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Legislative Issues Public Policy News
A Weekly Publication Of HCAHCAHCAHCAHCAHome Care Association of New York State
Helping New YorkersFeel RightAt Home
ASAPVolume 20, No. 32 September 18, 2015
See COMPLIANCE p. 2
See SCHUMER p. 4
Dombi Headliner
NAHC’s Bill Dombi took the stage at HCA’sSenior and Financial Manager’s Retreat thisweek. Our next big conference is the HCACorporate Compliance Symposium on October 8where one of the headliners is New York’s newOMIG Chief Dennis Rosen. Don’t miss this nextHCA signature conference. A brochure is at theback of ASAP.
Schumer to Lead Senate Letter on
Home Health Medicare RebasingSenate effort joins House campaign seeking CMS reconsiderationof its current rebasing methodology
At the request of home care associations nationally, Congress isfinalizing a series of letters addressed to the U.S. Centers forMedicare and Medicaid Services (CMS) pressing for areconsideration of CMS’s Medicare Home Health rebasingmethodology.
Oct. 8 HCA Symposium to Focus on Major
Compliance, Audit and Cybersecurity Concerns
Register today!
Wrapping up a successful Senior and Financial Manager’sRetreat this week, focus now turns to our next signatureconference coming up: the HCA Corporate ComplianceSymposium on October 8 in Albany.
If you thought the finance Retreat was excellent foryour CFO and financial management teams, you canexpect the same for your compliance officers, COOs,
Inside Inside Inside Inside Inside ASAPASAPASAPASAPASAP
Schumer to Lead Senate Letter on Rebasing.....................................1
Oct. 8 HCA Compliance Symposium: Register Today!.......................1
IPRO to Audit QIVAPP Pool Eligibility.................................................3
DSRIP Update......................................................................................3
Managed Care Update.......................................................................4
‘Stay’ Requested on FLSA Court Ruling .............................................5
Court Accepts HCA Amicus Brief in Live-In Home Care Case.............5
HCA Regional Meet-Ups: Help Us Help You!.....................................6
HCA, DOH Meet on Uniform Billing Codes for Managed Care.........7
ICD-10 Update....................................................................................7
Fiscal Intermediary Services Update...................................................8
NGS Updates......................................................................................8
Home Health Survey Protocol Training Item Revised.........................9
MA Value-Based Insurance Design Model Webinar To Be Held.........9
2
ASAP is a weekly publication of the Home Care Association of NewYork State (HCA). Unless otherwise noted, all articles appearing inASAP are the property of the Home Care Association of New YorkState. Reuse of any content within this newsletter requires permissionfrom HCA.
Joanne Cunningham, [email protected]
Roger L. Noyes, Director of Communications, [email protected]
Al Cardillo, Executive Vice President, Policy & Programs, [email protected]
Patrick Conole, Vice President, Finance & Management, [email protected]
Andrew Koski, Vice President, Program Policy and Services, [email protected]
Alexandra Blais, Director of Public Policy, [email protected]
Laura Constable, Senior Director, Membership & Operations, [email protected]
Celisia Street, Director of Education, [email protected]
Mercedes Teague, Finance Manager, [email protected]
Jenny Kerbein, Director of Governance and Special Projects, [email protected]
Billi Hoen, Manager, Meeting and Events, [email protected]
Teresa Brown, Administrative Assistant, [email protected]
President:
Editor:
388 Broadway, 4th Floor, Albany, NY 12207Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org
ASAP – a publication of the Home Care Association of New York State
COMPLIANCE from p. 1
Volume 20, No. 32 September 18, 2015
executives and other staff with responsibility forregulatory compliance at your agency – a prettybig tent, given the major implications ofregulatory compliance on home care.
Here are some big reasons to attend on October 8:
• The state’s new Medicaid InspectorGeneral, Dennis Rosen, will make hisHCA program debut. Get to know thenew OMIG chief, hear his priorities andask questions about what to expect fromthe state’s primary Medicaid audit unitunder his helm.
• While Dennis Rosen will offer the bigpicture of OMIG priorities, we’ll alsohave OMIG’s deputy chief, ThomasMeyer, on hand to field your questionsabout the intricacies of OMIG’s workplan for home care and the status of auditissues in a changing health care landscape.
• Rebecca Fuller Gray, Director of theDivision of Home and Community BasedServices at the state Department ofHealth, is a household name in the New
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York Home Care compliance arena.Her name is on virtually all theDALs in your file drawer spelling outthe state’s regulatory requirements.She’ll be at our Symposium,addressing some of the regulatoryalignment issues facing you undermanaged care and the DeliverySystem Reform Incentive Payment(DSRIP) program, including manyof the areas that the Home andCommunity Based RegulatoryWorkgroup has been working to sortout.
