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COMING UP
HCA CorporateCompliance SymposiumOct. 6RenaissanceAlbany HotelAlbany, NY
Home Care Bootcamp:Understanding theFederal and State Wage& Hour Rules for HomeCareOct. 20VNSNY, 107 East 70th St.NYC
Downstate LHCSAForumOct. 28, 2016Selfhelp FamilyHome Care, Inc.520 EighthAvenue, 5th FloorNYC
PAGE 5 PAGE 7-8 PAGE 12 PAGE 13
Reps. Rice, McGovern Push Stop on Home Health Pre-Claim Review.........1Reminder: Oct. 20 Bootcamp on Federal, State Wage & Hour Rules.........3HCA Prepares Advocacy on Care Planning Improvement Act....................4Western NY Agencies Invited to Voluntary Emergency Exercise................4LTHHCP Exception Code Removed..........................................................5MLTC Update.........................................................................................6HCA and Partners Unveil Sepsis Tool Seeking Provider Buy-In..................7HCA, IPRO Bring Sepsis Awareness to Radio News.................................8DOH Posts Regulatory Agenda................................................................8CMS Announces New CERT Contractor Effective Oct. 14...........................9
Member Hiring Announcements.........................................................10,11Come to HCA’s Downstate LHCSA Forum: Oct. 28....................................11NGS: Hospice Claims Incorrectly Returned to Providers.............................12Quality of Patient Care Star Ratings Preview Reports Now Available...........12Hospice PEPPER Webinar Underscores Importance of Data........................12Final Rule Adopted on OT Assistants............................................................13New Common Benefit Identification Card Available.....................................13NGS Updates.............................................................................................14SS Numbers to be Removed from Medicare Cards.........................................14eMedNY Posts Fall Training.......................................................................15Resources......................................................................................15
INSIDE
Register for all HCAprograms atwww.hcanys.org.
Your Source for HOME CARE News, Policy and Advocacy Vol. 1, Issue 4 | October 3, 2016
See DEMO p. 2
LTHHCP
HCA asks DOH to clear-up“Medicaid Update” articleimplying contrary informationon the role of LTHHCP.
SEPSIS
HCA launches statewiderollout of home care sepsistool and major radio newssplash.
PEPPER
PEPPER webinar explains howreports can be used to identifyintegrity risk.
OT
New OccupationalTherapy rule goes intoeffect.
Reps. Rice, McGovernPush Bill for One-YearMoratorium on HomeHealth Pre-ClaimReview
As you’ve seen in our biweeklynews clips and newsletter, theU.S. Centers for Medicare andMedicaid Services (CMS) hastemporarily paused expansionof its pre-claim review demo,which already went into effectin Illinois – the first demo state– and was slated forimplementation in severalother states (not New York) aswell.
The pause, CMS asserts, wasdue to the need for “additionaleducation efforts” that “will be
HCA held a successful first Women in Healthcare LeadershipSummit in Saratoga late last week, where women health careCEOs, COOs, CFOs, management staff, consultants and public-affairs experts gathered for training on work-life-balanceissues, negotiation strategies, communications, networkingand more. The Summit also featured an Executive Head-Shotbooth, where women got a free photo to share on theirprofessional networks and CVs, as well as an array ofvendors, a wine tasting and other networking events. HCA isproud of all the exceptional women who participated to makethis inaugural program a success, sharing their stories andlearning from one another. Check out the photo above on ourFacebook page (www.facebook.com/HCANYS) and tag yourselfto show your camaraderie with fellow women leaders inhealthcare.
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The Situation Report is a weeklypublication of the Home CareAssociation of New York State(HCA). Unless otherwise noted, allarticles appearing in The SituationReport are the property of theHome Care Association of NewYork State. Reuse of any contentwithin this newsletter requirespermission from HCA.
Joanne CunninghamHCA President
Roger L. NoyesDirector of Communications,Editor of The Situation Report
Al CardilloExecutive V ice President,
Policy & [email protected]
Patrick ConoleVice President,
Finance & [email protected]
Andrew KoskiVice President,
Program, Policy & [email protected]
Alexandra Fitz BlaisDirector of Public Policy
Laura Constable Senior Director,
Membership & [email protected]
Celisia StreetDirector of Education
Mercedes Teague Finance Manager
Jenny KerbeinDirector of Governance &
Special [email protected]
Billi Wilson Manager, Meetings & Events
Teresa BrownAdministrative Assistant
The Situation Report: the Home Care Association of New York State Volume 1, No. 4 October 3, 2016
DEMO from p. 1
Home Care Association of New York State (HCA)388 Broadway, 4th Floor, Albany, NY 12207
Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org
helpful before expansion of the demo to other states.”
In the latest development, two Members of Congress are steppingin to urge support from colleagues on legislation that would delaythe demo for a year. The bill would also require CMS to report onthe project’s impact. “After seven weeks of challenges in Illinois,CMS has plentiful information available to get to the root of anypaperwork concerns and work with Congress on a more targetedcorrective action plan,” states the “Dear Colleague” letter recentlycirculated by U.S. Reps. Tom Price of Georgia and Jim McGovern ofMassachusetts.
