WAGE AMOUNTS
WIOs
EMERGENCY PREP
LAWTALK
As minimum wage increases are set to go into effect, HCA reminds members on new thresholds, including for Wage Parity.
Workforce Investment Organizations have begun offering training events for your staff as part of state initiative. Learn more about the different WIOs operating statewide, including opportunities for wage replacement coverage.
The state has published a new toolkit developed by HCA, HCP in conjunction with the state Department of Health to support preparedness efforts and informational resources to patients.
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The latest installment of our LawTalk column (from attorneys at our counsel’s firm) offers insights on addressing allegations of workplace violence. PAGE 13
UPCOMING PROGRAMS HCA, HCP, HPCANYS Emergency Preparedness Networking Session on Long Island Nov. 8 Quality and Technology Symposium Nov. 14 and 15 Join HCA for Downstate & Upstate CHHA Forums in Late November Upstate (Albany): Nov. 27 Downstate (NYC): Nov. 29 HCA Bootcamp: Regulatory & Compliance Update for Fiscal Intermediaries Under NY’s CDPAP Dec. 5, 2018 Register at https:// hca-nys.org/eventseducation/upcomingevents
Your Source for HOME CARE News, Policy and Advocacy
Vol. 3, Issue 43 | November 5, 2018
CMS Finalizes 2019 HHPPS and 2020 PDGM As announced to members in an alert on Thursday, the U.S. Centers for Medicare and Medicaid Services (CMS) has finalized its calendar year (CY) 2019 payment rule for home health, which also includes CMS’s much-anticipated Patient-Driven Groupings Model (PDGM) for 2020, the biggest overhaul to the payment system in 20 years. The final rule is available for download at https://s3.amazonaws.com/publicinspection.federalregister.gov/2018-24145.pdf. See PDGM p. 3
Urgent: If You Miss LHCSA Statistical Report Due Date Next Week, Your LHCSA Could Be Prohibited from Operating The state Department of Health (DOH) reached out to HCA last week asking for our assistance on an urgent matter. DOH has informed HCA that only 200 out of nearly 1,500 LHCSAs have completed the 2017 Statistical Report, which is due next week. See URGENT p. 2
INSIDE CMS Finalizes 2019 HHPPS and 2020 PDGM.................................................1 Urgent: Don’t Miss LHCSA Report Due Date Next Week..................................1 QIVAPP Funds Approved by DOB...................................................................1 A Message from HCA Sponsor RBC Limited..................................................3 Wage Parity and Minimum Wage Amounts for 2019.....................................5 Take the Pledge for Home Care and Hospice Month......................................6 HCA, State EMS Association Building Potent Collaboration.........................8 Free Workforce Training Available through WIOs.........................................9
QIVAPP Funds Approved by DOB Next step is to issue payment to MLTC plans After much advocacy by HCA to expedite the issuance of the Quality Incentive Vital Access Provider Pool (QIVAPP) monies to MLTC plans and providers, the state Division of the Budget (OMB) has approved the 201718 QIVAPP funding. The next step is for the monies to be loaded into the system and paid to the MLTCs. In past years, once those payments were made, See QIVAPP p. 5
EVV Open Door Forum to be Held..................................................................10 CMS Extends Deadline for Electronic Cost Reporting....................................11 New Preparedness Toolkit, Plus Upcoming HEPC Meetings...........................11 LawTalk: Addressing Workplace Violence...................................................13 Upcoming Due Dates and Deadlines.........................................................15 CMS Delays Publication of Discharge Planning Rule.....................................16 CMS Issues Transmittal on the Redesign of Hospice Periods..........................16 Change in Internet Browser Requirement for HCS......................................17 Health Resources......................................................................................18
The Situation Report: the Home Care Association of New York State
URGENT from p. 1 DOH directly sought our assistance in notifying agencies of this urgent deadline. If you do not complete the report by the November 16 deadline, along with the registration requirement as part of it, your agency may be prohibited from operating. You may also face fines of $500 per day and other sanctions. HCA has informed our members of this requirement repeatedly in the past several weeks and urges immediate action by LHCSAs to complete the statistical report if you have not done so already. It is important that you complete the Statistical Report well ahead of the deadline because the process is new and may take you additional time. Also, you could experience system issues in the process of downloading the software or when transmitting the report, and you don’t want to take chances that an IT error could result in a late report or that DOH is consumed with inquiries and will be unable to provide you with technical support at the eleventh hour. FAQs about the Statistical Report, instructions on how to download the new platform, instructions on completing each section of the report, and five videos, are on the Health Commerce System (HCS) at https:// commerce.health.state.ny.us/public/hcs_login.html. You need to first go to “My Contact” on the top bar, then the “Documents by Group,” “View all Document Groups,” “Long Term Care,” “Training,” “Home Care,” and, lastly, “LHCSA Statistical Report.” Please complete the report as soon as possible. Questions should be sent to hcstatrpts@health.ny.gov. 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 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
The Situation Report: the Home Care Association of New York State PDGM from p. 1 HCA is conducting a close analysis of the rule which we will share with the membership in an upcoming Public Policy Memo outlining the payment calculations and other factors of the rule in greater detail. What follows is a cursory glance at some of the main elements of the rule thus far identified. The rule can be understood as having two main parts: 1) the payment changes for the Home Health Prospective Payment System (HHPPS) beginning on January 1, 2019, along with any regulatory or reporting requirements, update factors, and changes; and 2) the implementation of PDGM, including new case-mix classifications and episode increment changes, applicable on January 1, 2020.
