January 15, 2016 Edition of ASAP

ASAP

A Weekly Publication Of HCA Home Care Association of New York State

Legislative Issues  Public Policy

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News

Volume 21, No. 2 January 15, 2016

Cuomo Budget Scant on Health Funding; Proposes $15 Wage, Advanced Aides, More Managed Care Transition HCA members should plan to be in Albany February 1-2 for HCA Advocacy – and participate in January 26 HCA conference call to discuss proposals and advocacy strategy On Wednesday, Governor Cuomo delivered his combined State-of-the-State and budget address announcing priorities for the state budget – which is due April 1 – while officially beginning the state legislative season and budget negotiations with the Legislature. The Governor’s $145 billion plan includes proposals covering ethics See BUDGET p. 2

HCA Extends Financial Survey Deadline to January 21 – Complete the Survey as Soon as Possible Your responses will inform a major report for our advocacy With HCA’s state advocacy program fast approaching on February 1-2 – on the heels of the Governor’s State Budget release this past week – HCA still needs responses from you to support one of our central advocacy documents: HCA’s 2015-16 home care financial condition report.

Feb. 1-2 Advocacy Program Focuses on ‘One-Two’ Agenda of Reimbursement Fixes, Operational Support HCA needs New York’s home care leaders – like you – in the lineup for our February 1-2 state advocacy program to help support what we are calling a “One-Two Plan.”

By now you’ve seen some of the logistical details.

Please take the time today to register for this important program on February 1-2. Please also

See SURVEY p. 7

Inside ASAP

See ADVOCACY p. 4

Note: HCA fices ar e closed Monday for the Martin Luther King, Jr HCA’’s of offices are Jr.. Holiday Holiday..

Cuomo Budget Proposes $15 Wage, Advanced Aides, More.........1 Info on State Advocacy Program: Feb. 1-2........................................1 HCA Extends Financial Survey Deadline to January 21 ....................1 Conference Call for LHCSAs on DOH ‘Desk Audits’.........................5 HCA Launches 2016 Federal Advocacy with Congressional Visits...8 FLSA and QIVAPP Funding Update...................................................9 Member Hiring Announcement............................................................9 Check Resources for FIDA Withdrawals Affecting Patients.............10 Register for Bootcamp: Retooling Your Compliance Program.......11 Reach for the Aide Stars with Recruitment Webinar Series..............11 October Global Cap Report: Spending $23M Over Projections...12 DSRIP Update...................................................................................13 CMS Releases New “G” Codes for Hospice...................................13 OPWDD Transformation Panel Drafts Recommendations..............14 Medicaid Trainings Scheduled for 2016..........................................15 eMedNY Training Schedule Posted.................................................15 NGS Closed for Martin Luther King, Jr. Day....................................16 Publications.............................................................................16

Helping New Yorkers Feel Right At Home

Volume 21, No. 2 January 15, 2016

ASAP – a publication of the Home Care Association of New York State BUDGET from p. 1

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reform, tourism, economic development, education, infrastructure, criminal justice, transportation, the environment, labor, and, of course health care.

However, very few specific health care proposals were mentioned in his spoken address in Albany this week.

HCA’s Policy staff is focused on a detailed review of the actual budget bills to further assess and report on these and other proposed health and related actions in the Executive budget. Once we have completed this further analysis, HCA will circulate a detailed budget memorandum for the membership.

Health care proposals

Wage proposal

According to a printed version of the State-of-theState and Budget Message, the Governor’s budget proposal would extend many of his prior-year Medicaid projects and financing policies, including the Medicaid Global Cap and initiatives like the Delivery System Reform Incentive Payment (DSRIP) program.

The Advanced Aide language is the most direct proposal for home care; but the biggest home care impact of the Governor’s budget is his broad plan to raise the state’s minimum wage to $15 per hour over a multi-year period that varies by New York City and the rest of the state.

Aside from targeted investments in cancer screening and certain other public health areas, the proposal appears extremely scant on urgently needed health care investments, particularly for home care.

HCA anticipated this $15 proposal based on past statements by the Governor and legislative leaders calling for a wage hike. As a result, HCA has been working with association partners to calculate the impact of a $15 per hour wage across the entire health care continuum, and the cost implications for home care are enormous.

Meanwhile, the proposal also calls for: an “Advanced Home Health Aide” designation (with no evidence of detail or funding); movement to value-based payment; and a policy to allow for 12 weeks of paid family leave.

HCA’s initial analysis finds an overall statewide cost impact of over $1.7 billion for home health

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

Joanne Cunningham, jcunningham@hcanys.org Roger L. Noyes, Director of Communications, rnoyes@hcanys.org Al Cardillo, Executive Vice President, Policy & Programs, acardillo@hcanys.org Patrick Conole, Vice President, Finance & Management, pconole@hcanys.org Andrew Koski, Vice President, Program Policy and Services, akoski@hcanys.org Alexandra Blais, Director of Public Policy, ablais@hcanys.org Laura Constable, Senior Director, Membership & Operations, lconstable@hcanys.org Celisia Street, Director of Education, cstreet@hcanys.org Mercedes Teague, Finance Manager, mteague@hcanys.org Jenny Kerbein, Director of Governance and Special Projects, jkerbein@hcanys.org Billi Hoen, Manager, Meeting and Events, bhoen@hcanys.org Teresa Brown, Administrative Assistant, tbrown@hcanys.org 388 Broadway, 4th Floor, Albany, NY 12207 Tele: 518-426-8764; Fax: 518-426-8788; Website www.hcanys.org

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agencies and personal care providers. This impact is over half of the estimated $3 billion cost for hospitals, nursing homes and home health combined, according to the initial analysis being conducted by HCA, the Healthcare Association of New York State, LeadingAge New York, and the New York State Association of Health Care Providers.

HCA has long advocated for increased funding to support home health worker compensation, recruitment and retention. However, in the form and manner being proposed by the Governor, the wage proposal is a massive new, unfunded cost that would be imposed on an already financially vulnerable home care system dealing with increasing costs (especially the recent federal overtime requirements for home care), a plunge in operating margins, and reimbursement cuts like the CHHA episodic payment system rebasing reductions.

These are among the critical reasons why we urgently need you to complete our financial condition survey of the membership, so we can accurately account for these cost pressures in our advocacy on your behalf.

HCA has extended the deadline for your completion of this survey. (See related p. 1 story.) Though we have already drafted a report based on your initial responses, we will refresh the data with any new responses that you can provide on the survey, now due by Thursday, January 21.

