November 26, 2018 Edition of The Situation Report

WEBINAR ON THIRDPARTY PAYERS

CHHA FORUM

WAGE PARITY

GLOBAL CAP

HCA has changed our downstate and upstate CHHA Forums into a single statewide call to facilitate broad participation. E-mail us to RSVP for our Nov. 29 program.

A reminder to complete your Wage Parity Certification forms and submit them to contractors

by December 1.

Higher-than-expected enrollment continues to put pressure on Medicaid Global Cap, according to latest report.

HCA offers members a free Dec. 6 webinar on successfully billing and collecting from thirdparty payers.

PAGE 4

PAGE 6

PAGE 9

PAGE 9

UPCOMING PROGRAMS Statewide CHHA Forum Call New Date: Nov. 29 (10:30 a.m. to noon).

HCA Bootcamp: Regulatory & Compliance Update for CDPAP FIs Dec. 5 (NYC) Dec. 10 (Albany) Webinar for Agencies Not Yet Using HCA’s Sepsis Tool Dec. 5 Tips and Tricks for Working with ThirdParty Payers Free Webinar Dec. 6 2019 Northeast Home Health Leadership Summit Jan. 22-24, 2019 Boston Register at https:// hca-nys.org/eventseducation/upcomingevents

Your Source for HOME CARE News, Policy and Advocacy

Vol. 3, Issue 46 | November 26, 2018

HCA Comments on CMS Regulatory Relief Proposals HCA last week submitted comments to the U.S. Centers for Medicare and Medicaid Services (CMS) on its proposed regulatory relief actions related to home health, hospice and emergency preparedness.

Our comments are at https://hca-nys.org/wp-content/uploads/2018/11/CMS-ProposedRegulatory-Relief_092018_HCA-comments.pdf.

HCA had conferred with the National Association for Home Care and Hospice (NAHC) and the Hospice and Palliative Care Association of New York State and thanks them for their input and collaboration.

See PROPOSALS p. 2

Haven’t Yet Adopted HCA’s Sepsis Tool? Register Today for Dec. 5 Webinar to Get Started On December 5, HCA and IPRO are jointly holding a webinar (from 10:30 a.m. to 12 p.m.) for all New York State CHHAs and LHCSAs who are not yet users of the HCA Home Care Sepsis Screening and Intervention Tool. The webinar will offer information on how you can adopt and apply this tool in the home care setting.

See TOOL p. 5

INSIDE HCA Comments on CMS Regulatory Relief Proposals.................................1 Dec. 5 Webinar to Get You Started Using HCA Sepsis Tool..........................1 Provider Enrollment Fee Increases in 2019..................................................3 HCA Member Hiring Announcement.........................................................3 HCA Changes In-Person CHHA Forums to Statewide Call on Nov. 29............4 HCA Takes to Airwaves for National Home Care Month..............................5 Quarterly Wage Parity Certifications Due December 1.............................6 DOH Issues New DAL on OASIS-D...............................................................7

PHHPC Establishment and Project Review Committee Agenda Posted.....................8 September Global Cap Report: Medicaid Spending $44M Above Projections...........9 Free Webinar for Members on Tips and Tricks for Working with Third-Party Payer.....9 Conflict of Interest Update for NHTD and TBI.........................................................10 Upcoming Deadlines and Due Dates....................................................................11 Outpatient Hospice-Related Services Posted as Audit Issue..................................12 CMS Issues Multiple Medlearn Matters Articles Important to Home Care...............12 Health Resources............................................................................................13

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

PROPOSALS from p. 1 The proposals are at https://www.govinfo.gov/content/pkg/FR2018-09-20/pdf/2018-19599.pdf.

In our comments, we support home health and hospice proposals that would: limit the necessary scope of aide competency evaluations (targeting just the skill areas where a deficiency is found); limit the required areas of patient verbal patient notifications; ease hospice interdisciplinary group consultation requirements; and defer to states for certain hospice aide training and competency requirements.

In other cases, we provided partial support for CMS’s proposals and additionally recommended further relief in areas not addressed by CMS, such as: allowing the use of “pseudopatients” for testing aide competencies, requiring Medicare Administrative Contractors to consider the home health agency’s documentation (with or without an additional, discrete physician “sign-off”) in making any home health eligibility determinations, and streamlining patient notification requirements that are otherwise duplicated or eliminated in other areas of statute.

We also supported the following emergency preparedness proposals: 

Change the review of an agency’s emergency preparedness program from annual to every two years.



