EVV BILL SIGNED
CONTRACT GUIDANCE
ESSENTIAL PERSONNEL
LAWTALK
President Trump signs a bill to delay implementation of electronic visit verification requirements until 2020.
The state is poised to release guidance outlining criteria for MLTCs implementing the contracting limits with LHCSAs, along with enrollee notification, access-to-care and other requirements. HCA weighs in.
HCA meets with legislators, stakeholders on implementation of essential personnel statue. Join us for Sept. 27 program on emergency prep.
Experts from Jackson Lewis offer latest installment of their LawTalk column on effective and compliant quality assurance performance improvement requirements.
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UPCOMING PROGRAMS Webinar: The Aide’s Role in Caring for Older Adults in Home Care (Aug. 9) Webinar: New and Changed ICD-10CM Codes (Aug. 14) Senior Financial Managers Retreat (Sept. 6 & 7) New Paltz Ready and in Command: Hot Topics and BestPractices in Emergency Preparedness (Sept. 27) Troy Register at https:// hca-nys.org/ events-education/ upcoming-events
Your Source for HOME CARE News, Policy and Advocacy
Vol. 3, Issue 32 | August 6, 2018
HCA President Cunningham Announces Departure for National Home Care Post, Inspired by HCA Members, Proud of the HCA Team, and Confident of Continued Association Strength In a special July 26 announcement to HCA members, HCA President Joanne Cunningham and the HCA Board of Directors announced that Ms. Cunningham will be departing as President of HCA at the end of August to assume a new position as Executive Director of the Partnership for Quality Home Healthcare. The Partnership is a national organization based in Washington, DC that works collaboratively with Congressional and federal representatives to ensure access to quality home health care services for all Americans. It represents nearly 3,000 home health agencies nationwide on reforms to improve the integrity, quality and efficiency of home health care for the nation’s Medicare population. “My past 11 years at HCA have been enormously fulfilling, in great part because of HCA’s members, who have inspired me with their passionate, exceptional dedication to home care and hospice patients and services,” Ms. Cunningham said. “A new opportunity, See CUNNINGHAM p. 2 The Situation Report is on a biweekly summer schedule. Our next edition will be on August 20. HCA will notify you of breaking news by e-mail alert.
INSIDE HCA President Cunningham Announces Departure........................................1 President Signs EVV Delay Legislation............................................................3 A Special Message From HCA Sponsor RBC Limited..........................................3 HCA Comments on Draft MLTC-LHCSA Contract Limit Guidance.........................4 PHHPC Approves AHHA Regs........................................................................5 HCA Provides Detailed Memo on FY 2019 Hospice Payment Rule......................6 HCA Comments on Proposal to Reinstate Pre-Claim Review.............................6 Critical Updates on LHCSA-MLTC Changes and More on 9/6-7........................ 7 OIG Report Scrutinizes Hospice.....................................................................8 Member Hiring Announcement.....................................................................8
Legislature Convenes Collaborative Meeting on “Essential Personnel” Bill.....9 LawTALK: Effective and Compliant QA/PI Programs........................................11 Upcoming ICD-10, OASIS Programs Help Ensure Clinical Accuracy, Compliance....12 New Medicare Cards Mailed to New York Beneficiaries.................................13 DOH Updates FAQs on Value Based Payments for Managed Care Plans............14 Guidance Issued on ‘Temporary Schedule Changes’ for NYC Employees...........15 Upcoming Deadlines...................................................................................16 New Medicaid Timely Billing Webinar: August 17..........................................17 CMS Updates Hospice “Public Use File” Data................................................17 May Global Cap Report: Medicaid Spending $13M Above Projections...........18 Resources.......................................................................................19
The Situation Report: the Home Care Association of New York State CUNNINGHAM from p. 1
however, has welcomed me to continue my work in home care, this time on a national level.” “I am very proud of all we’ve accomplished in my time at HCA, working with the membership and an exceptional HCA staff team who are truly the experts at what they do,” Ms. Cunningham added. “You can be assured that I am leaving New York’s largest home care association in capable hands with an incredible team of staff, a committed Board of Directors, and an engaged membership.” HCA’s Board of Directors Chair Susan Larman, CEO of VNA Home Health, said the HCA Board will be mapping out a transition process. “HCA’s extraordinarily strong and resilient team is well prepared to manage this transition and continue delivering on HCA’s committed member service in the policy, advocacy and education areas,” Ms. Larman said. “I thank Joanne for all she has accomplished in nearly a dozen years at HCA, especially her work to build an HCA team and organizational structure that is equipped for this next step as she assumes a home care leadership position at the national level.” She added: “The board has appointed Al Cardillo as Interim HCA President, effective August 22, with full confidence in Al’s leadership ability to move forward with HCA initiatives, continually keeping the best interest of the membership in the forefront.” HCA will be keeping the membership up to date on all facets of this transition process as the Board and HCA team prepare for Ms. Cunningham’s departure and this next stage for HCA.
