SEPSIS HEROES
MLTC-LHCSA LIMITS
CHHA, HOSPICE RATES
EMERGENCY PREP
Sepsis Heroes gala in New York City recognizes HCA’s Stop Sepsis at Home initiative.
With October 1 effective date coming for yetstricter contract ratios, MLTCs have until October 15 to submit certifications on LHCSA contracting.
An update on the CHHA Medicaid pediatric rates, as well as a new announcement of hospice non-residence rates following last week’s report on hospice residence rates.
DOH reports back to HCA on home care participation rates in recent emergency drills, including completion rates on required surveys, suggesting more education, assistance and technical changes necessary.
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Your Source for HOME CARE News, Policy and Advocacy
UPCOMING PROGRAMS Know The Drill: Successful Emergency Planning, Preparedness and Compliance Strategies for Home Care & Hospice Sept. 17 (Troy) Blueprint for OASIS Accuracy: OASIS D-1 Data Set Sept. 23 and 24 Workshop | Sept. 25 COS-C Exam (NYC) PDGM Bootcamp for Clinical Managers and Quality Staff Oct. 23 (Fairport) Find all the details and registration for our upcoming programs and events at https:// hca-nys.org/ events-education/ upcoming-events.
Vol. 4, Issue 32| September 16, 2019
AG Probes 24-Hour/Live-in Care, Immigrant Protections in Latest Wave of Actions on Wage-and-Hour Issues HCA: “There is no place for any organization … to exploit an individual’s immigration status” Last week brought yet another wave of intense focus on 24-hour/live-in home care and corresponding labor law/policies with a settlement agreement announced by New York State Attorney General Letitia James and a home care provider on Friday. This time the matter also involved an alleged violation of law protecting immigrants from an employer’s threats of retaliation. See AG p. 5
HCA, Nat’l Colleagues Press for Repeal, Replace of PDGM ‘Behavioral Adjustment’ Cuts in D.C. Visits HCA’s executive and policy team met with several Congressional offices last week to enlist cosponsorship on legislation to repeal and replace the “behavioral adjustment” cuts from the Patient-Driven Groupings Model (H.R.2573/S.433). The team also advocated on other issues of importance to home care providers. See D.C. p. 4
HCA Comments on Home Health Rule, PDGM HCA Vice President for Finance and Management Patrick Conole last week sent comments to the U.S. Centers for Medicare and Medicaid Services (CMS) on its proposed 2020 payment rule for home health (see here: https://tinyurl.com/y3bdrpca). See COMMENTS p. 2
INSIDE AG Probes 24-Hour/Live-in Care, Immigrant Protections…..................................1 HCA Comments on Home Health Rule, PDGM…...................................................1 HCA, Nat’l Colleagues Press for Repeal, Replace of Cuts.................................…..1 HCA’s Stop Sepsis at Home Honored with 2019 Sepsis Hero Award....................….6 MLTC-LHCSA Limit Certifications due Oct. 15....................................................…7 HCA Participates in Meeting on New Home Care Cost Report…...........................7 MLTC Policy Meeting Yields Updates, Issue Discussions….................................9
CMS Issues Rule to Tighten Provider Enrollment…................................................9 Update on 2019 CHHA Peds Rates, MW Adjustments........................................11 DOH Posts 2019 Hospice Non-Residence Medicaid Rates..................................12 Emergency Drill Completion Rates Suggest More Assistance Needed.................12 New CFCO FAQs Available, Eyeing January 2020 Implementation......................13 CMS to Host Home Health and Hospice Open Door Forum: September 18…..........14 Health Resources….........................................................................................15