Require agencies to have a process for – but not mandating that they document their efforts at – cooperation and collaboration with local, tribal, regional, state and federal emergency preparedness officials’ efforts to maintain an integrated response during a disaster or emergency situation.



Require agencies to provide emergency preparedness training biennially instead of annually after they have conducted initial training on their emergency program.

Continued on next page

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

2

Volume 3, No. 46 November 26, 2018 

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 Alyssa Lovelace Director for Policy and Advocacy alovelace@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 Continued from previous page 



Require that providers of outpatient services conduct only one – instead of two – testing exercise (emergency preparedness) per year.

Clarify the testing requirement exemption by noting that if a provider experiences an actual natural or man-made emergency which requires activation of its emergency plan, inpatient and outpatient providers will be exempt from their next required full-scale community-based exercise or individual, facility-based functional exercise following the onset of the actual event.

Provider Enrollment Fee Increases in 2019 The fee is increasing for home care and other providers that are initially enrolling in Medicare, Medicaid or the Children’s Health Insurance Program (CHIP), revalidating their enrollment, or adding a new Medicare practice location.

Starting January 1, 2019, the fee will be $586 (up from $569 in 2018).

The announcement is at https://www.govinfo.gov/ content/pkg/FR-2018-11-19/pdf/2018-25012.pdf.

Medicare requires Certified Home Health Agencies to revalidate every five years and Medicaid requires all Medicaid providers to revalidate every five years.

Providers who do not revalidate face termination from participating in Medicare and/or Medicaid.

Volume 3, No. 46 November 26, 2018 

HIRING: RN / Staff Development Education Supervisor – Home Health Full Time 9 am-5 pm Driven to Be the Best.

NYU Winthrop Hospital’s Home Health Agency ranks as a topperforming US Home Health Agency!

Come join our stellar team of nurses, therapy professionals and social workers who provide home health care to our maternal, child and adult population.

We have an exceptional opportunity for a Staff Development Education Supervisor to be responsible for home health staff education, development and professional growth, including orientation program (didactic and practical components). Collaborating with the Director of Quality Management/Staff Development and the departments’ management team, you will identify, develop and plan appropriate staff development programs to support agency needs to provide optimum patient outcomes. Working with the Administrator and the Director of Patient Services, you will research, coordinate and establish new programs for the agency.

We require:  

  

Information on the Medicare revalidation process is at https://www.cms.gov/Medicare/Provider-Enrollmentand-Certification/MedicareProviderSupEnroll/ Revalidations.html; Medicaid revalidation information is at https://www.emedny.org/info/ProviderEnrollment/ revalidation/index.aspx.

NYS Registered Nurse License BSN with 2 years’ experience in Education in a Certified home care agency; Master’s degree in Nursing, preferred 2-3 years clinical nursing practice 2 years’ community health nursing Good communication and basic computer skills, knowledge of agency clinical and business functions

To apply for our Staff Development Education Supervisor position, visit https://jobs.winthrop.org/job/8799934/ registered-nurse-staff-developmentsupervisor-home-care-mineola-ny/ An EOE m/f/d/v.

3

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

Volume 3, No. 46 November 26, 2018 

TOOL from p. 1 This special webinar is provided at no charge to agencies, and it is supported by a New York State Health Foundation (NYS Health) grant to promote statewide training and adoption of this intervention.

Register today at: https://cc.readytalk.com/registration/#/ ?meeting=afplccm273j4&campaign=smp9sqvw9s5t.

Participation is open and urged for all New York State agencies, including HCA members and nonmembers alike.

Since December 2017, NYS Health has sponsored our in-person and web-based regional trainings called Stop Sepsis at Home to assist statewide adoption of HCA’s nationally innovative home care sepsis tool. Trainings have been provided for all home care agencies and collaborating partners including hospitals, EMS, physicians, managed care, community residences, and others across the state.

This December 5 statewide webinar is being conducted by HCA and IPRO as a supplemental opportunity for all CHHAs and LHCSAs in New York State that, to date, have not been able to attend one of the prior training sessions.

It will include: critical information about sepsis and home/community care; guidance on how to clinically apply, adopt and implement the tool; how to work with key clinical community and hospital partners in sepsis intervention; and more.

In just the past year and a half since this tool was launched, providers in 55 of the state’s 62 counties are either actively using or in the midst of implementing this tool. Providers, associations and health leaders across the country are also exploring its adoption.