The results of this survey will be incorporated into a final report that we will circulate as part of our Advocacy Day program on February 1-2.

Your answers will help us communicate the challenges you are already facing, as well as the need for home care cost relief, regulatory changes, and investment, especially amid the prospect of yet another added labor cost without an accompanying funding mechanism as of yet proposed.

MARK YOUR CALENDARS January 21: Due date for members to submit their responses to HCA’s financial survey January 26: Participate in HCA’s conference call on the state budget and advocacy messaging (3 to 4 p.m.)

February 1: Attend HCA’s PAC Reception for Senator Kemp Hannon (6 p.m.)

February 2: Arrive at Room 711A of the Legislative Office Building in Albany (9:30 a.m.) to hear from state officials and elected leaders, followed by Advocacy Day visits with your legislators in the afternoon (1 to 4 p.m.)

Register for January 26 conference call on the budget, strategy As announced to the membership yesterday, HCA is holding a free members-only call to brief the home care community on the Governor’s 2016-17 State Budget proposals affecting home care and to discuss our related advocacy strategy. The call is on January 26, from 3 to 4 p.m. To register for the call, simply complete the online form at https:// www.surveymonkey.com/r/2016-17Budget and dial-in instructions will be e-mailed to you by the day of the call.

Please read the other page 1 stories in this week’s ASAP for further details on the budget, HCA advocacy and our messaging this legislative session.

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HCA’s Spring 2016 Senior Financial Managers Summit is coming up on March 9 in Albany. This program, formerly called our CFO Forum, will be held at the Albany Hilton. Save the date and look for more details soon! See the flyer on page 6 for more information.

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Volume 21, No. 2 January 15, 2016 

ADVOCACY from p. 1 arrange your travels to Albany, make appointments with your legislators (for the afternoon of February 2), and get up to speed on the Governor’s budget proposals and some of the longstanding advocacy needs being prepared by HCA in our messaging materials.

All details about our Advocacy Day program (including a registration form and agenda) are posted to our website at http://hca-nys.org/general-news/join-hca-for-ourhome-care-leaders-state-advocacy-day-on-february-1-2.

In a nutshell, you need to simply remember our “OneTwo” plan for February 1 and February 2: 1. February 1: Register and plan to attend a Political Action Committee reception for Senate Health Committee Chairman Kemp Hannon on February 1 at 6 p.m. The event will be held at HCA’s offices in Albany: 388 Broadway, Fourth Floor, Albany, New York 12207.

2. February 2: Register for the main event of our advocacy program, which includes a 9:30 a.m. meeting of our Board of Directors where key elected officials are invited to present their thoughts on the health care agenda for 2016. All HCA members are invited to this session.

Following this meeting and lunch (in room 711A of the Legislative Office Building in Albany), we ask that you meet with your legislators (from 1 to 4 p.m.) to discuss HCA’s priorities for 2016.

Please let us know if you need help scheduling your afternoon appointments.

This agenda is all spelled out in the registration form at http://hca-nys.org/wp-content/uploads/2016/01/ 2016HCAAdvocacyDayEventFlyerandRegistration.pdf.

Please fax it back to HCA so that we can plan your attendance.

Messaging?

We’ve covered the logistical details … but what about messaging?

The best way to discuss HCA’s messaging related to the budget and our advocacy agenda is for you to plan on 4

participating in our January 26 conference call on the budget. (See related p. 1 story, or register directly at https://www.surveymonkey.com/r/ 2016-17Budget.)

During this call, we will walk you through the Governor’s budget proposals and discuss some of our strategy and messaging for February 1-2.

Aside from the conference call, we know you’ll need written material. HCA is preparing several Advocacy Day resource documents.

The first of these is a brief, one-page piece summarizing our “One-Two plan” of priorities for the budget and state legislative session.

These “One-Two” priorities include: 1) the need for fixes to the state’s reimbursement system for rate adequacy and coverage for home care and managed care; and 2) the need for a statutory and budget package that optimizes home care’s operation in the changing health care system.

This one-page piece will be accompanied by a more detailed summary of specific proposals that fall under these two categories, including the following: 1. Plan 1 – Reimbursement fixes and Payment Support that should address any new state wage mandates, including minimum wage, as well as closing gaps in: the state’s “Episodic Payment System” for home care; the state’s home care worker wage parity and other labor requirements and rules (including new federal overtime rules); the premium calculations for managed care plans; and the reimbursement calculations for home care under managed care. We are also calling for needed home care infrastructure support (like health information technology and workforce resources), and updating of the long antiquated state insurance law coverage Continued on next page

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Continued from previous page provisions for home care agency services.

2. Plan 2 – Statutory and budget support for home care optimization, including: fast-track authority for state regulatory changes that streamline and better align regulations; harnessing home care in priority public health areas such as sepsis, falls prevention, wound care prevention, maternal and child health, emergency response, and other; a proactive health information technology policy; funding for the hospital-homecare-physician collaboration program enacted in the 2015-16 state budget; home care and hospice quality innovation; palliative care access; and the creation of innovative payment and delivery demonstration models.

To support this “One-Two” plan of legislative needs, we’ll also arm you with the results of our 2015-16 home care financial condition report based on your survey responses. If you have not responded to our survey, please do so as soon as possible. We’ve extended the deadline until Thursday, January 21. (See related p. 1 story.)

Conference Call: What Every LHCSA Should Know about DOH ‘Desk Audits’ Register today for January 19 call As reported in last week’s ASAP newsletter, the state Department of Health (DOH) Division of Home and Community Based Services recently announced a pilot project to perform off-site surveillance activities of selected LHCSAs in all regions of the state.

The Department will select the LHCSAs to be included in the Pilot Project. This is non-voluntary and required for those agencies selected. The Regional Office surveillance staff will conduct specific audits to determine compliance with targeted requirement areas. The pilot project will begin on February 1.

HCA has invited the Department to participate in a statewide conference call on January 19 (2-3 p.m.) with LHCSAs to outline the compliance areas targeted by the audit and to discuss what agencies can expect during the process as well as how to prepare and respond should they be selected.

The Department has worked with us to schedule this timeframe to discuss the new audit project and we have collaborated with LeadingAge New York to expand outreach to as many potentially affected agencies as possible for participation in this important call.

We strongly encourage your participation in this call.

