REIMBURSEMENT
LHCSA FORUMS
CAHPS
EP
EPS reimbursement for LTHHCP coming soon, plus other reimbursement updates for CHHA EPS and personal care.
HCA has scheduled two LHCSA Forums for providers upstate and downstate to convene about critical issues.
Learn the latest requirements, deadlines, and trainings for CAHPS surveys; plus, preview reports are now available.
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PAGES 7 & 9
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HCA reminds North Country providers of upcoming emergency preparedness drill; plus, a series of preparedness webinars for Capital District and Northeastern region providers. PAGE 13
COMING UP Northeast Home Health Leadership Summit: “Extreme Makeover, Home Care Edition” Jan. 17-19, 2017 The Colonnade Hotel Boston Downstate LHCSA Forum in NYC Jan. 30, 2017 10 a.m. to 2 p.m. Selfhelp Family Home Care, Inc. 520 Eighth Avenue, 5th Floor New York, NY 10018 State Advocacy Day and PAC Reception Feb. 6-7, 2017 Albany, NY Feb. 6: PAC reception at HCA’s offices Feb. 7: HCA Board Meeting and appointments with legislators
Your Source for HOME CARE News, Policy and Advocacy
Vol. 2, Issue 2 | January 9, 2017
HCA Submits Additional Comments on Minimum Wage Survey Last Friday, HCA submitted additional comments to the state Department of Health (DOH) on its draft minimum wage survey. As described in last week’s edition of The Situation Report, DOH had sought HCA’s feedback on a survey to help identify actual provider/plan/worker funding needs. We had submitted preliminary comments and asked for more time to reach out to members for further input. See WAGE p. 2
Have You Renewed Your 2017 Membership? HCA sent membership renewal packets in December so you can continue your HCA membership in 2017. By now your organization should have received the mailing. If not, please contact HCA’s Director of Membership Laura Constable at lconstable@hcanys.org. Our renewal process is a bit different this year. The packet includes a dues invoice with a highlighted amount reflective of your past patient revenue and dues which we
INSIDE HCA Submits Additional Comments on Wage Survey........................................1 Have You Renewed Your 2017 Membership?...................................................1 Reimbursement Updates for LTHHCPs, CHHAs, Personal Care.........................3 HCA Extends Home Care Industry Survey Deadline to Jan. 13............................4 Uniform Managed Care Billing Codes to Take Effect by May 1, 2017....................5 HCA, MLTC Forum Leaders Bring Requested Improvements to DOH...................6 HCA & IPRO Announce Home Care Sepsis Webinars III and IV.............................6 Join HCA for March 9 Programs Upstate on CDPAP and LHCSA Forum.................7 DOH Extends Deadline for CHHA/LTHHCP Stat. Report, 2015 Hospice Report.....8 Downstate LHCSA Forum in NYC on Jan. 30 to Address Urgent Issues.................9 CMS Provides Update on Home Health CAHPS Survey.......................................9
See MEMBERSHIP p. 3 HHCAHPS Preview Reports with Star Ratings Available.........................................10 Important Clarification Regarding Caregiver Exclusion Searches for LHCSAs.........11 State-Industry Workgroup to Plan CFCO Implementation in Managed Care..........12 Emergency Preparedness Training Opportunities................................................13 Reminder: North Country Emergency Prep. “Extreme Weather” Exercise.............13 Round 3, Additional Round 2 DSRIP Reg. Waiver Request Responses......................14 DSRIP Mid-Point Assessment Final Report, Recommendations Available.............15 PACE Innovation Act Request for Information Announced.....................................15 Workers’ Compensation Board Issues Form Submission Guidelines....................16 Upcoming NGS Education Programs...................................................................17 IRS Announces 2017 Mileage Rates.....................................................................18 Resources........................................................................................................18
The Situation Report: the Home Care Association of New York State WAGE from p. 1 Additional feedback from members supported our points and also added the following that we sent to DOH: 1. The definition of “Employed Staff Full Time Equivalents” (FTEs) needs to be included so that agencies can correctly provide the requested data. 2. We supplemented our request that the survey utilize 2016 not 2015 data with the following costs that would not be part of 2015: wage parity increase in 2016 for Nassau, Suffolk and Westchester; double-digit Worker’s Compensation cost increases; Fair Labor Standards Act final rule changes (overtime, travel and 24-hour live-in cases); and state Domestic Worker Bill of Rights application to home care staff. 3. We questioned the need for an attestation since the minimum wage increase is part of the New York State labor law that employers must follow and attestations are not required for other labor law changes. In addition, an overall HCA comment was that while the survey is attempting to capture current practice/capacity with respect to the payment of wages, it does not reflect the full measure of the need or cost for recruiting, compensating and maintaining staffing adequate to the managed care and home care need in the state. We advocate for collaborative work with HCA and other respective associations to evaluate and adjust the payment methodologies for the plans and providers. In meetings with DOH this past week, HCA continued to press the need for actuarially sound and adequate premiums to managed care plans, recognizing their actual costs and sufficient payments to home care providers so that all can comply with the new labor law changes and other laws and requirements applicable to delivering quality patient services. HCA will notify members once the DOH survey is finalized and available to be completed. For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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. Joanne Cunningham HCA President jcunningham@hcanys.org Roger L. Noyes Director of Communications, Editor of The Situation Report rnoyes@hcanys.org Al Cardillo Executive V ice President, Policy & Programs acardillo@hcanys.org Patrick Conole Vice President, Finance & Management pconole@hcanys.org Andrew Koski Vice President, Program, Policy & Services akoski@hcanys.org Alexandra Fitz Blais Director of Public Policy ablais@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 & Special Projects jkerbein@hcanys.org Billi Wilson Manager, Meetings & Events bwilson@hcanys.org Teresa Brown Administrative Assistant tbrown@hcanys.org
