BILLS
DRILLS
CLAIM EDIT
APPEALS
The State Senate has introduced a new HCA bill that would support the tracking of aide in-service hours; plus our sepsis legislation is set for Assembly Health Committee action.
All home care and hospice provider types are required to participate in an emergency drill on June 1113; make sure your HCS info is current to receive details.
eMedNY originally proposed, and then reversed, a policy to deny claims on third submission. Payment will still be made but tracked for “informational purposes.”
CMS has finalized a rule that would change some of the procedures and timeframes in the Medicare appeals process.
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Your Source for HOME CARE News, Policy and Advocacy
UPCOMING PROGRAMS Webinar: The Art of Creating and Facilitating Grief Groups May 15, 2019 1-2:30 p.m. Two PDGM Programs PDGM Coding Essentials June 12, 2019 Schenectady, NY PDGM Bootcamp For Clinical Managers and Quality Staff July 11, 2019 Suffern, NY 6 Legal Experts, 1 Day of Hot Topics in Labor Law June 13, 2019 NYC
Vol. 4, Issue 19| May 13, 2019
Caregivers, Physicians, Innovators, Public Servants Honored with Home Care & Hospice Excellence Awards HCA’s Annual Conference awards program last week again drew a full capacity audience cheering on the leading lights of home care. “HCA’s award recipients are not only exemplary individuals, but each person has contributed to the home care and hospice fields in distinct ways,” said HCA President and CEO Al Cardillo. “They’ve gone to extraordinary lengths helping a particular patient on a particular day. They’ve improved a See AWARDS p. 2
HCA Welcomes New Slate of Board Members
In keeping with HCA’s Annual Conference theme, “Force for the Future,” HCA President Al Cardillo showcased his karate skills last week, chopping a board held by Paul Essner, Principal at TSG Financial, LLC, one of our sponsors. Watch a video on HCA’s Facebook page. (Photo and video courtesy of Bryan Pendrick, Partner at TSG.)
Last week’s Annual Conference ushered in a new slate of members to HCA’s Board of Directors, the governing body that shapes the direction of HCA policy, education, advocacy and operational priorities. HCA also welcomes a new Board Chair, Jane Shukitis, President and CEO of UR Medicine Home Care, who follows outgoing Chair Susan Larman, President and CEO of the Visiting Nurse Association of Albany, who has completed her term as an exceptional Board leader. See BOARD p. 5
INSIDE HCA Honors Caregivers, Physicians, Innovators, Public Servants.........................1 HCA Welcomes New Slate of Board Members........................................................1 CMS Issues New Instructions for PDGM Claims.....................................................6 Legislative Updates: HCA Bills on Aide In-service Tracking, Sepsis.........................7 Required Emergency Drill Coming June 11-13 for Home Care & Hospice................8 DOH, eMedNY Reverse Medicaid Edit on Claim Submission Limit..........................9 Revised Medicare HHCCN Required July 1, Onward..............................................9
Upcoming Deadlines and Meetings.................................................10 PHHPC Committee Posts Agenda...............................................................11 DOH Seeks Personal Care Rate Enhancement in Certain Rural Areas.............11 DOH Offers Technical Assistance on SDH.....................................................12 OMIG Work Plan for 2019-20 Posted.......................................................12 Medicare Appeals Rule Finalized.................................................................13 UAS Survey Distributed.............................................................................13 Health Resources............................................................................13
The Situation Report: the Home Care Association of New York State AWARDS from p. 1 patient’s overall experience of care. And they’ve influenced broader changes in the very way that home care and hospice are delivered.” Our conference website features more details about the awardees at http://hcaannualconference.com/2019-awardwinners/. Simply click each name on the page to navigate to a profile page for each individual, and feel free to share their profiles on social media. Caring Awards HCA presented three Caring Awards to: Catherine DeSeve, RN at Capital-Region-based Eddy Visiting Nurse and Rehab Association; Geraldine Singleton, Home Health Aide at Visiting Nurse Service of New York (VNSNY) in New York City; and Jena Yager, LPN at Community Health Center in the Johnstown, New York area.
