April 17, 2015 Edition of ASAP

ASAP

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

Legislative Issues  Public Policy

Legislative Session Resumes Monday for Post-Budget Policy Issues The state Senate and Assembly return this coming Monday, April 20, to resume the 2015 Legislative Session, addressing post-budget, policy and program issues.

Thousands of bills are typically introduced in a state legislative session. Among these, a smaller number will reach a point of both readiness and agreement to move through the committee and calendar process and proceed to the Senate and Assembly Floor for action by the full chamber.

HCA has been meeting and reaching out to key legislative offices and staff leaders on the details and applicability of various budget provisions, voicing our key legislative support for sponsorship of HCA-drafted bills, and to garner support for other home care priority concerns.

See RESUMES p. 4

Inside ASAP

Legislature Reconvenes Monday for Post-Budget Issues...................1 7 Reasons to ‘Catch the Wave’ at HCA’s Annual Conference..............1 Report on New LHCSA Applications Made at PHHPC Meeting.........2 DOH, HCA Engage on Implementation of Uniform Coding................5 Member Hiring Announcements........................................................5,7 DAL Posted on Home Care CoPs & Care Management.......................6 HCA to Hold Executive Order 38 Program on June 4...........................6 HCA Insurance Modernization Bill under Consideration....................8 Save The Date: May 28 Program on Navigating New Models of Care.............8 Webinar Outlines QIVAPP Issues.........................................................9 VBP Roadmap on Fast Track to Submission.......................................10 Senate Passes, President Signs SGR Bill..............................................11 CMS Updates Manuals to Reflect F2F Changes.................................12 DOH Releases 2015 LTHHCP Expenditures Caps...............................14 May, June Education Programs Provide Valuable Info.......................14 OMIG Posts 2015-16 Work Plan.........................................................16 DAL Covers Home Care-Managed Care Emergency Preparedness......18 State Releases February Medicaid Global Cap Report....................19 Capital Restructuring Financing Program RFA Re-Issued.................20 DSRIP Timeline Revised.......................................................................21 Change in Transfer of Assets Look-Back Period.................................21 NGS Updates......................................................................................22 HCS Mobile Application Available....................................................22 Publications....................................................................................................23

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News

Volume 20, No. 15 April 17, 2015

7 Reasons to ‘Catch the Wave’ at HCA’s Annual Conference Have you had a chance to look at all that’s new this year for HCA’s Annual Conference, which opens on May 7?

Please register now to secure your spot and join your colleagues in Saratoga Springs for “Catch The Wave: Are You Ready for the Turnaround?” which is the theme of this year’s conference.

In case you haven’t had a chance to look, here are 7 new offerings this year: 1. Value-based payment (VBP) is one of the hottest new topics in home care.

This is why we have added a session on VBP, along with other topical conference sessions on: population health; physician certification of home care; strategies to retain and recruit quality staff; and much, much more.

2. Our newly streamlined agenda has allowed HCA to keep costs lower than See REASONS p. 3

Helping New Yorkers Feel Right At Home

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

Volume 20, No. 15 April 17, 2015 

Report on New LHCSA Applications Made at PHHPC Meeting At this week’s Public Health and Health Planning Council (PHHPC) meeting, the state Department of Health (DOH) gave an update on applications to establish new Licensed Home Care Services Agencies (LHCSAs) over the past three years, and measures to ensure adequate surveillance of LHCSAs. This update was in response to concerns raised by Council members in recent meetings about the large number of newly approved LHCSAs and DOH’s capacity to conduct adequate LHCSA surveillance activities.

investigating complaints to ensure that urgent issues are promptly investigated. DOH is working to improve the efficiency and effectiveness of LHCSA surveillance capacity by expanding its “lean process improvement work” and exploring best practices, and alternative tools and methods for assessing agency compliance.

At this week’s meeting, the Council voted to approve: an application by a Certified Home Health Agency to expand into Livingston, Ontario and Wayne counties; thirty-two entities to establish LHCSAs, including eight outside of New York City (NYC), Long Island and Westchester; and five LHCSAs for a change of ownership, including three outside of the NYC metropolitan area.

DOH reported that 210 new LHCSAs were approved from January 2012 to January 2015, but only 134 are in operation. The total number of operating LHCSAs rose from 1,122 to 1,256 during this time period.

The background materials are at https://www.health.ny.gov/ facilities/public_health_and_health_planning_council/ meetings/2015-04-16/; a recorded webcast of the meeting is at http://www.totalwebcasting.com/view/?id=nysdoh.

In reporting on surveillance activities, DOH said that it prioritizes monitoring and

For more information, contact Andrew Koski at (518) 8100662 or akoski@hcanys.org.

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 Laura Constable, Senior Director, Membership & Operations, lconstable@hcanys.org Lynda Schoonbeek, Director of Education, lschoonbeek@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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ASAP – a publication of the Home Care Association of New York State

Volume 20, No. 15 April 17, 2015 

REASONS from p. 1 last year while actually providing you with more learning options, including our first-ever Leadership Institute. The post-conference Leadership Institute is optional, providing you with the flexibility you need: in other words, you can register for the regular conference alone, the Leadership Institute alone, or both sessions. Best yet, by joining the Leadership Institute, you’ll gain first-class training from the esteemed American College of Healthcare Executives.

3. We have 12 brand new vendors showcasing their products and services for you this year, all under one roof. You can preview the full list of over 30 vendors on our conference website (www.hcaannualconference.com) and learn more about ways your organization can benefit from technological efficiencies or the expertise of seasoned consultants ready to serve you.

4. You’ll receive Continuing Education Credits from the National Association of Long Term Care Administrator Boards (NAB). This is the first time HCA has offered these CEUs at our conference!

5. HCA will introduce to you our newest board members at the Annual Conference board meeting where you’ll learn all about new efforts at HCA to work on your behalf.

6. The new theme of our PAC fundraiser is a beach party and trivia night! Remember how much fun last year’s “Night at the Races” PAC event was? Expect nothing less at this year’s conference, while contributing to an important cause.

7. As if the PAC beach party wasn’t enough fun, we’ve also added a new “Pat’s Pub Crawl” to the social agenda for our conference. As you all know, Patrick Conole is HCA’s leading authority on home care finance and other policy issues, so why not get a tab going (with drink coupons included) as you, Pat and the rest of the HCA team unwind at some of the great establishments in Saratoga?

So what are you waiting for? Catch the Wave today before this opportunity floats out of reach.

See the brochure at http://www.hca-nys.org/documents/2015HCAAnnualConferenceBrochure-NewEvents.pdf.

Register online at https://www.eventville.com/Catalog/EventRegistration1.asp?EventId=1011491.

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RESUMES continued from p. 1 HCA-drafted initiatives HCA will be seeking legislative introduction of drafts (previously aimed for Article VII bills) to: •

Further build on the new budget language providing for payment adequacy.

•

Modernize State Insurance Law provisions for home care coverage. (See related p. 8 story.)

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Establish our proposed “Quality Innovation and Improvement through Home Care” program.

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Establish our “Home Care Clinical and Health Information Technology Act.”

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Authorize the state Department of Health to expeditiously implement (through waivers and emergency regulatory authority) the regulatory streamlining and alignment proposals of the Home and Community-Based Care Work Group.

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Amend the telehealth insurance and Medicaid coverage bill, signed earlier this year by the Governor, to address areas of inadvertent limitation and incompatibility for home care.

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Pilot a “Veterans Home Care” program.

Advanced Home Health Aide (AHHA) proposal in the post-budget session. For the third straight year, the Legislature rejected the Governor’s proposed AHHA proposal amid concerns regarding its design and effect on the Nurse Practice Act. HCA will work with colleagues on strategies for gaining consensus by the Legislature and stakeholders in a way that ensures successful implementation of AHHA by nurses, home care agencies and managed care plans.

Capital support HCA is also advocating for home care providers on capital monies. The capital provisions appear in portions over several final state budget bills; however, the applicability to home care and other sectors, apart from hospitals, is unclear in this final language. HCA has been working to clarify the provisions, but, with the Legislature and various staff on break this past week, we still await clear responses to our questions when legislative activity resumes on Monday.

Essential personnel

Wide funnel of other session bills

HCA has meetings scheduled throughout the coming week on all of our priority legislative items, including our already-introduced legislation (S.3482-A/A.5125-A) to provide “essential personnel” status for home care and hospice personnel as well as to formally integrate home care and hospice input into the local emergency planning process. In the latest update, this bill is up for consideration in the Assembly Government Operations Committee next week.

Advanced Home Health Aides

Apart from opportunities on HCA proactive initiatives and priority areas, the resumption of the legislative session also signals a ramp-up of HCA engagement and vigilance on countless bills and proposed legislative actions which may – positively or potentially adversely – affect home care. HCA will report weekly – and more frequently as necessary – on such bills, actions and related developments.

In addition, HCA intends to work with colleagues to reengage the Legislature in consideration and passage of an

For further information, please contact Al Cardillo at acardillo@hcanys.org.

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Volume 20, No. 15 April 17, 2015 

DOH, HCA Engage on Implementation of Uniform Coding HCA and state Department of Health (DOH) officials are engaged in collaborative efforts and beginning steps toward implementation of the new state budget initiative for uniform coding and claim/payment efficiency in home care-managed care.