Volume 3, No. 32 August 6, 2018
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 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
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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President Signs EVV Delay Legislation President Trump has signed legislation extending the deadline for state Medicaid programs to implement Electronic Visit Verification (EVV) for personal care services (including consumer-directed services) from January 1, 2019 to January 1, 2020. The legislation passed the House of Representatives in mid-June and the Senate in early July. In addition to a one-year delay, the bill eliminates a penalty on Medicaid reimbursement to states for not implementing EVV in 2019, allows the U.S. Centers for Medicare and Medicaid Services (CMS) to waive this penalty in 2020 for a state’s “goodfaith efforts,” and includes an opinion resolution (known as a “Sense of Congress”) that CMS obtain stakeholder input. The EVV requirement is different from a similar one in New York State for providers to utilize verification organizations (VOs) to conduct pre-claim review of aide services. That New York State law, by contrast, is applicable to home health aide and personal care aide services (not consumer directed
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services) provided by organizations with more than $15 million in Medicaid fee-for-service (FFS) and managed care revenues. It is not affected by this delay action. HCA has already met with the state Department of Health (DOH) repeatedly to discuss EVV implementation and has advocated for ways to minimize any disruptions to agency services and operations, adequate time to implement EVV, funding for this unreimbursed requirement, and our involvement in any stakeholder workgroup that would vet the design of EVV systems and policies. As mentioned in previous articles in The Situation Report, CMS has created a website that includes guidance on the EVV requirement at https:// www.medicaid.gov/medicaid/hcbs/guidance/ electronic-visit-verification/index.html. Upon news of the bill signing, HCA reached out to an official at DOH to inquire whether the state will be exercising the option for delay, given that at least one other state has reportedly indicated that it is still starting EVV on January 1, 2019. DOH said it is weighing its options and signaled that more time will allow for an effective implementation. HCA will inform the membership of any further details regarding the state’s implementation plan.
The Situation Report: the Home Care Association of New York State
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HCA Comments on Draft DOH MLTC-LHCSA Contract Limit Guidance With feedback from HCA members and Board members, HCA last week sent comments to the state Department of Health (DOH) on a draft guidance document that DOH has prepared for the LHCSA-MLTC contract limits required to go into effect on October 1, 2018. Implementation of this adopted budget provision will have deep implications for MLTCs, home care agencies, workers and patients. DOH provided HCA with a quick turnaround of three business days for sending our comments, but we will continue to advocate for a realistic and workable implementation. It is not known when these particular guidelines are expected to be finalized, though DOH officials indicated that they could be released within the next two weeks. DOH is required to develop the methodology for the contract limits taking effect by October 1, 2018. Our comments on the draft identify and recommend important language clarifications and improvements throughout. These include improvements to the description and application of DOH criteria that it asks plans to consider when implementing contract limits. We also seek, throughout the document, further references to reinforce the cap exceptions and flexibilities for MLTCs, as provided under statute, and we recommended language detailing whether a denied exception request can be appealed by the MLTC, as well as an MLTC-provider transition period for any denied exceptions. Our comments also call for an extension in time for notification of enrollees when a contract termination occurs, and the need for a model notice that plans can use for standardization purposes. We also comment on the document’s network adequacy provisions. Other areas of the guidance where we ask clarification or further detail include the impact on Consumer Directed Personal Assistance Program fiscal intermediaries, as well as our assertion that a home care Independent Practice Association (IPA) established for purposes of provider/health plan contract and service efficiency, quality and value should be counted as a single unit (and not counted by the number of agencies in its network) for purposes of determining the contract cap. “If an MLTC contracts with an IPA that has 100 LHCSAs in its network, that contract should only count as 1 contract not 100,” we state, in line with the Department’s treatment of IPA contracts under Value Based Payment arrangements. HCA will immediately inform the membership of any new updates on this substantial and formative area of policymaking. Please be sure to attend our September 6 and 7 Senior Financial Managers Retreat for an important segment on the issue of MLTC/LHCSA contracting with one of the state’s preeminent regulatory and licensure experts, Meghan McNamara of Hinman Straub P.C. At HCA’s Retreat, Ms. McNamara will walk you through the current policy landscape and what’s to come with the LHCSA moratorium, the potential shape of a LHCSA need methodology, and the impending contract limits. Registration is at https://hca-nys.org/wpcontent/uploads/2018/06/HCA-Senior-Financial-Managers-Retreat-Brochure-2018.pdf. Editor’s Note: a version of this article was sent to members as an e-mail alert last week.
