FIDELIS SALE
HOSPICE
APPEALS
WAGE PARITY
HCA answers state AG’s call for comments on approval of FidelisCentene Acquisition, urging high standards, charitable funds.
In the wake of a major new report on palliative care, HCA Hospice and Palliative Care Forum outlines action steps.
CMS announces less restrictive thresholds to take advantage of a Medicare appeals settlement program for providers with a significant volume of pending appeals.
The deadline for providers to submit their quarterly wage parity certifications is fast approaching, on June 1.
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Your Source for HOME CARE News, Policy and Advocacy
Vol. 3, Issue 23 | May 29, 2018
COMING UP Webinar: Surveys Under the New CoPs May 31, 2018 11:30 a.m. to 1 p.m.
Senate to Advance HCA Home Care Partnership, Sepsis Bills
Virtual Integrated Care Management (ICM) Training
The state Senate is poised to advance two HCA bills this week and the state Assembly is following suit, moving forward on HCA bill introductions.
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.
The Senate Committee on Mental Health and Developmental Disabilities is scheduled to take up HCA’s legislation to promote mental health program collaboration with home care, and the Committee on Health is schedule to take up HCA’s legislation to support home care provider implementation of the HCA home care sepsis screening and intervention initiative.
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
Assembly following suit with HCA bill introductions
Sepsis S.8669, sponsored by Senator Kemp Hannon, chair of the Senate Health Committee, would create a new section in Article 36 of the public health law to formally engage state policy drivers and resources for home care sepsis screening, prevention, intervention, mitigation, cross-sector collaboration and public education. The legislation lays out a series of provisions that the Department of Health may undertake to promote these goals, such as support for providers’ ability to integrate the sepsis tool into their electronic health records, agency and clinician training, public education, health information exchange across continuum partners and cross-sector collaboration (such as through the Hospital-Homecare-Physician Collaboration program) to foster seamless, timely response to sepsis. See BILLS p. 2
INSIDE Senate to Advance HCA Home Care Partnership, Sepsis Bill................................1 HCA Urges High Standards, Charitable Funds in Centene Acquisition of Fidelis.....3 Value Based Payment Moving to Shared Savings/Shared Risk Phase...................4 HCA Hospice and Palliative Care Forum Explores Major Items.............................5 Implementation of Certain CFCO Services Delayed............................................7 CMS Expands Medicare Appeals Settlement Program........................................7 HCA Sepsis Tool Users: Join HCA, IPRO for June 4 Tech. Assistance, Q&A Call..........8
SCOTUS Rules on Class Action Waivers in Arbitration Agreements..................9 Clarification on CoP Requirement for Written Plans of Care.........................10 Quarterly Wage Parity Certifications Due June 1.........................................10 In Letter to CMS, HCA Opposes Medicaid Access Reporting Exemptions.........11 Medicaid Report: Spending Below Cap for Entire 2018 Fiscal Year..................12 CMS to Host HQRP Data Submission and Reporting Webinar........................12 DOH Issues Notice on Investigation into Lab Provider Results.....................13 Resources..........................................................................................................13
The Situation Report: the Home Care Association of New York State BILLS from p. 1 The HCA sepsis initiative not only leads New York State but the entire nation in engaging the home care community on sepsis intervention. Sepsis is the number one cause of hospital 30-day readmissions, the number one cause of avoidable hospitalization expenses for the overall Medicaid population in New York State, the number one cause of death in hospitals, a killer of U.S. citizens every two minutes, and the cause of a hospitalization every 20 seconds. HCA’s initiative is strongly supported at the state, national and foundation level, and has had the support of a New York State Health Foundation grant for statewide training and adoption of the HCA sepsis tool through our Stop Sepsis at Home campaign. (Please see http://www.stopsepsisathomeny.org/.) Mental Health-Home Care Collaboration S.8632, sponsored by Senator Ortt, chair of the Senate Mental Health Committee, builds on the partnering work that HCA and the state Office of Mental Health (OMH) have been conducting over the past year to develop and promote widespread collaboration of mental health and