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COMING UP
INSIDE
Your Source for HOME CARE News, Policy and Advocacy Vol. 2, Issue 23 | June 5, 2017
“Ask HCA” Dine andDiscuss RoadshowSessions
June 20Albany, N.Y.3 to 5 p.m.
Wednesday, June 21Westchester11 a.m. to 1 p.m.
LHCSA “Hot Topics”ForumJune 22New York, NY
Make YourEmergencyPreparedness PlanCoP-ReadyJune 28Suffern, NY 10901
For moreinformation, visithttp://hca-nys.org/events-education/upcoming-events
See SEPSIS p. 3See SIDE p. 2
HCA, MSSNY Seek Waivers, Streamlining of Medicaid F2FJuly 1 effective date on horizon
HCA and the Medical Society of the State of New York (MSSNY) are working togetherproactively to mitigate provider and patient access challenges presented by theupcoming July 1 effective date of the Medicaid Face-to-Face (F2F) mandate in New York.This mandate would apply a F2F mandate in Medicaid home health and durable medicalequipment cases, akin to the mandate that already exists for Medicare cases.
HCA and MSSNY have drafted and submitted for state Department of Health (DOH)consideration a guidance document that physicians and home care agencies could usein Medicaid F2F implementation and compliance. It was developed with consultationand input from the associations’ joint Physician-Homecare Task Force that has been
Budget “Side-Letter” FormsBasis for Ongoing Deliberation
As has been extensively covered by HCA,this year’s state budget adoption includedan agreement through “side-letter” toexamine methodology changes forimproved premium and rate adequacy for
Commissioner Zucker And HCATeam Up on Sepsis Initiative
In affirmation of HCA’s home care sepsisintervention initiative, State HealthCommissioner Dr. Howard Zucker invitedHCA to an extensive meeting this pastweek to discuss collaboration andpromotion of this initiative.
See F2F p. 4
HCA, MSSNY Seek Waivers, Streamlining of Medicaid F2F...........................1Budget “Side-Letter” Forms Basis for Ongoing Deliberation.......................1Commissioner Zucker, HCA Team Up on Sepsis Initiative............................1A Message from HCA Sponsor FBA of Syosset..............................................4Avoid Costly Penalties, Invest Wisely, Get Your EP Plan CoP-Ready...............6HCA seeks Assembly Health Intro of Physician-Homecare Collab. Bill.........6Member Hiring Announcements...............................................................7HCA to Convene HR Committee – Membership Input Sought.......................8Conference Participation Scholarships Available....................................8
HCA, DOH Discuss Hospital/Clinic Offsite Services Parameters.............................9HCA Submits Member Comments on LHCSA Statistical Report..............................10CMS Guidance: Correcting Hospice RHC and SIA Payment Errors..........................11Certain Web Browsers Can No Longer Access the HCS..........................................11DFS Issues Paid Family Leave Final Rule, Announces Premium Rates....................12HCA, Duke Faculty Conduct PCCP Training............................................................13Care At Home Guidance Posted..........................................................................14OIG Posts Semiannual Report to Congress..........................................................15Encounter Reimbursement Process for Capitations Recovered in Audit...............15Resources..............................................................................................................................16
LHCSA REPORT
HCA submits general andspecific comments on theproposed changes to theLHCSA Statistical Report
COLLAB BILL
HCA presses for Assemblyintro of homecare-physician collaborationbill already sponsored inSenate.
PAGE 6 PAGE 10
OFFSITE SERVICES
HCA continues efforts toensure proper parameters onoffsite services bill to ensureArticle 36 and Article 40protections.
PAGE 9 PAGE 11
HOSPICE PAYMENTS
Hospices: take note ofpayment correctionprocess for RHC andSIA errors!
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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. 23 June 5, 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
SIDE from p. 1
managed long term care plans (MLTC) and homecare providers. Among the items, the letterspecifically calls for examining the establishmentof rate cells for nursing home and high-cost/high-need home care and personal care MLTCenrollees.
In a meeting last week with the Legislature, HCAdiscussed the status of the side-letter and theactivity under way for the required rateexamination. HCA also raised the relationshipbetween core issues impacting MLTC and homecare and the side-letter’s charge, asserting thatthe mounting mandates and costs on plans andproviders should be considered in themethodological improvement discussion.
