HCA last week shared with state health officials the findings of a home care provider survey on COVID-19. It uncovered that the vast majority of home and community-based providers (68%) do not have access to adequate personal protective equipment in their COVID-19 response.

Continue reading “COVID-19 Impact on Home Care by the Numbers” →

The state Department of Health (DOH) has updated its previous Medicaid Update on COVID-19 telehealth/telephonic billing and services allowances to more explicitly include home care and each discipline within home care following multiple appeals from HCA.

The new Medicaid Update, dated March 23, is here and may undergo future updates that providers should watch for.

Please specifically refer to the “Telephonic Reimbursement Overview”  table, which is intended to show payment pathways for telehealth using the “usual billing structure.” The revised version of the chart now specifically mentions home care services and rate codes under Billing Lanes 5 and 6 for “assessment and patient management” and “other services.”

HCA has communicated continuously with the Department over the last several days for more explicit practice, service and billing code recognition of home care in this guidance. We appreciate DOH’s responsiveness to our request. Members with questions or further needs on telehealth are encouraged to contact the HCA Policy staff.

Other updates

Yesterday, Governor Cuomo issued another in a near-daily set of Executive Orders. Executive Order No. 202.10 “permit(s) registered nurses to order the collection of throat or nasopharyngeal swab specimens from individuals suspected of being infected by COVID-19, for purposes of testing.”In addition, the Executive Order allows a hospice residence to designate any number of beds within such facility as dually certified inpatient beds.

Another section of the order provides relief from record-keeping requirements. It mentions “relief to the extent necessary for health care providers to perform tasks as may be necessary to respond to the COVID-19 outbreak, including, but not limited to, requirements to maintain medical records that accurately reflect the evaluation and treatment of patients, or requirements to assign diagnostic codes or to create or maintain other records for billing purposes,” granting “absolute immunity from liability for any failure to comply with any recordkeeping requirement” if done so in good faith except in certain circumstances.

UPDATE: HCA has confirmed the applicability of this provision with state Department of Health officials who state that the reference does cover home care providers; however, the licensed home care professional is only protected from liability if they are not maintaining accurate patient records due to their COVID-19 response (e.g., having a patient surge due to a COVID-19 outbreak). Licensed home care professionals could not use this waiver provision generally to avoid keeping accurate patient medical records, regardless of the COVID-19 connection.

Please continue to watch our COVID-19 resources page for the latest summary of waivers or suspended regulations.

A special edition of the state’s Medicaid Update issued last night (see here) includes a guidance broadly expanding the use of telehealth, telephonic services and other communications methods by Medicaid providers during the COVID-19 state of emergency.

Effective for dates of service after March 1, and for the duration of the state of emergency, “New York State Medicaid will reimburse telephonic assessment, monitoring, and evaluation and management services provided to members in cases where face-to-face visits may not be recommended and it is appropriate for the member to be evaluated and managed by telephone.” HCA has confirmed with DOH officials that the guidance applies to Article 36 home care providers.

Continue reading “State Medicaid Guidance Authorizes Telehealth, Telephonic Services and Billing for COVID-19 Emergency” →

Discussions have escalated in the last 24 hours on long-sought state COVID-19 guidance and assistance for home care and hospice. Throughout the weekend, HCA has again discussed with state officials a list of pressing requests for regulatory relief waivers, priority access to supplies, procedural guidance, and financial support to help providers amid the pandemic.

A just-released Dear Administrator Letter for Certified Home Health Agencies and Licensed Home Care Services Agencies (see here) provides some information on screening of patients and staff, as well as on the responsibilities of personnel in observing patients at home. It followed another guidance, sent earlier today (see here), with regulatory guidance for 1915(c) waiver programs (addressed to providers serving children and youth under the Children’s Waiver).

Yet many other critical areas of support, procedural guidance and regulatory waiver are needed across all home and community-based programs and providers.To help better define this request, HCA asks that all home care and hospice providers immediately complete a brief survey here. The aggregate results will be shared with the Department. Please complete the survey as soon as possible and no later than Tuesday, March 17, at noon. The earlier we begin collecting responses, the sooner we can convey specific needs to the Department of Health.

The Medicaid Redesign Team (MRT) met today in New York City for a second time to review a consolidated list of proposals from among over 2,200 submissions by the public.

The dozens of proposed recommendations discussed today were wide ranging, such as: changes to the global cap methodology; program integrity provisions; health information technology reforms; new approaches to care management, social determinants of health, transportation, and workforce supports; revenue raisers (such as insurance and health care taxes); and program-specific structural, enrollment, procedural or payment recommendations for various sectors, including additional proposals advanced by a long term care advisory committee. 

Many of these areas would touch the home care, hospice and Managed Long Term Care (MLTC) provider and plan infrastructure in a variety of ways. Continue reading “MRT Reviews Detailed Slate of Proposals for Consideration” →

HCA has extended the deadline to March 12 for our 2020 awards nominations. Don’t miss this opportunity to recognize an exceptional colleague or staff member at your organization.

Our award categories invite nominations for all staff roles, from front-line caregivers to prominent leaders in the field, from physician champions of community-based care to the most ardent advocates and program innovators. Awards are presented at HCA’s Annual Conference on May 6-8 in Saratoga Springs.

To learn more and make your nomination, use our online questionnaire here.

If you have any questions or want to e-mail information directly to HCA, please contact Jenny Kerbein at jkerbein@hcanys.org or (518) 810-0659.

Your nomination helps shine a light on home care’s most talented, honorable and commendable individuals. Their stories help bring visibility to what home care is, how it works, how it helps, and what makes it great. Please help tell this story in all of its many unique, individual ways, and join us in celebrating home care’s leading lights.

“No one should be surprised when we have positive cases” of novel coronavirus in New York State, remarked Governor Cuomo yesterday about the illness that has spread rapidly from its initial origins in China.

COVID-19 has now reached 37 countries, including 60 confirmed cases in the U.S. (at the time of this writing), with one case (announced yesterday) involving a person who “did not have relevant travel history or exposure to another known patient with COVID-19,” according to the U.S. Centers for Disease Control and Prevention (CDC).

While 83 people have been reportedly quarantined on a voluntary basis in Nassau County, there are no as-of-yet confirmed cases of the virus in New York State to date, according to reports. Yet national public health officials have warned of possible “community spread” in the future, the importance of preparation for such an event, and the prospect of future containment measures by public health or preparedness officials. Continue reading “Coronavirus Planning for Home Care, Hospice” →

Continue reading “Governor: Feds Deny $8B DSRIP Extension” →

 

On behalf of HCA and the membership, New York State Health Commissioner Dr. Howard Zucker, M.D., J.D. has provided a meaningful and poignant year-end video message to home care and hospice providers.