To register for this free membership call, please click https://www.surveymonkey.com/r/ offsitesurveillance, complete the online form, tell us whether you are a member of HCA or LeadingAge New York (or both), and registration information will be e-mailed to you in advance of the call date.

What Every LHCSA Should Know about the New DOH ‘Desk Audit’ Project Presented by: Rebecca Fuller Gray Director, Division of Home and Community Based Services, DOH January 19, 2016 2 to 3 p.m.

Register at https://www.surveymonkey.com/r/offsitesurveillance.

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SENIOR FINANCIAL MANAGERS SUMMIT (Formerly CFO Forum)

March 9, 2016 9:00am – 3:15pm Albany Hilton Albany, New York

SAVE THE DATE Join us for the Spring 2016 Senior Financial Manager’s Summit and learn about:

2016-2017 State Budget HCA Financial Condition Report Results Updates on Home Care Rates and Managed Care Premiums

Minimum Wage Funding And much more!

Watch for more information coming soon!

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SURVEY from p. 1 HCA has already prepared a draft of the report which is based on your initial responses to the statewide survey. The final report will be a major component of our call for payment adequacy in home care. Our goal is 80 responses, and, ideally, 100 responses to the survey.

We are still below the threshold of 80 responses, so we’ve extended the deadline until Thursday, January 21.

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Over 2/3 of Medicare-certified home health agencies are operating in the red.

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Based on your Cost Report responses, the average 2014 operating margin for CHHAs and LTHHCPs is -1.182 percent.

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On average, less than half (46 percent) of Medicaid claims are paid to home care providers within the prompt-pay timeframe required by law (30 days for electronic and 45 days for paper claims).

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The average percentage cut attributable to CHHA rebasing is 29 percent. Over half of agencies reported that they are experiencing a rebasing cut of more than 30 percent.

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The largest factors causing agencies’ financial challenges include wage, overtime and benefit costs.

Please note that this data is preliminary and will change as we obtain more responses. To give us more data, you can answer the survey two ways:

HCA’s initial survey findings

A quarter of home care agencies indicated that more than 20 percent of their revenue falls under bad-debt (not getting paid).

Over one-third of agencies have had to use a line of credit or borrow money to pay for operating expenses in the past two years.

HCA’s survey specifically asks home care agencies if they have yet calculated the impact of a proposed wage increase to $15 per hour for home care aides. One agency responded that “our rates we pay our aide vendors will increase by 25 percent at least.”

Another estimated an $830,000 cost increase. Others said the results will be “catastrophic” or “we are not sure our agency can stay in business with the proposed increase.”

HCA’s preliminary analysis of the survey responses so far is coupled with an examination of additional data obtained from the state Department of Health and other sources. Below are some initial results. If these results reflect your agency’s experience, please reinforce the data by increasing our sample size. If the results do not reflect your agency’s experience, please respond to the survey as soon as possible so that your voice is included in the data.

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Complete a PDF version of the survey. The PDF is published at the back of this week’s ASAP. You can print the PDF and complete it by hand or enter text edits and send it to HCA by fax at (518) 426-8788 or by e-mail (rnoyes@hcanys.org); or

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Complete the survey online through survey monkey, a collection tool available at https:// www.surveymonkey.com/r/ 2015HomeCareFinCondSurvey.

Please respond as soon as possible so that we have the most accurate and statistically sound data possible to support our advocacy for payment support and investment in home care.

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ASAP – a publication of the Home Care Association of New York State

HCA Launches 2016 Federal Advocacy Agenda with Congressional Delegation Visits This week, HCA President Joanne Cunningham met with several members of the New York Congressional Delegation in Washington to discuss and outline HCA’s federal advocacy priorities for the coming year. In the meetings, Ms. Cunningham discussed the need for Congressional efforts on the following issues that are top priorities of New York’s home care community: 1. Relief from the onerous and duplicative Medicare Face-to-Face (F2F) regulation. HCA has launched an aggressive strategy, working with state home care associations across the nation, to eliminate or significantly modify the F2F regulation through Congressional action.

In follow-up discussions with the Delegation, HCA outlined legislation introduced in the Senate that would take steps to reduce the burden of F2F. We also urged support for counterpart legislation to be introduced in the House that would go even further to reduce and eliminate the burden that F2F has imposed on agencies.

Delegation Members pledged their continued support and promised to continue to join Congressional efforts for a legislative solution.

2. Maintain opposition to copays and cuts to the home health benefit. While Congress has rejected efforts to include home health copays as revenue raisers over the past years, it is vital that HCA remain vigilant in our efforts to continue educating Members of Congress about the negative impact on providers and beneficiaries of copays for home health services. New York’s Congressional Delegation continues to strongly oppose home health copays and expressed strong

HCA President Joanne Cunningham met with offices of New York’s Congressional Delegation this week.

Here she is pictured with (from top): Reps. Elise Stefanik (R-Watertown), Tom Reed (R-Corning), Paul Tonko (D-Amsterdam) and Lee Zeldin (R-Patchogue).

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support for maintaining this position in the coming Congressional session.

3. Support for increasing access to home health through the enactment of legislation that would allow Nurse Practitioners to order and certify home health services for patients. This important legislation is being sponsored in the Senate by Senator Charles Schumer and is a top priority of HCA and New York’s home care community. HCA has an action item on our Legislative Action Center where you can write your Member of Congress in support of this sensible policy change. Please visit http://p2a.co/ z6HUax7 and follow the instructions for taking action.

Ms. Cunningham also briefed the New York Delegation Members on legislative and policy challenges facing providers in the state budget process (see related p. 1 stories), including the impact of Governor Cuomo’s priority legislation that would raise New York’s minimum wage to $15 per hour. Ms. Cunningham discussed the impact that this increase would have on the home care provider community and the need for funding provided to home care to offset the massive financial impact this increase would have on worker wages.

Delegation offices expressed interest and recognition of the need for tremendous support to offset this mandate.

In the daylong pre-State of the Union visits, Ms. Cunningham met with the offices of Senator Charles Schumer, Senator Kirsten Gillibrand, Rep. Yvette Clark (D-Brooklyn), and with Reps. Paul Tonko (D-Amsterdam), Tom Reed (R-Corning), Lee Zeldin (R-Patchogue) and Elise Stefanik (R-Watertown).

FLSA and QIVAPP Funding Update As agencies continue to deal with new costs (overtime, travel and live-in cases) due to the recent Fair Labor Standards Act (FLSA) changes, HCA has obtained updates from the state Department of Health (DOH) on its efforts to provide additional funding to managed care plans and their home care partners.