Though New York is not one of the states included in the CMSdemo, HCA was concerned from the outset of this proposal thatCMS would ultimately expand the demo beyond the initial phase tomake pre-claim review a national program (or phase it into NewYork). We have advocated vigorously against the proposal, as awhole, for its onerous intrusion into claims-authorization for dulyadministered home health services, not just in New York but inother states as well.
This intrusion comes in the form of third-party MedicareAdministrative Contractors (MACs) deciding, at the prepaymentstage, whether home health claims meet criteria in support ofmedical necessity and whether all coverage requirements are met,including the Medicare face-to-face (F2F) requirement, for eachepisode of care prior to the submission of a claim for billing. Withagencies required to submit documentation before a final claim issubmitted, this demo is a sweeping departure from past integrityefforts, which have largely focused on post-payment audits.
As Home Health Care News recently reported, the experience inIllinois has thus far been stilted, prompting CMS’s decision topause the program. “A major refrain” from the Illinois rollout, HomeHealth Care News reports, “was that there is apparently ‘no rhymeor reason’ as to which pre-claim submissions get affirmed versusdenied. Some agencies said that after an initial rejection, they havere-submitted without making any changes to the documentationand have had the claim affirmed.”
HCA will be alerting New York’s Congressional Delegation to thePrice-McGovern effort and legislation, urging their support to put astop to pre-claim review. HCA has already taken several preemptiveadvocacy steps on this issue, providing written comments to CMS
The Situation Report: the Home Care Association of New York State
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Volume 1, No. 4 October 3, 2016
HCA Offers Oct. 20 Bootcamp:Federal, State Wage & Hour Rules
The attorneys from Hodgson Russ are in-demand experts on all areas of home carelabor law. HCA has invited them to providean even deeper look at labor law issuesduring an October 20 Bootcamp in NewYork City entitled “Understanding theFederal and State Wage & Hour Rules forHome Care Providers and Rising Above theChallenges.”
Hodgson Russ Attorneys Peter Godfrey, JohnGodwin and Emina Poricanin specialize inwage and hour laws for the home careindustry. They’ll discuss the key federal andstate compensation requirements for homecare providers, and cover topics such as:accurate computation of the regular rate ofpay; properly paying overtime; accuratelytracking work time, including travel time;spread of hours and split-shift pay; call-inpay regulations; the Domestic Workers’ Billof Rights; and the Wage Parity Law.
The session will additionally provide anoverview of some of the most pressingchallenges to the home care industry,including litigation of live-in cases,complications created by the elimination ofthe companionship exemption, and the risein private plaintiff class-action litigation.Attendees will develop a greaterunderstanding of their legal obligations andlearn about tips to overcome some of themost difficult issues plaguing the home careindustry today.
You will not want to miss this session, whichis expected to draw a big turnout. Aregistration form is at the back of thisweek’s Situation Report or on our website atwww.hca-nys.org.
about the major flaws in its program, engaging the NewYork Delegation, and summoning our members forgrassroots advocacy.
The pre-claim review demo was originally a “prior-authorization” demo, and HCA’s efforts, including writtencomments and Congressional activity, targeted bothversions. After initially proposing a “prior-authorization”program, CMS changed course by essentially moving theMAC review process to the claims-submission stage(pre-claim review), as distinct from its original prior-authorization proposal, which would have required aMAC decision before services even commenced.
Both versions of the program presented uniqueintrusions: one, intruding on the decision-making ofclinicians at the outset of care (even before services arerendered), and the other questioning claims beingsubmitted for services duly rendered, authorized,documented and prepared for billing.
CMS says the demo was needed in response to previousgovernment reports that show “evidence of fraud andabuse in Medicare’s home health benefit” and a 59percent improper payment rate for home health claimsthat is attributed largely to insufficient documentation.Furthermore, the demonstration states were targeted as“high-risk states” under the temporary moratoria onhome health provider enrollment authorized under theAffordable Care Act.
HCA has argued that the physician F2F encounterrequirement is responsible for the large number ofdocumentation issues targeted by this demo, due to theonerous and unworkable way the requirement has beenadministered by CMS/MACs. HCA has worked and willcontinue to advocate for reforming and simplifying theF2F mandate so that it can be met by home healthagencies and ordering physicians.
HCA’s comments on pre-claim review and prior-authorization are posted to our website in the “Lettersand Comments” section at http://hca-nys.org/category/letters-and-comments.
We will continue to keep you informed of developmentson this new legislative effort and the need for grassrootsadvocacy.
HCA Prepares Advocacy for Lame Duck Push on Care Planning Improvement ActLook for member advocacy alert later this week
HCA and colleagues have long advocated for legislation to allow non-physician practitioners to order and referfor home health services. Legislation has been on the table – for just as long – to resolve this issue, called the“Home Health Care Planning Improvement Act” (S.578/H.R. 1342).
HCA and our federal lobbyist Brett Heimov, of Envision Strategy in Washington, DC, are gearing up for a speciallame duck advocacy campaign to press for this important bill to be passed in the Congressional Sessionanticipated after the November 8 election. HCA will employ its grassroots network of home care providersacross the state to push hard for this federal priority. Please be on the lookout for an advocacy alert this weekwith special instructions, including the use of our Phone2Action online advocacy tool.
This commonsense measure would ease current restrictions on home health care access by allowing nursepractitioners, physician assistants, clinical nurse specialists and other advance practice professionals to orderand certify Medicare home health services.