Covered previously in ASAP and in HCA’s budget communications with the membership, the establishment and adoption of this initiative is a major progressive development for the field. It follows several years of recommendation, submission of both budget and legislative language and joint advocacy by HCA, the New York State Association of Health Care Providers (HCP) and LeadingAge New York (LANY).

This week, DOH reimbursement representatives reached out to HCA to invite specific initial input on implementation, for which HCA will also be seeking individual member input.

HCA also connected with the directors of the DOH Divisions of Health Care Financing and Long Term Care to reinforce the significance of the initiative, the strong support of the provider community and, likewise, the support communicated from HCA MLTC members. HCA looks forward to ongoing collaboration with HCP, LANY and DOH in the implementation of this major system improvement.

For further information, please contact Patrick Conole pconole@hcanys.org or Al Cardillo acardillo@hcany.org.

HIRING Jewish Home Lifecare is currently hiring for the following positions: Associate Director of Rehabilitation Services, Part-Time Weekend RNs, Fee for Service Nutritionists, Fee for Service positions in OT, PT, SLP, and LMSW for our CHHA. We are also currently recruiting for an RN Instructor and Fee for Service RNs for our LHCSA. In addition to the above mentioned positions, we are looking for a Director to oversee Quality and Performance Improvement.

The Director of Clinical Excellence for QAPI (Quality Assurance Performance Improvement) is responsible for directing the development, implementation, and evaluation of the Quality Assurance Performance Improvement program for the organization’s Certified Home Health Agency (CHHA). This involves collaboration with the administrative and clinical leadership in order to effectuate a successful and regulatory compliant program. The Director of Clinical Excellence for QAPI fosters a culture that promotes a commitment to continually improving quality of care for clients and that empowers staff to build quality improvement processes into daily work activities.

License and current registration as a Registered Professional Nurse, Bachelor’s Degree in Nursing required. Minimum three years home care experience; knowledge of home health regulations, accreditation and quality standards.

We offer competitive compensation, excellent benefits, and a positive work environment. For further consideration, please send a cover letter and resume to: Victoria Izraylevsky, Director of Human Resources at vizraylevsky@jewishhome.org.

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DAL Posted on Home Care CoP Applicability for Care Management in MLTC The state Department of Health (DOH) has posted a Dear Administrator Letter (DAL) on the applicability of the federal Conditions of Participation (CoPs) for Certified Home Health Agencies (CHHAs) and Long Term Home Health Care Programs (LTHHCPs) who provide Care Management Services for Managed Long Term Care (MLTC) plans.

The DAL, posted on the Health Commerce System, was issued in response to numerous questions by HCA, others and the Home and CommunityBased Care Work Group, which began work after last year’s budget to examine regulatory realignment issues in the context of home care services under MLTC. A direct link to the DAL is at http://www.hca-nys.org/ documents/DALcmasMLTCs041415.pdf.

According to the DAL, the CoPs would not apply if the LTHHCP or CHHA is providing only Care Management Services for an MLTC enrollee through a Care Management Services Agreement with the MLTC and if the agency can demonstrate that it operates a “separate entity” or separate line of business for the provision of these Care Management Services.

In order for the Care Management Services to be considered a separate line of business, the following parameters must apply: •

The entity is not conducting a patient home visit for provision of Care Management Services. If the service requires the provider to cross the threshold of the patient’s home, then the CoPs will apply;

•

The entity is not providing any other home health service(s) to the MLTC enrollee; and

•

The entity must comply with all guidelines from the U.S. Centers for Medicare and Medicaid Services (CMS) for operating a “separate entity” found in Section 2183 of the State Operations Manual (SOM) at http://www.cms.gov/Regulations-andGuidance/Guidance/Manuals/downloads/som107c02.pdf.

In order to demonstrate that the organization operates a “separate entity,” the organization must differentiate the Care Management Services offered by the CHHA/LTHHCP from other services offered by the larger organization. It must be clear to staff and consumers that the “separate entity” is separate and distinct from the larger organization. The organization must demonstrate that it operates a “separate entity” in the operation of the agency, and through consumer and staff awareness. In addition to the requirements specified in the contractual arrangement 6

HCA to Hold Executive Order 38 Program on June 4 HCA will hold a members-only webinar on June 4, 2015 from 11 a.m. to noon on Executive Order 38.

As reported to members in numerous communications, Executive Order 38 establishes limits on executive compensation and administration costs for home care and other health care providers and entities that receive state funds directly or indirectly.

HCA’s Counsel, Frank Fanshawe, Attorney At Law at Wilson Elser Moskowitz Edelman & Dicker LLP, will provide a free-of-charge update, including an overview of the requirements, as well as information about the disclosure form that agencies must complete (by June 30) if they don’t file a cost report, and any new legal developments.

The registration form is at the end of this week’s ASAP.

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between the provider and the MLTC plan, the following guidelines apply to provider Care Management Services through the “separate entity”: •

There must be separate policies and procedures specific to the provision of Care Management Services that would describe, at a minimum, the process by which the services would be conducted; the responsible personnel; the supervisory structure; and the separate line of business distinctions.

•

Professional Scope of Practice is not waived. Plans and providers must ensure the care management tasks are provided as appropriate to the professional discipline’s scope of practice. For example, those tasks involving assessing needs, identifying needs, or developing a plan of care must be performed by an RN and may not be performed by administrative personnel.

Questions about this DAL should be sent to homecare@health.ny.gov (please copy HCA at info@hcanys.org).

HCA will also be seeking clarification on some of the DAL provisions.

HCA continues to work with allied associations and DOH to obtain clarity on the regulatory requirements that apply to home care agencies in their managed care business, including, but not limited to, the applicability of home health CoPs. These issues remain under consideration after being raised in the Home and CommunityBased Care Work Group, which the Department convened to examine regulatory realignment. HCA sought legislation during the recent budget negotiations that would compel DOH to move forward with the Work Group’s matrix of regulatory realignment recommendations.

While this DAL does address CoP/regulatory alignment issues in very specific instances, with very specific conditions, more work needs to be done to achieve comprehensive guidance from the Department on regulatory issues governing providers and plans in their mutual work. HCA will continue to direct our post-budget advocacy on this important aim.

HIRING Jefferson County Public Health Service Director of Patient Services is responsible for the administrative, professional and financial operations of the home health programs. Minimum qualifications include licensure as a registered nurse with two years of experience as a Supervising Public Health Nurse; or two years of home care nursing experience plus a master’s degree in nursing, public health, business administration or another health related field. Master’s degree preferred.

Supervising Public Health Nurse is responsible for supervising a nursing team to ensure comprehensive home care services are provided to achieve positive patient outcomes. Minimum qualifications include BS degree in nursing, two years of experience as a public health nurse and licensed to practice as an RN in NYS. Physical Therapist is responsible for evaluating, planning and providing physical therapy treatment to patients in accordance with physician orders. Minimum qualifications include licensure and currently registration by the New York State Education Department as a Physical Therapist.

Applications Accepted At: Jefferson County Department of Human Resources, 175 Arsenal Street, Watertown, NY 13601, (315)-785-3147. EOE. http://www.co.jefferson.ny.us

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

HCA ‘Insurance Modernization Bill’ under Consideration HCA’s “Home Care Insurance Modernization Bill” is currently being reviewed for legislative introduction upon resumption of the Legislative Session next week.

This week HCA met with representatives of the Senate Insurance Committee on post-budget introduction of the bill. The discussion, building on our initial presentation of the bill-draft during budget negotiations, continued to be very positively received as to the need, merit and significance of the HCA proposal in enabling private and commercial coverage provisions for home care to work within the current and evolving health care system.

HCA described the current, antiquated provisions of the State Insurance Law as it pertains to home care coverage – provisions enacted in 1972 and never materially updated since that time to fit the major system changes that have ensued.

HCA highlighted not only the delivery system and coverage changes which have occurred since 1972, but also current major trends that have so dramatically increased and changed home care’s role and significance in the system. These include the focus on avoidable hospital readmissions, emergency room and other complex care use; implementation of integrated care and coverage models (like FIDA, DSRIP, ACOs, health homes and others); the state-federal transition to Value Based Payment; medical management through home care/physician partnerships, and others.

The HCA bill would replace the present law’s outdated and artificial limitations on the scope, breadth and circumstances for home care coverage with contemporary and dynamic provisions that allow coverage to be approved in the way that home care is currently indicated and used in the system. This would include provisions that account for effective transitions in care, for more appropriate and cost-effective in-home services that would otherwise have to be provided outside the home (and covered under the policy), and for medical management of complex/high-risk conditions, such as congestive heart failure, wound care, and others.

The bill would substantially synchronize private and commercial coverage to the way the current and evolving system works, and, overall, would support the operation of the entire system – from hospitals to physicians to other community care services. The consumer would be the ultimate beneficiary.

Taxpayers, too, would benefit as the change in coverage would fill some of the gaps in the current system which create arbitrary cliffs in coverage, too often forcing individuals to fall into Medicaid, or existing recipients to use Medicaid because their home care coverage will not work.

HCA has further meetings scheduled on this initiative in the coming week.

For further information, please contact Al Cardillo at acardillo@hcanys.org.