Ms. DeSeve created a process to transition patients safely out of a controlled setting and back into the community with tools and strong support systems for dealing with mental health conditions, including substance abuse. Ms. Singleton has been at her organization for 40 years – the agency’s second-longest-serving aide. She’s formed deep bonds with clients, including an elderly woman from Barbados whose lack of appetite and increasing frailty prompted Ms. Singleton to learn how to cook Barbadian food, helping the patient gain weight and become healthier. Ms. Yager lets no barrier prevent her from delivering care to those she serves. From having to spot-repair a flat car tire between patient care visits on New Year’s Day to toughing out a broken nose that occurred after tripping at a patient’s home, she puts her patients first and dedicates herself wholeheartedly to her mission.
Ruth F. Wilson Award HCA’s highest honor, the Ruth F. Wilson Award, was presented to Penny Feldman, Ph.D., Senior Research Scientist/Director Emerita of VNSNY’s Center for Home Care Policy & Research. Dr. 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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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 Rebecca Fuller Gray Executive V ice President for Clinical and Program Affairs rgray@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
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Feldman’s ground-breaking career contributions include: pioneering the use of data analytics and quality measures in home health care; designing and testing numerous interventions to improve home care delivery and outcomes; and working with government officials at the state and national levels to broaden the scope and improve the quality of home and community-based health care. She is the founder of the first – and still the nation’s only – research institute devoted exclusively to home and community-based care. Physician Champions HCA bestowed Physician Champion awards to Dr. Martin Doerfler, M.D., Associate Chief Medical Officer and Senior Vice President of Clinical Strategy and Development at Northwell Health, and Dr. Thomas Caprio, M.D., Chief Medical Officer at UR Medicine Home Care (URMHC) in Rochester. Dr. Doerfler is a pioneer in the development of evidence-based protocols and training programs in the hospital setting to detect and treat sepsis, saving untold lives and suffering throughout Northwell hospitals on Long Island, New York City and Westchester County. His medical expertise and extensive collaboration with HCA on our Stop Sepsis at Home initiative were critical from inception to completion. Dr. Caprio is an expert on quality initiatives and performance improvement. He is also a staunch patient care advocate, recently intervening on behalf of an elderly man with significant wound care needs and a history of prior hospitalizations who was dropped from another physician’s practice shortly after it referred him to home care. Advocacy Award New York State Office for the Aging (NYSOFA) Director Greg Olsen, HCA’s 2019 Advocacy Award recipient, has been a staunch and
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Joining HCA President Al Cardillo to receive awards last week were Penny Feldman and Geraldine Singleton of VNSNY (top photo); Catherine DeSeve of Eddy Visiting Nurse and Rehab Association (middle photo); and Jena Yager of Community Health Center (bottom photo).
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consistent advocate for home care. He has partnered with HCA on strategies for supporting the home care workforce and responding to the worker shortage. He and his team have adopted a proactive orientation to HCA, inviting our views and concrete input on policies. Triple Aim Quality & Innovation Award People Home Health Care Certified, Inc. of Western New York was recognized as a team for its efforts to integrate telemedicine technology into communitybased care for people with intellectual and developmental disabilities. Emergency room visits have subsequently dropped from 120 to 80 per month, with urgent care visits now executed in the home whenever possible. Bookmark a candidate for future awards HCA’s Annual Awards are a staple of our annual conference and an excellent way to recognize your staff and peers. As you reflect on the profiles above, consider a similarly dedicated individual deserving of an HCA award. Take note of this person, and bookmark his or her candidacy on your calendar for next year when we reopen the nomination process, usually in February.
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Counter-clockwise from top right: National Association for Home Care and Hospice President Bill Dombi delivers his closing keynote at HCA’s Annual Conference; NYSOFA Director Greg Olsen receives HCA’s Advocacy Award; the team at People Home Health Care Certified, Inc. receives the Triple Aim Quality & Innovation Award; and colleagues celebrate Dr. Thomas Caprio (fifth from right) on receiving the HCA Physician Champion Award.
