LTHHCP
SEPSIS
PEPPER
OT
HCA asks DOH to clear-up “Medicaid Update” article implying contrary information on the role of LTHHCP.
HCA launches statewide rollout of home care sepsis tool and major radio news splash.
PEPPER webinar explains how reports can be used to identify integrity risk.
New Occupational Therapy rule goes into effect.
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COMING UP HCA Corporate Compliance Symposium Oct. 6 Renaissance Albany Hotel Albany, NY Home Care Bootcamp: Understanding the Federal and State Wage & Hour Rules for Home Care Oct. 20 VNSNY, 107 East 70th St. NYC Downstate LHCSA Forum Oct. 28, 2016 Selfhelp Family Home Care, Inc. 520 Eighth Avenue, 5th Floor NYC Register for all HCA programs at www.hcanys.org.
Your Source for HOME CARE News, Policy and Advocacy
Vol. 1, Issue 4 | October 3, 2016
Reps. Rice, McGovern Push Bill for One-Year Moratorium on Home Health Pre-Claim Review As you’ve seen in our biweekly news clips and newsletter, the U.S. Centers for Medicare and Medicaid Services (CMS) has temporarily paused expansion of its pre-claim review demo, which already went into effect in Illinois – the first demo state – and was slated for implementation in several other states (not New York) as well. The pause, CMS asserts, was due to the need for “additional education efforts” that “will be See DEMO p. 2
INSIDE Reps. Rice, McGovern Push Stop on Home Health Pre-Claim Review.........1 Reminder: Oct. 20 Bootcamp on Federal, State Wage & Hour Rules.........3 HCA Prepares Advocacy on Care Planning Improvement Act....................4 Western NY Agencies Invited to Voluntary Emergency Exercise................4 LTHHCP Exception Code Removed..........................................................5 MLTC Update.........................................................................................6 HCA and Partners Unveil Sepsis Tool Seeking Provider Buy-In..................7 HCA, IPRO Bring Sepsis Awareness to Radio News.................................8 DOH Posts Regulatory Agenda................................................................8 CMS Announces New CERT Contractor Effective Oct. 14...........................9
HCA held a successful first Women in Healthcare Leadership Summit in Saratoga late last week, where women health care CEOs, COOs, CFOs, management staff, consultants and publicaffairs experts gathered for training on work-life-balance issues, negotiation strategies, communications, networking and more. The Summit also featured an Executive Head-Shot booth, where women got a free photo to share on their professional networks and CVs, as well as an array of vendors, a wine tasting and other networking events. HCA is proud of all the exceptional women who participated to make this inaugural program a success, sharing their stories and learning from one another. Check out the photo above on our Facebook page (www.facebook.com/HCANYS) and tag yourself to show your camaraderie with fellow women leaders in healthcare. Member Hiring Announcements.........................................................10,11 Come to HCA’s Downstate LHCSA Forum: Oct. 28....................................11 NGS: Hospice Claims Incorrectly Returned to Providers.............................12 Quality of Patient Care Star Ratings Preview Reports Now Available...........12 Hospice PEPPER Webinar Underscores Importance of Data........................12 Final Rule Adopted on OT Assistants............................................................13 New Common Benefit Identification Card Available.....................................13 NGS Updates.............................................................................................14 SS Numbers to be Removed from Medicare Cards.........................................14 eMedNY Posts Fall Training.......................................................................15 Resources......................................................................................15
The Situation Report: the Home Care Association of New York State DEMO from p. 1 helpful before expansion of the demo to other states.” In the latest development, two Members of Congress are stepping in to urge support from colleagues on legislation that would delay the demo for a year. The bill would also require CMS to report on the project’s impact. “After seven weeks of challenges in Illinois, CMS has plentiful information available to get to the root of any paperwork concerns and work with Congress on a more targeted corrective action plan,” states the “Dear Colleague” letter recently circulated by U.S. Reps. Tom Price of Georgia and Jim McGovern of Massachusetts. Though New York is not one of the states included in the CMS demo, HCA was concerned from the outset of this proposal that CMS would ultimately expand the demo beyond the initial phase to make pre-claim review a national program (or phase it into New York). We have advocated vigorously against the proposal, as a whole, for its onerous intrusion into claims-authorization for duly administered home health services, not just in New York but in other states as well. This intrusion comes in the form of third-party Medicare Administrative Contractors (MACs) deciding, at the prepayment stage, whether home health claims meet criteria in support of medical necessity and whether all coverage requirements are met, including the Medicare face-to-face (F2F) requirement, for each episode of care prior to the submission of a claim for billing. With agencies required to submit documentation before a final claim is submitted, this demo is a sweeping departure from past integrity efforts, which have largely focused on post-payment audits. As Home Health Care News recently reported, the experience in Illinois has thus far been stilted, prompting CMS’s decision to pause the program. “A major refrain” from the Illinois rollout, Home Health Care News reports, “was that there is apparently ‘no rhyme or reason’ as to which pre-claim submissions get affirmed versus denied. Some agencies said that after an initial rejection, they have re-submitted without making any changes to the documentation and have had the claim affirmed.” HCA will be alerting New York’s Congressional Delegation to the Price-McGovern effort and legislation, urging their support to put a stop to pre-claim review. HCA has already taken several preemptive advocacy steps on this issue, providing written comments to CMS 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