To learn more about this effort and why home care must play a role, visit our Stop Sepsis at Home website at www.stopsepsisathomeny.org.

HCA Changes In-Person CHHA Forums to Single Statewide Call on November 29: Please RSVP to Join the Discussion For your convenience, and to facilitate member participation, HCA is changing both our upstate and downstate CHHA forums into a single member call this week that you can dial-in to from any location.

The new call date is Thursday, November 29, from 10:30 a.m. to noon.

Existing registrants have already been notified about the new dial-in format and date.

If you have not yet registered and want to participate with the convenience of this dial-in opportunity, please send an e-mail to info@hcanys.org and include the subject line “CHHA Forum,” along with a message stating your name and organization. HCA will send you dial-in information prior to the November 29 call.

Continued on next page

4

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

Volume 3, No. 46 November 26, 2018 

Continued from previous page These members-only forums are an important benefit of your membership in HCA, with select information and updates geared specifically to your organization. They provide an opportunity to hear from you about local concerns, policy issues and other matters that HCA can address.

The discussion will be devoted to the many unique and pressing issues for CHHAs at this time. This includes workforce shortages, especially in the nursing field, regulatory/procedural challenges, processing of referrals, partnerships with hospitals and physicians, operational and contracting concerns, surveillance and compliance challenges, the upcoming state budget and more.

HCA Takes to Airwaves for National Home Care Month: Please Join Us and Keep Up Your Outreach to the Public, Policymakers As part of National Home Care and Hospice Month, HCA took to the airwaves this past Saturday for a live program on WGY News Radio (810 AM and 103.1 FM) where HCA President Al Cardillo spoke about home care, hospice and prominent issues in the field with WGY Weekend host Joe Gallagher.

HCA will share a link to the broadcast once it is posted.

HCA has also circulated op-eds to various publications in a final push for news coverage about home care and hospice tied to this November’s celebrations as part of our #HomeCareConnect campaign.

If you have any stories, pictures, news links or information to share about your National Home Care Month celebrations tied to HCA’s campaign, please continue sending them to HCA’s Communications Director Roger Noyes at rnoyes@hcanys.org so that we can share them on social media and on our website www.nationalhomecaremonth.com.

Please also continue to reach out to your legislators so that they know the value of the work you do, the role of your organization and the patients you serve. November is also a great opportunity to invite elected officials on a home care visit with a patient.

Even though November’s National Home Care Month celebration is drawing to a close, the opportunity to engage with lawmakers is a year-round activity – and a home care visit (bringing together elected officials with your patients) offers a vital connection with policymakers at any time.

Indeed, if your organization has not yet completed the activities on our #HomeCareConnect campaign, there’s still time to start, and you can use the final week of November as a launching pad for further work to close out 2018 and prepare for 2019.

As a concrete example of your work making an impact, HCA, during the week of Veteran’s Day, compiled stories submitted by HCA members about veterans in home care and hospice who are featured in a special publication created by our communications and graphic design team. You can

5

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

Volume 3, No. 46 November 26, 2018 

download the publication, Saluting Veterans in Home Care and Hospice, at https://hca-nys.org/wpcontent/uploads/2018/11/Saluting-Veterans-in-Home-Care-and-Hospice.pdf.

This piece was shared with the entire State Legislature, New York State Congressional Delegation, state agencies and beyond. It prompted some legislative offices to reach HCA for further background about home care and hospice as well as information about local agencies in their districts to facilitate recognition of patients.

Please let us know how we can support you in raising the profile of home care and hospice this month and throughout the year.

Quarterly Wage Parity Certifications Due December 1 The next round of state-required Wage Parity certification forms is due December 1, 2018 for Licensed Home Care Services Agencies (LHCSAs) and other entities, including Fiscal Intermediaries (FIs), that contract with Managed Care Organizations (MCOs), Certified Home Health Agencies (CHHAs) and/or Long Term Home Health Care Programs (LTHHCPs) serving New York City, Long Island and Westchester.

The Wage Parity Law and related certification requirement do not apply to areas outside of New York City, Long Island and Westchester.

MCOs, CHHAs and/or LTHHCPs that contract with LHCSAs and FIs are required to obtain a written certification on a quarterly basis from the LHCSA/FI or other entity which attests to the LHCSA/FI’s compliance. The form due December 1, 2018 covers the period December 1, 2018 through February 28, 2019 and is sent to the MCO, CHHA and/or LTHHCP, not the state Department of Health (DOH).