“As we turn the calendar from 2019 to 2020, I extend warm thanks and appreciation to the many individuals delivering vital care at home to over half a million New Yorkers,” says Dr. Zucker.

He adds: “I also commend the Home Care Association of New York State for supporting this work through its mission: to ‘promote and enhance the quality and accessibility of health care and support at home.’”

HCA has posted the video to Facebook and YouTube. HCA members, colleagues and all organizations with Facebook accounts are strongly urged to share the video as widely as possible. In doing so, please join HCA in returning the thanks to Dr. Zucker for such powerful sentiments about the important work we do in community-based care.

Livanta, the new Medicare Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), reports to HCA that many health care providers, including home health and hospice providers, have not signed a required Memorandum of Agreement (MOA) mandated of Medicare providers under Section 1866(a)(1)(E) of the Social Security Act.

Providers in New York were required to sign the MOA by June 8, 2019. Livanta has set a deadline of December 31, 2019 after which “instances of non-compliance will be reported to CMS,” Livanta states.

HCA has written about this requirement in our weekly newsletter, most recently on October 28, 2019, noting that 92 percent of home health agencies and 95 percent of hospices have not submitted the required form.

In the latest update, Livanta explains that unless you received an e-mail confirmation from the BFCC-QIO on October 1, 2019, your organization’s MOA has not been received. It is urgent that all Medicare providers complete this requirement of the Conditions of Participation (CoPs).

We also stress that all previously signed agreements were invalid as of June 7, 2019, so a new MOA must be completed if you have not done so already for this present period. Information about Livanta’s MOA process is available in this flyer or see the following web pages:

• Livanta QIO website
• MOA Bulletin (May 28, 2019)
• MOA Audit Bulletin (September 9, 2019)

If you have any questions, please contact the Livanta Communications team here.

The state Department of Health (DOH) has posted information on the actions that providers should take to prepare for the upcoming winter weather season. See here.

DOH recommends that all facilities and agencies review their Emergency Response and Evacuation Plans to ensure procedures are up to date and understood by staff and that contact information for all key staff and response partners is current. Providers should be ready to activate these plans when needed. Continue reading “Winter Storm Season Alert Posted” →

Earlier today, Governor Cuomo declared a State of Emergency for Cayuga, Chautauqua, Cortland, Dutchess, Erie, Essex, Hamilton, Herkimer, Montgomery, Oneida, Saratoga and Warren Counties due to heavy rains and high winds that have caused flooding and power outages throughout most of the state. Continue reading “State of Emergency Declared in 12 Counties” →

“If you think compliance is expensive, try non-compliance,” former U.S. Deputy Attorney General Paul McNulty once wisely observed.

The toll is not just financial: as in government fines or penalties, civil liabilities, legal or recovery costs, or loss of licensure/operational privileges, which are bad enough. Noncompliance costs can also be counted in the form of grave reputational risks to your organization, straining or ruining relationships with referral sources or contractors at a time when state policies are imposing even greater restrictions and obligations on network contracts.

Most at stake is your hard-won trust with patients in the community.

HCA’s flagship Corporate Compliance Symposium provides your compliance officers and executive teams with the tools, resources, information and guidelines to overcome these risks. This includes procedural best-practices for self-auditing, so that your own internal investigations can detect pitfalls instead of government or law enforcement doing so on your behalf, and at great expense to your organization.

Each session covers prominent compliance issues by eight highly esteemed legal and compliance minds, all available to you at one time and one place. Don’t miss out.

Sometime next week, without advance notice, the state Department of Health (DOH) will hold an Interoperable Communications (IOC) drill for the entire state.

However, the drill will take place on a rolling basis in staggered stages. As mentioned previously, the IOC drill will be targeted to home care, hospice and other providers across the entire state; though voluntary, it can be used to fulfill federal and/or state requirements for agencies to hold emergency preparedness exercises.

Continue reading “Prepare Now for Emergency Drill to be Held Next Week  “ →

 

HCA holds a vast repository of over 100 reports – and thousands of home care, hospice and MLTC data cells – available exclusively to HCA members through our web-based HCA DATA platform.

These reports provide a major advantage for HCA members in their business and operations planning. They support and inform your financial benchmarking, local market analysis, strategic plan development, contract negotiations, consulting work, and many more functions across various departments.

Through HCA Data, you’ll find everything from big picture trends on statewide home care financial performance to operational data on every individual CHHA, MLTC, LHCSA and Hospice in the state. This data includes operating revenues and expenses across payors, cost factors for salaries and wages, payor mix, visit totals by discipline, caseload capacity by county, unit costs, medical expense ratios, live discharge data (for hospice), and many more items.

Give your CFOs, financial managers, chief strategy officers, operations managers and business planners the keys to this powerful resources today. Learn more and obtain an account here today!

 

 

New York City home care agencies put their emergency preparedness plans into action earlier this month during two July power outages that left tens of thousands of New Yorkers in the dark on two consecutive weekends: on July 14 and July 21.

Nurses, home health aides and other home care personnel play a vital role for patients during emergencies like these — just as they provide critical supports to vulnerable populations at home each day. This includes New Yorkers who are among the 2.5 million individuals nationally relying on home medical equipment, like in-home respiratory ventilators, that require reliable power to function.

Home care providers have plans in place to assist these and other patients living at home who are vulnerable to heat-related illness or environmental conditions during a disaster, especially a situation like the recent power outages coinciding with a wave of near-record high temperatures that gripped the metropolitan region.

Learn more by reading our recent blog post here.

The state Legislature remains in session at the time of this writing to consider a range of final bills, with an expected adjournment sometime tomorrow, according to reports.

Two HCA bills cleared both houses this week with votes in the Assembly yesterday following earlier passage in the Senate. They include HCA’s aide in-service tracking bill and our sepsis legislation.

HCA also participated in a press conference and media outreach yesterday, along with representatives from 20 other community-based provider associations and Assembly Health Committee Chairman Richard Gottfried, on a third bill related to health care transformation funds. Continue reading “HCA’s Sepsis, In-Service Bills Pass Both Houses” →

HCA is receiving one of five Sepsis Heroes awards from Sepsis Alliance in recognition of our Stop Sepsis at Home initiative.

