June 10, 2019 Edition of The Situation Report

EVV

EMERGENCY PREP

RED TAPE

MLTC PATIENT DATA

Along with NYS’s Listening Sessions, HCA seeks provider input on personal care electronic visit verification beginning January 1 (though NYS expects to seek a delay waiver).

Beyond this week’s required response drill, HCA reports back on two Health Emergency Preparedness Coalition sessions where we represented home care, hospice & MLTC.

HCA will examine a new CMS RFI on paperwork reduction for possibilities to reduce the reporting and regulatory burdens on providers.

DOH requests MLTC patient attribution data by August 1 to create aggregated quality results.

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UPCOMING PROGRAMS PDGM Coding Essentials June 12 (Schenectady, NY)

PDGM Bootcamp For Clinical Managers and Quality Staff July 11 (Suffern, NY)

6 Legal Experts, 1 Day of Hot Topics in Labor Law June 13 (NYC)

Blueprint for OASIS Accuracy – OASIS D Data Set June 17-18 (Workshop); June 19 (Optional COS-C Exam) in Webster, NY (near Rochester) September 23-24 (Workshop); September 25 (Optional COS-C Exam) in NYC

Your Source for HOME CARE News, Policy and Advocacy

Vol. 4, Issue 23| June 10, 2019

HCA Hones Priority Bills, Presses Advance with Coalition Partners on Transformation Fund Investments With only seven session days remaining before the scheduled adjournment of the state legislature, HCA remains a continued presence at the state Capitol urging cosponsorship, committee action, and floor votes on several priority bills.

Foremost among these are bills developed by HCA in collaboration with bill sponsors. (See our summary table at https://tinyurl.com/ y6lpxg32.)

We are also on watch for any new bills that may emerge requiring HCA’s response in the form of amendments or withhold requests.

Two HCA bills are the focus of grassroots campaigns that all members must act upon to help advance our cause.

See HONES p. 4

‘All Agencies Should Be Doing This’ July 11 PDGM Bootcamp “I came into this program knowing 10% about PDGM and left with knowledge of 95% of PDGM” ...“This conference was an eye-opener” ...“Great workshop: real life examples help you create a real work plan and make PDGM work ...“All agencies should be doing this workshop.”

These are just a few of the more than 30 accolades evaluating Barbara Katz’s PDGM clinical program in Connecticut last month.

HCA has invited her to bring this exceptional program to New York State on July 11 in Suffern. Please take the advice above and get a seat at the table.

See PDGM p. 2

INSIDE HCA Hones Priority Bills, Presses Advance on Transformation Funds...................1 ‘All Agencies Should Be Doing This’ July 11 PDGM Bootcamp................................1 Last Opportunity to Prepare for Emergency Response Drill................................2 EVV Input Sought...............................................................................................3 CMS to Add Publicly Reported Quality Measure for Home Health........................5 A Message from HCA Sponsor TSG Financial.......................................................5 New Federal Bills on OT Assessments and Home Care Savings Accounts..............6

Hospice Provider Preview Reports: Review Your Data by July 1............................7 Emergency Preparedness Update.....................................................................7 CMS Releases RFI on Paperwork Reduction Initiative..........................................8 ePACES to Hold Private Duty Nursing Webinar.....................................................9 Upcoming Meetings and Deadlines.................................................................10 State Requests Patient Attribution Data from MLTC Plans................................11 Home Care Applications Approved at PHHPC Meeting......................................11 Health Resources...........................................................................................12

The Situation Report: the Home Care Association of New York State PDGM from p. 1 Attendees will learn the four key elements of the PDGM scoring system: admission source and timing, clinical groupings, functional levels and comorbidities. Clinical managers will leave with specific techniques for obtaining accurate information to support coding, scoring and billing, all while using the least amount of resources to produce the best outcomes.

As with her PDGM training, Barbara Katz, RN, MSN has gotten similarly rave reviews for other past HCA education programs.

This particular topic, PDGM, is among the most important learning areas for your agency’s success in 2020. Make sure your clinicians are ready to drive that success. Register today at https://hca-nys.org/wp-content/uploads/2019/05/PDGMPrograms-HCA-2019.pdf.

Last Opportunity to Prepare for Emergency Response Drill Tomorrow will be the start of a three-day emergency response drill that the state Department of Health (DOH) is requiring for all home care and hospice providers. Those who do not participate will face a deficiency citation and possible enforcement action.