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PHHPC Approves AHHA Regs Council also discusses LHCSA need methodology and approves home care applications The Public Health and Health Planning Council (PHHPC) met on August 2 to: approve state Department of Health (DOH) regulations for Advanced Home Health Aides (AHHA); act on home care applications; and discuss Licensed Home Care Service Agency (LHCSAs) policies, such as the LHCSA moratorium, pending need methodology design, and registration and reporting requirements. The meeting began with a DOH summary of the AHHA regulations. Members of the council asked questions about some specifics, such as whether DOH would consider allowing AHHA supervision by LPNs, in addition to RNs. DOH said the statute appears to allow this flexibility but recommended moving forward with the regulations as written, requiring RN supervision exclusively, with the possibility of future discussions on any additional flexibility. One council member also asked how LHCSA compliance with the regulations would be overseen, and DOH indicated that the existing surveillance monitoring and annual reporting mechanisms would encompass AHHA regulation compliance. The council then approved the regulatory changes which: include AHHA services among the list that constitutes “health care services”; establish clinical supervision requirements and reporting requirements by AHHAs to their supervising nurses (RNs); require 18 hours of in-service education each year for AHHAs; and provide that a patient has a right of refusal, in which case tasks must be performed by an RN. (The full list of changes is at https://www.health.ny.gov/ facilities/ public_health_and_health_planning_council/ meetings/2018-08-02/docs/18-04.pdf.) In addition, the regulatory changes also apply Criminal History Record Checks (CHRC) and Home Care Worker Registry requirements to workers in hospice programs, as well as the inclusion of information related to the training and testing of AHHAs in the Registry.
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HCA believes there are areas within the regulations that can be further improved for accommodation to providers, plans, workers and patients. We will continue our engagement with the state on these regulations for clarity, guidance and support. This includes support that would assist MLTCs and providers with regard to their synchronicity in AHHA procedure. The meeting included a brief discussion of several initiatives and PHHPC discussion items by Daniel Sheppard, Deputy Commissioner, Office of Primary Care and Health Systems Management, including the LHCSA establishment process. Mr. Sheppard outlined the plans for development of a public-need and financial feasibility review requirement (adopted in this year’s state budget) that will govern PHHPC review of LHCSA applications beyond the existing standards that now require character-and-competence review. He noted that LHCSAs will also be required to report and register annually, with the possibility of license revocation for providers who do not report (i.e. comply with statistical report requirements) for two years. The state has solicited input on the need-methodology, with comments due October 12. The statute requires the needmethodology to be in place by April 1, 2020. In this development period, HCA will be working with the membership to vet, shape and provide our input to the Department. The meeting closed with the PHHPC giving approval or contingent approval to: a change of indirect ownership of two CHHAs; applications for two LHCSAs affiliated with Assisted Living Programs (ALPs); and a LHCSA change of ownership with consolidation. Under the LHCSA moratorium adopted in this year’s state budget, LHCSA applications can be processed only if meeting certain exceptions. While the above applications are among those meeting these exceptions, there is growing concern about overreach and rigidity in the parameters that act to disqualify applications whose effects and goals are unrelated to the intentions of the moratorium as well as applications that are otherwise consistent with broad state policy goals. HCA is continuing our discussions with the administration and legislature on these barriers.
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HCA Provides Detailed Memo on Newly Finalized FY 2019 Hospice Payment Rule With the release of the final fiscal year (FY) 2019 Medicare hospice payment rule, HCA last week circulated a detailed memo for hospices and other members seeking details on the new payment rates, wage index and other factors included in the rule. The memo can be downloaded here: https://hca-nys.org/wp-content/ uploads/2018/08/CMS-Final-FY-2019-Hospice-Rule.pdf. The final rule, in full, is now available in the Federal Register at https://www.gpo.gov/fdsys/pkg/FR-2018-0806/pdf/2018-16539.pdf. The U.S. Centers for Medicare and Medicaid Services (CMS) estimates that hospices nationally will see an estimated 1.8 percent ($340 million) increase in their payments for FY 2019 over FY 2018. CMS’s rule finalizes updates to the hospice payment rates and the hospice aggregate cap. The final rule also confirms that physician assistants (PAs) may be considered the Attending Physician, and it finalizes changes to the Hospice Quality Reporting Program (HQRP), including: a new factor for HQRP measure removal; new data review and correction time frames for data submitted using the Hospice Item Set (HIS); changes to the quality measures displayed on Hospice Compare in FY 2019; updates to the public display of HIS Measures; and an extension of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey participation requirements, exemption criteria, and public reporting policies for future years. HCA’s memo outlines all of these components, and it includes a series of tables showing the rate calculations for the various hospice payment categories.
