October 29, 2018 Edition of The Situation Report

#HomeCareConnect

LEARN VBP METRICS

MLTC BENEFIT CHANGES

In a special video message today, HCA urges members to participate in our National Home Care Month campaign, called #HomeCareConnect.

HCA’s Quality and Technology Summit features a special segment offering you resources to meet key value based payment metrics targeting potentially avoidable hospitalizations.

DOH posts waiver amendment changes limiting MLTC coverage of nursing home benefits to three months and a lock-in period for MLTC enrollees.

Comments due Nov. 23.

April 2017 to March 2018 data is now posted on Home Health Compare.

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UPCOMING PROGRAMS Three-Part Webinar Series on Hospice Billing: Become an Elite Hospice Biller!

(Series available individually or as a discounted group) Oct. 29, Nov. 1, Nov. 8 Mastering the LHCSA Survey Process: NYC Session Oct. 30 Home Care and Dementia 4-Part Webinar Series Nov. 2, 9, 16 & 30 HCA, HCP, HPCANYS Emergency Preparedness Networking Session on Long Island Nov. 8 Quality and Technology Symposium Nov. 14 and 15 Register at https:// hca-nys.org/eventseducation/upcomingevents

Your Source for HOME CARE News, Policy and Advocacy

HHCAHPS RESULTS

Vol. 3, Issue 42 | October 29, 2018

Minimum Wage Policy and Requirements Continue Under Review Minimum wage (MW) interpretations and requirements continued under major scrutiny and unclear status throughout last week, the weekend and into today. HCA has been in near-daily communication with the Governor’s Office and the state Department of Health about the status and exact plans of the state for clarifying its policy and funding of MW for MLTCs and See MW p. 2

New Bills Aim to Remove 6.42% Behavioral Adjustment Cut from PDGM Be on the lookout for HCA grassroots advocacy tools to press your support HCA, colleague state and national associations, and other stakeholders are urging support for a set of Congressional bills that seek to remove home health “behavioral adjustment” payment cuts – of about $1 billion nationally – that are assumed as part of the Patient Driven Groupings Model (PDGM) set to go into effect for Medicare home health in 2020.

This legislation takes on new urgency as the U.S. Centers for Medicare and Medicaid Services (CMS) is expected to finalize PDGM later this week as part of its Home Health See PDGM p. 3

INSIDE Minimum Wage Policy and Requirements Remain Under Review..........................1 New Bills Aim to Remove 6.42% Behavioral Adjustment Cut from PDGM.................1 A Special Message from HCA Sponsor RBC Limited.................................................3 Can We Count on You to #HomeCareConnect in November?...................................4 Associations Gain Another Extension on LHCSA Need Methodology Comments......5 OMIG Issues 2nd Demand Bill Notification for Cases in First Half of FFY 2018..........5 Achieve VBP Metrics with HHQI Experts on November 14 and 15............................6 HCA Posts DOH Surveillance Tools to Support Your Compliance..............................7

CMS Meeting Focuses on Partner Collaboration, Innovation.............................7 MLTC Nursing Home and Lock-in Changes Posted................................................8 CMS Announces Proposed Changes to Medicare Managed Care..........................8 Data, National Discussion Show Significance of Sepsis Protocol Adoption............9 New Security Risk Assessment Tool Posted.......................................................10 Upcoming Deadlines and Due Dates................................................................11 HHCAHPS Survey Results Updated on Home Health Compare............................12 State Comptroller Reports Health Care Job Growth Across New York...................12 eMedNY Provides Notice on New Delay Reason Code 11.....................................13 Health Resources............................................................................................14

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

MW from p. 1 providers. Additionally HCA is appealing for movement of the MW adjustment for CHHAs under the Episodic Payment System (EPS) – also affecting LHCSAs contracted to CHHAs – which has never been processed for the 2018 CHHA CHHA EPS rates.

