RURAL HEALTH RFA
FLU MASK
SEPSIS
TRAINING RESOURCES
Nearly $5 million in funds available for rural health networks. Questions due May 23, and applications due June 28.
Commissioner declares flu is no longer “prevalent,” ending flu mask requirement for the season.
In the next installment of our “Stop Sepsis at Home” initiative, HCA to hold a June 4 Q&A and technical assistance call for existing and prospective users of the HCA screening tool.
DOH posts resources on advanced home health aides; home care registry; criminal history record checks; aide training program operation guides; and more.
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Your Source for HOME CARE News, Policy and Advocacy
Vol. 3, Issue 21 | May 21, 2018
COMING UP Webinar: Surveys Under the New CoPs May 31, 2018 11:30 a.m. to 1 p.m. Virtual Integrated Care Management (ICM) Training WEBEX Training Dates June 5: 1-3 p.m. June 12: 1-3 p.m. June 19: 1-3 p.m. June 26: 1-3 p.m. Driving Decisions with Data: A Seminar for Clinical Managers June 6, 2018 Albany Registration for these and other HCA programs are on our Education and Events page at: https://hca-nys.org/ events-education/ upcoming-events
CMS Issues Guidance on EVV Requirement for Pre-Payment Validation Requirement, beginning in 2019 for personal care and 2023 for home health, is separate but similar to state VO requirement applicable to organizations with $15 million or more in Medicaid revenues Last week, the U.S. Centers for Medicare and Medicaid Services (CMS) released an Informational Bulletin and frequently asked questions (FAQs) document covering the Electronic Visit Verification (EVV) requirements specified in the 21st Century CURES Act. This initiative is separate and distinct from a similar requirement in New York State for verification organizations (VOs) to use EVV for pre-claim review, applicable to home health aide and personal care aide services by organizations with more than $15 million in Medicaid revenues. See EVV p. 4
New FAQs on Requirement for Provider Enrollment in Medicaid, or Else Face July 1 Termination of Managed Care Contracts The state has posted new Frequently Asked Questions, including some asked by HCA, on the requirement that all providers who contract with managed care plans must enroll in Medicaid and obtain a Medicaid provider number. The FAQs are at https://www.emedny.org/info/ProviderEnrollment/ManagedCareNetwork/ FAQs.aspx?new=true. See ENROLLMENT p. 2
INSIDE CMS Issues Guidance on EVV Requirement...........................................................1 New FAQs on Requirement for Provider Enrollment in Medicaid.............................1 Rural Health Network Development Program RFA Released..................................3 A Message from HCA Sponsor RBC Limited............................................................3 Understand LHCSA Contract, Licensing, Moratorium Changes at 6/13 HCA Program.....5 Flu Mask Requirement No Longer In Effect for Current Season................................6 New FAQs Posted on Medicare Cards....................................................................6 ICM Improves Outcomes, Can Flourish at Your Organization With June Training......7 Statewide Technical Assistance and Q&A Call for Sepsis Tool Users on June 4.......8 HCA MLTC/PACE Members Convene on Program, Advocacy Initiatives....................8 Home Care Training Materials Posted............................................................9
Avoid “Data Waste,” Invest in Clinician Data Actions during June 6 Seminar...10 State Medical Society and HCA Advance Collaboration Plans...........................10 HCA Participates in Capital District HEPC Meeting..........................................11 U.S. DOL Posts Regulatory Agenda that Includes Emergency Preparedness.....12 OIG Posts Updated Work Plan........................................................................12 Workers’ Compensation Changes.................................................................13 MLTC Nursing Home Members to Receive Letters w/ Corrected Benefit Info.....13 Hospice Compare Quarterly Refresh Available...............................................13 PHHPC Review Committee Meets, Advances Applications..............................14 Upcoming Deadlines.....................................................................................15 NGS Offices Closed on May 28 for Memorial Day..............................................16 Resources...............................................................................................................................16
The Situation Report: the Home Care Association of New York State ENROLLMENT from p. 1 Some of the new questions cover:
How this requirement applies to Consumer Directed Personal Assistance Programs (CDPAP). The FAQs indicate that CDPAP providers need to enroll. CDPAP Fiscal Intermediaries “are only managed care, so you would check the Managed Care only box as they are not a billing service provider,” the FAQs state.