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BOARD from p. 1 Several of the 13 newly appointed Board Members have served on the Board previously, while many are new to the position. They represent a full complement of geographic regions, agency types and sizes, and professional specializations, from nursing to physical therapy and health care business administration. To learn more about HCA’s newest Board Members, please see our profiles sheet at https:// hca-nys.org/wp-content/ uploads/2019/05/New-BoardProfiles.pdf.
CMS’s Director of the Quality Improvement and Innovation Group, Dennis Wagner (left), joined a panel of HCA members for a pre-conference session at HCA’s Annual Conference last week followed by an engaging discussion with HCA’s Board of Directors where he heard about several unique program innovations being pioneered by providers in New York State. Mr. Wagner is pictured here with HCA President Al Cardillo and HCA Director of Education Celisia Street.
Collectively, their background includes: experience with collaborative models under the Delivery System Reform Incentive Payment program; performance and operational improvement efforts; mergers and system integration; hospice expertise; corporate restructuring and health IT; local-government-sponsored home care; managed care; services to special needs populations, including children, and home telehealth innovations to serve these populations effectively; influential roles on state and national workgroups or committees; and program growth. Board appointments are for a two-year term.
HCA also recognizes the following individuals who have completed their terms of exceptional service to HCA’s Board:
Marie Andreacchio, President, Allen Health Care Services Susan Brett, COO, Senior Vice President, People Care Anne Calvo, Assistance Vice President, NYU Winthrop Hospital Home Health Agency Michael Feinman, Director of Operations, Any-Time Home Care Pam Joachim, Executive Director, Montefiore Medical Center Home Health Irina Mitzner, Vice President, Clinical Operations, Northwell Health – Home Care Network Brian Schiel, Vice President/Field Operations, Bestcare Inc. Mary Zagajeski, President and CEO, ArchCare at Home Elizabeth Zicari, President, HCR Home Care
For a full list of current Board members, please visit https://hca-nys.org/about/board-of-directors.
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CMS Issues New Instructions for PDGM Claims The U.S. Centers for Medicare and Medicaid Services (CMS) has recently released a second set of revisions to Chapter 10 of the Medicare Claims Processing Manual with instructions for claims submission under the Patient Driven Groupings Model (PDGM). CMS Transmittal No. 4294/Change Request (CR) 11272 provides some clarity over the first set of revisions that CMS released in CR 11081. CMS’s latest Transmittal or CR can be downloaded at: https:// www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2019Downloads/R4294CP.pdf. Our colleagues at the National Association for Home Care and Hospice (NAHC) reached out to CMS with questions that remained after the release of CR 11081. These questions, along with additional revisions to the Claims Processing Manual, have been addressed in CR 11272. CMS offered the following clarifications:
The percentage payment for the Request for Anticipated Payment (RAP) under PDGM is based on the HIPPS code as submitted. It was previously unclear how the Medicare systems would be able to identify the correct HIPPS code at the time the RAP is submitted since the OASIS does not need to be submitted prior to the RAP and the HIPPS code is derived from the OASIS. (This will remain the case under PDGM.) This HIPPS code is used to match the claim to the corresponding RAP that was previously paid. After this match is completed, the HIPPS code used for final payment of the period of care will be determined in Medicare’s claim processing systems. At that time, the submitted HIPPS code on the claim will be replaced with the system-calculated code.