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add-on policy mandated by the Bipartisan Budget Act of 2018 for CY 2019 (a $20 million decrease). As extensively reported to the membership, this new rural add-on policy requires CMS to classify rural counties into one of three categories based on: 1) high home health utilization; 2) low population density; and 3) all others. PDGM in 2020 CMS is finalizing its proposal to overhaul the HHPPS from 60-day episodes of care to 30-day periods of care, along with related case-mix changes. The rule states that these changes are budget-neutral.
2019 HHPPS Changes For 2019, CMS projects a payment increase of 2.2 percent, or $420 million. This includes a 2.2 percent update percentage (a $420 million increase); a 0.1 percent increase in payments due to decreasing the fixed-dollar-loss (FDL) ratio (a $20 million increase); and a 0.1 percent decrease in payments due to the new rural
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However, as reported in last week’s newsletter (and confirmed in this final rule), the new model still includes the risk of a significant “behavioral adjustment” based solely on assumptions of behavioral changes that home health agencies might undertake in the future. CMS originally
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Continued from previous page proposed a 6.42 percent reduction in base payment rates for this purpose but the final rule does not offer the 2020 actual rates, and instead notes that such an adjustment is required for the first year of PDGM. The cut, as originally proposed at 6.42 percent, was based on assumptions of “behavioral changes” by home health agencies that have no basis in data or methodological forecasting by CMS. Such a cut may have dire circumstances for many agencies, including those who are forecasted to have a net benefit over the full course of PDGM, even if CMS fulfills its assurance of budgetneutrality with restorations in the later years of PDGM implementation. Other Items CMS is making some changes to the measures in the Home Health Value Purchasing Model (which is not in effect in New York State); is allowing remote patient monitoring as an allowable cost on home health agency cost reports; and is eliminating the requirement that a certifying physician estimate how much longer skilled services are required when recertifying the need for home care. While this latter regulatory change provides some relief, CMS nevertheless keeps intact the onerous home health face-to-face requirement which remains one of the top provider and patient-care access burdens, and is a top reason for home health denials that HCA will continue to seek relief from. Also, the remote patient monitoring provision is basically incorporated in the Medicare cost reports as an allowable cost, but this doesn’t mean a promise of adequate coverage; the cost reporting function would install these costs into the base of reimbursement for future payment methodologies with as-of-yet unknown treatment in the update factors for later years. HCA will need to examine each of these in detail. We will also report to you on the finalized payment calculations and forecasts, recalibrated case-mix
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weights, wage index changes, more details on the rural add-on and other items in our forthcoming memo. As previously shared with the membership, our HCA Data page includes a PDGM forecast provided by CMS. HCA has refined the forecast to include only New York State providers. It details, by Medicare provider number, how each agency is expected to fare under PDGM. If you haven’t viewed this spreadsheet, you can do so at https:// hca-nys.org/hca-data. An HCA member account is needed to access the page. (Contact HCA’s Communications Director Roger Noyes at rnoyes@hcanys.org if you need assistance.) HCA Advocacy HCA and our federal legislative-affairs firm, Envision Strategy, have already begun outreach to New York’s Congressional Delegation and are scheduling upcoming visits with Members of Congress. As part of this outreach, we are urging co-sponsorship and support for House and Senate legislation that would require Medicare to institute rate adjustments only after home health agency behavioral changes actually occur, basing any behavioral adjustment on real “observed evidence.” The legislation would also ensure Medicare budget neutrality but require the phase-in of any necessary rate increases or decreases to be no greater than 2 percent per year to limit the risk of disruption in care. HCA wrote about this package of bills (S.3545; S. 3458; and H.R. 6932) in last week’s edition of The Situation Report. Please stay tuned for more information and updates.
