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COMING UP
INSIDE
Your Source for HOME CARE News, Policy and Advocacy Vol. 2, Issue 26 | June 26, 2017
“Ask HCA” Dine andDiscuss RoadshowSessions
June 27 Utica (4 to 6p.m.); June 28Potsdam (11:30 a.m. to1:30 p.m.)
Make Your EmergencyPreparedness Plan CoP-ReadyJune 28 Suffern, NY10901
See F2F p. 4See ADJOURNS p. 2
As Senate Bill Goes Public, HCA Heads to D.C. Opposing Medicaid Cuts .......1State Legislature Adjourns with Gains, Risks, Next Steps............................1Medicaid F2F Guidelines “Finalized” at DOH.............................................1A Message from HCA Sponsor FBA of Syosset............................................4Last Call for 6/28 Workshop on CoP-Enforced EP Rule..................................5EO 38 Court Decision Issued......................................................................6HCA Submits Comments on FY 2018 Hospice Proposed Rule.......................7
Summer Schedule
As in previous years,HCA is publishing TheSituation Report on abiweekly schedule forthe summer. There willbe no newsletter nextMonday, July 3, and ouroffices will be closedon July 3 and 4 for theholiday. Our next editionof The Situation Reportwill be on July 10. Asalways, we will notifyyou by e-mail of allimportant updates andbreaking news.
State Legislature Adjournswith Gains, Risks, Next Steps The state legislature concluded its 2017session just prior to midnight onWednesday of last week. Severalmeasures (including home care andhospice) were approved by one or bothchambers, while many items (includingfor home care) remained in thecommittee process, restricted by a
Medicaid F2F Guidelines“Finalized” at DOHPosting and circulation are awaited, asenforcement takes effect on July 1
Federal Face-to-Face (F2F) compliancerequirements for Medicaid home care takeeffect as of July 1.
The state Department of Health (DOH) hasinformed HCA that state guidelines to
HCA Submits Comments on Draft Provider Reconciliation Cost Report...................9HHCAHPS Preview Reports with Star Ratings Available...........................................9Member Hiring Announcement..........................................................................10HCA Provides Memos on NGS Home Care and Hospice Updates.............................11Case Management Caseload Limits for Care at Home Waivers.............................11Employer’s Statement of Wage Earnings Revised.................................................12Resources...............................................................................................12
As Senate Bill Goes Public, HCA Heads to WashingtonOpposing Even Deeper Medicaid Cuts
The Senate last week issued a draft health care bill with even deeper Medicaid cuts thanthe already adopted House plan.
HCA, meanwhile, has continued its work in collaboration with a New York coalition ofhealth care organizations urging members of New York’s Congressional Delegation toresist the Senate measure, along with any consensus bill that would follow in like form.
See SENATE p. 5
HOSPICE
HCA comments onhospice rule,targeting regulatoryand payment issues.
EO 38 IN THE COURTS
Legal saga continues onregulations limitingadministrative expenses andexecutive compensation forentities receiving state funds.
PAGE 6 PAGE 7
LAST CALL: EP WORKSHOP
Now is your last chance toregister for Wednesday’sworkshop on the federalemergency preparednessrule.
PAGE 5 PAGE 9
COST REPORT COMMENTS
HCA continues to weigh in oncost report mechanism, underdevelopment, to captureprovider use of minimum wagefunds.
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The Situation Report is a weeklypublication of the Home CareAssociation of New York State(HCA). Unless otherwise noted, allarticles appearing in The SituationReport are the property of theHome Care Association of NewYork State. Reuse of any contentwithin this newsletter requirespermission from HCA.
Joanne CunninghamHCA President
Roger L. NoyesDirector of Communications,Editor of The Situation Report
Al CardilloExecutive V ice President
Patrick ConoleVice President,
Finance & [email protected]
Andrew KoskiVice President,
Program, Policy & [email protected]
Alexandra Fitz BlaisDirector of Public Policy
Laura Constable Senior Director,
Membership & [email protected]
Celisia StreetDirector of Education
Mercedes Teague Finance Manager
Jenny KerbeinDirector of Governance &
Special [email protected]
Billi Wilson Manager, Meetings & Events
Teresa BrownAdministrative Assistant
Volume 2, No. 26 June 26, 2017
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
The Situation Report: the Home Care Association of New York State
ADJOURNS from p. 1
narrowing funnel in the session wind-down.
