October 21, 2019 Edition of The Situation Report

COST REPORTS

MBI IN, HICN OUT

EVV RFI

FLU

In its fourth meeting, Cost Report Workgroup continues to examine issues as state plans to expand report requirements for CHHAs, LHCSAs and FIs.

80% of home health claims are using MBIs instead of HICNs, which are phasing out. Starting Jan. 1, claims will be rejected without MBI.

The state has issued an RFI for vendors in its implementation of Electronic Visit Verification following last week’s report on stakeholder concerns, recommendations.

State advisory outlines flu reporting requirements. Mask mandate is not yet in effect.

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Your Source for HOME CARE News, Policy and Advocacy

UPCOMING PROGRAMS PDGM Bootcamp for Clinical Managers and Quality Staff Oct. 23 (Fairport) Webinar: Immigration Law Compliance for Home Health, Hospice Oct. 30 2-3 p.m.

Save The Date: 2020 Northeast Home Health Leadership Summit Jan. 28-30 (Boston)

Registration for these and other programs are on HCA’s website at https://hcanys.org/eventseducation/ upcoming-events.

Vol. 4, Issue 37| October 21, 2019

Gottfried to State Officials: Community Providers Belong in “DSRIP Driver’s Seat” Assembly Health Committee Chairman Richard Gottfried wrote to state health officials this week stating, directly, that “community-based providers belong in the DSRIP driver’s seat” as the state seeks to extend its Delivery System Reform Incentive Payment (DSRIP) waiver with a federal ask of $8 billion.

See GOTTFRIED p. 2

DOH: FI PMPM Structure “Suspended” In the wake of a related court ruling, the state Department of Health (DOH) on October 17 notified managed care plans that the portion of Managed Care Policy 19.01 implementing the per-member-per-month (PMPM) rate structure for fiscal intermediary (FI) administrative services is “suspended unless and until further notice.”

See SUSPENDED p. 3 At HCA’s flagship Corporate Compliance Symposium last week in Albany, Randi Seigel and Megan Sherman of Manatt, Phelps and Phillips, LLP, outline internal auditing and monitoring processes and tips for compliance in home care, hospice and Managed Long Term Care. Robert Hussar of Barclay Damon, LLP, who is also a former official at the state Office of the Medicaid Inspector General, describes areas of audit contractor scrutiny for providers to focus on in their compliance defense work.

INSIDE Gottfried: Community Providers Belong in “DSRIP Driver’s Seat”........1 DOH: FI PMPM Structure “Suspended”..............................................1 Member Hiring Announcement........................................................3 Discussions Continue on New Cost Report for CHHAs, LHCSAs & FIs.....4 A Special Message from GWR Medical...............................................4 Transition Ending Soon for New Medicare Cards.................................5 Responses Due Nov. 7 on New EVV Vendor RFI.....................................5

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HCA Comments on Home Health ABN...................................................................6 ACHC Accreditation Savings for HCA Members.....................................................7 Advisory on Flu Surveillance, Reporting Requirements................................................8 QIES Getting Upgrade to iQIES.....................................................................................8 Letter Released on Nursing Home Resident Rights and Community Services................9 Social Security Announces 1.6 Percent Increase for 2020.....................................9 OIG Posts Updated Work Plan.............................................................................9 Health Care Resources..........................................................................................10

The Situation Report: the Home Care Association of New York State GOTTFRIED from p. 1 “If New York truly intends a broader continuum of providers to collaborate meaningfully, then the payment model must equitably reward the community based primary and long term care providers that care for, stabilize and maintain the population most vulnerable to avoidable acute care events,” he added. “DSRIP must provide them a more substantial leadership role and greater financial support to incentivize and support their strength and innovations, rather than leaving them only to bear risk.” You can read the entire letter at https://hca-nys.org/wp-content/uploads/ 2019/10/DSRIP-Gottfried-letter.pdf.