The Situation Report: the Home Care Association of New York State COMMENTS from p. 1 The proposed rule includes updates on a mix of longstanding payment-related programs and structures, alongside the major structural overhaul known as the Patient-Driven Groupings Model (PDGM). CMS is expected to finalize the rule, following the comment period, in November, with the rule going into effect on January 1, 2020. PDGM Behavioral Adjustment Our comments lead by addressing the most prominent part of the proposed rule: PDGM. Top among our concerns are the “behavioral adjustment” cuts that “establish a target for gaming behavior.” These adjustments have not been adequately described or modeled for providers or associations, despite wielding a stunning 8.01 percent cut at the outset of PDGM. These cuts are a continuing target for redress in legislation that HCA and partners are pushing for passage this fall to prohibit presumptive cuts. Our comments to CMS call for a full description and disclosure of the “behavioral adjustment” methodology without which the total withdrawal of these adjustments is imperative as is a prohibition on cuts without validation of behavior prompting need. RAP proposal HCA also strongly rejects CMS’s proposal on Requests for Anticipated Payment (RAPs), which would reduce RAP payments to 20 percent in 2020 and eliminate them entirely for 2021. RAPs are vital to an agency’s cash-flow in order to initiate services, especially given upfront documentation burdens that otherwise constrain timely reimbursement. CMS should withdraw its RAP proposal, which was ostensibly advanced for fraud-detection reasons, and instead focus on other indicators of fraud such as “anomalous volume and timing changes that may be a ‘red flag’ of abusive behavior” using predictive analytics and other more surgical approaches, we argue. Other PDGM, new proposals HCA also addresses issues with the intricacies of the new PDGM model such as the case-mix adjustments based on admission 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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source, which create new and unintended incentives and are a “poor substitute for measures based on patient characteristics.” Meanwhile, CMS’s proposal to require a home health notice of admission (NOA) – akin to the hospice notice of election (NOE) – creates a whole new set of burdens, problems and unrealistic timetables, especially in coordination with the existing plan-of-care requirements and given the lag times before Medicare Advantage eligibility or authorization information is available to providers on the Common Working File (CWF). Longstanding issues HCA also addresses longstanding concerns on the following: The face-to-face requirement, left unchanged in this proposed rule; the inadequacy and inconsistencies of the wage index classifications (which do not adequately reflect market conditions in many locales); the need for extension and refinements to the rural add-on tiers; vendor software and Medicare Administrative Contractor (MAC) readiness concerns for the roll out of PDGM; some considerations on the inclusion of new measures in the Home Health Quality Reporting Program; and other items. Advocacy HCA’s Executive Vice President for Clinical and Program Affairs Rebecca Fuller Gray and Lauren Ford, HCA’s Director of Program Research, Development and Policy, were in Washington last week for further work with the Council of State Home Care Associations and to conduct legislative visits on PDGM-related legislation and other federal priorities. Their meetings with Congress (see related p. 1 story) follow a letter that HCA President and CEO Al Cardillo is circulating individually to every member of New York’s Congressional Delegation urging their cosponsorship and support for a bill (H.R. 2573) which would overturn the approach to “behavioral adjustment” cuts under PDGM in favor of a more rational, retrospective, and surgical construct for rate adjustments. You can help by joining us in this call to action on H.R. 2573 using the campaign on our Legislative Action Center at https://p2a.co/fwWNZT0. Please write Congress today! PDGM-readiness for your clinicians HCA’s Senior Financial Managers Retreat on September 6 and 7 provided insights on PDGM finance issues and now, by popular demand, we are also sponsoring a second session on issues to support the readiness of your clinicians and quality directors for PDGM. As noted by one participant from our previous session of the program, it “was by far the best PDGM education session I have participated in ... I left with real action plans to implement within my agencies!” Please register today for HCA’s PDGM Bootcamp for Clinical Managers and Quality Staff on October 23 in Fairport, near Rochester. A flyer and registration form are at: https://hca-nys.org/wp-content/uploads/ 2019/09/HCA-PDGM-Bootcamp-with-Barb-Katz-Registration-Form-10-23-19-2.pdf.
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D.C. from p. 1 The meetings were part of the Council of State Home Care and Hospice Associations’ Public Policy Summit and Advocacy Day, attended by HCA’s Executive Vice President Rebecca Gray and Director for Program Research, Development and Policy Lauren Ford. HCA has been reaching out to all Congressional Representatives from New York asking them to sign-on as cosponsors of the Home Health Payment Innovation Act (H.R.2573/S.433). Last week’s Hill visits were part of HCA’s continuing, vigorous efforts to boost full co-sponsorship in follow-up to recent communications directly to Congress from HCA President and CEO Al Cardillo, among other initiatives aimed squarely at getting this bill passed. In addition to this important PDGM fix, Gray and Ford, who were joined by HCA’s federal government-affairs representative Brett Heimov, also emphasized issues related to rural home care access, and the need to make the three-percent add-on permanent for home health providers in rural areas, along with nurse practitioner and physician assistant authority to order home care. We also outlined the inherent faults of the current Medicare home health wage-index methodology which does not comport with regional market conditions. HCA encourages all members to meet with your Congressional representatives in their local or Washington offices. It is critical that these officials know who you are, your agency, the services you offer their constituents, and the impact you make to their community as an employer. All of HCA’s briefing documents on the Home Health Payment Innovation Act, rural add-on, wage index and other issues are on our federal advocacy page at https://hca-nys.org/advocacy-pac/federal. For the summit part of the program, HCA also had the opportunity to engage in policy discussions with colleagues from around the nation, hearing from expert consultants, public officials and policymakers at the U.S. Centers for Medicare and Medicaid Services (CMS) and its Medicare Administrative Contractors. While PDGM was a core focus, the summit delved into critical issues involving: Medicare Advantage, including what the newly expanded “supplemental benefits” options and hospice carve-in components mean for providers; how to most effectively prepare and collaborate with community and plan partners on care transitions; preparing for Electronic Visit Verification (EVV); and more. HCA encourages all members to view the Public Policy Summit slides for further information at http:// www.thehomecarecouncil.org/ index.php?pID=31.
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AG from p. 1 Attorney General (AG) James announced the settlement involving a non-HCA-member home care agency for charges of labor law hour and compensation violations, and for the employer’s alleged use of workers’ undocumented immigration status to avoid full payment obligations. The AG’s press release cited the provider for allegedly “threatening to call immigration authorities when these workers sought their unpaid wages” related to 24-hour care “in violation of the New York Labor Law and the New York City Human Rights Law.” This action coincides with efforts by a group of state lawmakers seeking to pass legislation limiting continuous home health aide and personal assistant hours and overtime. That bill was publicized at a recent press conference and media blitz which drew responses by HCA published in several media accounts, including Crain’s Health Pulse, Politico New York, the Albany Times Union and, just this past week, in Home Health Care News. HCA covered the issue extensively in the September 9 edition of The Situation Report and also discussed it with providers and health plans at HCA’s Financial Managers retreat on September 5 and 6. HCA has been working to educate lawmakers, senior legislative staff, other state health officials, and the media about the implications of this legislation. While well-intended, the bill would create gaping holes in the system, with adverse impacts to workers, patients and services. Separate from the legislators’ press conference, the AG’s recent announcement, widely publicized on Friday, involved the added dimension of employer retaliation with respect to immigration status. In response to media coverage, HCA prepared a pointed response to the AG’s press announcement. We proclaimed full and responsible support for home health personnel. And while deferring judgment on the settling parties, not knowing all circumstances of this case, we spoke in broad terms condemning any action that would deliberately intimidate an individual on the basis of his or her immigration status, and we establish a red line and admonishment of any would-be violator of the law in this regard, whether in home care or any health field. “There is no place in New York’s home care system – or in the broader health care system – for any organization to deliberately engage in unlawful practices described in the AG’s press release, or to exploit an individual’s immigration status as has been charged,” said HCA President and CEO Al Cardillo who “echo[ed] Attorney General Letitia James’s sentiments regarding the tireless, vital work of home health aides in caring for the most vulnerable New Yorkers.” Our statement was reported by the New York Law Journal and Crain’s Health Pulse. You can read it in full here: https://hca-nys.org/press-releases/statementattorney-general-james-settlement-for-100-home-health-aides/. The circumstances, legal structures and legislative responses to 24-hour home care have become a mounting development in recent media accounts, driven by lawmakers and interested stakeholders seeking to advance the narrative on these complex issues, especially in the past two weeks. HCA will be meeting further with state officials to shape appropriate policies and enforcement perspectives involving all of these areas, especially given a recent rise in policy and legal activity on this matter. Stay tuned for HCA updates and advocacy planning.
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HCA’s ‘Stop Sepsis at Home’ Honored with 2019 Sepsis Hero Award HCA is 1 of 5 recognized for national sepsis leadership HCA greatly appreciates Sepsis Alliance (SA) for presenting HCA’s “Stop Sepsis at Home” initiative with one of SA’s Sepsis Heroes awards at its annual gala in New York City last week. A profile for the award is on Sepsis Alliance’s website at https://www.sepsis.org/ sepsis-heroes/2019-sepsis-hero-stop-sepsisat-home/. We especially extend profound thanks to Sepsis Alliance Executive Director Thomas Heymann (photo at bottom) for presenting HCA with this honor and for his organization’s valiant fight against sepsis. HCA also specifically thanks the clinical leader on this initiative, HCA Board Member Amy Bowerman (top photo at center), Executive Director of Senior Network Health and Quality Director for the VNA of Utica and Oneida County; the Stop Sepsis at Home QIO Clinical and Education Leader, Sara Butterfield, Senior Quality Director at IPRO; as well as partners from Sepsis Alliance, the Rory Staunton Foundation for Sepsis Prevention, Eve Bankert (formerly of IPRO), and the many experts on our project team. HCA’s Executive, Policy and Communications teams were especially honored to be joined at the event not only by Amy Bowerman but also Jillian Thibault, a sepsis survivor with Visiting Nurse Association of Albany (top photo at right). This award is a tribute to the over 2,000 clinicians who have been trained and the providers pioneering the use of HCA’s Stop Sepsis at Home screening tool, knowing what it means for their patients and for the home care system broadly. HCA hopes this recognition will prompt further spread of this model in New York and across the country.
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The Situation Report: the Home Care Association of New York State
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MLTC-LHCSA Limit Certifications due Oct. 15 The state Department of Health (DOH) reminds managed long term care (MLTC) plans that they have to submit certifications by October 15 regarding compliance with limits in the number of Licensed Home Care Services Agencies (LHCSAs) they can contract with. These limits, outlined in a reminder article in the August 12 Situation Report, are changing October 1 so that each MLTC plan can only contract with a maximum number of LHCSAs in accordance with the following ratios (based on enrollment as of July 1, 2019):
For downstate (New York City, Nassau, Suffolk and Westchester), the ratio is 1 LHCSA per each 100 enrollees (1:100) in a plan.
For the rest of the state, the ratio is 1 LHCSA per 60 enrollees (1:60) in a plan.
Certifications are required annually and should be returned to LHCSAExceptions@health.ny.gov. The state’s guidance (https://tinyurl.com/y2uofws2) explains the criteria that MLTCs should consider in making contract decisions that meet the thresholds, network adequacy rules, special situations or exceptions, and enrollee notification of any terminated LHCSA contracts. While the contract limits are effective October 1, 2019, plans and providers are advised that enrollee notification of terminated contracts must generally be sent within fifteen days of the notice of termination to the LHCSA. In addition, according to the guidance, compliance with the limits may be included in DOH audit and surveillance activities. DOH may also monitor the amount of enrollees that are converted to a consumerdirected arrangement. Any questions about the LHCSA contracting ratios, and how the exception process works, should be directed to LHCSAExceptions@health.ny.gov.
HCA Participates in Meeting on New Home Care Cost Report Last week, HCA participated in a meeting held by the state Department of Health (DOH) to discuss a new home care cost report being developed for Certified Home Health Agencies (CHHAs), Licensed Home Care Services Agencies (LHCSAs) and Fiscal Intermediaries (FIs) providing services under consumer directed care. The meeting was attended by some HCA members and other associations and agencies. The new cost report, once finalized, will be required for all non-hospital-based CHHAs, LHCSAs and FIs throughout New York State, including New York City, and will apply to those who provide Medicaid fee-forservice and/or Medicaid managed care services. Continued on next page
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Continued from previous page According to DOH, the purpose of this meeting and another one held in New York City last week was to obtain feedback from providers to ensure:
The cost report instructions are clear, logical and provide enough information;
Agencies understand what information is required for each of the cost report schedules;
Agencies understand the source documentation that should be leveraged to complete each of the schedules; and
Agencies understand the functionality of the web-based tool for cost report submission and the audit procedures (to be done by KPMG).
The information at the meeting was provided by DOH and KPMG, the state’s contractor on the new report. HCA emphasized the need to roll out the new cost report over a long period of time to assist with education and timely completion, as many LHCSAs and FIs do not currently complete a cost report. DOH said it will release the new cost report sometime in spring 2020 (based on 2019 data) and will allow adequate time to complete it. DOH will hold numerous educational opportunities and agencies will be able to ask questions regarding each schedule during these sessions and while completing the report. At the meeting, there was much discussion about how many cost reports will have to be submitted by agencies that currently submit more than one cost report and/or have multiple sites and how many cost reports will be required for FIs that serve multiple counties. In addition, it is not clear as to how the new cost report will affect those LHCSAs and FIs that receive county-specific rates. DOH agreed to provide clarification on these vital issues. DOH informed participants that specific form schedules are designed to capture different wage components, including base wages, overtime, and average wage calculations, as well as data on both live-in and split-shift cases, including the number of individuals served, days/hours of services, and associated wages. DOH reported that no CPA certification will be needed, which is very positive news. Still, KPMG will conduct audits of the reports and this process will be outlined during the educational sessions. It was suggested that agencies create a Zip folder to store all relevant files used for the completion of the cost report so that agencies can provide backup documentation to support the data in their report, for KPMG’s review. HCA suggested that DOH alert the state Office of the Medicaid Inspector General (OMIG) about the audit process so that OMIG is aware that the cost reports will be reviewed. After holding last week’s meetings, DOH intends to ask meeting participants to complete the new home care cost report using 2018 data as a test. DOH will provide assistance in completion and will conduct a follow-up workshop with the participants to review the audit section of the tool and to discuss the roles and responsibilities of all parties in the audit process. HCA will keep members informed on any new developments with the new cost report. For more information, including a review of the proposed cost report, contact Andrew Koski at akoski@hcanys.org or (518) 810-0662, or Patrick Conole at pconole@hcanys.org or (518) 810-0661.
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MLTC Policy Meeting Yields Updates, Issue Discussions On September 12, HCA participated in the state Department of Health (DOH) Managed Care Policy and Planning Meeting. (See the handouts at https://hca-nys.org/wp-content/uploads/2019/09/ MLTCUpdateSept12PlanningMtg.pdf.) Some updates and issues include the following:
MLTC enrollment increased 12.06 percent from September 2018, including a 12.20 percent increase in partial cap plans.
On July 12, DOH released the Community First Choice Option (CFCO) Plan Readiness survey to Mainstream and Managed Long Term Care Plans. Responses were due back to the Department by August 12. Managed Care Organizations (MCOs) started to receive feedback from the Department on September 6 and that feedback is being sent in weekly batches to the MCOs. That feedback is being sent back directly to the plan representative who submitted the assessment. (See related p. 13 story.)
DOH’s annual Licensed Home Care Services Agency (LHCSA) certification is due October 15, 2019 for MLTC partial capitation plans. Effective October 1, 2019, and using enrollment as of July 1, 2019, each MLTC plan may contract with a certain maximum number of LHCSAs. (See related p. 7 story.)
The Fully Integrated Duals Advantage (FIDA) demonstration is ending December 31, 2019. DOH has scheduled bi-weekly calls beginning September 17 to review FIDA close-out activities, including plan requirements to assist with Medicaid re-certifications, passive enrollments and distribution of member notices. FIDA plans should receive the final non-renewal letters shortly.
DOH held an MCO webinar on August 15 on the 21st Century Cures Act. During the webinar DOH provided updates on: provider enrollment; Consumer Directed Personal Assistance Program (CDPAP) enrollment; re-validation versus re-instatement in fee-for-service (FFS) Medicaid; MLTC activities; and Part B edit terminations.
DOH plans to soon release additional guidance on the CDPAP/Fiscal Intermediary issue as well as information on rates that are broken down into direct wages and benefits and administration for CDPAP.
CMS Issues Rule to Tighten Provider Enrollment The U.S. Centers for Medicare and Medicaid Services (CMS) has recently issued a final rule that confers CMS with new provider revocation powers, specifically in connection to affiliate entities. The final rule (https://www.govinfo.gov/content/pkg/FR-2019-09-10/pdf/2019-19208.pdf) is named “Program Integrity Enhancements to the Provider Enrollment Process” (CMS-6058-FC). Notably, a new “affiliations” authority in the rule allows CMS to identify and deny enrollment to individuals and organizations that pose an undue risk of “fraud, waste or abuse based on their relationships with other
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previously sanctioned entities,” such as a currently enrolled or newly enrolling organization that has an owner/managing employee who is “affiliated” with another previously revoked organization. The final rule also requires certain providers and suppliers to disclose any current or previous direct or indirect affiliation with a provider or supplier that has uncollected debt; has been or is subject to a payment suspension under a federal health care program; has been excluded from Medicare, Medicaid, or CHIP; or has had its billing privileges denied or revoked for the above programs. CMS says it may deny enrollment based on such an affiliation when CMS determines that it poses an “undue risk of fraud, waste, or abuse.” The rule also provides CMS with the authority to do the following:
Deny or revoke Medicare enrollment if CMS determines that the provider or supplier is currently revoked under a different name, numerical identifier, or business identity, and the applicable reenrollment bar period has not expired.
Revoke Medicare enrollment – including all practice locations – if the provider or supplier billed for services from a location that it knew or should reasonably have known did not comply with Medicare enrollment requirements.
Revoke a physician’s or eligible professional’s Medicare enrollment if he or she has a pattern or practice of ordering, certifying, referring, or prescribing Medicare Part A or B services, items, or drugs that is abusive, represents a threat to the health and safety of Medicare beneficiaries, or otherwise fails to meet Medicare requirements.
Increase the maximum reenrollment bar from three to ten years, with some exceptions.
Prohibit a provider or supplier from enrolling in Medicare for up to three years if its enrollment application is denied because the provider or supplier submitted false or misleading information on or with (or omitted information from) its application in order to gain enrollment in the Medicare program.
Revoke a provider’s or supplier’s Medicare enrollment if the provider or supplier has an existing debt that CMS refers to the U.S. Department of Treasury.
Deny a Medicare enrollment application if: 1) the provider or supplier is currently terminated or suspended (or otherwise barred) from participation in a state Medicaid program or any other federal health care program; or 2) the provider’s or supplier’s license is currently revoked or suspended in a state other than that in which the provider or supplier is enrolling.
CMS did not finalize its proposal to expand the requirements under Section 424.507 that all physicians and eligible professionals who order, certify, refer, or prescribe Part A and Part B service items and drugs be enrolled in Medicare. Section 424.507 limits Medicare enrollment to those physicians and eligible professionals that order imaging, clinical laboratory services, durable medical equipment, prosthetics, orthotics, and supplies, and home health services. Had CMS finalized this proposed provision, hospice providers would have had to ensure that all practitioners ordering hospice services were enrolled in Medicare. Continued on next page
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Continued from previous page CMS did finalize the provision related to a temporary moratorium which states: “A temporary moratorium does not apply to any enrollment application that has been received by the Medicare contractor prior to the date the moratorium is imposed” in recognition that the current provisions would have impacted providers who spent significant resources to prepare for enrollment only to have their applications denied near the end of the enrollment process because of the sudden imposition of a moratorium. The effective date for the final rule is November 4, 2019. HCA will update the membership as any additional information on the rule becomes available.
Update on 2019 CHHA Peds Rates, MW Adjustments As a follow-up to last week’s report about the 2019 CHHA Medicaid pediatric rates, HCA wanted to share some additional information gathered since that time. The state Department of Health (DOH) will allow rate appeals to be filed by September 29 (30 days from the date of its letter on the rates). Initial rate payments will be made in Medicaid Cycle 2195, with a check release date of October 2, 2019. The rates have been posted to the new Healthcare Financial Data Gateway within the Health Commerce System (HCS) at https://commerce.health.state.ny.us. After signing-in to the HCS, select “My Content” on the toolbar and then “Healthcare Financial Data Gateway” under “All Applications.” These rates reflect a zero “roll” factor adjustment as well as an overall zero trend factor for 2019. (The final 2019-20 state budget eliminated the possibility of any Medicaid trend factor through March 31, 2020.) A Dear Administrator Letter (DAL) provides additional information on the statewide aggregate Administrative and General (A&G) cap, which is 26.71 percent in 2019; regional guidelines or ceilings; worker recruitment and retention adjustments; and the rate appeals process. The initial 2019 CHHA rates include the three percent adjustment for recruitment and retention of nonsupervisory home care services workers with direct patient care responsibilities, along with a 4.7 percent rate add-on adjustment for the newer Recruitment, Training and Retention (RT&R) initiative ($100 million statewide). More info on minimum wage adjustments Effective January 1, 2019, the minimum home health aide payment rate has been increased per the following:
NYC $2.35 Westchester/Long Island $1.18 Rest of State $0.82
The minimum wage adjustments, if applicable, have been applied to the bottom-line “Revised 2019 Rates” on page three of the rate sheets, through an adjustment to the “Misc” adjustment line. Questions can be sent to DOH at CHHA-Rates@health.ny.gov.
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DOH Posts 2019 Hospice Non-Residence Medicaid Rates Includes base rates, minimum wage & RTR add-ons, similar to last week’s report on hospice residence rates The state Department of Health (DOH) has published the Medicaid hospice non-residence rates, following last week’s HCA report about the residence rates being posted. Both rate types are for the current 2019 calendar year (January 1 through December 31, 2019). DOH will make the initial rate payments in Medicaid Payment Cycle 2195 (with an expected release date of October 2, 2019). The rates and a Dear Administrator Letter (DAL) are here: https://www.health.ny.gov/facilities/long_term_care/reimbursement/hospice/. These hospice residence base rates represent 94 percent of the weighted average calendar year Medicaid rates of nursing facilities in each wage equalization factor (WEF) region. The rates also include a payment add-on of $9.92 per day for agencies that have filed certifications for Recruitment, Training and Retention (RTR). They also include a three percent add-on payment authorized by Section 3614.9 of the Public Health Law for hospices that have filed an RTR certification. Additionally, minimum wage increases have been incorporated into these rates based on survey data that was submitted and attested to by hospice programs. Questions can be sent to Hospice-Rates@health.ny.gov.
Home Care Emergency Drill Participation, Completion Rates Suggest Need for More Assistance Emergency preparedness drill participation and completion rates from two exercises held in June suggest that providers need continuing assistance in fulfilling required emergency preparedness protocols. In a meeting with the state Department of Health (DOH) Office of Health Emergency Preparedness (OHEP) and the Office of Primary Care and Health Systems Management (OPCHSM), HCA and colleague associations – the New York State Association of Health Care Providers (HCP) and the Hospice and Palliative Care Association of New York State (HPCANYS) – were informed that: 50 percent of Licensed Home Care Services Agencies (LHCSAs) participated in the required June 11 and 13 drill by submitting all survey forms (35 percent submitted some of the forms); 68 percent of Certified Home Health Agencies submitted all forms (29 percent submitted some); and 71 percent of hospices submitted all survey forms (7 percent submitted some). These numbers demonstrate the continued need for assistance to providers in survey completion, and HCA will work with DOH on this issue. HCA has emphasized – and will continue to do so – the necessity for all home care and hospice providers to participate in required and non-required drills in order to improve their preparedness for emergencies. Providers nevertheless encountered many issues during the drills, including: confusion about how to access the Integrated Health Alerting System (IHANS) through which drill notices are sent; which roles in the Health Commerce System receive IHANS notifications; what an After Action Report is and who has to complete it;
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conflicting timeframes for completing survey forms during each day of the drill; and the number of surveys that have to be completed by agencies with multiple sites. HCA discussed all of these issues with DOH and will follow-up for approaches to remedy these issues and/or educate providers in their readiness for future drills. HEPC meetings In addition to our meetings with OHEP/OPCHSM, HCA also participated in gatherings of the Lower Hudson Valley and Long Island Health Emergency Preparedness Coalition (HEPCs) as part of a grant we receive, along with HCP and HPCANYS, to support home care and hospice roles in emergency preparedness. The Lower Hudson Valley HEPC meeting discussed: training activities; lessons learned from a recent vehicle accident at West Point; development of training specifically for mass-casualty incidents; and use of electronic medical record data by one hospital that records the incidence of infectious disease and other illnesses to assist with resource management, surge planning, situational awareness, and community outreach. The meeting also included breakout groups to discuss medical surge and pediatric surge. The Long Island HEPC meeting included: a presentation on an “active shooter” exercise held at a local hospital; breakout sessions on medical and/or pediatric capability and capacity for incidents such as an active shooter situation, surge in burn patients and release of hazardous materials; and future tabletop exercises. HEPCs are regional coalitions of health care providers, local and state emergency managers and local public health preparedness officials who work together to develop and coordinate emergency preparedness activities. Under the OHEP grant, HCA, HCP and HPCANYS are responsible for participating in HEPC meetings on behalf of providers across the state outside of New York City where we advocate for home care’s and hospice’s involvement in emergency preparedness drills and other activities. For more information, contact Andrew Koski at akoski@hcanys.org or (518) 810-0662 or Alyssa Lovelace at alovelace@hcanys.org or (518) 810-0658.
New CFCO FAQs Available, Eyeing January 2020 Implementation The state Department of Health (DOH) has issued Frequently Asked Questions (FAQs) on contracting and credentialing related to the Community First Choice Option (CFCO). See here: https://hca-nys.org/wpcontent/uploads/2019/09/CFCO-Contracting-Credentialing-FINAL.pdf. As reinforced in the FAQs, CFCO implementation is scheduled for January 2020 with all waiver enrollees continuing to access soon-to-be CFCO-covered services (be it assistive technology, home-delivered meals, environmental or vehicle modifications, or others) “through the current waiver programs.” CFCO is a federally-funded long-term care benefit through the state Medicaid plan to provide eligible New Yorkers with assistance with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) and other supports. Over the past several months, HCA has reported regularly to the membership about the delayed CFCO implementation process – specifically, the staggered roll-out of guidance, information, rate codes and more
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The Situation Report: the Home Care Association of New York State
Volume 4, No. 32 September 16, 2019
Continued from previous page that are necessary for plan and provider implementation. This year’s state budget established the most recent implementation delay, from July 1, 2019 to January 1, 2020. HCA has been pressing DOH for workable approaches to CFCO implementation since the outset of the CFCO discussions. We have advanced proposals that would have streamlined and simplified the process. DOH has proceeded in the fashion as the guidelines map out, and HCA continues to share and relay the concerns of MLTCs and providers about the approaches being undertaken to implementation. We will continue to advocate from every angle for a fair and manageable process for CFCO. This new set of information from DOH – the FAQs – provides basic background information, including a link to where previous guidance documents are compiled at https://www.health.ny.gov/health_care/medicaid/ redesign/community_first_choice_option.htm. The FAQs also cover technical requirements related to administrative agreements for the various coverable services; contract amendment procedures; network adequacy requirements; treatment of single-case agreements; when CFCO service providers may be added to networks (they “may be added at any time,” though plans “are to have a full, adequate network of these CFCO services no later than the 2nd quarter 2020”; and other issues. It is important that both plans and providers read the FAQs and all applicable state guidance or requirements. Of note is question 19 from the FAQs: “The state has identified providers on its website, but plans reported that some of these providers are no longer offering these services or there are no providers available in certain areas. Will the state be updating the list” of providers online? To this question, DOH answered that it “has provided a non-exhaustive list,” making it all the more important for interested providers to engage in discussions with plan partners on CFCO readiness and network availability.
CMS to Host Home Health and Hospice Open Door Forum: September 18 The U.S. Centers for Medicare and Medicaid Services (CMS) has scheduled a Home Health and Hospice Open Door Forum for Wednesday, September 18 from 2 to 3 p.m. Some of the topics include:
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CMS-6058-FC – Program Integrity Enhancements to the Provider Enrollment Process. (See related p. 9 story.)
Clarifications and Follow-up Items from the August 21 Home Health Patient-Driven Groupings Model (PDGM) National Provider Call: Registration is here: https://www.cms.gov/Outreach-and-Education/ Outreach/NPC/National-Provider-Calls-and-Events-Items/2019-08-21-Home-Health-Call.html.
Updates and Announcements from the Home Health and Hospice Quality Reporting Program.
Updates and Announcements from the Home Health and Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey. Continued on next page
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Open Question & Answer Session.
Dial-in is as follows: 1-888-455-1397; conference passcode 4676500# CMS recommends that participants call in at least 15 minutes prior to the forum start time.
Health Resources
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“Telehealth and Medicare: What Is Covered,” AARP Public Policy Institute www.aarp.org/ppi/info-2019/telehealth-and-medicare-what-is-covered.html
“Medicaid: Efforts to Identify, Predict, or Manage High-Expenditure Beneficiaries,” United States Government Accountability Office https://www.gao.gov/products/GAO-19569?utm_campaign=usgao_email&utm_content=topic_health&utm_medium=email&utm_source=govdelivery