The 2018 certification forms and required wage parity levels for 2018 and 2019 are at https:// www.health.ny.gov/health_care/medicaid/redesign/mrt_61.htm.

In completing the form, HCA recommends adding a date after the signature and noting on the form that the certification covers the December 1, 2018 through February 28, 2019 period, and retaining copies of all certifications for your own records.

Questions about wage parity can be sent to DOH at HCWorkerParity@health.ny.gov.

While the state Home Care Worker Wage Parity law does not apply to home care providers outside of NYC, Long Island and Westchester, the state minimum wage law does apply. Information on the minimum wage levels is at https://www.labor.ny.gov/workerprotection/laborstandards/workprot/ minwage.shtm.

6

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

Volume 3, No. 46 November 26, 2018 

DOH Issues New DAL on OASIS-D Goes Into Effect January 1, 2019 The state Department of Health (DOH) recently posted a Dear Administrator Letter (DAL) to the Health Commerce System (HCS) (https://commerce.health.state.ny.us/hcs/index.html) notifying Certified Home Health Agencies (CHHAs) and Long Term Home Health Care Programs (LTHHCPs) of several changes coming to the OASIS Data Sets that will be effective January 1, 2019. DOH’s DAL can also be downloaded at https:// hca-nys.org/wp-content/uploads/2018/11/OASIS_D_HCBS-18-04.pdf.

OASIS-D will be effective for assessments with a M0900 Date Assessment Completed on or after January 1, 2019. The DAL provides a summary of the changes in OASIS-D, training, and resources available for providers.

IMPACT Act of 2014 The main purpose of the change in OASIS-D is to increase standardization of certain assessment elements across post-acute care (PAC) settings. The Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 requires post-acute care providers to report standardized patient assessment data and quality measure data. This applies to: Home Health Agencies (HHAs), Inpatient Rehabilitation Facilities, Skilled Nursing Facilities and Long-Term Care Hospitals.

OASIS-D Changes The OASIS-D changes effective January 1, 2019 include: 

Six new standardized items (GG0100, GG0110, GG0130, GG0170, J1800, J1900) in Sections J and GG that pertain to patient falls and functional abilities and will be collected uniformly across the PAC settings;



Seven revised items (M1028, M1306, M1311, M1322, M1324, M2102, M2310); and



Twenty-eight removed items to reduce data collection burden. These items were removed since they did not support quality process measures, the Prospective Payment System, the survey process for Medicare certification, Value Based Purchasing, critical risk adjustment factors, or Conditions of Participation. (An attachment to the DAL shows the items that are removed.)

Revisions to OASIS-D Involve:      

Changes to the assessment item and related guidance; Revisions to the Guidance Manual only; Removal of some response options to reduce provider burden; Creating different time point versions for some items; Incorporating National Pressure Ulcer Advisory Panel (NPUAP) terminology updates; or Revising language to align with other PAC settings.

Continued on next page

7

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

Volume 3, No. 46 November 26, 2018 

Continued from previous page The OASIS-D Guidance Manual provides resources and guidance for all the changes noted above. It is available for download at https://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/HomeHealthQualityInits/HHQIOASISUserManual.html. The manual should be readily accessible as a resource for clinicians conducting the OASIS data collection.

DOH’s DAL also includes a list of CMS-approved OASIS Training and Resources that agencies are encouraged to view and download.

PHHPC Establishment and Project Review Committee Agenda Posted The state Department of Health (DOH) has posted the agenda for the November 29 meeting of the Public Health and Health Planning Council (PHHPC) Establishment and Project Review Committee.

The agenda, and supporting documents, are at https://www.health.ny.gov/facilities/ public_health_and_health_planning_council/meetings/2018-11-29/.

The agenda includes applications by: 

One Certified Home Health Agency (CHHA) to merge with another CHHA;



One CHHA for a 3-year extension to its limited life operating certification;



One CHHA to establish one entity as its parent and another entity as its grandparent;



One hospice to merge with another hospice;



One Licensed Home Care Services Agency (LHCSA) for a change in ownership;



Two entities to become LHCSAs affiliated with an Assisted Living Program (ALP); and



One LHCSA affiliated with an ALP for a change in ownership.

Those applications accepted by the Establishment and Project Review Committee will go to the full PHHPC for review at its December 13 meeting.

All meetings of the PHHPC and its committees can be viewed via webcast at https://www.health.ny.gov/events/webcasts/.