Right now, only physicians can issue home health orders and conduct certifications. Physician shortages inmany regions of the country result in access disparities for home health services, and the current process ofrequiring physician sign-off is unnecessarily expensive. In fact, a study by Dobson Davanzo estimated a five-year savings of $82.5 million resulting from more flexibility.
HCA has extensively reported on this bill and our past advocacy to push for its resolution. As Congress headsinto a lame-duck session, several measures require its urgent attention, including a spending bill that extendsgovernment funding and addresses the Zika crisis, as well as other bills. This period offers a prime opportunityfor a big push on S.578/H.R. 1342 and other home care priorities. Stay tuned for more information later thisweek.
Western NY Agencies Invited to Voluntary Emergency Exercise
During the week of October 31 to November 4, collaborating partners in the Western Region of the state will beconducting a regional exercise called WRECKIT 2016 (Western Region Emergency Communications, Knowledge,and Information Tests). Western New York providers are encouraged to save the date to participate but it is notrequired.
This voluntary exercise will begin October 31 and progress in stages over the week. It will simulate theapproach and impact of a significant ice storm.
According to planning officials, those home care agencies wishing to participate will engage in an information-gathering effort involving the reporting of high-acuity patients, often referred to as Level 1. This exercise datawill be collated and shared with regional partners, counties and others to build awareness and encourageplanning to meet the needs of this population.
As additional details of this program are shared, we will notify the membership of specific instructions. In themeantime, check for updates on the WRECKIT website at www.wreckit2016.com.
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The Situation Report: the Home Care Association of New York State Volume 1, No. 4 October 3, 2016
LTHHCP Exception Code RemovedHCA asks for clarification
HCA has reached out to the state Department of Health (DOH) about an article in The September 2016Medicaid Update entitled “End-Dating the Long Term Home Health Care Program (LTHHCP) ExceptionCode 30.”
The article is at http://www.health.ny.gov/health_care/medicaid/program/update/2016/sep16_mu.pdf(page 8).
While the article covers the removal of code 30 for LTHHCP participants who are transitioning intomanaged care, it gives the impression that the program closed on May 27, 2016, when in fact the waiverexpiration is an entirely separate matter from the LTHHCP operating authority and broader options forLTHHCPs to continue to serve patients and contract with partners.
The continued vital role for LTHHCPs is indicated in a DOH Questions and Answers (Q&A) documentdated July 26, 2016 (http://www.health.ny.gov/health_care/medicaid/redesign/mrt90/2016-08-10_qandas_lthhcp.htm) that offers guidance on LTHHCP provider operations, roles, patient access, andnew opportunity areas.
This guidance resulted from the advocacy of HCA, provider members and key DOH officials.
The Q&As both clarify and affirm that LTHHCPs are authorized in their own right, and under theiroperating certificates, to operate and provide services under Medicaid and Medicaid/Medicare directly(following home health agency procedures), as well as under:
Medicare, Managed care, MLTC and FIDA plans to provide services, care management or otherpermissible contract services (including skilled and nonskilled, professional, aide and waiveredservices) for Medicaid or dual Medicaid-Medicare managed care plan enrollees, includingcontracts for services allowable under PHL Article 49 (utilization review organizations);
Medicaid-covered personal care services for local departments of social services, the DeliverySystem Reform Incentive Payment (DSRIP) program, accountable care organizations, healthhomes, value based payment arrangements, private pay, etc.
Additionally, LTHHCPs may contract to provide both state plan services and waivered services or caremanagement services under the Community First Choice state plan amendment, the Nursing HomeTransition and Diversion Waiver, the Traumatic Brain Injury Waiver, and the Care at Home Waivers.
HCA expressed our concern to DOH that managed care plans, providers and other entities will read theMedicaid Update story and think that the LTHHCP is closed, and we have asked the Department to issuea clarification.
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Volume 1, No. 4 October 3, 2016The Situation Report: the Home Care Association of New York State
MLTC Update
The following managed long term care (MLTC) update was presented at the September 29 meeting of thestate’s Medicaid Managed Care Advisory Review Panel.
FIDA
The state is running a Fully Integrated Duals Advantage (FIDA) ad campaign until January 2017 that consistsof: audio, digital, print, outdoor advertisements and promotional materials. The state hopes to make adecision about the future of FIDA by the end of October, including any revisions to the program.
NHTD/TBI Transition to Managed Care
A Waiver Stakeholder Phase II meeting was held on September 14, at which the 1915(c) waivertransition timeline and Common Elements of Public Comments were discussed.
The state’s draft NHTD/TBI Transition Plan, as well as materials from a June 22 webinar, Transitiontimeline, and Common Elements of Public Comments, are at https://www.health.ny.gov/health_care/medicaid/redesign/mrt90/tbi-nhtd_waiver_trans_ingo.htm.
A second Waiver Stakeholder Phase II meeting is scheduled for October 19.
Community First Choice Option
New York State Medicaid is adding Community First Choice Option (CFCO) State Plan services toMedicaid Managed Care (MMC) and MLTC, effective January 1, 2017.
Access to CFCO services requires Medicaid-eligible consumers to: have an assessed need for aninstitutional level of care; be able to live safely in the community if they receive CFCO services; andreside in their own home or the home of a family member.