The side-letter implementation plan is expectedto involve regular meetings between theExecutive and Legislature over the summer andfall, leading to recommendations by year’s end,ostensibly as a foundation for 2018 state budgetproposals. As the meetings proceed, this forumwill necessarily become a broader venue fordeliberation of related issues that affect financialstatus and operations. This will likely include, forexample, workforce and infrastructure needsexplored during the Assembly hearings andbudget proposals, potential response to the court-State Department of Labor controversy over theDepartment’s payment standards for live-in homecare cases, and so on.
With this focus in mind, HCA will be working withthe MLTC and provider membership to garner andprovide ongoing input, as permissible, into theside-letter analyses and issue deliberations.
For further information, contact Al [email protected].
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SEPSIS from p. 1
Joining Commissioner Zucker were theDepartment’s Medical Director, Dr. MarcusFriederich; Special Advisor to theCommissioner Mark Kissinger; DeputyCommissioner of the Office of Primary Careand Health Systems Management DanSheppard; Division of Home and CommunityBased Services Director Rebecca FullerGray; and Aging and Long Term Care Teammember Heather Bennett.
The discussion focused on steps that theDepartment and HCA will consider insupporting broader awareness, provideradoption, clinician training, data andresearch support, and related actions tofurther the initiative and, ultimately, NewYork’s health system response to sepsis.
Commissioner Zucker was enthusiasticabout HCA’s work and the prospect ofcollaboration, recognizing the potential forhome care and New York State to lead onthis preventive and early interventionaction.
Participating with HCA President JoanneCunningham and Executive Vice PresidentAl Cardillo were IPRO’s Sara Butterfield andEve Bankert (also members of HCA’s SepsisWorkgroup) and Mohawk Valley HealthSystem/VNA of Utica’s Amy Bowerman(also HCA’s Sepsis Workgroup clinicalleader).
Contact HCA to adopt this sepsis initiative
Agencies or plans wishing to incorporatethe HCA sepsis screening, intervention andpatient education tools should [email protected] to request furtherbackground and the HCA user agreement.
Agencies in New York State and around the country,including full health systems, continue to contactHCA to engage in this important and far-reachingsepsis intervention effort.
Statewide sepsis webinar planned for managedcare/MLTC
In initial follow-up to the meeting withCommissioner Zucker, HCA and DOH havediscussed conducting and offering a statewidewebinar for managed care plans and managed longterm care plans.
As sepsis gains prominence as a top public healthand cost concern, especially within value basedpayment discussions, the webinar will provide keybackground for health plans who may directly – orthrough their providers – adopt the new home andcommunity based sepsis initiative launched byHCA.
State training funds
HCA also followed up the meeting by furtherinquiring whether the impending $245 million innew health workforce training and educationmonies to be channeled through MLTCs willcontinue to include home care sepsis training asone of its allowed purposes. Sepsis training hadbeen among the allowed purposes on the priordraft iterations for this program right up throughthe last public version.
Statewide Senior Action Council Features Sepsis“Teach-in”
The New York Statewide Senior Action Council hasasked HCA and the National Sepsis Alliance toconduct a statewide teach-in on the HCA sepsisinitiative for geriatric professionals, advocates andsenior consumers. The teach-in is scheduled forJune 27. The session is intended to increasestatewide awareness of sepsis and of the HCAinitiative, setting the stage for further support andadvocacy.
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.
The Situation Report: the Home Care Association of New York State
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F2F from p. 1
meeting for the past year to make recommendationson supporting collaboration between providers. Muchof the focus has sought to address obstacles inengagement, especially the challenges created by theMedicare F2F requirement.
As the Task Force continues working at the state andfederal levels to mitigate F2F overall (for Medicareand Medicaid), the Task Force moved to take proactivesteps to try to avoid a repeat layer of burden from theonset of F2F for Medicaid cases specifically, givenwhat is, ostensibly, a still-formative process.
In addition to streamlining the procedures andlanguage of the prospective state guidance, the HCA-MSSNY draft seeks to widely apply to Medicaid F2F theexemption currently granted to managed care casesunder Medicare F2F. We propose exempting alltraditional managed care cases, as well as cases inany and all of New York’s managed care models.
Moreover, HCA and MSSNY propose that – sincemodels like DSRIP and VBP are functioning under a
total managed care waiver in NY, inclusive of homecare – ultimately, all NY Medicaid home care underthese care models should qualify for such anexemption. HCA and MSSNY thus urge DOH to alsoseek a full exemption from CMS. In the meantime,HCA and MSSNY offer a concrete document to assistDOH, providers and physicians.
