PROFESSIONAL ADVISORY COMMITTEES
FI WORKGROUP
WAGE PARITY CERT.
PDGM
In response to member inquiries, HCA confirms that NYS regulations still require a Professional Advisory Committee for CHHAs even though the federal CoP standards do not.
The state held its first meeting of a workgroup to examine fiscal intermediary services, with a focus on procurement criteria, best-practices, quality and more.
HCA reminds members that quarterly wage parity certification forms are due June 1 from contractors to their MCOs, CHHAs/LTHHCPs.
Three upcoming programs are designed to help your team overcome the PDGM knowledge gap in clinical coding, clinical management and OASIS.
PAGE 3
PAGE 4
PAGE 9
PAGE 10
UPCOMING PROGRAMS Two PDGM Programs PDGM Coding Essentials June 12 (Schenectady, NY) PDGM Bootcamp For Clinical Managers and Quality Staff July 11 (Suffern, NY)
6 Legal Experts, 1 Day of Hot Topics in Labor Law June 13 (NYC)
Blueprint for OASIS Accuracy – OASIS D Data Set June 17-18 (Workshop); June 19 (Optional COS-C Exam) in Webster, NY (near Rochester) September 23-24 (Workshop); September 25 (Optional COS-C Exam) in NYC
Your Source for HOME CARE News, Policy and Advocacy
Vol. 4, Issue 20| May 20, 2019
State Senate Intros HCA CHHA Rate Update, Benchmarking Bill State Senate Health Committee Chairman Gustavo Rivera has introduced HCA’s priority rate and benchmarking bill (S.5915). You can read the bill and summary content at https:// www.nysenate.gov/legislation/bills/2019/s5915. HCA proposed the measure during the state budget process and we appreciate Chairman Rivera’s sponsorship of a standalone version post-budget. HCA is working on an Assembly companion bill as well, and we will soon launch a grassroots advocacy campaign to engage a groundswell of HCA members to urge legislative support for the reimbursement sustainability provided by this bill. The bill, now in the Senate Health Committee, does two things: it provides a 10 percent increase in the base episodic payment system (EPS) rates and fee-for-service rates (FFS) to Certified Home Health Agencies (CHHAs); and it establishes rate benchmarking standards for other home care payors to consider. See BILL p. 2
ICYMI: With House Intro of PDGM Fix, Your Advocacy Needed to Push Bills in Both Chambers In case you missed it from our alert last week, the U.S. House of Representatives has introduced companion legislation to a Senate bill that would mitigate the so-called “behavioral-adjustment” cut under the Patient Driven Groupings Model (PDGM). See PDGM p. 3 Note: HCA’s offices will be closed on May 27 for Memorial Day. We will publish the next Situation Report on Tuesday, May 28.
INSIDE State Senate Intros HCA CHHA Rate Update, Benchmarking Bill..........................…1 ICYMI: Your Advocacy Needed on PDGM Bills…......................................................1 Clarification for CHHAs: Advisory Committee Still Required by NYS Regs….............3 HCA Participates in First FI Workgroup Meeting….................................................4 State Launches EVV Website, Listening Sessions and Other EVV News..................5 Key Hospice, Home Health Updates from CMS Open Door Forum..........................6 HCA Member Discount Code for ACHC Accreditation, Services…...........................7
Quarterly Wage Parity Certifications Due June 1.........................................…9 Join the 3% and Bridge the PDGM ‘Knowledge Gap’ with HCA….....................10 OMIG Issues 2nd Demand Bill Notification for FFY 2018….............................11 CMS to Host Hospice Quality Reporting Program Webinar: June 11...............11 Home Care Applications Addressed at PHHPC Committee Meeting.…..........12 Clinical Tools Available to Reduce Falls......................................................12 Meetings and Due Dates............................................................................13 Person-Centered Planning Training Announced…........................................14 Health Resources…....................................................................................14