Some of these items may well bring the Legislature back later thissummer or in the fall, including extension of authority of localtaxes, and the issue of mayoral control of New York City schools, abig-ticket matter which remained unresolved at the closing of theregularly scheduled session. What follows is a summary of HCA bills and legislation of interest/concern that were in play in these final session days. HCA willsoon provide a more complete status report on all of the legislationaffecting home care, hospice and MLTC, including a round-up oflegislation passed earlier in the session as well as the status ofbills primed for future action. Among these is a last-minute billwhich is a new iteration of long-debated legislation requiring RNsto obtain a BSN degree within ten years of their initial licensure.(More detail to follow).
Legislation That Passed Both Houses of the Legislature
HCA’s “Essential Personnel Bill” for Home Care andHospice (S.5016-A by Senator Lanza and A.6549-A byAssemblyman Cusick): HCA worked extensively and quicklywith the sponsors, both houses of the Legislature and theGovernor’s office to craft in the final days an amendedversion of this longstanding priority bill to give the bestchance yet of approval by the Governor following pastvetoes. HCA’s memorandum of support, which explains theamended bill and the strong justification for approval, canbe viewed at http://hca-nys.org/wp-content/uploads/2017/06/HCA-Memo_Support_S5016-A-A-6549-A_Emergency-Preparedness.pdf.
Hospice Legislation for Expanded Swing Bed Capacity inHospice Residences (S.6364 by Senator Hannon andA.7775-A by Assemblyman Gottfried); Hospice ResidenceRate Adjustment (S.5662-A by Senator Valesky and A.6408-A by Assemblyman Dinowitz); and Technical Amendmentsto Criminal History Record Check Law (S.6347 by SenatorHannon and A.7846 by Assemblyman Gottfried): HCApartnered with the State Hospice Association and engagedthe direct work of our legislative-affairs team at Hinman-Straub to support each of these hospice-benefitting bills.
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Volume 2, No. 26 June 26, 2017
Sepsis Education Programming (S.4971-A by Senator Marcellino and A.6053-A byAssemblymember Nolan): Requires that sepsis be included in school educational programming aswell as part of the existing infection control education/training required of health clinicians understate law. HCA has engaged the bill sponsors and looks forward to being a voice inimplementation consistent with our efforts to maximize home care’s work on sepsis education,prevention, early identification, mitigation and treatment, specifically through our first-in-the-nation sepsis screening tool.
Nurse Family Partnership (NFP) Regulatory Relief (S.6656 by Senator Hannon and A.8388 byAssemblyman Gottfried): While HCA supports NFP and further supports regulatory flexibility tofacilitate providers and patient beneficiaries of the program, HCA strongly opposes this bill as ithas been written and in the absence of corrective amendments. HCA was informed by thesponsors that the legislation is intended to provide regulatory relief, and is not meant to adverselyaffect home care agencies; but the legislation is a complete bypass of Article 36 of Public HealthLaw which governs, sanctions and sets standards for all home care services the state. It wouldallow entities other than home care agencies to provide in-home nursing at a time of widespreadabuse of the law by entities ignoring state public health law requirements to deliver in-home care.Simultaneous efforts are under consideration for an administrative solution on NFP regulatoryrelief (without the need for this problematic legislative language); HCA will work hard to supportthat solution for providers and avoid the clearly unintended consequences of the legislation as itwas written and passed.
Bills-in-Waiting
HCA’s Bill for Physician-Homecare Collaboration programs (S.6345 by Senator Hannon): Thislegislation would provide cutting-edge opportunities for home care and physicians to partner forcritical health services. The Senate introduced this bill and HCA worked to gain a matching bill inthe Assembly. The Assembly felt there is a possibility of initiating this program through a recent“collaboration” law already enacted, and written by HCA. HCA is already pursuing this directionwith a proposal to DOH. Stay tuned for further details, and, if this administrative route does notpermit, HCA will revisit a legislative approach with the Assembly and seek that chamber’spassage.
