June 26, 2017 Edition of the Situation Report

LAST CALL: EP WORKSHOP

EO 38 IN THE COURTS

HOSPICE

COST REPORT COMMENTS

Now is your last chance to register for Wednesday’s workshop on the federal emergency preparedness rule.

Legal saga continues on regulations limiting administrative expenses and executive compensation for entities receiving state funds.

HCA comments on hospice rule, targeting regulatory and payment issues.

HCA continues to weigh in on cost report mechanism, under development, to capture provider use of minimum wage funds.

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COMING UP “Ask HCA” Dine and Discuss Roadshow Sessions June 27 Utica (4 to 6 p.m.); June 28 Potsdam (11:30 a.m. to 1:30 p.m.)

Make Your Emergency Preparedness Plan CoPReady June 28 Suffern, NY 10901

Your Source for HOME CARE News, Policy and Advocacy

Vol. 2, Issue 26 | June 26, 2017

As Senate Bill Goes Public, HCA Heads to Washington Opposing Even Deeper Medicaid Cuts The Senate last week issued a draft health care bill with even deeper Medicaid cuts than the already adopted House plan.

HCA, meanwhile, has continued its work in collaboration with a New York coalition of health care organizations urging members of New York’s Congressional Delegation to resist the Senate measure, along with any consensus bill that would follow in like form.

See SENATE p. 5

Summer Schedule As in previous years, HCA is publishing The Situation Report on a biweekly schedule for the summer. There will be no newsletter next Monday, July 3, and our offices will be closed on July 3 and 4 for the holiday. Our next edition of The Situation Report will be on July 10. As always, we will notify you by e-mail of all important updates and breaking news.

State Legislature Adjourns with Gains, Risks, Next Steps The state legislature concluded its 2017 session just prior to midnight on Wednesday of last week. Several measures (including home care and hospice) were approved by one or both chambers, while many items (including for home care) remained in the committee process, restricted by a See ADJOURNS p. 2

Medicaid F2F Guidelines “Finalized” at DOH Posting and circulation are awaited, as enforcement takes effect on July 1 Federal Face-to-Face (F2F) compliance requirements for Medicaid home care take effect as of July 1.

The state Department of Health (DOH) has informed HCA that state guidelines to See F2F p. 4

INSIDE As Senate Bill Goes Public, HCA Heads to D.C. Opposing Medicaid Cuts .......1 State Legislature Adjourns with Gains, Risks, Next Steps............................1 Medicaid F2F Guidelines “Finalized” at DOH.............................................1 A Message from HCA Sponsor FBA of Syosset............................................4 Last Call for 6/28 Workshop on CoP-Enforced EP Rule..................................5 EO 38 Court Decision Issued......................................................................6 HCA Submits Comments on FY 2018 Hospice Proposed Rule.......................7

HCA Submits Comments on Draft Provider Reconciliation Cost Report...................9 HHCAHPS Preview Reports with Star Ratings Available...........................................9 Member Hiring Announcement..........................................................................10 HCA Provides Memos on NGS Home Care and Hospice Updates.............................11 Case Management Caseload Limits for Care at Home Waivers.............................11 Employer’s Statement of Wage Earnings Revised.................................................12 Resources...............................................................................................12

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

Volume 2, No. 26 June 26, 2017 

 ADJOURNS from p. 1 narrowing funnel in the session wind-down.

Some of these items may well bring the Legislature back later this summer or in the fall, including extension of authority of local taxes, and the issue of mayoral control of New York City schools, a big-ticket matter which remained unresolved at the closing of the regularly scheduled session.

What follows is a summary of HCA bills and legislation of interest/ concern that were in play in these final session days. HCA will soon provide a more complete status report on all of the legislation affecting home care, hospice and MLTC, including a round-up of legislation passed earlier in the session as well as the status of bills primed for future action. Among these is a last-minute bill which is a new iteration of long-debated legislation requiring RNs to obtain a BSN degree within ten years of their initial licensure.