The award honors “Sepsis Heroes who have made a significant contribution to sepsis awareness and education among both the general public and health care professionals.” Awards are presented at an annual gala in New York City on September 12 during Sepsis Awareness Month. Learn more about the event here.

HCA’s Stop Sepsis at Home initiative has been adopted in 55 of New York’s counties where nurses are using the screening tool to potentially identify life-threatening cases of sepsis and help triage follow-up protocols.

HCA thanks Sepsis Alliance for this recognition, and we hope it elevates the importance of this initiative for the 80% of home care cases that originate in the home and community-based setting.

National home care, hospice expert brings unmatched experience and skills to HCA

HCA President Al Cardillo and the HCA Board proudly and enthusiastically announce the appointment of state and national home care expert Rebecca Fuller Gray as HCA’s new Executive Vice President for Clinical and Program Affairs. Ms. Gray starts her position on May 1.

Continue reading “HCA Appoints Rebecca Fuller Gray to Executive Role” →

HCA has learned that the “Employee Scheduling” rule, which was proposed by the state Department of Labor (DOL), will not be promulgated at this time, due to comments raised by HCA and other organizations who argued that the approach was impracticable to certain industries or sectors, like home care and hospice.

The rule, first proposed on November 22, 2017 and then revised on December 12, 2018, would have required employers to pay additional hours for “unscheduled shifts,” “cancelled shifts,” “on-call” and “call for schedule.” HCA had argued that the proposal was incompatible with how care at home is delivered, where hours are started, increased, decreased or eliminated due to reasons unique to home care and hospice and their patients, and beyond the control of the employer.

Continue reading “State DOL Employee Scheduling Rule Put on Hold” →

The Home Care Association of New York State, the Hospice and Palliative Care Association of New York State, and the New York State Association of Health Care Providers are jointly holding a January 8 Home and Community Care Services Open Forum for State Legislators and their staff at the Legislative Office Building in Albany. Details are in the flyer here. Continue reading “Home Care 101 for Legislators, Staff on January 8” →

November is National Home Care Month and HCA has launched a campaign called #HomeCareConnect. Watch our video message about the campaign here and download our flyer to share with your staff.

Continue reading “#HomeCareConnect for National Home Care and Hospice Month!” →

HCA, IPRO, HANYS, the Rory Staunton Foundation for Sepsis Prevention, Sepsis Alliance and partner organizations invite you to register for a first-of-its-kind All-Sector Sepsis Summit on October 3 in Albany.

Click the event page here for online registration and to download the brochure for the full agenda, which includes top state health officials, physician experts, representatives of the various health sectors, public policy and education partners, and quality and clinical experts.

Continue reading “Join HCA, IPRO, HANYS and Partners for Major Cross-Sector Sepsis Summit on Oct. 3 in Albany” →

The state Department of Health (DOH) has posted a notice to home care agencies, medical directors and other provider representatives on the Health Commerce System (HCS) regarding an investigation into the reliability of a laboratory service provider’s glucose and potassium test results that could affect HCA members.

The notice, available here, states the following:

On 5/22/2018 the New York State Department of Health (Department) issued an Order for Summary Action against a laboratory service provider, Modern Diagnostic Laboratory Inc. due to findings of an investigation by the Wadsworth Center’s Clinical Laboratory Evaluation Program. The investigation determined that glucose and potassium test results were not reliable and in some instances falsely reported.

Today (5/23/2018), the Department issued an Amended Order for Summary Action against MDL. The Amended Order enables MDL to resume providing services under existing contracts. The Amended Order requires that MDL meet certain requirements, including but not limited to, the immediate employment of an independent consultant who will be approved by the Department, and the cessation of any inappropriate testing and reporting practices.

For providers seeking to contract with an alternative laboratory, a list of other approved laboratories can be found at the following link: https://www.wadsworth.org/regulatory/clep/approved-labs.

No other information is available at this time regarding actions that providers should take for lab services affected by these findings. HCA remains in communication with the Department for further information, which we will share in an alert to the membership or in our newsletter as necessary.

 

Caring Awards

The Caring Award recognizes a staff person of an agency who has exhibited the compassion, skills and service that sets his or her contribution apart and/or whose actions on a particular day or over a period of time exemplify caring in home care.

Vicky Gentile, Home Health Aide at New York City-based Selfhelp Community Services

“Vicky Gentile embodies the caring, dedicated spirit we wish to be associated with our name,” says Selfhelp Community Services, noting Ms. Gentile’s exceptional care to patients.

Continue reading “HCA’s 2018 Award Recipients” →

The national push for extension of the home health rural add-on continues, as Congress considers extension bills and other fiscal matters amid the ongoing debate over the continuing budget resolution.

In a separate but important federal matter, HCA has also learned that key leaders are considering a priority bill for authorization of home care services as part of an omnibus package. The bill is sponsored by Buffalo-area Congressman Chris Collins and has strong support from New York’s Congressional Delegation who we need to press Congressional leaders for final adoption of this measure.  Continue reading “Act Now on Home Health Rural Add-on, NPP Authorization of Home Care” →

For a low cost of $149/$249 (member/non-member rate), HCA is offering an unlimited number of your HR, executive and management staff to get guidance from top legal experts on the law, policies-and-procedures, and staff training to address sexual harassment in the workplace and reduce your organization’s exposure to costly legal liabilities. Join our webinar on January 30 from 10 to 11 a.m.  Continue reading “Webinar Offers Premium Legal Guidance for Home Care HR/Execs on Sexual Harassment Law, Procedures” →

End-of-the-year Congressional activity is putting home care at risk, and we need your action now to reach your Congressional Representatives in Washington. 

Continue reading “Urgent Action Alert: Take 1 Minute to Write Congress Opposing BIG End-of-year Home Health Cuts” →

Responding to a united voice of advocacy from the home care community, the U.S. Centers for Medicare and Medicaid Services (CMS) has withdrawn its Home Health Groupings Model (HHGM) from the final Calendar Year 2018 Medicare Home Health Prospective Payment System (HHPPS) rule, posted late this afternoon.

Noting the volume of technical comments on “various aspects of the proposed case-mix adjustment methodology under the HHGM,” CMS says that commenters “were most concerned about the proposed change in the unit of payment from 60 days to 30 days and such change being proposed for implementation in a non-budget neutral manner.”