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MEMBERSHIP from p. 1 invite you to select for your 2017 commitment. If your patient revenue has changed, however, simply choose the other options available on the printed invoice. Also, to help you manage, plan and budget for HCA education, our invoice invites you to pre-pay a designated amount for your staff to participate in signature events like HCA’s Senior and Financial Manager’s Retreat, Annual Conference, Compliance Symposium, webinars, bootcamps, workshops and more. Your staff benefits from these programs; and your commitment now will give staff the flexibility to register whenever events or conferences are announced. You can change the amount designated for HCA education, and your staff are certainly encouraged to attend as many educational programs as necessary, beyond this initial commitment. We hope you find this option useful in your education budgeting. The packet also includes a piece called “HCA in 2017” describing some of the many ways in which HCA provides value to you and your organization. We welcome you to read this brief publication and share it with any decision-makers at your organization who may be involved in budgeting or processing your organization’s membership. You can read the piece here: http://hca-nys.org/wp-content/uploads/2016/12/ HCA-Value-Statement-2017.pdf. Have you contributed to HCA’s PAC? Now is also a good time to make a contribution to HCA’s Political Action Committee (PAC), which we invite you to do in conjunction with your member dues invoice. Your PAC contributions help HCA engage in the political process to support candidates who oppose home care cuts and advance policies to assist home care’s function in a changing health care environment. Instructions are listed on the dues invoice. For-profit entities may contribute directly to the PAC. Please note, however, that not-for-profit organizations may not directly contribute, but employees of these organizations certainly can. We look forward to being your advocate, your source of information and technical assistance, and your goto place for education and resources on all home and community-based matters throughout New York State in 2017.
Reimbursement Updates for LTHHCPs, CHHAs and Personal Care DOH continues work to finalize, test new EPS billing system for LTHHCPs; plus, rate updates coming soon for personal care and CHHA EPS State Department of Health (DOH) reimbursement officials continue to work to finalize, test and launch the new Episodic Payment System (EPS) billing system for Long Term Home Health Care Program (LTHHCP) providers. As of Friday, the new rates were loaded into the system and DOH staff were waiting the outcome of the loading to check for any system errors and to correct any issues prior to going live with providers. HCA has written extensively about the progression related to the LTHHCP. The most significant developments on this issue began with the Department’s posting last August of a policy affirmation of the continued standing of LTHHCPs, their capacity to admit and serve patients directly (the same as CHHAs) under home health agency rules, their capacity to contract, and their expanded capacities to provide
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personal care and personal care assessments to local districts and serve patients under other waiver programs (which LTHHCPs had not been permitted to do previously under federal and state “dual waiver” limits). The LTHHCP move to EPS commenced this fall, following discussions with HCA and HCA LTHHCP members. The final rate installment has taken longer than anticipated, but with Friday’s report, it appears imminent that the EPS rate system will be up and available for LTHHCPs. Other Reimbursement Updates 1. CHHA EPS and Minimum Wage Adjustment – The Department is in the process of updating the CHHA EPS to include a minimum wage adjustment that will be retrospective to January 1, 2017. DOH told HCA that the adjustment and a detailed Dear Administrator Letter (DAL) should be issued in the next week or two; however, DOH has not yet indicated the amount of the adjustment and whether it will only be applicable for CHHAs providing services in the five boroughs of New York City (NYC). 2. Initial 2017 Upstate Personal Care Medicaid Rates – The Department expects to post to the Health Commerce System (HCS) the initial 2017 personal care Medicaid rates and detailed DAL for providers outside of NYC within the next week. HCA encourages personal care providers to check the HCS regularly. 3. Update on Controller’s Audit of CHHA EPS – As HCA reported in the December 12, 2016 edition of The Situation Report (http://hca-nys.org/wp-content/uploads/2016/12/ SitRep121216.pdf), the state Comptroller’s Office has recently released the results of an audit which found that DOH “erroneously” made $16.6 million in Medicaid payments to 95 CHHAs over a three-and-one-half-year period (May 1, 2012 through December 31, 2015). DOH has indicated to HCA that the Office of Medicaid Inspector General’s (OMIG) will be handling the actual collection of any overpayments, but the state is first doing a complete review of the socalled erroneous claims for the time period in question to be sure that the Comptroller’s findings are accurate. OMIG has indicated that this process may take a few months. HCA will update the membership immediately upon the availability of further information on any of the aforementioned issues. For further information, please contact Al Cardillo acardillo@hcanys.org or Patrick Conole pconole@hcanys.org.