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The Situation Report: the Home Care Association of New York State
QIVAPP from p. 1 DOH had asked plans to provide the funds within 30 days to eligible LHCSAs with whom they contract for aide services. When the draft QIVAPP allotments were announced in September, HCA created individualized tools to help inform eligible LHCSA members of the estimated amount of state funding they will receive. QIVAPP has been available since the 2014-15 state fiscal year for New York City home care providers who contract with MLTC plans for aide services and meet certain criteria. More information on QIVAPP is at https://www.health.ny.gov/health_care/medicaid/redesign/mrt_61.htm. Questions about QIVAPP can be directed to Andrew Koski at akoski@hcanys.org or (518) 810-0662.
Wage Parity and Minimum Wage Amounts for 2019 Amounts apply to NYC, Long Island and Westchester The wage parity amounts that apply to home care aides in New York City, Long Island and Westchester for 2019 are listed below. These include the new minimum wage amounts that increase December 31, 2018. The state Department of Health included these amounts in two Dear Administrator Letters (DALs) posted on October 31, 2017 at https://www.health.ny.gov/health_care/medicaid/redesign/mrt_61.htm. The following charts show the wage parity levels, including minimum wage amounts, for this year and next year.
State Wage Parity Law County
December 31, 2017 to December 31, 2018
December 31, 2018 to December 31, 2019
NYC
$13 + $1.69 additional wages and $2.40 supplemental wages ($17.09 total)
$15 base wage + $1.69 additional wages and $2.40 supplemental wages ($19.09 total compensation)
Nassau
$11 + $3.22 supplemental wages ($14.22 total)
$12 base wage + $3.22 supplemental wages ($15.22 total compensation)
Suffolk
$11 + $3.22 supplemental wages ($14.22 total)
$12 base wage + $3.22 supplemental wages ($15.22 total compensation)
Westchester
$11 + $3.22 supplemental wages ($14.22 total)
$12 base wage + $3.22 supplemental wages ($15.22 total compensation) Continued on next page
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Continued from previous page The definitions for “additional wages,” “base wage,” “supplemental wages” and “total compensation” are included in the DALs. Minimum Wage for 2019 The minimum wage amounts, effective December 31, 2018, for 2019 are: $15 per hour in New York City (up from $13); $12 per hour in Nassau, Suffolk and Westchester (up from $11); and $11.10 per hour in the rest of the state (up from $10.40). Minimum wage amounts are also on the New York State Department of Labor’s website at https://www.labor.ny.gov/workerprotection/laborstandards/workprot/minwage.shtm. For more information, contact Andrew Koski at akoski@hcanys.org or (518) 810-0662.
What Are You Waiting For? Take the Pledge for Home Care and Hospice Month With November in full swing, take a moment and commit to the #HomeCareConnect pledge for National Home Care Month. If you’ve already done so, thank you! Last week, HCA e-mailed some special instructions and resources to those who have already signed up, but we need a lot more of you to do so and multiply our impact! All of the information you need is on one page at https://hca-nys.org/general-news/homecareconnect. Also, we’ve created a flyer you can share with your staff promoting this campaign: https://hca-nys.org/wpcontent/uploads/2018/11/OnePagerNationalHomeCareMonth.pdf. Here is a summary of the Week 1 activities which you can choose from for this week: Week 1 Action Items: November 1-9
I will notify my staff about National Home Care Month and HCA’s #HomeCareConnect campaign, why it is important, and ask them to participate with me on all of the action items in my pledge.
I will “like” HCA’s Facebook page (https://www.facebook.com/HCANYS/) and invite others to do so (including all of my staff).
I will use HCA’s Facebook frame for my profile picture and encourage others to do so (including all of my staff). See our Facebook page for details.
I will host a staff appreciation event for my front-line team.
I will write and send a letter to the editor of my local newspaper (download a sample letter to the editor at https://hca-nys.org/wp-content/uploads/2018/11/Sample-Home-Care-Month-Letter-to-theEditor.docx.) Continued on next page
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Continued from previous page
I will contact my local TV news or radio news station to pitch a news segment about home care.