The Situation Report: the Home Care Association of New York State BILL from p. 1 This latter provision offers a basis for rate adequacy outside the Medicaid FFS/EPS systems, given that FFS Medicaid home care rates are often used as a benchmark for Medicare Advantage, commercial insurers and other payors. Much of these payment sources are outside Medicaid’s direct cost responsibility and, thus, have a marginal cost impact on the state budget. As Senator Rivera’s office writes in its justification of the bill’s EPS/FFS rate updates: “Unlike other Medicaid service providers, CHHAs have not received a payment rate trend adjustment to either rate in over ten years. During this time, unfunded mandates, labor obligations, and operation costs have escalated.” It adds: “Benchmarking is a method of equalizing payment rates within the Medicaid service system ... This benchmark would ensure that home health agencies are able to operate at sustainable rates in order to provide services to the state’s frail and vulnerable populations.” All HCA members in Senator Rivera’s district (Bronx) are urged to write him in appreciation of the bill and to bolster his support. Other members should reach their Senate representatives about the bill as well. Please be on alert for an HCA grassroots messaging campaign soon for further assistance. Additional HCA-developed Language Advances in the Senate In addition to the CHHA rate/benchmark legislation advancing, two other HCA bills are on tomorrow’s Senate Health Committee Agenda. These include S.5605 (Senator G. Rivera), which requires submission and inclusion of an individual’s annual in-service training and hours in the state’s Home Care Worker Registry by the provider conducting the in-service for the worker; and S.4942 (Senator J. Sanders)/A.6772 (Majority Leader C. PeopleStokes), which promotes home care-physician-hospital collaboration models to address health care disparities. We strongly encourage providers to contact their lawmakers, urging support for both of these critical pieces of legislation. You can access your lawmakers’ contact information at https:// p2a.co/8SH2CRX. For questions or concerns about these bills, please contact HCA’s director for policy and advocacy, Alyssa Lovelace, at alovelace@hcanys.org. Home Care Association of New York State (HCA) 388 Broadway, 4th Floor, Albany, NY 12207 Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org
2
Volume 4, No. 20 May 20, 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 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
Volume 4, No. 20 May 20, 2019
PDGM from p. 1 HCA has already sent members a grassroots advocacy campaign for you to write New York’s Senators and your Congressional Representative seeking their co-sponsorship and passage of both bills (S.433/ H.R.2573). If you haven’t done so, please act on this campaign today at https://p2a.co/uCwQXWF. As extensively reported, the U.S. Centers for Medicare and Medicaid Services (CMS) has proposed a 6.42percent behavioral adjustment cut at the outset of PDGM, assuming that providers will alter their coding and claims practices in order to gain higher payments or to bypass new financial disincentives/ corrections when PDGM is rolled out. HCA has argued that there is no reasonable statistical justification for this cut, which is based on an unforeseeable prediction of assumed future activity under an as-of-yet untested reimbursement system. S.433/H.R.2573, alternatively, requires that reimbursement adjustments be made only after – and to the extent that – behavioral adjustments do, indeed, occur, rather than merely anticipating or assuming that behavior will change. The bill also limits “behavioral adjustment” rate cuts to two percent per year under PDGM. Write your elected representatives today on this priority measure. NPP Authorization Bill “It’s a win for patients, a win for practitioners and a win for Medicare’s bottom line,” says Rep. Jan Schakowsky (D-Ill.) about her recently introduced bill, the “Home Health Care Planning Improvement Act of 2019” (H.R. 2150), according to a recent article in Home Health Care News. “Empowering well-trained nurse practitioners and physician assistants is the way that we need to go to expand our health care workforce. This is a very important step forward in making health care accessible.” Rep. Stachowsky makes the cost-savings and accessibility case for this important and long-needed measure, which would allow non-physician practitioners to order and refer for home health services. You should too. In addition to the PDGM fix, please use HCA’s Legislative Action Center to urge passage of sensible reforms in the care authorization process through H.R. 2150/S.296. That campaign is at https://p2a.co/ bGifz1e.
Clarification for CHHAs: Professional Advisory Committee Still Required Over the past several weeks, HCA has fielded several inquiries from Certified Home Health Agencies (CHHAs) asking whether they are still required to have a Professional Advisory Committee (PAC) now that the revised federal Conditions of Participation (CoPs) eliminated the PAC requirement. The answer is yes, a PAC is still required, because state regulations (at Section 763.11) still require it.