As the July 1 date nears, unless there is state orfederal rollback, home care agencies should beginpreparations for F2F compliance for Medicaid cases.Simultaneously, HCA and MSSNY are urging stateDOH leaders to quickly move forward with theconsideration of our draft, or of a similar alternative,that avoids additional layers of administrativeburden, cost and access challenge to patients.
HCA appreciates the opportunity for DOH engagement,and especially thanks our colleagues at MSSNY.
For further information, please contact Al Cardillo, [email protected], or Patrick Conole, [email protected].
A message from HCA sponsor FBA of Syosset
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The Situation Report: the Home Care Association of New York State Volume 2, No. 23 June 5, 2017
Avoid Costly Penalties, Invest Wisely in Planning, and Get Your EP Plan CoP-Readyon June 28
According to analysts, the work you and colleagues must do to prepare for imminent emergencypreparedness (EP) requirements will cost as much as $75.6 million for home care providers and $22.4million for hospices nationally in the first year alone.
With price tags that size and the prospect of hefty enforcement penalties (including potential terminationfrom Medicare for noncompliance with the EP rule or other federal Conditions of Participation), it isincumbent on all provider CEOs, COOs, Operations Managers, Compliance Staff and Emergency PreparednessPlanners to get as much information as possible in time for the fast-approaching November 16, 2017implementation date.
On June 28, in Suffern, NY (conveniently located for upstate and downstate agencies alike), HCA is hostingRBC President and emergency preparedness expert Barbara Citarella for a comprehensive workshop tohelp get your emergency preparedness plan in shape to meet these federal rules and the correspondingchanges to the Conditions of Participation.
This session will help you understand the four major components of this regulation; plan for requiredcontinuity of operations (COOP); operationalize required policies and procedures; establish compliantcommunication protocols; and conduct/test a required training program related to your emergency plans.
Be sure to reserve your space in this vital workshop to help you invest wisely in your planning resources andavoid compliance risks. A full brochure and registration form are below.
Download the brochure: http://hca-nys.org/wp-content/uploads/2017/04/Make-Your-EP-Plan-CoP-Ready-June-28-2017.pdf
Register online: https://www.eventville.com/Catalog/EventRegistration1.asp?EventId=1012193
HCA seeks Assembly Health Intro of Physician-Homecare Collaboration BillCommunity Paramedicine and EP bills are the focus of upcoming stakeholder meetings
HCA met with Assembly Health Committee staff to seek Chairman Richard Gottfried’s introduction of HCA’slegislation for physician-homecare collaboration in support of primary care, public health and medicalmanagement.
The legislation, S.6345, introduced in the Senate by Health Committee Chairman Kemp Hannon, would enablestreamlined agency engagement with physicians for discrete patient or public health services under thephysician’s direction.
The services that could be provided under the physician plan of care might include, for example, caretransition assistance, a post-surgical or medical treatment visit, home immunization, a home evaluation forasthma or falls risk or other public health screening, a visit for timely evaluation of a patient unable to get to
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the physician, etc. Further detail onthis bill was provided in the May 30edition of The Situation Report, andHCA will be following up with morebackground and updates.
HCA has met with the stateDepartment of Health to also discussthe proposal, and has reached out tophysician practices, hospital-basedmedical practices, home caremembers and other stakeholders onthe potential benefits of thelegislation. HCA hopes to secureAssembly introduction this week,following the Legislature’s return fromlast week’s Memorial Dayobservances.
With just a few weeks left in the 2017session calendar, vocal support andmomentum will be critical to securingaction in both chambers.
Community Paramedicine bill update
Further negotiations on communityparamedicine legislation (S.5588Hannon/A.2733-A Gottfried) awaitpending meetings with stakeholders,including the New York State NursesAssociation and EMS providers,particularly on finding common groundrelated to the level of serviceemergency medical technicians mightprovide in non-emergency situationsunder the legislation, and theappropriate line between theseservices and the Nurse Practice Act.
The current legislation, co-drafted byHCA, holds all provider andpractitioner lines constant, and doesnot permit crossover into nursingpractice by a non-nurse or crossoverinto home care practice by a non-article 36 provider. Agreement on
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OVERVIEW:
VNA Home Health is a CHHA providing services in Albany and surrounding counties. At VNA Home Health, you will have a unique opportunity to apply your transformative skills to lead a caring, professional team.
