The Situation Report | September 23, 2024

HCA and its CHHA member special workgroup has been meeting and working intensively on critical CHHA policy and advocacy steps to support agencies’ in their mission to meet their communities’ home health needs.

The workgroup has been focusing on both state and federal home health priority issues. To date, these have included multi-tiered efforts by HCA and workgroup members to halt the US Centers for Medicaid and Medicare Services (CMS) proposed 2025 cuts to Medicare home health payment under the Patient Driven Groupings Model (PDGM), and efforts to pass and fund HCA’s proposed budget initiatives for supplement state aide to meet community home health needs. Workgroup members are generating and sharing data on the impact of the current home health finance and workforce landscape on patient access, agency operations, and broadly on the functioning of their community’s health system.

The workgroup’s Federal PDGM advocacy met with success on one of its elements this past Friday, where HCA members and HCA lobbyists secured signatures from nearly all of NY’s Congressional Delegation on a co-signed letter to President Biden, and CMS and Office of Management and Budget leadership calling for a halt to and reexamination of CMS’s proposed PDGM cuts to home health. See related SR article here.

On the state level, HCA and the workgroup have been refining a one-page document outlining our proposal for supplemental state aid to home health to meet community need. This HCA document should be available for member circulation and use imminently.  HCA will follow with direction to the membership on utilization of this document for outreach to and education of your state legislative members about this state aide proposal, your home health agencies’ needs, and the importance to legislators’ constituents. During the past two legislative sessions, HCA has been successful in getting the proposal language introduced in the Legislature, as well as in getting either the Senate or Assembly to introduce the funding for it. In these two years, the Senate and Assembly have each alternately proposed funding. The goal must be to gain the simultaneous support of the Executive and both the Senate and Assembly to include this program and the funds in the 2025 budget.

Currently, HCA member CHHAs from across NYS are serving on the workgroup, which is meeting every other Tuesday. If your agency is not currently serving, and would like to, please email info@hcanys.org under subject heading HCA CHHA Workgroup, and a member of the HCA team will be in touch to welcome you as a participant! Every HCA CHHA needs to be part of this effort, whether you are a member of this workgroup, or stepping up to help educate policymakers about home health agencies and their patient and community needs.

An easy way to start? Complete the annual State of the Industry survey!

HCA is calling on every CHHA, LHCSA, hospice, MLTC/PACE, and CDPAP/FI statewide to participate in the Association’s Annual State of the Industry Survey.

The information gathered from this annual survey will assist us in providing a comprehensive analysis of home and community-based care in New York State. Our analysis brings together data from various sources to present trends and challenges, as well as profiles of CHHAs, LHCSAs, Hospice and Palliative Care, MLTC/PACE and CDPAP/FI.

Your participation in this survey is critical as we use this data and report for our state and federal advocacy for the upcoming legislative session – help us help you!

HCA has learned that the Centers for Medicare & Medicaid Services (CMS) and Wisconsin Physicians Service Insurance Corporation (WPS) began notifying people whose protected health information or other personally identifiable information (PII) may have been compromised in connection with Medicare administrative services provided by WPS. WPS is a CMS contractor that handles Medicare Part A/B claims and related services for CMS.

The notification comes following discovery of a security vulnerability in the MOVEit software, a third-party application developed by Progress Software and used by WPS for the transfer of files in providing services to CMS. WPS is among many organizations in the United States that have been impacted by the MOVEit vulnerability. The security incident may have impacted PII of Medicare beneficiaries that was collected in managing Medicare claims as well as PII collected to support CMS audits of healthcare providers that some individuals who are not Medicare beneficiaries have visited to receive health care services.

CMS and WPS are mailing written notifications to 946,801 current people with Medicare whose PII may have been exposed, informing them of the breach and explaining actions being taken in response. CMS is also posting a substitute notice with similar information for those individuals for whom there is insufficient or out-of-date contact information for sending a written notification.

View the full letter here.

If you are impacted by the data breach or use the MOVEit software, please let us know at jvandecarr@hcanys.org. HCA will keep you informed as we learn more.

The Senate and Assembly introduced resolutions related to their respective one-house budgets this week.

HCA has prepared this memorandum with preliminary analysis of the Senate and Assembly’s proposed 2024-25 State Fiscal Year (SFY) One House Budgets, developed in response to the Governor’s Executive Budget released in January. This analysis contains particular emphasis on the Medicaid and health-related provisions.

HCA developed and has strenuously advocated key positions in response to the Executive Budget since its release in January. It is with cautious optimism and gratitude toward the Legislature for taking home healthcare’s voice into consideration in their proposals that we report the results of the one house budgets to you, and next plot our course forward.

With the release of these one-house budget proposals, we have turned a corner into the next major phase of the State Budget process. The legislature has indicated through their proposed budgets that our advocacy has been working; we thank our advocates for joining us in meetings, sending messages, making calls. Every voice counts!

In order to ensure these proposals stay in the final enacted State Budget, we cannot relent. We need every HCA member to weigh in on how critical the maintenance of these positions is for the sustainability of this industry and the delivery of home healthcare to patients across New York State.

Legislators want and need to hear from you: the individuals casting votes in their districts and taking care of the patients who do the same and employing thousands of workers.

Please take a moment to locate the contact information for your representatives, using this tool, and place a call to their offices. Begin with acknowledging and thank them for their support in their health and Medicaid budget bill, and urge them to see this through to the final adopted budget. Arrange to have a meeting with them and reiterate the points we have outlined above, or even leave a message with their staff if you are pressed for time! They need to know how important this is to you.

HCA will continue to contact you directly to encourage these legislative meetings and offer assistance.