home care agencies for the “total” care and care management of patients. This particular bill amends the Geriatric Service Demonstration Program (currently under OMH) to include collaboration with home health for the purpose of coordination, integration and improved access of health and mental health services for individuals with co-occurring mental health and physical health needs. The legislation and aspiring new policy direction aims to better assist individuals to age-in-place in their homes and communities, avoid hospitalizations, promote better care transitions from hospital to home, and support quality of health and life for New Yorkers with mental health conditions. HCA members should call and write to Senator Hannon and Senator Ortt in support of this legislation! Do it today; do it right now! In your calls or e-mails, reference the bill numbers, thank the Senators for introduction and for advancing the bills for Committee vote, and urge their continued leadership to pass the bills. Senator Hannon’s e-mail address is hannon@nysenate.gov. Assemblyman Ortt’s e-mail is Ortt@nysenate.gov. Meanwhile, Assembly Committee on Aging Chair, Assemblywoman Donna Lupardo, has submitted two HCA workforce bills for Assembly introduction. HCA bill A.10818 would create a new rate add-on 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. Joanne Cunningham HCA President jcunningham@hcanys.org Roger L. Noyes Director of Communications, Editor of The Situation Report rnoyes@hcanys.org Al Cardillo Executive V ice President acardillo@hcanys.org Patrick Conole Vice President, Finance & Management pconole@hcanys.org Andrew Koski Vice President, Program, Policy & Services akoski@hcanys.org Laura Constable Senior Director, Membership & Operations lconstable@hcanys.org Celisia Street Director of Education cstreet@hcanys.org Mercedes Teague Finance Manager mteague@hcanys.org Jenny Kerbein Director of Governance & Graphic Design jkerbein@hcanys.org Billi Wilson Manager, Meetings & Events bwilson@hcanys.org Teresa Brown Administrative Assistant tbrown@hcanys.org
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targeted to workforce shortage areas and shortage disciplines. It authorizes pilot use of the funds for core worker supports like transportation, child care, education/training/professional development and other uses. The bill would provide these targeted funds to home care, hospice and Managed Long Term Care (MLTC). Senate Committee on Aging Chair Susan Serino introduced the Senate version of this bill, S.8687, further described in last week’s edition of The Situation Report. A second HCA workforce bill filed by Assemblywoman Lupardo contains two HCA proposals. One proposal creates and directs a competitive labor market study for health care, with the focus of determining policies and reimbursement levels for home care, hospice and MLTC to enable competitive recruitment and retention salaries and benefits. The other proposal establishes a joint interagency state taskforce to promote career interest, entry and value in home care and hospice occupations. As of the Memorial Day holiday, the bill number was not as yet available. This bill was also introduced by Senator Serino S.8559, and summarized further in last week’s edition of The Situation Report. Other proposals HCA continues to press for action on our other key legislative proposals which we have written and successfully introduced post-budget. These bills, previously summarized for members, include additional initiatives aimed at workforce support, nursing home benefit flexibility under MLTC, home care public health support, and others. These measures have been introduced in the Senate, and we await introduction of companion bills by Assembly sponsors with whom HCA has met. HCA’s health disparities bill was already introduced by the Assembly and is A.2925; the Senate version is S.8656, sponsored by Senator Hannon. As the Legislature returns this week for a three to four week period of intense legislative activity leading to the session’s conclusion, there is wide speculation that, this year, the end-of-session calendar may be truncated both in duration and/or number of bills taken up. The dynamics at play that could shorten session’s end include the election year for all statewide offices (Governor, Attorney General, Comptroller) and all 213 state Legislative offices, as well as major changes in the power structure of the state Senate involving the dissolution of the Independent Senate Democratic Conference and its merger with the Senate Minority Democratic Conference. The potential for a limited legislative period is all the more reason for HCA members to be vocal on bills and to be at the ready to act upon any HCA advocacy alerts. For further information, contact Al Cardillo at acardillo@hcanys.org.
HCA Urges High Standards, Charitable Funds in Centene Acquisition of Fidelis HCA took the opportunity to respond to a solicitation from the Office of the Attorney General (AG) seeking public comments on its approval of the Fidelis Care acquisition by Centene. In our comments, HCA urged the AG to focus on high and elevated standards in care and coverage. We also emphasized the necessary public purposes of charitable funds to be provided for under the transition. HCA stressed the significant consequences of the proposed Fidelis Care takeover for “the direct care of patients, as well as for the proper support and stability of health care providers across the continuum, including the many home care agencies that serve Fidelis enrollees throughout the entire state.” HCA
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underscored the needed and hoped-for elevation under Centene in Fidelis Care’s “capabilities in patient care, provider partnership and relations, adequacy and timeliness of service coverage and reimbursement, and operational and technological infrastructure in support of clinical integration, innovation and excellence in care.” HCA also spoke to the charitable purposes proposed through the transaction, which would include a dedicated Health Care Foundation funded at $200 million annually, with an opportunity to commit these funds to support home and community based services to needy New Yorkers. HCA noted that the fund stands to provide a “milestone opportunity, to assist with the vital health, home health and community service needs of New Yorkers currently unmet through either public or private health coverage funds alone.” HCA urged the Office of the Attorney General to consider these critical factors in acting on the CenteneFidelis transaction. HCA has had preliminary discussions with Centene representatives and looks forward to the opportunity to work together to help forge strong health care partnerships under the plan’s new corporate structure. For further information, contact Al Cardillo at acardillo@hcanys.org.
Value Based Payment Moving to Shared Savings/Shared Risk Phase This past week, the state’s Value Based Payment (VBP) Committee met to hear and provide feedback on the latest state Department of Health (DOH) plans and developments for VBP. Numerous elements were discussed in the marathon meeting. Three areas in particular are DOH’s plans to: 1) shift MLTC-home care VBP to more predominantly “shared risk/shared savings” arrangements by April 2019; 2) track VBP data sharing; and 3) move forward on pediatric VBP measures, incentives and risk. VBP Shared Savings/Shared Risk DOH offered a preliminary model with a minimum percentage risk/share savings for MLTC-home care for the next phase of VBP. DOH emphasized that the presentation of this model was to generate feedback from stakeholders, including alternative ideas and approaches we might offer. The proposal prompted much discussion, including the uncertain impact on VBP of the October 1 contracting limits for Licensed Home Care Services Agencies (LHCSAs) and Managed Long Term Care (MLTC) plans. HCA summarized VBP comments from our just-held discussions with HCA member MLTCs and home care agencies. HCA also cited our recent meetings with the Department and KPMG in which we were asked to present and identify MLTChome care VBP innovations as well as challenges. HCA offered ideas on how to further facilitate and support MLTC-VBP going forward. VBP Data Sharing DOH described survey results from the field indicating that VBP performance data was being received as needed and substantially shared with plans and providers. HCA underscored the wide concerns being relayed about data access, the sources and time periods of data being used by DOH for VBP benchmarking,
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and the general lack of real-time information needed for plans and providers to understand and work with performance targets. Pediatrics DOH walked through some of its pediatric performance measures and discussed potential directions for pediatrician VBP. This prompted concern about holding pediatricians to VBP risk when significant variables correlating to outcome are not in the pediatrician’s control. The Office of Mental Health and HCA both emphasized the value of collaborating partners in pediatrics, such as home care and community behavioral health providers, which are better positioned to address such variables. DOH in particular stressed the lack of improvement in asthma measures, which led HCA to once again emphasize the performance of home care agencies in dramatically reducing avoidable hospitalizations and emergency visits by asthma patients as an example of why DOH should be promoting pediatric collaboration under VBP. HCA again offered to provide DOH with examples of home care’s effectiveness in these areas. HCA also reminded DOH officials of the opportunities available under the hospital-homecarephysician collaboration Dear Administrator Letter (DAL) issued by DOH last December, with HCA’s contributions. On Thursday, DOH also offered a webinar directly for MLTC and home care stakeholders on the next phase of VBP. The webinar was recorded and is available at https://meetny.webex.com/meetny/ lsr.php?RCID=cf33d30cc41a4b338d6ad4a6ab2d8c8b. DOH invites MLTCs and providers to directly submit any questions or comments to MLTCVBP@health.ny.gov. HCA will continue to work with and provide assistance and informational programing to MLTC and home care agency members on VBP, as well as continue to reach out to DOH to recommend approaches that would help both the industry and the Department in achieving VBP goals. For further information, contact Al Cardillo at acardillo@hcanys.org.
HCA Hospice and Palliative Care Forum Explores Major Items HCA’s Hospice and Palliative Care Forum met this past week to explore major items and opportunity areas for the field in New York State, and nationally. The Forum has been prolific in its work, including having served as the genesis of the new landmark effort charged to the State Palliative Care Council to support palliative care education and training for clinicians in New York State, with the ultimate goal of increasing hospice and palliative care access and care throughout. This milestone report and the Forum’s input on its recommendations were a featured part of this week’s meeting. Forum member Cornelia Schimert, RN, BSN, VNA of Hudson Valley/Northwell At Home, presented the report’s findings and proposals to Forum participants. (Ms. Schimert is also HCA’s recommended appointment to the State Council.) Forum members choreographed a series of major actionable steps that
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HCA and the membership could undertake, in coordination with the State Council, the state Department of Health (DOH) and the state education and professional community. Representatives from DOH joined in this meeting to hear the comments, feedback and suggestions of the Forum. Other areas taken up at the Forum meeting included:
Recommendations reacting to DOH’s Certificate of Need (CON) workgroup proposals on hospice.
Developments on Advanced Care Planning/MOLST (Medical Orders for Life-Sustaining Treatments), with discussions led by IPRO and joined by the New York e-Health Collaborative to explore a potential path to help on integration of advanced directives with Regional Health Information Organizations (RHIOs), now called Qualified Entities, or QEs.
A discussion on the hospice federal payment rule and related federal developments led by Theresa Forster, Vice President for Hospice and Policy for the National Association for Home Care and Hospice. The discussion mapped out areas of Federal challenge, opportunity and advocacy strategy.
The meeting produced robust input and recommendations on all of the above areas, as well as on additional access, infrastructure and policy concerns and proposals. Meanwhile, a series of workforce proposals intended to benefit hospice, home care and MLTC were recently developed by HCA and introduced in the State Legislature. These proposals, summarized in last week’s edition of The Situation Report, seek to address core aspects of workforce recruitment, retention, compensation, market competition, pipeline/occupational development, and personal supports critical to hospice and home care staffing. The bills are introduced in the Senate by Senate Health Chair Kemp Hannon (S.8613) and Senate Committee on Aging Chair Susan Serino (S.8687 and S.8559). All HCA member hospices, providers and MLTC-PACE plans with palliative care programs are invited to be members of the HCA Hospice and Palliative Care Forum. Data, Data, Data In related news, HCA Vice President for Finance and Management Patrick Conole continues to build a series of important data worksheets for HCA members, including hospice and palliative care. The data base already includes cost report information available to HCA hospice members. The online data page requires a member account. To receive one, please contact HCA’s Communications Director Roger Noyes at rnoyes@hcanys.org. HCA always welcomes further recommendations for us to pursue new categories of data on hospice and palliative care that would be helpful to the HCA membership. For further information, contact Al Cardillo at acardillo@hcanys.org or Patrick Conole at pconole@hcanys.org.
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Implementation of Certain CFCO Services Delayed Last week, the state Department of Health (DOH) sent out a notice that that the full implementation of the Community First Choice Option (CFCO) Skill Acquisition, Maintenance and Enhancement service has been changed to January 1, 2019 (from July 1, 2018). DOH stated that this will permit additional time to ensure provider network capacity, access to services and system readiness. According to DOH, 1915c waivers are not impacted by this reschedule and waiver participants will continue to access these services without interruption. Effective April 1, 2018, managed long term care plans were responsible for identifying enrollees eligible for CFCO services and reporting this information to the state’s enrollment broker to facilitate identification on the individual’s enrollment file. Other CFCO services that are effective on January 1, 2019 include:
Assistive Technology beyond Durable Medical Equipment (DME) Community Transitional Services Moving Assistance Home Delivered/Congregate Meals Environmental Modifications Vehicle Modifications Social Transportation
HCA has been proposing streamlined and consolidated approaches for CFCO implementation focused on avoiding the administrative impacts that CFCO currently portends for Managed Long Term Care (MLTC) plans, Program of All-Inclusive Care for the Elderly (PACE) and Managed Care Organizations (MCOs), and capitalizing on the experience of some of the longstanding waivered service programs and providers that could directly assist here. Following HCA’s recent MLTC-PACE Forum member meetings last week, and our discussions with member plans regarding CFCO concerns and HCA ideas, HCA has re-upped its discussions of streamlining and relief with DOH. HCA will keep MLTC-PACE and provider members closely apprised of the developments.
CMS Expands Medicare Appeals Settlement Program The U.S. Centers for Medicare and Medicaid Services (CMS’s) Office of Medicare Hearings and Appeals (OMHA) said it is revising the criteria for its Settlement Conference Facilitation (SCF) program. The announcement was made during a Medicare Learning Network (MLN) webcast last week. As HCA has extensively reported, SCF is an alternative dispute resolution process that gives certain providers and suppliers an opportunity to resolve their eligible Part A and Part B appeals pending at the Administrative Law Judge (ALJ) level and the Medicare Appeals Council (Council). During the webcast, OMHA stated its intent to begin sometime in June 2018 the process of significantly reducing the number of appeals an appellant must have at the ALJ and/or Council to be eligible for SCF participation. OMHA is expanding the current SCF program to reach additional providers and suppliers. Continued on next page
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Continued from previous page Currently, the SCF addresses providers and suppliers with high volume and/or high billed amounts on appeals. Appellants must have 500 or greater appeals waiting at the ALJ/ Council or appeals that are at $9,000 or greater in billed amounts. The revised criteria would require that appellants have only 25 or more eligible appeals pending or, if less than 25 eligible appeals, then at least one appeal that has more than $9,000 in billed amounts. Because the current SCF program does not accommodate small providers, CMS began the Low Volume Appeals (LVA) initiative for settlements by providers and suppliers with fewer than 500 pending appeals and billed amounts less than $9,000 per appeal. The LVA program began in February, 2018 and is scheduled to end June 8, 2018. The most notable difference between the LVA and SCF programs, outside of the eligibility criteria, is the settlement process. The SCF is a negotiated settlement between CMS and the appellant using a conference facilitator. The LVA settlement is a set 62 percent of the net Medicare approved amount on the appeals. It is unknown whether CMS intends to allow the LVA program to expire as scheduled and require all provider and suppliers to work through the SCF process for eligible appeals. OMHA will be updating the SCF website soon to reflect the settlement expansion. An audio recording and a transcript of the webcast will be available in the coming weeks; meanwhile HCA members interested in additional information can access the slide presentation reviewed during the webcast at: https:// tinyurl.com/y745n3wp.
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HCA Sepsis Tool Users: Join HCA & IPRO for June 4 Technical Assistance, Q&A Call Users of the HCA sepsis tool are invited to a June 4 call (10:30 a.m. to noon) with IPRO and HCA to provide technical assistance and answer your questions on your use of the tool thus far or your plans to operationalize the tool. Please RSVP 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. This call is for organizations that have signed our user agreement, which is a condition for using HCA’s sepsis tool. If you have not done so, it’s easy. Just download the user agreement from our Stop Sepsis at Home campaign website, in the tools and resource section at http://stopsepsisathomeny.org/ tools-and-resources. You can send the signed user agreement back to HCA at sepsistool@hcanys.org. You can also use this e-mail address to request the user agreement or additional information. If your organization has attended any of our Stop Sepsis at Home statewide training sessions and signed the user agreement, please join us for this June 4 call with your questions, comments, experiences, suggestions, best practices, challenges and support needs. HCA’s Stop Sepsis at Home initiative is supported by a grant from the New York Health Foundation and in partnership with the Rory Staunton Foundation for Sepsis Prevention, Sepsis Alliance, IPRO and leading medical and clinical professionals.
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U.S. Supreme Court Rules Class Action Waivers in Employment Arbitration Agreements are Enforceable A divided U.S. Supreme Court ruled last week that class and collective action waivers in employee arbitration agreements do not violate the National Labor Relations Act (NLRA) and must be enforced in accordance with the Federal Arbitration Act (FAA). Media and legal sources indicate that the court’s ruling resolves the federal circuit court “split” on whether class or collective action waivers in employee arbitration agreements violate the NLRA. As such, the Supreme Court reversed the recent decision of the N.Y.S. Appellate Division, First Department, in Gold v. New York life Insurance Co., which held that employee arbitration agreements are unenforceable to the extent they waive an employee’s right to assert claims against the employer on a collective or class action basis. (HCA previously reported on the Gold decision in the August 21, 2017 edition of The Situation Report.) Importantly, this ruling does not affect the rights of unionized employees, as their collective bargaining rights entitle them to collective representation. Rather, the ruling addresses the lawfulness and enforceability of a class or collective action waiver in an arbitration agreement between an employer and a non-unionized employee. Arbitration agreements between employers and employees have been enforced for many decades pursuant to the FAA, a federal law enacted in 1925. It provides that agreements to arbitrate are enforceable unless there are grounds at law or in equity for the revocation of the agreement. In 2013, however, the National Labor Relations Board (NLRB) ruled that employers violate the NLRA when they require in an agreement that their employees submit employment claims to an individual arbitration. The NLRA, the NLRB found, protects an employee’s right to act concertedly, a right that cannot be bargained away in an agreement, and that such a conclusion did not conflict with the FAA. Some federal circuit courts agreed with the NLRB’s ruling, while others rejected it – leading to an eventual “split” in the circuits. In the so-called “24 hour/live-in” cases that made their way to the state Appellate Division (previously reported on in a number of issues of The Situation Report), there were questions concerning the appropriateness of class certification of the plaintiffs. Those cases, however, did not involve arbitration agreements in which the plaintiffs agreed to waive their right to assert collective or class action claims. As a result, it does not appear that the U.S. Supreme Court ruling will have any bearing on those cases. The U.S. Supreme Court issued its decision in three consolidated cases: Epic Systems Corp. v. Lewis; Ernst & Young LLP et al. v. Morris et al.; and National Labor Relations Board v Murphy Oil USA, Inc., et al. This ruling provides important clarity around the enforceability of employment agreements that require employees to submit their workplace claims to arbitration on an individual basis. With that in mind, home care agencies should consult with their legal counsel on the potential use of employee arbitration agreements with their non-unionized employees.
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Clarification on CoP Requirement for Written Plans of Care HCA, the National Association for Home Care and Hospice (NAHC), and others have queried the U.S. Centers for Medicare and Medicaid Services (CMS) for clarification on federal requirements regarding whether written plans of care (POCs) must be provided to patients. Questions about this specific requirement – which is part of the expanded home health Conditions of Participation (CoPs) – were raised by members at HCA’s Annual Conference earlier this month during an open Q&A session with the HCA Policy staff. Additional questions have arisen from members in response to an announcement by the Joint Commission, on May 2, stating that it “will no longer score deemed home health organizations that fail to give their patients a written plan of care,” effective April 30. Indeed, CMS emphasized in its January 13, 2017 Federal Register posting on the final CoPs that “in light of the many logistical and burden-related concerns raised by commenters, we have revised the regulation at 484.50(c) to remove the requirement that home health agencies must routinely provide a copy of the plan of care to each patient.” When the rules were finalized, HCA reached out to a technical adviser in CMS’s Clinical Standards Group for clarification on the multiple sections in question. Beyond the removal of requirements at 484.50(c), as outlined above, the CMS official delineated the issue as follows: Section 484.60(e) requires HHAs to provide each patient with certain written information and, “by contrast,” 484.60(a) spells out requirements for the plan of care. “We do not believe that the written information described in 484.60(e) is at all equivalent to the plan of care described at 484.60(a),” the official wrote. For reference, section 484.60(e) requires the home health agency to provide the patient and the caregiver with written information on the visit schedule; patient medication schedule/instructions; treatments to be administered by home health agency personnel; any other instruction related to the patient’s care and treatments that the agency will provide; and the name and contact information of the agency’s clinical manager. Providers should pay close attention to these various interrelated sections of the CoPs which outline distinct requirements regarding what must be included in the POC, on the one hand, and what must be included in the written information to patients, on the other hand.
Quarterly Wage Parity Certifications Due June 1 The next round of state-required Wage Parity certification forms is due June 1, 2018 for Licensed Home Care Services Agencies (LHCSAs) and other entities, including Fiscal Intermediaries (FIs), that contract with Managed Care Organizations (MCOs), Certified Home Health Agencies (CHHAs) and/or Long Term Home Health Care Programs (LTHHCPs) serving 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
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due June 1, 2018 covers the period June 1, 2018 through August 31, 2018 and is sent to the MCO, CHHA and/or LTHHCP, not the state Department of Health (DOH). The 2018 certification forms and required wage parity levels for 2018 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, 2018 through August 31, 2018 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.
In Letter to CMS, HCA Opposes Thresholds Exempting States from Having to Submit Monitoring Plans that Examine Medicaid Access HCA last week submitted comments to the U.S. Centers for Medicare and Medicaid Services (CMS) urging CMS to maintain its existing requirement for states, like New York, to submit an access monitoring review plan that holds states accountable on Medicaid access to care. Under a rule known as the “equal access provision,” states are required to set Medicaid fee-for-service (FFS) rates to ensure access to services for Medicaid beneficiaries at a comparable level to non-Medicaid FFS-insured individuals. To hold states accountable for keeping competitive rates, CMS in 2015 began requiring states to submit an access monitoring review plan (or AMRP) every three years when rate changes occur (among other factors) to fee-for-service entities like Certified Home Health Agencies (CHHAs) and other FFS providers. A new CMS proposal, however, would exempt states like New York from this critical reporting requirement on its fee-for-service program if Medicaid rate cuts were less than four percent for one year, or less than six percent for two years, or if 85 percent of beneficiaries are covered by a managed care organization. In the letter, HCA challenges CMS’s assertion that rate cuts of four percent (or six percent over two years) are “nominal,” especially “given the accumulation of reductions in past years that magnify the financial impact of even slight proposed cuts, coupled with regulatory, enrollment, contracting, labor and other state policy impacts that do not necessarily classify as cuts but would nevertheless result in more CHHAs experiencing operating losses, some CHHAs closing, and threatening access to skilled home health services throughout the state.” At 78 percent Medicaid managed care enrollment, New York State is very close to reaching the 85 percent managed care threshold that would exempt New York from submitting an access monitoring plan. “The FFS and managed care payment systems do not exist in silos,” HCA writes. “All of these services exist in Medicaid and, therefore, warrant monitoring by states and CMS for assuring access regardless of managed care volume.” The full letter to CMS is posted on our website at https://hca-nys.org/wp-content/uploads/2018/05/ HCACommentsCMSMedicaidFFSAccesstoCare052118.pdf.
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Volume 3, No. 22 May 29, 2018
Medicaid Cap Report: Overall Spending Below Cap for Entire 2018 Fiscal Year The state Department of Health’s latest Medicaid Global Spending Cap Report (dated March 2018) this time covers the entire 2018 fiscal year (as opposed to segments of the fiscal year), reporting that spending was $6 million below the targeted $19.5 billion cap. Total expenditures for the fiscal year were $19.522 billion. The state’s fiscal year runs from April 1 to March 31. Of the provider and managed care expenditures, however, most sectors exceeded their individual caps, according to the report, with DOH crediting most of the underspending to “Medicaid Administrative Costs,” the “OHIP Budget/State Operations” and the “All Other” categories. The only provider or managed care sector that fell below the cap, according to the report, was mainstream managed care (at $29 million below its cap). As with all other provider or managed care categories, the category “other long term care” (which includes home care, but also other long term care sectors) and managed long term care both exceeded the cap, by $46 million and $137 million respectively. For both categories, DOH cited higher enrollment as a cause. The Department continues to lump home care into “other long term care,” so it is not clear exactly how home care providers performed as an isolated category, but the report does indicate that there were 4,430 more personal care recipients than anticipated. Overall Medicaid enrollment reached 6,164,818 recipients, a net increase of 49,165 enrollees over the fiscal year. The full report is at: https://www.health.ny.gov/health_care/medicaid/regulations/ global_cap/monthly/sfy_2017-2018/docs/mar_2018_report.pdf.
CMS to Host Hospice Quality Reporting Program Data Submission and Reporting Webinar The U.S. Centers for Medicare and Medicaid Services (CMS) will host a Hospice Quality Reporting Program and Data Submission and Reporting webinar on Wednesday, May 30 from 2 to 3:30 p.m. During the webinar, hospice providers can learn about reports available through the Hospice Quality Reporting Program and how to access the information. The webinar focuses on how to navigate the Certification and Survey Provider Enhanced Reports (CASPER) system, including a live demonstration, an introduction of the Hospice Item Set and Consumer Assessment of Healthcare Providers and Systems (CAHPS) Provider Preview Reports, and a brief review of information available in previously released reports. Registration is at https://secure.confertel.net/tsRegisterD.asp?course=6962809.
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The Situation Report: the Home Care Association of New York State
Volume 3, No. 22 May 29, 2018
DOH Issues Notice on Investigation into Reliability of Glucose, Potassium Results by Lab Provider The state Department of Health (DOH) has posted a notice to home care agencies, medical directors and other provider representatives on the Health Commerce System (HCS) regarding an investigation into the reliability of a laboratory service provider’s glucose and potassium test results that could affect HCA members. The notice (at https://hca-nys.org/wp-content/uploads/2018/05/ctrlaccamstmpNotification_24466.pdf) states the following: On 5/22/2018 the New York State Department of Health (Department) issued an Order for Summary Action against a laboratory service provider, Modern Diagnostic Laboratory Inc. due to findings of an investigation by the Wadsworth Center’s Clinical Laboratory Evaluation Program. The investigation determined that glucose and potassium test results were not reliable and in some instances falsely reported. Today (5/23/2018), the Department issued an Amended Order for Summary Action against MDL. The Amended Order enables MDL to resume providing services under existing contracts. The Amended Order requires that MDL meet certain requirements, including but not limited to, the immediate employment of an independent consultant who will be approved by the Department, and the cessation of any inappropriate testing and reporting practices. For providers seeking to contract with an alternative laboratory, a list of other approved laboratories can be found at the following link: https://www.wadsworth.org/regulatory/clep/ approved-labs.
No other information is available at this time regarding actions that providers should take for lab services affected by these findings.
Resources
“Deaths from Falls Among Persons Aged 65 Years or Over – United States, 2007–2016,” by the Centers for Disease Control and Prevention http://nasuad.org/sites/nasuad/files/mm6718a1-H.pdf
“Estimating the Economic Burden Related to Older Adult Falls by State,” by the Centers for Disease Control and Prevention http://nasuad.org/sites/nasuad/files/Estimating_the_Economic_Burden_Related_to_Older.99483.pdf
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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