ELECTIONS CALL
STATISTICAL REPORTS
QUALITY MEASURES
CDPAP BOOTCAMP
Join HCA and our lobbying teams from Albany and Washington on a statewide call this Friday to discuss implications of the mid-term elections.
Complete your LHCSA Statistical Report by Friday or risk getting fined; plus other penalties await for late reports, including exclusion from operating as a LHCSA.
New quality measures are posted on Home Health Compare. See how NYS fared with national outcomes.
HCA has added an Albany session on top of NYC program (both in December) to help you navigate CDPAP FI regulations and compliance.
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UPCOMING PROGRAMS 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 (NYC) Dec. 10, 2018 (Albany) Register at https:// hca-nys.org/eventseducation/upcomingevents HCA’s offices are closed for Veteran’s Day on November 12 and will reopen on November 13.
Your Source for HOME CARE News, Policy and Advocacy
Vol. 3, Issue 44 | November 12, 2018
HCA Members Act Strongly on National Home Care and Hospice Month Celebrations: Will You Join Them? Some pretty engaged HCA members have taken our #HomeCareConnect pledge for National Home Care and Hospice Month and they’ve run with it! If you haven’t done so yet, there’s still time to catch up! All the information you need is at https://hca-nys.org/general-news/homecareconnect. See CONNECT p. 3
HCA Provides Memo, Sets Nov. 20 Briefing on HHPPS & PDGM HCA has prepared a memo on the recently finalized calendar year (CY) 2019 Home Health Prospective Payment System rule, including its finalization of the Patient-Driven Groupings Model (PDGM) for 2020. The memo is available at https://hca-nys.org/wp-content/uploads/ 2018/11/110618CMS2019FinalRuleFINAL.pdf. The memo details and provides calculation tables on the 2019 rate-setting under the current 60-day episode system applicable on January 1, 2019 including such factors as: a newly rebased market-basket update; another recalibration of the case-mix weights; application of the budget neutrality adjustment factor; Low Utilization Payment Adjustment (LUPA) payments; the outlier methodology; a newly tiered version of the home health rural add-on; and other adjustments. See MEMO p. 2
INSIDE HCA Members Act Strongly on Home Care, Hospice Month..........................1 HCA Provides Memo, Sets Nov. 20 Briefing on HHPPS & PDGM........................1 Member Call This Friday on Elections Outcome...........................................5 A Message from HCA Sponsor RBC Limited....................................................5 LHCSA Statistical Report Update..............................................................6 HCA, Colleagues Comment on LHCSA Public Need RFI....................................6 HCA & Coalition Urge Community Workforce Investment From Fidelis Sale....7 QIVAPP Funds Coming to MLTC Plans, Providers..........................................8 CMS Posts Updated Quality Measures Data on Home Health Compare.........8
HCA, Home Care-Mental Health Partnership Featured at Statewide Conference.......9 HCA, HCP Hold Networking Session on LI.............................................................10 Play to Win at 2019 Northeast Leadership Summit in Boston..............................11 CMS Proposes Medicaid Managed Care Changes...............................................12 Upcoming Deadlines and Due Dates..................................................................13 Retrospective CHRC Payments Expected in December........................................14 HCA Holds Albany & NYC Bootcamp on CDPAP FI Regs, Compliance.......................14 NORC RFA Posted...............................................................................................15 NHTD Waiver Update........................................................................................15 Health Resources.............................................................................................15
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MEMO from p. 1 It also provides further details on PDGM in 2020, including: the change to 30-day increments for payment purposes; the application of 432 home health resource groups; a new splitpercentage for Requests for Anticipated Payments (RAPs); the expectation of a “behavioral adjustment” at a to-be-determined percentage cut amount; admission source categorization factors; new clinical groupings; and more. The rule also contains several important changes in benefits and process requirements outlined in the memo, including:
A new home infusion therapy benefit;
A new definition of remote patient monitoring in regulation for the Medicare home health benefit and the inclusion of remote patient monitoring as an allowable cost on the home health agency cost report (yet with no direct reimbursement mechanism and with considerable remaining limitations on originating sites);
The elimination of requirements that certifying physicians must state how much longer care would be needed when recertifying the need for continued home care; and
Allowing the incorporation of home health agency records into physician records, including through the use of the plan of care (a nominal move, but in the right direction, on burden relief for the physician face-to-face requirement).