HCA Extends Home Care Industry Survey Deadline to Jan. 13 As reported in an alert to the membership, HCA has extended the deadline for providers to complete our annual survey of the industry. The new deadline is January 13. HCA recognizes that providers have faced a lot of major demands in recent weeks, from minimum wage negotiations to statistical reports and countless others. But unique from some of the other tasks you
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face, this survey is yours, as a member of HCA and as a home care provider, to tell your story. It is absolutely vital that as many providers complete this survey as possible. It is your chance to illustrate all of the pressures you are facing, and for HCA to have hard data to advocate on your behalf during fastapproaching state budget negotiations. If your agency has already completed the survey, thank you very much. If not, there are two ways to do so. You can download and complete the PDF version at http://hca-nys.org/wp-content/uploads/2016/11/ FinancialConditionSurvey2017.pdf (and e-mail or scan it back to HCA), or you can complete the survey online at https://www.surveymonkey.com/r/HCAfinancesurvey. It doesn’t matter how you complete it, as long as we receive your responses as soon as possible, and by January 13, so we can begin our analysis and presentation of the data for our February 7 State Advocacy Day. If you have any questions at all, do not hesitate to contact any member of the HCA Policy staff; or, for technical issues, contact Roger Noyes at rnoyes@hcanys.org and (518) 810-0665.
Uniform Managed Care Billing Codes to Take Effect by May 1, 2017 The state Department of Health (DOH) has issued a “Dear Providers and Plans Letter” to inform Medicaid managed care plans and providers that uniform billing codes will be required by May 1, 2017 for Medicaidcovered home and community-based long term care services. In addition, DOH’s letter (see http://hca-nys.org/wp-content/uploads/2017/01/DAL-Universal-Billing-Codesfor-Home-and-Community-LTC.pdf) states that managed care plans are required to pay claims electronically via electronic funds transfer. HCA and the other associations provided feedback to DOH on the draft letter before it was finalized last week. The letter includes a list of the uniform billing codes for personal care aide, home health aide, consumer directed personal assistant, nursing, therapies, telehealth, medication dispensers, and adult day health care services. These uniform billing requirements, along with the electronic funds transfer mandate, were sought by HCA to help home care agencies and their managed care contractors by simplifying billing procedures and facilitating timely payments. These provisions for uniform billing implementation were then included in the final 2015-16 state budget. HCA has worked with other associations and plan representatives for over a year (along with some HCA members) to develop the uniform codes. Providers or plans that have specific questions regarding the implementation deadline of these billing codes should contact the Department immediately by e-mail (at nfrates@health.ny.gov) with the subject heading “Home Care Billing Codes.” For further information, contact Andrew Koski at akoski@hcanys.org or Patrick Conole at pconole@hcanys.org.
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HCA, MLTC Forum Leaders Bring Requested Improvements to DOH HCA, its MLTC Forum co-chairs and MLTC members of the HCA Board of Directors met with state Department of Health (DOH) officials on Friday, bringing a series of issues and recommendations discussed at HCA’s recent MLTC member forum meetings. HCA’s government advocacy representatives from Hinman Straub also participated. The issues discussed with DOH included: rate/payment adequacy concerns, and synchronicity of adjustments with real-time need and costs for quality service delivery and payment; the need to remedy and prevent erroneous MLTC enrollments and delayed disenrollments by the state’s contracted enrollment broker Maximus; the need for clarification of responsibilities and protocols for respective parties with regard to collection/payment of “spend-down” for MLTC nursing home residents; questions related to Consumer Directed Personal Assistance Program services and oversight; and other issues. DOH officials agreed to pursue these issues and to consider the recommendations offered. DOH invited additional details and examples to assist their follow-up and we anticipate continued advocacy and collaboration toward these improvements. Meanwhile, HCA is continuing our direct legislative and budget advocacy for MLTC rate/premium adequacy. HCA has already presented legislative and budget proposals for rate/premium adequacy to the Governor’s office, the Division of Budget, the Senate and Assembly in late November and throughout December, and will be strongly working toward incorporation of these in the coming budget preparations and negotiations. The HCA MLTC Member Forum meets in person and via teleconference. Participation is strongly promoted for HCA MLTC members. The Forum informs HCA MLTC legislative, budgetary and program advocacy, identifies new innovations and areas of educational support, and assists in coordination with HCA’s overall goals and strategies for supporting home and community based care for HCA members, and the system as a whole. For further information, please contact the HCA Policy Staff.
HCA & IPRO Announce Home Care Sepsis Webinars III and IV: Jan. 19 and Feb. 9 Webinar series gains recognition, posting on CDC website As announced in an e-mail alert last week to the membership, HCA and IPRO have scheduled the next two of four sequential webinars for implementing the HCA home care sepsis screening tool and protocol. The first two programs of this series were conducted on September 30 and October 20, 2016. The next webinar dates, topics and registration instructions are listed on the next page. Participation in these (and all four) webinars is a prerequisite for use of this new tool. The procedures for issuance will follow the webinar series via HCA-issued instructions and authorization for use. HCA, through its Quality Committee and in partnership with IPRO and the National Sepsis Alliance, has developed this national-first-of-a-kind tool implemented through home care to screen for early
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The Situation Report: the Home Care Association of New York State recognition and treatment of sepsis, including identification of risk cases, opportunity for prevention, and patient/family/community education. The series continues to garner important attention from national sources with a high-profile link on the website of the U.S. Centers for Disease Control and Prevention (CDC) at https://www.cdc.gov/sepsis/clinicaltools/index.html. Webinar Dates and Topics Thursday, January 19 10:30 a.m. to noon Webinar III Topic: Integrating the HCA Home Care Sepsis Tool into Agency EHR This session is for home care agency IT principals, clinical leaders, and administration. (Note: While the topic of EHR integration was introduced at the October 20 webinar, this session will go into depth and provide agency/ EHR software examples of successful integration.) To register for the webinar, click or copy and paste this URL to your web browser: https://qualitynet.webex.com/mw3100/mywebex/ default.do?siteurl=qualitynet. Next, locate the session by date (listed chronologically) and click on “Register” to the right of the session name, enter the information requested, and click “submit.” You will receive a confirmation e-mail with login information. Please note: this e-mail may go to your spam or junk folder. It will come from the e-mail address messenger@webex.com. Thursday, February 9 10:30 a.m. to noon Webinar IV Topics: Train-the-Trainer and Introduction of Screening Tool Protocol This session is for home care clinical leaders, educators and administration. A registration link for February 9 will be provided at a later date. In the meantime, please save the date. Additional Information Prerequisites for these upcoming webinars are the initial two webinars, recordings of which can be accessed at the following link: http:// atlanticquality.org/initiatives/sepsis-initiative/educational-eventswebinars/. Under the educational Webinar Program section, please scroll down to Parts I and Parts II of the program entitled Early Recognition of Sepsis in the Outpatient Setting: The Role of Home Healthcare for Improved Patient Outcomes (September 30, 2016 and October 20, 2016). Questions on the home care sepsis initiative can be directed to HCA at acardillo@hcanys.org or to IPRO at Sara.Butterfield@areaI.hcqis.org or Eve.Bankert@area-I.hcqis.org.