Veterans Day is next week. I will identify a patient who is a veteran and share his or her story with HCA (and a picture) for circulation to lawmakers.
Take the pledge today at https://www.surveymonkey.com/r/HomeCareConnect.
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HCA, State EMS Association Building Potent Collaboration HCA and one of New York State’s two major emergency medical services (EMS) associations, the United New York Ambulance Network (UNYAN), are developing what may promise to be a new and potent collaboration within the health care system. This week, HCA President Al Cardillo presented to the EMS association board in Binghamton on the work of the home care community and potential opportunities our associations can create together for EMS and home care to address critical health and health system issues. Board officers sought a full briefing on HCA’s Stop Sepsis at Home initiative. Mr. Cardillo and UNYAN immediate past chair, Lester Freemantle, discussed ways in which home care providers and EMS could nurture and further advance home care-EMS collaboration in the sepsis effort, given the compatibility of the HCA sepsis tool with EMS collaborative protocols for sepsis (a near identical match). They stressed the importance of joint work in responding to requests for sepsis patient transport, as well as broader issues such as: critical health information exchange for home care/EMS/physician/ER partners; the possibilities of start-of-care from the home environment and during transport; and joint efforts in community education. HCA and UNYAN have been working closely on HCA’s sepsis initiative, with UNYAN actively collaborating on our Steering Committee and in our Stop Sepsis at Home training sessions with IPRO. (UNYAN also cosponsored the October 3 All-partner Sepsis Summit.) HCA and UNYAN have also created a joint training/ education module for home care and EMS providers which we have submitted to the state Health Department. HCA and UNYAN have likewise been collaborating in the areas of emergency preparedness, exploration of collaborative models of community paramedicine, and potential new approaches for synchronizing home care, EMS and MLTC partner efforts. This new ground would focus on preventing emergency episodes and avoidable emergency transports where possible (HCA is currently working with community partners to collect data supporting a model program), as well as in pursuing new ways of addressing conditions like congestive heart failure, COPD, stroke, and others where timing, health information exchange and coordinated delivery to the ER are critical. The presentation concluded with the EMS board energized for next steps on this new and building alliance. A core component being emphasized in HCA planning under Mr. Cardillo’s and the Board’s leadership is the increased and powerful potential of wider and more in-depth collaboration by HCA with health system partners, which serves to better synchronize, position and innovate on behalf of all partners at the field and policy levels while improving patient care. Look for much more about this in our subsequent communications.
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Free Workforce Training Available through Regional WIOs Several free trainings are available to your staff in home care agencies throughout the state of New York via the recently established Workforce Investment Organizations (WIOs). The state Department of Health approved eleven such organizations in the fall of 2017 that are collectively receiving up to $245 million beginning from April 2018 to March 2020 for initiatives to retrain, recruit and retain health care workers in the long-term care sector as part of the state’s Medicaid Redesign Team (MRT) waiver amendment. Under this workforce development program, the Department of Health (DOH) required MLTC plans, which include Fully Integrated Dual Advantage (FIDA) plans, to contract with the designated WIOs to target directcare workers for training, with the goals of supporting the critical long term health care workforce infrastructure through retraining, redeployment, and enhancing skillsets. A list of participating MLTCs and their WIO-contracted partners is available on the DOH website at https://www.health.ny.gov/health_care/ medicaid/redesign/2018/2018-03-28_wip_y1.htm. Each WIO is approved to service one or more regions across the state. Included below are the approved WIOs and their service areas in addition to any available contact information. HCA will provide updates on any additional contact or website information as we obtain them. Long Term Care Workforce Investment Organizations (WIO) 1199 SEIU/Homecare Industry Education Fund – Ladders to Value (Regions: Central, Hudson, Long Island, NYC and Western New York) If you are interested in having your 1199SEIU employees and members take part in this training, please email LTV@1199Funds.org or contact Frances Sadler at (212) 284-9296 or Florence Wong at (212) 494-0598. ArchCare(Regions: Hudson, Long Island, and NYC) https://www.archcare.org/caremember/workforce-investment-organization Audacia Foundation (Regions: Central, Long Island, NYC, Northeast, and Western New York) http://audaciafoundation.org/workforce-investment-organization/ Finger Lakes Performing Provider System (Region: Western New York) https://flpps.org/Workstreams/Workforce Iroquois Healthcare Association (Regions: Central, Hudson, Long Island, NYC, Northeast and Western New York) http://www.ihawio.org/ Montefiore (Regions: Hudson and NYC) https://www.montefiore.org/ Continued on next page
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Continued from previous page Paraprofessional Healthcare Institute (Region: NYC) https://phinational.org/services/ SelfHelp Community Services, Inc. (Regions: Long Island and NYC) https://selfhelp.net/ Each respective WIO has developed its own trainings. In addition, some WIOs have also made wage replacement available (to cover agencies for the cost of worker participation in offered trainings) as well as incentive payments (offered to workers for training undertaken during off-work hours). Information about the available training resources is emerging from the respective organizations and HCA will be sharing that information as it becomes available. HCA will also be extending an invitation to each of the WIOs to participate in an informational webinar for our members to provide details about their offerings, so stay tuned. At a time when the workforce needs of home care couldn’t be greater, the WIOs provide an opportunity for evidence-based trainings to enhance, support and retain critical front-line staff. Trainings on such topics as MLTC quality metrics and Potentially Avoidable Hospitalizations (PAHs) will serve to enhance your agency’s ability to survive and thrive in a Value-Based Payment environment by improving patient outcomes.