In its November 9, 2015 “Dear Colleague” letter, DOH indicated that it would include additional funding of $0.34 per hour across all aide hours to help agencies to meet the FLSA requirements. DOH had expected to advance state-share-only payments to managed care plans by December, but now that date has been delayed.

In addition, DOH intends to provide rate adjustments under Medicaid fee-for-service payments sometime in January. As reported in last week’s ASAP, DOH has delayed the release of the initial 2016 Medicaid rates for

Title: Director of Performance Improvement and Staff Development Organization: Winthrop University Hospital Home Health Agency

HIRING

Winthrop seeks a Director of Performance Improvement and Staff Development for the CHHA, which services Nassau, Suffolk and Queens. The PI Director is responsible for the quality assessment/assurance program, compliance with DOH regulations and The Joint Commission standards as well as corporate compliance and the educational programs of the agency.

Minimum qualifications include: BSN, NYS RN license, two years professional nursing experience, two years supervisory experience in a CHHA or related program. Knowledge of Performance Improvement and Quality Assurance, as well as a working knowledge of Joint Commission standards and DOH regulations, are a must.

Master’s degree preferred.

Send résumés to Anne Calvo via e-mail to acalvo@winthrop.org.

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CHHAs, LTHHCPs, and Personal Care providers so that the Department can finalize a retrospective rate adjustment to account for the new FLSA costs. This week, DOH said that the FLSA package is with the state Division of the Budget (DOB) and DOH is awaiting DOB’s approval. Once received, DOH will load the payments.

FLSA Survey This week, HCA, along with other provider associations, reviewed and provided substantive and detailed input on a draft survey developed by the state to ascertain the new costs faced by home care providers under the FLSA changes. HCA will be meeting with DOH next week to discuss our survey concerns and recommendations. We will keep members informed on the status of the survey before it is sent to all home care providers.

QIVAPP DOH has informed HCA that the Quality Incentive/Vital Access Payment Program (QIVAPP) review from IPRO has resulted in significant changes as to the providers who meet the requirements for QIVAPP monies.

DOH is working through the reconciliation at this time and it will be a couple of weeks before it is finalized.

CMS Bulletin The U.S. Centers for Medicare and Medicaid Services (CMS) has issued an Informational Bulletin to remind states that CMS is available to offer technical assistance to states seeking to make adjustments to current or future home and community-based waiver programs or state plan services to accommodate FLSA costs in Medicaid reimbursement.

The Bulletin is at https://www.medicaid.gov/Federal-Policy-Guidance/Federal-PolicyGuidance.html?filterBy=bulletin%23dynamic-list#TopOfPage (click on Federal Policy Guidance at top of page).

For more information on the FLSA or QIVAPP funding, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.

Check Resources for FIDA Withdrawals Affecting Patients With the recent decision by some managed care organizations (MCOs) to withdraw from the Fully Integrated Duals Advantage (FIDA) market, HCA advises members to check the status of the FIDA and non-FIDA MLTC plans whose patients you serve.

Two resources for a list of FIDA plans are: http://www.health.ny.gov/health_care/medicaid/redesign/ fida_plans_by_region.htm and http://nymedicaidchoice.com/choose/find-long-term-care-plan.

Before MCOs can drop their FIDA (or non-FIDA MLTC plan), they have to provide advance notice to their patients and offer them the options to enroll in another FIDA plan, return to their MLTC plan or choose another MLTC plan.

More information on FIDA is at http://www.wnylc.com/health/entry/202/ and http://www.health.ny.gov/ health_care/medicaid/redesign/fida/.

In addition, as managed care enrollees can change plans on a monthly basis, HCA members are advised to check the Medicaid Eligibility Verification system a few times each month and to tell patients and their families to notify the home care provider if they change plans.

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ASAP – a publication of the Home Care Association of New York State

Register for 2/23 HCA Bootcamp: Retooling Your Compliance Program

At a time when everyone is looking at your agency’s quality and client outcomes, you need to focus on star recruitment! Reach this goal by having the volume of applicants, interviewees and on-boarding best practices to be successful.

Kick off the New Year by ensuring that your compliance activities meet federal and state Office of Medicaid Inspector General (OMIG) requirements. One of OMIG’s most knowledgeable health system compliance experts will provide an in-depth look at the eight critical elements of a comprehensive compliance program.

This webinar series (on January 26, February 9 and March 15) offers three exciting sessions all taking place from 3 to 4 p.m.

You can register for all three programs (live or recorded) or pick and choose the ones that interest you. Download the flyer and registration form at http://hca-nys.org/wpcontent/uploads/2016/01/Reach-for-the-AideStars-Webinar-Series-flyer.pdf to learn more.

Following OMIG, a home care compliance expert will outline ways for agencies to successfully conduct internal audits, incorporate OMIG audit protocols into your compliance activities, and gain insight on the OMIG auditing process. Learn how to use OMIG’s Compliance Guidance and Work Plan to guide your agency’s compliance program.

Data-Driven Recruitment: Tips to Get More Aide Applicants ( January 26)

Presenters include: Matthew Babcock, Assistant Medicaid Inspector General for Compliance, Office of the Medicaid Inspector General

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Rachel Hold-Weiss, RPA-C, JD, Associate General Counsel, Personal Touch Home Care

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Reach for the Aide Stars with Data Driven Recruitment: A New Webinar Series

In February, HCA is bringing the next installment of our popular home care bootcamp series with a session in New York City on “Retooling Your Compliance Program.”

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Want to know why caregivers apply to your jobs (and why they don’t)? Join us for a data-packed session and walk away with insight to generate more applicants.

Data-Driven Recruitment: Increasing Interview Show-Ups (February 9) Did you know average industry show-up rates are 50-60%? Learn why and what you can do to entice more caregivers into your company.

Further details are below. The registration form is at http://hca-nys.org/wp-content/uploads/2016/ 01/Feb-23-Retooling-Compliance-RegistrationForm.pdf.

Data-Driven Recruitment: 90-Day Caregiver Onboarding Best Practices (March 15)

HCA Bootcamp: Retooling Your Compliance Program Tuesday, February 23 Noon to 3:45 p.m.

Conference Center 130 East 59th Street (near Lexington Ave.) 7th Floor New York, NY 10022

Did you know the average turnover is 63.2%?