(More detail to follow).

Legislation That Passed Both Houses of the Legislature 



HCA’s “Essential Personnel Bill” for Home Care and Hospice (S.5016-A by Senator Lanza and A.6549-A by Assemblyman Cusick): HCA worked extensively and quickly with the sponsors, both houses of the Legislature and the Governor’s office to craft in the final days an amended version of this longstanding priority bill to give the best chance yet of approval by the Governor following past vetoes. HCA’s memorandum of support, which explains the amended bill and the strong justification for approval, can be viewed at http://hca-nys.org/wp-content/uploads/2017/ 06/HCA-Memo_Support_S5016-A-A-6549-A_EmergencyPreparedness.pdf.

Hospice Legislation for Expanded Swing Bed Capacity in Hospice Residences (S.6364 by Senator Hannon and A.7775-A by Assemblyman Gottfried); Hospice Residence Rate Adjustment (S.5662-A by Senator Valesky and A.6408A by Assemblyman Dinowitz); and Technical Amendments to Criminal History Record Check Law (S.6347 by Senator Hannon and A.7846 by Assemblyman Gottfried): HCA partnered with the State Hospice Association and engaged the direct work of our legislative-affairs team at HinmanStraub to support each of these hospice-benefitting bills.

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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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 Alexandra Fitz Blais Director of Public Policy ablais@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 & Special Projects 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 2, No. 26 June 26, 2017 

Continued from previous page 

Sepsis Education Programming (S.4971-A by Senator Marcellino and A.6053-A by Assemblymember Nolan): Requires that sepsis be included in school educational programming as well as part of the existing infection control education/training required of health clinicians under state law. HCA has engaged the bill sponsors and looks forward to being a voice in implementation consistent with our efforts to maximize home care’s work on sepsis education, prevention, early identification, mitigation and treatment, specifically through our first-in-thenation sepsis screening tool.



Nurse Family Partnership (NFP) Regulatory Relief (S.6656 by Senator Hannon and A.8388 by Assemblyman Gottfried): While HCA supports NFP and further supports regulatory flexibility to facilitate providers and patient beneficiaries of the program, HCA strongly opposes this bill as it has been written and in the absence of corrective amendments. HCA was informed by the sponsors that the legislation is intended to provide regulatory relief, and is not meant to adversely affect home care agencies; but the legislation is a complete bypass of Article 36 of Public Health Law which governs, sanctions and sets standards for all home care services the state. It would allow entities other than home care agencies to provide in-home nursing at a time of widespread abuse of the law by entities ignoring state public health law requirements to deliver in-home care.

Simultaneous efforts are under consideration for an administrative solution on NFP regulatory relief (without the need for this problematic legislative language); HCA will work hard to support that solution for providers and avoid the clearly unintended consequences of the legislation as it was written and passed.

Bills-in-Waiting 

HCA’s Bill for Physician-Homecare Collaboration programs (S.6345 by Senator Hannon): This legislation would provide cutting-edge opportunities for home care and physicians to partner for critical health services. The Senate introduced this bill and HCA worked to gain a matching bill in the Assembly. The Assembly felt there is a possibility of initiating this program through a recent “collaboration” law already enacted, and written by HCA. HCA is already pursuing this direction with a proposal to DOH. Stay tuned for further details, and, if this administrative route does not permit, HCA will revisit a legislative approach with the Assembly and seek that chamber’s passage.



HCA Bill for Collaborative Programs of Community Paramedicine (S.5588 by Senator Hannon and A.2733-A by Assemblyman Gottfried): This legislation would provide a collaborative framework for the design and operation of community paramedicine programs and services in the state, with requisite design partners being home care, EMS, hospitals and physicians. The legislation, as co-drafted by HCA, specifically avoids any crossover from one scope of licensure to another – a point of emphasis made by HCA and partners in our collaborative advocacy with the Legislature. This bill passed the Senate, but was held in the Assembly to allow for representatives of the New York State Nurses Association (NYSNA) to provide further input, at which point it will almost certainly be the focus of future efforts to enact once session resumes.