Many CFCO State Plan services are already available in the managed care benefit package, includingNon-Emergency Transportation.
New services being added include assistive technology; activities of daily living and instrumentalactivities of daily living skill acquisition, maintenance, and enhancement; community transitionalservices; home-delivered meals; environmental modifications; and vehicle modifications.
An informational webinar was recently recorded for stakeholders to announce the launch of CFCOservice options, available at: https://www.health.ny.gov/health_care/medicaid/redesign/community_first_choice_option.htm. Questions from this webinar are being used to develop aguidance document that will provide more detailed information for stakeholders.
An Administrative Directive Memorandum (ADM) was drafted to introduce CFCO and provide detailedguidance for Local Departments of Social Services (LDSS) regarding delivery and implementation of
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The Situation Report: the Home Care Association of New York State
this set of services. The ADM underwent a public comment period; editing and review of a finalversion is underway.
October deliverables include: 1) provide a policy paper for plans, including billing guidelines andservice-authorization criteria; 2) provide plans with a list of providers to allow them to begincontracting; 3) provide plans with an insert for the member handbook regarding CFCO services; 4)develop a template letter for plans to distribute to members announcing Medicaid coverage of CFCOservices; 5) and continue to work with the state’s enrollment broker, New York Medicaid Choice, toensure readiness to educate consumers on CFCO services and enrollment options.
November deliverables include: a webinar specifically geared towards managed care organizationsand trade associations to provide information on best practices for implementation of CFCO servicesand supports; and DOH guidance and work with plans to ensure their ability to explain and deliverservices, including service-authorization criteria, a member handbook, educational materials, policiesand procedures, and establishment of provider network.
HCA, Partners Unveil First-in-Nation Home Care Sepsis Tool Seeking Provider Buy-In
On Friday, HCA was joined by major national and state partners on a groundbreaking webinar to unveil afirst-of-its-kind effort for sepsis awareness, prevention, early recognition and intervention in home care.
HCA partners on the webinar included representatives of the U.S. Centers for Disease Control andPrevention, the Governor’s Office, the state Department of Health, IPRO, the National Sepsis Alliance, andthe Rory Staunton Foundation for Sepsis Prevention.
The webinar drew over 200 participants. It provided the first statewide walkthrough and launch of HCA’ssepsis screen and protocol developed for implementation through home care agencies. IPRO has alreadyincorporated the tool as the basis for community-based sepsis screening and home care agency trainingunder a U.S. Centers for Medicare and Medicaid Services project.
Webinar leaders provided background on sepsis, declared it a “health emergency,” and outlined staggeringdata about this severe and life-threatening condition. The webinar’s core purpose, however, was a statewideintroduction of the HCA home care sepsis screening tool and protocol, including a detailed step-by-stepwalkthrough of the tool’s screening and corresponding intervention processes.
Over a quarter of a million individuals die of sepsis every year. Sepsis is the number one cause of Medicare30-day hospital readmissions in New York State. At nearly $24 billion annually, sepsis is among the leadingnational health care expenditures.
The HCA sepsis tool breaks new ground in New York and nationally in equipping home health providers withan instrument and protocol to prevent and combat this condition, and to take aim at this public health priorityand emergency.
Friday’s webinar was the first of at least three installments that will prepare providers for incorporation ofthe tool. To register for the next sessions, which are listed on the next page, click the registration link at
Volume 1, No. 4 October 3, 2016
The Situation Report: the Home Care Association of New York State
(https://qualitynet.webex.com/mw3100/mywebex/default.do?siteurl=qualitynet). Next, locate each of thesessions by date (listed chronologically) and click on “Register” to the right of the session name.
Part II: Oct. 20 (10:30 a.m. to noon), focuses on agency adoption of the tool and integration intoyour electronic health records.
Part III: Nov. 9 (10:30 a.m. to noon). This is a train-the-trainer program.
HCA urges all home care providers to adopt and incorporate this critical, lifesaving initiative within youragencies upon its release.
For further information, please contact [email protected].
HCA, IPRO Bring Sepsis Awareness to Radio News Broadcasts on Several UpstateNew York Stations HCA Executive Vice President Al Cardillo, IPRO Quality Director Sara Butterfield, and IPRO Sepsis ProjectLeader Eve Bankert were featured this weekend on a widely broadcast radio-news program to promotesepsis public awareness and describe clinical initiatives being partnered by IPRO and HCA.
The radio coverage, as part of the Upstate Issues weekly program, spanned several radio stations,including WGY, which reaches across broader New York State and New England. The program reached alarge set of stations including WGY (810 AM and 103.1 FM) and FM stations: The River (99.5), Kiss FM(102.3), Oldies 98.3, and PYX 106 (106.5).
A link to the segment online is at http://wgy.iheart.com/onair/upstate-issues-57169/a-deadly-ignorance-15142256/. HCA thanks Diane Donato, News Anchor/Public Affairs Director at iHeartMedia, for theinterview, as well as WGY radio host Joe Gallagher for recommending the topic.
DOH Posts Regulatory Agenda
The September 28 State Register includes the state Department of Health’s posting of regulatory actions underconsideration for submission as a Notice of Proposed Rulemaking from June through December 2016.
The notice is at http://docs.dos.ny.gov/info/register/2016/sept28/toc.html. (See p. 145.)