This means steady calls from every HCA member and member staff to your Senator and Assemblymember (beginning with your acknowledgement of their support and your thanks for supporting home care, hospice, MLTC, and CDPAP in their budget bills), letters and emails to them, and meetings in their local districts. In addition, HCA may be calling all members to Albany to rally at the Capitol.

If you are new to this, don’t worry! You can keep it very simple and you don’t need to have all the details to still be effective. Here is a quick overview of the basics!

Please stay tuned, in the coming days HCA will be in touch with a multi-tiered plan for you to take action over the next several weeks. We need you and we thank you for your continued support and advocacy.

New York State Office for Aging (NYSOFA) and the Association on Aging in New York are launching the first-ever statewide needs assessment survey of older adults. The community assessment findings support state priorities for older adults as NYSOFA prepares its four-year plan to the federal government. Which will provide as a guide for service delivery and policy development for aging services programs that support older adults throughout New York State. The community assessment findings will also provide further information to support the goals of the Master Plan for Aging.

HCA is asking for your assistance in sharing this important survey with anyone age 60 and over.

The anonymous survey will take approximately 10-15 minutes to complete; it closes on March 30, 2023.

Attached here is suggested messaging from NYSOFA to use on social media, in your organization’s newsletter, on your website, or any other method of outreach you can assist with.

If you have any questions, please contact NYSOFA@aging.ny.gov.

 

The Situation Report | February 27, 2023

On February 24, the U.S. Centers for Disease Control and Prevention (CDC) has posted a Health Advisory on Shigellosis.   

The CDC states that it has been monitoring an increase in extensively drug-resistant (XDR) Shigella infections (shigellosis) reported through national surveillance systems. In 2022, about 5% of Shigella infections reported to CDC were caused by XDR strains, compared with 0% in 2015.  

Clinicians treating patients infected with XDR strains have limited antimicrobial treatment options. Shigella bacteria are easily transmissible. XDR Shigella strains can spread antimicrobial resistance genes to other enteric bacteria. Given these potentially serious public health concerns, CDC asks healthcare professionals to be vigilant about suspecting and reporting cases of XDR Shigella infection to their local or state health department and educating patients and communities at increased risk about prevention and transmission. 

The Advisory includes background information; recommendations for healthcare professionals, public health officials and the public; and resources. 

The Situation Report | January 30, 2023

At the end of 2022 Congress passed the Consolidated Appropriations Act of 2023 to fully fund government functions for the fiscal year. Included in the 4500 page bill are a number of provision affecting health care and in particular home care.

• Continues telehealth flexibilities through the end of 2024
• Extends the Acute Care Hospital at home program through the end of 2024
• 1% rural health care add-on
• Reduces the sequestration cuts in the second half of 2023 to zero
• Reauthorizes the Jackie Walorski Maternal and Child Home Visiting Program
• Protections Against Spousal Impoverishment for Recipients of Home and Community Based Services through December 20027
• Permanent Reauthorization of in home IVIG services
• Requires state Medicaid programs to provide 12 months of continuous coverage for children and permanently allow states to allow 12 months of coverage for post partem women

A number of these provisions will need to be revisited at the end of 2023 and the end of 2024.  The Home Care Association will continue its advocacy to reauthorize and/or extend these provisions as necessary to support home care services.

The Situation Report | January 17, 2023

The Occupational Safety and Health Administration (OSHA) reminds employers to submit their 2022 OSHA Form 300A (Summary of Work-Related Injuries and Illnesses) data by March 2, 2023. 

Who is required to submit Form 300A data? 

• Establishments with 250 or more employees that are required to keep OSHA injury and illness records.  
• Establishments with 20 to 249 employees in designated industries.  

• Establishments under Federal OSHA jurisdiction can use the ITA Coverage Application to determine if they are required to electronically report their injury and illness information to OSHA. Establishments under State Plan jurisdiction should contact their State Plan.  

Home health care agencies with less than 250 employees don’t have to submit Form 300A, but still have to complete it. 

How to submit Form 300A data: 

As part of the Department of Labor’s IT modernization and security enhancement efforts, the Injury Tracking Application transitioned its login procedure to Login.gov — a secure sign-in service used by many government agencies. Current and new account holders need to create a Login.gov account to submit their 2022 injury and illness data. Detailed guidance on how to carry out this change is available as a job aid and video. 

If you have questions, visit the FAQs webpage. If the FAQs don’t address your questions, complete the Help Request Form located on the page. 

On November 9, Governor Hochul issued Executive Order (EO) 21.2 that extends the previously issued EO 21.1 which continued the declaration of a Disaster in New York State due to the ongoing spread of polio. 

It continues certain changes to EO 21 that were made by EO 21.1.  These are: 

• The allowance of certified emergency medical technicians-paramedics and advanced EMS providers to provide community paramedicine services with prior approval of the Department of Health to administer vaccinations against poliovirus is modified to allow certified emergency medical technicians-paramedics and advanced EMS providers to also administer vaccinations against poliovirus which contain tetanus, pertussis, hepatitis B, and Hib vaccines. 
• The allowance of authorized midwives to administer vaccinations against poliovirus to any patient pursuant to a non-patient specific order under the medical supervision of licensed physicians, licensed physician assistants, or certified nurse practitioners is modified to allow midwives to also administer vaccinations against poliovirus which contain diphtheria, tetanus, pertussis, hepatitis B, and Hib vaccines. 
• The allowance of pharmacists to administer vaccinations against poliovirus pursuant to a non-patient specific order is modified to allow pharmacists to also administer vaccinations against poliovirus pursuant to a patient specific order and also to allow pharmacists to administer vaccinations against poliovirus which contain tetanus, pertussis, hepatitis B, and Hib vaccines pursuant to a non-patient specific and a patient specific order. 
• The allowance of authorized physicians and certified nurse practitioners to issue a non-patient specific regimen to persons authorized by law or by this executive order to administer vaccinations against poliovirus is modified to allow physicians and certified nurse practitioners to also issue non-patient specific regimen to administer vaccinations against poliovirus which contain diphtheria, tetanus, pertussis, hepatitis B, and Hib vaccine, and also to issue patient specific orders to licensed pharmacists for administration of immunizations to prevent poliovirus including vaccinations which contain diphtheria, tetanus, pertussis, hepatitis B, and Hib vaccine. 