HCA Comments on Proposal to Reinstate Pre-Claim Review Demo in 5 States HCA has submitted comments on a revamped proposal to reinstate the pre-claim review demonstration. New York is not one of the five states that would be subject to the demo (Illinois, Ohio, North Carolina, Florida, and Texas). However, the U.S. Centers for Medicare and Medicaid Services (CMS) has left open the possibility of including additional states. HCA is concerned that CMS has not provided meaningful analysis or justification for reinstating the demo and risking the possibility of extending its well-documented problems into other regions of the country, including New York. “One reason why pre-claim review was halted in 2017 is that it did not find evidence of unnecessary care or ineligible services,” we write, referencing the experience in Illinois, which is the first and only state to undergo the previous iteration of pre-claim review before it was suspended. Meanwhile, the home care infrastructure in Illinois was substantially impacted. According to reports, 57 Illinois agencies voluntarily closed or exited the Medicare home health business at the time of the demo or shortly after the demo was halted. Estimates from the National Association for Home Care and Hospice (NAHC) suggest a possible loss of 18,000 beneficiaries at the time of this demo, with smaller agencies disproportionately affected by the process and an overall 17 percent reduction in the volume of paid Medicare episodes. Instead of identifying fraud, “the demo merely found correctable documentation issues unrelated to the suitability of care provided or the inherent need for home health services to beneficiaries,” HCA writes. As
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we note, many of the documentation issues that trigged pre-claim review denials in Illinois had to do with Medicare face-to-face requirements, which have long been the subject of dispute, confusing guidelines, and are a target of separate audit activities such as the probe-and-educate initiative. “Pre- or post-claim review will not address this major driver of denials,” we write. Distinct from the prior version of pre-claim review, this newer revised demo would provide two options, including an avenue for post payment review. Providers could either: 1) submit all claims for review before or after payment has been made; or 2) undergo minimal post-payment review of a smaller portion of claims but with an accompanying 25 percent cut in payment. “While this latter option appears to provide some relief on the administrative and claims review side, it nevertheless comes with a devastating 25 percent payment cut,” we write. “Such a sizeable reduction is an unprecedented condition for an agency to still nevertheless undergo payment review.” We also note that the initiative places new administrative costs and demands on Medicare Administrative Contractors (MACs) in addition to the tremendous paperwork burden on agencies, putting a delay on the initiation of services while duplicating longstanding audit controls that already exist. Editor’s Note: a version of this article was sent to members as an e-mail alert last week.
Lots Happening on the MLTC/LHCSA Contracting Limits & New LHCSA Need Methodology; Get Critical Updates at 9/6-7 HCA Finance Conference The state Department of Health is moving on some big developments affecting the state’s LHCSA infrastructure and the entities that contract with LHCSAs – all new developments since our June program in NYC on the state budget’s LHCSA provisions. This includes initial steps on a need methodology for LHCSAs that will affect the process of obtaining a license or making licensure changes. The Department also recently requested input on a draft guidance document about the limits on MLTC and LHCSA contracting (see related p. 4 story.) There’s a lot going on in this area of policy development, and HCA’s upcoming Senior Financial Managers Retreat is excited to have one of the state’s preeminent regulatory and licensure experts, Meghan McNamara, at the conference to help you navigate these changes. Ms. McNamara is a principal at Hinman Straub P.C. and member of the Firm’s Health Law Department. She has represented clients on all facets of regulatory representation including certificate of need applications, licensure applications, responses to solicitations of interest and regulatory compliance issues. At HCA’s Retreat, Ms. McNamara will walk you through the current policy landscape and what’s to come with the LHCSA moratorium, the potential shape of a LHCSA need methodology, and the MLTC/ LHCSA contracting limits which go into effect on October 1, less than a month after the conference. This is your best chance to get the latest on all of these developments before they hit the system. Our retreat also offers the latest updates on all Medicaid home care, hospice and MLTC rate changes, the Medicare home health prospective payment system, the upcoming patient driven groupings model, Level II
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value based payments, and all other critical finance issues. Register today at https://hca-nys.org/wp-content/ uploads/2018/06/HCA-Senior-Financial-Managers-Retreat-Brochure-2018.pdf.
OIG Report Scrutinizes Medicare Hospice Program The U.S. Department of Health and Human Services Office of Inspector General (OIG) released a draft report it sent to the U.S. Centers for Medicare and Medicaid Services (CMS) last week which examines the Medicare hospice benefit since 2005 and describes the growth in hospice utilization and reimbursement. The study also scrutinizes several areas that OIG considers to be key vulnerabilities in hospice use and oversight. The full report from OIG can be downloaded at: https://oig.hhs.gov/oei/reports/oei-02-1600570.pdf. HCA will be studying and discussing the report with our national hospice affiliates and state Hospice Association colleagues to coordinate our advocacy response. OIG reports that hospice use has grown steadily over the past decade, with Medicare paying $16.7 billion for this care in 2016. Approximately 1.4 million beneficiaries received hospice care in 2016. While highlighting the importance of hospice, OIG’s report also:
Raises concerns about service use in certain cases, as well as concerns about the general oversight of hospice service quality, and specific concerns related to symptom and medication management. Continued on next page HIRING
Staff Development Education Supervisor – Home Health Full Time 9am-5pm NYU Winthrop Hospital’s Home Health Agency ranks as a top-performing US Home Health Agency! Come join our stellar team of nurses, therapy professionals and social workers who provide home health care to our maternal, child and adult population. We have an exceptional opportunity for a Staff Development Education Supervisor to be responsible for home health staff education, development and professional growth, including our orientation program (didactic & practical components). With collaboration of the Director of Quality Management/Staff Development and the department’s management team, you will identify, develop and plan appropriate staff development programs to support agency needs to provide optimum patient outcomes. Working with the Administrator and the Director of Patient Services, you will research, coordinate & establish new programs for the agency. We require: NYS RN License BSN with 2 years’ experience in education in a Certified home care agency 2-3 years clinical nursing practice 2 years community health nursing Good communication/computer skills NYU Winthrop Hospital is located on Long Island in Western Nassau County just 25 miles from Manhattan. Email HRHomeCare@nyuwinthrop.org.