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Join HCA for March 9 Programs Upstate on CDPAP and LHCSA Forum On March 9, HCA is holding two programs upstate for LHCSAs and for all home care agencies looking to participate as fiscal intermediaries under the Consumer Directed Personal Assistance Program (CDPAP). The March 9 sessions will be held at the Mohawk Valley Health System Sogg’s Room (1650 Champlin Avenue) in Utica. The first program is entitled Successfully Acting as a Fiscal Intermediary in the Consumer Directed Personal Assistance Program (CDPAP), starting at 9:30 with registration and breakfast followed by a 10 a.m. to noon program. Immediately following this event, HCA is hosting a members-only Upstate LHCSA Forum at the same location from noon to 3 p.m., beginning with lunch. A statewide Medicaid program, CDPAP empowers consumers by giving them flexibility and freedom to choose who
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provides their care and how it is provided. LHCSAs can participate in this growth by becoming a Fiscal Intermediary (FI). At this morning session, you will get important information about CDPAP, including: consumer eligibility requirements and obligations; the process to become an FI; advantages and disadvantages of LHCSAs serving as FIs; requirements and obligations of the FI; policies and procedures; required contracts; wage and hour issues facing FIs; potential risk areas; and best practices of a successful program. The program will be presented by Michael Weiner, a partner in the law firm of Glaser & Weiner, LLP. For more than 20 years, Michael has been a trusted advisor to his clients, providing them with practical legal counsel and business advice. LHCSAs are encouraged to participate in this CDPAP program and to stay for the noon Upstate LHCSA Forum for an exchange of valuable information, advocacy concerns and recommendations for action, including on: state budget developments; federal legislative issues; uniform billing codes; the minimum wage increase and state funding; the state’s offsite surveillance pilot program; CDPAP; the Delivery System Reform Incentive Payment Program (DSRIP) and value based payment; and issues in your region. Participants should register for either one or both programs. Separate registration forms are at http://hcanys.org/wp-content/uploads/2017/01/HCA-Bootcamp-Fiscal-Intermediary-CDPAP-March-9-2017.pdf and http:// hca-nys.org/wp-content/uploads/2017/01/HCA-Upstate-LHCSA-Forum-March-9-Registration-Form.pdf.
DOH Extends Deadline for CHHA/LTHHCP Statistical Report, Hospice Report The state Department of Health (DOH) has extended the deadline to January 10, 2017 (from December 30, 2016) for submission of the 2015 CHHA/LTHHCP Statistical Report and the 2015 Hospice Cost and Utilization Report. All reports are submitted via the HERDS application on the Health Commerce System. As indicated by DOH earlier, failure to submit all required information in the appropriate format may subject the agency to an enforcement action under Section 12 of the Public Health Law resulting in the agency being liable for civil penalties of violations of Article 36 (for CHHAs and LTHHCPs) or Article 40 (for Hospices) of the Public Health Law and New York State Medical Facilities Code. Furthermore, administrators should be aware that DOH’s ability to make an affirmative statement to the agency’s character and competence will be negatively impacted if an enforcement action for failure to submit is pursued. In addition, any certificate of need applications currently in process for agencies determined to be delinquent for this submission will not be processed. Currently 146 CHHAs/LTHHCPs have completed the 2015 Statistical Report, which represents 76 percent of those agencies that received the survey. Additionally, 37 Hospices have completed the 2015 Cost and Utilization Report, which represents 82 percent of those hospices that received the survey. The original Dear Administrator Letter (October 31, 2016) about the statistical reports has instructions for completing and submitting the forms. Please see http://hca-nys.org/wp-content/uploads/2016/10/CHHA-2015Statistical-Report-DAL_102716.pdf. Any questions about the reports can be sent to hcstatrpts@health.ny.gov.