• Gerald Archibald of the BonadioGroup will help you tackle severalother DSRIP issues, in hispresentation “An Epic Program withBig Compliance Considerations,” asyou wade through unprecedentedpartnership negotiations, sharedgovernance, new levels ofinformation sharing and competitivemarketplace considerations.
• And, newly added to the program,HCA’s expert Counsel FrankFanshawe of Wilson Elser willpresent on “eRisks and Responses,”keeping you informed of practicesand responsibilities related tocybersecurity.
This program is being held in Albany tofacilitate participation from state officialsyou need to hear from. Some big players inthe state’s compliance field will be there foryou, and all you need to do is register today.Please download the PDF brochure at theback of this week’s ASAP or register onlineat http://tinyurl.com/qbbpjsh.
All of HCA’s education registration formsand links are on the Education and Eventspage of our website at www.hca-nys.org.Please be sure to register for our ComplianceSymposium today.
IPRO to Audit QIVAPP Eligibility The state Department of Health (DOH) has reportedthat IPRO will be sending an e-mail to about 200providers as part of an audit for Quality IncentiveVital Access Provider Pool (QIVAPP) eligibilityduring the second round of funding.
Specifically, IPRO will e-mail New York Cityproviders who have been identified as eligible for thesecond installment of the QIVAPP monies to requestdocumentation that these home care providers do, infact, meet the eligibility criteria. DOH hopes to finalize its draft list of QIVAPPawardees by the end of September. Then it intends tosend a request to the U.S. Centers for Medicare andMedicaid Services (CMS) by the end of the month.Prior to the completion of IPRO’s audit process,DOH plans to pursue MLTC rate increases for theQIVAPP “adjustment,” which could take a few monthspending CMS review. DOH will then make any necessary changes to theQIVAPP awardee amounts based on IPRO’s auditfindings, likely after a decision is made by CMS.
DSRIP Update
The state Department of Health (DOH) has posted theDSRIP 1115 Quarterly Report that covers the firstquarter of DSRIP year one from April 1, 2015 to June30, 2015. The report is at http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/docs/first_quarterly_report_2015.pdf.
It covers Performing Provider System (PPS) valuationawards; regulatory waivers; value based payments;Certificates of Public Advantage; Performance Fundpayments: information technology; and capital grants.
DOH has also posted the Value Based PaymentSubcommittees’ materials at https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/vbp_reform.htm.
HCA is participating in a number of subcommitteesalong with members.
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SCHUMER from p. 1
In meetings with the offices of New York Senators CharlesSchumer and Kirsten Gillibrand this week, HCA President
Joanne Cunningham specifically reinforced the New York homecare community’s call for Congressional action on rebasing,along with other urgent issues, like the need to fix CMS’sburdensome Medicare face-to-face rule.
In response to advocacy by the National Association for HomeCare and Hospice (NAHC) and HCA, Senator Schumeragreed to lead a letter in the Senate on rebasing, with co-signatures by Senators Deborah Stabenow, Susan Collins andPat Roberts who will circulate the draft for further sign-onamong Senate colleagues before sending it to CMS.
The Schumer-led effort joins a House-initiated letter – alsoaddressed to CMS – being finalized by Reps. Greg Walden,Tom Price, Earl Blumenauer and James P. McGovern.
The House letter, which has 117 signatures, specificallyrequests that CMS “reconsider its proposed case mix cut until itevaluates the specific causes of case mix changes from 2012 to2014,” among other recommendations related to CMS’sproposed 2016 Home Health Prospective Payment SystemRule.
HCA and our government affairs representative, Brett Heimovat Envision Strategy, have appealed for support from NewYork’s House Delegation on the letter. As of ASAP press time,the following New York Representatives had signed-on: YvetteD. Clarke (D-NY-9); Richard Hanna (R-NY-22); BrianHiggins (D-NY-26); John Katko (R-NY-24); Peter T. King (R-NY-2) and Kathleen Rice (D-NY-4).
HCA appreciates the support of these CongressionalRepresentatives and Senator Schumer’s office for theirunderstanding of the grave risk posed by CMS’s rebasing cuts.
To read HCA’s major arguments against rebasing and otheraspects of the proposed 2016 Home Health ProspectivePayment System Rule, please download our advocacy paper athttp://hca-nys.org/policy-positions/home-health-prospective-payment-system-rule-for-cy-2016-what-it-means-for-ny-providers.
As CMS looks to finalize its rule later in the fall, HCA willkeep the members informed of key advocacy developments andaction items.
Managed Care Update
Members should take note of new datesposted on the updated “Managed CareBenefit and Population Expansion”chart:
• January 1, 2016 – Office forPersons with DevelopmentalDisabilities (OPWDD) Phase1 voluntary enrollment intoOPWDD-FIDA (FullyIntegrated Duals Advantage)for dual eligibles in New YorkCity, Long Island, Westchesterand Rockland.