Please be on the lookout for a more comprehensive summary of the session outcome as well as further updates on the status of bills as they make their way to the Governor’s desk.

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Volume 2, No. 26 June 26, 2017

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



 F2F from p. 1 assist home care agencies and physicians with implementing the Medicaid F2F rule have been agreed to, and DOH update is expected to soon post or circulate these guidelines.

As soon as DOH decides on its route for making this guidance available, we will issue a membership-wide alert.

The new guidance was developed based on the combined work of HCA, the State Medical Society and a joint Task Force of our two associations which have been meeting and working at multiple levels over the past year. The guidance we developed, and which we are informed will be adopted for use by DOH, widely exempts managed care cases under New York’s broad Medicaid reform models for F2F applicability. The guidance is also anticipated to streamline compliance in other helpful ways.

Stay tuned for an HCA follow-up alert as soon as DOH acts on the availability of the guidance.

Simultaneous Federal advocacy aims at F2F roots Simultaneous with our state mitigation efforts, HCA has been further working with the State Medical Society at the federal level, engaging additional states from around the country in our joint efforts to garner the American Medical Association’s (AMA) active support on F2F reform. This AMA effort, spearheaded by our State Medical Society colleagues, resulted in AMA’s adoption earlier this month of a national advocacy resolution for F2F relief.

HCA continues to take aim at federal F2F reform through this and direct advocacy channels with Members of Congress, state home care association partners, the Visiting Nurse Association of America, and other concerned organizations.

A message from HCA sponsor FBA of Syosset

Are You Compliance Ready for CDPAP?

Don’t Get Caught Out of Compliance! i i

i i i

Did you know that starting on July 1

st

, 2017, Wage Parity will be required for

all CDPAP Cases??

Employees working for the Consumer Directed Personal Assistance Program, better know as CDPAP, will now be equivalent to Home Health Aides in terms of Wage Parity Compliance!

Do you know what is considered to be “compliant”?

In order to be Wage Parity compliant, a Home Health Care Agency must provide its Aides with a “Bona Fide Benefit Plan” But what qualifies as a “Bona Fide Benefit Plan”?

*FBA

of Syosset is the leader in Wage Parity Benefits and Compliance. To find out how FBA can help you keep in compliance, call our Director of Sales, Stephen Squires, before July 1st at 516-289-9009.

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

SENATE from p. 1



Last Call: Register for 6/28 Workshop on CoPEnforced Emergency Preparedness Rule

Broadly, the Senate bill mirrors key aspects of the House legislation, also known as the American Health Care Act (AHCA), which cuts as much as $800 billion from Medicaid. That bill – which was the second attempt by Congress this year to repeal and replace the Affordable Care Act (ACA) – passed the House on May 4 in a partyline vote of 217 Republicans to 213 Democrats.

Time is running out to register for HCA’s most comprehensive workshop on the imminent emergency preparedness rule for home care. Our program takes place in just two days, on Wednesday!

Don’t miss out on this last chance to register and learn the intricacies of this rule which begins enforcement on November 16.

The Senate bill goes further with its cuts to Medicaid, but in a similar manner as the House bill, shifting the program to a capped blockgrant program while phasing out the Medicaid expansion option that many states, like New York, entered into under ACA.

According to the guidance, “compliance with the Emergency Preparedness requirements will be determined in conjunction with the existing survey process for health and safety compliance surveys,” and the requirements are encompassed by the sweeping new changes proposed for the home health Conditions of Participation (CoPs). Notably, while the other home health CoP changes have been delayed, the emergency preparedness provisions separately go into effect on November 16.

Like the House bill, the Senate legislation would also create tax credits for individuals to purchase health insurance, though the schedule of credits differs from the House bill in terms of income and age thresholds. The bill also likewise overturns the tax increases underpinning much of ACA’s funding mechanism for extending coverage to lower-income citizens.