EO 21.2 will expire on 12/8/22 unless it is renewed. 

HCA joined with state home care associations across the country over the weekend to discuss some of the most dominating issues in the field. The meeting included association executives, executive and policy representatives of the National Association for Home Care and Hospice (NAHC), and members of the NAHC Board of Directors.

NAHC President and CEO, Bill Dombi, led discussions on subject areas that included:

1. The effort to turn back the Centers for Medicare and Medicaid Services (CMS) proposed massive cuts Medicare home health payments.
   • Advocacy by NAHC and by the state home care associations is continuing. At a meeting on Friday, October 21 between CMS and NAHC where the issues with the proposed cuts were again discussed, CMS reportedly provided no insights as to its intended action in the reconsideration of the cuts. In the meantime, Congressional Leaders including Senate Majority Leader Charles Schumer and House Speaker Nancy Pelosi have both weighted in directly with the Administration expressing concern with CMS’s proposal. Also, HCA, NAHC and state associations across the US continue to petition all Members of Congress to co-sponsor the “Patient Access to Home Health Act,” S.4605/H.R.8581, that would halt such cuts through 2025 if CMS proceeds to adopt the 2023 Medicare Home Health Payment Rule with the cuts as proposed. The CMS Final Rule is anticipated to be issued within the next week, and thus every effort must continue to be waged to urge CMS to abandon these cuts. Every HCA member should continue to follow the grassroots advocacy guidance here. HCA thanks agencies and individual staff who follow-up, and we urge everyone who has yet to participate, to please do so today, and those have already reached out, to please continue in this final push!
2. Home Care Workforce initiatives.
   • NAHC is pursuing a multitiered process, together with a consultant and a series of working committees to address elements central to home care workforce recruitment, training and retention. A major part of this effort that was reviewed by Mr. Dombi is working to further build the strong “public image” of home care, what does, what it means for individuals needing the care, what it means to the health system, what it means to those working in the field. HCA President Al Cardillo described HCA’s and related NYS initiatives to address the health workforce need. He cited HCA’s statewide collaboration workforce summit and our summary report (https://hcanys.memberclicks.net/assets/site/Final%20Update%20-%20Workforce%20Summit%20Summary.pdf) and an array of HCA program initiatives both direct and collaboration with association partners.
3. NAHC-sponsored studies on home care and hospice partnerships with Medicare Advantage Plans and on hospice benefit.
   • Reports on these studies are both anticipated by the end of the year, and expected to render important data and perspectives to assist the field in the related goals of working in conjunction with Medicare Advantage Plans – which are serving a growing proportion of Medicare beneficiaries, including expansion to incorporate hospice under the Value Based Insurance Design(VBID) model, testing the hospice benefit under VBID.
4. A proposed US Department of Labor rule on classification of “employees” versus “independent contractors.” (This issue is also discussed in the October 17 edition of the Situation Report, https://hca-nys.org/rule-proposed-on-employee-or-independent-contractor-classification/) The proposed rule has been filed with a 45 day comment period (now midway) and HCA will be working with NAHC and others on the analysis and implications for the field.
5. A class action complaint filed against the US Department of Health and Human Services seeking Medicare beneficiary access to home health aide coverage under the Medicare home health benefit.

• On October 11, the Center for Medicare Advocacy filed a lawsuit representing Medicare beneficiaries who rely on home health aide services, in the complaint entitled Johnson v. Becerra, No. 1:22-cv-03024. The Plaintiffs claim that the HHS Secretary has “adopted policies and practices that impede and restrict the availability and accessibility of Medicare-covered home health aide services for eligible beneficiaries with chronic, disabling conditions.” They state that “the Secretary has effectively redefined eligibility for Medicare-covered home health aide services to exclude people who require more than very minimal aide services for a short duration of time.” Dombi and the Forum participants discussed the case and the implications at length, and considerations for how the industry might participate.

Members of the NAHC policy and regulatory team led discussions on the future of hospice and palliative care policy and delivery, MedPAC issues, and a package hospice and palliative care legislative initiatives in the Congress. HCA will providing additional information on these hospice developments at our November 2 HCA Hospice Forum meeting. All HCA hospice member leaders and staffs are invited to join in this discussion, as it also coincides with National Home Care and Hospice Month. Hospices should register for the Forum at: https://us02web.zoom.us/meeting/register/tZAqcOippzguHNIw-Y7YYDK-B33pKm2QS3g9

Hospices should register for the Forum here.

Situation Report | October 3, 2022 

We continue to monitor the New York Independent Assessor (NYIA) implementation and engage with the Department on critical issues impacting plans and their members. To inform these efforts—as well as our ongoing NYIA advocacy strategy—we will continue to collect information from plans on a monthly basis via a Survey Monkey tool that plans helped develop. To simplify plans’ work in response to these requests, we have joined forces with our fellow plan associations and now have one survey tool that all plan associations will use moving forward. As a result, you do not need to complete more than one survey per month, even though you may receive the request from other associations. The plan associations, including the MLTC and PHP Coalitions, HPA, Manatt, and Leading Age, will be working together to analyze results, elevate issues for resolution, and pull key findings for discussion with policymakers and other stakeholders in support of plans and their members. As always, data collected will be anonymized.

