COST REPORTS
RURAL HEALTH
EVV
LAWTALK
HCA gains extensions on 2018 CHHA, Personal Care cost reports, raises concerns about timing, as final 2018 rates not yet finalized. (DOH says initial rates will remain unchanged).
At Assembly hearing on rural health, HCA urges action on rate add-ons, market analysis, cross-training, health IT integration and other proposals.
First state Listening Session on EVV provides background, hears concerns about continuity of care and timely implementation.
The latest installment of our LawTalk series examines requirements for non-discrimination notices to current and prospective patients.
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UPCOMING PROGRAMS PDGM Coding Essentials
Your Source for HOME CARE News, Policy and Advocacy
Vol. 4, Issue 22| June 3, 2019
NY Legislative Session Enters Final Month: Rate/ Benchmarking, In-Service Bills Compel HCA Member Advocacy
June 12 (Schenectady, NY)
Take part now at Legislative Action Center
PDGM Bootcamp For Clinical Managers and Quality Staff
During this final month of the state legislative calendar, activity at the state Capitol has reached a fevered pitch, with late-night adjournments, legislative staff working all hours on bill preparations, and near-daily scheduled workweeks of session.
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
There are 11 scheduled days of session left to go until adjournment on June 19, not counting the many hours of off-the-floor work in each chamber. See SESSION p. 3
HCA Enlists Workgroup of Providers, Leading Academics to Shape Pioneering New Virtual Home Care Research ‘Incubator’ HCA-led project seeks to connect researchers with providers on mutual interests, resource sharing through web-based platform After months of internal strategic planning, HCA took a major step forward this week on an exciting new project to elevate – and make vital connections – in the home care research space. This pioneering new project, dubbed the HCA Virtual Research Incubator (VRI), involves the future development of a web-based platform that academics and home care providers would use to connect with one another on research projects of mutual benefit. See INCUBATOR p. 2
INSIDE NY Legislative Session Enters Final Month.........................................................1 HCA Enlists Providers, Academics on Research ‘Incubator’.................................1 DOH Posts 2018 CHHA, Personal Care Cost Report Software…............................4 HCA Testifies at Assembly Hearing on Rural Health Challenges...........................5 Hiring Announcement…....................................................................................5 Message from HCA Sponsor TSG Financial….......................................................5
State Hosts Listening Session on EVV..................................................................6 CMS Releases Final PACE Rule…..........................................................................7 CMS to Host Special June 12 Open Door Forum on Hospice Assessment Tool........8 ‘Conflict of Interest’ Information Posted for NHTD/TBI…......................................9 Emergency Preparedness Update….................................................................10 LawTalk: ACA Non-Discrimination Notice and Tagline Obligations…..................11 Updates to Disability Benefits Claim Forms…...................................................12
The Situation Report: the Home Care Association of New York State INCUBATOR from p. 1 Researchers would gain ready access to de-identified provider data, expertise and operational models for potential research projects. And, over the long term, such research projects would support home care provider business practices and drive betterinformed policymaking. The idea arose from an identified need: a dearth of academic research examining the home care sector (and, as a result, informing policy), as well as the logistical barriers that currently exist for academics when they do want to pursue research in this field. The VRI project – overseen by HCA’s Director of Program Research, Development and Policy Lauren Ford – has been the subject of internal planning, HCA Board discussions, and initial feeler outreach to academic institutions on technical and procedural design work, including the enlistment of two interns from the economics and MBA programs at Union College, Marc Perlman and Sahil Khullar. They’ve played a pivotal role in helping to model the VRI: what it might look like; potential development challenges; sources of seed money; and how the VRI would be structured and managed. As a next step, HCA held an inaugural workgroup meeting last week with over 30 HCA member providers, health care academic research experts, and other potential stakeholders at the State University at Albany. The meeting yielded several excellent recommendations on: how to scale and grow the project; how to achieve buy-in by best meeting the mutual interests of providers and researchers; other models or services that are similar in design or methods