• December 1, 2016 – enrollmentof Assisted Living Program(ALP) residents (duals and non-duals) into managed care andALP benefit added to managedcare.
• January 1, 2017 – enrollment ofNursing Home Transition andDiversion (NHTD) and certainCare at Home consumers intomanaged care.
• April 1, 2017 – enrollment ofTraumatic Brain Injuryconsumers into managed care(moved from January 1, 2017).
• December 1, 2017 – enrollmentof Medicaid spend-downpopulation into managed care.
You can read the chart at http://www.health.ny.gov/health_care/medicaid/redesign/docs/mrt1458_timeline.pdf.
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Home Care Plaintiffs Request ‘Stay’ on Court Ruling to Eliminate FLSA Exemption The National Association for Home Care and Hospice (NAHC) and other plaintiffs filed briefs this week withthe U.S. Court of Appeals requesting a stay of the court’s recent decision to uphold the U.S. Department of Labor(U.S. DOL) rule that eliminates the ‘companionship exemption’ for home care agencies, among other changes tothe Fair Labor Standards Act (FLSA). If a stay is not granted, then the plaintiffs say they will request that the U.S. Supreme Court issue a stay and hearthe case. Without a stay by either court, the ruling may go into effect on or about October 13. Meanwhile, the U.S.DOL argued in its brief that the Court of Appeals ruling should take effect sooner than October 13. As indicated in previous communications to members, the most direct effects of the U.S. DOL rule are that aideswill have to be paid at time-and-a-half of their regular rate of pay rather than time-and-a-half of minimum wage.The rule would also result in more stringent recordkeeping for live-in/sleep-in cases. HCA will keep members informed of any new developments.
Court Accepts HCA Amicus Brief in Live-In Home Care CaseHCA to hold program on labor implications
The state Supreme Court Appellate Division (Second Judicial Department) has accepted a motion by HCA andother associations to file an amicus brief in a case that has major implications for home care providers andconsumers.
In the case, Andryeyeva v. New York Health Care, Inc., the judge decided that home attendants working on 24-hour/sleep-in cases must be paid for each hour of the 24-hour shift, also ruling that sleep (eight hours) and mealperiods (of up to three hours) cannot be deducted unless the attendant resides in the home of the person who isreceiving care.
This ruling conflicts with state Department of Labor opinions that agencies have depended upon. Those rulingsprovide that third-party employers of 24-hour care attendants may pay their employees for 13 hours of a 24-hourshift, if the attendant gets 8 hours of sleep, five of which are uninterrupted, and three uninterrupted hours formeals.
The issues raised by this lawsuit are very significant and have surfaced in a number of other recent judicialproceedings. If this decision is upheld, the cost of 24-hour sleep-in services would be prohibitive; agencies andmanaged care plans would not be able to afford such care for Medicaid recipients; the cost for private pay patientswho need such care would increase tremendously; and the availability of such services for all populations wouldbe severely limited.
HCA expects to file the amicus sometime later this month. We will notify members once we have done so, and wewill soon be finalizing an education program on this topic. Please stay tuned for the program date where we’lldiscuss the issues raised in this case and similar ones, and how agencies can prepare now in the event that thejudge’s decision is upheld.
For more information, contact Andrew Koski at (518) 810-0662 or [email protected].
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ASAP – a publication of the Home Care Association of New York State Volume 20, No. 32 September 18, 2015
HCA Meets with DOH on Uniform Billing Codes for Managed Care
This week, HCA and other associations met with the state Department of Health (DOH) and managed care planrepresentatives to discuss the establishment of standard billing codes for home and community-based servicesunder managed care.
This change was long sought by HCA to simplify the claims processing for both home care agencies and managedcare plans and was included in this year’s state budget as a direct result of HCA advocacy and legislative development.
HCA had already solicited member feedback on the codes used by plans, and all the associations had compiled acomprehensive list of codes for home care services.
At the meeting, plan representatives raised issues with the accuracy and utility of codes we developed, and alsocontended that it was not possible to meet the January 1, 2016 effective date for uniform billing codes, due to: thecomplexity of code development; the need for contract amendments; and systems’ reprogramming.
Both home care and plan representatives agreed to establish a workgroup to drill further into the codes and toaddress issues raised by both. We also agreed to focus on home care services and later address waiver services.
DOH will be sending an e-mail to the MLTC plans about the standard billing code requirement, and to ask theplans to identify the codes they use for home care services and to select plan representatives to participate in areview of the codes.
HCA will keep members updated on this issue.
For more information, contact the HCA Policy staff.
ICD-10 Update
As the October 1 due date for ICD-10 approaches, the state Department of Health (DOH) has announced twoeducation sessions geared to Uniform Assessment System (UAS) users.