We are seeking a dynamic homecare leader to fill the position of Director of Clinical Practice and Innovation. Reporting directly to the CEO, this senior leader will be responsible for overseeing the delivery of all Nursing, Rehabilitation, Social work, and home health aide services. He/she will develop and execute innovative clinical models and programs to promote excellence in clinical practice, optimal patient outcomes, and successful positioning for new and innovative reimbursement models; as well as lead the development of strategies to expand clinical programs and promote growth
QUALIFICATIONS:We are looking for someone with strong organization, management, and communication skills, along with enthusiasm and creativity. The successful candidate must have a Baccalaureate Degree in Nursing, Master’s Degree in nursing or related field highly desirable; a current NYS RN license and a Minimum of five (5) years Supervisory/ Management experience, two (2) of which should be in Community Health. VNA Home Health is proud to offer an excellent compensation and benefits package including competitive salary, health/Dental and vision insurance, paid time off, life insurance and 403 (b) with employer match. Relocation Expenses are included. Candidates meeting the desired qualifications are encouraged to submit a cover letter, resume/CV and salary requirement to [email protected].
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Volume 2, No. 23 June 5, 2017
language related to these parameters willbe a threshold issue as to whether a viablebill is possible this session.
The current (HCA) bill is a collaborativemodel, requiring the participation andagreement of home care, hospital,physician and EMS partners, who togetherwould collaboratively form and operate acommunity medicine program.
Emergency Preparedness bill update
HCA’s “essential personnel” legislation forhome care and hospice emergencypreparedness and response (S.5016 Lanza/A.6549 Cusick) is once again backed by theLegislature.
Given Governor Cuomo’s three-time vetoof the bill – despite repeatedclarifications, negotiated amendments andwidespread support of need – thesponsors will be looking to see what otherlanguage or angles on the proposed policymight persuade the Governor to agree tothe bill.
Further discussions with the Governor’soffice and relevant state agency officialswill help determine next steps by thesponsors, at which point we will know theplan and prospect for passage thissession, and will target our advocacyaccordingly.
Meanwhile, any case-examples from homecare and hospice that support this criticalbill should be sent to HCA to share withthe sponsors and the Governor’s office.Case examples can be directed to either AlCardillo [email protected] orAlexandra Blais at [email protected].
For further information, please contact AlCardillo at [email protected].
Conference Participation ScholarshipsAvailable
The New York State Health Foundation (NYSHealth)has announced that its Sponsoring ConferenceParticipation in Support of Healthy Communicationsrequest for proposals (RFP) is open.
Through this RFP, NYSHealth will sponsorcommunity-based organizations, healthdepartments, and other low-resource organizationsto attend and present at local, State, and nationalconferences related to building healthycommunities. Applications will be accepted on arolling basis.
Applicants must complete and submit an onlineapplication here: http://tinyurl.com/y9zrr2sg.
All applicants will be notified about the outcome oftheir applications within three weeks of onlinesubmission.
Programmatic questions should be addressed toProgram Officer Bronwyn Starr [email protected]. Technical questions regardingthe online application system should be e-mailed [email protected].
More information is at http://tinyurl.com/y88nq36l.
HCA to Convene HR Committee –Membership Input Sought
HCA is developing a Human Resources (HR)committee to assist agencies in dealing withcommon issues and concerns related toemployment. We would like your input on whichissues the committee should address. Pleasecomplete the short survey at the link below assoon as possible, and no later than June 30.
https://www.surveymonkey.com/r/VXJTGPS
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HCA, DOH Discuss Hospital/Clinic Offsite Services Parameters
The May 22 edition of The Situation Report described the release of a state Department of Health (DOH)Dear Administrator Letter (DAL) announcing implementation of a new hospital/clinic “offsite serviceslaw.” (Please refer to this May 22 article.)
This law will permit hospitals and diagnostic and treatment centers (D&TCs) to provide, “offsite,” thesame primary care services that they otherwise are licensed to provide “onsite” in their facilities. The lawwill enable primary care services to be conducted in patients’ homes (essentially, “house calls”) when: 1)patients have an existing relationship with the hospital or D&TC primary care provider, and 2) they areeither homebound or would experience undue burden in making the primary care visit on-site.