HCA made this a major point in our comments on the rule, noting that “HHGM must be revised to be implemented in a true budget-neutral fashion,” we wrote. “Budget neutrality is an essential hallmark of past payment reform policies and is an important protection against system-wide fiscal destabilization.” Continue reading “In Win for Home Care, HHGM Withdrawn from 2018 HHPPS Final Rule” →

HCA’s upcoming Quality and Technology Symposium, on November 16 & 17 in Suffern, NY, is our signature conference geared for home care clinical managers, directors of patient services, quality improvement officers and strategic planners, including the executive teams at your organization who need to think big about the many quality and technology imperatives in home care.

Download the brochure

Register online

BK Health Care Consulting chief Barbara Katz got rave reviews for her segment at one of HCA’s value-based payment programs last year, and we are thrilled to tap her unique expertise again for two exceptional sessions on November 16 and 17:

• An interactive seminar on clinician time and task-management to help you “climb out of chaos” and gain a “roadmap to sanity” while juggling constant change and running an effective operation; plus

• A segment on what is perhaps the biggest hot-topic in quality of care: meeting the new Conditions of Participation (CoPs) for implementing a Quality Assurance/Quality Improvement (QAPI) program.

Continue reading “QAPI CoPs, Clinician Time Management Seminar Among 10 Hot Topics at HCA Quality & Tech Symposium” →

In preparation for federal advocacy efforts on September 12, HCA has prepared a series of advocacy documents to guide our visits with lawmakers and their staff.

We encourage you to read these for a review of HCA’s messaging. Please also share them with your Congressional contacts to encourage their action on critical home care federal priorities.

Foremost among our concerns is the ongoing threat to Medicaid, posed by Congressional attempts to repeal and replace the Affordable Care Act, as well as the new Home Health Groupings Model that the U.S. Centers for Medicare and Medicaid Services (CMS) has proposed for 2019, with cuts of up to $1 billion from the system.

HCA is also pressing for: continuation of the Medicare rural add-on; Congressional opposition to hospice rebasing; and relief from regulatory burdens like the Medicare face-to-face rule, pre-claim review, and the current limits on practitioners permitted to order and refer for home care services.

See the PDF downloads below for more information.

• “Home Care Advocacy Ask: Regulatory Relief for Home Care Providers”
• “2018 Proposed Rule: Reject Drastic New HHGM Payment System for Home Care”
• “Continue 3% Medicare Add-On for Rural Home Health”
• “CMS Should Collaborate with Industry to Evaluate Impact of Hospice Payment Reform Before Implementing Any Rebasing Initiatives”
• “Why Medicaid Works – and Why AHCA Cuts are Wrong”

 

 

Continue reading “DOH Hurricane Alert: Immediate Action for Home Care, Hospice Storm Preparedness” →

Program includes tabletop exercise that partly fulfills imminent CoP requirement; plus, group registration discounts offered for HCA members!

September 27, 2017
Albany

HCA presents a comprehensive full-day program on September 27 in Albany, during National Preparedness Month, that will delve into all critical and timely aspects of home care and hospice emergency preparedness affecting your operation.

The program features state health and emergency preparedness officials, including regional officers, planning managers and the Director of the Office of Health Emergency Preparedness, Michael J. Primeau, for insights on challenges and opportunities in home care and hospice preparedness. This is a great opportunity to share your experiences and concerns with top health emergency preparedness officials. Continue reading “Are You Prepared: Emergency Preparedness Essentials in Home Care & Hospice Settings” →

One of our signature programs, HCA’s one-day Corporate Compliance Symposium (October 19 in Albany) is packed with five carefully designed sessions bringing the expertise of legal minds, top consultants, health association leaders and public officials to address your most relevant compliance worries, concerns and needs.

From big-picture considerations to the concrete mechanics of your compliance program planning, this conference will:

• Emphasize the focus areas targeted by government auditors (i.e., OMIG and OIG) so you can assure your readiness;
• Provide takeaways and best-practice guidance based on real-world cases of HIT- and HIPAA-related breaches and enforcement actions;
• Help you overcome exposure and identify new risks introduced by your participation in new integrated models of care; and
• Examine growing segments of the home care continuum that are drawing scrutiny and new regulatory activity from state compliance agencies.

Learn more. Check out the brochure and register online at the links below.

The Senate last week issued a draft health care bill with even deeper Medicaid cuts than the already adopted House plan.

HCA, meanwhile, has continued its work in collaboration with a New York coalition of health care organizations urging members of New York’s Congressional Delegation to resist the Senate measure, along with any consensus bill that would follow in like form. Continue reading “As Senate Bill Goes Public, HCA Heads to Washington Opposing Even Deeper Medicaid Cuts” →

Today, HCA Executive Vice President Al Cardillo delivered testimony before a panel of the state Assembly and Senate on the Health and Medicaid portions of the proposed state budget. HCA’s written testimony is posted to our website here.

The hearing drew testimony from multiple sectors of health care, with stakeholders commenting on the Governor’s Executive Budget proposals and pursuing issues for the Legislature’s consideration in its own one-house budgets and/or resolutions.

Legislators also received testimony from officials at the state Department of Health, office of the State Medicaid Inspector General, Department of Financial Services and other offices representing the Executive on various components of the Health and Medicaid budget.

The Legislature addressed some important and sometimes pointed questions to state officials on issues of relevance to home care. This included: the state’s management of the Medicaid global cap and related Executive “super-powers” for rate changes; the state’s distribution of minimum wage funds to home care; the purview of the Governor’s proposed Health Care Regulation Modernization Team; and other issues. Continue reading “HCA Budget Testimony Stresses Payment, Regulatory, Workforce and Infrastructure Needs” →

The state Department of Health (DOH) has sent an urgent alert to providers that the Health Emergency Data System (HERDS) is activated in preparation for Hurricane Matthew; providers (including home care and hospice) are required to submit data within three hours.

An alert is the “highest priority emergency communication” and “warrants immediate action or attention by the recipient,” according to the DOH communication.

Hurricane Matthew made landfall in Cuba at about 8 p.m. last night. It is a Category 4 storm carrying maximum sustained winds of 130 mph and moving north at 8 mph.

To plan for this event and its potential New York impact, DOH is requiring home care, hospice and other providers to complete one or more survey forms in advance of Hurricane Matthew. Providers should check the Health Commerce System (HCS) to access these required surveys and instructions.

Continue reading “Hurricane Matthew Alert: DOH Requires HERDS Data Response in Three Hours” →

All home care providers are urged to attend an important September 30 webinar (from 10:30 a.m. to noon) launching HCA’s home care screening tool and protocol for sepsis recognition and intervention.

