January 6, 2020 Edition of The Situation Report

MIN. WAGE

NEW RAP %

ABN INSTRUCTIONS POSTED

WORKFORCE SURVEY

HCA again reminds members of minimum wage increases, including effect of wage parity, as of Dec. 31.

Request for Anticipated Payment (RAP) changes are now in effect, with 20% splitpercentage payments for each 30-day unit under new Patient Driven Groupings Model.

Changes to the instructions for Advance Beneficiary Notices are posted (used when providers believe Medicare will not pay for certain services); yet materials still pending federal budget office review.

The Center For Health Workforce Studies has extended the due date for completing its workforce survey, now due January 30.

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Your Source for HOME CARE News, Policy and Advocacy

UPCOMING PROGRAMS Webinar: Navigating the New Fiscal Intermediary Process Jan. 10, 2020 10-11:30 a.m.

Webinar: Getting Ready for HCA Advocacy Day 2020 Jan. 14, 2020 1-1:30 p.m.

2020 Northeast Home Health Leadership Summit Jan. 28-30, 2020 (Boston) HCA’s State Advocacy Day Feb. 5, 2020 (Albany) Information and registration for these and other programs are on HCA’s website at https://hca-nys.org/ events-education/ upcoming-events.

Vol. 5, Issue 1| January 6, 2020

With 1% Medicaid Cut, and Greater Risk on the Horizon, Your Advocacy is Essential Complete HCA’s finance survey NOW, and join us for Jan. 14 webinar to plan for State Advocacy Day in February On New Year’s Eve, state officials took an unprecedented step, triggering 1 percent Medicaid payment cuts amounting to $124 million across sectors for the current fiscal year (ending March 31) and $496 million for each state fiscal year thereafter, suggesting an intention to sustain the reductions as part of the coming-year budget, due for adoption by April 1.

As HCA noted in comments to Home Health Care News this week, the cuts’ “timing, just before the release of a new budget proposal in only a few weeks, is a harbinger of just how serious the state’s fiscal outlook is — and what else is yet to come amid a projected $6 billion deficit.” (See the story here: https://tinyurl.com/yfl473de.)

See ESSENTIAL p. 2

2018-19 QIVAPP Funding to be Released On January 3, the state Department of Health (DOH) notified Managed Long Term Care (MLTC) plans about the final 2018-19 Quality Incentive Vital Access Provider Pool (QIVAPP) allocations for their approved contracted Licensed Home Care Services Agencies (LHCSAs).

DOH plans to distribute the funding to MLTC plans in cycle 2212 with a check release date of January 29, 2020. Plans will then have until March 2 to pass the funding to their eligible contracted LHCSA providers.

See QIVAPP p. 4

INSIDE With 1% Cut, and Greater Risk on Horizon, Your Advocacy is Essential................1 2018-19 QIVAPP Funding to be Released..........................................................1 CHHA Minimum Wage Survey Again Extended: Now Jan. 15..............................3 Reminder on Minimum Wage Changes in New Year...........................................3 DOH Amends Required FI RFO Process..............................................................4 A Reminder on RAP Changes in 2020.................................................................5 State Issues Flu Health Advisory.......................................................................5 CMS Posts Revised ABN Instructions..............................................................6

Deadline Extended for Your Responses to SUNY-CHWS Workforce Survey..........6 Cybersecurity Guidance Issued.....................................................................7 Home Health, Hospice See Drop in Improper Payment Rates..........................7 Next Home Health & Hospice Open Door Forum: Jan. 8....................................8 Medicaid Levels Increase for 2020.................................................................8 CMS Requests Feedback on Scope of Practice & Reg. Relief..............................8 DOH Adjusts NHTD Rates...............................................................................9 IRS Issues Standard Mileage Rates for 2020....................................................9

The Situation Report: the Home Care Association of New York State ESSENTIAL from p. 1 Given this environment, we urgently need you at HCA’s State Advocacy Day on February 5 in Albany. This is your opportunity to meet with state legislators and advocate on behalf of the industry at a time of unprecedented risk for the financing of vital home and community-based services. Please lend your voice on February 5.