Along with serious questions about overall MW funding adequacy for MLTCs and providers, MLTC and provider concerns are compounded by the lack of clarification over MW funding increments that, beginning April 1, 2018, were lowered from the January 1, 2018 increments reflected in provider contracts for the full 2018 year. In response, some plans have questioned whether the lowered (April) increments mean that funds paid out on the basis of the higher January increments are to be recouped by plans and returned to the state.

DOH has stated that the incremental adjustment and the total MW payout are not one in the same as it relates to MW payments to providers, and that MW payments are a combination of funds via the premium base and the increment. DOH stated that it is pursuing further data analysis to try to respond to the many questions related to funding and payment amounts.

Meanwhile, one plan that notified its network of its presumed obligation to recoup monies has been a particular focus of DOH discussions; DOH and the Governor’s office have informed us that this plan has been asked to not implement such recoupments, and that DOH is working to determine the proper guidance and next steps as it relates to overall MW funding, including the change in MW increments.

HCA will continue advocating that no state recoupment from MLTCs or providers be implemented, as we assert that MLTCs and providers remain underfunded by the state for MW. HCA will continue seeking up-to-the-minute updates on MW status and will keep the membership informed of material developments.

We will further gear for permanent remedy of this issue as we continue our advocacy discussions with the Executive and Legislative.

Home Care Association of New York State (HCA) 388 Broadway, 4th Floor, Albany, NY 12207 Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org

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Volume 3, No. 42 October 29, 2018 

The Situation Report is a weekly publication of the Home Care Association of New York State (HCA). Unless otherwise noted, all articles appearing in The Situation Report are the property of the Home Care Association of New York State. Reuse of any content within this newsletter requires permission from HCA. Al Cardillo President and CEO acardillo@hcanys.org Roger L. Noyes Director of Communications, Editor of The Situation Report rnoyes@hcanys.org Patrick Conole Vice President, Finance & Management pconole@hcanys.org Andrew Koski Vice President, Program, Policy & Services akoski@hcanys.org Laura Constable Senior Director, Membership & Operations lconstable@hcanys.org Celisia Street Director of Education cstreet@hcanys.org Mercedes Teague Finance Manager mteague@hcanys.org Jenny Kerbein Director of Governance & Graphic Design jkerbein@hcanys.org Billi Wilson Manager, Meetings & Events bwilson@hcanys.org Teresa Brown Administrative Assistant tbrown@hcanys.org

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

Volume 3, No. 42 October 29, 2018 

PDGM from p. 1 Prospective Payment System final rule for 2019. It also coincides with a close to the current session of Congress, and the opportunity to fix PDGM as part of an omnibus package that may be under consideration in the lame-duck period before a new session of Congress in 2019.

CMS has time and again emphasized PDGM’s budget-neutrality language protections; yet the new payment model would nevertheless be front-loaded, in year one, with a cut of 6.42 percent based on assumptions of “behavioral changes” by home health agencies that have no basis in data or methodological forecasting by CMS. Such a cut may have dire circumstances for many agencies, including those who are forecasted to have a net benefit over the full course of PDGM, even if CMS fulfills its assurance of budget-neutrality with restorations in the later years of PDGM implementation.

The PDGM-fix legislation now under consideration is: S.3545 introduced by Senators Collins (R-ME), Stabenow (D-MI) and Nelson (D-FL); S. 3458 introduced by Senators Kennedy (R-LA) and Cassidy (R-LA); and H.R. 6932 introduced by Representatives Ralph Abraham (R-LA), Garrett Graves (R-LA), Scott DesJarlais (R-TN), Vern Buchanan (R-FL), and Terri Sewell (D-AL). The bills make the following targeted changes to PDGM: 

Require Medicare to institute rate adjustments only after home health agency behavioral changes actually occur, basing any behavioral adjustment on real “observed evidence.”



Ensure Medicare budget neutrality but require the phase-in of any necessary rate increases or decreases to be no greater than 2 percent per year to limit the risk of disruption in care.