HCA Bill for Collaborative Programs of Community Paramedicine (S.5588 by Senator Hannonand A.2733-A by Assemblyman Gottfried): This legislation would provide a collaborativeframework for the design and operation of community paramedicine programs and services in thestate, with requisite design partners being home care, EMS, hospitals and physicians. Thelegislation, as co-drafted by HCA, specifically avoids any crossover from one scope of licensure toanother – a point of emphasis made by HCA and partners in our collaborative advocacy with theLegislature. This bill passed the Senate, but was held in the Assembly to allow for representativesof the New York State Nurses Association (NYSNA) to provide further input, at which point it willalmost certainly be the focus of future efforts to enact once session resumes.
Please be on the lookout for a more comprehensive summary of the session outcome as well as furtherupdates on the status of bills as they make their way to the Governor’s desk.
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Are You Compliance Ready for CDPAP?
Don’t Get Caught Out of Compliance!
Did you know that starting on July 1st, 2017, Wage Parity will be required for
all CDPAP Cases??
Employees working for the Consumer Directed Personal Assistance Program, better
know as CDPAP, will now be equivalent to Home Health Aides in terms of Wage Parity
Compliance!
Do you know what is considered to be “compliant”?
In order to be Wage Parity compliant, a Home Health Care Agency must provide its
Aides with a “Bona Fide Benefit Plan”
But what qualifies as a “Bona Fide Benefit Plan”?
*FBA of Syosset is the leader in Wage Parity Benefits and
Compliance. To find out how FBA can help you keep in
compliance, call our Director of Sales, Stephen Squires, before
July 1st at 516-289-9009.
A message from HCA sponsor FBA of Syosset
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Volume 2, No. 26 June 26, 2017
F2F from p. 1
assist home care agencies and physicians withimplementing the Medicaid F2F rule have beenagreed to, and DOH update is expected to soonpost or circulate these guidelines.
As soon as DOH decides on its route for makingthis guidance available, we will issue amembership-wide alert.
The new guidance was developed based on thecombined work of HCA, the State Medical Societyand a joint Task Force of our two associationswhich have been meeting and working at multiplelevels over the past year. The guidance wedeveloped, and which we are informed will beadopted for use by DOH, widely exempts managedcare cases under New York’s broad Medicaidreform models for F2F applicability. The guidanceis also anticipated to streamline compliance inother helpful ways.
Stay tuned for an HCA follow-up alert as soon as DOHacts on the availability of the guidance.
Simultaneous Federal advocacy aims at F2F roots
Simultaneous with our state mitigation efforts, HCAhas been further working with the State MedicalSociety at the federal level, engaging additionalstates from around the country in our joint efforts togarner the American Medical Association’s (AMA)active support on F2F reform. This AMA effort,spearheaded by our State Medical Society colleagues,resulted in AMA’s adoption earlier this month of anational advocacy resolution for F2F relief.
HCA continues to take aim at federal F2F reformthrough this and direct advocacy channels withMembers of Congress, state home care associationpartners, the Visiting Nurse Association of America,and other concerned organizations.
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Volume 2, No. 26 June 26, 2017
Last Call: Register for 6/28 Workshop on CoP-Enforced Emergency Preparedness Rule Time is running out to register for HCA’s most comprehensiveworkshop on the imminent emergency preparedness rule for homecare. Our program takes place in just two days, on Wednesday!Don’t miss out on this last chance to register and learn theintricacies of this rule which begins enforcement on November 16.
As reported to the membership, enforcement planning for the newfederal rule took a major step forward earlier this month with theposting of Interpretive Guidelines (see https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Downloads/Advanced-Copy-SOM-Appendix-Z-EP-IGs.pdf). This document assists state surveillance efforts andenforcement as well as potential penalty actions fornoncompliance.
According to the guidance, “compliance with the EmergencyPreparedness requirements will be determined in conjunction withthe existing survey process for health and safety compliancesurveys,” and the requirements are encompassed by the sweepingnew changes proposed for the home health Conditions ofParticipation (CoPs). Notably, while the other home health CoPchanges have been delayed, the emergency preparednessprovisions separately go into effect on November 16.