This firm position is consistent with Assembly Member Gottfried’s expressed support for broader community-based care participation and funding access during this past legislative session. As previously reported, he stood with a coalition of 21 providers and representatives, including HCA, at a press conference calling for proportionate investment of health care transformation funds for community care providers, as embodied in his bill (A.7977A/ S.6376) with Senate Health Committee Chairman Gustavo Rivera.

HCA greatly thanks Assembly Member Gottfried for affirming this position. In recent months, HCA has met with legislative and Executive officials to outline our recommendations for the DSRIP waiver following a letter from HCA and six collaborating associations on the matter. The current iteration of DSRIP has largely empowered and funded institutions – namely, hospitals – to lead Performing Provider Systems which manage fund flows and project decision-making to meet the state’s goal of reduced hospital utilization. This structure has not only created a gaping imbalance, in funding across sectors, but it has also incentivized jurisdictional cross-over that bypasses home and communitybased providers.

HCA is calling for realignment of the DSRIP waiver and a more bilateral approach in DSRIP II. Our Capitol Report newsletter and other communications, meanwhile, have also been highlighting some of the promising work of home care providers outside DSRIP or with some DSRIP project support that could be substantially elevated with a reorientation of DSRIP funds and administration.

With a projected $4 billion state deficit next year, the waiver extension will be a high-stakes focus of state health care policymaking.

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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Volume 4, No. 37 October 21, 2019 

The Situation Report is a weekly publication of the Home Care Association of New York State (HCA).

Unless otherwise noted, all articles appearing in The Situation Report are the property of the Home Care Association of New York State. Reuse of any content within this newsletter requires permission from HCA. Al Cardillo President and CEO acardillo@hcanys.org Roger L. Noyes Director of Communications, Editor of The Situation Report rnoyes@hcanys.org Rebecca Fuller Gray Executive V ice President for Clinical and Program Affairs rgray@hcanys.org Patrick Conole Vice President, Finance & Management pconole@hcanys.org Andrew Koski Vice President, Program, Policy & Services akoski@hcanys.org Alyssa Lovelace Director for Policy and Advocacy alovelace@hcanys.org Lauren Ford Director of Program Research, Development and Policy lford@hcanys.org Laura Constable Senior Director, Membership & Operations lconstable@hcanys.org Celisia Street Director of Education cstreet@hcanys.org Mercedes Teague Finance Manager mteague@hcanys.org Jenny Kerbein Director of Governance & Graphic Design jkerbein@hcanys.org Billi Wilson Manager, Meetings & Events bwilson@hcanys.org Teresa Brown Administrative Assistant tbrown@hcanys.org

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

Volume 4, No. 37 October 21, 2019 

SUSPENDED from p. 1 The notice is here: https://hca-nys.org/wp-content/uploads/2019/10/CDPAP-FI-Suspension-Notice-Plans.pdf.

As a reference, Managed Care Policy 19.01 is here: https://hca-nys.org/wp-content/uploads/2019/07/PolicyGuidance-FI-PMPM-and-Transition-Provisions-7.1.19_.pdf.

The remainder of Policy 19.01 is unchanged, DOH adds. This appears to suggest that several provisions remain intact concerning the transition of consumers and written notice to consumers in the event an FI “chooses to cease operations or leave its service area.”

Also suspended are the Frequently Asked Questions regarding FI changes (https://hca-nys.org/wp-content/ uploads/2019/10/CDPAP-FI-FAQs_revised-082719.pdf) and the October 9 guidance for Consumer Directed Personal Assistance Program claims and encounters.

Last week’s notice nevertheless leaves unanswered questions about the status of PMPM payment terms that may already have been negotiated in contract amendments among plans and FIs pending last week’s court decision.

In addition, on October 17, DOH released a guidance (https://hca-nys.org/wp-content/uploads/2019/10/ FI_PMPM_LDSS_101719.pdf) related to consumer directed services provided under contract with local Departments of Social Services. It states: Effective immediately, the Dear Administrator Letters dated August 30 and September 27, 2019 regarding changes to the Fiscal Intermediary services rates under the Consumer Directed Personal Assistance Program are suspended unless and until further notice. Billing codes 8400-8402 have been

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Volume 4, No. 37 October 21, 2019 

suspended. Claims processed using these codes will be automatically adjusted.