Upon notice of the recent DAL, HCA immediately contacted DOH to discuss the required parameters ofthe new law, which expressly excludes hospitals and clinics from exercising offsite authority for servicedisciplines provided by home care agencies under article 36. The exclusion was specifically framed andnegotiated into the bill by HCA prior to its passage last year.
This week, HCA and DOH convened a lengthy meeting on the home care service exclusion, with HCAoutlining the background and exact parameters of the exclusion, as well as the intended parameters ofthe in-home primary care referenced by the bill. HCA stressed the need for DOH to amend and/or follow-up the recently issued DAL with detailed guidance to hospitals and clinics on these exact parameters.HCA emphasized the already widespread unlawful crossovers into article 36 (home care) and article 40(hospice) occurring prior to this law’s implementation, underscoring all the more the importance ofexplicit guidance to ensure compliance and avoid unintended violation under this new law.
HCA also noted to DOH that a new homecare-physician collaboration bill written by HCA and introducedby Senator Hannon (S.6345) could creatively work in tandem with the offsite/house calls law to positionhome care agencies, hospital physicians and clinic practitioners in broad collaboration for patients’primary care and home care.
DOH will be drafting additional guidance as well as accompanying regulations for the offsite services law.Home care will have input into these new rules, as the law requires consultation with HCA, home careproviders and hospitals on any guidance or regulations issued. This assurance of input and protection wasanother HCA language insert into the final legislation.
HCA will keep the membership apprised of any developments and asks that members notify usimmediately if you detect signs of implementation or service practices that are contrary to the parametersof this law.
For further information, contact [email protected].
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HCA Submits Member Comments on LHCSA Statistical Report
HCA has submitted comments to the state Department of Health (DOH) on its Licensed Home Care ServicesAgency (LHCSA) Statistical Report.
The comments, based on member feedback, were submitted last week prior to this week’s upcomingmeeting of the workgroup organized by DOH to make revisions to the Statistical Report. As reported innumerous communications, the goal of the workgroup is to “redesign and restructure the report to increasethe timely and accurate submission of information by identifying areas of reporting that can be streamlinedto increase compliance and accuracy in data reporting.”
The workgroup held its first meeting on May 1 and the next meeting is June 7. The first meeting wasattended by DOH staff, HCA and other associations, and a number of HCA members. Our comments providegeneral as well as section-specific recommendations for various parts of the report.
Some of our general recommendations include:
DOH should consider allowing LHCSAs with multiple licenses to submit one report. One report cancapture details surrounding all geographic locations. This would save significant time and resourcesfor affected LHCSAs.
The instructions should be more comprehensive and detailed. Many terms are unclear and all shouldbe fully defined, along with detailed sample answers for each question.
Agencies need at least one year to implement any changes to the LHCSA Statistical Report to allow forsoftware developers and system engineers to capture and generate the requested information.
DOH should consider providing a csv (excel) file template for agencies (so they can copy and pastedata from their internal records) to upload to the DOH portal; this would be more efficient thanrequiring agencies to manually enter all of the data to DOH’s site.
Some recommendations on specific forms include:
LSR6 (Staffing and Wages) should be changed to require annual, not quarterly, data.
LSR7 (Disease and Disability Services by County) should be eliminated or greatly reduced.
LSR8 (Subcontracts) needs to be streamlined to account for the multiple subcontractingarrangements LHCSAs may have.
HCA thanks those members who took the time to give us very valuable feedback. HCA will keep membersinformed on the deliberations of the LHCSA Statistical Report workgroup and any actions by DOH.
DOH intends to release the 2016 LHCSA Statistical Report in August; it will be similar to the 2015 Report. DOHhopes to incorporate any changes to the 2016 Report in time for the release of the 2017 Report in the summer of2018.
For more information, contact Andrew Koski at (518) 810-0662 or [email protected], or Patrick Conole at(518) 810-0661 or [email protected].
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CMS Guidance: Correcting Hospice RHC and SIA Payment Errors
A recent Medlearn Matters (MLN) article (SE17014) by the U.S. Centers for Medicare and Medicaid Services(CMS) explains the steps hospices should take to submit claim adjustments for payment errors that CMS isnot able to mass-adjust.
Beginning on January 1, 2016, Medicare hospice payments were revised to apply a two-tiered payment ratefor Routine Home Care (RHC) services and to make Service Intensity Add-on (SIA) payments at the end of life.Since then, CMS discovered and corrected various payment errors associated with these policies; but twoadditional errors, discovered in February, could not be mass-adjusted in the following instances:
If the prior days used are greater than 99, Medicare systems are calculating an incorrect payment.Medicare will correct its systems to eliminate this error on August 21, 2017.
