Plugged Into Health @ Hinman Straub – September 17, 2018

VBP Updates

VBP Quarterly Update Webinar

Last week, DOH held the VBP Quarterly Update webinar. DOH announced one notable program change. Going forward, 91.75% of total QIP funding will exist in the Essential Plan QIP, retro to April 1, 2018. Only 9.25% of the total funding will continue to be distributed as Medicaid Managed Care funds. These MMC funds will be associated with P4R metrics and milestones. Alternatively, the EP QIP funds will be associated with all P4P milestones. DOH said the expansion to EP QIP will not have an impact on total DY4 funding amounts for each facility.

Three notable program changes will occur based on the shift of QIP from MMC to EP.

Funds Flow: There is no longer a PPS in in the QIP funds flow. Funds will flow in from DOH to the EP Plan, and then directly to the facility. DOH’s QIP team will be reaching out to each MCO to set up individual meetings to discuss funds flow.
Pediatric Alternate Measures are no longer Useable: Facilities that formerly had pediatric measures will need to update their performance measures before October 31, 2018, when the QIT reports are due. Because EP only covers individuals ages 19 to 64, facilities that selected children’s measures as alternate measures as part of VBP QIP will be required to choose substitute measures. These measures must be selected from the same focus area/domain. In addition, once a facility has selected a measure, it must submit a “Retired Measure Substitution Form” to formally retire the no longer applicable pediatric measure.
Measure Credit Update: Because payments cannot be made through the EP for achievements associated under Medicaid, “measure credits” can no longer be earned. Measure credits were earned based on achieving P4R milestones. Previously under the program, DOH proposed to allow facilities to use such credits to augment P4P performance on quarterly and annual performance reports.

Other Updates:

H said the April 2018 MMC premiums include VBP QIP funds for SFY 2018-19. These rates have been approved by DOB and are live in cycle number 2141. MCOs should receive the premium September 19.
DOH received a total of 76 VBP contracts.
DOH Responses in Q&A:
- DOH will send confirmation letters to facilities to let them know VBP contracts have been approved.
- DOH instructed that no contracts need to be re-executed due to the expansion to EP. This was the opinion of DOH VBP QIP staff without consulting DOH legal counsel. We encourage all MCOs and facilities to consult with their own legal counsel before making any determinations.
- DOH advised that no back-dating or other changes in measure reporting are required.
- The DY4 EP and VBP QIP pairings table was shared during the presentation. This table does not include admin and surplus that will be added. The EP admin and surplus will be the same level as Medicaid.

The next VBP Quarterly webinar will take place December 12.

2018 Edition of New York Consumer Guide to Health Insurers

The Department of Financial Services has released the 2018 New York State Consumer Guide to Health Insurers. The New York Consumer Guide to Health Insurers contains a ranking of HMOs and health insurance companies based on complaint (prompt payment, reimbursement, coverage, benefits, rates and premiums), statistics, and enrollee satisfaction surveys. Also included, is information on the number of successful appeals to independent external review agents. The guide, which is published on an annual basis, is designed to help consumers when choosing a health insurance company. Prior editions of the guide can be found here.

Managed Care Policy and Planning Meeting

On Thursday, the Department of Health held the monthly Policy and Planning Meeting with the State’s Medicaid Managed Care plans. Highlights from the meeting include:

Mainstream Enrollment: Statewide enrollment for August was 4,368,967, a 1.1% decrease from July (4,417,638). Enrollment decreased .92% in NYC and 1.36% Upstate. Most of the decrease is due to enrollees migrating to HARP through passive enrollment.
MLTC Enrollment: MLTC enrollment through the month of August is 234,703, an increase of 1,411 since July (233,292) and 4,778 since June (229,925). Overall, the MLTC program has grown by 8.27% since last August 2017. The majority of this growth continues to be in the MLTC partial cap program, which is currently at 212,730. While enrollment has declined considerably in FIDA (-13% YTD), MAP enrollment has grown to more than 11,400, a 20% increase from enrollment just last August.
ALP Carve-in: In response to a question from plans about the impending carve-in, which at this point both plans and the State had assumed would be delayed, DOH announced that the ALP carve-in to managed care has officially been delayed. DOH has told CMS they will need at least two more years.
Home Health Aide Shortage Downstate: Plans were asked to confirm reports from the local districts that there are locations within the downstate region experiencing home health aide and personal care aide shortages. One plan responded that they have observed this to be an issue in Suffolk County. Plans were asked to provide feedback if they are witnessing this.
Nursing Home “Lock-in” and other Budget Changes: The SPA for the nursing home benefit has been submitted to CMS for their review. DOH announced that draft guidance for other MLTC budget initiatives (e.g., SADC) are in process and will be sent to plans for review and comment shortly.
LHCSA Network Limitation: DOH continues to work on FAQs and expects to hold a webinar in the next week or two. They have not yet received any exception requests.

