Provider Manual

Chapter 35: Regulatory Mandatory Reporting

Federal, state and city agencies, including the New York State Department of Health and the New York City Department of Health and Mental Hygiene, enacted laws practitioners must follow to track conditions that affect public health and ensure public safety. This chapter outlines the government reporting procedures required of all EmblemHealth practitioners.

 

In order to track conditions that affect the public health at large, agencies within New York State, the New York State Department of Health and the New York City Department of Health and Mental Hygiene have enacted laws that require practitioners to follow in order to ensure public safety. Our practitioners are required to participate in these government reporting procedures.

New York State requires regular reporting on issues ranging from diseases to medical research. For more information, visit the New York State Department of Health (NYSDOH) website at www.health.ny.gov and search for "Rules, Regulations and Laws".

 

Physicians are also required to report communicable diseases, including cases, suspected cases and certain carriers, to local public health agencies (LPHAs). This includes sexually transmitted diseases (STDs) and tuberculosis. For mandatory physician reporting of patient information, visit the NYSDOH website at www.health.ny.gov and search for "Infection Control Reporting Requirements".

For Medicaid/CHPlus members, EmblemHealth and our participating practitioners are also required to provide data exchange services to support the Citywide Immunization Registry (CIR) and Lead Poisoning Prevention Program (LPPP).

 

New York City Resources

The Compendium of Public Health Requirements and Recommendations: For Health Care Providers Working with Managed Care Organizations, published by the New York City Department of Health and Mental Hygiene (NYCDOHMH), contains public health requirements focusing on two areas:

  • Reporting requirements for communicable diseases and injuries, immunizations, lead test results, termination of pregnancy, and school health
  • Guidelines for prevention, diagnosis and management on the following topics: communicable diseases, immunizations, emergency preparedness, child development, breast-feeding, child safety, adolescent health, domestic violence, reproductive health, oral health, chronic diseases, and chronic health problems

For additional guidelines and information, visit www.nyc.gov.

EmblemHealth network practitioners may need to report to one or more of the following agencies:

 

  • Centers for Disease Control and Prevention
  • Centers for Medicare & Medicaid Services
  • Food and Drug Administration
  • New York City Department of Health and Mental Hygiene
  • New York State Cancer Registry
  • New York State Central Register of Child Abuse and Maltreatment
  • New York State Department of Health
  • New York State Immunization Information System
  • New York State Justice Center
  • New York State Penal Code
  • New York State Pesticide Poisoning Registry
  • New York State Rules and Regulations on Controlled Substances – Public Health Law
  • NYCDOHMH Citywide Immunization Registry
  • NYCDOHMH Lead Poisoning Prevention Program
  • NYSDOH Alzheimer's Disease and other Dementias Registry
  • NYSDOH Bureau of Communicable Disease Control
  • NYSDOH Bureau of Occupational Health – Occupational Lung Disease Registry
  • NYSDOH Center for Environmental Health
  • NYSDOH Congenital Malformations Registry
  • NYSDOH Division of Quality and Surveillance for Nursing Homes and ICFs/MR
  • NYSDOH Hospital Complaints
  • NYSDOH Office of Professional Medical Conduct

New York State law requires home care organizations to file annual and/or quarterly signed certifications confirming their compliance with minimum wage requirements specified in Public Health Law §3614-c — Home Care Worker Wage Parity. The requirements for our network providers serving EmblemHealth Medicaid, CHPlus, and/or HARP members in New York City, Nassau, Suffolk, and/or Westchester counties are as follows:

  • Consumer Directed Personal Assistance Services (CDPAS) Fiscal Intermediaries (FI): Quarterly written certification
  • Licensed Home Care Services Agencies (LHCSAs): Quarterly written certification 
  • Certified Home Health Agencies (CHHAs): Annual written certification

Note: Entities that have a CHHA or long-term home health care program (LTHHCP) that contracts with LHCSAs or other third parties are required to submit an annual certification to the NYSDOH. In addition, they must obtain quarterly written certification from the contracted entities, attesting compliance with this provision.

 

Submitting Your Certifications to EmblemHealth

Certifications must be made using the approved NYSDOH certification forms.

 

Quarterly certifications are due to EmblemHealth on March 1, June 1, September 1 and December 1 of each year. Annual certifications are due to EmblemHealth and the NYSDOH by March 1 of each year.

 

Fax or email the certification to EmblemHealth's Network Compliance department at 1-212-510-5330 or WageParity@emblemhealth.com.

 

Consequences of Noncompliance

EmblemHealth must annually certify that its contracted CDPAS FIs, CHHAs, LTHHCPs and LHCSAs follow the Home Care Worker Wage Parity law. An organization’s failure to submit required certifications to EmblemHealth may result in termination of our agreement with your organization.

 

Required Record Keeping

EmblemHealth and all providers must maintain records of compliance for at least 10 years. These records must be made available to the NYSDOH upon request. If you have any questions about complying with this request, please contact your EmblemHealth provider representative.

 

More Information

For more information about the Home Care Worker Wage Parity provision and its implementation, send an email to homecare@health.state.ny.us with "Home Care Worker Wage Parity" in the subject line.