Some areas under consideration by DOH include:
Update the need methodology used to estimate the need for CHHAs.
Update the need methodology used to estimate the need for hospice care and services.
Provide for reimbursement of the cost of preadmission assessments by Assisted Living Programs.
Continued on next page
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The Situation Report: the Home Care Association of New York State
Requiring managed care organizations to maintain a file on each request for health care services orbenefits and associated appeals.
Update the criminal history record check program to include definitions and requirements for hospicesand adult care facilities.
Amend the hospice regulations to make them consistent with the federal conditions of participation.
Consolidate and streamline provisions related to assisted living residences as they exist in adult homesand enriched housing programs.
Set forth in regulations the requirements for the Community First Choice Option.
Allow for annual authorizations and delete the requirement that authorization of Personal EmergencyResponse Services (PERS) be contingent upon a reduction or elimination of personal care aide/homehealth aide hours.
Allow primary care services to be provided offsite by all Article 28 outpatient departments of generalhospitals and Diagnostic and Treatment Centers and both to be reimbursed consistent with what iscurrently allowed for Federally Qualified Health Centers
HCA monitors the posting of proposed and final rules in the State Register, notifies members on significant rules,and provides comments on issues that affect home care and hospice providers and consumers.
CMS Announces New CERT Documentation Contractor Effective October 14
The U.S. Centers for Medicare and Medicaid Services (CMS) has announced an August 16 contract withAdvanceMed for Comprehensive Error Rate Testing (CERT) Review Contractor work.
This new contract replaces Livanta, the current CERT Documentation Contractor, as of October 13, 2016. Thework will be transitioned to the new contract and fully operational on October 14, 2016.
October 6, 2016 is the last day that the current CERT Documentation Contractor will be receiving medical recordsand CERT inquiries at its location.
Beginning October 7, 2016, all CERT inquires and medical records are to be sent to the following locations: CERTDocumentation Center, 1510 East Parham Road, Henrico, VA 23228; fax to 804-261-8100; customer service at443-663-2699; toll free number is 888-779-7477; e-mail is [email protected].
The public website (https://www.certprovider.com) will remain in use as the official web address. The MedicareAdministrative Contractor (MAC) website (https://www.certdoc.org) will remain active temporarily and take usersto the existing CERT Claim Status web site where new features have been added.
Note: The functionality to accept provider address updates will not be available from October 6, 2016 throughOctober 13, 2016.
For further information, contact Patrick Conole at (518) 810-0661 or [email protected].
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Volume 1, No. 4 October 3, 2016
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The Situation Report: the Home Care Association of New York State
Director of Patient Services, HomeCare/Hospice Program—BrookhavenMemorial Hospital Medical Center(Patchogue, Long Island, NY) is changingevery day. With a brand new cardiac carecenter about to open and constant careadvances throughout the hospital, there’san air of change and excitement about all ofthe possibilities of the future. Our stellar306-bed acute-care community hospital ispart of a multidisciplinary, multi-campus,healthcare complex, serving 28communities in Suffolk County.
Duties and requirements of home careDPS:
Plan, direct, coordinate andevaluate the delivery of homehealth/hospice services
Ensure high quality and effectivepatient care
Ensure that Home Care/Hospicedepartmental activities are incompliance with all regulatoryguidelines
Assign middle managers toimplement the planning, directionand controlling of service deliverymanagement
Education: Knowledge of nursingtheory/practice acquired throughcompletion of at least 2 years oftraining at an accredited school ofnursing a must. BSN required.Master’s preferred.
Experience: 2-3 years’ experienceas a supervisory community healthnurse/home care manager.
Knowledge: Communityhealthcare, governmentallicensure regulations and Medicarecriteria.
Licenses/Cert: Current NYS RN &BLS required.
Strong interpersonal skills toeffectively interact with patients/people in their support system aswell as analytical ability to assess/develop clinical solutions.
Email a résumé: [email protected]/M/F/Vet/Disabled
Living Resources Certified Home Health Agency in Albany is growing and weare seeking a dynamic leader to fill this pivotal DPS position.
This position is responsible for overall strategic, clinical, operational andfinancial leadership to the CHHA and ensures high quality, cost effective care.This individual will work in collaboration with the Living ResourcesCorporation’s CEO and Associate Executive Director to ensure the integrity ofthe agency in accordance with the goals and objectives of the agency as setforth by the Board of Directors.
Qualifications: Current RN license, required Bachelor’s degree, Master’sdegree preferred; minimum of three years of management experience inhome health care or related field.
For immediate consideration, please forward résumé/cover letter and salaryrequirements in confidence to Lisa Razanousky [email protected].
Additional opportunities available: Clinical Manager, RNs, Physical Therapists,Occupational Therapists, Home Health Aides and PCAs.
HIRING: Director of Patient Services (DPS) Sought at Three Organizations
Essex County Nursing Services, Elizabethtown, New York, located in theheart of the Adirondacks is seeking an experienced individual who has the willand determination to successfully lead the agency in today’s home healthcare environment.
This DPS position involves planning, organizing, directing, coordinating andevaluating patient care services provided by the certified home healthagency. The Director of Patient Services is responsible for the professional andfinancial operations of the agency; and provides and ensures that qualityimprovement is the main focus of the agency.