For claim “From” dates on or after January 1, 2020, the ICD code and principal diagnosis used for payment grouping will be determined by claim coding rather than in the OASIS item. As a result, the claim and OASIS diagnosis codes will no longer be expected to match in all cases. Typically, the codes will match between the first claim in an admission and the start of care assessment (Reason for Assessment – RFA 01) as well as claims corresponding to recertification (RFA 04) assessments. Second 30-day claims in any 60-day period will not necessarily match the OASIS assessment. When diagnosis codes change between one 30-day claim and the next, there is no absolute requirement for the home health agency to complete an “other follow-up” (RFA 05) assessment to ensure that diagnosis coding on the claim matches to the assessment. However, the agency would be required to complete an RFA 05 assessment when such a change would be considered a major decline or improvement in the patient’s health status
For claim “From” dates before January 1, 2020, the other diagnoses and ICD codes reported on the claim must match the additional diagnoses reported on the OASIS form item M1022 (“Other Diagnoses”). For claim “From” dates on or after January 1, 2020, claim and OASIS diagnosis codes may vary as described under “Principal Diagnosis.”
In CR 11081 there was a section titled “Significant Change in Condition” (SCIC) without any additional information. This has been removed from the Claims Processing Manual, but it is expected that CMS will provide additional information in this section in a future CR. Continued on next page
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Continued from previous page Additional revisions include technical instructions describing systems handling of the claims as well as language that holds home health agencies responsible for submitting claims with required visit charge information. All services must be billed on one claim for the entire episode/period. The Medicare Administrative Contractor will return to the provider (type of bill 0329) a claim submitted without any visit charges. CMS has indicated it will continue to release instructions for billing under PDGM. HCA will update the membership as CMS does so.
Senate Introduces HCA Bill on Annual In-service Tracking; Sepsis Prevention Legislation Advances in the Assembly Late last week, the chairman of the state Senate Health Committee, Gustavo Rivera, introduced HCAproposed legislation, S.5605, which would require submission and inclusion of an individual’s annual inservice training and hours in the state’s Home Care Worker Registry by the provider conducting the inservice for the worker. This legislation was developed by HCA for the 2019-20 state budget to improve the in-service tracking process, but the measure was not included in the final budget. Since then, HCA has been working with both chairs of the Senate and Assembly Health Committees to advance standalone legislation addressing the annual in-service training process. The process becomes both inefficient and redundant when aides work for more than one agency at a time, making it difficult to track the amount of in-service training hours the aide has satisfied when each agency provides such training. To resolve this issue, S.5605 ensures the availability of records on the number of in-service training hours each aide has taken to meet the requirements – six hours for personal care aides and 12 hours for home health aides – as well as the required topics. The updated Registry will save agencies time and resources because they will no longer have to verify such training with their aides’ current and/or past employers. HCA’s Public Policy team is working with the chairman of the Assembly Health Committee, Richard Gottfried, to review the current Home Care Worker Registry process in order to advance the bill prior to the end of the legislative session. HCA’s sepsis legislation advances in the Assembly After unanimously passing the Senate on Monday, May 6, HCA’s sepsis legislation is now on the Assembly Health Committee Agenda for tomorrow, May 14. The bill, S.1817 (G. Rivera)/A.3839 (J. McDonald), would allow for the integration of home care into the state’s public health and prevention efforts. We will keep providers updated as the bill advances in the Assembly. For questions related to HCA’s priority legislation, or to learn more about the Association’s legislative agenda, please contact Alyssa Lovelace at alovelace@hcanys.org or call (518) 810-0658.
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The Situation Report: the Home Care Association of New York State
Required Emergency Drill Coming June 11-13 for Home Care & Hospice Providers must ensure that HCS roles in the communications directory are current In a May 10 Dear Administrator Letter (DAL), the state Department of Health (DOH) announced an upcoming emergency response drill starting on June 11 and ending on June 13. Providers will not be notified in advance about the nature of the drill, so it is important to keep your contact records up to date to learn more. The DAL is at https://www.health.ny.gov/facilities/home_care/dal/docs/19-05.pdf. All Certified Home Health Agencies (CHHAs), Long Term Home Health Care Programs (LTHHCPs), Licensed Home Care Services Agencies (LHCSAs) and hospices are required to participate in this drill. Failure to do so will result in a deficiency citation and possible enforcement action. The exercise will simulate an emergency event that:
Allows providers to implement all aspects of their emergency preparedness plan; document activities conducted; evaluate their plan’s effectiveness; and, for federal providers, execute the required AfterAction Report.