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Downstate LHCSA Forum in NYC on Jan. 30 to Address Urgent Issues HCA announces our Downstate LHCSA Forum on January 30 in New York City, from 10 a.m. to 2 p.m. All HCA-member LHCSAs are invited to attend this critical forum. With the recent increase in the state’s minimum wage and Medicaid funding distribution issues, among other critical LHCSA impacts, your team will not want to miss this opportunity for face-to-face discussion with the HCA policy team about the latest updates, next steps and exchange of experiences so that we can advocate on your behalf with decision-makers. Some of the vital issues to be covered include:
Minimum Wage Increase and Funding
Fair Labor Standards Act (FLSA) and Quality Incentive/Vital Access Provider Pool (QIVAPP) Monies
Regulatory Issues and Changes
Uniform Billing Codes
DSRIP and Value Based Payments
Additional Issues or Concerns
This forum is for HCA members only and is an important benefit of your membership in HCA to gain updates specific to your organization. Please register for this important forum by downloading the flyer at http://hca-nys.org/wp-content/uploads/2017/01/HCA-Downstate-LHCSA-Forum-January-30-2017Registration-Form.pdf.
CMS Provides Update on Home Health CAHPS Survey The U.S. Centers for Medicare and Medicaid Services (CMS) has recently provided the following updates regarding the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey:
HHCAHPS participation from April 2016 to March 2017 counts toward the calendar year (CY) 2018 annual payment update (APU). Home health agencies that are not participating – because they had 59 or fewer patients in the reference count period of April 2015-March 2016 – must complete a CY 2018 APU HHCAHPS Participation Exemption Request form by 11:59 p.m. on March 31, 2017. The form is at https://homehealthcahps.org.
The next HHCAHPS data submission deadline is January 19, 2017. All HHAHPS Survey Vendors must submit HHCAHPS survey data for Quarter 3, 2016 by 11:59 p.m. on January 19, 2017.
Updated HHCAHPS data will be publicly reported on Home Health Compare on January 15, 2017. The HHCAHPS data will be through June 30, 2016. Star ratings will be updated for HHCAHPS data. Continued on next page
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Continued from previous page
Agencies may view their Preview Reports for HHCAHPS data as of January 6, 2017. (See related p. 10 story.)
HHCAHPS annual survey vendor training is soon. Registration will be available at https:// homehealthcahps.org. On January 31 (Session I) and February 1 (Session II), from 1 to 5 p.m., CMS will offer Introductory Training. Sessions I and II have different content, so attendees should register for both Sessions I and II. Introductory training is for new vendors, currently approved vendors, subcontractors to vendors, new staff with vendors, and interested home health agencies. CMS will have an HHCAHPS Survey Vendor Update Training on February 3, 2017, from noon to 2 p.m. All current HHCAHPS survey vendors must register and attend Update Training.
CMS will post its revised annually-issued HHCAHPS Protocols and Guidelines Manual and revised HHCAHPS Data Submission Manual at https://homehealthcahps.org on or about January 24, 2017.
If your agency is not yet participating in HHCAHPS, please note that it is never too late to start participation. The next APU period is for CY 2019 APU, and the participation is from April 2017-March 2018. Agencies may register for HHCAHPS and select your survey vendor for HHCAHPS at https:// homehealthcahps.org. For assistance, send an e-mail to HHCAHPS@rti.org or call 1-866-354-0985.
For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
HHCAHPS Preview Reports with Star Ratings Available Preview Reports reflecting results from the Home Health Care Consumer Assessment of Homecare Providers and Systems (HHCAHPS) survey are now available for the July 2015 through June 2016 period (quarter 3 of 2015 to quarter 2 of 2016). Once logged in, the reports can be found at https://homehealthcahps.org under the “For HHAs” tab. These same data will be updated on Home Health Compare (www.medicare.gov) this month. The Preview Reports present the publicly reported results with star ratings for those agencies with a sufficient number of completed interviews to receive star ratings. Agencies must have data for 40 or more patient surveys in the reporting period in order to have star ratings. To access an agency’s HHCAHPS Preview Report, log into the HHCAHPS website using your username and password. Select the “Preview Reports” link under the “For HHAs” tab. If you have forgotten your password, click the Login link, type in your username, click “Reset Password,” and you will be e-mailed a “password reset link.” Follow the instructions provided in the e-mail message to reset your password. If you have comments about your HHCAHPS star ratings on the Preview Report, please e-mail the following information by January 20, 2017 to hhcahps@rti.org:
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Your name, facility name, CCN (U.S. Centers for Medicare and Medicaid Services Certification Number), and contact information.
Your comments about your preview report.
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If you believe your HHCAHPS star ratings are not correct, submit evidence showing why. (Note: If you have historically experienced higher ratings than are shown, this is not considered evidence. You must provide information showing that the data submitted by your vendor for the most recent quarter are incorrect and, therefore, may have impacted the assigned HHCAHPS star ratings for your agency.)
For more information about the Preview Reports, please refer to this document on the HHCAHPS website, accessible once you are logged in: https://homehealthcahps.org/LinkClick.aspx?fileticket=rEmqINcxYK8%3d&tabid=277. For more information about HHCAHPS Star Ratings, including frequently asked questions, go to https:// homehealthcahps.org/GeneralInformation/StarRatingsInformation.aspx. Questions about the HHCAHPS star ratings or HHCAHPS Preview Report can be directed to the HHCAHPS Survey Coordination Team at hhcahps@rti.org or (866) 354-0985.
