DOH Releases Further Guidance on Minimum Wage ... - HCA-NYS

MINIMUM WAGE

As the state issues new guidance on minimum wage funding, HCA urges providers and plans to report your experiences, issues.

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OT RULE

A federal court has blocked a rule on overtime exemption thresholds for "white-collar" workers.

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HOME CARE MONTH

As November winds to a close, HCA presents two final stories about the work of nurses in recognition of National Home Care Month.

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DEADLINES

Wage Parity Certifications, Statistical Reports, Flu Vaccination Reports ? Find all of the deadlines and due dates in one chart!

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COMING UP

Bootcamp: Successfully Acting as a Fiscal Intermediary in the Consumer Directed Personal Assistance Program Dec. 1, 2016 Visiting Nurse Service of New York 107 East 70th Street (between Park and Lexington Ave) New York, NY 10021 9:30 to 10 a.m. (Registration and continental breakfast) 10 a.m. to noon program

Tools, Resources and Knowledge for VBP Readiness and Success Dec. 15, 2016 DoubleTree by Hilton Hotel Tarrytown 455 S. Broadway, Tarrytown, NY 10591

Your Source for HOME CARE News, Policy and Advocacy

Vol. 1, Issue 12 | November 28, 2016

DOH Releases Further Guidance on Minimum Wage Funding

Last week, the state Department of Health (DOH) released further guidance on the distribution of funding from the state to the MLTC plans for purposes of reimbursing New York City providers for the December 31, 2016 minimum wage increase. The guidance documents are at the links below:

Supplemental MLTC Minimum Wage Guidance: See WAGE p. 3

Learn the Data Essentials During Must-Attend Dec. 15 Program on Value Based Payments

HCA's must-attend program on Value Based Payment (VBP) readiness is fast approaching ? our final major education program of the year, and one that will provide you with tangible action steps to prepare for VBP. Be sure you are registered to join us on December 15 in Tarrytown for this unique and important opportunity.

See VBP p. 2

INSIDE

DOH Releases Further Guidance on Minimum Wage Funding..................1 Get Data Essentials at Dec. 15 VBP Program...................................................1 Court Blocks "White-Collar" OT Exemption Changes.......................................4 National Home Care Month Stories..............................................................5 Updates from CMS Home Health and Hospice Open Door Forum.......................7

Annual Update of HCPCS Codes for Consolidated Billing.........................8 DAL Posted on Hospice Nursing Contract Exemption..............................8 New Restrictive Code for Nursing Home Residents...............................9 Important Upcoming Deadlines...........................................................10 Resources.....................................................................................................10

The Situation Report: the Home Care Association of New York State

VBP from p. 1

As you know, VBP is the predominate focus of state Medicaid policymaking that will alter the field for reimbursements and clinical outcomes. Meanwhile, the federal government is taking steps to pilot similar initiatives at the federal level, for Medicare, to drive value over volume. Your agency will be impacted by these changes and must position itself for success in increasingly risk-oriented systems of payment and quality outcomes.

Our December 15 program offers five sessions, including a data workshop to help you drive decision-making for VBP readiness.

Internal data assessment is one of the most powerful and proactive steps a home care agency can take on the eve of VBP implementation in the Medicaid and Medicare marketplaces. On December 15, you will gain a deep dive into your clinical data through an established and proven four-step process (Ask, Assemble, Analyze, Act) using powerful tools, including: benchmarking, percentages and rates, graphs and charts, check-sheets, stratification and trending. This interactive workshop will teach you the techniques for using data to improve outcomes, lower costs and improve patient satisfaction ? all critical to success in a VBP environment.

Data assessment is just one of several segments during this December 15 program offering insights on: VBP operational readiness for home care; VBP workforce investment opportunities for home care; a panel of managed care payors explaining their needs and expectations of providers under VBP; as well as other tools and inside knowledge to help you position your organization for VBP. Don't miss this final signature HCA program of 2016. Registration links are below.

Download the brochure: uploads/2016/11/VBP-Readiness-and-Success-Brochure-Dec15-2016.pdf.

Register online: EventRegistration1.asp?EventId=1012048.

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

Tele: 518-426-8764; Fax: 518-426-8788; Website

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Volume 1, No. 12 November 28, 2016

The Situation Report is a weekly publication of the Home Care Association of New York State (HCA). Unless otherwise noted, all articles appearing in The Situation Report are the property of the Home Care Association of New York State. Reuse of any content within this newsletter requires permission from HCA.