The memo also describes changes to the home health valuebased purchasing (HHVBP) program, which is currently operating in nine randomly selected states (New York is still not one of the nine states), and proposed changes or final process requirements under the Home Health Quality Reporting Program (HHQRP). November 20 Statewide Call To provide you with further insights on the rule’s implications for 2019 and 2020, and to answer your questions, HCA is holding an upcoming statewide, members-only call on the final CY 2019 HHPPS payment rule. The call will be held on Tuesday, November 20, from 10 to 11 a.m., but you must register in advance, and HCA will send you the dial-in information before November 20. To register, please complete the form at https:// www.surveymonkey.com/r/2019HHPPS. 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
Volume 3, No. 44 November 12, 2018
The Situation Report: the Home Care Association of New York State
CONNECT from p. 1 We’ve been sharing many of your efforts on Facebook and on our National Home Care Month website at www.nationalhomecaremonth.com. One of the first stories we received was from Americare nurse Carline Francois, RN MPH who told of her journey from the U.S. Navy to a continued service commitment in home care, by becoming a nurse. “After leaving the Navy, I worked as a computer analyst for Ernst & Young for five years,” she says. “I loved and enjoyed working as a computer analyst; but I felt empty; I felt I was missing something. I discussed this feeling with my parents and took their advice and made my decision to enroll in nursing school; my parents’ advice was the catalyst of a U-turn to embrace my true calling.”
Americare RN and veteran Carline Francois
We thank Americare and Ms. Francois for committing to one of HCA’s requested action items: sharing a story about a veteran in home care. Others have done so as well and we invite you to send these stories as soon as possible, so that we can share them with the Legislature this week! As another great example, Visiting Nurse Services in Westchester (VNSW) CEO and HCA Board Member Tim Leddy worked with the office of state Senator Terrance Murphy on presenting a proclamation to World War II veteran Alexander Nardone, 95, who is a home care patient. VNSW also held a staff appreciation event attended by 150 people and is running an ad in local press getting the word out among the public about home care. HCA also wants to commend UR Medicine Home Care’s team, especially its hospice, which has provided us with some amazing stories about veterans in its system’s programs. Their recent recognition events, through their participation in the national “We Honor
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ABOVE: Tim Leddy, CEO of Visiting Nurse Services in Westchester (VNSW), at right, joins WWII veteran Alexander Nardone as he receives a proclamation from the office of state Senator Terrance Murphy. RIGHT: RN Team Leader Diane Jones (holding Staff Recognition Day program), who won a service award for 10 years at VNSW.
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Continued from previous page Veterans Program,” included ceremonies honoring the oldest survivor of the Battle of the Bulge in Western New York, Wilbur Cooper, as well as a ceremony in September for National Guard Veteran Richard Jopson. They’ve also gotten some pretty outstanding news coverage for these events, too, as shared in HCA’s news clips distribution (and on Facebook) on Friday. There are still lots you can do to make the most of National Home Care Month, Hospice patient Wilbur Cooper, the oldest survivor of the and HCA is no exception. We are Battle of the Bulge in Western New York. preparing some press engagement of our own as well as direct outreach to all of the newly elected and reelected members of Congress and the State Legislature. This is a great opportunity for you to do this same kind of legislative outreach, now that the election outcomes are known and with the window of opportunity presented by National Home Care and Hospice Month. Which brings us to the Week II activities in HCA’s #HomeCareConnect pledge ... As emphasized in a postelection communication we sent you from HCA President Al Cardillo on Wednesday, please connect now with your elected officials so they know the value you provide for constituents. All last week, the pundits referred to the various “political waves” during the midterm elections; but you can help provide a “home care wave” of outreach that will help best position the home care, hospice and MLTC sectors as we approach a new Congress, state legislative session and state budget season. Here’s a reminder of the Week II #HomeCareConnect pledge activities we’ve already asked you to commit to – and will continue reminding you about as the week unfolds. Week II Action Items: November 12-16
I will meet with my newly elected or reelected state and federal officials.