Important Clarification Regarding Caregiver Exclusion Searches for LHCSAs HCA recently received a provider inquiry about requirements for searching databases of LHCSA caregiver exclusions. The state Department of Health (DOH) has clarified to HCA that (according to the Provider Contract Standard Clauses for managed care contractors) LHCSAs providing services on behalf of a Medicaid MLTC plan or a mainstream Medicaid managed care plan need to monitor their employees against the following databases:
Death Master file from the Social Security Administration (https://www.ssdmf.com/FolderID/1/ SessionID/%7B6851614A-AA5B-48B8-B42C-43A08D1549CA%7D/PageVars/Library/InfoManage/ Guide.htm)
The National Plan and Provider Enumeration System (NPPES) (https://nppes.cms.hhs.gov/NPPES/ Welcome.do)
Office of the Inspector General’s List of Excluded Individuals and Entities (LEIE) (https://oig.hhs.gov/ exclusions/)
Additionally, the Medicaid Model Contact requirements pertain to LHCSAs providing services for mainstream Medicaid managed care plans and specify that LHCSAs “identify and determine the exclusion status of managing employees through routine checks of federal databases” including the three databases listed above and:
The Excluded Parties List System (EPLS), now through the SAM systems and General Services Administration (https://www.sam.gov/portal/SAM/##11)
The state Office of the Medicaid Inspector General (OMIG) Exclusion List (https://omig.ny.gov/ index.php/fraud/medicaid-exclusions)
Any other databases as the Secretary may prescribe Continued on next page
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Continued from previous page NOTE: The Medicare Exclusion Database (MED) (https://www.cms.gov/Research-Statistics-Data-andSystems/Computer-Data-and-Systems/MED/Overview-MED.html) can be checked in place of the LEIE to satisfy this requirement. While it is specified that agencies consult the databases at least monthly, providers may want to check all lists on a more frequent schedule, based on some members informing us that monthly was not enough to ensure compliance. Further, DOH noted that the additional databases to check for mainstream managed care will soon be requirements for LHCSAs providing services on behalf of MLTC plans, once the MLTC model contracts are revised. HCA will monitor this and provide notice to the membership when these revisions are formally made. Please contact Alex Fitz Blais (ablais@hcanys.org) or Andrew Koski (akoski@hcanys.org) with any questions.
State-Industry Workgroup to Plan CFCO Implementation in Managed Care The state Department of Health has convened a workgroup of managed care plans and managed care plan member associations to advise on the implementation of the Community First Choice Option (CFCO) within managed care. HCA participated in the workgroup’s first meeting last Thursday. CFCO was created as an option under the Affordable Care Act and was included as a New York State benefit in 2011. Implementation within the managed care structure has significant implications for managed care plans, providers and patients, as CFCO will add new service benefits, operational requirements, rate and contract changes, and other changes. The Department reviewed its overall plan to incorporate CFCO into the benefit structure of both mainstream managed care organizations and MLTCs. The Department’s plan (summarized in the slide deck at http://hcanys.org/wp-content/uploads/2017/01/CFCO-Workgroup-010517-FINAL.pdf) lists the specific CFCO services intended to be added to mainstream plans and MLTCs. It also indicates the features of CFCO intended to be made part of mainstream and MLTC implementation, such as requirements for “person-centered care planning,” parallel provision of CFCO through LHCSA and Consumer Directed Personal Assistance Programs (CDPAP), and other items. HCA and other workgroup participants raised a wide range of issues and questions to be determined, including: parameters for the new CFCO services and their authorization; rate setting and reimbursement; provider network development; coding and billing; reporting; clinical management and operations; and differential approaches or procedures that may be needed for Programs of All-Inclusive Care for the Elderly (PACE) models versus MLTCs, and for CFCO delivery through CDPAP versus LHCSA/direct provider delivery. The Department proposed to address these issues and additional program details and recommendations through the creation of individual work groups consisting of mainstream managed care, MLTC and association representatives. Also planned is an overall steering committee that will review and coordinate the results of the committee process, and also address broad-based and priority issues. An intensive workplan is anticipated to follow, as the federal government has given the state six months for implementation. Continued on next page
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Continued from previous page HCA will inform the membership of the roles we will play in this committee process once the Department’s appointments are made. Meanwhile, MLTCs and mainstream plans wishing to participate in the committee process are invited to contact departmental staff for details. HCA will provide further information on these and other implementation plans as the process goes forward. For further information, please contact the HCA Policy staff.
Emergency Preparedness Training Opportunities The State Department of Health Office of Health Emergency Preparedness has announced the following emergency preparedness webinar training opportunities in the Incident Command System (ICS) for providers and personnel serving the broader Capital District/Northeastern New York region. HCA strongly encourages providers to engage staff in ICS training. ICS should be considered core to staff preparation, leadership and, as necessary, broader regional collaboration in emergency preparedness and response. Incident Command System Webinar Series ICS 700 – National Incident Management System: An Introduction Training Date/Time: January 18, 2017 (10 a.m. to noon) Register: click https://www.nylearnsph.com and search course catalog for RTC-IS700-Web02 ICS 100 – Introduction to the Incident Command System Training Date/Time: January 23, 2017 (10:30 a.m. to 12:30 p.m.) Register: click https://www.nylearnsph.com and search course catalog for RTC-IS100-Web02 ICS 200 – ICS for Single Resources and Initial Action Incidents Training Date/Time: February 1, 2017 (10 a.m. to noon) Register: click https://www.nylearnsph.com and search course catalog for RTC-IS200-Web02 HICS – Hospital Incident Command System Training Date/Time: February 8, 2017 (10 a.m. to noon) Register: click https://www.nylearnsph.com and search course catalog for RTC-HICS-Web02
Reminder: North Country Regional Emergency Preparedness “Extreme Weather” Exercise As reported in last week’s edition of The Situation Reports, the state Department of Health (DOH) is conducting an “extreme weather” emergency preparedness exercise on January 12 for providers serving counties in the North Country area of the state. This exercise is for providers approved to serve Clinton,
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Essex, Franklin and Hamilton counties. The exercise will simulate the approach and impact of a significant ice storm. As part of this drill, the Health Emergency Response Data System (HERDS) survey will be activated the day before the exercise, on January 11, 2017. You may receive a phone call from your county health department to discuss patients potentially impacted by the storm during the exercise. Agency participation will be voluntary, but all agencies serving the exercise region are urged to participate. DOH will send notification via IHANS (Integrated Health Alerting and Notification System) alert and a HERDS survey activity on the Health Commerce System. The survey activity will be open from 8 a.m. to 2 p.m. ONLY on January 11, 2017. HCA will be participating in the debriefing/after-action review of the exercise and will share any information, insights and recommendations. For further information, please contact Nancy Simonds at DOH at HCEmergency@health.ny.gov; or HCA’s Alex Fitz Blais at ablais@hcanys.org or Al Cardillo at acardillo@hcanys.org.