Thursday’s program, Make Your Emergency Preparedness Plan CoP-Ready in Suffern, New York, is being led by national home careemergency preparedness expert Barbara Citarella of RBC Limited.She will assist agencies in: understanding the four majorcomponents of this regulation; planning for required continuity ofoperations (COOP); operationalizing policies and proceduralrequirements of the rule; communication; and conducting/testing atraining program related to your emergency plans.
This is one program that you won’t want to miss, not only for youragency’s compliance with the rule but for the sake of ensuring asolid plan that protects your patients and operations in times ofcrisis.
Download the brochure at http://hca-nys.org/wp-content/uploads/2017/04/Make-Your-EP-Plan-CoP-Ready-June-28-2017.pdf.
Broadly, the Senate billmirrors key aspects of theHouse legislation, also knownas the American Health CareAct (AHCA), which cuts asmuch as $800 billion fromMedicaid. That bill – whichwas the second attempt byCongress this year to repealand replace the AffordableCare Act (ACA) – passed theHouse on May 4 in a party-line vote of 217 Republicansto 213 Democrats.
The Senate bill goes furtherwith its cuts to Medicaid, butin a similar manner as theHouse bill, shifting theprogram to a capped block-grant program while phasingout the Medicaid expansionoption that many states, likeNew York, entered into underACA.
Like the House bill, the Senatelegislation would also createtax credits for individuals topurchase health insurance,though the schedule ofcredits differs from the Housebill in terms of income andage thresholds. The bill alsolikewise overturns the taxincreases underpinning muchof ACA’s funding mechanismfor extending coverage tolower-income citizens.
Continued on next page
SENATE from p. 1
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HCA President Joanne Cunningham has represented HCA in a multi-stakeholder coalition of 30organizations opposing the House bill and, now, the Senate plan. The coalition has written joint letters toCongress, met with members of the New York Delegation and is holding meetings this week in Washingtonto continue its charge against the proposals being considered in Congress.
Though the House has already passed its own bill, any legislation coming from the Senate wouldtraditionally undergo a process of reconciliation in conference committees between the two houses beforea final vote and delivery to the President for his signature. Yet, HCA is hearing that the current legislativestrategy may bypass the conference committee process and hasten a final vote by having the House simplypass the Senate’s version of the bill.
Please stay tuned for further updates on HCA’s advocacy activities and grassroots member action alerts asthe debate over health care continues to consume Congress.
EO 38 Court Decision Issued
On June 22, 2017, the New York State Appellate Division, Third Department issued a decision inLeadingAge New York v. Shah (litigation in which HCA is a co-petitioner) related to Executive Order 38 (EO38) that limits executive compensation and administrative expenditures by covered entities, includinghealth care providers and managed care plans that receive state funds or state-authorized payments abovecertain minimum thresholds.
Similar to the lower Supreme Court decision, the Third Department upheld the state Department of Health(DOH) regulations insofar as they limit the payment of executive compensation and administrativeexpenses from state-only funds and state-authorized payments (“hard cap”), but determined that DOHexceeded its authority by limiting executive compensation that is paid from all funds, including state andnon-state funds (“soft cap”).
Either party to the case may seek a further appeal to the New York Court of Appeals. In addition, therehave been other court decisions on EO 38 that HCA has reported to the membership on which HCA willcontinue to provide updates.
HCA will be providing additional information on the LeadingAge New York v. Shah decision after a closereview of it.
Disclosure Form
HCA reminds members that EO 38 Disclosure forms are due August 15, 2017 for Certified Home HealthAgencies and August 16, 2017 for Personal Care Providers.
More information on EO 38 is at https://executiveorder38.ny.gov.
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The Situation Report: the Home Care Association of New York State Volume 2, No. 26 June 26, 2017
The Situation Report: the Home Care Association of New York State Volume 2, No. 26 June 26, 2017
HCA Submits Comments on FY 2018 Hospice Proposed Rule
Today, HCA submitted extensive written comments on the Fiscal Year 2018 proposed rule for Medicarehospice payment updates, wage index changes and quality reporting posted in April by the U.S. Centers forMedicare and Medicaid Services (CMS).