HCA has provided many communications to members on this drill, as described in the Dear Administrator Letter at https:// www.health.ny.gov/facilities/home_care/dal/docs/19-05.pdf.

Every day of the drill, DOH will send an Integrated Health Alerting System (IHANS) e-mail through the Health Commerce System (HCS).

It goes to the “24/7 Contact Office” and the “Office of the Administrator,” as well as several HCS roles who’ll have access to a required Health Electronic Response Data System (HERDS) survey that must be completed every day of the drill.

The message will describe the exercise scenario and what survey is required to be completed by agencies.

To receive IHANS messages, you must have complete and accurate HCS business and emergency contact information on file with DOH. Continued on next page 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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Volume 4, No. 23 June 10, 2019 

The Situation Report is a weekly publication of the Home Care Association of New York State (HCA).

Unless otherwise noted, all articles appearing in The Situation Report are the property of the Home Care Association of New York State. Reuse of any content within this newsletter requires permission from HCA. Al Cardillo President and CEO acardillo@hcanys.org Roger L. Noyes Director of Communications, Editor of The Situation Report rnoyes@hcanys.org Rebecca Fuller Gray Executive V ice President for Clinical and Program Affairs rgray@hcanys.org Patrick Conole Vice President, Finance & Management pconole@hcanys.org Andrew Koski Vice President, Program, Policy & Services akoski@hcanys.org Alyssa Lovelace Director for Policy and Advocacy alovelace@hcanys.org Lauren Ford Director of Program Research, Development and Policy lford@hcanys.org Laura Constable Senior Director, Membership & Operations lconstable@hcanys.org Celisia Street Director of Education cstreet@hcanys.org Mercedes Teague Finance Manager mteague@hcanys.org Jenny Kerbein Director of Governance & Graphic Design jkerbein@hcanys.org Billi Wilson Manager, Meetings & Events bwilson@hcanys.org Teresa Brown Administrative Assistant tbrown@hcanys.org

The Situation Report: the Home Care Association of New York State

Volume 4, No. 23 June 10, 2019 

Continued from previous page Agencies may also receive phone calls and/or texts directing them to check their e-mails for such messages.

Some of the information expected to be requested in the surveys, based on prior drills, include: agency capacity/patient census by county; patient classification levels (Levels 1, 2, and 3); transportation assistance levels (TALs); ventilator and electricity dependent patients; community partners; ability to serve your current caseload and to serve additional patients; ability to contact staff and patients; and more.

Questions should go to HCEmergency@health.ny.gov (please copy Andrew Koski at akoski@hcanys.org).

The drill will meet the state and one of the federal requirements for home care and hospice agencies to hold exercises each year. Certified Home Health Agencies and hospices will be expected to complete an After Action Report (AAR). A blank AAR is at https://hca-nys.org/wp-content/uploads/2019/05/AAR-IP_TemplateBLANK-for-CMS-EP-exercises.docx.

Questions about the drill can be sent to HCEmergency@health.ny.gov (please copy Andrew Koski at akoski@hcanys.org).

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.

EVV Input Sought HCA is seeking feedback from members on the upcoming requirement that home care providers implement an electronic visit verification (EVV) system for personal care services starting January 1, 2020.

While we have been advised that New York will request a one-year delay in this mandate by demonstrating that it has made a “good-faith” effort to implement EVV, the state Department of Health (DOH) is holding listening sessions across the state to obtain stakeholder input.

HCA intends to submit feedback and is asking members to send us any concerns, questions or issues they may have with the EVV requirement so we can incorporate them into our comments. These should be sent to Andrew Koski at akoski@hcanys.org.

While many home care providers already conduct EVV under an existing state Office of the Medicaid Inspector General (OMIG) requirement (https://www.omig.ny.gov/index.php/information/home-healthverification) or local department of social services contract, they may have concerns about how this new mandate will further affect them, as well as insights, from their own experiences, regarding a more expansive EVV program for services statewide.

DOH has set up a website with information on the listening sessions, frequently asked questions and additional materials at https://www.health.ny.gov/health_care/medicaid/redesign/evv/index.htm.

The U.S. Centers for Medicare and Medicaid Services has a website dedicated to EVV at https:// www.medicaid.gov/medicaid/hcbs/guidance/electronic-visit-verification/index.html. (Note: just today, the state announced an additional New York City Listening Session date on July 19, from 1-3 p.m.)

Agencies are encouraged to complete a survey that DOH has developed on EVV. It is available at https:// www.health.ny.gov/health_care/medicaid/redesign/evv/docs/2019_readiness_survey.pdf.