We reported on the webinar in Monday’s edition of The Situation Report newsletter, but HCA just wanted to draw your attention to this important program, given recent alarms by the U.S. Centers for Disease Control and Prevention (CDC) about this top cause of health care morbidity and cost. (Please see our recent press release on the tool for more information and reasons why home care adoption of sepsis intervention is a top priority.)

The September 30 webinar is being hosted by IPRO, HCA and other key organizations. It is the first of three sessions on the adoption, integration and use of this sepsis tool in patient care. Continue reading “Free Sept. 30 Webinar to Launch Home Care Sepsis Screening Tool” →

HCA is offering several sponsorship opportunities for organizations that want to support — and gain exposure at — HCA’s first-ever Women’s Healthcare Leadership Summit on September 28 to 29 in Saratoga. What better or more positive way is there to promote your brand than at this important leadership program for women in healthcare? Continue reading “Invitation to Sponsor: First-ever Women’s Healthcare Leadership Summit” →

As you read in Friday’s ASAP newsletter, HCA recently sent a letter to New York’s Congressional Delegation expressing firm objections to a recently announced “prior-authorization” demo for Medicare home health services.

HCA is excited to formally introduce Bring The Vote Home New York (BTVH-NY).

HCA President Joanne Cunningham previewed this new campaign at HCA’s Annual Conference earlier this month. Today we are formally launching New York’s version of this national initiative, which is helping home care patients get registered and able to vote, so their voices are heard in the political process.

Bring the Vote Home is taking place in states across the country, including New York. In essence, the campaign offers an easy process for your staff to distribute forms during home visits so their patients can register and receive an absentee ballot. HCA is sponsoring the New York part of the campaign. Continue reading “HCA Invites You to Bring The Vote Home-NY” →

Continue reading “HCA & Association Partners Sponsor June 2 Webinar on Medicare Documentation, F2F” →

The U.S. Centers for Medicare and Medicaid Services (CMS) has released a final rule that covers many aspects of Medicaid managed care.

The rule and fact sheets are at https://www.medicaid.gov/medicaid-chip-program-information/by-topics/delivery-systems/managed-care/managed-care-site.html.

The rule covers long term services and supports (LTSS); care coordination; provider screening and program integrity; subcontractual relationships; quality; beneficiary information and appeals; delivery system reform efforts; and other areas.

Last July, HCA had submitted extensive comments on the then proposed rule, which can be viewed at https://hca-nys.org/letters-and-comments/comments-on-medicaid-managed-care-proposed-rule

HCA’s comments address: the misalignment between federal and state regulations for home care; the need for actuarial soundness of rates by states to managed care plans and rates by plans to home care providers; disenrollment due to home care provider changes; transitions of care; state monitoring requirements; grievances and appeals and aid continuing; provider screening and enrollment; uniform billing; and plan contacts.

HCA will be reviewing the final rule – which, including public comments and CMS’s responses, is over 1,000 pages – to learn if the issues we raised were addressed, and to determine which provisions will affect managed care in New York.

A full summary of the provisions is provided below.  Continue reading “Final Medicaid Managed Care Rule Released  “ →

OMIG has released its 2016-17 Work Plan, detailing the areas of focus in the Medicaid program for State Fiscal Year April 1, 2016 to March 31, 2017.

According to OMIG, this year’s Work Plan continues a focus on organizing work according to categories of service. Building on the 2015-16 Work Plan, OMIG continues to utilize its Business Line Teams across a number of areas, including but not limited to the Delivery System Reform Incentive Payment Program (DSRIP), Managed Long Term Care, Transportation, Home and Community Care Services, and Managed Care.

Further, OMIG will continue to emphasize provider outreach and education, particularly focusing on providers having proactive compliance programs that will prevent or, when necessary, detect and address abusive practices.

The 2016-17 WorkPlan, and plans from previous years, are at: https://www.omig.ny.gov/index.php/information/work-plan. It outlines several areas of focus in home care, LTHHCP and CHHA rates, compliance program review and managed care.

The following are some areas of OMIG focus in the 2016-17 Work Plan follow. Agencies should use these targeted activities, along with the OMIG audit protocols and other materials on the OMIG’s website, to strengthen their ongoing compliance work. Continue reading “OMIG 2016-17 Work Plan Now Available” →

This week, President Obama released his 2017 proposed budget. While the provisions are not expected to pass as part of the budget, various provisions could become part of other Congressional actions, and HCA will remain vigilant in monitoring such legislation.

A summary of the health provisions is at http://www.hhs.gov/sites/default/files/fy2017-budget-in-brief.pdf. Additional information is at https://www.whitehouse.gov/omb. Continue reading “President Obama Releases 2017 Proposed Budget” →

Updated January 25, 2016

HCA’s State Advocacy Program is on February 1 and 2 in Albany. Below are some resources to register and learn more about what HCA is seeking as part of the state budget process and 2016 legislative session. Please check this page regularly for updates.

Registration

Download: Registration for HCA’s PAC Reception for Senate Health Committee Chairman Kemp Hannon (Feb. 1) and our State Advocacy Day (Feb. 2)

Download: Invitation to HCA’s PAC Reception for Senator Hannon

Resources

HCA Resource Guide: Advocacy Day and Home Care’s “Asks” Made Simple

HCA’s 2016-17 State Budget Testimony

HCA’s 2016 Financial Condition Report (“Risk Factors: What You Need to Know about the Financial Condition of New York’s Home Care Community”)

HCA’s “Priority Asks: Position Home Care to Meet the State’s Policy Goals”

HCA invites you, one of New York’s exceptional home care leaders, to attend our 2016 Advocacy Day for Home Care Leaders on February 1-2 in Albany.

The program begins at 6 p.m. on the evening of February 1 with a special fundraising reception hosted by HCA’s Political Action Committee (PAC) for Senate Health Committee Chairman Kemp Hannon who will address attendees, followed by our main Advocacy Day program on February 2 beginning at 9:30 a.m.

Continue reading “Join HCA for our Home Care Leaders State Advocacy Day on February 1-2” →

HCA participated in a meeting yesterday with the state Department of Health (DOH) officials to review DOH-revised survey instruments for home care agencies and hospices for completion and tracking during public emergencies.

Specific parts of a multipart survey process are designed by DOH to be put into motion in emergencies depending on the nature, extent and details of the emergency.

The sections of the survey include basic agency and patient information, agency surge capacity resources and/or assistance needs, evacuation and repatriation information, and others.