As noted in an alert to members last week, we also need you to take some more immediate actions. At present, the response rate to our annual finance survey needs a major boost in time for HCA to convey the results on Advocacy Day. If you have not completed this important survey, please do so now at https:// www.surveymonkey.com/r/201920FinancialSurvey.

This survey must be completed by all home care agency organizations as it is our main instrument for accurately characterizing the position of home care agencies on the precipice of what will surely be a hard budget ahead. HCA is also separately using a variety of data sources to outline key financial statistics for hospice and Managed Long Term Care.

Also, individuals considering to attend our February 5 State Advocacy Day should join us for a special January 14 webinar with HCA’s Director for Public Policy and Advocacy Alyssa Lovelace who will describe the steps necessary for you to make the most of State Advocacy Day. The webinar will explain what’s on the Advocacy Day agenda, the ins and outs of advocacy meetings, how to schedule legislative meetings, messaging, and more.

Registration for the webinar on January 14 and HCA’s February 5 State Advocacy Day are on HCA’s website at https://hcanys.org/events-education/upcoming-events.

Details Expected in State of the State this Week, Followed by Executive Budget Proposal Governor Cuomo’s State of the State address is on Wednesday, January 8. In lead-up to the address, his office has been progressively unveiling pieces of the Governor’s 2020 agenda, much of which will be incorporated in the budget. As of press time for The Situation Report, nearly 20 proposals have been

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 5, No. 1 January 6, 2020 

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 5, No. 1 January 6, 2020 

announced, with some related to health care, such as a plan to address prescription drug costs, banning Fentanyl analogs to combat the opioid crisis, and the creation of a new website where consumers can compare health care costs and quality of procedures by hospitals. These are all a prelude to the full series of proposals expected this week. HCA will be watching for those items related to Medicaid or home and community-based services that will take shape in the Governor’s soon ensuing release of a state budget proposal. In the meantime, please act now on our survey and plan to join us for HCA’s State Advocacy Day.

CHHA Minimum Wage Survey Again Extended: Now Jan. 15 The state-required Certified Home Health Agency (CHHA) minimum wage survey has again been extended and is now due January 15 to the state Department of Health (DOH).

As reported to members, HCA worked with DOH to revise the initial survey to account for CHHAs that contract with Licensed Home Care Services Agencies (LHCSAs) for all aide services and to include CHHA rate increases to LHCSAs for minimum wage increases for 2017 to 2019.

CHHAs that plan to include such costs on the survey should have some type of documentation to show that their increased rates to LHCSAs were for the minimum wage increases that affected the LHCSA aides.

More information is at https://tinyurl.com/tg3fn7p; individual questions can be addressed to CHHA-Rates@health.ny.gov.

Reminder on Minimum Wage Changes in New Year HCA again reminds providers about wage changes in the New Year.

Effective December 31, the minimum wage outside of New York City has risen to $13 per hour on Long Island and Westchester and $11.80 elsewhere (i.e., upstate). See the chart at https://tinyurl.com/ js8tvyj for the various tiers. (The New York City minimum remains $15.)

Wage parity levels may also apply, generating total compensation amounts of $16.22 on Long Island and Westchester and $19.09 in New York City once supplemental wages are added to the base minimum wage.

Agencies contracting with Nassau and/or Suffolk counties must additionally meet local living wage laws. (See https://www.nassaucountyny.gov/1597/Living-Wage and https://www.suffolkcountyny.gov/Departments/Labor/Living-Wage.)

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QIVAPP from p. 1 In early October, when the draft QIVAPP amounts were shared with HCA, we had sent individualized provider-specific data to inform eligible LHCSAs of the estimated amount they were expected to receive from plans.

QIVAPP has been available since the 2014-15 state fiscal year for New York City 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.

For additional information, contact Andrew Koski at akoski@hcanys.org or (518) 810-0662.

DOH Amends Required FI RFO Process Complimentary HCA webinar on January 10 to provide guidance The state Department of Health (DOH) has amended its recently released Request for Offers (RFO) required of Fiscal Intermediaries (FIs) to continue operating under the Consumer Directed Personal Assistance Program (CDPAP).