RHC visits are overpaid when there is a transfer within the benefit period because the days prior tothe transfer are not being recognized. Medicare will correct its systems in a future release, but aworkaround allows claims to be adjusted in the interim.
Mass-adjustments are not possible because CMS cannot identify hospice provider claims from information inthe Medicare Administrative Contractor’s (MAC’s) claims history. Payment errors depend on information onlyavailable in Medicare’s Common Working File (CWF). Systematic correction would require adjusting nearly allhospice claims processed in 2016. On many claims, this would not result in payment changes but would havea disruptive effect on accounting at all hospices nationwide. The hospices themselves have the best availableinformation about which claims need to be adjusted, CMS says.
Required Action
Hospices should now submit adjustments to claims with outstanding SIA and RHC payment errors, except forthose where the prior benefit days are greater than 99. Hospices can identify adjustments to be made byreviewing the CWF hospice benefit file to see if the benefit days used on prior election periods total morethan 99 with no 60-day gap in between periods. Hospices may adjust claims with greater than 99 prior daysafter August 21, 2017.
For additional guidance on how to access the CWF hospice benefit file, contact New York’s principal MAC,National Government Services (NGS), at: 866-590-6728.
Additional information is in MLN article SE17014 at: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE17014.pdf.
Certain Web Browsers Can No Longer Access the HCS
Starting June 1, the Health Commerce System (HCS) has discontinued access for computers running WindowsXP and Microsoft Internet Explorer 9 (IE9) and older web browsers, as they pose a security risk to HCSapplications.
Windows XP users must upgrade their operating system and IE9 users must upgrade their browser by June 1,2017 to continue using the HCS, as the HCS will block connections from computers running Windows XP andIE9 browser and older.
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The following applications could be affected:
Home Care Worker Registry; Criminal History Record Check; and Electronic Plan of Correction.
Please see the May 8 edition of The Situation Report for instructions on how to update your browsers for HCScompatibility.
Users of MacOS, OSX, Windows 7, Windows 8, or Windows 10 and users of Google Chrome, MicrosoftInternet Explorer 10 or newer, or Safari on the Mac platform, are not affected by this change.
DFS Issues Paid Family Leave Final Rule, Announces Premium Rates for BenefitsPaid Family Leave highlighted at June 22 HCA program
The state Department of Financial Services (DFS) has issued a final rule on the new Paid Family Leaveprogram. The rule is at http://www.dfs.ny.gov/insurance/r_finala/2017/rf211txt.pdf. The rule was issued oneweek after the state Workers’ Compensation Board (WCB) issued its own rule on Paid Family Leave (see theMay 30 edition of The Situation Report).
DFS has also established the premium rate for Paid Family Leave benefits (see http://www.dfs.ny.gov/insurance/r_other/dec_prem_rate_flb_06012017.pdf). The DFS Superintendent has determined that thepremium rate for Family Leave Benefits and the maximum employee contribution for coverage (beginningJanuary I, 2018) shall be 0.126 percent of an employee’s weekly wage up to and not to exceed the statewideaverage weekly wage.
Under the final DFS rule:
Family leave benefits will be community rated and risk adjusted. According to DFS, community ratingensures that all employees are charged a rate based upon the same principles and are not subject tocost variations based upon age, gender, geographic location, or any other demographic factor.
Family leave benefits coverage may be subject to a risk adjustment mechanism to prevent issuersfrom experiencing disproportionate losses due to high utilization of benefits and also to eliminate anydisincentives that the statewide community rate would have on the issuance of policies to employerswith high utilization of benefits.
The DFS Superintendent will set the maximum employee contribution on or before June 1, 2017 andannually in future years on or before September 1.
Insurance companies may charge an additional premium for “enhanced” benefits.
If the issuer of family leave benefits decides to discontinue such coverage, it must send a notice ofdiscontinuance to affected employers and a separate notice to employees that will be distributed by theemployer.