as the VRI proposal; the role of Institutional Review Boards (IRB); identifying specific disciplines that would be interested in home care-related research; data sourcing and challenges; and other issues. HCA thanks the University at Albany’s School of Social Welfare for hosting our first workgroup meeting – one of several academic departments and institutions keenly interested in the project and eager to play an active role. We also thank the many experts who volunteered their time to help shape the discussion. To learn more or to review the background materials, please contact Ms. Ford at lford@hcanys.org. HCA will provide updates as this exciting initiative takes further shape. Home Care Association of New York State (HCA) 388 Broadway, 4th Floor, Albany, NY 12207 Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org
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The Situation Report is a weekly publication of the Home Care Association of New York State (HCA). Unless otherwise noted, all articles appearing in The Situation Report are the property of the Home Care Association of New York State. Reuse of any content within this newsletter requires permission from HCA. Al Cardillo President and CEO acardillo@hcanys.org Roger L. Noyes Director of Communications, Editor of The Situation Report rnoyes@hcanys.org Rebecca Fuller Gray Executive V ice President for Clinical and Program Affairs rgray@hcanys.org Patrick Conole Vice President, Finance & Management pconole@hcanys.org Andrew Koski Vice President, Program, Policy & Services akoski@hcanys.org Alyssa Lovelace Director for Policy and Advocacy alovelace@hcanys.org Lauren Ford Director of Program Research, Development and Policy lford@hcanys.org Laura Constable Senior Director, Membership & Operations lconstable@hcanys.org Celisia Street Director of Education cstreet@hcanys.org Mercedes Teague Finance Manager mteague@hcanys.org Jenny Kerbein Director of Governance & Graphic Design jkerbein@hcanys.org Billi Wilson Manager, Meetings & Events bwilson@hcanys.org Teresa Brown Administrative Assistant tbrown@hcanys.org
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SESSION from p. 1 Here’s where things stand – and what you can do this week to support HCA’s advocacy agenda. Rate Update and Benchmarking HCA’s top priority is rate stability and a benchmark for home care, as embodied in A.7798/S.5915. We’ve summarized this bill extensively for the membership, and we again urge your advocacy by using HCA’s Legislative Action Center campaign (https://p2a.co/2yqd7OO) to help expand the number of bill cosponsors in both houses. This measure is fiscal in nature. As such – even with a cost-savings offset promised by other home care legislation – the bill needs as much support as possible to overcome what may otherwise be a fiscal litmus test, especially with so many other end-of-session agenda items competing for action. Please act today to help build a base of support for rate adequacy in home care. In-Service Bill Passes Senate, Assembly Action Needed The Senate last week passed the HCA-developed home care in-service training bill (S.5605). HCA is working to get this bill passed in the Assembly as well (A.7854). As strongly recommended by HCA members, this measure supports compliance with in-service training regulations by requiring trainers to submit to the existing Home Care Registry a record of each in-service training and the hours completed by workers toward the fulfillment of annual in-service training requirements. It gives home care employers an efficient and reliable source for determining whether a new hire has fulfilled these requirements, eliminating the administrative burden of tracking down this information from a prior employer. It also avoids unnecessary duplication of administrative and oversight efforts when an aide works for more than one agency at a time. HCA has brought together all of these key arguments for you in a new message on our Legislative Action Center at https://p2a.co/0dhM5uO. Please send this message to the Assembly today. Other measures These are just a few of the measures that HCA has advanced this legislative session, with many more updates to come. Please see our chart of priority bills at https://tinyurl.com/yyxet48h and be ready for advocacy alerts as new measures get positioned for action, compelling grassroots advocacy. May Edition of the Capitol Report Please also see HCA’s may edition of the Capitol Report newsletter, which was circulated to the Legislature and HCA members last week, for further updates on our legislative advocacy efforts (https:// tinyurl.com/yxk2gooj). In addition to bills, this month’s report features HCA’s recent award winners and the work of two providers on sepsis screening and telemedicine protocols to triage patients, avoiding ER use. The purpose of this report is to not only highlight legislative goals and positions, but also show the many innovations happening in the field, reaching legislators on different registers of advocacy, information flow, education and awareness.