A state Supreme Court judge recently faulted officials for not following the required State Administrative Procedures Act (SAPA) when the state promulgated the PMPM rates, ordering DOH to revert to the previous rate methodology.

That decision did not address the merits of the case, however; and, thus, DOH can either appeal or issue a proposed regulation under SAPA to implement the PMPM policy.

Discussions Continue on New Cost Report for CHHAs, LHCSAs and FIs During the fourth meeting of the state’s Cost Report Workgroup, HCA and colleague associations continued to press fundamental issues with a draft cost report that the state Department of Health (DOH) is planning to adopt for most home care providers, including nonhospital-based Certified Home Health Agencies, Licensed Home Care Services Agencies (LHCSAs) and Fiscal Intermediaries (FIs) sometime in 2020.

The cost report will be new for many LHCSAs and FIs who don’t currently submit cost reports. It will also be a significant expansion of what’s already required for those CHHAs, LHCSAs and FIs who currently submit cost reports.

At the meeting, HCA inquired about the audit role of KPMG, the state’s contractor for the cost report. While a separate meeting will be held on audits, in November, KPMG did review some of what its role will entail. HCA again stressed that any findings by KPMG should not be held against providers in the first year of the new cost report.

Stakeholders also stressed to DOH and KPMG the importance of including some cost report software vendors as well as other third party

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Volume 4, No. 37 October 21, 2019 

data consultants in the workgroup, which DOH said it will consider. LHCSAs and FIs also asked specific questions about the forms and data required.

HCA continues to maintain that the cost report should not be released in 2020 (based on 2019 data), as DOH has proposed, especially since, to date, much of the data has not been collected in the format required by the cost report. We will also continue to call for a 2021 reporting cycle using 2020 data instead.

While the Department says it is still planning a 2020 implementation, HCA and HCA provider/FI members on the workgroup will continue to press for changes and an implementation delay considering that many issues remain unresolved.

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.

Transition Ending Soon for New Medicare Cards HICNs out, MBIs in, or else claims get rejected The 21-month Medicare Beneficiary Identifier (MBI) transition period ends on December 31, 2019. Starting January 1, 2020, providers must use the MBI when billing Medicare regardless of the date of service. Claims and eligibility transactions submitted with the Health Insurance Claim Numbers (HICNs) will be rejected.

At last count, providers submitted 80 percent of fee-for-service claims with MBIs. If you don’t have an MBI for patients, see the links and instructions provided in MLN Matters at https:// www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/ SE18006.pdf. This article explains how to help your patients obtain a new Medicare card, as well instructions to access the Medicare Administrative Contractor’s look-up tool.

Providers are also advised to check the remittance advice where the MBI can be found for every claim with a valid and active HICN.

Responses Due Nov. 7 on New EVV Vendor RFI On October 17, the state Department of Health (DOH) issued a request for information (RFI) seeking responses from technology vendors as state officials develop a federally required electronic visit verification (EVV) program for personal care and home health services.

Responses to the RFI (at https://www.health.ny.gov/funding/rfi/evv/docs/20042.pdf) are due on or before November 7 with an anticipated target timetable of November 18 to 22 when DOH expects to invite vendors for demonstrations in Albany.

As HCA reported in last week’s newsletter, the state recently issued a report on stakeholder concerns and recommendations related to EVV. The RFI stresses that some providers have already adopted EVV, adding that the RFI is intended to address stakeholder input in the current environment.

Among HCA’s recommendations, which we presented at a DOH Listening Session in July, are: flexibility for existing EVV adopters; funds for implementation; and several other EVV implementation “principles” outlined

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in an HCA letter to state officials over the summer (see https://hca-nys.org/wp-content/uploads/2019/ 10/EVV-Principles_070819.pdf).