As communicated in numerous articles, when fully implemented, Paid Family Leave (starting January 1, 2018and phased in over 2018 to 2021) will provide employees up to 12 weeks of paid family leave in any given
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52-week benefit period to: 1) care for a family member (including a child, parent, grandparent, grandchild,spouse or domestic partner) with a serious health condition; 2) bond with an employee’s newborn ornewly placed adoptive or foster child during the first 12 months following birth or placement; or 3)address any qualifying exigency to a spouse, domestic partner, child or parent who is serving on activemilitary duty.
Paid Family Leave is employee-funded, through payroll deductions, with the exception of anyadministrative costs incurred by employers. Employee participation is also mandatory, with certainexceptions.
Benefits will be phased in, starting on January 1, 2018, at which time employees may receive up to eightweeks of paid benefits in 2018. Benefits will be paid at 50 percent of the employee’s average weeklywage, not to exceed 50 percent of the state average weekly wage. These benefits will gradually increaseuntil January 1, 2021, when they will provide 12 weeks of coverage at 67 percent of the employee’saverage weekly wage.
More information on Paid Family Leave is at https://www.ny.gov/programs/new-york-state-paid-family-leave and http://www.wcb.ny.gov/PFL/pfl-regs.jsp.
HCA will be holding a June 22 program in New York City that includes a representative from the stateWorkers’ Compensation Board on New York’s Paid Family Leave program discussing the obligations ofemployers and the rights and responsibilities of employees. The program also covers other LHCSA “HotTopics,” such as labor law issues and health information technology integration tips.
Registration for this program is at http://hca-nys.org/wp-content/uploads/2017/05/LHCSA-Hot-Topics-Forum-Registration-Form.pdf.
HCA, Duke Faculty Conduct PCCP Training
HCA Executive Vice President Al Cardillo joined with Duke University faculty in once again conducting theonsite portion of the Duke Population Care Coordinator Program (PCCP), hosted by the Visiting NurseService (VNS) of New York at its New York City offices.
The PCCP is a multi-week curriculum, blending on-site and online training for intensive skill developmentintegrating population health, evidence-based practice, patient-centered care and other skills critical forpractice in the new and evolving models of care. The program is targeted to clinicians, primarily nursing,but also commonly includes therapists, clinical social workers, physicians and/or other primarypractitioners.
In his role in the PCCP training, Mr. Cardillo links the skill sets in PCCP training to the major models andelements of the health system.
HCA provider or MLTC members wishing to learn more about the program for their staffs’ training canaccess the program’s homepage at http://pccp.nursing.duke.edu/ or contact Al Cardillo [email protected].
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Care At Home Guidance Posted
The state Department of Health (DOH) has posted two General Information System (GIS) guidances on theCare At Home (CAH) I/II Waiver Program.
One guidance addresses approval by the U.S. Centers for Medicare and Medicaid Services (CMS) for renewalof the program and the other covers application and eligibility determination processes.
Both guidances are posted at: https://www.health.ny.gov/health_care/medicaid/publications/pub2017gis.htm (GIS 17 MA/09 and MA/10).
According to GIS 17 MA/09, CAH I/II has been approved by CMS effective April 1, 2017. The approvedapplication includes language indicating that the waiver will transition into managed care via the 1115authority on January 1, 2018.
This waiver provides services to children 17 years old and younger who have physical disabilities and requireeither a skilled nursing facility or hospital level of care. The waiver will continue to serve children living athome with parents or legal guardians.
Approved waiver services include: Case Management, Bereavement Services, Expressive Therapies,Massage Therapy, Home and Vehicle Modifications and Family Palliative Care Education (Training). Pain andSymptom Management and Respite Services are removed as services from the CAH I/II waiver program.
All Case Management services will continue to be reimbursed using the existing rates and 15-minute unitfee schedule. CAH I/ II waiver program will implement a caseload size limit of no more than thirtyindividuals per case manager effective October 1, 2017.
Case Management services are limited to 120 hours annually, not to exceed 10 hours monthly, unlessotherwise indicated in the participant’s plan of care and authorized by the local Department of SocialServices. All waiver participants must have a monthly face-to-face visit with their case manager.
The GIS also reviews changes to family palliative care education, bereavement, home modifications andother services.
GIS 17 MA/10 reviews the enrollment process and eligibility determination procedures for CAH I/II, includingthe timeframe and documentation requirements.
Questions about either GIS can be directed to DOH at (518) 473-6020 or [email protected].
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OIG Posts Semiannual Report to Congress
The federal Office of Inspector General (OIG) has posted its Semiannual Report to Congress that coversOctober 1, 2016 to March 31, 2017 (first half of federal fiscal year 2017).
