hca president advocates with new york congressional...

EDITORrsquoSNOTE

Your Source for HOME CARE News Policy and Advocacy Vol 3 Issue 29 | June 25 2018

INSIDE

See FIXES p 4

HCA President Advocates with New York CongressionalDelegation to Protect and Advance Home Care

HCA President Joanne Cunningham spent muchof last week in Washington DC for a series ofmeetings with members and staff of the NewYork Congressional Delegation including theOffices of Senator Kirsten GillibrandRepresentatives Brian Higgins (D-BuffaloNiagara Falls) Chris Collins (R-LancasterGeneseo) Joseph Crowley (D-Queens) YvetteClarke (D-Brooklyn) and Grace Meng (D-Queens)

Legislature Concludes Scheduled

Session but Return is Likely The state Legislature gaveled out of its scheduled 2018 calendar on Thursday concluding avery narrow funnel of state legislative activity as the summer political campaigns take hold

HCA President Advocates w NY Congressional Reps to Protect Advance Home Care1Legislature Concludes Scheduled Session but Return is Likely1EVV Delay Legislation Passes House of Representatives3Messages from HCA Supporters and Sponsors46State DOL Extends Emergency Rule on 24-HourLive-in Care8HCA Continues to Press on CHHA Minimum Wage Reimbursement Increase9Member Hiring Announcements10HCA Data Webpage Now Includes Q4 2017 MLTC amp PACE MMCOR Data11CMS Provides New Guidance for CERT Reviews11

MedPAC Report Makes Sweeping Analysis of Post-acute Quality Payments12Settlement Conference Facilitation Program Expanded15Change to OPWDD Medicaid Service Coordination16HHCAHPS Preview Reports with Star Ratings Available16OMIG Posts Updated 2018-19 Work Plan17Update on UAS for NHTD and TBI Posted18Important Upcoming Deadlines20CMS Updates Hospital Transfer Policy for Early Discharges to Hospice21CMS Launches Data Element Library Supporting Interoperability21Resources22

HCA President Joanne Cunningham left with RepYvette Clarke

See SESSION p 5

See DELEGATION p 2

This is the lastweekly edition ofThe SituationReport untilSeptemberDuring the pastfew summersHCA hasimplemented abiweeklyschedule (everytwo weeks) Ournext publicationwill be on July 9followed by July23 andcontinuingbiweekly untilSeptember 3 Asalways we willnotify you by e-mail of anyimportantbreaking newsstories orupdates

MMCOR DATA POSTED

HCArsquos members-onlydata webpage has newspreadsheets withmanaged care data formembers to view anddownload

PAGE 12PAGE 11

EVV DELAY

House passes legislationto delay federalrequirement for state-ledelectronic verificationprograms to reviewpersonal care services

PAGE 8PAGE 3

13-HOUR RULE

The state Department ofLabor again extends theemergency rule codifyingthe 13-hour standard forcompensable hours in24-hourlive-in cases

MedPAC

MedPACrsquos annual report expressesconcerns about the quality of post-acute care providers along withfurther analysis of its unified post-acute payment system as well asmanaged care and ACO findings

2

The Situation Report is a weeklypublication of the Home CareAssociation of New York State(HCA) Unless otherwisenoted all articles appearingin The Situation Report are theproperty of the Home CareAssociation of New YorkState Reuse of any contentwithin this newsletterrequires permission fromHCA

Joanne CunninghamHCA President

jcunninghamhcanysorg

Roger L NoyesDirector of CommunicationsEditor of The Situation Report

rnoyeshcanysorg

Al CardilloExecutive V ice President

acardillohcanysorg

Patrick ConoleVice President

Finance amp Managementpconolehcanysorg

Andrew KoskiVice President

Program Policy amp Servicesakoskihcanysorg

Laura Constable Senior Director

Membership amp Operationslconstablehcanysorg

Celisia StreetDirector of Education

cstreethcanysorg

Mercedes Teague Finance Manager

mteaguehcanysorg

Jenny KerbeinDirector of Governance amp

Graphic Designjkerbeinhcanysorg

Billi Wilson Manager Meetings amp Events

bwilsonhcanysorg

Teresa BrownAdministrative Assistant

tbrownhcanysorg

Home Care Association of New York State (HCA)388 Broadway 4th Floor Albany NY 12207

Tele 518-426-8764 Fax 518-426-8788 Website wwwhcanysorg

The Situation Report the Home Care Association of New York State Volume 3 No 29 June 25 2018

DELEGATION from p 1

In each of the meetings Ms Cunningham discussed the need toprotect home care providers from upcoming changes in theMedicare home health payment system (called the Home HealthGroupings Model ndash HHGM) including the need to

Ensure that the US Centers for Medicare and MedicaidServices (CMS) does not begin the new system before 2020offering enough time for testing demonstrations andindustry technical guidance

Clarify that the newly created 30-day increments in HHGMwork in a complementary fashion with the existing 60-dayepisode of care that is embedded within the home healthpayment regulatory and operational structure HCA urges alegislative fix so that this 30-day increment is defined as aldquounit of servicerdquo not a ldquounit of paymentrdquo as it is currentlydesigned This would ensure that providers will be paid forall services delivered in the episode and not just receive onepayment for the first 30 days of care

Instruct CMS to examine the physician record along with thehome health agency record for compliance with the federalface-to-face requirement

Ensure that CMS does not include a ldquobehavioral adjustmentrdquoin the new payment system which is not based on dataderived from the actual new payment system

Ms Cunningham also emphasized the need for adoption of HR1825S 445 the Home Health Planning Improvement Act Thislegislation would allow non-physician practitioners such as nursepractitioners and physician assistants to order and certify homehealth services under Medicare This legislation would increaseaccess to home health services for the Medicare population and isstrongly supported by a bipartisan group of Members of Congress inboth chambers HCA has been meeting over the past months withthe office of Rep Chris Collins to assist in strategizing on this billand we support his efforts as the bill sponsor to ensure its passagebefore Congress adjourns in the fall

HCA also brought information to the Congressional Delegationregarding the announcement by CMS to restart its pre-claim reviewdemonstration even after serious problems were identified in the

3


first round of the demo launched in Illinois two yearsago Those serious problems prompted a suspension ofthe program entirely and a delay in its rollout to fourother states in March of 2017 This newly revampedversion of pre-claim review will again begin in Illinois(no earlier than October 2018) but it also pivots tosome new states

Though New York is not one of the states CMS holdsopen the possibility of expanding this newer version ofthe demo potentially spreading some of the problemsthat have beleaguered the program to date without anyserious effort on CMSrsquos part to be transparent andaccountable about those problems HCA educated theNew York Congressional Delegation about its impactand also its unprecedented construct that subjectsMedicare providers to a front-end program integritymeasure that has no relationship to whether thebeneficiary qualifies or requires the service but israther focused on documentation HCA and the homecare industry at the national level believe that this is aradical shift from prior Medicare integrity efforts whichhad exclusively used targeted post-payment audits

In preparing for last weekrsquos visits HCA created a newset of position papers all of which are available at the bottom of our federal advocacy page athttpshca-nysorgadvocacy-pacfederal (see documents labelled ldquo2018rdquo)

EVV Delay Legislation Passes House of Representatives

On June 18 the US House of Representatives passed by voice vote a bill that extends the deadline for stateMedicaid programs to implement Electronic Visit Verification (EVV) for personal care services for one year ndashuntil January 1 2020

The bipartisan bill HR 6042 is sponsored by Rep Brett Guthrie (R-KY-2) and co-sponsored by Reps JimLangevin (D-RI-2) Diana DeGette (D-CO-1) and Greg Walden (R-OR-2)

Having passed the legislation through the House the billrsquos sponsors now hope the Senate will soon pass itsversion with a unanimous consent vote

The EVV requirement is different from a similar requirement in New York State for verification organizations(VOs) to use EVV for pre-claim review That New York State law by contrast is applicable to home health aideand personal care aide services provided by organizations with more than $15 million in Medicaid fee-for-service and managed care revenues

Continued on next page

HCA President Joanne Cunningham outside the USCapitol


4

The federal 21st Century CURES Act requires that states implement an EVV system for personal careservices by January 1 2019 and for home health services by January 1 2023 Personal care services includeany personal care provided to individuals in Medicaid fee-for-service (and Medicaid managed care)consumer directed services and personal care provided in Nursing Home Transition and Diversion (NHTD)Traumatic Brain Injury (TBI) or any other waiver program

The EVV systems must verify the type of services provided individual receiving the service date of theservice location of service delivery individual providing the service and time the service begins and ends

HCA has already met with the state Department of Health (DOH) twice to discuss EVV implementation andhas advocated for ways to minimize any disruptions to agency services and operations adequate time toimplement EVV funding for thisunreimbursed requirement and ourinvolvement in any stakeholderworkgroup that would vet the designof EVV systems and policies

New York Statersquos separaterequirements on verificationorganizations (again applicable toorganizations with more than $15million in Medicaid revenues) are athttpsomignygovinformationhome-health-verification

As described in the May 21 editionof The Situation Report the USCenters for Medicare and MedicaidServices (CMS) in mid-May releasedan Informational Bulletin andfrequently asked questions (FAQs)document covering the EVVrequirements specified in the 21stCentury CURES Act