The Department also reviewed a survey intended for completion by hospice providers to determine the status and extent of emergency preparedness planning.

The Department also plans to issue in the next several months a Dear Administrator letter reminding, clarifying and stipulating for providers the required contact persons and roles for indication on the Health Commerce System (HCS). HCA reminds providers to check their agency’s contacts currently listed/required for the HCS to be sure that all such individuals and related information is accurate and up to date.

HCA’s home care agencies and hospices can review the draft surveys at the links below and provide HCA with any further comments on the survey, which we, in turn, will add to our feedback to the Department.

• Home Care Emergency Evacuation Survey
• Home Care Emergency Repatriation Survey
• Home Care Emergency Survey: Agency Form
• Home Care Emergency Survey Capacity Form
• Home Care Abbreviated Emergency Response Provider Survey
• Hospice Emergency Planning Survey

DOH plans an HCS emergency preparedness drill this spring using the revised survey tools. HCA requested and DOH agreed to conduct a webinar, likely to be held in February, providing a walk-through of the surveys and an opportunity for exchange with the home care sector.

For further information, please contact Al Cardillo at acardillo@hcanys.org.

During a state Department of Health (DOH) Managed Care Policy and Planning meeting this week, DOH provided key updates on changes it is implementing in the Fully Integrated Duals Advantage (FIDA) Program which home care provider contractors and plans should take note of. The changes are as follows:

• Passive enrollment is suspended until further notice, except in limited circumstances (such as plan drops out of FIDA).

• DOH will be monitoring the effect of these changes prior to expanding enrollment into region 2 (Suffolk and Westchester) and does not expect it to start until after mid-2016.

• The coverage continuity period for out-of-network providers remains 90 days or until a Person Centered Service Plan (PCSP) is developed and implemented, whichever is later.

UAS

• Plans may use the existing MLTC schedule for completion of a participant’s Uniform Assessment (UAS) if the Participant is transferring from a sister MLTC/PACE/MAP plan; i.e., each FIDA enrollee transferring from a sister plan need not complete a new assessment until six months from the date of their last MLTC assessment.

• The FIDA plan must contact the participant and review any available medical record and claims history from the pre-enrollment period to determine changes in health status, health event, or needs that would trigger an updated UAS.

• If an updated UAS is required, it will be conducted within six months of the last UAS, and development of PCSP implemented within 90 days following the enrollment effective date.

• All other participants have a PCSP deadline of 90 days from the enrollment effective date.

Assurance and Participant Satisfaction

DOH/CMS and the Contract Management Team (CMT) will evaluate the FIDA Plan’s IDT delivery and operations. Specifically, the CMT will assess a Plan’s IDT performance against the following existing measures:

• In the last six months, did anyone from the participant’s health plan, doctor’s office, or clinic help coordinate care among these doctors or other health providers?

• How satisfied is the participant with the help in coordinating care in the last year?

• What is the percentage of participants discharged from a hospital who were readmitted within 30 days, either for the same condition as their recent hospital stay or for a different reason?

• What is the percentage of patients 65 years or older discharged from any inpatient facility and seen within 60 days following discharge by the physician providing on-going care, who had a reconciliation of the discharge medications with the current medication list in the medical record documented?

• What is the total percentage of all participants who saw their primary care doctor during the year?

• What is the percentage of participants in FIDA who reside in a nursing facility (NF), wish to return to the community, and were referred to preadmission screening teams or the Money Follows the Person Program?

• What is the number of nursing home-certifiable participants who lived outside the NF during the current measurement year as a proportion to those during the previous year?

• Follow-up required after hospitalization for mental illness.

 Medicare Rates

• CMS has committed to an upward adjustment related to the Medicare Part A and B rates for all of 2016 and 2017.

• The 2016 rates are not yet final but will be retroactive to January 1, 2016.

• CMS will send rate letters to plans explaining the adjustment.

• CMS is conducting additional analysis of the Part D bids.

• CMS is open to reconsidering the assumptions used in determining the adjustment for calendar year 2016 based on revised projections of enrollment and recent experience in the demonstration.

Quality Withhold

• The quality withhold (QW) is effective upon execution of the Three-way Contract Amendments.

• The 2015 and 2016 quality withhold (QW) payments will be tied to participation through December 31, 2016. This will essentially add a new criterion to the QW calculation that excludes an organization from receiving QW amounts if the organization does not participate at least through 2016. (QW amounts are 1 percent of rate in 2015 and 2 percent in 2016).

• For any plans that do not continue through December 31, 2016, quality withhold amounts from 2015 and 2016 will be pooled and added to amounts earned by FIDA plans participating on January 1, 2017 (based on 2016 performance).

IDT Reforms

• The participant has a right to choose the make-up of its Interdisciplinary Team (IDT) and its members. The IDT can consist of just a care manager and participant, or broader, with a variety of members (from the original IDT list).

• IDT members may meet at different times. The care manager may separately meet with different IDT members in developing the PCSP.

• Provider participation in an IDT is adjustable, depending on member availability, items being discussed in a given meeting, or the needs, wishes, and goals of the participant.

• Primary care providers may sign off on a completed PCSP without attending IDT meetings.

• Plans have authorization over any medically necessary services included in the PCSP that are outside of the scope of practice of IDT members.

• IDT training will be encouraged, but not

• Plans develop their own procedures for communication among IDT members.

• Plans retain responsibility for effective and efficient information sharing among providers (including non-IDT participants), including any PCSP revisions.

• DOH/CMS and the Contract Management Team (CMT) will evaluate the FIDA plan’s IDT delivery and operations.

• FIDA plans must meet Medicare-Medicaid Plan Model of Care (MOC) elements and consistently update MOCs to reflect changes to the IDT policy.

• The CMT will assess a Plan’s IDT performance against specific data collected and percentages calculated.

Reporting

• Completion of the bi-weekly and monthly dashboards is no longer required.

• DOH/CMS will streamline several reporting measures (e.g., NY1.1, NY1.2, and NY2.1) based on the new IDT policy (to be released). Changes to these measures would be applicable beginning with the 4^th quarter of 2015 (October – December) reporting period.

Marketing

Plans now have authorization to do the following:

• Market multiple lines of business under the Medicare Marketing Guidelines.

• Provide a written or verbal comparison (either DOH/CMS prepared or plan-prepared) among their MLTC (Partial, PACE, MAP) and FIDA programs.

• Conduct outbound FIDA marketing calls to individuals enrolled in any other Medicaid or Medicare product line with the plan or company.