The sessions focus on: transitioning from ICD-9 to ICD-10; editing ICD codes in an assessment; carryingforward existing ICD codes; and offline ICD code processing requirements.
Dates and registration information follows:
For the September 21 session (10 a.m.), register at http://tinyurl.com/oz55rqx.
For the September 23 session (1 p.m.), register at http://tinyurl.com/p9rvhee.
HCA has updated its chart of MLTC plans and their activities related to the ICD-10 transition. The chart is athttp://hca-nys.org/wp-content/uploads/2015/09/ICD10chartforMLTCtransition.pdf.
Lastly, the U.S. Centers for Medicare and Medicaid Services (CMS) has posted a new ICD-10 resource,“Claims Submission Alternatives for Providers Who Have Difficulties Submitting ICD-10 Claims.” It
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i s at https :// www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1522.pdf.
Fiscal Intermediary Services Update
The state Department of Health (DOH) has provided clarification to HCA on its recently issued policyguidance regarding requirements for entities that want to provide fiscal intermediary (FI) services for individualsenrolled in MLTC plans who are receiving consumer directed personal assistance services.
The current guidance is at http://www.health.ny.gov/health_care/medicaid/redesign/mltc_policy_15-05.htm.
It includes the following language about organizations interested in becoming an FI for an MLTC plan:
The organization must apply for a discrete Medicaid provider ID number thatis solely associated with its FI by completing the New York State MedicaidEnrollment Form available at the following link: https://www.emedny.org/info/ProviderEnrollment/personal_care/index.aspx.
This was interpreted by home care providers, plans and the Associations to mean that entities were required toapply for another Medicaid provider number for their FI services even if they already had one for other lines ofhome care business.
HCA had informed DOH that this was a burdensome and unnecessary requirement for providers that alreadyhad Medicaid provider numbers and were providing personal care/FI services.
DOH has now clarified that such entities don’t have to obtain another Medicaid provider number. Entitiesthat want to provide FI services and don’t already have a Medicaid provider number still must obtain one.
All providers still must meet the other requirements outlined in the guidance.
Home care providers contacted by their MLTC contractors about their discrete Medicaid provider numbershould provide their already existing provider number to the plans.
DOH will be issuing some type of clarification on this issue and HCA will notify members when that happens.
For more information, contact Andrew Koski at (518) 810-0662 or [email protected].
NGS Updates
National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), has recentlyposted the following information to its website.
• NGS to Conduct EDI Maintenance on September 30 – On September 30, the Electronic DataInterchange (EDI) Gateway will be shut down for maintenance at 5 p.m. for approximately six hours
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in preparation for ICD-10. Once reactivated, all claims with dates of service October 1, 2015 and latermust be submitted with ICD-10 diagnosis and procedure codes.
• Certifying Home Health Care Webinar – On Monday, September 21, from 12:30 to 2 p.m., NGSwill host a webinar on patient/beneficiary eligibility, face-to-face encounters and certificationrequirements. Visit NGS’s website to register at http://www.ngsmedicare.com.
For further information, contact Patrick Conole at (518) 810-0661 or [email protected].
Home Health Survey Protocol Training Item Revised
The U.S. Centers for Medicare and Medicaid Services (CMS) has issued a letter to State Survey AgencyDirectors on the revision of a home health agency (HHA) survey protocol training item.
It is at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-15-52.pdf.
When surveyors determine that expected outcomes have not been met for the various standards/tags within aCondition, the HHA Survey Protocol provides HHA-specific guidelines for when surveyors may considerciting the actual Condition at issue.
Previous trainings advised surveyors that the phrase “consider citing the Condition” in the protocol implied thesurveyor “should” cite a Condition-level deficiency. CMS has now revised its training to indicate that surveyorsmay consider citing the Condition when indicated by the regulation, but the phrase should not be taken as aprescriptive element of the guidance over surveyor judgment.
MA Value-Based Insurance Design Model Webinar To Be Held
The Center for Medicare and Medicaid Innovation in the U.S. Centers for Medicare and Medicaid Services(CMS) is hosting a September 24 webinar at 3:30 p.m. to discuss the recently-announced Medicare AdvantageValue-Based Insurance Design Model (MA-VBID).
Attendees will receive an overview of the model as well as an opportunity for questions and answers about themodel.
Registration is at https://engage.vevent.com/index.jsp?eid=3536&seid=265.
As described in the September 4 ASAP, MA-VBID will test the hypothesis that higher quality and cost savingswould result from giving Medicare Advantage (MA) plans flexibility to offer targeted extra supplementalbenefits or reduced cost sharing to enrollees who have specified chronic conditions.
The MA-VBID model will begin January 1, 2017 and run for five years. CMS will test the model in 7 states:Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania, and Tennessee.
More information is at http://innovation.cms.gov/initiatives/vbid/index.html.
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