EVV Open Door Forum to be Held The U.S. Centers for Medicare and Medicaid Services (CMS) will hold a national call on November 7 from 1 to 3 p.m. to obtain stakeholder feedback on implementation of the Electronic Visit Verification (EVV) requirement. The participant dial-in number is 800-837-1935; conference ID number is 33979177. No registration is required, but agencies are advised to call in 10 minutes before the 1 p.m. start time. Further information is at https://content.govdelivery.com/accounts/USCMSMEDICAID/bulletins/213124e. During the call, CMS will address information submitted in advance through the previously established EVV mailbox (EVV@cms.hhs.gov) and will provide an opportunity for individuals to offer additional feedback. A transcript and audio recording will be posted to the Podcast and Transcripts website at https:// www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/PodcastAndTranscripts.html. As communicated many times to members, states are required under this federal mandate to implement an EVV system for personal care services by January 1, 2020 (which was changed from January 1, 2019) and for home health services by January 1, 2023. The legislation that delayed EVV for personal care services until January 1, 2020 included additional non-binding language indicating that CMS should “convene at least one public meeting in 2018 for the
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purpose of soliciting ongoing feedback from Medicaid stakeholders on guidance issued” by CMS on EVV. This national call is being held to address this language. While New York has decided not to implement EVV as per the federal legislation allowing for a delay until January 1, 2020, the state already has a similar requirement for certain agencies to contract with verification organizations that use EVV for pre-claim review. In contrast, the state law is applicable to home health aide and personal care aide services provided by organizations with more than $15 million in Medicaid fee-for-service and managed care revenues. More information on the state requirement is at https://omig.ny.gov/index.php/information/home-healthverification. Additional information on the federal requirement is at https://www.medicaid.gov/medicaid/hcbs/ guidance/electronic-visit-verification/index.html. For more information, contact Andrew Koski at akoski@hcanys.org or (518) 810-0662.
CMS Extends Deadline for Electronic Cost Reporting to January 2, 2019 The U.S. Centers for Medicare and Medicaid Services (CMS) has recently issued Transmittal No. 2153 to inform providers about the new Medicare cost report electronic filing system and the extended deadline of January 2, 2019. Medicare Administrative Contractors (MACs) were originally instructed to close their portals for acceptance of electronic cost report submissions effective July 2, 2018. This new Transmittal instructs MAC portals to continue accepting electronic cost report submissions until January 2, 2019, after which electronic cost report submissions must be submitted through CMS’s Medicare Electronic Filing System. The Transmittal is available at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/ 2018Downloads/R2153OTN.pdf.