Community First Choice Option (CFCO): The start of CFCO for skill acquisition, maintenance, and enhancement remains January 1, 2019. Plans continue to ask for a delay. DOH asked plans to provide specific reasons why January 1, 2019 is unfeasible. At the meeting, plans noted several open issues and questions remain, notwithstanding the fact that final rates and rate codes have not been provided.

All LHCSAs Required to Register with DOH by November 16

Earlier this year, NYS enacted a new law requiring all Licensed Home Care Services Agencies (“LHCSAs”), including those affiliated with an Assisted Living Program (“ALP”), to annually register with the Department of Health. The Department recently issued a Dear Administrator Letter (“DHCBS 18-02 2017 LHCSA Statistical Report”) detailing the registration process and establishing a registration deadline of November 16, 2016.

The LHCSA registration process will be completed through the LHCSA Statistical Report. The LHCSA Statistical Report has been amended to include the necessary registration information. LHCSA registration for the period beginning January 1, 2019, can only be accomplished through the successful submission of a complete 2017 LHCSA Statistical Report.

Failure to complete and submit the statistical report by the stipulated deadline will result in the following penalties:

A $500 fine will be assessed for each month, or part of a month, that the organization is not registered
Agencies that are not registered will not be allowed to operate until they become registered
Agencies that fail to register timely for two years, not necessarily consecutive, may have their licenses revoked

The platform for submitting the annual LHCSA Statistical Report has been changed from previous years. The 2017 LHCSA Statistical Report will use the Universal Data Collection System (“UDCS”) platform, which contains significant differences from the previous methods. The new UDCS platform can be viewed and downloaded from the Health Commerce System (“HCS”).

While all LHCSAs associated with an ALP are required to submit the 2017 Statistical Report, ALP LHCSAs that do not serve patients in the community only need to complete and submit designated portions. ALP LHCSAs that also serve patients in the community must fill out and submit all sections of the 2017 LHCSA Statistical Report.

DOH to Hold Medicaid Drug Cap Webinar

The Department of Health will be hosting a webinar on the SFY 2018-19 Medicaid Drug Cap on September 17, 2018 at 2:00 pm, with an opportunity for questions and answers afterwards. In announcing the event, the Department indicated that the Department of Budget has determined that the projected State share of Medicaid drug spending, net of all rebates, will exceed the annual Medicaid Drug Cap in State Fiscal Year 2018-19.

DOH to Hold Webinar on MLTC Minimum Wage Issues

The Department of Health Office of Health Insurance Programs (“OHIP”) will be hosting a webinar on September 28, 2018 at 2:00 p.m. to discuss Medicaid Managed Long Term Care (“MLTC”) minimum wage adjustments and calculations.

To register for the webinar, click here.

DOH Reminds Nursing Homes of Patient Care Related Electrical Equipment (“PCREE”) Requirements

The Department of Health has issued a Dear Administrator Letter (DAL NH 18-04 Inspection & Maintenance of Patient Care Related Electrical Equipment and Generator Testing (PCREE)) to nursing home administrators regarding facilities’ required compliance with the National Fire Protection Association (NFPA) 99 & 101.

Specifically, the DAL calls attention to requirements for the inspection and maintenance of Patient Care Related Electrical Equipment (“PCREE”). The DAL reminds facilities that generators must be inspected weekly and run under load for at least 30 minutes monthly. Complete documentation of all inspections, maintenance and testing must be maintained at the facility. NFPA 110 can be referenced for the complete and detailed requirements.