8

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

September Global Cap Report: Medicaid Spending $44M Above Projections The state Department of Health (DOH) has issued its latest monthly Medicaid Global Cap report (see https://www.health.ny.gov/health_care/ medicaid/regulations/global_cap/monthly/sfy_2018-2019/docs/ sept_2018_report.pdf).

The Medicaid Global Spending Cap has increased 6.7 percent, from $19.5 billion in fiscal year (FY) 2018 to $20.8 billion in FY 2019. This September 2018 report marks the sixth report for the new fiscal year. It finds that overall spending for this period was $44 million above projections, across all sectors, a difference of $12.008 billion in actual spending versus $11.964 billion in estimated spending for the first six months of the state fiscal year.

Specifically, DOH mentions the following two significant pressures on the Global Cap: 

Medicaid spending in major Medicaid Managed Care categories was $58 million over projections.



Medicaid spending in major fee-for-service categories was $47 million over projections with clinic spending $9 million above estimates. This is a result of total claims billed being 8.4 percent higher than anticipated through September.

In other important items: 

DOH is reporting that total Managed Long Term Care (MLTC) spending exceeded its monthly cap, by $31 million, due to higher-than-expected enrollment. There were approximately 5,339 more individuals enrolled in the MLTC partial capitation plan than budgeted.



Total Medicaid enrollment reached 6,158,310 enrollees at the end of September 2018. This reflects a net increase of 10,276 enrollees since March 2018.



The state’s Accounts Receivable (A/R) ending balance for FY 2018 was $224 million. DOH is expected to recoup $174 million by the end of FY 2019, resulting in a projected A/R balance of $50 million by March 2019. Through the end of September, retroactive rates owed to the state were $141 million. This reflects net recoveries of $83 million since March 2018.

For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

9

Volume 3, No. 46 November 26, 2018 

Free Webinar for Members on Tips and Tricks for Working with Third-Party Payers HCA is offering members a free webinar on December 6 from 10 to 11 a.m. ($149 for nonmembers) offering Tips and Tricks for Working with ThirdParty Payers.

The webinar will be led by Phil Feldman, who is Vice President for Revenue Management Solutions at Sandata Technologies, which is the unit at Sandata that provides endto-end revenue cycle management services to home care agencies to improve revenue and cash flow.

During this presentation, he will discuss contract conformance and management, authorizations management, the new uniform billing codes for New York State, claim filing, claim eligibility maintenance, payroll and cost management, current events in the payer market, and value based payments.

HCA members may register multiple staff members at no charge, but each site connection must be registered by having individuals complete the form at https://hcanys.org/wp-content/uploads/ 2018/11/Working-With-ThirdParty-Payers-Webinar-Dec-6thReg-Form.pdf. Non-members must register each connection at the non-member rate.

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

Volume 3, No. 46 November 26, 2018 

Conflict of Interest Update for NHTD and TBI The U.S. Centers for Medicare and Medicaid Services (CMS) has agreed to extend the date for the state’s Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) programs to become compliant with Conflict of Interest requirements.

In making the announcement, the state Department of Health (DOH) said it will work with CMS to submit an amendment to each of the waivers to extend the date for compliance to the new date: January 1, 2021.

DOH will immediately begin to work with CMS to discuss timelines and milestones and required adjustments to the Corrective Action Plan. Within the next few weeks, DOH will be reaching out with information and meeting dates to establish a collaborative process to discuss with participants, providers and stakeholders on how best to design a service model that will prevent and mitigate potential conflicts of interest under 1915(c) HCBS waivers while meeting the needs of service recipients. This work will include identifying gaps in service capacity and what safeguards are necessary to ensure participant protections while meeting compliance criteria.

Federal regulations, known as the home and community-based services (HCBS) settings rule, require that person-centered service plan development cannot be performed by the individual’s provider of direct services unless there is no other willing and qualified entity available to that individual. Case managers, however, are able to develop service plans, as case management is not considered to be a direct service in conflict with person-centered planning.

Conflict occurs not just if the entity is a provider, but if the entity has an interest in a provider or if it is employed by a provider.

The U.S. Centers for Medicare and Medicaid Services (CMS) has defined a conflict of interest as: 

When the same entity helps an individual gain access to services and provides services to that individual;



When the same entity is responsible for assuring and honoring free choice of providers and is a service provider;



When the same entity is responsible for overseeing quality and outcomes on behalf of the individual and is a service provider; and



When the case management agency for an individual has a fiduciary relationship with a provider of services to that individual.