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Save The Date: May 28 Program on Navigating New Models of Care On May 28, HCA will hold a daylong program in Albany entitled Are You Ready to Navigate New Models of Care and Coverage?

This program is geared for home health provider and health plan CEOs, CFOs, COOs and those who need to gain a better understanding of emerging care models to position your organization successfully in a service and payment delivery environment of new models of care.

With the enactment of farreaching health care reforms at the federal and state levels, changes to the health care delivery and payment systems are evolving quickly. It is important for home care providers to get up to speed on all of these fastmoving developments.

Speakers at this program will include top state health care program officials, expert consultants and more.

Look for a registration form and brochure next week.

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

Volume 20, No. 15 April 17, 2015 

Webinar Outlines QIVAPP Issues On April 15, the state Department of Health (DOH) held a webinar to address many issues raised by HCA and others on the Quality Incentive Vital Access Provider Pool (QIVAPP) monies that are available to certain home care providers who provide aide services in New York City.

The webinar materials are at http://www.health.ny.gov/health_care/medicaid/redesign/docs/ ohip_qivapp_ppt-final_04142015.pdf.

DOH said it plans to post a Questions and Answers document based on the topics brought to its attention prior to and at this week’s webinar.

During the webinar, DOH reviewed the requirements for QIVAPP that are outlined in the April 23, 2014 Dear Administrator Letter at http://www.health.ny.gov/health_care/medicaid/redesign/docs/2014-0423_dal_qual_incent_vap_pool.pdf.

In order for a Managed Long Term Care (MLTC) plan to receive QIVAPP funds, it must: be in compliance with the state wage parity law; complete and send to DOH a revised QIVAPP Reconciliation spreadsheet (that was distributed March 26); and submit a QIVAPP Reconciliation Attestation to DOH. Both documents are due by May 1.

DOH provided the following information in response to questions asked by HCA prior to and during the program as well as questions posed by other organizations: •

Qualified Incentive Pool Providers (QIPPs) must participate in a health benefit fund for their home health care and/or personal care aides and/or provide comprehensive health insurance coverage to their employees. To meet this requirement, agencies should review the sample health benefits at http:/ / w w w. h e a l t h . n y. g o v / h e a l t h _ c a r e / m e d i c a i d / r e d e s i g n / d o c s / 2 0 1 4 - 0 6 - 1 3 _benefits_overview_qivapp_application_attach2.pdf. HCA seeks further guidance on whether the benefits must exactly match those in this document.

•

If a home care provider offers its aides comprehensive health coverage, as outlined above, but some aides don’t take the coverage, the provider can still be considered to meet the comprehensive health insurance coverage requirement. HCA has sought clarification.

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The requirement that a QIPP have a written and implemented quality assurance program also includes an internal review of policies and patient records, a complaint resolution process, and a written summary of review findings.

•

Distribution of initial state-share QIVAPP monies was based on information sent to DOH by the MLTC plans last August. DOH did not directly address why some providers who submitted the required information to MLTC plans in August were not part of the initial QIVAPP awardees except to emphasize that determinations were based on what information DOH received from plans.

•

Home care providers should work with their contracted MLTC plans to ensure that the plans receive the most recently requested data on aide services (actual hours of aide services from April 1, 2014 to

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aide training program and participation in a health benefit fund).

February 28, 2015 and estimated hours for March 1 to March 31, 2015) and submit that data to DOH by May 1.

•

•

•

•

MLTC plans have until mid-April to distribute the initial QIVAPP monies to their eligible home care providers; if providers don’t receive these funds, they should first contact the plan before seeking DOH’s assistance.

VBP Roadmap, with ‘Final Edits,’ on Fast Track to Submission

All supporting documentation for the MLTC plan’s attestation is subject to validation by DOH.

The Value Based Payment (VBP) draft Roadmap is receiving final edits today through the weekend and is scheduled for submission to the federal government for its approval of the document as soon as early next week.

If the reconciliation completed as part of the federal QIVAPP distribution results in some plans owing money for one of their home care contractors, DOH will recoup that money from the plan. Additional information on the recoupment process will be forthcoming.

The state Department of Health, in cooperation consultants from KPMG, invited any final edits from HCA and other VBP workgroup members in the form of proposed “redline” changes to the draft. The draft, already in its fourth iteration, has been consistently evolving with the workgroup’s input. The successive iterations have increased flexibility; added softer edges for timelines, targets and requirements; and included wider opportunities for VBP models and qualification.

DOH reiterated that the requirement to participate in a specialty training program for home health aides (HHAs) and personal care aides (PCAs) is met if the home care provider’s training program exceeds the standard 75 hours of training for HHAs or 40 hours of training for PCAs and/or exceeds the hours of DOH annually required in-service training of 12 hours for HHAs and 6 hours for PCAs.

•

DOH does not know how long it will take to receive federal approval for the next round of QIVAPP ($35 million) nor if there will be any additional state QIVAPP monies.

•

MLTC plans – not their contracted providers – are expected to sign the QIVAPP attestation forms that they must submit to DOH by May 1.

They should work with their providers to verify that all program requirements are met.

•

Questions about QIVAPP should be sent to hcworkerparity@health.ny.gov. (Please copy Andrew Koski at akoski@hcanys.org on any correspondence about these issues).

As an active member of the workgroup, HCA has been offering input throughout the process and this week again joined colleagues in requesting further revisions to the Roadmap, building on the prior changes and areas of improvement to date.

These latest, proposed revisions by HCA included:

QIVAPP is not directed only to home care providers with a unionized workforce (despite some of the requirements that relate to a letter of support from a labor organization for a provider’s 10

•

Tailored flexibility for plans and providers to establish and grow VBP models consistent with their actual capacity and speed-potential for such development.

•

Inclusion of home care and home care’s potential role in VBP arrangements where such may have been omitted or left ambiguous within the draft. This includes

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clarifying and ensuring the option for VBP participation of providers outside of existing Performing Provider System (PPS) networks, either as partners to managed care plans or partners to PPS bundles or other multi-provider partner arrangements.

•

Adequate network formation and participation of community providers, including avoidance of duplication or marginalization of community providers by a PPS where existing providers already possess the capacity and expertise to address the needs of the PPS and VBP goals.

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Assurance that providers contributing to savings will receive their equitable share of such savings.

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Distinct state and VBP fiscal support for home care provider readiness and capacity to participate in VBP. This specifically included a request for readiness-support for health information technology necessary for clinical and operational integration, as well as for vital data for provider/plan VBP computations and outcome measurements.

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VBP funding adequacy for essential costs, including assurance that VBPs are adequately financed for infrastructure and “public goods,” coverage of “mandated” costs and expenses of state and federal regulation, and reimbursement for staffing and staff compensation requirements.

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Suggestion of additional clinical areas and pathways for VBP bundle possibilities – e.g., including wound care, joint replacement, falls prevention, septicemia, and other clinical interventions, in addition to categories already listed in the draft.

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Regulatory alignment and streamlining for provider/health plan partnership. This included the request for state mitigation of mandates and related changes in policy to reduce high input costs to providers and plans.

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Updates to the Roadmap as needed during implementation to address issues, problems, workability and improvement needs as they arise.

The Department will next be moving into a more detailed subcommittee process (tentatively in June/July) and inviting further participation in the process.

Meanwhile, HCA will feature in-depth presentations on VBP from KPMG project leaders at the HCA Annual Conference during a special May 8 session. Please see the brochure at the back of this week’s ASAP for details.

For further information, please contact Al Cardillo at acardillo@hcanys.org.

Senate Passes, President Signs SGR Bill with Rural Add-on, Market Basket Cap The U.S. Senate has passed, and the President has signed, a House physician payment reform bill that includes an extension of the home care rural payment add-on through 2017 (at 3 percent) as well as a cap on the 2018 market-basket update (at 1 percent) for home health and other post-acute care providers.

Also of concern to home care providers, the bill contains a modification of the home health surety bond requirements, setting the bond minimum at $50,000 and allowing Medicare to scale the bond value up

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commensurate with the volume of Medicare revenue in the home health agency. HCA will be monitoring closely how this provision is implemented by the U.S. Centers for Medicare and Medicaid Services (CMS).

The bill’s main objective is to overhaul the Sustainable Growth Rate (SGR) formula for physicians who would otherwise have gotten a 21-percent Medicare payment cut absent Congressional action.

As previously reported to the membership (most recently in the March 27 edition of our ASAP newsletter), Congress has enacted several short-term legislative fixes to the SGR in the past several years, repeatedly dodging the onset of major physician payment cuts. Distinct from these short-term fixes, this latest bill repeals the SGR entirely.

Throughout negotiations over the SGR-repealer, HCA pressed Congressional offices for supportive home care policies including: mitigation of the home health face-to-face (F2F) rule; an extension of the soon-to-expire Medicare rural add-on; resistance to cuts that would otherwise add to the financial blow of Medicare rebasing; and opposition to home health beneficiary copayments.

Of major concern was the fact that reductions (or new costs like a copayment) to home care and other sectors would be needed to pay for the high-price tag of physician payment reform. HCA repeatedly emphasized to Congress the severe financial distress already occurring in home care in an effort to block further cuts or new costs.

Copayments were very much on the table at the early stages of negotiations and, although rejected from the final SGR bill, they remain an ongoing threat. While copayments were rejected, the bill does otherwise seek to offset the physician payments, in part through imposing a cap on the market-basket update for 2018 (at 1 percent).