Copies of the NFPA materials, including the 2012 LSC (NFPA 101), the 2012 HCFC (NFPA 99), and the 2010 Standard for Emergency and Standby Power Systems (NFPA 110) can be obtained from the National Fire Protection Association, 1 Batterymarch Park, Quincy, Massachusetts, 02169, or through the NFPA website, here.

State Seeking Applications for Specialized I/DD Plan – Provider Led

The Department of Health and the Office for People with Developmental Disabilities (“OPWDD”) will be seeking applications from qualified parties interested in becoming a Specialized I/DD Plan – Provider Led (“SIP-PL”) to serve individuals with Intellectual/Developmental Disabilities (“I/DD”) through managed care in accordance with the State’s transition plan. The transition plan is available here.

As a first step in the Application process, the State has released a draft version of the New York State Medicaid Managed Care Organization I/DD System Transformation Requirements and Standards to Serve Individuals with Intellectual and/or Developmental Disabilities in Specialized I/DD Plans – Provider Led (SIPs-PL) for stakeholder review and comment.

Comments on the draft requirements and standards document are due on or before October 3, 2018. Comments may be submitted electronically to [email protected].

NYS Comptroller Reports on State Health Insurance Programs

Comptroller DiNapoli has released a report, “7 Million and Counting: More New Yorkers Benefit from State Health Coverage,” summarizing the expansion of Medicaid and other state health care programs over the last 10 years. The report examines enrollment, spending and ACA impacts on NYS Medicaid, the Essential Plan, Child Health Plus (“CHP”), subsidized coverage (“QHPs”) through the New York State of Health (“NYSOH”), Elderly Pharmaceutical Insurance Coverage (“EPIC”), Early Intervention Program (“EI”), Healthy NY program, and overall statewide insurance coverage rates. The report also examines the impacts that Medicaid reform and the Delivery System Reform Incentive Payment (“DSRIP”) have had on the costs of care.

According to the Comptroller, Medicaid and other state health care programs now cover over a third of the state’s residents. The report found that the number of people covered by Medicaid and other major state programs rose by 57% over the past decade, largely due to enactment of the federal ACA and other changes in federal and state health care policies. Combined, Medicaid, Child Health Plus (“CHP”), the Essential Plan and subsidized coverage through the New York State of Health (“NYSOH”), cost a total of more than $75 billion in state fiscal year (SFY) 2017-18.

In his press release, Comptroller DiNapoli stressed that the Affordable Care Act (“ACA”), and other changes in federal and state health care policies, have helped reduce the percentage of people lacking health insurance in New York. He warned that calls in Washington to repeal the ACA and make changes to Medicaid could cut federal funding by billions of dollars and jeopardize health care coverage for many New Yorkers.

Ambulatory Patient Group (“APG”) Information Updated

The APG website has been updated to reflect the following changes:

APG Rates: Hospitals, D&TCs and ASCs’ APG rates by Provider were updated.
FQHC Rates: FQHC rates by Provider were updated

Regulatory Update

Update Standards for Adult Homes and Standards for Enriched Housing Programs

The Department of Health recently issued a notice of emergency rulemaking and a similar notice of proposed rulemaking that would prohibit adult care facility (“ACF”) operators from excluding individuals who primarily use a wheelchair for mobility. The emergency regulations require ACF operators to make reasonable accommodations to the extent necessary to admit such individuals, consistent with the Americans with Disabilities Act (“ADA”).

An earlier version of this emergency rulemaking was published in the June 13, 2018 edition of the NYS Register, and expired on August 22, 2018. The new emergency/proposed rulemaking contains non-substantive changes from the earlier version. The new emergency/proposed rulemaking makes conforming changes where references to the impacted sections are cited elsewhere in the regulations.

The emergency regulations are effective as of August 23, 2018, and will expire on November 20, 2018. The Department is accepting comments on the proposed regulations until November 13, 2018. Comments may be submitted by mail or electronically.