Round 3, Additional Round 2 DSRIP Regulatory Waiver Request Responses Released The state Department of Health (DOH) recently released new responses to regulatory waiver requests by Performing Provider Systems (PPSs) regarding Delivery System Reform Incentive Payment (DSRIP) project activities. Three additional responses for round two of regulatory waiver requests and four additional responses to requests for round three are now available on the DSRIP website at: http://www.health.ny.gov/ health_care/medicaid/redesign/dsrip/reg_flex_guide_res_prog_stat_waiver_resp_approvals.htm. The additional regulatory waiver request responses that may be of interest to HCA members include:
Ordering of home care services by physician assistants (PAs) and nurse practitioners (NPs): Montefiore Hudson Valley Collaborative and Bronx Lebanon Health Center (BLHC) requested waivers of 10 NYCRR 766.4(b) (and approved by DOH) allowing physician assistants or nurse practitioners to order home care services for DSRIP project purposes. DOH made clear in the approval for the Bronx Lebanon waiver request that this does not allow PAs and NPs to provide home care services if not contracted with a LHCSA.
Montefiore Hudson Valley Collaborative submitted a waiver request for 10 NYCRR 86–4.9, 86– 8.14, 401.2; 14 NYCRR 599.14; 14 NYCRR Parts 822, 841 related to payment for Article 28 clinic off-site services. DOH responded that DOH doesn’t currently have federal approval to pay Article 28 clinics for off-site services, except for Federally Qualified Health Centers. Similarly, BLHC requested a waiver for 10 NYCRR 86–4.9(c)(8) related to billing for Article 28 clinic off-site services and DOH denied that request, responding likewise.
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BLHC additionally requested a waiver of 14 NYCRR 599.14, related to Medicaid reimbursement for off-site Office of Mental Health (OMH) clinic services. The waiver was denied by DOH; however, DOH’s response was: “The prohibition on Medicaid reimbursement for off-site OMH clinic services is in federal law, and therefore cannot be waived. However, with the recent
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approval of NYS’s amended 1115 waiver, CMS will permit certain off-site-clinic-associated services to be provided by licensed OMH providers to enrollees of Medicaid Managed Care Plans. Specifically, as Medicaid managed care plans transition to include behavioral health services … plans will begin authorizing off-site clinical services at locations other than a clinic’s main site or satellite locations. The state will release guidance on the provision of off-site services under Medicaid managed care in the near future, which will assist in the development and implementation of DSRIP projects. The PPSs would not need a regulatory waiver for such services to be provided once these services are fully-authorized.” Similarly, BLHC requested a waiver for 14 NYCRR Part 841 regarding Office of Alcoholism and Substance Abuse Services (OASAS) to allow Medicaid reimbursement for off-site providers to provide home visits for substance abuse treatment. DOH stated that no waiver was necessary because of the aforementioned recent approval of NYS’s amended 1115 waiver. These and other responses were made to requests by PPSs due to the Regulatory Waiver and Project Tracking tool on November 18, 2016. Any questions can be directed to DSRIP@health.ny.gov.
DSRIP Mid- Point Assessment Final Report and Recommendations Available The state Department of Health (DOH) provided notice this week that the DSRIP Independent Assessor has developed and released its final Mid-Point Assessment reports for all 25 Performing Provider Systems (PPSs) after receipt and review of public comments to the initial recommendations in December. The final report(s), including the Companion Document, are available on the DSRIP website at https://www.health.ny.gov/ health_care/medicaid/redesign/dsrip/pps_map/midpoint/index.htm and includes a redline version highlighting changes that were made. The final PPS reports and the Companion Document are available for a second public comment period until January 23, 2017, and all comments should be sent to dsrip_midpoint@pcgus.com. Following this comment period, final recommendations will be presented to the Project Approval and Oversight Panel (PAOP) between January 31 and February 3, 2017.
PACE Innovation Act Request for Information Announced The U.S. Centers for Medicare and Medicaid Services (CMS) has released a Request for Information (RFI) seeking public input on potential adaptations of the model of care employed by the Programs of AllInclusive Care for the Elderly (PACE). This would be for new populations, including individuals with physical disabilities, under the authority provided by the PACE Innovation Act. The PACE Innovation Act of 2015 (PIA) provides authority to test application of PACE-like models for additional populations, including populations under the age of 55 and those who do not qualify for a nursing-home-level of care, under Section 1115A of the Social Security Act. The RFI includes two parts: 1.