• Organize in-person appointments if they are solicited by the individual.

• Conduct promotional activities and make nominal gifts at the Medicare Marketing Guidelines levels ($15).

• Send, with a prior approval from DOH/CMS, FIDA educational materials (e.g., letters, newsletters, etc.) to participants who have opted out.

• Plans may submit enrollment requests to Maximus (consistent with MLTC procedure). Maximus will process the enrollment and send letters, which include Independent Consumer Advocacy Network Independent Consumer Advocacy Network Independent Consumer Advocacy Network Independent Consumer Advocacy Network (ICAN) contact information, to the individuals that: 1) confirms the Participant’s enrollment in FIDA; 2) informs the Participant that choice counseling is available through Maximus; and 3) informs the participant of the option to switch or disenroll from a FIDA Plan at any time.

• Plans may remain on the phone when prospective participants call Maximus.

• Plans do not have to include both the plan phone number and enrollment broker number in their marketing materials.

ADA Attestation Form

• No provider should be terminated from a FIDA plan network for not answering in the affirmative to elements on the form.

• The form is to help FIDA participants identify which providers offer specified accessibility features.

• Completion or non-completion of the form, or responding in the affirmative to elements included therein does not alter existing obligations to comply with the Americans with Disabilities Act (ADA).

• FIDA plans must maintain a complete and accurate provider directory, including information collected by the form. FIDA plans have discretion on how to address provider refusals to complete the form.

Next Steps

• DOH will release the full set of FIDA Reforms, including an updated IDT policy.

• Reforms are effective immediately unless otherwise stated.

• Plans should make sure that they participate in the Friday FIDA plan conference calls.

This post provides an October 2015 emergency preparedness update for the home and community services sector. It coordinates information from several recent state and regional emergency preparedness communications. (You can download this update in memo format as a PDF here.)

HCA is a collaborative partner to the New York State Department of Health for statewide emergency preparedness efforts. HCA thanks the Office of Health Emergency Preparedness (OHEP), the Office of Primary Care and Health Systems Management (OPHSM), the regional Health Emergency Preparedness Coalitions (HEPCs) and the Regional EP Training Centers (RTCs) for this ongoing partnership, support and resource.

Continue reading “Emergency Preparedness Information and Resource Update: October 2015” →

The state Department of Health (DOH) has yet again issued its monthly Medicaid Global Cap report. This latest report, for July, covers the period ending July 31 and beginning at the start of the fiscal year: on April 1.

It finds that overall spending for this period was $4 million below Medicaid Global Cap projections, across all sectors, a difference of $5.984 billion in actual spending versus $5.988 billion in estimated spending for the four-month period.  Continue reading “July Medicaid Global Cap Report: Spending $4M Under Projections” →

The Office of the National Coordinator for Health Information Technology (ONC) has released the updated Federal Health IT Strategic Plan 2015-2020 at http://www.healthit.gov/policy-researchers-implementers/health-it-strategic-planning. Continue reading “Final Federal Health IT Strategic Plan 2015-2020 Released” →

The state Department of Health (DOH) has posted a summary of the Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) Transition Workgroup meeting held on August 24 and Frequently Asked Questions (FAQs) related to the Workgroup.

The materials are available at http://www.health.ny.gov/health_care/medicaid/redesign/mrt_90.htm.  Continue reading “NHTD & TBI Transition Workgroup Materials Posted” →

The New York State Office for the Aging (SOFA) is conducting a survey related to state legislation that authorizes it to study the feasibility of creating an Office of Community Living “with the goal of providing improvements in service delivery and improved program outcomes that would result from the expansion of community living integration services for older adults and persons of all ages with disabilities.”

A primary component of this effort is data and information collection through working with stakeholders. SOFA has developed a stakeholders group and is holding public forums throughout the state.

SOFA is conducting a survey of consumers and providers about the possibility of creating a new state Office of Community Living. The provider survey is at https://bostonu.qualtrics.com/jfe/form/SV_b28zoikIEQnU2BD.

More information on this effort is at http://www.aging.ny.gov/CommunityLiving/index.cfm.

The state Department of Health is expanding the NYSE-CON application to allow pre-opening inspections for Certificate of Need (CON)-approved projects, utilizing the “Regional Office” tab in NYSE-CON.

The Regional Office tab, available since May 2015, is accessible when CON projects have been approved and contingencies have been satisfied.

The tab now enables applicants to create project phases, attach documentation for DOH review prior to the pre-opening inspection, and receive communications from DOH staff regarding the preopening inspection.

Additional information can be found at http://www.health.ny.gov/facilities/cons/nysecon/.

Questions can be directed to nysecon@health.ny.gov.

The U.S. Centers for Medicare and Medicaid Services (CMS) has posted a transmittal that provides detailed information on its Medicare Care Choices Model (MCCM).

The transmittal is at https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R121DEMO.pdf.

Under MCCM, Medicare and dual eligible beneficiaries with advanced cancers, chronic obstructive pulmonary disease, congestive heart failure, or HIV/AIDS who meet hospice eligibility requirements under the Medicare hospice benefit will be eligible to receive palliative care services from certain hospice providers while concurrently receiving services from curative care providers. Continue reading “Transmittal Issued on Medicare Care Choices Model” →

This week, the U.S. Centers for Medicare and Medicaid Services (CMS) Office of Minority Health unveiled the first CMS plan to address health equity in Medicare. Its plan focuses on six priority areas and aims to reduce health disparities in four years.

The Equity Plan focuses on Medicare populations that experience disproportionately high burdens of disease, lower quality of care, and barriers accessing care. These include racial and ethnic minorities, sexual and gender minorities, people with disabilities, and those living in rural areas.

The six priority areas include expanded collection and analysis of standardized data; integration of equity solutions across CMS programs; developing approaches to reduce disparities; health care workforce; improving communications and language access for those with limited proficiency; and increasing the physical accessibility of health care facilities.

To learn more, visit: https://www.cms.gov/About-CMS/Agency-Information/omh/index.html.

Medicare has contracted with a Supplemental Medical Review/Specialty Contractor (SMRC) that is evaluating medical records and related documents to determine whether claims were billed in compliance with coverage, coding, payment, and billing practices.

However, some providers may not be getting the medical records because the provider address is incorrect or because they do not know about the SMRC.

New York’s Medicare Administrative Contractor, National Government Services (NGS), urges all providers to update their addresses in the National Plan and Provider Enumeration System (NPPES). The SMRC uses this source to mail additional development requests (ADRs) for medical records; an incorrect address can result in records being returned and, as a result, claims being denied.