With the amendment (see details below), DOH has also extended the deadline to submit questions, as requested by HCA. That deadline is now January 10. HCA has already submitted questions and encourages members to do so (and copy Andrew Koski at akoski@hcanys.org).

The amendment (https://www.health.ny.gov/funding/rfo/20039/amendment1.pdf) also includes the following new section 1.1 on “Who Needs to Apply?” FIs should read the whole section. Notably, it says: “all entities providing FI services or that are interested in providing FI services, regardless whether such entities previously submitted for, or received, an authorization for approval as a fiscal intermediary, must respond to this RFO by the February 18, 2020 deadline.”

This is a very important clarification that all must complete the RFO, including every currently operating FI as well as those who want to provide FI services for the first time.

HCA webinar As previously announced, HCA will hold a January 10 webinar at 10 a.m. (free for members, $129 for nonmembers) to review the new application process, forms and documents. Led by HCA member Michael Weiner of Glaser & Weiner, P.C., the program will also highlight required FI services, best practices, and reporting requirements related to FI organizational, fiscal or quality-monitoring functions. There’s still time to register at https://hca-nys.org/wp-content/uploads/2019/12/HCA-Webinar_RFO-for-FIs-Under-CDPAPJan_10.pdf.

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

Volume 5, No. 1 January 6, 2020 

A Reminder on RAP Changes in 2020 New York’s Medicare Administrative Contractor, National Government Services (NGS), reminds home health agencies about Request for Anticipated Payment (RAP) processing changes now in effect as a result of the federal home health payment rule for 2020.

All RAPs are required at the beginning of each 30-day period of the Patient Driven Groupings Model (PDGM).

The split-percentage payment will be 20 percent of the estimated final payment for all 30-day periods of care (initial and subsequent). However, agencies newly enrolled in Medicare on or after January 1, 2019 will not receive split-percentage payments on RAPs as of January 1. Data fields and billing instructions required for a RAP are not changing.

Additional information is at https://www.cms.gov/Center/Provider-Type/Home-Health-Agency-HHA-Center or at www.ngsmedicare.com.

State Issues Flu Health Advisory The state Department of Health (DOH) has issued a Health Advisory on the current influenza season. (See https://hca-nys.org/wp-content/uploads/2020/01/Health-Advisory_Influenza_010320.pdf).

It provides updated influenza prevention, surveillance and control guidance along with links and references to influenza resources.

DOH indicates that influenza activity has not yet peaked, there have been steep increases in cases in the last few weeks, and influenza activity is expected to continue to increase in the upcoming weeks.

Data indicates that influenza A/H1 and influenza B/Victoria virus are co-circulating with the predominate virus type varying by region. Influenza A/H1 is the predominate virus in the New York City, Metropolitan/ Hudson Valley and Capital District regions, while influenza B/Victoria is the predominate virus in Central and Western regions. While influenza viruses can cause severe illness in people of all ages, influenza A/H1 and influenza B viruses are known to cause disproportionately more severe illness in young children, adolescents and middle-aged adults, reports DOH. DOH continues to strongly advise that all persons aged six months and older get the influenza vaccine immediately if they have not yet been vaccinated.

As reported previously to members, influenza is considered prevalent and thus the flu mask requirement is in effect. This means that home care and other health care staff must either be vaccinated or wear a surgical or procedure mask.

More information on this requirement is at http://health.ny.gov/FluMaskReg.

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CMS Posts Revised ABN Instructions The U.S. Centers for Medicare and Medicaid Services (CMS) has released revised instructions for the Advance Beneficiary Notice of Non-coverage (ABN) form.

These are posted on the Paperwork Reduction Act (PRA) website at https://www.cms.gov/Regulationsand-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing-Items/CMS-R-131 but have not been posted yet to the ABN website (https://www.cms.gov/Medicare/Medicare-General-Information/BNI/ABN).

HCA inquired and CMS explained that the materials are in a 30-day comment period, awaiting approval from the Office of Management and Budget. Once approved, CMS will post the revised instructions and the ABN with a new expiration date. HCA will notify members when these are posted.

