FI WORKGROUP
EVV
CHRC
HEALTHY NEIGHBORHOODS
New PMPM payment change foremost among concerns as state workgroup examines Fiscal Intermediary bestpractices in third meeting.
HCA stakes out recommendations at NYC listening session on implementation of electronic visit verifications, including: timetable, funding support, guidance clarity, and “provider choice” option.
Starting August 1, the fingerprinting processing fee is going up to $13.50 for criminal history record checks.
DOH to make 15-20 contracts available, at up to $275k annually, under grants directed toward county governments, partner organizations to provide environmental health services.
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UPCOMING PROGRAMS 6 HCA Strategy Sessions Coming to You This Summer on Next-stage DSRIP, MRT II & More July 16 (Albany) July 17 (Utica) July 24 (Rochester) Aug. 6 (Newburgh) Aug. 13/14 (NYC) Aug. 20 (Farmingdale) 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 22, August 5 and August 19. We will alert you, as always, by e-mail for breaking news.
Your Source for HOME CARE News, Policy and Advocacy
Vol. 4, Issue 27| July 15, 2019
2020 Proposed Rule Maintains PDGM With 8% Behavioral Adjustment Immediate, all-out advocacy needed! As announced in an alert last week to the membership, the U.S. Centers for Medicare and Medicaid Services (CMS) on Thursday, July 11, posted its highly anticipated proposed 2020 payment rule for home health. The proposal substantially leaves the Patient Driven Groupings Model (PDGM) intact from last year’s rule, including the so-called “behavioral-adjustment” cuts that have been a target of HCA and industry advocacy. See RULE p. 3
Join HCA This Week in Albany and Utica, then Rochester, Newburgh, NYC & Farmingdale for Important Regional Strategy Sessions Sessions to be led by HCA VP Rebecca Fuller Gray and Policy Team colleagues HCA’s summer regional strategy sessions begin this week in Albany and Utica, followed by five other meetings statewide to hear from members on the best ways to represent home care in the next stages of DSRIP, MRT II and other big upcoming policy discussions. See STRATEGY p. 2
INSIDE 2020 Proposed Rule Maintains PDGM, Plus 8% Behavioral Adjustment...............1 Join HCA This Week in Albany and Utica for Regional Strategy Sessions...............…1 HCA Presses PDGM-Correction Bill in D.C.............................................................5 Member Hiring Announcement…........................................................................5 OIG Releases Two Reports on Hospice Quality of Care, Enforcement Actions......…6 FI Workgroup Holds Third Meeting in Aftermath of New PMPM Guidance…............7 Update on FI PMPM.................................................................................8 Home Care Innovations Wanted...................................................................9
HCA Participates at EVV Listening Session…..................................................9 CHRC Fee Increases.................................................................................11 DOH Provides Updates on MLTC Policy Issues…...........................................11 Upcoming Deadlines................................................................................13 US DOL Issues New Opinion Letters…............................................................14 UAS-NY Will Upgrade to Version 1.6…..........................................................14 ‘Healthy Neighborhoods’ Grant RFA Announced..........................................15 PHHPC Committee Posts Agenda…..............................................................16
The Situation Report: the Home Care Association of New York State STRATEGY from p. 1 Providers in the northeast and central New York regions are urged to register today for the first of these programs tomorrow and Wednesday: on July 16 in Albany and July 17 in Utica. These will be followed by stops in the following locations:
Rochester (7/24)
Newburgh (8/6)
NYC (8/13 for LHCSAs and 8/14 for CHHAs)
Farmingdale (8/20)
Please pick the session closest to you and register today so that we can be ready to hear from you at the link below: https://www.surveymonkey.com/r/regionalsess2019. As you know, 2020 marks a threshold period for the state’s Delivery System Reform Incentive Payment (DSRIP) program and Value Based Payment (VBP) performance aims. It is imperative that home care seize a more active role in any successor programs or waiver renewal efforts as these programs transition. All of these changes, meanwhile, lay against a backdrop of the state possibly reconvening an MRT version II for further remodeling amid the continued threat of global cap funding actions that remain the legacy of MRT I. Each of our six regional sessions include separate segments for CHHAs and LHCSAs led by HCA’s Executive VP for Clinical and Program Affairs Rebecca Fuller Gray and HCA Policy Team colleagues. Please also see here our sheet of potential discussion questions to help prepare: https://hca-nys.org/wpcontent/uploads/2019/07/HCA-Summer-Regional-StrategySessions-for-Home-Care-Discussion-Questions.pdf. Home Care Association of New York State (HCA) 388 Broadway, 4th Floor, Albany, NY 12207 Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org