Given the timing of this request, we are simultaneously sharing two survey links—one for the July-August period and another for the August-September period. We have staggered the due dates for these two months’ survey responses, but if it is easier for your plan to complete them at the same time, please feel free to do so.

• July-August Survey: Please complete the survey for the enrollment period of 7/21-8/19 by EOD Wednesday, October 12^th:  https://www.surveymonkey.com/r/SZBB8Q3
• August-September Survey: Please complete the survey for the enrollment period of 8/20-9/20 by EOD Wednesday, October 19^th:  https://www.surveymonkey.com/r/W33L2KV.

Finally, we recognize that not all plans may be tracking the data points included in these requests; you will have the option to indicate so as part of your response. All questions are optional.

Please do not hesitate to contact a member of the HCA team if you have any questions. Thank you in advance for your attention to this matter.

Situation Report | October 3, 2022 

The U.S. Centers for Medicare and Medicaid Services (CMS) has published the annual adjustment in the Amount in Controversy (AIC) threshold amounts for Administrative Law Judge (ALJ) hearings and judicial review under the Medicare appeals process.  

The adjustment to the AIC threshold amounts will be effective for requests for ALJ hearings and judicial review filed on or after January 1, 2023. The calendar year 2023 AIC threshold amounts are $180 for ALJ hearings (same as in 2022) and $1,850 for judicial review (up from $1,760 in 2022).    

The notice is available here.

Situation Report | August 8, 2022 

Last week, the New York State Comptroller’s office released an audit of managed long term care (MLTC) plans for the period January 2015 to March 2021, which found:

• Medicaid paid about $701 million in improper MTLC premium payments on behalf of 52,397 recipients who were no longer eligible for MLTC enrollment (did not receive services, deceased, in hospital for more than 45 days, not Medicaid eligible or not eligible for MLTC services).
• Medicaid paid $2.8 billion in MLTC premium payments on behalf of 51,947 recipients who received a limited number of community-based long-term care services; for instance, 22,048 recipients only received between 1 and 30 days of services during six-month assessment periods.

The Comptroller recommends that the state Department of Health (DOH) should review the $701 million in premium payments and make any appropriate recoveries; develop a process to ensure timely MLTC disenrollment of ineligible recipients; and monitor MLTC recipients to ensure that they are properly assessed for enrollment and are receiving the appropriate level of care.

HCA will be reviewing the audit findings, but notes that DOH calculates plan premiums to cover individuals who may need few services and those who need frequent services; part of the audit period covered the COVID-19 pandemic which affected the delivery of services; unclear DOH guidance on service termination; and the unknown future effects of changing the assessment process to utilize the New York Independent Assessor.

 

Situation Report | May 23, 2022

HCA reminds our home care and hospice members that they must submit the Healthcare Personnel Influenza Vaccination Report by June 1.

All facilities covered under New York Codes, Rules and Regulations, Title 10, Section 2.59 (10 NYCRR Section 2.59), including home care and hospice, are required to document the number and percentage of personnel vaccinated against influenza for the current season.

This year’s report covers healthcare personnel (HCP) employed by or affiliated with your facility or agency from October 1, 2021 through March 31, 2022.

The report may be accessed on the Health Electronic Response Data System (HERDS) which is located on the Health Commerce System.

A pre-recorded webinar training session for the Healthcare Personnel Influenza Vaccination Report is available here, under the heading “Training”. DOH advises that the person completing the report views the pre-recorded webinar and reviews the FAQs.

Some important points in the FAQs include:

• Each separate facility or agency must submit an individual report under its own Permanent Facility Identifier (PFI). Reports from facilities or agencies with different PFIs cannot be combined into a single report.
• If a HCP works in or is affiliated with more than one facility or agency, then this individual must be counted in the total number of HCP for each facility or agency where he or she works.
• Any HCP that received influenza vaccine after July 1, 2021 should be counted as vaccinated, since influenza vaccine for a given year may be available as early as July or August.
• HCP who verbally indicate that they received an influenza vaccine off-site, but who cannot provide written documentation of the vaccination, should be counted in the “unknown vaccination status” category.

Questions about the report should be directed to the NYSDOH Bureau of Immunization at either (518) 473-4437 or immunize@health.ny.gov. Technical questions about the report or on the use of HERDS should be directed to the Health Emergency Preparedness Program at (518) 408-5163 or hseppny@health.ny.gov.  Questions about the requirement that agencies document the number and percentage of personnel vaccinated against influenza for the current season should be directed to flumaskreg@health.ny.gov.

State lawmakers passed a final state budget on Saturday for Fiscal Year (FY) 2022-23, and Governor Hochul signed and approved the bills later that afternoon. The $220 billion budget, which includes wage increases for home care aides, health care worker bonuses and other increases for health care funding, is $4 billion more than the Governor originally presented as part of the Executive Budget Proposal that was released in January. Governor. Hochul touted the budget agreement as a “bold and fiscally responsible plan [that] makes historic investments in communities across the State.”  

Along with the new wage increases, bonuses and health care funding, the final budget agreement includes several new and expanded initiatives, including an increase in the state’s reserves to a record level of 15% of State Operating Funds spending by FY 2025. The final budget also addresses bail reform measures, the expansion of Kendra’s Law, $5 billion in spending for childcare and record-level housing, transportation and clean energy initiatives, among many others. Click here for an overview of the items included in the final budget agreement.  