New Emergency Preparedness Toolkit, Plus Upcoming HEPC Meetings Announced Last week, the state Department of Health (DOH) Office of Emergency Preparedness posted and circulated an Emergency Preparedness Toolkit for home care and hospice providers and their patients. The Toolkit can be accessed by going to the Health Commerce System (HCS) at https:// commerce.health.state.ny.us/public/hcs_login.html. You need to go to “My Content,” “Documents by Group,” “View All Document Groups,” “Long Term Care,” “Preparedness” and then scroll down to the Toolkit. HCA compiled the Toolkit, with the assistance of a workgroup of providers, the New York State Association of Health Care Providers (HCP), and DOH. HCA and HCP are collaborative partners with DOH on multi-tiered initiatives in emergency preparedness and response. Continued on next page
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Continued from previous page The Toolkit is a compilation of resources for agencies to use in assisting their patients and families on preparations for any type of emergency situation. The resources address a variety of issues and considerations necessary for effective preparedness planning. The information within the Toolkit can be provided to patients and their families at admission to your agency so that the planning process is begun and in place as intended – well before an emergency event takes place. This Toolkit should also assist agencies and patients under the new federal Conditions of Participation for emergency preparedness, which require patient-specific emergency plans. The Toolkit can be shared in its entirety with staff, patients and families, or an agency can select from among the resources provided that best fit the needs of their staff and clients. The following categories of resources are included in this Toolkit:
General Preparedness Tips Food Safety Emergency Supply Checklist & Communication Plans Utility Outages Special Safety Resources
Health Emergency Preparedness Coalitions HCA continues to encourage your involvement with local Health Emergency Preparedness Coalitions (HEPCs). HEPCs are coalitions of health care providers, local and state emergency management and local public health preparedness officials that develop and coordinate emergency preparedness across the continuum, including readiness among individual health sectors, holding exercises and ‘hotwashes,’ conducting hazard and vulnerability assessments and other important activities. HEPCs will offer you the opportunity to take part in exercises required by the state Department of Health and the U.S. Centers for Medicare and Medicaid Services and to improve your emergency preparedness efforts with your patients and staff. The following are upcoming HEPC meetings; those interested in participating should contact Andrew Koski at akoski@hcanys.org. HEPC Meetings Lower Hudson Valley – December 5, 2018 Long Island – December 6, 2018 Western New York Northern Area (Genesee, Orleans, Niagara, and Wyoming) – February 15, 2019 Western New York Urban Area (Erie county) – February 8, 2019 Western New York Southern Tier Area (Allegany, Cattaraugus and Chautauqua) – February 1, 2019 Finger Lakes All Partners – March 18, 2019 & June 17, 2019 Continued on next page
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Continued from previous page Finger Lakes Northern Area (Monroe county) – January 7, 2019 & April 8, 2019 Finger Lakes Eastern Area (Livingston, Ontario, Seneca, Wayne and Yates) – February 11, 2019 & May 13, 2019 Finger Lakes Southern Area (Chemung, Schuyler, and Steuben) – November 19, 2018, February 25, 2019 & May 20, 2019 Central NY East sub-region – December 3, 2018 Central NY North sub-region – December 4, 2018 Central NY West sub-region – December 5, 2018 Central NY South sub-region – December 6, 2018 Capital District – December 4, 2018, March 14, 2019 & May 16, 2019 Capital District North Country – November 26, 2018, March 7, 2019 & May 2, 2019 HCA and HCP work together under a grant from the DOH Office of Emergency Preparedness with all home care and hospice providers to support their roles in emergency preparedness. This includes participating in HEPC meetings across the state. Training Programs The Aware Prepare Update (https://www.urmc.rochester.edu/emergency-preparedness/training.aspx) is a monthly electronic newsletter that includes upcoming trainings related to preparedness. These trainings may be provided in one or more of the following formats, including: live webcasts, webinars, in-person training, archived webcasts and on-demand eLearning.
LawTalk: Addressing Workplace Violence By Deirdre M. Salsich, Associate and Frank J. Fanshawe, Principal, Jackson Lewis, the firm for HCA’s Counsel Workplace violence is an often misunderstood term of art in the home health care sector. For many employees, the term “violence” often connotes physical violence, and many neglect to think of verbal acts or other behaviors that actually fall within the realm of workplace violence. Much has been said about the effects of bullying in the workplace. Bullying can be loosely defined as the act of intimidating a less powerful colleague for any number of reasons. In the health care world, the hierarchy of clinicians over other health care providers is a reality, but can sometimes lead to the perception of bullying if the clinician is particularly assertive. Some may perceive that seemingly positive quality as aggression. In the home care realm, home health aides interact with nurses, doctors, family members and other caregivers. The patient’s home is a unique environment in which respect for the patient must be paramount. In this space, workplace violence allegations can occur when there is a verbal disagreement. Home health aides provide an invaluable service to their patients and their families, but this intimate relationship can be ripe for misunderstandings. Cultural differences or the patient’s medical conditions, such as dementia or Alzheimer’s disease, can influence what would normally be a benign interaction. Your organization’s employees at every level can learn to navigate these challenges tactfully to avoid potentially
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negative outcomes. Employees in the home health care sector have been disciplined up to and including termination for workplace violence in myriad scenarios. In reality, the accused party could be the caregiver, the patient, the patient’s family member or friend, or any third party who enters the patient’s home. The following is a list of tips for addressing an accusation of workplace violence, regardless of the accused or accuser’s role in, or outside of, your organization:
DO: Acknowledge that the accuser has raised a concern. Assure the accuser that the company takes all complaints seriously and will investigate the complaint.