Continued on next page

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Volume 3, No. 42 October 29, 2018 

Continued from previous page 

S. 3545 also includes a provision strongly supported by the home health community that would permit the waiving of the homebound regulatory requirement to enable greater flexibility for Medicare beneficiaries in Medicare Advantage plans to receive home health services.

One key argument that HCA and colleagues are making is the fact that a new payment model for Skilled Nursing Facilities (SNFs) expressly rejected assumption-based adjustments which are otherwise included in PDGM for home health. The same protection should be extended for home care, we argue.

In the days ahead, look for more information on how you can advocate for these bills with Members of Congress, especially key members on the relevant committees of jurisdiction for health care, using HCA’s Legislative Action Center and other tools.

Can We Count on You to #HomeCareConnect During National Home Care and Hospice Month in November?

As announced in an alert earlier today with a special video message from HCA’s Communications Director Roger Noyes, we’ve launched an exciting National Home Care and Hospice Month campaign seeking your pledges to participate on several specific action items to raise awareness about home care and hospice throughout the month of November.

This is especially important in the lead-up to a new session of Congress and the State Legislature in January, following the November elections, as we work to ensure that lawmakers are responsive to the needs of home care and hospice based on a deeper understanding of the work you and your staff do.

The campaign, called #HomeCareConnect, asks HCA member leaders to engage their staff on a range of weekly action items such as social media informational posts, conducting home care visits with elected officials, outreach to local agencies on aging, media outreach, staff recognition events, and more.

Once we get your commitments, on a survey that members are asked to complete, we will be sending you reminder e-mails about your pledge each week, along with further information or resources to help facilitate your participation in each weekly activity.

Importantly, we ask that you document all of your efforts in photos, videos, social media posts, articles from your local press and more using the hash tag #HomeCareConnect on Facebook and other social media platforms. HCA will do the same and share your efforts on our Facebook feed and on our National Home Care and Hospice Month website at www.nationalhomecaremonth.com.

Please watch the video message (at https://youtu.be/VDbrfJvKv7A), complete the survey (at https:// www.surveymonkey.com/r/HomeCareConnect) and be on the lookout for communications throughout the month of November as we ramp up this important opportunity to connect with lawmakers, connect with your community and connect with the public.

If you have any questions, do not hesitate to contact HCA’s Communications Director Roger Noyes for assistance at rnoyes@hcanys.org or (518) 810-0665.

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

Volume 3, No. 42 October 29, 2018 

Associations Gain Another Extension on LHCSA Need Methodology Comment Deadline to Allow for Unified Recommendations In an effort to provide time for a unified set of recommendation from the state associations representing LHCSAs, the state Department of Health has granted HCA, the New York State Association of Health Care Providers (HCP) and LeadingAge New York with an extension on our comments addressing the elements of a LHCSA need-methodology.

As extensively reported, this year’s state budget included, among several provisions affecting LHCSAs, the development of a need methodology that would replace longstanding requirements for LHCSA licensure that, to date, have included character and competency review, but not a review based on public need.

The need-methodology would be effective April 1, 2020 and would be used to make determinations for new licensing of LHCSAs or licensing changes such as ownership transfers, purchases or mergers, services to specific populations and in determining geographic needs.

The need-methodology process would be implemented with the expiration of the current LHCSA moratorium, which was also enacted in the budget. The RFI seeks recommendations for planning area designations, factors to include in the methodology, exceptions to the methodology, and additional requirements or priority considerations to include.

HCA will be reaching out to some of our LHCSA members for feedback in the coming week as we continue fine-tuning our joint recommendations with colleagues at HCP and LeadingAge. We will also immediately share our joint association comments as soon as they are completed and submitted to DOH.

OMIG Issues Second Demand Bill Notification for Cases Identified in First Half of FFY 2018 The state Office of the Medicaid Inspector General (OMIG) has sent Certified Home Health Agencies (CHHAs) a second demand bill notification letter to remind providers of their obligation to submit demand bills to Medicare for cases identified for the first half of federal fiscal year (FFY) 2018.