MINIMUM QUALIFICATIONS: A Masters or Baccalaureate Degree in Nursingfrom an approved program, or from a non-approved program supplementedby content which can be equated to an approved program, and either: A) Twoyears of experience in a management level position in a certified home healthagency; or B) A combination of education and experience which is deemedequivalent to the experience requirement as specified above and by the StateOffice of Health Systems Management.
BENEFITS: Excellent county/government benefits including New York StateRetirement System. Great team of professionals to work with.
Candidates must possess a limited permit to practice or licensure and currentregistration to practice as a Registered Professional Nurse in New York Stateat the time of appointment.
Qualified candidates will be subject to a civil service examination to beannounced at a later date. Applications will be accepted until the announcedclosing date for the examination.
Please go to www.co.essex.ny.us/job.asp to complete an application and toview a complete job description.
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The Situation Report: the Home Care Association of New York State Volume 1, No. 4 October 3, 2016
Come to HCA’s DownstateLHCSA Forum: Oct. 28
As recently reported in HCA alertsand communications, a set of draftstate guidelines on the minimumwage funding mechanism for homecare is fast taking shape. Thisdevelopment is among the top issuesthat HCA’s policy and executive teamwill bring to you during our October28 Downstate LHCSA Forum in NewYork City.
HCA recently held an upstate sessionof the LHCSA Forum, with an agendaof items unique to LHCSAs in thisregion. Our Downstate LHCSA Forumon October 28 will similarly addressissues of concern for LHCSAs in thedownstate region, includingminimum wage, Fair Labor StandardsAct (FLSA) and Quality Incentive/Vital Access Provider Pool (QIVAPP)monies, regulatory changes affectingyour operation, the status of uniformbilling codes, DSRIP and Value BasedPayments, and any additional issuesor concerns you want to raise.
These Forums are for HCA members-only and offer a chance for yourteam to get LHCSA-focused updates.If your agency is a LHCSA or has aLHCSA in your organization, pleasebe sure to register, so we can planfor your attendance, or share thisprogram with your downstate LHCSAcolleagues. Simply complete the PDFform at the link below.
Register for Downstate LHCSAForum: http://hca-nys.org/wp-content/uploads/2016/09/HCA-Downstate-LHCSA-Forum-October-28-2016-Registration-Form.pdf.
HIRING: Hospice & Palliative CareAssociation of NYS (HPCANYS)President/CEO
Reporting to the Board of Directors, the President/CEOhas overall strategic and operational responsibility forthe HPCANYS nonprofit’s staff, programs, expansionand mission. This individual will initially develop deepknowledge of core programs, operations, financialsand business plans.
The President/CEO leads association activities, asauthorized by the Board of Directors, HPCANYS’strategic plan, and budget. He or she serves as liaisonbetween member providers, the NYS Department ofHealth and the community, including building,developing and fostering communications withpolitical, economic and affiliated organizations in thestate and national realm.
Responsibilities Include:
Ensure programmatic excellence andevaluation, as well as consistent quality offinance and administration, fundraising,communications, and systems.
Design and implement short-term and long-range plans to fulfill membership goals andorganizational mission within a sustainablebudget framework.
Policy, legislative, and regulatory advocacysupporting the Association’s mission.
Revenue expansion and fundraising forexisting and future program operations,including grants and non-dues revenue.
Serving as external local and national presencecommunicating program results with anemphasis on successes and sharedpartnerships.
For all requirements and information, visit https://www.ziprecruiter.com/jobs/new-york-state-hospice-palliative-association-d27bcf66/president-ceo-hospice-palliative-care-association-of-nys-da6667f6.
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Hospice Claims Incorrectly Returned to Provider with Reason Code U5112
New York’s hospice Medicare Administrative Contractor, National Government Services (NGS), reported lastweek that hospice claims are incorrectly being returned to the provider with reason code U5112. Providerswill also see a secondary reason code of U5196 on the returned claim.
Multiple bill types for hospice claims are being returned. The cause of this issue has been identified by theFiscal Intermediary Standard System (FISS). No provider action is required at this time. NGS says it willprovide updates when available, and encourages providers to watch the Production Alerts section of itswebsite and e-mail updates for additional information regarding this issue.
Quality of Patient Care Star Ratings Preview Reports Now Available
The U.S. Centers for Medicare and Medicaid Services (CMS) announced this week that the Home HealthQuality of Patient Care Star Ratings Preview Reports and the Home Health Compare Provider Preview Reportsare now available in the Provider CASPER folders.
These reports contain data that will be publicly reported on the Home Health Compare website in January2017.
October 24, 2016 is the deadline to submit a request to have the Quality of Patient Care star rating datasuppressed. Providers should follow the directions laid out in the Quality of Patient Care Star Rating PreviewReport to submit a suppression request.
The October 2016 refresh of the Home Health Compare website will occur on October 19, 2016. This data willmatch the preview reports that were uploaded to CASPER in July.
Questions about these reports can be directed to [email protected].
Additional information on CMS’s Home Health Quality Initiative is at:https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/HHQISpotlight.html.
For further information, contact Patrick Conole at (518) 810-0661 or [email protected].