DO: Inform the accused of the nature of the complaint. Ask for his or her version of events. Keep an open mind while conducting the investigation.
DO: If the charges of verbal workplace violence are serious (abusive language or threats of physical harm), and/or the accuser feels afraid for his or her safety, consider placing the accused on administrative leave with pay pending the outcome of the investigation.
DO: Maintain an Anti-Workplace Violence Policy in your employee handbook. Review this policy at least yearly to ensure compliance with all applicable local, state and federal laws.
DO: Review New York State’s recent changes to the law regarding sexual harassment in the workplace, including the Division of Human Rights’ (DHR) webpage regarding an employer’s obligations to train employees and address complaints from any and all parties. Changes to the law include language that opens an employer up to liability based on the actions of third parties, including contractors and non-employees. Information can be found at https://www.ny.gov/ combating-sexual-harassment-workplace/employers.
DON’T: Characterize the complaint as founded or unfounded until a full investigation has been completed.
DON’T: Jump to conclusions.
DON’T: Retaliate against any accuser or any other individual who participates in good faith in the investigation. Disciplinary or other adverse employment action against an employee who accuses another party of workplace violence or harassment opens the employer up to potential liability if the employee files a complaint with a state, federal or local agency, or a lawsuit in state or federal court.
A helpful fact sheet can be found at: https://www.jacksonlewis.com/sites/default/files/assets/practicegroups/Investigation-Services.pdf. Please note that 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.
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Volume 3, No. 43 November 5, 2018
Upcoming Deadlines and Due Dates
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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
Medicare Open Enrollment: Beneficiaries can change their Medicare coverage from managed October 15 to care plan to feeͲforͲservice December 7, 2018 or vice versa, and can join or switch prescription drug plans
www.medicare.gov
Electronic Visit Verification November 7, 2018 Open Door Forum
https://content.govdelivery.com/accounts/USCMSMEDICAID/bulletins/213124e
Home Health, Hospice & DME Open Door Forum
November 14, 2018
https://www.cms.gov/OutreachͲandͲ Education/Outreach/OpenDoorForums/ODF_HHHDME.html
HCA/HCP Long Island Emergency Preparedness Networking Session
November 8, 2018
Contact akoski@hcanys.org
Advance Care Planning Request for Information
Comments due November 16, 2018
https://hcaͲnys.org/wpͲcontent/uploads/2018/10/RFI_AdvancedͲCareͲPlanningͲ _OctoberͲ2018.pdf
2017 LHCSA Statistical Report Due
November 16, 2018
https://commerce.health.state.ny.us/public/hcs_login.html
CMS Regulatory Relief Proposed Rule
Comments due November 19
https://www.gpo.gov/fdsys/pkg/FRͲ2018Ͳ09Ͳ20/pdf/2018Ͳ19599.pdf
MLTC Enrollment LockͲIn Starts
December 1, 2018
https://www.health.ny.gov/health_care/medicaid/program/update/2018/2018Ͳ 06.htm#mltc
LHCSA Registration Process
Effective January 1, 2019
https://commerce.health.state.ny.us/public/hcs_login.html (part of LHCSA Statistical Report)
The Situation Report: the Home Care Association of New York State
Volume 3, No. 43 November 5, 2018 ď Žď€
CMS Delays Publication of Discharge Planning Rule The U.S. Centers for Medicare and Medicaid Services (CMS) has announced a one-year extension, until November 3, 2019, to publish the discharge planning final rule for home health agencies and other providers. The CMS announcement came as a notice in the Federal Register for the final rule titled Medicare and Medicaid Programs; Revisions to Requirements for Discharge Planning for Hospitals, Critical Access Hospitals, and Home Health Agencies (https://www.govinfo.gov/content/pkg/FR-2018-11-02/pdf/201823922.pdf). On November 3, 2015, CMS published a proposed rule that requires home health and other providers to meet specific discharge planning requirements in order to participate in the Medicare and Medicaid programs. The proposed rule also implemented the discharge planning requirements of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. In the proposed rule, CMS outlines an elaborate discharge planning process for home health providers when patients are discharged to another post-acute care provider. Additionally, CMS would require a lengthy list of information to be provided to a receiving facility or practitioner whenever a patient is discharged from home health services. In its comments on the proposed rule, HCA highlighted concerns about the burden the proposed requirements would have on home health providers. We also asserted that CMS failed to recognize the uniqueness of home health care providers in its proposals for discharge planning. Based on both public comments and stakeholder feedback, CMS determined that significant policy issues needed to be resolved, prompting the need for an extension.