The final budget also includes some relief for record high fuel prices at the pump, providing a gas tax holiday, which pauses the state’s 16-cent per gallon gas tax from June 1, 2022 through December 31, 2022. The state would suspend both the 8-cent per gallon motor fuel tax and 8-cent per gallon sales tax on gasoline. According to the Governor, the tax break will cost the state $585 million in lost revenue for the year. HCA has repeatedly pressed the Executive and Legislature on the impact of the high fuel costs on home care workers, and more must be done to reduce costs and reflect the expenses in the state’s reimbursement methodologies.  

Minimum Wage Increase for Home Care Aides
The final budget agreement includes a plan for over $7 billion in spending on a $3 per hour wage increase for home care workers over a two-year period. Beginning October 1, 2022, the hourly minimum wage for a home care aide will increase by $2; and beginning October 1, 2023, the minimum wage will increase by an additional dollar per hour. For periods on or after January 1, 2023, the wage parity benefit portions remain at $4.09 (New York City) and $3.22 (Long Island and Westchester). It is not self-evident in the language of the final budget bills whether or how the final budget provides reimbursement to the home care providers and managed care plans  

The dollar amounts for home health wage increases included in the final budget are significantly less than the amounts proposed by both the Senate and the Assembly in their one-house budget proposals, which used standalone legislation known as Fair Pay for Home Care Workers and would have increased the minimum wage by 150% and provided reimbursement to providers.  

The final home care wage provisions were negotiated and settled among the very final budget items and at the legislative “leaders” level, and thus very little additional detail is available at this time. HCA will be reaching out to key budget sources to finish putting the home care wage and funding picture together as quickly as possible.  

Bonus Pay for Health and Mental Health Workers  

The final budget also includes bonus pay for frontline health care staff working in health and mental health settings. According to the language, Medicaid providers that employ one employee and bills for services under the state plan or a home and community-based services waiver or have a provider agreement to bill for services provided or arranged through a managed care provider are eligible. 

Worker bonuses are commensurate with the number of hours worked during the vesting period that will be determined by a vesting schedule issued by the Commissioner of Health. The schedule will provide for total payments not to exceed $3,000 per employee based upon the number of hours worked per week over the course of the vesting period. Specifically, the bonus pay will be distributed as follows:  

• Employees who have worked an average of at least 20 but less than 30 hours per week over the course of a vesting period would receive a $500 bonus for the vesting period.  
• Employees who have worked an average of at least 30 but less than 35 hours per week over the course of a vesting period would receive a $1,000 bonus for such vesting period.  
• Employees who have worked an average of at least 35 hours per week over the course of a vesting period would receive a $1,500 bonus for such vesting period.  
• Full-time employees who are exempt from overtime compensation as established in the labor commissioner’s minimum wage orders or otherwise provided by New York state law or regulation over the course of a vesting period would receive a $1,500 bonus for such vesting period.  

An alternative number of vesting periods may be provided through regulation, provided that total payments do not exceed $3,000 per employee.  

Employees will be eligible for bonuses for no more than two vesting periods per employer, in an amount equal to but not greater than $3,000 per employee across all employers.  

Upon completion of a vesting period with an employer, an employee will be entitled to receive the bonus and the employer will be required to pay the bonus no later than the date specified under the law; however, that prior to such date the employee does not terminate, through action or inaction, the employment relationship with the employer.  

Consumer Directed Provisions  

The final budget also addresses the Consumer Directed Personal Assistance Program Fiscal Intermediary Request for Offers (CDPAP FI RFO). Under this provision, those not selected under the initial RFO process would now qualify if the FI served more than 200 in cities of more than one million (i.e., New York City), and at least 50 consumers in other areas of the state at any time between January 1, 2020 and March 31, 2020.   

Other Budget Provisions 

The final budget also includes the following provisions and allocations:   

• 1% rate increase for home care, hospice and other health care providers and elimination of the current 1.5% reduction to Medicaid rates.  
• Cost of Living Adjustment: 5.4% increase for human services providers and workers.  
• Telehealth: Requires telehealth services to be reimbursed at the same rate as in-person services, though certain telehealth costs would not be eligible for reimbursement, such as facility fees.  
• New Statewide Health Care Facility Transformation Funds: Up to $25 million for home care and hospice providers.  
• Medically fragile adults and children: Increased rates for private duty nursing services provided to medically fragile adults.  

Managed Care Procurement Rejected 

Critically important, the final budget rejects a procurement process for managed care organizations that had been proposed and pressed by the Executive. HCA had strongly opposed the procurement process and fought for its rejection. The budget agreement does require a report by an independent contractor that reviews and makes recommendations about the status of services offered by managed care organizations.  

Independent Assessor (IA) Extensions 

Language is included that amends current IA provisions. Specifically, it permits the state Department of Health to extend (1) the existing Maximus contract to perform IA services until September 30, 2025, but thereafter requires a procurement; (2) the enrollment broker and conflict-free evaluation Maximus contracts until August 19, 2026; and (3) the contract for independent physician panel services through September 20, 2025. The final budget prohibits extensions beyond such dates. 

HCA had led an effort beginning in January among five major associations with managed long term care members, urging the Governor and Legislature to fully repeal the IA and will resume efforts to persuade the Governor to rid the IA from state policy.  

Licensed Home Care Services Agency (LHCSA) Authorization Process  

The final budget does not repeal the LHCSA Authorization Process, despite constant HCA advocacy for repeal and the pickup of substantial support in the Legislature. HCA will continue to fight for the RFO repeal in the post-budget session of the Legislature. 