Joanne Cunningham HCA President

jcunningham@

Roger L. Noyes Director of Communications, Editor of The Situation Report

rnoyes@

Al Cardillo Executive V ice President,

Policy & Programs acardillo@

Patrick Conole Vice President, Finance & Management pconole@

Andrew Koski Vice President, Program, Policy & Services akoski@

Alexandra Fitz Blais Director of Public Policy

ablais@

Laura Constable Senior Director, Membership & Operations lconstable@

Celisia Street Director of Education

cstreet@

Mercedes Teague Finance Manager mteague@

Jenny Kerbein Director of Governance &

Special Projects jkerbein@

Billi Wilson Manager, Meetings & Events

bwilson@

Teresa Brown Administrative Assistant

tbrown@

The Situation Report: the Home Care Association of New York State

Volume 1, No. 12 November 28, 2016

WAGE from p. 1

Minimum Wage Funding for MLTC Partial Capitation Program FY16-17 NYC Region:

These should be read in tandem with previous DOH-issued guidance on October 28. See wp-content/uploads/2016/10/MWGuidelines102816.pdf.

The new guidance provides managed care plans with their minimum wage allocation amount. It is accompanied by a chart that shows how much money each plan is receiving for the minimum wage increase for October 1, 2016 to March 31, 2017 and the number of plan enrollees for this time period.

The guidance otherwise largely reiterates terms covered in the initial October 28 guidance, and leaves unaddressed major points of clarity and protection requested by both providers and plans. For instance, the guidance does not stipulate, as requested, the amount of the $1.33 per-hour increase that plans are required to pay through to home care agencies. The guidance also fails to state that managed care plan rate reductions, offsetting the increase, are prohibited.

Last week, HCA met with officials from the state Division of Budget and the Governor's Office to continue advocacy on these concerns. These officials affirmed in very strong terms the Administration's intention that these funds fully reach the providers and workers, and asked to be apprised of reported problems or contradiction in practices.

The new guidance advises plans and providers to start contract negotiations as soon as possible, and requires plans to submit to DOH a list of providers for which agreements have not been reached by December 7.

DOH intends to convene a third Stakeholder Workgroup meeting to develop managed care plan and provider cost reporting changes to account for this funding and discuss audit protocols developed by DOH, the state Department of Labor and the Office of the Medicaid Inspector General. DOH expects that these audit protocols will provide greater clarity as to how managed care plans and providers will account for minimum wage funds. The guidance states that DOH will be conducting reviews to determine that funding was used as reported by plans and providers solely for minimum wage purposes.

The guidance appears to also separately address Fair Labor Standards Act (FLSA) funding. It indicates that plans are required to pass on FLSA funding to home care providers and are not permitted to retain any of these funds. HCA has informed DOH that some plans were not passing through these monies or are unsure how much they had to pass on; therefore, this clarification should be helpful.

HCA will be seeking further clarification on the unresolved funding issues and asks members to report their experiences to us as implementation proceeds.

CHHA Funding

DOH has also posted its state plan amendment (SPA) that would increase Medicaid fee-for-service/episodic rates to CHHAs to account for the December 31, 2016 minimum wage increase.

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Volume 1, No. 12 November 28, 2016

The SPA was submitted to the U.S. Centers for Medicare and Medicaid Services (CMS) on November 18 and is at .

DOH has informed us that a "Dear Administrator Letter" discussing minimum wage rate issues will be released when the notice of the initial CHHA rates for January 1 through December 31, 2017 is issued in December.

For further information, contact the HCA Policy staff.

Court Blocks "White-Collar" OT Exemption Changes; However, NYS OT Reg. Prevails

A federal District Court in Texas on November 22 stopped the implementation of the "white-collar" overtime exemption changes, which were supposed to go into effect on December 1, 2016.

The federal District Court issued a nationwide preliminary injunction (see NevadaDOL112216.pdf) that bars the U.S. Department of Labor (US DOL) from implementing the changes until the Court makes a final determination on the merits of the case. The US DOL will appeal the District Court's preliminary injunction ruling to the Fifth Circuit Court of Appeals.

A comprehensive article discussing the Texas case and its impact was written by HCA's Legal Counsel at Jackson Lewis. You can read it at .

Jackson Lewis is holding a webinar today to discuss the decision and the options employers have in light of the ruling and the US DOL's likely appeal. HCA shared the webinar information last week and will report on any necessary updates in a forthcoming communication.