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The Situation Report: the Home Care Association of New York State

Volume 4, No. 23 June 10, 2019 

HONES from p. 1 Both are sponsored by the Health Committee Chairs in the Senate, Gustavo Rivera, and Assembly, Richard Gottfried: 

S.5605/A.7854 would require the submission of mandatory annual in-service hours for home health aides and personal care aides in the Home Care Worker Registry. This legislation has already passed in the Senate and, in the latest development, has been reported to the Assembly Rules Committee, putting it on a promising track.



S.5915/A.7798 provides a 10-percent increase in the base episodic payment system rates and fee-forservice rates to Certified Home Health Agencies, plus it establishes rate benchmarking standards for other home care payors to consider.

In addition to these and other priority bills, HCA has been working with the New York State Council for Community Behavioral Healthcare and myriad other state associations and stakeholders to advance proportionate investments for home care and community-based providers from the Health Care Transformation Fund.

A bill meeting this purpose (S.6376/A.7977-A), also sponsored by Senator Rivera and Assemblyman Gottfried, would require the allocation of at least 25 percent of transformation funds to the community-based sector on an annual basis. (Home care and hospice providers are included within the definition of “community-based health care provider.”)

The bill was reported to the Assembly Ways and Means Committee and introduced to the Senate Rules Committee which are decisive committees for consideration and potential floor action in each chamber.

Please be on watch for a grassroots campaign related to this bill soon.

For questions or concerns, please contact Alyssa Lovelace at alovelace@hcanys.org or (518) 810-0658.

https://hca-nys.org/events-education/upcoming-events

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The Situation Report: the Home Care Association of New York State

Volume 4, No. 23 June 10, 2019 

CMS to Add Publicly Reported Quality Measure for Home Health The Potentially Preventable 30-Day Post-Discharge Readmissions (PPR) measure is expected to be displayed on Home Health Compare with the October 2019 refresh. This measure was originally scheduled for display on the January 2019 refresh, but the U.S. Centers for Medicare and Medicaid Services (CMS) decided to do further testing, which is now complete.

This particular measure was added by The Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014, which required a measure that reflects all-condition risk-adjusted potentially preventable hospital readmission rates for use in home health, skilled nursing facilities, long term care hospitals and other settings.

CMS did make some revisions to the measure after testing it, including the method for assigning performance categories and aligning measures with hospital readmission measures used in other programs. This refinement will be reflected in both the fall 2019 quarterly refresh and the summer 2019 Provider Preview Reports.

CMS will post performance rates and categories, showing whether the provider’s rate is “better,” “worse” or “no different” than the national rate for this measure. It will also publish the provider’s confidence interval – a measure of the uncertainty surrounding the provider’s rate, which is used as the basis for the performance categories.

The October 2019 Compare refresh, including the Potentially Preventable 30-Day Post-Discharge Readmission measure, is expected to be available in providers’ Certification and Survey Provider Enhanced Reports (CASPER) folders on June 24. A “Fact Sheet” and FAQ

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Volume 4, No. 23 June 10, 2019 

document are at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ NursingHomeQualityInits/Downloads/Fact-Sheet-for-Potentially-Preventable-Readmission-Measures-forthe-Post-Acute-Care-QRPs.pdf and https://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/NursingHomeQualityInits/Downloads/FAQs-for-Potentially-Preventable-ReadmissionMeasures-for-the-Post-Acute-Care-QRPs.pdf.

New Federal Bills on OT-Provided Assessments and Home Care Savings Accounts New York Congressman Paul Tonko is cosponsor of a bill introduced in the U.S. House of Representatives last week by Texas Rep. Lloyd Doggett that would permit occupational therapists (OTs) to conduct the initial assessment visit and complete the comprehensive assessment under a Medicare home health plan of care for certain rehabilitation cases.

The bill, introduced on June 5, was referred to the Committee on Ways and Means and the Committee on Energy and Commerce. A Senate version was also introduced as S.1725.

While only a brief bill summary is available at this time, HCA will obtain the text for further analysis about the specifics.

According to the federal Conditions of Participation (CoPs), OTs can conduct the initial assessment visit and the start-of-care comprehensive assessment on therapy-only patients for whom occupational therapy “establishes eligibility” (42CFR484.55).

HCA will seek to determine whether this legislation affords additional flexibility beyond what the CoPs currently permit.

Other recent federal legislation of note includes H.R.2878, a bill that would amend the Internal Revenue Code to allow tax-free distributions from health savings accounts (HSAs) to cover qualified home care services.