Learn simple tips to create a stellar 90-day onboarding experience. It’s proven if you keep a caregiver for 90 days, they’re likely to stay longterm. We’ll also highlight some best practices we’ve gleaned to retain top caregivers.

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October Medicaid Global Cap Report: Spending $23M Over Projections The state Department of Health (DOH) has issued its monthly Medicaid Global Cap report. This latest report, for October, covers the period of April 1 to October 31, 2015.

It finds that overall spending for this period was $23 million above Medicaid Global Cap projections, across all sectors, a difference of $10.667 billion in actual spending versus $10.644 billion in estimated spending for the seven-month period.

According to the report, the state has done a mid-year (six-month) update to the current Global Medicaid Spending Cap estimates based on experience through September 2015. Specifically, DOH mentions the following two significant pressures on the Global Cap which must now be incorporated: •

Significant enrollment growth in the Managed Long Term Care program. Year-to-date growth (through September) was 11,000 individuals, primarily in New York City (68 percent). The original estimates only assumed an annual growth of 10,000 and have been revised to reflect projected growth of 16,375 recipients; and

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Recent court ruling on the Fair Labor Standards Act (FLSA) requiring overtime to be paid at time and one half of wage, travel time is compensable hours, and changes to live-in rules.

Because of these mid-year updates, the category that includes home care (“Other Long Term Care”) was only $1 million over projection, a difference between actual spending of $405 million versus projected spending of $406 million, which is significant improvement from the September 2015 report which showed Other Long term Care services as being $34 million over estimated spending as a result of more recipients billed than anticipated in personal care.

Medicaid Managed Care (MMC) was $5 million over projections, a difference of $7.438 billion (actual spending) versus $7.433 billion (estimated spending), which is also significantly better than the September report when MMC spending was $81 million over estimates.

Medicaid total enrollment reached 6,325,794 enrollees at the end of October 2015. This reflects an increase of 149,727 enrollees, or 2.4 percent, since March 2015.

The full report is at: http://www.health.ny.gov/health_care/medicaid/regulations/global_cap/monthly/ sfy_2015-2016/docs/october_2015_report.pdf.

HCA is analyzing these reports carefully in an information gathering effort, combined with other data analysis, related to home care’s performance under the Global Cap. The Medicaid Global Cap for the current fiscal year (April 1, 2015 to March 31, 2016) is $17.7 billion for all sectors.

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

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DSRIP Update The Delivery System Reform Incentive Payment (DSRIP) program Year 1 Timeline has been updated to reflect recent changes to key DSRIP deliverables, and a new DSRIP Year 2 Timeline (which begins April 1, 2016) has been released.

The DSRIP Timelines are at: http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/timelines/ index.htm.

The 2015 updates include the date for performance payments to be released to Performing Provider Systems (PPSs) as well as the announcement of a Request for Proposals (RFP) for the procurement of a DSRIP Independent Evaluator.

Some notable dates and events in the Year 2 Timeline include: •

January 20: DSRIP Year 1 second payment made to PPSs

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February 1: Round two regulatory waiver responses completed

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Mid-Late February: Phase II DSRIP Notice and Opt-out letters mailed

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Late March: Revised draft Value Based Payment Roadmap released for public comment

Questions related to the timelines can be directed to DSRIP@health.ny.gov.

MRT Innovation eXchange DOH has updated practices taking place at PPSs across New York as they work to implement DSRIP projects, and added questions and discussion topics related to DSRIP. The updates are posted on the MRT Innovation eXchange at https://www.ny-mix.org/ (registration required).

CMS Releases New “G” Codes for Hospice The U.S. Centers for Medicare and Medicaid Services (CMS) recently posted Change Request (CR) no. 9459 (dated January 6, 2016), which makes edits to the Integrated Outpatient Code Editor for home health and hospice.

CR no. 9459 can be downloaded at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/ 2016-Transmittals-Items/R3437CP.html?DLPage=1&DLEntries=10&DLSort=1&DLSortDir=descending.

These edits include new “G” codes. Hospices and home health agencies were expecting to see the two new codes for RN and LPN visits included, G0299 and G0300 respectively. However, this CR also includes a series of new “G” codes for hospice.

The new G Codes correlate to the “visits at the end of life” measure that the National Quality Forum (NQF) is reviewing and CMS is developing. Many in the industry believe these codes will be used on hospice claims in the future. There is also an oncology measure related to hospice referrals and there are new codes that correspond to 13

ASAP – a publication of the Home Care Association of New York State

Volume 21, No. 2 January 15, 2016 

this measure as well. The following is a full listing of the new G Codes that are hospice-related and included in the Integrated Outpatient Code Editor • • • • • • • • • • • • •

G0299: Home Health or Hospice Registered Nurse (RN) Visit G0300: Home Health or Hospice Licensed Practice Nurse (LPN) Visit G9473: Chaplain services at hospice G9474: Diet counselling at hospice G9475: Other counselor at hospice G9476: Volunteer service at hospice G9477: Care coordination at hospice G9478: Other therapist at hospice G9479: Pharmacist at hospice G9480: Admission to MCCM G9524: Referral to hospice G9525: Doctor has no reason for hospice referral G9526: No reason, no referral to hospice

Note that new codes are only created once a year, so CMS is clearly anticipating the need for these for reporting (and new measures) in the relatively near future but neither HCA nor our industry colleagues are aware of the exact timing that providers will be required to use these codes. It is possible that the proposed measure “visits at the end of life” could be included in the payment rule which should be released in the late April timeframe, and HCA will be updating the membership when CMS issues the proposed hospice rule this spring.

For further information, contact the HCA Policy staff.

OPWDD Transformation Panel Draft Recommendations Released The Office for People with Developmental Disabilities (OPWDD) has released for comment the Transformation Panel’s draft recommendations.

The recommendations are at http://www.opwdd.ny.gov/sites/default/files/documents/panel_report.pdf.

They lay out the process, vision and recommendations of the Transformation Panel, a diverse group of people brought together to change the OPWDD system.

Comments are due by January 22 and should be sent to transformation.panel@opwdd.ny.gov.

In its report, the panel defines three key priorities: community, outcomes, and flexible system platforms.

•

Community: People with developmental disabilities will be accepted as part of our communities, living the lives they choose while experiencing good health, growth, and personal relationships.

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Outcomes: The focus is on the quality of the person’s experience and the outcomes the consumers want, which includes living and working in the community while directing their own services and supports.

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Flexible System Platforms: Integrated, quality services must be supported by networks of high performing providers with the flexibility to meet people’s needs. All system platforms, including managed care, need to measurably further this vision.

