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So far Barry Pollack has created 100 blog entries.

DOL Homecare Rule Webinar

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WEBINAR INFORMATION:

The Department of Labor (DOL) published a Final Rule on October 1, 2013 extending minimum wage and overtime pay protections under the Fair Labor Standards Act (FLSA) to most home care workers (who may have job titles such as home health aide or personal care assistant) who provide essential assistance to people with disabilities and older adults.  On August 21, 2015, the U.S. Court of Appeals for the D.C. Circuit issued a decision upholding the Final Rule.  On Friday, September 18th from 2:00-3:00pm Eastern Time, senior leadership from the U.S. Department of Labor’s Wage and Hour Division and Office of the Solicitor will hold a webinar to discuss the Home Care Final Rule.  Presenters will provide an overview of the Final Rule as well as the Department’s guidance regarding joint employment in domestic service employment under the FLSA and the application of the FLSA to shared living programs.  Our comments will address questions we have received from states, including about the home care litigation.

TO REGISTER FOR THE WEBINAR:

Please click https://www.eventbrite.com/e/home-care-final-rule-implementation-webinar-for-states-registration-18538483102  to register for the webinar.

Once you register, you will receive an email with the information you need to access the webinar.

QUESTIONS:

There will be a question and answer period after DOL’s presentation.  If you would like to submit a question(s) in advance, please email it totatum.laura@dol.gov at your earliest convenience.  During the webinar, we will respond to as many questions as possible.

FOR MORE INFORMATION:

Information about the Home Care Final Rule is available athttp://www.dol.gov/whd/homecare/.

Information about the litigation related to the Home Care Final Rule is available at http://www.dol.gov/whd/homecare/litigation.htm.

U.S. Court of Appeals Unanimously Upholds DOL Home Care Rul

U.S. Court of Appeals Unanimously Upholds DOL Home Care Rule

 

Thank you for your engagement with the Department of Labor’s Wage and Hour Division regarding the Home Care Final Rule.On Friday, August 21, the U.S. Court of Appeals for the District of Columbia issued a unanimous decision upholding the Home Care Final Rule. DOL issued the statement below, which is available on our website at http://www.dol.gov/whd/homecare/litigation.htm

This site will be updated with any changes related to litigation, so please check back for updates.

Today’s decision from the U.S. Court of Appeals for the District of Columbia is vital to nearly two million home care workers, who will now qualify for minimum wage and overtime protections. The decision confirms this rule is legally sound. And just as important, the rule is the right thing to do — both for employees, whose demanding work merits these fundamental wage guarantees, and for recipients of services, who deserve a stable and professional workforce allowing them to remain in their homes and communities.

The DOL has led an unprecedented implementation program to help employers prepare for compliance, including offering an extensive and individualized technical assistance program, providing a 15-month period before the effective date to aid compliance, and adopting a time-limited non-enforcement policy. DOL has repeatedly encouraged states and other employers to take the necessary steps toward implementation. The Department continues to stand ready to provide technical assistance to states and other entities as they implement the Final Rule.

Florida Medicaid Provider Self Audit Resources – Now Available

FLORIDA MEDICAID
A Division of the Agency for Health Care Administration

Florida Medicaid Health Care Alert
July 2015

Provider Self Audit Resources are Now Available on the Agency’s Website

Medicaid providers are encouraged to voluntarily conduct self-audits and remedy any issues of non-compliance that are identified, including either voiding/adjusting improper claims or submitting to the Agency’s Bureau of Medicaid Program Integrity (MPI), the self-audit findings and repayment of the improper claims.

MPI recommended that providers review claims with dates of service as old as five years to the present.  MPI also encourages providers to engage in routine self-audits of more current claims (most recent twelve months).  This allows providers to have the opportunity to remedy the claims before an Agency-initiated audit.  When the Agency conducts an audit, it is entitled to recover the costs of the audit and is required to assess sanctions for the non-compliance.  A provider who conducts a self-audit, submits the results, and remits payment, may avoid sanctions for their voluntary disclosure and repayment of overpayments so long as the Agency determines that the disclosure is valid and so long as it is not discovered to be an attempt to alleviate liability for fraudulent practices.

Information about conducting self-audits is available on the Agency’s website, on the MPI landing page.  Please see the below screen-shot which demonstrates how to navigate from the Agency’s home page to the MPI landing page.