3
The Situation Report: the Home Care Association of New York State
Volume 4, No. 20 May 20, 2019
HCA Participates in First FI Workgroup Meeting On May 15, HCA participated in the first meeting of the state’s Fiscal Intermediary (FI) Workgroup. As mentioned in numerous communications, the workgroup was included in the final 2019-20 state budget in place of an initial proposal that would have overhauled the delivery of FI services. While the workgroup is charged with multiple considerations – including FI best-practices, criteria for selecting and contracting with entities for FI services, FI quality reporting and transition plans for consumers switching FIs – the final state budget also, more immediately, transitions to a per member per month (PMPM) payment for FI administrative services beginning July 1. HCA is joined on the workgroup by HCA members: Michael Rosenblut, AgeWell/Parker Jewish Institute for Health Care and Rehabilitation; Elizabeth Martin, Consumer Directed Choices; Marianne Grady, Empire BlueCross BlueShield HealthPlus; Andrew Cruikshank, Fort Hudson Health System; Christina Wong, Healthfirst; Ray Donovan, Maxim Healthcare Services; Kate Rolf, Nascentia Health; and Lori Ferguson, VNSNY CHOICE. Other members include consumers; provider associations; local departments of social services; legal advocates; additional managed care plans; independent living centers; and other stakeholders. Participants discussed a new FI procurement process and other charges of the workgroup. New criteria for FIs, as outlined in the final state budget, are to include: the ability to appropriately serve individuals participating in the program; geographic distribution to ensure access in rural and underserved areas; demonstrated cultural and language competencies; ability to provide timely consumer assistance; experience serving individuals with disabilities; the availability of peer support for consumers; and demonstrated compliance with all applicable federal and state laws and regulations, including for wages and labor. This new procurement replaces the previous authorization process. FIs that provide services on or prior to April 1, 2019 will be required to submit an application within 60 days of DOH posting the procurement process. This applies to all FIs, including those who submitted applications under the recent authorization process. HCA asked whether entities who have never provided FI services will be able to apply under the new procurement process and DOH responded that it is checking on an answer. DOH did confirm that independent living centers and those FIs established prior to January 1, 2012 will not be given preference over other applicants. DOH also reviewed the current FI requirements as outlined in the regulations (18 NYCRR 505.28-i) along with new language (10 NYCRR 365-f) from the final budget referencing “other related responsibilities” of FIs “which may include, as determined by the commissioner, assisting consumers to perform the consumer’s responsibilities ... in a manner that does not infringe upon the consumer’s responsibilities and selfdirection.” The workgroup discussion covered many topics, including specific factors to be considered in the contracting procurement process, such as the number of regions served and number of staff, the availability
4
The Situation Report: the Home Care Association of New York State
Volume 4, No. 20 May 20, 2019
of peer support, having a local presence, ensuring access in rural areas, having culture- and languagecompetent personal assistants, and demonstrating that the care plan is being carried out. Workgroup participants also discussed the need for: standardization of what is required of FIs and managed care plans; the need for DOH to collect data on FIs that can be made available to consumers; as well as the roles and responsibilities of consumers versus those of FIs related to hiring of personal assistants, scheduling and monitoring of services, obtaining the plan of care, reviewing the consumer’s ability to be self-directing and whether any designated representatives are fulling their responsibilities, the reauthorization process, and compliance activities. HCA pointed out that the roles and responsibilities of both parties need to be better delineated and then explained to enforcement agencies so that FIs are not targeted for actions (or inactions) which are not within their purview. The group also started to discuss some best practices and value or quality measures for FIs and was asked to submit ideas on both issues that will then be shared with the group prior to its next meeting on July 10. HCA requested that DOH update the Workgroup in July on the change to PMPM payments for FI administrative services, as this will affect the future of FIs. DOH also announced the following future meetings (not open to the public) and topics:
June 18, 11 a.m. to 2 p.m. – Consumer FI Transition Process and Protections July 10, 11 a.m. to 2 p.m. – Quality and Reporting Requirements August 7, 11 a.m. to 2 p.m. – Recommendations for FI Selection and Contracting Criteria
FIs that have best practices and/or ideas on quality indicators for FIs are encouraged to send them to Andrew Koski at akoski@hcanys.org so he can share them with the FI Workgroup. For more information, contact Andrew Koski at akoski@hcanys.org or (518) 810-0662.
State Launches EVV Website, Listening Sessions and Other EVV News The state Department of Health (DOH) has launched a webpage dedicated to sharing information on New York State’s implementation of an Electronic Visit Verification (EVV) system, as required by federal law under the 21st Century Cures Act. This webpage is at https://www.health.ny.gov/health_care/medicaid/redesign/evv/index.htm. It includes program information, stakeholder information, frequently asked questions, and a calendar with important public engagement events specific to EVV implementation. Regional Listening Sessions are happening from May 30 to June 27 for public input on New York’s EVV design and implementation. Registration is at https://www.eventbrite.com/o/the-nys-department-of-health20146751935. Continued on next page
5
The Situation Report: the Home Care Association of New York State
Volume 4, No. 20 May 20, 2019
Continued from previous page DOH will be e-mailing an EVV Readiness Survey to personal care providers, home health providers and Medicaid plans who contract with these providers to help inform the planning process. A copy of the survey is at http://www.health.ny.gov/health_care/medicaid/redesign/evv/2019_readiness_survey.htm. EVV updates are available through the EVV ListServ at listserv@listserv.health.state.ny.us. To subscribe, please include the following in your e-mail request: SUBSCRIBE EVV-L YourFirstName YourLastName. Questions on EVV can be directed to DOH at EVVHelp@health.ny.gov. The 21st Century Cures Act requires all state Medicaid programs to implement an EVV system for personal care and home health. To avoid a reduction in federal Medicaid funding, states must implement EVV systems beginning January 1, 2020 for personal care and by January 1, 2023 for all Medicaid-funded home health, or else otherwise demonstrate that the state has made a “good-faith” effort to implement EVV, and that the state has encountered unavoidable system delays. DOH has informed us that it intends to request a delay in implementing EVV for personal services by the January 1, 2020 deadline under the “good-faith-effort” provision. The U.S. Centers for Medicare and Medicaid Services has a website dedicated to EVV at https://www.medicaid.gov/medicaid/hcbs/guidance/electronic-visit-verification/index.html. This EVV mandate is separate from an existing New York State requirement that home care providers must utilize a verification organization (VO) to perform a pre-claim review if they exceed $15 million in Medicaid fee-for-service and/or Medicaid managed care reimbursements. Participating providers are required to contract with a VO vendor that uses electronic means of verification, including but not limited to contemporaneous telephone verification or contemporaneous verified electronic data, to ascertain whether a service or item was provided to an eligible Medicaid recipient. More information on this requirement is at https://www.omig.ny.gov/index.php/information/home-health-verification.
Key Hospice, Home Health Updates from CMS Open Door Forum The following are key home health and hospice updates from the Open Door Forum held last week by the U.S. Centers for Medicare and Medicaid Services (CMS). Hospice Compare The Hospice Compare May refresh will include data from the Hospice Provider Utilization and Payment Data File (PUF) based on adjudicated claims, as well as an update to the zip code file (to improve the search function). Newly added data will include: the average number of patients cared for by hospice each day (i.e., the average daily census); levels of hospice care provided; medical conditions treated; and location of care. CMS Continued on p. 8
6
Volume 4, No. 20 May 20, 2019
The Situation Report: the Home Care Association of New York State
experience the achc difference achc‘s commitment to customer service makes the difference.
$500 OFF
ACHC has become synonymous with providing value, integrity, and the industry’s best customer service. Our mission is simple - we aim to deliver the best possible accreditation experience. ACHC and Home Care Association of New York State (HCA) have partnered to meet the specific needs of home health providers who seek accreditation services.
ACCREDITATION Discount will be applied upon final payment. Only one discount is applicable per company.
Get started by visiting cc.achc.org
Our organizations are committed to working together to guide providers through the ACHC accreditation process by offering HCA members a discount on educational resources and accreditation.
$50 OFF WORKSHOP OR WORKBOOK
Demonstrate your commitment to quality
Create distinction among competition
Drive continuous improvement
Attend an ACHC workshop or purchase an ACHC Accreditation Guide to Success digital workbook and receive $50 off.
More info at achcu.com
USE THE COUPON BELOW DURING CHECKOUT
hca discount code
HCANYS219 $500 OFF ACCREDITATION $50 OFF WORKSHOP OR WORKBOOK $500 discount will be applied upon final payment and only one discount is applicable per company for accreditation. $50 discount may be used for any HCA member attending an ACHC workshop or any member purchasing the ACHC Guide to Success digital workbook.
achc.org
iso 9001:2015 certified. cms approved.
7
The Situation Report: the Home Care Association of New York State
Volume 4, No. 20 May 20, 2019
Continued from p. 6 has also proposed adding data from other sources – like the Census Bureau and Institutes of Health – to help patients make better informed choices. The August refresh will include data from Measure 1 of the “Visits When Death is Imminent” measure pair. Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) The next hospice CAHPS data submission deadline is August 14 (following the most recent May 8 deadline), and providers should confirm vendor data submission through the Survey Data Warehouse. The size exemption form for the 2018 reference year is due December 31, 2019. Providers with suggestions on the survey can write CMS at hospicecahpssurvey@HCQIS.org. CMS also said it is starting an analysis of survey data to consider it as a basis for a possible star ratings system on Hospice Compare. An implementation timeline is unknown at this time, and it is also unclear how this newly announced plan, utilizing CAHPS data, relates to the use of a hospice assessment tool (still under development) which was previously understood to be a basis for any future ratings formula. Software Bug Causing Hospice Underpayments CMS is working to fix the Medicare software system bug that has resulted in underpayment to hospices in situations where a patient has transferred. The problem stems from a claims processing system change referenced in MLN Matters Article MM10180 (https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/ Downloads/MM10180.pdf). A fix is scheduled for October 7. Until then, hospices should not submit adjustments when there is a transfer within the benefit period. Beginning October 7, hospices can resume submitting adjustments. If the dates of service are beyond the timely filling period, submit a reopening request using Type of Bill 8XQ. Hospice Notices of Election CMS indicates that only 6 percent of Notices of Election (NOE) have been submitted electronically since implementation of this option. Officials emphasized that electronic submission can help reduce or eliminate problems such as errors in the direct entry process. For more information, see the Companion Guide for Electronic Notices of Election as well as Change Request (CR) No. 10064, which relates to the implementation of this option (https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/ R3866CP.pdf). Home Health CAHPS CMS instructed home health agencies to check their CAHPS data submission reports by entering the Home Health CAHPS website (https://homehealthcahps.org/) and clicking on the icon “for HHAs.” Providers are reminded that April 1, 2019 began the participation period (through March 2020) for the calendar year 2021 annual payment update. Any agency with 59 or fewer CAHPS-eligible patients for the previous period (April
8
The Situation Report: the Home Care Association of New York State
Volume 4, No. 20 May 20, 2019
2018 through March 2019) should complete the Participation Exemption Request form at: https://homehealthcahps.org/For-HHAs/Participation-Exemption-Request-Form. Claims Manual Changes for PDGM As HCA reported in last week’s newsletter, the latest revisions to the Medicare Claims Processing Manual include important changes to prepare for the Patient Driven Groupings Model (PDGM). CMS reviewed the changes during last week’s forum. Most importantly, ICD-10 codes used for payment groupings will now be taken from claims instead of the OASIS. As a result, the second 30-day claim 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 requirement for agencies to complete an OASIS “Other Follow-up Assessment” (RFA05) just to ensure that the diagnosis codes match the assessment. However, the agency is required to complete the RFA05 when there is a change due to major decline or improvement in the health status of the patient. Again, this change is not reflected in the Request for Anticipated Payment (RAP) section of the Change Request and CMS plans to make this correction. Home Health Compare Home Health Compare is currently undergoing a series of software updates, and the April refresh will take place as soon as the final updates are completed. When available, an announcement will be made on the Home Health Quality Reporting Program (HHQRP) webpage. CMS will soon announce the annual performance training for HHQRP, scheduled for June 19, 2019. The next Home Health and Hospice Open Door Forum is on June 12, 2019.
Quarterly Wage Parity Certifications Due June 1 The next round of state-required Wage Parity certification forms is due June 1, 2019 for Licensed Home Care Services Agencies (LHCSAs) and Fiscal Intermediaries (FIs) that contract with Managed Care Organizations (MCOs), Certified Home Health Agencies (CHHAs), and/or Long Term Home Health Care Programs (LTHHCPs) that serve New York City, Long Island and Westchester. The Wage Parity Law and related certification requirement do not apply to areas outside of New York City, Long Island and Westchester. MCOs, CHHAs and/or LTHHCPs that contract with LHCSAs and FIs are required to obtain a written certification on a quarterly basis from the LHCSA/FI or other entity which attests to the LHCSA/FI’s compliance. The form due June 1, 2019 covers the period June 1, 2019 through August 31, 2019 and is sent to the MCO, CHHA and/or LTHHCP, not the state Department of Health (DOH). The 2019 forms and wage parity levels are at https://www.health.ny.gov/health_care/medicaid/redesign/mrt_61.htm. In completing the form, HCA recommends adding a date after the signature and noting on the form that the certification covers the June 1, 2019 through August 31, 2019 period, and retaining copies of all certifications for your own records. Questions about wage parity can be sent to DOH at HCWorkerParity@health.ny.gov.
9
The Situation Report: the Home Care Association of New York State
Volume 4, No. 20 May 20, 2019
Join the 3% and Bridge the PDGM ‘Knowledge Gap’ with HCA PDGM clinical knowledge, PDGM coding knowledge, OASIS mastery all in store throughout NYS According to a new survey reported in Home Health Care News, most of your clinicians “face a PDGM knowledge gap”! (See https://homehealthcarenews.com/2019/05/home-health-clinicians-face-pdgmknowledge-gap/.) Only 33 percent of home care executives said their clinical staff members are adequately prepared for PDGM; just 29 percent agreed their staff fully understands the elements of PDGM; and only 3 percent “strongly agreed” their staff fully understands the PDGM elements. What elements count? Well, for starters the 432 case-mix groupings and the role of admission source, episode timing, comorbidities, therapy utilization and how OASIS items determine a patient’s functional impairment level – all of these affect your organization’s success. HCA has three upcoming programs in three regions of the state (downstate, capital region and Rochester area) to help you become one of the three percent of organizations strongly confident in your team’s clinical and coding PDGM readiness, including the fundamentals of OASIS vital to your current operations and under the new PDGM paradigm. Learn more about each of these programs by clicking the links below. PDGM Coding Essentials* (https://hca-nys.org/wp-content/uploads/2019/05/PDGM-Programs-HCA-2019.pdf) Featuring Trish Tulloch June 12, 2019 Schenectady, NY PDGM Bootcamp For Clinical Managers and Quality Staff* (https://hca-nys.org/wp-content/uploads/2019/05/PDGM-Programs-HCA-2019.pdf) Featuring Barbara Katz July 11, 2019 Suffern, NY *Save by registering for both of the above programs at a group discount. Blueprint for OASIS Accuracy: OASIS D Data Set** June 17-18 (Workshop); June 19 (Optional COS-C Exam) Webster, NY (near Rochester) (https://hca-nys.org/wp-content/uploads/2019/02/Blueprint-for-OASIS-Flyer-Rochester-June-2019.pdf) **Hotel deadline extended to Friday, May 24. Make your reservations now.
10
The Situation Report: the Home Care Association of New York State
Volume 4, No. 20 May 20, 2019
OMIG Issues Second Demand Bill Notification for Cases Identified in Second Half of FFY 2018 The state Office of the Medicaid Inspector General (OMIG) has sent Certified Home Health Agencies (CHHAs) a second notification letter reminding providers of their obligation to submit demand bills to Medicare for cases identified for the second half of federal fiscal year (FFY) 2018. This notice follows an earlier one (mailed on March 13, 2019) that most Medicare-certified home care providers should have received from OMIG and its Third Party Liability (TPL) contractor, the University of Massachusetts Medical School (UMMS). The letter identified which cases have been selected to undergo appeals (through demand billing), with dates of services that occurred in the third and fourth quarters of FFY 2018 only (April 1, 2018 through September 30, 2018 or the end of the episodic period billed to Medicaid). If you have already demand billed as requested in the March 13 letter, you can disregard this second notification from OMIG. UMMS’s letter also says providers should continue monitoring the status of their demand bill claim(s) once submitted. Providers are required to correct any claims that are rejected or suspended by the Medicare Administrative Contractor (MAC), National Government Services (NGS). In addition, providers are required to timely submit a complete medical record to NGS once the Additional Development Request (ADR) is issued. A final remittance advice for each episode billed (by demand bill) will be issued within 60 days of the final bill submission to Medicare. Upon receipt of the final remittance advice, providers must send copies of the following documents to the TPL contractor, UMMS, within 10 business days:
A copy of the original claim submitted to the MAC for each 60-day episode billed. A copy of the final claim remittance advice sent to you from the MAC. A copy of each medical record your agency submitted to the MAC upon the ADR request.
HCA members interested in knowing whether they should have received a letter from OMIG can e-mail HCA at info@hcanys.org. For specific questions about the letters, contact UMMS’s Laurie Burns at (866) 626-7594.
CMS to Host Hospice Quality Reporting Program Webinar: June 11 The U.S. Centers for Medicare and Medicaid Services (CMS) will be hosting a hospice quality reporting webinar on Tuesday, June 11, 2019, from 2 to 3:30 p.m. The webinar will show how to use the new “Review and Correct Report” to verify the data displayed on the Hospice Compare website. Additional details can be found on the Hospice Quality Reporting Program Spotlight and Announcements website at https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospiceQuality-Reporting/Spotlight.html.
11
The Situation Report: the Home Care Association of New York State
Volume 4, No. 20 May 20, 2019
Home Care Applications Addressed at PHHPC Committee Meeting The Public Health and Health Planning Council Committee on Establishment and Project Review met on May 16 and acted upon a number of home care applications. The following were recommended for approval and will be acted upon by the full PHHPC at its June 6 meeting:
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.
The agenda and supporting documents are at https://www.health.ny.gov/facilities/ public_health_and_health_planning_council/meetings/2019-05-16/. All Committee and full Council meetings are webcast and archived at https://www.health.ny.gov/events/webcasts/.
Clinical Tools Available to Reduce Falls The U.S. Centers for Disease Control and Prevention (CDC) has released two new complimentary clinical tools to help health care providers reduce older adult falls. These include:
Coordinated Care Plan to Prevent Older Adult Falls: Framework for implementing a Stopping Elderly Accidents, Deaths, and Injuries (STEADI)-based clinical fall prevention program (https://www.cdc.gov/ steadi/pdf/Steadi-Coordinated-Care-Final-4_24_19.pdf); and
STEADI: Evaluation Guide for Older Adult Clinical Fall Prevention Programs: Key steps for measuring and reporting on the success of your program (https://www.cdc.gov/steadi/pdf/Steadi-EvaluationGuide_Final_4_30_19.pdf)
CDC notes that older adult falls are the leading cause of all fatal and nonfatal injuries among adults age 65 and over in the U.S., accounting for over 3 million emergency department visits, 962,000 hospitalizations, and approximately 30,000 deaths in 2016. To learn more, visit the STEADI webpage at https://www.cdc.gov/steadi/pdf/Steadi-Evaluation-Guide_Final_4_30_19.pdf.
12
Volume 4, No. 20 May 20, 2019
The Situation Report: the Home Care Association of New York State
MEETINGS & DEADLINES
13
Requirement/Change/Meeting
Effective/Due Date
More Information
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/
Electronic Visit Verification (EVV) Public Listening Session in Albany
May 30, 2019, 1 to 4 p.m.
https://www.eventbrite.com/e/albanyͲelectronicͲvisitͲ verificationͲevvͲregionalͲlisteningͲsessionͲregistrationͲ 61165457530
Quarterly Wage Parity Certification forms due from LHCSAs and Fiscal Intermediaries who operate in NYC, Long Island and Westchester
June 1, 2019
https://www.health.ny.gov/health_care/medicaid/rede sign/2016/2016Ͳ02Ͳ17_wage_parity_alert.htm
Electronic Visit Verification (EVV) Public Listening Session in Rochester
June 5, 2019, 9 a.m. to noon
https://www.eventbrite.com/e/rochesterͲelectronicͲ visitͲverificationͲevvͲregionalͲlisteningͲsessionͲ registrationͲ61172828577
Lower Hudson Valley Health Emergency Preparedness Coalition (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
https://www.health.ny.gov/facilities/home_care/dal/d ocs/19Ͳ05.pdf
Western Region HEPC All Partners meeting
June 12, 2019, 8:30 a.m. to 4:30 p.m.
https://tinyurl.com/yyk5vr3q
Electronic Visit Verification (EVV) Public Listening Session on Long Island
June 17, 2019, 1 to 4 p.m.
https://www.eventbrite.com/e/longͲislandͲelectronicͲ visitͲverificationͲevvͲregionalͲlisteningͲsessionͲ registrationͲ61173247831
Fiscal Intermediary Workgroup meeting
June 18, 2019, 11 a.m. to 2 p.m.
akoski@hcanys.org
Electronic Visit Verification (EVV) Public Listening Session in New York City
June 18, 2019, 1 to 4 p.m.
https://www.eventbrite.com/e/nycͲelectronicͲvisitͲ verificationͲevvͲregionalͲlisteningͲsessionͲregistrationͲ 61173885739
Electronic Visit Verification (EVV) Public Listening Session in Lake Placid
June 27, 2019, 1 to 4 p.m.
https://www.eventbrite.com/e/lakeͲplacidͲelectronicͲ visitͲverificationͲevvͲregionalͲlisteningͲsessionͲ registrationͲ61174344110
Revised Home Health Change of Care Notice (HHCCN)
July 1, 2019
https://www.cms.gov/Medicare/MedicareͲGeneralͲ Information/BNI/HHCCN.html
Fiscal Intermediary Workgroup meeting
July 10, 2019, 11 a.m. to 2 p.m.
akoski@hcanys.org
Fiscal Intermediary Workgroup meeting
August 7, 2019, 11 a.m. to 2 p.m.
akoski@hcanys.org
Emergency Preparedness Coalition of Manhattan (EPCOM) meeting
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
The Situation Report: the Home Care Association of New York State
Volume 4, No. 20 May 20, 2019
Person-Centered Planning Training Announced The state Department of Health (DOH) has announced that registration is open for the Person-Centered Planning Comprehensive System Transformation Statewide Training Initiative. Information on available Learning Institutes and Regional Training sessions throughout the state is at https://www.cvent.com/c/calendar/a80427e7-4d30-4cfe-864b-a4080b07e48e. The focus of the trainings and institutes will be to grow person-centered thinking, planning, and practice capacity in Home and Community-Based Services (HCBS) systems in the state. Regional Trainings will consist of full- and half-day trainings, led by instructors certified in Person-Centered Planning/Plan Facilitation by The Learning Community for Person-Centered Practices (TLCPCP). Topics include:
Person-Centered Plan Development Person-Centered Plan Implementation Person-Centered Practice for Managers Person-Centered Thinking Train-the-Trainer
This training initiative is intended to support system transformation and best practices in HCBS-compliant person-centered planning throughout the state. The initiative is sponsored by DOH in partnership with Public Consulting Group, Inc. (PCG) and subject matter experts from the New York Alliance for Inclusion and Innovation, Support Development Associates (SDA), and the National Association of State Directors of Developmental Disabilities Services (NASDDDS). Questions about the initiative or the registration process can be sent to NYDOHPCPTraining@pcgus.com.
Health Resources
14
“Past as Prologue: Revised Histories and Extraordinary Trends in the New York City Economy,” by the New York City Independent Budget Office https://ibo.nyc.ny.us/iboreports/past-as-prologue-revised-histories-and-extraordinary-trends-in-thenew-york-city-economy-may-2019.pdf
“Medicare Part B Immunization Billing: Seasonal Influenza Virus, Pneumococcal, and Hepatitis B,” by the U.S. Centers for Medicare and Medicaid Services https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/MLNPublications-Items/ CMS1243321.html?DLPage=1&DLEntries=10&DLFilter=part%20b%20imm&DLSort=0&DLSortDir=ascending
“New York’s Medicare Accountable Care Organizations Improve Performance in Year 5 of the Medicare Shared Savings Program,” by the United Hospital Fund https://uhfnyc.org/media/filer_public/86/6b/866bb253-17e3-4c03-b37a-d0118e302c98/mssp-acos20190516.pdf Continued on next page
The Situation Report: the Home Care Association of New York State
Volume 4, No. 20 May 20, 2019
Continued from previous page
15
“Medicaid Demonstrations: Approvals of Major Changes Need Increased Transparency,” by the U.S. Government Accountability Office https://www.gao.gov/products/GAO-19315?utm_campaign=usgao_email&utm_content=daybook&utm_medium=email&utm_source=govdelivery
“Assessing the Out-of-pocket Affordability of Long-Term Services and Supports,” by the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services http://www.nasuad.org/sites/nasuad/files/ASPE%20Affordability%20Brief.pdf