Continued on next page

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Volume 2, No. 26 June 26, 2017

As reported to the membership, enforcement planning for the new federal rule took a major step forward earlier this month with the posting of Interpretive Guidelines (see https://www.cms.gov/ Medicare/Provider-Enrollment-and-Certification/ SurveyCertEmergPrep/Downloads/Advanced-Copy-SOM-Appendix-ZEP-IGs.pdf). This document assists state surveillance efforts and enforcement as well as potential penalty actions for noncompliance.

Thursday’s program, Make Your Emergency Preparedness Plan CoPReady in Suffern, New York, is being led by national home care emergency preparedness expert Barbara Citarella of RBC Limited.

She will assist agencies in: understanding the four major components of this regulation; planning for required continuity of operations (COOP); operationalizing policies and procedural requirements of the rule; communication; and conducting/testing a training program related to your emergency plans.

This is one program that you won’t want to miss, not only for your agency’s compliance with the rule but for the sake of ensuring a solid plan that protects your patients and operations in times of crisis.

Download the brochure at http://hca-nys.org/wp-content/uploads/ 2017/04/Make-Your-EP-Plan-CoP-Ready-June-28-2017.pdf.

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Continued from previous page HCA President Joanne Cunningham has represented HCA in a multi-stakeholder coalition of 30 organizations opposing the House bill and, now, the Senate plan. The coalition has written joint letters to Congress, met with members of the New York Delegation and is holding meetings this week in Washington to continue its charge against the proposals being considered in Congress.

Though the House has already passed its own bill, any legislation coming from the Senate would traditionally undergo a process of reconciliation in conference committees between the two houses before a final vote and delivery to the President for his signature. Yet, HCA is hearing that the current legislative strategy may bypass the conference committee process and hasten a final vote by having the House simply pass the Senate’s version of the bill.

Please stay tuned for further updates on HCA’s advocacy activities and grassroots member action alerts as the debate over health care continues to consume Congress.

EO 38 Court Decision Issued On June 22, 2017, the New York State Appellate Division, Third Department issued a decision in LeadingAge New York v. Shah (litigation in which HCA is a co-petitioner) related to Executive Order 38 (EO 38) that limits executive compensation and administrative expenditures by covered entities, including health care providers and managed care plans that receive state funds or state-authorized payments above certain minimum thresholds.

Similar to the lower Supreme Court decision, the Third Department upheld the state Department of Health (DOH) regulations insofar as they limit the payment of executive compensation and administrative expenses from state-only funds and state-authorized payments (“hard cap”), but determined that DOH exceeded its authority by limiting executive compensation that is paid from all funds, including state and non-state funds (“soft cap”).

Either party to the case may seek a further appeal to the New York Court of Appeals. In addition, there have been other court decisions on EO 38 that HCA has reported to the membership on which HCA will continue to provide updates.

HCA will be providing additional information on the LeadingAge New York v. Shah decision after a close review of it.

Disclosure Form HCA reminds members that EO 38 Disclosure forms are due August 15, 2017 for Certified Home Health Agencies and August 16, 2017 for Personal Care Providers.

More information on EO 38 is at https://executiveorder38.ny.gov.

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Volume 2, No. 26 June 26, 2017 

HCA Submits Comments on FY 2018 Hospice Proposed Rule Today, HCA submitted extensive written comments on the Fiscal Year 2018 proposed rule for Medicare hospice payment updates, wage index changes and quality reporting posted in April by the U.S. Centers for Medicare and Medicaid Services (CMS).

Our comments can be downloaded at: http://hca-nys.org/wp-content/uploads/2017/06/ FY2018HospiceComments.pdf.

On the payment side, our comments specifically address several items in the proposed rule, including: the continuation of the two-tier routine home care (RHC) payment rates; the service intensity add-on payment and the wage index which is especially problematic for hospice providers in New York and particularly in need of revision.

We also include comments on the sources of clinical information for certifying terminal illness as well as item-by-item comments on three different areas within the Hospice Quality Reporting Program (HQRP) that includes: 1) whether CMS should account for social risk factors in risk adjustments for Quality Measures; 2) a new data collection submission mechanism under consideration called the Hospice Evaluation & Assessment Reporting Tool (HEART); and 3) the impact of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, which is another unfunded mandate in need of reimbursement.

CMS’s proposed rule asked for input on areas that could use some regulatory flexibility and/or efficiencies.

HCA appreciated the opportunity to offer the following recommendations that we believe would help reduce the regulatory burden on hospice providers: 1. Revise the Face-to-Face (F2F) Regulatory Requirement for Hospices: The intent of the F2F requirement was to ensure adequate and appropriate involvement and accountability of physicians relative to certification of eligibility for hospice care. However, as currently written and interpreted

by CMS, it may delay access to care and serve as a deterrent for some hospices to take eligible patients in need of immediate care onto service. This was neither its intent nor an advisable result of the requirement.

HCA urges CMS to work with the hospice industry to significantly revise the F2F provision so that regulations and guidance governing F2F provide sufficient flexibility, allowing hospice programs to comply without any threat of delayed access to care for beneficiaries in need of hospice services, and without undue financial burdens.

2. Address Costly and Burdensome Requirement Related to Processing of Notices of Election (NOEs) and Notices of Termination /Revocation (NOTRs): HCA fully recognizes the need for NOEs to be submitted timely and accurately, and understands that election information is necessary for the payment system to operate most effectively. The additional exception implemented by CMS in late 2016 provides some relief. However, antiquated Medicare systems with serious functional limitations are the main reason why many NOEs are not received within the

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five-day limit. Changes to the data systems are not within providers’ control. HCA advocates that CMS should update its data systems to allow for the automatic electronic submission of the NOE. 3. Amend Sequential Billing Requirements for Hospices that Cause Payment Delays and Increase Regulatory Burdens: CMS’s sequential billing policy prohibits hospice providers from submitting claims for care to beneficiaries where previously submitted claims are pending. However, claims processing can be delayed for weeks or months for many reasons, including medical review activities, common working file (CWF) problems, CMS or Medicare Administrative Contractor (MAC) claimsprocessing problems and pending claims from other providers, etc.

HCA recommends that CMS still require hospices to submit claims in chronological order but process and pay all clean claims as submitted, regardless of whether previous claims have been processed, and allow more than one claim per beneficiary per month when the reason for the multiple claims is due to the hospice exceeding the 450-line claim limit. CMS should also pay interest on claims that are not processed timely.

In our comments we also took the opportunity to strongly encourage CMS to begin offering capital Health Information Technology (HIT) funding and/or grants so that more and more hospices and home health agencies can begin advancing the interoperable exchange of critical health information to their critical health care partners.

For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

Senior Financial Managers Retreat S September 7-8, 2017 S Mohonk Mountain House- New Paltz, NY M H HCA’s Senior Financial Managers Retreat offers financial leaders innovative perspectives and expert analysis by HCA’s Policy Team as well as targeted insights from subject-matter experts who e will provide a comprehensive update of the home care and hospice financial landscape. w

Corporate Compliance Symposium C October 19, 2017 O Hilton- Albany, NY H H HCA’s Corporate Compliance program is a must-attend, highly anticipated annual event that brings together top legal experts, state regulators and organizational compliance specialists to b keep your team up to date on: new requirements, changes in laws and regulations, tools, k rresources and best-practices for fulfilling your compliance responsibilities.

Quality and Technology Conference Q November 16-17, 2017 N Crowne Plaza- Suffern, NY C H HCA’s Quality & Technology Symposium will present some of the unique technological and programmatic approaches driving positive clinical outcomes, and focusing your clinical p intervention strategies on core priority areas. in

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

Volume 2, No. 26 June 26, 2017 

HCA Submits Comments on Draft Provider Reconciliation Cost Report Last week, HCA submitted comments to the state Department of Health (DOH) on its draft Provider Reconciliation Cost Report.

As communicated to members on numerous occasions, DOH is developing this Cost Report to verify the appropriate use of funding by home care providers to help meet the recent minimum wage increase.

HCA received an overwhelming number of responses from members on the draft report and incorporated them into one document. Our comments included general remarks and covered every section of the report.

Some issues and concerns include: 

We urge DOH to provide a cover letter to the survey that will explain the survey purposes; define certain terms and provide examples; give the return date and mailbox to return it to; and ask that provider associations be allowed to review it before it is finalized.



We reiterate the need for a webinar on the report far in advance of the due date.



We seek a reasonable time period (at least 60 days) for providers to complete the report, especially since CHHAs and personal care providers are working on their 2016 Cost Reports now.



We repeatedly ask for clarification of terms and which data DOH is requesting for each section.



We ask DOH to indicate in every question if Consumer Directed Personal Assistance Program (CDPAP) cases/data should be included.

The draft Provider Reconciliation Cost Report is at the following links in PDF and Excel formats:  

http://hca-nys.org/wp-content/uploads/2017/06/Provider-Reconciliation-Cost-Report-06-05-17-1.pdf http://hca-nys.org/wp-content/uploads/2017/06/Provider-Reconciliation-Cost-Report-1.xlsx

Our comments are at http://hca-nys.org/wp-content/uploads/2017/06/Provider-Reconciliation-Cost-ReportComments.pdf.

HHCAHPS Preview Reports with Star Ratings Available Preview Reports reflecting results from the Home Health Care CAHPS (HHCAHPS) Survey from January 2016 through December 2016 (2016, Q1-Q4) are now available for home health agencies (HHAs) to review. You can access them at https://homehealthcahps.org under the “For HHAs” tab. You must be logged into the website to view your report. These same data will be updated on Home Health Compare (HHC) on www.medicare.gov in July 2017.

The Preview Reports present the publicly reported results with Star Ratings for those agencies with a sufficient number of completed interviews to receive Star Ratings. Agencies must have data for 40 or more patient surveys in the reporting period in order to have Star Ratings.

To access your agency’s HHCAHPS Preview Report, log into the HHCAHPS website using your username and password. Select the “Preview Reports” link under the “For HHAs” tab. If you have forgotten your password,

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click the Login link, type in your username, click “Reset Password,” and you will be emailed a “password reset link.” Follow the instructions provided in the e-mail message to reset your password.

If you have comments about your HHCAHPS Star Ratings on the Preview Report, please e-mail the following information to the HHCAHPS Coordination Team at hhcahps@rti.org by July 7, 2017: 

Your name, your facility name, your Certification Number (CCN), and your contact information.



Your comments about your preview report.



If you believe your HHCAHPS Star Ratings are not correct, submit evidence showing why the Star Ratings are incorrect: Note that if you have historically had higher ratings than are shown, this is not considered evidence. You must provide information showing that the data submitted by your vendor for the most recent quarter are incorrect and therefore may have impacted the assigned HHCAHPS Star Ratings for your agency.

For more information about the Preview Reports, please refer to this document on the HHCAHPS website, accessible once you are logged in: https://homehealthcahps.org/ LinkClick.aspx?fileticket=rEmqINcxYK8%3d&tabid=277.

For more information about HHCAHPS Star Ratings, including Frequently Asked Questions, please click here: https://homehealthcahps.org/GeneralInformation/StarRatingsInformation.aspx.

If you have any questions about the HHCAHPS Star Ratings or your HHCAHPS Preview Report, please contact the HHCAHPS Survey Coordination Team via e-mail at hhcahps@rti.org or call toll-free at (866) 354-0985.

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HCA Provides Memos on NGS Home Care and Hospice Updates New York’s Medicare Administrative Contractor, National Government Services (NGS), held two advisory meetings last week with updates to the home care and hospice provider communities. HCA Vice President Patrick Conole participated in both of these meetings, collecting information and providing feedback to NGS. Memos summarizing both meetings are posted at the links below.

Home health memo: http://hca-nys.org/wp-content/uploads/2017/06/062217NGSHomeHealthMemo.pdf.

Hospice memo: http://hca-nys.org/wp-content/uploads/2017/06/062217NGSHospiceMtgSummary.pdf.

The memos provide information on Medicare payment and regulatory issues. The home care memo has some specific insights about the “probe-and-educate” audit process for face-to-face (F2F) documentation requirements as well as Comprehensive Error Rate Testing (CERT) data findings that will assist providers in responding to these reviews and ensuring compliance. The hospice memo similarly provides audit and reimbursement updates, medical review and appeals data and more.

NGS Closed July 4 NGS will be closed on Tuesday, July 4, 2017, for Independence Day. This includes the following departments: Electronic Data Interchange (EDI) Help Desk; Provider Contact Center; Provider Enrollment Line; and the Telephone Reopening Unit. Electronic claim files transmitted after 5 p.m. on Monday, July 3, will have a claim receipt date of Wednesday, July 5, 2017. EDI front-end acknowledgement transactions will be created as expected as EDI claim files are received. The Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE) Provider Online System will be available on Monday during regular hours.

While DDE will be available, there will be no support available to respond to any issues. Providers will be able to access NGSConnex and use NGS’s Interactive Voice Response (IVR) system at 1-866-275-3033. NGS’s offices will reopen on Wednesday, July 5 for normal business hours.

For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

Case Management Caseload Limits for Care at Home Waivers As part of the consolidation of the Care at Home III, IV, and VI waivers into the “OPWDD Care at Home Waiver,” caseload limits have been established for dates of service beginning June 30, 2017.

OPWDD established a maximum caseload size of no more than 30 individuals per case manager. This caseload limit is inclusive of any individual that the case manager renders case management services to. It is not limited to those individuals receiving services under the “OPWDD CAH Waiver.” This caseload size reflects the individual case manager’s scope of responsibility, and accounts for the level of support required by individuals receiving services under the CAH waiver.

Continued on next page

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Volume 2, No. 26 June 26, 2017 

Continued from previous page According to the eMedNY announcement, a case manager’s caseload is composed of a mixture of individuals with varying needs. The development and ongoing management of caseloads is based on the assumption that at any time, the needs of all individuals on the caseload could be very high and intense, necessitating the need for significant case management assistance.

Employer’s Statement of Wage Earnings Revised The state Workers’ Compensation Board has revised the Employer’s Statement of Wage Earnings (form C-240).

The revised C-240 is at http://www.wcb.ny.gov/content/main/forms/Forms_EMPLOYER.jsp#C240.

In claims where an injured worker may be entitled to compensation benefits or death benefits, employers must submit the injured worker’s wage earnings information to the Board on form C-240 within 10 days of the Board’s request. Form C-240 captures an injured worker’s wage earnings information for the 52 weeks prior to the date of injury or illness. This information is used to calculate the injured worker’s average weekly wage and benefit rate.

If the injured worker did not work a “substantial” part of the year, the employer is required to also provide the wage earnings of another worker of the same class who worked a substantial part of the year for the 52 weeks prior to the injured worker’s injury date. A new “Employer of the Same Class” table has been added to Form C240 to capture this payroll information when applicable.

In lieu of completing the table(s) on page 2 of the form, detailed payroll information can be attached on a separate sheet or file (if submitting the form electronically). The employer must enter the total days paid and the total gross pay for the injured worker on Form C-240 in Questions 5 and 6.

Information on other changes to C-240, including the definition of “substantial part of the year,” is at http:// www.wcb.ny.gov/content/main/SubjectNos/sn046_949.jsp.

Resources 

“How Much Long-Term Care Do Adult Children Provide?” by the Center for Retirement Research at Boston College http://crr.bc.edu/wp-content/uploads/2017/06/IB_17-11.pdf

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

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