This notice follows an earlier one (mailed on August 14, 2018) that most Medicare-certified home care providers should have received from OMIG and its Third Party Liability (TPL) contractor, the University of Massachusetts Medical School (UMMS).

The letter identified which cases have been selected to undergo appeals (through demand billing), with dates of services that occurred in the first and second quarters of FFY 2018 only (October 1, 2017 through March 31, 2018 or the end of the episodic period billed to Medicaid).

If you have already demand billed as requested in the August 14 letter, you can disregard this second notification from OMIG. UMMS’s letter also says providers should continue monitoring the status of their demand bill claim(s) once submitted. Providers are required to correct any claims that are rejected or suspended by the Medicare

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Administrative Contractor (MAC), National Government Services (NGS). In addition, providers are required to timely submit a complete medical record to NGS once the Additional Development Request (ADR) is issued.

A final remittance advice for each episode billed (by demand bill) will be issued within 60 days of the final bill submission to Medicare. Upon receipt of the final remittance advice, providers must send copies of the following documents to the TPL contractor, UMMS, within 10 business days:   

A copy of the original claim submitted to the MAC for each 60-day episode billed.

A copy of the final claim remittance advice sent to you from the MAC. A copy of each medical record your agency submitted to the MAC upon the ADR request.

HCA members interested in knowing whether they should have received a letter from OMIG can e-mail HCA at info@hcanys.org.

For specific questions about the letters, contact UMMS’s Laurie Burns at (866) 626-7594.

Achieve VBP Metrics for Potentially Avoidable Hospitalizations with HHQI Experts on November 14 and 15 With Level 1 Value Based Payment (VBP) contracts in effect, and with the continued march toward VBP Level 2 targets, MLTC plans and their home care contractors must focus on the critical measures for potentially avoidable hospitalizations (PAHs).

HCA’s Quality and Technology Symposium in just over two weeks (November 14 and 15 in Suffern) is offering a unique and timely session to help providers achieve key VBP Metrics no matter what level your contract is at, including success on the PAH measures that are at the heart of this initiative: sepsis, urinary tract infection, heart failure, electrolyte imbalance, anemia, and respiratory infection.

Regardless of your VBP participation – but especially because of it – providers need to consider all of the tools and resources at your disposal to achieve hospital-avoidance and other key clinical outcomes.

Our Symposium closes with experts from the Home Health Quality Improvement Campaign (HHQI) offering evidence-based tools, timely data reports and other resources that target the latest value-based performance metrics for MLTCs established by the state Department of Health. This session will provide a helpful crosswalk of the available HHQI resources to help you target these key metrics, including the six PAHs. This session is just one of over a half-dozen segments bringing you up to speed and offering crucial insights for clinical leadership staff, quality program development staff and your key organization leaders on such topics as: the Home Health Conditions of Participation (CoP) Interpretive Guidelines, telehealth, population health management, tools for achieving success under value-based payments, home carepharmacy collaborations, and process improvements from one of HCA’s highest-rated speakers on clinical issues, Barbara Katz of BK Health Care Consulting.

Please register today at: http://stopsepsisathomeny.org/wp-content/uploads/2018/10/HCA-2018-Quality-andTechnology-Brochure.pdf.

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Volume 3, No. 42 October 29, 2018 

HCA Posts DOH Home Health, Hospice Surveillance Tools to Support Your Compliance As HCA members strive to remain compliant with regulations and procedures that impact CHHAs, LHCSAs and hospices, we are happy to announce that the state Department of Health (DOH) has shared with HCA the tools its surveyors use for conducting surveys of home care and hospice agencies.

HCA has posted these nearly 40 individual files (as PDFs) to an unlisted section of our website being shared with members only. Please click https://hca-nys.org/survey-files to reach a page where you can view the documents listed as a series of file titles.