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ASAP – a publication of the Home Care Association of New York State

Volume 21, No. 2 January 15, 2016 

Medicaid Trainings Scheduled for 2016 The New York City Human Resources Administration has released its schedule of Medicaid trainings for 2016.

Some of the programs include: Medicaid prescreening eligibility for aged, blind and disabled individuals; advance training for aged, blind and disabled eligibility; excess income/spend-down program; nursing home eligibility; and Medicare Savings Programs.

Registration information is at http://a069-marc.nyc.gov/marc/default.aspx (requires registration for the MAP Authorized Resource Center).

eMedNY Training Schedule Posted The eMedNY Training Schedule for January through March is now available. Some of the topics offered include: •

ePACES for Professional, Institutional, Dental, Private Duty Nursing, Transportation, Nursing Home, and Physician

•

eMedNY Website Review

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New Provider/New Biller

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Medicaid Eligibility Verification Systems (MEVS)

eMedNY training seminars are being held at the following locations: • • • • • • • • • •

Batavia Buffalo Canandaigua Hauppauge Mayville New York City Poughkeepsie Rensselaer Syracuse Utica

eMedNY also offers webinars; the training schedule is at https://www.emedny.org/training/index.aspx.

Questions can be directed to the eMedNY Call Center at 800-343-9000.

15

ASAP – a publication of the Home Care Association of New York State

Volume 21, No. 2 January 15, 2016 

NGS Closed for Martin Luther King, Jr. Day National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), will be closed Monday, January 18 for the Martin Luther King, Jr. holiday. This includes the Electronic Data Interchange (EDI) Help Desk, Provider Contact Center, Provider Enrollment Line, and Telephone Reopening Unit.

Electronic claim files transmitted after 5 p.m. on Friday, January 15 will have a claim receipt date of Tuesday, January 19, 2016. EDI front-end acknowledgement transactions will be created as expected as EDI claim files are received.

Providers will be able to access NGSConnex and use the Interactive Voice Response (IVR) system at 1866-275-3033.

For further information, contact HCA’s Patrick Conole at (518) 810-0661 or at pconole@hcanys.org.

Publications •

“Medicaid Assisted Living Programs (ALP) in NYS,” by the New York Legal Assistance Group http://www.wnylc.com/health/entry/150/

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“Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors,” by the National Academy of Sciences Institute of Medicine http://iom.nationalacademies.org/Reports/2016/Accounting-for-Social-Risk-Factors-inPa y me n t . a s p x ? ut m _ s o u r ce = I O M + E m a i l + L i s t & u t m _ c a mp a i g n = f ab d 6 9 ca 6 8 1_12_SES_Medicare1_11_2016&utm_medium=email&utm_term=0_211686812e-fabd69ca68180152073

For more information, contact Andrew Koski at (518) 810-0662 or akoski@hcanys.org.

16

2015 State Home Care Financial Condition Survey SECTION 1: Demographic Information 1. List your contact information Your Organization Your Name Your Title Your E­mail Your Phone Number

2. Please check only one answer for your home care provider type, and please be sure to complete a separate survey for each type if you have multiple types of agencies.

CHHA LHCSA LTHHCP

3. My agency is ____ (Please only check one answer) Voluntary Proprietary Public

2015 State Home Care Financial Condition Survey SECTION 2: Financial Data Questions 4 and 5 should be completed by CHHAs and LTHHCPs. Question 6 should be completed by LHCSAs. Your answers can be taken directly from your 2014 Medicaid Cost Reports or your 2013 Statistical Reports. Your Finance Director/Chief Financial Officer can assist you.

To help, we have created a reference chart, available HERE. This document references the exact schedules on your cost reports and statistical reports for the information sought in questions 5 and 6.

Again, all agency­specific information provided to us will be kept confidential and will only be used in the aggregate.

REMEMBER ... For numerical entries, do not use dollar signs ($), commas (,), decimal points (.), percent signs (%) or other characters, just the raw number. Please round up or down if your answer involves a decimal point.

4. If your agency filed a 2014 cost report, are you completing the cost report section of this survey for your LTHHCP or your CHHA? If you are a LHCSA, please skip to question 6.

CHHA (my 2014 cost report) LTHHCP (my 2014 cost report)

5. Provide the following data from your 2014 Cost Report (for CHHAs or LTHHCPs). If you are a LHCSA, please skip to question 6.

No. of Full Time Employees (FTEs) Medicare Fee­for­service Revenues Medicaid Fee­for­service Revenues All Other Payor Revenues, including Managed Care Total Patient Service Revenue All Other Non­Payor Revenues Total Revenue Total Operating Expenses

2015 State Home Care Financial Condition Survey 6. For LHCSAs, please complete the following data from your 2013 LHCSA Statistical Report. If you are not a LHCSA, skip to the next question.

Total Cases Unduplicated Patient Count Number of Full Time Staffing (as of Oct. 1) Total Contract Revenue Total Direct Revenue Total Costs

2015 State Home Care Financial Condition Survey SECTION 3: Payment and Program Information This section asks for your responses about the impact of billing, regulatory and payment issues.

7. Please estimate what % of your Medicaid managed care claims are paid within the "prompt" pay law timeframe for "clean" claims needing no edits (30 days for electronic claims, 45 for paper). Please just enter a raw number: no percentage sign. ___%

8. What is the average number of days that your revenues (from all payors) remain in Accounts Receivable? Please provide your best estimate.

Days

9. What percent of your revenue in Accounts Receivable results in “bad debt” or not getting paid?

0 – 10% 11 – 20% 21 – 30% Over 30%

2015 State Home Care Financial Condition Survey 10. Assuming that your costs have increased in the last year, please rate the impact of each cost factor below on your increased costs. For any that have the "largest impact," please tell us more about about the specific cost impact in the text box below.

No Impact Wage and Overtime Costs Benefits Costs Fuel Costs Unfunded Mandates (e.g. Flu vaccination requirements, TPL) Capital Costs Technology investment Other Administrative Costs Billing/Administrative Expenses Associated with Managed Care Basic or advanced staff training Emergency Preparedness and response Staff time and partnership development work on MLTC/DSRIP activities Tell us more about your largest cost impacts

Minimal Impact

Medium Impact

Large Impact Largest Impact

2015 State Home Care Financial Condition Survey 11. If your estimated Medicaid revenues have decreased between 2014 and 2015, please rate the impact of the following factors for this change in your Medicaid revenues.