The bill, which ostensibly would foster access to care by making it more affordable, was referred to the House Ways and Means Committee on May 21.

It coincides with a recent study, reported in HCA’s biweekly news clips, finding that the oldest and sickest Americans are least likely to afford home care. The study, published in Health Affairs, found that 74 percent of older Americans could fund at least two years of a moderate amount of paid home care if they liquidated all of their assets, and 58 percent could fund at least two years of an extensive amount of paid home care.

“Among older adults with significant disabilities, however, only 57 percent could fund at least two years of moderate paid home care by liquidating all of their assets, and 40 percent could fund at least two years of extensive paid home care.”

Use HCA’s Legislative Action Center for Advocacy Today!

If you haven’t done so already, HCA urges all members to use our Legislative Action Center to press for action on federal priorities. Foremost among these are legislation to remove the behavioral adjustment cut from the Patient Driven Groupings Model and another bill permitting non-physician practitioners to order and refer home care services. All of our campaigns are at https://p2a.co/CrvM1NC.

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Volume 4, No. 23 June 10, 2019 

Hospice Provider Preview Reports: Review Your Data by July 1 The U.S. Centers for Medicare and Medicaid Services (CMS) has made the following two reports available in hospice providers’ Certification and Survey Provider Enhanced Reports (CASPER) non-validation reports folder: 

Hospice provider preview report: Review Hospice Item Set (HIS) quality measure results from the fourth quarter of 2017 to the third quarter of 2018.



Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) provider preview report: Review facility-level CAHPS survey results from the fourth quarter of 2016 to the third quarter of 2018.

CMS is encouraging hospice providers to review their HIS and CAHPS results by July 1. If you believe the denominator or other HIS quality metric is inaccurate or if there are errors in the results from the CAHPS survey data, the following websites explain how to request a CMS review: 

HIS Preview Reports and Requests for CMS Review website at: https://www.cms.gov/Medicare/ Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/Public-ReportingHIS-Preview-Reports-and-Requests-for-CMS-Review-of-HIS-Data.html.



CAHPS Preview Reports and Requests for CMS Review website at: https://www.cms.gov/Medicare/ Quality-Initiatives-Patient-Assessment-Instruments/Hospice-Quality-Reporting/Public-ReportingCAHPS-Preview-Reports-and-Requests-for-CMS-Review-of-CAHPS-Data.html.

Additional information such as report access instructions can be found at the following websites: 

Hospice Provider Preview Reports at: https://www.cms.gov/Medicare/Quality-Initiatives-PatientAssessment-Instruments/Hospice-Quality-Reporting/Downloads/Hospice-Provider-PreviewReport-Access-Instructions.pdf.



Hospice CAHPS Provider Preview Reports at: https://www.cms.gov/Medicare/Quality-InitiativesPatient-Assessment-Instruments/Hospice-Quality-Reporting/Downloads/HospiceCAHPS%C2%AEProvider-Preview-Report-Access-Instructions-Final-12-1-17.pdf.

Emergency Preparedness Update In addition to helping home care and hospice agencies prepare for this week’s state-mandated emergency response drill (see separate story), HCA traveled to Putnam County and Long Island for Health Emergency Preparedness Coalition (HEPC) meetings.

HEPCs are regional coalitions of health care providers, local and state emergency managers and local public health preparedness officials who work together to develop and coordinate emergency preparedness activities. Under a state Department of Health (DOH) Office of Health Emergency Preparedness grant, HCA and the New York State Association of Health Care Providers (HCP) are

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Volume 4, No. 23 June 10, 2019 

responsible for participating in HEPC meetings on behalf of home care providers across the state outside of New York City where we advocate for home care’s involvement in emergency preparedness drills and other activities.

The June 5 Lower Hudson Valley HEPC meeting drew a long discussion about a recent Coalition Surge Test (CST) exercise under which some hospitals and nursing homes had to evacuate a certain number of patients and send them home with or without services, to hospitals, to nursing homes or to other settings.

HCA and home care agencies at the meeting emphasized the role of home care in caring for some of these patients and the need for home care to be considered in simulated discharges. Many participants agreed and it was suggested that this be built into future CST exercises.

The meeting also discussed: the measles outbreak and what hospitals and local health departments are doing to address this issue; the EmPower tool that includes data on Medicare beneficiaries who are energy dependent (wheelchair, ventilator, dialysis, oxygen, etc.); a recent Medical Countermeasures exercise; and upcoming trainings.