I will invite my elected officials to go on a home care visit.
I will share with HCA a picture and a story about a veteran cared by my organization.
I will post about home care month on my elected officials’ Facebook pages and encourage them to post about home care.
If you have any questions or need help with this work, please contact HCA’s Communications Director Roger Noyes at rnoyes@hcanys.org.
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Join Call This Friday With HCA, State & Federal Lobbyists on Elections Outcome and What’s Ahead Last Wednesday, HCA President Al Cardillo sent a special message to members on the implications of this week’s historic midterm elections. (See https://conta.cc/2DwnHwc.) Since that time, certain races have been settled, others are still contested, and we are learning more about the expected changes in legislative leadership structure and committees of jurisdiction affecting the HCA membership and our work on your behalf. Later this week, November 16 (2 to 3:30 p.m.), both our Albany and Washington Government Affairs Teams will join HCA on a statewide call with the membership to provide you the latest updates, implications, HCA advocacy response plan, and forecasts stemming from the elections and the new political environment that directly affects you, especially with a new Congress and state legislative session coming in January. It’s important that you have this information as a table-setter for what’s to come on the grassroots advocacy front for HCA in the coming months. Please register for the call by completing the form below and HCA will send you dial-in instructions in advance. Register at https://www.surveymonkey.com/r/ElectionsOutcomeCall.
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LHCSA Statistical Report Update Fines for those who submit late Reports On November 8, the state Department of Health (DOH) held a conference call with HCA and the New York State Association of Health Care Providers (HCP) during which it informed us that Licensed Home Care Services Agencies (LHCSAs) who don’t submit the 2017 LHCSA Statistical Report by November 16 (this Friday) will incur penalties. These penalties will be: $500 if not submitted by November 16; another $500 if not submitted by December 1; and another $500 if not submitted by January 1, 2019. Any LHCSA that has not submitted the Statistical Report by January 1, which includes the new registration process, will not be able to operate or receive reimbursement from any source. DOH has already informed Certified Home Health Agencies (CHHAs), managed long term care plans, and associations representing Assisted Living Programs of this requirement. HCA reminds members that you have to receive a confirmation e-mail to confirm your Report submission. If not, you have not met the Statistical Report/registration requirement. So far, only about 368 of nearly 1,500 LHCSAs have submitted the Report. Last week, HCA received a list of those who had submitted the Report and those who had not. We then notified those members who were nonsubmitters and urged them to not wait until close to the deadline; otherwise, they may face delays and wait times for support. LHCSAs are encouraged to submit any questions to HCStatRpts@health.ny.gov (and copy Andrew Koski at akoski@hcanys.org).
HCA and Other Associations Submit Comments on LHCSA Public Need RFI Last week, HCA, along with the New York State Association of Health Care Providers (HCP) and LeadingAge New York submitted joint comments to the state Department of Health (DOH) in its Request for Information (RFI) on the recently enacted requirement that DOH develop a public need methodology for the approval of Licensed Home Care Services Agencies (LHCSAs). Our comments are at https://hca-nys.org/wp-content/uploads/2018/11/LHCSA-Need-Methodology-RFIComments-110618.pdf. The RFI sought recommendations for planning area designations; factors to include in the need methodology; exceptions to the methodology; experience for a LHCSA operator; any caps on the number of LHCSAs in a county; any special considerations for prioritizing initial licensure applications; whether any need methodology should apply to changes in ownership and/or expansions by existing LHCSAs into other areas; whether public need should consider if a LHCSA intends to serve Medicare and Medicaid patients; and additional requirements or priority considerations. Continued on next page
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Continued from previous page In the cover communication sent with our joint comments, we “recommend that a workgroup be established to deliberate and advise DOH in greater depth and detail on the questions posed by the RFI and on implementation of the new process.” “In addition, we ask that the use of this or any other detailed criteria in the application and review process not be applied in ways that add layers, administrative burdens, costs or time delays to providers or the Department. The LHCSA Certificate of Need process should, to the maximal extent, be as efficient, timely and seamless as possible for all concerned.” Our comments try to balance the components of a required public need methodology with the desire not to interfere with the entrance of new entities that can bring necessary services to patients in need.