Which enrollment application a Licensed Home Care Services Agency should complete if it wants to be a billing provider or a managed care only (non-billing) provider, including how to complete the applications if the LHCSA only bills managed care plans but intends to bill a county sometime in the future.
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
Availability of pending provider list at https:// www.emedny.org/info/ProviderEnrollment/ ManagedCareNetwork/index.aspx.
Al Cardillo Executive V ice President acardillo@hcanys.org
Template notices that DOH will be providing to managed care organizations for providers and members, along with timeframes for notice distribution.
Patrick Conole Vice President, Finance & Management pconole@hcanys.org
Whether plans may execute single case agreements with providers not currently enrolled with Medicaid fee-for-service (yes they can, the FAQs state, “until further guidance from DOH”).
The fact that enrollment applies to managed long term care (MLTC) plans, but not Programs of All-Inclusive Care for the Elderly (PACE) or Fully Integrated Duals Advantage (FIDA). Non-traditional managed care providers under the Community First Choice Option (CFCO) program will not have to enroll, given that the services implemented on April 1, 2018 are already in place in both MLTC and Medicaid Mainstream Managed Care plans.
As communicated to members, those who don’t currently have a Medicaid provider number will face termination of their managed care contracts by July 1 if they do not apply for and receive one. DOH will be reissuing a survey to managed care plans to determine how many of their contracted providers have not enrolled in Medicaid.
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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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. 21 May 21, 2018
Rural Health Network Development Program RFA Released The state Department of Health has posted a request for applications (RFA) for the Rural Health Network Development Program (RHNDP). It is at https://hca-nys.org/wp-content/uploads/2018/05/Rural-Health-Network-Development-Program_RFP_May-2018.pdf. Questions are due May 23; questions, answers and updates will be posted about May 30; and applications are due June 28. The objectives of the RHNDP are to strengthen cooperation and coordination of rural health services, increase community involvement, support the development “and continued vitality” of comprehensive and cost-effective rural health care systems, promote the financial viability of rural health providers, increase access and the number of health care personnel trained to practice in rural communities, strengthen accountability of local providers, and foster improvements in the economic position of the local community. Approximately $4,980,000 in state funding is available annually for up to five years to support the formation and operation of rural health networks. DOH anticipates awarding approximately 30 contracts, each for a five-year term from January 1, 2019 through December 31, 2023. Applicants should propose to use the funding to address the unique health care challenges of their communities in the context of health care delivery system reform and the focus on patient value and population health.
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The Situation Report: the Home Care Association of New York State
EVV from p. 1 The FAQs provide responses to an array of critical questions received from states since the passage of the CURES Act, including clarification on the specific types of personal care and home health services that must utilize EVV systems for pre-payment validation of services rendered.
The CURES Act does not require states to capture each location as the individual is moving throughout the community. Services either starting or stopping in the individual’s home are subject to EVV requirements; capturing the location in which the service is started and stopped is sufficient for meeting the minimum requirements specified in the CURES Act.
CMS encourages states to select EVV systems that facilitate accommodation of self-directed models by ensuring flexibilities such as fluid scheduling modifications, choice of worker, engagement in community activities, and proper interaction with Financial Management Services (FMS) entities, which are known as Fiscal Intermediaries in New York State.
While CMS does not have the authority to provide an enhanced federal funds match for administrative costs for providers or managed care organizations, provider costs associated with the purchase of the EVV devices and/or equipment could be built into the rate paid to the provider for the rendering of services.
The Bulletin and FAQs, along with webinar materials, are available at https://www.medicaid.gov/medicaid/ hcbs/guidance/electronic-visit-verification/ index.html. The CURES Act requires that states implement an EVV system for personal care services by January 1, 2019 and for home health services by January 1, 2023. Personal care services include any personal care provided to individuals in Medicaid fee-forservice (and Medicaid managed care); consumer directed services; and personal care provided in Nursing Home Transition and Diversion (NHTD), Traumatic Brain Injury (TBI), or any other waiver program. The EVV systems must verify the: type of services provided; individual receiving the service; date of the service; location of service delivery; individual providing the service; and time the service begins and ends. According to CMS’s FAQs:
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EVV requirements don’t apply to personal care services provided in congregate residential settings, nor to services under the Program of All-Inclusive Care for the Elderly (PACE).