The Bulletin and FAQs along withwebinar materials are available athttpswwwmedicaidgovmedicaidhcbsguidanceelectronic-visit-verificationindexhtml

For more information contactAndrew Koski at (518) 810-0662 orakoskihcanysorg

Continued from previous page

Simione Healthcare Consultants advances quality and cost

efficiency providing reliable experts technology and tools to

grow and improve home- and community-based services

Get more insight 8442931529 infosimionecom Simionecom

bull Operationsbull Compliance amp Riskbull Financebull Sales amp Marketing

Home Care amp Hospice Business Solutions

bull Cost Reportingbull Mergers amp Acquisitionsbull Information Technologybull Talent Management


5

As HCA has emphasized in past communications election-year dynamics were among the biggestimpediments for lawmakers and the Governor to reach agreements on several measures including thoseadvocated by HCA

Indeed one Senate memberrsquos mid-session departure for military service resulted in a 31-31 split ofRepublicans and Democrats This combined with the dissolution of the Senatersquos Independent Democraticconference (who had until recently co-led the chamber as a voting coalition) left the house withoutmajority control for its operations bill processes and overall agenda Although the scheduled session calendar has concluded some required actions remain and the Governorand legislators are signaling a likelihood of returning to Albany for further work Among these pendingitems are a number of local laws requiring extensions

Throughout this process HCA engaged the membership on messaging through a new landing page on ourLegislative Action Center which had 1000 visits and netted hundreds of e-mails to legislative sponsors onseven individual campaigns to support HCA-developed bills We thank members who joined us on grassrootsadvocacy and ask that you use our Legislative Action Center in even greater numbers as you receive notificationson new campaigns prompted by additional ensuing developments Your grassroots support is vital to the successof our legislative agenda and an even higher level of member engagement is critical What follows is a preliminary report on the sessionrsquos conclusion as conveyed in an e-mail alert to memberson Friday along with any further developments relating to home care hospice and Managed Long TermCare (MLTC) Bills that Passed Both Houses and Await Delivery to the Governor

HCA-authored legislation to promote Home Care-Mental Health Provider Collaboration (S8632 bySenator Robert Ortt and A10938 by Assemblywoman Aileen Gunther) passed both the Senate andAssembly unanimously

This legislation is part of a multi-level partnership plan that HCA the State Office of Mental Health(OMH) and mental health providers and associations have been forging at the state and providerlevels It specifically amends the Geriatric Service Program in the State Mental Hygiene Law to addmental health-home health provider collaboration for the purpose of coordination integration andimproved access of health and mental health services for individuals with co-occurring mentalhealth and physical health needs HCA OMH and partner associations will be working to promotethese collaborative models to better assist individuals to age-in-place in their homes andcommunities avoid hospitalizations promote better care transitions from hospital to home andsupport quality of health and life for New Yorkers with mental health conditions

HCA will be providing guidance to the membership on outreach to the Governor to urge his signatureof this HCA-developed measure

SESSION from p 1



6

The Physical Therapy Assistant Extender bill (S8217 by Senator Kenneth LaValle and A10381-Aby Assemblyman Victor Pichardo) passed both the Senate and Assembly This legislation supportedby HCA would extend through June 30 2022 the authorization of physical therapy assistants (PTAs)to provide services in home care settings Originally enacted in 1993 the provision has beenextended numerous times The bill awaits delivery to the Governor for signature ostensibly in timebefore the current extender lapses on June 30

Legislation (S7713-B by Senator Kemp Hannon and A10345-A by Assemblyman Richard Gottfried)to permit Nurse Practitioner authorization under the Health Care Proxy law passed the Senateand Assembly The legislation authorizes nurse practitioners to witness a health care proxy act asa health care agent and determine competency of the principal of such a proxy

Legislation Extending Various Health Laws (A10221-A by Assemblyman Richard Gottfried andS8093-A by Senator Kemp Hannon) passed the Senate and Assembly This bill would extend anumber of health-related programs currently in effect that are set to expire this year including theapproval of and reimbursement to Limited Licensed Home Care Services Agencies that serveindividuals who are residents of adult homes and Enriched Housing Programs until June 30 2019This is currently set to expire on June 30 2018




7

Legislation developed by LeadingAge New York and the Empire State Association for Assisted Living(A10459-A by Assemblywoman Donna Lupardo and S8353-A by Senator Kemp Hannon) passed bothhouses to allow residents of an assisted living facility who are receiving Medicaid to be able toaccess hospice services while remaining in their assisted living facility Currently Assisted LivingProgram residents cannot access hospice services while also remaining in assisted living forcingdisplacement of individuals and increased costs to the system HCA will be guiding the membershipon next steps in communications on this initiative

Bills that Passed the Senate Pending in the Assembly The following important home care hospice and MLTC bills passed the Senate HCA had secured prominentAssembly sponsorship of these measures and we will continue working with the sponsors and the Assemblyleadership to mobilize support for these bills upon a return of the Legislature

HCA-authored legislation establishing a Labor Competitive Market Study for Home Care andHospice and Recommendations for Securing Home Care and Hospice Recruitment ampRetention (S8559 by Senator Susan Serino and A10940 by Assemblywoman Donna Lupardo) passedthe Senate unanimously This bill responds to critical marketplace issues that impede home care andhospice recruitment and retention and consequently also impede workforce adequacy for MLTCservice delivery The bill would authorize the state Commissioner of Labor with collaborating stateagencies to conduct a competitive labor market study to assess and make recommendations forhome care and hospice capability including appropriate reimbursement and policy support tocompete in the labor market for recruitment and retention of direct-care staff

This same legislation would also establish a Temporary State Task Force to Promote Occupationsin Home Care and Hospice This taskforce would be led by the Commissioners of Labor and Agingwith collaboration from the Commissioners of Health Education and Mental Health to promoteentrance practice career development and retention in home health and hospice occupationsincluding home health aide nursing physical therapy occupational therapy and social work

HCA-authored legislation to support HCA and providersrsquo work in implementing the HCA Home CareSepsis Screening and Intervention Initiative (S8669 by Senator Kemp Hannon and A11078 byAssemblyman John McDonald) unanimously passed the Senate The legislation would add a newsection in Article 36 of the public health law to further engage state Department of Health support forhome care sepsis screening prevention intervention mitigation cross-sector collaboration andpublic education The bill has a series of provisions which the Department may undertake to promotehome carersquos work on sepsis such as support for electronic health record (EHR) integration of theHCA-developed sepsis tool providerclinician training public education health information exchangeacross continuum partners and cross-sector collaboration to foster seamless timely response tosepsis

Legislation to add an additional category of exemption to the LHCSA moratorium (S8942 bySenator Kemp Hannon and A11126 by Assemblyman Richard Gottfried) passed the Senate The billwould add a provision allowing the Commissioner of Health to provide an exemption to themoratorium for applications which based on the Commissionerrsquos discretion are consistent with the


8


State DOL Extends Emergency Rule on 24-HourLive-in Care

The state Department of Labor (DOL) has posted an extension until July 30 2018 of its emergency rule thatcodifies ldquothe Commissionerrsquos longstanding and consistent interpretation that compensable hours worked underthe State Minimum Wage Law do not include meal periods and sleep time of home care aides who work shiftsof 24 hours or morerdquo

The posting is in the June 20 State Register at httpsdocsdosnygovinforegister2018june20tochtml (page12)

As noted in many articles for The Situation Report and alerts to members the DOL emergency rule was initiallyposted on October 25 2017 It was the result of vigorous efforts by HCA and other provider associations andentities to solidify DOLrsquos so-called ldquo13-hour rulerdquo guidance for ldquo24-hourlive-inrdquo cases in the face of courtdecisions ruling that aides on 24-hour cases were to be paid for all 24 hours regardless of whether they wereafforded 8 hours of sleep (including 5 hours of uninterrupted sleep time) and three hours for meals

HCA reminds members that state DOL is holding a hearing on July 11 2018 on a proposed rule that would notcount meals periods and sleep time for any employee (not just home care aides) who works a shift of 24 hoursor more That rule was announced in the April 25 2018 State Register (httpsdocsdosnygovinforegister2018april25tochtml page 43) DOL requests that comments on the proposed rule be submitted prior to thehearing but DOL will accept them until five days after the hearing ndash until July 16

A notice of the July 11 hearing and registration form to testify are at httpswwwlabornygovworkerprotectionsleep-timeshtm HCA plans to testify and urges members to submit comments andor testify


statersquos goals of consolidation and improving care delivery With the blunt provisions for themoratorium enacted as part of the 2018-19 state budget this legislation would provide flexibility forexemptions not delineated in the budget language list

Legislation relating to Minimum Wage Adjustments for home and community based long term careservices providers and fiscal intermediates (S8473-A by Senator Kemp Hannon and A11200 byAssemblyman Richard Gottfried) passed the Senate The legislation seeks to address providerfinancing needs but does not simultaneously address the adequacy or timing of state payments tohealth plans

HCA will provide further details on the status of all HCA priority home care hospice and MLTC-relatedlegislation that were kept from action in the extremely tight session calendar (such as legislation toaddress MLTC-nursing home enrollment in rural areas HCA will continue to seek support for Assemblypassage of our priority bills that have passed the Senate along with the support of both chambers and theExecutive for additional bills and issues we have advanced

HCA thanks the members of the Legislature who sponsored and supported our priority bills and also theindividual members of HCA who acted at the grassroots level to call and write with their support HCA looksforward to the Governorrsquos support and approval of bills upon delivery to him


9

In early March the Second Department Appellate Division granted a motion to appeal in a pertinent caseon this issue ndash Andryeyeva v New York Health Care Inc ndash permitting the case to be considered by theCourt of Appeals which is New Yorkrsquos highest court In that case the Second Department ruled that DOLrsquosopinion letter setting forth the ldquo13-hour rulerdquo is inconsistent with the plain language of underlying stateregulation

HCA will be submitting an amicus to the Court of Appeals on this case

HCA Continues to Press on CHHA Minimum Wage Reimbursement Increase

Last week HCA met again with the state Department of Health (DOH) to discuss the need for minimumwage adjustments to the Certified Home Health Agency (CHHA) episodicfee-for-service (FFS) rates for2018

This was a follow-up to a previous meeting with DOH (see the June 11 edition of The Situation Report)that followed DOHrsquos decision not to raise the 2018 CHHA FFS rates to account for the December 31 2017minimum wage increase DOH based this action on responses it got from CHHAs on a fall 2017 surveythat showed that the minimum wage increase resulted in very minimal new direct costs to CHHAs for aideservices

At last weekrsquos meeting DOH said that only about 57 of the 120 existing CHHAs completed the survey ForCHHAs that contracted out for aide services DOH estimated the minimum wage costs by multiplying thenumber of hours for contracted aide services by the December 31 2017 minimum wage increase

DOH said that those CHHAs who incurred FFS minimum wage expenses for 2018 and want to obtainfunding for these costs will be able to utilize a ldquoreconciliationrdquo process that DOH intends to develop HCAwill alert members when any information on such a reconciliation process is available

DOH also offered to share with HCA some information it used to develop an approximate 6 percentincrease in 2017 to the CHHA episodic rate to account for the December 31 2016 minimum wageincrease In addition DOH sought HCA input on how to determine any adjustments to the CHHA episodicrate for future years to account for minimum wage increases

HCA advises all home care providers and plans to respond to all DOH wage (and other) surveys as thefindings are used to calculate future provider and plan payments

For more information contact the HCA Policy staff



10

HIRING

Executive Vice President and Chief of ProviderServices VNSNY

As the nationrsquos largest not-for-profit home- andcommunity-based health care organization VNSNY istransforming to become a leading home- andcommunity-based care management organizationVNSNY is hiring for the Executive Vice President andChief of Provider Services to move the organizationforward on this continuum by providing strategicplanning leadership and direction to all VNSNYProvider Services operations and our population healthand clinical support services business development andclinical education departments

Responsibilities

Oversees strategies for Provider Servicesprograms consistent with established VNSNYfinancial targets and corporate objectives

Plans directs and coordinates the efforts ofcorporate sales and marketing functions toachieve VNSNY short- and long-term strategicgoals

Monitors and evaluates issues trends and needsfor Provider Services programs formulatesstrategies to address trendsneeds

Required Experience

10+ years of progressively responsible leadershipor program implementation experience incomplex integrated health care hospital andorhome health provider organization

Excellent financial and operational track recordproven ability to manage a challenging andconstantly changing health care delivery systemin a competitive environment and within thecontext of health care reform

Masterrsquos Degree in a health care-related field

Interested candidates should e-mail their CV to AndrewWise Vice President Talent Management andOrganizational Development atAndrewWisevnsnyorg

BRANCH DIRECTOR QUEENS LOCATION

Able Health Care Services believes in quality carefor our clients Join us for an exciting career inHealth Care Currently we are looking for a BranchDirector to join our team We offer competitivesalary and benefits

Position Summary

Management and supervision of a team ofprofessional paraprofessional and clericalemployees accountable for providingcompetent care and achieving optimalpatientclient outcomes for the CertifiedAgency

Supervises InquiryIntake referrals forhome care services to individual patientsclients and their families

Provides nursing education and training asdeemed necessary to increase the value ofpatient care as well as enhance theagencyrsquos ability to offer new clinicalinitiatives

The candidate for this position must be a NYSlicensed Registered Nurse bachelorrsquos preparedwith

A minimum of 5 years work experience inLicensed and Certified Home Careagencies

Strong Knowledge of MedicareMedicaidMLTC and managed care regulations

Excellent communication human relationsand organizational skills are needed

Self-motivator assertiveness andindependent decision-making skills areessential

Please e-mail inquiries to Sandra Weintraub atSandraWablehealthcarecom

Able Health Care Services Inc is an EqualOpportunity Employer


11

HCA Data Webpage Now Includes Q4 2017 MLTC amp PACE MMCOR Data

This week HCA staff posted to our HCA Data website an HCA-developed spreadsheet of the fourth quarter2017 Medicaid Managed Care Operating Reports (MMCORs) from each Managed Long Term Care (MLTC) andProgram of All-Inclusive Care for the Elderly (PACE) plan in the state

HCA Data is a members-only page that provides data reports to assist home care and hospice providers andmanaged care plans in their benchmarking efforts understanding of system-wide trends and access toreimbursement and premium rates The page is not visible on our site unless you are logged in with an HCAmember website account

Our log-in page is here httphca-nysorglogin Upon login the HCA Data link will appear in the site menu atthe top right (though you may have to refresh your browser first) Simply e-mail HCArsquos Communications DirectorRoger Noyes at rnoyeshcanysorg if you do not yet have an HCA website account or would like furtherinformation

HCArsquos spreadsheets include multiple sheets summarizing key MMCOR data including such items as planenrollments per-member-per-month premium revenue and premium income balance sheet data contingentreserves and escrow balances additional funding for minimum wage unit costs utilization data and otherinformation

Earlier this year HCA posted a spreadsheet with data from the 2016 Medicaid Cost Reports for all non-hospitalbased CHHAs in the state as well as for the first time 2015 Statistical Report data from all reporting LicensedHome Care Service Agencies (LHCSAs) in the state

For further information contact Patrick Conole at (518) 810-0661 or pconolehcanysorg

CMS Provides New Guidance for CERT Reviews

The US Centers for Medicare and Medicaid Services (CMS) recently issued Change Request (CR) No10778 offering guidance to Medicare Administrative Contractors (MACs) on Comprehensive Error Rate Testing(CERT) findings

Specifically CR No 10778 instructs MACs on procedures when the CERT contractor identifies providers whohave not responded to additional documentation requests (ADRs) or when there is insufficient documentationto support the decision to pay the claim The CR (at httpswwwcmsgovRegulations-and-GuidanceGuidanceTransmittals2018DownloadsR800PIpdf) is effective July 17 2018

If the CERT contractor receives no response to an ADR request it informs the MAC In turn the MAC can do thefollowing

1 Contact those providers who have failed to submit medical records and encourage them to submit therequested records to the CERT review contractor for review

2 Collect the overpayment immediately andor


12


3 Collect the overpayment within 10 business days of the deadline for entering final MAC feedback

CMSrsquos policy has always provided MACs with an opportunity to contact providers and request thedocumentation if the provider did not respond to a CERT audit However the CR also instructs the MACs toreach out to providers to submit requested documentation to the CERT contractor when there is insufficientdocumentation to support payment of the claim (ie documentation submitted is inadequate to supportpayment for the serviceitem billed or if the auditor could not conclude that the billed serviceitem wasactually provided was provided at the level billed andor was medically necessary)

The majority of CERT contractor improper payment decisions are related to insufficient documentation It isunclear how this process will impact the CERT improper payment rates since the determination ofinsufficient documentation would have been made prior to contacting the MAC HCA recommends that CMSwork towards reducing the CERT improper payment rate by allowing providers to submit additionaldocumentation when requested by the contractor


MedPAC Report Includes Sweeping Analysis of Post-Acute Care Quality IntegratedPayment Systems and More

The Medicare Payment Advisory Commission (MedPAC) has issued its annual Report to Congress titledldquoMedicare and the Health Care Delivery Systemrdquo which examines a variety of Medicare payment systemissues

The full report is available at httpmedpacgovdocsdefault-sourcereportsjun18_medpacreporttocongress_secpdfsfvrsn=0

The report has ten chapters Some key highlights follow

Encouraging Medicare Beneficiaries to Use ldquoHigher Quality Post-Acute Providersrdquo

About 40 percent of Medicare acute inpatient hospital discharges result in the use of post-acute care(PAC) ldquoThe selection of a provider within a PAC category can be crucial because the quality of carevaries widely among providersrdquo Medicare discharge planning regulations make hospitals responsiblefor educating beneficiaries about their PAC provider choices but hospitals cannot recommendspecific PAC providers the report states

The Commissionrsquos analysis of referral patterns of Medicare beneficiaries who were discharged tohome health agencies (HHAs) and skilled nursing facilities (SNFs) indicate that many beneficiarieshad another nearby provider that offered ldquobetter quality carerdquo (though not all of the ldquohigher-qualityrdquoproviders may have had available capacity) Ninety-four percent of beneficiaries who used HHA orSNF services had at least one provider within a 15-mile radius that was of ldquohigher qualityrdquo than theprovider that served them MedPACrsquos report uses different indicators for its definition of ldquohigherqualityrdquo though it generally refers to ldquocomposite quality indicatorsrdquo with specific references to


13


publicly reported staffing ratios quality measures for short-stay patients compliance survey resultsand vehicles such as the Star Ratings system Nursing Home Compare and Home Health Compare

MedPAC asserts that allowing hospital discharge planners to recommend specific PAC providersbased on the quality of care they provide could help beneficiaries select ldquobetter quality PACprovidersrdquo Medicare could expand the authority of discharge planners to recommend ldquohigher qualityrdquoPAC providers in a number of different ways ranging from prescriptive approaches that providespecific metrics that hospitals must use to more flexible approaches that allow hospitals to decideon the metrics they use to identify ldquohigh-qualityrdquo PAC providers Ultimately beneficiaries shouldretain freedom of choice but have ldquobetter informationrdquo to make that choice

Paying for Sequential Stays in a Unified PPS for Post-Acute Care

Medicare uses separate prospective payment systems (PPSs) to pay for stays in each of the four PACsettings SNFs HHAs inpatient rehabilitation facilities (IRFs) and long-term care hospitals (LTCHs)As a result Medicarersquos fee-for-service (FFS) payments can differ substantially for similar patientstreated in different settings MedPAC states As mandated by Congress in June 2016 theCommission developed a prototype design and estimated the impacts of a unified PAC PPS MedPACconcluded that it is feasible to design a PAC PPS that spans the four settings and uniformly basespayments on patient characteristics (HCA has reported on these designs extensively in prior editionsof our newsletter)

To further advance the unified PAC PPS the Commission now examines two payment issues thatwould ldquoincrease the accuracy of paymentsrdquo for sequential stays which is defined as PAC stays withinseven days of each other The first issue has to do with the way the cost of a stay can vary dependingon where it falls in a sequence of PAC stays The second issue involves how to identify for paymentpurposes distinct phases of care for a PAC provider that treats a patient ldquoin placerdquo as care needsevolve Under a unified PAC PPS there needs to be a way to trigger payments for different phases ofcare so that such providers are not financially disadvantaged MedPAC states

MedPAC finds that costs of a sequence of home health care stays decline over the course of anepisode more than payments would under its prototype PAC PPS suggesting that payments forsequential home health stays need to be adjusted downward (as they are in the current HHA PPS) Incontrast PAC PPS payments for institutional stays ldquowould remain reasonably well alignedrdquo with thecost of stays throughout a sequence of care

To make accurate payments to providers offering a range of services under the PAC PPS Medicarecould make a single payment for all post-acute care provided during an episode of PAC TheCommission will continue to explore episode-based payments for PAC

Managed Care Plans for Dually Eligible Beneficiaries

Dual-eligible beneficiaries often have complex health needs but are at risk of receiving fragmented orlow-quality care because of the challenges in obtaining services from two distinct programs Manyargue that the two programs could be better integrated by developing managed care plans thatprovide both Medicare and Medicaid services Integrated plans could improve quality and reduce

14


federal and state spending because they would have stronger incentives to coordinate careHowever these plans have been difficult to develop and only 8 percent of full-benefit dual-eligiblebeneficiaries are now enrolled in a plan with a high level of Medicare and Medicaid integration Thismirrors New Yorkrsquos experience with Fully Integrated Duals Advantage (FIDA) plans wherebyenrollment has been much less than anticipated while enrollment in partial capped (managed longterm care) plans continues to grow

There are four types of plans that serve dual-eligible beneficiaries The Medicare-Medicaid Plans(MMPs) under the financial alignment demonstration Medicare Advantage dual-eligible specialneeds plans (D-SNPs) fully integrated dual-eligible SNPs (FIDA SNPs) and the Program of All-Inclusive Care for the Elderly There are significant differences among these plans in several keyareas including their level of integration with Medicaid ability to use passive enrollment andpayment methodology

Three potential policies to encourage the development of integrated plans are limiting how oftendual eligible beneficiaries can change their coverage limiting enrollment in D-SNPs to dual eligibleswho receive full Medicaid benefits and expanding the use of ldquopassiverdquo (automatic) enrollment

Recent Performance of Long Term Care Issues Confronting Medicare Accountable Care Organizations

Medicare Accountable Care Organizations (ACOs) were created to reduce growth in Medicarespending and improve the quality of care for beneficiaries by giving providers greater responsibilityfor costs and quality of care The Commission finds that ldquotwo-sidedrdquo ACOs have been moresuccessful at producing savings than ldquoone-sidedrdquo ACOs and MedPAC considers six issues that areimportant to sustaining two-sided ACOs in Medicare the role of hospitals as participants in ACOsthe trade-offs of asymmetric models setting appropriate benchmarks an alternative for distributingthe 5 percent bonus for clinicians in advanced alternative payment models the role of specialists inACOs and the long-term viability of two-sided ACOs in the Medicare program

The various MedPAC reports issued each year are non-binding These reports reflect advisoryrecommendations that would require legislation from Congress andor administrative action from the USCenters for Medicare and Medicaid Services (CMS)

HCA has long challenged the underlying assumptions of MedPACrsquos data analysis in position papers toCongress and in our direct advocacy with both MedPAC and CMS HCA has specifically noted MedPACrsquos useof selective data sets that do not reflect the financial struggles of many home care providers especially instates like New York where unique system and patient-demographic factors have resulted in providersoperating at a loss on Medicare for fifteen years in a row The items identified in this report are sweeping innature and will require further extensive analysis and continued education of both MedPAC and Members ofCongress to ensure that any changes to payment models or assumptions about quality-of-care and dischargeplanning processes do not inhibit access to care or the viability of the home care infrastructure

HCArsquos federal advocacy efforts with Congress have sought to counter many of MedPACrsquos home healthrecommendations including reductions in HHA payments and we will continue to focus our activities in thisarea


15

Settlement Conference Facilitation Program Expanded

The federal Low Volume Appeals program expired on June 8 2018 That program applied to outstandingclaims at the Administrative Law Judge (ALJ) or Medicare Appeals Council

However the Office of Medicare Hearings and Appeals (OMHA) has expanded the criteria to allowproviders and suppliers with low volume appeals to participate in a separate and distinct SettlementConference Facilitation (SCF) program

As reported in past newsletters SCF is an alternative dispute-resolution process giving certain providersand suppliers an opportunity to resolve their eligible Part A and Part B appeals

To make an appeal under SCF the provider or supplier

Must be a Medicare provider or supplier that has been assigned a National Provider Identifier (NPI)

Must have 25 or more SCF-eligible appeals pending at OMHA and the Council combined or fewerthan 25 SCF-eligible appeals pending at OMHA or the Council and at least one appeal that has morethan $9000 in billed charges

Cannot have filed for bankruptcy andor expect to file for bankruptcy and

May be excluded from participation if he or she has or has had False Claims Act litigation orinvestigations pending against them or other program integrity concerns including pending civilcriminal or administrative investigations

SCF-eligible appeals must meet the following tests

The appeals must involve request(s) for ALJ hearing or Council review filed on or before November 3 2017

The request(s) for ALJ hearing andor Council review must arise from a Medicare Part A or Part BQualified Independent Contractor (QIC) reconsideration decision

All jurisdictional requirements for OMHA or Council review must be met for the eligible appeals

All pending OMHA and Council appeals associated with a single NPI and corresponding ProviderTransaction Access Number (PTAN) must be included in SCF

Appeals must not be scheduled for an ALJ hearing or an ALJ hearing must not have been conducted

The billed amount of each individual claim must be $1000000 or less and

Appeals must not be actively engaged in a US Centers for Medicare and Medicaid Services (CMS)Medicare appeals initiative that was available on or after November 3 2017 (ie CMSrsquos Low VolumeAppeals settlement option the QIC Demonstration Project or the CMS Serial Claims Initiative)

More information including forms and frequently asked questions is at httpswwwhhsgovaboutagenciesomhaaboutspecial-initiativessettlement-conference-facilitationindexhtml

16


Change to OPWDD Medicaid Service Coordination

The state Department of Health (DOH) has posted a General Information System (GIS) message to informlocal departments of social services (LDSS) of a change to the Medicaid Service Coordination (MSC) programfor individuals served through the state Office for People With Developmental Disabilities (OPWDD)

The GIS is at httpswwwhealthnygovhealth_caremedicaidpublicationsdocsgis18ma009pdf

Effective July 1 2018 coordination of services will be transitioned from Medicaid Service Coordinationidentified by RestrictionException (RE) code 35-Case Management to comprehensive care managementprovided by Care Coordination Organizations (CCOs)

Each county will have a minimum of two different CCOs that will provide two products of care managementfrom which individuals can choose ndash CCO Health Home services (CCOHH) and CCO HCBS Basic Plan Support

CCOHH care managers will coordinate a variety of health care wellness and developmental disabilityservices to achieve a holistic and integrated approach to meet the full range of needs of OPWDD individuals

CCOBasic HCBS Plan Support care managers will coordinate developmental disability supports and servicesonly

HHCAHPS Preview Reports with Star Ratings Available

Preview Reports reflecting results from the Home Health Care Consumer Assessment of Healthcare Providersand Systems (HHCAHPS) survey from January 2017 through December 2017 are now available for homehealth agencies (HHAs)

They can be accessed at httpshomehealthcahpsorg under the ldquoFor HHAsrdquo tab You must be logged into thewebsite to view your report These same data will be updated on Home Health Compare (HHC) onwwwmedicaregov in July 2018

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 ormore patient surveys in the reporting period in order to have star ratings

To access your agencyrsquos HHCAHPS Preview Report log into the HHCAHPS website Select the ldquoPreviewReportsrdquo link under the ldquoFor HHAsrdquo tab (Passwords can be reset by typing your username clicking ldquoresetpasswordrdquo and following instructions e-mailed to you)

Comments about your HHCAHPS Star Ratings on the Preview Report can be e-mailed to hhcahpsrtiorg byJuly 6 2018 Comments should include your name your facility name your CMS Certification Number (CCN)and your contact information

If you believe your HHCAHPS star ratings are not correct your comments should include evidence showingwhy However if yoursquove ldquohistorically had higher ratings than are shown this is not considered evidencerdquo


17

according to HHCAHPS officials ldquoYou must provide information showing that the data submitted by yourvendor for the most recent quarter are incorrect and therefore may have impacted the assigned HHCAHPS StarRatings for your agencyrdquo

For more information about the Preview Reports refer to this document on the HHCAHPS website accessibleonce you are logged in httpshomehealthcahpsorgLinkClickaspxfileticket=rEmqINcxYK83damptabid=277

For more information about HHCAHPS star ratings including Frequently Asked Questions please go tohttpshomehealthcahpsorgGeneralInformationStarRatingsInformationaspx

If you have any questions about the HHCAHPS star ratings or your HHCAHPS Preview Report contact theHHCAHPS Survey Coordination Team via e-mail at hhcahpsrtiorg or call toll-free at (866) 354-0985

OMIG Posts Updated 2018-19 Work Plan

The state Office of the Medicaid Inspector General (OMIG) has posted an update to its 2018-19 Work Plan(httpsomignygovinformationwork-plan)

The following are new action items

Compliance Certification Change OMIG is transitioning from a system that utilizes the FederalEmployer Identification Numbers (FEIN) to a system based on Provider Identification Numbers in orderto make the annual compliance certification process more efficient

Drug Utilization Alerts OMIG is working to proactively educate providers where a substanceutilization review indicates that a recipient may have an accumulation of a controlled substance butdid not meet the criteria for restriction under OMIGrsquos Recipient Restriction Program A ldquoControlledSubstance Accumulationrdquo notice will be sent to alert providers of the potential overutilization andabuse

Transportation Review OMIG is conducting Credential Verification Reviews (CVR) throughout thestate to ensure Medicaid transportation providers are adhering to all requirements of the Departmentof Health (DOH) Transportation Manual policy guidelines

Medi-Medi Crossover OMIG is collaborating with Unified Program Integrity Contractors (UPIC) andRecovery Audit Contractors (RAC) to identify duplicative payments occurring between Medicare andMedicaid Providers who are not properly using the Medicare crossover process ndash and thereforeobtaining duplicative payments ndash will be identified and repayment of Medicaid claims will be sought

The Work Plan also includes current action items for compliance home health and community-based serviceslong term care Medicaid managed care ongoing program integrity and data analytics

Some important current activities include

Continuing to conduct both CHHA fee-for-service audits and CHHA Episodic Payment System (EPS)audits


18


Continuing to audit and investigate personal care services (PCS) fee-for-service (FFS) Medicaid claimsas well as managed care organization (MCO) PCS services

Auditing and investigating Consumer Directed Personal Assistance Program (CDPAP) providers toensure compliance with rules and regulations including services reimbursed through FFS and MCOs

Continuing to examine Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI)FFS claims to determine compliance with program requirements

Continue reviews and collaborative work with DOH and the state Department of Labor to ensure thathome care providers are providing wage and fringe benefit compensation to employees in compliancewith wage parity laws

Continued reviews and collaborative work with DOH to ensure that MCOs are appropriately passingon supplemental Medicaid payments to home care providers in compliance with DOH directives

Auditing MLTCs to ensure enrollees are eligible to qualify for the program and that appropriate caremanagement is being provided by the MLTC plans

Reviewing enrollment records recipient plans of care and claims data to determine if the MLTC plansare providing the specific services deemed medically necessary Additionally OMIG will examinecasecare management system notations to confirm that appropriate care management is also beingrendered to MLTC members OMIG will continue to assess MLTC plans to ensure that their contractualobligations in serving their recipient population are being met

Audits of Medicaid managed care operating reports (MMCOR) These audits will focus on the reviewof reported pertinent medical and administrative costs for accuracy and allowability to ensure onlyproper costs were utilized in the development of respective rate components

OMIGrsquos Value-Based Payments (VBP) Project Team will continue to work with DOH to gain anunderstanding of how value-based payments will be reflected in the Medicaid data to discuss ways ofensuring integrity within the data and to ensure access to information is readily available to OMIG tobe able to audit and investigate in a VBP environment

Update on UAS for NHTD and TBI Posted

Last week eMedNY posted an update on the use of the Uniform Assessment System (UAS-NY) tool for theNursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) programs

Upon approval by the US Centers for Medicare and Medicaid Services (CMS) ndash effective April 1 2014 for theNHTD program and September 1 2017 for the TBI program ndash the state implemented the use of the UAS-NYassessment tool for both initial and annual level-of-care determinations for NHTD and TBI waiver applicantsand participants



19


NHTD

For NHTD recipients each Regional Resource Development Center (RRDC) is required to maintain accurateparticipant enrollment for the UAS-NY in the Health Commerce System (HCS) and to maintain a case list

Should an assessment determine that an individual does not meet the Nursing Facility Level of Care (NFLOC)the individual may seek a second assessment with the assistance of the RRDC All negative eligibilitydeterminations are afforded due process through the fair hearing system

Questions regarding NHTD waiver services and level-of-care assessments can be sent tonhtdwaiverhealthnygov

TBI

Should an assessment determine that an individual with TBI does not meet NFLOC the individual may seek asecond assessment with the assistance of the RRDC If the second assessment fails to support NFLOC theTBI waiver applicantparticipant may seek a clinical evaluation from specialists with expertise in TBIdisability andor cognitive deficit examinations

The clinical evaluation must demonstrate evidence of neurocognitive behavioral andor functional deficits ona physical exam or diagnostic testing andor meet DSM-5 criteria for major neurocognitive disorder This isreferred to as ldquoalternate routerdquo

Upon completion of the evaluation the specialist must clearly determine and prescribe that the applicantparticipant meets NFLOC as a result of TBI and should be considered for waiver eligibility This specialistrsquosreport is submitted to the RRDC who submits it to the state Department of Health for review by anindependent assessor The RRDC is advised of the assessment findings

Should the assessment determine the individual to be in need of NFLOC the Notice of Decision will bewithdrawn by the RRDC Should the assessment and related documents determine the individual does notmeet NFLOC the participant may continue to seek adjudication through fair hearing All negative eligibilitydeterminations are afforded due process through fair hearing

All waiver participants are required to have an annual re-assessment of waiver eligibility regardless of themethod for the previous eligibility determination

Any questions regarding TBI waiver services and level-of-care assessments should be directed totbihealthnygov


20


Upcoming Deadlines

RequirementChangeEffective

Due DateMore Information

Home Care Fiscal Intermediaries

and other providers who contract

with Managed Care Organizations

must be enrolled in Medicaid

Still being

accepted but

providers are

advised to

submit now

httpswwwemednyorginfoProviderEnrollmentManagedCareNetwork

indexaspx

Transition Period for Using Health

Insurance Claim Number (HICN) or

new Medicare Beneficiary Identifier

(MBI)

April 1 2018 to

December 31

2019

httpswwwcmsgovMedicareNew Medicare Cardindexhtml

Rural Health Network Development

Program RFA

Due June 28

2018

httpshca nysorgwp contentuploads201805Rural Health Network

Development Program _RFP_May 2018pdf

Call for Social Determinants of

Health Innovations

Application due

June 29httpswwwsurveymonkeycomrSDH_Innovations

Managed care organizations will

initiate termination of contracted

providers who have not enrolled in

Medicaid

July 1 2018httpswwwemednyorginfoProviderEnrollmentManagedCareNetwork

indexaspx

OSHA 2017 Form 300A form (A

Summary of Work Related Injuries

and Illnesses)

Due July 1 2018 httpswwwoshagovinjuryreportingindexhtml

MLTC Plans must report to the state

Department of Health the number of

aide hours for QIVAPP program

allocations in New York City

Due July 6 2018 httpswwwhealthnygovhealth_caremedicaidredesignmrt_61htm

Hearing on state Department of

Laborrsquos proposed rule to exclude

meals and sleep time for all

employees

July 11 2018 wwwlabornygov

Certified Home Health Agency 2017

Medicaid Cost Report

Due July 16

2018 (extensions

may be granted

as per HCArsquos

request to DOH

contact HCA for

details)

httpscommercehealthstatenyuspublichcs_loginhtml

Personal Care Provider 2017


New Due Date

July 30 2018httpscommercehealthstatenyuspublichcs_loginhtml


CMS Issues Change Request on Updated Hospital Transfer Policy for EarlyDischarges to Hospice Care

The US Centers for Medicare and Medicaid Services (CMS) recently issued Change Request (CR) No10602 that will update the transfer policy as required by recent legislation for discharges occurring on orafter October 1 2018 when provided hospice care by a hospice program

CR No 10602 can be downloaded at httpswwwcmsgovRegulations-and-GuidanceGuidanceTransmittals2018DownloadsR2094OTNpdf

Prior to CR No 10602 when a patient is transferred to another hospital and his or her length of stay is lessthan the geometric mean length of stay for the Medicare Severity Diagnosis-Related Group (MS-DRG) thetransferring hospital would be paid based on a graduated per-diem rate for each day of stay not to exceedthe full MS-DRG payment For discharges to certain post-acute care settings this per-diem-based paymentadjustment is limited to discharges to certain MS-DRGs Currently the regulation limits post-acute caretransfers to those where the patient is transferred to a distinct part of a hospital unit a skilled nursingfacility or discharged with a written plan for home health services commencing within three days ofdischarge

However Section 53109 of the Bipartisan Budget Act of 2018 modified the law extending it to hospicecare Now the regulations require that beginning in Federal Fiscal Year (FFY) 2019 discharges to hospicecare would also qualify as a post-acute care transfer and be subject to payment adjustments


CMS Launches Data Element Library Supporting Interoperability

The US Centers for Medicare and Medicaid Services (CMS) announced last week the agencyrsquos first DataElement Library This is a new CMS database that supports the exchange of electronic health informationIt is at httpsdelcmsgovDELWebpubHome

This free centralized resource allows the public to view the specific types of data that CMS requires post-acute care facilities (such as home health agencies nursing homes and rehabilitation hospitals) to collectas part of the health assessment of their patients

These assessments include questions and response options (data elements) about patients such asdemographics medical problems and other types of health evaluations Many of these data elements havebeen standardized which means that they are exactly the same no matter which type of post-acute carefacility is using them

This information is used for multiple purposes such as payment by CMS quality measurement and qualityimprovement The Data Element Library does not contain any patient-identifiable data

It also includes the health information technology (health IT) standards that support the collection ofhealth information which are the nationally agreed upon methods for connecting electronic healthsystems together Integrating these data elements into Electronic Health Records (EHRs) will ultimately

21

22


allow health information to flow more easily from one provider to another because the systems will all beldquospeaking the same languagerdquo CMS says

This database is just one part of the MyHealthEData (httpswwwcmsgovNewsroomMediaReleaseDatabasePress-releases2018-Press-releases-items2018-03-06html) initiative CMS isalso proposing to overhaul the Medicare and Medicaid Electronic Health Record Incentive Programs toincrease flexibility and reduce burden for providers promote information sharing between providers andpatients and incentivize providers to make it easier for patients to obtain their medical recordselectronically

Additional information on CMSrsquos new database can be found at httpswwwcmsgovNewsroomMediaReleaseDatabaseFact-sheets2018-Fact-sheets-items2018-06-21html

Questions can be sent to DELHELPcmshhsgov

Resources

ldquoRevised government data reveals moderation in health spending growthrdquo by the Altarum Centerfor Value in Health Carehttpsaltarumorgsitesdefaultfilesuploaded-related-filesSHSS-Spending-Brief_June_2018pdf

ldquoThe Facts on Medicare Spending and Financingrdquo by the Kaiser Family FoundationhttpfileskfforgattachmentIssue-Brief-Facts-on-Medicaid-Spending-and-Financing

For more information contact Andrew Koski at (518) 810-0662 or akoskihcanysorg

2018 - 2019

Webinars for

Home Health and

Hospice Aides

wwwhca-nysorg

E N JO Y TH E B EN EF ITS O F W EBIN AR B ASED E DUC ATIO N

bull Convenient

bull Cost-Effective

bull No travel expenses or time

bull No limit to the number of participants from your agency through your registered site connection

All Live Webinars Are Held From 300 ndash 400 PM

A Recording of Each Webinar Will Be Accessible for 30 Days Following The Live Event

July 12 2018 The Aidersquos Role in Understanding Hospice and End of Life Care (registration deadline is July 6) Speaker Cindy Morgan RN MSN CHC CHPN What does End-of-Life and Hospice care really mean This presentation will clarify the meaning of hospice and EOL care Some of the misconceptions about hospice and EOL care will be discussed and explained Participants will have a better understanding of helping patients live until they die and strategies that will promote quality of life at the end of life for patients and families

September 13 2018 The Aidersquos Role in Quality Improvement in Home Care (registration deadline is September 7) Speaker Jane Garrett RN BSN MHSA What is QAPI This session will describe the requirement for home health and hospice agencies to conduct Quality Assessment and Performance Improvement (QAPI) activities including a family satisfaction survey How your agency performs on these measures is available to the public In-home aides will learn how they play a role in supporting QAPI

November 8 2018 The Aidersquos Role in Managing Stress in the Workplace (registration deadline is November 2) Speaker Kathie Smith RN BSN Stress is the bodyrsquos reaction to any change that requires an adjustment or response The body reacts to these changes with physical mental and emotional responses You can experience stress from your environment your body your thoughts Even positive life changes such as a promotion or the birth of a child produce stress Taking care of yourself is an important part of your overall wellbeing and stress management is a component of that This presentation will cover tips on managing stress

August 9 2018 The Aidersquos Role in Caring for Older Adults in Home Care (registration deadline is August 3) Speaker Kathie Smith RN BSN According to Healthy People 2020 from the Office of Disease Prevention and Health Promotion as Americans live longer growth in the number of older adults is unprecedented In 2014 463 million of the US population was aged 65 or older and is projected to reach 98 million by 2060 In 2012 60 of older adults managed 2 or more chronic conditions Many of the clients you provide care for in the home will be older adults with chronic conditions such as heart lung kidney disease diabetes cancer or other conditions This presentation will focus on providing care for the older population

October 11 2018 The Aidersquos Role in HIPAA and Confidentiality (registration deadline is October 5) Speaker Michelle White DNP RN CNL This workshop will focus on assisting your In-Home Aides in understanding HIPAA and confidentiality guidelines This workshop will offer practical tips to ensure that the para-professional adheres to the required privacy standards Also included the impact of social media such as Facebook My Space YouTube and cell phones text messages etc

December 13 2018 The Aidersquos Role in Post-Traumatic Stress Disorder (registration deadline is December 7) Speaker Cindy Morgan RN MSN CHC CHPN An estimated 8 of Americans or 244 million people ndash have PTSD at any given time Learn the risk factors related to PTSD how to best work with your patients who have PTSD and strategies to help promote their best quality of life by attending this webinar

April 11 2019 The Aidersquos Role in Professionalism and Work Ethic in Home Care (registration deadline is April 5) Speaker Kathie Smith RN BSN Providing care in a setting that enables one-to-one care offers opportunities for the client to be able to stay in their home and for the In-home aide to build strong relationships with the client and family These relationships can feel rewarding to both the client and the In-home aide While having that positive and caring relationship is important to the clientrsquos care it is also important to remember that as an employee of an agency and as a home care provider in the home certain standards need to be upheld These standards help you to maintain a professional relationship with the client and family This presentation will cover professionalism for the In-home aide

June 13 2019 The Aidersquos Role in Understanding CVAs (registration deadline is June 7) Speaker Jane Garrett RN BSN MHSA In this webinar it will be discussed how 80 of all strokes can be prevented with healthy behaviors long term effects of a stroke may be minimized with immediate treatment and more people are surviving and beating stroke

January 10 2019 The Aidersquos Role in Ethical Issues Facing Nursing Assistants (registration deadline is January 4) Speaker Jane Garrett RN BSN MHSA In this webinar commonly accepted principles of health care ethics will be discussed This program will help the learner explore examples of difficult situations and how to put these principles into practice and make ethical decisions in the home health care environment

February 14 2019 The Aidersquos Role in TBD (registration deadline is February 1) Speakers John Conrad and Libby Hart RN This session has not been finalized at this time

March 14 2019 The Aidersquos Role in Infection Prevention and Control (registration deadline is March 1) Speaker Michelle White DNP RN CNL This workshop will focus on understanding the basic principles of infection prevention and control This workshop will also focus on Blood Borne Pathogens and the principles surrounding transmission and methods in which the aide can protect themselves and the patient

May 9 2019 The Aidersquos Role in Understanding Legal Issues for the Nurse Assistant (registration deadline is May 3) Speaker Cindy Morgan RN MSN CHC CHPN No health care provider is immune from the potential for legal issues When providing care for patients it must be done in a legal and ethical manner This presentation will list ethical principles we should consider when delivering care as well as the more common allegations such as negligence assault and battery and abuse that Nurse Aides should understand Increased knowledge promotes adherence to standards of care and compliance with regulations and your agencyrsquos policies and procedures

This webinar series is presented by the Association for Home amp Hospice Care of North Carolina in partnership with HCA Education amp Research Inc offering providers valuable information tools and techniques to enhance practice skills Please be aware that NYS laws and regulations may differ from that discussed in the webinar All NYS providers must adhere to all relevant state and local laws

Fax to (518) 426-8788

REGISTRATION FORM Agency Name _____________________________________________________________________________________ Street Address ____________________________________________________________________________________ CityStateZip _____________________________________________________________________________________ Contact Name and Title _____________________________________________________________________________ Phone_____________________________________________ Fax _________________________________________ Email ___________________________________________________________________________________________ (Required)

PAYMENT Check method of payment (If paying by check check must be received 2 days prior to program date)

________MasterCard ________VISA ________ Check Make checks payable to HCA Education and Research and Mail to 388 Broadway 4th Floor Albany NY 12207

Credit Card _________________________________ Exp Date________ Security Code ____________ ________________________________________________ ________________________________________________ Street Address (Billing for Card) CityStateZip (Billing for Card) ________________________________________________ Name on Card ________________________________________________ Authorized Signature

REGISTRATION FEE Check all that apply (Please note all webinars take place from 300 pm ndash 400 pm)

____ July 12 ____ August 9 ____ Sept 13 ____ Oct 11 ____ Nov 8 _____ Dec 13

____ Jan 10 _____ Feb 14 ____ March 14 ____ April 11 _____ May 9 _____ June 13

HCA Member $149 per program X _____ ( of programs) = $___________ TOTAL DUE

Non-Member $199 per program X _____ ( of programs) = $___________ TOTAL DUE

2018-2019 Webinars for Home Health amp Hospice Aidersquos

Cancellation Policy Fees will be refunded only if written cancellation is received by HCA at infohcanysorg one week prior to the selected program(s) In the event you cancel HCA will retain or charge $40 of the initial fee per registrant to cover administrative processing No refunds after handouts are provided Please contact infohcanysorg if you need assistance or call 518-426-8764

Certificate of Completion Following the webinar a certificate of completion will be emailed to the primary registrant The agency supervisor may sign a certificate for each HHA participating in the webinar for documentation of their training

There is no limit to the number of attendees from your agency who may participate through your single site connection Registration fees are based on each connection and may not be shared between agencies or sites within an agency For multi-site participation each location must be registered Prior to each webinar you will receive an e-mail containing your dial-in and log-in information handouts and a sign-in sheet for your site participants

Recording of each webinar will be made available after the program and will be accessible for 30 days following the live event

Check here to register for the Full Series of 12 Webinars and save $240 HCA Member- $1548 Non-Member- $2148

2

The Situation Report is a weeklypublication of the Home CareAssociation of New York State(HCA) Unless otherwisenoted all articles appearingin The Situation Report are theproperty of the Home CareAssociation of New YorkState Reuse of any contentwithin this newsletterrequires permission fromHCA

Joanne CunninghamHCA President

jcunninghamhcanysorg

Roger L NoyesDirector of CommunicationsEditor of The Situation Report

rnoyeshcanysorg

Al CardilloExecutive V ice President

acardillohcanysorg

Patrick ConoleVice President

Finance amp Managementpconolehcanysorg

Andrew KoskiVice President

Program Policy amp Servicesakoskihcanysorg

Laura Constable Senior Director

Membership amp Operationslconstablehcanysorg

Celisia StreetDirector of Education

cstreethcanysorg

Mercedes Teague Finance Manager

mteaguehcanysorg

Jenny KerbeinDirector of Governance amp

Graphic Designjkerbeinhcanysorg

Billi Wilson Manager Meetings amp Events

bwilsonhcanysorg

Teresa BrownAdministrative Assistant

tbrownhcanysorg

Home Care Association of New York State (HCA)388 Broadway 4th Floor Albany NY 12207

Tele 518-426-8764 Fax 518-426-8788 Website wwwhcanysorg


DELEGATION from p 1

In each of the meetings Ms Cunningham discussed the need toprotect home care providers from upcoming changes in theMedicare home health payment system (called the Home HealthGroupings Model ndash HHGM) including the need to

Ensure that the US Centers for Medicare and MedicaidServices (CMS) does not begin the new system before 2020offering enough time for testing demonstrations andindustry technical guidance

Clarify that the newly created 30-day increments in HHGMwork in a complementary fashion with the existing 60-dayepisode of care that is embedded within the home healthpayment regulatory and operational structure HCA urges alegislative fix so that this 30-day increment is defined as aldquounit of servicerdquo not a ldquounit of paymentrdquo as it is currentlydesigned This would ensure that providers will be paid forall services delivered in the episode and not just receive onepayment for the first 30 days of care

Instruct CMS to examine the physician record along with thehome health agency record for compliance with the federalface-to-face requirement

Ensure that CMS does not include a ldquobehavioral adjustmentrdquoin the new payment system which is not based on dataderived from the actual new payment system

Ms Cunningham also emphasized the need for adoption of HR1825S 445 the Home Health Planning Improvement Act Thislegislation would allow non-physician practitioners such as nursepractitioners and physician assistants to order and certify homehealth services under Medicare This legislation would increaseaccess to home health services for the Medicare population and isstrongly supported by a bipartisan group of Members of Congress inboth chambers HCA has been meeting over the past months withthe office of Rep Chris Collins to assist in strategizing on this billand we support his efforts as the bill sponsor to ensure its passagebefore Congress adjourns in the fall

HCA also brought information to the Congressional Delegationregarding the announcement by CMS to restart its pre-claim reviewdemonstration even after serious problems were identified in the

3













4

















5







SESSION from p 1



6







7








8














9













10

HIRING



Responsibilities




Required Experience







Position Summary












11















12














13











14











15



















16

















17
















18
















19


NHTD




TBI








20


Upcoming Deadlines







Still being

accepted but

providers are

advised to

submit now


indexaspx




(MBI)

April 1 2018 to

December 31

2019



Program RFA

Due June 28

2018




Health Innovations

Application due





Medicaid


indexaspx



and Illnesses)










employees




Due July 16

2018 (extensions

may be granted

as per HCArsquos

request to DOH

contact HCA for

details)




New Due Date















21

22






Resources




2018 - 2019

Webinars for

Home Health and

Hospice Aides

wwwhca-nysorg


bull Convenient

bull Cost-Effective


















Fax to (518) 426-8788
















3













4

















5







SESSION from p 1



6







7








8














9













10

HIRING



Responsibilities




Required Experience







Position Summary












11















12














13











14











15



















16

















17
















18
















19


NHTD




TBI








20


Upcoming Deadlines







Still being

accepted but

providers are

advised to

submit now


indexaspx




(MBI)

April 1 2018 to

December 31

2019



Program RFA

Due June 28

2018




Health Innovations

Application due





Medicaid


indexaspx



and Illnesses)










employees




Due July 16

2018 (extensions

may be granted

as per HCArsquos

request to DOH

contact HCA for

details)




New Due Date















21

22






Resources




2018 - 2019

Webinars for

Home Health and

Hospice Aides

wwwhca-nysorg


bull Convenient

bull Cost-Effective


















Fax to (518) 426-8788

















4

















5







SESSION from p 1



6







7








8














9













10

HIRING



Responsibilities




Required Experience







Position Summary












11















12














13











14











15



















16

















17
















18
















19


NHTD




TBI








20


Upcoming Deadlines







Still being

accepted but

providers are

advised to

submit now


indexaspx




(MBI)

April 1 2018 to

December 31

2019



Program RFA

Due June 28

2018




Health Innovations

Application due





Medicaid


indexaspx



and Illnesses)










employees




Due July 16

2018 (extensions

may be granted

as per HCArsquos

request to DOH

contact HCA for

details)




New Due Date















21

22






Resources




2018 - 2019

Webinars for

Home Health and

Hospice Aides

wwwhca-nysorg


bull Convenient

bull Cost-Effective


















Fax to (518) 426-8788

















5







SESSION from p 1



6







7








8














9













10

HIRING



Responsibilities




Required Experience







Position Summary












11















12














13











14











15



















16

















17
















18
















19


NHTD




TBI








20


Upcoming Deadlines







Still being

accepted but

providers are

advised to

submit now


indexaspx




(MBI)

April 1 2018 to

December 31

2019



Program RFA

Due June 28

2018




Health Innovations

Application due





Medicaid


indexaspx



and Illnesses)










employees




Due July 16

2018 (extensions

may be granted

as per HCArsquos

request to DOH

contact HCA for

details)




New Due Date















21

22






Resources




2018 - 2019

Webinars for

Home Health and

Hospice Aides

wwwhca-nysorg


bull Convenient

bull Cost-Effective


















Fax to (518) 426-8788

















6







7








8














9













10

HIRING



Responsibilities




Required Experience







Position Summary












11















12














13











14











15



















16

















17
















18
















19


NHTD




TBI








20


Upcoming Deadlines







Still being

accepted but

providers are

advised to

submit now


indexaspx




(MBI)

April 1 2018 to

December 31

2019



Program RFA

Due June 28

2018




Health Innovations

Application due





Medicaid


indexaspx



and Illnesses)










employees




Due July 16

2018 (extensions

may be granted

as per HCArsquos

request to DOH

contact HCA for

details)




New Due Date















21

22






Resources




2018 - 2019

Webinars for

Home Health and

Hospice Aides

wwwhca-nysorg


bull Convenient

bull Cost-Effective


















Fax to (518) 426-8788

















7








8














9













10

HIRING



Responsibilities




Required Experience







Position Summary












11















12














13











14











15



















16

















17
















18
















19


NHTD




TBI








20


Upcoming Deadlines







Still being

accepted but

providers are

advised to

submit now


indexaspx




(MBI)

April 1 2018 to

December 31

2019



Program RFA

Due June 28

2018




Health Innovations

Application due





Medicaid


indexaspx



and Illnesses)










employees




Due July 16

2018 (extensions

may be granted

as per HCArsquos

request to DOH

contact HCA for

details)