HCA and Coalition Call for Investment of Centene Sale Funds into Home, Community-based & Mental Health Care Workforce HCA and a broad coalition of organizations this week called upon the Governor to reserve windfalls from the Fidelis sale (to Centene) for investment in the home, community-based and mental health care workforce. See the press release here: https://hca-nys.org/wp-content/uploads/2018/11/Workforce-Press-Release-4.pdf. In it, the coalition repeats our recurring request that at least 25 percent of health care investments “be directed toward less costly community care,” amounting to at least $169 million (state-share). “Unaddressed rising job vacancies and turnover rates have resulted in a full-scale access to care crisis for community-based primary care, home care, and mental health and substance use disorder services,” we state. “Our workers deserve an immediate infusion of resources to slow the crippling erosion of the community care workforce. Retention bonuses could hold workers in place until longer term community workforce solutions can be implemented. Paid training and similar incentives may help with recruitment.” As we’ve reported in the past, the 2018-19 state budget included a windfall amount, negotiated by the Executive, to capture $2 billion for the Medicaid program as a result of Fidelis being sold to Centene. The funding, however, has, in large part, been directed to hospitals and other institutions at a time when workforce investment in home care is vital. Workforce pressures and needs in home care are well documented, including: recruitment and retention; staff cross-training for work in the community sector; wage and non-wage compensation and incentive supports; and education opportunities for staff to fulfill state policy goals (such as value based payments and hospital use avoidance). HCA last legislative session made these kinds of investments and initiatives a focus of our state legislation proposals, as we have in the past and as we will continue to do this coming legislative session. We are also working to help support the state’s Workforce Investment Organization (WIO) initiative, as we reported in last week’s newsletter, which is one avenue for preparing New York’s long term care workforce to
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meet new models of care; address core clinical and quality outcomes; overcome disparities, access-to-care issues, population health gaps; and meet the prerogatives of the Triple Aim. Yet direct investment in the home care workforce infrastructure is not only absent but sorely needed. Our call for workforce investment was reported in Friday’s edition of Crain’s Health Pulse (you can read the article at https://hca-nys.org/wp-content/uploads/2018/11/Behavioral-health-home-care-providers-wantpiece-of-Fidelis-windfall.pdf) and we will continue to report on this effort, our follow-up with the Governor’s office on our requests, and other workforce support initiatives.
QIVAPP Funds Coming to MLTC Plans, Providers The state Department of Health (DOH) will be distributing the 2017-18 Quality Incentive Vital Access Provider Pool (QIVAPP) monies to MLTC plans by lump sum payment in cycle 2151 with a check release date of November 28, 2018. HCA had strongly advocated that the funding allocations be approved timely by DOH and the state Division of the Budget (DOB). In September, when the draft QIVAPP amounts were announced, HCA had sent individualized providerspecific tools to inform eligible LHCSA members of the estimated amount of QIVAPP funding they were expected to receive from plans. The pass-through amounts are now scheduled for distribution to providers from plans by December 28, 2018. DOH has informed us that the final QIVAPP amounts differ only slightly from the draft amounts shared with members. 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.