The Situation Report: the Home Care Association of New York State about the major flaws in its program, engaging the New York Delegation, and summoning our members for grassroots advocacy. The pre-claim review demo was originally a “priorauthorization” demo, and HCA’s efforts, including written comments and Congressional activity, targeted both versions. After initially proposing a “prior-authorization” program, CMS changed course by essentially moving the MAC review process to the claims-submission stage (pre-claim review), as distinct from its original priorauthorization proposal, which would have required a MAC decision before services even commenced. Both versions of the program presented unique intrusions: one, intruding on the decision-making of clinicians at the outset of care (even before services are rendered), and the other questioning claims being submitted for services duly rendered, authorized, documented and prepared for billing. CMS says the demo was needed in response to previous government reports that show “evidence of fraud and abuse in Medicare’s home health benefit” and a 59 percent improper payment rate for home health claims that is attributed largely to insufficient documentation. Furthermore, the demonstration states were targeted as “high-risk states” under the temporary moratoria on home health provider enrollment authorized under the Affordable Care Act. HCA has argued that the physician F2F encounter requirement is responsible for the large number of documentation issues targeted by this demo, due to the onerous and unworkable way the requirement has been administered by CMS/MACs. HCA has worked and will continue to advocate for reforming and simplifying the F2F mandate so that it can be met by home health agencies and ordering physicians. HCA’s comments on pre-claim review and priorauthorization are posted to our website in the “Letters and Comments” section at http://hca-nys.org/category/ letters-and-comments. We will continue to keep you informed of developments on this new legislative effort and the need for grassroots advocacy.
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HCA Offers Oct. 20 Bootcamp: Federal, State Wage & Hour Rules The attorneys from Hodgson Russ are indemand experts on all areas of home care labor law. HCA has invited them to provide an even deeper look at labor law issues during an October 20 Bootcamp in New York City entitled “Understanding the Federal and State Wage & Hour Rules for Home Care Providers and Rising Above the Challenges.” Hodgson Russ Attorneys Peter Godfrey, John Godwin and Emina Poricanin specialize in wage and hour laws for the home care industry. They’ll discuss the key federal and state compensation requirements for home care providers, and cover topics such as: accurate computation of the regular rate of pay; properly paying overtime; accurately tracking work time, including travel time; spread of hours and split-shift pay; call-in pay regulations; the Domestic Workers’ Bill of Rights; and the Wage Parity Law. The session will additionally provide an overview of some of the most pressing challenges to the home care industry, including litigation of live-in cases, complications created by the elimination of the companionship exemption, and the rise in private plaintiff class-action litigation. Attendees will develop a greater understanding of their legal obligations and learn about tips to overcome some of the most difficult issues plaguing the home care industry today. You will not want to miss this session, which is expected to draw a big turnout. A registration form is at the back of this week’s Situation Report or on our website at www.hca-nys.org.
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HCA Prepares Advocacy for Lame Duck Push on Care Planning Improvement Act Look for member advocacy alert later this week HCA and colleagues have long advocated for legislation to allow non-physician practitioners to order and refer for home health services. Legislation has been on the table – for just as long – to resolve this issue, called the “Home Health Care Planning Improvement Act” (S.578/H.R. 1342). HCA and our federal lobbyist Brett Heimov, of Envision Strategy in Washington, DC, are gearing up for a special lame duck advocacy campaign to press for this important bill to be passed in the Congressional Session anticipated after the November 8 election. HCA will employ its grassroots network of home care providers across the state to push hard for this federal priority. Please be on the lookout for an advocacy alert this week with special instructions, including the use of our Phone2Action online advocacy tool. This commonsense measure would ease current restrictions on home health care access by allowing nurse practitioners, physician assistants, clinical nurse specialists and other advance practice professionals to order and certify Medicare home health services. Right now, only physicians can issue home health orders and conduct certifications. Physician shortages in many regions of the country result in access disparities for home health services, and the current process of requiring physician sign-off is unnecessarily expensive. In fact, a study by Dobson Davanzo estimated a fiveyear savings of $82.5 million resulting from more flexibility. HCA has extensively reported on this bill and our past advocacy to push for its resolution. As Congress heads into a lame-duck session, several measures require its urgent attention, including a spending bill that extends government funding and addresses the Zika crisis, as well as other bills. This period offers a prime opportunity for a big push on S.578/H.R. 1342 and other home care priorities. Stay tuned for more information later this week.