HCA will continue to stress to Congress that the home care sector has been especially impacted by prior reductions in payment or reimbursement, through rebasing and other actions, as we urge the restoration of the marketbasket update. We note, however, that the market-basket cap affects multiple sectors – and thus has a significant budgeting score – which complicates negotiations to change this provision.

Meanwhile, F2F relief remains a top aim of our federal advocacy. The SGR-repealer bill was just one opportunity for a statutory F2F fix, and HCA continues to explore other avenues in our outreach with the Congressional Delegation who have written CMS urging F2F relief and are well engaged with HCA on pursuing a solution.

CMS Transmittals Update the Medicare Manuals to Reflect F2F Changes Members will gain F2F updates from CMS contractor, NGS, at HCA Annual Conference: register today!

The U.S. Centers for Medicare and Medicaid Services (CMS) recently issued two transmittals that provide updates to various sections of the Medicare home health manual to reflect policy changes in the 2015 final rule as it relates to the face-to-face (F2F) requirements for physician certification and recertification of patient eligibility for Medicare home health services.

Transmittal 91 (https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/ R91GI.pdf ) codifies the 2015 final rule regulatory amendments into CMS’s Publication 100-01 Medicare General Information, Eligibility and Entitlement Manual.

It references the following three changes for episodes beginning on or after January 1, 2015: •

As HCA has previously reported, CMS has eliminated the narrative requirement. However, the certifying physician is still required to certify that a F2F patient encounter occurred and document the date of the 12

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encounter as part of the certification of eligibility. For medical review purposes, CMS requires documentation in the certifying physician’s medical records and/or the acute/post-acute care facility’s medical records (if the patient was directly admitted to home health) to be used as the basis for certification of patient eligibility; •

If a home health claim is denied, the corresponding physician claim for certifying/re-certifying patient eligibility for Medicare-covered home health services is considered non-covered as well because there is no longer a corresponding claim for Medicare-covered home health services; and

•

CMS clarified that a F2F encounter is required for certifications, rather than initial episodes; and that a certification (versus a re-certification) is generally considered to coincide with any new start of care assessment initiating care.

CMS also indicates in the transmittal that, as a matter of medical review, the physician’s record should support the certification.

Transmittal 207 (https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/ R207BP.pdf ) provides a detailed update to many of CMS’s provisions within Publication Manual 100-02 Medicare Benefit Policy, which specifies the coverage standards for the home health benefit. Included within the update are revisions of the F2F and physician certification requirements. While much of the revision is directly consistent with the language in the 2015 final rule changes, please note the following: •

CMS’s policy in the transmittal states that home health agencies should make an effort to obtain the signed physician certification prior to the end of an episode. Longstanding policy simply required signed certifications prior to billing. While that remains the standard, the policy change adds the requirement that a home health agency cannot wait until the end of the episode to try to obtain the signed certification.

•

More detail is offered on the requirement that the physician record is the basis for determining whether coverage criteria are met. This change presents some inconsistencies in that it would not be logical to limit coverage determinations to a physician record for the entire episode while also requiring early physician certifications given that a patient’s status in relation to coverage requirements can change following the physician certification at the end of an episode.

Neither transmittal provides any greater clarity from a medical review perspective as to what the Medicare Administrative Contractor (MAC) would find acceptable – or not – when conducting a review of the F2F certification. HCA is working to obtain clearer guidance on all of these issues while we advocate for a simpler approach to F2F certification.

For further education on F2F, individuals attending HCA’s Annual Conference will be able to hear first-hand from New York’s MAC about the new F2F requirements and gain answers on these issues. Shelly Bernardini, RN – who is the Medicare Home Health Clinical Consultant at New York’s MAC, National Government Services (NGS) – will be providing insights on the latest certification and patient eligibility requirements. To register for the conference and learn more about the overall agenda, please see the brochure at the back of this week’s ASAP. Online registration is available on the conference website at www.hcaannualconference.com.

For further information, contact the HCA Policy staff.

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Volume 20, No. 15 April 17, 2015 

DOH Releases 2015 LTHHCP Expenditures Caps The state Department of Health (DOH) this week released the 2015 Long Term Home Health Care Program (LTHHCP) participant maximum allowable expenditure caps.

A notice announcing the caps is at: http://www.health.ny.gov/health_care/medicaid/publications/gis/ 15ma006.htm.

DOH has also posted the actual 2015 statewide LTHHCP expenditures caps, which are effective immediately at: http://www.health.ny.gov/health_care/medicaid/publications/docs/gis/15ma006att.pdf. Expenditure caps are based on the January 1, 1992 average Medicaid reimbursement rates for nursing facilities in a county trended forward to the current year. The Medicaid trend factor remains eliminated in 2015, meaning that the participant expenditure caps are unchanged from the maximum allowed in 2014.

Additional language has been added to the expenditure cap table headings to reflect the use of the Uniform Assessment System-New York (UAS-NY) assessment instrument when determining nursing facility level of care (LOC), in place of the Long Term Care Placement Form Medical Assessment Abstract (DMS-1). An LOC score of 15 or more on the UAS-NY is equivalent to a DMS-1 score of 180 or more and an LOC score of 5 to 14 on the UAS-NY is equivalent to a DMS-1 score of 60 to 179.

For specific questions regarding these expenditure caps, providers can contact DOH’s Russ Smith at (518) 473-4421. For general questions regarding the LTHHCP, providers can contact DOH’s Vicki Rockefeller at (518) 474-5271.

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

Upcoming Education Programs Provides Valuable Information, Strategies Robust, just-in-time education programs are a priority for HCA – to provide members with the information, strategies, and opportunities they need to remain an integral part of the continuum of health care.

Each week, HCA updates its education webpage with the latest webinars, in-person programs, signature events and members-only briefings. HCA also offers a substantial registration discount to our members, and all staff within your organization are welcome to take advantage of this discount.

Early registration for programs guarantees a slot and handout materials. Below are some valuable programs scheduled for May and June.

May 6 and 7 – HCA’s Annual Conference – Saratoga Springs This signature event includes a wide variety of learning programs for staff at every role in your organization, networking opportunities with peers, and one-stop shopping with more than 30 vendors. There is still time to register. Learn more at www.hcaannualconference.com.

May 8 – HCA’s Leadership Institute – Saratoga Springs At the request of members, HCA is pleased to bring the American College of Healthcare Executives (ACHE) program “The Courage to Lead: Critical Skills for Healthcare Leaders” to our area. This half-day workshop 14

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piggybacks the Annual Conference, so you can attend both events, or just this one. This workshop is for seasoned leaders as well as those who are new to management. Participants will earn ACHE face-to-face education credits as well as contact hours from the National Association of Boards of Examiners of Long Term Care Administrators (NAB/NCERS).

May 13 – Home Care Survival Bootcamp Part 4 – New York This half-day workshop will focus on establishing effective compliance manuals and understanding the state Department of Health survey process. Both components of the program will include a review of key focus areas and how to address them.

May 14 – The Aide’s Role in Recognizing When to Call for Help – Webinar (3 to 4 p.m.)

Invite your aides to learn how they can best respond or call for help when encountering various patient scenarios.

June 4 – Executive Order 38 Update – Webinar (11 a.m. to noon) This complimentary, members-only program, presented by HCA’s Counsel Frank Fanshawe of WEMED, will provide an update on Executive Order 38, including the requirements, the disclosure form and new legal developments related to this mandate, which sets limits on executive compensation and administrative expenditures by organizations receiving state funds.

June 23-24 – Blueprint for OASIS Accuracy – Albany This two-day workshop on Data Collection Rules and Guidance will teach participants how to audit and collect OASIS-C1 items accurately through expert instruction, problem-solving discussions and application scenarios.

An early-bird discount is available until June 2 for HCA members. In addition, participants will have the opportunity to take the optional Certificate for OASIS Specialist-Clinical (COS-C) at the same location, on June 25.

Other Programs Coming Soon!

Be sure to save the date for the following programs that will be available for registration shortly: •

May 28 – Navigating New Models of Care and Coverage – Albany: This full-day program will provide updates for navigating new models of care, including managed long term care, Fully Integrated Duals Advantage (FIDA) and the Delivery System Reform Incentive Payment (DSRIP) program as well as information on Value Based Payment models and the opportunity to learn what you need to do within your organization to prepare for these new standards.

•

June 16 – HCA’s Technology Symposium – Albany: One of HCA’s most popular signature events, the Technology Symposium affords agencies the opportunity to learn more about the federal and state directions in supporting technology, including electronic health records, new models of care, and payment methodologies. The program will offer a showcase of providers sharing their use of technological tools for enhanced patient care and streamlined operations along with a vendor fair.

Information on all of these programs is available at www.hcanys.org/events.cfm. Take advantage of these opportunities to learn, explore resources and find new opportunities.

For further information, contact Lynda Schoonbeek at (518) 810-0656 or Lschoonbeek@hcanys.org.

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OMIG Posts 2015-16 Work Plan The state Office of the Medicaid Inspector General (OMIG) has posted its 2015-16 Work Plan. HCA members are advised to review it closely to ensure that their compliance activities are aligned with OMIG priorities.