Medicaid providers are encouraged to voluntarily conduct self-audits and remedy any issues of non-compliance that are identified, including either voiding/adjusting improper claims or submitting to the Agency’s Bureau of Medicaid Program Integrity (MPI), the self-audit findings and repayment of the improper claims.

Questions regarding conducting a self-audit may be directed to Pam Fante via email at Pam.Fante@ahca.myflorida.com and please include the question in the email.

APD-IBudget Meeting

Notice of Meeting/Workshop Hearing

We Need You at This Meeting

This is an opportunity for the public to provide input and let APD know if the proposed rules will negatively impact your loved one, through the iBudget process.

The Agency for Persons with Disabilities announces a public meeting to which all persons are invited.

August 19, 2015, 2:00 p.m. – 4:00 p.m.

PLACE: Agency for Persons with Disabilities, 4030 Esplanade Way, Room 301, Tallahassee, FL.

DEPARTMENT OF CHILDREN AND FAMILY SERVICES

Agency for Persons with Disabilities

 

RULE NOS.:         RULE TITLES:

65G-4.0213 Definitions

65G-4.0214 Allocation Algorithm

65G-4.0215 General Provisions

65G-4.0216 Establishment of the iBudget Amount

65G-4.0217 iBudget Cost Plan

65G-4.0218 Significant Additional Needs Funding

 

The Agency for Persons with Disabilities announces a public meeting to which all persons are invited.

August 19, 2015, 2:00 p.m. – 4:00 p.m.

PLACE: Agency for Persons with Disabilities, 4030 Esplanade Way, Room 301, Tallahassee, FL

 

GENERAL SUBJECT MATTER TO BE CONSIDERED:

Changes made to proposed rules 65G-4.0213 through 65G-4.0218 noticed in the Florida Administrative Register Vol. 40 No. 235 published on December 5, 2014 regarding the implementation of iBudget Florida as required by Section 393.0662, F.S., as these proposed rules have been modified by the Notice of Change noticed in the Florida Administrative Register Vol 41 No. 84 published on April 30, 2015 and as further modified by the Notice of Change noticed in the Florida Administrative Register Vol 41 No. 98 published on May 20, 2015.

For more information or a copy of the agenda contact: David De La Paz, Esq., Agency for Persons with Disabilities, 4030 Esplanade Way, Suite 380, Tallahassee, Florida 32399, (850)922-9512,david.delapaz@apdcares.org.

CMS Releases Heightened Scrutiny Guidance for Home and Community Based Services (HCBS) Rules

Washington, DC (June 26, 2015)

The Centers for Medicaid and Medicare Services (CMS) issued guidance on how they intend to address “heightened scrutiny” for settings that are subject to the home and community based services (HCBS) rule that went into effect on March 17, 2014.  The guidance restates the standard for settings that are presumed institutional (located in a building that is also a publicly or privately operated facility that provides inpatient institutional treatment, or in a building located on the grounds of, or immediately adjacent to, a public institution).  Additionally, any setting which has the effect of isolating individuals will be presumed to be institutional.  For any of these instances, a state may submit evidence to overcome the presumption and demonstrate how the setting does meet the HCBS standards set forth.  The new rules also offer states the option to develop “tiered standards for residential settings” which will allow states to “close the front door” to some providers while allowing existing providers of the same services to continue.  This means that a state could set one compliant standard for existing providers and set a different, higher standard for new providers.

CMS: New Manged Care and Quality Assurance Standards

The “correct” quality assurance program will always be a question until CMS requires states to standardize their Managed Care processes among MCOs in each state. We all have the opportunity to discuss standardization now, which will not come around again for years. Please see the below information from ANCOR. I encourage people to comment on the CMS proposed rules. CMS Issues

Landmark Proposed Rule on Medicaid Managed Care

On June 1, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule titled “Medicaid and Children’s Health Insurance Program (CHIP) Programs; Medicaid Managed Care, CHIP Delivered in Managed Care, Medicaid and CHIP Comprehensive Quality Strategies, and Revisions Related to Third Party Liability.” The agency states that this proposed rule would modernize the Medicaid managed care regulations to reflect changes in the usage of managed care delivery systems.