NGSConnex and IVR Systems Not Available this Weekend

NGS also reports that, due to scheduled maintenance, NGSConnex and the Interactive Voice Response System (IVR) systems will not be available this weekend.

For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

Home care and personal care spending slightly above projections

The state Department of Health (DOH) has issued its June 2015 Medicaid Global Spending Cap Report.

It shows overall spending to be $11 million less than projected for the current fiscal year through June. (The current state fiscal year began on April 1, 2015 and ends March 31, 2016.) Continue reading “DOH Releases June 2015 Global Cap Report” →

eMedNY has notified providers of rate changes for certain services under the Nursing Home Transition and Diversion (NHTD) waiver program. Also, the state Department of Health (DOH) has announced a stakeholder group for the transition of the NHTD and Traumatic Brain Injury (TBI) programs to managed care.

The following rate changes were implemented July 13 and are effective retroactive to April 1, 2015: Continue reading “Some NHTD Rates Change: New TBI Rates Coming Soon” →

The state Office of the Medicaid Inspector General (OMIG) has posted revised (July 3, 2015) audit protocols for the Traumatic Brain Injury (TBI) program.

They are available at https://www.omig.ny.gov/images/stories/audit_protocols/tbi_protocol_7_3_2015.pdf.

The protocols cover: missing/incomplete service plan; missing documentation of service; billed more hours than authorized or documented; incorrect rate code billed; services performed by unqualified staff; staff training not completed; failure to meet health requirements; and other issues.

HCA members providing TBI services are strongly advised to review the revised audit protocols for compliance purposes.

National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), has recently posted the following information to its website.

• Impact of Sequestration on Hospice Aggregate Cap – NGS has drafted a notice that includes an example informing hospice providers of how sequestration will be handled within the aggregate cap determinations starting with the 2013 cap calculation and beyond. NGS will calculate the aggregate cap determinations by adding the sequestration and net reimbursement amounts together found on the Provider Statistical and Reimbursement (PS&R) report to determine the pre-sequester reimbursement amount. The pre-sequester reimbursement amount will be compared to the allowable Medicare payment amount which will determine the hospice’s pre-sequester payment in excess of the cap amount. If there is a pre-sequester payment in excess of the cap, that amount will be reduced by 2 percent. This amount cannot be greater than the sequestration amount found on the PS&R report. Therefore, these two amounts will be compared and the lesser of the two will be applied to the calculation.

Continue reading “Updates From the Medicare Contractor: NGS” →

On July 28, the Uniform Assessment System (UAS-NY) online application was upgraded from version 7.18 to version 7.23.

Upon login to the UAS-NY, users are presented with a list of all required and recommended training courses that are completed and not completed. Users will now have the option to “Show All Courses” or “Hide Completed Courses.”

Version 7.23 will limit the timeframe for creating an assessment. Users may only initiate an assessment if the Assessment Reference Date is no more than 30 days prior to the current date. For example, if the current date is July 24, 2015, a new assessment may be initiated if the Assessment Reference Date is between June 24, 2015 and July 24, 2015.

The state Department of Health (DOH) has posted a General Information System (GIS) message to advise local departments of social services (LDSS) that an annual review of managed care exemption (91) and exclusion (90) Restrictive/Exception (R/E) entered codes should take place.

With most Medicaid populations transitioning into mandatory managed care, DOH stresses the importance of placing an end date on 90/91 R/E codes to avoid impeding managed care enrollment.

The GIS is at http://www.health.ny.gov/health_care/medicaid/publications/pub2015gis.htm (see GIS 15 MA/012).

Livanta has been operating as the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) since August 1, 2014. It is responsible for reviewing all Medicare discharge appeals and quality of care concerns for beneficiaries in many states, including New York.

Livanta has created a bulletin which offers several important reminders regarding standards of practice for physical therapy (PT) and discharge appeals.

Livanta has asked us to share this latest bulletin with our provider membership and we recommend that you forward this information to the appropriate staff in your agencies. It is at https://hca-nys.org/wp-content/uploads/2015/08/PTDischargePlanningReminderFinal.pdf.

For further information, contact Patrick Conole at (518) 810-0661 or pconole@hcanys.org.

The Public Health and Health Planning Council (PHHPC) met on August 6 where it approved all of the following items:

• One application for a change in ownership by a CHHA that serves the general population in Greene, Orange, Ulster and Westchester as well as the developmentally disabled population in Dutchess, Putnam, and Sullivan.

• Under another application, the same entity proposes a change in ownership of its CHHA and LTHHCP that serves western New York.

• Applications by 29 entities (8 outside of the New York City metropolitan area) to establish a LHCSA; and

• Applications by 10 LHCSAs for a change in ownership (including 3 outside of the New York City metropolitan area).

The meeting materials are at https://www.health.ny.gov/facilities/public_health_and_health_planning_council/meetings/2015-08-06/.

This week, the U.S. Centers for Medicare and Medicaid Services (CMS) announced the participants in the Medicare Care Choices Model.

The Choices Model provides Medicare beneficiaries who qualify for coverage under the Medicare hospice benefit and dually eligible beneficiaries who qualify for the Medicaid hospice benefit the option to elect to receive supportive care services typically provided by hospice, while continuing to receive curative services. Continue reading “Medicare Care Choices Model Awards Announced” →

The National Association for Home Care and Hospice (NAHC) reports that the federal Occupation Safety and Health Administration (OSHA) has issued Instructions for  general enforcement policies and procedures to be followed when conducting inspections and issuing citations related to occupational exposure to tuberculosis (TB). Continue reading “OSHA Issues Revised TB Inspector Instructions  “ →

The U.S. Centers for Medicare and Medicaid Services (CMS) has made available, beginning July 20, provider-specific comparative data reports for Home Health Agencies.

The Program for Evaluating Payment Patterns Electronic Report (PEPPER) summarizes claims data statistics for areas that may be at risk for improper Medicare payments. PEPPER is a free report comparing an agency’s Medicare billing practices with other agencies in the nation, Medicare Administrative Contractor (MAC) jurisdiction, and state. Agencies can use the data to support internal auditing and monitoring activities. Claims statistics include:

• Average case mix
• Average number of episodes
• Episodes with 5 or 6 visits
• Non- Low Utilization Payment. Adjustment (LUPA) payments
• High therapy utilization episodes
• Outlier payments

Continue reading “Home Health Agencies to Receive Comparative Data Reports” →