The Work Plan is at http://www.omig.ny.gov/images/stories/work_plan/2015-16_work_plan.pdf.

Some key areas are summarized below.

Delivery System Reform Incentive Payment Program •

Conduct reviews of attestations submitted

by Performing Provider Systems (PPSs) about their network providers.

•

Provide guidance on compliance risk areas associated with organizational structure and functions of PPSs.

•

Conduct compliance program reviews of PPS Leads to assess their success in meeting these mandatory compliance obligations.

in an institutional setting where the billed services are covered by the facility rate.

•

Examine overlapping payments for consumers who are dually eligible for Medicare and Medicaid and are receiving home health services. OMIG will determine if Medicaid, as the payor of last resort, paid an excessive amount for home health aide services.

•

Identify and notify those providers whose Medicaid reimbursements from fee-forservice (FFS) or managed care exceeds $15 million and, thus, are required to utilize a verification organization (VO). OMIG will work with the VOs to standardize data sets and develop reports.

•

Review Long Term Home Health Care Program (LTHHCP) and Certified Home Health Agency (CHHA) cost reports to verify per-visit and hourly rates calculated for the various ancillary services provided, with an emphasis on both high Medicaid utilization and rate capitations. OMIG will also review rate add-ons, including funds dedicated to worker recruitment, training, and retention.

•

Work with OMIG’s contractor, the University of Massachusetts Medical School, to pursue reimbursement for dual eligible recipients who have received home health services paid for by Medicaid that should have been paid for by Medicare.

Home Health and Personal Care •

Analyze claims to determine: if services that require supervision were provided; that staff rendering services were properly qualified, licensed and trained; and that other personnel requirements were met.

•

Analyze claims to determine if an approved patient care plan exists, plan services were deemed necessary, services were rendered consistent with the patient care plan, and hours billed were authorized by the care plan.

•

Determine if the home care provider processes the spend-down requirements correctly in cases where the respective county assigns responsibility for monitoring the spend-down to the provider.

•

Identify home health and personal care providers who bill while the consumer is not at home but instead is in a hospital or resides

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Continued from p. 16 Managed Care •

Review FFS payments made for managed care consumers to determine if the services were already included in the managed care benefit package.

•

Examine claims for managed care consumers who had a date of service after their date of death, or during a period of incarceration or institutionalization.

•

Review various aspects of the managed care cost reports to identify whether unallowed costs are included in the report.

•

Determine whether managed care organizations are returning monthly capitation payments based on retroactive disenrollment of consumers by local districts and the New York State of Health (the health insurance exchange). In addition, OMIG continues to track consumers who are retroactively disenrolled from managed care.

Developmental Disabilities Services •

Review day habilitation providers to determine whether services were provided in accordance with Medicaid requirements.

•

Review Medicaid Service Coordination services to determine whether services were provided in accordance with Medicaid requirements.

•

Review individual residential alternative habilitation services to determine whether developmental disability services were provided in accordance with Medicaid requirements.

Assisted Living Program •

Conduct reviews focused on the documentation of care given to Assisted Living Program (ALP) residents. These reviews will focus on timely medical evaluations, interim assessments, plans of care, functional assessments, and the presence of relevant evidence of service provision.

•

Identify goods and services delivered to ALP residents by other providers and billed to the Medicaid program that were also included in the ALP payment rates.

•

Provide oversight of ALP rate reviews that are conducted by County Demonstration program participants.

Managed Long Term Care •

•

Review the enrollment records to see if Managed Long Term Care plans properly determined eligibility for enrollment and provided proper care management to selected members.

Continue to independently investigate social adult day care centers (SADCs). When possible, OMIG will seek to jointly investigate SADCs with the Medicaid Fraud Control Unit and the New York City Buildings Department. OMIG will also coordinate with the state’s Department of Health and Office for the Aging to improve system controls over SADC.

Other Areas •

Conduct compliance reviews of providers who do not meet annual certification requirements and those who have repeated issues with OMIG or other regulating agency requirements.

•

Work with the U.S. Centers for Medicare and Medicaid Services and IPRO, the

Early Intervention •

Review early intervention providers who received reimbursement from Medicaid.

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Medicaid Integrity Contractor, to identify areas to review and coordinate audit reports.

•

Conduct prepayment review activities by assessing claims submitted by providers. Areas of activity include CHHAs and home health agencies’ transportation billing, durable medical equipment claims submitted with no diagnostic code, misuse of National Provider Identifiers as a prescribing, referring, or servicing provider, pharmacy and private-duty nurses.

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

DAL Covers Home Care-Managed Care Emergency Preparedness Responsibilities The state Department of Health (DOH) issued an April 14 Dear Administrator Letter (DAL), reference number DHCBS 15-06, on the subject of Responsibilities of Home Care Providers related to Emergency Preparedness for Managed Care Plan enrollees.

HCA has urged DOH for the past several years to work with the provider and health plan communities to clarify and delineate respective plan/provider roles and responsibilities in emergency preparedness, response and recovery under managed care. Moreover, over the past couple of months, HCA and the Home Based Care Alliance (HBCA) have been in contact with multiple divisions across DOH to join in an HBCA-sponsored roundtable on emergency preparedness under home care-managed care, along with representatives of the HBCA Executive Committee (comprised of agencies and emergency management representatives), the State Health Plan Association and individual health plans. A date and further logistics for the roundtable are in process.

HCA views this DAL (developed by the Department) to be a step in this process, with further state discussion and delineation necessary.

The DAL, which can be viewed at http://www.hca-nys.org/documents/DALEmergencyPreparedness041415.pdf, stipulates its purpose in providing “guidance and clarification to home care providers regarding their role and responsibilities during an emergency event as it relates to Managed Long Term Care (MLTC) patients and plans.”’

The DAL reiterates that home care providers are required to have a current emergency plan that includes procedures to be followed to assure the health care needs of patients are met in emergencies that interfere with delivery of services [10 NYCRR 766. 9(c) & 10 NYCRR 763.11 (a)(10)].

It advises home care providers to share the May 10, 2005 emergency preparedness DAL (http://www.hcanys.org/documents/DALEmergencyPreparedness051005.pdf ) with their contracted plans so the plan is aware of applicable DOH requirements.

The DAL further indicates that home care providers may be required to provide MLTCs with daily updates based on their contractual agreement with the plan, citing regulations at 10 NYCRR Part 766 (LHCSA) and Part 763 (Certified Home Health Agencies & Long Term Home Health Care Programs) which require agencies to have an “effective communication system through the Health Commerce System (HCS) for purposes of emergency communication with the Department and to ensure a rapid response for information as requested by the Department.”

The DAL stresses that home care providers and entities they contract with for the provision of home health services “understand what their individual provider responsibilities are related to patient care, case management 18

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and reporting to those entities during an emergency event,” providing further that “the contract clearly delineate those responsibilities and roles.”

Again, HCA believes this issue and required delineation and guidance needs to be further honed and that further, direct work to assist providers and plans in joint planning and understanding of respective roles is necessary.

HCA will be following up with DOH on this DAL and on next steps, including additional information and assistance to providers.

For further information, please contact Al Cardillo at acardillo@hcanys.org. Questions on the DAL itself are requested to be directed to homecare@health.ny.gov.

State Releases February Medicaid Global Cap Report Home care and personal care spending above projections The state Department of Health (DOH) has issued its February 2015 Medicaid Global Spending Cap report, following just days after the January report was released. HCA wrote about the January report in last week’s edition of ASAP. The February report shows overall spending to be $9 million less than projected for the current fiscal year through February. (The current state fiscal year began on April 1, 2014 and ended March 31, 2015.)

The actual spending amount for this eleven-month period was $15.434 billion versus an estimated spending amount of $15.443 billion. The cap for the entire 2014-2015 fiscal year (FY) is $17 billion.

DOH’s report is at: http://www.health.ny.gov/health_care/medicaid/regulations/global_cap/monthly/ sfy_2014-2015/docs/february_2015_report.pdf.

For reporting purposes, home care and personal care services are lumped into the category labelled “Other Long Term Care.” According to the report, that category was $27 million above projections for the elevenmonth period ending February 28 – a difference between projected spending of $611 million and actual spending of $638 million.

The report does not reveal which component of “Other Long Term Care” is over-target; however, it indicates that the higher spending is due to a slower than anticipated shift to the Managed Long Term Care program.

Medicaid Managed Care was $59 million over the projection of $11.309 billion for this period, according to the report. More specifically: •

Mainstream Managed Care was $113 million above projections, due to higher than expected paid claims through February.

•

Managed Long Term Care was $54 million below projections through February. Total enrollment in the program is approximately 7.4 percent below expected levels (by a difference of 10,649 recipients).

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Continued from p. 19 Medicaid enrollment reached 6,177,709 at the end of February 2015, an increase of 473,272 enrollees (or 8.3 percent) since March 2014.

DOH’s report also provides other data on accounts receivable, Medicaid rate adjustments, enrollment in the state’s health care exchange, and various state Medicaid savings initiatives.

As noted in last week’s ASAP article on the January report, HCA has expressed concerns to DOH about the impact of retroactive payments on the global cap. The state’s calculation of spending relative to the global cap is cash-based, meaning that any retroactive payments made to providers for services in one year could actually be measured against the cap in a later year, leaving the system vulnerable to spending overruns if the cap forecast doesn’t account for the payment delay.