Home care providers will want to be aware that the proposed rule proposes to add a definition for long term care support services (LTSS).  The CMS proposal defines LTSS as “services and supports provided to beneficiaries of all ages who have functional limitations and/or chronic illnesses that have the primary purpose of supporting the ability of the beneficiary to live or work in the setting of their choice, which may include the individual’s home, a provider-owned or controlled residential setting, a nursing facility, or other institutional setting.”  CMS states that they intend for community based services within the scope of this definition to be largely non-medical in nature and focused on functionally supporting people living in the community.  Examples of what CMS would consider community based LTSS include Home- and Community-Based Services (HCBS) delivered through a section 1915(c) waiver, section 1915(i), or section 1915(k) state plan amendments, as well as personal care services otherwise authorized under the state plan.

HCAOA also notes that CMS is seeking to amend the existing regulation requiring each state to establish a credentialing and re-credentialing policy that addresses all the providers, including LTSS providers, covered in their managed care program regardless of the type of service provided by such providers.

Comments on the proposed rule will be accepted through July 27, 2015. A copy of the proposed rule can be found at http://www.regulations.gov/#!documentDetail;D=CMS-2015-0068-0001

New Personal Care and Support Coordination Rates for APD providers

New Rates for July 1, 2015

APD announced that effective July 1, 2015, Personal Supports QH, Personal Supports Day, Support Coordination and CDC+ Consultant will all have an increased rate.  Please see the link below for all the new rates.  The changes to the cost plans and budgets will be made electronically and will not require the WSCs to redo any service authorizations and will not require the Regions to re-approve any service authorizations. That is the good news!

1) iBudget will be brought down on July 1st so the changes can be made.  All FY 15-16 cost plans must be in approved status.  Any cost plans that are in draft, or pending review status will have to be deleted by IT and any changes that have been made to those plans will be lost.

2) Please review all cost plans that are Pending Area Office Review for FY 15-16 and get them to approved status as soon as possible.  If the reason for the pending review is due to a rejected service authorization that you are unable to resolve, complete a help desk ticket.

3) State Office staff will be reviewing any cost plans in Pending State Office Review to get them in approved status.

4) If support coordinators have consumers who currently have a FY 15-16 budget, however; they will not have a cost plan built prior to 7/1/15; the support coordinator will need to work with Region staff to get the budgets adjusted manually.  Since those cost plans may or may not come for Region review, they will need to notify you who those consumers are.

5) Please encourage support coordinators to stop making any changes to cost plans after June 28, 2015 unless there is an emergency.  This will give both the Region and State Office staff time to assist with getting all plans into approved status.

New Hampshire House Passes First-In-The-Nation Legislation To End Payment of Subminimum Wages To People with Disabilities

New Hampshire House Passes First-In-The-Nation Legislation To End Payment of Subminimum Wages To People with Disabilities

Press  Release,  April 15, 2015
CONCORD, NH – Today the New

Hampshire House of Representatives passed SB 47. New Hampshire becomes the first state in the country to repeal statutes that permit employers to pay persons with disabilities less than the state minimum wage simply because they have a disability. SB 47 received unanimous bipartisan support in both the house and the senate.

“SB 47 is a historic policy statement that reflects the current approach to hiring persons with disabilities that has evolved since the 1940’s in New Hampshire – every person with a disability can be competitively employed with the right supports and right job match,” said Chris Rueggeberg, Policy Director for the New Hampshire Council on Developmental Disabilities. “Paying people with disabilities subminimum wages is not necessary or helpful for them to get a job. They can be hired on their merits and abilities,” added Rueggeberg.

SB 47 prime sponsor Senator Hosmer has hired people with disabilities at his AutoServ business for the past 20 years. “The people I hire improve the whole culture and working atmosphere for all my employees,” said Senator Hosmer. SB 47 repeals outdated statutes and outdated approaches to hiring persons with disabilities that date to 1949.  Employers in New Hampshire no longer pay persons with disabilities a subminimum wage. Sheltered workshops are closed. Disability rights organizations, rehabilitation professionals, persons with disabilities working at competitive wage jobs and their employers, the NH Labor Department, the NH Department of Health and Human Services, and Vocational Rehabilitation and Services for Blind and Visually Impaired in the NH Department of Education all worked to pass SB 47. “I’m very pleased that the House has approved SB 47.  Last year, when I discovered that it is was legal in New Hampshire to pay persons with a disability less than the minimum wage simply because of their disability I introduced legislation to study this issue. The
study committee that I chaired unanimously recommended legislation to ban this practice in New Hampshire, ”  said former State
Representative  Chris Muns.