The Long Island HEPC meeting also discussed a recent CST exercise and HCA was very supportive of efforts by the affected hospitals to refer some patients to home care and hospice.

HCA encourages its members (and non-members) to participate with their local HEPCs and attend meetings. For information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org; or Alyssa Lovelace at (518) 810-0658 or alovelace@hcanys.org.

CMS Releases RFI on Paperwork Reduction Initiative Last week, the U.S. Centers for Medicare and Medicaid Services (CMS) issued a Request for Information (RFI) for input on its ‘Patients over Paperwork’ initiative. Since the fall of 2017, according to CMS, “Patients over Paperwork has streamlined regulations to significantly cut the ‘red tape’ that weighs down our healthcare system and takes clinicians away from their primary mission – caring for patients.”

The RFI invites patients and their families, the medical community, and other healthcare stakeholders to recommend further changes to rules, policies, and procedures that would “shift more of clinicians’ time and resources from needless paperwork to high-quality care that improves patient health.”

The RFI is in the Federal Register at: https://www.federalregister.gov/documents/2019/06/11/2019-12215/ request-for-information-reducing-administrative-burden-to-put-patients-over-paperwork.

CMS is especially seeking ideas on ways to relieve burden and improve: 

Reporting and documentation requirements.



Coding and documentation requirements for Medicare or Medicaid payment.



Prior authorization procedures.

Continued on next page

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Volume 4, No. 23 June 10, 2019 

Continued from previous page 

Policies and requirements for rural providers, clinicians, and beneficiaries.



Policies and requirements for dually enrolled (i.e., Medicare and Medicaid) beneficiaries.



Beneficiary enrollment and eligibility determination.



CMS processes for issuing regulations and policies.

Comments must be submitted by August 12, 2019.

In November 2018, HCA had submitted comments on some CMS regulatory relief proposals related to home health and hospice services and emergency preparedness. We will be examining this new RFI to determine if there are additional areas on which we should provide feedback.

Regulations like face-to-face physician documentation and limits on practitioners ordering and referring for home care are among our top and continuing areas of advocacy on mandate relief. Our federal Legislative Action Center includes a campaign for you to help advance legislation in both houses that would allow non-physician practitioners to order and refer for Medicare home care. Please act on this campaign and others for state and federal advocacy by visiting our Action Center at https://p2a.co/ CrvM1NC. More information on the Patients over Paperwork initiative is available at: https://www.cms.gov/aboutcms/story-page/patients-over-paperwork.html.

ePACES to Hold Private Duty Nursing Webinar eMedNY has added “ePACES Other Payer for Private Duty Nursing” to its training schedule on June 12, 2019 at 10:30 a.m.

The session is intended for Private Duty Nurses and Nurse Registries.

The meeting agenda includes:       

Overview of other payers for private duty nursing Review of MEVS transactions (eligibility) Creation of other payer support files Review of secondary billing related to other payers (co-insurance/deductibles, 0-fill situations, etc.)

Claim status in real time responses Online resources – provider manual, MEVS Manual, ePACES Claim Quick Reference Guide.

Questions and answers

View the training schedule and register at https://www.emedny.org/training/index.aspx. Questions can be directed to the eMedNY Call Center at 800-343-9000

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Volume 4, No. 23 June 10, 2019

The Situation Report: the Home Care Association of New York State



MEETINGS & DEADLINES Requirement/Change/Meeting

Effective/Due Date

More Information

Emergency response drill for all home care and hospice providers

June 11Ͳ13, 2019

https://www.health.ny.gov/facilities/home_care/dal/docs/19Ͳ05.pdf

Western Region Health Emergency Preparedness Coalition (HEPC) All Partners meeting

June 12, 2019, 8:30 a.m. to 4:30 p.m.

https://tinyurl.com/yyk5vr3q

Bronx Emergency Preparedness Coalition Meeting

June 13, 2019, 12 p.m.

akoski@hcanys.org

Electronic Visit Verification (EVV) Public Listening Session on Long Island

June 17, 2019, 1 to 4 p.m.

https://www.eventbrite.com/e/longͲislandͲelectronicͲvisitͲ verificationͲevvͲregionalͲlisteningͲsessionͲregistrationͲ61173247831

EVV Public Listening Sessions in NYC

June 18, 2019, 1 to 4 p.m.