HCA has discussed this issue with the Department and will be carefully assessing the reconciliation of funds relative to the cap.

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

Capital Restructuring Financing Program RFA Re-Issued The state Department of Health has reissued a request for applications (RFA) for the Capital Restructuring Financing Program (CRFP) due to a provision of the final state budget that requires CRFP funds to be awarded regionally in proportion to the applications received from this RFA. The RFA is at http://www.health.ny.gov/funding/rfa/1504100252/index.htm.

Applications are due May 6.

According to DOH, there have been no changes to the application form or attachments. Therefore applicants may submit the same application submitted under the previous RFA (#14-10100351) to be considered in response to this RFA. New applications (i.e., not submitted in response to the previous RFA or applications which the applicant wishes to modify from that previously submitted) may also be submitted in response to this RFA. CRFP grants will be awarded to capital projects that further the objectives of the Delivery System Reform Incentive Payment (DSRIP) program. These include: •

Improve population health.

•

Support transformational change to the health care delivery system.

•

Reduce costs of health care services.

•

Increase access to appropriate and high quality health care for all New Yorkers.

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Continued from p. 20 •

Reduce avoidable hospital use and improve other health and public health measures at both the system and the state level.

•

Ensure that delivery system transformation continues beyond the waiver period through leveraging managed care payment reform.

•

Preserve essential safety net providers across the state.

Individual CRFP applications from organizations participating in DSRIP must be submitted by the Performing Provider System (PPS) lead entity, while applications will also be accepted from organizations not participating in DSRIP. Questions about CRFP and the RFA should be directed to CRFP@health.ny.gov.

DSRIP Timeline Revised The Delivery System Reform Incentive Payment (DSRIP) Year 1 Timeline has been revised to reflect updated deliverables and due dates and is now available at http://www.health.ny.gov/health_care/medicaid/redesign/ dsrip/timelines/index.htm. Activities and deadlines have been added for the latter part of this year and the first 7 months of 2016.

Any questions related to the Timeline may be directed to DSRIP@health.ny.gov.

Change in Transfer of Assets Look-Back Period The state Department of Health (DOH) has posted guidance about a change in the start date of the transfer of assets look-back period for individuals seeking Medicaid coverage of nursing facility services in the threemonth retroactive eligibility period.

The guidance, along with a look-back period chart, is at http://www.health.ny.gov/health_care/medicaid/ publications/pub2015gis.htm (see GIS 15 MA/007) Individuals seeking Medicaid coverage of long-term nursing home care, or when rehabilitation services in a nursing home exceed 29 days, are subject to a review of assets for the 60-month transfer-of-assets look-back period. The look-back period is the 60 months immediately prior to the date an individual is both institutionalized and has applied for Medicaid (the application date).

In cases where an applicant is requesting coverage of nursing home care in the three-month retroactive eligibility period, the look-back period is 60 months immediately preceding the month of application. It had been the Department’s policy to apply the look-back period 60 months prior to the first month Medicaid coverage was sought, including months in the retroactive eligibility period.

Effective immediately, districts are to limit their review of assets to the 60-month period preceding the month of institutionalization and application for Medicaid.

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NGS Updates National Government Services (NGS), New York’s Medicare Administrative Contractor (MAC), has recently posted the following information to its website.

•

Provider Statistical and Reimbursement (PS&R) Report: IACS Registration Has Been Enabled – Beginning April 15, 2015, CMS has enabled IACS (“Individuals Authorized Access to the CMS Computer Services”) registration functionality for PS&R users. Users with existing IACS accounts will remain unaffected and may continue using IACS and PS&R as they have been since the transition to the Enterprise Identity Management System (EIDM) began two months ago. Users who have been unable to register during this period may resume organization and account registration activities via the same IACS pages in use thus far: https://idm.cms.hhs.gov/idm/user/newregistration.jsp[idm.cms.hhs.gov.

NGS will provide an update when the EIDM transition resumes. For support regarding your IACS account, contact EUS (from 7 a.m. to 7 p.m.) at either 1-866-484-8049 or at eussupport@cgi.com.

Additional information can also be found at https://eus.custhelp.com.

•

Required Quarterly Credit Balance Report Can Be Completed Using FISS/DDE – All Medicare providers are required to submit a completed certification page to NGS within 30 days after the close of each calendar quarter. If the provider has credit balances to report, a CMS-838 credit balance report detail page must also be submitted.

NGS wants providers to know that the credit balance report detail page information can be entered directly into the Fiscal Intermediary Standard System (FISS) Direct Data Entry System (DDE).

Protected Health Information (PHI) and Personally Identifiable Information (PII) are secure when submitted via DDE. Quick entry and submission of accurate reports through DDE also prevent potential untimely credit balance report submission. The system will prompt you when any required information is missing, thus preventing rejections.

To learn more, review the recently updated computer-based training (CBT) module in Medicare University entitled “ PTA-C-0022: FISS DDE Credit Balance Detail Report” at www.MedicareUniversity.com.

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

HCS Mobile Application Available The state Department of Health (DOH) has announced the availability of a mobile application for accessing the Health Commerce System (HCS).

The mobile application will provide access to the last 50 notifications posted to the HCS’s Important Health Notifications. The app currently displays protected and targeted notifications normally posted on the HCS home page, as well as all public notifications that do not require login to HCS. To download and begin using the

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Health Alert mobile app today, point an Android or iOS device to https://commerce.health.state.ny.us, log in and click the Mobile Apps button at the top of the page. A link to the mobile apps page is also available under My Content/Mobile Apps.

DOH is seeking feedback on this app and asks that comments be sent to hcsoutreach@health.ny.gov.

Publications •

“Genworth 2015 Annual Cost of Care Study” h t t p s : / / w w w. g e nw o r t h . c o m / d a m / A m e r i c a s / U S / P D F s / C o n s u m e r / c o r p o r a t e / 130568_040115_gnw.pdf

•

“Avoiding and Troubleshooting Enrollment Delays in Managed Long Term Care for People with a Medicaid Spend-Down and People Being Discharged from Nursing Homes,” by the New York Legal Assistance Group http://www.wnylc.com/health/download/534/

•

“Medicaid Transportation in NYS,” by the New York Legal Assistance Group http://www.wnylc.com/health/entry/143/

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

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Webinar June 4 11:00am to 12noon

On June 4, from 11:00 am to 12 Noon, HCA is holding a member webinar led by HCA’s Counsel, Frank Fanshawe, who will provide an update on Executive Order 38. This program will include an overview of the requirements, the disclosure form agencies that don’t file a cost report have to submit by June 30, and any new legal developments. There will be an opportunity for participants to ask questions during the program.

As extensively reported to members, Executive Order 38 places limits on executive compensation and administration costs for entities, including home care and other health providers that receive state funds directly or indirectly.

This is an HCA members only program and there is no charge to participate, however, registration is required by May 29. Log‐in/dial‐in information will be sent one day prior to the webinar to the e‐mail address provided below.

Sponsored by:

REGISTRANT INFORMATION Registration deadline is May 29.

Name: __________________________________________________________________ Title:____________________________________________________________________ Agency:_________________________________________________________________ Address:________________________________________________________________ City/State/Zip:___________________________________________________________ Phone:______________________________ Ext._________ Fax: __________________ Email: __________________________________________________________________ (Required)

Return your registration form by: • Fax to: (518) 426‐8788 • Scanning and emailing to: info@hcanys.org • Mail to: HCA, 388 Broadway, 4th Floor, Albany NY 12207

Frank Fanshawe, Esq., is an integral part of the Health Care law practice at the Albany office of Wilson Elser Moskowitz Edelman & Dicker, LLP. He has practiced health care law for more than 20 years and served as a senior adviser to the New York State Senate Health Committee Chair on legislative and public policy issues in connection with New York's Health Care Reform Act and other major health care initiatives.

2015 Annual Membership Conference May 6 & 7, 2015 ACHE Leadership Institute May 8, 2015 Saratoga Hilton – Saratoga Springs, NY

Dear Members and Friends of HCA,

Who Should Attend Chief Executive Officers, Executive Directors, Administrators, Finance Managers, Clinical Leaders or any other department leader who plays a key role in the success of your operation.

Why not use the HCA Annual Conference as an educational retreat for your team?

Let us know if we can help make that happen!

NAB Continuing Education Clock Hours This educational offering has been reviewed by the National Continuing Education Review Service (NCERS) of the National Association of Long Term Care Administrator Boards (NAB) and approved for 12.25 clock hours and 8.25 participant hours.

A sea of change is happening in health care, and we all have weathered its rough waters over the past two years. But with change comes renewed purpose. Today you are no doubt seeing this outcome as you run a tighter ship, diversify what you offer your community, and extend new lines of outreach well beyond the deck of your organization, engaging new players and partners in an increasingly coordinated system.

On this new course, home care needs to ride the wave of opportunity, and avoid getting overwhelmed by the flow of new information, expectations and shifting currents. This takes skill, intelligence, strategic thinking, patience and courage. HCA’s 2015 Annual Membership Conference aims to support you in this effort by bringing you tips, tools and strategies to help you successfully point your ship in the right direction and embark on a course of positive change.