Western NY Agencies Invited to Voluntary Emergency Exercise During the week of October 31 to November 4, collaborating partners in the Western Region of the state will be conducting a regional exercise called WRECKIT 2016 (Western Region Emergency Communications, Knowledge, and Information Tests). Western New York providers are encouraged to save the date to participate but it is not required. This voluntary exercise will begin October 31 and progress in stages over the week. It will simulate the approach and impact of a significant ice storm. According to planning officials, those home care agencies wishing to participate will engage in an informationgathering effort involving the reporting of high-acuity patients, often referred to as Level 1. This exercise data will be collated and shared with regional partners, counties and others to build awareness and encourage planning to meet the needs of this population. As additional details of this program are shared, we will notify the membership of specific instructions. In the meantime, check for updates on the WRECKIT website at www.wreckit2016.com.
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LTHHCP Exception Code Removed HCA asks for clarification HCA has reached out to the state Department of Health (DOH) about an article in The September 2016 Medicaid Update entitled “End-Dating the Long Term Home Health Care Program (LTHHCP) Exception Code 30.” The article is at http://www.health.ny.gov/health_care/medicaid/program/update/2016/sep16_mu.pdf (page 8). While the article covers the removal of code 30 for LTHHCP participants who are transitioning into managed care, it gives the impression that the program closed on May 27, 2016, when in fact the waiver expiration is an entirely separate matter from the LTHHCP operating authority and broader options for LTHHCPs to continue to serve patients and contract with partners. The continued vital role for LTHHCPs is indicated in a DOH Questions and Answers (Q&A) document dated July 26, 2016 (http://www.health.ny.gov/health_care/medicaid/redesign/mrt90/2016-0810_qandas_lthhcp.htm) that offers guidance on LTHHCP provider operations, roles, patient access, and new opportunity areas. This guidance resulted from the advocacy of HCA, provider members and key DOH officials. The Q&As both clarify and affirm that LTHHCPs are authorized in their own right, and under their operating certificates, to operate and provide services under Medicaid and Medicaid/Medicare directly (following home health agency procedures), as well as under:
Medicare, Managed care, MLTC and FIDA plans to provide services, care management or other permissible contract services (including skilled and nonskilled, professional, aide and waivered services) for Medicaid or dual Medicaid-Medicare managed care plan enrollees, including contracts for services allowable under PHL Article 49 (utilization review organizations);
Medicaid-covered personal care services for local departments of social services, the Delivery System Reform Incentive Payment (DSRIP) program, accountable care organizations, health homes, value based payment arrangements, private pay, etc.
Additionally, LTHHCPs may contract to provide both state plan services and waivered services or care management services under the Community First Choice state plan amendment, the Nursing Home Transition and Diversion Waiver, the Traumatic Brain Injury Waiver, and the Care at Home Waivers. HCA expressed our concern to DOH that managed care plans, providers and other entities will read the Medicaid Update story and think that the LTHHCP is closed, and we have asked the Department to issue a clarification.
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MLTC Update The following managed long term care (MLTC) update was presented at the September 29 meeting of the state’s Medicaid Managed Care Advisory Review Panel. FIDA The state is running a Fully Integrated Duals Advantage (FIDA) ad campaign until January 2017 that consists of: audio, digital, print, outdoor advertisements and promotional materials. The state hopes to make a decision about the future of FIDA by the end of October, including any revisions to the program. NHTD/TBI Transition to Managed Care
A Waiver Stakeholder Phase II meeting was held on September 14, at which the 1915(c) waiver transition timeline and Common Elements of Public Comments were discussed.
The state’s draft NHTD/TBI Transition Plan, as well as materials from a June 22 webinar, Transition timeline, and Common Elements of Public Comments, are at https://www.health.ny.gov/health_care/ medicaid/redesign/mrt90/tbi-nhtd_waiver_trans_ingo.htm.
A second Waiver Stakeholder Phase II meeting is scheduled for October 19.
Community First Choice Option
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New York State Medicaid is adding Community First Choice Option (CFCO) State Plan services to Medicaid Managed Care (MMC) and MLTC, effective January 1, 2017.
Access to CFCO services requires Medicaid-eligible consumers to: have an assessed need for an institutional level of care; be able to live safely in the community if they receive CFCO services; and reside in their own home or the home of a family member.
Many CFCO State Plan services are already available in the managed care benefit package, including Non-Emergency Transportation.
New services being added include assistive technology; activities of daily living and instrumental activities of daily living skill acquisition, maintenance, and enhancement; community transitional services; home-delivered meals; environmental modifications; and vehicle modifications.