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Continued from previous page States that more information should be provided to beneficiaries, their families and caregivers to make
decisions about their care.
Warns of billing issues and high-cost service use. It suggests that the current Medicare hospice payment system – where a hospice is paid for every day a beneficiary is in its care, regardless of the quantity or quality of services – creates the wrong incentives for achieving service efficiency. While CMS made some changes to payments, the underlying structure of the payment system remains unchanged, OIG says.
OIG Recommendations The OIG report concludes by recommending that CMS implement 15 specific actions that relate to 7 areas for improvement. Specifically, OIG says that CMS should strengthen the survey process – its primary tool to promote compliance – to better ensure that hospices provide beneficiaries with needed services and quality care. Also, OIG says that CMS should:
Develop and disseminate additional information on hospices, including complaint investigations, to help beneficiaries and their families and caregivers make informed choices about hospice care.
Educate beneficiaries and their families and caregivers about the hospice benefit, working with partners to make consumer-friendly information available.
Promote physician involvement and accountability to ensure that beneficiaries get appropriate care.
Strengthen oversight of hospices and analyze claims data, tying payment to beneficiary care needs and quality of care to ensure that services adequately serve beneficiaries’ needs, and seeking statutory authority if necessary.
For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
Legislature Convenes Collaborative Meeting on “Essential Personnel” Bill, Plus Other Emergency Preparedness Updates The legislative sponsors of the new emergency preparedness (“Essential Personnel”) law for home care and hospice convened a meeting this past week to discuss the status of implementation and steps to further support preparedness with and for home care, hospice and MLTC. The meeting was held by the offices of Senator Andrew Lanza and Assemblyman Michael Cusick who sponsored this law. It included HCA (which originated the legislation) and representatives of the state Department of Health, state Division of Homeland Security and Emergency Services, the New York State Association of Health Care Providers (HCP) and the Continuing Care Leadership Coalition. The Essential Personnel law was signed in October. It required local emergency management plans to be updated to reflect the input of home care and hospice, and to be submitted to the state within 180 days of
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enactment. The input is to include issues and areas that support the effective preparation and execution of local emergency preparedness plans, including “procedures by which providers may be granted essential access to care for their patients during an emergency.” The meeting participants discussed providers’ and county managers’ reported experiences to date with implementation – which have varied by locality – and ideas for collaborative initiatives at both the state and local levels to further achieve the goals of the legislation. These include: increased outreach and communications on the new law, its purposes and goals; development of a guidance document as standard assistance to all localities and providers to guide implementation of the new law; vehicles for effective communications capabilities between emergency managers and home care/hospice in emergencies (including increased use of the Health Commerce System by managers); and continued mutual education for home care, hospice, MLTC and emergency managers. HCA and HCP discussed our joint work to date in convening local and regional networking meetings for providers, local emergency managers and public health officers. We have conducted these networking sessions for 55 of the state’s 62 counties over the past two and a half years. Our intentions are to further utilize this foundation to promote goals of the new Essential Personnel law, and of effective and supportive emergency preparedness efforts overall. Today (Monday), HCA is convening a planning session with state, regional and county emergency preparedness partners for our next round of local networking sessions this coming fall. The target counties for this fall include Nassau and Suffolk Counties. Details will follow as to dates, times and locations based on today’s planning call. HCA extends thanks to the legislative sponsors, state agency officials and association partners for what was a solid table-setter for next steps in this important area. August Aware Prepare The August issue of Aware Prepare has been issued by the Department of Health. It is available at https:/ /hca-nys.org/wp-content/uploads/2018/08/2018_August_Aware-Prepare.pdf. Aware Prepare, issued each month, provides helpful resource information on emergency preparedness for all emergency preparedness partners. HCA urges providers and MLTCs to review and take advantage of these resources. September 27 HCA Emergency Preparedness Education & Training Conference Enhance your command and preparedness for emergencies, learn critical new information on preparedness and participate in a tabletop drill/exercise that will meet requirements by participating in HCA’s September 27 emergency preparedness education and training conference. All CHHAs, LHCSAs, Hospices and MLTCs should participate in this important resource and opportunity. Preparedness is critical before an emergency strikes. For more details and to register, see https://hca-nys.org/wp-content/uploads/2018/08/HCA-EmergencyPreparedness-Conference-9-27-18-Brochure.pdf. For further information, contact Al Cardillo at acardillo@hcanys.org.