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DOH Posts 2018 CHHA, Personal Care Cost Report Software DOH extends submission deadlines after discussion with HCA The state Department of Health (DOH) has posted the 2018 Medicaid cost report software for non-hospital based Certified Home Health Agencies (CHHAs) and non-New York City (NYC) personal care providers. Cost report software for both provider types are on the Health Commerce System (HCS) at https://commerce.health.state.ny.us. Below each respective Dear Administrator Letter (DAL) in the cost report sections of the HCS are “Submission Guidelines” and “Electronic Certification Access Instructions.” For non-hospital-based CHHAs, the cost report and certifications are now due by July 29, 2019. For personal care providers, the due date is now August 27, 2019. After DOH originally set a July 16 due date for both reports, HCA reminded the Department of its policy to give CHHAs at least 60 days to complete the reports. We also noted that Title 18 Section 505.14 of the regulations give personal care providers 90 days to do so. This prompted the deadline changes noted above. The personal care DAL also clarifies that Part 1 of the General Reimbursement information should only include revenue from the Worker Recruitment and Retention add-on, not any monies from the Fair Labor Standards Act or any other reimbursement. HCA also expressed serious concerns about these reports being disseminated before DOH issues the 2018 final (or hotline) Medicaid rates. DOH maintained that the 2018 initial rates would remain unchanged – with the exception of approximately five personal care providers that submitted rate appeals. HCA also told DOH that we will continue pursuing DOH adjustments to the 2018 and 2019 Episodic Payment System (EPS) for New York City CHHAs to account for increases in minimum wage. DOH indicated a willingness to work with us on these updates but did not believe the matter warranted a delay in issuing the 2018 CHHA cost report software. Both DALs include information on how to certify your cost report electronically. (The CPA and agency signatory must each have an HCS account.) The Department has also been developing a new cost report for the 2019 reporting year. DOH says it will be communicating the new cost report requirements and process to both CHHAs and personal care providers through a series of trainings over the summer. Specific questions on the personal care cost reports should be directed to DOH’s Robert Yankowski at (518) 473-4606 or at PersonalCare-Rates@health.ny.gov. CHHAs with questions should contact Lindsey Chapman or Jada Eberle in DOH’s Bureau of Residential Health Care Reimbursement at CHHA-Rates@health.ny.gov. HCA will continue to press the Department on the importance of the CHHA EPS minimum wage adjustments and will update the membership when any new information becomes available.
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HCA Testifies, Provides Recommendations to Leverage Home Care as Asset to Rural Health Challenges HCA President Al Cardillo on Friday testified at the state Assembly Health Committee’s public hearing on rural health initiatives and the challenges that rural communities face in health care delivery and financing.
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Director of Patient Services Opportunity We are looking for an experienced nursing Director of Patient Services to provide nursing leadership for a growing, thriving Joint Commission accredited licensed home care agency in Brooklyn, New York. This full time position requires a self-driven, experienced and committed RN to provide hands-on support, guidance and day-to-day management for the nursing staff. Passionate about patient care, and committed to organizational expansion goals and professional excellence. Strong people skills and a good understanding of community relationships are a must. Interested candidates may forward resumes to rbc@netstep.net.
The panel heard from many providers, associations, advocates and stakeholders about a range of concerns, including emergency and nonemergency transportation, workforce recruitment and retention, and rate adequacy. HCA’s remarks focused on home care’s specific needs in rural areas and how best to position home care as an asset for rural populations. Many of our recommendations are included in pending legislation, referenced throughout HCA’s testimony. Addressing the issue of severe rural health workforce challenges, Mr. Cardillo called for a new rate adjustment in home care, hospice and managed long term care, targeted to workforce shortage disciplines and geographic areas for purposes of personnel support. HCA is currently working to shepherd legislation aimed at this goal (A.6768), requesting that the sponsor, Assembly Member Harry Bronson, advance it through committee. Mr. Cardillo also urged the Legislature to: pass legislation prompting a competitive labor
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market analysis for home care and hospice (A.6902/Bronson); establish a state-interagency initiative to promote value and interest in home care and hospice occupations (also in A.6902); promote cross-training collaboratives; establish tracking of aides’ annual in-service training (see related p. 1 story); and promote rate stabilization to enable staff compensation and workforce adequacy (see also p. 1 story). He stressed that advanced interoperability and connectivity of clinical information would also better integrate health care services. Mr. Cardillo also highlighted numerous other HCA proposals to costeffectively benefit individual, public health and population health in rural areas. Watch an archive of the hearing at https://nyassembly.gov/av/hearings/. For questions or concerns regarding HCA’s testimony, please contact Alyssa Lovelace at alovelace@hcanys.org.