Hospice PEPPER Webinar Underscores Importance of Data in Uncovering Audit Risk
HCA staff this week participated in a webinar sponsored by the Visiting Nurse Associations of America(VNAA) on “Understanding Your Hospice PEPPER.” The webinar was conducted by the Medicare contractorTMF, Health Quality Institute.
The Program for Evaluating Payment Patterns Electronic Report (PEPPER) summarizes an individual hospice’sMedicare claims data statistics and compares it with aggregate Medicare data for all hospices in the nation,for all hospices in one’s Medicare Administrative Contractor (MAC) Jurisdiction, as well as with all hospices inone’s state. The report is also available for home health.
The webinar explained that hospices and other providers should pay close attention to their PEPPER reportssince Medicare providers are under intense audit scrutiny by entities such as the Office of Inspector General
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(OIG), the MACs, Recovery Auditors, Supplemental Medical Review Contractors and the ComprehensiveError Rate Testing Contractors. By reviewing one’s PEPPER report, providers can determine if any of theirMedicare claims statistics might be considered an outlier – compared to peers across the nation, MACJurisdiction or state – and might be a “red flag” to auditors.
For hospices unable to participate in the webinar, the presentation can be downloaded at http://hca-nys.org/wp-content/uploads/2016/10/HospicePEPPERVNAA092816.pdf. It provides additional information onthe PEPPER comparison groups, the percentiles used in determining outliers in PEPPER, how to access one’sPEPPER, as well as strategies to consider when reviewing it.
For further information, contact Patrick Conole at (518) 810-0661 or [email protected].
Final Rule Adopted on OT Assistants
On September 13, the state Education Department (SED) Board of Regents adopted a rule that covers thelicensure of Occupational Therapy Assistants.
The rule is at http://www.counsel.nysed.gov/common/counsel/files/rulesandregs/Part%2076%20TERMS_0.pdf.
It codifies and defines the practice of occupational therapy assistants, establishes requirements forlicensure, and requires at least one occupational therapy assistant to serve on the State Board forOccupational Therapy.
The practice of occupational therapy assistant is defined as the provision of occupational therapy andclient-related services under the direction and supervision of an occupational therapist or a licensedphysician. The rule also establishes the requirements for licensure of occupational therapy assistants,which include education, experience and examination requirements. In addition, it provides for a “grand-parenting” licensure pathway for individuals to qualify for a license as an occupational therapy assistant,without an examination, if they had a current registration on February 3, 2012 with SED and satisfy thespecified education, experience, age, moral character and fee requirements.
The rule is effective September 28.
New Common Benefit Identification Card Available
Effective August 1, 2016, the new Common Benefit Identification Card (CBIC) is available to Medicaidconsumers who do not already have a card or need to request a replacement card.
Issuance of the new cards began at the two over-the-counter card issuance sites in New York City, and amailing of CBIC cards with the new design will begin statewide in late September 2016.
There will be no mass replacement of existing cards as a result of the new card design. Existing active blueand white cards with the current logo will continue to work throughout this transition and must be acceptedby all Medicaid enrolled providers, including pharmacies, according to current procedures.
CBIC cards (also called Electronic Benefits Transfer/EBT) are available to those who qualify forSupplemental Nutrition Assistance Program (SNAP) or cash benefits (Temporary Assistance). The EBT card
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looks like a debit card and allows consumers to buy groceries and other items with their cash benefits atparticipating stores and other locations.
Additional information on the new card design can be found at: www.otda.ny.gov/workingfamilies/ebt.asp.
NGS Updates
National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), has recentlyposted the following information to its website.
NGS Closed for Columbus Day – All NGS offices will be closed Monday, October 10, 2016 for theColumbus Day holiday. Providers will be able to access NGSConnex and use the Interactive VoiceSystem (IVR) system at 1-866-275-3033.
NGS to Conduct Hospice Cap Review – NGS is completing a hospice cap look-back review for the2012-2014 periods. (The review ends September 30, 2016.) Medicare regulation 42 CFR Section405.1885 provides that all hospice cap calculations may be reopened by the MAC within three yearsof the cap determination notice. This three-year look-back review is due to the potential ofbeneficiary and reimbursement changes.
Current beneficiary totals and net reimbursement for each applicable cap period will be compared tothe beneficiary totals and net reimbursement computed during the original calculation using thatperiod’s statutory cap amounts. NGS will send a letter reopening the hospice cap to the provider,identifying any additional amount due or any refund as a result of the review.
The 2015 hospice cap review is scheduled to occur in the last quarter of 2016 and notices will be sentto all hospice providers with the results. Providers that have questions related to this hospice caplook-back review can send an e-mail to: [email protected]
For further information, contact Patrick Conole at (518) 810-0661 or [email protected].
Social Security Numbers to be Removed from Medicare Cards
Previously enacted Federal legislation requires the U.S. Centers for Medicare and Medicaid Services (CMS) toremove Social Security Numbers (SSNs) from all Medicare cards by April 2019.
A new randomly generated Medicare Beneficiary Identifier (MBI) will replace the SSN-based HealthInsurance Claim Number (HICN) on the new Medicare cards for Medicare transactions like billing, eligibilitystatus, and claim status. The MBI will be 11 characters in length and made up only of numbers anduppercase letters (no special characters).