CMS Posts Updated Quality Measures Data on Home Health Compare Website The Island Peer Review Organization (IPRO) recently provided HCA with an October 2018 home health quality measure update that includes Home Health Compare data for the 12-month time period of January 1, 2017 through December 31, 2017. The data showed home health agencies (HHAs) in the state improving performance in 13 quality measures compared to results in the July update, which analyzed quality data from the period of October 1, 2016 through September 30, 2017. As with last quarter, “improvement in bed transfer” saw the most improvement (of 1.4 percent), while “improvement in management of oral medications” also improved by 1.2 percent overall. The measure for “depression assessment conducted” worsened by 0.1 percent. Acute care hospitalizations in the state remained at 15.8 percent, while urgent, unplanned care in the emergency room worsened, increasing from 12.9 percent to 13 percent. For the October 2018 Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) measures covering the April 1, 2017 through March 30, 2018 time period, the state improved in
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“communication with patients” and “recommendation of agency to family and friends” in comparison to the July update for calendar year 2017. The New York State Star Rating average remains at 3 while the national rating is at 3.5. Furthermore, New York’s home health agencies performed better than or equal to the national average for six quality measures: improvement in dyspnea; timely initiation of care; depression assessment; flu and pneumococcal vaccine assessment; foot care for diabetics; and emergent care without admission. HCA Medicare-certified home health agencies are encouraged to visit the Home Health Compare website at https://data.medicare.gov/data/home-health-compare and use the drop down for Star Ratings at the agency level. You can also compare measures by state, by year, by release date, and by agencies in the top 10 or top 20 percent.
HCA, Home Care-Mental Health Partnership Featured at Statewide Conference The opportunities for home care-mental health partnering, including HCA’s efforts, were featured this week at the conference of the State Association for Community Living Agencies in Mental Health (ACL). HCA President Al Cardillo addressed the convention, speaking about collaboration possibilities between home care agencies, MLTC plans, hospices and mental health providers. Mr. Cardillo described the work that he and senior officials at the state Office of Mental Health (OMH) have initiated over the past year-and-a-half to explore and promote mental health-home health collaboration through proactive program/policy development and by working to overcome regulatory, finance, workforce and other procedural barriers. Among some next steps are the mental health-home health legislation written by HCA in conjunction with OMH and signed into law on October 1 by the Governor. The legislation is designed to promote and facilitate mental health-home health collaboration for the care and management of individuals’ holistic physical, psychosocial and environmental needs, and it will next be the basis for a follow-up meetings with the Governor’s office, Division of Budget and Legislature. OMH officials presented data on home care, managed care and long term support services access and utilization by individuals living in the community (including congregate housing, supportive housing and other models), posing questions and potential directions for collaborative follow-up by OMH, HCA and ACL. The convention evolved into a high-energy “working session,” with participants and OMH, HCA and ACL leaders formulating elements of a collaborative work plan for driving opportunities at the state and service levels. Stay tuned for more details on this new effort and the opportunities HCA is working to create.
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HCA-HCP Networking Session on LI Brings Together Providers and Emergency Preparedness Partners On November 8, HCA and New York State Association of Health Care Providers (HCP) worked in conjunction with the state Department of Health (DOH) Office of Emergency Preparedness (OHEP) and with the state Division of Homeland Security and Emergency Services to hold an emergency preparedness networking program on Long Island that was enthusiastically received by all who attended. The almost 100 participants included many home care and hospice providers, other health care entities, county emergency managers and county public health preparedness representatives, as well as regional DOH emergency preparedness personnel. The meeting was an opportunity to: familiarize local emergency preparedness officials with the structure and services of home care and hospice and the challenges faced by these agencies in preparing for and responding to emergencies; acquaint health care providers with local emergency management staff, roles, procedures, services, response plans; and highlight local training and education opportunities offered by the Metropolitan Area Regional Office (MARO) Regional Training Center. There were many lively discussions centering on the challenges faced by providers in responding to emergencies, participating in state drills, meeting state and federal requirements, knowing whom to contact at the local level, and more. But there was also great interest in providers working closely with local emergency managers and public health officials. The meeting was a great opportunity to make such initial contacts as well as to stress the value for providers who participate in other networking opportunities, such as the Health Emergency Preparedness Coalitions (HEPCs), which meet regularly across the state. The participants broke into two groups – one for Nassau and one for Suffolk – and were able to make important contacts as well as discuss ways to work closely together, while sharing unique challenges that providers face in each county. There were many suggestions for improving preparedness activities and linkages with emergency preparedness officials. HCA and HCP will be formulating next steps to take from this meeting and other meetings held throughout the state. HCA and HCP work together under a grant from the DOH OEP with all home care and hospice providers to support their roles in emergency preparedness, including sessions like the one on Long Island, communications and resources to providers about drills and other emergency preparedness information and directives, as well as participation in the HEPCs. For more information, contact Andrew Koski at akoski@hcanys.org or (518) 810-0662.