Our conference is now a two-day event, on May 6 and 7, reducing the cost to you and limiting the amount of time spent away from your office while offering you the same caliber of excellent learning and networking opportunities that have always been a signature of our conference. Also new this year, we are adding a half-day Leadership Institute on May 8, brought to you by the American College of Healthcare Executives. You can choose to attend both programs – the HCA Annual Conference and the Leadership Institute – or only one. All programs will take place at the Saratoga Hilton, in Saratoga Springs, where we’ll have an exciting lineup of world-renowned speakers and industry experts offering thought-provoking ideas and valuable learning opportunities.

The Annual Conference is an ideal setting to network with your peers, pay tribute to outstanding individuals in the industry through our awards program, and visit with an assortment of vendors who will be on hand showcasing their latest products or services. If you are new to home care, new to your agency or if your agency just recently joined HCA, the Annual Conference is a perfect way to get your feet wet, meet HCA’s team, make new contacts, and learn. To broaden your team’s learning experience, HCA is also offering one of your staff members the opportunity to attend the conference at half price and the leadership institute at the lowest price possible if they’ve never attended HCA’s conference before. To take advantage of this “first-timer” opportunity, you must register yourself and your staff person by April 6. This is a great way to show your appreciation to a valuable member of your staff. (Online registration for this offer is not available; please use the registration form in this brochure.)

So what are you waiting for? Check out the agenda and register today! I look forward to seeing you there.

Joanne Cunningham President HCA

We also extend a special thanks to HCA’s Board of Directors who donate their time and talents for the success of HCA.

Hotel Information The Saratoga Hilton, Saratoga Springs, NY is the site of the HCA Annual Conference. Rooms at the Saratoga Hilton are per night. This discounted rate is available until April 5. After this date, higher rates will prevail. Parking is $5 per night.

$162

To make a reservation, call 888-866-3596 or register online at https://resweb.passkey.com/go/HCANYS2015 The hotel’s check-in time is 4 p.m. and check out is 11 a.m. Luggage storage is available should your room not be ready prior to check-in time.

HCA graciously thanks those Sponsors and Exhibitors who have already committed to support you and this signature educational event.

Marie Andreacchio Allen Health Care Services Susan Brett, People Care, Inc. Maura Cahill-Bordas Hebrew Hospital Home, Inc. Anne Calvo, Winthrop University Hospital Home Health Agency Susan Caputo, Individual Member Northport, NY Shelly Eggleton Lourdes At Home/Hospice At Lourdes Michael Feinman Any-Time Home Care, Inc. Ann Frisch, New York City HHC – Health & Home Care Bridget Gallagher Jewish Home Lifecare Ginger Hall, Jefferson County Public Health Services Pamela Joachim, Montefiore Medical Center Home Health Agency Orael Keenan Visiting Nurse Association of Long Island

Additional Sponsors Arthur J. Gallagher Risk Management Services, Inc. Bassett Healthcare Network, At Home Care Brookhaven Memorial Hospital Medical Center Byram Healthcare Dominican Sisters Family Health Service, Inc. Hinman Straub, P.C. People Care, Inc. RBC Limited Healthcare and Management Consultants VNS Westchester Winthrop University Hospital

Kenneth Kilroy Progressive Home Health Services Sue Larman, VNA Home Health Russell Lusak Selfhelp Community Services Irina Mitzner, North Shore – Long Island Jewish Health Care Network Laurie Neander Basset Healthcare Network: At Home Care Karen O’Kane, Brookhaven Memorial Hospital Medical Center

Exhibitors AccuPoint, LLC Avanti Health Care Services Black Tree Healthcare Consulting Bosch Healthcare Brinster & Bergman, LLP Cardiocom, a Medtronic Company ContinuLink The Corridor Group Delta Health Technologies, LLC Fazzi Associates Forcura Friedlander Group Grassi & Co. CPA’s Homecare Homebase

Homecare Software Solutions. LLC LCG Community Trust Mobile Health MobilexUSA Mom’s Meals Nourish Care MyCNAjobs Philips Hospital to Home Quality in Real Time Senior Planning Services MLTC Simione Healthcare Consultants Stay at Home Solutions TSG Financial Total Program Management United Healthcare Community Plan

Mary Kate Rolf, VNA Homecare Paul Rosenfeld, CenterLight Health System Brian Schiel, Bestcare

Rae Szymanski, Visiting Nurse Association of Hudson Valley Vivian Torres-Suarez, Individual Member Bayside, NY Joseph Twardy, VNS of Northeastern NY Mary Wagner Metropolitan Jewish Health System

Sponsorship and Exhibitor opportunities are still available. Visit

Mary Zagajeski Dominican Sisters Family Health Service

www.hcaannualconference.com

Elizabeth Zicari, HCR Homecare

to learn about all the benefits you will receive as a supporter.

Wednesday, May 6 10:00am – 5:00pm Hotel Lobby

HCA Registration Opens At the registration desk, you will obtain your conference program, name badge and directions to your first session.

1:00pm to 1:30pm

HCA Annual Meeting of the Corporation (Note New Time) All HCA members are invited to attend the Annual Meeting of the Corporation. This brief meeting of the HCA corporation will include membership review and passage of the 2014 audit and financials, a synopsis of the year’s activities, and ratification of the Slate of Board of Directors members. (The HCA Board of Directors meeting, which all members are encouraged to attend, will be held on Thursday, May 7, from 4:15pm to 6:00pm.)

1:30pm to 1:45pm – HCA Welcome 1:45pm to 2:45pm

The Healing of America: Opportunities for Home Care T.R. Reid, author of the national best-seller ‘The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care,’ will examine why all other industrialized democracies manage to provide high-quality universal health care but still spend half as much as the U.S. does. Mr. Reid’s PBS documentary, ‘U.S. Health Care: The Good News,’ reveals how some U.S. communities have found ways to improve the quality of care, and contain costs, by orchestrating their local health care providers to work together, rather than waiting for Washington to tell them what to do.

T.R.Reid has become one of the nation’s best known reporters through his books, articles, and documentary films. His work includes reporting for the Washington Post, NPR’s Morning Edition and PBS. 3:00pm to 4:30pm

You Can Never NOT Communicate We all understand the importance of communicating effectively in the health care field.

But do you realize that you can never NOT communicate? In this presentation, Janene Schneider will help you bring communication to the conscience level by focusing on nonverbal communication and providing you with tips to enhance your professional interactions.

Janene Schneider is chair of the English Department for Franklin Academy in Wake Forest, NC. With a Master’s in Communication from the University of Iowa, she has developed a passion for nonverbal communication and is a frequent speaker for Duke University’s Population Care Coordinator Program.

3:00pm

Exhibit Gallery Opens HCA is pleased to have 31 exclusive vendors on hand to showcase the latest home health products and services expressly for HCA conference participants. Take advantage of this one-stop shopping opportunity – no appointment needed.

Wednesday, May 6 – continued 4:30pm to 6:00pm

Welcome Reception Before heading out to dinner at one of Saratoga’s many fine restaurants, be sure to take the time to visit with old friends and new, peruse the exhibits of our home health vendors and register for their great raffle prizes.

Dinner is on your own this evening.

8:30pm to 11:00pm

PAC Beach Party and Trivia Night Join in the fun at this fundraiser for HCA’s Political Action Committee (PAC). Attendees who make a $50 minimum personal donation will get to enjoy drinks and light refreshments while making their best guesses for prizes in response to questions on pop culture, sports, geography, science, history and more. Anyone who has attended HCA’s popular PAC fundraisers in the past will know what a great time to expect at this year’s event, so please encourage your peers to join you.

Thursday, May 7 7:00am

Registration Opens The registration desk is open bright and early for those who haven’t yet obtained their conference program, name badge and directions.

7:30am to 8:30am

Exhibit Gallery Enjoy coffee while meeting with vendors to learn more about their latest products or services that support home health.

8:30am to 9:30am

HCA’s Breakfast of Champions During this morning’s breakfast, HCA pays tribute to recipients of the Ruth F. Wilson Award, the Caring Award and the Advocacy “Giraffe” Award – a highlight of our annual conference.

Join your peers as we recognize these champions over an elegant breakfast.

9:30am to 10:00am

Catching the Wave – An Address by HCA’s President, Joanne Cunningham Home care is a vital line of support for the patients you serve, and HCA’s ongoing goal is to help you navigate potential obstacles, tie-up alongside partner organizations in integrated models, and keep home care in its flagship role as the driver of community-level support services.

10:15am to 11:15am

The Art of Audacity Can one person really change the world? National Geographic journalist Tom Clynes will bring us along on assignment to some of the most dramatic and intriguing places on Earth. Through his provocative stories and stunning photos, we’ll meet the extraordinary people who dared to challenge and change the status quo: The explorer whose Congo Basin expedition led to the biggest African conservation victory in decades … the “elephant whisperer” who rescued the animals in the Baghdad Zoo … as well as virus hunters, Ebola doctors, climatologists, and a pre-teen nuclear physicist.

Along the way we’ll discover the life lessons behind the success of those who dared to follow their audacious dreams, and to shape once-ordinary lives into world-changing adventures.

Tom Clynes is an author and photographer who covers the adventurous side of science, the environment and public health. He writes regularly for National Geographic and Popular Science where he is a contributing editor.