In October, HCA commented on the then-proposed changes to the instructions. Among our recommendations, though not included, was language for home health agencies to direct dual-eligible patients to choose Option Box 1 on the ABN when the state Medicaid office does not want a claim filed with Medicare prior to filing a claim with Medicaid. In the revised instructions, if a dual-eligible beneficiary wants to obtain a Medicare determination, agencies are advised to instruct the patient to check Option Box 1 and the agency is advised to cross out certain accompanying language regarding a patient’s responsibility for payment should Medicare not pay (since duals cannot be billed when the ABN is furnished).

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.

For more information, contact Andrew Koski at akoski@hcanys.org or (518) 810-0662.

Deadline Extended for Your Responses to SUNY-CHWS Workforce Survey In November, the Center for Health Workforce Studies (CHWS) at the State University at Albany’s School of Public Health sought responses from HCA members and other providers on its annual health care workforce survey to gauge recruitment and retention issues. HCA annually collaborates with CHWS on this important survey.

CHWS staff are seeking a greater response rate and have extended the deadline for your responses until January 30, 2020. As workforce is a priority issue, HCA urges members to participate.

The survey takes five to ten minutes to complete and culminates in a yearly report that is influential in health care policymaking, so it is important that this report accurately reflect field-level conditions. Please take the time to complete this survey today at https://healthresearch.co1.qualtrics.com/jfe/form/ SV_0koFD8yVHqyTx7D. Last year’s report – The Health Care Workforce in New York, 2017-2018: Trends in the Supply and Demand for Health Workers – can be found on the CHWS website at http://www.chwsny.org.

Technical questions can be directed to Kris Stiegler at (518) 402-0250 or at kstiegler@albany.edu.

Comments or questions that members wish to communicate to HCA should be sent to Lauren Ford, HCA's Director of Program Research, Development and Policy, at lford@hcanys.org.

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Home Health, Hospice See Drop in Improper Payment Rates The U.S. Centers for Medicare and Medicaid Services (CMS) reports that the improper payment rate for home health providers has dropped to 12.1 percent in 2019 (from 17.6 percent the prior year). The rate for non-hospital based hospices was 8.9 percent, a decrease from 11 percent in 2018. For hospital-based hospices it was 18.9 percent, down slightly from 19.3 percent in 2018.

This data is issued annually. The 2019 report includes Medicare claims from July 1, 2017 through June 30, 2018. See https://www.cms.gov/files/document/2019-medicare-fee-service-supplemental-improperpayment-data.pdf.

According to the report, insufficient documentation was the most significant reason for improper payments, accounting for between 65 percent and 81.7 percent of improper payments to home care and hospices.

Other common causes were medical necessity, incorrect coding and no documentation.

Cybersecurity Guidance Issued As a result of “recent events involving the United States and Iran, and the threat of retaliation (potentially cyber-based) by Iran,” the state Department of Health (DOH) is asking HCA and other associations to reach out to health providers about the need for increased vigilance for potential cyber events.

While there is no specific retaliatory threat known at this time, DOH wants to remind providers of basic preventative measures to avoid phishing attempts, exposure of data from systems and interruption of patient/resident services. These measures include: 

Screening e-mails for unknown senders.

  

Avoiding the use of personal e-mail or social media at workstations.

Using caution in following e-mail links and opening attachments without authenticating the sender.

Monitoring of the functioning of medical devices throughout the facility and immediate action if any suspicious performance is recognized.

Additionally, DOH reminds providers to notify DOH if they have discovered a breach of their systems and refers to a Dear Administrator Letter, updated cyber-reporting poster and Frequently Asked Questions document distributed in October 2019. These are all at https://hca-nys.org/wp-content/uploads/2020/01/ CybersecDAL-Revised.pdf.

Lastly, DOH has shared the following links for further information: 

National Terrorism Advisory System Bulletin (January 4, 2020) https://www.dhs.gov/sites/default/files/ntas/alerts/20_0104_ntas_bulletin.pdf



Food and Drug Administration’s Medical Device Cybersecurity website (https://www.fda.gov/ consumers/consumer-updates/medical-device-cybersecurity-what-you-need-know)

For questions, please contact ohim@health.ny.gov.