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The Situation Report is a weekly publication of the Home Care Association of New York State (HCA). Unless otherwise noted, all articles appearing in The Situation Report are the property of the Home Care Association of New York State. Reuse of any content within this newsletter requires permission from HCA. Al Cardillo President and CEO acardillo@hcanys.org Roger L. Noyes Director of Communications, Editor of The Situation Report rnoyes@hcanys.org Rebecca Fuller Gray Executive V ice President for Clinical and Program Affairs rgray@hcanys.org Patrick Conole Vice President, Finance & Management pconole@hcanys.org Andrew Koski Vice President, Program, Policy & Services akoski@hcanys.org Alyssa Lovelace Director for Policy and Advocacy alovelace@hcanys.org Lauren Ford Director of Program Research, Development and Policy lford@hcanys.org Laura Constable Senior Director, Membership & Operations lconstable@hcanys.org Celisia Street Director of Education cstreet@hcanys.org Mercedes Teague Finance Manager mteague@hcanys.org Jenny Kerbein Director of Governance & Graphic Design jkerbein@hcanys.org Billi Wilson Manager, Meetings & Events bwilson@hcanys.org Teresa Brown Administrative Assistant tbrown@hcanys.org
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RULE from p. 1 While a -6.42 percent behavioral-adjustment had been suggested in previous CMS communications, the proposed rule goes further with a stunning -8.01 percent downward adjustment. The adjustment has three parts affecting: clinical group coding; comorbidity coding; and presumed extra visits by agencies seeking to surpass the Low Utilization Payment Adjustment (LUPA) threshold. As extensively reported since the introduction of the PDGM model, the behavioral-adjustment cuts – only now delineated at specific levels for the first time – are being proposed at the outset of PDGM under the assumption that providers will alter their coding and claims practices in order to gain higher payments or to bypass new financial disincentives or corrections when PDGM is rolled out on January 1, 2020. HCA and colleague associations have argued that there is no reasonable statistical justification for such cuts based on unforeseeable predictions; these deeper reductions in the newly announced 2020 proposal will only further destabilize the home health sector from the outset at a time when agencies are working to adapt to an entirely new model. HCA has repeatedly pressed for easing or elimination of the behavioral-adjustment cut in advocacy with New York’s Congressional Delegation, including visits last week in Washington, D.C. by HCA’s Director for Public Policy and Advocacy Alyssa Lovelace who met with Congressional offices on this priority payment issue. (See related p. 5 story.) In support of this effort to curtail the behavioraladjustment cuts, a bipartisan group of legislators has introduced a bill (S.433/H.R.2573) allowing
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for reimbursement adjustments such as these only after behavioral changes do, indeed, occur, rather than merely anticipating or assuming prospectively that behavior will change. The bill also limits “behavioraladjustment” rate cuts to two percent per year under PDGM, a major difference from what CMS is now proposing. In recent months, HCA created an advocacy campaign on this legislation, which so far has engaged 500 HCA members in reaching Congress to urge the bill’s passage. With CMS now proposing an even more draconian level of cuts, we will further redouble our effort on a Congressional intervention. Please be on the lookout for grassroots advocacy tools aimed at this outcome. Other details At nearly 400 pages, the proposed rule will require extensive analysis by HCA to further detail the effect on providers. HCA is further reviewing the rule and will soon begin a detailed policy memo summarizing its various components. Below are some additional details thus far identified from our preliminary review.
For 2020, the proposed rule includes a market-basket update of 1.5 percent, as mandated by the Balancing Budget Act of 2018. CMS indicates that overall payments will increase by about $250 million.
CMS is implementing a dramatic measure – ostensibly for integrity purposes – that would eliminate Requests for Anticipated Payments (RAPs) which agencies rely on for cash flow. Under the proposal, RAP payments for existing providers would be phased out over the next year and
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eliminated completely for 2021; new providers would receive no RAP payments. For existing providers, CMS would reduce the RAP payments to 20 percent in 2020.
CMS also “solicits comments on the wage index used to adjust home health payments and suggestions for possible updates and improvements to the geographic adjustment of home health payments.” HCA has repeatedly taken issue with CMS’s wage index due to the distorted market-area definitions that CMS uses in these calculations and the incompatibilities between hospital cost-reporting and labor mix as compared to other settings. We will use this opportunity to further press our call for reform of the wage index.
CMS continues its policy (from 2019) of a tiered rural add-on calculation, depending on population density or whether an agency is deemed to be in a high utilization county. Agencies in so-called “frontier” counties (those with fewer than seven persons per square mile) will see their add-on decrease from 4 percent to 3 percent. The add-on for counties classified as “high utilization” will drop from 1.5 percent to 0.5 percent; and the remaining counties will drop from 3 percent to 2 percent. A phase out will continue in later years.
Other components of the proposed rule include revisions to the Home Health Quality Reporting Program and a new permanent home infusion therapy benefit that HCA will further detail in our upcoming memo.
Two PDGM Sessions at September Finance Retreat HCA is finalizing the program for our highly anticipated Senior Financial Managers Retreat in New Paltz on September 5 and 6. It will contain two sessions on PDGM, including a final-stage PDGM readiness checklist to help ensure that you’ve considered what’s necessary to succeed, plus a comparative analysis of financial outcomes (pre- and post-PDGM) based on benchmark data using 2017-2018 claims data. All HCA member CEOs, CFOs, finance managers and others with budgeting responsibility and finance planning roles should attend. Please save the dates and be on the lookout for registration information soon. Comments on CMS’s proposal are due September 9. While this comment period is an important opportunity for HCA and others to weigh in on the proposed rule, the severity of this payment regimen will require immediate advocacy from HCA and our federal partners, as well as outreach by individual agencies within the HCA membership to members of Congress. Please be ready to respond to action alerts and other important notifications as we press changes within CMS and as we further mobilize action from Congress on a sensible, budget-neutral approach to the new methodology.
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HCA Presses PDGM-Correction Bill in D.C. Congressional meetings urge co-sponsorship of legislation eliminating behavioral-adjustment cuts Included in the 2020 home health payment rule On the eve of the new 2020 payment proposal getting released, HCA’s Director for Public Policy and Advocacy Alyssa Lovelace joined HCA’s federal government-affairs representative, Brett Heimov of Envision Strategy, to meet with Congressional offices urging co-sponsorship of a bill to mitigate cuts proposed by the U.S. Centers for Medicare and Medicaid Services (CMS). The team met with the offices of Reps. Brian Higgins, Thomas Suozzi, Paul Tonko, Yvette Clarke and Nita Lowey on legislation (H.R. 2573/S.433) that would specifically eliminate the “behavioral-adjustment” cuts included in the proposed 2020 payment rule for home health. During the meetings, Lovelace and Heimov provided updates on the payment rule to the legislative staff and urged the Representatives to co-sponsor H.R. 2573. With the 2020 home health payment rule implementation date expected in January, HCA called for lawmakers to act swiftly and stressed the importance of eliminating the behavioral-adjustment as soon as possible due to the detrimental effects the payment reduction would have on already stressed providers. Lovelace invited the representatives and staff to join their provider constituents for in-home visits and calls
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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with providers in the coming weeks so representatives can learn first-hand about the impacts this payment rule will have on the home care providers in their districts. At this time, we remain confident that the representatives will support and sign-on to the bill – particularly because CMS released the final 2020 payment rule for home health the same day, leaving the Patient Driven Groupings Model (PDGM) intact from last year’s rule, including the behavioral-adjustment reductions. However, this rule increases the behavioral-adjustment from -6.42 percent to -8.01 percent (see related p. 1 story.) For questions or concerns about these Congressional meetings and HCA’s legislative and advocacy strategies, please contact Alyssa Lovelace, alovelace@hcanys.org, (518) 810-0658.
OIG Releases Two Reports Examining Hospice Quality of Care Concerns and Enforcement Actions The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently released two reports representing an in-depth study of findings from hospice quality surveys from 2012 through 2016. One report provides broad findings on frequencies of deficiencies and recommends greater public access to survey findings as well as increased CMS-sponsored education for hospice providers. The second report describes 12 cases that represent significant harm to hospice patients. OIG made several recommendations in both reports to strengthen safeguards to protect Medicare hospice beneficiaries from harm and to ensure hospices are held accountable for deficiencies in their programs. The two reports are at the following links:
https://oig.hhs.gov/oei/reports/oei-02-1700020.asp?utm_source=mmpage&utm_medium=web&utm_campaign=OEI-02-17-00020
https://oig.hhs.gov/oei/reports/oei-02-1700021.asp?utm_source=mmpage&utm_medium=web&utm_campaign=OEI-02-17-00021
These reports reflect a wide range of deficiencies and accountability issues. HCA joins our federal association colleagues who represent hospice in urging a targeted approach that focuses corrective action on the most dramatic instances of patient-care failings identified by OIG. We likewise support OIG’s recommendation for further education, so that providers understand the intricacies of any regulatory issues that result in deficiency citations. We will be examining these reports for further specific areas to include in our compliance education programming.
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FI Workgroup Holds Third Meeting in Aftermath of New PMPM Guidance Just days after issuing a major guidance on fiscal intermediary (FI) payment changes, the state Department of Health (DOH) held a third FI workgroup meeting with stakeholder representatives, including HCA, FIs, managed long term care (MLTC) plans, local departments of social services (LDSS), association representatives, and consumers. As we reported in an alert to members last week, DOH announced for the first time its per-member permonth (PMPM) payment tiers for FI administrative expenses, which go into effect September 1. Please see our alert at https://tinyurl.com/y5pewq9a. Please also see related story on next page. Though the PMPM issue is not in the purview of the Workgroup, this issue was foremost on many stakeholders’ minds. Representatives made the point that the reduction in payment for administrative expenses threatens their current operations, including the kinds of best-practices that the Workgroup is charged with examining for broader procedural application. Among the practices discussed at the meeting were: changing the reauthorization period from every six months to once a year and eliminating the annual TB test. The group also discussed the necessity for standard forms for referring a consumer to an FI and for assessing the ability of consumers to fulfill their responsibilities; and timeliness standards for “onboarding” – the days between receipt of an authorization and the date that services begin. In addition, there was a lengthy discussion about how to measure quality in the Consumer Directed Personal Assistance Program (CDPAP), including the use of satisfaction surveys; timely payroll processing; tracking and monitoring complaints; avoiding preventable hospitalizations and emergency room visits; and compliance with wage and other labor requirements. The meeting also addressed the selection criteria for FIs seeking to contract with the state under the new procurement process (to be released sometime in the fall). Some of these were included in the final state budget: ability to appropriately serve individuals participating in the program; a geographic distribution that ensures access in rural and underserved areas; demonstrated cultural and language competencies specific to the population of consumers and those of the available workforce; ability to provide timely consumer assistance; experience serving individuals with disabilities; availability of peer support; and demonstrated compliance with all applicable federal and state laws and regulations, including wage and labor. Some additional criteria suggested by Workgroup members included: adherence to the Americans with Disabilities Act; having some type of local/regional presence; length of time an FI has been operating; number of contracts with MLTCs and/or LDSSs; a robust compliance program; demonstrated consumer satisfaction with FI and personal assistants; and training offered by FIs to consumers and personal assistants (this generated a long discussion). The next meeting on August 7 is expected to cover the transition process for consumers whose FI decides to no longer provide services or to leave a service area as well as workgroup recommendations for FI selection and contracting criteria. Meanwhile, HCA is developing a series of recommendations for the Workgroup and seeks any suggestions from our members.
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Update on FI PMPM Last week, HCA received an update on the new per-member-per-month (PMPM) payment for fiscal intermediary (FI) administrative services in a call with the state Department of Health (DOH) and other provider associations that represent managed long term care (MLTC) plans. The call was held to obtain clarification on DOH’s Managed Care Policy 19.01 which implements, effective September 1, 2019, a PMPM payment system for FIs’ administrative services under the Consumer Directed Personal Assistance Program (CDPAP). You can read Policy 19.01 at https://hcanys.org/wp-content/uploads/2019/07/Policy-Guidance-FI-PMPM-and-Transition-Provisions7.1.19_.pdf. DOH said the contract amendments that MLTC plans send to their contracted FIs should include a wage component and a separate administrative component. For the administrative component, plans can decide whether or not to use the three-tiered approach and associated payment amounts outlined in DOH’s guidance, or negotiate administrative rates which may, or may not need to be, PMPM rates. DOH stated that the adjustment to plans’ rates – to account for the PMPM changes – will be riskadjusted and included in the July plan rates. DOH hopes to finalize and release these rates in late August or early September. DOH stipulated their intent that there be no reconciliation associated with the new FI payment process, as there has been previously for minimum wage funding. HCA expressed very serious concerns about the unknown impact of the reduced rates on MLTCs and in turn the providers/FIs (through the PMPM rate schedule provided by the Department), and the overall impact on MLTC rate adequacy. HCA expressed further our concern that uncertainties in the rates and rate adequacy – combined with the compressed timeframe for sending out contracts and receiving signed copies in time for the September 1 deadline – would exacerbate the annual difficulties that plans and providers have been presented in the contracting/rate negotiation process. Accentuating these concerns are the need for the state to release new rate codes and a template for FIs that are closing or leaving a service area to give to their affected CDPAP consumers. HCA also pointed out the potential dislocation this change will have for FIs, plans and consumers. HCA is developing a series of recommendations for the FI Workgroup (see separate p. 7 story) and will keep members informed of any new developments.
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Home Care Innovations Wanted At a time of reimbursement cuts/constraints, new care models and performance mandates, home care must demonstrate how it is doing its part — how it is truly innovating. During HCA’s upcoming summer regional strategy sessions (see related p. 1 story), we’ll be asking you to share your innovations for possible modelling in upcoming policy discussions. This is vital in the context of state waiver and cost-containment efforts. We must ensure that reforms draw upon home care’s strengths rather than create hardships. We also invite your contributions on unique program innovations for our monthly Capitol Report newsletter which is distributed on the last Wednesday of every month to legislative offices. This feature is a great way for legislators to see the work you are doing. Please send these summaries to HCA’s Communications Director Roger Noyes at rnoyes@hcanys.org. Innovation: What It Is, What It Isn’t In a recent blog post on the subject, HCA’s Communications Director Roger Noyes lays out five core principles that should be a part of your innovation summary and substance. “Innovation is as much a communications issue as it is a content or substance issue,” he writes, outlining five core principles. An innovation must: 1. Have a name (or be nameable 2. Have a “methodology” (not just “methods”) 3. Be served by technology, and not merely be a technological service 4. Have structural specificity 5. Have measurable (and measured) outcomes that align with larger system-wide policies Please read the article and sample innovation project (https://tinyurl.com/y4yrqxm9) and consider these core concepts as a roadmap for developing and communicating your innovation to lawmakers and the public.
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HCA Participates at EVV Listening Session Last week, HCA attended the state Department of Health’s Electronic Visit Verification (EVV) Listening Session in New York City and presented recommendations for EVV implementation. We advocated that: 1. New York should adopt the “Provider Choice” model under which providers can select an EVV vendor of their choice. We believe that this would allow existing utilizers of EVV and verification organizations to continue to use their current vendors (as long as they meet general requirements about what must be measured, etc.) and thus not face a disruption in their services or added costs. 2. Simplicity and ease of use are important attributes of any system and potential connectivity to an agency’s electronic health record. 3. There should be adequate time (at least six months) to implement the EVV requirement, particularly for those who have to change their electronic health record vendor and/or EVV vendor (if the state approves only some vendors) or select an EVV vendor for the first time. 4. New York State should request a one-year delay in EVV
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implementation to ensure that adequate time is given to the state to roll it out and for providers to meet this new mandate. 5. The state needs to ensure funding is available to home care providers to help pay for the EVV requirement. The $10 million included in the 2019-20 state budget for EVV implementation should be targeted to provider costs for EVV. 6. DOH should promulgate clear and timely guidance on any EVV requirements, including but not limited to: the implementation deadline; who can be an EVV vendor; what EVV must track and how this differs from what is done now by verification organizations (for organizations that use VOs voluntarily or due to state requirements applicable to providers of a certain size); where information must be sent; etc. 7. DOH should convene a workgroup so that HCA and other stakeholders will have the opportunity to provide feedback on any EVV guidance and on the various stages by which the state implements EVV. 8. DOH should be sensitive to any unique issues related to consumer directed services. This would include allowing for the location to include the “Home” or “Community” or “Both” (workers’ login devices can be used at multiple locations, including community settings) to ensure that EVV can be used for consumers who receive services outside of the home. As we have communicated to members on numerous occasions, the federal CURES Act requires states to use an EVV system for personal care, including consumer directed services (starting January 1, 2020), and for home health care services (starting January 1, 2023). DOH is holding listening sessions across the state to obtain stakeholder input on EVV implementation even as it intends to request a one-year delay under a “good-faith” clause allowed by the federal government for states that “encounter unavoidable system delays.” The NYC Listening Session was attended by many consumers who receive services under the Consumer Directed Personal Assistance Program (CDPAP) and who spoke vehemently against the EVV requirement. They said that it would reduce the pool of personal assistants, particularly immigrants, who don’t want to be “monitored” by EVV. Some said EVV would threaten the consumer’s ability to live an independent life at home and in the general community. DOH has established 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 also has a website dedicated to EVV at https://www.medicaid.gov/medicaid/hcbs/guidance/electronic-visit-verification/index.html. Agencies are encouraged to complete a survey that DOH has developed on EVV. It is at https:// www.health.ny.gov/health_care/medicaid/redesign/evv/docs/2019_readiness_survey.pdf.
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CHRC Fee Increases The state Department of Health (DOH) has announced that, effective August 1, 2019, the fingerprinting processing fee for Criminal History Record Checks (CHRCs) will increase by $1.50 as the Idemia administrative fee increased to $13.50. DOH reminds providers that, under Public Health Law Article 28-E, Section 2899-a(11), “no provider shall seek, directly or indirectly, to obtain from a prospective employee, temporary employee or employee compensation in any form for the payment for the fee or any facility costs associated with obtaining the criminal history information check required by this article.” The DOH guidance is at https://hca-nys.org/wp-content/uploads/2019/07/DAL_CHRC-Fee-Increase_071119.pdf. DOH had issued payments for agencies’ 2017 CHRCs in February 2019 and will issue a Dear Administrator Letter when it plans to reimburse for 2018 CHRC costs. Agencies are reminded to verify that their information in the Statewide Financial System (SFS) and the Health Commerce System Communications Director is accurate. For assistance with the SFS, contact the Help Desk at 855-233-8363 or HelpDesk@sfs.ny.gov.
DOH Provides Updates on MLTC Policy Issues Last week, the state Department of Health (DOH) briefed managed long term care (MLTC) plans and MLTC member associations on a variety of policy issues. The meeting included an update on the new payment methodology for fiscal intermediary administrative services and electronic visit verification (see separate related articles for details), along with the following additional highlights below. FIDA Updates DOH issued the Fully Integrated Duals Advantage (FIDA) phase-out plan on June 24. Based on FIDA’s December 31, 2019 end date, the following timeline is currently underway:
DOH posts phase-out plan for public comment until July 22, 2019. DOH will review comments between July 22 and August 5, 2019. DOH submits phase-out plan to CMS no later than August 5, 2019. CMS expects to approve phase-out plan by August 19, 2019. DOH and CMS begin implementing phase-out plan on August 26, 2019.