No Impact Caseload change due to managed care transition Effect of payment cuts/reimbursement changes (e.g., CHHA EPS rebasing, GRT) Inadequate managed care rates Delay in managed care payments Drop in Medicaid volume due to fewer referrals Staffing cuts

Minimal Impact

Medium Impact

Large Impact

Largest Impact

2015 State Home Care Financial Condition Survey No Impact

Minimal

Medium

Large

Largest

Impact

Impact

Impact

Impact

Other (please specify)

12. On October 1, the state implemented CHHA episodic payment system rebasing cuts.

Please provide the average % reduction in your Medicaid revenue due to this initiative?

(Remember: be sure to only enter the raw number: no percentage sign.)

Avg. Percentage reduction (%)

2015 State Home Care Financial Condition Survey 13. If you have Medicaid managed care contracts (MCO and MLTC), please estimate the aggregate % differences between your Medicaid fee­for­service (FFS) rates and your negotiated managed care rates for the following service disciplines. (You may leave any of the boxes blank if the statement doesn't apply.)

Our aggregate managed care nursing service rate is LESS than FFS by (­__%) Our aggregate managed care nursing service rate is MORE than FFS by (+__%) Our aggregate managed care home health aide/personal care service rate is LESS than FFS by (­__%) Our aggregate managed care home health aide/personal care service rate is MORE than FFS by (+__%)

14. How have your overall contracted Medicaid managed care (MCO and MLTC) rates changed between 2014 and 2015? Enter zero if your rates have not changed. (Also, be sure to only enter the raw number: no percentage sign.)

Increased by ____% Decreased by ____%

15. At any time over the past two years (2014 and 2015), have you had to use a line of credit or borrow money (including gap­payment financing from parent organization) to pay for operating expenses?

Yes No

16. Please rank from 1­5 the (actual or potential) impact of the following state regulatory requirements/initiatives (1=highest impact and 5=lowest impact).

Elimination of the "companionship exemption" for home care

Executive compensation/administrative limits

Medicaid ordering, prescribing, referring and attending (OPRA) edit

DSRIP

State Wage Parity requirements in New York City, Long Island, Westchester

2015 State Home Care Financial Condition Survey 17. Which of the following actions does your agency plan to take in response to fiscal pressures, a changing health care environment and new models like DSRIP? (Please check all that apply.)

Merge with another agency Collaborate as part of a Health Home, IPA, ACO, DSRIP/PPS or other health system Technology upgrades (EHR, etc.)

Workforce retraining Reduce staff and other expenses to become more efficient Use LTHHCP in contracting capacity Phase­out LTHHCP Purchase a CHHA Increase use of CHHA Decrease use of CHHA Apply to open a LHCSA Increase use of LHCSA Decrease use of LHCSA Discontinue telehealth program Close our organization Other (please specify)

2015 State Home Care Financial Condition Survey 18. In your contracts with MLTCs/MCOs, how would you rate the overall impact of the following issues or experiences? (Please check all that apply.)

No Impact Inadequate rates Lack of timely authorizations/reauthorizations Lack of timely payment (or increase in accounts receivable) Inconsistent billing codes A lack of state policy clarity about the regulatory requirements (e.g. responsibilities for physician orders, plans of care, supervision) I do not have a CHHA and the MLTC/MCO only wants to contract with a CHHA I do not have a LHCSA and the MLTC/MCO only wants to contract with a LHCSA The MLTCs/MCOs feel they already have a sufficient number of contracts The MLTCs/MCOs plan to cancel our contract

Minimal Impact

Medium Impact

Large Impact

Largest Impact

2015 State Home Care Financial Condition Survey No Impact

Minimal

Medium

Large

Largest

Impact

Impact

Impact

Impact

Other (please specify)

19. What % of your Medicaid receipts are Fee­For­Service versus Medicaid Managed Care (MLTC/MCOs)?

Fee­for­service % is ____ Managed Care % is ____

20. What % of your Medicare receipts are Fee­For­Service versus Medicare Managed Care?

Fee­for­service % is ____ Managed Care % is ____

21. If you are contracting with an MLTC or MCO, please provide the percentage of your Medicaid revenue derived from each of the following service/contract arrangements.

(Simply enter a zero for any services that you do not provide.)

Care management services to plan enrollees account for ___% of our Medicaid revenue from plans.

Professional services (nursing, therapy) to plan enrollees account for ___% of our Medicaid revenue from plans.

Aide services to plan enrollees account for ____% of our Medicaid revenue from plans.

Assessment services account for ____% of our Medicaid revenue from plans.

Other services account for ____% of our Medicaid revenue from plans.

22. Does your agency contract with MLTCs/MCOs for telehealth services?

Yes No

2015 State Home Care Financial Condition Survey 23. If you answered "yes" to the previous question, is your payment for telehealth services adequate under managed care? (Please explain.)

24. If you are involved in a DSRIP Performing Provider System (PPS), what payment arrangement are you involved in or expect directly from the PPS? Fee­for­service Capitated payments Bundled payments/Value­Based Payments Specific project area funding Unsure Other (please specify)

25. Has your agency yet received payment directly from a DSRIP PPS? Yes No

2015 State Home Care Financial Condition Survey 26. If you answered "yes" to the previous question, how much payment has your agency received from the PPS and for what purpose(s)? (Please explain in the box below.)

27. If you are involved in a DSRIP PPS, please rate the following experiences.

Strongly Disagree

Disagree

Don't Know

Agree

Strongly Agree

N/A

Payment will adequately cover costs and makes participation in DSRIP worthwhile My organization expects increased referral activity from the PPS PPS committees understand the role of home care in meeting DSRIP goals DSRIP participation offers opportunity for growth in home care industry I don't know how my agency will participate in DSRIP

28. By what percentage do you expect your costs will increase due to recent changes (implemented on Oct. 13, 2015) in the federal "companionship exemption" requirements?

(Remember, enter only the raw number and no percentage sign.)

Percentage Increase (%)

2015 State Home Care Financial Condition Survey 29. Has your agency calculated the potential impact of the proposed minimum wage increase to $15 per hour? If yes, what were your findings and how did you arrive at this calculation?

30. Please rank from 1­10 which of the following are needed to support you in this current fiscal, regulatory and program environment for home care (1=highest importance and 10=lowest importance).