Our comments can be downloaded at: http://hca-nys.org/wp-content/uploads/2017/06/FY2018HospiceComments.pdf.
On the payment side, our comments specifically address several items in the proposed rule, including: thecontinuation of the two-tier routine home care (RHC) payment rates; the service intensity add-on paymentand the wage index which is especially problematic for hospice providers in New York and particularly inneed of revision.
We also include comments on the sources of clinical information for certifying terminal illness as well asitem-by-item comments on three different areas within the Hospice Quality Reporting Program (HQRP) thatincludes: 1) whether CMS should account for social risk factors in risk adjustments for Quality Measures; 2)a new data collection submission mechanism under consideration called the Hospice Evaluation &Assessment Reporting Tool (HEART); and 3) the impact of the Consumer Assessment of HealthcareProviders and Systems (CAHPS) survey, which is another unfunded mandate in need of reimbursement.
CMS’s proposed rule asked for input on areas that could use some regulatory flexibility and/or efficiencies.HCA appreciated the opportunity to offer the following recommendations that we believe would helpreduce the regulatory burden on hospice providers:
1. Revise the Face-to-Face (F2F) Regulatory Requirement for Hospices: The intent of the F2Frequirement was to ensure adequate and appropriate involvement and accountability of physiciansrelative to certification of eligibility for hospice care. However, as currently written and interpretedby CMS, it may delay access to care and serve as a deterrent for some hospices to take eligiblepatients in need of immediate care onto service. This was neither its intent nor an advisable resultof the requirement.
HCA urges CMS to work with the hospice industry to significantly revise the F2F provision so thatregulations and guidance governing F2F provide sufficient flexibility, allowing hospice programs tocomply without any threat of delayed access to care for beneficiaries in need of hospice services,and without undue financial burdens.
2. Address Costly and Burdensome Requirement Related to Processing of Notices of Election(NOEs) and Notices of Termination /Revocation (NOTRs): HCA fully recognizes the need forNOEs to be submitted timely and accurately, and understands that election information isnecessary for the payment system to operate most effectively. The additional exceptionimplemented by CMS in late 2016 provides some relief. However, antiquated Medicare systemswith serious functional limitations are the main reason why many NOEs are not received within the
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five-day limit. Changes to the data systems are not within providers’ control. HCA advocates thatCMS should update its data systems to allow for the automatic electronic submission of the NOE.
3. Amend Sequential Billing Requirements for Hospices that Cause Payment Delays and IncreaseRegulatory Burdens: CMS’s sequential billing policy prohibits hospice providers from submittingclaims for care to beneficiaries where previously submitted claims are pending. However, claimsprocessing can be delayed for weeks or months for many reasons, including medical review activities,common working file (CWF) problems, CMS or Medicare Administrative Contractor (MAC) claims-processing problems and pending claims from other providers, etc.
HCA recommends that CMS still require hospices to submit claims in chronological order but processand pay all clean claims as submitted, regardless of whether previous claims have been processed,and allow more than one claim per beneficiary per month when the reason for the multiple claims isdue to the hospice exceeding the 450-line claim limit. CMS should also pay interest on claims thatare not processed timely.
In our comments we also took the opportunity to strongly encourage CMS to begin offering capital HealthInformation Technology (HIT) funding and/or grants so that more and more hospices and home healthagencies can begin advancing the interoperable exchange of critical health information to their criticalhealth care partners.
For further information, contact Patrick Conole at (518) 810-0661 or [email protected].
Senior Financial Managers Retreat September 7-8, 2017 Mohonk Mountain House- New Paltz, NY HCA’s Senior Financial Managers Retreat offers financial leaders innovative perspectives and expert analysis by HCA’s Policy Team as well as targeted insights from subject-matter experts who will provide a comprehensive update of the home care and hospice financial landscape.
Corporate Compliance Symposium October 19, 2017 Hilton- Albany, NY HCA’s Corporate Compliance program is a must-attend, highly anticipated annual event that brings together top legal experts, state regulators and organizational compliance specialists to keep your team up to date on: new requirements, changes in laws and regulations, tools, resources and best-practices for fulfilling your compliance responsibilities.