DOH is seeking to transition FIDA enrollees to new fully integrated care models for dual-eligibles, and to expand enrollment in these new models significantly across the state. HCA has reviewed DOH’s preliminary concepts in prior issues of The Situation Report. Enrollment of individuals in these new models will have major implications for plans, providers of all types, and patients. HCA has
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participated in preliminary DOH briefings and is working to queue a special session with DOH on the planned model at HCA’s upcoming September 5 to 6 Senior Financial Managers Retreat. HCA and members will need to be prepared for extensive input and reaction to the state’s workplan as the DOH proposals and framework continue to take shape in both DOH and in its negotiations with CMS. Right to Information on Home and Community-Based Services On May 29, DOH published a proposed regulation in the New York State Register to codify the roles and responsibilities of nursing home facilities to ensure that individuals know their right to receive services in the least restrictive setting. Comments are due to the Department by July 29, 2019. Person-Centered Planning Trainings DOH shared information on its Person-Centered Planning Comprehensive System Transformation Statewide Training Initiative. These trainings can be found at http://www.cvent.com/events/ learning-institute-capital-region/event-summary-71416b761e4044d191ba88ef81b4ef17.aspx and can be filtered by training type, region, or specific location. United Healthcare -MLTC Updates United Healthcare Personal Assist MLTC Plan has given notice of its intent to close its MLTC plan. The target date for closure is September 1, 2019. The counties affected by the United Healthcare MLTC closure are Bronx, Kings, New York, Queens, and Richmond. Enrollee notices were mailed on June 18, 2019. Enrollees must choose a new plan by August 20, 2019. Those enrollees who do not choose a new plan will be auto-enrolled into a new plan on August 14, 2019. Enrollees can call Maximus up until August 31 to choose a plan for September 1, 2019. Enrollees will receive 120 days of continuity of care as indicated in MLTC Policy 17.02. Statewide Enrollment The following are enrollment numbers and the percentage changes in enrollments from June 2018 to June 2019:
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MLTC Partial Cap Plans – 235,945 members, up 13.09 percent. PACE – 5,776 members, up 2.10 percent. MAP – 15,977 members, up 47.89 percent. MA – 5,175 members, down 20.63 percent. FIDA – 2,812 members, down 27.80 percent. FIDA IDD – 1,300 members, up 38.15 percent. Total – 266,985 members, up 16.12 percent.
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UPCOMING Deadlines
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Requirement/Change/Meeting
Effective/ Due Date
More Information
EVV Public Listening Session in Buffalo
July 17, 2019, 1 to 4 p.m.
https://www.eventbrite.com/e/buffaloͲelectronicͲvisitͲverificationͲevvͲregionalͲlisteningͲ sessionͲticketsͲ63561169168
EVV Public Listening Session in Syracuse
July 18, 2019, 1 to 4 p.m.
https://www.eventbrite.com/e/syracuseͲelectronicͲvisitͲverificationͲevvͲregionalͲlisteningͲ sessionͲticketsͲ63561282507
Interoperable Communications Drill Webinar
July 23, 2019, 1 to 2 p.m.
https://meetny.webex.com/meetny/j.php?MTID=m723113b30ca6e58d5355e043d4e40cdf
EVV Public Listening Session via webinar
July 24, 2019, 9 a.m. to 12 p.m.
https://www.eventbrite.com/e/electronicͲvisitͲverificationͲevvͲregionalͲlisteningͲsessionͲ webinarͲregistrationͲ62614410387
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=mde10f4cb2c8638945550a240a130549c
2019 Adult Care Facility 2nd Quarter Statistical Information Report
July 31, 2019
https://commerce.health.state.ny.us
Criminal History Record Check Fee Increase
August 1, 2019
https://hcaͲnys.org/wpͲcontent/uploads/2019/07/DAL_CHRCͲFeeͲIncrease_071119.pdf
Fiscal Intermediary Workgroup meeting
August 7, 2019, akoski@hcanys.org 11 a.m. to 2 p.m.
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/cmsͲseeksͲpublicͲinputͲpatientsͲoverͲ paperworkͲinitiativeͲfurtherͲreduceͲadministrativeͲregulatory
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/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
The Situation Report: the Home Care Association of New York State
Volume 4, No. 27 July 15, 2019
US DOL Issues New Opinion Letters On July 1, the U.S. Department of Labor (DOL) issued three new opinion letters that address compliance issues related to the Fair Labor Standards Act (FLSA). An opinion letter is an official, written opinion by the Department’s Wage and Hour Division (WHD) on how a particular law applies in specific circumstances presented by the individual person or entity that requested the letter. The opinion letters issued are:
FLSA2019-7, addressing the calculation of overtime pay for nondiscretionary bonuses paid on a quarterly and annual basis (https://www.dol.gov/whd/opinion/FLSA/2019/2019_07_01_07_FLSA.pdf).
FLSA2019-8, addressing the application of the highly compensated employee exemption to paralegals employed by a trade organization (https://www.dol.gov/whd/opinion/FLSA/2019/ 2019_07_01_08_FLSA.pdf).
FLSA2019-9, addressing permissible rounding practices for calculating an employee’s hours worked (https://www.dol.gov/whd/opinion/FLSA/2019/2019_07_01_09_FLSA.pdf).