The RFI establishes certain state EVV guidelines for consideration related to: federal statutory requirements; accessibility standards; data-reporting capabilities; ability to interface with existing New York State systems; and flexible rules-based technologies, maximizing “the use of cost-effective, industry-related, and application-ready Commercial Off-the-Self (COTS) technologies wherever feasible.”

The RFI also again reiterates the Department’s intention to elect a good-faith-effort waiver to extend its implementation target date by one year (to January 1, 2021) for personal care EVV. EVV for home health is required by January 1, 2023.

More information on EVV is at https://www.health.ny.gov/health_care/medicaid/redesign/evv/index.htm and https://www.medicaid.gov/medicaid/hcbs/guidance/electronic-visit-verification/index.html.

HCA Comments on Home Health ABN Last week, HCA submitted comments on the Advance Beneficiary Notice of Noncoverage (ABN) form instructions.

The proposed revisions are at https://www.cms.gov/Regulations-and-Guidance/Legislation/ PaperworkReductionActof1995/PRA-Listing-Items/CMS-R131.html?DLPage=3&DLEntries=10&DLSort=1&DLSortDir=descending.

According to the U.S. Centers for Medicare and Medicaid Services (CMS), no changes were made to the ABN. But the Instructions include new language about serving individuals dually eligible for Medicare and Medicaid, and some minor language and grammar edits.

HCA expressed concern that dual eligible patients receiving services from home health agencies that operate in New York State under the Third Party Liability (TPL) program may incorrectly choose Option Box One unless further guidance is included in the instructions. We also pointed out conflicting and unclear language and we suggested revisions.

ABNs must be given to Medicare fee-for-service beneficiaries when home health agencies (and other providers) believe that Medicare will not provide payment in certain cases. CMS estimates that about 4.6 million ABNs are given annually to patients for home health.

The current form and instructions are at https://www.cms.gov/Medicare/Medicare-General-Information/BNI/ABN.html.

Under the federal Paperwork Reduction Act, the ABN is subject to public comment and re-approval every three years. The current ABN has an expiration date of March 2020.

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Volume 4, No. 37 October 21, 2019

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

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Volume 4, No. 37 October 21, 2019 

Advisory on Flu Surveillance, Reporting Requirements On October 18, the state Department of Health (DOH) issued a health advisory on Influenza Surveillance and Reporting Requirements for the 2019-20 influenza season.

The advisory is at https://www.health.ny.gov/diseases/communicable/influenza/seasonal/providers/docs/ current_influenza_surveillance_and_reporting_requirements.pdf.

So far, DOH has not declared influenza to be prevalent and, thus, the mask requirement is not in effect. Under this requirement, staff must wear surgical or procedure masks during patient care activities if they have not received the influenza vaccine.

According to the health advisory: 

Any suspected or confirmed cases of novel influenza A virus (including viruses suspected to be of animal origin) must be immediately reported by telephone to the Local Health Department (LHD) of the patient’s county of residence. Contact information for LHDs is at http://www.nysacho.org/i4a/pages/ index.cfm?pageid=3713.

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Any suspected lack of response to antiviral therapy, despite a full course of antiviral therapy, should be promptly reported to the LHD of the patient’s county of residence; and all available clinical specimens or samples should be forwarded to DOH’s Wadsworth Center for antiviral resistance testing.

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Suspected or confirmed influenza-associated deaths in children under 18 must be reported to the LHD of the patient’s county of residence.

General resources on influenza, including vaccine information, are available at http://www.health.ny.gov/diseases/ communicable/influenza/seasonal/ and http://www.cdc.gov/flu/. Information about documentation of vaccination against influenza, or wearing of a surgical or procedure mask, is at http://www.health.ny.gov/flumaskreg.

QIES Getting Upgrade to iQIES The Quality Improvement and Evaluation System (QIES) is being upgraded “to make the system more reliable, scalable, secure, and accessible,” according to the U.S. Centers for Medicare and Medicaid Services (CMS).

Providers and vendors use QIES to submit assessment data. Upgrades to iQIES, as the new system will be called, are occurring in phases by sector, with upgrades for Certified Home Health Agencies occurring in January 2020.