Quality and Technology Conference November 16-17, 2017 Crowne Plaza- Suffern, NY HCA’s Quality & Technology Symposium will present some of the unique technological and programmatic approaches driving positive clinical outcomes, and focusing your clinical intervention strategies on core priority areas.
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Volume 2, No. 26 June 26, 2017
HCA Submits Comments on Draft Provider Reconciliation Cost Report
Last week, HCA submitted comments to the state Department of Health (DOH) on its draft ProviderReconciliation Cost Report.
As communicated to members on numerous occasions, DOH is developing this Cost Report to verify theappropriate use of funding by home care providers to help meet the recent minimum wage increase.
HCA received an overwhelming number of responses from members on the draft report and incorporatedthem into one document. Our comments included general remarks and covered every section of the report.Some issues and concerns include:
We urge DOH to provide a cover letter to the survey that will explain the survey purposes; definecertain terms and provide examples; give the return date and mailbox to return it to; and ask thatprovider associations be allowed to review it before it is finalized.
We reiterate the need for a webinar on the report far in advance of the due date.
We seek a reasonable time period (at least 60 days) for providers to complete the report, especiallysince CHHAs and personal care providers are working on their 2016 Cost Reports now.
We repeatedly ask for clarification of terms and which data DOH is requesting for each section.
We ask DOH to indicate in every question if Consumer Directed Personal Assistance Program(CDPAP) cases/data should be included.
The draft Provider Reconciliation Cost Report is at the following links in PDF and Excel formats:
http://hca-nys.org/wp-content/uploads/2017/06/Provider-Reconciliation-Cost-Report-06-05-17-1.pdf http://hca-nys.org/wp-content/uploads/2017/06/Provider-Reconciliation-Cost-Report-1.xlsx
Our comments are at http://hca-nys.org/wp-content/uploads/2017/06/Provider-Reconciliation-Cost-Report-Comments.pdf.
HHCAHPS Preview Reports with Star Ratings Available
Preview Reports reflecting results from the Home Health Care CAHPS (HHCAHPS) Survey from January 2016through December 2016 (2016, Q1-Q4) are now available for home health agencies (HHAs) to review. Youcan access them at https://homehealthcahps.org under the “For HHAs” tab. You must be logged into thewebsite to view your report. These same data will be updated on Home Health Compare (HHC) onwww.medicare.gov in July 2017.
The Preview Reports present the publicly reported results with Star Ratings for those agencies with asufficient number of completed interviews to receive Star Ratings. Agencies must have data for 40 or morepatient surveys in the reporting period in order to have Star Ratings.
To access your agency’s HHCAHPS Preview Report, log into the HHCAHPS website using your username andpassword. Select the “Preview Reports” link under the “For HHAs” tab. If you have forgotten your password,
The Situation Report: the Home Care Association of New York State Volume 2, No. 26 June 26, 2017
click the Login link, type in your username, click “Reset Password,” and you will be emailed a “password resetlink.” 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 followinginformation to the HHCAHPS Coordination Team at [email protected] by July 7, 2017:
Your name, your facility name, your Certification Number (CCN), and your contact information.
Your comments about your preview report.
If you believe your HHCAHPS Star Ratings are not correct, submit evidence showing why the StarRatings are incorrect: Note that if you have historically had higher ratings than are shown, this is notconsidered evidence. You must provide information showing that the data submitted by your vendor for themost recent quarter are incorrect and therefore may have impacted the assigned HHCAHPS Star Ratings foryour 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, please click here:https://homehealthcahps.org/GeneralInformation/StarRatingsInformation.aspx.
If you have any questions about the HHCAHPS Star Ratings or your HHCAHPS Preview Report, please contactthe HHCAHPS Survey Coordination Team via e-mail at [email protected] or call toll-free at (866) 354-0985.
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Continued on next page
HCA Provides Memos on NGS Home Care and Hospice Updates
New York’s Medicare Administrative Contractor, National Government Services (NGS), held two advisorymeetings last week with updates to the home care and hospice provider communities. HCA Vice PresidentPatrick Conole participated in both of these meetings, collecting information and providing feedback to NGS.