Policies that ensure adequate reimbursement

Uniform billing codes for managed care payments

Greater state clarity on the role and regulatory responsibilities for agencies

Regulatory relief

Capital and technology funding support

Staff recruitment or retraining funds

Agency/market data and cost analysis

Marketing materials and documentation showing the home care value proposition

Technical assistance through education programming on new models

Assistance in receiving timely authorization/payments

2015 State Home Care Financial Condition Survey THANK YOU Thank you for completing this important survey. If you have any additional comments, please note them in the text box below.

31. Comments

HCA State Advocacy Day Events!

HCA State Advocacy Leaders Program HCA's State Advocacy Day program for Home Care Leaders is on February 1-2, 2016 in Albany. This program includes a focused agenda of legislative visits and meetings between HCA member leaders and top state officials. During these meetings, we’ll explain the current state of home care in New York. We’ll also communicate HCA's priorities for the 2016 state budget and legislative session which begins with the Governor’s State of the State and Budget Address on January 13.

HCA’s PAC Hosts Senator Kemp Hannon Fundraising Reception on February 1 Help us kick-off our Advocacy Day events by attending a Fundraising Reception for Senator Kemp Hannon the night before our main Advocacy Day program. HCA’s PAC will be holding the reception for Senator Hannon at HCA's office located at 388 Broadway in downtown Albany, from 6 to 7:30 p.m. on Monday, February 1. Refreshments and hors d’oeuvres will be served and Senator Hannon will present his vision for 2016. A minimum donation of $100 to Senator Hannon’s campaign fund is requested. Please see the next page for registration and details for donations.

Advocacy Day Main Event on February 2 Our February 2 Advocacy Day program begins with a Board of Directors meeting, which starts first thing in the morning. After this regular board session, we’ll have a 9:30 a.m. segment open to all HCA member home care leaders, which is the time you should plan to arrive at room 711A in the Legislative Office Building (remember: you’ll have to pass through security first). For this time slot, we've invited legislators and key state officials to address the Board – an important way for you to interact with influential decision-makers and get briefed on HCA's home care priorities.

Following the 9:30 session and lunch in room 711A, the HCA Board, HCA Policy team and other HCA members will participate in legislative visits throughout the afternoon at the state Capitol and Legislative Office Building.

Planning Ahead If you are interested in participating on February 2, we invite you to schedule your own appointments now to meet with your legislative representatives in their Albany offices during the afternoon; or, you can join HCA's Policy staff and the Board on visits that we are scheduling on behalf of the Board. As you complete this registration form, please indicate whether you will be making your own appointments or if you’d like to join HCA on pre-scheduled appointments so we can communicate the logistical details for you.

To guide you, HCA is preparing several Advocacy Day resources, including a succinct guide to our legislative priorities and our 2016 financial condition report, which uses data submitted by you and your colleagues through a survey recently issued to the membership. If you have not completed this survey, please do so as soon as possible.

Please join us for this important program to bring the home care message to state officials and elected leaders.

Monday, February 1, 6:00 – 7:30pm HCA’s PAC Fundraising Reception for Senator Hannon HCA office, 388 Broadway, 4th Floor, Albany, NY 12207 Tuesday, February 2, 9:30am – 4:00pm HCA Board Meeting and Advocacy Day (See details on registration form) Legislative Office Building Meeting Room 711A

HCA State Advocacy Day EVENTS! REGISTRATION A confirmation email will be sent to you prior to the event with details on parking and building access.

Organization Name:____________________________________________________________________ ________________________________________ ___________________________________________ ____________________________________________ Participant’s Name Title Email ________________________________________ ___________________________________________ ____________________________________________ Participant’s Name Title Email

HCA’s PAC Fundraising Reception for Advocacy Day Tuesday, February 2, 2016 Senator Kemp Hannon Monday, February 1, 2016: 6:00 – 7:30pm HCA Office 388 Broadway, Fourth Floor Albany, NY 12207 Prior to our Advocacy Day, please join us on Monday evening for a fundraising reception for Senator Kemp Hannon, Chair of the Senate Standing Committee on Health. Regarded widely as an expert in health care public policy, Senator Hannon has worked to improve the quality of health care for all New Yorkers. The fundraising reception will be held at the HCA office. Refreshments and hors d’oeuvres will be provided. A

minimum $100 donation to “Citizens for Hannon” is requested.

Corporate and LLC checks are acceptable under NYS Election Law. 501 (c) (3) Organizations are prohibited from making political contributions.

HCA PAC Reception ____ Hannon Fundraising Reception @ $100 per person = $_________ (Please provide your payment information below for your donation)

Please make check payable to: Citizens for Hannon and mail to 388 Broadway, 4th Floor, Albany, NY 12207; or pay by credit card: _______ American Express

________ MasterCard

________ VISA

9:30am – 12:30pm HCA Board of Directors Meeting with Legislators LOB 711A The HCA Board of Directors will welcome several key legislative leaders to present their vision for 2016. Invited are: Senator Kemp Hannon, Chair, Senate Health Committee Assemblyman Richard Gottfried, Chair, Assembly Committee on Health Senator James Seward, Chair, Senate Insurance Committee Assemblyman Kevin Cahill, Chair, Assembly Committee on Insurance Jason Helgerson, State Medicaid Director, DOH Paul Francis, Deputy Secretary of Health and Human Services, DOH Advocacy Day handouts will be provided for your afternoon legislative appointments.

12:30pm – 1:00pm – Lunch 1:00pm – 4:00pm Legislative Appointments Please schedule your legislative appointments as soon as you have registered to attend HCA’s Advocacy Day, or indicate on the registration whether you would like to join in HCA’s scheduled legislative visits.

(3 digit code on reverse) ________________ Exp. Date ____/____/____ Card Number ________________________________________________

HCA Board Meeting and Legislative Appointments

Cardholder’s Name ___________________________________________

Please indicate your participation below:

Cardholder’s Address _________________________________________

____ I will attend the HCA Board Meeting in the morning.

___________________________________________________________ Signature ___________________________________________________

Hotel Information

____ I will participate in HCA‘s afternoon legislative appointments.

____ I will schedule my own afternoon legislative appointments.

There are several hotels in the downtown area including:

Renaissance Hotel 144 State Street, Albany, NY Phone: (518) 992-2500

Hampton Inn Downtown Albany 25 Chapel St, Albany, NY Phone: (518) 432-7000

Hilton Hotel 40 Lodge St. (Corner of State), Albany, NY Phone: (518) 462-6611

FAX completed form to (518) 426-8788