Data submission processes will not change. However, all users must create an account in the Healthcare Quality Information System (HCQIS) Access, Roles and Profile system (HARP), a secure identity management portal. Access levels will be similar except with the added role of Provider Security Official (PSO).

Organizations must designate a PSO for approving or rejecting iQIES user access requests.

For details, see: https://qtso.cms.gov/news-and-updates/register-iqies-account-action-required-1. Frequently Asked Questions (FAQs) on HARP are at https://harp.qualitynet.org/login/help.

For additional questions, contact help@qtso.com or (800) 339-9313.

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Letter Released on Nursing Home Resident Rights and Community Services A new letter to nursing homes on the state’s Health Commerce System (HCS) requires facilities to ensure that all residents and/or their designated representatives are provided information on home and communitybased services and community transition programs that may be available to support them in returning to the community.

These notifications – to all residents and/or their designated representatives – must occur upon admission stating the right to live in the most integrated and least restrictive setting. Nursing homes are also expected to make a referral to the “local contact agency” at any time the resident requests to speak to someone about returning to the community.

Discharge planning staff must also be made available to discuss options that consider the resident’s medical, physical, and psychosocial needs.

Social Security Announces 1.6 Percent Increase for 2020 Social Security and Supplemental Security Income (SSI) benefits will increase 1.6 percent in 2020.

In addition, the maximum amount of earnings subject to the Social Security tax (taxable maximum) will increase to $137,700 from $132,900. Other changes for 2020 are in a fact sheet at https://www.ssa.gov/news/press/factsheets/colafacts2020.pdf.

Beneficiaries are normally notified by mail in early December about their new benefit amount. Most people who receive Social Security payments will be able to view their COLA notice online through their “My Social Security” account.

HCA will provide information about Medicare changes for 2020 once they are announced.

OIG Posts Updated Work Plan The U.S. Office of Inspector General has posted its updated Work Plan at https://oig.hhs.gov/reports-and-publications/workplan/updates.asp.

Of note is an item regarding “Reviews of Hospice Inpatient and Aggregate Cap Calculations.” The Work Plan states: Medicare imposes two annual limits to payments made to hospice providers: the inpatient cap and the aggregate cap. The inpatient cap limits the number of days of inpatient care for which Medicare will pay to 20 percent of a hospice’s total Medicare patient care days, and a hospice must refund to Medicare any payment amounts in excess of the inpatient cap. The aggregate cap limits the total aggregate payments that any individual hospice can receive in a cap year to an allowable amount based on an annual per-beneficiary cap amount and the number of beneficiaries served. Any amount paid to a hospice for its claims in

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excess of the aggregate cap is considered an overpayment and must be repaid to Medicare.

OIG is expected to complete a review of hospice inpatient aggregate cap calculations sometime in 2020.

Notably, as reported in last week’s Situation Report, the hospice aggregate cap is being reviewed by the Medicare Payment Advisory Commission (MedPAC) for possible reductions and wage index adjustment factors. More broadly, however, hospice compliance has been under recent OIG scrutiny, most alarmingly in an OIG report this summer which emphasized vulnerabilities and condition-level deficiencies nationally. HCA is part of a hospice advisory council led by the National Association for Home Care and Hospice (NAHC) which recently issued a document “to provide a summary of the OIG’s findings and some additional contextual insights into the findings presented by the OIG, as well as to present a broad framework for addressing the concerns raised in the reports and as part of industry reactions to the OIG’s findings.”

Health Care Resources

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“Busting the cap: Why New York is losing control of its Medicaid spending again,” by the Empire Center for Public Policy https://www.empirecenter.org/wp-content/uploads/2019/10/Busting-the-Cap-Final.pdf

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“Telehealth Services,” by the U.S. Centers for Medicare and Medicaid Services https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/ Downloads/Telehealth-Services-Text-Only.pdf

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“Cost of Care Survey 2019,” Genworth https://www.genworth.com/aging-and-you/finances/cost-of-care.html