Memos summarizing both meetings are posted at the links below.
Home health memo: http://hca-nys.org/wp-content/uploads/2017/06/062217NGSHomeHealthMemo.pdf.
Hospice memo: http://hca-nys.org/wp-content/uploads/2017/06/062217NGSHospiceMtgSummary.pdf.
The memos provide information on Medicare payment and regulatory issues. The home care memo has somespecific insights about the “probe-and-educate” audit process for face-to-face (F2F) documentationrequirements as well as Comprehensive Error Rate Testing (CERT) data findings that will assist providers inresponding to these reviews and ensuring compliance. The hospice memo similarly provides audit andreimbursement updates, medical review and appeals data and more.
NGS Closed July 4
NGS will be closed on Tuesday, July 4, 2017, for Independence Day.
This includes the following departments: Electronic Data Interchange (EDI) Help Desk; Provider ContactCenter; Provider Enrollment Line; and the Telephone Reopening Unit. Electronic claim files transmitted after5 p.m. on Monday, July 3, will have a claim receipt date of Wednesday, July 5, 2017. EDI front-endacknowledgement transactions will be created as expected as EDI claim files are received. The FiscalIntermediary Standard System (FISS) Direct Data Entry (DDE) Provider Online System will be available onMonday during regular hours.
While DDE will be available, there will be no support available to respond to any issues. Providers will beable to access NGSConnex and use NGS’s Interactive Voice Response (IVR) system at1-866-275-3033. NGS’s offices will reopen on Wednesday, July 5 for normal business hours.
For further information, contact Patrick Conole at (518) 810-0661 or [email protected].
Case Management Caseload Limits for Care at Home Waivers
As part of the consolidation of the Care at Home III, IV, and VI waivers into the “OPWDD Care at HomeWaiver,” caseload limits have been established for dates of service beginning June 30, 2017.
OPWDD established a maximum caseload size of no more than 30 individuals per case manager. Thiscaseload limit is inclusive of any individual that the case manager renders case management services to. Itis not limited to those individuals receiving services under the “OPWDD CAH Waiver.” This caseload sizereflects the individual case manager’s scope of responsibility, and accounts for the level of support requiredby individuals receiving services under the CAH waiver.
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Continued from previous page
According to the eMedNY announcement, a case manager’s caseload is composed of a mixture of individualswith varying needs. The development and ongoing management of caseloads is based on the assumption thatat any time, the needs of all individuals on the caseload could be very high and intense, necessitating the needfor significant case management assistance.
Employer’s Statement of Wage Earnings Revised
The state Workers’ Compensation Board has revised the Employer’s Statement of Wage Earnings (form C-240).
The revised C-240 is at http://www.wcb.ny.gov/content/main/forms/Forms_EMPLOYER.jsp#C240.
In claims where an injured worker may be entitled to compensation benefits or death benefits, employers mustsubmit the injured worker’s wage earnings information to the Board on form C-240 within 10 days of the Board’srequest. Form C-240 captures an injured worker’s wage earnings information for the 52 weeks prior to the dateof injury or illness. This information is used to calculate the injured worker’s average weekly wage and benefitrate.
If the injured worker did not work a “substantial” part of the year, the employer is required to also provide thewage earnings of another worker of the same class who worked a substantial part of the year for the 52 weeksprior to the injured worker’s injury date. A new “Employer of the Same Class” table has been added to Form C-240 to capture this payroll information when applicable.
In lieu of completing the table(s) on page 2 of the form, detailed payroll information can be attached on aseparate sheet or file (if submitting the form electronically). The employer must enter the total days paid andthe total gross pay for the injured worker on Form C-240 in Questions 5 and 6.
Information on other changes to C-240, including the definition of “substantial part of the year,” is at http://www.wcb.ny.gov/content/main/SubjectNos/sn046_949.jsp.
Resources
“How Much Long-Term Care Do Adult Children Provide?” by the Center for Retirement Research atBoston Collegehttp://crr.bc.edu/wp-content/uploads/2017/06/IB_17-11.pdf
For more information, contact Andrew Koski at (518) 810-0662 or [email protected].
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