Tests communication/plan systems with community partners. When doing so, the agency should clearly state that “this is an exercise.”
Familiarizes providers with the communication methods and information needed by DOH during and after an emergency event, which will help agencies develop systems to gather this information quickly.
Familiarizes providers with the revised survey tool used to collect information – the Health Electronic Response Data System (HERDS) Home Care Emergency Response Survey.
Allows DOH to test the communication and data collection systems prior to a real emergency event.
The Health Commerce System (HCS) is the primary means of communication between providers and DOH during emergencies as well as for normal operational issues. All communication between DOH and providers for this drill and during a real emergency will be conducted via the HCS Integrated Health Alert Notification System (IHANS). Thus, agencies must ensure that roles in the HCS Communication Directory are up to date. In past drills, the following home care/hospice agency roles were notified of drills: 24 by 7 Facility Contact; Office of the Administrator; Administrator; Director, Patient Services for home care and Director, Clinical Services for hospice; Emergency Response Coordinator; and HPN Coordinator. Providers will receive notification of the drill and what the nature of the drill will be on June 11, 2019 via IHANS. DOH regularly conducts training on the Communications Directory, HERDS Data Entry and Report, HCS and other topics. The next Communications Directory Certification training is June 11; HERDS Data Entry and Reports training is May 14; and Introduction to HCS is June 5. Continued on next page
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Continued from previous page More information is on the HCS at https://commerce.health.state.ny.us/public/hcs_login.html and https://www.nylearnsph.com/. Questions about the drill can be sent to HCEmergency@health.ny.gov (please copy Andrew Koski at akoski@hcanys.org).
DOH, eMedNY Reverse Medicaid Edit that Would Have Denied Payment for Third Claim Submission The Electronic Medicaid System of New York State (eMedNY), used to submit HIPAA-compliant Medicaid transactions, has announced it is reversing course on a recently announced edit that would have affected payment on multiple claim submissions for the same service. In the latest update, effective May 1, 2019, edit 02292 (“claims limit exceeded”) will be changed from “DENY” to “PAY/REPORT.” eMedNY indicates that claims which fail the edit will be paid and tracked for informational purposes. HIPAA reason code 273 will still be reported on the 835 remittances so that providers can identify patterns and trends for multiple claims submissions. eMedNY had initially announced that the edit would deny all claim types after the second claim resubmission based on regulations indicating that “any returned claim not correctly resubmitted within 60 days or on the second resubmission is neither valid nor enforceable against the department or social services district.” HCA is pleased that the state and its claims processing system will not deny payment in such cases. For questions or assistance in determining the reason for denial of a claim, please contact the eMedNY call center at (800) 343-9000.
Revised Medicare HHCCN Required July 1, Onward A revised Home Health Change of Care Notice (HHCCN) was issued on May 8 and must be used starting July 1, 2019 (for Medicare fee-for-service cases). The form, which has an expiration date of April 30, 2022 on the bottom, is at https://www.cms.gov/Medicare/Medicare-General-Information/BNI/HHCCN.html. It is very similar to the current form, except for a change in the expiration date, and the instructions no longer reference a discontinued document (the Home Health Advance Beneficiary Notice of Non-coverage). Home health agencies (HHAs) are required to provide the HHCCN whenever they reduce or terminate a beneficiary’s home health services due to physician orders or limitations of the HHA (such as staff shortages) in providing the specific service. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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The Situation Report: the Home Care Association of New York State
Upcoming Deadlines and Meetings Requirement/Change/Meeting
Effective/Due Date
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
Emergency Planners in Inclusive Communities (Oneida County emergency preparedness) meeting
May 14, 2019
dhanley@ocgov.net
Central NY HEPC Meeting
May 15, 2019, 9:30 a.m. to 4 p.m.