Legislative Spotlight

Now that the 2018 Legislative session has adjourned, bills that have passed both houses of the Legislature will be delivered to the Governor in “batches” over the next several months. Once a bill has been delivered to the Governor, he has 10 days (excluding Sundays) to either sign the bill into law or veto the bill.

The following bill was recently signed into law by the Governor.

5890-B/A.8176-A (Seward/Woerner): This bill provides for the continuation of the Managed Care Saving Account demonstration to allow municipalities with large group HMO coverage to offer group high deductible health plans, in conjunction with a health savings account or a health reimbursement account, provided that the municipality contributes an amount at least equal to the deductible required by the plan. The plan must be offered pursuant to an existing collective bargaining agreement. The provisions of this bill will sunset on December 31, 2021.

Grants/Funding Opportunities

Regional Resource Development Centers for Combined Admin of Nursing Home Transition and Diversion and Individuals with a Traumatic Brain Injury

The Department of Health has issued a Request for Applications (“RFA”) from qualified not-for-profit agencies as Regional Resource Development Centers (“RRDC”) to assist the Department with the administration of the Nursing Home Transition and Diversion (“NHTD”) and Traumatic Brain Injury (“TBI”) waiver programs. A copy of the RFA can be viewed here.

According to the RFA, approximately $9.073 million will be available per year for the local administration of the NHTD and the TBI services. The funding will be approximately $4.24 million for NHTD services per year and $4.83 million for TBI services per year. The resulting contract(s) will be awarded for a five-year period, and are expected to begin May 1, 2019, ending April 30, 2024. The total funds expected to be made available over the entire 60 month period is approximately $45.365 million. The RRDC contracts will be awarded for ten (10) regions as: single or multiple region contractors, or a single statewide contractor covering all New York State counties

Eligible applicants must:

be prequalified in the New York State Grants Gateway, if not exempt, on the date applications are due
be a not-for-profit organization
have three (3) years’ experience in NHTD, providing services to seniors or people with disabilities, and/or TBI services.
have sufficient ADA compliant facility space to host meetings and training sessions

The NHTD and TBI waivers are Home and Community Based Services (“HCBS”) 1915c programs which provide a community-based alternative for eligible adults who require an institutional level of care but have chosen to receive care in their homes. The two waivers enroll individuals eighteen years of age or older, who, considered as an aggregate group, can be served appropriately and at less cost than institutional care in a community setting.

The NHTD and TBI waiver programs are designed and implemented to reduce the incidence of unnecessary institutionalization through:

Transition: Assisting eligible individuals currently living in nursing homes to move to appropriate community-based settings.
Diversion: Preventing in-state and out-of-state facility placements through development of community based services and supports for waiver eligible individuals.

Key RFA Dates:

Letter of Interest/Intent Due: September 24, 2018
Questions Due: September 26, 2018
Questions, Answers and Updates Posted: October 15, 2018 (on or about)
Applications Due: November 1, 2018 by 4:00 PM

Upcoming Calendar

*Thursday, September 20, 2018*	Drug Utilization Review Board (DURB) 9:00 a.m. to 4:00 p.m. Empire State Plaza, Concourse Level, Meeting Room 3, Albany, NY
*Thursday, September 20, 2018*	Early Intervention Coordinating Council 10:15 a.m. to 3:00 p.m.
*Thursday, September 27, 2018*	Committees of the Public Health and Health Planning Council 10:00 a.m. New York State Department of Health, 90 Church Street, 4th Floor, Rooms 4A and 4B, New York, NY
*Friday, October 5, 2018*	Continuing Care Retirement Communities (CCRC) Council Regulatory and Framework Improvement Committee 10:00 a.m. to 12:00 p.m. New York State Department of Health, Main Conference Room, 875 Central Avenue, Albany, NY
*Tuesday, October 9, 2018*	State Health Innovation Plan Council 10:30 a.m. to 2:30 p.m.
*Thursday, October 11, 2018*	Public Health and Health Planning Council 9:30 a.m. New York State Department of Health, 90 Church Street, 4th Floor, Rooms 4A and 4B, New York, NY