HCA members are advised to review the forms and worksheets to gain a better understanding of their responsibilities in several areas, including: quality assurance; clinical records; personnel records; influenza vaccinations; emergency preparedness; the home care registry; Medicare Conditions of Participation (CoPs); infection control; the Health Commerce System (HCS); and more.

CMS Meeting Focuses on Partner Collaboration, Innovation The U.S. Centers for Medicare and Medicaid Services (CMS) national “All-Partners” meeting convened in Baltimore this past week. HCA President Al Cardillo participated in the meeting, bringing home care’s innovations, experience and ideas to this wide-ranging health care and quality innovation group.

The “All-Partners” initiative meets several times a year to discuss the status and advancement of CMS quality and innovation goals. CMS’s top quality administrators convene with hospital innovation networks, state hospital associations, quality improvement organizations, patient health and safety, and other “partners” to discuss programmatic progress and data in key areas and markers that have been set by CMS. Focal points at this October meeting included rehospitalizations, infection rates, sepsis, pressure injury rates, patient-family engagement initiatives, falls, preventable errors and harm, innovations in practice, and an invaluable opportunity to share “offers” and “requests” across states and participants.

This opportunity for cross-exchange on quality and innovation yields informational “takeback” to support participants’ work back in their own settings and with essential partners. One particular initiative that garnered much interest involved a project where clinician’s prioritized the continuous engagement of patients in the question “What’s important to you?” The partners discussed the project’s impact on patient quality and experience, and other significant findings.

In discussions with partners, HCA offered insights from home care’s experiences and capabilities in a number of the key areas discussed at the conference, including care transitions, preventable hospitalizations and ER episodes, sepsis, pressure ulcer reduction and hospital-home care collaboration.

HCA’s presence in the discussions ensures the benefit of the home care perspective and the consideration of home care in these national, hospital and quality formulations. In this vein, Mr. Cardillo’s comments earned HCA an invitation to the planning group for CMS’s national quality conference in late January, and a potential featured presentation on the work home care is doing in New York.

The Partners meeting afforded HCA much invaluable information which we will plan to incorporate in our upcoming program planning and member support.

For further information, please contact Al Cardillo at acardillo@hcanys.org.

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Volume 3, No. 42 October 29, 2018 

MLTC Nursing Home and Lock-in Changes Posted The state Department of Health (DOH) has posted information about two changes made in the final state budget: a limit on nursing home benefits in managed long term care (MLTC) plans of three months; and a lock-in period for MLTC enrollees.

The proposed 1115 waiver amendment and attachments for these changes, along with draft model notices, have been posted at https://www.health.ny.gov/health_care/medicaid/redesign/mrt11202/index.htm and https://www.health.ny.gov/health_care/medicaid/redesign/mrt11204/index.htm.

Under the first change, partially capitated MLTC plan enrollees who have been permanently placed in a nursing home for a period of three calendar months will be disenrolled from the plan and returned to fee-forservice Medicaid. The period of three months will commence once any available Medicare coverage has been maximized. This limitation only impacts the nursing home benefit for partial capitation plans. There is no impact to the nursing home benefit for Medicaid Advantage Plus (MAP), Program of All-Inclusive Care for the Elderly (PACE), Fully Integrated Duals Advantage (FIDA), or Mainstream Medicaid Managed Care.

With the lock-in change, individuals who enroll in a partially capitated MLTC plan will be prohibited from transferring to another available MLTC plan more than once a year, unless “good cause” is demonstrated.

Members will be allowed a grace period of 90 days from point of enrollment, during which time they may elect one transfer for any reason. For the remainder of a twelve-month period beginning with the effective date of their enrollment, enrollees may pursue transfer only if good cause is demonstrated.

On September 12, 2018, DOH submitted to CMS a proposal to amend New York’s Medicaid Section 1115 Demonstration Medicaid Redesign Plan to implement these two changes.

To provide stakeholders additional time to comment on the proposed amendment, DOH is accepting comments for an additional thirty days, or until November 23, 2018.