State Hosts Listening Session on Electronic Visit Verification CMS provides further guidance on EVV ‘good-faith effort’ exemptions HCA attended the first of six Regional Listening Sessions on electronic visit verification (EVV) in Albany last week. As part of the 21st Century Cures Act, all state Medicaid programs are required to implement an EVV system for personal care and home health, or else receive a reduction in federal Medicaid funding. EVV may include multiple point-of-care verification technologies – such as telephonic, mobile, and web-based verification inputs – to verify the occurrence of service visits for purposes of service and billing integrity. The state Department of Health (DOH) has scheduled these Listening Sessions through June to provide an opportunity for input on EVV design and implementation from beneficiaries, family caregivers, providers, workers, advocates and other interested parties. In Albany’s session, participants received an update on EVV requirements. They also actively engaged in a back-and-forth dialogue with state DOH representatives on such issues as continuity of care and a timely implementation process. (HCA will share the state’s PowerPoint presentation once it is made available.) In response to advocates’ requests, DOH has since scheduled a webinar version of the Listening Session for those who cannot attend in person. This webinar will be on June 24 from 1 to 4 p.m. Registration is at: https://www.health.ny.gov/health_care/medicaid/redesign/evv/index.htm. EVV is required for personal care by January 1, 2020, and for all home health care by January 1, 2023. States can seek a one-year extension, as long as they demonstrate “good-faith” efforts to implement EVV by the deadlines but faced unavoidable delays. The U.S. Centers for Medicare and Medicaid Services (CMS) recently provided further guidance on this option (https://www.medicaid.gov/medicaid/hcbs/downloads/guidance/evv-gfe-update-pcs.pdf). CMS will accept requests for good-faith exemptions beginning July 1, 2019, and strongly encourages all requests be made by November 30, 2019. Continued on next page
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Continued from previous page It is our understanding that DOH will be making such a request. CMS says it will announce its determination in response to a state’s request within 30 days. If the request is not approvable, CMS will give reasons why and will offer to schedule a conference call with the state. The state will then have the opportunity to revise and resubmit its request. To learn more about EVV, visit https://www.health.ny.gov/health_care/medicaid/redesign/evv/index.htm. For real time updates from the state’s EVV initiative, sign up for the EVV listserv by e-mailing listserv@listserv.health.state.ny.us. Please make sure to include the following in your e-mail request: SUBSCRIBE EVV-L YourFirstName YourLastName. For questions or concerns related to EVV, please contact Andrew Koski (akoski@hcanys.org) or Alyssa Lovelace (alovelace@hcanys.org).
CMS Releases Final PACE Rule Last week, the U.S. Centers for Medicare and Medicaid Services (CMS) released a final rule for the Programs of All-Inclusive Care for the Elderly (PACE) which, according to CMS, “removes redundancies and eliminates outdated information” allowing “clinicians and other care providers to focus more of their time on patients and less time on paperwork.” A fact sheet on the rule is at https://www.cms.gov/newsroom/fact-sheets/programs-all-inclusive-careelderly-pace-final-rule-cms-4168-f; the rule is at https://www.govinfo.gov/content/pkg/FR-2019-06-03/pdf/ 2019-11087.pdf. HCA is reviewing the 200-plus-page rule and, so far, we have identified the following provisions that are important to PACE. The rule:
Makes the PACE organizations’ interdisciplinary teams (IDT) more flexible, including allowing one individual to fill two different roles on the team if that person has the appropriate licenses and qualifications for both roles, and permitting the primary care provider (required for each IDT) to include nurse practitioners, physician assistants and community-based physicians.
Removes the requirement that members of the interdisciplinary team primarily serve PACE participants.