New Due Date















21

22






Resources




2018 - 2019

Webinars for

Home Health and

Hospice Aides

wwwhca-nysorg


bull Convenient

bull Cost-Effective


















Fax to (518) 426-8788

















8














9













10

HIRING



Responsibilities




Required Experience







Position Summary












11















12














13











14











15



















16

















17
















18
















19


NHTD




TBI








20


Upcoming Deadlines







Still being

accepted but

providers are

advised to

submit now


indexaspx




(MBI)

April 1 2018 to

December 31

2019



Program RFA

Due June 28

2018




Health Innovations

Application due





Medicaid


indexaspx



and Illnesses)










employees




Due July 16

2018 (extensions

may be granted

as per HCArsquos

request to DOH

contact HCA for

details)




New Due Date















21

22






Resources




2018 - 2019

Webinars for

Home Health and

Hospice Aides

wwwhca-nysorg


bull Convenient

bull Cost-Effective


















Fax to (518) 426-8788

















9













10

HIRING



Responsibilities




Required Experience







Position Summary












11















12














13











14











15



















16

















17
















18
















19


NHTD




TBI








20


Upcoming Deadlines







Still being

accepted but

providers are

advised to

submit now


indexaspx




(MBI)

April 1 2018 to

December 31

2019



Program RFA

Due June 28

2018




Health Innovations

Application due





Medicaid


indexaspx



and Illnesses)










employees




Due July 16

2018 (extensions

may be granted

as per HCArsquos

request to DOH

contact HCA for

details)




New Due Date















21

22






Resources




2018 - 2019

Webinars for

Home Health and

Hospice Aides

wwwhca-nysorg


bull Convenient

bull Cost-Effective


















Fax to (518) 426-8788

















10

HIRING



Responsibilities




Required Experience







Position Summary












11















12














13











14











15



















16

















17
















18
















19


NHTD




TBI








20


Upcoming Deadlines







Still being

accepted but

providers are

advised to

submit now


indexaspx




(MBI)

April 1 2018 to

December 31

2019



Program RFA

Due June 28

2018




Health Innovations

Application due





Medicaid


indexaspx



and Illnesses)










employees




Due July 16

2018 (extensions

may be granted

as per HCArsquos

request to DOH

contact HCA for

details)




New Due Date















21

22






Resources




2018 - 2019

Webinars for

Home Health and

Hospice Aides

wwwhca-nysorg


bull Convenient

bull Cost-Effective


















Fax to (518) 426-8788

















11















12














13











14











15



















16

















17
















18
















19


NHTD




TBI








20


Upcoming Deadlines







Still being

accepted but

providers are

advised to

submit now


indexaspx




(MBI)

April 1 2018 to

December 31

2019



Program RFA

Due June 28

2018




Health Innovations

Application due





Medicaid


indexaspx



and Illnesses)










employees




Due July 16

2018 (extensions

may be granted

as per HCArsquos

request to DOH

contact HCA for

details)




New Due Date















21

22






Resources




2018 - 2019

Webinars for

Home Health and

Hospice Aides

wwwhca-nysorg


bull Convenient

bull Cost-Effective


















Fax to (518) 426-8788
















12














13











14











15



















16

















17
















18
















19


NHTD




TBI








20


Upcoming Deadlines







Still being

accepted but

providers are

advised to

submit now


indexaspx




(MBI)

April 1 2018 to

December 31

2019



Program RFA

Due June 28

2018




Health Innovations

Application due





Medicaid


indexaspx



and Illnesses)










employees




Due July 16

2018 (extensions

may be granted

as per HCArsquos

request to DOH

contact HCA for

details)




New Due Date















21

22






Resources




2018 - 2019

Webinars for

Home Health and

Hospice Aides

wwwhca-nysorg


bull Convenient

bull Cost-Effective


















Fax to (518) 426-8788
















13











14











15



















16

















17
















18
















19


NHTD




TBI








20


Upcoming Deadlines







Still being

accepted but

providers are

advised to

submit now


indexaspx




(MBI)

April 1 2018 to

December 31

2019



Program RFA

Due June 28

2018




Health Innovations

Application due





Medicaid


indexaspx



and Illnesses)










employees




Due July 16

2018 (extensions

may be granted

as per HCArsquos

request to DOH

contact HCA for

details)




New Due Date















21

22






Resources




2018 - 2019

Webinars for

Home Health and

Hospice Aides

wwwhca-nysorg


bull Convenient

bull Cost-Effective


















Fax to (518) 426-8788
















14











15



















16

















17
















18
















19


NHTD




TBI








20


Upcoming Deadlines







Still being

accepted but

providers are

advised to

submit now


indexaspx




(MBI)

April 1 2018 to

December 31

2019



Program RFA

Due June 28

2018




Health Innovations

Application due





Medicaid


indexaspx



and Illnesses)










employees




Due July 16

2018 (extensions

may be granted

as per HCArsquos

request to DOH

contact HCA for

details)




New Due Date















21

22






Resources




2018 - 2019

Webinars for

Home Health and

Hospice Aides

wwwhca-nysorg


bull Convenient

bull Cost-Effective


















Fax to (518) 426-8788

















15



















16

















17
















18
















19


NHTD




TBI








20


Upcoming Deadlines







Still being

accepted but

providers are

advised to

submit now


indexaspx




(MBI)

April 1 2018 to

December 31

2019



Program RFA

Due June 28

2018




Health Innovations

Application due





Medicaid


indexaspx



and Illnesses)










employees




Due July 16

2018 (extensions

may be granted

as per HCArsquos

request to DOH

contact HCA for

details)




New Due Date















21

22






Resources




2018 - 2019

Webinars for

Home Health and

Hospice Aides

wwwhca-nysorg


bull Convenient

bull Cost-Effective


















Fax to (518) 426-8788
















16

















17
















18
















19


NHTD




TBI








20


Upcoming Deadlines







Still being

accepted but

providers are

advised to

submit now


indexaspx




(MBI)

April 1 2018 to

December 31

2019



Program RFA

Due June 28

2018




Health Innovations

Application due





Medicaid


indexaspx



and Illnesses)










employees




Due July 16

2018 (extensions

may be granted

as per HCArsquos

request to DOH

contact HCA for

details)




New Due Date















21

22






Resources




2018 - 2019

Webinars for

Home Health and

Hospice Aides

wwwhca-nysorg


bull Convenient

bull Cost-Effective


















Fax to (518) 426-8788

















17
















18
















19


NHTD




TBI








20


Upcoming Deadlines







Still being

accepted but

providers are

advised to

submit now


indexaspx




(MBI)

April 1 2018 to

December 31

2019



Program RFA

Due June 28

2018




Health Innovations

Application due





Medicaid


indexaspx



and Illnesses)










employees




Due July 16

2018 (extensions

may be granted

as per HCArsquos

request to DOH

contact HCA for

details)




New Due Date















21

22






Resources




2018 - 2019

Webinars for

Home Health and

Hospice Aides

wwwhca-nysorg


bull Convenient

bull Cost-Effective


















Fax to (518) 426-8788
















18
















19


NHTD




TBI








20


Upcoming Deadlines







Still being

accepted but

providers are

advised to

submit now


indexaspx




(MBI)

April 1 2018 to

December 31

2019



Program RFA

Due June 28

2018




Health Innovations

Application due





Medicaid


indexaspx



and Illnesses)










employees




Due July 16

2018 (extensions

may be granted

as per HCArsquos

request to DOH

contact HCA for

details)




New Due Date















21

22






Resources




2018 - 2019

Webinars for

Home Health and

Hospice Aides

wwwhca-nysorg


bull Convenient

bull Cost-Effective


















Fax to (518) 426-8788
















19


NHTD




TBI








20


Upcoming Deadlines







Still being

accepted but

providers are

advised to

submit now


indexaspx




(MBI)

April 1 2018 to

December 31

2019



Program RFA

Due June 28

2018




Health Innovations

Application due





Medicaid


indexaspx



and Illnesses)










employees




Due July 16

2018 (extensions

may be granted

as per HCArsquos

request to DOH

contact HCA for

details)




New Due Date















21

22






Resources




2018 - 2019

Webinars for

Home Health and

Hospice Aides

wwwhca-nysorg


bull Convenient

bull Cost-Effective


















Fax to (518) 426-8788
















20


Upcoming Deadlines







Still being

accepted but

providers are

advised to

submit now


indexaspx




(MBI)

April 1 2018 to

December 31

2019



Program RFA

Due June 28

2018




Health Innovations

Application due





Medicaid


indexaspx



and Illnesses)










employees




Due July 16

2018 (extensions

may be granted

as per HCArsquos

request to DOH

contact HCA for

details)




New Due Date















21

22






Resources




2018 - 2019

Webinars for

Home Health and

Hospice Aides

wwwhca-nysorg


bull Convenient

bull Cost-Effective


















Fax to (518) 426-8788





























21

22






Resources




2018 - 2019

Webinars for

Home Health and

Hospice Aides

wwwhca-nysorg


bull Convenient

bull Cost-Effective


















Fax to (518) 426-8788
















22






Resources




2018 - 2019

Webinars for

Home Health and

Hospice Aides

wwwhca-nysorg


bull Convenient

bull Cost-Effective


















Fax to (518) 426-8788
















2018 - 2019

Webinars for

Home Health and

Hospice Aides

wwwhca-nysorg


bull Convenient

bull Cost-Effective


















Fax to (518) 426-8788































Fax to (518) 426-8788
















hca president advocates with new york congressional...

Documents