Comments can be submitted via e-mail to mltcinfo@health.ny.gov. In the subject line, please indicate “Proposed NH Benefit/Lock In 1115 Amendment Comments.”

CMS Announces Proposed Changes to Medicare Managed Care Telehealth expansion included On Friday, October 26, the U.S. Centers for Medicare and Medicaid Services (CMS) announced a proposed rule that would make changes to the Medicare Advantage (MA) managed care program, including allowing plans to cover telehealth services at home.

Many of these changes were required by the Bipartisan Budget Act of 2018.

A fact sheet on the proposed rule is at https://www.cms.gov/newsroom/fact-sheets/contract-year-cy-2020medicare-advantage-and-part-d-flexibility-proposed-rule-cms-4185-p. The proposed rule is at https:// s3.amazonaws.com/public-inspection.federalregister.gov/2018-23599.pdf (this link will change when the rule is posted to the Federal Register on November 1).

Continued on next page

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Volume 3, No. 42 October 29, 2018 

Continued from previous page According to CMS’s fact sheet and press release, some of the provisions include: 

Give MA plans more flexibility to offer government-funded telehealth benefits to all their enrollees, whether they live in rural or urban areas.

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Allow greater ability for Medicare Advantage enrollees to receive telehealth from places like their homes, rather than requiring them to go to a health care facility to receive telehealth services.

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Unify grievance and appeals procedures for individuals enrolled in Dual Eligible Special Needs Plans (D-SNPs).

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Modify measures used for calculating plans’ Star Ratings.

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Revise an earlier regulation that made available to Part D sponsors and Medicare Advantage plans a list of precluded providers and prescribers that have engaged in behavior barring their enrollment in Medicare.

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Take steps to help CMS recover improper payments made to MA plans.

HCA will be reviewing the entire proposed rule and let members know of any other important provisions.

CMS will accept comments on the proposed rule until December 31, 2018.

Data, National Discussion Show Significance of Sepsis Protocol Adoption Data, promise of improved outcomes featured at Rory Staunton Foundation National Forum on “Sepsis Breakthrough” A prestigious slate of state and national leaders, sepsis survivors and families headlined the national “Sepsis Breakthrough” forum convened by the Rory Staunton Foundation for Sepsis Prevention last Friday at the New York Academy of Medicine.

HCA, IPRO, the Healthcare Association of New York State, the Greater New York Hospital Association, the National Family Council, and medical, health and governmental leaders from New York, Washington and other states joined for this national dialogue.

New York State Health commissioner Dr. Howard Zucker, Department of Health Medical Director Dr. Marcus Friedrich, and fellow clinicians, researchers and officials from the U.S. Centers for Medicare and Medicaid Services and from the Centers for Disease Control and Prevention offered compelling data analyses from recent studies showing the progress and promise for better outcomes resulting from adherence to sepsis protocols. Areas for continued research and knowledge development were also targeted.

Ciaran and Orlaith Staunton – co-founders of the Rory Staunton Foundation for Sepsis Prevention, and parents of 12-year-old Rory Staunton who lost his life to sepsis – along with Cheryl Douglas, a sepsis

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Volume 3, No. 42 October 29, 2018 

survivor who lost all four limbs to sepsis, but whose courage and spirit in fighting for others has been unyielding, appealed to all sectors to take up the call to work together and reach out in all directions to combat this health emergency.

National and other state participants took great interest in HCA’s unique home care sepsis initiative and they plan follow-up to learn more and bring the initiative to hospitals, home care agencies and consumers in other states.

The focus on sepsis data throughout the conference underscores the importance of collecting data through HCA’s Stop Sepsis at Home initiative. The data analysis, being conducted through our partnership with IPRO, will produce a national-first profile of sepsis screening and intervention in the home and community, where 80 to 90 percent of sepsis infections originate. The data should provide agencies with critical information on their patients, practices and community population health. It will also assist home care in being an even greater part of the medical, state and national dialogue and partner solutions in sepsis.