HCA Budget Briefing This Wednesday, April 13 

HCA Public Policy staff are currently reviewing the contents of the final budget and will provide a more detailed analysis in the coming days.  

Members are encouraged to join HCA on Wednesday, April 13 from 1 p.m. to 2 p.m. for a budget briefing on the items most important to the membership. Please register here for the ZOOM meeting.   

Please join the Home Care Association of New York State (HCA), the Iroquois Healthcare Association (IHA) and the Healthcare Association of New York State (HANYS) for the next webinar in a series of monthly sessions on hospital-home care collaboration.

The next live webinar will be presented on Thursday, April 7, 2022 from 12 p.m. to 1 p.m.

During this webinar, Catholic Health System and Catholic Home Care will address the integration of physical and mental health services to at risk patients requires collaboration across the care continuum.

Learn how one hospital and home care agency strove to move patients with mental illness seamlessly across acute care, outpatient and home care settings during the COVID-19 pandemic. A focus on telehealth greatly contributed to this collaborative model.

Click here to join the webinar on April 7. The link will be accessible 15-minutes prior to session.

Add the event to your calendar!

This program is sponsored by HCA, HANYS and IHA as part of the Statewide Hospital-Home Care Collaborative initiative funded to HCA under a grant from the Mother Cabrini Health Foundation. Visit the Statewide Hospital-Home Care Collaborative website to learn more.

HCA’s bi-monthly Member Forums sessions continue in April – this is the second meeting in the set of three that commenced in early 2022.

Continue reading “HCA Members Only Virtual Forums” →

Situation Report | March 7, 2022

 

Join HCA, the Healthcare Association of New York State (HANYS) and the Iroquois Healthcare Association (IHA) for the next webinar in a series of monthly sessions on hospital-home care collaboration.

The next webinar in our series of monthly sessions on hospital-home care collaboration will be presented Thursday, March 10 from 12 p.m. to 1 p.m.

This session will feature Catholic Health System and Catholic Home Care.

Join the webinar here. The link will be accessible 15 minutes prior to the session.

This webinar will present newest, cutting-edge designs for collaboratives being undertaken by a major hospital system and home health agency. It will delve into the newest areas and approaches employing collaborative strategies. Learn the latest from system leaders on how they are advancing the horizons of health program development and interventions through hospital-home care collaboration.

 

Add the event to your calendar.

For further background and resources related to the Statewide Collaborative, please click here.

 

This program is sponsored by HCA, HANYS and IHA as part of the Statewide Hospital-Home Care Collaborative initiative funded to HCA under a grant from the Mother Cabrini Health Foundation. 

Situation Report | February 28, 2022

 

“It’s Your Time to Shine!” Shine the light on your star employees or highlight one of your colleagues for their contributions in furthering the home care and hospice industry. All these opportunities, and more, are available to you through the 2022 HCA Home Care and Hospice Awards Program.

 

Award categories include the Caring Award, Patient (Shining Light) Award, Quality and Innovation, Physician Champion, Advocacy, and HCA’s highest honor – the Ruth F. Wilson award. A detailed description of each award category is provided here.

 

This year, award winners will be featured on HCA’s website, social media and press releases. In addition, all the winners will be honored during a special Awards Reception at our 2022 Annual Conference in Saratoga on May 4-6. The Awards Reception is always the highlight of the Conference and a moment you won’t want to miss!

 

Watch for more information about the Annual Conference coming soon. In the meantime, help make this year’s awards ceremony something truly special by submitting your nominations. Nominations may be submitted through March 14^th. 

 

Questions can be directed to Jenny Kerbein, Director of Governance, at jkerbein@hcanys.org.

 

Situation Report | January 31, 2022

The Centers for Medicare and Medicaid Services (CMS) has issued guidance to state Survey Agency Directors about the vaccine status and procedures for state surveyors.

CMS advises that surveyors who are not fully vaccinated (unless vaccination is medically contraindicated or the individual is legally entitled to a reasonable accommodation under federal civil rights laws because they have a disability or sincerely held religious beliefs, practices, or observances that conflict with the vaccination requirement) should not participate as part of the onsite survey team performing federal oversight of certified providers and suppliers (including accreditation surveys performed under an Accrediting Organization’s (AO’s) deeming authority).

Unvaccinated personnel may be used, at the state survey agency’s or AO’s discretion, for offsite survey or enforcement activities.

The state survey agencies and AOs are ultimately responsible for compliance with CMS’s vaccine expectations. Therefore, certified providers and suppliers are not permitted to ask surveyors for proof of their vaccination status as a precondition for entry. Providers and suppliers may have questions about the process a state or AO is using to implement this guidance, including verification of surveyor vaccination, mitigation expectations for unvaccinated staff with approved exemptions, and ensuring proper tracking of vaccination status. Those questions should be addressed to the state survey agency or AO.

CMS encourages state survey agencies and AOs to proactively communicate with providers and suppliers about their efforts to implement this guidance.

Situation Report | December 27, 2021 

The state Department of Health issued the Medicaid Global Spending Cap Report (April through September 2021 Quarterly Report) on December 21, 2021. According to the Report, the Medicaid Global Spending Cap increased from $19.9 billion in Fiscal Year (FY) 2021 to $22.3 billion in FY2022, a net increase of $2.4 billion.  

This net increase primarily includes the Global Cap index growth of $580 million (based on the 2.9 percent trend of the ten-year rolling average of the Medical Care Consumer Price Index [CPI]), increased costs for minimum wage rate adjustments of $369 million, and the year-to-year decline of COVID-19 enhanced Federal Medical Assistance Percentage (eFMAP) support of $1.2 billion.  