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LawTALK: Effective and Compliant QA/PI Programs By Rosemary McKenna, Frank Fanshawe, and Amanda Whitfield Agencies are generally required to comply with state and federal laws concerning quality assurance and program improvement. At both the state and federal level, there are requirements for operating a quality assurance program. New York Public Health Law section 3616-A states that every agency is required to establish a quality assurance program. State regulations (New York Codes, Rules and Regulations sections 763.11 and 766.9) also require agencies to ensure continuous quality improvement. Home care providers who contract with managed care plans are also expected to meet certain quality standards as part of value based payments and overall contracting arrangements as evidenced by criteria in the recently proposed LHCSA-MLTC contracting requirements. (See related p. 4 story.) The federal government imposes numerous quality assurance and performance improvement (QAPI) requirements on agencies that participate in Medicare and Medicaid Conditions of Participation (COPs). According to 42 CFR section 484.65, there are five standards every agency must implement and maintain: 1) Program Scope; 2) Program Data; 3) Program Activities; 4) Performance Improvement Projects; and 5) Executive Responsibilities. Implementing these five standards will meet the overarching goal of having the best practice in place for your agency’s QAPI program. Taken one at a time, the following provides a brief overview of the five federal standards: 1. Program scope – Having quality indicators in place to measure, analyze, and track is key within this standard. The agency needs to be capable of showing measured improvement in its QAPI program through these means. A quality indicator is a “specific, valid, and reliable measure” of outcomes, access, satisfaction, and process. 2. Program data – The quality indicators gather data that the agency’s QAPI program uses to monitor the effectiveness and safety of its services. This standard directs agencies to use objective data from OASIS in conjunction with their own data to ensure that actual improvements have taken place, such as care outcomes and patient satisfaction. Data is used to monitor effectiveness and safety as well as identify areas needing improvement. 3. Program activities – The goal of this standard is to identify high-risk and problem-prone areas and immediately take steps to correct them. Program improvement activities respond to adverse events patients experience, locate their source and implement preventive measures. Agencies are required to track all corrective measures and ensure that improvements are achieved and sustained. 4. Performance improvement projects – This standard is a reflective step in the process, as its goal is to reflect on the “scope, complexity and past performance of the agency’s services and operations.” Once areas for improvement have been identified, this standard develops policies, procedures and tools that not only test the QAPI program but also ensure regulatory compliance. 5. Executive responsibilities – Under this standard, the governing body is tasked with a number of requirements. Overall, they must ensure that the QAPI program is clearly defined and running, that
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priorities in improvement are effective, that patient safety is paramount, and that no fraud or waste occurs at any step. Together, quality assurance and performance improvement drive an agency toward running a best-practice home care program with desired outcomes. Targeted outcomes are achieved by reducing and resolving identified problems in the home care setting. Operating from a best-practice approach benefits both the health and care of the patient as well as the proficiency and financial security of the agency. Together with regulatory compliance, a spirit of proactivity and patient inclusion, an agency will be successful in running a high-standard QAPI. LawTalk is a monthly series of articles prepared by attorneys at the firm for HCA’s counsel. Please note that HCA LawTalk articles: are for general, informational purposes; are not legal “advice”; and do not create an attorney-client relationship. Because each case is unique, the information provided should be considered to be general in nature, and should never be considered a substitution for legal counsel. Readers should not take, or refrain from taking, any action based on information in this article without first seeking legal advice from competent counsel.
Upcoming ICD-10 and OASIS Programs for Coders, Clinicians to Ensure Clinical Accuracy, Compliance HCA is offering two upcoming programs (one in just over a week and another in October) for your coders and clinicians to ensure operational accuracy and compliance with ICD-10-CM and OASIS assessments. See below and register your teams today at https://hca-nys.org/events-education/upcoming-events. August 14 webinar on ICD-10-CM Changes Effective Oct. 1 Accurate ICD-10-CM codes are vital for reducing clinical errors, improving outcomes and lowering costs. With 615 code changes set to take place on October 1, your team needs to focus on the specific codes and changes that will directly impact home health and hospice. Our August 14 webinar with RN and ICD-10-CM expert trainer Judy Adams will provide an overview of the relevant new codes and changes as well as steps to prepare for implementation. This webinar is convenient and cost-effective, requiring no travel costs or time ... plus there’s no limit on the number of people from your agency who can participate through a single registered site connection. October 22-23 Blueprint for OASIS Accuracy: OASIS-D Data Set (plus optional October 24 credentialing exam) in NYC HCA traditionally offers two OASIS programs per year: one upstate and one downstate. Our only downstate session this year is coming in October in New York City, and the timing couldn’t be better given the move to OASIS-D on January 1. This major change to OASIS-D is slated to include the removal of 235 data elements, plus 6 new questions with multiple data items added. Your field clinicians and managers need to get up to speed on these changes so that they can: select OASIS responses that accurately represent clinical assessment findings; collect and review accurate data for
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quality measurement and reimbursement purposes; and maintain compliance with CMS resources and instructions. Plus, clinicians will be eligible for contact hours and can get their first or renewed COS-C certification (which expires every three years). The COS-C certification is optional, on October 24, at the same location as the workshop.
New Medicare Cards Mailed to New York Beneficiaries In July, the U.S. Centers for Medicare and Medicaid Services (CMS) started mailing new Medicare cards to people with Medicare who live in New York, Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, Rhode Island and Vermont. CMS will continue to mail new cards to people who are new to Medicare. If someone with Medicare says they did not get a card, CMS suggests that you print and give them the “Still Waiting for Your New Card?” handout available at the links below:
https://www.cms.gov/Medicare/New-Medicare-Card/Outreach-and-Education/Tear-Off-for-After-CardMailing-Ends.pdf (English)
https://www.cms.gov/Medicare/New-Medicare-Card/Outreach-and-Education/Tear-Off-for-After-CardMailing-Ends-Spanish.pdf (Spanish)
The enrollee can also:
Sign into MyMedicare.gov to see if they were mailed their card. If so, they can print an official card. They need to create an account if they do not already have one.