The New Hampshire Council on Developmental Disabilities is a federally funded state agency that supports public policies and initiatives that remove barriers and promote opportunities in all areas of life. The Council carries out its mission through education, advocacy and the funding of innovative projects that make a difference in people’s lives. Find out more at http://www.nhddc.org.

Alert: Florida APD Billing Instruction for Life Skills Development Level 3

 

Florida Medicaid Health Care Alert
February 2015

Provider Type(s): 67Billing Instruction for Life Skills Development Level 3 (ADT) Services

 

Beginning March 1, 2015, Individual Budgeting (iBudget) providers of life skills development level 3 services (procedure codes S5102UC and T2021UC) must adhere to the following billing procedure:

 

  • Providers must submit claims for life skills development level 3 at the end of the month(or on the last day of the service period).
  • The claim must include the total actual hours of services provided.
  • The provider must round the total number of hours to the nearest hour. Providers should round only once at the end of the month (or the end of the billing period).

 

The Agency for Health Care Administration is committed to its mission of providing “Better Health Care for All Floridians.” The Agency administers Florida’s Medicaid program, licenses and regulates more than 45,000 health care facilities and 34 health maintenance organizations, and publishes health care data and statistics atwww.FloridaHealthFinder.gov.  Additional information about Agency initiatives is available via Facebook (AHCAFlorida), Twitter(@AHCA_FL) and YouTube (/AHCAFlorida).

 

Agency for Health Care Administration  |  2727 Mahan Drive, Tallahassee, FL 32308  |  http://ahca.myflorida.com


Florida Medicaid Fee-for-Service Monitoring

AHCA Logo

 

Better Health Care for All Floridians
FLORIDA MEDICAID
A Division of the Agency for Health Care Administration
Florida Medicaid Health Care Alert
February 2015

Provider Type(s): 08, 23, 81, and 67

Medicaid Fee-for-Service Monitoring

Monitoring is being conducted to provide feedback to providers regarding their adherence to Medicaid requirements for recipients who are not enrolled in a Medicaid managed care plan.

The Medicaid Fee-for-Service Monitoring Unit has begun conducting monitoring reviews of service providers for the following programs:

  • Adult Cystic Fibrosis (ACF) Waiver
  • Model Waiver
  • Project AIDS Care (PAC) Waiver
  • Traumatic Brain Injury and Spinal Cord Injury (TBI/SCI) Waiver
  • Early Intervention Services (EIS)
  • Certified School Based Services Match
  • Medical Foster Care (MFC)

Providers will be contacted by telephone or e-mail for notification of the date of review and will receive a letter detailing the documentation the Monitoring Unit will review. A copy of the monitoring tool, based on state and federal Medicaid policy, for the specific service will accompany the letter.  After the review, a monitoring report/summary will be sent to the provider.

Medicaid Provider Agreement (5)(e) and section 409.907(3)(e), Florida Statutes, requires Medicaid providers to send, at the provider’s expense, all Medicaid-related information, which may be in the form of records, logs, documents, or computer files, and other information pertaining to services or goods billed to the Medicaid program, including access to all patient records to the Agency for Health Care Administration, Attorney General, or Federal Government entity.

LINKS

Florida Medicaid Web Portal | Florida Medicaid Health Information Network | Florida Medicaid HIPAA Information | HIPAA Transactions & Code Sets Standard | National Provider Identifier Standard (NPI) | Florida Medicaid EHR Incentive Program | FloridaHealthFinder.gov

QUESTIONS ABOUT FLORIDA MEDICAID?

Please direct questions about Medicaid policies to your local Medicaid field office. The Medicaid field offices’ addresses and phone numbers are available on the Field Offices Web page.

ALERTS INFORMATION

The Florida Medicaid program has created an e-mail alert system to supplement the present method of receiving Provider Alerts information and to alert registered subscribers of “late-breaking” health care information. An e-mail will be delivered to your mailbox when Medicaid policy clarifications or other health care information is available that is appropriate for your selected area and provider type.

Visit the Florida Medicaid’s Health Care Alerts page to subscribe now. You may unsubscribe or update your subscription at any time by clicking on the “Manage your subscription” icon in the footer of each e-mail. Other questions regarding the e-mail alert system can be sent to the Florida Medicaid Alerts Administrator.

© 2015 Agency for Health Care Administration