It is at https://oig.hhs.gov/reports-and-publications/archives/semiannual/2017/sar-spring-2017.pdf.
The Report describes OIG’s investigative work relating to the administration of programs and operationsunder the U.S. Department of Health and Human Services (HHS). Historically, about 80 percent of OIG’sresources are directed to work related to Medicare and Medicaid. This includes a series of efforts to combatfraud, waste and abuse and other integrity efforts driving OIG’s work planning for audits and evaluations aswell as OIG’s approach to enforcement.
During the first half of fiscal year 2017, OIG reported expected investigative recoveries of over $2.04 billion.OIG also reported 468 criminal actions against individuals or entities that engaged in crimes against HHSprograms, 461 civil actions, and 1,422 exclusions of individuals and entities from participation in federalhealth care programs.
During this period, OIG focused on fraud in non-institutional settings, including Medicare home healthpersonal care services and home and community based services.
Home care providers should familiarize themselves with OIG’s work when developing and making changes totheir compliance activities.
Information Posted on Encounter Reimbursement Process for Capitation PaymentsRecovered in Audit
The state Department of Health (DOH) has posted information in the May 2017 Medicaid Update on theMedicaid managed care encounter reimbursement process for capitation payments recovered in audits.
The May Medicaid Update is at http://www.health.ny.gov/health_care/medicaid/program/update/2017/may17_mu.pdf.
During the audit process, the Office of Medicaid Inspector General (OMIG) may identify and recover anyinappropriately paid capitation payments, including those months with encounters, consistent with statelaws, regulations and the Medicaid Managed Care Model Contract (Contract). However, a managed care planmay subsequently receive reimbursement for costs following the issuance of the Final Audit Report, and afterthe plan has repaid all identified overpayments.
When these conditions are met, DOH will reimburse the plan for costs incurred during the recoveredcapitation month. The reimbursement will be based on encounters which the plan has successfully submittedto DOH. Encounters not eligible for reimbursement include administratively denied encounters andencounters for which the plan has already been reimbursed for the cost of services.
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The article includes a chart of scenarios approved by the U.S. Centers for Medicare and Medicaid Services(CMS) where plans may be reimbursed for services.
DOH’s reimbursement procedure for costs incurred is as follows:
On a semi-annual basis, DOH will receive plan audit recovery information from OMIG. This informationwill be reviewed and matched to plan-submitted and accepted header-level encounter data, with aminimum six months of runout from the applicable recovery period.
Upon completion of the data-matching process, DOH will share results with plans to review for aperiod of 30 days prior to payment effectuation. In instances where a plan may have discrepancieswith DOH’s calculated “lump sum” reimbursement amount, DOH will develop a process to review theexpenditure analysis with plans. Plans will not be allowed to amend or submit encounter data whichwould alter the results of services provided. Note: encounter reimbursement audits post EncounterIntake System (EIS) implementation will take place after a validation of the data is complete.
Once the 30–day review period has expired, DOH will initiate plan-specific reimbursements, based ona calculated summary of plan encounter expenditures incurred. Payments will then be processed insubsequent plan cycle remittance checks. Plans will be notified of the pending reimbursement amountsand supporting detail via a plan-specific remittance statement generated by DOH.
Questions regarding enrollment or eligibility should be directed to DOH at [email protected]. Questions orissues related to the OMIG audit process should be directed to OMIG at [email protected] or issues regarding the DOH reimbursement process should be directed to DOH at [email protected].
Resources
“The Aging Apple: Older Immigrants a Rising Share of New York’s Seniors,” Center for an Urban Futurehttps://nycfuture.org/research/the-aging-apple
“Medicare Care Choices Model (MCCM) – Per Beneficiary per Month Payment (PBPM) –Implementation (Eligibility Updates and Clarification),” by the U.S. Centers for Medicare and MedicaidServiceshttps://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10094.pdf
“Multiple Chronic Conditions in the United States,” by the Rand Corporationhttp://www.fightchronicdisease.org/sites/default/files/TL221_final.pdf
“Building Additional Serious Illness Measures Into Medicare Programs,” Health Affairs Blog (May 25,2017)http://healthaffairs.org/blog/2017/05/25/building-additional-serious-illness-measures-into-medicare-programs/
For more information, contact Andrew Koski at (518) 810-0662 or [email protected].
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