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Play to Win at 2019 Northeast Home Health Leadership Summit in Boston Registration is now open for the 17th Annual Northeast Home Health Leadership Summit in Boston on January 22-24, which seeks to inspire and stimulate a “play-to-win” mindset among home care leaders like you. At the Summit, you’ll get the information and perspectives necessary to navigate the policy, reimbursement and regulatory field of home care services, especially as a new political environment in Washington, post-election, influences this framework. The Summit will also provide you with some tactics, tools and resources to make on-field gains in such areas as: negotiating or assessing new models of care, rethinking what it means to enhance the patient experience of care, as well as recruiting and retaining a winning team. Our experts will also help you improve your team’s peak performance and its communication skills across generations, moving cooperatively toward your play-to-win goals. Here’s The Game Plan
Flip through the conference brochure outlining all of the amazing sessions we have in store. An online booklet version and PDF download are available at http://nehomehealthsummit.com/ registration.
Register before the early-bird deadline (12/3) for the best rate at http://nehomehealthsummit.com/ registration/.
Invite and register a rising star at your organization to join you at a special Leadership Succession Planning Bonus Discounted rate (see page 12 of the brochure for details).
Make your hotel reservations at the Colonnade Hotel (http://nehomehealthsummit.com/hotelinformation/).
Look for more highlights of this all-star strategy session for executives from eight northeast states. Bonus Session: Medical Directors Meeting In addition to the pre-conference and full Summit program, we are offering a free, bonus Home Care & Hospice Special Medical Directors Meeting that coincides with the conference on January 23, from 8:30 to 10 a.m. Check out the flyer here for details: http://nehomehealthsummit.com/wp-content/uploads/2011/06/ Med-Directors-Flyer.pdf All the information you need is at www.nehomehealthsummit.com.
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CMS Proposes Medicaid Managed Care Changes Last week, the U.S. Centers for Medicare and Medicaid Services (CMS) proposed major changes to a 2016 rule covering Medicaid managed care plans that, according to CMS, will “relieve regulatory burdens; support state flexibility and local leadership; and promote transparency, flexibility and innovation in care delivery.” A fact sheet is at https://www.medicaid.gov/medicaid/managed-care/downloads/guidance/factsheet-cms2408-p.pdf and the proposed rule is at https://s3.amazonaws.com/public-inspection.federalregister.gov/201824626.pdf. Some of the proposals include:
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Providing states with greater flexibility to develop and certify a rate range under specific conditions and limitations, including that the rate range be actuarially sound.
Removing barriers that made it difficult to transition new services and populations into managed care because of existing fee-for-service payment arrangements by providing states with a three-year transition period to come into compliance with requirements related to pass-through payments.
Providing states more flexibility to set meaningful network adequacy standards using quantitative standards that take into account new service delivery models like telehealth.
Removing outdated and overly prescriptive administrative requirements that govern how plans communicate with beneficiaries to better align with standards used across federal programs and enable the use of modern means of electronic communication when appropriate.
Maintaining the requirement for states to develop a Quality Rating System (QRS) for health plans to facilitate beneficiary choice and promote transparency, but with greater ability for states to tailor an alternative QRS to their unique program while requiring a minimum set of mandatory measures.
