Association of NYS group rate.

REGISTRANT INFORMATION – Please register by May 22 Name: __________________________________________________________________________ Title:____________________________________________________________________________ Agency:_________________________________________________________________________ Address:_________________________________________________________________________ City/State/Zip:____________________________________________________________________ Phone:________________________________ Ext._________ Fax: _________________________ Email: ___________________________________________________________________________ (Required)

HCA REGISTRATION FEE* ____ HCA Member Fee

 $239

____ Non‐Member Fee

 $389

*Fee includes continental breakfast and lunch.

PAYMENT – Please check method of payment: ________MasterCard _______VISA ______American Express ______Check* *Make checks payable to: HCA Education and Research and mail to 388 Broadway, 4th Floor, Albany, NY 12207. Checks must be received by May 30. ______________________________________________________________________________ Card Number _______________________________________ __________________________________ Expiration Date Security Code ______________________________________________________________________________ Mailing Address of Card Holder ______________________________________________________________________________ City, State, Zip ______________________________________________________________________________ Name on Card ______________________________________________________________________________ Authorized Signature

FAX to 518-426-8788

HCA Cancellation Policy HCA registration cancellations received by May 23 are refundable less a 25% administrative fee. No refunds will be issued after this date.

Cancellations must be received in writing at info@hcanys.org.

Substitutions are permitted.

Special Needs In accordance with the Americans with Disabilities Act, or special dietary needs, please let us know how we can accommodate you: ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________