Thursday, May 7 – continued 11:15am to 3:00pm

Three Workshops in Two Sessions Session 1 (11:15am to 12:15pm) Session 2 (2:00pm to 3:00pm) All three of the programs summarized below are held concurrently from 11:15 a.m. to 12:15 p.m. (Session 1) and then repeated, again concurrently, from 2 to 3 p.m. (session 2). These workshops will help you gain further knowledge on: specific regulatory compliance issues like the Medicare face-to-face requirement, workforce recruitment and retention, and population health – all of which are vital to the success of your organization.

Session 1 & 2 Descriptions Certifying Home Health Services On January 1, the U.S. Centers for Medicare and Medicaid Services (CMS) changed the requirements for the face-to-face documentation mandate. New York’s Medicare Administrative Contractor, National Government Services (NGS), is your main point of interaction for Medicare payment and is empowered with enforcement activity related to face-to-face. Hear directly from a representative of NGS who will help you gain a greater understanding of patient eligibility, face-to-face encounters and certification requirements for home health. Attendees will receive NGS/CMS resources and the opportunity to ask questions.

Shelly Bernardini, RN, CPHM, is the Medicare Home Health Clinical Consultant for Jurisdictions K and 6 at NGS where she provides outreach and education.

A Caregiver’s Perspective: Data-Driven Recruitment Get under the hood to discover the perspective of Certified Nursing Assistants and Home Health Aides on working in home care. This session will unveil key insights from a caregiver's point of view – gleaned from thousands of survey results – alongside key strategies to drive more caregivers to apply to your jobs, show up for the interview, entice them to want to work for you, and stay with your organization for the long run.

Maggie Keen is Director of Customer Success for myCNAjobs. She is a national caregiver recruitment speaker, and key researcher behind The Caregiver Trend Report. Her team consults with home care recruiters across the country to optimize local recruitment efforts.

Population Health Explore how multilevel care coordination can help your organization be best positioned to improve clinical and financial outcomes by increasing communication across settings, effectively analyzing patterns and addressing health care needs for your entire patient population.

Sharon Rushton, MSN, MS, RN, CCM is Assistant Professor at Duke University School of Nursing.

Her interests include care coordination of complex patients, transitions of care, resource utilization and patient/family education.

Thursday, May 7 – continued 12:15pm to 1:15pm

Networking Buffet Lunch 12:30pm to 2:00pm

Desserts in the Exhibit Gallery While enjoying dessert, take advantage of this last opportunity to meet with vendors who are showcasing their products and services exclusively for you.

2:00pm to 3:00pm

Session 2 – Workshops Workshops from Session 1 (held at 11:15am) are repeated. Please refer to previous page for session descriptions.

3:00pm to 4:00pm

Physicians and Home Health: Partners in Care In this closing segment, you’ll discover new strategies for working more collaboratively with your local physician groups in achieving the same goals: better coordination of care for the patients you serve and reduced re-hospitalizations.

Linda Lambert, CAE, is Executive Director for the New York Chapter of the American College of Physicians, the state's largest medical specialty organization representing over 12,000 internal medicine physicians dedicated to advancing the specialty of Internal Medicine and improving patient care through education, advocacy and quality improvement.

4:15pm to 6:00pm – HCA Annual Board of Directors Meeting All HCA members are encouraged to attend the HCA Board of Directors meeting, which will focus on Board discussion and debate of federal and state policy and advocacy strategy as well as organizational and operational priorities. This event is an important tradition and includes an invited guest speaker from the public policy arena.

Dinner is on your own this evening at one of the many fine restaurants Saratoga Springs has to offer.

8:00pm – Pat’s Pub Crawl After dinner, join HCA Staff and your peers for our first-ever Saratoga Pub Crawl. Visit a variety of venues that offer something for every taste including the upscale atmosphere of wine bars, authentic brew pubs and jazzy lounges. Free drink coupons for all pub crawl participants. Watch for further details coming soon.

Friday, May 8 - Bonus Session!

7:30am to 8:45am

Value Based Payment Workshop and Breakfast Enjoy a full buffet breakfast and the opportunity to learn more about an emerging policy and payment priority at both the State and the National level focusing on value-based payment. Hear from expert faculty on how value based payments are developed, and how home health agencies can position themselves to benefit in value based payment models.

Be sure to take advantage of HCA’s Leadership Institute on Friday, May 8th!

Program Agenda Friday, May 8 7:30am to 8:45am

Breakfast and Value Based Payment Workshop Enjoy a full buffet breakfast and the opportunity to learn more about an emerging policy and payment priority at both the State and the National level focusing on value-based payment. Hear from expert faculty on how value based payments are developed, and how home health agencies can position themselves to benefit in value based payment models. (Coffee will be available beginning at 7:00 am.)

9:00am to1:00pm

The Courage to Lead: Critical Skills for Healthcare Leaders This session, presented by the American College of Healthcare Executives (ACHE), is exclusively for HCA onlocation.

Leadership is an applied skill, but too often it is left to chance as something to be picked up on the job.

Progressing as a successful leader requires more. In this half-day session, designed for health care leaders at all levels of their careers, you will use proven tools and techniques to identify and develop your leadership philosophy and to develop your leadership skills even if you have little formal authority.

You will also learn how to: • Create an action plan using course content through an illustrative case study, leadership tools and integrative discussions.

• Increase your influence and effectiveness by becoming a quiet but strong leader.

• Practice ways to recognize and reward employee contributions and build a winning team.

This program is presented by Jody Rogers, PhD, FACHE, visiting professor in the health care administration graduate program, Trinity University, San Antonio, TX. He has more than 30 years of experience as a health care executive in public and private health care organizations and is a certified master facilitator of The Leadership Challenge.

Accreditation Participants will receive ACHE Face-to-Face Education credits as well as contact hours from the National Association of Boards of Examiners of Long Term Care Administrators (NAB).

About the American College of Healthcare Executives The American College of Healthcare Executives is an international professional society of more than 40,000 health care executives who lead hospitals, healthcare systems and other healthcare organizations. ACHE offers its prestigious FACHEÂŽ credential, signifying board certification in healthcare management. ACHE's established network of 80 chapters provides access to networking, education and career development at the local level. In addition, ACHE is known for its magazine, Healthcare Executive, and its career development and public policy programs. Through such efforts, ACHE works toward its goal of being the premier professional society for healthcare executives dedicated to improving healthcare delivery.

HCA’s Leadership Institute can be purchased in conjunction with the Annual Conference registration which offers the best value. The Leadership Institute is also available for purchase separate from the HCA Annual Conference. See the registration form for fees and discounts.

2015 ANNUAL CONFERENCE REGISTRATION Catch the Wave! Are You Ready for the Turn-Around?

Return this completed registration form with your payment by fax to (518) 426-8788 or mail it to 388 Broadway, 4th Floor, Albany, NY 12207. You may duplicate this form for additional attendees. Please save a copy for your records.

Register online at: www.eventville.com/hcanys CONFERENCE PARTICIPANT REGISTRATION NAME ______________________________________________________________

TITLE ____________________________________________________

AFFILIATION ____________________________________________________________________________________________________________________ ADDRESS ______________________________________________________________________________________________________________________ CITY/STATE/ZIP _________________________________________________________________________________________________________________ PHONE _____________________________________________________________ FAX _____________________________________________________ E-MAIL ________________________________________________________________________________________________________________________

METHOD OF PAYMENT:

REGISTRATION FEE:

Please select your method of payment: ________MasterCard

________Visa

________American Express

Credit Card No.________________________________________________

We encourage you to attend both the Annual Conference and ACHE Leadership Institute for the best value. No credits can be given for meals not taken or unattended education programs.

REGISTRATION FEE Seven Registration Options Please indicate your registration choice below:

Name on Card_________________________________________________

Expiration Date __________________ Security Code _________________ _____________________________________________________________ Billing Address for Card _____________________________________________________________ City, State, Zip Authorized Signature____________________________________________

_____Check* Make payable to: HCA Education and Research Mail to: 388 Broadway, 4th Floor, Albany, NY 12207 Checks must be received by May 2.

Cancellation Policy: Cancellations received by April 22 will receive a full refund, less 25% of total due as an administrative fee. Cancellations received on April 23 or later will forfeit their registration fee, as will those who register and do not attend. Substitutions are permitted.

1. HCA Member – Annual Conf. and Leadership Inst.

$768 

2. HCA Member – Annual Conference Only

$489 

3. Non-Member – Annual Conf. and Leadership Inst.

$948 

4. Non-Member – Annual Conference Only

$599 

5. Leadership Institute Only (Members and Non-Members)

$349 

6. *First Time Attendee HCA Member – Annual Conf. Only

$244 

7. *First Time Attended HCA Member – Ann. Conf. & Ldr. Inst. $523  *Must register by April 6.

TOTAL DUE: $__________

Beach and Trivia Night HCA PAC Party Wednesday, May 6th – Saratoga Hilton Lounge

I will attend the HCA PAC Fundraiser



My personal donation will be submitted separately.

In accordance with the Americans with Disabilities Act or special meal needs, please let us know how we can accommodate you: ___________________________________________________________ ____________________________________________________________ I will attend the Pat’s Pub Crawl

FAX THIS FORM TO (518) 426-8788



388 Broadway Fourth Floor Albany, New York 12207