Maintaining the current regulatory framework for program and fiscal integrity, including provisions related to the actuarial soundness of rate setting, provider screening and enrollment standards, and medical loss ratio (MLR) standards;
Eliminating the requirement for enrollees to submit a written, signed appeal after submitting an oral appeal.
Changing the timeframe for enrollees to request a state fair hearing to no less than 90 calendar days and no greater than 120 calendar days to better align with Medicaid fee-for-service requirements.
Permitting paper provider directories to be updated quarterly rather than monthly if the managed care plan offers a mobile-enabled provider directory.
Permitting notices of provider terminations to be sent by the later of 30 calendar days prior to the effective date of the termination or 15 calendar days after the receipt or issuance of a termination notice.
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Upcoming Deadlines and Due Dates Requirement/Change
Effective/ Due Date
Transition Period for Using Health Insurance Claim Number (HICN) or new Medicare Beneficiary Identifier (MBI)
April 1, 2018 to December 31, https://www.cms.gov/Medicare/NewͲMedicareͲCard/index.html 2019
Medicare Open Enrollment: Beneficiaries can change October 15 to their Medicare coverage from managed care plan to December 7, feeͲforͲservice or vice versa, 2018 and can join or switch prescription drug plan
www.medicare.gov
Home Health, Hospice & DME Open Door Forum
November 14, 2018
https://www.cms.gov/OutreachͲandͲ Education/Outreach/OpenDoorForums/ODF_HHHDME.html
Advance Care Planning Request for Information
Comments due https://hcaͲnys.org/wpͲcontent/uploads/2018/10/RFI_AdvancedͲ November 16, CareͲPlanningͲ_OctoberͲ2018.pdf 2018
2017 LHCSA Statistical Report Due
November 16, 2018
LHCSA Registration Process
Must be submitted with LHCSA https://commerce.health.state.ny.us/public/hcs_login.html Statistical Report by November 16, 2018
CMS Regulatory Relief Proposed Rule
Comments due https://www.gpo.gov/fdsys/pkg/FRͲ2018Ͳ09Ͳ20/pdf/2018Ͳ19599.pdf November 19
MLTC Enrollment LockͲIn Starts
December 1, 2018
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More Information
https://commerce.health.state.ny.us/public/hcs_login.html
https://www.health.ny.gov/health_care/medicaid/program/update/ 2018/2018Ͳ06.htm#mltc
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Retrospective CHRC Payments Expected in December The state Department of Health (DOH) is expected to process payment amounts due to home care providers since 2016 for Criminal History Record Check (CHRC) activities. DOH has indicated that the amounts are expected to be distributed in December checks, including retrospective reimbursement covering the end of 2016 through the third quarter of 2018. The payments cover fingerprinting and other administrative expenses as part of the process whereby certain prospective paraprofessional employees providing direct care must undergo a criminal history background check. HCA will provide further information on the expected check release date as we learn more.
In December, HCA Adds Albany Session to Follow NYC Bootcamp Program on Navigating CDPAP FI Regulations & Compliance Consumer Directed Personal Assistance Program (CDPAP) fiscal intermediary (FI) requirements and compliance activities are becoming increasingly more complex and under scrutiny. To help existing and prospective FIs navigate this growth area of home care, we are offering two Bootcamp sessions: one in New York City on December 5 and another newly added one in Albany on December 10. This program will offer a comprehensive update on the relevant statutes and regulations as well as strategies for maintaining compliance, as presented by regulatory expert Hermes Fernandez of Bond Schoeneck and King. Topics include: the latest on the FI Authorization process; marketing restrictions under a recent state budget provision and related state guidance issued in late September; joint employment issues; responsibilities of consumers, FIs and plans or local social services districts; time sheets and other recordkeeping issues; personal assistant wage and benefit issues (wage parity, Domestic Worker Bill of Rights, Workers Compensation, Earned Sick Time, state Paid Family Leave program, etc.); written agreements on 24-hour/ live-in cases; and other potential problem areas and how to address them. Here are the details:
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NYC Session: December 5 at Conference Center, 130 East 59th St. (near Lexington Ave.), Room 712 New York, NY 10022. Register at https://hca-nys.org/wp-content/uploads/2018/10/HCA-BootcampCDPAP-Compliance-Update-Dec-5-2018.pdf.