CMS Issues Transmittal on the Redesign of Hospice Periods The U.S. Centers for Medicare and Medicaid Services (CMS) recently issued Transmittal 4152 (https:// www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2018Downloads/R4152CP.pdf), which outlines the systems and operational changes needed to redesign how the Common Working File (CWF) stores and updates hospice election and benefit period information. It also provides claim submission instructions relating to the redesign. Generally, the redesign ensures that election and revocation date information are separate from benefit period information, so the two types of information can be updated independently. Since the implementation date of the redesign, Medicare Administrative Contractors (MACs) have identified processing scenarios that call for additional changes. This Change Request (CR) seeks to resolve the two following scenarios: 
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Scenario 1: Initially, Medicare instructed hospices that if a revocation date was submitted entirely in error (for instance, the beneficiary actually transferred to another hospice, rather than revoking his or her hospice benefit), the hospice could remove the revocation date by submitting Type of Bill
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(TOB) 8xB with zeros in the through date. This process is not working, requiring hospices to use more cumbersome correction procedures. Information in the Transmittal helps MACs revise the Medicare systems so that this process can be supported via Direct Data Entry.
Scenario 2: If hospices submit incorrect election or revocation dates, they can correct them using occurrence code 56 and condition code D0. Hospices have not been educated regarding a similar process to correct errors in transfer or change of ownership dates. CWF mechanisms exist to support action code 2 corrections of transfer dates or change of ownership dates using TOB 8xA. Information in the Transmittal describes a process for hospices to submit corrected dates using 8xC and 8xE submissions, while Medicare systems employ the existing 8xA mechanisms behind the scenes.
Transmittal No. 4152 also updates Chapter 11 of the Medicare Claims Processing Manual to reflect information about the hospice redesign that was previously published only in provider education materials.
Change in Internet Browser Requirement for HCS Microsoft Internet Explorer Version 10 not compatible starting January 2 Due to state application and data security requirements, the state Department of Health (DOH) will discontinue Health Commerce System (HCS) support for Microsoft Internet Explorer version 10 in the near future. Beginning Wednesday, January 2, 2019, Internet Explorer version 10 will be unusable for accessing the HCS. This stems from a decision by Microsoft to no longer provide support for older versions, causing Internet Explorer 10 to rapidly become unsecure and making the transmission or exchange of data risky. On the Windows platform, the HCS currently supports Microsoft Internet Explorer version 11, and Google Chrome. You can download the latest version of these browsers from the following links:
Microsoft Internet Explorer: http://windows.microsoft.com/en-us/internet-explorer/download-ie
Google Chrome: https://www.google.com/chrome/browser/desktop/
Support for Microsoft Edge will be added on January 2, 2019. If you are not sure which Internet browser you are using, visit http://whatsmybrowser.org to determine your browser and version. Please contact hcsoutreach@health.ny.gov for questions or assistance.
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Health Resources
“Prior Authorization in Medicare Advantage Plans: How Often Is It Used?,” by the Kaiser Family Foundation http://files.kff.org/attachment/Data-Note-Prior-Authorization-in-Medicare-Advantage-Plans-HowOften-Is-It-Used
“Medicare Advantage 2019 Spotlight: First Look,” by the Kaiser Family Foundation http://files.kff.org/attachment/Data-Note-Medicare-Advantage-2019-Spotlight-First-Look
“Redesign of Hospice Periods – Additional Requirements,” by the U.S. Centers for Medicare and Medicaid Services https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNMattersArticles/downloads/MM10967.pdf
For more information, contact Andrew Koski at akoski@hcanys.org or (518) 810-0662.
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