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Volume 5, No. 1 January 6, 2020 

Next Home Health & Hospice Open Door Forum: Jan. 8 The U.S. Centers for Medicare and Medicaid Services (CMS) will host its next Home Health and Hospice Open Door Forum on Wednesday, January 8 from 2 to 3 p.m. The agenda includes:      

Status of Home Health Patient Driven Groupings Model (PDGM).

Home Health and Hospice Consumer Assessment of Health Care Providers and Systems (CAHPS) Survey Update.

Hospice Compare Update.

Hospice Benefit Component of the Value Based Insurance Design (VBID) Model.

Home Health Quality Reporting Program (HHQP) Update. iQIES Update for Home Health

To participate, dial 1-888-455-1397 and use the following passcode: 9375124.

Medicaid Levels Increase for 2020 The Medicaid eligibility levels have increased for 2020. See https://www.health.ny.gov/health_care/ medicaid/publications/pub2019gis.htm (GIS 19 MA/12). 

The new monthly income levels are $875 (individuals) and $1,284 (for couples).



The new resource limits are $15,750 for individuals and $23,100 for couples, though additional amounts can be set in a burial fund ($1,500 for individuals or $3,000 for couples) or any amount toward an irrevocable pre-need funeral agreement.



Also, the maximum federal community spouse resource allowance is $128,640 and the home equity limit for Medicaid coverage of nursing facility services and community-based longterm care is $893,000.

The 2019 levels are at https://www.health.ny.gov/health_care/medicaid/publications/ pub2018gis.htm (GIS 18 MA/015).

CMS Requests Feedback on Scope of Practice & Reg. Relief HCA members are urged to leverage this positive opportunity for regulatory relief and streamlining In response to an executive order (no. 13890), the U.S. Centers for Medicare and Medicaid Services (CMS) seeks additional input and recommendations on the elimination of specific Medicare regulations that require more stringent supervision than existing state scope-of-practice laws or that limit health professionals from practicing at the top of their license.

In response to previous suggestions, CMS made some changes already, such as allowing therapist assistants to perform maintenance therapy under the Medicare home health benefit, as well as

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redefining or reducing minimum levels of physician supervision in the case of physician assistant or hospital outpatient therapeutic services.

Recommendations may be sent to PatientsOverPaperwork@cms.hhs.gov with “Scope of Practice” in the subject line by January 17, 2020. HCA asks that members submitting regulatory relief recommendations to also please share copies of your correspondence with HCA. To do so, please write to either Rebecca Fuller Gray, Executive Vice President for Clinical and Program Affairs, at rgray@hcanys.org, or Alyssa Lovelace, Director for Public Policy and Advocacy, at alovelace@hcanys.org.

DOH Adjusts NHTD Rates The state Department of Health (DOH) has loaded new Medicaid rates for Nursing Home Transition and Diversion (NHTD) providers inclusive of minimum wage as well as a rural county adjustment for certain counties.

An accompanying Dear Administrator Letter (DAL) is at https://hca-nys.org/wp-content/uploads/2020/01/NHTD-Rate-increase_121919.pdf.

The new rural rates go into effect August 1, 2019 and will appear in cycle 2209, which is the Electronic Funds Transfer (EFT) remittance dated December 23, 2019 (scheduled to be released on January 8, 2020).

The DAL also includes information about a rate load error that occurred starting January 1, 2019 in New York City. DOH’s correction will appear in cycle 2210 with a retroactive payment.

Questions can be directed to 1915CR@health.ny.gov.

IRS Issues Standard Mileage Rates for 2020 The Internal Revenue Service recently issued the 2020 optional standard mileage rates used to calculate the deductible costs of operating an automobile for business, charitable, medical or moving purposes.

Beginning on January 1, 2020, the standard mileage rates will be:   

57.5 cents per mile driven for business use.

17 cents per mile driven for medical or moving purposes.

14 cents per mile driven in service of charitable organizations.

The business mileage rate decreased one half of a cent for business travel driven and three cents for medical and certain moving expenses from the rates for 2019. The charitable rate is set by statute and remains unchanged.

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