As reported by HCA in numerous communications, US DOL had finalized a rule that increases the salary amount to determine whether a "white-collar" worker is excluded from being paid overtime. A memo on the changes is available at .

Under this final federal rule, the weekly salary amount, for workers exempt from mandatory overtime payment, would be increased to $913 per week, which is the equivalent of $47,476 annually for a fullyear worker (the "salary level test"). This threshold is an increase from the current state requirement of $675 per week or $35,100 per year (the federal level was $455 weekly or $23,660 annually). The change is intended to make more workers eligible for overtime by raising the salary thresholds at which employees are exempt from overtime. In addition, the rule includes a cost-of-living adjustment that would revise the thresholds every three years, starting in 2020.

The rule has also raised the annual compensation threshold for "highly compensated" employees from $100,000 to $134,004 annually.

HCA members should note that even with the court's nationwide preliminary injunction preventing the federal rule from going into effect, the state Department of Labor recently proposed increases to the

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Volume 1, No. 12 November 28, 2016

minimum salary thresholds for the state's white collar exemptions (see page 12 of the November 7, 2016 edition of The Situation Report at ) that would be effective on December 31, 2016.

Under this proposal, the state's thresholds will increase from $675 to $825 per week for "executive" and "administrative" (not "professional") employees (for New York City) and lower amounts for the rest of the state.

The state's proposed regulations are at . (See page 14).

HCA will keep members informed of any late breaking news on the federal lawsuit and its impact on providers.

National Home Care Month Stories Feature Caring Work of Two Nurses

Throughout November, for National Home Care Month, HCA has been sharing stories from home care providers and staff demonstrating exceptional work for patients in the community. Our final two stories for the month feature two RNs ? one who helped a patient open up about depression, and another who got involved in a unique program that helps elderly veterans travel to Washington so they can visit the national war memorials.

Helping patients with depression and a sense of loss

Bassett Healthcare Network-At Home Care RN Betsy Holway recently shared a story showing the importance of home care in meeting not only the medical needs of patients, but also in providing psychosocial supports.

Depression can be a major factor in a patient's health and wellbeing, and Ms. Holway describes her efforts to help a patient open up about the loss of her husband ? a cause of emotional hurt that wasn't being heard by the patient's family or friends.

"Last year, I had an elderly patient who was on service with our agency for teaching and monitoring for falls and falls prevention," says Ms. Holway, an RN who performs admissions, recertifications, routine visits, and resumption-of-care encounters. "I've always been very in tune with my patients' mental and emotional wellbeing as well as their physical health. This particular patient was able to share that she was still depressed because of her husband's death."

Betsy Holway, RN, with her patient, Madeline.

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Volume 1, No. 12 November 28, 2016

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When Ms. Holway asked her patient how long ago he had passed away, "she answered 12 years. I encouraged her to talk and share about her feelings and thoughts surrounding his death," Ms. Holway says.

The patient opened up to explain that none of her friends or family lent an open ear about her husband's death and the depression that it had caused her. "She reported that they would tell her not to cry, and that it would be ok, and time would heal her pain. But no one would talk with her about it after 12 years," says Ms. Holway. "She shared with me how wonderful her marriage had been, what a good husband he was, and how much she missed him. After only about 20 minutes of talking with her, she verbalized that she felt emotionally better than she had in 12 years. It was a rewarding experience."

Honor Flight nurse dedicated to veterans

Schofield Certified Home Care nurse Sheila Vester's passion to help veterans started at a young age.

The Lancaster native, who has been a registered nurse for 26 years, recently assisted with Honor Flight, a unique service that provides free transport of U.S. military veterans to Washington, D.C. to see the memorials of the respective wars they fought in. The flight was arranged by the office of state Senator Robert Ortt.

Ms. Vester loved to hear her dad talk about his service in the Army. "Growing up, we loved his war stories and were totally enthralled with the fact that he was a bottom gunner on a B17," she says.

Her work piecing together this period of history ? and her father's role ? continued in 2012 when Ms. Vester received a letter from a man in the Netherlands who was researching a WW2 plane crash in his hometown. "My father, long gone by then, was listed as part of the crew but missed that flight due to a war injury," she said. "From that moment, I was more than hooked," Ms. Vester added. "I became involved with the members of the 457th Bomber Group, my dad's bomber group based out of Glatton, England, and have been attending their yearly reunions ever since, fascinated by the stories from those brave and humble men."