For participants in the HCA sepsis initiative, your agency data was due to IPRO on October 18. Please be sure to follow-through. Participants having difficulty or questions should contact IPRO or HCA. Home care agencies that have yet to register to adopt the HCA sepsis tool, should take that step and do so by writing to sepsistool@hcanys.org.

New Security Risk Assessment Tool Posted The U.S. Department of Health and Human Services (HHS) has updated its Health Insurance Portability and

Accountability Act (HIPAA) security risk assessment tool.

The tool is designed to help small to medium sized covered entities and business associates conduct and document risk assessments as part of their security management process, although health care providers of any size may use it.

The tool is at https://www.healthit.gov/topic/privacy-security-and-hipaa/security-risk-assessment.

New features of the tool include:       

Enhanced user interface; Modular workflow with question branching logic; Custom assessment logic; Progress tracker; Improved threats and vulnerabilities ratings; Detailed reports; Functionality for tracking business associates and assets.

The HIPAA Security Rule requires that covered entities and their business associates conduct a risk assessment of their health care organization. A risk assessment helps your organization ensure it is compliant with HIPAA’s administrative, physical and technical safeguards. A risk assessment also helps reveal areas where your organization’s protected health information (PHI) could be at risk.

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Volume 3, No. 42 October 29, 2018 

Upcoming Deadlines and Due Dates

Requirement/Change

More Information

Transition Period for Using Health April 1, 2018 Insurance Claim Number (HICN) or to December new Medicare Beneficiary 31, 2019 Identifier (MBI)

https://www.cms.gov/Medicare/NewͲMedicareͲCard/index.html

Medicare Open Enrollment: Beneficiaries can change their October 15 to Medicare coverage from managed December 7, care plan to feeͲforͲservice or vice 2018 versa, and can join or switch prescription drug plan

www.medicare.gov

RFA for Regional Resource Development Centers for NHTD and TBI programs

November 1, 2018

https://www.health.ny.gov/funding/rfa/17782/index.htm

HCA/HCP Long Island Emergency Preparedness Networking Session

November 16, 2018

Contact akoski@hcanys.org

Advance Care Planning Request for Information

Comments https://hcaͲnys.org/wpͲcontent/uploads/2018/10/RFI_AdvancedͲCareͲPlanningͲ due November _OctoberͲ2018.pdf 16, 2018

2017 LHCSA Statistical Report Due

November 16, 2018

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

MLTC Enrollment LockͲIn Starts

December 1, 2018

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

LHCSA Registration Process

Effective January 1, 2019

https://commerce.health.state.ny.us/public/hcs_login.html (part of LHCSA Statistical Report)

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Effective/ Due Date

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Volume 3, No. 42 October 29, 2018 

HHCAHPS Survey Results Updated on Home Health Compare Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) Survey results from services in April 2017 to March 2018 are now reported on the Home Health Compare link (http:// www.Medicare.gov/).

HHCAHPS Survey results are updated each calendar year quarter.

These data are also available on the HHCAHPS website (https://homehealthcahps.org/) through the “Archived Publicly Reported Data” link under the “General Information” tab. On this webpage, you can access the following: 

HHA-level data;



State and national averages;

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Star ratings cut points; and

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Patient mix adjustment coefficients for the linearized data used to construct the Star Ratings.

As a reminder, information on how the star ratings were constructed is provided in the CMS Technical Notes at https://homehealthcahps.org/Portals/0/HHCAHPS_steps_calculate_composites.pdf?ver=2016-11-07101103-157. This link provides more information about how the data were analyzed as well as the patientmix adjustment factors that were used to statistically adjust the results that are currently being publicly reported on Home Health Compare.

State Comptroller Reports Health Care Job Growth Across New York The state Comptroller’s Office recently released a report which confirmed that the state’s health care jobs exceeded 1.2 million in 2017 and that health care employment rose by more than 18 percent over the past decade, more than double the pace of overall employment growth.