Mandates all personnel that have direct participant contact must have a minimum of one year of experience working with a frail or elderly population; or adds that if the individual has less than one year of experience, he or she must receive appropriate training upon hire.
Allows PACE to use remote technology to conduct unscheduled assessments in some situations when a participant makes a request to initiate, eliminate or continue a particular service. Continued on next page
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Continued from previous page
Requires plan of care to be developed within 30 days of the date of participant’s enrollment (instead of “promptly”).
Requires PACE organizations to adopt a compliance oversight program so they can promptly respond to, investigate and correct potential non-compliance, and fraud, waste and abuse.
Reduces the number of on-site visits to PACE organizations, after a three-year trial period for new organizations, by using a risk assessment to choose which programs will be audited.
Implements changes related to PACE enforcement actions, including sanctions and civil monetary penalties, to strengthen accountability measures.
Increases transparency and simplifies the regulations for PACE organizations – “changes that will help clarify enrollment policies and requirements for quality improvement.”
Bars PACE employment of individuals with a conviction for criminal offences relating to physical, sexual or drug or alcohol abuse or use if their contact with patients would pose a potential risk.
Clarifies that PACE organizations offering qualified prescription drug coverage must comply with Medicare Part D prescription drug program requirements unless the requirement has been waived.
CMS had originally proposed changes to PACE in August 2016 and HCA had submitted comments in October 2016. Notably, the aforementioned bullets on interdisciplinary teams and one-year experience requirements were supported by HCA, and we will be looking to learn if any other HCA recommendations were adopted. PACE is a managed care program for the frail elderly who are assessed as needing a nursing-home-level of care, most of whom are dually-eligible for Medicare and Medicaid. It includes, as core services, the provision of adult day health care and IDT care management, through which access to and allocation of all health services are managed. Physician, therapeutic, ancillary, and social support services are furnished in the participant’s residence or on-site at a PACE center. Hospital, nursing home, home health, and other specialized services are generally furnished under contract. In New York State, there are 5,804 individuals enrolled in PACE (May), while more than 45,000 are enrolled in PACE nationwide.
CMS to Host Special June 12 Open Door Forum on Hospice Assessment Tool The U.S. Centers for Medicare and Medicaid Services’ (CMS) Center for Clinical Standards and Quality (CCSQ) will host a Special Open Door Forum (ODF) on the development of a Hospice Assessment Tool. It will take place on Wednesday, June 12, 2019 from 2 to 3 p.m. as a conference call only. This forum is part of a series that CMS plans to host on this tool and other key topics related to the Hospice Quality Reporting Program. Continued on next page
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Continued from previous page The purpose of a hospice assessment tool is to understand the care needs of people through the dying process and to ensure the safety and comfort of individuals enrolled in hospice institutions nationwide. The call-in and conference identification number is:
Participant Dial-In No.: 1-800-837-1935
Conference ID No.: 9490006
Additional information on the hospice assessment tool can be found at: https://www.cms.gov/Medicare/ Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/HEART.html.
‘Conflict of Interest’ Information Posted for NHTD/TBI The state Department of Health (DOH) has posted information on conflict of interest (COI) provisions that affect the provision of Nursing Home Transition & Diversion and Traumatic Brain Injury (TBI) services. A PowerPoint presentation is at https://www.health.ny.gov/health_care/medicaid/redesign/mrt90/2019/ 2019-05-14_coi_models.htm. It was discussed at a May 14 meeting held to review options put forth by consumers, providers, DOH and the U.S. Centers for Medicare and Medicaid Services (CMS) on the path and next steps for COI compliance. Under the COI requirement, providers of home and community based services (HCBS) for the individual – or those who have an interest in or are employed by a provider of HCBS for the individual – must not provide case management or develop the person-centered service plan, except when the state demonstrates that the only willing and qualified entity to provide case management and/or develop person-centered service plans in a geographic area also provides HCBS. In these cases, states must devise COI protections, including separation of entity and provider functions within provider entities, which must be approved by CMS. Some of the options discussed on May 14 included:
Allowing providers to continue to provide multiple services, but not to provide service coordination and other direct waiver services to the same individual.
Allowing a plan development agency to develop the initial, revised, and addenda to service plan while a service broker identifies providers for the individual that are conflict-free, ready and willing.