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
NYC Health Care Coalition Leadership Council Meeting (emergency preparedness)
May 30, 2019
https://www.programinfosite.com/oepr/nychccͲ registration/
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, 9 a.m. to 12:30 p.m.
Gyongyi.McQueston@health.ny.gov
Long Island HEPC meeting
June 6, 2019, 9 a.m. to 12:30 p.m.
drew.fried@health.ny.gov
Emergency response drill for home care and hospice providers
June 11Ͳ13, 2019
See related article in this week’s newsletter
Western Region HEPC All Partners meeting
June 12, 2019, 8:30 a.m. to 4:30 p.m.
https://tinyurl.com/yyk5vr3q
Emergency Preparedness Coalition of Manhattan (EPCOM)
August 7, 2019, 12 to 1:30 p.m.
Caitlin.Flynn@nyulangone.org
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
Medicare will only accept claims submitted with the Medicare Beneficiary Identifier (MBI)
January 1, 2020
https://www.cms.gov/Medicare/NewͲMedicareͲ Card/index.html
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More Information
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PHHPC Committee Posts Agenda The state Department of Health (DOH) has posted the agenda for the May 16 meeting of the Public Health and Health Planning Council (PHHPC) Committee on Establishment and Project Review. The agenda and supporting documents are at https://www.health.ny.gov/facilities/ public_health_and_health_planning_council/meetings/2019-05-16/. The following home care applications will be discussed:
An entity to become the operator of a special pilot Certified Home Health Agency;
Change in ownership and consolidation/merger of two Licensed Home Care Services Agencies (LHCSAs); and
Change in ownership of a LHCSA that provides Nursing Home Transition and Diversion and Traumatic Brain Injury services.
All Committee and full Council meetings are webcast at https://www.health.ny.gov/events/webcasts/. Once acted upon at the committee level, the applications will go to the full PHHPC for review at its June 6 meeting.
DOH Submits State Plan Amendment to CMS for Personal Care Rate Enhancement in Certain Rural Areas of State The state Department of Health (DOH) recently submitted a State Plan Amendment (SPA) to the U.S Centers for Medicare and Medicaid Services (CMS) requesting a rate enhancement for Medicaid-qualified personal care providers in Federally Designated Frontier and Remote (FAR) areas of the state. This rate enhancement stems from 2018-19 State Budget language authorizing the Rural Health Council to look at the need for such an enhancement. The potential personal care rate adjustment would apply to specific counties (not select zip codes) as long as providers are eligible based on combined losses in Personal Care II, Nursing Supervision, and Nursing Assessment services compared to current Medicaid reimbursement rates. A difference will be calculated between actual cost and current rates paid for the sum of Level II, Nursing Assessment and Nursing Supervisor using Cost Report data. Counties affected include Allegany, Clinton, Delaware, Essex, Franklin, Hamilton, and St. Lawrence. This proposed amendment pertains to Medicaid fee-for-service (FFS) rates/care only. If DOH’s SPA is approved, any rate adjustment would be retroactive to January 1, 2019. The Department also plans to amend the Nursing Home Transition and Diversion (NHTD)/Traumatic Brain Injury (TBI) waiver for a similar rate enhancement later this year. HCA members can download DOH’s SPA at: https://www.health.ny.gov/regulations/state_plans/status/ ltcare/original/docs/os_2019-03-29_spa_19-06.pdf.
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DOH Offers Technical Assistance on SDH The state Department of Health (DOH) Bureau of Social Determinants of Health is providing technical assistance for all MLTC plans and providers on Social Determinants of Health (SDH). The assistance will address SDH ideas based on geographic location and members/recipients, troubleshooting barriers, finding community-based organization partners, or answering questions related to the requirements on SDH and community based organizations (CBOs). For scheduling technical assistance, plans and providers should e-mail sdh@health.ny.gov. (Additional resources are available on the SDH CBO webpage at https://www.health.ny.gov/health_care/ medicaid/redesign/sdh/index.htm.) SDH is a critical component of Value Based Payments (VBP). Under the state’s VBP Roadmap, all level 2 and 3 VBP arrangements must:
Implement at least one SDH;
Contract with at least one Tier 1 community based organization;
Provide investment or seed funding to providers which implement the SDH intervention (this investment is included on the MLTCRR under “Other Medical.”)