An informational webinar was recently recorded for stakeholders to announce the launch of CFCO service options, available at: https://www.health.ny.gov/health_care/medicaid/redesign/ community_first_choice_option.htm. Questions from this webinar are being used to develop a guidance document that will provide more detailed information for stakeholders.
An Administrative Directive Memorandum (ADM) was drafted to introduce CFCO and provide detailed guidance for Local Departments of Social Services (LDSS) regarding delivery and implementation of
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this set of services. The ADM underwent a public comment period; editing and review of a final version is underway.
October deliverables include: 1) provide a policy paper for plans, including billing guidelines and service-authorization criteria; 2) provide plans with a list of providers to allow them to begin contracting; 3) provide plans with an insert for the member handbook regarding CFCO services; 4) develop a template letter for plans to distribute to members announcing Medicaid coverage of CFCO services; 5) and continue to work with the state’s enrollment broker, New York Medicaid Choice, to ensure readiness to educate consumers on CFCO services and enrollment options.
November deliverables include: a webinar specifically geared towards managed care organizations and trade associations to provide information on best practices for implementation of CFCO services and supports; and DOH guidance and work with plans to ensure their ability to explain and deliver services, including service-authorization criteria, a member handbook, educational materials, policies and procedures, and establishment of provider network.
HCA, Partners Unveil First-in-Nation Home Care Sepsis Tool Seeking Provider Buy-In On Friday, HCA was joined by major national and state partners on a groundbreaking webinar to unveil a first-of-its-kind effort for sepsis awareness, prevention, early recognition and intervention in home care. HCA partners on the webinar included representatives of the U.S. Centers for Disease Control and Prevention, the Governor’s Office, the state Department of Health, IPRO, the National Sepsis Alliance, and the Rory Staunton Foundation for Sepsis Prevention. The webinar drew over 200 participants. It provided the first statewide walkthrough and launch of HCA’s sepsis screen and protocol developed for implementation through home care agencies. IPRO has already incorporated the tool as the basis for community-based sepsis screening and home care agency training under a U.S. Centers for Medicare and Medicaid Services project. Webinar leaders provided background on sepsis, declared it a “health emergency,” and outlined staggering data about this severe and life-threatening condition. The webinar’s core purpose, however, was a statewide introduction of the HCA home care sepsis screening tool and protocol, including a detailed step-by-step walkthrough of the tool’s screening and corresponding intervention processes. Over a quarter of a million individuals die of sepsis every year. Sepsis is the number one cause of Medicare 30-day hospital readmissions in New York State. At nearly $24 billion annually, sepsis is among the leading national health care expenditures. The HCA sepsis tool breaks new ground in New York and nationally in equipping home health providers with an instrument and protocol to prevent and combat this condition, and to take aim at this public health priority and emergency. Friday’s webinar was the first of at least three installments that will prepare providers for incorporation of the tool. To register for the next sessions, which are listed on the next page, click the registration link at
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(https://qualitynet.webex.com/mw3100/mywebex/default.do?siteurl=qualitynet). Next, locate each of the sessions by date (listed chronologically) and click on “Register” to the right of the session name.
Part II: Oct. 20 (10:30 a.m. to noon), focuses on agency adoption of the tool and integration into your electronic health records.
Part III: Nov. 9 (10:30 a.m. to noon). This is a train-the-trainer program.
HCA urges all home care providers to adopt and incorporate this critical, lifesaving initiative within your agencies upon its release. For further information, please contact acardillo@hcanys.org.
HCA, IPRO Bring Sepsis Awareness to Radio News Broadcasts on Several Upstate New York Stations HCA Executive Vice President Al Cardillo, IPRO Quality Director Sara Butterfield, and IPRO Sepsis Project Leader Eve Bankert were featured this weekend on a widely broadcast radio-news program to promote sepsis public awareness and describe clinical initiatives being partnered by IPRO and HCA. The radio coverage, as part of the Upstate Issues weekly program, spanned several radio stations, including WGY, which reaches across broader New York State and New England. The program reached a large set of stations including WGY (810 AM and 103.1 FM) and FM stations: The River (99.5), Kiss FM (102.3), Oldies 98.3, and PYX 106 (106.5). A link to the segment online is at http://wgy.iheart.com/onair/upstate-issues-57169/a-deadly-ignorance15142256/. HCA thanks Diane Donato, News Anchor/Public Affairs Director at iHeartMedia, for the interview, as well as WGY radio host Joe Gallagher for recommending the topic.
DOH Posts Regulatory Agenda The September 28 State Register includes the state Department of Health’s posting of regulatory actions under consideration for submission as a Notice of Proposed Rulemaking from June through December 2016. The notice is at http://docs.dos.ny.gov/info/register/2016/sept28/toc.html. (See p. 145.) Some areas under consideration by DOH include:
Update the need methodology used to estimate the need for CHHAs.