New: July 9, 2019, 1 to 4 p.m.

https://www.eventbrite.com/e/nycͲelectronicͲvisitͲverificationͲevvͲ regionalͲlisteningͲsessionͲregistrationͲ61173885739

Fiscal Intermediary Workgroup meeting

June 19, 2019, 11 a.m. to 2 p.m.

akoski@hcanys.org

Nassau County Health & Medical MultiͲ Agency Coordinating Group (Emergency Preparedness) meeting

June 27, 2019, 2 to 4:30 p.m.

nfischer@nassaucounty.ny.gov

EVV Public Listening Session in Lake Placid

June 27, 2019, 1 to 4 p.m.

https://www.eventbrite.com/e/lakeͲplacidͲelectronicͲvisitͲ verificationͲevvͲregionalͲlisteningͲsessionͲregistrationͲ61174344110

Revised Home Health Change of Care Notice (HHCCN)

July 1, 2019

https://www.cms.gov/Medicare/MedicareͲGeneralͲ Information/BNI/HHCCN.html

Fiscal Intermediary Workgroup meeting

July 10, 2019, 11 a.m. to 2 p.m.

akoski@hcanys.org

EVV Public Listening Session via webinar

July 24, 2019, 9 a.m. to 12 p.m.

https://www.eventbrite.com/e/electronicͲvisitͲverificationͲevvͲ regionalͲlisteningͲsessionͲwebinarͲregistrationͲ62614410387

CHHA Cost Report due

July 29, 2019

https://commerce.health.state.ny.us/public/hcs_login.html ; CHHAͲ Rates@health.ny.gov

Fiscal Intermediary Workgroup meeting

August 7, 2019, 11 a.m. to 2 p.m.

akoski@hcanys.org

Emergency Preparedness Coalition of Manhattan (EPCOM) meeting

August 7, 2019, 12 to 1:30 p.m.

Caitlin.Flynn@nyulangone.org

Personal Care Cost Report due

August 27, 2019

https://commerce.health.state.ny.us/public/hcs_login.html; PersonalCareͲRates@health.ny.gov

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

Changes in MLTCͲLHCSA Contracting Limits

October 1, 2019

https://www.health.ny.gov/health_care/medicaid/redesign/mrt90/ mltc_policy/lhsca_contract_guidance.htm

Medicare will only accept claims submitted with the Medicare Beneficiary Identifier (MBI)

January 1, 2020

https://www.cms.gov/Medicare/NewͲMedicareͲCard/index.html

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The Situation Report: the Home Care Association of New York State

Volume 4, No. 23 June 10, 2019 

State Requests Patient Attribution Data from MLTC Plans The state Department of Health (DOH) is requesting managed long term care (MLTC) plans to submit a patient attribution file, which will be used to create aggregated quality results by provider or valuebased payments contractor.

DOH will calculate all reportable Category 1 quality measure results for the arrangements. The attribution methodology and patient attribution file layout is included in Section III of the 2019 Value Based Payment Reporting Requirements Technical Specifications Manual, which is located at https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/vbp_library/2018/docs/ 2019_tech_spec_manual.pdf.

Files are to be submitted to DOH via the Secure File Transfer 2.0 of the Health Commerce System.

Files should be submitted to the OQPS MLTC Evaluation mailbox by close of business on August 1, 2019. Comments and questions specifically relating to the submission of your plan’s data should be submitted via e-mail to NYSQARR@health.ny.gov.

Home Care Applications Approved at PHHPC Meeting On June 6, the Public Health and Health Planning Council (PHHPC) met and acted upon a number of home care applications.

The following were approved: 

An entity to become the operator of a special pilot Certified Home Health Agency;



Change in ownership and consolidation/merger of two Licensed Home Care Services Agencies (LHCSAs); and



Change in ownership of a LHCSA that provides Nursing Home Transition and Diversion and Traumatic Brain Injury services.

The agenda and supporting documents are at https://www.health.ny.gov/facilities/ public_health_and_health_planning_council/meetings/2019-06-06/.

All Council and committee meetings are webcast and archived at https://www.health.ny.gov/events/webcasts/.