DOL offers a search function (https://www.dol.gov/whd/opinion/search/fullsearch.htm) allowing users to search existing opinion letters by keyword, year, topic, and a variety of other filters. DOL also encourages the public to submit requests for opinion letters (https://www.dol.gov/whd/opinion/) to obtain an opinion or to determine whether existing guidance already addresses their questions. The Division exercises its discretion in determining whether and how it will respond to each request.
UAS-NY Will Upgrade to Version 1.6 Training must be completed by August 5 An online upgrade to the Uniform Assessment System (UAS-NY) software will begin on Thursday, August 1, 2019 at 5 p.m. through August 2 at 8 a.m. at the latest, according to the state Department of Health. (The system may be available sooner.) During this time, as the software is upgraded to version 1.6 (v.1.6), both the online and offline applications will be unavailable. DOH is also releasing v.1.6 of the UAS-NY Offline Application/Client. This is a required upgrade for all Offline Client users. Complete instructions for upgrading the UAS-NY Offline Application to v.1.6 will be available in the UAS-NY Training Environment References and Resources 8500 Online and Offline Application by close of business Friday, July 19, 2019. DOH suggests that you read the instructions in their entirety before updating/installing v.1.6. Providers should not upgrade to offline v.1.6 before close of business August 1, as it will not work until the online upgrade is complete. Continued on next page
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The Situation Report: the Home Care Association of New York State
Volume 4, No. 27 July 15, 2019
Continued from previous page Education DOH is offering revised training materials in the Training Environment to assist with the release of version 1.6. Courses that are affected by the new training content will be moved from “Required” to “Recommended” courses and updated to read “Not Complete”. The courses must be completed by August 5, 2019; otherwise, users will not be able to access the UAS-NY until they do so. Courses with new/revised content include the following:
1100 UAS-NY Interface 1250 Indicating a Program or Plan Enrollment 1300-Using the UAS-NY to Conduct Assessments
For questions or additional information, contact the UAS-NY Project Team at (518) 408-1021 or uasny@health.ny.gov.
‘Healthy Neighborhoods’ Grant RFA Announced for Counties, Community Partners HCA is notifying members of $3.9 million in anticipated annual state grant funds becoming available as part of the state’s Healthy Neighborhoods Program (HNP). The newly announced Request for Applications (RFA) is called “Healthy Neighborhoods Preventive Health Cornerstones.” Questions on the RFA are due July 26, just under two weeks from now. While these grants are restricted to county and city health departments with qualified environmental health staff, the RFA specifically requires the involvement of “at least three other community, government, or faithbased organizations in the development and implementation of this project,” which is designed to provide preventive environmental health services to targeted geographic areas. This opens a few avenues for HCA member participation. First, HCA members who are county-government-sponsored agencies may be especially interested in this grant opportunity for direct eligibility. Second, HCA also encourages all non-government home care agencies to contact their counties or cities about possibly collaborating under this grant as one of the three required community partner organizations, as described above. The state Department of Health anticipates that 15 to 20 contracts will be awarded as a result of this RFA over a five-year cycle (April 1, 2020 to March 31, 2025). Each contract will be funded at a maximum award of $275,000 per year. More information and the RFA are here: https://grantsgateway.ny.gov/intelligrants_NYSGG/module/nysgg/ goportal.aspx?NavItem1=4&ngoID=5001440.
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The Situation Report: the Home Care Association of New York State
Volume 4, No. 27 July 15, 2019
PHHPC Committee Posts Agenda The state Department of Health (DOH) has posted the agenda for the July 18 meeting of the Public Health and Health Planning Council (PHHPC) Committee on Establishment and Project Review. The agenda and supporting documents are at https://www.health.ny.gov/facilities/ public_health_and_health_planning_council/meetings/2019-07-18/. The following Licensed Home Care Services Agency (LHCSA) applications will be discussed:
Two entities to become a LHCSA associated with an Assisted Living Program (ALP).
Change in ownership with consolidation/merger of two LHCSAs.
All Committee and full Council meetings are webcast at https://www.health.ny.gov/events/webcasts/. Once acted upon at the committee level, the applications will go to the full PHHPC for review at its August 8 meeting.
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