Utilizing a statewide organization to provide service coordination only.
Utilizing a “passive parent” model whereby an entity with its own governing structure appoints and oversees the boards of related affiliate agencies without assuming financial control.
COI requirements need to be in place for NHTD and TBI programs no later than January 1, 2021. CMS anticipated a June 1 date for DOH to present its final model for review. New York needs to establish
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Continued from previous page transition steps by April 13, 2020 and begin implementation activities by June 1, 2020 in order to operate under a new service model by the January 1, 2021 deadline. Additional information on COI is at https://www.health.ny.gov/health_care/medicaid/redesign/mrt90/policy_docs.htm. Questions and/or comments can be sent to waivertransition@health.ny.gov.
Emergency Preparedness Update Last week, HCA met with representatives of the state Department of Health (DOH) Office of Health Emergency Preparedness (OHEP) and the Office of Primary Care and Health Systems Management (OPCHSM) as part of a monthly meeting with the state’s home care and hospice associations – HCA, the New York State Association of Health Care Providers and the Hospice and Palliative Care Association of New York State. HCA and the other associations receive funding to work with all home care and hospice providers to support their roles in emergency preparedness. The meeting discussed the upcoming home care and hospice emergency response drill being held from June 11 to June 13, and some of the new contract year deliverables, including enhancing integration of home care agencies into regional emergency preparedness activities via existing Health Emergency Preparedness Coalitions (HEPCs); recent Coalition Surge Test/Interoperable Communications/Medical Countermeasures (CST/IOC/MCM) exercises; and preparedness workshops that DOH will hold for the associations. June 11 to June 13 Drill As extensively reported to HCA members, DOH will hold a required (for home care and hospice agencies) emergency response drill starting on June 11 and ending on June 13. Agency contacts in the Health Commerce System (HCS) Communications Directory will be notified about the drill, so providers should ensure their contact information is updated. Home care and hospice providers will be expected to complete four forms over the three-day period; more information is at https://www.health.ny.gov/facilities/home_care/dal/docs/19-05.pdf. CST/IOC/MCM Exercises HCA discussed challenges with CST exercises that were held earlier this year outside of New York City, including the lack of referrals to home care agencies by hospitals that had to decompress their capacity during the drill. We suggested that home care providers reach out to hospitals to inform them about their services and any availability to accept patients discharged from hospitals, and that hospitals be informed of successful interactions between hospitals and home care providers in some regions. The next CST exercises will be held from January to March 2020, and agencies will be given a two-week window for the exercises. Continued on next page
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Continued from previous page The next IOC drill will occur on some unannounced day in August 2019 in regions outside of New York City. DOH said it has addressed an issue raised by HCA for home care providers located in New York City but who serve counties outside of the City. These providers could not participate in past drills due to their main office location being located outside of the drill area, even though they serve areas within the footprint of the drill. IOC drills test the ability of providers to use a primary and back-up communication system to communicate with community partners such as: the internet, including Voice over Internet Protocol/VOIP; radio; and cellular and satellite phone. DOH has agreed to conduct a webinar on IOC drills sometime in July. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org; or Alyssa Lovelace at (518) 810-0658 or alovelace@hcanys.org.