Sheila Vester, RN, accompanies Harry Schack on an Honor Flight trip.

Inspired by these experiences, Ms. Vester recently volunteered for the Honor Flight program and was selected to accompany 25 veterans on their travels to Washington this past October.

"When I was chosen to accompany the flight on October 19, I was thrilled and surprised to hear that I was the only nurse on the flight," says Vester who, upon arriving at the airport, was immediately paired off with 88-year-old Harry Schack, who served in the Korean War.

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Although none of the Honor Flight passengers are served by Schofield Care, Ms. Vester's caring service and admiration for her father's "Greatest Generation" has given her a call of duty that extends beyond the work of her agency.

To read more stories in recognition of National Home Care Month, visit .

Updates from CMS Home Health and Hospice Open Door Forum

The U.S. Centers for Medicare and Medicaid Services (CMS) hosted a Home Health and Hospice Open Door Forum (ODF) call recently on a variety of issues affecting home health and hospice providers.

Much of the call was dedicated to the 2017 home health prospective payment system (HHPPS) final rule, which has already been reported in recent editions of The Situation Report as well as in a detailed HCA Public Policy Memo at: . Last week, HCA also held the first in a series of conference calls with CFOs and senior financial managers on reimbursement issues, dedicating the first call to a walk-through and question-and-answer session on the 2017 HHPPS.

The following are some other new highlights from the CMS call.

Home Health and Hospice PEPPER

CMS staff provided a description of the PEPPER report along with how providers can use the report and the current 10 risk areas on the 2016 report. While the report could identify patterns in payment indicative of risk, the presence of improper payment can only be validated through review of the home health and hospice clinical record, CMS confirmed.

Hospice Quality Reporting Program

New hospice quality measures reports will be available in mid to late December 2016. Reports with facility and patient level data will be available prior to public reporting in 2017 and located in the CASPER system.

Quality reporting announcements will be posted on the "Spotlight and Announcement" section of CMS's Hospice Item Set (HIS) website at: .

Also, the Public Use Files (PUF) files will be posted on data. in December, comparing states on a national level. An announcement will be made by CMS when these are available.

Hospice CAHPS Announcement

CMS also provided an update on the hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys.

Regarding smaller agencies, an exemption from reporting CAHPS data will be accepted until December 31,

2016. The exemption form and request are only good for one year, so providers must reapply for an exemption

if it is applicable.

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Also, CMS reminded providers that their CAHPS vendor must be authorized to submit data. A CAHPS vendor authorization form (in PDF format) is on the CAHPS website.

For technical assistance with CAHPS, providers can contact the CAHPS Hospice Survey Project Team at hospicecahpssurvey@ or 1-844- 472-4621

CMS Issues Annual Update of HCPCS Codes Used for Home Health Consolidated Billing Enforcement

The U.S. Centers for Medicare and Medicaid Services (CMS) issued Change Request (CR) No. 9771 which provides the 2017 annual update to the list of Healthcare Common Procedure Coding System (HCPCS) codes used by Medicare systems to enforce consolidated billing of home health services.

CMS periodically updates the lists of HCPCS codes that are subject to the consolidated billing provision of the Home Health Prospective Payment System (HHPPS). Additional updates may occur as frequently as quarterly in order to reflect the creation of temporary HCPCS codes (for example, K codes) throughout the calendar year.

The new coding identified in each update describes the same services that were used to determine the applicable HHPPS payment rates. No additional services will be added by these updates; in other words, new updates are required by changes to the coding system and not because the services subject to consolidated billing are being redefined.

The HCPCS codes in CR 9771 are being added to the consolidated billing therapy code list, effective for services on or after January 1, 2017.

CR No. 9771 can be downloaded at: .

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

DAL Posted on Hospice Nursing Contract Exemption

The state Department of Health (DOH) has posted a Dear Administrator Letter (DAL) informing hospices of an extension in the period during which hospices may qualify for an "extraordinary circumstance" exemption. The U.S. Centers for Medicare and Medicaid Services (CMS) has authorized the extension, which permits contracting for nursing services until September 30, 2018.

The federal directive is at SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-17-01.html.

DOH's DAL is at DALHospiceNursingContractExemption111716.pdf.

The regulations allow a hospice to use contracted staff, if necessary, to supplement hospice employees in order to meet the needs of patients during periods of peak patient loads or under extraordinary

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