Major changes to Medicaid spending, as reflected in the Mid-Year Financial Plan Update, include the extension of the COVID-19 public health emergency eFMAP benefit, the resulting costs associated with persistently elevated enrollment and delayed MRT II savings, attributable to the Federal Center of Medicare and Medicaid Services (CMS) Maintenance of Effort (MOE) guidelines restricting program restructuring efforts, and increased support to financially distressed hospital providers.  

These impacts are accounted for separately in the Financial Plan and do not result in an adjustment to the Global Cap.  

Read the Report. 

Situation Report | December 27, 2021 

Over the holiday weekend, Governor Hochul released Executive Order 11, which includes a number of efforts to address the latest COVID-19 Omicron variant and surge in cases. 

Under the EO, local governments are allowed to lift an in-person renewal requirement for property tax exemptions for low-income senior citizens and persons with disabilities. 

Local governments may also automatically renew 2022 benefits for all property owners who received the benefit in 2021 unless the locality has reason to believe an individual has changed their primary address, added another owner to the deed, transferred the property to a new owner, or passed away. 

The EO also permits certified clinical laboratories to use out-of-state facilities for New Yorkers’ COVID-19 testing to mitigate testing capacity issues. 

Finally, the EO also grants the state Senate and Assembly the discretion to meet remotely, consistent with legislation passed in September that currently applies to other public bodies, to meet remotely. The law allows public bodies to meet remotely but requires the contents of the meetings to be publicly available. 

The Legislature is expected to convene Monday, January 10, 2022 to begin the Legislative Session.

State of the State Address Canceled

In keeping with COVID-19 guidelines, Governor Hochul also announced that the annual State of the State Address will no longer take place in-person on January 5. It would have been the first time in a decade the annual address was held back in the Assembly Chamber. It remains uncertain if the Governor will address the public with an outline of her Executive Budget Proposal. 

Legislative Update  

Throughout the last month, the Legislature has sent hundreds of bills in batches the Governor’s office for her approval or veto. A large number of bills remain on the Governor’s desk, awaiting action. Governor Hochul has until midnight, New Years Eve, to decide on the bills, otherwise they are automatically pocket vetoed. 

As it relates to the home care industry, Governor Hochul approved the following bills: 

• Reimagining Long Term Care Task Force (A.3922-A (Cruz)/S.598-B (May): The bill creates a Task Force made up of 26 stakeholders, including executive and legislative appointments, as well as community stakeholders, including HCA and other associations, chaired by the Director of Aging. The Task Force will examine the challenges and issues generated by the COVID-19 pandemic, infection control protocols, enforcement, staffing and visitation bans at long term care facilities, to inform future emergencies. 
• Investing in Care Act (A.6590-B (Kelles)/S.4651-B(May)): This bill mandates the Commissioner of Economic Development to study, develop and propose how to implement a long term strategy to support the growth of the caregiving industry in New York State, including the home care industry. The strategy will then be based on an analysis of financial support for the growth of caregiving industry businesses and non-profits; workforce development, recruitment and retention needs, and innovation and new modes of caregiving delivery. 

The new laws are effective immediately.  

For questions or concerns about this legislation, please contact HCA’s Director for Advocacy and Public Policy Alyssa Lovelace. 

 

Situation Report | December 27, 2021

The December 9, 2021 Home and Community-based Services Social Adult Day Care (HCBS SADC) Site Self-Assessment Compliance slide deck presentation, audio recording and written transcript are now posted to the MRT 90 website  under MLTC policy 21.05. 

Reminders for preparing and for the Managed Long Term Care (MLTC) plans on returning the completed SADC Site Self Assessments by December 30, 2021 are below:  

Completing Self-Assessment Tool: Please read all instructions provided on page one of the Self-Assessment tool before completing.  

• SADC sites complete the Self-Assessment tool for each Partial Cap and/or MAP Plan (line of business) and location.  Example:  if a site contracts with one MLTC and has two locations and provides both MAP and Partial at each, the site will need to complete 4 assessment tools.   
• SADC sites include individual membership totals (“Number of HCBS Waiver Clients Served at the Setting”) for each line of business and location on each Self-Assessment tool. 
• If SADC site is reporting “closed/no members” to their MLTC plan, the site should still complete the tool and write the sites status in the comment field for question #1 in the SADC site section 2 table starting on page 5. In addition, sites must indicate (in the comments field) if the site is fully or partially closed, as well as if the closure is permanent or temporary with a description for why (i.e. COVID related) by line of business. Both MLTC plan and DOH will validate the site’s contracting status with the MLTC plan in Phase II via the MLTC plan’s PNDS submission. When those SADC sites prepare to “reopen” those sites are required to meet and have all HCBS SADC standards validated BEFORE re-opening. 
• Per the Self-Assessment tool instructions all “Yes” and “No” answers require a comment.  
• Instructions: If answering “No” to a question, thereby potentially demonstrating a lack of HCBS Rule compliance, please provide a brief explanation as to why in the far-right “Comments” column and any remediation efforts in progress. If answering “Yes”, provide a brief explanation in Comments as to how to demonstrate compliance.” 

Tool Submission and Due Dates: 

• SADC sites submit each individually completed Self-Assessment tool back to their MLTC contracted plans. The tool should remain in Word Document format and should not be converted to PDF.  PDF versions will be returned to MLTC plans by the state Department of Health (DOH) and considered not submitted. Only the Word Document format can be collectively merged for analysis by DOH.   
• SADC site submits individual completed Self-Assessments back to each MLTC plan by the December due date communicated by the plan.  
• MLTC plans submit all completed individual SADC Self-Assessments back to DOH via the HCS along with the Aggregated Results (Plan Aggregated Results Template is forthcoming) back to DOH by Dec 30, 2021.  