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Volume 4, No. 23 June 10, 2019 

Health Resources 

“Spring Semiannual Report to Congress,” Office of Inspector General https://go.usa.gov/xmF4g



“Disaster Assistance: FEMA Action Needed to Better Support Individuals Who Are Older or Have Disabilities,” by the General Accountability Office https://www.gao.gov/assets/700/699061.pdf



“Complex Construction: A Framework for Building Clinical-Community Partnerships to Address Social Determinants of Health,” by United Hospital Fund https://uhfnyc.org/media/filer_public/d8/b5/d8b53198-a7db-4f7f-adac-da4c0dc6b1f9/ uhf_phip_report_20190606.pdf



“A Dozen Facts About Medicare Advantage in 2019,” by the Kaiser Family Foundation http://files.kff.org/attachment/Data-Note-A-Dozen-Facts-About-Medicare-Advantage-in-2019



“Medicare Advantage” (June 2019 Fact Sheet), by the Kaiser Family Foundation http://files.kff.org/attachment/Fact-Sheet-Medicare-Advantage

For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.

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PDGM

PROGRAMS

Coding Essentials June 12, 2019 Schenectady, New York

Bootcamp for Clinical Managers and Quality Staff July 11, 2019 Suffern, New York

PDGM

DoubleTree by Hilton 100 Nott Terrace Schenectady, NY 12308

CODING ESSENTIALS June 12, 2019

Who Should Participate:

8:30AM

Registration and Continental Breakfast Provider Quality and ICD‐10‐CM Code and Review Staff; Educators; Clinical, Performance Improvement and Compliance Staff and those responsible for the oversight and review of all provider clinical documentation that supports the delivery of care and services in the certified home health care setting.

9:00AM – 4:30PM Program (Lunch is included) Presented by: Trish Tulloch, RN, BSN, MSN, HCS‐D, Senior Consultant, RBC Limited

Program Outcomes in a Nutshell

With PDGM coming, your outcomes and financial viability demand precision and accuracy in the capturing and reporting of all clinical data. This includes OASIS‐D1 and ICD‐ 10‐CM diagnosis coding practices that are essential to quality outcomes and agency reimbursement within the larger construct of new clinical groupings and subgroupings under PDGM.

• Review the nuts and bolts of PDGM; • Detail ICD‐10‐CM Diagnosis Code updates that impact accurate provider reimbursement in PDGM; • Discuss strategies to support PDGM transition processes to successfully prepare for January 1, 2020.

This program will make vital connections across the various coding categories and functions for PDGM readiness, including ICD‐10‐CM Code Updates, Coding Clinic clarifications, and PDGM Diagnosis Codes for each ICD‐10‐CM Chapter, ensuring that coders and reviewers have an in‐ depth understanding of the nuances of PDGM.

About the Presenter Trish Tulloch RN, BSN, MSN, HCS‐D, is a Senior Consultant with RBC Limited with more than thirty years in the health care industry, including twelve years in home health and hospice management and more than twenty years in health care consulting. She currently consults with multiple health care organizations and agencies to meet regulatory and accrediting standards. She has received rave reviews from conference attendees and is a frequent presenter sponsored by professional, state and national organizations. Education topics include clinical and management best practices, OASIS‐D, ICD‐10‐CM Coding, legal documentation, survey and certification issues, quality improvement and Health Care Reform initiatives.

The program will also specifically address multiple complex home health scenarios that challenge providers to accurately represent clinical complexity and comprehensive care planning, with major implications under PDGM. It will also explore an integrated approach to vital agency quality and ICD‐10‐CM diagnosis code audit and review initiatives so that your team can assess your PDGM performance in real time.

Upon completion of this program, participants will be able to: 1.

Detail critical elements of PDGM, including both OASIS‐D1 and ICD‐10‐CM Diagnosis Code updates;

2.

Recognize the PDGM clinical groupings and sub‐ groups that impact home health case mix in PDGM;

3.

Discuss and apply ICD‐10‐CM Code Guidelines and Coding Clinic Updates to complex home health case scenarios;

4.

List strategies to support provider PDGM transition work plans.

Hotel Information DoubleTree by Hilton 100 Nott Terrace Schenectady, NY 12308 HCA has reserved a limited number of rooms at the DoubleTree by Hilton in Schenectady, NY for the night of Tuesday, June 11 at a discounted rate of $124 per night. To receive this special rate, please call (518) 393‐4141 prior to May 17, and ask for the Home Care Association (HCA) group rate.

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PDGM

Crown Plaza Suffern – Mahwah 3 Executive Blvd.