Albany/Upstate Session: December 10 at University at Albany Alumni House, 1400 Washington Avenue Albany, NY 12222. Register at https://hca-nys.org/wp-content/uploads/2018/11/HCABootcamp-CDPAP-Compliance-Update-Dec-10-2018.pdf.
The Situation Report: the Home Care Association of New York State
Volume 3, No. 44 November 12, 2018
NORC RFA Posted The New York State Office for Aging (NYSOFA) has posted a Request for Applications entitled “Expansion of the Classic Naturally Occurring Retirement Community (Classic NORC) Program and Neighborhood Naturally Occurring Retirement Community (Neighborhood NORC) Program.” The RFA, along with an applicant webinar, is at https://aging.ny.gov/ContractsandGrants/index.cfm. Under this RFA, NYSOFA seeks applications from eligible not-for-profit organizations to operate a NORC program to provide services to older adults, aged 60 and older, residing in areas that qualify as Classic NORCs or Neighborhood NORCs. NYSOFA currently funds 16 Classic NORC programs and 13 Neighborhood NORC programs. The purpose of this RFA is to expand NYSOFA’s NORC program by funding additional programs throughout the state, particularly in underserved areas or for underserved populations. Applications will be accepted from:
Organizations proposing to serve a qualified service area that does not currently receive NORC funding from NYSOFA; and
Organizations that currently receive NORC funding from NYSOFA that are applying to serve a qualified service area that is distinct from and does not overlap any other service area for which the organization already receives NYSOFA NORC funding.
NYSOFA anticipates a maximum of six applicants may be selected to operate a Classic NORC program and an additional maximum of seven applicants may be selected to operate a Neighborhood NORC program. NYSOFA intends to fund programs throughout the state to assure a geographic balance. The maximum award for a Classic NORC program will be $200,000 and the minimum award for a Neighborhood NORC program will be $60,000 for a twelve-month period. Applicants must demonstrate their ability to provide total matching funds of at least 25 percent. The contract period shall be for a five-and-ahalf year period, beginning July 1, 2019 and ending December 31, 2024. Questions on the RFA must be submitted by November 28; answers to questions will be posted by December 14; and applications are due February 1, 2019.
NHTD Waiver Update The state Department of Health (DOH) has posted a PowerPoint presentation from a September 13, 2018 webinar that reviewed the Nursing Home Transition and Diversion (NHTD) waiver renewal application approved by the U.S. Centers for Medicare and Medicaid Services on July 12, 2018. The PowerPoint is at https://www.health.ny.gov/health_care/medicaid/redesign/mrt90/docs/2018-0913_nhtd_waiver_app_chgs.pdf. The approved application is at https://www.health.ny.gov/health_care/medicaid/redesign/mrt90/docs/201807-12_1915c.pdf. Members who provide NHTD services are advised to review the PowerPoint and approved application to learn about changes in the program.
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The Situation Report: the Home Care Association of New York State
Volume 3, No. 44 November 12, 2018
Health Resources
“Trends in Health Care Employment in New York State,” by the Centers for Health Workforce Studies http://www.chwsny.org/wp-content/uploads/2018/11/ Trends_in_NY_Health_Care_Employment_Brief_2018.pdf
“Certifying Patients for the Medicare Home Health Benefit,” by the U.S. Centers for Medicare and Medicaid Services https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNMattersArticles/downloads/SE1436.pdf
“Medicare Cost Report E-Filing (MCReF),” by the U.S. Centers for Medicare and Medicaid Services https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNMattersArticles/downloads/MM10611.pdf
For more information, contact Andrew Koski at akoski@hcanys.org or (518) 810-0662.
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