Call 1-800-MEDICARE (1-800-633-4227). There might be something that needs to be corrected, such as updating their mailing address.
To ensure that people with Medicare continue to get care, health care providers and suppliers can use either the former Social Security number-based Health Insurance Claim Number or the new alpha-numeric Medicare Beneficiary Identifier (MBI) for all Medicare transactions through December 31, 2019. CMS advises providers and others to continue to direct people with Medicare to Medicare.gov/NewCard for information about the mailings and to sign up to get e-mail about the status of card mailings in their state. Information on the transition to the new MBI is at:
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New MBI Get It, Use It MLN Matters Article (Updated7/11/18): https://www.cms.gov/Outreach-andEducation/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE18006.pdf
Transition to New Medicare Numbers and Cards MLN Fact Sheet: https://www.cms.gov/Outreach-andEducation/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ TransitiontoNewMedicareNumbersandCards-909365.pdf
New Medicare Card information website: https://www.cms.gov/medicare/new-medicare-card/nmc-home.html
The Situation Report: the Home Care Association of New York State
Volume 3, No. 32 August 6, 2018 ď Žď€
DOH Updates FAQs on Value Based Payments for Managed Care Plans The state Department of Health (DOH) has updated the Frequently Asked Questions (FAQs) for MLTC value based payments (VBP). The FAQ documents can be found in the MLTC folder of the VBP Resource Library at https:// www.health.ny.gov/health_care/medicaid/redesign/dsrip/vbp_library/index.htm. A direct link to the FAQs is here: https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/ vbp_library/2018-06_vbp_for_pcp_faqs.htm. DOH says the FAQ document is designed to address questions related to the implementation of VBP for plans. Questions and answers will be updated or added on a periodic basis with a date at the bottom to reflect when revisions were made. The FAQs include 75 items related to general VBP questions, contracting, finance, quality measures, social determinants of health and more. All questions can be sent to MLTCVBP@health.ny.gov.
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Guidance Issued on ‘Temporary Schedule Changes’ for NYC Employees The New York City Department of Consumer Affairs (DCA) Office of Labor Policy & Standards has released “Temporary Schedule Change Law: What Employers/Workers Need to Know,” as well as a mandatory notice to be posted, and Frequently Asked Questions (FAQs) as guidance on the temporary schedule change provisions of the New York City Fair Workweek Law. Employers are required to post a notice, “You Have a Right to Temporary Changes to Your Work Schedule,” in an area visible to employees. Employers must post this notice in English and in any language that is the primary language of at least 5 percent of the workers at a workplace if the translation is available on DCA’s web page.
An employer guide is at https://www1.nyc.gov/assets/dca/downloads/pdf/workers/ TemporaryScheduleChange-Overview.pdf.
The notice (English version) is at https://www1.nyc.gov/assets/dca/downloads/pdf/workers/ TemporaryScheduleChange-Notice-English.pdf
The FAQs are at https://www1.nyc.gov/assets/dca/downloads/pdf/workers/FAQsTemporaryScheduleChangeLaw.pdf
DCA has developed a website with links to the above materials and more at https://www1.nyc.gov/site/dca/workers/workersrights/temporary-schedule-change-law-employees.page. As explained in the July 9 edition of The Situation Report, the temporary schedule change provisions, effective July 18, require most New York City employers to grant employees two temporary changes to their work schedules each calendar year for certain “personal events.” A “personal event” includes any of the following:
The need to care for a child under the age of 18.
The need to care for a “care recipient,” a person with a disability who is a family or household member and relies on you for medical care or to meet the needs of daily living.
The need to attend a legal proceeding or hearing for public benefits to which the employee, a family member, or the employee’s minor child or care recipient is a party.
Any other reason for which the employee may use leave under NYC’s Paid Safe and Sick Leave law.
Employees have the right to two temporary schedule changes per year. The law also prohibits retaliation against workers who request schedule changes, even if the employer is not required to grant the change under the law. Continued on next page
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Continued from previous page A “temporary change” is a limited change to an employee’s usual schedule, including in the hours, times, or locations an employee is expected to work. The change can include: using short-term unpaid leave, paid time off, working remotely, or swapping or shifting working hours with a coworker. Employees covered by the law include all employees who work 80 or more hours per calendar year in NYC and who have worked for their employer 120 or more days. Those not covered include: 1) government employees; 2) certain employees subject to a collective bargaining agreement; and 3) certain employees in motion picture, television, and live entertainment industries.