Suffern, NY 10901

BOOTCAMP FOR CLINICAL MANAGERS AND QUALITY STAFF July 11, 2019

8:30AM Registration & Continental Breakfast: 8:30AM

About the Presenter

9:00AM – 4:30PM Program (Lunch is included)

Barbara Katz is an experienced clinician, manager, trainer and health care consultant. She is a graduate of the Yale School of Nursing, has a Certificate in Training and Development from Fairfield University and a Coaching Certification from the American Talent Development Association. Barbara was the 2013 winner of the Connecticut Association for HealthCare at Home’s Judith A. Hriceniak Award for Excellence in Nursing Leadership. Barbara has been a hospital nurse, an APRN, a training manager, a director of quality improvement and a clinical manager for a group of medical practices. She has also been a marketing director for a home health care agency and has managed operations for a private duty home care agency. She has designed and taught seminars on process improvement, data analysis, management, motivational interviewing and team‐building. Barbara frequently speaks on topics that include the practical use of data to improve outcomes, motivational interviewing, health literacy, collaboration and care transitions and adapting to the new world of health care.

Presented by: Barbara Katz, RN, MSN, President, BK Health Care Consulting Home Health Care Clinical Managers/Supervisors of Clinical Services, Quality Management staff and Clinical Educators will play a key role in the successful implementation of the new Medicare Patient Driven Groupings Model (PDGM). In this interactive session, attendees will learn the four key elements of the PDGM scoring system: admission source and timing, clinical groupings, functional levels and comorbidities.

Managers will leave with specific techniques for obtaining accurate information to support coding, scoring and billing, all while using the least amount of resources to produce the best outcomes. Areas covered include: optimizing complex care, episode utilization and case management, interdisciplinary teamwork, care coordination and collaboration. The session will also describe key PDGM measures and monitoring techniques to optimize efficiency, achieve success and prevent pitfalls.

At the completion of this session, participants will be able to:

Hotel Information

• Describe key elements of Medicare’s PDGM payment model • Explain the impact of the new regulations on clinical operations and clinical managers • Identify key clinical operations changes that will be required for PDGM success • Create an initial action plan for successful PDGM implementation

HCA has reserved a limited number of rooms at the Crowne Plaza for the night of Wednesday, July 10 at a discounted rate of $115 per night. To receive this special rate, please call 1‐800‐227‐6963 prior to June 19 and ask for the Home Care Association group rate (code: PDG).

Crowne Plaza Suffern – Mahwah 3 Executive Blvd., Suffern, NY 10901

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PDGM Programs June 12th and July 11th Single Program Registration

Registration

June 12, 2019

Name: _______________________________________________

PDGM Coding Essentials with Trish Tulloch Schenectady, NY

Title: ________________________________________________

□ HCA Member $249 □ Non‐Member $399 July 11, 2019 PDGM Bootcamp for Clinical Managers and Quality Staff with Barbara Katz Suffern, NY

□ HCA Member $249 □ Non‐Member $399

Organization:__________________________________________ Mailing Address: _______________________________________ ______________________________________________________ City/State/Zip:__________________________________________ Email:_________________________________________________ (Required for registration) Phone:________________________________________________

Package Rate Registration

Second Registrant (for Package Rate)

The Package Rate includes a discount if you register for both programs (June 12 and July 11). The Package Rate may be shared between two individuals from the same agency. If sharing the Package Rate, please register the second individual.

To be completed with Registration above if sharing the Package Rate.

Name: _______________________________________________ Title: ________________________________________________

June 12, 2019 AND July 11, 2019

□ HCA Member $425 □ Non‐Member $748 June 12th Program Cancellation Policy: Cancellations received by June 3, 2019 will receive a full refund, less a 25% administrative fee. Cancellations must be received in writing via e‐mail at info@hcanys.org. Cancellations received on June 4th or later will forfeit their registration fee, as will those who register and do not attend. Substitutions are permitted.

July 11th Program Cancellation Policy: Cancellations received by July 1, 2019 will receive a full refund, less a 25% administrative fee. Cancellations must be received in writing via e‐mail at info@hcanys.org. Cancellations received on July 2nd or later will forfeit their registration fee, as will those who register and do not attend. Substitutions are permitted.

Email:_________________________________________________ (Required for registration) Phone:________________________________________________

Payment Information Please check method of payment: ____MasterCard ____VISA ____Am Exp

____Check*

*Make checks payable to: HCA Education & Research and mailed to 388 Broadway, 4th Floor, Albany, NY 12207.

Checks must be received in advance of the event. ________________________________________________________ Card Number _____________________________ _______________________ Expiration Date Security Code ________________________________________________________ Billing Address of Card Holder ________________________________________________________ City, State, Zip

FAX TO: (518) 426‐8788 For more information, contact HCA at (518) 426‐8764 or info@hcanys.org

________________________________________________________ Name on Card ________________________________________________________ Authorized Signature