CMS will start mailing new Medicare cards with MBIs to people with Medicare no earlier than April 2018.CMS plans to have a transition period where providers can use either the HICN or MBI to exchange data. Thetransition period will begin no earlier than April 1, 2018 and run through December 31, 2019.
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CMS advises providers to look at their practice management systems and business processes anddetermine what changes need to be made to use the new randomly generated MBI. Providers will need tomake those changes and test them by April 2018, before CMS sends out new Medicare cards.
Providers, starting in 2018, can ask their Medicare patients at the time of service if they have a new cardwith an MBI. During the transition period, CMS will return the MBI on the remittance advice when a claimis submitted using the patient’s HICN.
CMS will use the message field on the eligibility transaction responses to tell providers when it hasmailed a new Medicare card to each person with Medicare.
During the transition period, providers can use the patient’s MBI or HICN to check Medicare eligibility.Once the transition period ends, providers must use the MBI to check eligibility.
More information is at https://www.cms.gov/Medicare/SSNRI/Index.html.
eMedNY Posts Fall Training
eMedNY has posted its fall training for seminars and webinars and registration is being accepted.
Some of the topics include:
Revalidation
ePACES for Home Health, DME, Institutional settings, Nursing Homes, Physicians, Private DutyNursing, and Transportation
eMedNY Website Review
New Provider/ New Biller
Medicaid Eligibility Verification Systems (MEVS)
Seminars are available at the following locations: Hauppauge, Mayville, New York City, Poughkeepsie,Rensselaer, Syracuse, Watertown.
The training calendar is at https://www.emedny.org/training/index.aspx.
Resources
“Electronic Health Information: HHS Needs to Strengthen Security and Privacy Guidance andOversight” by the Government Accountability Officehttp://www.gao.gov/products/GAO-16-771
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“New Law Requires 7-Day Medicaid Application Approval if ‘Immediate Need’ for Personal Care orCDPAP — Addresses Delays in Enrolling in MLTC Plans,” by New York Legal Assistance Grouphttp://www.wnylc.com/health/entry/203/
“DSRIP Annual Statewide Learning Symposium (September 20-22, 2016)http://www.publicconsultinggroup.com/client/nysdsrip/library/may2016.html
“Quality in Home and Community-Based Services to Support Community Living: Addressing Gaps inPerformance Measurement,” by the National Quality Forumhttp://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=83433
“Fingerprint Requirements for Medicare Enrollment,” National Government Serviceshttp://tinyurl.com/hvwv7gl
“Handwriting on Claims Submitted to Medicare,” National Government Serviceshttp://tinyurl.com/hs2s727
“Preparing for Better Health and Health Care for an Aging Population,” Journal of the AmericanMedical Association (September 26, 2016)http://jama.jamanetwork.com/article.aspx?articleid=2556000
“Falls and Fall Injuries Among Adults Aged 65 Years — United States, 2014,” by the Center for DiseaseControl and Preventionhttp://www.cdc.gov/mmwr/volumes/65/wr/mm6537a2.htm
For more information, contact Andrew Koski at (518) 810-0662 or [email protected].
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October 20, 2016 10:00am – 12:30pm Employment attorneys from Hodgson Russ, LLP, specializing in wage and hour laws for the home care industry, will discuss the key federal and state compensation requirements for home care providers. This session will cover topics such as accurate computation of the regular rate of pay, properly paying overtime, accurately tracking work time, including travel time, spread of hours and split-shift pay, call-in pay regulations, the Domestic Workers’ Bill of Rights, and Wage Parity Law. The session will also provide an overview of some of the most pressing challenges to the home care industry, including litigation of live-in cases, complications created by the elimination of the companionship exemption, and the rise in private plaintiff class action litigation. Through an interactive and question-and-answer session, attendees will develop a greater understanding of their legal obligations and learn about tips to overcome some of the most difficult issues plaguing the home care industry today. Presenters from Hodgson Russ, LLP: Peter Godfrey, Partner John Godwin, Partner Emina Poricanin, Senior Associate
October 20, 2016
Location: Visiting Nurse Service
of New York 107 East 70th Street
(between Park and Lexington Ave) New York, NY 10021
9:30 to 10:00am
Registration and continental breakfast
10:00am to 12:30pm
Program
Understanding the Federal and State Wage & Hour Rules for Home Care Providers and Rising Above the Challenges
REGISTRATION – (Deadline October 14th) Name: _________________________________________________ Title:__________________________________________________ Agency:________________________________________________ Address:_______________________________________________ City/State/Zip:___________________________________________ Phone:______________________________ Ext._______________ Email: _________________________________________________
REGISTRATION FEE
HCA Members $79 ________ Non-Members $179 ________
PAYMENT ____MasterCard ____VISA ____ American Express ________ Check*
*Make checks payable and mailed to: HCA Education and Research
388 Broadway, 4th Floor, Albany, NY 12207
Credit Card #: _______________________ Exp. Date:_______ Security Code: ________
_________________________________________________________________________
Name and/or Company Name on Card
_________________________________________________________________________
Billing Address of card (including City, State and Zip Code)
_________________________________________________________________________
Authorized Signature
Cancellations received by October 14th are refundable less a 25% administrative
fee. Cancellations must be received in writing via e-mail to [email protected]. No
refunds after that time or for no shows. Substitutions are permitted.
FAX TO: (518) 426-8788
Thanks to our program sponsor:
