NEW HHCN NOW REQUIRED
DUALS
LABOR LAW
FIDA is ending on December 31, affecting 2,700 enrollees. Learn more about the state’s transition plan.
Among the flurry of bills that passed this state legislative session are a series of changes to labor law regarding salary history, pay equity and race discrimination based on hair or hairstyles.
Effective today, July 1, agencies must use the revised Home Health Change of Care Notice (HHCCN).
HCA's June edition of the Capitol Report continues to connect with lawmakers, highlighting the legislative session finale, pediatric home care, rural home health access, and more.
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Your Source for HOME CARE News, Policy and Advocacy
UPCOMING PROGRAMS PDGM Bootcamp For Clinical Managers and Quality Staff July 11 (Suffern, NY) Blueprint for OASIS Accuracy – OASIS D Data Set September 23-24 (Workshop); September 25 (Optional COS-C Exam) in NYC Editor's note: HCA will resume our schedule of biweekly summer newsletters in July and August. There will be no editions on July 8, July 22, August 5 and August 19. We will alert you, as always, by e-mail for breaking news.
CAPITOL REPORT
Vol. 4, Issue 26| July 1, 2019
2020 HHPPS Proposed Rule Expected This Week HCA to examine PDGM items, updates or changes in sprawling Medicare payment rule In order to meet the public comment and implementation thresholds to go live on January 1, 2020, the U.S. Centers for Medicare and Medicaid Services (CMS) customarily issues its proposed Home Health Prospective Payment System (HHPPS) rule this week in anticipation of the upcoming calendar year. See RULE p. 2
PMPM, Technical Issues Scoped at 2nd FI Workgroup Meeting At its second meeting, on June 25, members of the state’s Fiscal Intermediary (FI) Workgroup raised imminent payment changes for FIs that are foremost on the minds of FIs and advocates, though payment discussions are not a part of the workgroup’s explicit charge. See WORKGROUP p. 3
INSIDE 2020 HHPPS Proposed Rule Expected This Week.............................................1 PMPM, Technical Issues Scoped by FI Workgroup...........................................…1 State Outlines Duals Plan in Concert with FIDA Phase-Out.............................…4 A Special Message from HCA Sponsor TSG Financial....................................….4 Member Hiring Announcement....................................................................…5 Labor Changes Included in Final Legislative Session......................................…6 Revised Medicare HHCCN Form Required Starting July 1............................….7
During a special ceremony at Northwell Health recently, HCA President and CEO Al Cardillo presented Dr. Martin Doerfler with a 2019 HCA Physician Champion award. Joining Northwell’s leadership, legislators and advocates, HCA was delighted to present Dr. Doerfler’s award at this feature event recognizing his instrumental role on HCA’s ‘Stop Sepsis at Home’ initiative. “Working with HCA on its sepsis initiative has brought to home care the kind of rigor and evidence-based protocols that have made a difference in the hospital setting,” says Dr. Doerfler in a press release. “I am proud to see the outcomes already being observed by this groundbreaking endeavor.” You can read the full press release at https://tinyurl.com/ y4jps8bq. Photo above courtesy of Northwell Health: Martin Doerfler, center, was recognized by, left, Al Cardillo; Ciaran Staunton of The Rory Staunton Foundation for Sepsis Prevention; State Senator Anna Kaplan; and Northwell President and CEO Michael Dowling.
HHCAHPS Preview Reports with Star Ratings Available…................................8 June Edition of Capitol Report Highlights Legislative Session & More.........…8 Home Health Agency PEPPER Review Webcast: July 18, 2019......................…9 HCA Memo on NGS Hospice Advisory Updates.............................................…9 Due Dates and Deadlines…........................................................................10 LawTalk: Best Practices for New Director Onboarding.................................11 July Aware Prepare Offers Preparedness Training Info, Resources..............11 Health Resources…..................................................................................12
The Situation Report: the Home Care Association of New York State RULE from p. 1 The HHPPS rule, for Medicare services, outlines the various payment adjustments, wage index methodology factors, quality reporting requirements and other mechanisms that influence Medicare reimbursement in 2020. This year, all eyes will be watchful for sections of the rule related to the Patient-Driven Groupings Model (PDGM), the biggest overhaul in home health payments in 20 years, which has already been cued as part of last year’s payment rule. HCA has provided regular education and updates on PDGM and will be sure to flag notable PDGM elements in this week’s expected proposed HHPPS, along with our summary of the other items included in the sprawling rule. We will alert you about any prominent updates as soon as we identify them in the rule, and we will also provide the membership with a detailed memo next week once our fuller analysis is complete. Upcoming Programs on PDGM, Home Health Payment In addition to this analysis, please be on the lookout for details coming soon on our September 5-6 Senior Financial Manager’s Retreat at the Mohonk Mountain House in New Paltz where we’ll have several updates on HHPPS and PDGM, along with other finance issues. Please also make sure that your clinical managers and other nursing staff are ready for PDGM implementation by attending next week’s Bootcamp For Clinical Managers and Quality Staff. This July 11 program in Suffern, led by clinician expert Barbara Katz, got rave reviews from agencies who participated in a similar seminar in May. 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. A registration form is at the back of this week’s Situation Report. 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
The Situation Report: the Home Care Association of New York State
WORKGROUP from p. 1 Many workgroup members argued that raising the standards and/or requirements for FIs while reducing payment for FI administrative expenses is not feasible for sustainability. As previously reported, the state is pursuing a change to per-member-per-month (PMPM) payments for FI administrative services due for implementation today, July 1. The state Department of Health (DOH) did indicate that it has received a request to delay the PMPM implementation. That request was submitted by the respective Chairs of the Assembly and Senate Health Committees (Assemblyman Richard Gottfried and Senator Gustavo Rivera). The Department did not provide any other information on the PMPM proposal or its status at last week’s meeting. However, it is our understanding, as of today, that the state is considering a delay, and HCA may have further information on the status of this matter after press time for The Situation Report. If there is a substantive development, we will report back to members via email alert.) As noted in prior HCA reports, the workgroup, which stems from the final state budget, is specifically charged with: identifying and developing best practices for FIs; criteria for DOH to use in selecting and contracting FI services; developing quality reporting requirements; and establishing transition plans for consumers that need to switch to another FI. The meeting involved a deeper examination of best practices by FIs that were identified and submitted by workgroup members. Some workgroup members have proposed expanding the potential responsibilities for FIs, including: sustaining a local and regional presence; maintaining contact with consumers (in person, phone or other means); training of consumers and/or personal assistants (PAs); providing firewalls between FIs and LHCSAs that are part of the same organization; maintaining an emergency contact list for consumers and an emergency preparedness plan; conducting health assessments and tests for PAs; conducting criminal history record checks on PAs; recruitment of PAs; requiring managed care plans and local departments of social services to provide
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consumers with lists of FIs; provision of peer mentoring; and more. There was a lot of discussion on all of these issues, particularly on FIs having a local and regional presence, expectations for visits or calls by FIs to consumers, and any FI training. DOH wants the workgroup to further explore these at a future meeting. At the next meeting (July 10), participants will continue the discussion on best practices and also cover potential quality indicators for FIs. The final state budget also included a new procurement process for FIs. The criteria for selecting FIs, as outlined in the state budget, includes the following items that the workgroup is charged with examining: ability to appropriately serve individuals participating in the program; geographic distribution that will ensure access in rural and underserved areas; demonstrated cultural and language competencies; ability to provide timely consumer assistance; experience serving individuals with disabilities; the availability of peer support for consumers; and demonstrated compliance with all applicable federal and state laws and regulations, including wage and labor. FIs that provide services on or prior to April 1, 2019 will be required to submit an application within 60 days of DOH posting the procurement process. DOH confirmed again at HCA’s inquiry that independent living centers and those FIs who were established prior to January 1, 2012 will not be given preference over other applicants who meet the final selection criteria. DOH indicated that it expects the new process to be released sometime in the fall, as it is required to be in effect by January 1, 2020. HCA will provide information to members once it is released. The PowerPoint for the FI Workgroup meeting is at https://tinyurl.com/yy7fo9cl.
The Situation Report: the Home Care Association of New York State
Volume 4, No. 26 July 1, 2019
State Outlines Duals Plan in Concert with FIDA Phase-Out The state Department of Health (DOH) has provided additional information on the phase-out of the Fully Integrated Duals Advantage (FIDA) program whereby FIDA will end on December 31, 2019, affecting about 2,700 enrollees. FIDA would be replaced by a new stage model being developed for the duals population. This initiative has major implications for all sectors and stakeholders. HCA will be working to maximize our involvement and input into the state plans and by engaging members in this process. HCA is seeking to feature a state presentation on this topic at our upcoming September 5-6 Senior Financial Managers Retreat. In the latest development, DOH is accepting public comments until July 22 on a draft phase-out plan. DOH will review all comments then submit its plan to the U.S. Centers for Medicare and Medicaid Services (CMS) by August 5. DOH and CMS are expected to approve the plan by August 19 and start the plan by August 26. The draft phase-out plan is at https://hca-nys.org/wp-content/ uploads/2019/07/FIDA-phase-outplan.v7_MMS-003.pdf. DOH and CMS have been working on the transition of FIDA participants to Medicaid Advantage Plus (MAP) plans fully aligned with Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs). All FIDA plans currently offer a D-SNP aligned with a MAP plan owned by the same Medicare Advantage (MA) parent organization. Medicare benefits For the beneficiaries’ Medicare benefits, DOH has requested that CMS allow for individuals to be passively enrolled from their current FIDA plan to that plan’s MAP-participating D-SNP. Enrollees would still have the option to elect different Medicare coverage options (e.g.,
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“original” Medicare or a different Medicare Advantage plan) under this scenario. These passive enrollments would take effect January 1, 2020. CMS is currently considering whether to allow this passive enrollment based on the following requirements:
Existing Medicare providers for the FIDA plan and MAP-participating D-SNPs must be comparable;
Medicare benefits between the FIDA plan and MAP-participating D-SNP must be similar;
Premium and cost-sharing between the FIDA plan and MAP-participating D-SNP must be similar; and
Medicare payment for the MAP-participating D-SNPs must be less than or equal to the Medicare feefor-service rate.
CMS will review the above criteria for each FIDA plan that applies for passive enrollment on a county-bycounty basis. FIDA plans that meet the above requirements in a particular county will be eligible for passive enrollment of their FIDA participants in that county into that organization’s MAP-participating D-SNP for the same county. Medicaid coverage For Medicaid coverage, FIDA participants are required to enroll in a Medicaid Managed Long-Term Care plan (i.e., MAP, partially capitated managed long term care/MLTC, or Program of All-inclusive Care for the Elderly/
HIRING: DIRECTOR OF CLINICAL SERVICES Are you passionate about home care? Do you want to have an impact? Health Services of Northern NY, a CHHA in Potsdam, NY serving St. Lawrence County, is hiring a Director of Patient Services. The selected candidate will lead our team of direct care providers to achieve sales, customer satisfaction, quality of care and compliance goals. The Director of Clinical Services is the clinical leader ensuring that the care team is providing first-class service. It is imperative that the chosen candidate provide exceptional communication to our team and act as a fair yet approachable resource for all. Requirements:
Must be a Registered Nurse with a current license for the state of New York. Two years as a supervising community health nurse OR two (2) years of home care nursing experience PLUS a master’s degree in Nursing or health-related field. Prior proven effective managerial/supervisory experience to direct, train, and develop a staff of clinicians to provide top-level care. Top-notch clinical skills for mentoring, training and use in the field to ensure education of staff skills. Leadership qualities to include the ability to listen, inspire and motivate others, set expectations and lead a team to great results.
We are looking for someone who can build trust, is committed to the team, and holds themselves and others accountable. If patient care is your passion, we want to hear from you! We will reward the right person with a competitive salary and comprehensive benefit package to include medical, dental, 401(k) and paid time off. Some relocation assistance may be offered. E-mail your résumé and a letter of interest to mobryan@hsnny.com.
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PACE) to access their Medicaid benefits. Enrollment into Medicaid coverage will be completed by the state’s independent enrollment broker, New York Medicaid Choice (Maximus). During the FIDA transition, effective October 2019, Medicaid plans must accept the transfer enrollment of all enrollees that select or are auto assigned to the plan. The transferring enrollee’s new plan must continue to provide services under the enrollee’s existing plan of care, and utilize existing providers, for the earlier of the following: 1) 120 days after enrollment; or 2) until the new plan has conducted an assessment and the enrollee has agreed to the new plan of care. The transferring enrollee’s new plan is required to conduct an assessment within 30 days of the transfer enrollment effective date, unless a longer time frame has been expressly authorized by the state Department of Health (DOH). By October 2, 2019, FIDA participants will receive the DOH/CMS-approved nonrenewal notice informing them that their FIDA plan is ending December 31, 2019. This letter will be mailed by the FIDA plan. By November 1, 2019, the first of two additional letters will be mailed to FIDA participants eligible for passive enrollment. Both letters will be mailed by Maximus. The first letter will be mailed 60 days prior to the effective date of enrollment. By December 1, 2019, a second 30-day notice will be mailed. These letters will list the name of the plan that the FIDA participant will be enrolled into if they do not take action with an effective enrollment date of January 1, 2020. FIDA enrollees with questions can contact Maximus (855-600-FIDA) or the Independent Consumer Advocacy Network (844-614-880).
Labor Changes Included in Final Legislative Session The state Legislature has passed three bills that will bar employers from inquiring about an applicant’s past salary history, prohibit wage differentials based on “protected class” status, and ban race discrimination based on an employee’s hair or hairstyle. Salary History The new legislation on salary history will prevent employers from orally or in writing requesting or relying on the wage or salary history of an applicant in determining whether to offer employment or the amount of salary to be offered. An employer cannot refuse to consider or retaliate against an applicant who refuses to divulge his or her salary history. The applicant may voluntarily provide this information if he or she is not coerced or promoted into doing so. The provision will take effect 180 days after enactment. The measure applies to job applicants not currently employed by the employer, as well as the employer’s current employees seeking a new position within the company. The state legislation is similar to one passed in New York City (NYC). The NYC law bans employers there from inquiring about the salary history of a job applicant. There are key differences: the NYC law prevents
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employers from “conduct[ing] a search of publicly available records or reports for the purpose of obtaining an applicant’s salary history,” and the NYC law only applies to applicants, not to current employees. Equal Pay Wage differentials based on protected class status will be prohibited by new legislation that will expand on current law. The current law protects against gender-based pay inequity by requiring equal pay for “substantially similar work” and prohibiting pay differentials based on a person’s membership in a host of protected classes, including age, race, sexual orientation, disability, and domestic violence victim status. The new legislation will lower the burden of proof for a person claiming wage or salary discrimination based on his or her protected class membership by not requiring a showing of “equal” work. Pay differentials will be permitted when they are based on a seniority system, a methodology measuring earnings by quantity or quality, or a bona fide reason other than the individual’s membership in a protected class. The pay differential must be job-related and due to business necessity, such as geography, education, or experience. Treble damages are possible under state Labor Law Section 198 for violations of this law. The law will take effect 90 days after being signed by the Governor. Race Discrimination Based on Hair or Hairstyle “Race” in the Executive and Education laws will be amended to include “traits historically associated with race, including, but not limited to, hair texture and protective hairstyles” under this legislation. Protective hairstyles include, but are not limited to, “such hairstyles as braids, locks and twists.” This measure will take effect immediately upon signing by the Governor. This state legislation follows guidance issued on the same topic by the NYC Commission on Human Rights (CCHR) in February 2019. The stated purpose is to prevent employer policies issued on the purported grounds of “neatness” that, in effect, limit “the way black people move through workplaces, public spaces and other settings.” This story is based on an online article by Jackson Lewis, HCA’s legal counsel, and used by permission. (See: https://www.jacksonlewis.com/publication/new-york-adopts-laws-aimed-combating-salary-inequality-andrace-discrimination.)
Revised Medicare HHCCN Form Required Starting July 1 The U.S. Centers for Medicare and Medicaid Services (CMS) is requiring that Home Health Agencies (HHAs) use a revised Home Health Change of Care Notice (HHCCN) starting today, July 1. The form, applicable to Medicare fee-for-service cases, has an expiration date of April 30, 2022 on the bottom. It, along with instructions, is at https://www.cms.gov/Medicare/Medicare-General-Information/BNI/ HHCCN.html. Continued on next page
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Continued from previous page The new HHCCN is very similar to the current form, except for a change in the expiration date, and the instructions no longer reference a discontinued document (the Home Health Advance Beneficiary Notice of Non-coverage). HHAs are required to provide the HHCCN whenever they reduce or terminate a beneficiary’s home health services due to physician orders or limitations of the HHA (such as staff shortages) in providing the specific service. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
HHCAHPS Preview Reports with Star Ratings Available Preview Reports reflecting the latest results from the Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) Survey are now available at https://homehealthcahps.org under the “For HHAs” tab. The results are from January 2018 through December 2018 (quarter 1 to 4). 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 this month. The Preview Reports present the publicly reported results with star ratings for those agencies with a sufficient number of completed interviews (40 or more patient surveys) to receive 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, click the login link, type in your username, click “Reset Password,” and follow the instructions. For more information about the Preview Reports, 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, go to https://homehealthcahps.org/GeneralInformation/StarRatingsInformation.aspx. Questions about the HHCAHPS star ratings or your HHCAHPS Preview Report can be directed to the HHCAHPS Survey Coordination Team at hhcahps@rti.org or (866) 354-0985.
June Edition of Capitol Report Highlights Legislative Session Finale, Pediatric Home Care, Rural Home Health Access and More HCA’s seventh edition of the monthly Capitol Report newsletter was dispatched to legislative offices last week, applauding legislators for passing home care bills on sepsis intervention and tracking protocols for aide inservice training. HCA’s Communications Director Roger Noyes also shared a message inviting legislative staff to call upon HCA for any assistance with messaging to their constituents on home care issues. This includes legislation as well as assistance with other helpful source material for constituent newsletters, press outreach, correspondence
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and other communications. He highlighted some of the post-session public-affairs work HCA conducted with legislative offices on the sepsis initiative and home care infrastructure funding that netted coverage in Crain’s Health Pulse, Politico, The Albany Times Union, the Utica Observer-Dispatch and on WRGB News Channel 6. The newsletter also announces HCA’s receipt of a 2019 Sepsis Heroes Award from Sepsis Alliance, forthcoming at a September gala event. And we highlight two prominent issues in home care service delivery: rural access to home care, which was the subject of a legislative hearing at which HCA President Al Cardillo testified in May, and pediatric home health services, which face major unique challenges according to a recent Health Affairs article on payment disparities for this specialized service demographic. We point out some of the struggles that New York State providers, patients and professionals face in line with the Health Affairs report when it comes to pediatric services. According to that report, only 2 percent of Medicaid spending for children with medical complexity has gone to home health care, driving a disparity in wages that disincentives home care for kids. HCA also shares some recommendations to fix some of these problems. You can read the May edition of the Capitol Report at https://tinyurl.com/y6ym8eas.
Home Health Agency PEPPER Review Webcast: July 18, 2019 On Thursday, July 18 at 3 p.m., the RELI Group will host a webcast to review the new Home Health Agency (HHA) Program for Evaluating Payment Patterns Electronic Report (PEPPER). This PEPPER release is scheduled for July 8, 2019 and the data will be from the fourth quarter of 2018. Registration is limited to 1,000 sites, so HHAs are encouraged to coordinate internally for group access to a single webcast connection. HCA members interested in participating can register for the webcast at: https://tinyurl.com/yxz3kedl. The session will be recorded and posted on https://pepper.cbrpepper.org/ in the HHA “Training and Resources” section within two weeks following the event. Handout for the webcast will also be posted on the website in the HHA “Training and Resources” section the day prior to the event. It will also be available via WebEx upon joining the session.
HCA Memo on NGS Hospice Advisory Updates HCA’s Vice President for Finance and Management Patrick Conole has prepared a policy memo containing updates from a recent hospice advisory meeting with National Government Service (NGS), the Medicare Administrative Contractor (MAC) for New York State. The meeting yielded key updates on: upcoming NGS education; the substance of Medicare appeals letters in the case of an unfavorable determination; medical review and appeals data; audit and reimbursement; Comprehensive Error Rate Testing (CERT) results; and more. Download the memo: https://hca-nys.org/wp-content/uploads/2019/06/062519NGSHospiceMtgSummaryFINAL.pdf.
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The Situation Report: the Home Care Association of New York State
MEETINGS & DEADLINES
10
Requirement/Change/Meeting
Effective/Due Date
More Information
Revised Home Health Change of Care Notice (HHCCN)
July 1, 2019
https://www.cms.gov/Medicare/MedicareͲGeneralͲ Information/BNI/HHCCN.html
EVV Public Listening Session in New York City
July 9, 2019, 1 to 4 p.m.
https://www.eventbrite.com/e/nycͲelectronicͲvisitͲ verificationͲevvͲregionalͲlisteningͲsessionͲregistrationͲ 63108415971
Fiscal Intermediary Workgroup meeting
July 10, 2019, 11 a.m. to 2 p.m.
akoski@hcanys.org
EVV Public Listening Session via webinar
July 11, 2019, 6 to 9 p.m.
https://www.eventbrite.com/e/electronicͲvisitͲverificationͲ evvͲregionalͲlisteningͲsessionͲwebinarͲticketsͲ63563471053
EVV Public Listening Session in Buffalo
July 17, 2019, 1 to 4 p.m.
https://www.eventbrite.com/e/buffaloͲelectronicͲvisitͲ verificationͲevvͲregionalͲlisteningͲsessionͲticketsͲ 63561169168
EVV Public Listening Session in Syracuse
July 18, 2019, 1 to 4 p.m.
https://www.eventbrite.com/e/syracuseͲelectronicͲvisitͲ verificationͲevvͲregionalͲlisteningͲsessionͲticketsͲ 63561282507
Interoperable Communications Drill Webinar
July 23, 2019, 1 to 2 p.m.
https://meetny.webex.com/meetny/j.php?MTID=m723113b30 ca6e58d5355e043d4e40cdf
EVV Public Listening Session via webinar
July 24, 2019, 9 a.m. to 12 p.m.
https://www.eventbrite.com/e/electronicͲvisitͲverificationͲ evvͲregionalͲlisteningͲsessionͲwebinarͲregistrationͲ 62614410387
CHHA Cost Report Due
July 29, 2019
https://commerce.health.state.ny.us/public/hcs_login.html; CHHAͲRates@health.ny.gov
Interoperable Communications Drill Webinar
July 30, 2019, 1 to 2 p.m.
https://meetny.webex.com/meetny/j.php?MTID=mde10f4cb2 c8638945550a240a130549c
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
Comments due on CMS Request for Information on Regulatory Relief
August 12, 2019
https://www.cms.gov/newsroom/pressͲreleases/cmsͲseeksͲ publicͲinputͲpatientsͲoverͲpaperworkͲinitiativeͲfurtherͲ reduceͲadministrativeͲregulatory
Personal Care Cost Report
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/NewͲMedicareͲ Card/index.html
Changes in MLTCͲLHCSA Contracting Limits
October 1, 2019
https://www.health.ny.gov/health_care/medicaid/redesign/mr t90/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/NewͲMedicareͲ Card/index.html
The Situation Report: the Home Care Association of New York State
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LawTalk: Best Practices for New Director Onboarding By Frank Fanshawe, Esq. and Ashley Solowan, Esq. A Board of Directors governs all not-for-profit home health agencies, managed long term care plans and hospices. There are certain best practices these boards should follow when on-boarding new members to ensure they properly carry out the organization’s mission, protect organizational assets and appropriately set the stage for how the organization will conduct itself at the highest levels. Best practices suggest organizations should have a formalized process for board of director orientation. Orientations can be formal or informal and should include the history of the organization, key accomplishments, and a review of the board’s organizational policies and procedures including emphasis on the conflicts-of-interest policy. Establishing and setting expectations from the onset affords board members an opportunity to understand their respective roles and responsibilities within the organization. Expectations can be uniform, or they can vary considerably based on the individual members’ skills, job expectations, or time commitment. New board directors should be made aware of their legal and fiduciary responsibilities and should receive a written or electronic document outlining these duties and responsibilities during the onboarding process. New board directors should also receive the most recent copies of the organization’s financial statements, meeting minutes, and the annual strategic plan. This will ensure new members are up to date on all company policies, procedures, and important fiscal matters. Following these best practices for onboarding will help ensure that new Board members are prepared to contribute in a meaningful way that is consistent with their legal duties. LawTalk is a monthly feature by attorneys at Jackson Lewis, HCA’s counsel. Please note that LawTalk articles are for general, informational purposes, are not legal “advice,” and do not create an attorneyclient 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.
July Aware Prepare Offers Preparedness Training Info, Resources The state Department of Health’s July 2019 issue of the Aware Prepare Update is now available. HCA has posted it to our website at https://hca-nys.org/wp-content/uploads/2019/07/2019_July_AP.pdf. This monthly electronic newsletter offers a guide to upcoming emergency preparedness trainings and more.
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Health Resources
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“Medicaid Alerts & Other Protocols published by the NYC HRA Medical Insurance and Community Services Administration (MICSA),” by the New York Legal Assistance Group http://www.wnylc.com/health/entry/140/
“Key Drivers Behind Continued Medicare Advantage Penetration,” by L.E.K. Consulting https://www.lek.com/sites/default/files/insights/pdf-attachments/2135-Medicare-AdvantagePenetration.pdf
“Handy Reference Guide to the Fair Labor Standards Act,” U.S. Department of Labor https://www.dol.gov/whd/regs/compliance/hrg.htm
“Medical Surge and the Role of Home Health and Hospice Agencies,” by Assistant Secretary for Preparedness and Response and Technical Resources, Assistance Center, and Information Exchange (TRACIE) https://files.asprtracie.hhs.gov/documents/aspr-tracie-medical-surge-and-the-role-of-home-healthand-hospice-full-report.pdf
“Engagement of Home Health and Hospice Agencies in Medical Surge Activities,” by Technical Resources, Assistance Center, and Information Exchange (TRACIE) https://files.asprtracie.hhs.gov/documents/aspr-tracie-engagement-of-home-health-and-hospiceagencies-in-medical-surge-activities-q-and-a.pdf
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