Update the need methodology used to estimate the need for hospice care and services.
Provide for reimbursement of the cost of preadmission assessments by Assisted Living Programs. Continued on next page
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Continued from previous page
Requiring managed care organizations to maintain a file on each request for health care services or benefits and associated appeals.
Update the criminal history record check program to include definitions and requirements for hospices and adult care facilities.
Amend the hospice regulations to make them consistent with the federal conditions of participation.
Consolidate and streamline provisions related to assisted living residences as they exist in adult homes and enriched housing programs.
Set forth in regulations the requirements for the Community First Choice Option.
Allow for annual authorizations and delete the requirement that authorization of Personal Emergency Response Services (PERS) be contingent upon a reduction or elimination of personal care aide/home health aide hours.
Allow primary care services to be provided offsite by all Article 28 outpatient departments of general hospitals and Diagnostic and Treatment Centers and both to be reimbursed consistent with what is currently allowed for Federally Qualified Health Centers
HCA monitors the posting of proposed and final rules in the State Register, notifies members on significant rules, and provides comments on issues that affect home care and hospice providers and consumers.
CMS Announces New CERT Documentation Contractor Effective October 14 The U.S. Centers for Medicare and Medicaid Services (CMS) has announced an August 16 contract with AdvanceMed for Comprehensive Error Rate Testing (CERT) Review Contractor work. This new contract replaces Livanta, the current CERT Documentation Contractor, as of October 13, 2016. The work will be transitioned to the new contract and fully operational on October 14, 2016. October 6, 2016 is the last day that the current CERT Documentation Contractor will be receiving medical records and CERT inquiries at its location. Beginning October 7, 2016, all CERT inquires and medical records are to be sent to the following locations: CERT Documentation Center, 1510 East Parham Road, Henrico, VA 23228; fax to 804-261-8100; customer service at 443-663-2699; toll free number is 888-779-7477; e-mail is certmail@admedcorp.com. The public website (https://www.certprovider.com) will remain in use as the official web address. The Medicare Administrative Contractor (MAC) website (https://www.certdoc.org) will remain active temporarily and take users to the existing CERT Claim Status web site where new features have been added. Note: The functionality to accept provider address updates will not be available from October 6, 2016 through October 13, 2016. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
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HIRING: Director of Patient Services (DPS) Sought at Three Organizations Director of Patient Services, Home Care/Hospice Program—Brookhaven Memorial Hospital Medical Center (Patchogue, Long Island, NY) is changing every day. With a brand new cardiac care center about to open and constant care advances throughout the hospital, there’s an air of change and excitement about all of the possibilities of the future. Our stellar 306-bed acute-care community hospital is part of a multidisciplinary, multi-campus, healthcare complex, serving 28 communities in Suffolk County.
Living Resources Certified Home Health Agency in Albany is growing and we are seeking a dynamic leader to fill this pivotal DPS position.
Duties and requirements of home care DPS:
For immediate consideration, please forward résumé/cover letter and salary requirements in confidence to Lisa Razanousky at lrazanousky@livingresources.org.
Plan, direct, coordinate and evaluate the delivery of home health/hospice services Ensure high quality and effective patient care Ensure that Home Care/Hospice departmental activities are in compliance with all regulatory guidelines Assign middle managers to implement the planning, direction and controlling of service delivery management Education: Knowledge of nursing theory/practice acquired through completion of at least 2 years of training at an accredited school of nursing a must. BSN required. Master’s preferred. Experience: 2-3 years’ experience as a supervisory community health nurse/home care manager. Knowledge: Community healthcare, governmental licensure regulations and Medicare criteria. Licenses/Cert: Current NYS RN & BLS required. Strong interpersonal skills to effectively interact with patients/ people in their support system as well as analytical ability to assess/ develop clinical solutions.
Email a résumé: careers@bmhmc.org. EOE/M/F/Vet/Disabled
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This position is responsible for overall strategic, clinical, operational and financial leadership to the CHHA and ensures high quality, cost effective care. This individual will work in collaboration with the Living Resources Corporation’s CEO and Associate Executive Director to ensure the integrity of the agency in accordance with the goals and objectives of the agency as set forth by the Board of Directors. Qualifications: Current RN license, required Bachelor’s degree, Master’s degree preferred; minimum of three years of management experience in home health care or related field.
Additional opportunities available: Clinical Manager, RNs, Physical Therapists, Occupational Therapists, Home Health Aides and PCAs. Essex County Nursing Services, Elizabethtown, New York, located in the heart of the Adirondacks is seeking an experienced individual who has the will and determination to successfully lead the agency in today’s home health care environment. This DPS position involves planning, organizing, directing, coordinating and evaluating patient care services provided by the certified home health agency. The Director of Patient Services is responsible for the professional and financial operations of the agency; and provides and ensures that quality improvement is the main focus of the agency. MINIMUM QUALIFICATIONS: A Masters or Baccalaureate Degree in Nursing from an approved program, or from a non-approved program supplemented by content which can be equated to an approved program, and either: A) Two years of experience in a management level position in a certified home health agency; or B) A combination of education and experience which is deemed equivalent to the experience requirement as specified above and by the State Office of Health Systems Management. BENEFITS: Excellent county/government benefits including New York State Retirement System. Great team of professionals to work with. Candidates must possess a limited permit to practice or licensure and current registration to practice as a Registered Professional Nurse in New York State at the time of appointment. Qualified candidates will be subject to a civil service examination to be announced at a later date. Applications will be accepted until the announced closing date for the examination. Please go to www.co.essex.ny.us/job.asp to complete an application and to view a complete job description.
The Situation Report: the Home Care Association of New York State
HIRING: Hospice & Palliative Care Association of NYS (HPCANYS) President/CEO Reporting to the Board of Directors, the President/CEO has overall strategic and operational responsibility for the HPCANYS nonprofit’s staff, programs, expansion and mission. This individual will initially develop deep knowledge of core programs, operations, financials and business plans. The President/CEO leads association activities, as authorized by the Board of Directors, HPCANYS’ strategic plan, and budget. He or she serves as liaison between member providers, the NYS Department of Health and the community, including building, developing and fostering communications with political, economic and affiliated organizations in the state and national realm. Responsibilities Include:
Ensure programmatic excellence and evaluation, as well as consistent quality of finance and administration, fundraising, communications, and systems.
Design and implement short-term and longrange plans to fulfill membership goals and organizational mission within a sustainable budget framework.
Policy, legislative, and regulatory advocacy supporting the Association’s mission.
Revenue expansion and fundraising for existing and future program operations, including grants and non-dues revenue.
Serving as external local and national presence communicating program results with an emphasis on successes and shared partnerships.
For all requirements and information, visit https:// www.ziprecruiter.com/jobs/new-york-state-hospicepalliative-association-d27bcf66/president-ceohospice-palliative-care-association-of-nys-da6667f6.
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Come to HCA’s Downstate LHCSA Forum: Oct. 28 As recently reported in HCA alerts and communications, a set of draft state guidelines on the minimum wage funding mechanism for home care is fast taking shape. This development is among the top issues that HCA’s policy and executive team will bring to you during our October 28 Downstate LHCSA Forum in New York City. HCA recently held an upstate session of the LHCSA Forum, with an agenda of items unique to LHCSAs in this region. Our Downstate LHCSA Forum on October 28 will similarly address issues of concern for LHCSAs in the downstate region, including minimum wage, Fair Labor Standards Act (FLSA) and Quality Incentive/ Vital Access Provider Pool (QIVAPP) monies, regulatory changes affecting your operation, the status of uniform billing codes, DSRIP and Value Based Payments, and any additional issues or concerns you want to raise. These Forums are for HCA membersonly and offer a chance for your team to get LHCSA-focused updates. If your agency is a LHCSA or has a LHCSA in your organization, please be sure to register, so we can plan for your attendance, or share this program with your downstate LHCSA colleagues. Simply complete the PDF form at the link below. Register for Downstate LHCSA Forum: http://hca-nys.org/wpcontent/uploads/2016/09/HCADownstate-LHCSA-Forum-October28-2016-Registration-Form.pdf.
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Hospice Claims Incorrectly Returned to Provider with Reason Code U5112 New York’s hospice Medicare Administrative Contractor, National Government Services (NGS), reported last week that hospice claims are incorrectly being returned to the provider with reason code U5112. Providers will also see a secondary reason code of U5196 on the returned claim. Multiple bill types for hospice claims are being returned. The cause of this issue has been identified by the Fiscal Intermediary Standard System (FISS). No provider action is required at this time. NGS says it will provide updates when available, and encourages providers to watch the Production Alerts section of its website and e-mail updates for additional information regarding this issue.
Quality of Patient Care Star Ratings Preview Reports Now Available The U.S. Centers for Medicare and Medicaid Services (CMS) announced this week that the Home Health Quality of Patient Care Star Ratings Preview Reports and the Home Health Compare Provider Preview Reports are now available in the Provider CASPER folders. These reports contain data that will be publicly reported on the Home Health Compare website in January 2017. October 24, 2016 is the deadline to submit a request to have the Quality of Patient Care star rating data suppressed. Providers should follow the directions laid out in the Quality of Patient Care Star Rating Preview Report to submit a suppression request. The October 2016 refresh of the Home Health Compare website will occur on October 19, 2016. This data will match the preview reports that were uploaded to CASPER in July. Questions about these reports can be directed to HomeHealthQualityQuestions@cms.hhs.gov. Additional information on CMS’s Home Health Quality Initiative is at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/ HHQISpotlight.html. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
Hospice PEPPER Webinar Underscores Importance of Data in Uncovering Audit Risk HCA staff this week participated in a webinar sponsored by the Visiting Nurse Associations of America (VNAA) on “Understanding Your Hospice PEPPER.” The webinar was conducted by the Medicare contractor TMF, Health Quality Institute. The Program for Evaluating Payment Patterns Electronic Report (PEPPER) summarizes an individual hospice’s Medicare claims data statistics and compares it with aggregate Medicare data for all hospices in the nation, for all hospices in one’s Medicare Administrative Contractor (MAC) Jurisdiction, as well as with all hospices in one’s state. The report is also available for home health. The webinar explained that hospices and other providers should pay close attention to their PEPPER reports since Medicare providers are under intense audit scrutiny by entities such as the Office of Inspector General
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(OIG), the MACs, Recovery Auditors, Supplemental Medical Review Contractors and the Comprehensive Error Rate Testing Contractors. By reviewing one’s PEPPER report, providers can determine if any of their Medicare claims statistics might be considered an outlier – compared to peers across the nation, MAC Jurisdiction or state – and might be a “red flag” to auditors. For hospices unable to participate in the webinar, the presentation can be downloaded at http://hcanys.org/wp-content/uploads/2016/10/HospicePEPPERVNAA092816.pdf. It provides additional information on the PEPPER comparison groups, the percentiles used in determining outliers in PEPPER, how to access one’s PEPPER, as well as strategies to consider when reviewing it. For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
Final Rule Adopted on OT Assistants On September 13, the state Education Department (SED) Board of Regents adopted a rule that covers the licensure of Occupational Therapy Assistants. The rule is at http://www.counsel.nysed.gov/common/counsel/files/rulesandregs/ Part%2076%20TERMS_0.pdf. It codifies and defines the practice of occupational therapy assistants, establishes requirements for licensure, and requires at least one occupational therapy assistant to serve on the State Board for Occupational Therapy. The practice of occupational therapy assistant is defined as the provision of occupational therapy and client-related services under the direction and supervision of an occupational therapist or a licensed physician. The rule also establishes the requirements for licensure of occupational therapy assistants, which include education, experience and examination requirements. In addition, it provides for a “grandparenting” licensure pathway for individuals to qualify for a license as an occupational therapy assistant, without an examination, if they had a current registration on February 3, 2012 with SED and satisfy the specified education, experience, age, moral character and fee requirements. The rule is effective September 28.
New Common Benefit Identification Card Available Effective August 1, 2016, the new Common Benefit Identification Card (CBIC) is available to Medicaid consumers who do not already have a card or need to request a replacement card. Issuance of the new cards began at the two over-the-counter card issuance sites in New York City, and a mailing of CBIC cards with the new design will begin statewide in late September 2016. There will be no mass replacement of existing cards as a result of the new card design. Existing active blue and white cards with the current logo will continue to work throughout this transition and must be accepted by all Medicaid enrolled providers, including pharmacies, according to current procedures. CBIC cards (also called Electronic Benefits Transfer/EBT) are available to those who qualify for Supplemental Nutrition Assistance Program (SNAP) or cash benefits (Temporary Assistance). The EBT card
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looks like a debit card and allows consumers to buy groceries and other items with their cash benefits at participating stores and other locations. Additional information on the new card design can be found at: www.otda.ny.gov/workingfamilies/ebt.asp.
NGS Updates National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), has recently posted the following information to its website.
NGS Closed for Columbus Day – All NGS offices will be closed Monday, October 10, 2016 for the Columbus Day holiday. Providers will be able to access NGSConnex and use the Interactive Voice System (IVR) system at 1-866-275-3033.
NGS to Conduct Hospice Cap Review – NGS is completing a hospice cap look-back review for the 2012-2014 periods. (The review ends September 30, 2016.) Medicare regulation 42 CFR Section 405.1885 provides that all hospice cap calculations may be reopened by the MAC within three years of the cap determination notice. This three-year look-back review is due to the potential of beneficiary and reimbursement changes. Current beneficiary totals and net reimbursement for each applicable cap period will be compared to the beneficiary totals and net reimbursement computed during the original calculation using that period’s statutory cap amounts. NGS will send a letter reopening the hospice cap to the provider, identifying any additional amount due or any refund as a result of the review. The 2015 hospice cap review is scheduled to occur in the last quarter of 2016 and notices will be sent to all hospice providers with the results. Providers that have questions related to this hospice cap look-back review can send an e-mail to: selfreportedhospicecap@anthem.com
For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.
Social Security Numbers to be Removed from Medicare Cards Previously enacted Federal legislation requires the U.S. Centers for Medicare and Medicaid Services (CMS) to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. A new randomly generated Medicare Beneficiary Identifier (MBI) will replace the SSN-based Health Insurance Claim Number (HICN) on the new Medicare cards for Medicare transactions like billing, eligibility status, and claim status. The MBI will be 11 characters in length and made up only of numbers and uppercase letters (no special characters). CMS will start mailing new Medicare cards with MBIs to people with Medicare no earlier than April 2018. CMS plans to have a transition period where providers can use either the HICN or MBI to exchange data. The transition period will begin no earlier than April 1, 2018 and run through December 31, 2019. Continued on next page
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Continued from previous page CMS advises providers to look at their practice management systems and business processes and determine what changes need to be made to use the new randomly generated MBI. Providers will need to make those changes and test them by April 2018, before CMS sends out new Medicare cards. Providers, starting in 2018, can ask their Medicare patients at the time of service if they have a new card with an MBI. During the transition period, CMS will return the MBI on the remittance advice when a claim is submitted using the patient’s HICN. CMS will use the message field on the eligibility transaction responses to tell providers when it has mailed a new Medicare card to each person with Medicare. During the transition period, providers can use the patient’s MBI or HICN to check Medicare eligibility. Once the transition period ends, providers must use the MBI to check eligibility. More information is at https://www.cms.gov/Medicare/SSNRI/Index.html.
eMedNY Posts Fall Training eMedNY has posted its fall training for seminars and webinars and registration is being accepted. Some of the topics include:
Revalidation
ePACES for Home Health, DME, Institutional settings, Nursing Homes, Physicians, Private Duty Nursing, and Transportation
eMedNY Website Review
New Provider/ New Biller
Medicaid Eligibility Verification Systems (MEVS)
Seminars are available at the following locations: Hauppauge, Mayville, New York City, Poughkeepsie, Rensselaer, Syracuse, Watertown. The training calendar is at https://www.emedny.org/training/index.aspx.
Resources
“Electronic Health Information: HHS Needs to Strengthen Security and Privacy Guidance and Oversight” by the Government Accountability Office http://www.gao.gov/products/GAO-16-771 Continued on next page
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Continued from previous page
“New Law Requires 7-Day Medicaid Application Approval if ‘Immediate Need’ for Personal Care or CDPAP — Addresses Delays in Enrolling in MLTC Plans,” by New York Legal Assistance Group http://www.wnylc.com/health/entry/203/
“DSRIP Annual Statewide Learning Symposium (September 20-22, 2016) http://www.publicconsultinggroup.com/client/nysdsrip/library/may2016.html
“Quality in Home and Community-Based Services to Support Community Living: Addressing Gaps in Performance Measurement,” by the National Quality Forum http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=83433
“Fingerprint Requirements for Medicare Enrollment,” National Government Services http://tinyurl.com/hvwv7gl
“Handwriting on Claims Submitted to Medicare,” National Government Services http://tinyurl.com/hs2s727
“Preparing for Better Health and Health Care for an Aging Population,” Journal of the American Medical Association (September 26, 2016) http://jama.jamanetwork.com/article.aspx?articleid=2556000
“Falls and Fall Injuries Among Adults Aged 65 Years — United States, 2014,” by the Center for Disease Control and Prevention http://www.cdc.gov/mmwr/volumes/65/wr/mm6537a2.htm
For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.
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Understanding the Federal and State Wage & Hour Rules for Home Care Providers and Rising Above the Challenges October 20, 2016 10:00am – 12:30pm
October 20, 2016 Location: Visiting Nurse Service of New York 107 East 70th Street (between Park and Lexington Ave) New York, NY 10021 9:30 to 10:00am Registration and continental breakfast 10:00am to 12:30pm Program Thanks to our program sponsor:
Employment attorneys from Hodgson Russ, LLP, specializing in wage and hour laws for the home care industry, will discuss the key federal and state compensation requirements for home care providers. This session will cover topics such as accurate computation of the regular rate of pay, properly paying overtime, accurately tracking work time, including travel time, spread of hours and split-shift pay, call-in pay regulations, the Domestic Workers’ Bill of Rights, and Wage Parity Law. The session will also provide an overview of some of the most pressing challenges to the home care industry, including litigation of live-in cases, complications created by the elimination of the companionship exemption, and the rise in private plaintiff class action litigation. Through an interactive and question-and-answer session, attendees will develop a greater understanding of their legal obligations and learn about tips to overcome some of the most difficult issues plaguing the home care industry today.
Presenters from Hodgson Russ, LLP: Peter Godfrey, Partner John Godwin, Partner Emina Poricanin, Senior Associate
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