OMIG Work Plan for 2019-20 Posted The state Office of the Medicaid Inspector General (OMIG) has posted its 2019-20 Work Plan at https://omig.ny.gov/information/work-plan#MCPIR. Agencies should review it to strengthen their compliance activities. The Work Plan includes three goals: 1) provider and managed care organization (MCO) compliance with the rules, regulations, and contracts of the state Medicaid program; 2) safeguarding Medicaid resources to ensure that the state can meet the needs of eligible recipients by actively employing best practices and state-of-the-art tools to address fraud, waste, and abuse; and 3) recipient safety and promoting high-quality patient care through program integrity initiatives. Managed care program integrity reviews are identified as a new action item in the Work Plan to determine MCO adherence to the requisite program integrity functions delineated in their contracts with the state. OMIG, in consultation with the state Department of Health (DOH), will publish a list of those contractual obligations that may be subject to review on its website, including benchmarks, prior to the reviews. OMIG will conduct its reviews in the same manner that it conducts audits of Medicaid providers. Other ongoing initiatives include: analysis of encounter and other plan-submitted data; coordination with the state’s Recovery Audit Contractor (RAC) for home health and other areas; reviews related to wage and fringe
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benefit compensation to employees in compliance with wage parity laws; pass-through of supplemental Medicaid payments to home care providers, in compliance with DOH directives on minimum wage; CHHA fee-for-service and Episodic Payment System (EPS) audits; continued audits and investigations of personal care services and Consumer Directed Personal Assistance Program providers; and scrutiny of Traumatic Brain Injury and Nursing Home Transition and Diversion waiver program compliance.
Medicare Appeals Rule Finalized The U.S. Centers for Medicare and Medicaid Services (CMS) has issued a final rule that makes changes to the appeals process for Medicare Parts A, B and D. The final rule is at https://www.govinfo.gov/content/pkg/FR-2019-05-07/pdf/2019-09114.pdf. The rule would: 1) allow beneficiaries to submit appeal requests without a signature on their request; 2) revise the timeframe for vacating a dismissal of an appeal request from 6 months to 180 days of the date of the notice of dismissal; 3) reflect the new Health Insurance Claim Number (HICN) or Medicare Beneficiary Identifier (MBI) on appeal forms; 4) change the timeframe for referral of a case to the Medicare Appeals Council; 5) make technical corrections to actions that are not initial determinations; and 6) institute other technical changes.
UAS Survey Distributed The state Department of Health (DOH) UAS-NY Project Team requests that providers complete a survey to understand how UAS-NY reporting functionality can better support agencies’ business processes and reporting needs. DOH asks providers to share this survey (https://hca-nys.org/wp-content/uploads/2019/05/UAS-NYReporting-Survey-for-Long-Term-Care.pdf) with staff who routinely use UAS-NY reporting. One survey response is sought per organization. Completed surveys can be e-mailed to uasny@health.ny.gov by close of business on May 31, 2019.
Health Resources
“2019 Home Health Care Report,” by Homecare Homebase https://homehealthcarenews.com/hhcn-hchb-2019-home-health-care-outlook-report/
“Home Health Patient-Driven Groupings Model (PDGM) Additional Manual Instructions,” by the U.S. Centers for Medicare and Medicaid Services https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2019Downloads/ R4294CP.pdf https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNMattersArticles/Downloads/MM11272.pdf Continued on next page
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Continued from previous page
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“Do People Who Sign Up for Medicare Advantage Plans Have Lower Medicare Spending?” by the Kaiser Family Foundation http://files.kff.org/attachment/Issue-Brief-Do-People-Who-Sign-Up-for-Medicare-AdvantagePlans-Have-Lower-Medicare-Spending