Upcoming Deadlines Requirement/Change
Effective/Due Date
More Information
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
Comments due on state Education Department emergency/proposed rule on advanced home health aides
August 26, 2018
All NY employers are required to adopt sexual harassment prevention policies and provide annual training
Effective October 9, 2018
http://www.regents.nysed.gov/co mmon/regents/files/618ppca2.pdf
www.labor.ny.gov https://dhr.ny.gov
https://hcaͲnys.org/wpͲ
LHCSA proposed public need
Comments due October
content/uploads/2018/07/9594a96
methodology
12, 2018
8Ͳ7de4Ͳ4c67Ͳb52dͲ 62fa0234c9cb.pdf https://www.health.ny.gov/health_
MLTC Enrollment LockͲIn Starts
December 1, 2018
care/medicaid/program/update/20 18/2018Ͳ06.htm#mltc
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New Medicaid Timely Billing Webinar: August 17 The state Department of Health (DOH) Bureau of Medical Review, Pended Claims Unit will be conducting a webinar on Friday, August 17, 2018 from 10 to 11 a.m. for all providers regarding the Department’s timely filing edits and procedures. Topics will include:
Use of adjustments vs. voids in claims correction Use of delay reason codes Specific instances where delay reason codes are not needed for Claims processing
DOH will leave time at the end for questions. HCA members interested in the webinar can register at: https://csra.webex.com/csra/onstage/g.php?MTID=e43bf6f0ad3018066f9c14902cee3486c. For additional information, providers can contact the Bureau of Medical Review, Pended Claims Unit at 1-800-342-3005 (option 3).
CMS Updates Hospice “Public Use File” Data The U.S. Centers for Medicare and Medicaid Services (CMS) has updated its Hospice “Public Use Data File” which provides in-depth detail on hospice payments, utilization, and patient demographics at the individual hospice and state levels. The calendar year (CY) 2016 Hospice Utilization and Payment Public Use File (PUF) contains information on utilization, payment, submitted charges, primary diagnoses, sites of service, and hospice beneficiary demographics organized by CMS Certification Number (6-digit provider identification number), and by state. When CMS first began releasing this data a few years ago, it represented some of the most detailed hospice data available to the public without charge. Data is based on information from CMS’s Chronic Conditions Data Warehouse (CCW) data files. The 2016 data now available contains 100 percent final-action (i.e., all claim adjustments have been resolved) hospice claims for the Medicare population including beneficiaries enrolled in a Medicare Advantage plan. Although the Hospice PUF has an array of payment and utilization information about hospice services, it does not indicate the quality of care provided by individual hospice providers. CMS’s Medicare Hospice Compare website (https://www.medicare.gov/hospicecompare/) provides information on quality metrics reported on a quarterly basis, though the data are not risk-adjusted and thus do not account for differences in patient populations. The Hospice PUF contains the following two Excel spreadsheet tables:
Aggregated information by provider: Medicare Provider Aggregate Table, CY 2016 Aggregated information by state: Medicare State Aggregate Table, CY 2016
Continued on next page
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Continued from previous page The two spreadsheets and other PUF information may be accessed at https://www.cms.gov/ResearchStatistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Hospice.html. Specific inquiries regarding this data can be sent to MedicareProviderData@cms.hhs.gov.
May Global Cap Report: Medicaid Spending $13M Above Projections The state Department of Health (DOH) has issued its latest monthly Medicaid Global Cap report. The full report is at: https://www.health.ny.gov/health_care/medicaid/regulations/global_cap/monthly/ sfy_2018-2019/docs/may_2018_report.pdf. Pursuant to legislation, the Medicaid Global Spending Cap has increased from $19.5 billion in fiscal year (FY) 2018 to $20.8 billion in FY 2019, an increase of 6.7 percent. This May 2018 report marks the second report for the new fiscal year. It finds that overall spending for this period was $13 million above Medicaid Global Cap projections, across all sectors, a difference of $4.356 billion in actual spending versus $4.343 billion in estimated spending for the first two months of the state fiscal year. Specifically, DOH mentions the following two significant pressures on the Global Cap:
Medicaid spending in major Medicaid Managed Care categories was $12 million over projections.
Medicaid spending in major fee-for-service categories was $26 million over projections with inpatient spending $6 million above estimates. This is a result of slightly higher than expected utilization.
As with all other provider or managed care categories, the category “other long term care” (which includes home care, but also other long term care sectors) exceeded its monthly cap, by $2 million, but DOH did not provide any additional explanation for this variance. In other report highlights:
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Total Managed Long Term Care (MLTC) spending was on target for the month of May and only $2 million above projections.
Total Medicaid enrollment reached 6,174,937 enrollees at the end of May 2018. This reflects a net increase of 22,870 enrollees since March 2018.
The state’s Accounts Receivable (A/R) ending balance for FY 2018 was $224 million. DOH is expected to recoup $174 million by the end of FY 2019, resulting in a projected A/R balance of $74 million by March 2019. Through the end of May, retroactive rates owed to the state were
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$250 million. This reflects net increases of $26 million since March 2018. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
Resources
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“Stable Housing, Stable Health: Addressing Housing Insecurity Through Medicaid Value-Based Payment,” by the United Hospital Fund https://uhfnyc.org/publications/881328