CMS seeks comment on potential elements of a five-year PACE-like model test provisionally called “Person Centered Community Care” or P3C. The target population includes individuals:
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Dually eligible for Medicare and Medicaid;
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Age 21 and older;
With disabilities that impair their mobility;
Who are assessed as requiring a nursing home level of care; and
With potentially other eligibility criteria.
CMS also seeks comment on the types of technical assistance that potential P3C organizations and states would require to participate in this model test. 2.
CMS seeks information on additional specific populations whose health outcomes could benefit from enrollment in PACE-like models, and how the PACE model of care could be adapted to better serve the needs of these populations and the currently eligible population.
The RFI is available at: https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-MedicaidCoordination/Medicare-Medicaid-Coordination-Office/PACEInnovationAct.html. Comments must be received by February 10, 2017 and should be submitted electronically in PDF form to MMCOcapsmodel@cms.hhs.gov. HCA recently submitted comments on a CMS-proposed rule that would make changes to PACE. The proposed rule addresses application and waiver procedures, sanctions, enforcement actions and termination, administrative requirements, PACE services, participant rights, quality assessment and performance improvement, participant enrollment and disenrollment, payment, federal and state monitoring, data collection, record maintenance, and reporting. Our comments are at http://hca-nys.org/ wp-content/uploads/2016/10/PACEcommentsFinal101716.pdf.
Workers’ Compensation Board Issues Form Submission Guidelines The Workers’ Compensation Board (WCB) has issued guidelines on submitting forms and other documents. Duplicate filing of forms The Board asks that organizations refrain from submitting forms more than once or in multiple formats. Duplicate filings increase the amount of time required to respond to a customer request for further action or a status update on a pending request. According to WCB, duplicate submissions may be deemed to be raising or continuing an issue without reasonable grounds, will never result in higher fees being granted, and may subject the sender to penalties under Workers’ Compensation Law § 114-a(3). Submission methods There are multiple methods to submit forms, including:
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An online web form;
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Uploading forms electronically through the WCB Web Upload Link on the Forms section of the Board’s website. Go to “Forms” (http://www.wcb.ny.gov/content/main/Forms.jsp), and then select WCB Web Upload Link;
E-mail to the Board’s centralized e-mail address at wcbclaimsfiling@wcb.ny.gov;
Mail to the Board’s centralized mailing address at P.O. Box 5205, Binghamton, NY 13902-5205; or
Fax to the Board’s centralized fax number at (877) 533-0337. To ensure that the form is legible and that all pages can be identified, do the following before faxing the form: set the scanner to black and white to optimize image quality, add the WCB case number and/or claimant identifiers to each page, and number each page (1 of 5, 2 of 5, etc.).
If you are faxing or mailing a form, ensure that you are using the most recent version of the form from the Board’s website. If, occasionally, you must send a corrected version of the form or document, please indicate on the top of the form that it is a corrected version of a form already submitted, including the date of the original (i.e., Corrected Version – Original Dated MM-DD-YYYY). Online forms or web upload link The most frequently submitted forms are available for online submission on the Board’s website. You are encouraged to use these online web forms to maximize legibility and minimize filing turnaround times. Forms submitted electronically are routed automatically to the proper case folder, bypassing the scanning process. Forms submitted online appear in eCase the following business day. Online web forms currently available are listed at http://www.wcb.ny.gov/content/ebiz/WEBForms/webform_allForms.jsp
Upcoming NGS Education Programs National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), will be hosting the following educational webinars this week, as listed below.
Provider Enrollment – Getting Connected to PECOS: Tuesday, January 10, from 2 to 3 p.m. Registration is at https://attendee.gotowebinar.com/register/2423188766903657475
Ordering & Certifying Medicare Home Health Services: Wednesday, January 11, from 1 to 2 p.m. Registration is at https://attendee.gotowebinar.com/register/6730431010978654978
Provider Enrollment Revalidation: Thursday, January 12, from 10 to 11 a.m. Registration is at https:// attendee.gotowebinar.com/register/6632890035681828356
Home Health Billing Basics: Thursday, January 12, from 10 to 11:30 a.m. Registration is at https:// attendee.gotowebinar.com/register/7609413591592430595
For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
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IRS Announces 2017 Mileage Rates The Internal Revenue Service (IRS) has issued 2017 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, 2017, the standard mileage rates are:
53.5 cents per mile for business miles driven, down from 54 cents for 2016
17 cents per mile driven for medical or moving purposes, down from 19 cents for 2016
14 cents per mile driven in service of charitable organizations
Additional information can be found at: https://www.irs.gov/uac/2017-standard-mileage-rates-forbusiness-and-medical-and-moving-announced. For more information, contact the HCA Policy staff.
Resources
“Medicaid Pocket Primer,” by the Kaiser Family Foundation http://files.kff.org/attachment/Fact-Sheet-Medicaid-Pocket-Primer
“Report to Congress: Social Risk Factors and Performance Under Medicare’s Value-Based Purchasing Programs,” by the Office of Assistant Secretary for Planning and Evaluation https://aspe.hhs.gov/sites/default/files/pdf/253971/ASPESESRTCfull.pdf
“Report to Congress,” by the CMS Innovation Center https://innovation.cms.gov/Files/reports/rtc-2016.pdf
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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