LawTalk: ACA Section 1557 Non-Discrimination Notice and Tagline Obligations By Frank Fanshawe, Esq. and Ashley Solowan, Esq., Jackson Lewis, P.C. Section 1557 of the Affordable Care Act and its implementing regulations prohibit discrimination on the grounds of race, color, national origin, sex, age, or disability. These regulations apply to health care providers, insurers and other health programs which receive federal funding, such as Medicare and Medicaid. Home health agencies, MLTCs and hospices are generally subject to the regulations. Among other requirements, home health agencies, MLTCs, and hospices must provide patients and prospective patients with notices of nondiscrimination (a sample is located here: https://www.hhs.gov/ civil-rights/for-individuals/section-1557/translated-resources/index.html) and so-called taglines – which are brief statements written in a non-English language that indicates the availability of language assistance services free of charge for patients and prospective patients (a sample is located here: https:// www.hhs.gov/civil-rights/for-individuals/section-1557/translated-resources/index.html). These taglines must be posted in at least the top 15 non-English languages spoken in the state where the home health agency, MLTC, or hospice is located. The HHS website provides a listing of the top non-English spoken languages by state at https://www.hhs.gov/civil-rights/for-individuals/section-1557/translatedresources/index.html. Both the notices of nondiscrimination and the 15 or so non-English taglines must be posted in: 1) significant publications or communications (just about any written communications with a patient or prospective patient); 2) physical locations where the home health agency, MLTC, or hospice interacts with the public; and 3) on the home health agency, MLTC, or hospice website. Special rules permit home health agencies, MLTCs and hospices to post a briefer notice of nondiscrimination (a sample is at https:// www.hhs.gov/civil-rights/for-individuals/section-1557/translated-resources/index.html) and a more limited number of taglines if the publication or communication is small in size (e.g., a postcard). It is important to note that the Final Rule – and its requirements to post notices of nondiscrimination and taglines – has been in effect since October 16, 2016. So the obligations to post notices of nondiscrimination and taglines are not new. HHS, however, is now working to repeal these obligations as
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part of a broader set of amendments. See the HHS website (https://www.hhs.gov/about/news/2019/05/24/ hhs-proposes-to-revise-aca-section-1557-rule.html) for more information about the potential amendments. According to HHS, the notification and tagline requirements are costly and unnecessary regulatory burdens. In any case, it will likely be many months – and possibly even years – before these amendments are officially adopted by HHS. And HHS has been clear that it intends to continue to vigorously enforce Section 1557 and its implementing regulations, including, presumably, the notice of nondiscrimination and tagline requirements. Therefore, to the extent home health agencies, MLTCs, and hospices are not providing notices of nondiscrimination and taglines as required by the regulations, they should take steps to do so immediately. LawTalk is a monthly series of articles by legal experts at Jackson Lewis, the firm for HCA’s counsel. Please note that LawTalk articles are for general, informational purposes, are not legal “advice,” and do not create an attorney-client relationship. Because each case is unique, the information provided should be considered to be general in nature and should never be considered a substitution for legal counsel. Readers should not take, or refrain from taking, any action based on information in this article without first seeking legal advice from competent counsel.
Updates to Disability Benefits Claim Forms The New York State Workers’ Compensation Board (WCB) has made updates to forms used for disability benefits claims. Two disability benefits claim forms have been updated to streamline the process of reviewing a total or partial payer rejection of a disability benefits claim, while two other disability benefits forms have been made obsolete. In addition, the mailing address of the Board’s Disability Benefits Bureau has changed. The updated forms include:
“Notice and Proof of Claim for Disability Benefits” (Form DB-450) has been updated to collect additional clarifying information regarding eligibility and collection of other benefits (e.g., workers’ compensation, unemployment insurance, etc.) that impact eligibility for disability benefits. The form is at http://www.wcb.ny.gov/content/main/forms/AllForms.jsp. Version 5/19 of the form is effective for use as of June 1, 2019. Version 9/17 of the form will continue to be accepted through September 30, 2019.
“Notice of Total or Partial Rejection of Claim for Disability Benefits” (Form DB-451) has been updated to provide a more comprehensive list of rejection reasons and provide clearer instructions on how the form and different rejection reasons should be used. Payors may contact the WCB Forms Department at formsdepartment@wcb.ny.gov to obtain this form. Version 5/19 of the form is effective for use as of June 1, 2019. Older versions will continue to be accepted if mailed to the claimant on or before September 30, 2019; requests for review of Form DB-451s will be found in favor of the claimant if sent to the claimant on or after October 1, 2019 using older versions.
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Continued from previous page Some obsolete forms include the Notice of Disability Benefits Payment (Form DB-455) and Tables of Permanent Contributions (Form DB-791).
Mailing Address All correspondence to the Disability Benefits Bureau should be mailed to the below address: Workers’ Compensation Board Disability Benefits Bureau PO Box 9029 Endicott, NY 13761-9029 More information is at http://www.wcb.ny.gov/content/main/SubjectNos/sn046_1173.jsp.
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