The Comptroller’s report (which can be downloaded at https://www.osc.state.ny.us/reports/economic/ health-care-employment-2018.pdf) found the health care industry in New York provided nearly $71 billion in wages, with an average annual wage of $57,200 in 2017. With 7.2 percent of the total, New York ranked third in the nation for its share of health care jobs.

Growth in private sector health care employment occurred in every region of the state over the last decade, with gains of more than 10 percent for six of ten regions. New York City led with an increase of nearly 33 percent, followed by Long Island (25.1 percent), the Finger Lakes (18.9 percent), the Hudson Valley (17.8 percent), and Western New York (16.7 percent). In the Mohawk Valley, health care made up almost 20 percent of all private-sector jobs in 2017. Both upstate and downstate, employment growth in health care was stronger than in all other industries combined over the past ten years.

In many regions, the health care industry paid out higher average annual wages than the rest of the private sector. In the North Country, average annual wages in health care were more than 50 percent higher than

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the average for all other industries. Average wages rose in that region over the past decade by nearly 42 percent, and by more than 30 percent in Western New York and Long Island.

Other findings include: 

The private sector comprised 90 percent of all health care industry employment and grew by 18.1 percent from 2007 to 2017, adding nearly 216,000 jobs.



Total private sector wages for the industry increased by $23.2 billion over the past decade while average annual wages rose by over $10,400.



The largest number of jobs created in the health care field over the last decade have been those for health care assistants and aides, an increase of over 48,000 jobs.



Doctors, dentists and nurses comprised nearly 40 percent of health care occupations, with doctors and dentists garnering the highest annual average wages at $152,650. Nurses averaged $79,240.

Health care assistants and aides – the single largest occupation at 33.5 percent – received the lowest average wage at $29,120.



New Yorkers spent nearly $158 billion on health care in 2017, representing 16.1 percent of personal consumer expenditures in the state.

eMedNY Provides Notice on New Delay Reason Code 11 eMedNY recently issued a notice that an additional edit for Delay Reason Code 11 would be implemented (Edit 02287) on October 25, last Thursday.

Delay Reason Code 11 is for Other Delay Reasons and will pend for review for all Medicaid claim types.

HIPAA reason code 29 (Adjustment Reason Code 29 with no Remittance Remark Code) will be reported on the 835 remittances. Claim status code 718 will be reported when the claim is pended for manual review.

Claims will be manually reviewed and, if denied, must be resubmitted as a paper claim with appropriate documentation to support the use of delay reason 11 to the following address: CSRA, PO Box 4601, Rensselaer, NY 12144-4601. eMedNY encourages providers to confirm that delay reason code 11 is appropriate when submitting these claims.

For specific examples of when to use Delayed Reason Code 11, HCA members should review Slides 29 to 37 of the following state Department of Health (DOH) presentation: https://www.emedny.org/ProviderManuals/AllProviders/Guide_to_Timely_Billing.pdf.

General questions for claims submission should be directed to eMedNY’s Call Center at: 1-800-343-9000 (providers should have their Medicaid, MMIS and NPI numbers available). Questions on specific claims that

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

Volume 3, No. 42 October 29, 2018 

are pended for review should be directed to the Bureau of Medical Review, Pended Claims Unit at 1-800342-3005 (option 3). eMedNY is used to submit HIPAA-compliant transactions via a web-based application. To successfully use eXchange, Medicaid providers first need to enroll in ePACES and successfully login on ePACES. The ePACES User ID and password are also used for eXchange access.

Health Resources 

“Prior Authorization in Medicare Advantage Plans: How Often Is It Used?” – by the Kaiser Family Foundation http://files.kff.org/attachment/Data-Note-Prior-Authorization-in-Medicare-Advantage-Plans-HowOften-Is-It-Used

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“Medicare Advantage 2019 Spotlight: First Look,” by the Kaiser Family Foundation http://files.kff.org/attachment/Data-Note-Medicare-Advantage-2019-Spotlight-First-Look

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

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