Entities providing services under NHTD and/or TBI had to complete one Compliance Implementation Plan form

by April 1, 2018 for each region where it provides NHTD and one form for each region where it provides TBI services.

Webinar materials from a DOH program on conflicts of interest are at https://hca-nys.org/wp-content/uploads/ 2018/01/COI-Compliance-Implemenation-Plan-Power-Point.pdf.

Any questions may be directed to:waivertransition@health.ny.gov.

10

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

Volume 3, No. 46 November 26, 2018 ď Žď€

Upcoming Deadlines and Due Dates

11

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/New Medicare Card/index.html

Medicare Open Enrollment: Beneficiaries can change their Medicare coverage from managed care plan to fee for service or vice versa, and can join or switch prescription drug plan

October 15 to December 7, 2018

www.medicare.gov

2017 LHCSA Statistical Report Due

LHCSAs will face fines if submitted between November 16, 2018 and December 31, 2018

https://commerce.health.state.ny.us/public/hcs_login.html

LHCSA Registration Process

Must be submitted with LHCSA Statistical Report; if not submitted by https://commerce.health.state.ny.us/public/hcs_login.html November 16, 2018, agency will incur fines

MLTC Enrollment Lock In Starts

December 1, 2018

https://www.health.ny.gov/health_care/medicaid/program/update/2018 /2018 06.htm#mltc

OASIS D for Certified Home Health Agencies

January 1, 2019

OASIS D Guidance Manual: https://www.cms.gov/Medicare/Quality Initiatives Patient Assessment Instruments/HomeHealthQualityInits/HHQIOASISUserManual.html

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

Volume 3, No. 46 November 26, 2018 

Outpatient Hospice-Related Services Posted as Audit Issue The U.S. Centers for Medicare and Medicaid Services (CMS) has posted “outpatient hospice-related services” as an approved Recovery Audit Contractor (RAC) topic.

The announcement is at https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/ Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/Approved-RAC-Topics.html (see December 11, 2018 listing).

It notes that services related to a hospice terminal diagnosis provided during a hospice period are included in the hospice payment and are not paid separately for Medicare Part A inpatient claims.

According to CMS, the mission of the Recovery Audit Program is to identify and correct overpayments made on claims for health care services provided to beneficiaries, to identify underpayments to providers, and to provide information that allows CMS to implement corrective actions which will prevent future improper payments.

Additional information on RACs is at https://www.cms.gov/Research-Statistics-Data-and-Systems/ Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/Resources.html.

Performant is the RAC that covers New York and some other states. Its website is https:// performantrac.com/.

CMS Issues Multiple Medlearn Matters Articles Important to Home Care The U.S. Centers for Medicare and Medicaid Services (CMS) has recently issued the following Medlearn Matters articles (MLN) that are important to all Medicare Certified Home Health Agencies (CHHAs):

12



Home Health Prospective Payment System (HHPPS) Rate Update for Calendar Year (CY) 2019 – MLN Article 10992: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNMattersArticles/Downloads/MM10992.pdf



Home Health Rural Add-on Payments – MLN Article MM10782: https://www.cms.gov/Outreachand-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10782.pdf



Common Working File (CWF) Provider Queries National Provider Identification (NPI) and Submitter ID – MLN Article MM10983: https://www.cms.gov/Outreach-and-Education/MedicareLearning-Network-MLN/MLNMattersArticles/downloads/MM10983.pdf



HCPCS Code Updates for Home Health Consolidated Billing Enforcement – MLN Article MM11040: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNMattersArticles/Downloads/MM11040.pdf

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

Volume 3, No. 46 November 26, 2018 

Health Resources 

“When an MLTC Plan Closes – What are the Members’ Rights?” by the New York Legal Assistance Group http://www.wnylc.com/health/entry/217/



“A Medicare Advantage Checkup,” New England Journal of Medicine (November 14, 2018) https://www.nejm.org/doi/full/10.1056/NEJMhpr1804089?query=featured_home



“Medicaid Managed Care: Additional CMS Actions Needed to Help Ensure Data Reliability,” by the U.S. Government Accountability Office https://www.gao.gov/assets/700/695069.pdf



“Home Health Prospective Payment System (HH PPS) Rate Update for Calendar Year (CY) 2019,” by the U.S. Centers for Medicare and Medicaid Services https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNMattersArticles/Downloads/MM10992.pdf

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

13