Please contact the Department of Health via email to HCBSSADCSiteAssessments@health.ny.gov with questions.

Please note that HCA’s office will be closed Wednesday, November 23-Friday, November 26 for Thanksgiving. We wish our members a joyous and safe holiday with family and friends!

November 22, 2021 | Volume 6, Issue No. 40

Accreditation Commission for Health Care (ACHC) announces the renewal of its partnership with Home Care Association of New York State, a premiere nonprofit association in New York that promotes home care as an integral part of the health care system.

Continue reading “ACHC and HCA of New York State Renew Support of Home Care Providers” →

Under the state’s vaccination mandate, staff of home care, hospice and other health care organizations must receive the COVID-19 vaccination (first dose by October 7, 2021), with only a limited exception for medical reasons.

Continue reading “Responses Needed by Oct. 13: Follow-up HCA COVID-19 Vaccine Mandate Survey” →

HCA confirming impact of separate OSHA emergency rule; join us for July 13 webinar sorting it out

Importantly, DOL clarifies that while employers must adopt plans … the plans are currently “not required to be in effect.”

Last week, HCA alerted members that the state Department of Labor (DOL) posted revisions to already-proposed employee scheduling (“call-in pay”) regulations.

HCA has prepared a document that compares the previously proposed regulations with the newly released regulations. It is posted at https://hca-nys.org/wp-content/uploads/2018/12/Call-in-Pay-side-by-side.pdf.

The newly proposed rule can be found on the DOL website at https://www.labor.ny.gov/workerprotection/laborstandards/pdfs/employee-scheduling-proposed-rule.pdf.

An initial version of these regulations was proposed on November 22, 2017, requiring employers to provide additional pay when a shift is cancelled or not scheduled within a certain advanced time requirement. It would also mandate additional pay for employees who are required to be in contact with the employer about a possible upcoming shift. HCA commented and delivered testimony on the original proposals earlier this year (see https://hca-nys.org/general-news/4547).

The revised regulations will trigger yet another comment period where HCA will reiterate our call for the state to carve-out the home care, hospice and MLTC sectors from the proposed regulations should they be adopted.

DSRIP, FIDA, VBP … the alphabet soup is getting thick, and HCA members have asked for help navigating these and other new acronym-heavy payment models that are now with us and on the near horizon.

These new models will affect you; it’s only a matter of when, as the state juggles multiple waiver and Medicaid pilot initiatives with the federal government in an effort to construct incentive programs.

To help you, HCA will hold a daylong program in Albany on May 28 entitled Are You Ready to Navigate New Models of Care and Coverage? Registration is now open here.

This program is geared for home health provider and health plan CEOs, CFOs, COOs and those who need to gain a better understanding of emerging care models to position your organization successfully in a service and payment delivery environment of new models of care.

With the enactment of far-reaching health care reforms at the federal and state levels, changes to the health care delivery and payment systems are evolving quickly. It is important for home care providers to get up to speed on all of these fast-moving developments.

Speakers at this program will include top state health care program officials, expert consultants and more, including: State Medicaid Director Jason Helgerson; Value Based Payment expert Dr. Marc Berg of KPMG; Greg Allen, Director of the Division of Program Development and Management within the New York State Office of Health Insurance Programs (OHIP); Tracy E. Miller, a health law expert at Bond Schoeneck and King; and others.

In addition to providing insights on these new models, how the incentives work, and their structure, this program will also focus on how to strengthen your business model to remain competitive.

Please register today for this important program at the links below.

DOWNLOAD THE BROCHURE

REGISTER ONLINE

 

Registration is now open for HCA’s Annual Membership Conference on May 6 and 7 at the Saratoga Hilton in Saratoga Springs, our premier annual event.

This year’s conference is more streamlined and fully packed with new offerings that will not only inform you but also enhance your professional credentials and development.

For the first time, this year we have applied and are awaiting approval for continuing education credits from the National Association of Boards of Examiners of Long Term Care Administrators (NAB/NCERS). We have also added an optional, Leadership Institute on the day following the conference. This special program is presented exclusively for HCA by the American College of Healthcare Executives. Designed for health care leaders at all levels, the program will provide proven tools and techniques to identify and develop your leadership philosophy and skills.

Read more here.

Governor Cuomo’s Executive Order 38 establishes limits on executive compensation and administrative expenses for entities receiving state funds, either directly or indirectly. To enforce Executive Order 38, many state agencies have promulgated similar rules that are effective for various entities within their respective jurisdictions, including rules by the state Department of Health (DOH), Office for Aging, Office for People with Developmental Disabilities, Office of Alcoholism and Substance Abuse Services, and Office of Mental Health.

In mid-September, 2013, the United States Department of Labor (DOL) issued a final rule that eliminates the federal “companionship exemption” for certain “domestic service” workers, including home care aides employed by agencies. The final rule also institutes new record-keeping requirements for agencies employing “live-in” staff. These changes are effective January 1, 2015. This action follows up on a proposed DOL rule issued on December 27, 2011 that covered the companionship exemption.

Since March 2012 in New York City – and March 2013 in Westchester and Long Island – home care providers have been required to comply with a Worker Wage Parity Law that establishes a “minimum rate of home care aide total compensation.” Now that the rate for 2014 in New York City has reached an unsustainable level and the rate continues to increase for Westchester and Long Island, HCA has redoubled its efforts to advocate funding for home care worker compensation and benefits as well as the reimbursement, through state methodologies and managed care premiums, to support these direct care personnel.