Home health services are defined to include nursing services, home health aide services, as well as medical supplies, equipment, and appliances. At the state’s option, the benefit may also include physical therapy, occupational therapy, and speech pathology and audiology services. HCA is verifying with CMS that EVV would thus apply to nursing and therapy services in addition to home health aide and personal care aide services.
HCA has already met with the state Department of Health to discuss EVV implementation and plans to meet again soon to advocate on behalf of providers and consumers and discuss the state’s approach to implementing the federal requirements. New York State already requires some home care providers to utilize a
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Volume 3, No. 21 May 21, 2018
verification organization (VO) to perform a pre-claim review. This applies to organizations with more than $15 million in Medicaid revenues (fee-for-service and managed care). 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. In New York, the VO must verify the home health service(s) within the claim or encounter, collected from the electronic visit verification (EVV), prior to submission of the claim or encounter to the Department of Health (DOH) or to a managed care provider. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
LHCSA Contract Limits, Licensing Changes, Moratorium & More In-Depth at 6/13 HCA Program in NYC What: A Primer on the New LHCSA Regulatory Changes When: June 13, 2018 (9:30 a.m. to noon) Where: NYC Who: Presented by Meghan McNamara, Principal, Hinman Straub How: Register at https://hca-nys.org/wp-content/uploads/2018/05/HCA-Bootcamp-New-LHCSA-Reg-ChangesJune-13-2018-1.pdf. Among all home care changes in the new State Budget, LHCSAs are subject to the biggest overhaul in their current and future ability to serve patients and to enter the home care marketplace. These changes constitute a fundamental reconfiguration of longstanding marketplace dynamics as well as licensure and certificate-of-need standards that providers need to get a handle on. On June 13, HCA is holding the next installment of our popular Bootcamp series to help you understand these complex issues, including the new: multi-tiered limits on the number of LHCSAs that can contract with MLTC plans; two-year moratorium on the processing and approval of LHCSA applications; exceptions to the moratorium for certain transfers or changes of LHCSA ownership; and more. Still other LHCSA changes are also on the horizon for discussion, including a new registration process and limits on provider marketing. This session is for LHCSAs, MLTC plans or other entities that contract with LHCSAs. It will help you unpack the intricacies of these new requirements to support your long-term business and strategic planning as a LHCSA or in partnership with LHCSAs. Presenter Meghan K. McNamara, Esq., is a member of Hinman Straub’s Health Law Department representing health care and behavioral health providers in all facets of regulatory representation including certificate-ofneed applications, licensure applications, responses to solicitations of interest and other regulatory compliance issues.
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Flu Mask Requirement No Longer In Effect for Current Season Commissioner reminds public, providers that season is not over yet, and individuals should still take precautions State Health Commissioner Dr. Howard Zucker’s office has circulated an advisory announcing that influenza is no longer prevalent in New York State, thus no longer requiring a flu mask for unvaccinated health care staff this season. The advisory can be read at https://hca-nys.org/wp-content/uploads/2018/05/ ctrlaccamstmpNotification_24444.pdf. Under the flu mask requirement, individuals not vaccinated against influenza must wear a surgical or procedure mask while in areas where patients or residents may be present during a period of the flu season when influenza is “prevalent,” as determined by a declaration of the Health Commissioner. Dr. Zucker declared flu to be prevalent on December 13, 2017, which is when the flu mask requirement went into effect for the current season. This requirement has been in regulation since the 2013-14 season. According to the Commissioner’s office, flu activity in the state peaked during the week ending February 17, 2018, when there were more than 18,252 laboratory-confirmed cases in one week. Those numbers have since fallen to 457 in the week ending May 12, 2018. The number of flu cases has decreased across the state for 11 out of the last 12 weeks. As of May 12, 2018, 128,020 laboratory-confirmed cases of influenza have been reported and 23,317 people have been reported as hospitalized with influenza in New York this season. There have been six pediatric influenza-associated deaths this flu season. 20,704 children under the age of five have been diagnosed with lab-confirmed influenza and 1,543 have been reported as hospitalized. Frequently Asked Questions about the flu mask regulation and other resources are available at http:// health.ny.gov/FluMaskReg. For more information, please e-mail FluMaskReg@health.ny.gov.
New FAQs Posted on Medicare Cards The U.S. Centers for Medicare and Medicaid Services (CMS) has published an updated version of its frequently asked questions (FAQs) regarding the New Medicare Card rollout and the Medicare Beneficiary Identifier (MBI) that is replacing the Social Security Number-based Health Insurance Claim Number (HICN). The questions pertain to all Medicare providers and discuss crossover, claim submission, eligibility checks and more. The FAQs are at https://www.cms.gov/Medicare/New-Medicare-Card/NMC-FAQs-5-18.pdf. Additional resources on the new cards are at https://www.cms.gov/medicare/new-medicare-card/nmc-home.html. CMS has also clarified that the Medicare Administrative Contractor (MAC) portal MBI look-up tool will only return an MBI if the new Medicare card has been mailed; this is intended to avoid potential confusion that would result from an MBI being used before the beneficiary receives his or her new Medicare card/MBI.
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Integrated Care Management Improves Outcomes, Can Flourish at Your Organization With ICM Train-the-trainer Program in June CEUs, ICM certification, convenient webinar format and train-the-trainer design all offer dividends for your investment in staff training through the renowned Sutter Center What: ICM Train-the-Trainer and Certification When: Various dates for live webinars (June 5, 12, 19 and 26) and additional dates for self-directed modules How: https://hca-nys.org/wp-content/uploads/2018/04/HCA-ICM-Training-Registration.pdf Research shows that integrated care management, or ICM, better engages patients suffering from chronic disease while statistically improving their outcomes. In one study, 24.6 percent of patients receiving a team-based integrated approach followed their diabetes protocols, with only 19.5 percent of traditional care patients doing so. Self-care plans were implemented 48 percent of the time in team-based versus just 8.6 percent of the time in traditional settings. Emergency room visits and hospital readmission rates were also significantly lower. Based on these outcomes, and others, ICM is the kind of tool that your agency must nurture in an environment demanding new patient engagement and clinical requirements (i.e., the expanded Conditions of Participation, or CoPs, for home health), Value Based Care, and other partnership models. The Sutter Center for Integrated Care is renowned for its ICM training, which includes certification for trainees in ICM principles. HCA is bringing this training to you in a convenient four-part live webinar and self-directed webinar program format. For a minimal time commitment, your agency’s clinicians will get 12 CEUs, ICM training certification, and the tools to train the rest of your clinicians on evidence-based ICM principles. Because this program teaches ICM principles as well as how to train others in these principles, each single investment of staff participation in Sutter’s train-the-trainer format is designed to extend learning competencies and practices team-wide at your organization. In addition to modules on heart failure, diabetes, COPD and depression, this program will provide an overview of chronic care and patient engagement best practices, including Wagner’s Care Model, health care policy research findings on the Integrated Care Model, insights on motivational interviewing and health coaching, interventions for patients with low health literacy and patient education best practices, an overview of care-transitions best-practices, the pivotal role of the integrated care manager in the future health care environment, tips and takeaways for hard-wiring ICM best practice, and more. This is a singular opportunity to train your staff, bring evidence-based models to your entire clinical approach and see powerful outcomes.
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Volume 3, No. 21 May 21, 2018
Statewide Technical Assistance, Q&A Call for Sepsis Tool Users on June 4 Sepsis faculty leaders from IPRO and HCA will be conducting a statewide technical assistance and Q&A call for all users of the HCA sepsis tool. The call-in is scheduled for Monday, June 4. It will begin at 10:30 a.m. and run until noon. Faculty will include clinical and program representatives from IPRO and HCA. All HCA Sepsis users, including those who have filed sepsis use agreements (and are using the tool), as well as those who have filed and are in process of implementation, are encouraged to participate in this call. Call in with your questions, comments, experiences, suggestions, best practices, challenges and support needs. Please register using the online link at https://www.surveymonkey.com/r/June4sepsiscall. Dial-in information will be sent to you in advance of the call using the e-mail address submitted with your registration. If your agency has not yet filed a user-agreement for the HCA sepsis tool, you can do so by downloading the document on our resources page at http://stopsepsisathomeny.org/tools-and-resources or by e-mailing us at sepsistool@hcanys.org. Meanwhile, HCA continues working diligently with IPRO, the Rory Staunton Foundation for Sepsis Prevention, the national Sepsis Alliance, the state hospital association (HANYS), the state Department of Health, and additional partners across the continuum on sepsis. This includes our work on an all-partner, statewide sepsis summit (for home care, hospitals, physicians, EMS, managed care, and additional key sectors and state and national health officials and sepsis leaders) planned for early fall. The HCA sepsis initiative continues to be featured across sectors in New York State and across the country. Legislation was also just introduced by Senate Health Committee Chairman Kemp Hannon, S.8669 and S.8620, to support this tool and effort. HCA’s work also continues to be supported through the New York State Health Foundation, which awarded HCA a grant to promote statewide training and adoption of HCA’s sepsis tool by all home care providers in New York. For further information, please contact Al Cardillo at acardillo@hcanys.org.
HCA MLTC/PACE Members Convene on Program, Advocacy Initiatives HCA met this past week with MLTC/PACE members in forums conducted both upstate and downstate to discuss program developments, issues and initiatives. Among the areas taken up were: implementation and timing issues surrounding the myriad MLTC actions taken in the budget, including LHCSA contracting limits, the carve-out of permanent nursing home resident services, and administrative rate changes; new rate calculations, questions and concerns surrounding the methodology by Deloitt, New York’s contractor; program issues with Value Based Payments, forthcoming
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Advanced Home Health Aide (AHHA) implementation and the need to synchronize the AHHA regulations with MLTC operations; options for streamlining/easing the implementation of the Community First Choice Option; new CMS directions with in-home care and Medicare Advantage; HCA proposals on MLTC-home care regulatory streamlining; and a slate of HCA legislative proposals for MLTC, home care and hospice in play in these final weeks of the state Legislative Session. The discussions yielded invaluable planning and strategy for MLTC/PACE and home care advocacy on all of the above. HCA will be further surveying MLTC/PACE members for input, and we will also be working with the state Department of Health, the Legislature and others in our follow-up. Stay tuned for an important announcement soon from HCA with regard to a new initiative we are launching with MLTC/PACE members, LHCSAs, CHHAs and state officials that grew from discussions in the HCA Nurse Advisory Committee. HCA thanks our MLTC/PACE Forum Co-Chairs and Board Members June Castle of Nascentia Health and Marianne Grady of Empire Blue Cross Blue Shield, as well as all of the participating plan members and our New York City hosts at VNSNY, for these productive and invaluable input meetings. For further information, please contact a member of the HCA Policy Team.
Home Care Training Materials Posted The state Department of Health (DOH) has posted materials on various topics important to home care providers. These include webinar recordings and materials covering advanced home health aides; criminal history record checks; the home care worker registry; home care curriculum; home health aide training program matrix; guide to operation of a home health aide training program; health commerce system; and the Licensed Home Care Services Agency (LHCSA) Statistical Report. The materials are at https://commerce.health.state.ny.us/public/hcs_login.html. You can access them as follows:
Click on “My Content” on the top tool bar; Go to “Documents by Group”; Click on “View all Document Groups”; Go to “Long Term Care”; Click on “Training”; and Go to “Home Care”
Note that the Home Health Aide folder is on the top half of the page.
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Avoid “Data Waste,” Invest in Clinician Data Actions during June 6 Seminar Put your clinicians in the driver’s seat to analyze – and act on – data for clinical outcomes “A data scientist may have the technical and scientific skills, but often lacks the specific subject matter expertise needed to develop a clinically practical/useful data project,” writes Virginia Long, a predictive analytics scientist in an opinion piece for Information Management (see https://healthitanalytics.com/ news/integrated-care-delivery-may-bring-better-outcomes-lower-costs). “The inverse is true for a clinician,” she adds, citing an MIT study which finds that the unnecessary wall between data analysis and clinician talent results in “data waste” and “a slow uptake of innovation that might otherwise improve patient outcomes.” HCA’s June 6 seminar on Driving Decisions with Data seeks to address this gap by putting the power of data analysis in the hands of clinician managers and their teams. Register today at https://hca-nys.org/wpcontent/uploads/2018/03/Driving-Decisions-with-Data-Seminar-June-6-2018.pdf. Your organization may not have a statistician or data scientist on staff; but you do have clinician experts whose work is directly affected by this kind of analysis. They are also best equipped to act on data findings because they understand its usefulness for your day-to-day clinical operations, for meeting the home health Conditions of Participation (CoPs) and fulfilling value based care metrics. 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 home health Conditions of Participation (CoPs) for Quality Assurance and Performance Improvement (QAPI) projects.
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
State Medical Society and HCA Advance Collaboration Plans HCA, Executive staff of the Medical Society of the State of New York (MSSNY) and new MSSNY Long Term Care Committee Chair Dr. Jay Slotkin, MD, started meetings this week on next and new rounds of collaboration between the state associations and memberships. MSSNY’s Long Term Care Committee (HCA Executive Vice President Al Cardillo is a participant) met this week under its new chair, Dr. Slotkin, and new MSSNY President Dr. Thomas Madejski, MD. The Committee outlined its goals and priorities for the coming year, including collaborative areas with HCA, and between physicians and home care agencies. Continued on next page
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Continued from previous page MSSNY and HCA conducted a Physician-Home Care engagement task force that worked closely together last year on a host of issues, especially on regulatory and procedural areas, and most particularly on state and federal streamlining of the face-to-face (F2F) documentation rules for Medicare and Medicaid services. Our mutual work led to direct collaboration with the state Department of Health on a lean approach to state Medicaid F2F implementation and on national advocacy for federal F2F changes that included the support of the American Medical Association. In the next several weeks, HCA and MSSNY will confer on specific new initiatives for the joint task force (comprised of MSSNY physicians and HCA provider and MLTC board members), as well as working together on current high profile items in health and long term care, including such items as hospital-at-home, community paramedicine, telehealth, sepsis, palliative care, and regulatory/procedural streamlining. HCA expresses appreciation for the continued collaborative work with MSSNY under its new leadership, and we greatly thank and salute long time MSSNY Long Term Care chair Dr. Evelyn P. Dooley-Seidman, MD, for her staunch support and work with HCA. For further information, please contact Al Cardillo at acardillo@hanys.org.
HCA Participates in Capital District HEPC Meeting Last week, HCA participated in the Capital District Health Emergency Planning Coalition (HEPC) Sub Regional meeting in East Greenbush. HEPCs are coalitions of health care providers, local and state emergency management and local public health preparedness officials that develop and coordinate emergency preparedness across the continuum, including readiness among individual health sectors, holding exercises and ‘hotwashes,’ conducting hazard and vulnerability assessments, and other important activities. The May 15 Capital District HEPC meeting included discussions on a Point of Dispensing (POD) exercise held on April 3; the potential role of HEPCs in “Mass Gatherings” (activities that involve 5,000 or more people, such as a concert, Hall of Fame Induction, etc.); regional training events; and updates by individual HEPC participants. At the meeting, HCA stressed the importance of involving home care and hospice agencies in POD and other exercises and preparedness activities. HCA has been encouraging home care and hospice providers to get involved in their local HEPCs – which are excellent resources for building internal emergency preparedness planning and for meeting state and federal requirements. Some home care provider representatives participated at the May 15 meeting, and HCA encourages others to attend the next meeting in the fall. Under a grant from the state Department of Health Office of Emergency Preparedness, HCA and the New York State Association of Health Care Providers (HCP) work with all home care and hospice providers to support their roles in emergency preparedness.
Continued on next page
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Continued from previous page Those interested in participating in their local HEPC should contact Andrew Koski at akoski@hcanys.org. A list of upcoming HEPC meetings follows. HEPC Lower Hudson Valley Long Island Western New York Sub Regional Central New York Bronx Emergency Preparedness Coalition Finger Lakes Sub Regional Emergency Preparedness Coalition of Manhattan
MEETING DATE June 6 June 7 June 14 June 14 June 14 June 18 August 15
U.S. DOL Posts Regulatory Agenda that Includes Emergency Preparedness The U.S. Department of Labor (US DOL) has posted its Regulatory Agenda which includes a total of twenty regulatory entries for specific actions by the Occupational Safety and Health Administration (OSHA). In this year’s regulatory agenda, there are nine regulatory actions in the pre-rule stage, including Emergency Response and Preparedness. It states: OSHA currently regulates aspects of emergency response and preparedness; some of these standards were promulgated decades ago, and none were designed as comprehensive emergency response standards. Consequently, they do not address the full range of hazards or concerns currently facing emergency responders, nor do they reflect major changes in performance specifications for protective clothing and equipment. The Agency acknowledged that current OSHA standards also do not reflect all the major developments in safety and health practices that have already been accepted by the emergency response community and incorporated into industry consensus standards. OSHA is considering updating these standards with information gathered through a Request for Information (RFI) and public meetings. More information is at https://www.reginfo.gov/public/do/eAgendaViewRule?pubId=201804&RIN=1218AC91&operation=OPERATION_PRINT_RULE. HCA will inform members when U.S. DOL issues any proposed rules on emergency response and preparedness.
OIG Posts Updated Work Plan The federal Office of Inspector General has posted its monthly Work Plan update. It is at https://oig.hhs.gov/reports-and-publications/workplan/index.asp. Two topics of interest are:
2017 Hurricane Emergency Preparedness and Response Efforts: OIG will review HHS’s oversight of programs and funds expended for recovery and response efforts related to Hurricanes Harvey, Irma, and Maria in 2017. Continued on next page
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Continued from previous page
Examining Healthcare Coalitions’ Partnerships With Non-Hospital-Based Facilities in Community Preparedness Efforts: OIG will examine the extent to which Healthcare Coalitions (HCCs) ensure “a successful whole community response” by integrating non-hospital-based facilities into their emergency preparedness activities and technological strategies. HCCs are groups of public and private health care organizations, emergency preparedness planners, responders, and other types of health officials in specified jurisdictions (see story on page 11 about the Capital District Health Emergency Preparedness Coalition).
Workers’ Compensation Changes The Workers’ Compensation Board has revised certain forms to accommodate new Permanent Impairment Guidelines for Scheduled Loss of Use Evaluations that were effective January 1, 2018. The 2018 Guidelines clarify how to evaluate permanent impairment when maximum medical improvement is reached. This includes measuring active ranges of motion and comparing them to contralateral body parts where applicable. To support the new Guidelines, the Board has revised the Doctor’s Report of MMI/Permanent Impairment (Form C-4.3) and Independent Medical Examination Reports. More information is at http://www.wcb.ny.gov/content/main/SubjectNos/sn046_1067.jsp.
MLTC Nursing Home Members to Receive Letters with Corrected Benefit Info New York Medicaid Choice/Maximum, the state’s Enrollment Broker, will be sending letters to managed long term care (MLTC) plan members who were sent incorrect information about changes in the MLTC nursing home benefit. These changes were part of the final state budget. The letters, dated May 23, will be sent out in batches over this week. Subject to approval by the U.S. Centers for Medicare and Medicaid Services (CMS), mandated MLTC enrollment will end for newly identified, permanently placed dual-eligible individuals in nursing homes. Those consumers will stay in fee-for-service (FFS) Medicaid. With CMS approval, those individuals who were permanently placed in a nursing home in April 2018 will be disenrolled to FFS beginning July 2018.
Hospice Compare Quarterly Refresh Available The May 2018 quarterly Hospice Compare refresh of quality data is now available. It is based on Hospice Item Set (HIS) quality measure results from data collected during the third quarter of 2016 and second quarter of 2017 and Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey results reported from the third quarter of 2015 through the second quarter of 2017. Continued on next page
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The Situation Report: the Home Care Association of New York State
Volume 3, No. 21 May 21, 2018
Continued from previous page CMS encourages hospice providers to visit Hospice Compare (https://www.medicare.gov/ hospicecompare/) to view their data. Additional information can be found at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Hospice-QualityReporting/Public-Reporting-Background-and-Announcements.html.
PHHPC Committee on Establishment and Project Review Meets, Advances Applications to Full PHHPC The Public Health and Health Planning Council (PHHPC) Establishment and Project Review Committee met on May 17 and acted on several applications. The agenda and supporting documents are at https://www.health.ny.gov/facilities/ public_health_and_health_planning_council/meetings/2018-05-17/. The Committee approved and sent to the full PHHPC for its consideration applications by:
One hospice to merge with another hospice;
An existing Certified Home Health Agency (CHHA) to purchase another CHHA;
A CHHA for a transfer of ownership; and
Five entities to establish a Licensed Home Care Services Agency (LHCSA) with an Assisted Living Program.
The Committee deferred the application by an existing CHHA for a 3-year extension to its limited life operating certification until certain financial information is submitted. In addition, the Committee deferred two CHHA applications due to lack of a quorum – one for a change in indirect ownership and another for a not-for-profit corporation to become the sole corporate member of an existing CHHA. Those applications will be considered at a special Establishment and Project Review Committee meeting to be held prior to the fall PHHPC meeting on June 7. These were the first LHCSA applications considered since the release of guidance (see last week’s edition of The Situation Report) on the recently imposed two-year moratorium, with limited exceptions, on the processing and approval of new LHCSA applications. Among the exceptions are applications for licensure of a LHCSA that is submitted with an application for an Assisted Living Program (ALP). On June 13, HCA is holding a special Bootcamp program to explain all of the new LHCSA changes implemented in this year’s state budget, including the moratorium on new licenses, contracting limits with Managed Long Term Care (MLTC) plans and more. (See related p. 5 story.) The full Council will meet on June 7 and that meeting can be attended in person or watched by webcast at https://www.health.ny.gov/events/webcasts/.
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Volume 3, No. 21 May 21, 2018
The Situation Report: the Home Care Association of New York State
Upcoming Deadlines 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/ManagedCareNet work/index.aspx
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/NewͲMedicareͲCard/index.html
Submission of Expression of Interest for the Medicare Low Volume Appeals Initiative
Due April 12 to June 8
https://www.cms.gov/Medicare/AppealsͲandͲ Grievances/OrgMedFFSAppeals/AppealsͲSettlementͲInitiatives/LowͲ VolumeͲAppealsͲInitiative.html
Changes in appeals system for Medicaid managed care enrollees
May 1, 2018
https://www.health.ny.gov/health_care/managed_care/plans/appeals /index.htm
Long Term Care Planning Council Survey
Due June 18, 2018
https://www.surveymonkey.com/r/HM9DM97
Health Workforce Retraining Program RFA
Due June 22, 2018
https://www.health.ny.gov/funding/rfa/17842/index.htm
Rural Health Network Development Program RFA
Due June 28, 2018
https://hcaͲnys.org/wpͲcontent/uploads/2018/05/RuralͲHealthͲ NetworkͲDevelopmentͲProgramͲ_RFP_MayͲ2018.pdf
Managed care organizations will initiate termination of contracted providers who have not enrolled in Medicaid
July 1, 2018
https://www.emedny.org/info/ProviderEnrollment/ManagedCareNet work/index.aspx
OSHA 2017 Form 300A form (A Summary of WorkͲRelated Injuries and Illnesses)
Due July 1, 2018
https://www.osha.gov/injuryreporting/index.html.
Hearing on state Department of Labor’s proposed rule to exclude meals and sleep time for all employees
July 11, 2018
www.labor.ny.gov
Certified Home Health Agency 2017 Cost Report
Due July 16, 2018; HCA is seeking an extension
https://commerce.health.state.ny.us/public/hcs_login.html
Personal Care Provider 2017 Cost Report
New Due Date: July 30, 2018
https://commerce.health.state.ny.us/public/hcs_login.html
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The Situation Report: the Home Care Association of New York State
Volume 3, No. 21 May 21, 2018
NGS Offices Closed on May 28, Memorial Day National Government Services (NGS) will be closed on Monday, May 28. This includes the: Electronic Data Interchange (EDI) Help Desk; Provider Contact Center; Provider Enrollment Line; and Telephone Reopening Unit. Electronic claim files transmitted after 5 p.m. on Friday, May 25, 2018 will have a claim receipt date of Tuesday, May 29, 2018. EDI front-end acknowledgement transactions will be created as expected as EDI claim files are received. The FISS/DDE Provider Online System will be available on Friday, during regular hours. While DDE will be available, there will be no support available to respond to any issues. However, providers can access NGSConnex or use NGS’s Interactive Voice Response (IVR) system at 1866-275-3033. NGS’s offices will reopen on Tuesday, May 29 for normal business hours. For further information, contact Patrick Conole at (518) 810-0661 orpconole@hcanys.org.
Resources
“Using Telehealth to Improve Home-Based Care for Older Adults and Family Caregivers,” by the AARP Public Policy Institute https://www.aarp.org/content/dam/aarp/ppi/2018/05/using-telehealth-to-improve-home-basedcare-for-older-adults-and-family-caregivers.pdf
“State Telehealth Laws and Reimbursement Policies Report,” by the Center for Connected Health Policy https://tinyurl.com/yabqyruq
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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